Fractures
The patient arrives at the emergency department with an injury to the left arm. Which intervention should the nurse implement first?
a. assess the nailbeds for capillary refill
b. Remove the patient's clothing from the arm
c. Call radiology for a STAT xray of the extremity
d. Prepare the patient for the application of a cast
A. Assess the nailbed for capillary refill
A nurse is developing a care plan for a patient who has just been placed in Buck's traction for a fractured femur. Which nursing intervention is the highest priority for this patient?
A) Educate the patient about the importance of deep breathing exercises.
B) Assess neurovascular status of the affected limb every hour.
C) Encourage the patient to use the call light for assistance with toileting.
D) Monitor the patient’s nutritional intake to support healing.
B) Assess neurovascular status of the affected limb every hour.
Which clinical finding would be a priority to report to the HCP about an 80 year old patient who is immobile due to a fractured hip 3 days ago?
a. pulse 95 bpm
b. K level 4.9 mg/dL
c. No stool for 3 days
d. Ca level 9.6 mg/dL
C. no stool for 3 days
patient most likely has been taking pain medications, which can increase the risk for constipation
A nurse is teaching a group of parents about managing juvenile idiopathic arthritis (JIA) in their children. Which statement by a parent indicates a need for further education?
A) "I should encourage my child to participate in regular physical activity."
B) "It's important to monitor my child’s temperature and joint swelling."
C) "My child can skip medications if they are feeling better."
D) "I need to ensure my child is following a balanced diet."
C) "My child can skip medications if they are feeling better."
Rationale: This statement indicates a misunderstanding of the importance of consistent medication adherence in managing JIA, even when symptoms seem to improve. Regular medication is essential to control inflammation and prevent flares. The other statements reflect appropriate understanding of management strategies.
A nurse is assessing a patient with osteoarthritis. Which of the following findings is most characteristic of this condition?
A) Morning stiffness lasting longer than 30 minutes
B) Symmetrical joint swelling and pain
C) Crepitus and joint pain during movement
D) Fatigue and fever
C) Crepitus and joint pain during movement
Rationale: Crepitus (a grating sound or sensation) and joint pain during movement are characteristic features of osteoarthritis, which is a degenerative joint disease. Morning stiffness is typically brief in OA, while symmetrical swelling and systemic symptoms like fatigue and fever are more indicative of rheumatoid arthritis.
The unlicensed assistive personnel reports a patient with a fractured femur has a fatty globules floating in the urinal. What intervention should the nurse implement first?
a. Assess the patient for dyspnea and altered mental status
b. Obtain an arterial blood gas and order a portable chest xray
c. Ask the patient has this happened before
d. Instruct the UAP to keep the patient on strict bed rest
A. Assess the client for dyspnea and altered mental status
A patient with a fractured pelvis is in both skin and skeletal traction. The nurse is assessing the patient's pain and mobility. Which assessment finding would be most concerning and require immediate intervention?
A) The patient reports pain rated at 6/10 in the affected area.
B) The patient exhibits a positive straight leg raise on the unaffected side.
C) The patient shows signs of dehydration with dry mucous membranes.
D) The patient has difficulty moving their toes on the affected limb.
D) The patient has difficulty moving their toes on the affected limb.
The nurse is preparing the care plan for a patient with a fractured lower extremity. Which outcome is most appropriate for the patient?
a. the patient will maintain function of the leg
b. the patient will ambulate with assistance
c. the patient will be turned every 2 hours
d. the patient will have no infection
A. the patient will maintain function of the leg
the outcome for a patient with a fracture is maintaining or restoring function to the extremity
A nurse is caring for a child diagnosed with Ewing sarcoma. Which of the following symptoms should the nurse monitor closely for potential complications of this condition?
A) Fatigue and pallor
B) Localized pain at the tumor site
C) Swelling in the affected limb
D) All of the above
d. all of the above
All of these symptoms are significant in monitoring for complications associated with Ewing sarcoma, including anemia (fatigue and pallor), localized pain due to tumor growth or metastasis, and swelling that could indicate tumor expansion or obstruction. Comprehensive monitoring of these symptoms is critical for early intervention.
A patient with a history of gout is admitted with severe pain in the big toe. Which medication should the nurse anticipate will be ordered for acute management of this condition?
A) Allopurinol
B) Colchicine
C) Prednisone
D) Methotrexate
Correct Answer: B) Colchicine
Rationale: Colchicine is commonly used to treat acute gout attacks by reducing inflammation and pain. Allopurinol is used for long-term management to lower uric acid levels, while prednisone is used for other inflammatory conditions. Methotrexate is typically used for rheumatoid arthritis or other autoimmune diseases, not gout.
Which statement by the patient diagnosed with a fractured ulna indicates to the nurse the patient needs further teaching?
a. "I need to eat a high protein diet to ensure healing"
b. "I need to wiggle my fingers every hour to increase circulation"
c. "I need to take my pain medication before my pain is too bad"
d. "I need to keep the immobilizer on when lying down only"
d. "I need to keep the immobilizer on when lying down only"
Which assessment finding in a patient with a fracture who is in traction requires immediate intervention?
a. The weights are freely hanging on the floor
b. Pin sites are free from drainage
c. Patient uses the overhead trapeze bar to move around the bed
d. patient's extremities have a capillary refill of less than 2 seconds
a. Weights used for traction should freely hang but NOT on the floor
A 88 y/o patient is admitted to the orthopedic floor with the diagnosis of fractured pelvis. Which intervention should the nurse implement first?
a. Insert an indwelling catheter
b. administer a Fleet's enema
c. Assess the abdomen for bowel sounds
d. Apply Buck's traction
C. Assess the abdomen for bowel sounds
review common complications of fractured pelvis in text; assessing the bowel sounds should be 1st priority to rule out ileus
A nurse is assessing an infant for signs of developmental dysplasia of the hip (DDH). Which finding would be most indicative of this condition?
A) Limited hip abduction
B) Bilateral equal leg lengths
C) Positive Ortolani sign
D) Presence of a click when moving the hip
c. Positive Ortolani sign
A positive Ortolani sign, which indicates a dislocated hip that can be reduced, is a key indicator of developmental dysplasia of the hip. Limited hip abduction and the presence of a click may also be present, but the Ortolani sign is the most definitive finding during assessment.
A nurse is providing education to a patient recently diagnosed with rheumatoid arthritis. Which statement by the patient indicates a correct understanding of the disease?
A) "I should avoid all physical activity to prevent joint damage."
B) "RA can affect my organs as well as my joints."
C) "I will only need to take medication when I have a flare-up."
D) "I can expect my joint pain to improve with rest."
B) "RA can affect my organs as well as my joints."
Rationale: Rheumatoid arthritis is an autoimmune disease that can affect not only the joints but also other organs, such as the lungs and heart. The other statements reflect misconceptions about RA management; patients should remain active within their limits, use medication consistently, and understand that rest does not necessarily improve joint pain due to the inflammatory nature of the disease.
Which foods should the nurse recommend to a patient when discussing sources of dietary calcium?
a. Yogurt, dark-green leafy vegetables
b. Oranges and citrus fruits
c. Bananas and dried apricots
d. Wheat bread and bran
a. Yogurt, dark-green leafy vegetables
A nurse working on an orthopedic unit is caring for four patients. Which of the following patient should the nurse identify as being at greatest risk for skin breakdown?
A. An adolescent who has a cervical fracture and is in a halo brace
b. A young adult who has a femur fracture and is in skeletal balanced suspension traction
C. A middle adult who has a fractured radius and an arm cast
D. An older adult who has a hip fracture and is in Buck's traction
D. An older adult who a hip fracture and is in Buck's traction
Which statement by a patient, who just received a cast on the right arm for a fracture, requires you to notify the HCP?
a. "Its really itchy inside my cast"
b. My pain is so severe that it hurts to stretch or elevate my arm"
c. " I can feel my fingers and move them"
d. "I've been using ice packs to reduce swelling"
B. "My pain is so severe that it hurts to stretch or elevate my arm"
You should be thinking compartment syndrome
A nurse is educating a new parent about the treatment for clubfoot in their infant. Which statement by the parent indicates a good understanding of the treatment plan?
A) "I should expect my baby to wear a cast for several weeks without any changes."
B) "Surgery is usually the first option for treating clubfoot."
C) "I need to bring my baby in for regular follow-ups to adjust the casting."
D) "Once the clubfoot is corrected, no further treatment will be needed."
C) "I need to bring my baby in for regular follow-ups to adjust the casting."
Rationale: Regular follow-ups are essential for adjusting the casting as the infant grows and to monitor progress in the correction of clubfoot. The other statements reflect misunderstandings about the treatment plan; while casts are often used, they require monitoring and adjustments. Surgery is usually considered if non-surgical methods fail, and ongoing assessment is often needed even after initial correction.
A nurse is assessing a patient with systemic lupus erythematosus (SLE). Which of the following symptoms should the nurse recognize as a common manifestation of this condition?
A) "Butterfly" rash across the cheeks and nose
B) Joint stiffness that improves with movement
C) Unilateral joint swelling
D) Chronic cough and hemoptysis
A) "Butterfly" rash across the cheeks and nose
Rationale: The "butterfly" rash is a classic symptom of SLE, often appearing across the cheeks and nose. immune response from sun exposure. Joint stiffness that improves with movement and unilateral swelling are more characteristic of conditions like osteoarthritis and rheumatoid arthritis, while chronic cough and hemoptysis can occur but are less common primary symptoms of SLE.
A nurse is teaching a patient about the care of a cast applied to a fractured wrist. Which of the following statements by the patient indicates a need for further teaching?
A) "I should keep my cast dry and avoid getting it wet."
B) "It's normal for my fingers to feel slightly numb or tingly at times."
C) "I will check my fingers for swelling or changes in color."
D) "I can use a hairdryer on a cool setting to help dry my cast if it gets damp."
B) "It's normal for my fingers to feel slightly numb or tingly at times."
A nurse is caring for a patient in Buck's traction after a hip fracture. Which of the following findings should prompt the nurse to assess for potential complications related to the traction?
A) The patient reports mild discomfort at the traction site.
B) The patient’s affected leg appears shorter than the other leg.
C) The traction weights are hanging freely and unobstructed.
D) The patient’s toes are warm and pink.
B) The patient’s affected leg appears shorter than the other leg.
Rationale: An affected leg that appears shorter may indicate improper alignment or displacement of the fracture, which could lead to complications if not addressed. The other findings (mild discomfort, proper weight hanging, warm and pink toes) suggest that the traction is functioning appropriately, while a noticeable change in limb length requires immediate assessment and possible intervention.
Your patient is 2 hours post op from a cast placement on the right leg. The patient has family in the room. Which action by the significant other requires you to re-educate the patient and family about cast care?
A. gently moving the cast with the fingertips of the hand every 2 hours to help with the drying process
b. positioning the cast at heart level with pillows
c. checking the color and temperature of the right foot
d. using a hair dryer on the cool setting to help with drying
A. gently moving the cast with the fingertips of the hand every 2 hours to help with the drying process
cast should always be moved with the palms of the hands NOT fingertips during drying period to prevent dents in the cast which could lead to pressure ulcers
A child undergoing treatment for Ewing sarcoma is experiencing nausea and vomiting. Which nursing intervention is the priority to address this side effect?
A) Administer antiemetic medication as prescribed.
B) Encourage the child to eat small, frequent meals.
C) Assess the child’s hydration status regularly.
D) Provide a quiet environment to reduce stimuli.
A) Administer antiemetic medication as prescribed.
Rationale: Administering antiemetic medication is the priority intervention to manage nausea and vomiting effectively, helping to improve the child’s comfort and ability to tolerate treatment. While the other options are also important aspects of care, addressing the immediate symptom of nausea is the first step in managing the child's overall well-being.
A nurse is preparing to administer calcitonin to a patient with osteoporosis. Which of the following actions should the nurse take prior to administration?
A) Assess the patient's calcium levels.
B) Encourage the patient to take the medication with food.
C) Check for signs of hypercalcemia.
D) Inform the patient that this medication will increase bone density immediately.
A) Assess the patient's calcium levels.
Rationale: Prior to administering calcitonin, it is important to assess the patient's calcium levels to ensure they are within an appropriate range. Calcitonin can help lower elevated calcium levels, so knowing the baseline is essential for safe administration. While informing the patient about the medication's effects and encouraging proper administration are important, assessing calcium levels is the priority action to ensure patient safety.