Nokea
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.
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A nurse is caring for a patient who has suffered an unstable thoracolumbar fracture. Which of the following is the priority during nursing care?
- A. Preventing infection
- B. Maintaining spinal alignment
- C. Maximizing function
- D. Preventing increased intracranial pressure
Correct Answer: B
Rationale: Patients with an unstable fracture must have their spine in alignment at all times in order to prevent neurologic damage. This is a greater threat, and higher priority, than promoting function and preventing infection, even though these are both valid considerations. Increased ICP is not a high risk.
Which of the following is the most appropriate nursing intervention to facilitate healing in a patient who has suffered a hip fracture?
- A. Administer analgesics as required.
- B. Place a pillow between the patients legs when turning.
- C. Maintain prone positioning at all times.
- D. Encourage internal and external rotation of the affected leg.
Correct Answer: B
Rationale: Placing a pillow between the patients legs when turning prevents adduction and supports the patients legs. Administering analgesics addresses pain but does not directly protect bone remodeling and promote healing. Rotation of the affected leg can cause dislocation and must be avoided. Prone positioning does not need to be maintained at all times.
A nurse is caring for a patient who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the patient does which of the following in order to prevent common complications associated with a hip fracture?
- A. Avoid requesting analgesia unless pain becomes unbearable.
- B. Use supplementary oxygen when transferring or mobilizing.
- C. Increase fluid intake and perform prescribed foot exercises.
- D. Remain on bed rest for 14 days or until instructed by the orthopedic surgeon.
Correct Answer: C
Rationale: Deep vein thrombosis (DVT) is among the most common complications related to a hip fracture. To prevent DVT, the nurse encourages intake of fluids and ankle and foot exercises. The patient should not be told to endure pain; a proactive approach to pain control should be adopted. While respiratory complications commonly include atelectasis and pneumonia, the use of deep-breathing exercises, changes in position at least every 2 hours, and the use of incentive spirometry help prevent the respiratory complications more than using supplementary oxygen. Bed rest may be indicated in the short term, but is not normally required for 14 days.
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.
A nurse is writing a care plan for a patient admitted to the emergency department (ED) with an open fracture. The nurse will assign priority to what nursing diagnosis for a patient with an open fracture of the radius?
- A. Risk for Infection
- B. Risk for Ineffective Role Performance
- C. Risk for Perioperative Positioning Injury
- D. Risk for Powerlessness
Correct Answer: A
Rationale: The patient has a significant risk for osteomyelitis and tetanus due to the fact that the fracture is open. Powerlessness and ineffective role performance are psychosocial diagnoses that may or may not apply, and which would be superseded by immediate physiologic threats such as infection. Surgical positioning injury is not plausible, since surgery is not likely indicated.