Nokea
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.
You may also like to solve these questions
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.
A patient is scheduled for a total hip replacement and the surgeon has explained the risks of blood loss associated with orthopedic surgery. The risk of blood loss is the indication for which of the following actions?
- A. Use of a cardiopulmonary bypass machine
- B. Postoperative blood salvage
- C. Prophylactic blood transfusion
- D. Autologous blood donation
Correct Answer: D
Rationale: Many patients donate their own blood during the weeks preceding their surgery. Autologous blood donations are cost effective and eliminate many of the risks of transfusion therapy. Orthopedic surgery does not necessitate cardiopulmonary bypass and blood is not salvaged postoperatively. Transfusions are not given prophylactically.
A patient is planning the care of a patient who will require a prolonged course of skeletal traction. When planning this patient's care, the nurse should prioritize interventions related to which of the following risk nursing diagnoses?
- A. Risk for Impaired Skin Integrity
- B. Risk for Falls
- C. Risk for Imbalanced Fluid Volume
- D. Risk for Aspiration
Correct Answer: A
Rationale: Impaired skin integrity is a high-probability risk in patients receiving traction. Falls are not a threat, due to the patient's immobility. There are not normally high risks of fluid imbalance or aspiration associated with traction.
A nurse is caring for a patient who has a leg cast. The nurse observes that the patient uses a pencil to scratch the skin under the edge of the cast. How should the nurse respond to this observation?
- A. Allow the patient to continue to scratch inside the cast with a pencil but encourage him to be cautious.
- B. Give the patient a sterile tongue depressor to use for scratching instead of the pencil.
- C. Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persists.
- D. Obtain an order for a sedative, such as lorazepam (Ativan), to prevent the patient from scratching.
Correct Answer: C
Rationale: Scratching should be discouraged because of the risk for skin breakdown or damage to the cast. Most patients can be discouraged from scratching if given a mild antihistamine, such as diphenhydramine, to relieve itching. Benzodiazepines would not be given for this purpose.
A nurse is caring for an older adult patient who is preparing for discharge following recovery from a total hip replacement. Which of the following outcomes must be met prior to discharge?
- A. Patient is able to perform ADLs independently.
- B. Patient is able to perform transfers safely.
- C. Patient is able to weight-bear equally on both legs.
- D. Patient is able to demonstrate full ROM of the affected hip.
Correct Answer: B
Rationale: The patient must be able to perform transfers and to use mobility aids safely. Each of the other listed goals is unrealistic for the patient who has undergone recent hip replacement.