Nokea
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.
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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 is brought to the emergency department by ambulance after stepping in a hole and falling. While assessing him the nurse notes that his right leg is shorter than his left leg; his right hip is noticeably deformed and he is in acute pain. Imaging does not reveal a fracture. Which of the following is the most plausible explanation for this patients signs and symptoms?
- A. Subluxated right hip
- B. Right hip contusion
- C. Hip strain
- D. Traumatic hip dislocation
Correct Answer: D
Rationale: Signs and symptoms of a traumatic dislocation include acute pain, change in positioning of the joint, shortening of the extremity, deformity, and decreased mobility. A subluxation would cause moderate deformity, or possibly no deformity. A contusion or strain would not cause obvious deformities.
An elite high school football player has been diagnosed with a shoulder dislocation. The patient has been treated and is eager to resume his role on his team, stating that he is not experiencing pain. What should the nurse emphasize during health education?
- A. The need to take analgesia regardless of the short-term absence of pain
- B. The importance of adhering to the prescribed treatment and rehabilitation regimen
- C. The fact that he has a permanently increased risk of future shoulder dislocations
- D. The importance of monitoring for intracapsular bleeding once he resumes playing
Correct Answer: B
Rationale: Patients who have experienced sports-related injuries are often highly motivated to return to their previous level of activity. Adherence to restriction of activities and gradual resumption of activities needs to be reinforced. Appropriate analgesia use must be encouraged, but analgesia does not necessarily have to be taken in the absence of pain. If healing is complete, the patient does not likely have a greatly increased risk of reinjury. Dislocations rarely cause bleeding after the healing process.
A nurse is caring for a patient who had a right below-the-knee amputation (BKA). The nurse recognizes the importance of implementing measures that focus on preventing flexion contracture of the hip and maintaining proper positioning. Which of the following measures will best achieve these goals?
- A. Encouraging the patient to turn from side to side and to assume a prone position
- B. Initiating ROM exercises of the hip and knee 10 to 12 weeks after the amputation
- C. Minimizing movement of the flexor muscles of the hip
- D. Encouraging the patient to sit in a chair for at least 8 hours a day
Correct Answer: A
Rationale: The nurse encourages the patient to turn from side to side and to assume a prone position, if possible, to stretch the flexor muscles and to prevent flexion contracture of the hip. Postoperative ROM exercises are started early, because contracture deformities develop rapidly. ROM exercises include hip and knee exercises for patients with BKAs. The nurse also discourages sitting for prolonged periods of time.
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.