PrepU ch 37

Which principle applies to the client in traction? Knots in the ropes should touch the pulley. Weights are removed routinely. Skeletal traction is never interrupted. Weights should rest on the bed.

Skeletal traction is never interrupted

A client comes to the emergency department and it is found that the client's radial head is partially dislocated. What is this partially dislocated radial head documented as? Volkmann's contracture Subluxation Sprain Compartment syndrome

Subluxation

An elite high school football player has been diagnosed and treated for a shoulder dislocation. What should the nurse emphasize during health education to facilitate the player's rejoining the team? The importance of adhering to the prescribed treatment and rehabilitation regimen The need to take analgesia regardless of the short-term absence of pain The importance of monitoring for intracapsular bleeding once he resumes playing The fact that he has a permanently increased risk of future shoulder dislocations

The importance of adhering to the prescribed treatment and rehabilitation regimen

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed? The skin may be covered with a yellowish crust that will shed in a few days. The leg will look as it did prior to the cast being applied. The leg strength is enforced by the wearing of the cast. The leg will look moist and will have small bumps that will go away in a few days.

The skin may be covered with a yellowish crust that will shed in a few days.

Which statement describes external fixation? The bone is surgically exposed and realigned. 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 surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. The bone is restored to its normal position by external manipulation.

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? Arthrodesis Osteotomy Total arthroplasty Hemiarthroplasty

Total arthroplasty

A client is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm? Use of isometric exercises Repositioning the arm in the cast Proper use of a sling Abduction and adduction of the shoulder

Use of isometric exercises

Which is not one of the general nursing measures employed when caring for the client with a fracture? cranial nerve assessment providing comfort measures administering analgesics assisting with ADLs

cranial nerve assessment

Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia? Avascular necrosis (AVN) Fat embolism syndrome (FES) Disseminated intravascular coagulation (DIC) Complex regional pain syndrome (CRPS)

isseminated intravascular coagulation (DIC)

A client has been diagnosed with a muscle strain. What does the physician mean by the term "strain"? subluxation of a joint injuries to ligaments surrounding a joint stretched or pulled beyond its capacity injury resulting from a blow or blunt trauma

stretched or pulled beyond its capacity

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse? "You would have to stay here much longer because it takes a cast longer to dry." "It is best if an orthopedic doctor applies the cast." "Not all fractures require a cast." "A splint is applied when more swelling is expected at the site of injury."

"A splint is applied when more swelling is expected at the site of injury."

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? "Apply ice packs for the first 12 to 18 hours." "Apply heat packs for the first 24 to 48 hours." "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours." "Apply ice packs for the first 24 to 48 hours, then apply heat packs."

"Apply ice packs for the first 24 to 48 hours, then apply heat packs."

A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse? "Elevating the leg might lead to a flexion contracture." "You need to turn yourself side to side. If your leg is on a pillow, you would not be able to do that." "I am sorry. We ran out of pillows. I can elevate it on a few blankets." "Elevating the extremity may increase your chances of compartment syndrome."

"Elevating the leg might lead to a flexion contracture."

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? "I need to remember not to cross my legs. It's such a habit." "I'll need to keep several pillows between my legs at night." "I don't know if I'll be able to get off that low toilet seat at home by myself." "The occupational therapist is showing me how to use a sock puller to help me get dressed."

"I don't know if I'll be able to get off that low toilet seat at home by myself."

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching? "I'll start with ice for the first couple of hours and then apply heat." "I need to stay off my ankle for at least the next 3 to 4 weeks." "I'll get the prescription filled for the narcotic pain reliever." "I'll make sure to keep my ankle elevated as much as possible."

"I'll make sure to keep my ankle elevated as much as possible."

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care? "Keep your right leg elevated above heart level." "Use a knitting needle to scratch itches inside the cast." "Cover the cast with a blanket until the cast dries." "A foul smell from the cast is normal."

"Keep your right leg elevated above heart level."

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? "Avoid weight bearing until the hip is completely healed." "Limit hip flexion to 90 degrees." "Perform rotation exercises each day." "Intermittently cross and uncross your legs several times each day."

"Limit hip flexion to 90 degrees."

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? "Monitoring skin integrity is important while the continuous passive motion device is in place." "Bleeding is a complication associated with the continuous passive motion device." "The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." "The continuous passive motion device can decrease the development of adhesions."

"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device."

A client is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The client is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement? "For the first 2 weeks after the surgery, you can use a wheelchair to meet your mobility needs." "Actually, clients are only on bed rest for 2 to 3 days before they begin walking with assistance." "The physical therapist will likely help you get up using a walker the day after your surgery." "Our goal will actually be to have you walking normally within 5 days of your surgery."

"The physical therapist will likely help you get up using a walker the day after your surgery."

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain? Give pain medication to the client after providing care. Administer prescribed pain medication only when the client requests it. Administer prescribed analgesics around-the-clock. Avoid administering too much medication because the client is older

Administer prescribed analgesics around-the-clock.

A client with a fractured femur is placed in skeletal traction. Which intervention will increase client independence when moving in bed? Remind to use the heel of the unaffected foot to reposition. Remove the weights prior to repositioning. Apply a trapeze to the bed frame. Instruct to use the elbows to reposition.

Apply a trapeze to the bed frame

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction? Apply heat to the fracture site. Use crutches for 1 week. Perform ankle dorsiflexion three times per day. Apply ice to the fracture site.

Apply ice to the fracture site.

A young client is being treated for a femoral fracture suffered in a snowboarding accident. The nurse's most recent assessment reveals that the client is uncharacteristically confused. What diagnostic test should be performed on this client? Electrolyte assessment Arterial blood gases Electrocardiogram Abdominal ultrasound

Arterial blood gases

A nurse is caring for a client who is in skeletal traction. To prevent the complication of skin breakdown in a client with skeletal traction, what action should be included in the plan of care? Assess the pin insertion site every 8 hours. Encourage the client to push up with the elbows when repositioning. Encourage the client to perform isometric exercises once a shift. Apply occlusive dressings to the pin sites.

Assess the pin insertion site every 8 hours.

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? Assessing the extremity for neurovascular integrity Keeping the client from sliding to the foot of the bed Keeping the ropes over the center of the pulley Ensuring that the weights hang free at all times

Assessing the extremity for neurovascular integrity

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? Administer nonsteroidal anti-inflammatory drugs (NSAIDs) regularly. Assist with a gradual introduction of activity. Apply a cold pack to the affected area every night. Apply heat to the affected area every night.

Assist with a gradual introduction of activity.

An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement? The client's pain will increase until the joint is realigned. Avascular necrosis may develop at the site if it is not promptly resolved. Dislocation can become permanent if the process of bone remodeling begins. The longer the joint is displaced, the more difficult it is to get it back in place.

Avascular necrosis may develop at the site if it is not promptly resolved.

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client? Administering prescribed analgesics. Changing the client's position within prescribed limits. Assisting with range-of-motion and isometric exercises. Applying warm compresses.

Changing the client's position within prescribed limits.

Which cleansing solution is the most effective for use in completing pin site care? Chlorhexidine Betadine Hydrogen peroxide Alcohol

Chlorhexidine

The nurse is assisting with the application of a cast. What will the nurse expect to be done first? Arranging for an x-ray to check bone alignment. Covering the skin with a stockinette. Applying strips of the cast material evenly. Cleaning the skin surface.

Cleaning the skin surface

A client was playing softball and dislocated four fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as? Open reduction Open reduction with internal fixation External fixation Closed reduction

Closed reduction

A client comes to the emergency department complaining of localized pain and swelling of the 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? Strain Fracture Contusion Sprain

Contusion

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? Blood pressure of 140/90 mm Hg Heart rate of 94 beats/minute Client complains of pain in the affected rib area when taking a deep breath Crackles in the lung bases

Crackles in the lung bases

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? Re-fracture of the hip Contracture of the hip Avascular necrosis of the hip Dislocation of the hip

Dislocation of the hip

The nurse teaching the client with a cast about home care includes which instruction? Cover the cast with plastic or rubber Keep the cast below heart level Dry a wet fiberglass cast thoroughly to avoid skin problems Fix a broken cast by applying tape

Dry a wet fiberglass cast thoroughly to avoid skin problems

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? Applying heat to the stump as the client desires Elevating the stump for the first 24 hours Removing the pressure dressing after the first 8 hours Maintaining the client on complete bed rest

Elevating the stump for the first 24 hours

The nurse is caring for a patient postoperatively following orthopedic surgery. The nurse assesses an oxygen saturation of 89%, confusion, and a rash on the upper torso. What does the nurse suspect is occurring with this patient? Pneumonia Fat emboli syndrome Polyethylene-induced infection Disseminated intravascular coagulation

Fat emboli syndrome

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength. Have the patient extend both hands while the nurse compares the volume of both radial pulses.

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury? Septic Hypovolemic Cardiogenic Neurogenic

Hypovolemic

A patient sustains an open fracture with extensive soft tissue damage. The nurse determines that this fracture would be classified as what grade? III II I IV

III

A client has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing their ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed to this complication? Inadequate immobilization Inadequate vitamin D intake Bleeding at the injury site Venous thromboembolism (VTE)

Inadequate immobilization

A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture? Compression Stress Closed Incomplete

Incomplete

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan? Reduce fluid intake. Increase calorie intake. Increase fiber intake. Remove the weights during linen changes.

Increase fiber intake.

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis? Ineffective Coping related to prolonged immobility Activity Intolerance related to impaired mobility Deficient Diversional Activity related to prolonged hospitalization Impaired Physical Mobility related to traction

Ineffective Coping related to prolonged immobility

An older adult client experienced a fall and requires treatment for a fractured hip. Which factor(s) does the nurse identify may have contributed to the fall in this client? Select all that apply. Loss of visual acuity Medication effects Hearing loss Muscle weakness Slowed reflexes

Loss of visual acuity Medication effects Slowed reflexes Muscle weakness

The nurse assesses a client after total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse? Externally rotate the extremity. Apply Buck's traction. Bend the knee and rotate the knee internally. Notify the health care provider.

Notify the health care provider.

A nurse is admitting a client to the unit who presented with a lower extremity fracture. What signs and symptoms would suggest to the nurse that the client may have a peroneal nerve injury? Pallor to the dorsal surface of the foot Visible cyanosis in the toes Numbness and burning of the foot Inadequate capillary refill to the toes

Numbness and burning of the foot

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? Buck's traction Skeletal traction Internal fixation Open reduction

Open reduction

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? Open reduction Arthrodesis Total joint arthroplasty Joint arthroplasty

Open reduction

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? Impacted fracture Compound fracture Transverse fracture Pathologic fracture

Pathologic fracture

The nurse is caring for a client who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? Keep the hip flexed by placing pillows under the client's knee. Have the client reposition himself independently. Keep the affected leg in a position of adduction. Protect the affected leg from internal rotation.

Protect the affected leg from internal rotation.

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

Removing all external sources of pressure, such as clothing and jewelry

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain? Rotator cuff tears Heterotopic ossification Epicondylitis Acute compartment syndrome

Rotator cuff tears

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain? Sore and aching A dull, deep, boring ache Sharp and piercing Similar to "muscle cramps"

Sharp and piercing