c62musculoskeletaltrauma&orthopedicsurgery Flashcards
(46 cards)
Which information will the nurse teach seniors at a community recreation center about ways to prevent fractures?
a. Tack down scatter rugs in the home.
b. Expect most falls to happen outside the home.
c. Buy shoes that provide good support and are comfortable to wear.
d. Get instruction in range-of-motion exercises from a physical therapist.
ANS: C
Comfortable shoes with good support will help decrease the risk for falls. Scatter rugs should be eliminated, not just tacked down. Activities of daily living provide range of motion exercise; these do not need to be taught by a physical therapist. Falls inside the home are responsible for many injuries.
A factory line worker has repetitive strain syndrome in the left elbow. The nurse will plan to teach the patient about
a. surgical options. c. wearing a left wrist splint.
b. elbow injections. d. modifying arm movements.
ANS: D
Treatment for repetitive strain syndrome includes changing the ergonomics of the activity. Elbow injections and surgery are not initial options for this type of injury. A wrist splint might be used for hand or wrist pain.
The occupational health nurse will teach the patient whose job involves many hours of typing to
a. obtain a keyboard pad to support the wrist.
b. do stretching exercises before starting work.
c. wrap the wrists with compression bandages every morning.
d. avoid using nonsteroidal antiinflammatory drugs (NSAIDs) for pain.
ANS: A
Repetitive strain injuries caused by prolonged work at a keyboard can be prevented by using a pad to keep the wrists in a straight position. Stretching exercises during the day may be helpful, but these would not be needed before starting work. Use of a compression bandage is not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are appropriate to decrease swelling.
Which discharge instruction will the emergency department nurse include for a patient with a sprained ankle?
a. Keep the ankle loosely wrapped with gauze.
b. Apply a heating pad to reduce muscle spasms.
c. Use pillows to elevate the ankle above the heart.
d. Gently move the ankle through the range of motion.
ANS: C
Elevation of the leg will reduce swelling and pain. Compression bandages are used to decrease swelling. For the first 24 to 48 hours, cold packs are used to reduce swelling. The ankle should be rested and kept immobile to prevent further swelling or injury.
A tennis player has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included?
a. “You will not be able to serve a tennis ball again.”
b. “You will begin work with a physical therapist tomorrow.”
c. “Keep the shoulder immobilizer on for the first 4 days to minimize pain.”
d. “The surgeon will use the drop-arm test to determine the success of surgery.”
ANS: B
Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent “frozen shoulder.” A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of range of motion. The drop-arm test is used to test for rotator cuff injury but not after surgery. The patient may be able to return to tennis after rehabilitation.
The nurse will instruct the patient with a fractured left radius that the cast will need to remain in place
a. for several months.
b. for at least 3 weeks.
c. until swelling of the wrist has resolved.
d. until x-rays show complete bony union.
ANS: B
Bone healing starts immediately after the injury, but because ossification does not begin until 3 weeks after injury, the cast will need to be worn for at least 3 weeks. Complete union may take up to 1 year. Resolution of swelling does not indicate bone healing.
A patient with a fracture of the left femoral neck 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. loosen the traction and help the patient turn onto the unaffected side.
b. place a pillow between the patient’s legs and turn gently to each side.
c. have the patient lift the buttocks slightly by using a trapeze over the bed.
d. turn the patient partially to each side with the assistance of another nurse.
ANS: C
The patient can lift the buttocks slightly off the bed by using a trapeze. This will not affect the fracture fragments on the right leg. Turning the patient will tend to move the fracture fragments, causing pain and possible nerve impingement. Disconnecting the traction will interrupt the weight needed to decrease muscle spasms.
Which nursing intervention will be included in the plan of care after a patient with a right femur fracture has a hip spica cast applied?
a. Avoid placing the patient in prone position.
b. Ask the patient about abdominal discomfort.
c. Discuss remaining on bed rest for several weeks.
d. Use the cast support bar to reposition the patient.
ANS: B
Assessment of bowel sounds, abdominal pain, and nausea and vomiting will detect the development of abdominal cast syndrome. To avoid breakage, the cast support bar should not be used for repositioning. After the cast dries, the patient can begin ambulating with the assistance of physical therapy personnel and may be turned to the prone position.
A patient has a long-arm plaster cast applied for fracture immobilization. Until the cast has completely dried, the nurse should
a. keep the left arm in dependent position.
b. avoid handling the cast using fingertips.
c. place gauze around the cast edge to pad any roughness.
d. cover the cast with a small blanket to absorb the dampness.
ANS: B
Until a plaster cast has dried, using the palms rather than the fingertips to handle the cast helps prevent creating protrusions inside the cast that could place pressure on the skin. The left arm should be elevated to prevent swelling. The edges of the cast may be petaled once the cast is dry, but padding the edges before that may cause the cast to be misshapen. The cast should not be covered until it is dry because heat builds up during drying.
Which statement by the patient indicates a good understanding of the nurse’s teaching about a new short-arm synthetic cast?
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 off and on for 24 hours.”
d. “I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast.”
ANS: C
Ice application for the first 24 hours after a fracture will help reduce swelling and can be placed over the cast. Plaster casts should not get wet. The patient should be encouraged to move the joints above and below the cast. Patients should not insert objects inside the cast.
A patient who is to have no weight bearing on the left leg is learning to walk using crutches. Which observation by the nurse indicates the patient can safely ambulate independently?
a. The patient moves the right crutch with the right leg and then the left crutch with the left leg.
b. The patient advances the left leg and both crutches together and then advances the right leg.
c. The patient uses the bedside chair to assist in balance as needed when ambulating in the room.
d. The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.
ANS: B
Patients are usually taught to move the crutches and the injured leg forward at the same time and then to move the unaffected leg. Patients are discouraged from using furniture to assist with ambulation. The patient is taught to place weight on the hands, not in the axilla, to avoid brachial plexus damage. If the 2- or 4-point gaits are to be used, the crutch and leg on opposite sides move forward, not the crutch and same-side leg.
A patient who has had open reduction and internal fixation (ORIF) of left lower leg fractures continues to complain of severe pain in the leg 15 minutes after receiving the prescribed IV morphine. Pulses are faintly palpable and the foot is cool to the touch. Which action should the nurse take next?
a. Notify the health care provider.
b. Assess the incision for redness.
c. Reposition the left leg on pillows.
d. Check the patient’s blood pressure.
ANS: A
The patient’s clinical manifestations suggest compartment syndrome and delay in diagnosis and treatment may lead to severe functional impairment. The data do not suggest problems with blood pressure or infection. Elevation of the leg will decrease arterial flow and further reduce perfusion.
A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which nursing assessment finding indicates a potential complication of the fracture?
a. The patient states the pelvis feels unstable.
b. Abdomen is distended and bowel sounds are absent.
c. The patient complains of pelvic pain with palpation.
d. Ecchymoses are visible across the abdomen and hips.
ANS: B
The abdominal distention and absent bowel sounds may be due to complications of pelvic fractures such as paralytic ileus or hemorrhage or trauma to the bladder, urethra, or colon. Pelvic instability, abdominal pain with palpation, and abdominal bruising would be expected with this type of injury.
Which action will the nurse take in order to evaluate the effectiveness of Buck’s traction for a patient who has an intracapsular fracture of the right femur?
a. Assess for hip pain. c. Check peripheral pulses.
b. Assess for contractures. d. Monitor for hip dislocation.
ANS: A
Buck’s traction keeps the leg immobilized and reduces painful muscle spasm. Hip contractures and dislocation are unlikely to occur in this situation. The peripheral pulses will be assessed, but this does not help in evaluating the effectiveness of Buck’s traction.
A patient with a right lower leg fracture will be discharged home with an external fixation device in place. Which information will the nurse teach?
a. “Check and clean the pin insertion sites daily.”
b. “Remove the external fixator for your shower.”
c. “Remain on bed rest until bone healing is complete.”
d. “Take prophylactic antibiotics until the fixator is removed.”
ANS: A
Pin insertion sites should be cleaned daily to decrease risk for infection at the site. An external fixator allows the patient to be out of bed and avoid the risks of prolonged immobility. The device is surgically placed and is not removed until the bone is stable. Prophylactic antibiotics are not routinely given during external fixator use.
A patient who has had open reduction and internal fixation (ORIF) of a hip fracture tells the nurse he is ready to get out of bed for the first time. Which action should the nurse take?
a. Check the patient’s prescribed weight-bearing status.
b. Use a mechanical lift to transfer the patient to the chair.
c. Delegate the transfer to nursing assistive personnel (NAP).
d. Decrease the pain medication before getting the patient up.
ANS: A
The nurse should be familiar with the weight-bearing orders for the patient before attempting the transfer. Mechanical lifts are not typically needed after this surgery. Pain medications should be given because the movement is likely to be painful for the patient. The registered nurse (RN) should supervise the patient during the initial transfer to evaluate how well the patient is able to accomplish the transfer.
The nurse’s discharge teaching for a patient who has had a repair of a fractured mandible will include information about
a. administration of nasogastric tube feedings.
b. how and when to cut the immobilizing wires.
c. the importance of high-fiber foods in the diet.
d. the use of sterile technique for dressing changes.
ANS: B
The jaw will be wired for stabilization, and the patient should know what emergency situations require the wires to be cut to protect the airway. There are no dressing changes for this procedure. The diet is liquid, and patients are not able to chew high-fiber foods. Initially, the patient may receive nasogastric tube feedings, but by discharge, the patient will swallow liquid through a straw.
After the health care provider recommends amputation for a patient who has nonhealing ischemic foot ulcers, the patient tells the nurse that he would rather die than have an amputation. Which response by the nurse is best?
a. “You are upset, but you may lose the foot anyway.”
b. “Many people are able to function with a foot prosthesis.”
c. “Tell me what you know about your options for treatment.”
d. “If you do not want an amputation, you do not have to have it.”
ANS: C
The initial nursing action should be to assess the patient’s knowledge and feelings about the available options. Discussion about the patient’s option to refuse the procedure, seriousness of the condition, or rehabilitation after the procedure may be appropriate after the nurse knows more about the patient’s current knowledge and emotional state.
The day after a having a right below-the-knee amputation, a patient complains of pain in the missing right foot. Which action is most important for the nurse to take?
a. Explain the reasons for the pain.
b. Administer prescribed analgesics.
c. Reposition the patient to assure good alignment.
d. Inform the patient that this pain will diminish over time.
ANS: B
Acute phantom limb sensation is treated as any other type of postoperative pain would be treated. Explanations of the reason for the pain may be given, but the nurse should still medicate the patient. Alignment is important but is unlikely to relieve the pain. Although the pain may decrease over time, it currently requires treatment.
Which statement by a patient who has had an above-the-knee amputation indicates the nurse’s discharge teaching has been effective?
a. “I should elevate my residual limb on a pillow 2 or 3 times a day.”
b. “I should lie flat on my abdomen for 30 minutes 3 or 4 times a day.”
c. “I should change the limb sock when it becomes soiled or each week.”
d. “I should use lotion on the stump to prevent skin drying and cracking.”
ANS: B
The patient lies in the prone position several times daily to prevent flexion contractures of the hip. The limb sock should be changed daily. Lotion should not be used on the stump. The residual limb should not be elevated because this would encourage hip flexion contracture.
The nurse is caring for a patient who is to be discharged from the hospital 4 days after insertion of a femoral head prosthesis using a posterior approach. Which statement by the patient indicates a need for additional instruction?
a. “I should not cross my legs while sitting.”
b. “I will use a toilet elevator on the toilet seat.”
c. “I will have someone else put on my shoes and socks.”
d. “I can sleep in any position that is comfortable for me.”
ANS: D
The patient needs to sleep in a position that prevents excessive internal rotation or flexion of the hip. The other patient statements indicate the patient has understood the teaching.
Which action will the nurse include in the plan of care for a patient who had a cemented right total knee arthroplasty?
a. Avoid extension of the right knee beyond 120 degrees.
b. Use a compression bandage to keep the right knee flexed.
c. Teach about the need to avoid weight bearing for 4 weeks.
d. Start progressive knee exercises to obtain 90-degree flexion.
ANS: D
After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree flexion of the knee. The goal for extension of the knee will be 180 degrees. A compression bandage is used to hold the knee in an extended position after surgery. Surgeon orders allow weight bearing as tolerated after this procedure; protected weight bearing is not needed.
A high school teacher with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for arthroplasty of several joints in the left hand. Which patient statement to the nurse indicates a realistic expectation for the surgery?
a. “This procedure will correct the deformities in my fingers.”
b. “I will not have to do as many hand exercises after the surgery.”
c. “I will be able to use my fingers with more flexibility to grasp things.”
d. “My fingers will appear more normal in size and shape after this surgery.”
ANS: C
The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process. Hand exercises will be prescribed after the surgery.
When giving home care instructions to a patient who has comminuted left forearm fractures and a long-arm cast, which information should the nurse include?
a. Keep the left shoulder elevated on a pillow or cushion.
b. Avoid nonsteroidal antiinflammatory drugs (NSAIDs).
c. Call the health care provider for numbness of the hand.
d. Keep the hand immobile to prevent soft tissue swelling.
ANS: C
Increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified immediately to avoid damage to nerves and other tissues. The patient should be encouraged to move the joints above and below the cast to avoid stiffness. There is no need to elevate the shoulder, although the forearm should be elevated to reduce swelling. NSAIDs are appropriate to treat mild to moderate pain after a fracture.
