Lewis Chapter 65: Trauma and Ortho TEST BANK

Question 1

The nurse is counselling a patient about ways to prevent fractures. Which of the following
information should the nurse include?

a. Tack down throw 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

Answer 1

ANS: C
Comfortable shoes with good support will help decrease the risk for falls. Throw 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.

Question 2

The nurse is caring for a patient in the emergency department with repetitive strain injury to the left elbow as result of his employment as a checkout clerk in the grocery store. Which of the following treatment options should the nurse include in the teaching plan?

a. Surgical options
b. Elbow injections
c. Utilization of a left wrist splint
d. Modifications in arm movement

Answer 2

ANS: D
Treatment for a repetitive strain injury 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.

Question 3

The nurse is providing health-promotion teaching to a patient whose job involves many hours of word processing. Which of the following actions should the nurse include in the patient teaching plan?

a. Do stretching and warm-up exercises before starting work.
b. Wrap the wrists with a compression bandage every morning.
c. Use acetaminophen instead of nonsteroidal anti-inflammatory drugs (NSAIDs) for
wrist pain.
d. Obtain a keyboard pad to support the wrist while word processing.

Answer 3

ANS: D
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.

Question 4

The nurse is preparing a patient for discharge from the emergency department with a sprained wrist. Which of the following information should the nurse include?

a. Keep the wrist loosely wrapped with gauze.
b. Apply a heating pad to reduce muscle spasms.
c. Use pillows to elevate the arm above the heart.
d. Gently move the wrist through the range of motion.

Answer 4

ANS: C
Elevation of the arm will reduce the amount of swelling and pain. Compression bandages are
used to decrease swelling. For the first 24–48 hours, cold packs are used to reduce swelling.
The wrist should be rested and kept immobile to prevent further swelling or injury.

Question 5

The nurse is caring for a patient who is a baseball pitcher and had an arthroscopic repair of a rotator cuff injury performed in same-day surgery. Which of the following information should be included in the patient’s postoperative teaching plan?

a. “You have an appointment with a physical therapist for tomorrow.”
b. “You can still play baseball but you will not be able to return to pitching.”
c. “The doctor will use the drop-arm test to determine the success of surgery.”
d. “Leave the shoulder immobilizer on for the first few days to minimize pain.”

Answer 5

ANS: A
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

Question 6

The nurse is caring for a patient who has a cast in place after fracturing the radius and the
patient asks when the cast can be removed. Which of the following information related to the length of time that the cast will need to remain in place should the nurse tell the patient?

a. Several months
b. At least 3 weeks
c. Until swelling of the wrist has resolved
d. Until x-rays show complete bony union

Answer 6

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 healing

Question 7

The nurse is caring for a patient who has a comminuted fracture of the right femur and has
Buck’s traction in place while waiting for surgery. Which of the following actions should the nurse implement to assess for pressure areas on the patient’s back and sacral area and to provide skin care?

a. Loosen the traction and have 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 left leg.

Answer 7

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.

Question 8

The nurse is caring for a patient with a left femur fracture who has a hip spica cast applied.
Which of the following nursing interventions should be included in the plan of care?

a. Avoid placing the patient in the prone position.
b. Use the cast support bar to reposition the patient.
c. Ask the patient about any abdominal discomfort or nausea.
d. Discuss the reasons for remaining on bed rest for several weeks.

Answer 8

ANS: C
Assessment of bowel tones, 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.

Question 9

The nurse is caring for a patient who has a long-arm plaster cast applied for immobilization of a fractured left radius. Which of the following actions should the nurse implement until the
cast has completely dried?

a. Keep the left arm in a dependent position.
b. Handle the cast with the palms of the hands.
c. Place gauze around the cast edge to pad any roughness.
d. Cover the cast with a small blanket to absorb the dampness.

Answer 9

ANS: B
Until a plaster cast has dried, placing pressure on the cast should be avoided to prevent
creating areas inside the cast that could place pressure on the arm. The left arm should be
elevated to prevent swelling. The edges of the cast may be petalled 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.

Question 10

The nurse is providing discharge teaching to a patient who has a short-arm plaster cast
applied. Which of the following patient statements indicate a good understanding of the discharge teaching?

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 for the next 24 hours.”
d. “I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast.”

Answer 10

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.

Question 11

The nurse is evaluating the crutch-walking technique of a patient who is to have no weight
bearing on the right leg. Which of the following observations indicates that the patient can
safely ambulate independently?

a. The patient keeps the padded area of the crutch firmly in the axillary area when
ambulating.
b. The patient advances the right leg and both crutches together and then advances
the left leg.
c. The patient moves the left crutch with the left leg and then the right crutch with the
right leg.
d. The patient uses the bedside chair to assist in balance as needed when ambulating
in the room.

Answer 11

ANS: B
When using crutches, patients are usually taught to move the assistive device 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

Question 12

The nurse is caring for a patient who has had an open reduction and internal fixation (ORIF)
of left lower leg fractures who indicates constant severe pain in the leg which is unrelieved by the prescribed morphine. Pulses are faintly palpable and the foot is cool. Which of the following actions 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.

Answer 12

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.

Question 13

The nurse is caring for a patient who is on bed rest after having a complex pelvic fracture.
Which of the following assessment findings is most important to report to the health care
provider?

a. The patient states that the pelvis feels unstable.
b. Abdominal distention is present and bowel tones are absent.
c. There are ecchymoses on the abdomen and hips.
d. The patient complains of pelvic pain with palpation.

Answer 13

ANS: B
The abdominal distention and absent bowel tones 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.

Question 14

The nurse is caring for a patient with Buck’s traction who had an intracapsular fracture of the left femur. Which of the following actions should the nurse take to evaluate the effectiveness of Buck’s traction?

a. Assess for hip contractures.
b. Monitor for hip dislocation.
c. Check the peripheral pulses.
d. Ask about left hip pain level.

Answer 14

ANS: D
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.

Question 15

The nurse is preparing a patient with lower leg fracture and an external fixation device in
place for discharge. Which of the following information should the nurse include in the
discharge teaching?

a. “You will need to assess and clean the pin insertion sites daily.”
b. “The external fixator can be removed during the 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.”

Answer 15

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.

Question 16

The nurse is preparing to assist a patient who has had an open reduction and internal fixation
(ORIF) of a hip fracture out of bed for the first time. Which of the following actions should
the nurse take first?

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 out of bed to an unregulated care provider
(UCP).

Answer 16

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, since the movement is likely to be painful for the patient. The RN should
supervise the patient during the initial transfer to evaluate how well the patient is able to
accomplish this skill.

Question 17

The nurse is planning discharge teaching for a patient who has had a repair of a fractured
mandible. Which of the following information will the nurse include in the teaching plan?

a. When and how to cut the immobilizing wires
b. Self-administration of nasogastric tube feedings
c. The use of sterile technique for dressing changes
d. The importance of including high-fibre foods in the diet

Answer 17

ANS: A
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 fibre foods. Initially, the patient may receive nasogastric tube feedings, but by discharge the patient will swallow liquid through a straw

Question 18

After the health care provider has recommended an amputation for a patient who has ischemic foot ulcers, the patient tells the nurse, “If they want to cut off my foot, they should just shoot me instead.” Which of the following responses by the nurse is best?

a. “Many people are able to function normally with a foot prosthesis.”
b. “I understand that you are upset, but you may lose the foot anyway.”
c. “Tell me what you know about what your options for treatment are.”
d. “If you do not want the surgery, you do not have to have an amputation.”

Answer 18

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.

Question 19

The nurse is caring for a patient who is 1 day postoperative below-the-knee amputation who
indicates pain in the amputated limb. Which of the following actions is best for the nurse to
take?

a. Explain the reasons for the phantom limb pain.
b. Administer prescribed analgesics to relieve the pain.
c. Loosen the compression bandage to decrease incisional pressure.
d. Remind the patient that this phantom pain will diminish over time

Answer 19

ANS: B
Phantom limb pain is treated like any other type of postoperative pain would be treated.
Explanations of the reason for the pain may be given, but the nurse should still medicate the
patient. The compression bandage is left in place except during physical therapy or bathing.
Although the pain may decrease over time, it still requires treatment now.

Question 20

The nurse is preparing a patient who had an above-the-knee amputation for discharge. Which of the following patient statements indicates that the nurse’s discharge teaching has been effective?

a. “I should lay on my abdomen for 30 minutes three or four times a day.”
b. “I should elevate my residual limb on a pillow two or three times a day.”
c. “I should change the limb sock when it becomes soiled or stretched out.”
d. “I should use lotion on the stump to prevent drying and cracking of the skin.”

Answer 20

ANS: A
The patient lies in the prone position several times daily to prevent flexion contractures of the
hip. The limb sock should be changed daily. Lotion should not be used on the stump. The
residual limb should not be elevated because this would encourage flexion contracture

Question 21

The nurse is preparing a patient for discharge 4 days after insertion of a femoral head
prosthesis using a posterior approach. Which of the following patient statements indicate a
need for additional discharge instructions?

a. “I should not cross my legs while sitting.”
b. “I will use a toilet elevator on the toilet seat.”
c. “I will have someone else put on my shoes and socks.”
d. “I can sleep in any position that is comfortable for me.”

Answer 21

ANS: D
The patient needs to sleep in a position that prevents excessive internal rotation or flexion of
the hip. The other patient statements indicate that the patient has understood the teaching

Question 22

Which of the following nursing actions should the nurse include in the plan of care for a
patient who has had a total knee arthroplasty?

a. Avoid extension of the knee beyond 120 degrees.
b. Use a compression bandage to keep the knee flexed.
c. Start progressive knee exercises to obtain 90-degree flexion.
d. Teach about the need to avoid weight bearing for 4 weeks.

Answer 22

ANS: C
After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree
flexion of the knee. The goal for extension of the knee will be 180 degrees. A compression
bandage is used to hold the knee in an extended position after surgery. Full weight bearing is
expected before discharge

Question 23

The nurse is caring for a patient with ulnar drift caused by rheumatoid arthritis (RA) who is
scheduled for an arthroplasty of the hand. Which of the following patient statements indicate realistic expectation for the surgery?

a. “I will be able to use my fingers to grasp objects better.”
b. “I will not have to do as many hand exercises after the surgery.”
c. “This procedure will prevent further deformity in my hands and fingers.”
d. “My fingers will appear more normal in size and shape after this surgery.”

Answer 23

ANS: A
The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process. Hand exercises will be prescribed after the surgery.

Question 24

The nurse is providing home care instructions to a patient who has multiple forearm fractures
and a long-arm cast on the right arm. Which of the following information should the nurse
include in the teaching plan?

a. Keep the hand immobile to prevent soft tissue swelling.
b. Keep the right shoulder elevated on a pillow or cushion.
c. Avoid the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for the first 48
hours after the injury.
d. Call the health care provider for increased swelling or numbness.

Answer 24

ANS: D
Increased swelling or numbness may indicate increased pressure at the injury, and the health
care provider should be notified immediately to avoid damage to nerves and other tissues. The
patient should be encouraged to move the joints above and below the cast to avoid stiffness.
There is no need to elevate the shoulder, although the forearm should be elevated to reduce swelling. NSAIDs are appropriate to treat pain after a fracture.

Question 25

The nurse is admitting a patient who has a proximal humerus fracture that is immobilized with a left-sided long-arm cast and has a sling. Which of the following nursing interventions will
be included in the plan of care?

a. Use surgical net dressing to hang the arm from an IV pole.
b. Immobilize the fingers on the left hand with gauze dressings.
c. Assess the left axilla and change absorbent dressings as needed.
d. Assist the patient in passive range of motion (ROM) for the right arm.

Answer 25

ANS: C
The axilla can become excoriated when a sling is used to support the arm, and the nurse
should check the axilla and apply absorbent dressings to prevent this. A patient with a sling
would not have traction applied by hanging. The patient will be encouraged to move the
fingers on the injured arm to maintain function and to help decrease swelling. The patient will
do active ROM on the uninjured side.

Question 26

The nurse is caring for a patient who had hip replacement surgery using the posterior
approach. Which of the following patient actions require rapid intervention by the nurse?

a. The patient uses crutches with a swing-to gait.
b. The patient leans over to pull shoes and socks on.
c. The patient sits straight up on the edge of the bed.
d. The patient bends over the sink while brushing the teeth.

Answer 26

ANS: B
Leaning over would flex the hip at greater than 90 degrees and predispose the patient to hip
dislocation. The other patient actions are appropriate and do not require any immediate action by the nurse to protect the patient.

Question 27

The nurse is caring for a patient who has been hospitalized for 3 days with a hip fracture who
has sudden onset shortness of breath and tachypnea. The patient tells the nurse, “I feel like I am going to die!” Which of the following actions should the nurse take first?

a. Stay with the patient and offer reassurance.
b. Administer the prescribed PRN oxygen at 4 L/minute.
c. Check the patient’s legs for swelling or tenderness.
d. Notify the health care provider about the symptoms.

Answer 27

ANS: B
The patient’s clinical manifestations and history are consistent with a fat embolus, and the
nurse’s first action should be to ensure adequate oxygenation. The nurse should offer
reassurance to the patient, but meeting the physiological need for oxygen is a higher priority. The health care provider should be notified after the oxygen is started and pulse oximetry and assessment for fat embolus or venous thrombo-embolism (VTE) are obtained.

Question 28

The nurse is admitting a patient to the emergency department after falling on the right arm and shoulder. Which of the following findings is most important for the nurse to communicate to the health care provider immediately?

a. There is bruising at the shoulder area.
b. The right arm appears shorter than the left.
c. There is decreased range of motion of the shoulder.
d. The patient is complaining of arm and shoulder pain.

Answer 28

ANS: B
A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency.
Bruising, pain, and decreased range of motion also should be reported, but these do not
indicate that emergent treatment is needed to preserve function.

Question 29

The nurse is caring for a patient who arrives in the emergency department with ankle swelling
and severe pain after twisting the ankle playing soccer. Which of the following prescribed
collaborative interventions will the nurse implement first?

a. Wrap the ankle and apply an ice pack.
b. Administer naproxen 500 mg PO.
c. Give acetaminophen with codeine.
d. Take the patient to the radiology department for x-rays.

Answer 29

ANS: A
Immediate care after a sprain or strain injury includes the application of cold and compression to the injury to minimize swelling. The other actions should be taken after the ankle is wrapped with a compression bandage and ice is applied.

Question 30

The nurse is caring for a patient in the emergency department who has a soft tissue injury and an open leg fracture. Which of the following actions should the nurse implement first?

a. If dislocation, apply compression bandage
b. Realignment of the bone(s)
c. Administer tetanus with an open fracture
d. Apply heat to the affected area

Answer 30

ANS: C
An initial action in the emergency treatment of soft tissue injuries is to administer tetanus if
there is evidence of an open fracture. If dislocation is suspected a compression bandage is contraindicated. The nurse would apply ice, not heat, to the affected area. Realignment of the bone is not to be attempted.

Question 31

The nurse is caring for a patient in the emergency department who is experiencing severe pain and is diagnosed with a patellar dislocation. Which of the following actions should the nurse implement first?

a. Applying a knee immobilizer
b. Implementing passive knee flexion
c. Limiting activity restrictions
d. Preparing the patient for conscious sedation

Answer 31

ANS: D
The first goal of collaborative management is realignment of the knee to its original anatomic
position, which will require anesthesia or conscious sedation. Immobilization, gentle rangeof-motion (ROM) exercises, and discussion about activity restrictions will be implemented after the knee is realigned.

Question 32

The nurse is caring for a patient in the emergency department following a motor vehicle accident who has massive right lower leg swelling. Which of the following actions will the
nurse take first?

a. Elevate the leg on pillows.
b. Apply a compression bandage.
c. Check leg pulses and sensation.
d. Place ice packs on the lower leg.

Answer 32

ANS: C
The initial action by the nurse will be to assess the circulation to the leg and to observe for any
evidence of injury such as fractures or dislocations. After the initial assessment, the other actions may be appropriate based on what is observed during the assessment.

Question 33

The nurse is caring for a patient in the emergency department who has possible left lower leg fractures. Which of the following actions should the nurse implement initially?

a. Elevate the left leg.
b. Splint the lower leg.
c. Obtain information about the tetanus immunization status.
d. Check the popliteal, dorsalis pedis, and posterior tibial pulses.

Answer 33

ANS: D
The initial nursing action should be assessment of the neuro-vascular status of the injured leg.
After assessment, the nurse may need to splint and elevate the leg, based on the assessment
data. Information about tetanus immunizations should be done if there is an open wound.

Question 34

The nurse is developing a care plan for a patient with an open reduction and internal fixation
(ORIF) of an open, displaced fracture of the tibia. Which of the following nursing diagnoses is
priority?

a. Activity intolerance related to physical deconditioning
b. Risk for constipation as evidenced by electrolyte imbalance
c. Risk for impaired skin integrity as evidenced by pressure over bony prominence
d. Risk for infection as evidenced by invasive procedure

Answer 34

ANS: D
A patient having an ORIF is at risk for problems such as wound infection and osteomyelitis.
After an ORIF, patients typically are mobilized starting the first postoperative day, so
problems caused by immobility are not as likely.

Question 35

The nurse is caring for a patient with a fractured pelvis and on day 2 of the hospitalization the
patient develops acute onset confusion. Which of the following actions should the nurse take
first?

a. Take the blood pressure.
b. Assess patient orientation.
c. Check pupil reaction to light.
d. Assess the oxygen saturation.

Answer 35

ANS: D
The patient’s history and clinical manifestations suggest a fat embolus. The most important
assessment is oxygenation. The other actions also are appropriate but will be done after the
nurse assesses gas exchange.

Question 36

Which of the following information obtained by the emergency department nurse when
admitting a patient with a left femur fracture is most important to report to the health care
provider?

a. Bruising of the left thigh
b. Complaints of left thigh pain
c. Outward pointing toes on the left foot
d. Prolonged capillary refill of the left foot

Answer 36

ANS: D
Prolonged capillary refill may indicate complications such as arterial damage or compartment syndrome. The other findings are typical with a left femur fracture.

Question 37

The nurse is caring for a patient who has just arrived on the orthopedic unit after a right
above-the-knee amputation with an immediate prosthetic fitting. Which of the following
actions should the nurse implement first?

a. Place the patient in a prone position.
b. Check the surgical site for hemorrhage.
c. Remove the prosthesis and wrap the site.
d. Keep the residual leg elevated on a pillow.

Answer 37

ANS: B
The nurse should monitor for hemorrhage after the surgery. The prosthesis will not be
removed. To avoid flexion contracture of the hip, the leg will not be elevated on a pillow. The
patient is placed in a prone position after amputation to prevent hip flexion, but this would not be done during the immediate postoperative period.

Question 38

Before assisting a patient with ambulation on the day after a total hip replacement, which of
the following actions is most important for the nurse to implement?

a. Administer the ordered oral opioid pain medication.
b. Instruct the patient about the benefits of ambulation.
c. Ensure that the incisional drain has been discontinued.
d. Change the hip dressing and document the wound appearance.

Answer 38

ANS: A
The patient should be adequately medicated for pain before any attempt to ambulate.
Instructions about the benefits of ambulation may increase the patient’s willingness to
ambulate, but decreasing pain with ambulation is more important. The presence of an
incisional drain or timing of dressing change will not affect ambulation.