Prep-U Questions Med Surge Test 4

Q: Two days after application of a cast to treat a fractured femur, the patient tells the orthopedic health care provider that he is experiencing severe, deep, and constant pain in his leg. The nurse suspects a diagnosis of: a. Infection b. Chronic venous insufficiency c. Phlebitis d. Compartment syndrome

Answer: D Rationale: Compartment syndrome refers to the compression of nerves, blood vessels, and muscle within a closed space. This leads to tissue death from lack of oxygenation.

Q: Which term refers to an injury to ligaments and other soft tissues surrounding a joint? a. Sprain b. Strain c. Subluxation d. Dislocation

Answer: A Rationale: A sprain is caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.

Q: There are a variety of problems that can become complications after a fracture. Which is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head? a. Avascular necrosis b. Shock c. Pulmonary embolism d. Fat embolism

Answer: A Rationale: Avascular necrosis is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head.

Q: The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing. . . a. Compartment syndrome b. Delayed union c. Fat embolism syndrome d. Complex regional pain syndrome

Answer: C Rationale: The clinical manifestations described in the scenario are characteristics of fat embolism syndrome.

Q: A client presents to the emergency department with an open fracture. What is the first action the nurse should take? a. Perform a neurovascular assessment of the affected extremity. b. Cover the exposed bone with sterile dressing. c. Assist the physician with reduction of the fracture. d. Assess the client's vital signs and determine allergies.

Answer: B Rationale: The exposed bone should be covered with a sterile dressing to protect the deeper tissues from contamination.

Q: A nurse is caring for a client who has sustained ligament and a meniscal injury to the knee. Which action would be most appropriate to allow the client to progress without causing further injury? a. Assist with a gradual introduction of activity. b. Administer nonsteroidal anti-inflammatory drugs (NSAIDs) regularly. c. Apply heat to the affected area every night. d. Apply a cold pack to the affected area every night.

Answer: A Rationale: A gradual introduction of activity assists the client with a knee injury to ambulate without causing any further injury. Using NSAIDs or applying ice during the first 48 hours helps ease the pain and the inflammation. The application of heat at a later stage improves the blood circulation. However, the regular use of NSAIDs, cold packs, or heat does not help the client progress without causing any further injury.

Q: An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as? a. Sprain b. Compartment syndrome c. Subluxation d. Volkmann's contracture

Answer: C Rationale: A partial dislocation is referred to as a subluxation. A Volkmann's contracture is a claw like deformity that results from compartment syndrome or obstructed arterial blood flow to the forearm and hand. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space and affects nerve innervation, leading to subsequent palsy. A sprain is injury to the ligaments surrounding the joint

Q: An older adult man has been diagnosed with a femoral head fracture after falling outside his home, and his health care provider has chosen open reduction with internal fixation (ORIF). How should the nurse best explain this procedure to the patient? a. "The surgeon will place plates or rods outside your hip and keep you in traction until your bones heal." b. "The surgeon will give you an anesthetic and then apply a cast." c. "The surgeon will use a scope inserted through punctures in your skin to remove any bone fragments." d. "The surgeon will use pins and rods to keep your bones in place until they heal."

Answer: D Rationale: With an open fracture, surgical intervention is needed to align the bone fragments. Internal fixation devices (metallic pins, wires, screws, plates, nails, or rods) are used to hold the bone fragments in position until bone healing occurs. A cast is not used, and the procedure is not laparoscopic.

Q: Which term refers to a fracture in which one side of a bone is broken and the other side is bent? a. Greenstick b. Spiral c. Oblique d. Avulsion

Answer: A Rationale: A greenstick fracture is a fracture in which one side of a bone is broken and the other side is bent. A spiral fracture is a fracture twisting around the shaft of the bone. An avulsion is when a fragment of bone has been pulled away by a ligament or tendon and its attachment. An oblique is a fracture occurring at an angle across the bone.

Q: A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall? a. Pathologic fracture b. Transverse fracture c. Compound fracture d. Impacted fracture

Answer: A Rationale: A pathologic fracture is a fracture that occurs through an area of diseased bone and can occur without trauma or a fall. An impacted fracture is a fracture in which a bone fragment is driven into another bone fragment. A transverse fracture is a fracture straight across the bone. A compound fracture is a fracture in which damage also involves the skin or mucous membranes.

Q: The patient presents to the emergency room with an open fracture of the femur. Which action would the nurse implement to prevent the most serious complication of an open fracture? a. Cover the wound with a sterile dressing to prevent infection. b. Immobilize the joint to prevent movement of bone fragments. c. Apply a pressure bandage to decrease tissue damage. d. Reduce the fracture to prevent additional tissue damage.

Answer: A Rationale: The most important complication of an open fracture is infection. Therefore, the wound is covered with a sterile dressing. No attempt is made to reduce the fracture or apply pressure.

Q: A client has been diagnosed with a muscle strain. What does the physician mean with the term "strain"? a. Injury resulting from a blow or blunt trauma b. Stretched or pulled beyond its capacity c. Subluxation of a joint d. Injuries to ligaments surrounding a joint

Answer: B Rationale: A strain is an injury to a muscle when it is stretched or pulled beyond its capacity.

Q: Which factor inhibits fracture healing? a. Immobilization of the fracture b. History of diabetes c. Age of 35 years d. Increased vitamin D and calcium in the diet

Answer: B Rationale: Factors that inhibit fracture healing include diabetes, smoking, local malignancy, bone loss, extensive local trauma, age greater than 40, and infection. Factors that enhance fracture healing include proper nutrition, vitamin D and calcium, exercise, maximum bone fragment contact, proper alignment, and immobilization of the fracture.

Q: A client with a traumatic amputation of the right lower leg is refusing to look at the leg. Which action by the nurse is most appropriate? a. Encourage the client to perform range-of-motion (ROM) exercises to the right leg. b. Provide feedback on the client's strengths and available resources. c. Request a referral to occupational therapy. d. Provide wound care without discussing the amputation.

Answer: B Rationale: The nurse should encourage the client to look at, and assist with, care of the residual limb. Providing feedback on the client's strengths and resources may allow the client to start to adapt to the body image and lifestyle change. The nurse should also allow time for the client to discuss their feelings related to the amputation. Requesting a referral to occupational therapy and encouraging the client to perform ROM exercises are appropriate but do not address the emotional aspect of losing an extremity.

Q: An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? a. Compound b. Impacted c. Comminuted d. Depressed

Answer: C Rationale: A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.

Q: A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose? a. Subluxation b. Sprain c. Contusion d. Strain

Answer: C Rationale: A contusion is a soft tissue injury resulting from a blow or blunt trauma. Sprains are injuries to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A subluxation is a partial dislocation.

Q: A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician to perform? a. Ice and immobilization b. Analgesia and immobilization c. Heat and immobilization d. Joint manipulation and immobilization

Answer: D Rationale: The physician manipulates the joint or reduces the displaced parts until they return to normal position, then immobilizes the joint with an elastic bandage, cast, or splint for several weeks.

Q: Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture? a. Maintain Buck's traction. b. Assist the client with use of a trapeze. c. Apply a soft compression dressing. d. Maintain the internal fixator.

Answer: A Rationale: Buck's traction decreases pain, muscle spasm, and external rotation by immobilizing the hip fracture.

Q: Which is not one of the general nursing measures employed when caring for the client with a fracture? a. Providing comfort measures b. Administering analgesics c. Cranial nerve assessment d. Assisting with ADLs

Answer: C Rationale: Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care.

Q: Elderly clients who fall are most at risk for which injuries? a. Pelvic fractures b. Cervical spine fractures c. Humerus fractures d. Wrist fractures

Answer: A Rationale: Elderly clients who fall are most at risk for pelvic and lower extremity fractures. These injuries are devastating because they can seriously alter an elderly client's lifestyle and reduce functional independence. Wrist fractures usually occur with falls on an outstretched hand or from a direct blow. Such fractures are commonly found in young men. Humerus fractures and cervical spine fractures aren't age-specific.

Q: Which general nursing measure is used for a client with a fracture reduction? a. Encourage participation in ADLs b. Assist with intake of immune-enhancing tube feeding formulas c. Examine the abdomen for enlarged liver or spleen d. Promote intake of omega-3 fatty acids

Answer: A Rationale: General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation in ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. The nurse does not need to examine the abdomen for enlarged liver or spleen because fracture reduction treatment does not affect these organs. It is unlikely that a client with a fracture reduction will be prescribed immune-enhancing tube feeding formulas.

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

Answer: A Rationale: 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.

Q: The nurses instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client? a. Do not flex the hip more than 90 degrees. b. Do not flex the hip more than 60 degrees. c. Do not flex the hip more than 30 degrees. d. Do not flex the hip more than 120 degrees.

Answer: A Rationale: Proper alignment and supported abduction are encouraged for hip repairs. Flexion of the hip more than 90 degrees can cause damage to the a repaired hip fracture. By telling the patient to not to cross their legs, the leg stays in a the abducted position allowing for the hip to heal in the proper position. Having someone assist with the shoes does not allow for the hip to flex more than 90 degrees.

Q: A middle-aged woman sustained an elbow fracture in a bicycle crash and has required reduction and fixation to aid healing. The nurse is aware of the need for vigilant neurovascular assessment. How should the nurse assess the function of the patient's ulnar nerve? a. Ask the patient to spread her fingers as widely as possible. b. Touch the back of the patient's hand with a pen and ask if the patient is able to feel the sensation. c. Ask the patient to rotate her hand at the wrist. d. Ask the patient to clench and unclench her fist several times.

Answer: A Rationale: To assess the ulnar nerve, the nurse should ask the patient to spread her fingers as widely as possible. Clenching a fist, rotating the wrist, and touching the back of the patient's hand do not assess for ulnar nerve function.

Q: A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply. a. Pneumonia b. Skin breakdown c. Wound infection d. Diarrhea

Answer: A, B, C Rationale:After surgery, the nurse implements measures to prevent skin breakdown, wound infection, pneumonia, constipation, urinary retention, muscle atrophy, and contractures.

Q: Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome? a. Column A b. Column B c. Column C d. Column D

Answer: B Rationale: Fat embolism syndrome is characterized by fever, tachycardia, tachypnea, and hypoxia. Arterial blood gas findings include a partial pressure of oxygen (PaO2) less than 60 mm Hg, with early respiratory alkalosis and later respiratory acidosis.

Q: Which assessment findings would cause the nurse to suspect compartment syndrome after casting of the leg? a. Low-grade fever, dyspnea, tachycardia, and crackles b. Complaints of numbness and tingling in toes of affected leg c. Warm, pink foot and ability to move toes of affected leg d. Increased capillary refill and bounding pulses in affected leg

Answer: B Rationale: Numbness and tingling indicate nerve ischemia and edema, suggesting development of compartment syndrome.

Q: A client comes to the Emergency Department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely? a. Fracture b. Contusion c. Strain d. Sprain

Answer: B Rationale: The client's description of blunt trauma by a baseball bat and localized pain in conjunction with swelling and ecchymosis (Discoloration of the skin) would most likely suggest a contusion. A fracture would be manifested by pain, loss of function, deformity, swelling, and spasm. A sprain would be manifested by pain and swelling; ecchymosis may appear later. A strain is characterized by inflammation, local tenderness, and muscle spasms

Q: Two days after surgery to amputate his left lower leg, a client states that he has pain in the missing extremity. Which action by the nurse is most appropriate? a. Do nothing because it isn't possible to have pain in a missing limb. b. Administer medication, as ordered, for the reported discomfort. c. Initiate a consult with a psychologist. d. Contact the physician.

Answer: B Rationale: The sensation of pain and discomfort in an amputated extremity is known as phantom pain. Phantom pain is a normal occurrence after an amputation. It should be treated with medication. The nurse doesn't need to contact the physician at this time. Consultation with the psychologist isn't indicated, and the nurse shouldn't take this action without consulting the physician.

Q: A client has been in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma? a. Surgical repair b. Immobilization c. External Rotation d. Enhancing complications

Answer: B Rationale: Treatment of musculoskeletal trauma involves immobilization of the injured area until it has healed.

Q: The nurse at the pediatrician's office is assessing a 17-year-old soccer player who presented to the clinic stating that he sustained an injury that resulted in the knee being struck medially while his foot was firmly planted on the ground. The nurse knows that the patient likely has experienced what? a. Anterior cruciate ligament injury b. Lateral collateral ligament injury c. Medial collateral ligament injury d. Posterior cruciate ligament injury

Answer: B Rationale: When the knee is struck medially, damage may occur to the lateral collateral ligament. If the knee is struck laterally, damage may occur to the medial collateral ligament.

Q: A client sustains an injury to the ligaments surrounding a joint. The nurse identifies this as which of the following? a. Fracture b. Contusion c. Sprain d. Strain

Answer: C Rationale: A sprain is an injury to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A contusion is a soft tissue injury resulting from a blow or blunt trauma. A fracture is a break in the continuity of a bone.

Q: Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? a. Minimal pain with movement b. Ability to stretch arm over the head c. Difficulty lying on affected side d. Pain worse in the morning

Answer: C Rationale: Clients with a rotator cuff tear experience pain with movement and limited mobility of the shoulder and arm. They especially have difficulty with activities that involve stretching their arm above their head. Many clients find that the pain is worse at night and that they are unable to sleep on the affected side.

Q: A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states that he cannot feel or move his fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures? a. Muscle spasms b. Dislocation. c. Compartment Syndrome d. Subluxation

Answer: C Rationale: Separation of adjacent bones from their articulating joint interferes with normal use and produces a distorted appearance. The injury may disrupt local blood supply to structures such as the joint cartilage, causing degeneration, chronic pain, and restricted movement. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space. The fractured humerus may also be dislocated but is not the result of the impaired circulatory status. Muscle spasms may occur around the fracture site but are not the cause of circulatory impairment. Subluxation is a partial dislocation.

Q: A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? a. "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours." b. "Apply heat packs for the first 24 to 48 hours." c. "Apply ice packs for the first 24 to 48 hours, then apply heat packs." d. "Apply ice packs for the first 12 to 18 hours."

Answer: C Rationale: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.

Q: A patient is recovering in the hospital following a total hip replacement that was performed 2 days ago. In an effort to prevent the common complications associated with the surgical procedure, the nurse should implement which of the following interventions, as ordered? a. Passive range-of-motion (ROM) exercises with the affected leg b. Provision of a low-fiber, high-calorie diet c. Application of sequential compression devices d. Intermittent urinary catheterization to prevent urinary retention

Answer: C Rationale: The risk of venous thromboembolism is particularly great after reconstructive hip surgery. The nurse encourages the patient to consume adequate amounts of fluids, to perform ankle and foot exercises hourly while awake, and to use elastic stockings and sequential compression devices as prescribed. Passive ROM is not performed due to the high risk of injury. A low-fiber diet is not indicated, and intermittent catheterization is not used as a preventative measure.