Lewis Chapter 65: Trauma and Orthopedic Surgery Flashcards
When would the nurse suspect an ankle sprain for the client being seen at the urgent care centre?
a. Client was hit by another soccer player on the field.
b. Client has ankle pain after sprinting around the track.
c. Client dropped a 4.5-kg weight on his lower leg at the health club.
d. Client had a twisting injury while running bases during a baseball game.
D.
The nurse explains to a client with a distal tibial fracture returning for a 3-week checkup that healing is indicated by which of the following?
a. Callus formation
b. Complete bony union
c. Hematoma at the fracture site
d. Presence of granulation tissue
A.
A client with a comminuted fracture of the femur is to have an open reduction with internal fixation (ORIF) of the fracture. In which of the following situations is an ORIF indicated?
a. The client is able to tolerate prolonged immobilization.
b. The client cannot tolerate the surgery for a closed reduction.
c. A temporary cast would be too unstable to provide normal mobility.
d. Adequate alignment cannot be obtained by other nonsurgical methods.
D.
Which of the following indicates a neurovascular condition during the nurse’s assessment of a client with a fracture?
a. Exaggeration of extremity movement
b. Increased redness and heat below the injury
c. Decreased sensation distal to the fracture site
d. Purulent drainage at the site of an open fracture
C.
A client with a stable, closed fracture of the humerus caused by trauma to the arm has a temporary splint with bulky padding applied with an elastic bandage. For which of the following symptoms would the nurse suspect compartment syndrome and notify the health care provider?
a. Increasing edema of the limb
b. Muscle spasms of the lower arm
c. Rebounding pulse at the fracture site
d. Pain when passively extending the fingers
D.
Which of the following symptoms should the nurse be monitoring for in a client with pelvic fracture?
a. Changes in urinary output
b. Petechiae on the abdomen
c. A palpable lump in the buttock
d. Sudden increase in blood pressure
A.
During the postoperative period, what should the client with an above-the-knee amputation be told about the negative effect of routinely elevating the residual limb?
a. The flexed position can promote hip flexion contracture.
b. This position reduces the development of phantom pain.
c. This position promotes clot formation at the incision site and thigh.
d. Unnecessary movement of the extremity can cause wound dehiscence.
A.
What should the nurse teach a client recovering from a total hip replacement to avoid?
a. Sleeping on the abdomen
b. Sitting with the legs crossed
c. Abduction exercises of the affected leg
d. Bearing weight on the affected leg for 6 weeks
B.
The nurse is completing an admission history for an older patient who has osteoarthritis and has been admitted for knee arthroplasty. The nurse asks about the patient’s perception of the reason for admission. Which of the following patient responses should the nurse anticipate related to this question?
A. Recent knee trauma
B. Debilitating joint pain
C. Repeated knee infections
D. Onset of “frozen” knee joint
B. Debilitating joint pain
The most common reason for knee arthroplasty is debilitating joint pain despite attempts to manage it with exercise and drug therapy.
The nurse is caring for a patient with osteoarthritis who is about to undergo a left total knee arthroplasty (TKA). The nurse assesses the patient carefully to be sure that there is no evidence of which of the following symptoms in the preoperative period?
A. Pain
B. Left knee stiffness
C. Left knee infection
D. Left knee instability
C. Left knee infection
It is critical that the patient be free of infection before a total knee arthroplasty (TKA). An infection in the joint could lead to even greater pain and joint instability, requiring extensive surgery. For this reason, the nurse monitors the patient for signs of infection, such as redness, swelling, fever, and elevated white blood cell count.
The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for an older person following a left total knee replacement. Which of the following actions would be an appropriate nursing intervention for this patient?
A. Promote vitamin D and calcium intake in the diet.
B. Provide passive range of motion to all of the joints q4h.
C. Encourage isometric quadriceps setting exercises at least QID.
D. Keep the left leg in extension and abduction to prevent contractures.
C. Encourage isometric quadriceps setting exercises at least QID.
Great emphasis is placed on postoperative exercise of the affected leg, with isometric quadriceps setting beginning on the first day after surgery.
The nurse is caring for an older patient who has undergone a left knee arthroplasty with prosthetic replacement of the knee joint to relieve the pain of severe osteoarthritis. Which of the following interventions should the nurse expect to be included in the plan of care for the affected leg postoperatively?
A. Progressive leg exercises to obtain 90-degree flexion
B. Early ambulation with full weight bearing on the left leg
C. Bed rest for three days with the left leg immobilized in extension
D. Immobilization of the left knee in 30-degree flexion for two weeks to prevent dislocation
A. Progressive leg exercises to obtain 90-degree flexion
The patient is encouraged to engage in progressive leg exercises until 90-degree flexion is possible. Because this is painful after surgery, the patient requires good pain management and often the use of a continuous passive motion (CPM) machine.
The nurse is caring for an older patient who underwent a left total knee arthroplasty and has a new health care provider order to be “up in chair today before noon.” Which of the following actions would the nurse implement to protect the knee joint while carrying out the order?
A. Administer a dose of prescribed analgesic before completing the order.
B. Ask the physiotherapist for a walker to limit weight bearing while getting out of bed.
C. Keep the continuous passive motion machine in place while lifting the patient from bed to chair.
D. Put on a knee immobilizer before moving the patient out of bed and keep the surgical leg elevated while sitting.
D. Put on a knee immobilizer before moving the patient out of bed and keep the surgical leg elevated while sitting.
The nurse should apply a knee immobilizer for stability before assisting the patient to get out of bed. This is a standard measure to protect the knee
The nurse is completing discharge teaching with an older patient who underwent a right total hip arthroplasty (THA). Which of the following patient statements indicates a need for further instruction?
A. “I need to avoid crossing my legs.”
B. “I need to use a toilet elevator on the toilet seat.”
C. “I need to notify any future caregivers about the prosthesis.”
D. “I need to maintain my hip in adduction and internal rotation.”
D. “I need to maintain my hip in adduction and internal rotation.”
The patient should not cross legs, force hip into adduction, or force hip into internal rotation.
Which patient would likely have immediate fitting for a prosthetic after an amputation?
A. A patient with an above the knee amputation
B. A patient with a below the knee amputation
C. An elderly patient with a below the elbow amputation
D. A patient with an active infection of the knee
B. A patient with a below the knee amputation
This patient would likely be fitted immediately for a prosthetic device. Immediate fitting has demonstrated improved wound healing, reduction of complications, and rapid stump maturation.
