Nokea
A patient has had a brace prescribed to facilitate recovery from a knee injury. What are the potential therapeutic benefits of a brace? Select all that apply.
- A. Preventing additional injury
- B. Immobilizing prior to surgery
- C. Providing support
- D. Controlling movement
- E. Promoting bone remodeling
Correct Answer: A,C,D
Rationale: Braces (i.e., orthoses) are used to provide support, control movement, and prevent additional injury. They are not used to immobilize body parts or to facilitate bone remodeling.
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An elderly patient's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment?
- A. The presence of leg shortening
- B. The patient's complaints of pain
- C. Signs of neurovascular compromise
- D. The presence of internal or external rotation
Correct Answer: C
Rationale: Because impaired circulation can cause permanent damage, neurovascular assessment of the affected leg is always a priority assessment. Leg shortening and internal or external rotation are common findings with a fractured hip. Pain, especially on movement, is also common after a hip fracture.
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.
The orthopedic surgeon has prescribed balanced skeletal traction for a patient. What advantage is conferred by balanced traction?
- A. Balanced traction can be applied at night and removed during the day.
- B. Balanced traction allows for greater patient movement and independence than other forms of traction.
- C. Balanced traction is portable and may accompany the patient's movements.
- D. Balanced traction facilitates bone remodeling in as little as 4 days.
Correct Answer: B
Rationale: Often, skeletal traction is balanced traction, which supports the affected extremity, allows for some patient movement, and facilitates patient independence and nursing care while maintaining effective traction. It is not portable, however, and it cannot be removed. Bone remodeling takes longer than 4 days.
A nurse is emptying an orthopedic surgery patient's closed suction drainage at the end of a shift. The nurse notes that the volume is within expected parameters but that the drainage has a foul odor. What is the nurse's best action?
- A. Aspirate a small amount of drainage for culturing.
- B. Advance the drain 1 to 1.5 cm.
- C. Irrigate the drain with normal saline.
- D. Inform the surgeon of this finding.
Correct Answer: D
Rationale: The nurse should promptly notify the surgeon of excessive or foul-smelling drainage. It would be inappropriate to advance the drain, irrigate the drain, or aspirate more drainage.
A nurse is caring for a patient who is in skeletal traction. To prevent the complication of skin breakdown in a patient with skeletal traction, what action should be included in the plan of care?
- A. Apply occlusive dressings to the pin sites.
- B. Encourage the patient to push up with the elbows when repositioning.
- C. Encourage the patient to perform isometric exercises once a shift.
- D. Assess the pin insertion site every 8 hours.
Correct Answer: D
Rationale: The pin insertion site should be assessed every 8 hours for inflammation and infection. Loose cover dressings should be applied to pin sites. The patient should be encouraged to use the overhead trapeze to shift weight for repositioning. Isometric exercises should be done 10 times an hour while awake.