Deck 59: Nursing Management: Musculoskeletal Trauma and Orthopaedic Surgery

Question 1

The day after a having a right below-the-knee amputation,a patient complains of pain in the right foot.Which action is best for the nurse to take?

A) Explain the reasons for the phantom limb pain.
B) Administer prescribed analgesics to relieve the pain.
C) Loosen the compression bandage to decrease incisional pressure.
D) Inform the patient that this phantom pain will diminish over time.

Answer 1

Administer prescribed analgesics to relieve the pain.

Question 2

The occupational health nurse will teach the patient whose job involves many hours of typing about the need to

A) obtain a keyboard pad to support the wrist.
B) do stretching exercises before starting work.
C) wrap the wrists with compression bandages every morning.
D) avoid using nonsteroidal antiinflammatory drugs (NSAIDs) for pain.

Answer 2

obtain a keyboard pad to support the wrist.

Question 3

Which nursing intervention will be included in the plan of care after a patient with a right femur fracture has a hip spica cast applied?

A) Avoid placing the patient in prone position.
B) Ask the patient about abdominal discomfort.
C) Discuss remaining on bed rest for several weeks.
D) Use the cast support bar to reposition the patient.

Answer 3

Ask the patient about abdominal discomfort.

Question 4

A patient has a long-arm plaster cast applied for immobilization of a fractured left radius.Until the cast has completely dried,the nurse should

A) keep the left arm in dependent position.
B) avoid handling the cast using fingertips.
C) place gauze around the cast edge to pad any roughness.
D) cover the cast with a small blanket to absorb the dampness.

Question 5

When doing discharge teaching for a 19-year-old patient who has had a repair of a fractured mandible,the nurse will include information about

A) administration of nasogastric tube feedings.
B) how and when to cut the immobilizing wires.
C) the importance of high-fiber foods in the diet.
D) the use of sterile technique for dressing changes.

Question 6

A 32-year-old patient who has had an open reduction and internal fixation (ORIF)of left lower leg fractures continues to complain of severe pain in the leg 15 minutes after receiving the prescribed IV morphine.Pulses are faintly palpable and the foot is cool.Which action should the nurse take next?

A) Notify the health care provider.
B) Assess the incision for redness.
C) Reposition the left leg on pillows.
D) Check the patient's blood pressure.

Question 7

After the health care provider has recommended amputation for a patient who has nonhealing ischemic foot ulcers,the patient tells the nurse that he would rather die than have an amputation.Which response by the nurse is best?

A) "You are upset, but you may lose the foot anyway."
B) "Many people are able to function with a foot prosthesis."
C) "Tell me what you know about your options for treatment."
D) "If you do not want an amputation, you do not have to have it."

Question 8

Which action will the nurse take in order to evaluate the effectiveness of Buck's traction for a 62-year-old patient who has an intracapsular fracture of the right femur?

A) Check peripheral pulses.
B) Ask about hip pain level.
C) Assess for hip contractures.
D) Monitor for hip dislocation.

Question 9

A 22-year-old tennis player has an arthroscopic repair of a rotator cuff injury performed in same-day surgery.When the nurse plans postoperative teaching for the patient,which information will be included?

A) "You will not be able to serve a tennis ball again."
B) "You will work with a physical therapist tomorrow."
C) "The doctor will use the drop-arm test to determine the success of surgery."
D) "Leave the shoulder immobilizer on for the first 4 days to minimize pain."

Question 10

A patient with a right lower leg fracture will be discharged home with an external fixation device in place.Which information will the nurse teach?

A) "You will need to check and clean the pin insertion sites daily."
B) "The external fixator can be removed for your bath or shower."
C) "You will need to remain on bed rest until bone healing is complete."
D) "Prophylactic antibiotics are used until the external fixator is removed."

Question 11

A 48-year-old patient with a comminuted fracture of the left femur has Buck's traction in place while waiting for surgery.To assess for pressure areas on the patient's back and sacral area and to provide skin care,the nurse should

A) loosen the traction and help the patient turn onto the unaffected side.
B) place a pillow between the patient's legs and turn gently to each side.
C) turn the patient partially to each side with the assistance of another nurse.
D) have the patient lift the buttocks by bending and pushing with the right leg.

Question 12

The nurse will instruct the patient with a fractured left radius that the cast will need to remain in place

A) for several months.
B) for at least 3 weeks.
C) until swelling of the wrist has resolved.
D) until x-rays show complete bony union.

Question 13

A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest.Which nursing assessment finding is important to report to the health care provider?

A) The patient states that the pelvis feels unstable.
B) Abdomen is distended and bowel sounds are absent.
C) There are ecchymoses across the abdomen and hips.
D) The patient complains of pelvic pain with palpation.

Question 14

Which statement by a 62-year-old patient who has had an above-the-knee amputation indicates that the nurse's discharge teaching has been effective?

A) "I should elevate my residual limb on a pillow 2 or 3 times a day."
B) "I should lay flat on my abdomen for 30 minutes 3 or 4 times a day."
C) "I should change the limb sock when it becomes soiled or each week."
D) "I should use lotion on the stump to prevent skin drying and cracking."

Question 15

Which discharge instruction will the emergency department nurse include for a patient with a sprained ankle?

A) Keep the ankle loosely wrapped with gauze.
B) Apply a heating pad to reduce muscle spasms.
C) Use pillows to elevate the ankle above the heart.
D) Gently move the ankle through the range of motion.

Question 16

When teaching seniors at a community recreation center,which information will the nurse include about ways to prevent fractures?

A) Tack down scatter rugs in the home.
B) Most falls happen outside the home.
C) Buy shoes that provide good support and are comfortable to wear.
D) Range-of-motion exercises should be taught by a physical therapist.

Question 17

A factory line worker has repetitive strain syndrome in the left elbow.The nurse will plan to teach the patient about

A) surgical options.
B) elbow injections.
C) wearing a left wrist splint.
D) modifying arm movements.

Question 18

A patient who is to have no weight bearing on the left leg is learning to walk using crutches.Which observation by the nurse indicates that the patient can safely ambulate independently?

A) The patient moves the right crutch with the right leg and then the left crutch with the left leg.
B) The patient advances the left leg and both crutches together and then advances the right leg.
C) The patient uses the bedside chair to assist in balance as needed when ambulating in the room.
D) The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.

Question 19

A patient who has had an open reduction and internal fixation (ORIF)of a hip fracture tells the nurse that he is ready to get out of bed for the first time.Which action should the nurse take?

A) Use a mechanical lift to transfer the patient from the bed to the chair.
B) Check the postoperative orders for the patient's weight-bearing status.
C) Avoid administration of pain medications before getting the patient up.
D) Delegate the transfer of the patient to nursing assistive personnel (NAP).

Question 20

Which statement by the patient indicates a good understanding of the nurse's teaching about a new short-arm plaster cast?

A) "I can get the cast wet as long as I dry it right away with a hair dryer."
B) "I should avoid moving my fingers and elbow until the cast is removed."
C) "I will apply an ice pack to the cast over the fracture site off and on for 24 hours."
D) "I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast."

Question 21

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

A) The patient uses crutches with a swing-to gait.
B) The patient leans over to pull shoes and socks on.
C) The patient sits straight up on the edge of the bed.
D) The patient bends over the sink while brushing teeth.

Question 22

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

A) Avoid extension of the right knee beyond 120 degrees.
B) Use a compression bandage to keep the right knee flexed.
C) Teach about the need to avoid weight bearing for 4 weeks.
D) Start progressive knee exercises to obtain 90-degree flexion.

Question 23

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

A) Encourage bed rest for 24 to 48 hours.
B) Avoid palpation or movement of the knee.
C) Apply a knee immobilizer to the affected leg.
D) Administer intravenous narcotics for pain relief.

Question 24

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?

A) Use surgical net dressing to hang the arm from an IV pole.
B) Immobilize the fingers of the left hand with gauze dressings.
C) Assess the left axilla and change absorbent dressings as needed.
D) Assist the patient in passive range of motion (ROM) for the right arm.

Question 25

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?

A) Ecchymosis of the left thigh
B) Complaints of severe thigh pain
C) Slow capillary refill of the left foot
D) Outward pointing toes on the left foot

Question 26

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?

A) Stay with the patient and offer reassurance.
B) Administer the prescribed PRN oxygen at 4 L/min.
C) Check the patient's legs for swelling or tenderness.
D) Notify the health care provider about the symptoms.

Question 27

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

A) elevate the right leg.
B) splint the lower leg.
C) check the pedal pulses.
D) verify tetanus immunizations.

Question 28

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

A) a knee immobilizer.
B) gentle knee flexion.
C) monitored anesthesia care.
D) physical activity restrictions.

Question 29

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?

A) Elevate the leg on 2 pillows.
B) Apply a compression bandage.
C) Check leg pulses and sensation.
D) Place ice packs on the lower leg.

Question 30

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

A) Reposition the patient every 1 to 2 hours.
B) Assess for skin irritation on the patient's back.
C) Teach the patient quadriceps-setting exercises.
D) Determine the patient's pain level and tolerance.

Question 31

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

A) place the patient in a prone position.
B) check the surgical site for hemorrhage.
C) remove the prosthesis and wrap the site.
D) keep the residual leg elevated on a pillow.

Question 32

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?

A) There is bruising at the shoulder area.
B) The patient reports arm and shoulder pain.
C) The right arm appears shorter than the left.
D) There is decreased shoulder range of motion.

Question 33

Before assisting a patient with ambulation 2 days after a total hip replacement,which action is most important for the nurse to take?

A) Observe the status of the incisional drain device.
B) Administer the ordered oral opioid pain medication.
C) Instruct the patient about the benefits of ambulation.
D) Change the hip dressing and document the wound appearance.

Question 34

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?

A) "I should not cross my legs while sitting."
B) "I will use a toilet elevator on the toilet seat."
C) "I will have someone else put on my shoes and socks."
D) "I can sleep in any position that is comfortable for me."

Question 35

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

A) activity intolerance related to deconditioning.
B) risk for constipation related to prolonged bed rest.
C) risk for impaired skin integrity related to immobility.
D) risk for infection related to disruption of skin integrity.

Question 36

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?

A) Take the patient to have x-rays.
B) Wrap the ankle and apply an ice pack.
C) Administer naproxen (Naprosyn) 500 mg PO.
D) Give acetaminophen with codeine (Tylenol #3).

Question 37

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

A) weakness in the right little finger.
B) tingling in the right thumb and fingers.
C) burning in the right elbow and forearm.
D) tremor when gripping with the right hand.

Question 38

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

A) Take the blood pressure.
B) Assess patient orientation.
C) Check the oxygen saturation.
D) Observe for facial asymmetry.

Question 39

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?

A) "This procedure will correct the deformities in my fingers."
B) "I will not have to do as many hand exercises after the surgery."
C) "I will be able to use my fingers with more flexibility to grasp things."
D) "My fingers will appear more normal in size and shape after this surgery."

Question 40

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?

A) Keep the left shoulder elevated on a pillow or cushion.
B) Keep the hand immobile to prevent soft tissue swelling.
C) Call the health care provider for increased swelling or numbness of the hand.
D) Avoid nonsteroidal antiinflammatory drugs (NSAIDs) for 24 hours after the injury.

Question 41

Which finding in a patient with a Colles' fracture of the left wrist is most important to communicate to the health care provider?

A) Swelling is noted around the wrist.
B) The patient is reporting severe pain.
C) The wrist has a deformed appearance.
D) Capillary refill to the fingers is prolonged.

Question 42

Based on the information shown in the accompanying figure and obtained for a patient in the emergency room,which action will the nurse take first?

A) Administer the prescribed morphine 4 mg IV.
B) Contact the operating room to schedule surgery.
C) Check the patient's oxygen saturation using pulse oximetry.
D) Ask the patient about the date of the last tetanus immunization.

Question 43

In which order will the nurse take these actions when caring for a patient in the emergency department with a right leg fracture after a motor vehicle accident? (Put a comma and a space between each answer choice [A,B,C,D,E,F].)

A) Obtain x-rays.
B) Check pedal pulses.
C) Assess lung sounds.
D) Take blood pressure.
E) Apply splint to the leg.
F) Administer tetanus prophylaxis.

Question 44

When a patient arrives in the emergency department with a facial fracture,which action will the nurse take first?

A) Assess for nasal bleeding and pain.
B) Apply ice to the face to reduce swelling.
C) Use a cervical collar to stabilize the spine.
D) Check the patient's alertness and orientation.

Question 45

After change-of-shift report,which patient should the nurse assess first?

A) Patient with a Colles' fracture who has right wrist swelling and deformity
B) Patient with a intracapsular left hip fracture whose leg is externally rotated
C) Patient with a repaired mandibular fracture who is complaining of facial pain
D) Patient with right femoral shaft fracture whose thigh is swollen and ecchymotic

Question 46

When caring for a patient who is using Buck's traction after a hip fracture,which action can the nurse delegate to unlicensed assistive personnel (UAP)?

A) Monitor the skin under the traction boot for redness.
B) Ensure that the weight for the traction is off the floor.
C) Check for intact sensation and movement in the affected leg.
D) Offer reassurance that hip and leg pain are normal after hip fracture.

Question 47

Which information obtained by the nurse about a 29-year-old patient with a lumbar vertebral compression fracture is most important to report to the health care provider?

A) Patient refuses to be turned due to back pain.
B) Patient has been incontinent of urine and stool.
C) Patient reports lumbar area tenderness to palpation.
D) Patient frequently uses oral corticosteroids to treat asthma.