Nokea
A client has delayed bone healing in a fractured right humerus. What should the nurse prepare the client for that promotes bone growth?
- A. Electrical stimulation
- B. Administration of low-dose heparin
- C. Joint fusion
- D. Administration of antibiotics
Correct Answer: A
Rationale: Delayed union may require surgical interventions to promote bone growth and correct the incorrect union. If necessary, prepare the client for use of electrical stimulation measures that promote bone growth, or for a bone graft. Administration of low-dose heparin would be used to prevent pulmonary embolism. Joint fusion may be used in the case of avascular necrosis. Administration of antibiotics would be used for the potential of infection or to treat an actual infection.
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A client was involved in an automobile accident and sustained multiple traumas. The client has a Volkmann contracture to the right hand. What objective data does the nurse document related to this finding?
- A. Extension of the fingers of the right hand
- B. Nodules on the knuckles of the third and fourth finger
- C. Clawlike deformity of the right hand without ability to extend fingers
- D. Dislocation of the fingers
Correct Answer: C
Rationale: A Volkmann contracture is a clawlike deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. The client is unable to extend the fingers and reports unrelenting pain, particularly if attempting to stretch the hand. Nodules on the knuckles and dislocation are not indicative of Volkmann contracture.
The nurse is caring for a client who reports wrist pain. What does the nurse identify as a positive indicator of the Phalen sign?
- A. Percussion of the median nerve causes tingling and numbness.
- B. Wrist flexion for 30 seconds causes pain and numbness.
- C. Electrical stimulation shows a delay in motor responses.
- D. Shaking hands causes a reduction in the pain
Correct Answer: B
Rationale: Phalen sign involves having the client flex the wrist for 30 seconds to determine if pain or numbness occurs, which if it does, indicates a positive sign for carpal tunnel syndrome. Tinel sign involves percussion of the median nerve, which if positive, elicits tingling, numbness, and pain for clients with carpal tunnel syndrome. Electrical stimulation with delay would be evaluated by electromyography. Shaking hands that leads to a reduction in pain is a method for assessing carpal tunnel syndrome.
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 arrives at the orthopedic clinic and reports suspecting a stress fracture of the right foot. The physician orders an x-ray with negative results. What does the nurse understand that these negative results can mean?
- A. The client does not have a stress fracture
- B. The client probably has a strain
- C. The stress fracture may not be seen on x-ray for a few weeks.
- D. The physician may have misread the x-ray.
Correct Answer: C
Rationale: A stress fracture may not be apparent radiographically for a few weeks. A bone scan usually can identify a nondisplaced or stress fracture earlier than an x-ray.
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.