MEDICAL ANS SURGICAL NURSING
CRISIS 5
Quiz
1. Patients who work in settings that require repetition of
the same hand movements over a long period of time have an increased risk for
which of the following disorders?
a.
Osteomyelitis.
b.
osteoporosis.
c.
carpal tunnel syndrome.
d.
Facture of the overused area.
2. You are caring for a patient who has just had open carpal
tunnel release surgery. The surgeon has requested that the patient’s hand and
arm remain elevated above the level of the heart after the surgery. This is to:
a.
Reduce lymphatic drainage.
b. Reduce postoperative swelling.
c.
Restrict hand movements.
d.
Decrease possibility of nosocomial infection
.
3. In obtaining the patient history for your patient with
carpal tunnel syndrome, you would expect to note a history of:
a. Pain and numbness or tingling sensation in
the hand (over the palmar surface of the thumb, index finger, middle finger,
and lateral aspect of the ring finger) that is worse at night.
b.
Crepitus (grating feeling on palpation over
joint during range of motion) due to loss of articular cartilage and bony
overgrowth in joint.
c.
Excessive forward curvature of the thoracic
spine (kyphosis) due to pathologic vertebral fractures, and collapsing of the
anterior portion of the vertebral bodies in the thoracic area.
d.
Acute onset of excruciating pain in joint due to
accumulation of uric acid within the joint.
4. Initial treatment of the patient with a fracture should
include:
a.
Surgical reduction of the fracture.
b.
Insertion of internal fixation device.
c.
Reduction of the fracture.
d. Immobilization of the area.
5. The first priority of care of the patient with a new
fracture includes assessing:
a. Respiratory rate and effort, pulse.
b.
The fracture site for bleeding.
c.
For signs of infection at the wound site of an
open fracture.
d.
For circulation and sensation distal to the
fracture site.
6. Patients with a history of osteoporosis have an increased
risk for:
a.
Infection in the bone.
b.
Peripheral blood clot formation.
c.
Painful joint inflammation.
d. Fracture formation.
7. Teaching patients about proper use of bisphosphonate
medications for treatment of osteoporosis should include taking medication:
a.
On a full stomach.
b. First thing in the morning on an empty
stomach with a full glass of water, 30 to 60 minutes before eating, without
lying down.
c.
Just before getting into bed.
d.
With an acidic liquid, like orange juice.
8. In order to allow for proper healing, patients with
osteomyelitis may need to have:
a. Debridement and drainage of the area.
b.
Immobilization of the area.
c.
Ice packs alternating with moist heat applied
externally.
d.
internal
fixation device inserted.
9. You have been caring for a patient with osteomyelitis. In
preparing the patient for discharge, you include teaching about:
a.
The importance of multiple-week treatment with
antibiotics.
b.
The side effects and interactions of the medications.
c.
Symptoms that necessitate a call to the
physician, nurse practitioner, or physician assistant.
d. All of the above.
10. The patient with gout will have periodic exacerbations
of painful joint inflammation. Acute episodes are treated with:
a. Nonsteroidal anti-inflammatory medications
and colchicine.
b.
Allopurinol and aspirin.
c.
Antibiotics and acetaminophen.
d.
Bisphosphonates and calcium.
MANAGEMENT OF
PATIENTS WITH MUSCOLOSKELETAL TRAUMA
1. A muscle tear that is microscopic and due to overuse is
called a:
a.
contusion.
b.
dislocation.
c.
sprain.
d. strain.
2. The acute inflammatory stage of a strain or sprain
usually lasts:
a.
less than 24 hours.
b. between 24 and 48 hours.
c.
about 72 hours.
d.
at least 1 week.
3. After arthroscopic surgery for a rotator cuff tear, a
patient can usually resume full activity in:
a.
3 to 4 weeks.
b.
8 weeks.
c.
3 to 4 months.
d. 6 to 12 months.
4. A patient who has a meniscectomy
by arthroscopic surgery needs to know that normal athletic activities can
usually be resumed after:
a.
2 weeks.
b. 3 weeks.
c.
2 months.
d.
6 months.
5. An open fracture with extensive soft tissue damage is
classified as a what grade fracture?
a.
I
b.
II
c. III
d.
IV
6. Emergency management of a fracture should include:
a.
covering the area with a clean dressing if the fracture
is open.
b.
immobilizing the affected site.
c.
splinting the injured limb.
d. all of the above nursing interventions.
7. The most serious complication of an open fracture is:
a. infection.
b.
muscle atrophy caused by loss of supporting bone
structure.
c.
necrosis of adjacent soft tissue caused by blood
loss.
d.
nerve damage.
a.
cardiogenic.
b. hypovolemic.
c.
neurogenic.
d.
septicemic.
9. As a complication of fractures, fat emboli:
a.
represent the major cause of death in fracture patients.
b. result in symptoms of decreased mental alertness.
c.
may compromise the patient’s respiratory status,
necessitating ventilator support.
d.
are characterized by all of the above.
10. After a fracture, the onset of symptoms for fat embolism
syndrome occurs:
a. within 1 to 2 days.
b.
1 to 2 weeks after the fracture is set.
c.
about 4 weeks after the bone fragments solidify.
d.
immediately after the fracture heals, when activity
begins.
11. The femur fracture that commonly leads to avascular
necrosis or nonunion because of an abundant supply of blood vessels in the area
is a fracture of the:
a.
condylar area.
b. neck.
c.
shaft.
d.
trochanteric region.
12. Patients who experience a fracture of the humeral neck
are advised that healing will take an average of ______ weeks, with restricted
vigorous activity for an additional ______ weeks.
a.
6, 2
b. 10, 4
c.
10, 6
d.
16, 2
13. After an arm fracture, pendulum exercises are begun:
a. as soon as tolerated, after a reasonable
period of immobilization.
b.
in 2 to 3 weeks, when callus ossification prevents
easy movements of bony fragments.
c.
in about 4 to 5 weeks, after new bone is well established.
d.
in 2 to 3 months, after normal activities are resumed.
14. The most serious complication of a supracondylar
fracture of the humerus is:
a.
hemarthrosis.
b.
paresthesia.
c.
malunion.
d. Volkmann’s ischemic contracture.
15. The two most serious complications of pelvic fractures
are:
a.
paresthesia and ischemia.
b. hemorrhage and shock.
c.
paralytic ileus and a lacerated urethra.
d.
thrombophlebitis and infection.
16. Nursing assessment for a pelvic fracture includes:
a.
checking the urine for hematuria.
b.
palpating peripheral pulses in both lower extremities.
c.
testing the stool for occult blood.
d. all of the above.
17. An acetabular fracture of the femur involves the:
a. neck of the femur.
b.
shaft of the femur.
c.
supracondylar area of the femur.
d.
trochanteric region of the femur.
18. The most common complication of a hip fracture in the
elderly is:
a.
avascular necrosis.
b.
infection.
c. nonunion.
d.
pneumonia.
19. An immediate nursing concern for a patient who has
suffered a femoral shaft fracture is assessment for:
a. hypovolemic shock.
b.
infection.
c.
knee and hip dislocation.
d.
pain resulting from muscle spasm.
20. The longest immobilization time necessary for fracture
union occurs with a fracture of the:
a.
intratrochanteric area of the femur.
b.
midshaft of the humerus.
c.
pelvis.
d. tibial shaft.
21. The major indicator of lower extremity amputation is:
a.
congenital deformity.
b.
malignant tumor.
c. peripheral vascular disease.
d.
trauma.
22. A nurse can foster a positive self-image in a patient
who has had an amputation by all of the following except:
a. encouraging the patient to care for the residual limb.
b. allowing the expression of grief.
c. introducing the patient to local amputee support groups.
d. encouraging family
and friends to refrain from visiting temporarily because this may increase the patient’s embarrassment.
Management of
Patients With Musculoskeletal Disorders
MULTIPLE CHOICE
Read each question
carefully. Circle your answer.
1. The intervertebral disks that are subject to the greatest
mechanical stress and greatest degenerative changes are:
a.
C3, C4, and L2.
b.
L1, L2, and L4.
c.
L2, L3, and L5.
d. L4, L5, and S1.
2. Back pain is classified as “chronic” when the pain lasts
without improvement for longer than:
a.
4 weeks.
b. 3 months.
c.
6 months.
d.
1 year.
3. The best position to ease low back pain is:
a.
high-Fowler’s to allow for maximum hip flexion.
b. supine with the knees slightly flexed and
the head of the bed elevated 30 degrees.
c.
prone with a pillow under the shoulders.
d.
supine with the bed flat and a firm mattress in
place.
4. When lifting objects, patients with low back pain should
be encouraged to maximize the use of the following muscles:
a.
gastrocnemius.
b.
latissimus dorsi.
c. quadriceps.
d.
rectus abdominis.
5. The nurse should encourage a patient with low back pain
to do all of the following except:
a. lie prone with legs slightly elevated.
b.
strengthen abdominal muscles.
c.
avoid prolonged sitting or walking.
d.
maintain appropriate weight.
6. Carpal tunnel syndrome is a neuropathy characterized by:
a.
bursitis and tendonitis.
b.
flexion contracture of the fourth and fifth fingers.
c. median nerve compression at the wrist.
d.
pannus formation in the shoulder.
7. The term for onychocryptosis, a common foot condition,
is:
a.
callus.
b.
bunion.
c.
flatfoot.
d. ingrown toenail
8. An overgrowth of the horny layer of epidermis on the foot
is called a:
a.
bunion.
b.
clawfoot.
c. corn.
d.
hammer toe.
9. The average 75-year-old woman with osteoporosis has lost
how much of her cortical bone?
a.
5%
b.
10%
c. 25%
d.
40%
10. The estimated intake of calcium to prevent bone loss for
a postmenopausal woman is ______mg/day. The actual intake is about ________
mg/day.
a.
600/200
b.
900/300
c.
1,200/400
d. 1,500/600
11. Bone formation is enhanced by:
a.
calcium intake.
b.
muscular activity.
c.
weight bearing.
d. all of the above.
12. The most common symptoms of osteomalacia are:
a.
bone fractures and kyphosis.
b. bone pain and tenderness.
c.
muscle weakness and spasms.
d.
softened and compressed vertebrae.
13. Most cases of osteomyelitis are caused by:
a.
Proteus.
b.
Pseudomonas.
c.
Salmonella.
d.
Staphylococcus aureus.
14. Signs and symptoms of osteomyelitis may include all of
the following except:
a.
pain, erythema, and fever.
b. leukopenia, swelling, and purulent
drainage.
c.
elevated erythrocyte sedimentation rate and increased
white blood cell count.
d.
positive wound cultures and localized discomfort.
15. The specific treatment for chronic osteomyelitis would probably be:
a.
antibiotic therapy.
b.
drainage of localized foci of infection.
c.
immobilization.
d. surgical removal of the sequestrum.
16. The most common benign bone tumor is:
a.
an enchondroma.
b.
a giant cell tumor.
c. an osteochondroma.
d.
an osteoid osteoma.
17. Appropriate nursing actions when caring for a patient
with a primary malignant bone tumor would include all of the following except:
a.
allowing the patient to independently plan his or
her daily routine.
b. estimating the size and location of the
mass daily by vigorously palpating the affected area.
c.
assuring the patient receiving chemotherapy that
alopecia, if it occurs, is temporary.
d.
encouraging range-of-motion exercises to prevent
atrophy of unaffected muscles.
Read the following case study. Fill in the blanks or circle
the correct answer.
CASE STUDY: Osteoporosis
Emily is a 49-year-old administrative assistant at a
community college who has just been diagnosed with osteoporosis. The physician
has asked you to answer some of Emily’s questions and explain the physician’s directions
for her level of activity and her nutritional needs.
1. Emily asks the nurse to explain why she is losing her
bone mass. The nurse’s explanation is based on the physiologic rationale that
bone mass loss occurs when ____________________________________________.
2. What two reasons could the nurse use to explain why women
develop osteoporosis more frequently than men: ________________________ and
________________________.
3. The nurse advises Emily that about ______ of Caucasian
women older than 50 years of age have some degree of osteoporosis.
a.
10%
b.
25%
c. 50%
d.
80%
4. The nurse advises Emily that the development of osteoporosis
is significantly dependent on:
a.
decreased
estrogen, which inhibits bone breakdown.
b.
increased calcitonin, which enhances bone resorption.
c.
increased vitamin D use, which interferes with calcium
use.
d.
increased parathyroid hormone, which decreases with
aging.
5. Part of Emily’s teaching plan includes nutritional
information about dietary calcium and vitamin D. The
nurse advises Emily that she needs ______ mg of calcium a
day.
a.
500
b.
1,000
c. 1,200
d.
1,500
6. Emily is told that her x-ray results indicated bone
radiolucency. The nurse knows that Emily has probably already exhibited ______
demineralization.
a.
5%
b.
10%
c.
20%
d. 30%
CASE STUDY: OSTEOPOROSIS answers.
1. the rate of bone resorption is greater than the rate of bone
formation
2. women have a lower peak bone mass than men and estrogen
loss affects the development of the disorder
3. c
4. a
5. c
6. d
SHORT QUESTIONS
Read each statement carefully. Write the best response
in the space provided.
1. Identify at least five musculoskeletal problems that
cause acute low back pain.
_____________________, _____________________,
_____________________,
_____________________, and _____________________.
2. List four nursing diagnoses for a patient undergoing foot
surgery: _____________________,
________________________, _________________________, and
______________________________.
3. Three significant characteristics of osteoporosis are:
______________________, ________________, and
_____________________.
4. Primary osteoporosis in women usually begins between the
ages of: __________________.
5. Explain the effects of the following on the development
of age-related osteoporosis:
a. Calcitonin: __________________________________
b. Estrogen: ___________________________________
c. Parathyroid hormone: ________________________
6. The primary deficit in osteomalacia is:
_____________________________.
7. Three medications used to treat Paget’s disease are:
____________________, _______________________,
and ________________________.
SHORT ANSWER
1. Answer should include five of these conditions: acute
lumbosacral strain, unstable lumbosacral ligaments, weak lumbosacral muscles,
osteoarthritis of the spine, spinal stenosis, intervertebral disk problems, and
unequal leg length.
2. risk for ineffective tissue perfusion; peripheral related
to swelling; acute pain related to surgery, inflammation, and swelling;
impaired physical mobility related to foot-immobilizing device, and risk for
infection related to the surgical procedure/surgical incision
3. reduced bone density, deterioration of bone matrix, and
diminished bone architectural strength.
4. age 45 and 55, after menopause
5. Calcitonin, which inhibits bone resorption and promotes
bone formation, hence osteoporosis is decreased. Estrogen, which inhibits bone
breakdown, hence osteoporosis is decreased. Parathyroid hormone, which
increases with age, enhances bone turnover and resorption, hence osteoporosis
is increased.
6. a deficiency in activated vitamin D (calcitriol), which promotes
calcium absorption from the gastrointestinal tract
7. calcitonin, bisphosphonates, and plicamycin
CHAPTER 66
Assessment of
Musculoskeletal Function
MULTIPLE CHOICE
Read each question carefully. Circle your answer.
1. The vertebrae can be classified as a type of:
a.
flat bone.
b. irregular bone.
c.
long bone.
d.
short bone.
2. The sternum, a bone that is a site for hematopoiesis, is
classified as a:
a. flat bone.
b.
irregular bone.
c.
long bone.
d.
short bone.
3. The basic cells responsible only for the formation of bone matrix are:
a. osteoblasts.
b.
osteoclasts.
c.
osteocytes.
d.
all of the above.
4. About 3 weeks after fracture, an internal bridge of
fibrous material, cartilage, and immature bone joins bone fragments so that
ossification can occur. The building of a “fracture bridge” occurs during the
stage of bone healing known as:
a.
inflammation.
b.
cellular
proliferation.
c.
callus formation.
d.
ossification.
5. The hip and shoulder are examples of diarthroses joints
that are classified as:
a. ball-and-socket joints.
b.
hinge joints.
c.
pivot joints.
d.
saddle joints.
6. The primary energy source for muscle cells is:
a. adenosine triphosphate (ATP).
b.
creatine phosphate.
c.
glucose.
d.
glycogen.
7. Isometric contraction of the vastus lateralis is part of
the exercises known as:
a.
biceps-tightening exercises.
b.
triceps-resisting exercises.
c.
gluteal-setting exercises.
d. quadriceps exercises.
8. Patient education for musculoskeletal conditions for the
aging is based on the understanding that there is a gradual loss of bone after
a peak of bone mass at age:
a.
20 years.
b. 35 years.
c.
40 years.
d.
50 years.
a.
15%
b. 40%
c.
60%
d.
75%
10. The removal of synovial fluid from a joint is called:
a.
arthrectomy.
b. arthrocentesis.
c.
arthrography.
d.
arthroscopy.
MATCHING
Match the range-of-motion term listed in column II with its
associated description listed in column I.
Column I Column II
1. _adduction_____
Pulling down toward the midline of the body
2. ___inversion___
The act of turning the foot inward
3. __extension____
The opposite movement of flexion
4. __rotation____
Turning around on an axis
5. __pronation____
Turning the palms down
6. ___protraction___
Pulling the jaw forward
7. __abduction____
Moving away from the midline
8. __circumduction____
Conelike circular movement
9. __supination____
Turning the palm up
10. __eversion____
Turning the foot outward
SHORT ANSWER
Read each statement carefully. Write the best response in
the space provided.
1. The leading cause of disability in the United States is:
______________________________________________. Arthritis
2. The most common musculoskeletal condition that
necessitates hospitalization in those over 65 years of age is:
___________________________________________________________________________________________.
Hip fracture
3. The approximate percentage of total body calcium present
in the bones is: ___________________________. 98%
4. In the human body, there are __206____ bones.
5. Approximately ________150___________ mg of calcium daily is essential to maintain adult
bone mass.
6. Red bone marrow is located in the shaft of four long and
flat bones: _________ribs_______,
_________vertebrae_______,
________sternum________,
and _______ileum_________.
7. The major hormonal regulators of calcium homeostasis are:
_____________parathyroid _____________
and
_____________calcitonin_____________________.
8. Ossification for major adult long bone fractures can take
up to: ________4 months__________.
9. The term used to describe the grating, crackling sound
heard over irregular joint surfaces like the knee is: ________crepitus__________________.
EXTRACTING INFERENCES
describe the physiologic function of listed structures.
1. Synovial cavity:
______________________________________________________________________________.
2. Bursa:
______________________________________________________________________________________.
3. Patella:
_____________________________________________________________________________________.
4. Fat pad: _____________________________________________________________________________________.
5. Articular cartilage:
___________________________________________________________________________.
6. Medial meniscus:
_____________________________________________________________________________.
7. Intrapatellar bursa:
___________________________________________________________________________.
Read the following case study. Circle the correct answer.
CASE STUDY: Above-the-Knee Amputation
William, a 70-year-old Catholic priest, lives in a center
city rectory. He is scheduled to have an above-the-knee amputation of his left
leg because of peripheral vascular disease.
1. Preoperatively, the nurse knows that the circulatory
status of the affected limb should be evaluated by assessing for:
a.
color and temperature.
b.
palpable pulses.
c.
positioning responses.
d. all of the above.
2. The level of William’s amputation was determined after
assessing:
a.
the circulatory status of the affected limb.
b.
the type of prosthesis to be used.
c.
William’s ability to understand and use the
prosthetic device.
d. all of the above.
3. Preoperatively, the nurse needs to assist William in
exercising the muscles needed for crutch walking.
The major muscle to be strengthened is the:
a.
pectoralis major.
b.
gastrocnemius.
c.
quadriceps femoris.
d. triceps brachii.
4. Postoperatively, William experiences phantom limb
sensations. The most appropriate nursing response is to:
a.
agree with his statements, recognizing that he is
expressing a psychological need.
b.
consistently stress the absence of the lower
leg.
c.
disagree with him and reorient him to reality.
d. keep him as active as possible and
encourage self-expression.
5. William’s amputation is treated with a soft compression
dressing. Nursing care would include all of the following except:
a. keeping the residual limb slightly elevated
on a pillow to decrease edema.
b.
monitoring vital signs to detect any indication of
bleeding.
c.
placing the residual limb in an extended position,
with brief periods of elevation.
d.
keeping a tourniquet nearby in case of hemorrhage.
6. Preprosthetic nursing care should attempt to avoid any
problem that can delay prosthetic fitting, such as:
a.
abduction deformities of the hip.
b.
flexion deformities.
c.
nonshrinkage of the residual limb.
d. all of the above.
7. The nurse who is preparing to apply a bandage to
William’s residual limb knows that she should:
a.
anchor the bandage on the posterior surface of the
residual limb.
b. begin the vertical turns on the anterior
surface of the residual limb.
c.
maintain the residual limb in a position of flexion
while bandaging.
use circular turns that run in a horizontal plane
from the proximal to the distal segment.
8. The nurse teaches William to massage his residual limb
to:
a.
decrease local tenderness.
b.
improve vascularity.
c.
mobilize the scar.
d. accomplish all of the above.
Musculoskeletal
Care Modalities
Read each question carefully. Circle your answer.
1. Choose the incorrect statement about the
traditional plaster cast. After a plaster cast has been set, it:
a. Will take
1 to 3 days to dry.
b. Should be
resonant to percussion.
c.
Should
be covered with a blanket to promote quick drying.
d. Will not
have maximum strength until it is dry.
2. A patient with an arm cast complains of pain. The
nurse should do all of the following except:
a. Assess
the fingers for color and temperature.
b.
Administer
a prescribed analgesic to promote comfort and allay anxiety.
c. Suspect
that the patient may have a pressure sore.
d. Determine
the exact site of the pain.
3. The nurse who assesses bone fracture pain expects
the patient to describe the pain as:
a. A dull,
deep, boring ache.
b.
Sharp
and piercing.
c. Similar
to “muscle cramps.”
d. Sore and
aching.
4. The nurse suspects “compartment syndrome” for a
casted extremity. She would assess for characteristic symptoms such as:
a. Decreased
sensory function.
b. Excruciating
pain.
c. Loss of
motion.
d.
All
of the above.
5. The nurse knows to assess the patient in an arm
cast for possible pressure ulcers in the following area:
a.
Lateral
malleolus.
b. Olecranon.
c. Radial
styloid.
d. Ulna
styloid.
6. After removal of a cast, the patient needs to be
instructed to do all of the following except:
a. Apply an
emollient lotion to soften the skin.
b. Control
swelling with elastic bandages, as directed.
c. Gradually
resume activities and exercise.
d. Use friction to remove dead surface
skin by rubbing the area with a towel.
7. A common pressure problem area for a long leg
cast is the:
a. dorsalis pedis.
b.
peroneal nerve.
c. Popliteal
artery.
d. Posterior
tibialis.
8. The nurse assesses for peroneal nerve injury by
checking the patient’s casted leg for the primary symptom of:
a. Burning.
b. Numbness.
c. Tingling.
d.
All
of the above indicators.
9. The nurse is very concerned about the potential
debilitating complication of peroneal nerve injury, which is:
a. permanent paresthesias.
b.
footdrop.
c. Deep vein
thrombosis (DVT).
d. Infection.
10. Choose the incorrect statement about turning a
patient in a hip spica cast.
a. A minimum of three persons are needed so that the
cast can be adequately supported by their palms.
b. Points over body pressure areas need to be supported
to prevent the cast from cracking.
c. The abduction bar should be used
to ensure that the lower extremity can be moved as a unit.
d. The patient should be encouraged to use the trapeze
or side rail during repositioning.
11. Skin traction is limited to a weight between:
a. 1 to 3
lb.
b.
4.5
to 8 lb.
c. 10 to 12
lb.
d. 13 to 15
lb.
12. A patient in pelvic traction needs his or her
circulatory status assessed. The nurse should check for a positive (1) Homans’
sign by asking the patient to:
a. Extend
both hands while the nurse compares the volume of both radial pulses.
b.
Extend
each leg and dorsiflex each foot to determine if pain or tenderness is present
in the lower leg.
c. Plantar
flex both feet while the nurse performs the blanch test on all of the patient’s
toes.
d. Squeeze
the nurse’s hands with his or her hands to evaluate any difference in strength.
13. Nursing assessment of a patient in traction
should include:
a. Lung
sounds and bowel sounds.
b. Circulation,
sensation, and motion of the extremities in traction.
c. The
patient’s level of anxiety and apprehension.
d.
All
of the above interventions.
14. The nurse expects that up to how much weight can
be used for a patient in skeletal traction?
a. 10 lb
b. 25 lb
c.
40
lb
d. 60 lb
15. When a patient is in continuous skeletal leg
traction, it is important for the nurse to remember to do all of the following
except:
a. Encourage
the patient to use the trapeze bar.
b. Maintain
adequate countertraction.
c.
Remove
the weights when pulling the patient up in bed to prevent unnecessary pulling
on the fracture site.
d. Use a
fracture bedpan to prevent soiling and to maintain patient comfort.
16. Patients with a hip and knee replacement begin
ambulation with a walker or crutches how long after surgery?
a.
24
hours
b. 72 hours
c. 1 week
d. 2 to 3
weeks
17. An artificial joint for total hip replacement
involves an implant that consists of:
a. An
acetabular socket.
b. A femoral
shaft.
c. A
spherical ball.
d.
All
of the above.
18.
The recommended leg position to prevent prosthesis dislocation after a total
hip replacement is:
a.
Abduction.
b. Adduction.
c.
Flexion.
d. Internal rotation.
19.
Postoperatively a patient with a total hip replacement is allowed to turn:
a.
45 degrees onto his or her un-operated side if the affected hip is
kept abducted.
b. From the prone to the supine position only, and the patient must
keep the affected hip extended and abducted.
c.
To any comfortable position as long as the
affected leg is extended.
d. To the operative side if his or her affected hip remains extended.
20.
The nurse caring for a postoperative hip-replacement patient knows that the
patient should not cross his or her legs, at any time, for how long after
surgery?
a.
2 months
b. 3 months
c.
4 months
d. 6 months
21.
One of the most dangerous of all postoperative complications is:
a.
Atelectasis.
b. Hypovolemia.
c.
Pulmonary embolism.
d. Urinary tract infection.
22.
After a total hip replacement, stair climbing is kept to a minimum for:
a.
1 month.
b. 2 months.
c.
3 to 6 months.
d. 6 to 8 months.
23.
After a total hip replacement, the patient is usually able to resume daily
activities after:
a.
3 months.
b. 6 months.
c.
9 months.
d. 1 year.
24.
Preoperative nursing measures that are appropriate for an orthopedic patient
should include:
a.
Encouraging fluids to prevent a urinary tract
infection.
b. Teaching isometric exercises and encouraging active range of
motion.
c.
Discouraging smoking to improve respiratory
function.
d.
All of the above interventions.
25.
Postoperative nursing concerns when caring for an orthopedic patient should
include:
a.
Determining that the patient’s pain is
controlled by administering prescribed analgesics.
b. Observing for signs of shock, such as hypotension and tachycardia.
c.
Preventing infection by using aseptic
technique when giving wound care.
d.
All of the above interventions.
SHORT ANSWER
Read each statement carefully. Write your response in the
space provided.
1.
List four purposes for using a cast:
Answer:
a.
Reduce a fracture
b.
Correct a deformity,
c.
Apply uniform pressure to underlying soft tissue
d.
Provide support and stability for weak joints
2.
The advantages of a fiberglass cast compared to
a plaster cast are:
Answer:
A fiberglass cast is light in weight and
water resistant.
It is more durable than plaster and water
resistant.
3.
Unrelieved pain for a patient in a cast must be
immediately reported to avoid four possible and serious potential problems:
Answer:
a.
To avoid necrosis of tissue,
b.
To avoid impaired tissue perfusion
c.
To avoid pressure ulcer formation,
d.
To avoid possible paralysis
4.
The nurse completes a neurovascular assessment
of either the fingers or toes of a casted extremity to determine circulatory
status. Describe expected outcomes. Which capillary refill test should be
performed?
Answer:
The toes or fingers should be pink, warm,
and easily moved (wiggled). There should be minimal swelling and discomfort.
The blanch test should be carried
out to determine rapid capillary refill.
5.
List the five “Ps” that should be assessed as
part of the neurovascular check:
Answer:
a.
Pain
b.
Pallor
c.
Pulselessness
d.
Paresthesia
e.
Paralysis
6.
List several danger signs of possible
circulatory constriction for a casted extremity:
Answer:
a.
Unrelieved pain,
b.
Swelling,
c.
Discoloration,
d.
Tingling and numbness,
e.
Inability to move fingers or toe
f.
Temperature changes.
7.
List three major complications of an extremity
that is casted, braced, or splinted.
Answer:
a.
Compartment syndrome
b.
Pressure ulcers
c.
Disuse Syndrome
8.
Name four purposes for traction application:
Answer:
a.
To minimize muscle spasms;
b.
To reduce, align, and immobilize fractures;
c.
To lessen deformities; and
d.
To increase space between opposing surfaces
within a joint
9.
The most effective cleansing solution for care
of a pin site is:
Answer:
Chlorhexidine solution
10.
A nursing goal for a patient with skeletal
traction is to avoid infection and the development of…..at the site of pin
insertion.
Answer:
Osteomyelitis
11.
List seven potential immobility-related complications that may develop when a patient is
in skeletal traction:
Answer:
a.
Pressure ulcers,
b.
Atelectasis,
c.
Pneumonia,
d.
Constipation,
e.
Anorexia,
f.
Urinary stasis and infection, and
g.
Venous thromboembolic with PE (pulmonary
embolism) or DVT (deep vein thrombosis)
12.
The nurse knows to assess a patient for DVT by
assessing the lower extremities for:
Answer:
a.
Unilateral calf tenderness
b.
Warmth
c.
Redness
d.
Swelling (increased calf circumference)
CLINICAL SITUATIONS
Read the following case studies. Fill in the blanks or
circle the correct answer.
CASE STUDY: Buck’s Traction
Bernadette is a 32-year-old bank secretary who was admitted
to the hospital for unilateral Buck’s extension traction to the left leg after
a hip injury. Bernadette is the single parent of three children younger than 12
years of age.
1. On the basis of her knowledge of running traction, the
nurse knows to expect that:
a.
The patient’s leg will be flat on the bed to
allow for a straight pulling force.
b.
The patient’s leg will be flexed at the knee to
allow for mobility without disruption of the pulling force.
c.
The traction will be applied directly to the
bony skeleton to maintain a constant pulling force.
d.
The traction will allow the patient’s leg to be
suspended off the bed so that no further damage can occur to the hip.
2. The nurse knows that countertraction must be considered whenever
traction is applied. Countertraction for Buck’s traction is provided by:
_______________________ and _______________________.
3. In preparing the patient’s skin for Buck’s traction
application, the nurse knows that it is necessary to:
_______________________ and _______________________.
4. The nurse makes certain that the weights applied will not
exceed:
a.
2 lb.
b.
4 lb.
c.
6 lb.
d.
8 lb.
5. The nurse consistently assesses neurovascular status when
traction is in place. List seven indicators that the nurse would evaluate.
__________________________________________________________________________________________________________
6. To prevent pressure ulcers and nerve damage, excessive
pressure is avoided over the ____________ and
_______________.
7. On assessment, the nurse notes a positive Homans’ sign.
Explain what this means.
__________________________________________________________________________________________________________
CASE STUDY:
Total Hip Replacement
Tom is a 62-year-old athletic coach at a high school. Sports
activities, especially baseball, have been the focus of his energies since he
was in high school and college. Because of prior hip joint injuries and
degenerative joint disease, he is scheduled for a total hip replacement.
1. Preoperatively, the nurse assesses the status of the
cardiovascular system based on the knowledge that mortality for patients over
60 years is directly related to the complications of: ______________________ and
______________________.
2. As part of preoperative teaching, the nurse makes the
patient aware of five major potential complications of hip replacement:
_________________, ____________________, ___________________, _____________, and
______________________.
3. On the basis of knowledge that limited hip flexion decreases
hip prosthesis dislocation, the nurse knows to:
a.
Keep the patient flat in bed with the leg extended.
b.
Gatch the knees to decrease the effect of
pulling force on the hip.
c.
Raise the head of the bed between 30 and 45
degrees.
d.
Maintain the patient in semi-Fowler’s position.
4. The nurse teaches Tom how to minimize hip extension
during transfers and while sitting. The nurse should encourage him to:
a.
Rotate the hip inward slightly during sitting to
prevent pressure on the external border of the hip.
b.
Hyperextend the leg during transfers so the hip socket
will not “pop out.”
c.
Maintain adduction and flexion when moving around
to minimize strain at the surgical site.
d.
Always pivot on the un-operated leg to protect the
operated leg from unnecessary work.
5. A dislocated prosthesis is evidenced by any of the
following six indicators:
_____________________, _____________________,
_____________________, _____________________,
_________________, and ____________________.
6. In assessing postoperative wound drainage, the nurse
knows that Tom’s drainage of how much in the first
24 hours is within normal range?
a.
150 mL
b.
350 mL
c.
600 mL
d.
1,000 mL
7. The nurse is careful to assess for evidence of DVT (3%
mortality), which occurs in approximately what percentage of patients who have
not had any type of preventive mechanical or pharmacologic prophylaxis?
a.
30%
b.
48%
c.
60%
d.
75%
8. The nurse advises the patient that an acute infection may
occur within how many months of surgery with delayed infections occurring up to
how many months?
__________________________________________________________________________.
CLINICAL SITUATIONS
CASE STUDY: BUCK’S TRACTION
1. a
2. the patient’s body weight and the bed position
adjustments
3. inspect the skin for abrasions and circulatory
disturbances
and make certain the skin is clean and dry
before any tape or foam boot is applied
4. d
5. skin color, skin temperature, capillary refill, edema,
pulses, sensations, and ability to move
6. malleolus and proximal fibula
7. A positive Homans’ sign indicates deep vein thrombosis.
CASE STUDY: TOTAL HIP REPLACEMENT
1. deep vein thrombosis and pulmonary embolism
2. dislocation of the hip prosthesis, excessive wound
drainage, thromboembolism, infection,and heal ulcer
pressure
3. c
4. d
5. leg shortening, inability to move the leg, abnormal
rotation, increased pain, swelling and immobilization
at the surgical site, acute groin pain in affected hip,
and a reported “popping” sensation
6. b
7. b
8. 3; 24
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