Orthopedics Flashcards
Cast
A rigid external immobilizing device made of fiberglass or plaster of Paris
Short-arm cast
Extends from below the elbow to the palmar crease, secured around the base of the thumb. If the thumb is included, it is known as a thumb spica or gauntlet cast
Long-arm cast
Extends from the axillary fold to the proximal palmar crease; the elbow usually is immobilized at a right angle
Short-leg cast
Extends from below the knee to the base of the toes; the foot is flexed at a right angle in a neutral position
Long-leg cast
Extends from the junction of the upper and middle third of the thigh to the base of the toes; the knee may be slightly flexed
Walking cast
A short or long-leg cast reinforced for strength
Body cast
Encircles the trunk
Shoulder spica cast
A body jacket that encloses the trunk, shoulder and elbow
Hip spica cast
Encloses the trunk and a lower extremity; a double hip spica cast includes both legs; typical 4-6 weeks
Uses of casts
Immobilize reduced fracture
Correct deformity
Apply uniform pressure to soft tissues
Support/stabilize weak joints
Splint
Contoured splints made of plaster or pliable thermoplastic
Uses of splint
Conditions that do NOT require rigid immobilization
Anticipated swelling
Those who require special skin care
Simple & stable fractures
Sprains
Tendon injuries
Soft tissue injuries
Brace
Custom fitted device (i.e. orthoses)
Uses of brace
Provide support
Control movement
Prevent additional injury
Patient care BEFORE application of cast/splint/brace
Assess general health, emotional status
Assess presenting signs and symptoms and condition of area
Give tetanus shot if wound dirty or last boost >5 years ago
Sterile dressing for the wound
Monitor and assess neurovascular status for potential complications
Treat any lacerations and abrasions before application
Explain purpose of treatment to patient
Explain procedure of application (sounds, sights, sensations)
Continual care with cast/splint/brace
Monitor neurovascular status using 6 Ps Q1-4H for first 24 hour
Monitor and treat pain (elevation, ice pack, analgesics)
Apply ice packs over fracture site for 1-2 days
Elevate leg to level of heart for first 24-48 hours
Lower extremity immobilization (patient in recumbent position to promote venous return)
Assess bowel sounds Q4-8H if have a body cast
7 Ps of neurovascular status checks
Pain
Poikilothermia
Pallor
Pulselessness
Paresthesias
Paralysis
Puffiness
Patient education of Cast/splint/brace
Impact of injury on ADLs
Activity, exercise rest
Medications
cast drying techniques
Controlling swelling and pain
Care of minor skin irritation
Cast removal
Date & time of next f/u appt
Conditions to report to provider
Compartment syndrome
Increased pressure in a confined space compromises blood flow that can cause ischemia and irreversible damage within hours
Pressure ulcer
Pressure ulcer occurs due to inappropriately applied case or too tight bandage; can cause tissue anoxia and ulcers and necrosis
Disuse Syndrome
Muscle atrophy and loss of strength
Infection
More common in an open wound and the moist/warm environment of splint/cast can facilitate the infection
S/s of compartment syndrome
1st indication - pain
7 Ps
Increased intra-compartmental pressure
Treatment of compartment syndrome
Notify surgeon
Cast may be removed/loosened
Emergency fasciotomy
Do NOT lift extremity higher than level of heart to maintain arterial perfusion
S/s of disuse syndrome
Joint stiffiness
Weakness
Treatment of disuse syndrome
Isometric exercises (tense/contract muscles, push down, make a fist)
Muscle setting exercises
Volkmann’s Ischemic contracture
Devastating impairment of motor function and sensibility
*missed compartment syndrome in the arm
Cast syndrome
Causes anxiety, behavior change, panic due to full body cast
Superior mesenteric artery syndrome
Decreased GI and physical activity causes abdominal distention, discomfort, BV, poor appetite and weight loss
External fixator
Provides skeletal stability for severely crushed/splintered fractures with soft tissue damage while permitting active treatment of extensive soft tissue damage
Use of external fixator
Complicated fractures of humerus, forearm, femur, tibia, pelvis;
correct defects treat nonunion, lengthen limbs
Pros & cons of external fixator
Pros: immediate fracture stabilization, minimization of blood loss when compared to internal fixation; increased patient comfort; improved wound care; promotion of early mobilization and weight bearing on affected limb; active exercise of adjacent uninvolved joints
Cons: increased risk for pin site loosening & infection (osteomyelitis)
Continual care of external fixator
GOAL: avoid osteomyelitis
Elevate extremity to level of heart to reduce swelling
Cover sharp points on pins with caps to prevent injury
Monitor neurovascular status Q2-4H
Assess pins for inflammation and infection Q8-12H
Aseptic technique during pin insertion
NEVER adjust clamps - HCP only
Isometric exercises if activity is restricted
Encourage patient mobility with assistive devices
Patient education for external fixators
Impact of injury on ADLs
Activity, exercise, rest
Medications
Controlling swelling and pain
Report to HCP
Ilizarov Fixation
A specific external fixator with numerous wires that penetrate limb and attached to circular frame to correct angular ion and rotation defects, treat nonunion, and lengthen limbs, can be on for months
Traction
Use of a pulling force to promote and maintain alignment to an injured part of the body to promote realignment of bone fractures, correct or prevent deformity, and decrease muscle spasms and pain;
May be necessary to be pulled in different directions
*short term - until ext/int fixation
Complications of traction
Pressure ulcers
Atelectasis
PNA
Constipation
Anorexia
Urinary stasis
Infection
DVT
Straight/running traction
Pulling force in a straight line with the body part resting on the bed
Ex. Buck’s extension traction
Balanced suspension traction
Supports the affected extremity off the bed and allows for some patient movement without disruption of line of pull
Nursing mgmt of traction
Must remain continuous and should NEVER be interrupted
Do not remove weights unless intermittent traction prescribed
Eliminate any factors that may reduce effective pull or alter its resultant line of pull
Ensure patient is in a good body alignment in the center of the bed while traction is applied
Unobstructed ropes
Weights must hang freely
Knots on rope do not touch pulley or foot of bed
Auscultation lungs Q4-8H
High fiber diet, fluids
Encourage voiding Q3-5H
Interventions for skeletal traction
Evaluate traction apparatus and patient position
Maintain alignment of body
Report pain promptly
Trapeze to help with movement
Assess pressure points in skin Q8H
Regular shifting of position
Special mattresses or other pressure reduction devices
Perform active foot exercises and leg exercise every hour
Syme amputation
Modified ankle disarticulation amputation of foot trauma
Below-the-knee (BK) amputation
Keeps knee joint and emergency requirements for walking
Knee disarticulation
Amputation through the joint, successful for young and active patient who can develop control of prosthesis
Hip disarticulation
Must rely on wheelchair
Osteomyelitis
Infection of the bone that causes inflammation, necrosis, and formation of new bone
Causes of osteomylelitis
(Normally MRSA, E.coli, proteus and Pseudomonas spp.)
Extension of soft tissue infection
Direct bone contamination
Blood borne spread from another site of infection
A nurse is caring for a patient who has had a plaster arm cast applied. Immediately post application, the nurse should provide what teaching to the patient?
A. The cast will feel cool to touch for the first 30 invites.
B. The cast should be wrapped snuggly with a towel until the patient gets home.
C. The cast should be supported on a board while drying.
D. The cast will only have full strength when dry.
D. The cast will only have full strength when dry.
A patient broke his arm in a sports accident and required the application of a cast. Shortly following application, the patient complained of an inability to straighten his fingers and was subsequently diagnosed with Volkmann contracture. What pathophysiologic process caused this complication?
A. Obstructed arterial blood flow to the forearm and hand.
B. Simultaneous pressure on the ulnar and radial nerves.
C. Irritation of Merkel cells in the patient’s skin surfaces.
D. Uncontrolled muscle spasms in the patient’s forearm.
A. Obstructed arterial blood flow to the forearm and hand.
A patient is admitted to the unit in traction for a fractured proximal femur and requires traction prior to surgery. What is the most appropriate type of traction to apply to a fractured proximal femur?
A. Russell’s traction
B. Dunlops traction
C. Buck’s extension traction
D. Cervical head halter
C. Buck’s extension traction
A nurse is caring for a patient who is in skeletal traction. To prevent the complication of skin breakdown in a patient with skeletal traction, what action should be included in the plan of care?
A. Apply occlusive dressings to the pin sites.
B. Encourage the patient to push up with the elbows when repositioning
C. Encourage the patient to perform isometric exercises once a shift
D. Assess the pin insertion site every 8 hours
D. Assess the pin insertion site every 8 hours
A nurse is caring for a patient who is postop day 1 right hip replacement. How should the nurse position the patient?
A. Keep the patient’s hips in abduction at all times.
B. Keep hips flexed at no less than 90 degrees
C. Elevate the HOB to high fowler’s
D. Seat the patient in a low chair as soon as possible
A. Keep the patient’s hips in abduction at all times
While assessing a patient who has had knee replacement surgery, the nurse notes that the patient has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would the priority nursing diagnosis for this patient?
A. Risk for infection
B. Risk for peripheral neurovascular dysfunction
C. Unilateral neglect
D. Disturbed kinesthetic sensory perception
B. Risk for peripheral neurovascular dysfunction
A patient was brought to the emergency department after a fall. The patient is taken to the operating room to receive a right hip prosthesis. In the immediate postop period, what health education should the nurse emphasize?
A. Make sure you don’t bring your knees close together
B. Try to lie as still as possible for the first few days
C. Try to avoid bending your knees until next week
D. Keep your legs higher than your chest whenever you can
A. Make sure you don’t bring your knees close together
A patient with a fractured femur is in balanced suspension traction. The patient needs to be repositioned toward the HOB. During repositioning, what should the nurse do?
A. Place slight additional tension on the traction cords
B. Release the weights and replace them immediately after positioning
C. Reposition the bed instead of repositioning the patient
D. Maintain consistent traction tension while repositioning
D. Maintain consistent traction tension while repositioning
A patient with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to bed after ambulating, he complains of a new onset of pain at the surgical site. What is the nurse’s best action?
A. Administer pain medication as ordered.
B. Assess the surgical site and the affected extremity
C. Reassure the patient that pain is a direct result of increased activity
D. Assess the patient for signs and symptoms of systemic infection
B. Assess the surgical site and the affected extremity
A nurse is caring for a patient who has a leg cast. The nurse observes that the patient uses a pencil to scratch the skin under the edge of the cast. How should the nurse respond to this observation?
A. Allow the patient to continue to scratch inside the cast with a pencil but encourage him to be cautious
B. Give the patient a sterile tongue depressor to use for scratching instead of the pencil
C. Encourage the patient to avoid scratching, and obtain and order for an antihistamine if severe itching persists
D. Obtain an order for a sedative, such as lorazepam (Ativan), to prevent the patient from scratching
C. Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persists
The nurse is caring for a patient who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis?
A. Keep the affected leg in a position of adduction
B. Have the patient reposition himself independently
C. Protect the affected leg from internal rotation
D. Keep the hip flexed by placing pillows under the patient’s knee
C. Protect the affected leg from internal rotation
A patient is complaining of pain in her casted leg. The nurse has administered analgesics and elevated the limb. Thirty minutes after administering the analgesics, the patient states the pain is unrelieved. The nurse should identify the warning signs of what complication?
A. Subcutaneous emphysema
B. Skin breakdown
C. Compartment syndrome
D. Disuse syndrome
C. Compartment syndrome
The nurse educator on an orthopedic trauma unit is reviewing the safe and effective use of traction with some recent nursing graduates. What principle should the educator promote?
A. Knots in the rope should not be resting against pulleys
B. Weights should rest against the bed rails
C. The end of the limb in traction should be braced by the footboard of the bed
D. Skeletal traction may be removed for brief period to facilitate the patient’s independence
A. Knots in the rope should not be resting against pulleys
The orthopedic surgeon has prescribed balanced skeletal traction for a patient. What advantage is conferred by balanced traction?
A. Balanced traction can be applied at night and removed during the day.
B. Balanced traction allows for greater patient movement and independence than other forms of traction
C. Balanced traction is portable and may accompany the patient’s movements
D. Balanced traction facilitates bone remodeling in as little as 4 days
B. Balanced traction allows for greater patient movement and independence than other forms of traction
The nursing care plan for a patient in traction specifies regular assessments for venous thromboembolism (VTE). When assessing a patient’s lower limbs, what sign or symptom is suggestive of deep vein thrombosis (DVT)?
A. Increased warmth of the calf
B. Decreased circumference of the calf
C. Loss of sensation to the calf
D. Pale-appearing calf
A. Increased warmth of the calf
A nurse is providing discharge education to a patient who is going home with a cast on his leg. What teaching point should the nurse emphasize in the teaching session?
A. Using crutches efficiently
B. Exercising joints above and below the cast, as ordered
C. Removing the cast correctly at the end of the treatment period
D. Reporting signs of impaired circulation
D. Reporting signs of impaired circulation
A patient with a right tibial fracture is being discharged home after having a cast applied. What instruction should the nurse provide in relationship to the patient’s cast care?
A. Cover the cast with a blanket until the cast dries
B. Keep your right leg elevated above the heart
C. Use a clean object to scratch itches inside the cast
D. A foul smell from the cast is normal after the first few days
B. Keep your right leg elevated above heart level
An elderly patient’s hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse’s priority assessment?
A. The presence of leg shortening
B. The patient’s complaints of pain
C. Signs of neurovascular compromise
D. The presence of internal or external rotation
C. Signs of neurovascular compromise
A nurse is caring for a patient who has had a total hip replacement. The nurse is reviewing health education prior to discharge. Which of the patient’s statements would indicate to the nurse that the patient requires further teaching?
A. “I’ll need to keep several pillows between my legs at night.”
B. “I need to remember not to cross my legs. It’s such a habit.”
C. “The occupational therapist is showing me how to use a ‘sock puller’ to help me get dressed.”
D. “I will need my husband to assist me in getting off the low toilet seat at home.”
D. “I will need my husband to assist me in getting off the low toilet seat at home.”
A nurse is admitting a patient to the unit who presented with a LE fracture. What signs and symptoms would suggest to the nurse that the patient may have aperoneal nerve injury?
A. Numbness and burning of the foot
B. Pillow to the dorsal surface of the foot
C. Visible cyanosis in the toes
D. Inadequate capillary refill to the toes
A. Numbness and burning of the foot
A patient has suffered a muscle strain and is complaining of pain that she rates at 6 on a 10-point scale. The nurse should recommend what action?
A. Taking an opioid analgesic as ordered.
B. Applying a cold pack to the injured site
C. Performing passive ROM exercises
D. Applying a heating pad to the affected muscle
B. Applying a cold pack to the injured site
A patient has had a brace prescribed to facilitate recovery from a knee injury. What are the potential therapeutic benefits of a brace? SATA.
A. Preventing additional injury
B. Immobilizing prior to surgery
C. Providing support
D. Controlling movement
E. Promoting bone remodeling
A. Preventing additional injury
C. Providing support
D. Controlling movement
A nurse is assessing the neurovascular status of a patient who has had a leg cast recently applied. The nurse is unable to palpate the patient’s dorsalis pedis or posterior tibial pulse and the patient’s foot is pale. What is the nurse’s most appropriate action?
A. Warm the patient’s foot and determine whether circulation improves
B. Reposition the patient with the affected foot dependent
C. Reassess the patient’s neurovascular status is 15 minutes
D. Promptly inform the PCP
D. Promptly inform the PCP
A physician writes an order to discontinue skeletal traction on an orthopedic patient. The nurse should anticipate what subsequent intervention?
A. Application of a walking boot
B. Application of a cast
C. Education on how to use crutches
D. Passive ROM exercises
B. Application of a cast
A patient has just begun been receiving skeletal traction and the nurse is aware that muscles in the patient’s affected limb are spastic. How does this change in muscle tone affect the patient’s traction prescription?
A. Traction must temporarily be aligned in a slightly different direction
B. Extra weight is needed initially to keep the limb in proper alignment
C. A lighter weight should be initially used
D. Weight will temporarily alternate between heavier and lighter weights.
B. Extra weight is needed initially to keep the limb in proper alignment
A nurse is planning the care of a patient who will require a prolonged course of skeletal traction. When planning this patient’s care, the nurse should prioritize interventions related to which of the following risk nursing diagnoses?
A. Risk for impaired skin integrity
B. Risk for falls
C. Risk for imbalanced fluid volume
D. Risk for aspiration
A. Risk for impaired skin integrity
A nurse is caring for a patient receiving skeletal traction. Due to the patient’s severe limits on mobility, the nurse has identified a risk for atelectasis or PNA. What intervention should the nurse provide in order to prevent these complications?
A. Perform CPT once per shift and as needed.
B. Teach the patient to perform deep breathing and coughing exercises
C. Administer prophylactic ABX as ordered
D. Administer nebulized bronchodilators and corticosteroids as ordered
B. Teaching the patient to perform deep breathing and coughing exercises
The nurse has identified the diagnosis of Risk for Impaired Tissue Perfusion related to deep vein thrombosis in the care of a patient receiving skeletal traction. What nursing intervention best addresses this risk?
A. Encourage independence with ADLs whenever possible
B. Monitor the patient’s nutritional status closely
C. Teach the patient to perform ankle and foot exercises within the limitation of traction
D. Administer clopidogrel (plavix) as ordered
C. Teach the patient to perform ankle and foot exercises within the limitations of traction
A patient scheduled for a total hip replacement and the surgeon has explained the risks of blood loss associated with orthopedic surgery. The risk of blood loss is the indication for which of the following actions?
A. Use of a cardiopulmonary bypass machine
B. Postoperative blood salvage
C. Prophylactic blood transfusion
D. Autologous blood donation
D. Autologous blood donation
The nurse is helping to set up Buck’s traction on an orthopedic patient. How often should the nurse assess circulation to the affected leg?
A. Within 30 minutes, then every 1-2 hours
B. Within 30 minutes, then every 4 hours
C. Within 30 minutes, then every 8 hours
D. Within 30 minutes then every shift
A. Within 30 minutes, then every 1-2 hours
A nurse is assessing a patient who is receiving traction. The nurse’s assessment confirms that the patient is able to perform plantar flexion. What conclusion can the nurse draw from this finding?
A. The leg that was assessed is free from DVT
B. The patient’s tibial nerve is functional
C. Circulation to the distal extremity is adequate
D. The patient does not have peripheral neurovascular dysfunction
B. The patient’s tibial nerve is functional
A nurse is caring for a patient in skeletal traction. In order to prevent bony fragments from moving against one another, the nurse should caution the patient against which of the following actions?
A. Shifting one’s weight in bed
B. Bearing down while having a BM
C. Turning from side to side
D. Coughing without splinting
C. Turning from side to side
A nurse is caring for an older adult patient who is preparing for discharge following recovery from a total hip replacement. Which of the following outcomes must be met prior to discharge?
A. Patient is able to perform ADLs independently
B. Patient is able to perform transfers safely.
C. Patient is able to weight-bear equally on both legs.
D. Patient is able to demonstrate full ROM of the affected hip
B. Patient is able to perform transfers safely
A nurse is caring for a patient who is recovering in the hospital following orthopedic surgery. The nurse is performing frequent assessments for signs and symptoms of infection in the knowledge that the patient faces a high risk of what infectious complication?
A. Cellulitis
B. Septic arthritis
C. Sepsis
D. Osteomyelitis
D. Osteomyelitis
A patient is being prepared for a THA, and the nurse is providing relevant education. The patient is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement?
A. Actually, patients are only on bed rest for 2-3 days before they begin walking with assistance
B. The physical therapist will likely help you get up using a walker the day after your surgery
C. Our goal will actually be to have you walking normally within 5 days of your surgery
D. For the first 2 weeks after the surgery, you can use a wheelchair to meet your mobility needs
B. The physical therapist will likely help you get up using a walker the day after your surgery
A patient has recently been admitted to the orthopedic unit for following THA. The patient has a closed suction device in place and the nurse has determined that there were 320 mL of output in the first 24 hours. How should the nurse best respond to this assessment finding?
A. Inform the primary care provider promptly
B. Document this as an expected assessment finding
C. Limit the patient’s fluid intake to 2 liters for the next 24 hours
D. Administer a loop diuretic as ordered
B. Document this as an expected assessment finding
A nurse is reviewing a patient’s activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation?
A. Straining during a bowel movement
B. Bending down to put on socks
C. Lifting items above shoulder level
D. Transferring from a sitting to standing position
B. Bending down to put on socks
A 91-year old patient is slated for orthopedic surgery and the nurse is integrated gerontological considerations into the patient’s plan of care. What intervention is most justified in the care of this patient?
A. Administration of prophylactic ABX
B. Total parenteral nutrition (TPN)
C. Use of pressure-relieving mattress
D. Use of Foley catheter until discharge
C. Use of pressure-relieving mattress
A nurse is emptying an orthopedic surgery patient’s closed suction drainage at the end of a shift. The nurse notes that the volume is within expected parameters but that the drainage has a foul odor. What is the nurses’s best action?
A. Aspirate a small amount of drainage for culturing
B. Advance the drain 1-1.5 cm
C. Irrigate the drain with NS
D. Inform the surgeon of this finding
D. Inform the surgeon of this finding
A nurse is planning the care of a patient who has undergone orthopedic surgery. What main goal should guide the nurse’s choice of interventions?
A. Improving the patient’s level of function
B. Helping the patient come to terms with limitations
C. Administering medications safely
D. Improving the patient’s adherence to treatment
A. Improving the patient’s level of function
The ER nurse delivers a report on a patient that is arriving on the orthopedic floor and states that the patient 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
B. Compound
The nurse is preparing a care plan for a patient who has sustained a long bone fracture. Which intervention will the nurse include in the care plan to enhance fracture healing?
A. Limit weight bearing and exercising
B. Monitor color, temperature, and pulses of the affected extremity
C. Avoid immobilization of the fracture fragments
D. Administer high doses of corticosteroids
B. Monitor color, temperature, and pulses of the affected extremity
An athletic patient presents to the ambulatory care facility complaining of pain in the right knee with weight bearing. He states that two days ago he ran 10 miles and woke up the next morning with knee pain. Upon examination, the nurse notes edema, tenderness, muscle spasms and, ecchymosis. Based upon these symptoms, the nurse anticipates the patient has experienced a:
A. First-degree strain
B. Second-degree strain
C. First-degree sprain
D. Second-degree sprain
B. Second-degree strain
The nurse preparing the patient who has sustained a sprain of the left ankle for discharge from the ER to home correctly instructs the patient to:
A. Apply heat for the first 24-48 hours after injury
B. Maintain the ankle in a dependent position
C. Exercise hourly by performing rotation exercises of the ankle
D. Apply an elastic compression bandage to the ankle
D. Apply an elastic compression bandage to the ankle
The nurse caring for a patient with an open fracture of the radius is developing a care plan for the patient. The nurse will assign priority to which of the following nursing diagnoses?
A. Risk for infection
B. Risk for activity intolerance
C. Risk for imbalanced nutrition, less than body requirements
D. Risk for powerlessness
A. Risk for infection
Upon assessment, an elderly patient who is recovering after surgery for a hip fracture complains of chest pain and has an increase HR, RR, and is febrile and hypoxic. The patient is also coughing and producing large amounts of thick white sputum. The nurse recognizes that this is a medical emergency and calls for assistance because this patient is likely demonstrating symptoms related to:
A. A vascular necrosis of bone
B. Compartment syndrome
C. Fat embolism syndrome
D. Complex regional pain syndrome
C. Fat embolism syndrome
The priority nursing diagnosis for a patient experiencing acute compartment syndrome is:
A. Activity intolerance
B. Risk for peripheral neurovascular dysfunction
C. Risk for imbalanced body temperature
D. Disturbed body image
B. Risk for peripheral neurovascular dysfunction
To prevent the most common complication associated with a hip fracture, the nurse will instruct the patient to:
A. Take the prescribed stool softener daily
B. Use the prescribed oxygen with ambulation
C. Increase fluid intake
D. Avoid movement of the feet and ankles
C. Increase fluid intake
A patient with a tibial fracture is placed in a short leg cast 4 weeks after the removal of the leg walking cast. The nurse explains to the patient that the short leg cast will allow for:
A. Ankle motion
B. Knee motion
C. Hip motion
D. Toe motion
B. Knee motion
A patient schedule for a Syme’s amputation asks for the nurse about his ability to stand on the amputated extremity. The nurse’s best response is:
A. “You will be able to withstand full weight bearing on this durable extremity after the amputation”
B. “You will have minimal weight bearing on this extremity and will require the use of an assistive device”
C. “You will not be able to use this extremity and will receive teaching on use of a wheelchair”
D. “You will be fitted for a prosthesis and your commitment to rehabilitation will determine your functional abilities”
A. “You will be able to withstand full weight bearing on this durable extremity after the amputation”
While providing teaching, the nurse instructs the patient with a simple fracture :
A. Elevate the affected extremity to shoulder level
B. Engage in exercises that strengthen the unaffected muscles
C. Take corticosteroids as prescribed
D. Expect to regain full strength and mobility in 2-4 weeks
B. Engage in exercises that strengthen the unaffected muscles
A patient returning to the outpatient office 6 weeks after an above the knee amputation (AKA) reports symptoms of phantom pain. To reduce the discomfort, the nurse correctly instructs the patient to:
A. Apply hot compresses to the area of the amputation
B. Avoid rehabilitation exercises until the pain subsides
C. Comfortably increase his level of activity
D. Assess for a pulse in the extremity of the amputation every 4-6 hours
C. Comfortably increase his level of activity
The nurse caring for a patient who had a right extremity below the knee amputation (BKA) recognizes the importance of implementing measures that focus on preventing flexion contracture of the hip and maintain proper positioning. Which of the following measures will 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 3 months after the amputation
C. Minimizing the movement of the flexor muscles of the hip
D. Encouraging the patient to sit in the chair for at least 8 hours a day
A. Encouraging the patient to turn from side to side and to assume a prone position
The nurse instructs a patient with a clavicle fracture who is wearing a sling for support of the arm to:
A. Elevate the arm above the shoulder 3-4 times daily
B. Avoiding moving the elbow, wrist, and fingers for about 2 months
C. Engage in active ROM using the affected bone
D. Use the arm for light activities within the ROM
A. Elevate the arm above the shoulder 3-4 times daily
The orthopedic nurse is aware that a patient with a fracture of which of the following bones is at risk for Volkmann’s contracture?
A. Femur
B. Humerus
C. Radial head
D. Clavicle
B. Humerus
A 16-year old girl who is kicked in the lower leg during a soccer match notices the area has become swollen and discolored. Upon presentation to the ER, the nurse recognizes that she has likely sustained a:
A. Sprain
B. Strain
C. Contusion
D. Dislocation
C. Contusion
A 20-year old man who injured his ankle during a basketball game states that he is experiencing pain in his ankle and cannot support his weight when standing. Which of the following injuries has this patient most likely experienced?
A. Strain
B. Sprain
C. Contusion
D. Dislocation
B. Sprain
The nurse instructs a patient that treatment for a sprain 2-3 days after it occurs includes which of the following?
A. Intermittent heat application
B. Intermittent cold application
C. Active exercise of the affective limb
D. Placing the limb in a dependent position
A. Intermittent heat application
X-ray films show that a patient injured in a motor vehicle accident has a partial dislocation of the articulating bone surfaces. The nurse is aware that this type of injury will be documented by the physician on the chart as a:
A. Dislocation
B. Sprain
C. Strain
D. Subluxation
D. Subluxation
The orthopedic nurse is aware that traumatic dislocations are treated as orthopedic emergencies due to the risk of diminished blood supply and subsequent tissue death. Tissue death due to anoxia and diminished blood supply is referred to as:
A. Avascular necrosis
B. Nerve palsy
C. Subluxation
D. Compartment syndrome
A. Avascular necrosis
A patient who engages in weight lifting states that she has pain in her right shoulder, is unable to sleep on her right side because it hurts, and is unable to lift anything over her head with her right arm. The nurse suspects that the patient may have experienced which of the following:
A. Rotator cuff tear
B. Epicondylitis
C. Medial collateral ligament injury
D. Posterior cruciate ligament injury
A. Rotator cuff tear
A 17-year old soccer player presents to the pediatrician’s office with an injury that resulted in the knee being struck medically while his foot was firmly planted on the ground. Based upon this information, the patient likely has experienced a:
A. Lateral collateral ligament injury
B. Medial collateral ligament injury
C. Anterior cruciate ligament injury
D. Posterior cruciate ligament injury
A. Lateral collateral ligament injury
Radiographs have been completed on a 10-year old boy who had his right upper arm injured. The humerus appears to be fractured on one side and slightly bent on the other. This is an example of which type of fracture?
A. Impacted
B. Compound
C. Compression
D. Greenstick
D. Greenstick
The nurse working in the ER is aware that emergency management of an open fracture of the left tibia includes which of the following?
A. Reducing the fracture
B. Using unpadded splints
C. Covering the wound with the patient’s clothes
D. Assessing the neurovascular status distal to the injury
D. Assessing the neurovascular status distal to the injury
Which of the following describes a grade II open fracture?
A. Clean wound less than 1 cm
B. Clean wound >5 cm without extensive tissue damage
C. Large wound without extensive soft-tissue damage
D. Highly contaminated wound with extensive soft-tissue damage
C. Large wound without extensive soft-tissue damage
A patient is admitted to the hospital with an open fracture, which was originally heavily contaminated. In preparing the plan of care for this patient, the nurse recognizes that the wound will likely be closed:
A. 4-8 weeks after the infection is absent
B. 5-7 days after the infection is absent
C. When swelling is absent
D. Immediately upon admission to the orthopedic unit after transfer from the emergency department
B. 5-7 days after the infection is absent
Upon assessment of a 28-year old man who fractured his humerus yesterday, the nurse finds the patient tachycardia, pale, and confused. The nurse suspects the patient may be experiencing which of the following complications?
A. Disseminated intravascular coagulopathy
B. Compartment syndrome
C. Fat emboli
D. Deep vein thrombosis
C. Fat emboli
A patient states that she has a throbbing deep pain of the forearm after sustaining a fracture to it. The nurse suspects that she may be experiencing compartment syndrome. Which of the following possible manifestations can the nurse expect to find?
A. Acute pain with passive stretching of the muscle of the affected limb
B. Control of pain with opioids
C. The affected muscle soft and shrunken
D. An absence of an arterial pulse in the affected limb
A. Acute pain with passive stretching of the muscle of the affected limb
Three months after fracturing her femur, a patient states that she still has pain in the affected area. X-rays results show that there is incomplete healing of the fracture, which is termed:
A. Non-union
B. Delayed union
C. Heterotrophic ossification
D. Normal healing
B. Delayed union
Which of the following would be appropriate exercises to promote immediately after internal fixation of a fractured distal humerus?
A. ROM exercises of the joint adjacent to the fracture
B. Active finger exercises
C. Pendulum exercises
D. Wall-climbing exercises
B. Active finger exercises
Which of the following is the most appropriate nursing intervention for the nursing diagnosis of impaired physical mobility relate to fractured hip?
A. Administer analgesics as required
B. Place a pillow between the legs when turning
C. Monitor vital signs
D. Assess wound appearance
B. Place a pillow between the legs when turning
In which of the following positions should a patient’s residual limb be placed after a below-the-knee amputation?
A. Elevated on a pillow
B. Abduction
C. External rotation
D. Extended position
D. Extended position
The nurse will refer in his documentation to the patient’s sensation of pain in the limb that has been amputated as:
A. Actual pain
B. Phantom pain
C. Ineffective coping
D. Referred pain
B. Phantom pain
The homecare nurse is visiting a patient with a LE amputation who was discharged from the hospital 6 days prior. Which of the following indicates that the patient is taking appropriate steps to care for the residual limb?
A. Washing the limb once a week
B. Inspecting the skin every other day
C. Removing bandages when the limb is in a dependent position
D. Repositioning himself frequently
D. Repositioning himself frequently
The patient who has had an above-the-knee amputation refuses to look at the stump. When the nurse attempts to speak with the patient about his surgery, he says that he doesn’t wish to discuss it. He also refuses to let his family visit. The nursing diagnosis that best describes the patient’s problem is:
A. Hopelessness
B. Powerlessness
C. Disturbed body image
D. Fear
C. Disturbed body image
When applying cold packs to a patient with a right ankle sprain, the nurse should:
A. Apply it immediately after the injury occurs
B. Use sterile technique
C. Secure the cooling device with pins so that the device doesn’t fall off
D. Discontinue any application longer than 3 hours
A. Apply it immediately after the injury occurs
The nurse is caring for a patient placed in traction to treat a fractured femur. Which nursing intervention has the highest priority?
A. Assess the extremity for neurovascular integrity
B. Keeping the patient from sliding to the foot of the bed
C. Keeping the ropes over the center of the pulley
D. Ensuring that the weights hang freely at all times
A. Assessing the extremity for neurovascular integrity
What signs indicated potential fat emboli in the patient with a fractured left femur?
A. Increased partial pressure of arterial oxygen (PaO2), reduced sensation in left leg or foot
B. Left leg pain, dyspnea
C. Bradycardia, skin bruises
D. Cyanosis, decreased PaO2
D. Cyanosis, decreased PaO2
The nurse is caring for a patient with a fractured humerus in a long arm cast. Twelve hours after the cast was applied, the patient begins to complain of arm pain, which is unrelieved by analgesics. Which nursing action is most appropriate?
A. Preparing the patient for cast removal or bivalving of the cast
B. Obtaining an order for a different pain medication
C. Encouraging the patient to wiggle and move his fingers
D. Petaling the edges of his cast
A. Preparing the patient for cast removal or bivalving of the cast
A patient undergoes cast placement for a fractured left radius. The nurse should suspect compartment syndrome if the patient experiences pain that:
A. Intensifies with the elevation of the left arm
B. Disappears with the flexion of the left arm
C. Increases with the arm in a dependent position
D. Radiates up the arm to the left scapula
A. Intensifies with the elevation of the left arm
