PrepU: Chapter 37
Which term refers to the failure of fragments of a fractured bone to heal together? A) Dislocation B) Subluxation C) Nonunion D) Malunion
C) Nonunion
Elderly clients who fall are most at risk for which injuries? A) Wrist fractures B) Humerus fractures C) Pelvic fractures D) Cervical spine fractures
C) Pelvic fractures
A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? A) Elevating the stump for the first 24 hours B) Maintaining the client on complete bed rest C) Applying heat to the stump as the client desires D) Removing the pressure dressing after the first 8 hours
A) Elevating the stump for the first 24 hours
A nurse is caring for a client with a cast on the left arm after sustaining a fracture. Which assessment finding is most significant for this client? A) Fingers on the left hand are swollen and cool B) Presence of a normal popliteal pulse C) Cast edges are rough, with skin irritation present D) Minimal pain in the left arm
A) Fingers on the left hand are swollen and cool
A fracture is considered pathologic when it: A) results in a fragment of bone being pulled away by a ligament or tendon and its attachment. B) occurs through an area of diseased bone. C) involves damage to the skin or mucous membranes. D) presents as one side of the bone being broken and the other side being bent.
B) occurs through an area of diseased bone.
Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia? A) Disseminated intravascular coagulation (DIC) B) Avascular necrosis (AVN) C) Complex regional pain syndrome (CRPS) D) Fat embolism syndrome (FES)
A) Disseminated intravascular coagulation (DIC)
A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? A) Elevate the affected extremity and use cold applications. B) Breathe deeply and cough every 2 hours until ambulation is possible. C) Do ROM exercises as indicated. D) Apply antiembolism stockings as indicated.
A) Elevate the affected extremity and use cold applications.
Which type of cast encloses the trunk and a lower extremity? A) Body cast B) Hip spica C) Long-leg D) Short-leg
B) Hip spica
A client has been diagnosed with a muscle strain. What does the physician mean by the term "strain"? A) stretched or pulled beyond its capacity B) injury resulting from a blow or blunt trauma C) injuries to ligaments surrounding a joint D) subluxation of a joint
A) stretched or pulled beyond its capacity
The nurse is helping to set up Buck's traction on an orthopedic client. How often should the nurse assess circulation to the affected leg? A) Within 30 minutes, then every 1 to 2 hours B) Within 30 minutes, then every 4 hours C) Within 30 minutes, then every 8 hours D) Within 30 minutes, then every shift
A) Within 30 minutes, then every 1 to 2 hours
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) contusion B) sprain C) strain D) subluxation
A) contusion
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) immobilization B) surgical repair C) external rotation D) enhancing complications
A) immobilization
A 14-year-old client is treated in the emergency room for an acute knee sprain sustained during a soccer game. The nurse reviews discharge instructions with the client's parent. The nurse instructs the parent that the acute inflammatory stage will last how long? A) 24 to 48 hours B) 3 to 4 days C) 4 to 5 days D) At least 7 days
A) 24 to 48 hours
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? A) Administer prescribed analgesics around-the-clock. B) Avoid administering too much medication because the client is older. C) Administer prescribed pain medication only when the client requests it. D) Give pain medication to the client after providing care.
A) Administer prescribed analgesics around-the-clock.
A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? A) Assessing the extremity for neurovascular integrity B) Keeping the client from sliding to the foot of the bed C) Keeping the ropes over the center of the pulley D) Ensuring that the weights hang free at all times
A) Assessing the extremity for neurovascular integrity
Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone? A) Compound B) Complete C) Incomplete D) Simple
A) Compound
Which would be contraindicated as a component of self-care activities for the client with a cast? A) Cover the cast with plastic to insulate it B) Cushioning rough edges of the cast with tape C) Elevate the casted extremity to heart level frequently D) Do not attempt to scratch the skin under a cast
A) Cover the cast with plastic to insulate it
Which type of fracture involves a break through only part of the cross-section of the bone? A) Incomplete B) Comminuted C) Open D) Oblique
A) Incomplete
A bone graft may be used for which of the following reasons? Select all that apply. A) Joint stabilization B) Defect filling C) Stimulation of bone healing D) Improvement of motion E) Reduction of a fracture
A) Joint stabilization B) Defect filling C) Stimulation of bone healing
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? A) Numbness and burning of the foot B) Pallor to the dorsal surface of the foot C) Visible cyanosis in the toes D) Inadequate capillary refill to the toes
A) Numbness and burning of the foot
Which intervention should the nurse implement with the client who has an external fixator? Select all that apply. A) Perform pin care as ordered. B) Turn the clamps by one-half every day. C) Supervise the client during transfers. D) Perform neurovascular assessment. E) Inspect pin sites for signs of infection.
A) Perform pin care as ordered. C) Supervise the client during transfers. D) Perform neurovascular assessment. E) Inspect pin sites for signs of infection.
The client presents with nausea and vomiting, sluggish bowel sounds, and abdominal distention. How does the nurse interpret these findings? A) Physiologic cast syndrome B) Impaired physical mobility C) Psychological cast syndrome D) Disuse syndrome
A) Physiologic cast syndrome
A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury? A) Sprain B) Dislocation C) Subluxation D) Strain
A) Sprain
A client is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm? A) Use of isometric exercises B) Proper use of a sling C) Repositioning the arm in the cast D) Abduction and adduction of the shoulder
A) Use of isometric exercises
Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture? A) Promote intake of omega-3 fatty acids B) Use frequent dependent positioning to prevent edema C) Encourage participation in ADLs D) Administer prescribed enema to prevent constipation
C) Encourage participation in ADLs
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? A) "You would have to stay here much longer because it takes a cast longer to dry." B) "A splint is applied when more swelling is expected at the site of injury." C) "It is best if an orthopedic doctor applies the cast." D) "Not all fractures require a cast."
B) "A splint is applied when more swelling is expected at the site of injury."
The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? A) An open reduction B) A fasciotomy C) A total hip replacement D) A total knee replacement
B) A fasciotomy
A nurse is reviewing a client's activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation? A) Straining during a bowel movement B) Bending down to put on socks C) Lifting items above shoulder level D) Transferring from a sitting to standing position
B) Bending down to put on socks
Which nursing assessment finding would be indicative of compartment syndrome in the client with a cast applied to the left forearm 3 hours earlier? A) Fingers pink and warm and move freely B) Capillary refill of left fingers greater than 3 seconds C) Radial pulses palpable and +2 bilaterally D) Absence of numbness and tingling
B) Capillary refill of left fingers greater than 3 seconds
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? A) Blood pressure of 140/90 mm Hg B) Crackles in the lung bases C) Client complains of pain in the affected rib area when taking a deep breath D) Heart rate of 94 beats/minute
B) Crackles in the lung bases
A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? A) Have the patient extend both hands while the nurse compares the volume of both radial pulses. B) Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. C) Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. D) Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength.
B) 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? A) Cardiogenic B) Hypovolemic C) Neurogenic D) Septic
B) Hypovolemic
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? A) A dull, deep, boring ache B) Sharp and piercing C) Similar to "muscle cramps" D) Sore and aching
B) Sharp and piercing
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? A) The need to take analgesia regardless of the short-term absence of pain B) The importance of adhering to the prescribed treatment and rehabilitation regimen C) The fact that he has a permanently increased risk of future shoulder dislocations D) The importance of monitoring for intracapsular bleeding once he resumes playing
B) The importance of adhering to the prescribed treatment and rehabilitation regimen
Which nursing intervention is appropriate for monitoring the client for the development of Volkmann's contracture? A) Assess capillary refill in the toes. B) Assess for paresthesia in the toes. C) Assess the radial pulse. D) Assess mobility of the shoulder.
C) Assess the radial pulse.
A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect? A) Infection B) Pulmonary embolism C) Avascular necrosis D) Hypovolemic shock
C) Avascular necrosis
The nurse caring for a client, who has been treated for a hip fracture, 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 30 degrees. B) Do not flex the hip more than 60 degrees. C) Do not flex the hip more than 90 degrees. D) Do not flex the hip more than 120 degrees.
C) Do not flex the hip more than 90 degrees.
Which factor inhibits fracture healing? A) Vitamin D B) Exercise C) Local malignancy D) Maximum bone fragment contact
C) Local malignancy
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? A) Keep the affected leg in a position of adduction. B) Have the client reposition himself independently. C) Protect the affected leg from internal rotation. D) Keep the hip flexed by placing pillows under the client's knee.
C) Protect the affected leg from internal rotation.
An elderly client's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment? A) The presence of leg shortening B) The client's complaints of pain C) Signs of neurovascular compromise D) The presence of internal or external rotation
C) Signs of neurovascular compromise
Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides? A) Brace B) Continuous passive motion (CPM) device C) Splint D) Trapeze
C) Splint
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? A) "I'll start with ice for the first couple of hours and then apply heat." B) "I need to stay off my ankle for at least the next 3 to 4 weeks." C) "I'll get the prescription filled for the narcotic pain reliever." D) "I'll make sure to keep my ankle elevated as much as possible."
D) "I'll make sure to keep my ankle elevated as much as possible."
The nurse is assisting with the application of a cast. What will the nurse expect to be done first? A) Covering the skin with a stockinette. B) Applying strips of the cast material evenly. C) Arranging for an x-ray to check bone alignment. D) Cleaning the skin surface.
D) Cleaning the skin surface.
A client with a fractured femur is in balanced suspension traction. The client needs to be repositioned toward the head of the bed. During repositioning, what should the nurse do? A) Place slight additional tension on the traction cords. B) Release the weights and replace them immediately after positioning. C) Reposition the bed instead of repositioning the client. D) Maintain consistent traction tension while repositioning.
D) Maintain consistent traction tension while repositioning.
A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? A) Buck's traction B) Skeletal traction C) Internal fixation D) Open reduction
D) Open reduction
Which is an inaccurate principle of traction? A) The weights are not removed unless intermittent treatment is prescribed. B) The weights must hang freely. C) The client must be in good alignment in the center of the bed. D) Skeletal traction is interrupted to turn and reposition the client.
D) Skeletal traction is interrupted to turn and reposition the client.
