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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.
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A nurses assessment of a patients knee reveals edema, tenderness, muscle spasms, and ecchymosis. The patient states that 2 days ago he ran 10 miles and now it really hurts to stand up. The nurse should plan care based on the belief that the patient has experienced what?
- A. A first-degree strain
- B. A second-degree strain
- C. A first-degree sprain
- D. A second-degree sprain
Correct Answer: B
Rationale: A second-degree strain involves tearing of muscle fibers and is manifested by notable loss of load-bearing strength with accompanying edema, tenderness, muscle spasm, and ecchymosis. A first-degree strain reflects tearing of a few muscle fibers and is accompanied by minor edema, tenderness, and mild muscle spasm, without noticeable loss of function. However, this patient states a loss of function. A sprain normally involves twisting, which is inconsistent with the patients overuse injury.
A patient is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The patient has been placed in traction until his femur can be rodded in surgery. For what early complications should the nurse monitor this patient? Select all that apply.
- A. Systemic infection
- B. Complex regional pain syndrome
- C. Deep vein thrombosis
- D. Compartment syndrome
- E. Fat embolism
Correct Answer: C,D,E
Rationale: Early complications include shock, fat embolism, compartment syndrome, and venous thromboemboli (deep vein thrombosis [DVT], pulmonary embolism [PE]). Infection and CRPS are later complications of fractures.
An older adult patient experienced a fall and required treatment for a fractured hip on the orthopedic unit. Which of the following are contributory factors to the incidence of falls and fractured hips among the older adult population? Select all that apply.
- A. Loss of visual acuity
- B. Adverse medication effects
- C. Slowed reflexes
- D. Hearing loss
- E. Muscle weakness
Correct Answer: A,B,C,E
Rationale: Older adults are generally vulnerable to falls and have a high incidence of hip fracture. Weak quadriceps muscles, medication effects, vision loss, and slowed reflexes are among the factors that contribute to the incidence of falls. Decreased hearing is not noted to contribute to the incidence of falls.
The orthopedic nurse should assess for signs and symptoms of Volkmanns contracture if a patient has fractured which of the following bones?
- A. Femur
- B. Humerus
- C. Radial head
- D. Clavicle
Correct Answer: B
Rationale: The most serious complication of a supracondylar fracture of the humerus is Volkmanns ischemic contracture, which results from antecubital swelling or damage to the brachial artery. This complication is specific to humeral fractures.
A 20 year-old is brought in by ambulance to the emergency department after being involved in a motorcycle accident. The patient has an open fracture of his tibia. The wound is highly contaminated and there is extensive soft-tissue damage. How would this patients fracture likely be graded?
- A. Grade I
- B. Grade II
- C. Grade III
- D. Grade IV
Correct Answer: C
Rationale: Open fractures are graded according to the following criteria. Grade I is a clean wound less than 1 cm long. Grade II is a larger wound without extensive soft-tissue damage. Grade III is highly contaminated, has extensive soft-tissue damage, and is the most severe. There is no grade IV fracture.