Chapter 43- Brunner Flashcards
1.
A nurse admits a patient who has a fracture of the nose that has resulted in a skin tear and involvement of the mucous membranes of the nasal passages. The orthopedic nurse is aware that this description likely indicates which type of fracture?
A)
Compression
B)
Compound
C)
Impacted
D)
Transverse
Ans:
B
Feedback:
A compound fracture involves damage to the skin or mucous membranes and is also called an open fracture. A compression fracture involves compression of bone and is seen in vertebral fractures. An impacted fracture occurs when a bone fragment is driven into another bone fragment. A transverse fracture occurs straight across the bone shaft.
2.
A patient has sustained a long bone fracture and the nurse is preparing the patient’s care plan. Which of the following should the nurse include in the care plan?
A)
Administer vitamin D and calcium supplements as ordered.
B)
Monitor temperature and pulses of the affected extremity.
C)
Perform passive range of motion exercises as tolerated.
D)
Administer corticosteroids as ordered.
Ans:
B
Feedback:
The nurse should include monitoring for sufficient blood supply by assessing the color, temperature, and pulses of the affected extremity. Weight-bearing exercises are encouraged, but passive ROM exercises have the potential to cause pain and inhibit healing. Corticosteroids, vitamin D, and calcium are not normally administered.
3.
A nurse’s assessment of a patient’s knee reveals edema, tenderness, muscle spasms, and ecchymosis. The patient states that 2 days ago he ran 10 miles and now it really hurts to stand up. The nurse should plan care based on the belief that the patient has experienced what?
A)
A first-degree strain
B)
A second-degree strain
C)
A first-degree sprain
D)
A second-degree sprain
Ans:
B
Feedback:
A second-degree strain involves tearing of muscle fibers and is manifested by notable loss of load-bearing strength with accompanying edema, tenderness, muscle spasm, and ecchymosis. A first-degree strain reflects tearing of a few muscle fibers and is accompanied by minor edema, tenderness, and mild muscle spasm, without noticeable loss of function. However, this patient states a loss of function. A sprain normally involves twisting, which is inconsistent with the patient’s overuse injury.
4.
A nurse is preparing to discharge a patient from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage which of the following?
A)
Apply heat for the first 24 to 48 hours after the injury.
B)
Maintain the ankle in a dependent position.
C)
Exercise hourly by performing rotation exercises of the ankle.
D)
Keep an elastic compression bandage on the ankle.
Ans:
D
Feedback:
Treatment of a sprain consists of resting and elevating the affected part, applying cold, and using a compression bandage. After the acute inflammatory stage (usually 24 to 48 hours after injury), heat may be applied intermittently. Rotation exercises would likely be painful.
5.
A nurse is writing a care plan for a patient admitted to the emergency department (ED) with an open fracture. The nurse will assign priority to what nursing diagnosis for a patient with an open fracture of the radius?
A)
Risk for Infection
B)
Risk for Ineffective Role Performance
C)
Risk for Perioperative Positioning Injury
D)
Risk for Powerlessness
Ans:
A
Feedback:
The patient has a significant risk for osteomyelitis and tetanus due to the fact that the fracture is open. Powerlessness and ineffective role performance are psychosocial diagnoses that may or may not apply, and which would be superseded by immediate physiologic threats such as infection. Surgical positioning injury is not plausible, since surgery is not likely indicated.
6.
A nurse is caring for a patient who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the patient does which of the following in order to prevent common complications associated with a hip fracture?
A)
Avoid requesting analgesia unless pain becomes unbearable.
B)
Use supplementary oxygen when transferring or mobilizing.
C)
Increase fluid intake and perform prescribed foot exercises.
D)
Remain on bed rest for 14 days or until instructed by the orthopedic surgeon.
Ans:
C
Feedback:
Deep vein thrombosis (DVT) is among the most common complications related to a hip fracture. To prevent DVT, the nurse encourages intake of fluids and ankle and foot exercises. The patient should not be told to endure pain; a proactive approach to pain control should be adopted. While respiratory complications commonly include atelectasis and pneumonia, the use of deep-breathing exercises, changes in position at least every 2 hours, and the use of incentive spirometry help prevent the respiratory complications more than using supplementary oxygen. Bed rest may be indicated in the short term, but is not normally required for 14 days
7.
A nurse is caring for a patient who has suffered an unstable thoracolumbar fracture. Which of the following is the priority during nursing care?
A)
Preventing infection
B)
Maintaining spinal alignment
C)
Maximizing function
D)
Preventing increased intracranial pressure
Ans:
B
Feedback:
Patients with an unstable fracture must have their spine in alignment at all times in order to prevent neurologic damage. This is a greater threat, and higher priority, than promoting function and preventing infection, even though these are both valid considerations. Increased ICP is not a high risk.
8.
The patient scheduled for a Syme amputation is concerned about the ability to eventually stand on the amputated extremity. How should the nurse best respond to the patient’s concern?
A)
You will eventually be able to withstand full weight-bearing after the amputation.
B)
You will have minimal weight-bearing on this extremity but you’ll be taught how to use an assistive device.
C)
You likely will not be able to use this extremity but you will receive teaching on use of a wheelchair.
D)
You will be fitted for a prosthesis which may or may not allow you to walk.
Ans:
A
Feedback:
Syme amputation (modified ankle disarticulation amputation) is performed most frequently for extensive foot trauma and produces a painless, durable extremity end that can withstand full weight-bearing. Therefore, each of the other teaching statements is incorrect.
9.
A patient with a simple arm fracture is receiving discharge education from the nurse. What would the nurse instruct the patient to do?
A)
Elevate the affected extremity to shoulder level when at rest.
B)
Engage in exercises that strengthen the unaffected muscles.
C)
Apply topical anesthetics to accessible skin surfaces as needed.
D)
Avoid using analgesics so that further damage is not masked.
Ans:
B
Feedback:
The nurse will encourage the patient to engage in exercises that strengthen the unaffected muscles. Comfort measures may include appropriate use of analgesics and elevation of the affected extremity to the heart level. Topical anesthetics are not typically used.
10.
Six weeks after an above-the-knee amputation (AKA), a patient returns to the outpatient office for a routine postoperative checkup. During the nurse’s assessment, the patient reports symptoms of phantom pain. What should the nurse tell the patient to do to reduce the discomfort of the phantom pain?
A)
Apply intermittent hot compresses to the area of the amputation.
B)
Avoid activity until the pain subsides.
C)
Take opioid analgesics as ordered.
D)
Elevate the level of the amputation site.
Ans:
C
Feedback:
Opioid analgesics may be effective in relieving phantom pain. Heat, immobility, and elevation are not noted to relieve this form of pain.
11.
A nurse is caring for a patient who had a right below-the-knee amputation (BKA). The nurse recognizes the importance of implementing measures that focus on preventing flexion contracture of the hip and maintaining proper positioning. Which of the following measures will best achieve these goals?
A)
Encouraging the patient to turn from side to side and to assume a prone position
B)
Initiating ROM exercises of the hip and knee 10 to 12 weeks after the amputation
C)
Minimizing movement of the flexor muscles of the hip
D)
Encouraging the patient to sit in a chair for at least 8 hours a day
Ans:
A
Feedback:
The nurse encourages the patient to turn from side to side and to assume a prone position, if possible, to stretch the flexor muscles and to prevent flexion contracture of the hip. Postoperative ROM exercises are started early, because contracture deformities develop rapidly. ROM exercises include hip and knee exercises for patients with BKAs. The nurse also discourages sitting for prolonged periods of time.
12.
A nurse is preparing to discharge an emergency department patient who has been fitted with a sling to support her arm after a clavicle fracture. What should the nurse instruct the patient to do?
A)
Elevate the arm above the shoulder 3 to 4 times daily.
B)
Avoid moving the elbow, wrist, and fingers until bone remodeling is complete.
C)
Engage in active range of motion using the affected arm.
D)
Use the arm for light activities within the range of motion.
Ans:
D
Feedback:
A patient with a clavicle fracture may use a sling to support the arm and relieve the pain. The patient may be permitted to use the arm for light activities within the range of comfort. The patient should not elevate the arm above the shoulder level until the ends of the bones have united, but the nurse should encourage the patient to exercise the elbow, wrist, and fingers.
13.
The orthopedic nurse should assess for signs and symptoms of Volkmann’s contracture if a patient has fractured which of the following bones?
A)
Femur
B)
Humerus
C)
Radial head
D)
Clavicle
Ans:
B
Feedback:
The most serious complication of a supracondylar fracture of the humerus is Volkmann’s ischemic contracture, which results from antecubital swelling or damage to the brachial artery. This complication is specific to humeral fractures.
14.
An emergency department nurse is assessing a 17-year-old soccer player who presented with a knee injury. The patient’s description of the injury indicates that his knee was struck medially while his foot was on the ground. The nurse knows that the patient likely has experienced what injury?
A)
Lateral collateral ligament injury
B)
Medial collateral ligament injury
C)
Anterior cruciate ligament injury
D)
Posterior cruciate ligament injury
Ans:
A
Feedback:
When the knee is struck medially, damage may occur to the lateral collateral ligament. If the knee is struck laterally, damage may occur to the medial collateral ligament. The ACL and PCL are not typically injured in this way.
15.
A school nurse is assessing a student who was kicked in the shin during a soccer game. The area of the injury has become swollen and discolored. The triage nurse recognizes that the patient has likely sustained what?
A)
Sprain
B)
Strain
C)
Contusion
D)
Dislocation
Ans:
C
Feedback:
A contusion is a soft-tissue injury that results in bleeding into soft tissues, creating a hematoma and ecchymosis. A sprain is an injury to ligaments caused by wrenching or twisting. A strain is a muscle pull from overuse, overstretching, or excessive stress. A dislocation is a condition in which the articular surfaces of the bones forming a joint are no longer in anatomic contact. Because the injury is not at the site of a joint, the patient has not experienced a sprain, strain, or dislocation.
16.
Radiographs of a boy’s upper arm show that the humerus appears to be fractured on one side and slightly bent on the other. This diagnostic result suggests what type of fracture?
A)
Impacted
B)
Compound
C)
Compression
D)
Greenstick
Ans:
D
Feedback:
Greenstick fractures are an incomplete fracture that results in the bone being broken on one side, while the other side is bent. This is not characteristic of an impacted, compound, or compression fracture.
17.
A nurse is performing a shift assessment on an elderly patient who is recovering after surgery for a hip fracture. The nurse notes that the patient is complaining of chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the patient is febrile and hypoxic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this patient is likely demonstrating symptoms of what complication?
A)
Avascular necrosis of bone
B)
Compartment syndrome
C)
Fat embolism syndrome
D)
Complex regional pain syndrome
Ans:
C
Feedback:
Fat embolism syndrome occurs most frequently in young adults and elderly patients who experience fractures of the proximal femur (i.e., hip fracture). Presenting features of fat embolism syndrome include hypoxia, tachypnea, tachycardia, and pyrexia. The respiratory distress response includes tachypnea, dyspnea, wheezes, precordial chest pain, cough, large amounts of thick, white sputum, and tachycardia. Avascular necrosis (AVN) occurs when the bone loses its blood supply and dies. This does not cause coughing. Complex regional pain syndrome does not have cardiopulmonary involvement.
18.
A young patient is being treated for a femoral fracture suffered in a snowboarding accident. The nurse’s most recent assessment reveals that the patient is uncharacteristically confused. What diagnostic test should be performed on this patient?
A)
Electrolyte assessment
B)
Electrocardiogram
C)
Arterial blood gases
D)
Abdominal ultrasound
Ans:
C
Feedback:
Subtle personality changes, restlessness, irritability, or confusion in a patient who has sustained a fracture are indications for immediate arterial blood gas studies due to the possibility of fat embolism syndrome. This assessment finding does not indicate an immediate need for electrolyte levels, an ECG, or abdominal ultrasound.
19.
Which of the following is the most appropriate nursing intervention to facilitate healing in a patient who has suffered a hip fracture?
A)
Administer analgesics as required.
B)
Place a pillow between the patient’s legs when turning.
C)
Maintain prone positioning at all times.
D)
Encourage internal and external rotation of the affected leg.
Ans:
B
Feedback:
Placing a pillow between the patient’s legs when turning prevents adduction and supports the patient’s legs. Administering analgesics addresses pain but does not directly protect bone remodeling and promote healing. Rotation of the affected leg can cause dislocation and must be avoided. Prone positioning does not need to be maintained at all times.
20.
A nurse is planning the care of an older adult patient who will soon be discharged home after treatment for a fractured hip. In an effort to prevent future fractures, the nurse should encourage which of the following? Select all that apply.
A)
Regular bone density testing
B)
A high-calcium diet
C)
Use of falls prevention precautions
D)
Use of corticosteroids as ordered
E)
Weight-bearing exercise
Ans:
A, B, C, E
Feedback:
Health promotion measures after an older adult’s hip fracture include weight-bearing exercise, promotion of a healthy diet, falls prevention, and bone density testing. Corticosteroids have the potential to reduce bone density and increase the risk for fractures.
21.
A patient is brought to the emergency department by ambulance after stepping in a hole and falling. While assessing him the nurse notes that his right leg is shorter than his left leg; his right hip is noticeably deformed and he is in acute pain. Imaging does not reveal a fracture. Which of the following is the most plausible explanation for this patient’s signs and symptoms?
A)
Subluxated right hip
B)
Right hip contusion
C)
Hip strain
D)
Traumatic hip dislocation
Ans:
D
Feedback:
Signs and symptoms of a traumatic dislocation include acute pain, change in positioning of the joint, shortening of the extremity, deformity, and decreased mobility. A subluxation would cause moderate deformity, or possibly no deformity. A contusion or strain would not cause obvious deformities.
22.
An emergency department patient is diagnosed with a hip dislocation. The patient’s family is relieved that the patient has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse’s statement?
A)
The longer the joint is displaced, the more difficult it is to get it back in place.
B)
The patient’s pain will increase until the joint is realigned.
C)
Dislocation can become permanent if the process of bone remodeling begins.
D)
Avascular necrosis may develop at the site of the dislocation if it is not promptly resolved.
Ans:
D
Feedback:
If a dislocation or subluxation is not reduced immediately, avascular necrosis (AVN) may develop. Bone remodeling does not take place because a fracture has not occurred. Realignment does not become more difficult with time and pain would subside with time, not become worse.
23.
The surgical nurse is admitting a patient from postanesthetic recovery following the patient’s below-the-knee amputation. The nurse recognizes the patient’s high risk for postoperative hemorrhage and should keep which of the following at the bedside?
A)
A tourniquet
B)
A syringe preloaded with vitamin K
C)
A unit of packed red blood cells, placed on ice
D)
A dose of protamine sulfate
Ans:
A
Feedback:
Immediate postoperative bleeding may develop slowly or may take the form of massive hemorrhage resulting from a loosened suture. A large tourniquet should be in plain sight at the patient’s bedside so that, if severe bleeding occurs, it can be applied to the residual limb to control the hemorrhage. PRBCs cannot be kept at the bedside. Vitamin K and protamine sulfate are antidotes to warfarin and heparin, but are not administered to treat active postsurgical bleeding.
24.
An elite high school football player has been diagnosed with a shoulder dislocation. The patient has been treated and is eager to resume his role on his team, stating that he is not experiencing pain. What should the nurse emphasize during health education?
A)
The need to take analgesia regardless of the short-term absence of pain
B)
The importance of adhering to the prescribed treatment and rehabilitation regimen
C)
The fact that he has a permanently increased risk of future shoulder dislocations
D)
The importance of monitoring for intracapsular bleeding once he resumes playing
Ans:
B
Feedback:
Patients who have experienced sports-related injuries are often highly motivated to return to their previous level of activity. Adherence to restriction of activities and gradual resumption of activities needs to be reinforced. Appropriate analgesia use must be encouraged, but analgesia does not necessarily have to be taken in the absence of pain. If healing is complete, the patient does not likely have a greatly increased risk of reinjury. Dislocations rarely cause bleeding after the healing process.
