ch29 book Flashcards
- The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complication should the nurse monitor related to the child’s immobilization status?
a. Metabolic rate increases
b. Increased joint mobility leading to contractures
c. Bone calcium increases, releasing excess calcium into the body (hypercalcemia)
d. Venous stasis leading to thrombi or emboli formation
ANS: D
The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. Loss of joint mobility leads to contractures. Bone demineralization with osteoporosis and hypercalcemia occur with immobilization.
DIF: Cognitive Level: Apply REF: p. 944
The nurse is caring for a preschool child immobilized by a spica cast. Which effect on metabolism should the nurse monitor on this child related to the immobilized status?
a. Hypocalcemia
b. Decreased metabolic rate
c. Positive nitrogen balance
d. Increased production of stress hormones
ANS: B
Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake. Immobilization leads to hypercalcemia and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity.
DIF: Cognitive Level: Understand REF: p. 944
The nurse should monitor for which effect on the cardiovascular system when a child is immobilized?
a. Venous stasis
b. Increased vasopressor mechanism
c. Normal distribution of blood volume
d. Increased efficiency of orthostatic neurovascular reflexes
ANS: A
The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, hypotension, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes with an inability to adapt readily to the upright position and with pooling of blood in the extremities in the upright position.
DIF: Cognitive Level: Understand REF: p. 944
Which can result from the bone demineralization associated with immobility?
a. Osteoporosis
b. Urinary retention
c. Pooling of blood
d. Susceptibility to infection
ANS: A
Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Urinary retention is secondary to the effect of immobilization on the urinary tract. Pooling of blood is a result of the cardiovascular effects of immobilization. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems.
DIF: Cognitive Level: Understand REF: p. 944
A young girl has just injured her ankle at school. In addition to calling the child’s parents, what is the most appropriate immediate action by the school nurse?
a. Apply ice.
b. Observe for edema and discoloration.
c. Encourage child to assume a position of comfort.
d. Obtain parental permission for administration of acetaminophen or aspirin.
ANS: A
Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. Observing for edema and discoloration, encouraging the child to assume a position of comfort, and obtaining parental permission for administration of acetaminophen or aspirin are not immediate priorities. The application of ice can reduce the severity of the injury.
DIF: Cognitive Level: Apply REF: p. 947
Which term is used to describe a type of fracture that does not produce a break in the skin?
a. Simple
b. Compound
c. Complicated
d. Comminuted
If a fracture does not produce a break in the skin, it is called a simple, or closed, fracture. A compound, or open, fracture is one with an open wound through which the bone protrudes. A complicated fracture is one in which the bone fragments damage other organs or tissues. A comminuted fracture occurs when small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue. These are rare in children.
DIF: Cognitive Level: Understand REF: p. 948
Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement?
a. Healing is usually delayed in this type of fracture.
b. Growth can be affected by this type of fracture.
c. This is an unusual fracture site in young children.
d. This type of fracture is inconsistent with a fall.
ANS: B
Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected. Healing of epiphyseal injuries is usually prompt. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma.
DIF: Cognitive Level: Apply REF: p. 949
The nurse is conducting a staff in-service on casts. Which is an advantage to using a fiberglass cast instead of a plaster of Paris cast?
a. Cheaper
b. Dries rapidly
c. Molds closely to body parts
d. Smooth exterior
A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast, which takes 10 to 72 hours to dry. Synthetic casts are more expensive and have a rough exterior, which may scratch surfaces. Plaster casts mold closer to body parts.
DIF: Cognitive Level: Apply REF: p. 952
The nurse is conducting teaching to parents of a 7-year-old child who fractured an arm and is being discharged with a cast. Which instruction should be included in the teaching?
a. Swelling of the fingers is to be expected for the next 48 hours.
b. Immobilize the shoulder to decrease pain in the arm.
c. Allow the affected limb to hang down for 1 hour each day.
d. Elevate casted arm when resting and when sitting up.
ANS: D
The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours. Joints above and below the cast on the affected extremity should be moved. The affected limb should not hang down for any length of time.
DIF: Cognitive Level: Apply REF: p. 952
The nurse uses the palms of the hands when handling a wet cast for which reason?
a. To assess dryness of the cast
b. To facilitate easy turning
c. To keep the patient’s limb balanced
d. To avoid indenting the cast
ANS: D
Wet casts should be handled by the palms of the hands, not the fingers, to avoid creating pressure points. Assessing dryness, facilitating easy turning, and keeping the patient’s limb balanced are not reasons for using the palms of the hand rather than the fingers when handling a wet cast.
DIF: Cognitive Level: Understand REF: p. 952
- Which should cause a nurse to suspect that an infection has developed under a cast?
a. Complaint of paresthesia
b. Cold toes
c. Increased respirations
d. “Hot spots” felt on cast surface
If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site. The five Ps of ischemia from a vascular injury are pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may be indicative of a respiratory tract infection or pulmonary emboli. This should be reported, and child should be evaluated.
DIF: Cognitive Level: Analyze REF: p. 952
A child is upset because when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. Which should the nurse suggest to remove this material?
a. Soak in a bathtub.
b. Vigorously scrub leg.
c. Apply powder to absorb material.
d. Carefully pick material off leg.
ANS: A
Simple soaking in the bathtub is usually sufficient for the removal of the desquamated skin and sebaceous secretions. It may take several days to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.
DIF: Cognitive Level: Apply REF: p. 953
An adolescent with a fractured femur is in Russell’s traction. Surgical intervention to correct the fracture is scheduled for the morning. Nursing actions should include which action?
a. Maintaining continuous traction until 1 hour before the scheduled surgery
b. Maintaining continuous traction and checking position of traction frequently
c. Releasing traction every hour to perform skin care
d. Releasing traction once every 8 hours to check circulation
ANS: B
When the muscles are stretched, muscle spasm ceases and permits realignment of the bone ends. The continued maintenance of traction is important during this phase because releasing the traction allows the muscle’s normal contracting ability to again cause malpositioning of the bone ends. Continuous traction must be maintained to keep the bone ends in satisfactory realignment. Releasing at any time, either 1 hour before surgery, once every hour for skin care, or once every 8 hours would not keep the fracture in satisfactory alignment.
DIF: Cognitive Level: Apply REF: p. 955
Which is a type of skin traction with the legs in an extended position?
a. Dunlop
b. Bryant
c. Russell
d. Buck extension
ANS: D
Buck extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease. Dunlop traction is an upper-extremity traction used for fractures of the humerus. Bryant traction is skin traction with the legs flexed at a 90-degree angle at the hip. Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position.
DIF: Cognitive Level: Understand REF: p. 955
Which type of traction uses skin traction on the lower leg and a padded sling under the knee?
a. Dunlop
b. Bryant
c. Russell
d. Buck extension
ANS: C
Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position. Dunlop traction is an upper-extremity traction used for fractures of the humerus. Bryant traction is skin traction with the legs flexed at a 90-degree angle at the hip. Buck extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease.
DIF: Cognitive Level: Understand REF: p. 955
