Nokea
An emergency department nurse is assessing a 17-year-old soccer player who presented with a knee injury. The patients description of the injury indicates that his knee was struck medially while his foot was on the ground. The nurse knows that the patient likely has experienced what injury?
- A. Lateral collateral ligament injury
- B. Medial collateral ligament injury
- C. Anterior cruciate ligament injury
- D. Posterior cruciate ligament injury
Correct Answer: A
Rationale: When the knee is struck medially, damage may occur to the lateral collateral ligament. If the knee is struck laterally, damage may occur to the medial collateral ligament. The ACL and PCL are not typically injured in this way.
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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.
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.
A 25-year-old man is involved in a motorcycle accident and injures his arm. The physician diagnoses the man with an intra-articular fracture and splints the injury. The nurse implements the teaching plan developed for this patient. What sequela of intra-articular fractures should the nurse describe regarding this patient?
- A. Post-traumatic arthritis
- B. Fat embolism syndrome (FES)
- C. Osteomyelitis
- D. Compartment syndrome
Correct Answer: A
Rationale: Intra-articular fractures often lead to post-traumatic arthritis. Research does not indicate a correlation between intra-articular fractures and FES, osteomyelitis, or compartment syndrome.
A rehabilitation nurse is working with a patient who has had a below-the-knee amputation. The nurse knows the importance of the patients active participation in self-care. In order to determine the patients ability to be an active participant in self-care, the nurse should prioritize assessment of what variable?
- A. The patients attitude
- B. The patients learning style
- C. The patients nutritional status
- D. The patients presurgical level of function
Correct Answer: A
Rationale: Amputation of an extremity affects the patients ability to provide adequate self-care. The patient is encouraged to be an active participant in self-care. The patient and the nurse need to maintain positive attitudes and to minimize fatigue and frustration during the learning process. Balanced nutrition and the patients learning style are important variables in the rehabilitation process but the patients attitude is among the most salient variables. The patients presurgical level of function may or may not affect participation in rehabilitation.
The nurse is providing care for a patient who has had a below-the-knee amputation. The nurse enters the patients room and finds him resting in bed with his residual limb supported on pillow. What is the nurses most appropriate action?
- A. Inform the surgeon of this finding.
- B. Explain the risks of flexion contracture to the patient.
- C. Transfer the patient to a sitting position.
- D. Encourage the patient to perform active ROM exercises with the residual limb.
Correct Answer: B
Rationale: The residual limb should not be placed on a pillow, because a flexion contracture of the hip may result. There is no acute need to contact the patients surgeon. Encouraging exercise or transferring the patient does not address the risk of flexion contracture.