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The nurse is caring for a patient who is a baseball pitcher and had an arthroscopic repair of a rotator cuff injury performed in same-day surgery. Which of the following information should be included in the patient's postoperative teaching plan?
- A. You have an appointment with a physical therapist for tomorrow.
- B. You can still play baseball but you will not be able to return to pitching.
- C. The doctor will use the drop-arm test to determine the success of surgery.
- D. Leave the shoulder immobilizer on for the first few days to minimize pain.
Correct Answer: A
Rationale: Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent 'frozen shoulder.' A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of range of motion (ROM). The drop-arm test is used to test for rotator cuff injury, but not after surgery. The patient may be able to return to pitching after rehabilitation.
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The nurse is preparing a patient with lower leg fracture and an external fixation device in place for discharge. Which of the following information should the nurse include in the discharge teaching?
- A. You will need to assess and clean the pin insertion sites daily.
- B. The external fixator can be removed during the bath or shower.
- C. You will need to remain on bed rest until bone healing is complete.
- D. Prophylactic antibiotics are used until the external fixator is removed.
Correct Answer: A
Rationale: Pin insertion sites should be cleaned daily to decrease the risk for infection at the site. An external fixator allows the patient to be out of bed and avoid the risks of prolonged immobility. The device is surgically placed and is not removed until the bone is stable. Prophylactic antibiotics are not routinely given when an external fixator is used.
The nurse is providing discharge teaching to a patient with a sprained right ankle. Which of the following information should be included in the teaching plan? (Select all that apply.)
- A. Elevate the limb.
- B. Use nonsteroidal anti-inflammatory drugs as required.
- C. Apply warm moist heat for 45 minutes, three times per day.
- D. Use an elastic bandage on the ankle during activity.
- E. Use ice alternating with heat 48 hours after the injury.
Correct Answer: A,B,D
Rationale: Teaching instructions for a sprain include elevation of the limb at all times, even during sleep, using NSAIDs for discomfort, and an elastic bandage during activity. Warm moist heat can be applied but it is not to exceed 30 minutes. Ice is only to be used during the initial 24-48 hours after the injury.
The nurse is caring for a patient with a left femur fracture who has a hip spica cast applied. Which of the following nursing interventions should be included in the plan of care?
- A. Avoid placing the patient in the prone position.
- B. Use the cast support bar to reposition the patient.
- C. Ask the patient about any abdominal discomfort or nausea.
- D. Discuss the reasons for remaining on bed rest for several weeks.
Correct Answer: C
Rationale: Assessment of bowel tones, abdominal pain, and nausea and vomiting will detect the development of cast syndrome. To avoid breakage, the support bar should not be used for repositioning. After the cast dries, the patient can begin ambulating with the assistance of physical therapy personnel and may be turned to the prone position.
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.
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.