dewit- chapter 33 Flashcards
A patient has come to the ambulatory care clinic with a sprain. The nurse correctly differentiates a grade 2 sprain from a grade 3 sprain with the assessment of:
A. pain.
B. swelling.
C. bleeding into the joint.
D. minor loss of function.
ANS: D The minor loss of function is the differentiating factor. Pain, swelling, and bleeding into the joint are true of both grade 2 and grade 3 sprains. A grade 3 sprain has loss of function of the joint.
An older adult has fallen and sprained his ankle in a local park. The correct initial management of the injury will include which action?
A. Elevating the foot to reduce swelling
B. Applying ice to delay swelling
C. Administering aspirin to combat pain
D. Having the person ambulate to test for ability to bear weight
ANS: A Elevation is the initial intervention as it can be done immediately. Applying ice and medicating for pain will follow quickly.
When the clinic nurse starts to take the “air cast” off the grade 2 sprain, the patient asks why it is being removed as he still has pain. The nurse explains that the cast is removed because:
A. the cast will interfere with adequate circulation.
B. the cast will increase the edema.
C. long-term immobilization can cause permanent disability.
D. another heavier cast will be applied.
ANS: C Lengthy immobilization can lead to permanent disability. Casts and splints are left on only until the joint is strengthened.
The nurse recognizes a need for further instruction about application of ice to a sprain when the patient says:
A. “I know this ice will reduce the swelling.”
B. “I will keep the ice on this knee for the rest of the day.”
C. “I will use the ice as you have directed for 24 hours.”
D. “I can elevate my leg and use ice to reduce swelling.”
ANS: B Ice should be applied for 20 minutes of each hour for the first 24 hours.
The industrial nurse examines an employee who states that his right shoulder hurts when he abducts it and points with one finger to the spot at the point of his shoulder that is painful. He mentions that he won a racquetball tournament yesterday. The nurse suspects the employee is suffering from:
A. rotator cuff tear.
B. bursitis.
C. dislocation.
D. subluxation.
ANS: B Bursitis occurs after overuse, with pain in the joint on activity with no erythema and little, if any, swelling. Dislocations are very painful and the pain is spread all over the shoulder. The shoulder also looks misshapen in a dislocation. Rotator cuff tear would prevent the patient from abducting his shoulder.
The patient, who is a legal secretary, asks the nurse how she can avoid developing carpal tunnel syndrome. The nurse suggests:
A. exercising the wrist with repetitive flexion movements.
B. wrapping the wrists with elastic bandages.
C. acquiring a pad to support wrists while typing.
D. applying warm compresses to wrists every evening.
ANS: C Elevating the wrist with a firm support eliminates the need to keep the wrists flexed for long periods of time. This wrist support will help prevent carpal tunnel syndrome.
. The nurse explains that carpal tunnel syndrome is caused when the carpal tunnel compresses the:
A. radial artery.
B. brachial artery.
C. median nerve.
D. ulnar nerve.
ANS: C When the median nerve is compressed by the carpal tunnel to the point that numbness, pain, and tingling occur, the result is carpal tunnel syndrome.
The patient with mild discomfort from carpal tunnel syndrome delightedly reports amazing relief from taking a daily dose of vitamin:
A. A.
B. B6.
C. B12.
D. C.
ANS: B Vitamin B6 has been found helpful in relieving the pain of carpal tunnel syndrom
The assessment made by the nurse caring for a patient just returned from surgery following a surgical decompression of the carpal tunnel that would require immediate remedy is:
A. fingers swollen and warm.
B. complaint of pain.
C. capillary refill of 8 seconds.
D. fingers rosy.
ANS: C A capillary refill of over 5 seconds is an indication of diminished perfusion. Pain and swelling are to be expected.
An 80-year-old man falls and suffers a compound fracture of the femur. The most appropriate immediate action is to:
A. help position him flat on his back.
B. place a tourniquet on the leg.
C. splint the leg as it is.
D. carefully straighten the leg.
ANS: C Any fracture, even a compound one, should be immobilized in position to avoid further injury to the soft tissue attached to the bones. Any other initial action may cause further injury.
The nurse explains that the major advantage of the external fixation device is that the patient:
A. will heal more quickly.
B. can bear weight right away.
C. has greater freedom of movement.
D. . experiences less pain.
ANS: C The external device for fracture reduction allows greater freedom of movement, decreasing the problems of immobility. Healing time and pain are the same as with any other fracture reduction method.
The patient in a long arm cast (from below the shoulder to the wrist, with a 90-degree elbow flexion) complains of a burning sensation over the elbow. The nurse’s initial intervention should be:
A. elevate the casted arm on pillows.
B. check to see if the cast is properly supported.
C. notify the charge nurse of developing pressure ulcer.
D. cut a “window” in the cast.
ANS: B The initial intervention should be to assess for adequate support to the cast, then elevate the limb for 30 minutes. If the pain has not diminished, document the intervention and notify the charge nurse.
The nurse is performing an assessment on the patient who is in bilateral Buck’s traction. Which finding indicates the need to reposition the patient?
A. Heels are not touching the surface of the mattress.
B. Elastic bandages need to be rewrapped.
C. Patient’s feet are against the footboard.
D. Weights are hanging free.
ANS: C When the patient’s feet are against the footboard, the traction is ineffective. The heels should be off the surface of the mattress to reduce the threat of pressure ulcer. The weights should be hanging free.
A patient in Russell’s traction with a Pearson attachment for a fracture of the tibia complains of intense pain at the fracture site. The nurse assesses a temperature of 102° F and increased swelling at the fracture site. These assessment findings suggest:
A. osteomyelitis.
B. fat embolism.
C. traction misalignment.
D. nonunion of the fracture.
ANS: A Osteomyelitis is a bacterial infection of the bone. The causative organism is most often Staphylococcus aureus, which enters the bloodstream from a distant focus of infection, such as a boil or furuncle, or from an open wound, as in an open (compound) fracture. It is usually found in the tibia or fibula, in vertebrae, or at the site of a prosthesis. Osteomyelitis has a sudden onset with severe pain and marked tenderness at the site, high fever with chills, swelling of adjacent soft parts, headache, and malaise.
. While the nurse is giving morning care to a patient who sustained a fractured pelvis and bilateral fractures of the femur in a motorcycle accident yesterday, the patient complains of shortness of breath and is audibly wheezing. An assessment of the oxygen saturation reveals 76%. The initial intervention by the nurse should be to:
A. alert the code team.
B. inform the charge nurse.
C. give oxygen at 4 to 5 L/min.
D. raise patient to high Fowler’s position.
ANS: D Raising the patient to high Fowler’s position is the best initial intervention as it can be done immediately. There is no need to notify the code team, and 5 L/min of oxygen is too much. Informing the charge nurse and giving oxygen at 2 to 3 L/min can be done when the patient has been made more comfortable.
