Nokea
A nurse is caring for a patient who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the patient does which of the following in order to prevent common complications associated with a hip fracture?
- A. Avoid requesting analgesia unless pain becomes unbearable.
- B. Use supplementary oxygen when transferring or mobilizing.
- C. Increase fluid intake and perform prescribed foot exercises.
- D. Remain on bed rest for 14 days or until instructed by the orthopedic surgeon.
Correct Answer: C
Rationale: Deep vein thrombosis (DVT) is among the most common complications related to a hip fracture. To prevent DVT, the nurse encourages intake of fluids and ankle and foot exercises. The patient should not be told to endure pain; a proactive approach to pain control should be adopted. While respiratory complications commonly include atelectasis and pneumonia, the use of deep-breathing exercises, changes in position at least every 2 hours, and the use of incentive spirometry help prevent the respiratory complications more than using supplementary oxygen. Bed rest may be indicated in the short term, but is not normally required for 14 days.
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A 20 year-old is brought in by ambulance to the emergency department after being involved in a motorcycle accident. The patient has an open fracture of his tibia. The wound is highly contaminated and there is extensive soft-tissue damage. How would this patients fracture likely be graded?
- A. Grade I
- B. Grade II
- C. Grade III
- D. Grade IV
Correct Answer: C
Rationale: Open fractures are graded according to the following criteria. Grade I is a clean wound less than 1 cm long. Grade II is a larger wound without extensive soft-tissue damage. Grade III is highly contaminated, has extensive soft-tissue damage, and is the most severe. There is no grade IV fracture.
Radiographs of a boys upper arm show that the humerus appears to be fractured on one side and slightly bent on the other. This diagnostic result suggests what type of fracture?
- A. Impacted
- B. Compound
- C. Compression
- D. Greenstick
Correct Answer: D
Rationale: Greenstick fractures are an incomplete fracture that results in the bone being broken on one side, while the other side is bent. This is not characteristic of an impacted, compound, or compression fracture.
A nurse is planning the care of a patient with osteomyelitis that resulted from a diabetic foot ulcer. The patient requires a transmetatarsal amputation. When planning the patients postoperative care, which of the following nursing diagnoses should the nurse most likely include in the plan of care?
- A. Ineffective Thermoregulation
- B. Risk-Prone Health Behavior
- C. Disturbed Body Image
- D. Deficient Diversion Activity
Correct Answer: C
Rationale: Amputations present a serious threat to any patients body image. None of the other listed diagnoses is specifically associated with amputation.
A patient is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The patient has been placed in traction until his femur can be rodded in surgery. For what early complications should the nurse monitor this patient? Select all that apply.
- A. Systemic infection
- B. Complex regional pain syndrome
- C. Deep vein thrombosis
- D. Compartment syndrome
- E. Fat embolism
Correct Answer: C,D,E
Rationale: Early complications include shock, fat embolism, compartment syndrome, and venous thromboemboli (deep vein thrombosis [DVT], pulmonary embolism [PE]). Infection and CRPS are later complications of fractures.
The orthopedic nurse should assess for signs and symptoms of Volkmanns contracture if a patient has fractured which of the following bones?
- A. Femur
- B. Humerus
- C. Radial head
- D. Clavicle
Correct Answer: B
Rationale: The most serious complication of a supracondylar fracture of the humerus is Volkmanns ischemic contracture, which results from antecubital swelling or damage to the brachial artery. This complication is specific to humeral fractures.