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An emergency department patient is diagnosed with a hip dislocation. The patients family is relieved that the patient has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurses statement?
- A. The longer the joint is displaced, the more difficult it is to get it back in place.
- B. The patients pain will increase until the joint is realigned.
- C. Dislocation can become permanent if the process of bone remodeling begins.
- D. Avascular necrosis may develop at the site of the dislocation if it is not promptly resolved.
Correct Answer: D
Rationale: If a dislocation or subluxation is not reduced immediately, avascular necrosis (AVN) may develop. Bone remodeling does not take place because a fracture has not occurred. Realignment does not become more difficult with time and pain would subside with time, not become worse.
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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.
A nurse is planning the care of a patient with osteomyelitis that resulted from a diabetic foot ulcer. The patient requires a transmetatarsal amputation. When planning the patients postoperative care, which of the following nursing diagnoses should the nurse most likely include in the plan of care?
- A. Ineffective Thermoregulation
- B. Risk-Prone Health Behavior
- C. Disturbed Body Image
- D. Deficient Diversion Activity
Correct Answer: C
Rationale: Amputations present a serious threat to any patients body image. None of the other listed diagnoses is specifically associated with amputation.
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 nurse is preparing to discharge a patient from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage which of the following?
- A. Apply heat for the first 24 to 48 hours after the injury.
- B. Maintain the ankle in a dependent position.
- C. Exercise hourly by performing rotation exercises of the ankle.
- D. Keep an elastic compression bandage on the ankle.
Correct Answer: D
Rationale: Treatment of a sprain consists of resting and elevating the affected part, applying cold, and using a compression bandage. After the acute inflammatory stage (usually 24 to 48 hours after injury), heat may be applied intermittently. Rotation exercises would likely be painful.
An older adult patient has fallen in her home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the patients presurgical care, the nurse should be aware of the patients heightened risk of what complication?
- A. Osteomyelitis
- B. Avascular necrosis
- C. Phantom pain
- D. Septicemia
Correct Answer: B
Rationale: Fractures of the neck of the femur may damage the vascular system that supplies blood to the head and the neck of the femur, and the bone may become ischemic. For this reason, AVN is common in patients with femoral neck fractures. Infections are not immediate complications and phantom pain applies to patients with amputations, not hip fractures.