Neuromuscular

For which clinical indicator should the nurse assess a client who just had a microdiskectomy for a herniated lumbar disk? A. Cerbral edema B. Sensory loss in legs C. Spasms of the bladder D. Pain referred to the flanks

B. Inflammation from the trauma of intravertebral disk surgery may lead to injury of the nerve root, with consequent motor or sensory dysfunction

The nurse is assigned to care for a client with a diagnosis of osteomyelitis. The client has just returned from surgery where the periosteum was excised and the cortex of the bone drilled. The client has drainage tubes from the bone, and the nurse is to instill and remove dilute antibiotic solutions through the drainage tubes. Which of the following actions on the part of the nurse is most important? a. Use of strict sterile technique when instilling and removing the antibiotic solution b. Checking the client's vital signs prior to instilling and removing the solution c. Measuring the amount of solution instilled and the amount removed d. Completion of instillation and removal of antibiotic solution within 10-15 minutes maximum

a. To prevent additional contamination of the infected bone, the nurse must use strict sterile technique when instilling and removing the solution.

A client has a total knee replacement, & a continuous passive motion device is being used. the nurse concludes that the teaching was effective when the client states, " the goal of this therapy is to: a. improve joint flexion." b. maintain muscle tone." c. prevent tissue breakdown." d. avoid formation of a blood clot."

a. a continuous passive motion device is most commonly used after knee replacement to gradually increase knee flexion without weight-bearning or strain

a client is in skin traction while awaiting surgery for repair of a fractured femur. the client reports leg discomfort & asks the nurse to release the traction. Which is the nurse's best initial response? a. "i can't b/c the weights are needed to keep the bone aligned." b. "I will remove half of the weights & notify your health care provider." c. "I'll get your prescribed pain medication to help relieve your discomfort." d. "I have to follow the health care provider's directions, & releasing weights is not ordered."

a. this response explains why the traction may not be released; a continuous pull must be maintained

Treatment of congenital clubfoot begins with the...

application of casts; cast is changed and affected limb is manipulated weekly for the first 6-12 weeks; surgical correction involves pin fixation and releast of tight joints and tendons followed by casting for 2-3 months.

with fractures of the femoral neck, the leg is a. adducted & internally rotated b. shortened, adducted, & externally rotated c. shortened, abducted, & internally rotated d. abducted & externally rotated

b.

a nurse is caring for a client who had a total hip replacement. what nursing action should be incorporated into the plan of care to prevent thrombus formation? a. turning the client from side to side b. encouraging the client to perform ankle exercise c. getting the client up to sit in a chair for as long as tolerated d. ambulating the client when the effects of anesthesia subside

b. ankle movement, particularly dorsiflexion of the foot, allows muscle contraction, which compresses veins, reducing venous stasis & the risk for thrombus formation pt is not usually allowed out of bed until the first postoperative day

a nurse is caring for a client who had a total hip replacement. what is the priority assessment when monitoring the client for hemorrhage? a. checking vital signs q 4hrs b.. examining the bedding under the client c. measuring the circumference of the thigh d. observing for ecchymosis at the operative site

b. b/c of the recumbent position, drainage may flow under the client & not be noticed

which of the following is a factor that inhibits fracture healing? a. exercise b. local malignancy c. vitamin D d. maximum bone fragment contact

b. factors that inhibit fracture healing include local malignancy, bone loss, & extensive local trauma. factors that enhance fracture healing include proper nutrition, vitamin D, exercise, & maximum bone fragment contact

To reduce a hip fracture, the client is placed in traction before surgery for an open reduction & internal fixation. b/c the client keeps slipping down in bed, increased countertraction is ordered. how does the nurse increase the countertraction. a. elevate the head of the bed b. add more weight to the traction c. use a slight trendelenburg position d. tie a chest restraint around the clinet

c. elevating the foot of the bed uses gravity & the client's weight for countertraction

What should the nurse do to control edema of the residual limb 1 week after a client has an above-the-knee amputation? a. administer the prescribed diuretic b. restrict the client's oral fluid intake c. rewrap the elastic bandage as necessary d. keep the residual limb elevated on a pillow

c.. elastic bandages compress the residual limb, preventig edema & promoting residual limb shrinkage & molding; the bandage must be rewrapped when it loosens.

which of the following is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? a. it provides active range of motion b. it prevents infection & controls edema & bleeding c. it promotes healing by immobilizing the knee joint d. it promotes healing by increasing circulation & movement

d. a CPM device applied after knee surgery promotes healing by increasing circulation & movement of the knee joint

Which nursing action is contraindicated when caring for a client with a newly applied long leg cast? a. elevating the cast on a pillow b. drying the cast by using a fan c. leaving the cast exposed to air d. handling the cast with fingertips

d. handling the cast with fingertips before it is dried may create indentations that can cause pressure

on the first postoperative day after a total hip replacement a client asks for assistance onto the bedpan. what should the nurse instruct the client to do? a. use the elbows and hands to lift the pelvis off the bed. b. extend both legs & pull on the trapeze to lift the pelvis. c. turn gently toward the operative side while lifting the pelvis off the bed d. flex the knee on the unoperated leg & pull on the trapeze to lift the pelvis

d. the pelvis is elevated by actions involving the unaffected upper extremities and unoperated leg

Which of the following is not a sign of developmental hip dysplasia? A. High-pitched cry B Lower knee position on the affected side C. Uneven skin on the thighs and buttocks D. Crepitus in the hip joint

A. A high-pitched cry is not an indication of this musculoskeletal disorder.

a fracture is termed pathologic when the fracture a. occurs through an area of diseased bone b. involves damage to the skin or mucous membrane c. results in a pulling away of a fragment of bone by a ligament or tendon and its attachment d. presents as one side of the bone being broken and the other side being bent

a. pathologic fractures can occur without the trauma of a fall. b is a compound fracture c is an avulsion fracture d is a greenstick fracture

a nurse is caring for a client who developed aseptic necrosis after a fracture of the head of the femur. the nurse understands that aseptic necrosis is associated with which factor? a. infection at the site of the wound b. weight-bearing before the fracture is healed c. immobilization after reduction of the fracture d.loss of blood supply to the head of the femur

d. after a fracture, if blood supply is cut off or impaired, necrosis of the bone may occur from lack of oxygen & nutrition

Which clinical indicator does the nurse expect to identify when assessing a client admitted with a herniated lumbar disk? A. Pain radiating to the hip & leg B.Bowel & bladder incontinence C. Paralysis of both lower extremities D. Overgrowth of tissue on the lower back

A. Because pressure on the sciatic nerve, pain radiating to the hip and leg is common

Developmental hip dysplasia is usually diagnosed by which of the following methods? A. Skeletal x-ray B. The need for triple diapering C. Leopold's maneuver D. Physical assessment

D. Physical assessment can determine the presence of developmental dysplasia.

When discussing home care for an infant who has developmental hip dysplasia, the LPN/LVN understands that the Pavlik harness will need to be used for what length of time? A. More than six months B. A month C. A few days D. Three to four months

D. Three to four months are the usual amount of time required to allow the development of muscles that will maintain proper functioning position of the hip in preparation for weight bearing.

after an open reduction & internal fixation of a fractured hip, what assessments of the client's affected leg should the nurse make? select all that apply. a. skin temp b. mobility of the hip c. sensation in the toes d. condition of the pins e. presence of pedal pulse

a, c, e increased skin temp may indicate the presence of an infection; decreased skin temp suggests impaired circulation. sensation of the toes assesses the neural integrity distal to the surgical site. pedal pulse assesses the circulatory integrity distal to the surgical site

a client with a fractured hip is placed in traction until surgery can be performed. what should the nurse explain is the purpose of the traction? a. relieve muscle spasm & pain b. prevent contractures from developing c. keep the client from turning and moving in bed d. maintain the limb in a position of external rotation

a. traction may be used in the treatment of a fractrued hip to align the bones (reduction of fracture). if such traction is not employed, the muscles may go into spasm, shifting the bone fragments & causing pain.

A 2-month-old infant has been placed in a Pavlik harness for hip reduction. To prevent shin irritation the nurse should instruct the parents to [Hint] a. take the harness off two hours and leave it on for two hours. b. have the infant wear a shirt and socks under the harness. c. take the harness off and apply baby oil to the areas where the harness touches the skin. d. use the harness only at night

b Shirt and socks under the harness should protect the infant's skin from irritation. The purpose of the splint is to ensure hip flexion and abduction and not to allow hip extension or adduction and should be worn the majority of the time.

For what clinical finding of compromised circulation should the nurse assess in a client with a long leg cast? select all that apply. a. fould odor b. swelling of the toes c. drainage on the cast d. increased temp e. prolonged cap refill

b, e constriction of circulation decreases venous return & increases pressure within te vessels. fluid then moves into the interstitial spaces, causing edema. impaired circulation is evidenced by prolonged cap refill

which crutch gait should the nurse teach the client wearing a prosthesis after a single-leg amputation? a. tripod b. four-piont c. three-piont d. swing-through

b. a four-point gait provides for weight-bearing on all points that touch the floor & maximum support during ambulation

which of the following is an early complication of fracture healing? a. nonunion b. fat embolism syndrome c. avascular necrosis d. delayed union

b. along with shock, compartment syndrom & DVT & PE. delayed union, nonunion, & avascular necrosis are delayed complications

A nurse is educating a family about the type of fracture their 8-year-old son has experienced. Which of the following would be an accurate way to explain a closed fracture of the radius to the family? a. "One of the bones in the arm broke completely and penetrated the skin." b. "One of the bones in the arm is crushed and broken incompletely." c. "One of the bones in the arm broke completely, but did not penetrate the skin." d. "One of the bones in the arm is broken incompletely, like a green twig."

c. A closed fracture will break completely, and will not penetrate the skin. An open fracture will penetrate the skin. The radius is in the arm. A fracture like a green twig break is called a greenstick fracture. When bone is crushed, it is called a compression fracture.

Which principle should the nurse consider when assisting a client with crutches to learn the four=point gait? a. elbows should be kept in rigid extension b. most of the weight should be supported by axillae c. the client must be able to bear weight on both legs d the affected extremity should be kept off the ground

c. in the four-point gait the client brings the left crutch forward first, followed by the right foot; then the right crutch is brought forward, followed by the left foot. thus, both legs must be able to bear some wight

An x-ray demonstraes a fracture in which a bone has spintered into several pieces, which type of fracture is this? a. depressed b. compound c. comminuted d. impacted

c. may require ORIF. depressed is when fragments are dreven inward. impacted is when bone fragment is driven into another bone. compound involves skin or mucous membranes

A client who had a total hip replacement asks the nurse about the continuous regional analgesia being used. What information should the nurse include when explaining the benefits of this treatment over conventional methods to control pain? a. adjusting the dose is easily done b. neuropathic pain can be relieved c. systemic side effects are minimal d. the need for parenteral medication is avoided

c. regional analgesia uses a local anesthetic to control pain; the local effect avoids systemic reactions

A nurse is caring for a client who had an orthopedic injury of the leg requiring surgery and application of a cast. Postoperatively, which nursing assessment is of highest priority? a) monitoring of heel breakdown b) monitoring of bladder distention c) monitoring of extremity shortening d) monitoring for loss of blanching ability of toe nailbeds

d. With cast application, concern for compartment syndrome development is of the highest priority. If postsurgical edema compromises circulation, the client will demonstrate numbness, tingling, loss of blanching of toenail beds, and pain that will not be relieved by opioids. Although bladder distention, extremity lengthening or shortening, or heel breakdown can occur, these complications are not potentially life-threatening complications.

An important aspect of nursing care for an adolescent with scoliosis is patient education. To promote compliance with the adolescent's treatment plan the nurse should [Hint] a. schedule time when the brace can be off and exercises done. b. discourage interactions with peers to prevent accidental injury. c. instruct parents only on exercises that will help decrease the severity of spinal curvature, because adolescents do not listen to adults. d. demonstrate the prescribed exercises and explain their purpose.

d. Adolescents and their parents should be instructed on the exercises that will help decrease the severity of spinal curvature. To promote a sense of control, allow the adolescent to choose when to exercise and when to be out of the brace within the treatment plan. The nurse should promote interaction with peers and suggest that the adolescent work with a peer support person who is being treated for scoliosis.

the pt who has had an arm amputated is assigned to nursing care. what potential complications should the nurse closely monitor for in the late postoperative periods of the patient? a. kidney dysfuntion b. sleeplessness, mausea, & vomiting c. hematoma, hemorrhage, & infection d. chronic osteomyelitits & causalgia

d. hematoma, hemorrhage, & inf/ sleeplessness, & N/V are potential complications in the immediate postop period. amputation does not cause kidney dysfunction

The infant grows rapidly, so the straps of the Pavlik harness should be checked every...

1-2 weeks for needed adjustments because vascular or nerve damage can occur with improper positioning.

a nurse is teaching crutch walking to a client who had arthroscopic surgery of the knee. on which part of the body should the nurse instruct the client to place weight? a. the upper arms b. the axillary region c. palms of the hands d. both lower extremities

c. to prevent nerve damage in the axillary area, the palms should bear all the weight

The nurse teaches the parents of an infant with developmental dysplasia of the hip how to handle their child in a Pavlik harness. Which of the following interventions would be most appropriate? A. fitting the diaper under the straps B. leaving the harness off while the infant sleeps C. checking for the skin redness under straps every other day D. putting powder on the skin under the straps every day

A The Pavlik harness is worn over a diaper. Knee socks are also worn to prevent the straps and foot and leg pieces from rubbing directly on the skin. For maximum results, the infant needs to wear the harness continuously. The skin should be inspected several times a day, not every other day, for signs of redness or irritation. Lotions and powders are to be avoided because they can cake and irritate the skin

The nurse is assessing an infant with developmental dysplasia of the hip. Which finding would the nurse anticipate? A. Unequal leg length B. Limited adduction C. Diminished femoral pulses D. Symmetrical gluteal folds

A. Shortening of a leg is a sign of developmental dysplasia of the hip.

What should the nurse include in the plan of care for a client who just had a posterior lumbar laminectomy? A. encourage the client to cough B. reposition the client by log rolling C. Assess the client for indication of peritonitis D. Instruct the client to bend the knee when turning

B. Log-rollong maintains the alignment of the vertebral column

A client has a total hip replacement. Which clinical indicators of pulmonary embolism indicate that the plan to prevent postoperative thrombus formation has been ineffective? Select all that apply. a. flushing of the face b. unilateral chest pain c. elevation of temp d. sudden onset of SOB e. pain rating increase from 2-8 in the hip

B; D chest pain is caused by decreased O2 to pulmonary tissues. because capillary perfusion is blocked by the pulmonary embolus, O2 stat drop & pt experiences SOB

The nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include: a. administration of narcotics for pain control. b. bed rest for painful exacerbations. c. administration of nonsteroidal anti-inflammatory drugs (NSAIDs). d. vigorous physical therapy for the joints.

C - NSAIDs are routinely used for anti-inflammatory and analgesic effects. NSAIDs reduce inflammation, which causes pain. Narcotics aren't used for pain control in osteoarthritis. Normal joint range of motion and exercise (not vigorous physical therapy) are encouraged to maintain mobility and reduce joint stiffness.

Which of the following nursing interventions is essential in caring for a client with compartment syndrome? a. Keeping the affected extremity below the level of the heart b. Wrapping the affected extremity with a compression dressing to help decrease the swelling c. Removing all external sources of pressure, such as clothing and jewelry d. Starting an I.V. line in the affected extremity in anticipation of venogram studies

C - Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.

When should the nurse begin the process of rehab when a client is scheduled for an amputation a. before the surgery b. during the convalescent phase c. on discharge from the hosp d. when it is time for a prosthesis

a rehab should begin immediately. this includes preoperative discussion of the nature of the operation & rehab techniques

a nurse is completing the health history of a client admitted to the hospital with osteoarthristis. which joints does the nurse expect the client to report were initially involved? select all that apply. a. hips b. knees c. ankles d. shoulders e. metacarpals

a,b. Osteoarthritis affects the weight-bearing joints first b/c they bear the most body weight. the resulting joint damage causes a series of physiologic respones that lead to more damage.

during which stage or phase of bone healing after fracture does callus formation occur? a. reparative b. revascularization c. inflammation d. remodeling

a. callus formation occurs during the reparative stage but is disrupted by excessive motion at the fracture site. remodeling is the final stage of fracture repair during which the new bone is reoganized into the bone's former structural arrangement.

the care plan for a client with a fractured hip includes nursing actions to prevent which type of contracture? a. flexion of the hip b. abduction of the hip c. hyperextension of the hip d. external rotation with extension of the knee & hip

a. after a fractured hip, the muscle spasms & the client's tendency to flex the hips can lead to flexion contractures of the hip

What does the nurse do for a client with a cervical laminectomy that differs from the nursing care for a client with a lumbar laminectomy a. assist with the removal of oral secretion b. maintain the client's head in a flexed position c. elevate the head of the client's bed to a 45 degree angle d. provide ROM exercise early during the postoperative period

a. increased oral secretions & sore throat that limits the ability to cough are expected responses after a cervical laminectomy

Which of the following nursing interventions would most likely work best for most clients with osteoarthritis? a. Aspirin every 4-6 hours b. Water aerobics c. Ice packs to affected joints d. Walking or jogging slowly

b. While exercising is good to promote weight loss and maintain muscle tone and joint support, the client with OA of the knees or hips will do better with nonweight-bearing exercise such as exercise in water. Heat applied to the affected joints can alleviate pain or discomfort. Acetaminophen is preferred over aspirin because it has fewer toxic side effects.

which of the following newer pharmacological therapies, used for the treatment of osteoarthritis, is thought to improve cartilage function & retard degradation as well as have some anti-inflammatory effects? a. capsaicin b. glucosamine c. viscosupplementation d. chondroitin

c. viscosupplementation, the intra-articular injection of hyaluronic acid, is thought to improve cartilage function & retard degradation, & anti-inflammatory. glusosamine & chondroitin are thought to improve tissue function & retard breakdown of cartilage. capsaicin is a topical analgesic

A nurse is caring for a child who has just received a cast. Which of the following considerations would be important in providing care for this child? a. Give the child a blunt object to help with the itching under the cast. b. Apply powder to the inside edges of the cast to help decrease moisture. c. When handling the cast in the first 24 hours, use fingertips only. d. Assess the casted extremity every 15-30 minutes the first two hours after cast application.

d. It is important not to use fingertips when touching the cast in the first 48 hours, because that can cause a dent and a pressure point on the child's extremity. Lotions and powders should not be used near the cast, because they can cause caking and skin irritation. It is important to assess the extremity in the cast for intact circulation, sensation, and movement every 15-30 minutes the first two hours. Absolutely no objects should be placed in the cast.

The nurse teaches the pt which of the following interventions in order to avoid hip dislocation after replacement surgery? a. bend forward only when seated in a chair b. avoid placing a pillow between the legs when sleeping c. keep the knees together at all times d. never cross the affected leg when seated

d. crossing the affected leg may result in dislocation of the hip joint after total hip replacement. pt knees should always be apart. pt should put pillow between knees when sleeping. pt should avoid bending forward when seated.

A nurse is caring for a child hospitalized for osteomyelitis. Which of the following interventions would be included in the child's plan of care? Select all that apply. a. Assess the child for signs of infection. b. Assess for rising ESR levels, which indicate healing. c. Encourage increased fluid intake. d. Avoid administration of opioid analgesics for pain. e. Administer intravenous antibiotics.

a.c.e Administering antibiotics, giving pain meds, watching for signs of infection, and promoting good nutrition and fluids all are appropriate nursing interventions when caring for a child with osteomyelitis. ESR and C-reactive protein levels should decrease if healing is occurring.

which is an example of the principles of body mechanics that the nurse uses when caring for immobilized clients? a. bending at the waist to provide the power for lifting b. placing the feet apart to increase the stability of the body c. keeping the body straight when lifting to reduce pressure on the abdomen d. relaxing the abdominal muscles wile using the extremities to prevent strain

b. placing the feet apart creates a wider base of support & brings the center of gravity closer to the ground. this improves stability

which is the most common complication following knee arthroscopy? a. infection b. knee giving way c. knee locking d. joint effusion

d. produces marked pain, & physician may need to aspirate the joint to remove fluid & relieve the pressure. Infection is not common. knee giving way & knee locking are associated with functioning of the injured knee prior to arthroscopy.

A nurse suspects the development of compartment syndrome for a client who has sustained blunt trauma to the forearm. for which early sign of compartment syndrome should the nurse assess the client? a. warm skin at site of injury b. escalating pain in the fingers c. rapid capillary refill in affected hand d. bounding radial pulse in the injured arm

B. elevated tissue pressure restricts blood flow, causing increasing ischemia & increasing pain; it is the cardinal early symptom of compartment syndrome

A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean? a. The fracture line extends through the entire bone substance. b. The fracture results from an underlying bone disorder. c. Bone fragments are separated at the fracture line. d. One side of the bone is broken and the other side is bent.

D - In a greenstick fracture, one side of the bone is broken and the other side is bent. A greenstick fracture also may refer to an incomplete fracture in which the fracture line extends only partially through the bone substance and doesn't disrupt bone continuity completely. (Other terms for greenstick fracture are willow fracture and hickory-stick fracture.) The fracture line extends through the entire bone substance in a complete fracture. A fracture that results from an underlying bone disorder, such as osteoporosis or a tumor, is a pathologic fracture, which typically occurs with minimal trauma. Bone fragments are separated at the fracture line in a displaced fracture.

which of the following terms refers to fixation or immobility of a joint? a. hemarthrosis b. ankylosis c. diarthrodial d. arthroplasty

b. ankylosis may result from disease or scarring due to trauma. hemarthrosis refers to bleeding into the joint. diarthrodial refers to a joint wiht two free moving parts. arthroplasty refers to replacement of a joint.

Which of the following terms refers to failure of fragments of a fractured bone to heal together? a. subluxation b. nonunion c. malunion d. dislocation

b. when nonunion occurs, the pt complains of persistent discomfort & movement at the fracture site. malunion refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union

which type of fracture is one in which the skin or mucous membranes extends to the fractured bone? a. simple b. compound c. complete d. incomplete

b. c invovles a creak across the entire cross-section of the bone & is frequently displaced. d invovles a break through only part of the cross-section of the bone. a does not cause a break in the skin

The nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize injury to the osteoarthritic client, the nurse should instruct the client to: a. install safety devices in the home. b. wear comfortable shoes. c. get help when lifting objects. d. wear protective devices when exercising.

A - Most accidents occur in the home and safety devices are the most important element in minimizing injury. Shoes should be supportive and not too worn. The client needs to use proper body mechanics when stooping or picking up objects. Protective devices aren't usually necessary for the client to perform exercises.

A 1-month old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip (DDH). The nurse assesses the infant, knowing that which of the following findings would be noted in this condition? a) limited range of motion in the affected hip b) an apparent lengthened femur on the affected side c) asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed d) symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table

A. limited ROM in the affected hip. R- the head of the femer is seated imporperly in the acetabellum or hip socket.

A client experiences a traumatic amputation of a leg in a motor vehicle accident. which nursing intervention initially should receive the lowest priority? a. teaching residual limb care b monitoring hemoglobin levels c. maintaining the compression dressing d. using therapeutic interviewing techniques

A. this is not a priority at this point. the client is too traumatized to learn. it will assume priority as the client's recovery progresses

what instructions should the nurse provide when the client is allowed out of bed after an above-the-knee amputations? a. keep hip in extension & alignment b. keep the hip raised with the residual limb elevated c. lift the shoulder & hip of the affected side when taking a step d. Use the ordered crutches until the residual limb is completely healed.

A. this position offsets the development of hip deformities resulting from contracture. it also maintains the correct center of gravity when the client is upright

pullselessness is a very late sign of compartment syndrome & may signify which of the following? a. nerve involvement b. lack of distal tissue perfusion c. diminished arterial perfusion d. venous congestion

b.

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis? a. Compartment syndrome b. Fat embolism c. Infection d. Volkmann's ischemic contracture

B - Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury. It occurs when fat droplets released at the fracture site enter the circulation, become lodged in pulmonary capillaries, and break down into fatty acids. Because these acids are toxic to the lung parenchyma, capillary endothelium, and surfactant, the client may develop pulmonary hypertension. Signs and symptoms of fat embolism include an altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae. Compartment syndrome and infection may complicate any fracture and aren't specific to a pelvis fracture. Volkmann's ischemic contracture is a potential complication of a hand or forearm fracture.

A 4-year old sustains a fall at home and is brought to the emergency room by the mother. After an x-ray examination, the child is determined to have a fractured arm and plaster cast is applied. The nurse provides instructions to the mother regarding care for the child's cast. Which statement by the mother indicates a need for further instructions? a) the cast may feel warm as the cast dries b) I can use lotion or powder around the cast edges to relieve itching c) a small amount of white shoe polish can touch up a soiled white cast d) if the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast

B. R- the mother needs to be instructed not to use lotion or powders on the skin around the cast edges or inside the cast; as they can become sticky and caked, causing skin irritation/ breakdown.

What should be included in the nurse's instructions to help a client prepare for walking with crutches? a. use of the trapeze to strengthen the biceps muscle b. exercises with or without weights to strengthen the muscles of the upper extremities c. the importance of keeping the affected limb in extension & abduction to prevent contractures d. isometric exercises of the hamstring muscles while sitting in a chair until circulatory status is stable

B. preparing muscles that will do the work in crutch-walking is imperative

when a client is in the right side-lying position after the insertion of a left hip prosthesis, the nurse ensures that the client has a pillow placed between the thighs and that the entire length of the upper leg is supported. what does this pillow prevent? a. strain on the operative site b. thrombus formation in the leg c. flexion surfaces from rubbing together d. skin surfaces rubbing together

a. this supports the site; the involved leg must be maintained in alignment, avoiding adduction to prevent dislocation of the prosthesis

a nurse provides discharge teaching for a client who had a total hip replacement. which activities to avoid identified by the client indicate an understanding of the teaching? select all that apply. a. climbing stairs b. crossing the legs c. stretching exercises d. sitting in a low chair e. lying prone for 30 mins

b & d b crossing the legs past the midline of the body puts stress on the operative site, which increases the risk for dislocation of the prosthesis d excessive flexion of the hip can cause dislocation of the prosthesis

A client had an above-the-knee amputation of the left leg b/c of trauma from a MVC. the health care provider orders ambulation with crutches until the residual limb is healed & the client can be fitted with a prosthesis. what should be the nurse's first intervention? a. demonstrate the swing-through crutch walking gait. b. determine if the client has ever used crutches before c. introduce the client to another client who is using crutches d. provide a pamphlet that has information about using crutches

b. information about the client's experiential background will influence the teaching plan. a teaching plan should be formulated based on what a client does r does not know.

A nurse is evaluating a child for compartment syndrome after fracture reduction. Which assessment finding would alert the nurse to the presence of this complication? a. Pain, relieved by medication b. Capillary refill under three seconds c. Absence of space between cast and extremity d. Pink extremities distal to cast

c. Capillary refill under three seconds, pink skin tone, and pain relieved by medication all are normal signs after a fracture reduction. A tight cast could indicate swelling with compartment syndrome.

a client is admitted with a fracture of the neck of the femur. in what position should the nurse maintain the client's affected extremity? a. internal rotation with flexion of the knee & hip b. external rotation with flexion of the knee & hip c. internal rotation with extension of the knee & hip d. external rotation with extension of the knee & hip

c. a fracture in the neck of the femur will cause shortening of the femur & external rotation. to correct this misalignment, the client's leg should be extended & maintained in slight internal rotation.

which of the following is one of the most common causes of death in pts diagnosed with fat emboi syndrome? a. MI b. stroke c. ARDS d. PE

c. acute pulmonary edema and ARDS are the most common causes of death

which position should a nurse avoid placing a client who had surgery for a total hip replacement? a. supine b. lateral c. orthopneic d. semi-fowler

c. this position involves hip flexion greater than 90 degrees. this puts stress on the operative site & may dislodge the prosthesis

which of the following statements reflect the progress of bone healing? a. all fracture healing takes place at the same rate no matter the type of bone fractured. b. the age of the pt influences the rate of fracture healing c. adequate immobilization is essential until there is ulrasound evidence of bone formation with ossification. d. serial x-rays are used to monitor the progress of bone healing.

d. the type of bone fractured, the adequacy of blood supply, the surface contact of the fragments, & general health of the person influence the RATE of fracture healing. c does not reflect the progress of bone healing

To care for a child that is in Bryant skin traction for dysplasia of the hip the nurse should ensure [Hint] a. the knots on the traction apparatus are loose. b. the weights are on the floor. c. the child is out of traction at least four hours a day. d. fluids and fiber are increased in the diet.

d. because a change in bowel or bladder status is commonly associated with immobility. The knots should be well tied and secured with tape. The time out of traction should not exceed one hour per day unless specified by the doctor. The nurse should ensure the weight amounts are correct and the weights are hanging freely. Implementation: Physiological Integrity; Application

A client has a long leg cast. What instructions should the nurse give the client in preparation for crutch walking? a. use the trapeze to strengthen the biceps b. keep the affected limb in extension & abduction c. sit up straight in a chair to develop the back muscles d. do exercises in bed to strengthen the upper extremities

d. in crutch walking the client uses the triceps, trapezius, and latissimus muscles. a client who has been in bed may need to implement an exercise program to strengthen these shoulder & upper arm muscles before initiating crutch walking

In congenital clubfoot (talipes equinovarus), the affected foot is usually...

smaller and shorter than the unaffected foot.

Parents of a child that requires a long leg cast for any condition should be cautioned about the use of umbrella strollers. This recommendation is based on information that [Hint] a. the strollers are difficult to turn. b. the stroller's fabric may irritate the infant's skin. c. they may not support the weight of a casted leg. d. they are difficult to get in and out of cars.

c. Umbrella strollers may not be sturdy enough to support an infant's casted leg.

Correction of DHD in infants less than 6 months of age involves the use of...

a Pavlik harness. Prevents hip extension or adduction and is worn continuously for about 3-6 months.

A nurse expects a client with a herniated intervertebral disk to report a sudden increase in pain with which activities? select all that apply A. coughing or sneezing B. sitting on cold surfaces C. Standing for extended periods D. Lying supine while flexing the knees E. Straining when having a BM

A; E. These actions, as well as lifting & straining, cause an increase in the intraspinal pressure, resulting in pain.

What action should the nurse take when caring for a client who has a possible skull fracture as a result of trauma? a. Monitor the client for signs of brain injury B. check for hemorrhaging from te oral and nasal cavities C. Elevate the foot of the bed if the client develops symptoms of shock D. Observe for clincal indicators of decreased intracranial pressure & temp.

A.head injuries can cause trauma to the brain, and the client should be monitored for symptoms of increased intracranial pressure (eg HA, dizziness, & visual disturbance)

what should the nurse do to prevent deformities of the knee in a client with an exacerbation of arthritis? select all that apply. a. encourage motion of the joint b. maintain a knee brace on the leg c. keep the client on a regimen of bed rest d. maintain joints in functional alignment when resting. e. immobilize the joint with pillows until pain subsides

a, d. Exercise of involved joints is important to maintain optimal mobility and prevent buildup of calcium deposits. functional alignment places the least strain on joints, muscles, and tendons. all other answers promotes contractures.

The nurse providing discharge instructions to parents of a child with a cast should include [Hint] a. skin care, possible complications, and when to call the physician. b. cast care, vital sign measurements, and activities of daily living. c. stretching exercises, possible complications, and skin care. d. musculoskeletal positions, decreasing calcium in diet, and when to call the doctor.

a. These subjects should be part of discharge instructions for care of a child that has a cast. Vital sign measurement is not an area that needs to be included in discharge instructions for a child with a cast. Stretching exercises are not an area that is related to cast care. Musculoskeletal positions and decreasing calcium in diet are not an area that is included in discharge instructions.

A client with a wound infection and osteomyelitis is to receive hyperbaric oxygen therapy. During the therapy, the nurse implements which priority intervention? a) maintains an intravenous access b) ensures that oxygen is being delivered c) administers sedation to prevent claustrophobia d) provides emotional support to the client's family

b. Hyperbaric oxygen therapy is a process by which oxygen is administered at greater than atmospheric pressure. When oxygen is inhaled under pressure, the level of tissue oxygen is greatly increased. The high levels of oxygen promote the action of phagocytes and promote healing of the wound. Because the client is placed in a closed chamber, the administration of oxygen is of primary importance. Although options 1, 3, and 4 may be appropriate interventions, option 2 is the priority.

a client is ready to walk with crutches after knee surgery. which crutch-walking techniue will the nurse most likely have to reinforce after the client returns from physical therapy? a. two-point b. four-point c. three-point d. swing-through

c. the tree-point gait, which requires arm strength, is used when a limb cannot bear weight, the affected leg & crutches are advanced together, & the strong leg swings through

An infant has a clubfoot and initial medical management is serial casting. The nurse caring for the child after the long leg cast has been applied should a. place the casted limb in a dependent position b. assess the casted lower extremity for circulation. c. apply powder to the edges of the cast to help the skin under the cast. d. cut off the rough edges of the cast.

b. Assess the circulation by checking for distal pulses, and checking the toes for color, warmth, capillary refill, and edema. After a cast is applied, elevate the extremity on a pillow above the level of the heart to reduce swelling and promote venous return. Powders or lotions should not be put near the edges of a cast as they can cause skin irritation. If the edges of the cast are rough pull the inner stockinette over the edge of the cast and tape, or alleviate the rough edges by petaling the cast.

which type of compartment syndrome occurs when massive external compression of a compartment occurs? a. chronic compartment syndrome b. crush compartment syndrom c. intermediate compartment syndrome d. acute compartment syndrom

b. crush compartment syndrome is caused by massive external compression or crushing of a compartment. a chronic compartment syndrome is characterized by pain, aching, & tightness in a muscle or muscle group that has been subjected to inordinate stress or exercise. there is not a classification of intermediate. acute compartment syndrome involves sudden & severe decrease in blood flow to the tissue distal to an area of injury that results in ischemic necrosis if prompt intervention does not occur

which of the following is a surgical fusion of a joint? a. open reduction with internal fixation (ORIF) b. arthrodesis c. arthroplasty d. heterotrophic ossification

b. arthrodesis of a joint is created surgically to treat chronic pain. ORIF refers to surgery to repair & stabilize a fx. heterotrophic ossification refers to formation of bone in the periprosthetic space. arthroplasty refers to surgical repair of a joint or joint replacement

an x-ray demonstrates a fracture in which the fragments of bone are driven inward. this type of fracture would be which of the following? a. comminuted b. depressed c. impacted d. compound

b. skull fracture occur as a result of blunt of trauma comminuted bone splintered into several pieces. compound damages skin or mucous membranes. impacted involves fragments driven into another bone

After an above-the-knee amputation of a leg, a client reports pain in the foot that is no longer there. what should the nurse include about phantom limb pain in a discussion with the client? a. tactile illusions associated with severed blood vessels b. nerve endings in the limb are still intact & react to stimuli c. an unconscious phenomenon to aid with gieving over the lost body part d. hallucinations secondary to emotional symptoms associated with the distress of amputation

b. the neural endings that innervated the limb are still intact & may be stimulated (touch, env temp, barometric pressure changes) within the residual limb

which of the following is an appropriate nursing intervention in the care of the pt with osteoarthritis? a. avoid the use of topical analgesics b. encourage wight loss & an increase in aerobic activity c. provide an analgesic after exercise d. asses for the gastrointestinal complication associated with a COX-II inhibtors

b. weight loss & increase aerobic activity such as walking are important approaches to pain management. GI complications are associated iwht the use fo NSAID's

a client with a fractured hip is helped from the bed to a chair after surgery. the nurse instructs the client to bear most of the weight on the unaffected leg before sitting in a chair. what should the nurse explain is the benefit of bearing most of the weight on the unaffected leg? a. can increase circulation in the lower extremities b. will help maintain the strength of the unaffected limb c. is the quickest method of getting the client to and from the bed d. reduces the amount of help necessary to lift the client from the bed to the chair

b. weight-bearing on the uninvolved leg helps maintain its muscle tone while limiting the stress on the involved extremity

A nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? a) I will encourage my child to perform prescribed exercises b) I will have my child wear soft fabric clothing under the brace c) I should apply lotion under the brace to prevent skin breakdown d) I should avoid the use of powder because it will cake under the brace

c. I should apply lotion under the brace to prevent skin breakdown. R- lotions and powder can become sticky and cake under the brace causing skin irritation/ breakdown

which clinical indicator should the nurse expect to identify when assessing a clinet with a fracture of the neck of the femur? a. adduction with internal rotation b. abduction with external rotation c. shortening of the affected extremity with external rotation d. lengthening of the affected extremity with internal rotation

c. as a result of contraction & pulling of the muscles on the two bone fragments, there is a characteristic shortening of the femur with external rotation of the extremity.

Nursing care for a client with a fractured hip should include the assessment of pedal pulses. the nurse should assess for which important characteristics of the pedal pulses? a. contractility & rate b. color of skin & rhythm c. amplitude & symmetry d. local temp & visual pulsation

c. assessment fo the pedal pulse should include the strength of the pulse. symmetry, the correspondence of homologous parts on opposite sides of the body, indicates whether the pulses are equal

what should the nurse do to promote early & efficient ambulation after a client has a midthigh amputation? a. keep the head of the bed elevated b. place the residual limb on a pillow c. turn the client to the prone position routinely d. encourage the client to lie on the unaffected side

c. flexion contracture of the hip can be prevented by routinely placing the client in a prone postion to extend the hip a,b cause flexion of the hip, which will result in a hip contracture

A client has an amputation of a lower limb. what instructions should the nurse give the client to prevent a hip flexion contracture? a. turn from side to side q 1-2 hrs b. sit in a chair for 30 min TID c. lie on the abdomen 30 min QID d. perform quadriceps muscle setting exercises BID

c. the hips are in extension when the client is prone; this keeps the hips from flexing a & b promote flexion contracture formation

a nurse is caring for a client who had an open reduction and internal fixation of a femoral neck fracture. the client has an order for ambulation with slight weight-bearing on the affected extremity. During the physical assessment the nurse identifies that the client has kyphosis and strong upper arm strength. what assistive devise does the nurse expect the provider to order? a. crutches b. quad cane c. straight cane d. standard walker

d. this type of walker can be used by a client with partial weight-bearing who has enough upper body strength to lift and move the walker forward. a standard walker with rubber tips is designed for those who need more support than a cane

A health care providers orders the application of warm compresses fro a client with arthritis. what is the appropriate temp range for the compresses that the nurse applies? a. 65- 79 F (18.3- 26.1 C) b. 80-92 F (26.6-33.3 C) c. 93-97 F (33.8-36.1 C) d. 98-105 F (36.6-40.5 C)

d. warm compresses ( at or slightly above body temp) dilate blood vessels, increasing blood flow to the area & decreasing edema