Nokea
The nurse is admitting a patient to the emergency department after falling on the right arm and shoulder. Which of the following findings is most important for the nurse to communicate to the health care provider immediately?
- A. There is bruising at the shoulder area.
- B. The right arm appears shorter than the left.
- C. There is decreased range of motion of the shoulder.
- D. The patient is complaining of arm and shoulder pain.
Correct Answer: B
Rationale: A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency. Bruising, pain, and decreased range of motion also should be reported, but these do not indicate that emergent treatment is needed to preserve function.
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The nurse is caring for a patient in the emergency department following a motor vehicle accident who has massive right lower leg swelling. Which of the following actions will the nurse take first?
- A. Elevate the leg on pillows.
- B. Apply a compression bandage.
- C. Check leg pulses and sensation.
- D. Place ice packs on the lower leg.
Correct Answer: C
Rationale: The initial action by the nurse will be to assess the circulation to the leg and to observe for any evidence of injury such as fractures or dislocations. After the initial assessment, the other actions may be appropriate based on what is observed during the assessment.
The nurse is providing home care instructions to a patient who has multiple forearm fractures and a long-arm cast on the right arm. Which of the following information should the nurse include in the teaching plan?
- A. Keep the hand immobile to prevent soft tissue swelling.
- B. Keep the right shoulder elevated on a pillow or cushion.
- C. Avoid the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for the first 48 hours after the injury.
- D. Call the health care provider for increased swelling or numbness.
Correct Answer: D
Rationale: Increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified immediately to avoid damage to nerves and vessels. The patient should be encouraged to move the joints above and below the cast to avoid stiffness. There is no need to elevate the shoulder. The forearm should be elevated to reduce swelling. NSAIDs can be used to manage pain and swelling.
The nurse is caring for a patient with Buck's traction who had an intracapsular fracture of the left femur. Which of the following actions should the nurse take to evaluate the effectiveness of Buck's traction?
- A. Assess for hip contractures.
- B. Monitor for hip dislocation.
- C. Check the peripheral pulses.
- D. Ask about left hip pain level.
Correct Answer: D
Rationale: Buck's traction keeps the leg immobilized and reduces painful muscle spasm. Hip contractures and dislocation are unlikely to occur in this situation. The peripheral pulses will be assessed, but this does not help in evaluating the effectiveness of Buck's traction.
The nurse is caring for a patient who has a long-arm plaster cast applied for immobilization of a fractured left radius. Which of the following actions should the nurse implement until the cast has completely dried?
- A. Keep the left arm in a dependent position.
- B. Handle the cast with the palms of the hands.
- C. Place gauze around the cast edge to pad any roughness.
- D. Cover the cast with a small blanket to absorb the dampness.
Correct Answer: B
Rationale: Until a plaster cast has dried, placing pressure on the cast should be avoided to prevent creating areas inside the cast that could place pressure on the arm. The left arm should be elevated to prevent swelling. The edges of the cast may be petalled once the cast is dry but padding the edges before that may cause the cast to be misshapen. The cast should not be covered until it is dry because heat builds up during drying.
The nurse is caring for a patient who has just arrived on the orthopedic unit after a right above-the-knee amputation with an immediate prosthetic fitting. Which of the following actions should the nurse implement first?
- A. Place the patient in a prone position.
- B. Check the surgical site for hemorrhage.
- C. Remove the prosthesis and wrap the site.
- D. Keep the residual leg elevated on a pillow.
Correct Answer: B
Rationale: The nurse should monitor for hemorrhage after the surgery. The prosthesis will not be removed. To avoid flexion contracture of the hip, the leg will not be elevated on a pillow. The patient is placed in a prone position after amputation to prevent hip flexion, but this would not be done during the immediate postoperative period.