Nokea
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.
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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.
An emergency department patient is diagnosed with a hip dislocation. The patients family is relieved that the patient has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurses statement?
- A. The longer the joint is displaced, the more difficult it is to get it back in place.
- B. The patients pain will increase until the joint is realigned.
- C. Dislocation can become permanent if the process of bone remodeling begins.
- D. Avascular necrosis may develop at the site of the dislocation if it is not promptly resolved.
Correct Answer: D
Rationale: If a dislocation or subluxation is not reduced immediately, avascular necrosis (AVN) may develop. Bone remodeling does not take place because a fracture has not occurred. Realignment does not become more difficult with time and pain would subside with time, not become worse.
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.
A young patient is being treated for a femoral fracture suffered in a snowboarding accident. The nurses most recent assessment reveals that the patient is uncharacteristically confused. What diagnostic test should be performed on this patient?
- A. Electrolyte assessment
- B. Electrocardiogram
- C. Arterial blood gases
- D. Abdominal ultrasound
Correct Answer: C
Rationale: Subtle personality changes, restlessness, irritability, or confusion in a patient who has sustained a fracture are indications for immediate arterial blood gas studies due to the possibility of fat embolism syndrome. This assessment finding does not indicate an immediate need for electrolyte levels, an ECG, or abdominal ultrasound.
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.