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A client sustains an injury to the left ankle after a fall. There was immediate swelling and pain from the injury, and the client was taken to the local emergency department. What initial test does the nurse anticipate the physician will order to rule out a fracture?
- A. Arthrography
- B. Arthroscopy
- C. X-ray
- D. Computerized tomography (CT scan)
Correct Answer: C
Rationale: X-rays may show a larger-than-usual joint space and rule out or confirm an accompanying fracture. Arthrography demonstrates asymmetry in the joint as a result of the damaged ligaments, or arthroscopy may disclose trauma in the joint capsule. A CT scan is costly and not used as a first-line diagnostic tool in the initial stage of an ankle injury.
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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.
The nurse is assisting with an examination of a client suspected of having carpal tunnel syndrome. The physician has the client flex the wrist for 30 seconds and percusses the median nerve. The client complains of pain and numbness when this is done. What does the nurse know this positive sign is documented as?
- A. Tinel sign
- B. Phalen sign
- C. Crepitus
- D. Spasm
Correct Answer: B
Rationale: Phalen sign involves having the client flex the wrist for 30 seconds to determine if pain or numbness occurs (a positive sign for carpal tunnel syndrome). The examiner percusses the median nerve, located on the inner aspect of the wrist, to elicit this response. Tinel sign is also a test that elicits pain and numbness in clients with carpal tunnel syndrome and occurs by lightly tapping the median nerve. Crepitus is a grating sound that is elicited when two bones rub together. Spasm is not indicative of carpal tunnel syndrome.
A client has a history of dislocations of the same joint. The nurse understands that this is most likely due to an insufficient deposit of collagen during the healing process leading to what complication?
- A. Loss of function
- B. Allergic reaction
- C. Lack of mobility
- D. Reduced tensile strength
Correct Answer: D
Rationale: A possible complication of dislocation during the healing process involves an insufficient deposit of collagen during the repair stage. The end result is that the ligaments may have reduced tensile strength and future instability, leading to recurrent dislocations of the same joint. An insufficient deposit of collagen does not lead to a loss of function necessarily, allergic reaction, or a complete lack of mobility.
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.
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.