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A client comes to the orthopedic clinic and reports having pain that radiates down the forearm and being unable to grasp objects firmly. What does the nurse suspect is occurring with the client?
- A. Carpal tunnel syndrome
- B. Ganglion cyst
- C. Epicondylitis
- D. Shoulder dislocation
Correct Answer: C
Rationale: Epicondylitis (tennis elbow) is a painful inflammation of the elbow that is caused by injury following excessive pronation and supination of the forearm, such as that which occurs when playing tennis, pitching a ball, or rowing. Client reports pain radiating down the dorsal surface of the forearm and a weak grasp. Carpal tunnel syndrome is compression of the median nerve and affects the hand with burning. Pain is more prominent in the early morning or at night. The pain of a ganglion cyst is more localized in the area of the cyst. The symptoms the client describes do not correlate with a diagnosis of shoulder dislocation.
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A client was playing softball and was hit in the right ankle by the ball, sustaining a contusion. What is the first action the nurse takes to help alleviate pain and swelling?
- A. Apply heat to the ankle.
- B. Apply a cold pack to the ankle.
- C. Administer ibuprofen (Advil).
- D. Ask the client to walk to stretch the ligaments.
Correct Answer: B
Rationale: Applying cold packs helps to alleviate local pain, swelling, and bruising. Heat is not used initially after injury, because it can dilate the blood vessels, causing increased bruising and pain. Ibuprofen (Advil) would not be a priority action at this time. The client should not walk on the injured foot or ankle until serious injury is ruled out.
A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client reports not being able to feel or move the fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures?
- A. Compartment syndrome
- B. Dislocation
- C. Muscle spasms
- D. Subluxation
Correct Answer: A
Rationale: Separation of adjacent bones from their articulating joint interferes with normal use and produces a distorted appearance. The injury may disrupt local blood supply to structures such as the joint cartilage, causing degeneration, chronic pain, and restricted movement. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space. The fractured humerus may also be dislocated but is not the result of the impaired circulatory status. Muscle spasms may occur around the fracture site but are not the cause of circulatory impairment. Subluxation is a partial dislocation.
A client suffered a subtrochanteric hip fracture after falling out of the bed. What complication should the nurse monitor closely for related to this type of fracture?
- A. Pulmonary edema
- B. Abdominal pain
- C. Urinary retention
- D. Hypovolemia
Correct Answer: D
Rationale: Subtrochanteric hip fractures can lead to significant blood loss into the surrounding tissues, increasing the risk of hypovolemia. The nurse should monitor for signs of hypovolemia, such as tachycardia, hypotension, and decreased urine output.
A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains?
- A. The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices.
- B. The client is unable to bear weight on the left ankle and has a large ecchymotic area.
- C. The client has ecchymosis, edema, and has no function of the left foot and ankle.
- D. The client complains of pain when the joint is moved and has mild edema.
Correct Answer: A
Rationale: A first-degree strain involves mild stretching of the muscle or tendon, causing some edema and muscle spasm, but no real loss of function. The second-degree strain is partial tearing of muscle or tendon, leading to inability to bear weight and causing edema, muscle tenderness, muscle spasm, and ecchymosis. The third-degree tear is severe muscle and/or tendon tearing, causing severe pain, muscle/spasm ecchymosis, edema, and loss of function. A first-degree sprain involves stretching of the ligament fibers characterized by mild edema, tenderness, and pain if the joint is moved.
A client arriving at the emergency department is diagnosed with a dislocation. Assessment would most likely result in which finding(s)?
- A. Complaint of a popping sound
- B. Protrusion in the joint
- C. Swelling
- D. Pain
Correct Answer: A,C,D
Rationale: With a dislocation, a client often reports hearing a popping sound when the dislocation occurs. In addition, the structural shape is altered, with a depression noted about the joint's circumference indicating that the bones above and below are no longer aligned. Swelling, coolness, numbness, tingling, and pale or dusky color of the distal tissue also are present. Pain is a common symptom associated with dislocations.