Question 1

The nurse is preparing for the initial placement of an orthotic device onto the patient's lower leg.Which of the following is the priority nursing intervention?

Accepted Answer

The most important nursing intervention is to obtain a baseline assessment of the area where the orthotic device will be placed.It is important to accomplish this before regular use of the orthotic because a pressure point potentially leads to skin breakdown and can result in patient inability to use the device.Providing patient education on maintaining the device occurs before ending the visit,but the first priority should be to establish the baseline assessment before the initial placement.

Question 2

During assessment of an African-American patient,the nurse notes that the fingernails on the hand casted in plaster are an ashen-gray color.What information should the nurse collect next?

Accepted Answer

Numbness and tingling are symptoms that correlate with a decrease in circulation,which can be manifested as an ashen-gray color in this patient.The color of the fingernails before the application of the cast is important to know,but information about the current status is more important.Allergies are checked,but they would not be manifested only on the affected extremity.Toenail beds can alert the nurse if a systemic cardiopulmonary problem is occurring.The comparison would be between the two hands.

Question 3

The nurse is preparing to help with removal of a long arm plaster cast.What information should the nurse include in patient preparation for plaster cast removal?

Accepted Answer

The nurse instructs the patient to use a cool enzyme wash to facilitate dead cell removal as long as the skin is intact because the skin under a cast becomes dry and flaky.The patient is advised to resume full range of motion gradually to prevent discomfort and patient injury.A nail brush is too rough to use on scaly,dry skin and could cause discomfort.The saw causes no discomfort,although a burning sensation can occur with the removal of a synthetic cast.

Question 4

1. The first sign that a neurovascular deficit is developing in a patient who is immobilized in a traction device after a fracture is ___________on passive range of motion.

Accepted Answer

The answer of 1. The first sign that a neurovascular...

Question 5

The nurse is instructing nursing assistant personnel (NAP)about caring for a patient with bilateral plaster long leg casts.Which activity can the nurse delegate to NAP?

Accepted Answer

The patient's legs should be positioned above the level of the patient's heart.Warm air from a blow dryer dries the cast from the outside,which is counterproductive.The cast must dry from inside to outside.Linens are not placed over the cast until it is completely dry.The nurse retains responsibility for turning a patient with an incompletely dry hip spica cast because the task requires critical thinking and nursing judgment.While turning or repositioning the patient,the nurse must maintain proper bone and cast alignment to allow the cast to dry and provide effective therapy.The nurse instructs the NAP about clinical indicators of infection for a patient in a hip spica cast,including fever and foul odors.

Question 6

The patient is complaining of increasing pain several hours after a cast was applied for a severe lower leg injury.What actions should the nurse implement after giving additional pain medication with no relief?

Accepted Answer

The patient is experiencing symptoms of compartment syndrome,which is a medical emergency.The physician must be notified,and the cast saw made available because the cast will need to be split (bivalved)so the leg can be assessed.Ice is contraindicated,as is placing the leg high.There is already decreased circulation of the extremity,and nothing should be done to further impair it.The nurse cannot alter the prescribed dose of medication that may be given to the patient without consulting the healthcare provider.Distracting the patient is not a useful response to this situation.The nurse should remain at the patient's bedside until the emergency situation is addressed.

Question 7

2. The nurse is performing pin site care using evidence-based guidelines.Those guidelines recommend using __________ solution to clean the pin sites.

Accepted Answer

The answer of 2. The nurse is performing pin site...

Question 8

The nurse is preparing a patient for discharge after application of a plaster cast.What information does the nurse include in the patient teaching?

Accepted Answer

The nurse instructs the patient to report changes in sensation or inability to move the affected tissues because these clinical indicators are consistent with neurovascular impairment,usually resulting from a compressed or irritated nerve.This potentially results from excessive intracast pressure from bleeding,edema,or compartment syndrome.The patient can facilitate cast drying by using a standard,household fan positioned 45 cm (18 inches)or more from the cast.

Question 9

The nurse is assisting an adolescent female with a Milwaukee back brace for treatment of scoliosis.Nursing care is correct if the nurse takes which action?

Accepted Answer

The nurse checks the thin cotton shirt under the brace so there are no wrinkles that could cause skin irritation.The shirt protects the skin from irritation and absorbs moisture.There is no need for a betadine shower before placing the brace.The menstrual cycle can be an annoyance when the brace is in place,but the skin integrity is priority.The brace must remain tight at certain points for it to work properly.The skin will be checked when it is removed daily.

Question 10

A patient with Buck's traction complains of increased pain after the traction is applied and pain medication is given.After loosening the traction slightly,the nurse assesses the extremity and can find nothing wrong,although the patient is still complaining of pain at a level of 4 on a scale of 0 to 10.What action should the nurse initiate next?

Accepted Answer

Once pain medication is given and the traction is loosened,the healthcare provider must be notified because of the chance of a neurovascular deficit.Administering additional pain medication is inappropriate since it may mask the problem.The need for an x-ray film is up to the healthcare provider to explore with the patient; speculating is inappropriate.If the patient is still experiencing pain,the healthcare provider needs to be called,regardless of the description of the pain.

Quiz 17: Traction, cast Care, and Immobilization Devices