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A nurse is caring for a patient who has suffered an unstable thoracolumbar fracture. Which of the following is the priority during nursing care?
- A. Preventing infection
- B. Maintaining spinal alignment
- C. Maximizing function
- D. Preventing increased intracranial pressure
Correct Answer: B
Rationale: Patients with an unstable fracture must have their spine in alignment at all times in order to prevent neurologic damage. This is a greater threat, and higher priority, than promoting function and preventing infection, even though these are both valid considerations. Increased ICP is not a high risk.
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A patient is being treated for a fractured hip and the nurse is aware of the need to implement interventions to prevent muscle wasting and other complications of immobility. What intervention best addresses the patients need for exercise?
- A. Performing gentle leg lifts with both legs
- B. Performing massage to stimulate circulation
- C. Encouraging frequent use of the overbed trapeze
- D. Encouraging the patient to log roll side to side once per hour
Correct Answer: C
Rationale: The patient is encouraged to exercise as much as possible by means of the overbed trapeze. This device helps strengthen the arms and shoulders in preparation for protected ambulation. Independent logrolling may result in injury due to the location of the fracture. Leg lifts would be contraindicated for the same reason. Massage by the nurse is not a substitute for exercise.
A patient with a simple arm is receiving discharge education from the nurse. What would the nurse instruct the patient to do?
- A. Elevate the affected extremity to shoulder level when at rest.
- B. Engage in exercises that strengthen the unaffected muscles.
- C. Apply topical anesthetics to accessible skin surfaces as needed.
- D. Avoid using analgesics so that further damage is not masked.
Correct Answer: B
Rationale: The nurse will encourage the patient to engage in exercises that strengthen the unaffected muscles. Comfort measures may include appropriate use of analgesics and elevation of the affected extremity to the heart level. Topical anesthetics are not typically used.
A patient has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing his ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed to this complication?
- A. Inadequate vitamin D intake
- B. Bleeding at the injury site
- C. Inadequate immobilization
- D. Venous thromboembolism (VTE)
Correct Answer: C
Rationale: Inadequate fracture immobilization can delay or prevent union. A short-term vitamin D deficiency would not likely prevent bone union. VTE is a serious complication but would not be a cause of nonunion. Similarly, bleeding would not likely delay union.
A patient who has undergone a lower limb amputation is preparing to be discharged home. What outcome is necessary prior to discharge?
- A. Patient can demonstrate safe use of assistive devices.
- B. Patient has a healed, nontender, nonadherent scar.
- C. Patient can perform activities of daily living independently.
- D. Patient is free of pain.
Correct Answer: A
Rationale: A patient should be able to use assistive devices appropriately and safely prior to discharge. Scar formation will not be complete at the time of hospital discharge. It is anticipated that the patient will require some assistance with ADLs postdischarge. Pain should be well managed, but may or may not be wholly absent.
A patient has sustained a long bone fracture and the nurse is preparing the patients care plan. Which of the following should the nurse include in the care plan?
- A. Administer vitamin D and calcium supplements as ordered.
- B. Monitor temperature and pulses of the affected extremity.
- C. Perform passive range of motion exercises as tolerated.
- D. Administer corticosteroids as ordered.
Correct Answer: B
Rationale: The nurse should include monitoring for sufficient blood supply by assessing the color, temperature, and pulses of the affected extremity. Weight-bearing exercises are encouraged, but passive ROM exercises have the potential to cause pain and inhibit healing. Corticosteroids, vitamin D, and calcium are not normally administered.