Chapter 32 Flashcards
A patient has come to the ambulatory care clinic with a sprain. The nurse correctly differentiates a grade 2 sprain from a grade 3 sprain with the assessment of which finding?
a. Pain
b. Swelling
c. Bleeding into the joint
d. Minor loss of function
ANS: D
The minor loss of function is the differentiating factor. Pain, swelling, and bleeding into the joint are true of both grade 2 and grade 3 sprains. A grade 3 sprain has loss of function of the joint.
An older adult has fallen and sprained his ankle in a local park. Which action should the responder perform first?
a. Elevate the foot.
b. Apply ice.
c. Administer aspirin.
d. Assist the patient with ambulation.
ANS: A
Elevation to reduce swelling is the most important initial intervention. Elevation may be done immediately. The responder will have to acquire the ice and pain medication, but should do so as quickly as possible. The responder should not attempt to ambulate the patient at this time
When the clinic nurse starts to take the “air cast” off the grade 2 sprain, the patient asks why it is being removed since he still has pain. Which explanation is best?
a. “Long-term immobilization can interfere with adequate circulation.”
b. “Long-term immobilization may increase long-term edema.”
c. “Long-term immobilization can cause permanent disability.”
d. “This cast will be replaced with a heavier cast.”
ANS: C
Air casts, braces, or supports are used only until a joint has been strengthened. If a joint is immobilized too long and muscles are not exercised, muscle atrophy—which begins in a matter of days—can cause permanent disability
Which statement indicates that the patient needs further instruction about application of ice to a sprain?
a. “I know this ice will reduce the swelling.”
b. “I will keep the ice on this knee for the rest of the day.”
c. “I will use the ice as you have directed for 24 hours.”
d. “I can elevate my leg and use ice to reduce swelling.”
ANS: B
Ice should be applied for 20 minutes of each hour for the first 24 hours.
The industrial nurse examines an employee who complains of right shoulder pain on abduction. He points with one finger to the exact location of the pain and mentions that he won a racquetball tournament yesterday. The nurse suspects the employee is suffering from which problem?
a. Rotator cuff tear
b. Bursitis
c. Dislocation
d. Subluxation
ANS: B
Bursitis occurs after overuse, with pain in the joint on activity with no erythema and little, if any, swelling. Dislocations are very painful and the pain is spread all over the shoulder. The shoulder also looks misshapen in a dislocation. Rotator cuff tear would prevent the patient from abducting his shoulder.
The nurse is caring for a patient who works as a legal secretary. The patient asks the nurse about ways to avoid developing carpal tunnel syndrome (CTS). Which action should the nurse suggest?
a. “Exercise your wrists with repetitive flexion movements nightly.”
b. “Wrap your wrists with elastic bandages.”
c. “Acquire a pad to support your wrists while typing.”
d. “Apply warm compresses to wrists every evening.”
ANS: C
Elevating the wrist with a firm support eliminates the need to keep the wrists flexed for long periods of time. This wrist support will help prevent CTS. Repetitive motion increases risk for carpal tunnel. Wrapping the wrists or applying warm compresses do not lessen risk of developing carpal tunnel.
Carpal tunnel syndrome (CTS) is caused when the carpal tunnel compresses which location?
a. Radial artery
b. Brachial artery
c. Median nerve
d. Ulnar nerve
ANS: C
When the median nerve is compressed by the carpal tunnel to the point that numbness, pain, and tingling occur, the result is CTS.
Which vitamin is essential in treating osteoporosis?
a. Vitamin A
b. Vitamin D
c. Vitamin B12
d. Vitamin C
ANS: B
Standard treatments for osteoporosis include vitamin D and calcium supplementation, along NURSINGTB.COM with weight-bearing exercise. Vitamins A, B12 , and C are not included in the standard treatment regimen for osteoporosis.
The nurse is caring for a patient who just returned from surgical decompression of the carpal tunnel. Which finding requires the nurse’s immediate action?
a. The patient’s fingers swollen and warm.
b. The patient complains of generalized pain 5/10.
c. The capillary refill time is 8 seconds.
d. The patient’s fingers are pink and cool bilaterally.
ANS: C
A capillary refill of over 5 seconds is an indication of diminished perfusion. Pain and swelling are to be expected, and pink but cool fingers bilaterally do not indicate circulatory compromise.
An 80-year-old man falls and suffers a compound fracture of the femur. Which immediate action is most appropriate?
a. Position him flat on his back.
b. Apply a tourniquet on the leg.
c. Carefully splint the leg as it is.
d. Carefully straighten the leg.
ANS: C
Any fracture, even a compound one, should be immobilized in position to avoid further injury to the soft tissue attached to the bones. Any other initial action may cause further injury
Which major advantage is specific to external fixation devices?
a. Faster healing time
b. Allowance for immediate weight bearing
c. Greater freedom of movement
d. Pain reduction
ANS: C
The external device for fracture reduction allows greater freedom of movement, decreasing the problems of immobility. Healing time and pain are the same as with any other fracture reduction method.
The patient in a long arm cast (from below the shoulder to the wrist, with a 90-degree elbow flexion) complains of a burning sensation over the elbow. The nurse’s initial intervention should be:
a. Elevate the casted arm on pillows.
b. Check to see if the cast is properly supported.
c. Notify the charge nurse of developing pressure ulcer.
d. Cut a “window” in the cast.
ANS: B
The initial intervention should be to assess for adequate support to the cast, then elevate the limb for 30 minutes. If the pain has not diminished, document the intervention and notify the charge nurse.
The nurse is performing an assessment on the patient who is in bilateral Buck traction. Which finding indicates the need to reposition the patient?
a. The patient’s heels are not touching the surface of the mattress.
b. The elastic bandages need to be rewrapped.
c. The patient’s feet are against the footboard.
d. The weights are hanging free.
ANS: C
When the patient’s feet are against the footboard, the traction is ineffective. The heels should be off the surface of the mattress to reduce the threat of pressure ulcer. The weights should be hanging free.
A patient in Russell traction with a Pearson attachment for a fracture of the tibia complains of intense pain at the fracture site. The nurse assesses a temperature of 102° F and increased swelling at the fracture site. Which complication do these findings suggest?
a. Osteomyelitis
b. Fat embolism
c. Traction misalignment
d. Nonunion of the fracture
ANS: A
Osteomyelitis is a bacterial infection of the bone. The causative organism is most often Staphylococcus aureus, which enters the bloodstream from a distant focus of infection, such as a boil or furuncle, or from an open wound, as in an open (compound) fracture. It is usually NURSINGTB.COM found in the tibia or fibula, in vertebrae, or at the site of a prosthesis. Osteomyelitis has a sudden onset with severe pain and marked tenderness at the site, high fever with chills, swelling of adjacent soft parts, headache, and malaise. These findings are not consistent with fat embolisms, traction misalignment, or nonunion of the fracture.
The nurse is performing morning care for a patient who sustained a fractured pelvis and bilateral femur fractures yesterday in a motorcycle collision. The patient complains of shortness of breath. Assessment reveals audible wheezes and oxygen saturation of 76%. What action should the nurse take first?
a. Establish a peripheral intravenous (IV) line.
b. Inform the charge nurse.
c. Explain the patient’s change in status to his family.
d. Raise patient to high Fowler position.
ANS: D
Fat embolism is a rare but serious complication of a fracture of a bone that has an abundance of marrow fat (e.g., the long bones, pelvis, and ribs). In the early postinjury period, patients with multiple fractures resulting from severe trauma are at risk for this complication. Signs and symptoms of fat embolism include a change in mental status, respiratory distress, tachypnea, crackles and wheezes on auscultating the lungs, rapid pulse, fever, and petechiae (a fine red rash over the chest, neck, upper arms, or abdomen). The nurse should stay with the patient; put him in a high Fowler position, use a nonre-breather mask to give high-flow oxygen, and establish a peripheral IV line. The nurse should also summon the provider immediately as there is about an 80% mortality rate from this complication. Raising the patient to high Fowler position is the best initial intervention as it can be done immediately. The nurse should then verify patent IV access, notify the charge nurse and provider, and update the family on the patient’s status change.
