Question 1

A woman is seen at the urgent care centre after falling on her right arm and shoulder.What is an assessment finding noted by the nurse that would indicate the patient has a dislocated shoulder?

Accepted Answer

A dislocated shoulder can cause the affected arm to appear shorter due to the displacement of the shoulder joint.

Question 2

A patient has a short arm plaster cast applied at the outpatient centre for a stable wrist fracture.An understanding of discharge teaching is apparent when the patient gives which of the following responses?

Accepted Answer

Applying an ice pack to the cast over the fracture site for the first 24 hours can help reduce swelling and pain. It's important to keep the cast dry and avoid inserting objects underneath it, which rules out the other options as correct advice.

Question 3

A patient with a fractured right tibia has a long leg cast applied and has been taught crutch walking with no weight bearing on his affected leg.The nurse determines that the patient is prepared to ambulate independently with the crutches on observing the patient do which of the following actions?

Accepted Answer

The correct technique for crutch walking with no weight bearing on the affected leg is to advance the right leg and both crutches together, and then advance the left leg. This allows the patient to maintain stability and balance while keeping weight off of the affected leg. Advancing the crutches together and swinging the body past the crutches (A) is not a safe or effective technique for crutch walking. Advancing the left crutch with the right leg and then the right crutch with the left leg (C) and advancing the left crutch, then the left leg, and then the right crutch followed by the right leg (D) are not the correct techniques for crutch walking with no weight bearing.

Question 4

In developing a care plan for a patient with an open reduction and internal fixation (ORIF)of an open,displaced fracture of the tibia,what is a priority nursing diagnosis?

Accepted Answer

ORIF involves disruption of the skin and soft tissues, increasing the risk for infection. This is the priority nursing diagnosis as it poses a risk to the patient's health and requires prompt management to prevent complications. The other options are also important considerations but not the priority in this case.

Question 5

A patient with a fractured pelvis is initially treated with bed rest,with no turning from side to side permitted.The second day after admission,the patient develops chest pain,tachypnea,and tachycardia.Which of the following nursing assessments helps determine that the patient's symptoms are most likely related to fat embolism?

Accepted Answer

Pinpoint red areas on the upper chest are a classic sign of petechiae, which is a manifestation of fat embolism syndrome. The other options are not specific to fat embolism and may be seen in other conditions as well.

Question 6

A 20-year-old baseball pitcher has an arthroscopic repair of a rotator cuff injury performed as same-day surgery.When the nurse plans postoperative teaching for the patient,which information will be included?

Accepted Answer

The patient will likely need physical therapy to regain strength and range of motion in the repaired rotator cuff, so it is important to schedule an appointment with a physiotherapist as part of the postoperative care plan.

Answer: B
 The patient may need to wear a shoulder immobilizer to help manage pain and protect the healing tissues in the shoulder, but this should be discussed with the surgeon to determine the best course of action.

Answer: C
 The drop-arm test is a diagnostic tool used to assess rotator cuff function, and is not typically used after a rotator cuff repair.

Answer: D
 The decision to continue playing a particular sport or position after a rotator cuff repair will depend on a variety of factors that are beyond the scope of standard postoperative teaching. The nurse should advise the patient to discuss any concerns about returning to sports with their surgeon.

Question 7

Following a motor vehicle accident,a patient arrives in the emergency department with massive right lower leg swelling.Which action will the nurse take first?

Accepted Answer

Checking the leg pulses and sensation is critical to assess the potential for compartment syndrome, which is a medical emergency. Elevating the leg on pillows and applying ice packs may be appropriate interventions, but they should not be done before assessing the leg pulses and sensation to rule out compartment syndrome. A compression bandage may also be appropriate, but it should not be applied until compartment syndrome has been ruled out.

Question 8

A 73-year-old woman tells the nurse that she is "slowing down" and does not try to push herself to do much these days because of her age.She spends most of the day and evening watching television and has hired someone to do most of her home maintenance chores.Recognizing that the woman is at risk for musculoskeletal problems,what is the best response to her comment?

Accepted Answer

Option B acknowledges the patient's concern about age-related changes but also provides a solution to the problem by suggesting mild, regular exercise to increase strength and coordination, as well as improve overall well-being. Option A may be too specific and may not be feasible for the patient, while Option C is not as helpful or informative. Option D may be true, but it does not provide any guidance on how to improve the patient's musculoskeletal health.

Question 9

A patient with a comminuted fracture of the right femur has Buck's traction in place while waiting for surgery.What should the nurse do to assess for pressure areas on the patient's back and sacral area and to provide skin care?

Accepted Answer

The nurse should have the patient lift the buttocks by bending and pushing with the left leg to assess for pressure areas and provide skin care without disrupting the traction.

Question 10

A patient with a fractured radius asks when the cast can be removed.The nurse will instruct the patient that the cast can be removed only after the bone completes which process?

Accepted Answer

The answer of A patient with a fractured radius asks...

Question 11

A patient hospitalized with multiple fractures has a long arm plaster cast applied for immobilization of a fractured radius.Until the cast has completely dried,what should the nurse do?

Accepted Answer

Handling the cast with the palms of the hands prevents indentations that could cause pressure points and skin breakdown.

Question 12

Following the application of a hip spica cast for a patient with a fracture of the proximal third of the left femur,what is an appropriate nursing intervention?

Accepted Answer

Assessing the patient for abdominal pain, and nausea and vomiting is crucial after the application of a hip spica cast because the cast can compress the abdomen, potentially causing gastrointestinal issues or discomfort.

Question 13

While working in an urgent care centre,the nurse sees many patients with sports-related injuries.In teaching these patients about health promotion during physical activity,what should the nurse emphasize?

Accepted Answer

Stretching and warm-up exercises are important because they help to prevent injury by preparing the body for physical activity. This can improve flexibility and range of motion while also increasing blood flow and oxygen to muscles. While adhesive tape may be appropriate for some injuries, it is not necessary for all joints and may hinder movement. Low-impact activities may be appropriate for some individuals, but others may benefit from the challenge of more strenuous exercise to improve cardiovascular health and strength. While rest and recovery are important after exercise, complete physical relaxation is not always necessary or feasible.

Question 14

A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer.All of the following orders are written by the physician.Which one will the nurse act on first?

Accepted Answer

Immediate care for a twisted ankle involves the RICE protocol (Rest, Ice, Compression, and Elevation). Wrapping the ankle and applying an ice pack (B) addresses swelling and pain and is the first step before administering medication or conducting further diagnostic tests.

Question 15

A patient is admitted to the emergency department with possible fractures of the bones of the left lower extremity.Before initiating treatment for the patient,what is it most important for the nurse to do?

Accepted Answer

Checking neurovascular status distal to the injury is the priority because it assesses blood flow and nerve function to the affected limb, which could be compromised due to the fracture. This assessment is essential before initiating any further intervention such as splinting or elevating the limb. Assessing tetanus immunization status is important but not the most crucial at this time.

Question 16

A cashier in a grocery store has muscle and tendon tears that have become inflamed,causing pain and weakness in her left hand and elbow.What should the nurse identify these symptoms as being related to?

Accepted Answer

The symptoms described are indicative of a repetitive strain injury (RSI), which can occur in individuals who perform repetitive motions on a regular basis, such as cashiers who are constantly scanning and bagging items. Bursitis may also cause inflammation and pain in the affected area, but it typically involves the fluid-filled sacs (bursae) located between bones and soft tissues. A meniscus injury is specific to the knee joint and involves damage to the cartilage between the bones. Carpal tunnel syndrome is a type of RSI that affects the nerves in the wrist and hand, but the symptoms typically include numbness, tingling, and weakness, rather than pain and weakness in the elbow and hand.

Question 17

A patient in the emergency department is diagnosed with a patellar dislocation.What will the nurse's initial patient teaching focus on?

Accepted Answer

The answer of A patient in the emergency department is...

Question 18

A 24-year-old man recently started an exercise regimen that includes running 5 to 7 km a day.He tells the nurse he has developed shin splints so severe that they limit his ability to run.What is an appropriate response?

Accepted Answer

Shin splints are a common overuse injury that can be caused by sudden increases in intensity, duration, or frequency of exercise. The nurse's response should address the possibility of overuse and suggest decreasing the intensity of the exercise to allow for recovery. The other options are not necessarily appropriate for the situation.

Question 19

Following X-ray films of an injured wrist,the patient is informed that it is just badly sprained.In teaching the patient to care for the injury,what should the nurse teach the patient to do?

Accepted Answer

Keeping the arm elevated above the heart, even during sleep, can help reduce swelling and promote healing. Applying heat can increase inflammation and delayed healing, wearing elastic compression bandages continuously can cut off circulation, and exercising the joint could exacerbate the injury.

Question 20

A patient with open,comminuted fractures of the tibia and fibula is treated with open reduction and application of an external fixator.The day following surgery,the patient complains of severe pain in her affected leg,which is unrelieved by ordered analgesics.The patient's toes are pink,but she says they are numb and tingling.What is the most appropriate nursing action?

Accepted Answer

Severe pain and numbness or tingling in the affected extremity could indicate a complication such as compartment syndrome, which is a medical emergency. The physician must be notified immediately to assess and treat the patient. Checking the patient's temperature, loosening the screws on the fixator pins, and applying ice may not address the underlying issue and could potentially cause harm.

Quiz 65: Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery