Ch. 75 Flashcards
Starting at the age of ____ men should discuss having a prostate specific antigen testing with their healthcare provider
50
Of all the malignancies, prostate cancer is one of the ______ growing and it metastases in a ______ pattern
Of all the malignancies, prostate cancer is one of the slowest growing and it metastise in a predictable pattern
Which groups of men are at the highest risk for prostate cancer?
- Men with a first degree relative with prostate cancer
2. African americans
Prostate specific antigen is a glycoprotein produced soley by the prostate. After treatment for prostate cancer, what does an elevated PSA level indicate?
Recurrence of the prostate cancer
A 49-year-old man is admitted with penile cancer. The nurse would expect to find which manifestations related to this condition?
- Wartlike growth on the penis
- Reddened lesion with plaques
- Ulcer under the glands under the prepuce
What are common tumor markers that confirm a diagnosis of testicular cancer?
- Lactate dehydrogenase
- Alpha fetoprotein
- Beta human chorionic gonadotropin
The nurses reviewing the laboratory results for a patient with metastasis of prostate cancer to the bone. Which elevated level does the nurse expect to see?
Serum alkaline phosphate
Which assessment tool is commonly used to ask patients about the fact of urinary symptoms on the quality of life?
International prostate symptoms score
A patient reports scrotal pain, edema, A heavy feeling in the testicle, dysuria, and discharge from the penis. These clinical manifestations are common to which two disorders?
Orchitis and epididymitis
An adult patient who had a prostatectomy earlier this morning has a Foley catheter. What type of urinary drainage does the nurse expect to see in this patient?
Light pink with small clots
The nurses teaching a patient diagnosed with erectile dysfunction about the common treatments and therapies. What topics as a nurse include?
- Phosphodiesterace 5 ( PDE5) inhibitors
- Intraurethral application
- Anticholinergics
- Penile injection
Which statement about testicular cancer is true?
Elevated alpha-fetoprotein level is used as a tumor marker for testicular cancer
During the first 24 hours after a prostatectomy, what is the priority assessment in the nursing care plan?
Hemorrhage
Which type of surgery is used to treat BPH while leaving no incision?
Transurethral resection
The patient is diagnosed with prostatitis. Which intervention does the nurse used to alleviate the discomfort associated with this condition?
Comfort measures such as sitz bath for pain
What is spermatocele
It usually requires no intervention unless the patient reports discomfort
Organic erectile dysfunction
Gradual deterioration of function
Varicocele
Palpation reveals a wormlike mass
Cryptochordism
Undescended testes with increased risk for testicular cancer
Penectomy
Increased risk of suicide after this procedure
Circumcision
If not done at birth, require strict personal hygiene to clean the prepuce
Phimosis
Constricted prepuce cannot be contracted over the glands
Scrotal support
Promotes drainage and comfort after surgery
Priapism
Uncontrolled, long maintained penile erection without sexual desire
Orchitis
Acute testicular inflammation
Inflammation of the prostate can be the result of which conditions?
Psychosexual problem, sexually-transmitted disease, viral or bacterial infection
The patient was testicular cancer is likely to have which common problem?
Azoospermia
Which condition as a result from a disorder in the lymphatic drainage of the scrotum, causing a mess around the testes?
Hydrocele
The patient has BPH. Based on the medical diagnosis, with what does the nurse prepared to assist the patient?
Urinary stasis or retention
Nurses interviewing a patient to determine the presence of lower urinary tract symptoms associated with BPH. What does the nurse question the patient about?
- Difficulty and starting and continuing urination
- Reduced force and size of urinary stream
- Postvoid dribbling
- Nocturia
- Sensation of incomplete bladder empty
The nurse is preparing to asses an obese patient who reports subjective symptoms and urinary patterns associated with BPH. Which technique does the nurse use to perform he physical assessment ?
Instructed patient to void and then use the bedside ultrasound bladder scanner
The practice nurses preparing to examine the patient’s prostate gland. Before the exam, what does the nurse tell the patient?
The gland will be massaged to obtain a fluid sample for possible prostatitis
The nurses reviewing the lab results from a patient being elevated for L UTS. What does an elevated PSA level and serum acid phosphate level in this patient indicate?
Prostate cancer
The patient has an enlarged prostate. Which procedure is used to test for bladder instruction?
Urodynamic pressure flow study
Patient is being treated for both BPH and hypertension. Which alpha blocker does the nurse anticipate will be prescribed for the patient?
Doxazosin (cardura)
The nurse is designing a teaching plan for patient with an enlarged prostate and obstructive symptoms. What does the nurse teach the patient to avoid?
Diuretics
Thermotherpay
Several noninvasive techniques to destroy excess prostate tissue using heating that
Transurethral needle ablation
Low radiofrequency energy shrinks the prostate
Transurethral microwave therapy
High temperatures heat and destroy excess tissue
Interstitial laser coagulation
Laser energy coagulates excess tissue
Electrovaporization
High-frequency electrical currents Cuts and vaporizes excess tissue
Patients with which condition meet the criteria for having a transurethral resection of the prostate?
- Acute urinary retention and hematuria
- Hydronephrosis
- Chronic urinary tract infection
The patient is undergoing large volume bladder irrigation. During and after the procedure the nurse observes the patient for confusion, muscle weakness, and increased gastrointestinal motility related to which potentially adverse effect of large volume irrigation?
Hyponatremia
A patient has had a TURP with a three-way urinary catheter taped to the left leg. Which position does the nurse instructed patient to maintain for the left leg?
Straight
An older adult patient has had a TURP at 8 AM. At 3 PM the nurse assesses the patient. Which finding does the nurse report to the physician?
Patient keeps moving and burgundy colored output is noted
The nurse Notes bright red blood with the numerous clots on the patient has had a TURP. After notifying the surgeon, what does the nurse do next?
Irrigate the catheter with normal saline
The nurse is giving discharge instructions to a patient who had a TURP What does the nurse including the instructions?
Reassurance a loss of control of urination or dribbling of urine is temporary
Based on the American Cancer Society recommendations, what does the nurse teach a patient about screening for prostate cancer?
Men with multiple first-degree young relatives with prostate cancer at an early age should begin screening at age 40
The nurses teaching a patient at risk for prostate cancer about food sources of omega-3 fatty acids. Which food does the nurse suggest
Fish
What sign or symptom is considered a late sign of prostate cancer question
Hematuria
Older patient is scheduled for an annual physical including a PSA and a digital rectal examination. How are these two test scheduled for the patient?
PSA is drawn before the DRE
The nurses reviewing PSA results for a patient who had a prostatectomy for prostate cancer several weeks ago. The PS a level is 40 MG/Ml. How Should the nurse interpret this data?
Cancer is most likely recurring
The patient had a transrectal ultrasound with biopsy. After this procedure what does the nurse instructed patient to do?
- Report fever, chills, bloody urine, and any difficulty voiding
- Avoid strenuous physical activity
- expect a small amount of bleeding that makes the urine turn pink
An older adult patients wife is very upset because my husband was just told that he had prostate cancer. He feels fine now, but the doctor told him to watch and wait. Why are we just watching? What are we watching for? What is the nurses best response?
Prostate cancer is very slow growing. Your husband will be scheduled for regular DRE and PSA testing and I will make you a list of symptoms to watch for
The nurses caring for a patient who had an open radical prostatectomy. During the assessment, the nurse notes at the penis and scrotum are swollen. What does the nurse to next?
Elevate the scrotum and penis, apply ice to the area, 20 minutes on 20 minutes off
Nurses teaching a patient who had an open radical prostatectomy about how to manage the common potential long-term complications. What does the nurse teach the patient?
How to perform kegel perennial exercises
The patient has undergone external beam radiation therapy for palliative treatment prostate cancer with suggestions of the nursemaid to help patient manage the cystitis radiation cystis secondary to ER BT?
Avoid intake of coffee, colas, & Tea
The patient is receiving internal radiation therapy or Breaky therapy and has had a low-dose radiation seed implanted directly into the prostate gland. What nursing implications related to this therapy?
Teach the patient that fatigue is common but should pass after several months
The patient is prescribed that LHRH agonist Lupron for treatment of a prostate tumor. What possible side effect of this medication does the nurse advised the patient about?
Erectile dysfunction
The patient reports having uncomfortable and unsettling episodes of hot flashes after receiving hormonal therapy for prostate tumor. To alleviate the symptoms, which prescription medication does the nurse assisted patient in obtaining?
Hormonal inhibitor drugs such as megestrol acetate (megace)
The nurses teaching a patient about self-care following a radical prostatectomy. What does the nurse including the health teaching?
- Teach how to care for the indwelling catheter and manifestations of infection
- Walk short distances
- Maintain an upright position and do not walk band or flexed
- Shower rather than soaking a bathtub for the first 2 to 3 weeks
Patient reports having erectile dysfunction is seeking a prescription for Viagra. Because of the potential for dangerous drug drug interactions the nurse asked the patient specifically if he takes which type of drug?
Nitrates
The nurses performing a testicular exam on a young Caucasian patient. The practitioner find a lump, which the patient reports is painless. This finding is considered the most common manifestation of which disease or disorder?
Testicular cancer
The nurses performing an assessment on a patient with organic erectile dysfunction. What are possible causes of this condition?
- Hypertension
- Thyroid disorder
- Diabetes mellitus
Young Patient has been diagnosed with testicular cancer. He has life been trying to conceive a child for several months. What information does the nurse give the couple about sperm storage?
Arrangements for sperm storage should be made as soon as possible after diagnosis
The nurses caring for a patient who had minimally invasive surgery for testicular cancer. The nurses also caring for the patient had an open radical retroperitoneal lymph node dissection for Testicular cancer. The nurse anticipates at the second patient has more of a risk for what condition?
Paralytic ileus
The nurses teaching a patient who had an open retroperitoneal lymph node dissection. What instruction does the nurse give to the patient?
- Do not drive a car for several weeks
- Notify the surgeon of chills, fever, or increasing tenderness or pain around the incision site
- Resume usual activities within one week after discharge, except for lifting
- Perform monthly testicular self-examination on the remaining testi
- Have follow-up diagnostic testing for at least three years after surgery
Yesterday a patient underwent a surgical removal of a Hydrocele with the drain inserted. Because the clinic for advice because he is unable to remember the discharge instructions. The nurse advises him to come into the clinic if he experiences which sign or symptom?
Malodorous and purulent drainage
The nurse teaches patients with benign prosthetic hyperplasia to follow which instructions?
- Avoid diuretics
- Avoid antihistamines
- Avoid caffeine
- Avoid drinking large amounts of fluid in a short time
The nurses caring for middle-age patient who had a total penectomy. Which behavior by the patient is strongest indicator that he needs referral for psychological assistance!
Starting to plan a hunting trip in a remote area
The nurses giving instructions to the UAP about hygienic care for an older patients who is uncircumcised. What does the nurse instruct the UAP to do?
Replace the foreskin over the penis after bathing
Which medical conditions can be associated with Priapism?
Leukemia, sickle cell disease, diabetes mellitus, malignancies
The patient comes in the emergency department reporting fever, chills, dysuria, urethral discharge, and a boggy, tender prostate. On exam there is a urethral discharge the shows wbc’s what does nurses fact in this patient?
Acute bacterial prostatitis
The nurses teaching a patient who is taking finasteride, five alpha reductase inhibitor. Which side effect of the nurse told the patient may be experiencing?
- Erectile dysfunction
- Dizziness
- Decreased libido
What are common sites of metastasis for prostate cancer?
- Bones of the pelvis
- Liver
- Lungs
Client admitted to the hospital with a tentative diagnosis of urinary retention related to benign prosthetic hyperplasia. There is a secondary diagnosis of delirium related to urosepsis. The healthcare provider prescribes the insertion of an indwelling urinary retention catheter. What nursing action is most important for this client safety?
Determine if any unsafe behavior patterns exist
….. Assessment is the first step in the nursing process
A nurses caring for a client with a diagnosis of cancer of the prostate. Which certain level should the nurse teach the client to have monitored to follow the course of the disease?
Prostate specific antigen
A nurses caring for a client with a diagnosis of benign prostatic hyperplasia. Which information about this condition is important for the nurse to consider when caring for this client?
It predisposes to hydronephrosis, inability to empty the bladder as a result of pressure exerted by the enlarging prostate on the urethra causes a backup of urine into the ureter and finally the kidneys
A client with cancer of the prostate request to your no at frequent intervals but either does not void or voids in very small amounts. What does the nurse conclude is most likely the causative factor?
Retention, an enlarged prostate constricts the urethra, interfering with urine flow and causing retention. When the bladder fills and approaches capacity, smallmouth can be voided, but the bladder never empties completely.
Which nursing action can best prevent infection from urinary retention catheter ?
Cleansing around the meatus routinely
A nurses caring for a client with the continuous bladder irrigation. Which is the most important nursing action?
Subtracting irrigant from output to determine urine volume
The client had a super pubic prostatectomy returns from the postanesthesia care unit and accidentally pulls out the urethral catheter. What should the nurse do first?
Notify the healthcare provider because the catheter must be reinserted by the healthcare provider to ensure bladder empty
The client had a super pubic prostatectomy. Which type of tubing can the nurse expect the client to have with the returns to his room from the postanesthesia care unit?
Cystostomy, postoperatively the client has a suprapubic cystostomy tube to instill a GU irrigant to dilute the urine and Limit clot formation, as well as an indwelling catheter under tension to limit bleeding
A nurses caring for a client with an indwelling urinary catheter. What is the most important action for the nurse to implement when irrigating the Bladder?
Measure the contents of the bedside drainage bag
When should the nurse due to obtain an accurate urine output for a client with a continuous bladder irrigation?
Subtract the volume of irrigant from the total drainage
Which is most important for the nurse to do when providing care to a client who is had a transurethral resection of the prostate?
Ensure patency of the indwelling catheter
What percentage of patients who had a hip fracture die within a year?
Between 25-40%
Intracapsular VS. Extracapsular
Intracapsular: within the joint capsule capsule
-Subcapital, Basilar neck fractures
Risk of avascular necrosis due to interruption of blood supply
Usually caused by osteoporosis/fall/elderly
Extracapsular: outside the joint capsule
Can be Intertrochanteric ( between lesser and greater trochanter)
Can be Subtrochanteric (below lesser trochanter)
Usually caused by traumatic injury
What is the biggest risk for hip fractures?
Osteoporosis
True or False
After a hip repair older adults frequently experience acute confusion, or delirium
True
What is a normal healing time for a femur fracture?
6 months or longer
How are most knee cap fractures caused?
Direct impact
What are some complications of hip fractures?
- Blood clots in your legs or lungs
- Bedsores
- Urinary tract infection
- Pneumonia
What are the most common fractured ribs?
Numbers 4-8
Because the pelvis is very vascular and is close to major organs and blood vessels, associated _______ is the major focus in fracture management
Internal damage
What are most vertebral fractures associated with?
- Osteoporosis
- Metastatic bone cancer
- Multiple myeloma
What are some causes of joint degeneration?
- Rheumatoid arthritis
- Degenerative joint disease or osteoarthritis
- Avascular necrosis of femoral neck fractures
What is the % of amputations of males between 15-30
80%
Are phantom limb pain and stump pain the same thing?
No….
True or False
Most amputations are elective
True, most are elective and are related to complications of peripheral vascular disease and arteriosclerosis
What is the primary cause of upper extremity amputation?
Traumatic amputations from accidents
True or false
lower extremity amputations are performed much more frequently than upper extremity amputations
true
What is the Syme amputation?
Most of the foot is removed but the ankle remains
True or False
Fewer than 10% of all amputations are upper extremity amputation
True
What are the most common complications of elective or traumatic amputations?
- Hemorrhage
- Infection
- Phantom limb pain
- Neuroma
- Flexion contractures
What is a Neuroma?
A sensitive tumor consisting of damaged nerve cells- forms most often in amputations of the upper extremities
How often should a limb be wrapped?
3 times a day
A middle-aged male patient has a tight cast on his left lower leg. An early assessment variable requiring further evaluation for compartment syndrome would be:
Pain more intense than that of the injury itself
The patient with a history of osteoporosis is at high risk for developing what type of fracture?
Compression
The nurse is concerned that a client who had an open reduction, internal fixation of his tibia and fibula is at risk for complex regional pain syndrome. What assessment findings at the affected area are common when a client has this complication? Select all that apply.
C. Muscle spasms
D. Skin discoloration
E. Paresis
F. Edema
The nurse plans to refer a client with an amputation and the client’s family to which community resource?
Amputee Coalition of America (ACA)
The client with a fracture asks the nurse about the difference between a compound fracture and a simple fracture. Which statement by the nurse is correct?
“Compound fracture, grade I, involves minimal skin damage.”
Which typical clinical manifestation does the nurse expect to observe for a client with a right tibial fracture?
A. Crepitation of extremity
A priority question to ask an older female with a long bone fracture would be:
“Are you taking estrogen supplements?”
A possible outcome for a patient who experienced a crush injury of his lower extremity may be:
Rhabdomyolysis
The best diagnostic test to determine musculoskeletal and soft tissue damage is:
Magnetic resonance imaging (MRI)
The nurses neighbor comes running over because her husband cut his finger off with a power saw. After calling for help what is the priority action when the nurse gets to the neighbors house?
Assess for airway or breathing problems
An excited group of teenagers brings a friend to the ED who severed a finger while playing sports. The bleeding from the site is well controlled and the patient is alert and stable. What does the nurse do with the severed finger?
Wrap it in dry gauze, place it in a water proof bag, and place the bag in ice water
Which nursing intervention is best to prevent increased pain in a patient experiencing phantom limb pain?
handle the residual limb carefully when assessing the site or changing the dressing
The nurse is caring for a patient with an above-the-knee amputation (AKA). In order to prevent hip flexion contractures, how does the nurse position the patient
prone position every 3 to 4 hours for 20 to 30 minute periods
The nurse applies bandages to a patient’s residual limb in order to help shape and shrink the limb for a prosthesis. What is the proper technique for the nurse to use?
D. use a figure-eight wrapping method to prevent restriction of blood flow
involves the use of a fabric fastener boot (Buck’s) belt, or halter, which is secured around a body part
skin traction
pins, wires, tongs, or screw surgically inserted directly into bone
skeletal traction
The nurse is caring for a patient with open reduction and internal fixation (ORIF) for a hip fracture. Because the patient is at risk for hip dislocation, the nurse ensures that the hip is maintained in which position?
C. abduction
A patient reports dramatic changes in color and temperature of the skin over the left foot with intense burning pain, sensitive skin, excessive sweating, and edema. The physician makes a preliminary medical diagnosis of complex regional pain syndrome. What is the priority for nursing care?
C. management of pain
A patient arrives in the ED reporting pain and immobility of the right shoulder. The patient reports a history of recurrent dislocation of the same shoulder. The nurse observes for which other signs and symptoms that are associated with a dislocation injury? SELECT ALL THAT APPLY
A. alteration in contour of the joint
B. deviation in length of the extremity
E. rotation of the extremity
Which description is true about sprains? SELECT ALL THAT APPLY
A. they involve an injury to a ligament
B. second and third degree sprains require immobilization
E. surgical repair is required for second and third degree sprains
Which statements are true about dislocations? SELECT ALL THAT APPLY
B. dislocation of a joint occurs when two bones are moved away from each other
C. partial dislocation of a joint is referred to as “subluxed”
D. a health care provider performs closed reduction on dislocated joints
What is Subluxation
partial joint surface separation
A client with a history of seizures is placed on seizure precautions. What emergency equipment with the nurse provide at the bedside? Select All That Apply. A. Padded tongue blade B. Oxygen setup C. NG tube D. Suction setup E. Artificial oral airway
B. Oxygen setup
D. Suction setup
E. Artificial oral airway
A young patient had a big toe amputated because of injury. The patient is depressed and withdrawn after the physician tells him that the amputation will affect balance and gait. What is the nurses best response?
When the doctor was explaining things, what were you thinking about?
Which factor carries the greatest risk for hip fracture?
Osteoporosis
An older adult patient has skin traction in place for a hip fracture. What is the main purpose for this type of traction?
It decreases painful muscle spasms
3. A patient is admitted to the unit in traction for a fractured proximal femur. What is the most appropriate type of traction to apply to a fractured proximal femur? A) Russell's traction B) Dunlop's traction C) Buck's extension traction D) Cervical head halter
BUCK’S EXTENSION TRACTION
**Buck’s extension is used for fractures of the proximal femur. Dunlop’s traction is applied to the upper extremity for supracondylar fractures of the elbow and humerus. Russell’s is used for lower leg fractures. Cervical head halters are used to treat back pain.
- The nurse is caring for a patient who is in skeletal traction. To prevent the complication of skin breakdown in a patient with skeletal traction, what preventive measures would the nurse implement?
ASSESS THE PIN INSERTION SITE EVERY 8 HRS
**The pin insertion site should be assessed every 8 hours for inflammation and infection. The patient should be encouraged to use the overhead trapeze to shift weight for repositioning. Ankle and calf exercises should be done 10 times an hour while awake.
You are caring for a patient who has had a right hip replacement. What should the nurse follow when caring for a patient who has just had hip replacement surgery?
KEEP THE HIPS IN ABDUCTION
**The hips should be kept in abduction by an abductor pillow. Hips should not be flexed more than 90 degrees, and the head of bed should not be elevated more than 60 degrees. The patient’s hips should be higher than the knees; as such, high seat chairs should be used.
While assessing a patient who has had knee replacement surgery, the nurse notes that the patient has developed a hematoma at the knee replacement surgical site. The affected leg has a decreased pedal pulse. What would be the most appropriate nursing diagnosis for this patient?
RISK OF PERIPHERAL NEUROVASCULAR DYSFUNCTION
**The hematoma may cause an interruption of tissue perfusion, so the most appropriate nursing diagnosis is Risk of peripheral neurovascular dysfunction.
A patient was brought to the emergency department after a fall. The patient is taken to the operating room to receive a right hip prosthesis. In the immediate postoperative period, what should the nurse do?
MAINTAIN THE LEG IN AN ABDUCTED POSITION
**After receiving a hip prosthesis, the affected leg should be kept abducted
A patient with a fractured femur is in balanced suspension traction. The patient needs to be repositioned toward the head of the bed. During repositioning, what should the nurse do?
MAINTAIN THE SAME DEGREE OF TRACTION TENSION
**Traction is used to reduce the fracture and must be maintained at all times, including during repositioning.
A patient who underwent a total hip replacement is being routinely turned. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?
PREVENT INTERNAL ROTAITON OF THE AFFECTED LEG
**External rotation and abduction of the hip helps to prevent dislocation of a new hip joint. Internal rotation and adduction should be avoided.
- What statement about skeletal traction is most accurate?
A) Traction weight is increased as muscles relax.
B) Often balanced traction is used.
C) Skeletal traction is used until the fracture is healed.
D) Pins are attached to the muscle of the affected limb.
OFTEN BALANCED TRACTION IS USED
**Balanced traction is often used with skeletal traction. As the muscles relax, the amount of weight is decreased, pins are inserted through the bone, and skeletal traction is discontinued when callus formation is evident by radiograph.
- A nurse is admitting an 83-year-old female patient who arrives at the emergency department by ambulance after falling on the ice outside her senior citizens’ housing facility. The admitting diagnosis is right hip fracture. What would be most important for the nurse to assess?
NEUROVASCULAR COMPROMISE
**Because impaired circulation can cause permanent damage, neurovascular assessment of the affected leg is always a priority assessment. Leg shortening and internal or external rotation are common findings with a fractured hip. Pain, especially on movement, is also common after a hip fracture.
A patient is scheduled for a total knee replacement. The surgeon explains the technique of creating a “bloodless” field for the surgery to the patient. What does this entail?
USE OF A PNEUMATIC TOURNIQUET
**Blood is conserved during surgery to minimize loss. During orthopedic surgery on a limb (eg, total knee replacement [TKR]), a pneumatic tourniquet may be applied to produce a “bloodless field.” This technique has the advantages of keeping the surgical field dry, minimizing blood loss, and providing some additional limb anesthesia.
You are working with a student nurse to set up traction on a patient with Buck’s traction. How often do you need to assess circulation to the affected leg?
WITHIN 30 MINUTES THEN EVERY 1-2 HOURS
**After skin traction is applied, the nurse assesses circulation of the foot or hand within 15 to 30 minutes and then every 1 to 2 hours
What does plantar flexion demonstrate?
FUNCTION OF THE TIBIAL NERVE
You are caring for a patient in skeletal traction. What do you caution the patient about to prevent bony fragments from moving against one another?
TURNING SIDE TO SIDE
**To prevent bony fragments from moving against one another, the patient should not turn from side to side; however, the patient may shift position slightly with assistance.
A patient has been in skeletal traction for 3 weeks. The nurse caring for the patient knows to assess what every 4 to 8 hours? A) Bladder B) Respiratory status C) Neurovascular status D) Skin
RESPIRATORY STATUS
**The nurse auscultates the patient’s lungs every 4 to 8 hours to assess respiratory status and teaches the patient deep-breathing and coughing exercises to aid in fully expanding the lungs and clearing pulmonary secretions
A patient is admitted to the same day surgery unti following a meniscetomy. What does postop care for this patient include?
- Perform neurovascular checks every hour for the first few hours and then every 4 hours
- Check the surgical dressing for bleeding
- Monitor vital signs
- Teach about signs and symptoms of infection
Following a meniscetomy, the nurse assists a patient to immediately start performing which exercises?
Straight leg raises on both legs
A patient arrives in the ED reporting pain and immobility of the right shoulder. The patient reports a history of recurrent dislocations of the same shoulder. The nurse observes for which other signs and symptoms that are associated with a dislocation injury?
- Alteration in the contour of the joint
- Deviation in length of the extremity
- Rotation of the extremity
Which descriptions are true about sprains?
- They involve an injury to a ligament
- Second and third degree sprains require immobilizations
- Sprains are usually precipitated by twisting motions from a sports injury
Which statements are true about dislocations?
- Dislocation of a joint occurs when two bones are moved away from each other
- Partial dislocation of a joint is referred to as subluxed
- A health care provider performs closed reductions on dislocated joints
True or False
The lateral meniscus is more likely to tear than the medial meniscus
False, the medial meniscus is more likely to tear
True or false
When the anterior cruciate ligament (ACL) is torn, the person may feel a snap
True
True or false
Complete healing of knee ligaments after surgery only takes 3-4 weeks
False, 6-9 months or longer
True or false
Rupture of the Achilles’ tendon is common in older adults
False, mostly in athletes who practice strenous events
True or false
A strain is excessive stretching of a ligament
False, a starin is excessive stretching of a muscle or tendon
True or false
Management of a strain usually involves cold and heat application
True
True or false
Patients with a torn rotator cuff have shoulder pain and cannot initiate or maintain adduction of the arm at the shoulder
False, cannot maintain abduction
A patient is informed by the physician that he must have a plaster cast applied. What does the nurse teach the patient before its applied?
The cast material will feel hot at first, but will quickly become cool
The nurse is caring for a patient with a plaster splint applied to the ankle. The patient received oral pain meds at 0900. At 1100, the patient reports that the pain is getting worse, not better. What is the nurses priority action?
Assess the pulses and skin temp distal to the splint
Which factors affect bone healing after a fracture has occured?
- Patients age
- Type of bone injured
- How the fracture is managed
- Presence of infection
The nurse is providing teaching for a patient with a forearm cast. What information does the nurse give to the patient?
The sling should distribute the weight over a large area of the shoulders and trunk
The nurse and nursing student are assisting a patient with a new hip spica cast to transfer from the stretcher to the bed. What does the nurse advise the student to do?
Handle the cast with the flat palmar surface of the hand
Partial joint surface separation is what?
Subluxation
Injury to ligament
Sprain
Joint surfaces are not approximated…
Dislocation
Excessive stretching of muscle or tendon
Strain
A patient with a lower extremity injury is being treated by external fixation. What nursing assessment is of particular concern in the care of this patient with this type of system?
Observing the points of entry of pins and wires
A patient with a long leg cast was applied in the ED is being admitted to the orthopedic unit. Which task is best for the nurse to delegate to the UAP?
Obtain a fracture pan and use caution to prevent spillage on the cast
A patient in a body cast reports nausea, vomitting, and epigastric pain. THe nurse notifies the physicians orders. Which intervention is the most conservative, and therefore the first thing to try to address the patients symptoms?
Cut a window over the abdominal area over the cast
The nurse is caring for a patient who had kyphoplasty. What does postop care for this patient include?
- monitor and record vital signs
- Perform frequent neuo assesment
- Assese the patient pain level and compare it to the preoperative level
- monitor for bleeding at the puncture site
How much drainage should you expect after a hip fracture?
Anticipate 500 ml in the first 24 hours, the drainage device is usually removed by the second postop day when drainage decreases to 30 ml
A client experiences a traumatic amputation of a leg in a motor vehicle accident. Which nursing intervention intially should recieve the lowest priority?
Teaching residual limb care
A client has an amputation of a lower limb. What instructions should the nurse give the client to prevent a hip flexion contracture?
Lie on the abdomen 30 minutes four times daily
What should the nurse do to control edema of the residual limb one week after a client has an above the knee amputation?
Rewrap the elastic bandage as necessary
What should be included in the nurses interventions to help a client prepare for walking with crutches?
Exercises with or without weights to strengthen the muscles of the upper extremities
What should the nurse do to promote early and efficient ambulation after a client has a midthigh amputation?
Turn the client to the prone position routinely
A client has a total hip replacement. Which clinical indicators of pulmonary embolism indicate that the plan to prevent postop thrombus formation has been ineffective?
- Unilateral chest pain
2. Sudden onset of shortness of breath
What instructions should the nurse provide when the client is allowed out of bed after an above the knee amputation?
Keep the hip in extension and alignment
A client has a total knee replacement and a continuous passive motion device is being used. The nurse concludes that the teaching was effective when the client states , the goal of this therapy is to…..
Improve joint flexion
When should the nurse begin the process of rehabilitation when a client is scheduled for an amputation?
Before the surgery
After an above the knee amputation of a leg, a client reports pain in the foot that is no longer there. What should the nurse include about phantom limb pain?
Nerve endings in the limb are still intact and react to stimuli
Which crutch gait should the nurse teach th client wearing a prosthesis after a single leg amputation?
Four point
Which principles should the nurse consider when assisting a client with crutches to learn the four point gait?
The client must be able to bear weight on both legs
A client in skin traction while waiting surgery for repair of a fractured femur. The client reports leg discomfort and asks the nurse to release the traction. Which is the nurses best initial response?
I cant because the weights are needed to keep the bone aligned
A client with a fractured hip is placed in traction until surgery can be performed. What should the nurse explain is the purpose of traction?
Relieve muscle spasms and pain
A client is admitted with a fracture of the neck of the femur. In what position should the nurse maintain the clients affected extremity?
Internal rotation with extension of the knee and hip
The care plan for a client with a fractured hip includes nursing actions to prevent which type of contracture?
Flexion of the hip
To reduce a hip fracture, the client is placed in traction before surgery for an open reduction and internal fixaion. Because the client keeps slipping down in bed, increased countertraction is ordered. How does the nurse increase countertraction?
Use a slight trendelenburg position
Which position should a nurse avoid placing a client who had surgery for a total hip replacement?
Orthopneic
A nurse is caring for a client who had a total hip replacement. What nursing action should be incorporated into the plan of care to prevent thrombus formation?
Encouraging the client to perform ankle exercises
Nursing care of a client with a fractured hip should include the assessment of pedal pulses. The nurse should assess which important characteristic of pedal pulses?
Amplitude and symmetry
What should a a total hip replacement patient avoid?
Crossing the legs
Sitting in low chair
A nurse is caring for a patient with a below the knee amputation. What should the nurse encourage the client to do to prepare the residual limb for prosthesis.
Press the end of the residual limb into a pillow periodically
The nurse is caring for a client with a fracture of the head of the femur. The health care provider places the patient in a Buck extension. What explanation does the nurse give the client for why the traction is being used?
To reduce muscle spasms
A client has a total hip arthroplasty. What should the nurse do when caring for this client after surgery?
Use a pillow to keep the legs abducted
A nurse is caring for a client who had an open reduction internal fixation of a fractured hip. Which nursing assessment of the affected leg is most important after this surgery?
Toes for mobility,
What client history places a woman at highest risk for developing endometrial (uterine) cancer?
Nulliparity, smokinbg, uterine polyps, hypertension
A client has gynecologic cancer. Which client statement demonstrates correct understanding of treatment options?
External beam radiation therapy may be used after my cancer surgery
Which lab tests would the nurse expect to see for a client with suspected uterine cancer?
- Alpha fetaprotein
- CA 125 test
- HCG test
- Hereditary nonpolyposis colon cancer
The client with BPH is being discharged with alpha adrenergic blockers. Which info is most important to include when teaching the client?
- Avoid drugs used to treat erection problems
- Be careful when changing positions
- Keep all appointments for follow up lab tests
