Ortho/Neuro Exam 3
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.
Two days after an accident in which a client sustained multiple injuries, including fractures, the client becomes confused and dyspneic and has a fever of 103.4° F. The nurse assesses that the client has developed a. a fat embolism. b. a pulmonary embolism. c. compartment syndrome. d. wound infection
a. a fat embolism.
When helping a patient with rheumatoid arthritis (RA) plan a daily routine, the nurse informs the patient that it is most helpful to start the day with a. a warm bath followed by a short rest. b. a 10-minute routine of isometric exercises. c. stretching exercises to relieve joint stiffness. d. active range-of-motion (ROM) exercises.
a. a warm bath followed by a short rest.
When helping a patient with rheumatoid arthritis (RA) plan a daily routine, the nurse informs the patient that it is most helpful to start the day with a. a warm bath followed by a short rest. b. a short routine of isometric exercises. c. active range-of-motion (ROM) exercises. d. stretching exercises to relieve joint stiffness.
a. a warm bath followed by a short rest.
The assessment that would alert the nurse to the possibility of cast syndrome in a client with a spica cast is a. abdominal distention. b. diminished pulses in the foot. c. "hot spot" felt on cast. d. musty, unpleasant odor to cast.
a. abdominal distention.
On the first postoperative day, a patient with a below-the-knee amputation complains of pain in the amputated limb. An appropriate action by the nurse is to a. administer prescribed opioids to relieve the pain. b. explain the reasons for phantom limb pain. c. loosen the compression bandage to decrease incisional pressure. d. remind the patient that this phantom pain will diminish over time.
a. administer prescribed opioids to relieve the pain.
The nurse is caring for a client who is 1 day post-total hip replacement. The nurse is instructing the client about how to perform quadriceps-setting exercises correctly. Which direction will the nurse provide to the client? a. "Straighten your legs and push the back of your knees into the mattress." b. "Straighten your legs and bring each leg separately off the mattress 6 inches." c. "Raise each leg 10 inches off the bed, keep it straight, and make circles with your ankle." d. "Bend each leg separately at the knee, and then rapidly point your toes downward and then upward."
a. "Straighten your legs and push the back of your knees into the mattress."
Which statement by a patient who is scheduled for an above-the-knee amputation for treatment of an osteosarcoma of the right tibia indicates that patient teaching is needed? a. "I did not have this bone cancer until my leg broke a week ago." b. "I wish that I did not have to have chemotherapy after this surgery." c. "I know that I will need to participate in physical therapy after surgery." d. "I will use the patient-controlled analgesia (PCA) to control postoperative pain."
a. "I did not have this bone cancer until my leg broke a week ago."
A patient with severe ulnar drift caused by rheumatoid arthritis (RA) is scheduled for an arthroplasty of the right hand and fingers. The nurse determines that the patient has realistic expectations of the outcome of surgery when the patient says, a. "I will be able to use my fingers to grasp objects better." b. "My fingers will appear normal in size and shape after this surgery." c. "This procedure will prevent further deformity in my hands and fingers." d. "I will not have to do as many hand exercises after the surgery."
a. "I will be able to use my fingers to grasp objects better."
A patient who has severe peripheral arterial disease and ischemic foot ulcers is upset with the health care provider's recommendation to have an above-the-knee amputation. The patient tells the nurse, "If they want to cut off my leg, they should just shoot me instead." The most appropriate response to the patient's statement is, a. "Let's talk about how you feel this surgery will affect you." b. "If you do not want the surgery, you do not have to have it." c. "I understand why you are upset, but there really is no choice because your leg is so badly diseased." d. "Many people are able to function normally with a prosthesis after amputation, and you can too."
a. "Let's talk about how you feel this surgery will affect you."
The client for whom skeletal traction is planned asks for an explanation regarding the purpose of this type of traction. Which is the nurse's best response? a. "This type of traction will aid in realigning the bone." b. "This type of traction will prevent you from having low back pain." c. "This type of traction will decrease muscle spasms that occur with a fracture." d. "This type of traction will prevent injury to the skin as a result of the fracture."
a. "This type of traction will aid in realigning the bone."
While assessing an older adult client admitted 2 days ago with a fractured hip, the nurse notes that the client is confused, tachypneic, and restless. Which is the nurse's first action? a. Administering oxygen via nasal cannula b. Applying restraints c. Slowing the IV flow rate d. Discontinuing the pain medication.
a. Administering oxygen via nasal cannula
When preparing a patient to ambulate the day after an ORIF for a hip fracture, which action is most important for the nurse to take? a. Administering the ordered oral opioid pain medication b. Instructing the patient about the benefits of ambulation c. Ensuring that the incisional drain has been discontinued d. Changing the hip dressing and document the appearance of the site.
a. Administering the ordered oral opioid pain medication
A client with a new fracture is complaining of pain. An opioid pain medication was administered 20 minutes ago. Which is the nurse's best intervention? (Select all that apply.) a. Administration of additional opioids b. Elevation of the extremity c. Application of ice d. Application of heat e. Keep the extremity in a dependent position
a. Administration of additional opioids b. Elevation of the extremity c. Application of ice
A client who has sustained a crush injury to the right lower leg complains of numbness and tingling of the affected extremity. The skin of the right leg appears pale. Which is the nurse's first intervention? a. Assessing pedal pulses b. Applying oxygen by nasal cannula c. Increasing the IV flow rate d. Documenting the finding as the only action.
a. Assessing pedal pulses
The nurse is caring for a postoperative client on the medical-surgical unit following a total left hip replacement the previous day. During the assessment, the nurse notes that the client's left leg is cool, with weak pedal pulses. What is the nurse's first action? a. Assessing the circulatory status of the client's right leg b. Notifying the surgeon c. Massaging the leg d. Checking for Homan's sign
a. Assessing the circulatory status of the client's right leg
An older woman is admitted after falling down the stairs. She was immobile for 3 days before being found by a neighbor. Which assessment findings require immediate intervention? (Select all that apply.) a. Blood pressure 80/50 mm Hg b. Potassium 6.0 mEq/L c. Dark brown urine d. Heart rate 90 beats/min e. Urine output 50 mL/hr
a. Blood pressure 80/50 mm Hg b. Potassium 6.0 mEq/L c. Dark brown urine
A home care nurse is visiting a diabetic client with a new cast on the arm. On assessment, the nurse finds the client's fingers to be pale, cool, and slightly swollen. Which is the nurse's first intervention? a. Elevating the arm above the level of the heart b. Encouraging active and passive range of motion c. Applying heat to the affected hand d. Applying a bivalve the cast
a. Elevating the arm above the level of the heart
A client who will not regain mobility has a case manager. What important topics does the nurse need to address in the client's long-term plan of care? (Select all that apply.) a. Informal caregivers b. Sexuality c. Recreation d. Vocational adjustments
a. Informal caregivers b. Sexuality c. Recreation d. Vocational adjustments
The nurse is caring for a client 3 days after a below-knee amputation. Which is a priority intervention? a. Range-of-motion exercises b. Use of a very soft bed mattress c. Placement of a pillow between the client's knees d. Placing the client in a high Fowler's position
a. Range-of-motion exercises
The nurse determines that teaching regarding diet for a patient with osteoporosis has been successful when the patient selects which of these meals as having the highest amount of calcium? a. Sardine sandwich on whole wheat bread, one cup of fruit yogurt, and one cup of skim milk b. Two-egg omelet with American cheese, one slice of whole-wheat toast, and a half grapefruit c. Ham and Swiss cheese sandwich on whole-wheat bread, steamed broccoli, and an apple d. Chicken stir-fry with bok choy, onions, and snap peas and one cup of steamed brown rice.
a. Sardine sandwich on whole wheat bread, one cup of fruit yogurt, and one cup of skim milk
A patient who had arthroscopic surgery of the left knee 5 days ago is admitted with a red, swollen, and hot knee. Which assessment finding by the nurse should be reported to the health care provider immediately? a. The blood pressure is 88/46 mm Hg. b. The white blood cell count is 14,200/µL. c. The patient is taking ibuprofen (Motrin). d. The patient says the knee is very painful.
a. The blood pressure is 88/46 mm Hg.
A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone (Deltasone) 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing a side effect of the medication? a. The patient's blood glucose is 165 mg/dL. b. The patient has no improvement in symptoms. c. The patient has experienced a recent 5-pound weight loss. d. The patient's erythrocyte sedimentation rate (ESR) has increased.
a. The patient's blood glucose is 165 mg/dL.
A patient has chronic osteomyelitis of the left femur, which is being managed at home with self-administration of IV antibiotics. On a home visit, the nurse identifies the nursing diagnosis of ineffective therapeutic regimen management when the nurse finds that the patient a. is unable to plantar-flex the foot on the affected side. b. uses crutches to avoid weight bearing on the affected leg. c. takes and records the oral temperature twice a day. d. is irritable and frustrated with the length of treatment required.
a. is unable to plantar-flex the foot on the affected side.
A patient with comminuted fractures of the tibia and fibula is treated with open reduction and application of an external fixator. The next day, the patient complains of severe pain in the leg, which is unrelieved by ordered analgesics. The patient's toes are pink, but the patient complains of numbness and tingling. The most appropriate action by the nurse is to a. notify the patient's health care provider. b. check the patient's blood pressure. c. assess the external fixator pins for redness or drainage. d. elevate the extremity and apply ice over the wound site.
a. notify the patient's health care provider.
Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that teaching about the disease has been effective when the patient says, a. "I should expect to have a low fever all the time with this disease." b. "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms." c. "I should try to ignore my symptoms as much as possible and have a positive outlook." d. "I can expect a temporary improvement in my symptoms if I become pregnant."
b. "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms."
The nurse is working with a client who has severe rheumatoid arthritis in her hands. The client states that she is frustrated at mealtime because it is difficult for her to manage cups and silverware. What is the nurse's best response? a. "I'll have the nursing assistants set up your meal trays while you are in the hospital." b. "Let's see if the occupational therapist can provide you with some utensils that are easier for you to use." c. "I'll arrange for a home nursing assistant to help you with your meals after you are discharged from the hospital." d. "Let's see if the physical therapist can suggest some muscle strengthening exercises for you."
b. "Let's see if the occupational therapist can provide you with some utensils that are easier for you to use."
A 35-year-old patient with three school-age children who has recently been diagnosed with rheumatoid arthritis (RA) tells the nurse that the inability to be involved in many family activities is causing stress at home. Which response by the nurse is most appropriate? a. "You may need to see a family therapist for some help." b. "Tell me more about the situations that are causing stress." c. "Perhaps it would be helpful for you and your family to get involved in a support group." d. "Your family may need some help to understand the impact of your rheumatoid arthritis."
b. "Tell me more about the situations that are causing stress."
A patient who has been hospitalized for 3 days with a hip fracture and Buck's traction has sudden onset shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first? a. Stay with the patient and offer reassurance. b. Administer oxygen at 4 L/min by a nasal cannula. c. Notify the health care provider about the patient's symptoms. d. Check the patient's legs for swelling or tenderness.
b. Administer oxygen at 4 L/min by a nasal cannula.
Which information will the nurse include when teaching range-of-motion exercises to a patient with an exacerbation of rheumatoid arthritis? a. Affected joints should not be exercised when pain is present. b. Application of cold packs before exercise may decrease joint pain. c. Exercises should be performed passively by someone other than the patient. d. Walking may substitute for range-of-motion (ROM) exercises on some days.
b. Application of cold packs before exercise may decrease joint pain.
When giving home-care instructions to a patient who has multiple forearm fractures and a long-arm cast on the right arm, which information should the nurse include? a. Keep the hand immobile to prevent soft tissue swelling. b. Call the health care provider for increased swelling or numbness. c. Keep the right shoulder elevated on a pillow or cushion. d. Avoid the use of NSAIDs for the first 48 hours after the injury
b. Call the health care provider for increased swelling or numbness.
The nurse obtains this information when assessing a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis. Which symptom is most important to report to the health care provider? a. Abdominal cramping b. Complaint of blurry vision c. Phalangeal joint tenderness d. Blood pressure 170/84 mm Hg
b. Complaint of blurry vision
A female client is seen at the clinic with the medical diagnosis of osteomalacia. When taking the client's history, what information is the most significant? a. Arm and leg strength b. Dietary intake of vitamin D c. Dietary intake of calcium d. Exercise habits
b. Dietary intake of vitamin D
A patient is hospitalized for initiation of regional antibiotic perfusion for acute osteomyelitis of the right femur. Which intervention will be included in the plan of care? a. Frequent weight-bearing exercise b. Immobilization of the right leg c. Avoid administration of NSAIDs d. Support right leg in a flexed position.
b. Immobilization of the right leg
Which finding will the nurse expect when assessing a 60-year-old patient who has osteoarthritis (OA) of the left knee? a. Heberden's nodules b. Pain upon joint movement c. Redness and swelling of the knee joint d. Stiffness that increases with movement
b. Pain upon joint movement
The nurse is caring for an older adult client who has had a hip replacement 2 days previously. Which assessment finding is the best indicator that the client does not need pain medication at this time? a. The client received two Darvocet tablets 2 hours ago. b. The client states that she has no pain. c. The client is sleeping. d. The client's vital signs are stable.
b. The client states that she has no pain.
The nurse observes a patient doing all these activities after having a hip-replacement surgery. Which patient action requires that the nurse intervene immediately? a. The patient sits straight up on the edge of the bed. b. The patient leans over to pull shoes and socks on. c. The patient bends over the sink while brushing the teeth. d. The patient uses crutches with a swing-to gait.
b. The patient leans over to pull shoes and socks on.
A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. All of the following orders are written by the health care provider. Which one will the nurse act on first? a. Administer naproxen (Naprosyn) 500 mg PO. b. Wrap the ankle and apply an ice pack. c. Give acetaminophen with codeine (Tylenol #3). d. Take the patient to the radiology department for x-rays.
b. Wrap the ankle and apply an ice pack.
Following the application of a hip spica cast for a patient with a fracture of the proximal third of the left femur, an appropriate nursing intervention is to a. use the cast support bar to reposition the patient every 2 to 3 hours. b. ask the patient about any abdominal discomfort or nausea. c. discuss the reasons for remaining on bed rest for several weeks. d. promote drying of the cast by placing the patient in a prone position every 4 hours.
b. ask the patient about any abdominal discomfort or nausea.
When getting a patient from the bed into the chair for the first time since having an ORIF of a hip fracture, the nurse should a. use a mechanical lift to transfer the patient from the bed to the chair. b. assist the patient to use a walker with partial weight bearing to assist in transfer to the chair. c. have the patient use crutches with a swing-through gait to transfer. d. ask a nursing assistant to help the patient to stand at the bedside and pivot to the chair.
b. assist the patient to use a walker with partial weight bearing to assist in transfer to the chair.
When teaching a patient who has rheumatoid arthritis (RA) about how to manage activities of daily living, the nurse instructs the patient to a. stand rather than sit when performing household chores. b. avoid activities that require continuous use of the same muscles. c. strengthen small hand muscles by wringing sponges or washcloths. d. protect the knee joints by sleeping with a small pillow under the knees.
b. avoid activities that require continuous use of the same muscles.
A patient undergoes a right above-the-knee amputation with an immediate prosthetic fitting. When the patient first arrives on the orthopedic unit after surgery, the nurse should a. place the patient in a prone position. b. check the surgical site for hemorrhage. c. remove the prosthesis and wrap the site. d. keep the residual leg elevated on a pillow.
b. check the surgical site for hemorrhage.
A client with a left lower leg fracture in a cast for 3 days complains to the nurse that the pain medication does not relieve the pain any more. The priority action by the nurse would be to a. administer more analgesics. b. do a neurovascular assessment. c. elevate the cast on pillows. d. notify the physician.
b. do a neurovascular assessment.
The nursing intervention that would be most appropriate for a client who has entered the emergency department with a severe strain to the knee is a. apply a heat pack to reduce swelling. b. elevate the leg and apply ice. c. manipulate the knee in the full range of motion. d. teach the client exercises to speed healing.
b. elevate the leg and apply ice.
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.
On admitting a client with acute osteomyelitis, the nurse is not surprised at the client's complaint of a. generalized bone pain. b. localized pain and redness. c. nausea and vomiting. d. paresthesias in the affected extremity.
b. localized pain and redness.
A patient undergoes a right below-the-knee amputation with an immediate prosthetic fitting. When the patient is returned to the nursing unit, the nurse should a. check the surgical site for hemorrhage. b. take the patient's vital signs frequently. c. keep the residual leg elevated on a pillow. d. place the patient in a prone position.
b. take the patient's vital signs frequently.
The nurse is caring for a client who has a history of severe rheumatoid arthritis. The client becomes combative and abusive to the staff when she is unable to perform personal care independently. What is the best statement that the nurse can make to the client at this time? a. "I will have to restrain your hands if you cannot keep them to yourself." b. "I will ask your doctor for a psychiatrist to talk to you about anger management." c. "I realize that you are frustrated. Let's take a minute for you to calm down and then we can talk about it." d. "I will call your doctor to get an order for some medication to help you settle down."
c. "I realize that you are frustrated. Let's take a minute for you to calm down and then we can talk about it."
When teaching a patient with osteoarthritis (OA) of the left hip and lower lumbar vertebrae about management of the condition, the nurse determines that additional instruction is needed when the patient says, a. "I can use a cane if I find it helpful in relieving the pressure on my back and hip." b. "A warm shower in the morning will help relieve the stiffness I have when I get up." c. "I should try to stay active throughout the day to keep my joints from becoming stiff." d. "I should take no more than 1 g of acetaminophen four times a day to control the pain."
c. "I should try to stay active throughout the day to keep my joints from becoming stiff."
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."
Which of these patients seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce risk for osteoarthritis (OA)? a. A 56-year-old man who is a member of a construction crew b. A 24-year-old man who participates in a summer softball team c. A 49-year-old woman who works on an automotive assembly line d. A 36-year-old woman who is newly diagnosed with diabetes mellitus
c. A 49-year-old woman who works on an automotive assembly line
A patient who has a proximal humerus fracture that is immobilized with a left-sided long-arm cast, and a sling is admitted to the medical-surgical unit. Which nursing intervention will be included in the plan of care? a. Use surgical net dressing to hang the arm from an IV pole. b. Immobilize the fingers on the left hand with gauze dressings. c. Assess the left axilla and change absorbent dressings as needed. d. Assist the patient in passive range of motion (ROM) for the right arm.
c. Assess the left axilla and change absorbent dressings as needed.
The nurse is caring for a client who has had right total knee replacement surgery 3 days ago. During the assessment, the nurse notes that the client's right lower leg is twice the size of the left. What is the nurse's priority intervention? a. Elevates the client's right leg b. Applies an antiembolism stocking (thromboembolism disease [TED] hose) to the client's right leg c. Assesses the client's respiratory status d. Checks the client's pedal pulses
c. Assesses the client's respiratory status
Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of rheumatoid arthritis. Which laboratory result will the nurse monitor to determine whether the medication has been effective? a. Blood glucose test b. Liver function tests c. C-reactive protein level d. Serum electrolyte levels
c. C-reactive protein level
A client who had a plaster cast applied to the right arm 3 weeks ago presents to the clinic with an erythrocyte sedimentation rate (ESR) that has increased from 15 to 25 mm/hr. Which is the nurse's best action? a. Repeating this laboratory assessment in 4 hours b. Having the cast reapplied c. Evaluate temperature and vital signs d. Obtaining blood for a platelet count.
c. Evaluate temperature and vital signs
A patient is being discharged after 2 weeks of IV antibiotic therapy for acute osteomyelitis in the left leg. Which information will be included in the discharge teaching? a. The reason for taking oral antibiotics for 7 to 10 days after discharge b. The need for daily aerobic exercise to help maintain muscle strength c. How to monitor and care for the long-term IV catheter site d. How to apply warm packs safely to the leg to reduce pain.
c. How to monitor and care for the long-term IV catheter site
A client's susceptibility to osteomalacia is related to which risk factor? a. Calcium level of 11 mg/dL (normal = 8.2 ? 10.2 mg/dL) b. Diet high in milk and soy c. Phosphate level of 1.0 mg/dL (normal = 2.5 ? 4.5 mg/dL) d. Taking vitamin D supplements
c. Phosphate level of 1.0 mg/dL (normal = 2.5 ? 4.5 mg/dL)
Which gait-training technique is correct when teaching the client who has left leg weakness to walk with a cane? a. Placing the cane in the client's left hand and moving the cane forward, followed by moving the left leg one step forward b. Placing the cane in the client's left hand and moving the cane forward, followed by moving the right leg one step forward c. Placing the cane in the client's right hand and moving the cane forward, followed by moving the left leg one step forward d. Placing the cane in the client's right hand and moving the cane forward, followed by moving the right leg one step forward
c. Placing the cane in the client's right hand and moving the cane forward, followed by moving the left leg one step forward
A home health patient with rheumatoid arthritis (RA) complains to the nurse about having chronically dry eyes. Which action by the nurse is most appropriate? a. Reassure the patient that dry eyes are a common problem with RA. b. Teach the patient more about adverse effects of the RA medications. c. Suggest that the patient start using over-the-counter (OTC) artificial tears. d. Ask the health care provider about lowering the methotrexate (Rheumatrex) dose.
c. Suggest that the patient start using over-the-counter (OTC) artificial tears.
When caring for a patient with a new diagnosis of rheumatoid arthritis, which action will the nurse include in the plan of care? a. Instruct the patient to purchase a soft mattress. b. Teach patient to use lukewarm water when bathing. c. Suggest that the patient take a nap in the afternoon. d. Suggest exercise with light weights several times daily
c. Suggest that the patient take a nap in the afternoon.
When the nurse is reviewing laboratory data for a patient who is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis, which information is most important to communicate to the health care provider? a. The blood glucose is 75 mg/dL. b. The rheumatoid factor is positive. c. The white blood cell (WBC) count is 1500/µL. d. The erythrocyte sedimentation rate is elevated.
c. The white blood cell (WBC) count is 1500/µL.
When evaluating the crutch-walking technique of a patient with a right-leg long-leg cast and no weight bearing on the right leg, the nurse determines that the patient is prepared to ambulate independently with the crutches on observing that the patient a. uses the bedside chair to assist in balance as needed when ambulating in the room. b. keeps the padded area of the crutch firmly in the axillary area when ambulating. c. advances the right leg and both crutches together and then advances the left leg. d. moves the left crutch with the left leg and then the right crutch with the right leg.
c. advances the right leg and both crutches together and then advances the left leg.
A patient is admitted to the emergency department with possible fractures of the bones of the left lower extremity. The initial action by the nurse should be to a. splint the lower leg. b. elevate the left leg. c. check the popliteal, dorsalis pedis, and posterior tibial pulses. d. obtain information about the patient's tetanus immunization status.
c. check the popliteal, dorsalis pedis, and posterior tibial pulses.
A 26-year-old woman has been diagnosed with early systemic lupus erythematosus (SLE) involving her joints. In teaching the patient about the disease, the nurse includes the information that SLE is a(n) a. hereditary disorder of women but usually does not show clinical symptoms unless a woman becomes pregnant. b. autoimmune disease of women in which antibodies are formed that destroy all nucleated cells in the body. c. disorder of immune function, but it is extremely variable in its course, and there is no way to predict its progression. d. disease that causes production of antibodies that bind with cellular estrogen receptors, causing an inflammatory response.
c. disorder of immune function, but it is extremely variable in its course, and there is no way to predict its progression.
The nurse notices a stain on a newly dried plaster cast over a client's fracture site. The most appropriate method to assess this finding is to a. assess for a "hot spot" over the stain. b. bivalve the cast and inspect the site. c. draw around the circumference with a pen and record. d. dry the stained area of the cast with a hair dryer.
c. draw around the circumference with a pen and record.
A client is admitted to the emergency department with a complete fracture of the left radius. The nurse understands that with this type of fracture, the bone is a. displaced with fragments out of normal position. b. fractured only through one cortex of bone. c. fractured through the entire bone. d. fragmented with multiple pieces of bone.
c. fractured through the entire bone.
In the emergent care of a client with a pelvic fracture, the nurse must be especially alert for indications of the complication of a. deep vein thrombosis. b. hyperthermia. c. hypovolemic shock. d. infection.
c. hypovolemic shock.
After falling at home, a patient is admitted to the emergency department, where x-rays confirm the presence of an extracapsular fracture of the femur. When assessing the patient, the nurse would expect to find a. bruising of the left hip and thigh. b. numbness in the left leg and hip. c. outward pointing toes on the left leg. d. weak or non palpable left leg pulses.
c. outward pointing toes on the left leg.
A 60-year-old patient has osteoarthritis (OA) of the left knee. A finding that the nurse would expect to be present on examination of the patient's knee is a. Heberden's nodules. b. redness and swelling of the knee joint. c. pain upon joint movement. d. stiffness that increases with movement.
c. pain upon joint movement.
A patient with severe osteoarthritis of the left knee has undergone left-knee arthroplasty with replacement of the total knee joint with a plastic prosthesis. Postoperatively, the nurse expects care of the leg to include a. bed rest for 3 days with the left leg immobilized in an extended position. b. use of a compression bandage to hold the left knee in a flexed position. c. progressive leg exercises to obtain 90-degree flexion. d. early ambulation with full weight bearing on the left leg.
c. progressive leg exercises to obtain 90-degree flexion.
In developing a care plan for a patient with an open reduction and internal fixation (ORIF) of an open, displaced fracture of the tibia, the priority nursing diagnosis is a. risk for constipation related to prolonged bed rest. b. activity intolerance related to deconditioning. c. risk for infection related to disruption of skin integrity. d. risk for impaired skin integrity related to immobility.
c. risk for infection related to disruption of skin integrity.
Following x-rays of an injured wrist, the patient is informed that it is badly sprained. In teaching the patient to care for the injury, the nurse tells the patient to a. apply a heating pad to reduce muscle spasms. b. wear an elastic compression bandage continuously. c. use pillows to keep the arm elevated above the heart. d. gently exercise the joint to prevent muscle shortening
c. use pillows to keep the arm elevated above the heart.
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
The nurse provides discharge instructions to a patient with an above-the-knee amputation who will be fitted with a prosthesis when healing is complete and the residual limb is well molded. The nurse determines that teaching has been effective when the patient says a. "I should change the limb sock when it becomes soiled or stretched out." b. "I should use lotion on the stump to prevent drying and cracking of the skin." c. "I should elevate my residual limb on a pillow 2 or 3 times a day." d. "I should lay on my abdomen for 30 minutes 3 or 4 times a day."
d. "I should lay on my abdomen for 30 minutes 3 or 4 times a day."
The nurse is teaching a client who has osteoarthritis ways to slow the progression of the disease. Which statement indicates that the client understands the nurse's instruction? a. "I will eat more vegetables and less meat." b. "I will avoid exercising to minimize wear on my joints." c. "I will take calcium with vitamin D every day." d. "I will start swimming twice a week."
d. "I will start swimming twice a week."
A patient with lower-leg fractures has an external fixation device in place and is scheduled for discharge. Which information will the nurse include in the discharge teaching? a. "You will need to remain on bed rest until bone healing is complete." b. "The external fixator can be removed during the bath or shower." c. "Prophylactic antibiotics are needed until the external fixator is removed." d. "You will need to assess and clean the pin insertion sites daily."
d. "You will need to assess and clean the pin insertion sites daily."
The nurse is caring for a client who has had right total knee replacement surgery. The client states that he is "sick and tired of lying on his back all the time." Which other position could be used safely for this client? a. Right side-lying b. Left side-lying c. Supine is only safe position for this client d. Any position comfortable for him
d. Any position comfortable for him
The second day after admission with a fractured pelvis, a patient develops acute onset confusion. Which action should the nurse take first? a. Take the blood pressure. b. Assess patient orientation. c. Check pupil reaction to light. d. Assess the oxygen saturation.
d. Assess the oxygen saturation.
Following a motor-vehicle accident, a patient arrives in the emergency department with massive right lower-leg swelling. Which action will the nurse take first? a. Elevate the leg on pillows. b. Apply a compression bandage. c. Place ice packs on the lower leg. d. Check leg pulses and sensation.
d. Check leg pulses and sensation.
Which dietary choice indicates that the client understands nutritional needs to assist in healing a fracture? a. Skim milk, vitamin D supplements, fish b. Soy milk, vitamin B supplements, bacon, lettuce and tomato sandwich c. Whole milk, vitamin A supplements, vegetable lasagna d. Low-fat milk, vitamin C supplements, roast pork.
d. Low-fat milk, vitamin C supplements, roast pork.
A 58-year-old patient has been diagnosed with osteoarthritis (OA) of the hands and feet. The patient tells the nurse, "I am afraid that I will be hopelessly crippled in just a few years!" The best response by the nurse is that a. progression of OA can be prevented with a regimen of exercise, diet, and drugs. b. OA is an inflammatory process with periods of exacerbation and remission. c. joint degeneration with pain and deformity occurs with OA by age 60 to 70. d. OA is common with aging, but usually it is localized and does not cause deformity.
d. OA is common with aging, but usually it is localized and does not cause deformity.
The nurse is caring for a client with a fractured femur. Which factor in the client's history may impede healing of the fracture? a. A sedentary lifestyle b. A history of smoking c. Oral contraceptive use d. Peripheral vascular disease.
d. Peripheral vascular disease.
Which information obtained by the emergency department nurse when admitting a patient with a left femur fracture is most important to report to the health care provider? a. Bruising of the left thigh b. Complaints of left thigh pain c. Outward pointing toes on the left foot d. Prolonged capillary refill of the left foot
d. Prolonged capillary refill of the left foot
The nurse is assessing a client with a body cast. Which assessment finding indicates a complication that needs to be reported to the health care provider? a. Blood pressure 130/85 mm Hg, temperature 99° F (37.2° C) b. Urinary output 40 mL/hr c. Redness around the edges of the cast d. Vomiting after meals
d. Vomiting after meals
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 right leg. d. check the chart for preoperative neuromuscular assessment data
d. check the chart for preoperative neuromuscular assessment data
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.
A patient with a fractured pelvis is initially treated with bed rest with no turning from side to side permitted. The second day after admission, the patient develops chest pain, tachypnea, and tachycardia. The nurse determines that the patient's symptoms are most likely related to fat embolism when assessment of the patient reveals a. a blood pressure of 100/65 mm Hg. b. anxiety, restlessness, and confusion. c. warm, reddened areas in the calf. d. pinpoint red areas on the upper chest.
d. pinpoint red areas on the upper chest.
A patient with a herniated intervertebral disk undergoes a laminectomy and diskectomy. Following the surgery, the nurse should position the patient on the side by a. elevating the head of the bed 30 degrees and having the patient extend the legs while turning to the side. b. turning the patient's head and shoulders and then the hips, keeping the patient centered in the bed. c. having the patient turn by grasping the side rails and pulling the shoulders over. d. placing a pillow between the patient's legs and turning the entire body as a unit.
d. placing a pillow between the patient's legs and turning the entire body as a unit.
In caring for a client in skeletal traction with a nursing diagnosis of Risk for Injury related to traction, the nurse should take special care to a. carefully inspect pin sites every other day to assess for pin site infection. b. encourage the client to assume a position of comfort to reduce the risk of pressure ulcers. c. knot ropes between the client and pulley to prevent weights from touching the floor. d. position weight ropes to ensure that the weights hang freely from pulleys.
d. position weight ropes to ensure that the weights hang freely from pulleys.
In developing a care plan for a patient with an open reduction and internal fixation (ORIF) of an open, displaced fracture of the tibia, the priority nursing diagnosis is a. activity intolerance related to deconditioning. b. risk for constipation related to prolonged bed rest. c. risk for impaired skin integrity related to immobility. d. risk for infection related to disruption of skin integrity
d. risk for infection related to disruption of skin integrity
