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The nurse is preparing to assist a patient who has had an open reduction and internal fixation (ORIF) of a hip fracture out of bed for the first time. Which of the following actions should the nurse take first?
- A. Use a mechanical lift to transfer the patient from the bed to the chair.
- B. Check the postoperative orders for the patient's weight-bearing status.
- C. Avoid administration of pain medications before getting the patient up.
- D. Delegate the transfer of the patient out of bed to an unregulated care provider (UCP).
Correct Answer: B
Rationale: The nurse should be familiar with the weight-bearing orders for the patient before attempting the transfer. Mechanical lifts are not typically needed after this surgery. Pain medications should be given, since the movement is likely to be painful for the patient. The RN should supervise the patient during the initial transfer to evaluate how well the patient is able to accomplish this skill.
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The nurse is caring for a patient who has a cast in place after fracturing the radius and the patient asks when the cast can be removed. Which of the following information related to the length of time that the cast will need to remain in place should the nurse tell the patient?
- A. Several months
- B. At least 3 weeks
- C. Until swelling of the wrist has resolved
- D. Until x-rays show complete bony union
Correct Answer: B
Rationale: Bone healing starts immediately after the injury, but since ossification does not begin until 3 weeks postinjury, the cast will need to be worn for at least 3 weeks. Complete union may take up to a year. Resolution of swelling does not indicate bone healing.
The nurse is caring for a patient in the emergency department with repetitive strain injury to the left elbow as a result of his employment as a checkout clerk in the grocery. Which of the following actions should the nurse include in the plan of care?
- A. Surgical options
- B. Elbow injections
- C. Use a wrist splint
- D. Modifications in arm movement
Correct Answer: D
Rationale: Treatment for a repetitive strain injury includes changing the ergonomics of the activity. Elbow injections and surgery are not initial options for this type of injury. A wrist splint might be used for hand or wrist pain, not elbow injuries.
The nurse is caring for a patient with a long-arm cast on the left arm. Which of the following nursing actions should be included in the plan of care?
- A. Suspend the arm from an IV pole.
- B. Immobilize the fingers on the left hand with gauze dressings.
- C. Assess the left axilla and change absorbent dressings as needed.
- D. Assist the patient in passive range of motion for the left arm.
Correct Answer: C
Rationale: The axilla can become excoriated when a long-arm cast is in place, and the nurse should check the axilla and apply absorbent dressings as needed to prevent skin breakdown. The arm should not be suspended from an IV pole, as this could cause discomfort and misalignment. The fingers should be encouraged to move to prevent stiffness. Passive range of motion is not typically needed unless specified, as the patient can actively move unaffected joints.
Which of the following nursing actions should the nurse include in the plan of care for a patient who has had a total knee arthroplasty?
- A. Avoid extension of the knee beyond 120 degrees.
- B. Use a compression bandage to keep the knee flexed.
- C. Start progressive knee exercises to obtain 90-degree flexion.
- D. Teach about the need to avoid weight bearing for 4 weeks.
Correct Answer: C
Rationale: After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree flexion of the knee. The goal for extension of the knee will be 180 degrees. A compression bandage is used to hold the knee in an extended position after surgery. Full weight bearing is expected before discharge.
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.