Question 1

A patient is being discharged 4 days after hip replacement surgery using the posterior approach.Which patient action requires immediate intervention by the nurse?

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 2

Which action will the nurse include in the plan of care for a patient who has had a total right 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 3

Which action will the urgent care nurse take when caring for a patient who has a possible knee meniscus injury?

Accepted Answer

A knee immobilizer may be used for several days after a meniscus injury to stabilize the knee and minimize pain.Patients are encouraged to ambulate with crutches.The knee is assessed by flexing,internally rotating,and extending the knee (McMurray's test).The pain associated with a meniscus injury will not typically require IV opioid administration; nonsteroidal antiinflammatory drugs (NSAIDs)are usually recommended for pain relief.

Question 4

A patient who slipped and fell in the shower at home has a proximal humerus fracture immobilized with a left-sided long-arm cast and a sling.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 5

A 42-year-old patient is admitted to the emergency department with a left femur fracture.Which information obtained by the nurse 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 6

After being hospitalized for 3 days with a right femur fracture,a 32-year-old patient suddenly develops 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 fat embolus or venous thromboembolism (VTE)are obtained.

Question 7

A pedestrian who was hit by a car is admitted to the emergency department with possible right lower leg fractures.The initial action by the nurse should be to

Accepted Answer

The initial nursing action should be assessment of the neurovascular 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 8

A patient who arrives at the emergency department experiencing severe left knee pain is diagnosed with a patellar dislocation.The initial patient teaching by the nurse will focus on the need for

Accepted Answer

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

Question 9

Following a motorcycle accident,a 58-year-old patient arrives in the emergency department with massive left lower leg swelling.Which action 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 10

Which nursing action for a patient who has had right hip replacement surgery can the nurse delegate to experienced unlicensed assistive personnel (UAP)?

Accepted Answer

Repositioning of orthopedic patients is within the scope of practice of UAP (after they have been trained and evaluated in this skill).The other actions should be done by licensed nursing staff members.

Question 11

A patient undergoes a left above-the-knee amputation with an immediate prosthetic fitting.When the patient arrives on the orthopedic unit after surgery,the nurse should

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 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 12

A patient arrived at the emergency department after tripping over a rug and falling at home.Which finding is most important for the nurse to communicate to the health care provider?

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 13

Before assisting a patient with ambulation 2 days after a total hip replacement,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 affect ambulation.

Question 14

The nurse is caring for a patient who is to be discharged from the hospital 5 days after insertion of a femoral head prosthesis using a posterior approach.Which statement by the patient indicates a need for additional instruction?

Accepted Answer

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

Question 15

The day after a 60-year-old patient has an open reduction and internal fixation (ORIF)for an open,displaced tibial fracture,the priority nursing diagnosis is

Accepted Answer

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

Question 16

A young man arrives in the emergency department with ankle swelling and severe pain after twisting his ankle playing basketball.Which of these 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 17

When assessing for Tinel's sign in a patient with possible right-sided carpal tunnel syndrome,the nurse will ask the patient about

Accepted Answer

Testing for Tinel's sign will cause tingling in the thumb and first three fingers of the affected hand in patients who have carpal tunnel syndrome.The median nerve does not innervate the right little finger or elbow and forearm.Tremor is not associated with carpal tunnel syndrome.

Question 18

The second day after admission with a fractured pelvis,a 64-year-old patient suddenly develops confusion.Which action should the nurse take first?

Accepted Answer

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

Question 19

A high school teacher with ulnar drift caused by rheumatoid arthritis (RA)is scheduled for a left hand arthroplasty.Which patient statement to the nurse indicates a 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 20

When giving home care instructions to a patient who has comminuted forearm fractures and a long-arm cast on the left 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.

Quiz 59: Nursing Management: Musculoskeletal Trauma and Orthopaedic Surgery