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1

Which type of traction is used to correct bone deformities of the lower extremities?
1
Russell's traction
2
Pelvic belt
3
Pelvic sling
4
90–90 traction

Answer 1- Russell's Traction

Russell's traction is a type of lower extremity traction in which the affected leg is extended and a sling under the knee suspends the leg. A pelvic belt is a type of pelvic traction in which a strap around the hips at the iliac crests is attached to weights at the foot of the bed. A pelvic sling is a type of pelvic traction where a wide strap around the hips is attached to an overhead bar to keep the pelvis off the bed. Overhead, or 90–90, traction is a type of upper extremity traction where the elbow is flexed and the arm is at a right angle to the body over the upper chest.

2

A rock climber has sustained an open fracture of the right tibia after a 20-foot fall. The nurse plans to assess the client for which potential complications after the first 24 hours? Select all that apply.
1
Acute compartment syndrome (ACS)
2
Fat embolism syndrome (FES)
3
Congestive heart failure
4
Urinary tract infection (UTI)
5
Osteomyelitis

Answer 1, 2, and 5, - ACS, FES, and Osteomyelitis

ACS is a serious condition in which increased pressure within one or more compartments reduces circulation to the area. A fat embolus is a serious complication in which fat globules are released from yellow bone marrow in the bloodstream within 12-48 hours after the injury. FES usually results from long bone fracture or fracture repair, but is occasionally seen in clients who have received a total joint replacement. Bone infection, or osteomyelitis, is most common in open fractures. Congestive heart failure is not a potential complication for this client; pulmonary embolism is a potential complication of venous thromboembolism, which can occur with fracture. The client is at risk for wound infection resulting from orthopedic trauma, not a UTI.

3

A client has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction does the nurse include in this client's teaching plan?
1
"Use pain medication as prescribed to control pain."
2
"Clean the pin site when any drainage is noticed."
3
"Wear the same clothing that is normally worn."
4
"Apply bacitracin (Neosporin) if signs or symptoms of infection develop around pin sites."

Answer 1- "Use pain medication as prescribed to control pain"

The client should be taught the correct use of prescribed pain medication to control pain adequately. Pin sites must be cleaned at least every 8 hours and as needed to reduce the risk for infection, not when any drainage is noticed. The client will have to adjust the type of clothing worn while the fixation device is in place. If signs and symptoms of infection develop around the pin sites, the client must notify the health care provider immediately. Infection at the pin sites places the client at risk for osteomyelitis.

4

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information does the nurse include in the teaching plan?
1
"Avoid contact sports."
2
"Avoid rigorous exercise."
3
"Wear helmets when riding a motorcycle."
4
"Avoid driving in inclement weather."

Answer 3- "Wear helmets when riding a motorcycle."\

Those who ride motorcycles or bicycles should wear helmets to prevent head injury. Telling the general public to avoid contact sports or to avoid driving in inclement weather is not realistic. Telling the general public to avoid rigorous exercise is not only unrealistic, it is also opposed to what many health care professionals recommend to maintain health.

5

Which statements about complex regional pain syndrome (CRPS) are accurate? Select all that apply.
1
It is also known as reflex sympathetic dystrophy.
2
It can be managed by intramuscular phentolamine.
3
It makes the skin hot and dry.
4
It is characterized by paresis and muscle spasms.
5
It can be managed by biphosphonates and antidepressants.

Answer- 1, 4, 5,

CRPS is also known as reflex sympathetic dystrophy. Paresis and muscle spasms are some of the symptoms of CRPS. Biphosphonates and antidepressants can be used to manage the condition. It may be managed by a chemical sympathetic nerve block using an intravascular infusion of phentolamine. With CRPS, the skin is not hot and dry; rather, the client experiences excessive sweating.

6

The nurse is caring for a client with Buck's traction. What care does the nurse provide for this client?
1
Inspect the skin every 12 hours for irritation or inflammation.
2
Remove the belt or boot used for traction to inspect the skin once a day.
3
Monitor circulation every 4 hours after traction is applied.
4
Ensure the weights are freely hanging at all times.

Answer 4- Ensure that the weights are freely hanging at all times

The nurse should ensure that the weights are freely hanging at all times. Weights are not to be removed without a prescription, and should not be lifted manually or allowed to rest on the floor. The nurse should inspect the skin at least every 8 hours for signs of irritation or inflammation. The belt or boot used for traction is removed every 8 hours and the skin is assessed. Circulation is usually monitored every hour for the first 24 hours after traction is applied and every 4 hours thereafter

7

A client is in traction after a major leg injury. What nursing care is necessary for the client? Select all that apply.
1
Inspect the skin every 14 hours.
2
Remove the belt used for traction once in a day.
3
Monitor circulation every 4 hours after traction is applied.
4
Ensure the weights are freely hanging at all times.
5
Inspect the traction equipment every 8 to 12 hours.

Answer 4 and 5- Ensure the weights are freely hanging at all times and inspect the traction equipment every 8-12 hours

When the client is in traction, the weights must be freely hanging at all times. Weights are not removed without an order. They should not be lifted manually or allowed to rest on the floor. The traction equipment is inspected every 8 to 12 hours for loosening, fraying, and positioning. The skin is inspected at least every 8 hours for signs of irritation or inflammation. The belt used for traction is removed every 8 hours to examine the skin. Circulation is usually monitored every hour for the first 24 hours after traction is applied and every 4 hours thereafter.

8

The nurse is educating a group of people at a community center about emergency care for physical trauma. What does the nurse teach this group? Select all that apply.
1
Call 911 then assess for airway, breathing, and circulation.
2
Remove the person's shoes.
3
Cut the clothing over the affected area.
4
Remove jewelry on the affected extremity.
5
Immobilize the extremity.

Answer- 1, 3,4,5,

The group should be instructed to first call 911 and then assess the injured person for the presence of adequate airway, breathing, and circulation. In an emergency, it is more important to provide lifesaving care before caring for the fracture. The clothing over the affected area should be cut or removed to inspect the area for the extent of damage and to check for bleeding. Jewelry on the affected extremity should be removed in case of swelling. The upper and lower end of the injury should be supported and splinted to immobilize the extremity. The person's shoes must not be taken off; it may add to the trauma.

9

What postoperative care is expected after hip replacement surgery for an older client? Select all that apply.
1
Instructing the client to maintain bedrest for a week
2
Monitoring the client frequently to prevent falls
3
Repositioning the client every 4 hours
4
Inspecting the client's heels every 8 to 12 hours
5
Encouraging the client for early ambulation

Answer 2, 4, 5,

After hip replacement, the older client is at risk for acute confusion and delirium. The client must be monitored frequently to prevent falls, especially when trying to get out of bed. The client's heels must be kept off the bed at all times to prevent ulcer formation. The heels and other bony prominences should be inspected every 8 to 12 hours. Early movement and ambulation decrease the chance of infection and increase surgical site healing. The client is encouraged to begin ambulating the day after surgery to prevent complications associated with immobility. The client must be repositioned every 1 to 2 hours to prevent pressure ulcers.

10

A football player is admitted to the emergency department with a sprained ankle. What emergency care is needed for the client with this type of injury?
1
Do not apply a splint below the injury.
2
Use elastic wrap for the first 24 to 48 hours.
3
Do not apply a splint above the injury.
4
Apply warm compresses for the first 24 hours.

Answer 2 Use elastic wrap for the first 24 to 48 hours

As part of emergency care for a client with sports-related injury, compression measures such as elastic wrap should be used for the first 24 to 48 hours. A splint may be applied above and below the injury to immobilize the joint. Ice is applied intermittently for the first 24 to 48 hours. Later, heat can be used.

11

For what type of fracture is physical assessment done with the client in a sitting or standing position?
1
Pelvic
2
Upper arm
3
Lower arm
4
Leg

Answer 2- Upper Arm

The client with a fracture of the upper arm and shoulder is assessed in a sitting or standing position to observe for drooping shoulder or other abnormal positioning. If the client has a fracture in a more distal area of the arm, the client is placed in a supine position with the extremity elevated to reduce swelling. The client with a fracture of the leg or pelvis is also placed in a supine position for assessment.

12

A client is in skeletal traction. Which nursing intervention ensures proper care of this client?
1
Ensure that weights are attached to the bed frame or placed on the floor.
2
Ensure that pins are not loose, and tighten as needed.
3
Inspect the skin at least every 8 hours.
4
Remove the traction weights only for bathing.

Answer 3- Inspect the skin at least every 8 hours

The client's skin should be inspected every 8 hours for signs of irritation, inflammation, or actual skin breakdown. Weights are not allowed to be placed on the floor; weights should hang freely at all times. Pin sites should be checked for signs and symptoms of infection and for security in their position to the fixation and the client's extremity. However, the nurse does not adjust the pins. Any loose pin site or alteration must be reported to the health care provider. Weights must never be removed without a request from the health care provider.

13

A client has been provided with a long-leg cast that is still wet. What instructions does the nurse provide to unlicensed assistive personnel (UAP) in caring for this client?
1
Elevate the client's leg on pillows covered with plastic.
2
Turn the client every hour.
3
Assist the client to the bathroom if required.
4
Wash any spillages off the client's cast.

Answer 2- turn the client every hour.

UAP may turn the client every hour to allow air to circulate and dry all parts of the cast. The client's legs are elevated on pillows covered with cloth to prevent edema; plastic-covered pillows will retain heat and delay drying of the cast. A bedpan must be provided to the client with a long-leg cast. The perineal area of the cast is covered with plastic to prevent spillage or contamination by urine or feces.

14

The nursing instructor is teaching a group of nursing students about emergency care for extremity fractures. What statement made by a participant indicates a need for further teaching?
1
"I should not apply direct pressure on the affected area."
2
"I should not remove the client's shoes."
3
"I should cut the clothing over the affected area."
4
"I should apply a splint above and below the fracture."

Answer- 1- "I should not apply direct pressure on the affected area"

During emergency care for an extremity fracture, direct pressure should be applied on the affected area to prevent bleeding. The client's shoes must not be taken off as it can increase the trauma. The clothing over the affected area is cut or removed to inspect the area for the extent of damage and to check for bleeding. The upper and lower end of the injury should be supported and splinted to immobilize the extremity

15

The nurse refers a client with an amputation and the client's family to which community resource?
1
American Amputee Society (AAS)
2
Amputee Coalition of America (ACA)
3
Community Workers for Amputees (CWA)
4
National Amputee of America Society (NAAS)

Answer- 2- Amputee Coalition of America (ACA)

The ACA is an available resource for clients with amputations and supports them and their families. The AAS, CWA, and NAAS do not exist.

16

What is a neuroma?

sensitive tumor consisting of damaged nerve cells

17

What is a flexion contracture?

occurs mostly in hip and knee of pts. with amputations of the lower extremity- must be avoided so the pt. can ambulate with a prosthetic device - do ROM and proper positioning to prevent the complication.

18

What are the 6 ps?

pain, pressure, paralysis, parathesia, pallor, pulselessness

19

What are the symptoms of a torn meniscus and what is the therapy for it?

Symptoms: pain, swelling, tenderness, clicking on movement

therapy: Menisectomy
-NV checks, knee immobilizer, elevate, weight baring exercises

20

How do you remove the dry scaley skin after cast removal?

SOAK don't scrub

21

What kind of pain is PLP?

constant and dull- may give beta blockers
sharp and burning- antiepileptic
cramping- antispasmatic
opioids are not effective

22

How do amputees get ready for a prosthetic?

Push down extremity into the mattress or pillow

23

what is carpal tunnel syndrome?

compression of median nerve in the wrist due to repetitive stress injury.
symptoms: pain, numberness, and sensory changes

24

What is the phalen's test?

produces parethesia in the median nerve distribution within 60 seconds due to increased internal carpal pressure.

25

What is a strain?

excessive stretching of the muscle

26

Describe the degrees of strains.

1st- mild inflammation, swelling, bruising
2nd- involves tearing of muscle or tendon
3rd- ruptured muscle or tendon with separation from the bone

27

What is the therapy for strains?

cold and heat application, NSAIDs, limit activity, surgical repairs

28

What is a sprain?

excessive stretching of ligaments

29

Describe the different degrees of therapy for sprains.

1st- RICE
2nd- immobilize, elevate, splint, partial weight bearing,
3rd degree- immobilize, surgery, 4-6 weeks recovery

30

Explain a rotater cuff injury.

injury to any of the muscles or tendons that keep the humerus in its socket.
Symptoms: pain with abduction that is the worst at night
Therapy: NSAIDs, steroid injections, PT- if there is surgery there is a long recovery.