Nokea
The nurse is caring for a patient with a fractured right femur who is not a candidate to repair the femur immediately. What intervention should the nurse anticipate the physician will order to relieve muscle spasm and pain until surgery is performed?
- A. Skeletal traction
- B. Skin traction
- C. Open reduction
- D. External fixator
Correct Answer: B
Rationale: If surgery for a fracture cannot be performed right away, Buck's traction or other skin traction may be applied to relieve muscle spasm and pain until surgery is performed. The other distractors all require surgical intervention.
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A client has a fractured jaw sustained in an automobile accident and has had the fracture surgically reduced and immobilized with a wire loop. What should the nurse ensure is present at the client's bedside in case of vomiting?
- A. Wire cutters
- B. A tracheostomy tray
- C. Ice water with a straw
- D. An antiemetic medication
Correct Answer: A
Rationale: Ensure that wire cutters are easily accessible at the client's bedside. The nurse should be familiar with how to cut wire loops if the client vomits or chokes. A tracheostomy tray is not necessary when an airway can be obtained by cutting the wires so the client does not aspirate. If vomiting occurs, the client should have nothing by mouth. Antiemetic medication should be administered prior to the client vomiting and should not be kept at the bedside.
A 68-year-old female client who had a below the knee amputation is to be discharged because her healing is almost complete. Which of the following would be most important for the nurse to discuss with this client?
- A. Advising the client to avoid red meat
- B. Urging her to keep the affected limb in an elevated position
- C. Educating the client about the effects of menopause
- D. Exploring factors related to the client's home environment
Correct Answer: D
Rationale: Exploring factors related to the older adult client's home environment and determining a plan for continued rehabilitation before discharge is most important. The client should be encouraged to eat foods rich in protein, calcium, and vitamin D. Because the healing is almost complete, the client need not always keep the affected limb elevated unless prescribed to do so. Because the client is in her late 60s, she is most likely to have already undergone menopause. Therefore, educating her about the effects of menopause is not as important.
During the assessment of a client scheduled for orthopedic surgery, the nurse discovers that the client was previously treated for the disorder. In such a case, what additional data need to be collected?
- A. Occurrence of complications or problems during treatment
- B. Measures taken to minimize postoperative wound infection
- C. Perception of the client about the previous treatment
- D. Details of the medical team that handled the previous treatment
Correct Answer: A
Rationale: If the same disorder has been treated earlier, the nurse needs to determine and document any complications or problems that occurred during treatment. The nurse can determine whether the client understands the treatment or not based on the measures taken by the client to minimize postoperative wound infection. However, this factor can be assessed later because the nurse needs to explain the new treatment to the client. Although the client's perceptions of the previous treatment may be helpful, this data would not be as important. In addition, the nurse does not need to get details about the medical team that handled the previous treatment, unless specifically asked to do so.
The nurse is caring for a client in skeletal traction. When performing pin care, which action by the nurse is most important?
- A. Clean the site, working toward the pin.
- B. Use an applicator only once.
- C. Gently remove crusts around pin sites.
- D. Apply an antimicrobial ointment.
Correct Answer: B
Rationale: When performing pin care, the nurse should use at least one applicator per pin and not use an applicator more than once, cleaning the site from the pin outward. Crusts around pin sites should be gently removed, but that is less important than not re-using applicators. Ointment is avoided unless it is specifically ordered.
A client is scheduled for a total left knee arthroplasty in 2 weeks. When would the best time for postoperative nursing management to begin?
- A. Before surgery
- B. When the client is taken to the postanesthesia care unit
- C. After the client returns to the room after surgery and receives pain medication
- D. Twenty-four hours after the procedure
Correct Answer: A
Rationale: Ideally, postoperative nursing management begins before surgery with demonstrations of deep-breathing and coughing exercises and descriptions and demonstrations of the incentive spirometer. Even if the client will have postoperative physical therapy, the nurse explains and helps the client practice active and isometric leg exercises. The nurse also describes other devices that may be used after surgery, such as intravenous infusions of fluid and blood, oxygen, a wound drain, elastic stockings, or roller bandages. It also is necessary to include a discussion of the possible use of traction or the CPM machine. The other options offered do not allow adequate time for instruction.