Med Surge Exam 4 Chapter 63 Flashcards
The nurse suspects and ankle sprain when a patient at the urgent care center relates
a) being hit by another soccer player during a game
b) having ankle pain after sprinting around the track
c) dropping a 10 lb weight on his lower leg at the health club
d) twisting his ankle while running bases during a baseball game
d) twisting his ankle while running bases during a baseball game
The explains to a patient with a fracture of the distal shaft of the humerus who is returning for a 4-week checkup that healing is indicated by
a) formation of callus
b) complete bony union
c) hematoma at fracture site
d) presence of granulation tissue
a) formation of callus
A patient with a comminuted fracture of the tibia is to have an open reduction with internal fixation of the fracture (ORIF) The nurse explains that ORIF is indicated when
a) the patient is unable to tolerate prolonged immobilization
b) the patient cannot tolerate the surgery of a closed reduction
c) a temporary cast would be too unstable to provide normal mobility
d) adequate alignment cannot be attained by other nonsurgical methods
d) adequate alignment cannot be attained by other nonsurgical methods
An indication of a neurovascular problem noted during assessment of the patient with a fracture is
a) exaggeration of strength with movement
b) increased redness and heat below the injury
c) decreased sensation distal to the fracture sight
d) purulent drainage at the site of an open fracture
c) decreased sensation distal to the fracture sight
A patient 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. The nurse suspects compartment syndrome and notifies the physician when the patient experiences
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) pain when passively extending the fingers
A patient with a fracture of the pelvis should be monitored for
a) changes in urine output
b) petachiae on the abdomen
c) a palpable lump on the buttock
d) sudden increase in blood pressure
a) changes in urine output
During the postoperative period, the nurse instructs the patient with an above-the-knee amputation that the residual limb should not be routinely elevated because this position promotes
a) hip flexion contractures
b) skin irritation and breakdown
c) clot formation at the incision site
d) increased risk of wound dehiscence
a) hip flexion contractures
A patient with osteoarthritis is scheduled for a total hip arthroplasty. The nurse explains the purpose of this procedure is to (select all that apply)
a) fuse the joint
b) replace the joint
c) prevent further damage
d) improve and maintain ROM
e) decrease the amount of destruction in the joint
b) replace the joint
d) improve and maintain ROM
In teaching a patient scheduled for a total ankle replacement, it is important to tell the patient that after surgery he should avoid
a) lifting heavy objects
b) sleeping on the back
c) abduction exercises of the affected ankle
d) bearing weight on the affected leg for six weeks
d) bearing weight on the affected leg for six weeks
A 19-year-old male patient has a plaster cast applied to the right upper extremity for a Colles’ fracture after a skateboarding accident. Which action, if taken by the nurse, is the most appropriate?
a) Elevate the right arm on two pillows for 24 hours.
b) Apply heating pad to reduce muscle spasms and pain.
c) Limit movement of the thumb and fingers on the right hand.
d) Place arm in a sling to prevent movement of the right shoulder
a) Elevate the right arm on two pillows for 24 hours.
The cast should be supported on pillows during the drying period to prevent denting and flattening of the cast. The casted extremity should be elevated at or above the heart level to reduce swelling or inflammation. Ice should be applied for the first 24 to 36 hours to reduce swelling or inflammation. Active movement of the thumb and fingers should be encouraged to reduce edema and increase venous return. A sling may be used to support and protect the extremity after the cast is completely dry but the patient should perform active movements of the shoulder to prevent stiffness or contracture.
The home care nurse visits a 74-year-old man diagnosed with Parkinson’s disease who fell while walking this morning. What observation is of most concern to the nurse?
a) 2 × 6 cm right calf abrasion with sanguineous drainage
b) Left leg externally rotated and shorter than the right leg
c) Stooped posture with a shuffling gait and slow movements
d) Mild pain and minimal swelling of the right ankle and foot
b) Left leg externally rotated and shorter than the right leg
Clinical manifestations of a hip fracture include external rotation, muscle spasm, shortening of the affected extremity, and severe pain and tenderness in the region of the fracture site. Expected clinical manifestations of Parkinson’s disease include a stooped posture, shuffling gait, and slow movements. An abrasion is a soft tissue injury. Mild pain and minimal swelling may occur with a sprain or strain.
A 28-year-old woman with a fracture of the proximal left tibia in a long leg cast complains of severe pain and a prickling sensation in the left foot. The toes on the left foot are pale and cool. Which action should the nurse take?
a) Notify the health care provider immediately
b) Elevate the left leg above the level of the heart.
c) Administer prescribed morphine sulfate intravenously.
d) Apply ice packs to the left proximal tibia over the cast.
a) Notify the health care provider immediately
Clinical manifestations of compartment syndrome include (1) paresthesia, (2) pain distal to the injury that is not relieved by opioid analgesics and pain on passive stretch of muscle traveling through the compartment, (3) pressure increases in the compartment, (4) pallor, coolness, and loss of normal color of the extremity, (5) paralysis or loss of function, and (6) pulselessness or diminished/absent peripheral pulses. Pain unrelieved by drugs and out of proportion to the level of injury is one of the first indications of impending compartment syndrome. Pulselessness and paralysis (in particular) are later signs of compartment syndrome. Notify the health care provider immediately of a patient’s changing condition. Because elevation of the extremity may lower venous pressure and slow arterial perfusion, the extremity should not be elevated above heart level. Similarly, the application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome.
A 42-year-old man has a recent amputation of the left leg below the knee as a result of a heavy farm machinery accident. Which intervention should the nurse include in the plan of care for this patient?
a) Sit in a chair for 1 to 2 hours three times each day.
b) Dangle the residual limb for 20 to 30 minutes every 6 hours.
c) Lay prone with hip extended for 30 minutes four times per day.
d) Elevate the residual limb on a pillow for 4 to 5 days after surgery.
c) Lay prone with hip extended for 30 minutes four times per day.
To prevent hip flexion contractures, patients should lie on their abdomen for 30 minutes three or four times each day and position the hip in extension while prone. Patients should avoid sitting in a chair for more than 1 hour with hips flexed or having pillows under the surgical extremity. The patient should avoid dangling the residual limb over the bedside to minimize edema.
A nurse performs discharge teaching for a 58-year-old woman after a left hip arthroplasty (posterior approach). Which statement, if made by the patient to the nurse, indicates teaching is successful?
a) “I should not try to drive a motor vehicle for 2 to 3 weeks.”
b) “Leg-raising exercises are necessary for several months.”
c) “I will not have any restrictions now on hip and leg movements.”
d) “Blood tests will be done weekly while taking enoxaparin (Lovenox).”
b) “Leg-raising exercises are necessary for several months.”
Exercises designed to restore strength and muscle tone will be done for months after surgery. The exercises include leg raises in supine and prone positions. Driving a car is not allowed for 4 to 6 weeks. In the posterior approach hip arthroplasties, extremes of internal rotation and 90-degree flexion of the hip must be avoided for 4 to 6 weeks postoperatively. The knees must be kept apart. The patient should never cross the legs or twist to reach behind. To prevent thromboembolism, enoxaparin is administered subcutaneously and can be given at home. Enoxaparin does not require monitoring of the patient’s coagulation status.
The patient asks, “What does the doctor mean when he says that I have an avulsion fracture in my leg? I thought I had a sprain!” What is the best response by the nurse?
a. “It in a fracture with more than two fragments.”
b. “It means that a ligament pulled a bone fragment loose.”
c. “The line of the fracture is twisted along the shaft of the bone.”
d. “The line of the fracture is at right angles to the longitudinal axis of the bone.”
b. “It means that a ligament pulled a bone fragment loose.”
An avulsion fracture occurs when a ligament pulls a bone fragment loose, with pain similar to a sprain. A fracture with two or more fragments is a comminuted fracture. It is a transverse fracture when the line of fracture is at right angles to the longitudinal axis.
