Chapter 63- Lewis Flashcards
- 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.
ANS: C
Comfortable shoes with good support will help decrease the risk for falls. Scatter rugs should be eliminated, not just tacked down. Activities of daily living provide range of motion exercise; these do not need to be taught by a physical therapist. Falls inside the home are responsible for many injuries.
- 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.
ANS: D
Treatment for repetitive strain syndrome includes changing the ergonomics of the activity. Elbow injections and surgery are not initial options for this type of injury. A wrist splint might be used for hand or wrist pain.
- 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.
ANS: A
Repetitive strain injuries caused by prolonged times working at a keyboard can be prevented by the use of a pad that will keep the wrists in a straight position. Stretching exercises during the day may be helpful, but these would not be needed before starting. Use of a compression bandage is not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are appropriate to use to decrease swelling.
- 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.
ANS: C
Elevation of the leg will reduce the amount of swelling and pain. Compression bandages are used to decrease swelling. For the first 24 to 48 hours, cold packs are used to reduce swelling. The ankle should be rested and kept immobile to prevent further swelling or injury.
- 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.”
ANS: B
Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent “frozen shoulder.” A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of range of motion (ROM). The drop-arm test is used to test for rotator cuff injury, but not after surgery. The patient may be able to return to pitching after rehabilitation.
- 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.
g.
ANS: B
Bone healing starts immediately after the injury, but since ossification does not begin until 3 weeks postinjury, the cast will need to be worn for at least 3 weeks. Complete union may take up to a year. Resolution of swelling does not indicate bone healin
- 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.
ANS: D
The patient can lift the buttocks off the bed by using the left leg without changing the right-leg alignment. Turning the patient will tend to move the leg out of alignment. Disconnecting the traction will interrupt the weight needed to immobilize and align the fracture.
- 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.
ANS: B
Assessment of bowel sounds, abdominal pain, and nausea and vomiting will detect the development of cast syndrome. To avoid breakage, the support bar should not be used for repositioning. After the cast dries, the patient can begin ambulating with the assistance of physical therapy personnel and may be turned to the prone position.
- 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.
ANS: B
Until a plaster cast has dried, using the palms rather than the fingertips to handle the cast helps prevent creating protrusions inside the cast that could place pressure on the skin. The left arm should be elevated to prevent swelling. The edges of the cast may be petaled once the cast is dry, but padding the edges before that may cause the cast to be misshapen. The cast should not be covered until it is dry because heat builds up during drying.
- 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.”
ANS: C
Ice application for the first 24 hours after a fracture will help reduce swelling and can be placed over the cast. Plaster casts should not get wet. The patient should be encouraged to move the joints above and below the cast. Patients should not insert objects inside the cast.
- 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.
ANS: B
Patients are usually taught to move the crutches and the injured leg forward at the same time and then to move the unaffected leg. Patients are discouraged from using furniture to assist with ambulation. The patient is taught to place weight on the hands, not in the axilla, to avoid nerve damage. If the 2- or 4-point gaits are to be used, the crutch and leg on opposite sides move forward, not the crutch and same-side leg.
- 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.
ANS: A
The patient’s clinical manifestations suggest compartment syndrome and delay in diagnosis and treatment may lead to severe functional impairment. The data do not suggest problems with blood pressure or infection. Elevation of the leg will decrease arterial flow and further reduce perfusion.
- 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.
ANS: B
The abdominal distention and absent bowel sounds may be due to complications of pelvic fractures such as paralytic ileus or hemorrhage or trauma to the bladder, urethra, or colon. Pelvic instability, abdominal pain with palpation, and abdominal bruising would be expected with this type of injury.
- 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.
ANS: B
Buck’s traction keeps the leg immobilized and reduces painful muscle spasm. Hip contractures and dislocation are unlikely to occur in this situation. The peripheral pulses will be assessed, but this does not help in evaluating the effectiveness of Buck’s traction.
- 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.”
ANS: A
Pin insertion sites should be cleaned daily to decrease the risk for infection at the site. An external fixator allows the patient to be out of bed and avoid the risks of prolonged immobility. The device is surgically placed and is not removed until the bone is stable. Prophylactic antibiotics are not routinely given when an external fixator is used.
- 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).
ANS: B
The nurse should be familiar with the weight-bearing orders for the patient before attempting the transfer. Mechanical lifts are not typically needed after this surgery. Pain medications should be given because the movement is likely to be painful for the patient. The registered nurse (RN) should supervise the patient during the initial transfer to evaluate how well the patient is able to accomplish this skill.
- 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.
ANS: B
The jaw will be wired for stabilization, and the patient should know what emergency situations require that the wires be cut to protect the airway. There are no dressing changes for this procedure. The diet is liquid, and patients are not able to chew high-fiber foods. Initially, the patient may receive nasogastric tube feedings, but by discharge, the patient will swallow liquid through a straw.
- 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 isbest?
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.”
ANS: C
The initial nursing action should be to assess the patient’s knowledge level and feelings about the options available. Discussion about the patient’s option to not have the procedure, the seriousness of the condition, or rehabilitation after the procedure may be appropriate after the nurse knows more about the patient’s current level of knowledge and emotional state.
