Question 1

The nurse is caring for a client in the emergency department who has possible left lower leg fractures. Which of the following actions should the nurse implement initially?

Accepted Answer

The initial nursing action should be assessment of the neuro-vascular status of the injured leg. After assessment, the nurse may need to splint and elevate the leg, based on the assessment data. Information about tetanus immunizations should be done if there is an open wound.

Question 2

The nurse is caring for a client with ulnar drift caused by rheumatoid arthritis (RA) who is scheduled for an arthroplasty of the hand. Which of the following client statements indicates realistic expectation for the surgery?

Accepted Answer

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.

Question 3

The nurse is admitting a client to the emergency department after falling on the right arm and shoulder. Which of the following findings is most important for the nurse to communicate to the health care provider immediately?

Accepted Answer

A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency. Bruising, pain, and decreased range of motion also should be reported, but these do not indicate that emergent treatment is needed to preserve function.

Question 4

Before assisting a client with ambulation on the day after a total hip replacement, which of the following actions is most important for the nurse to implement?

Accepted Answer

The client should be adequately medicated for pain before any attempt to ambulate. Instructions about the benefits of ambulation may increase the client's willingness to ambulate, but decreasing pain with ambulation is more important. The presence of an incisional drain or timing of dressing change will not affect ambulation.

Question 5

The nurse is caring for a client in the emergency department who is experiencing severe pain and is diagnosed with a patellar dislocation. Which of the following actions should the nurse implement first?

Accepted Answer

The first goal of collaborative management is realignment of the knee to its original anatomic position, which will require anesthesia or conscious sedation. Immobilization, gentle range-of-motion (ROM) exercises, and discussion about activity restrictions will be implemented after the knee is realigned.

Question 6

The nurse is caring for a client who arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. Which of the following prescribed collaborative interventions will the nurse implement first?

Accepted Answer

Immediate care after a sprain or strain injury includes the application of cold and compression to the injury to minimize swelling. The other actions should be taken after the ankle is wrapped with a compression bandage and ice is applied.

Question 7

The nurse is caring for a client in the emergency department following a motor vehicle accident who has massive right lower leg swelling. Which of the following actions will the nurse take first?

Accepted Answer

The initial action by the nurse will be to assess the circulation to the leg and to observe for any evidence of injury such as fractures or dislocations. After the initial assessment, the other actions may be appropriate based on what is observed during the assessment.

Question 8

The nurse is caring for a client with a fractured pelvis and on day 2 of the hospitalization the client develops acute onset confusion. Which of the following actions should the nurse take first?

Accepted Answer

The client's history and clinical manifestations suggest a fat embolus. The most important assessment is oxygenation. The other actions also are appropriate but will be done after the nurse assesses gas exchange.

Question 9

The nurse is preparing a client for discharge 4 days after insertion of a femoral head prosthesis using a posterior approach. Which of the following client statements indicates a need for additional discharge instructions?

Accepted Answer

The client needs to sleep in a position that prevents excessive internal rotation or flexion of the hip. The other client statements indicate that the client has understood the teaching.

Question 10

The nurse is providing discharge teaching to a client with a sprained right ankle. Which of the following information should be included in the teaching plan? (Select all that apply.)

Accepted Answer

Teaching instructions for a sprain includes elevation of the limb at all times, even during sleep, using NSAIDs for discomfort and an elastic bandage during activity. Warm moist heat can be applied but it is not to exceed 30 minutes. Ice is only to be used during the initial 24-48 hours after the injury.

Question 11

The nurse is caring for a client who has just arrived on the orthopedic unit after a right above-the-knee amputation with an immediate prosthetic fitting. Which of the following actions should the nurse implement first?

Accepted Answer

The nurse should monitor for hemorrhage after the surgery. The prosthesis will not be removed. To avoid flexion contracture of the hip, the leg will not be elevated on a pillow. The client is placed in a prone position after amputation to prevent hip flexion, but this would not be done during the immediate postoperative period.

Question 12

The nurse is caring for a client in the emergency department who has a soft tissue injury and an open leg fracture. Which of the following actions should the nurse implement first?

Accepted Answer

An initial action in the emergency treatment of soft tissue injuries is to administer tetanus if there is evidence of an open fracture. If dislocation is suspected a compression bandage is contraindicated. The nurse would apply ice, not heat, to the affected area. Realignment of the bone is not to be attempted.

Question 13

The nurse is caring for a client who has been hospitalized for 3 days with a hip fracture who has sudden onset shortness of breath and tachypnea. The client tells the nurse, "I feel like I am going to die!" Which of the following actions should the nurse takefirst?

Accepted Answer

The client's clinical manifestations and history are consistent with a fat embolus, and the nurse's first action should be to ensure adequate oxygenation. The nurse should offer reassurance to the client, but meeting the physiological need for oxygen is a higher priority. The health care provider should be notified after the oxygen is started and pulse oximetry and assessment for fat embolus or venous thrombo-embolism (VTE) are obtained.

Question 14

Which of the following information obtained by the emergency department nurse when admitting a client with a left femur fracture is most important to report to the health care provider?

Accepted Answer

Prolonged capillary refill may indicate complications such as arterial damage or compartment syndrome. The other findings are typical with a left femur fracture.

Question 15

In which order will the nurse take these actions when caring for a client with left leg fractures after a motor vehicle accident?
A)Obtain x-rays.
B)Check pedal pulses.
C)Assess lung sounds.
D)Take blood pressure.
E)Apply splint to the leg.
F)Administer tetanus prophylaxis.

Accepted Answer

The answer of In which order will the nurse take...

Question 16

The nurse is developing a care plan for a client with an open reduction and internal fixation (ORIF) of an open, displaced fracture of the tibia. Which of the following nursing diagnoses is priority?

Accepted Answer

A client having an ORIF is at risk for problems such as wound infection and osteomyelitis. After an ORIF, clients typically are mobilized starting the first postoperative day, so problems caused by immobility are not as likely.

Question 17

Which of the following nursing actions should the nurse include in the plan of care for a client who has had a total knee arthroplasty?

Accepted Answer

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. Full weight bearing is expected before discharge.

Question 18

The nurse is caring for a client who had hip replacement surgery using the posterior approach. Which of the following client actions requires rapid intervention by the nurse?

Accepted Answer

Leaning over would flex the hip at greater than 90 degrees and predispose the client to hip dislocation. The other client actions are appropriate and do not require any immediate action by the nurse to protect the client.

Question 19

The nurse is admitting a client who has a proximal humerus fracture that is immobilized with a left-sided long-arm cast and has a sling. Which of the following nursing interventions will be included in the plan of care?

Accepted Answer

The axilla can become excoriated when a sling is used to support the arm, and the nurse should check the axilla and apply absorbent dressings to prevent this. A client with a sling would not have traction applied by hanging. The client will be encouraged to move the fingers on the injured arm to maintain function and to help decrease swelling. The client will do active ROM on the uninjured side.

Question 20

The nurse is providing home care instructions to a client who has multiple forearm fractures and a long-arm cast on the right arm. Which of the following information should the nurse include in the teaching plan?

Accepted Answer

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 client 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 pain after a fracture.

Quiz 65: Nursing Management Musculo-skeletal Trauma and Orthopedic Surgery