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A client is admitted to the emergency department after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention?
- A. Compound
- B. Greenstick
- C. Oblique
- D. Spiral
Correct Answer: A
Rationale: A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.
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A client comes to the clinic 2 days after sustaining a sprain to the left ankle. What intervention can the nurse encourage the client to perform that will help improve circulation?
- A. Active range-of-motion exercises
- B. Take nonsteroidal anti-inflammatory drugs
- C. Applying cold compresses
- D. Applying heat
Correct Answer: D
Rationale: After 2 days, when swelling is no longer likely to increase, applying heat reduces pain and relieves local edema by improving circulation. Full use of the injured joint is discouraged temporarily. Nonsteroidal anti-inflammatory drugs will ease discomfort but not improve circulation. Applying cold compresses is only used in the first 24 to 48 hours after an injury to reduce swelling and relieve pain.
A client arrives in the emergency department complaining of severe pain in the left hip after falling out of the bed. What indication(s) upon assessment does the nurse recognize as a dislocated left hip?
- A. The left leg appears shorter
- B. The skin is warm to the touch
- C. Limited range of motion of the left hip
- D. Swelling around the hip
- E. The skin of the lower left leg is pale
- F. The client is able to bend the knee but not move toes
Correct Answer: A,C,D
Rationale: The leg may be shorter than its unaffected counterpart as a result of the displacement of one of the articulating bones. Range of motion is limited. Evidence of soft tissue injury includes swelling, coolness, numbness, tingling, and pale or dusky color. The client will not be able to bend the knee easily, and toe movement is typically preserved unless there is nerve damage.
A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of activity limitations when stating that a brace must be worn for which length of time?
- A. 2 to 4 weeks
- B. 6 to 8 weeks
- C. 10 to 12 weeks
- D. 14 to 16 weeks
Correct Answer: B
Rationale: Following surgical repair for a ruptured Achilles tendon, the client wears a brace or cast for 6 to 8 weeks. Two to four weeks is not long enough to support healing. The other answer choices are longer than necessary.
A client has sustained a left femur fracture in a skiing accident. When is the nurse aware that the complication of a fat emboli typically occurs and should be monitored for closely?
- A. The first hour after fracture of the long bone
- B. 8 to 12 hours
- C. 12 to 24 hours
- D. 48 to 72 hours
Correct Answer: D
Rationale: The client should be monitored for symptoms of a fat embolism, which typically occurs within 48 to 72 hours.
An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse employ to minimize energy loss in response to pain?
- A. Administer prescribed analgesics around-the-clock.
- B. Administer prescribed pain medication only when the client requests it.
- C. Give pain medication to the client after providing care.
- D. Avoid administering too much medication because the client is older.
Correct Answer: A
Rationale: Pain associated with hip fracture is severe and must be carefully managed with around-the-clock dosing of pain medication to minimize energy loss in response to pain. The client may not request the medication even if they are in pain, and it should be offered at the prescribed time. Giving pain medication prior to providing any type of care involved in moving the client is appropriate to reduce discomfort.