Nokea
A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the nurse should provide what teaching to the patient?
- A. The cast will feel cool to touch for the first 30 minutes.
- B. The cast should be wrapped snuggly with a towel until the patient gets home.
- C. The cast should be supported on a board while drying.
- D. The cast will only have full strength when dry.
Correct Answer: D
Rationale: A cast requires approximately 24 to 72 hours to dry, and until dry, it does not have full strength. While drying, the cast should not be placed on a hard surface. The cast will exude heat while it dries and should not be wrapped.
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A nurse is assessing a patient who is receiving traction. The nurse's assessment confirms that the patient is able to perform plantar flexion. What conclusion can the nurse draw from this finding?
- A. The leg that was assessed is free from DVT.
- B. The patient's tibial nerve is functional.
- C. Circulation to the distal extremity is adequate.
- D. The patient does not have peripheral neurovascular dysfunction.
Correct Answer: B
Rationale: Plantar flexion demonstrates function of the tibial nerve. It does not demonstrate the absence of DVT and does not allow the nurse to ascertain adequate circulation. The nurse must perform more assessments on more sites in order to determine an absence of peripheral neurovascular dysfunction.
A patient broke his arm in a sports accident and required the application of a cast. Shortly following application, the patient complained of an inability to straighten his fingers and was subsequently diagnosed with Volkmann contracture. What pathophysiologic process caused this complication?
- A. Obstructed arterial blood flow to the forearm and hand
- B. Simultaneous pressure on the ulnar and radial nerves
- C. Irritation of Merkel cells in the patient's skin surfaces
- D. Uncontrolled muscle spasms in the patient's forearm
Correct Answer: A
Rationale: Volkmann contracture occurs when arterial blood flow is restricted to the forearm and hand and results in contractures of the fingers and wrist. It does not result from nerve pressure, skin irritation, or spasms.
A patient is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The patient is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement?
- A. Actually, patients are only on bed rest for 2 to 3 days before they begin walking with assistance.
- B. The physical therapist will likely help you get up using a walker the day after your surgery.
- C. Our goal will actually be to have you walking normally within 5 days of your surgery.
- D. For the first two weeks after the surgery, you can use a wheelchair to meet your mobility needs.
Correct Answer: B
Rationale: Patients post-THA begin ambulation with the assistance of a walker or crutches within a day after surgery. Wheelchairs are not normally utilized. Baseline levels of mobility are not normally achieved until several weeks after surgery.
A nurse is planning the care of a patient who has undergone orthopedic surgery. What main goal should guide the nurse's choice of interventions?
- A. Improving the patient's level of function
- B. Helping the patient come to terms with limitations
- C. Administering medications safely
- D. Improving the patient's adherence to treatment
Correct Answer: A
Rationale: Improving function is the overarching goal after orthopedic surgery. Some patients may need to come to terms with limitations, but this is not true of every patient. Safe medication administration is imperative, but this is not a goal that guides other aspects of care. Similarly, adherence to treatment is important, but this is motivated by the need to improve functional status.
A patient has just begun been receiving skeletal traction and the nurse is aware that muscles in the patient's affected limb are spastic. How does this change in muscle tone affect the patient's traction prescription?
- A. Traction must temporarily be aligned in a slightly different direction.
- B. Extra weight is needed initially to keep the limb in proper alignment.
- C. A lighter weight should be initially used.
- D. Weight will temporarily alternate between heavier and lighter weights.
Correct Answer: B
Rationale: The traction weights applied initially must overcome the shortening spasms of the affected muscles. As the muscles relax, the traction weight is reduced to prevent fracture dislocation and to promote healing. Weights never alternate between heavy and light.