Question 1

The nurse is caring for a client who has a long-arm plaster cast applied for immobilization of a fractured left radius. Which of the following actions should the nurse implement until the cast has completely dried?

Accepted Answer

Until a plaster cast has dried, placing pressure on the cast should be avoided to prevent creating areas inside the cast that could place pressure on the arm. The left arm should be elevated to prevent swelling. The edges of the cast may be petalled once the cast is dry, but padding the edges before that may cause the cast to be misshapen. The cast should not be covered until it is dry because heat builds up during drying.

Question 2

The nurse is caring for a client with Buck's traction who had an intracapsular fracture of the left femur. Which of the following actions should the nurse take in order to evaluate the effectiveness of Buck's traction?

Accepted Answer

Buck's traction keeps the leg immobilized and reduces painful muscle spasm. Hip contractures and dislocation are unlikely to occur in this situation. The peripheral pulses will be assessed, but this does not help in evaluating the effectiveness of Buck's traction.

Question 3

The nurse is planning discharge teaching for a client who has had a repair of a fractured mandible. Which of the following information should the nurse will include in the teaching plan?

Accepted Answer

The jaw will be wired for stabilization, and the client 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 clients are not able to chew high fibre foods.
Initially, the client may receive nasogastric tube feedings, but by discharge the client will swallow liquid through a straw.

Question 4

The nurse is preparing a client with lower leg fracture and an external fixation device in place for discharge. Which of the following information should 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 client 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 5

The nurse is caring for a client who is on bed rest after having a complex pelvic fracture. Which of the following assessment findings is most important to report to the health care provider?

Accepted Answer

The abdominal distention and absent bowel tones may be due to complications of pelvic fractures such as paralytic ileus or hemorrhage or trauma to the bladder, urethra, or colon. Pelvic instability, abdominal pain with palpation, and abdominal bruising would be expected with this type of injury.

Question 6

The nurse is caring for a client in the emergency department who is employed as a checkout clerk in a grocery store and has a repetitive strain injury in the left elbow. Which of the following treatment options should the nurse include in the teaching plan?

Accepted Answer

Treatment for a repetitive strain injury includes changing the ergonomics of the activity. Elbow injections and surgery are not initial options for this type of injury. A wrist splint might be used for hand or wrist pain.

Question 7

The nurse is caring for a client who is a baseball pitcher and had an arthroscopic repair of a rotator cuff injury performed in same-day surgery. Which of the following information should be included in the client's postoperative teaching plan?

Accepted Answer

Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent "frozen shoulder." A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of range of motion (ROM). The drop-arm test is used to test for rotator cuff injury, but not after surgery. The client may be able to return to pitching after rehabilitation.

Question 8

The nurse is caring for a client who has a comminuted fracture of the right femur and has Buck's traction in place while waiting for surgery. Which of the following actions should the nurse implement to assess for pressure areas on the client's back andsacralarea and to provide skin care?

Accepted Answer

The client can lift the buttocks off the bed by using the left leg without changing the right-leg alignment. Turning the client will tend to move the leg out of alignment.
Disconnecting the traction will interrupt the weight needed to immobilize and align the fracture.

Question 9

The nurse is preparing to assist a client who has had an open reduction and internal fixation (ORIF) of a hip fracture out of bed for the first time. Which of the following actions should the nurse take first?

Accepted Answer

The nurse should be familiar with the weight-bearing orders for the client before attempting the transfer. Mechanical lifts are not typically needed after this surgery. Pain medications should be given, since the movement is likely to be painful for the client. The RN should supervise the client during the initial transfer to evaluate how well the client is able to accomplish this skill.

Question 10

The nurse is caring for a client who has had an open reduction and internal fixation (ORIF) of left lower leg fractures who indicates constant severe pain in the leg which is unrelieved by the prescribed morphine. Pulses are faintly palpable and the foot is cool. Which of the following actions should the nurse take next?

Accepted Answer

The client's clinical manifestations suggest compartment syndrome and delay in diagnosis and treatment may lead to severe functional impairment. The data do not suggest problems with blood pressure or infection. Elevation of the leg will decrease arterial flow and further reduce perfusion.

Question 11

The nurse is preparing a client who had an above-the-knee amputation for discharge. Which of the following client statements indicates that the nurse's discharge teaching has been effective?

Accepted Answer

The client lies in the prone position several times daily to prevent flexion contractures of the hip. The limb 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 12

The nurse is counselling a client about ways to prevent fractures. Which of the following information should the nurse include?

Accepted Answer

Comfortable shoes with good support will help decrease the risk for falls. Throw rugs should be eliminated, not just tacked down. Activities of daily living provide range of motion exercise; these do not need to be taught by a physical therapist. Falls inside the home are responsible for many injuries.

Question 13

After the health care provider has recommended an amputation for a client who has ischemic foot ulcers, the client tells the nurse, "If they want to cut off my foot, they should just shoot me instead." Which of the following responses by the nurse is best?

Accepted Answer

The initial nursing action should be to assess the client's knowledge level and feelings about the options available. Discussion about the client's option to not have the procedure, the seriousness of the condition, or rehabilitation after the procedure may be appropriate after the nurse knows more about the client's current level of knowledge and emotional state.

Question 14

The nurse is caring for a client who is 1 day postoperative below-the-knee amputation who indicates pain in the amputated limb. Which of the following actions is best for the nurse to take?

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 client. 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 15

The nurse is evaluating the crutch-walking technique of a client who is to have no weight bearing on the right leg. Which of the following observations indicates that the client can safely ambulate independently?

Accepted Answer

When using crutches, clients are usually taught to move the assistive device and the injured leg forward at the same time and then to move the unaffected leg. Clients are discouraged from using furniture to assist with ambulation. The client is taught to place weight on the hands, not in the axilla, to avoid nerve damage. If the 2- or 4-point gaits are to be used, the crutch and leg on opposite sides move forward, not the crutch and same-side leg.

Question 16

The nurse is preparing a client for discharge from the emergency department with a sprained wrist. Which of the following information should the nurse include?

Accepted Answer

Elevation of the arm will reduce the amount of swelling and pain. Compression bandages are used to decrease swelling. For the first 24-48 hours, cold packs are used to reduce swelling. The wrist should be rested and kept immobile to prevent further swelling or injury.

Question 17

The nurse is providing health-promotion teaching to a client whose job involves many hours of word processing. Which of the following actions should the nurse include in the client teaching plan?

Accepted Answer

Repetitive strain injuries caused by prolonged times working at a keyboard can be prevented by the use of a pad that will keep the wrists in a straight position. Stretching exercises during the day may be helpful, but these would not be needed before starting. Use of a compression bandage is not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are appropriate to use to decrease swelling.

Question 18

The nurse is caring for a client with a left femur fracture who has a hip spica cast applied. Which of the following nursing interventions should be included in the plan of care?

Accepted Answer

Assessment of bowel tones, abdominal pain, and nausea and vomiting will detect the development of cast syndrome. To avoid breakage, the support bar should not be used for repositioning. After the cast dries, the client can begin ambulating with the assistance of physical therapy personnel and may be turned to the prone position.

Question 19

The nurse is caring for a client who has a cast in place after fracturing the radius and the client asks when the cast can be removed. Which of the following information related to the length of time that the cast will need to remain in place should thenursetell the client?

Accepted Answer

Bone healing starts immediately after the injury, but since ossification does not begin until 3 weeks postinjury, the cast will need to be worn for at least 3 weeks. Complete union may take up to a year. Resolution of swelling does not indicate bone healing.

Question 20

The nurse is providing discharge teaching to a client who has a short-arm plaster cast applied. Which of the following client statements indicates a good understanding of the discharge teaching?

Accepted Answer

Ice application for the first 24 hours after a fracture will help reduce swelling and can be placed over the cast. Plaster casts should not get wet. The client should be encouraged to move the joints above and below the cast. Clients should not insert objects inside the cast.

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