Question 1

The nurse is documenting the interdisciplinary team report on an adolescent client who has a 35-degree Cobb angle confirmed by x-ray.What interventions should the nurse anticipate being included in the collaborative plan of care for this client? Select all that apply.

Accepted Answer

A)Treatment of children with a Cobb angle between 25 and 45 degrees consists of bracing for 12-23 hours per day with a TLSO or Milwaukee brace, mild pain medication, counseling or support group referral, and exercise to improve posture and maintain or increase spine flexibility. Mild scoliosis requires observation every 3-6 months. Severe scoliosis requires surgical intervention and subsequent physical therapy.
B)Treatment of children with a Cobb angle between 25 and 45 degrees consists of bracing for 12-23 hours per day with a TLSO or Milwaukee brace, mild pain medication, counseling or support group referral, and exercise to improve posture and maintain or increase spine flexibility. Mild scoliosis requires observation every 3-6 months. Severe scoliosis requires surgical intervention and subsequent physical therapy.
C)Treatment of children with a Cobb angle between 25 and 45 degrees consists of bracing for 12-23 hours per day with a TLSO or Milwaukee brace, mild pain medication, counseling or support group referral, and exercise to improve posture and maintain or increase spine flexibility. Mild scoliosis requires observation every 3-6 months. Severe scoliosis requires surgical intervention and subsequent physical therapy.
D)Treatment of children with a Cobb angle between 25 and 45 degrees consists of bracing for 12-23 hours per day with a TLSO or Milwaukee brace, mild pain medication, counseling or support group referral, and exercise to improve posture and maintain or increase spine flexibility. Mild scoliosis requires observation every 3-6 months. Severe scoliosis requires surgical intervention and subsequent physical therapy.
E)Treatment of children with a Cobb angle between 25 and 45 degrees consists of bracing for 12-23 hours per day with a TLSO or Milwaukee brace, mild pain medication, counseling or support group referral, and exercise to improve posture and maintain or increase spine flexibility. Mild scoliosis requires observation every 3-6 months. Severe scoliosis requires surgical intervention and subsequent physical therapy.

Question 2

On the first postoperative day after spinal fusion,the nurse assesses a client and notes the following vital signs: T 39.2°C,BP 100/50 mmHg,HR 118,and RR 23.Drainage at the client's incision site is clear and tests positive for glucose.Which assessment parameter indicates the highest risk for surgical wound infection?

Accepted Answer

The positive glucose test in the incisional drainage indicates a high likelihood of infection, as glucose is present in the body's fluids and may indicate the presence of bacteria. The elevated temperature may also indicate infection, but it could be due to other factors such as postoperative inflammation. The heart rate and presence of drainage are not as specific to wound infection risk.

Question 3

During which phase of the fracture healing process is woven bone replaced by lamellar bone?

Accepted Answer

During the remodeling phase of the fracture healing process, the woven bone is replaced by lamellar bone.

Question 4

A client hospitalized with an open reduction and internal fixation of a fractured femur reports right calf pain.The nurse notes that the client's right calf is 3.5 cm larger than the left calf with generalized posterior erythema.The right calf is tender to touch,and the dorsalis pedis pulse is 3/4+ bilaterally.Which of the following is the priority action by the nurse?

Accepted Answer

The client's symptoms are indicative of deep vein thrombosis (DVT), a serious complication following surgery. The nurse should notify the healthcare provider immediately for further assessment and possible treatment. Using a Doppler stethoscope and administering intravenous heparin may be necessary interventions, but the priority is to notify the healthcare provider. Applying a cast is not appropriate in this situation.

Question 5

The nurse is planning care for the client with chronic pain from herniated intervertebral discs who is also experiencing constipation.Which intervention should the nurse carry out to address constipation?

Accepted Answer

Encouraging fluid intake of 2500-3000 mL each day can help soften the stool and promote regular bowel movements. Restricting foods high in fiber and avoiding the use of stool softeners can exacerbate constipation. Medicating for pain around the clock may be necessary for pain management but will not directly address the issue of constipation.

Question 6

An adolescent client with scoliosis has a Cobb angle of 32 degrees.Given this information,what treatment will the nurse likely need to prepare the client for?

Accepted Answer

A Cobb angle of 32 degrees indicates a moderate degree of scoliosis and may require treatment with a brace to prevent further progression of the spinal curvature. Physical therapy may also be recommended, but a brace is the most likely treatment option. Spinal fusion surgery is typically only considered for severe cases of scoliosis with a Cobb angle greater than 40-50 degrees.

Question 7

A client is admitted to your inpatient rehabilitation unit.This client is currently in halo traction.(See exhibit. )Based on this information,which of the following should be the priority nursing diagnosis for the client?

Accepted Answer

The answer of A client is admitted to your inpatient...

Question 8

The nurse is teaching an older adult client and caregiver about appropriate ways to decrease the client's risk for falls.Which interventions are appropriate for the nurse to include in this teaching session? Select all that apply.

Accepted Answer

A)Interventions that are appropriate to decrease this client's risk for falls include wearing sensible shoes with good support when shopping and making sure hallways and stairways have adequate lighting, even at night. A mild to moderate exercise program is also beneficial, as it helps improve balance and strength, thus reducing the likelihood of falls. Nonslip footwear should be encouraged. Throw rugs should be discouraged.
B)Interventions that are appropriate to decrease this client's risk for falls include wearing sensible shoes with good support when shopping and making sure hallways and stairways have adequate lighting, even at night. A mild to moderate exercise program is also beneficial, as it helps improve balance and strength, thus reducing the likelihood of falls. Nonslip footwear should be encouraged. Throw rugs should be discouraged.
C)Interventions that are appropriate to decrease this client's risk for falls include wearing sensible shoes with good support when shopping and making sure hallways and stairways have adequate lighting, even at night. A mild to moderate exercise program is also beneficial, as it helps improve balance and strength, thus reducing the likelihood of falls. Nonslip footwear should be encouraged. Throw rugs should be discouraged.
D)Interventions that are appropriate to decrease this client's risk for falls include wearing sensible shoes with good support when shopping and making sure hallways and stairways have adequate lighting, even at night. A mild to moderate exercise program is also beneficial, as it helps improve balance and strength, thus reducing the likelihood of falls. Nonslip footwear should be encouraged. Throw rugs should be discouraged.
E)Interventions that are appropriate to decrease this client's risk for falls include wearing sensible shoes with good support when shopping and making sure hallways and stairways have adequate lighting, even at night. A mild to moderate exercise program is also beneficial, as it helps improve balance and strength, thus reducing the likelihood of falls. Nonslip footwear should be encouraged. Throw rugs should be discouraged.

Question 9

A client sustained multiple fractures in a motor vehicle crash.Of the various fracture types sustained by the client,which places the client at highest risk for osteomyelitis?

Accepted Answer

An open fracture, also known as a compound fracture, involves a break in the skin that allows bacteria to enter the body and potentially cause an infection such as osteomyelitis. This type of fracture carries the highest risk for infection compared to other fracture types listed.

Question 10

The x-ray of a client 14 weeks post-ulnar fracture exhibits no callus formation.Based on this data,which collaborative intervention should the nurse anticipate?

Accepted Answer

The lack of callus formation 14 weeks post-fracture indicates inadequate healing and warrants further evaluation by the surgeon. Traction, antibiotics, and exercise are not appropriate interventions for this issue.

Question 11

Which condition or symptom is most common in clients with a herniated cervical disc?

Accepted Answer

The most common symptom of a herniated cervical disc is a stiff neck and shoulder pain. Other symptoms may include numbness or weakness in the arms, hands, or fingers, and headaches. Sciatica is a symptom of a herniated lumbar disc, and changes in knee and ankle reflexes may be seen in clients with cauda equina syndrome, which is a rare but serious complication of a herniated disc.

Question 12

Which region of the spine is the most common location of herniated discs?

Accepted Answer

The lumbar region (lower back) is the most common location of herniated discs, accounting for about 90% of cases. The cervical region (neck) is the second most common location, with thoracic (upper back) and sacral (tailbone) region herniations being much less common.

Question 13

A nurse is teaching a mother warning signs and symptoms to watch for in her child,who will be discharged with a full leg cast.Which statements by the mother indicate the need for further instruction? Select all that apply.

Accepted Answer

A)The only option that indicates appropriate understanding of cast care is the mother's statement that her child may have pain that will be relieved by medication. All of the other statements indicate a need for further instruction. If the child's foot turns white and cold, the family should contact the physician. Itching may be helped by use of a blow dryer on the cool setting. Holes should not be cut in the cast, and the plaster should stay dry at all times.
B)The only option that indicates appropriate understanding of cast care is the mother's statement that her child may have pain that will be relieved by medication. All of the other statements indicate a need for further instruction. If the child's foot turns white and cold, the family should contact the physician. Itching may be helped by use of a blow dryer on the cool setting. Holes should not be cut in the cast, and the plaster should stay dry at all times.
C)The only option that indicates appropriate understanding of cast care is the mother's statement that her child may have pain that will be relieved by medication. All of the other statements indicate a need for further instruction. If the child's foot turns white and cold, the family should contact the physician. Itching may be helped by use of a blow dryer on the cool setting. Holes should not be cut in the cast, and the plaster should stay dry at all times.
D)The only option that indicates appropriate understanding of cast care is the mother's statement that her child may have pain that will be relieved by medication. All of the other statements indicate a need for further instruction. If the child's foot turns white and cold, the family should contact the physician. Itching may be helped by use of a blow dryer on the cool setting. Holes should not be cut in the cast, and the plaster should stay dry at all times.
E)The only option that indicates appropriate understanding of cast care is the mother's statement that her child may have pain that will be relieved by medication. All of the other statements indicate a need for further instruction. If the child's foot turns white and cold, the family should contact the physician. Itching may be helped by use of a blow dryer on the cool setting. Holes should not be cut in the cast, and the plaster should stay dry at all times.

Question 14

A client who is hospitalized after a left hip fracture is scheduled for surgery late this afternoon.After receiving report,the nurse evaluates the Buck traction applied by a new physical therapist.Which finding would indicate that the traction is correctly applied?

Accepted Answer

The correct application of Buck traction for a left hip fracture involves aligning the left knee and hip above a foam boot. Option A is incorrect as the foam boot should cover the left leg, not the right. Option B is incorrect as the weight used for Buck traction is typically 5-10 pounds, and 20-pound weights would be excessive and potentially harmful. Option C is incorrect as the weights should be suspended over the foot of the bed, not supported by a stool.

Question 15

The nurse is providing care for a client who experienced a fracture requiring a plaster cast.Which nursing intervention is appropriate for this client?

Accepted Answer

It is important to assess the client's neurovascular status regularly to ensure there is no compromise to blood flow or nerve function. This may include assessing for pain, sensation, and movement in the affected limb.

Question 16

The mother of a preadolescent client meets with the school nurse to discuss the client's recent diagnosis of scoliosis.Which interventions would be appropriate for the nursing diagnosis of Disturbed Body Image related to deformity and brace? Select all that apply.

Accepted Answer

Interventions that promote body acceptance and positive self-image are appropriate. Including the student and family in a meeting to discuss their feelings about the diagnosis and the brace can help the nurse identify areas where the family may need support. Arranging a meeting with an older peer who has successfully adapted to scoliosis may help the preadolescent feel less alone and more hopeful. Teaching the student and family about clothing options that disguise the brace may increase the preadolescent's comfort and confidence. However, encouraging the student to withdraw from school or suggesting medication should be avoided as they do not address the underlying emotional issues and may have negative consequences.

Question 17

The nurse in an orthopedic outpatient clinic expects to see several clients with fractures for follow-up.Based on the information provided below,which of the nurse's clients is at highest risk for a delayed union?

Accepted Answer

The client who is at highest risk for a delayed union is the 49-year-old teacher with osteoporosis who sustained an open ulnar fracture in a motor vehicle crash. Osteoporosis is a condition where there is decreased bone density, which can lead to delayed healing of fractures. Additionally, an open fracture is a risk factor for delayed healing due to the increased risk of infection at the fracture site. While smoking is also a risk factor for delayed union, cutting down to 10 cigarettes per day may not have a significant effect on healing. Type I diabetes mellitus and hypertension are not significant risk factors for delayed union. The bartender's history of peptic ulcer disease and desire for upper body resistance training are also not significant risk factors for delayed union.

Question 18

The nurse is caring for clients in an assisted living facility.Which resident would the nurse identify as being at the highest risk for the development of fractures from a fall?

Accepted Answer

The resident who hikes in the woods once a week and smokes 14 cigarettes per day is at the highest risk for the development of fractures from a fall. Smoking reduces bone density and increases the risk of fractures. Additionally, hiking in the woods increases the risk of falls compared to other activities like line dancing or yoga. The other residents mentioned all have some protective factors against fractures such as resistance training, calcium supplements, and lower alcohol intake.

Question 19

During a home care visit,an older adult client begins to cry softly when asked about coping with back pain.The client states,"My back hurts bad all the time.I am so confused about all these tests and scared that the doctor wants me to have surgery." In this scenario,which of the following nursing interventions is the highest priority?

Accepted Answer

The highest priority nursing intervention in this scenario is to attentively listen to the client's thoughts and fears. The client is expressing sadness and confusion about their back pain and potential surgery, indicating a need for emotional support and understanding. By actively listening to the client, the nurse can provide empathy and validation, which may help alleviate some of the client's anxiety and improve their overall well-being. While addressing the client's pain and explaining potential procedures are important interventions, they are secondary to addressing the client's emotional needs in this context.

Question 20

Which of the following fractures presents the greatest risk for development of fat embolism syndrome?

Accepted Answer

Closed fracture of the femur presents the greatest risk for development of fat embolism syndrome due to the large amount of bone marrow in the femur, which can release fat globules into the bloodstream after a fracture.

Quiz 13: Mobility