Nokea
A client is scheduled for a joint replacement surgery. Which action would be most important for the nurse to take?
- A. Ensure adequate fluid intake before the surgery.
- B. Withhold intake of solid food before the surgery.
- C. Withhold administration of aspirin before the surgery.
- D. Ensure adequate sleep before the surgery.
Correct Answer: C
Rationale: If a client is scheduled for a joint replacement or other surgery, it is crucial for the nurse to withhold aspirin before surgery to reduce the risk of excessive bleeding. It is also essential to monitor the complete blood count, prothrombin time, bleeding, and clotting time to ensure that the client is able to control bleeding. The impact of fluid or solid food intake does not have as strong implications as the impact of aspirin intake before surgery. Having adequate sleep before surgery is helpful but is not the most important action.
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The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed?
- A. The leg will look as it did prior to the cast being applied.
- B. The leg will look moist and will have small bumps that will go away in a few days.
- C. The skin may be covered with a yellowish crust that will shed in a few days.
- D. The leg strength is enforced by the wearing of the cast.
Correct Answer: C
Rationale: Once the cast is off, the skin appears mottled and may be covered with a yellowish crust composed of accumulated body oil and dead skin. The client usually sheds this residue in a few days. The leg will not look as it did prior to the cast but will regain the same shape and status as the other leg. There should be no bumps underneath the cast. The leg may be weak and stiff for some time after the cast is removed, not stronger.
A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for?
- A. Left hip arthroplasty
- B. Left hip arthroscopy
- C. Open reduction and internal fixation of the left hip.
- D. Closed reduction of the left hip.
Correct Answer: A
Rationale: Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip.
The clinic nurse is caring for a client with an injured body part that does not require rigid immobilization. What method of immobilization would the nurse expect the health care provider to use on a short-term basis?
- A. Cast
- B. Brace
- C. Splint
- D. Skin traction
Correct Answer: C
Rationale: A splint immobilizes and supports an injured body part in a functional position and is used when the condition does not require rigid immobilization, causes a large degree of swelling, or requires special skin treatment. Casts and traction provide rigid immobilization. A brace provides support, controls movement, and prevents additional injury for more long-term use.
A client has a fractured jaw sustained in an automobile accident and has had the fracture surgically reduced and immobilized with a wire loop. What should the nurse ensure is present at the client's bedside in case of vomiting?
- A. Wire cutters
- B. A tracheostomy tray
- C. Ice water with a straw
- D. An antiemetic medication
Correct Answer: A
Rationale: Ensure that wire cutters are easily accessible at the client's bedside. The nurse should be familiar with how to cut wire loops if the client vomits or chokes. A tracheostomy tray is not necessary when an airway can be obtained by cutting the wires so the client does not aspirate. If vomiting occurs, the client should have nothing by mouth. Antiemetic medication should be administered prior to the client vomiting and should not be kept at the bedside.
A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client?
- A. Cutting of a bivalve cast
- B. Cutting a cast window
- C. Removal of the cast
- D. Insertion of an external fixator
Correct Answer: B
Rationale: After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. A bivalve cast is when the cast is cut in two if the leg swells or if the client is being weaned from a cast, when a sharp x-ray is needed, or as a splint for immobilizing painful joints when a client has arthritis. The cast should not be removed due to the instability of a fracture. The client's condition does not indicate an external fixator is required.