Nokea
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.
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The nurse is caring for a patient in the emergency department who has a soft tissue injury and an open leg fracture. Which of the following actions should the nurse implement first?
- A. If dislocation, apply compression bandage.
- B. Realignment of the bone(s).
- C. Administer tetanus with an open fracture.
- D. Apply heat to the affected area.
Correct Answer: C
Rationale: An initial action in the emergency treatment of soft tissue injuries is to administer tetanus if there is evidence of an open fracture. If dislocation is suspected, a compression bandage is contraindicated. The nurse would apply ice, not heat, to the affected area. Realignment of the bone is not to be attempted.
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.
After the health care provider has recommended an amputation for a patient who has ischemic foot ulcers, the patient tells the nurse, 'If they want to cut off my foot, they should just shoot me instead.' Which of the following responses by the nurse is best?
- A. Many people are able to function normally with a foot prosthesis.
- B. I understand that you are upset, but you may lose the foot anyway.
- C. Tell me what you know about what your options for treatment are.
- D. If you do not want the surgery, you do not have to have an amputation.
Correct Answer: C
Rationale: The initial nursing action should be to assess the patient's knowledge level and feelings about the options available. Discussion about the patient's option to not have the procedure, the seriousness of the condition, or rehabilitation after the procedure may be appropriate after the nurse knows more about the patient's current level of knowledge and emotional state.
The nurse is providing health-promotion teaching to a patient whose job involves many hours of word processing. Which of the following actions should the nurse include in the patient teaching plan?
- A. Do stretching and warm-up exercises before starting work.
- B. Use a compression bandage to prevent wrist pain.
- C. Take nonsteroidal anti-inflammatory drugs (NSAIDs) for wrist pain.
- D. Obtain a keyboard pad to support the wrist while word processing.
Correct Answer: D
Rationale: Repetitive strain injuries caused by prolonged times working at a keyboard can be prevented by the use of a pad that will keep the wrists in a straight position. Stretching exercises during the day may be helpful, but these would not be needed before starting. Use of a compression bandage is not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are appropriate to use to decrease swelling but are not a preventive measure.
The nurse is providing discharge teaching to a patient who has a short-arm plaster cast applied. Which of the following patient statements indicate a good understanding of the discharge teaching?
- A. I can get the cast wet as long as I dry it right away with a hair dryer.
- B. I should avoid moving my fingers and elbow until the cast is removed.
- C. I will apply an ice pack to the cast over the fracture site for the next 24 hours.
- D. I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast.
Correct Answer: C
Rationale: Ice application for the first 24 hours after a fracture will help reduce swelling and can be placed over the cast. Plaster casts should not get wet. The patient should be encouraged to move the joints above and below the cast. Patients should not insert objects inside the cast.