Question 1

An older patient who sustained a fractured hip and femur in a motor vehicle accident is to be in Russell traction for several weeks.What should be the focus of care for the nurse?

Accepted Answer

When a patient is immobilized for an extended period of time, the risk of developing a DVT increases. Therefore, preventing DVT is an essential focus of care for the nurse. While pain relief and nutrition are also important, they are not the priority in this particular case. Offering distractions may be helpful for the patient's emotional well-being, but it is not as critical as preventing complications such as DVT.

Question 2

Two days after surgery for a crushed pelvis, a certified nursing assistant (CNA)reports that the patient is complaining of a shortness of breath and is demonstrating signs of confusion and restlessness.What should a nurse suspect, from these signs alone, that the patient has developed?

Accepted Answer

The combination of shortness of breath, confusion, and restlessness in a patient who has recently had surgery for a crushed pelvis could indicate the development of a fat embolus. Fat embolism syndrome (FES) occurs when fat globules enter the bloodstream and cause respiratory distress, confusion, and restlessness. This can be a serious complication and requires prompt medical intervention.

Question 3

Which assessment is of the greatest concern to a nurse when caring for a patient just admitted with a pelvic fracture?

Accepted Answer

No urinary output for 8 hours could indicate damage to the bladder or urethra, a serious complication commonly associated with pelvic fractures. Prompt recognition and treatment of this issue is crucial in preventing further complications. Pain, bruising, and complaints of back care are also important assessments to monitor, but they do not indicate an immediate threat to the patient's health and safety.

Question 4

A patient who has osteomyelitis after multiple fractures inquires what the physician meant when he said that surgery would follow the antibiotic therapy.What is the nurse's most helpful reply to explain why this surgery will be performed?

Accepted Answer

Surgery may be necessary to remove dead bone tissue and promote healing in cases of osteomyelitis.

Question 5

A patient in a full body cast (spica)complains of nausea and abdominal distention.What potential complication should a licensed vocational nurse (LVN)suspect?

Accepted Answer

Cast syndrome, also known as superior mesenteric artery syndrome, is a potential complication of a spica cast. It occurs when the cast compresses the duodenum, leading to nausea, vomiting, abdominal distention, and potentially life-threatening bowel obstruction. Constipation may be a result of the patient's immobility and limited diet, but it is not the primary concern in this case. Compartment syndrome and shock present with different symptoms and would require immediate intervention.

Question 6

What special precaution should a nurse implement when assisting with the application of a short arm plaster cast?

Accepted Answer

When applying a short arm plaster cast, the nurse should smooth the stockinette to prevent a pressure ulcer. This is important because the stockinette can create pressure points that may lead to skin breakdown if not properly smoothed. Dampening the skin can cause skin irritation and taping the arm before applying the stockinette is not necessary. Rolling the stockinette tightly can also create pressure points and compromise circulation.

Question 7

A patient has just had a plaster of Paris upper extremity cast placed because of a fractured radius.Which statement indicates that the patient understands the discharge teaching related to cast care?

Accepted Answer

Resting in bed with the arm elevated above the heart will help reduce swelling and promote healing. A tight plaster cast should not have any padding removed, as this can compromise the fit and stability of the cast. The cast should also not be wrapped in plastic, as this can trap moisture and lead to skin breakdown or infection. Using a spoon handle or other objects to scratch inside the cast can also cause damage to the skin or the cast itself.

Question 8

What should a nurse who is documenting and reporting the signs and symptoms of an infection underneath a cast include in the medical record?

Accepted Answer

Infection often presents with systemic signs such as an elevated temperature (fever), which should be documented as it indicates a possible infection.

Question 9

Which patient is most appropriate for a nurse to refer to home health care?

Accepted Answer

A single woman with a bedroom in a rooming house may have limited support and resources, making her a suitable candidate for home health care to ensure she receives the necessary medical and personal care.

Question 10

A patient with bilateral avascular necrosis of the hips is to walk with crutches using a four-point gait for 6 weeks after her bone decompression surgeries.Which statement would indicate that the patient understands this technique?

Accepted Answer

The four-point gait involves moving the opposite crutch and leg together, so option C correctly describes the technique. Option B describes a two-point gait and option D describes a swing-to gait, neither of which are appropriate for this patient's condition. Option A is also incorrect because the patient should not be bearing weight through the axillary bars, but rather through the cuffs around the forearms.

Question 11

Assistive devices such as canes, crutches, and walkers are used for people who need to limit weight-bearing activities on joints.Which statement by a nurse best illustrates an understanding of the appropriate use of these devices?

Accepted Answer

A) Canes are indeed used to provide minimal support and balance, and they are carried on the side opposite to the affected leg to help distribute weight away from the injured or weak side, which demonstrates an understanding of their appropriate use.

Question 12

An older woman falls down at church and immediately complains of severe pain in her left hip.Which observation is recognized as the cardinal sign of a fractured hip?

Accepted Answer

Shortening of the affected leg is a classic sign of a fractured hip. Downward curled toes and internal rotation of the leg may also be present, but shortening is the most reliable and significant finding. A hematoma may be present due to the injury, but it is not a cardinal sign of a fractured hip.

Question 13

A 78-year-old retired teacher with a history of osteoporosis has fallen in her bathroom and sustained a subcapital femoral fracture.She is scheduled for an open reduction and internal fixation (ORIF)procedure in the morning.Which type of traction will most likely be implemented?

Accepted Answer

Buck's traction is commonly used for femoral fractures, including subcapital femoral fractures, to provide temporary immobilization before surgery such as open reduction and internal fixation (ORIF). It helps in pain management and fracture stabilization by applying a pulling force.

Question 14

What should a nurse teach an older patient with a newly casted Colles fracture?

Accepted Answer

Moving the shoulders can help reduce the risk of contractures, which are a potential complication following immobilization due to casting. Keeping the shoulders active helps maintain joint mobility and muscle strength around the shoulder, which is important for overall arm function during the healing process. Choices A, B, and C are not recommended practices for managing a newly casted Colles fracture.

Question 15

An older adult patient is at risk for constipation after sustaining a pelvic fracture.Which nutritional suggestion by the nurse is most appropriate?

Accepted Answer

Immobilization can cause constipation, so increasing fluid intake can help prevent dehydration and improve bowel function. Choosing high-sodium foods (A) can actually worsen constipation, as can avoiding foods high in dietary fiber (B). Including milk products at every meal (D) may not necessarily improve bowel function in this case.

Question 16

A patient who sustained a simple fracture of the left fibula 7 days earlier asks in what stage of bone healing he might be.What stage of healing should the nurse relay to the patient?

Accepted Answer

At 7 days after the fracture, the patient is likely in the callus formation stage of bone healing. This stage occurs between 5 and 21 days after the fracture and is characterized by the formation of a soft callus made up of cartilage and fibrous tissue. This callus eventually becomes mineralized and calcified, leading to the formation of hard callus and eventual bridging of the fracture site.

Question 17

A nurse is told that a patient has a compound comminuted fracture.What characteristic of the bone in this type of fracture causes the nurse to be concerned?

Accepted Answer

A compound comminuted fracture is a fracture in which the bone is broken into two or more pieces, and bone fragments protrude through the skin. This type of fracture is concerning because it increases the risk of infection and may require surgical intervention to repair.

Question 18

A patient with a crushed forearm cannot get pain relief with opioid medications.The injury is swollen, cool, and cyanotic, with weak distal pulses.What should the nurse suspect?

Accepted Answer

The patient's symptoms are classic for compartment syndrome, which occurs when increased pressure in a confined space (such as a compartment in the body) compromises the circulation and function of the tissues within that space. The lack of pain relief with opioids, along with the appearance of the injury and the weak distal pulses, all suggest that this patient may have compartment syndrome.

Question 19

Which patient problem has the highest priority after surgery for the open reduction and external fixation of an ankle?

Accepted Answer

After surgery for open reduction and external fixation of an ankle, the highest priority patient problem is the potential for infection. Infection can lead to serious complications and delay the healing process, making it important for healthcare providers to monitor the surgical site closely and take proactive measures to prevent infection. The other patient problems listed (potential activity intolerance, immobility, and constipation) are important to address, but are not as urgent as preventing infection.

Question 20

What action should a nurse implement when caring for a patient diagnosed with a compound fracture?

Accepted Answer

Assessing for pulses distal to the injury is important to ensure adequate blood flow to the affected area. This can help detect any potential complications such as compartment syndrome. Limiting narcotics or monitoring respirations may be necessary, but assessing pulses is a priority. Verifying allergies to sulfa may also be important for medication administration, but it is not directly related to caring for a compound fracture.

Quiz 45: Fractures