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A nurse is planning the care of an older adult patient who will soon be discharged home after treatment for a fractured hip. In an effort to prevent future fractures, the nurse should encourage which of the following? Select all that apply.
- A. Regular bone density testing
- B. A high-calcium diet
- C. Use of falls prevention precautions
- D. Use of corticosteroids as ordered
- E. Weight-bearing exercise
Correct Answer: A,B,C,E
Rationale: Health promotion measures after an older adults hip fracture include weight-bearing exercise, promotion of a healthy diet, falls prevention, and bone density testing. Corticosteroids have the potential to reduce bone density and increase the risk for fractures.
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A nurse in a busy emergency department provides care for many patients who present with contusions, strains, or sprains. Treatment modalities that are common to all of these musculoskeletal injuries include which of the following? Select all that apply.
- A. Massage
- B. Applying ice
- C. Compression dressings
- D. Resting the affected extremity
- E. Corticosteroids
- F. Elevating the injured limb
Correct Answer: B,C,D,F
Rationale: Treatment of contusions, strains, and sprains consists of resting and elevating the affected part, applying cold, and using a compression bandage. Massage and corticosteroids are not used to treat these injuries.
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 presented to the emergency department with an injury to the wrist. The patient is diagnosed with a third-degree strain. Why would the physician order an x-ray of the wrist?
- A. Nerve damage is associated with third-degree strains.
- B. Compartment syndrome is associated with third-degree strains.
- C. Avulsion fractures are associated with third-degree strains.
- D. Greenstick fractures are associated with third-degree strains.
Correct Answer: C
Rationale: An x-ray should be obtained to rule out bone injury, because an avulsion fracture (in which a bone fragment is pulled away from the bone by a tendon) may be associated with a third-degree strain. Nerve damage, compartment syndrome, and greenstick fractures are not associated with third-degree strains.
Which of the following is the most appropriate nursing intervention to facilitate healing in a patient who has suffered a hip fracture?
- A. Administer analgesics as required.
- B. Place a pillow between the patients legs when turning.
- C. Maintain prone positioning at all times.
- D. Encourage internal and external rotation of the affected leg.
Correct Answer: B
Rationale: Placing a pillow between the patients legs when turning prevents adduction and supports the patients legs. Administering analgesics addresses pain but does not directly protect bone remodeling and promote healing. Rotation of the affected leg can cause dislocation and must be avoided. Prone positioning does not need to be maintained at all times.
Elevate the arm above the shoulder 3 to 4 times daily.
- A. Avoid moving the elbow, wrist, and fingers until bone remodeling is complete.
- B. Engage in active range of motion using the affected arm.
- C. Use the arm for light activities within the range of motion.
Correct Answer: D
Rationale: A patient with a clavicle fracture may use a sling to support the arm and relieve the pain. The patient may be permitted to use the arm for light activities within the range of comfort. The patient should not elevate the arm above the shoulder level until the ends of the bones have united, but the nurse should encourage the patient to exercise the elbow, wrist, and fingers.