Ortho Lab
Which intervention should the nurse implement with the client who has undergone a hip replacement? a) Instruct the client to avoid internal rotation of the leg. b) Place the client in high Fowler's position for meals. c) Adduct the legs by placing a pillow between the legs. d) Have the client bend forward to rise from the chair.
a) Instruct the client to avoid internal rotation of the leg. -------------------------------------- Explanation: The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. A pillow is used to keep the legs in abduction. The hip should not bend more than 90 degrees when seated. The head of bed should be kept at 60 degrees or less.
A client with a fractured hip is being taught correct use of the walker. The nurse is aware that the correct use of the walker is achieved if the: a) Palms rest lightly on the handles b) Elbows are flexed 0° c) Client walks to the front of the walker d) Client carries the walker
a) Palms rest lightly on the handles -------------------------------------- Explanation: The client's palms should rest lightly on the handles. The elbows should be flexed no more than 30° but should not be extended.
A 2-year-old is admitted for repair of a fractured femur and is placed in Bryant's traction. Which finding by the nurse indicates that the traction is working properly? a) The infant no longer complains of pain. b) The buttocks are 15° off the bed. c) The legs are suspended in the traction. d) The pins are secured within the pulley.
b) The buttocks are 15° off the bed.
A patient is to be discharged from the hospital 4 days after undergoing a total hip arthroplasty. A statement by the patient that indicates a need for additional discharge instructions is a) "I should not cross my legs while sitting." b)"I can sleep in any position that is comfortable for me." c)"I will use a toilet elevator on the toilet seat." d)"I will have someone else put on my shoes and socks."
b)"I can sleep in any position that is comfortable for me." ---------------------------------------------- Explanation: The patient needs to sleep in a position that allows excessive internal rotation or flexion of the hip.
A client has undergone an external fixation. Which actions would be the priority for this client? a) Monitoring the client's blood pressure. b) Planning the client's diet. c) Maintaining pin care. d) Monitoring the client's urine output.
c) Maintaining pin care. ------------------------------------------ Explanation: -Pin care is a priority for a client with external fixation, because pin sites are entry points for infection. -The nurse should also monitor redness, drainage, and tenderness at the site. -Planning the client's diet and monitoring the client's urine output and blood pressure, although necessary, are not as important as maintaining pin care.
A patient with an intracapsular fracture of the left femur is placed in Buck's traction before surgery for a hip replacement. The patient asks why traction is necessary when surgery is planned. The nurse's response to the patient is based on the knowledge that traction a) will help prevent flexion contractures of the affected hip. b) is necessary to prevent displacement of the fracture. c)will decrease the incidence of painful muscle spasms d) is used to maintain the leg in the external rotation position.
c)will decrease the incidence of painful muscle spasms
A complication of Buck's extension traction would be noted by a nurse if: a) Skin over the fracture site was flushed. b) Redness and purulent drainage appeared at the pin site. c) Dorsiflexion developed in the affected foot. d) Toes of affected leg became dusky in color.
d) Toes of affected leg became dusky in color. ------------------------------------------------ Explanation: Buck's is skin traction to the lower leg. Circulatory disturbances and skin abrasions are the most important nursing concerns.
A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast? a) More breathable b) Longer-lasting c) Better molding to the client d) Quicker drying
c) Better molding to the client
The client with a cervical fracture is placed in traction. Which type of traction will be utilized at the time of discharge? a) Russell's traction b) Buck's traction c) Halo traction d) Crutchfield tong traction
c) Halo traction
Which is an inaccurate principle of traction? a) Skeletal traction is interrupted to turn and reposition the client. b) The weights are not removed unless intermittent treatment is prescribed. c) The client must be in good alignment in the center of the bed. d) The weights must hang freely.
a) Skeletal traction is interrupted to turn and reposition the client.
Which statement describes external fixation? a) The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. b) The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. c) The bone is restored to its normal position by external manipulation. d) The bone is surgically exposed and realigned.
a) The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.
The nurse receives a client in the emergency room with an obvious deformity of the left leg. What is the first thing the nurse should do? a) Get an X-Ray b) Check a pedal pulse c) Ask the client to wiggle their toes d) Check a capillary refill
b) Check a pedal pulse
The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication? a) Re-fracture of the hip b) Dislocation of the hip c) Avascular necrosis of the hip d) Contracture of the hip
b) Dislocation of the hip
Which of these nursing actions included in the care of a patient after laminectomy can the nurse delegate to an experienced nursing assistant? a. Evaluation of the effectiveness of the PCA b. Monitoring plantar and dorsiflexion of the feet c. Logrolling the patient from side to side every 2 hours d. Determining the patient's readiness to ambulate
c. Logrolling the patient from side to side every 2 hours --------------------------------------------- Explanation: Repositioning a patient is included in the education and scope of practice of nursing assistants, and an experienced nursing assistant would be familiar with logrolling. Evaluation of the effectiveness of pain medications, assessment of neurologic function, and evaluation of a patient's readiness to ambulate after surgery require higher-level nursing education and scope of practice.
A client has undergone a lumbar laminectomy and has just returned to the nursing unit. It is essential for the nurse to perform which of the following activities during this period? a) Neurovascular checks b) Early ambulation c) Vital signs checks every half-hour d) Assessment of bladder function
a) Neurovascular checks -------------------------------------- Explanation: Bleeding and swelling following a laminectomy may cause compression of nerves in the spinal column that can lead to permanent neurological damage and paralysis. Frequent assessment of the neurovascular status of the client is essential following laminectomy. Neurovascular assessment includes assessing for pain, pulses, pallor, paresthesia, and paralysis.
A patient with a comminuted fracture of the right femur has Buck's traction in place while waiting for surgery. To assess for pressure areas on the patient's back and sacral area and to provide skin care, the nurse should a) have the patient lift the buttocks by bending and pushing with the left leg. b) turn the patient partially to each side with the assistance of another nurse. c) place a pillow between the patient's legs and turn gently to each side. d) loosen the traction and have the patient turn onto the unaffected side.
a) have the patient lift the buttocks by bending and pushing with the left leg. ------------------------------------------------ Explanation: The patient can lift the buttocks off the bed by using the left leg without changing the right-leg alignment. Turning the patient will tend to move the leg out of alignment. Disconnecting the traction will interrupt the weight needed to immobilize and align the fracture.
Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? a) "Monitoring skin integrity is important while the continuous passive motion device is in place." b) "The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." c) "Bleeding is a complication associated with the continuous passive motion device." d) "The continuous passive motion device can decrease the development of adhesions."
b) "The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." ---------------------------------------------- Explanation: -Further staff education is needed when the nurse states that the continuous passive motion device isn't needed because the client receives physical therapy twice per day. -The continuous passive motion device should be used in conjunction with physical therapy because the device helps prevent adhesions. -Bleeding is a complication associated with the continuous passive motion device; skin integrity should be monitored while the device is in use.
A patient hospitalized with multiple fractures has a long-arm plaster cast applied for immobilization of a fractured left radius. Until the cast has completely dried, the nurse should a) keep the left arm in a dependent position. b) handle the cast with the palms of the hands. c) place gauze around the cast edge to pad any roughness. d) cover the cast with a small blanket to absorb the dampness.
b) handle the cast with the palms of the hands. ------------------------------------------- Explanation: -Until a plaster cast has dried, placing pressure on the cast should be avoided to prevent creating areas inside the cast that could place pressure on the arm -The left arm should be elevated to prevent swelling. -The edges of the cast may be petaled once the cast is dry, but padding the edges before that may cause the cast to be misshapen. -The cast should not be covered until it is dry because heat builds up during drying.
A patient has a short-arm plaster cast applied at the outpatient center for a wrist fracture. An understanding of discharge teaching is apparent when the patient says, a) "I can get the cast wet as long as I dry it right away with a hair dryer." b) "I should avoid moving my fingers and elbow until the cast is removed." c) "I will apply an ice pack to the cast over the fracture site for the next 24 hours." d) "I can rub lotion on any itching areas under the cast with a cotton-tipped applicator."
c) "I will apply an ice pack to the cast over the fracture site for the next 24 hours." ----------------------------------------- Explanation: -Ice application for the first 24 hours after a fracture will help to reduce swelling and can be placed over the cast. -Plaster casts should not get wet. -The patient should be encouraged to move the joints above and below the cast. -Patients should not insert objects inside the cast.
A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? a) Ensuring that the weights hang free at all times b) Keeping the ropes over the center of the pulley c) Assessing the extremity for neurovascular integrity d) Keeping the client from sliding to the foot of the bed
c) Assessing the extremity for neurovascular integrity ----------------------------------------- Explanation: Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb
Which action would be most important postoperatively for a client who has had a knee or hip replacement? a) Using a continuous passive motion (CPM) machine. b) Encouraging expressions of anxiety. c) Providing crutches to the client. d) Assisting in early ambulation.
d) Assisting in early ambulation. -------------------------------------------- Explanation: -An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. -A CPM machine or crutches may be provided when prescribed. (not the priority action) -It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery.
Following a laminectomy with a spinal fusion, a patient reports numbness and tingling of the right lower leg. The first action indicated by the nurse is to a) report the patient's complaint to the surgeon. b) check the vital signs for indications of hemorrhage. c) turn the patient to the side to relieve pressure on the operative area. d) check the chart for preoperative neuromuscular assessment data.
d) check the chart for preoperative neuromuscular assessment data -------------------------------------------------- Explanation: -The postoperative movement and sensation of the extremities should be unchanged (or improved) from the preoperative assessment. If the numbness and tingling are new, this information should be immediately reported to the surgeon. -Numbness and tingling are not symptoms associated with hemorrhage at the site. -Turning the patient will not relieve the numbness.