Question 1

The health care provider initially orders bed rest for a patient with an open-book pelvic fracture. Which assessment data obtained by the nurse are most important to report to the health care provider?

Accepted Answer

Absent bowel tones may be due to complications of pelvic fractures such as paralytic ileus, hemorrhage, or trauma to the bladder, urethra, or colon. Unusual pelvic movement, abdominal pain, and abdominal bruising would be expected with this type of injury.

Question 2

A patient with severe ulnar drift caused by rheumatoid arthritis (RA) is scheduled for an arthroplasty of the right hand and fingers. The nurse determines that the patient has realistic expectations of the outcome of surgery when the patient says,

Accepted Answer

The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process.

Question 3

When getting a patient from the bed into the chair for the first time since having an ORIF of a hip fracture, the nurse should

Accepted Answer

The patient will use an assistive device such as a walker to help with the initial transfers and ambulation. A mechanical lift is not needed. Crutch walking is taught before discharge but would not be used for the initial transfer. The RN, not a nursing assistant, should supervise the patient during the initial transfer to evaluate how well the patient is able to accomplish this skill.

Question 4

On the first postoperative day, a patient with a below-the-knee amputation complains of pain in the amputated limb. An appropriate action by the nurse is to

Accepted Answer

Phantom limb pain is treated like 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. The compression bandage is left in place except during physical therapy or bathing. Although the pain may decrease over time, it still requires treatment now.

Question 5

A patient who has severe peripheral arterial disease and ischemic foot ulcers is upset with the health care provider's recommendation to have an above-the-knee amputation. The patient tells the nurse, "If they want to cut off my leg, they should just shoot me instead." The most appropriate response to the patient's statement is,

Accepted Answer

The initial nursing action should be to assess how the patient feels about the amputation and what the patient knows about the procedure and rehabilitation process. Discussion about the patient's option to not have the procedure, the reason the procedure is needed, or rehabilitation after the procedure may be appropriate after the nurse knows more about the patient's current level of knowledge and emotional state.

Question 6

A patient undergoes a right below-the-knee amputation with an immediate prosthetic fitting. When the patient is returned to the nursing unit, the nurse should

Accepted Answer

The vital signs should be monitored frequently to assess for hemorrhage because the nurse will not be able to visualize the surgical site. Flexion contracture of the hip would be encouraged by elevating the residual limb on a pillow. The patient is placed in a prone position after amputation to prevent hip flexion, but this would not be done during the immediate postoperative period.

Question 7

A patient with an intracapsular fracture of the left femur is placed in Buck's traction before surgery for a hip replacement. The patient asks why traction is necessary when surgery is planned. The nurse's response to the patient is based on the knowledge that traction

Accepted Answer

Buck's traction keeps the leg immobilized and reduces muscle spasm. Flexion contractures are not likely to occur during the short time before surgery. Displacement of the hip is prevented by keeping the patient on bed rest before surgery. The leg is externally rotated because of the hip fracture, not because of traction.

Question 8

The nurse provides discharge instructions to a patient with an above-the-knee amputation who will be fitted with a prosthesis when healing is complete and the residual limb is well molded. The nurse determines that teaching has been effective when the patient says,

Accepted Answer

The patient lies in the prone position several times daily to prevent flexion contractures of the hip. The limp sock should be changed daily. Lotion should not be used on the stump. The residual limb should not be elevated because this would encourage flexion contracture.

Question 9

The nurse observes a patient doing all these activities after having a hip-replacement surgery. Which patient action requires that the nurse intervene immediately?

Accepted Answer

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

Question 10

All these medications are ordered at 9:00 AM for a patient who has had a right-hip replacement the previous day and is scheduled to ambulate with the physical therapist for the first time at 9:45. Which medication should be given first?

Accepted Answer

The pain medication should be given so that it has time to take effect before the patient is ambulated. The other medications will not affect whether the patient can ambulate or not, although the antibiotic and anticoagulant medications should be given as soon as possible in order to maintain therapeutic blood levels.

Question 11

When giving home-care instructions to a patient who has multiple forearm fractures and a long-arm cast on the right arm, which information should the nurse include?

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 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 pain after a fracture.

Question 12

A patient who has been hospitalized for 3 days with a hip fracture and Buck's traction has sudden onset shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first?

Accepted Answer

The patient's clinical manifestations and history are consistent with a pulmonary embolus, and the nurse's first action should be to ensure adequate oxygenation. The nurse should offer reassurance to the patient, but meeting the physiologic 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 deep vein thrombosis (DVT) are obtained.

Question 13

A patient is to be discharged from the hospital 4 days after undergoing a total hip arthroplasty. A statement by the patient that indicates a need for additional discharge instructions is

Accepted Answer

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

Question 14

A patient with severe osteoarthritis of the left knee has undergone left-knee arthroplasty with replacement of the total knee joint with a plastic prosthesis. Postoperatively, the nurse expects care of the leg to include

Accepted Answer

After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree flexion of the knee. The patient is ambulated the first postoperative day. A compression bandage is used to hold the knee in an extended position after surgery. Full weight bearing is expected before discharge, but it is not started early after surgery.

Question 15

A patient is admitted with facial injuries after a bicycle accident and has a repair of a fractured mandible. When doing postoperative teaching, the nurse will include information about

Accepted Answer

The jaw will be wired for stabilization, and the patient should know what emergency situations require that the wires 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.

Question 16

A patient with lower-leg fractures has an external fixation device in place and is scheduled for discharge. Which information will the nurse include in the discharge teaching?

Accepted Answer

Pin insertion sites should be cleaned daily to decrease the 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 when an external fixator is used.

Question 17

A patient who has a proximal humerus fracture that is immobilized with a left-sided long-arm cast, and a sling is admitted to the medical-surgical unit. Which nursing intervention 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 patient with a sling would not have traction applied by hanging. The patient will be encouraged to move the fingers on the injured arm to maintain function and to help decrease swelling. The patient will do active ROM on the uninjured side.

Question 18

After falling at home, a patient is admitted to the emergency department, where x-rays confirm the presence of an extracapsular fracture of the femur. When assessing the patient, the nurse would expect to find

Accepted Answer

External rotation of the leg is a classic sign associated with a hip fracture. Bruising does not always appear rapidly, and bruising extending to the thigh might indicate hemorrhage. Numbness and decreased pulses are not typical of a hip fracture unless there is associated tissue swelling and trauma to blood vessels.

Question 19

When preparing a patient to ambulate the day after an ORIF for a hip fracture, which action is most important for the nurse to take?

Accepted Answer

The patient should be adequately medicated for pain before any attempt to ambulate. Instructions about the benefits of ambulation may increase the patient'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 impact on ambulation.

Quiz 63: Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery