Hip Hip Hooray
The nurse is caring for a patient who had a bipolar hip replacement following an intracapsular fracture and has orders to be turned every 2 hours. What is the correct nursing intervention to use with this patient?
Keep the patient’s legs adducted to prevent additional pain for the patient with turning.
Keep the patient’s legs abducted so the prosthesis does not become dislocated.
Keep the patient’s legs flexed to stabilize the prosthesis.
Keep the patient’s legs together so they do not separate while turning.
Keep the patient’s legs abducted so the prosthesis does not become dislocated.
Which is a potential cause of a delayed union or nonunion of a fracture?
Poor Perfusion
A patient who fell and fractured his wrist will require a closed reduction. Which statement demonstrates that the patient understands the procedure?
"There will be metal pins protruding from the skin surface.”
“A metal pin will be attached to the bone to stabilize it.”
“The bone ends will be aligned during a surgical procedure.”
“The bone ends will be manipulated manually into its normal position.”
“The bone ends will be manipulated manually into its normal position.”
The nurse is caring for a client with a newly applied plaster cast. How should the nurse touch and move the wet cast?
Support with the flat (palms) of the hand
Which is the best description of the difference between a strain and a sprain injury?
Strains are produced by minute muscle tears and overstretching of tendons whereas sprains are caused by a twisting of the joint
What part of the hip does the most common type of hip fracture occur?
Extracapsular
Why is meticulous wound care important post laminectomy?
An infection could lead to meningitits
The nurse is caring for a recently admitted patient with a pelvic fracture. Which assessment finding would he/she need to report immediately?
Complaints of pain with movement.
Complaints of a severe headache.
Hypotension, tachycardia and hematuria.
Abdominal pain and hypoactive bowel sounds.
Hypotension, tachycardia and hematuria.
A client dislocated four of his fingers while diving for a ball during a baseball game. The physician manipulated the client’s fingers into alignment and applied a splint to immoblilize the hand. What type of procedure did the physician perform?
Closed reduction
Which condition is a woman who knits for long periods of time at risk for developing?
Carpel Tunnel
A patient had a hip arthroplasty and returned to the med/surg floor from the PACU several hours ago. The patient is now restless and anxious and the nurse suspects the patient may be going into shock. What should the nurse do first?
Initiate vital signs every 15 minutes, compare them to the baseline and monitor trends.
Decrease anxiety by reassuring the patient that everything is going as expected.
Look at the urinary output and compare the total amount to the baseline.
Call the patient’s family and invite them to spend time at the bedside.
Initiate vital signs every 15 minutes, compare them to the baseline and monitor trends.
An adult is swinging a small child by the arms and the child screams and grabs his left arm. An x-ray shows that the radial head is partially dislocated. What type of injury has the child most likely sustained?
Subluxation
A client with a fracture develops compartment syndrome that requires surgical intervention. What is the procedure to correct this complication?
Fasciotomy
When providing care to a patient in skeletal traction, what action would be included in the nurse’s plan of care?
Cleanse the pin sites and observe for signs of infection
Which nursing intervention would be included when educating a patient diagnosed with carpal tunnel syndrome?
Proper splint placement
Ace bandage (elastic roller bandage) application
Elevation of leg
Smoking cessation.
Proper splint placement
How are we turning a postoperative client with a hip prosthesis?
Use the logrolling procedure onto the non-operative side with assistance.
Which nursing interventions are appropriate for the postoperative care of a hip fracture repair?
Wound assessment, including pain, color, amount and odor of any exudate.
Maintaining adduction of the legs.
Encouraging the use of chairs that are low to the ground once ambulating.
Turning the patient onto the operative side every 4 hours.
Wound assessment, including pain, color, amount and odor of any exudate.
The nurse is caring for a client who had a surgical amputation of the left leg related to complications from diabetes. The client asks the nurse “If my leg is really gone, then why am I having such bad pain” What is the best response by the nurse?
“It is called phantom pain and it may come and go.”
What should be the priority when caring for a client with a fracture?
Monitoring for cardiac problems
Monitoring for neurovascular compromise
Monitoring for altered kidney function
Monitoring hormonal imbalances
Monitoring for neurovascular compromise
Which finding is a positive indicator of Phalen’s sign?
Wrist flexion for 60 seconds causes numbness and tingling
A patient is hospitalized with a fractured right hip. What is the most typical sign of an extracapsular (intertrochanteric or subtrochanteric) fracture of the hip that would be noted during a physical assessment?
Bruising of the affected leg.
External rotation of the affected leg.
Lengthening of the affected leg.
Paralysis of the affected leg.
External rotation of the affected leg.
Why does an intracapsular fracture of the left hip require immediate surgical intervention?
To prevent avascular necrosis.
A nurse witnesses a client sustain a fall and suspects the leg may be fractured. Which nursing action is the highest priority?
Immobilize the leg before moving the client.
A client with a hip fracture asks the nurse why Buck’s extension traction is being applied before surgery. What does Buck’s extension traction do?
It provides comfort and support by reducing muscle spasms and immobilizes the fracture.
The nurse is caring for a client who has a subluxation of the right shoulder. Which nursing intervention would not be appropriate when caring for this patient?
Heat for the first 24 hours
Which complications are common following surgery for a fractured hip? Select all that apply.
Mental Disorientation
Constipation
Wound Infection
Pneumonia
Mental Disorientation
Constipation
Wound Infection
Pneumonia
A patient fell off of the roof and is experiencing middle back pain, partial loss of mobility, and loss of sensation to the legs. What would the nurse suspect has occurred?
A vertebral fracture.
What type of treatment is required for a client who is in need of internal fixation of a fracture?
Open reduction
A nurse is caring for a patient with a casted left arm who develops compartment syndrome. The patient asks the nurse how this happens. What causes compartment syndrome to develop?
Bleeding or swelling cause increased pressure in an area that cannot expand.
A client’s cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give to the client to address the skin problem?
Gently washing and applying lotion/cream to the area
What type of pharmacologic therapy will a patient receive to prevent complications related to a total hip arthroplasty post op day 1?
Anticoagulation therapy.
Which three symptoms are the best indication of impending shock in a patient with a complicated fracture?
Restlessness, anxiety, lethargy.
Explain what phantom pain is.
It is related to the severed nerves that are still sending messages to the brain.
What is the nursing goal when caring for a patient in the immediate postoperative period of an amputation?
Prevention of neuroma formation
Effective pain management and prevention of deformities
Teaching about the unexplainable burning pain (causalgia)
Prevention of osteomyelitis & osteocalcification formations
Effective pain management and prevention of deformities
What would the nurse expect to assess in a patient with a gas gangrene infected wound?
Gas bubbles (crepitation) and erythema around the edges of the wound.
Which is a serious complication that can occur in patients with a pelvic fracture?
Hemorrhage
A 16 year old male patient presents in the emergency room with pathologic fracture of the left femur, an elevated serum alkaline phosphatase level and complaints of pain on weight-bearing. Which of the following disorders would be suspected?
Osteogenic sarcoma
Thirty six hours after a patient sustained a fractured femur in a car accident, the nurse caring for the patient notes respirations of 25, crackles & wheezes in both lung fields, petechiae on the conjunctiva of the eyes, and that the patient is restless and irritable. What may be the cause of these symptoms?
Fat Embolism
Why is neurovascular assessment important when caring for a patient with a dislocation?
To determine whether vascular or nerve injury is present in the affected area
What position will the nurse place the client in several times per day after an above the knee amputation of the left leg to stretch the flexor muscles and to help maintain muscle and joint mobility
Prone
A postoperative laminectomy patient reports abdominal discomfort with a gaseous, bloated feeling and mild nausea. What should be the nurse’s first action?
Listen for bowel sounds
The nurse identifies a patient problem of impaired tissue integrity related to puncture wound; pins for a client in a skeletal traction. Which expected outcome would be appropriate for this client?
Wounds will heal without infection
During assessment of a patient’s traction device, which parts of the traction system are you monitoring?
cords, ropes, weights, body alignment
Which type of orthopedic device is usually a good option for older patients who need balance and support?
Cane