Deck 11: Orthopedic Measures

Question 1

An expected outcome of cast application that the nurse evaluates is:

A)skin irritation at the cast edges.
B)decreased capillary refill and pallor.
C)tingling and numbness distal to the cast.
D)slight edema, soreness, and limited range of motion.

Answer 1

slight edema, soreness, and limited range of motion.

Question 2

The nurse places the patient in traction.Expected outcomes would include which of the following?

A)Alignment of fracture fragments with formation of callus within 24 hours
B)Verbalization of pain level as a "4" on a scale of 0 to 10
C)Verbalization of immediate relief of symptoms
D)Distal skin tissue becoming cooler, with capillary refill greater than 3 seconds

Answer 2

Verbalization of pain level as a "4" on a scale of 0 to 10

Question 3

The nurse is caring for a patient who has had a new cast applied.The nurse is performing a neurovascular assessment so as to detect signs of possible compartment syndrome.Which of the following are signs of compartment syndrome? (Select all that apply.)

A)Inability to move body parts distal to the cast
B)Pain on passive motion of distal body parts
C)Hyperventilation
D)Tachycardia
E)None of above

Answer 3

Inability to move body parts distal to the cast
Pain on passive motion of distal body parts
Hyperventilation
Tachycardia

Question 4

The patient has a broken leg and needs to have a cast applied.When plaster of Paris is compared and contrasted versus the newer synthetic casts, which of the following statements is true?

A)Plaster of Paris can tolerate earlier weight bearing than synthetic casts.
B)Plaster of Paris is more expensive than synthetic casts.
C)Synthetic casts can withstand contact with water better than plaster of Paris.
D)Synthetic casts are lighter but take longer to set than plaster of Paris.

Question 5

The patient is admitted for a fractured tibia.The nurse is preparing for cast application and expects to administer a(n) _____ to the patient minutes before the procedure.

A)oral analgesic 10
B)intramuscular (IM) analgesic 10
C)intravenous (IV) analgesic 2 to 5
D)muscle relaxant 10

Question 6

For a patient who is to be placed in Russell's traction, the nurse prepares the:

A)occipital area.
B)arm and forearm.
C)back and abdomen.
D)lower extremities.

Question 7

An appropriate technique for the nurse to implement for a patient who is being placed in traction is to:

A)apply a traction boot tightly.
B)drop the weights after the traction is attached.
C)assess neurovascular status every 1 to 2 hours for the first day.
D)shave the hair off the area where traction is to be placed.

Question 8

Which type of traction does the nurse anticipate will be used for an adult patient with a fractured humerus?

A)Bryant's traction
B)Dunlop's traction
C)Gallows traction
D)Buck's extension

Question 9

According to the National Association of Orthopaedic Nurses (NAON), which of the following is possibly the most effective cleansing solution for pin-site care?

A)Normal saline
B)Hydrogen peroxide
C)Chlorhexidine
D)None of the above

Question 10

The patient is in traction and is at risk for fat embolism syndrome.Signs and symptoms of fat embolism include which of the following? (Select all that apply.)

A)Chest pain
B)Tachypnea
C)Tachycardia
D)Apprehension
E)Altered LOC

Question 11

In planning nursing care, the nurse knows that she will need to provide an abduction pillow for which patient?

A)A patient who will be immobilized for a long time
B)A patient who has undergone repair of a fractured right arm
C)A patient who is post hip replacement surgery
D)A patient who has a severely sprained ankle

Question 12

Skeletal traction is implemented primarily for: (Select all that apply.)

A)simple fracture.
B)multiple trauma.
C)fractured ankle.
D)acetabular fracture.
E)cervical fracture.

Question 13

For cast removal, which of the following instructions should the nurse provide to the patient?

A)Discomfort will be felt from the cast saw.
B)An enzyme wash may be applied to intact skin.
C)The skin will be scrubbed very well after the removal.
D)Aggressive range-of-motion exercises will be performed after removal.

Question 14

The patient has been in skeletal traction for external fixation of his femur for 2 days.Suddenly, he calls the nurse complaining of chest pain and shortness of breath.The nurse notes that the patient appears anxious, and that his pulse and respirations are elevated.She should do which of the following? (Select all that apply.)

A)Massage the lower extremity
B)Elevate the head of the bed
C)Administer oxygen
D)Notify the physician

Question 15

For a patient in traction who has skeletal pins, the nurse should:

A)use povidone-iodine to cleanse the pin site.
B)apply antiseptic ointment and cover with a split dressing.
C)use hydrogen peroxide as a rinse before a dressing is applied.
D)do both pin sites at the same time, with the same swab and solution.

Question 16

For a patient with a fractured femur, a nurse is alert to the possibility of a fat embolus.What should the nurse specifically watch for?

A)Bradypnea
B)Restlessness
C)Bradycardia
D)Calf pain

Question 17

An appropriate technique for the nurse to implement for the patient who is being casted is to:

A)apply ice to the top of the cast.
B)maintain the extremity below heart level.
C)handle the wet cast with the fingertips.
D)fold the stockinette or padding over the outer cast edges.

Question 18

When teaching cast care, the nurse instructs the patient to:

A)blow dry the wet cast on the "hot" setting.
B)report changes in sensation or mobility to the area.
C)use only soft objects to slide down the cast for scratching.
D)cut away the edges of the cast if the skin becomes irritated.

Question 19

The patient is brought into the emergency department after falling on the ice in her driveway.She is suspected of having a fractured hip.After comparing different available types of traction, she anticipates that which of the following will be used?

A)Bryant's traction
B)Dunlop's traction
C)Buck's extension
D)Gallows traction

Question 20

While in Buck's extension traction, the patient may be positioned on the back:

A)with the head of the bed elevated 45 degrees.
B)turning to the unaffected side for 10- to 15-minute periods.
C)with the buttocks slightly elevated off of the bed.
D)with the bed tilted toward the side that is opposite the traction.

Question 21

After application of the cast, the nurse ensures that plaster crumbs are removed and rough edges are _________ to prevent skin breakdown.

Question 22

When applying a plaster of Paris cast, it is important to keep the cast exposed for at least _____________ minutes.

Question 23

A _______________ is an externally applied structure that holds musculoskeletal tissues in a specific position to permit healing of injuries or fractures or to align malpositioned tissues.

Question 24

__________________ involves monitoring for the five Ps (pain, pallor, pulselessness, paresthesia, and paralysis).

Question 25

After applying a cast, the nurse should be able to insert _______ fingers between the cast and the limb.

Question 26

An immobilization device used to immobilize and protect a body part is known as a ________.

Question 27

____________________ consists of a metal frame that secures pins inserted through the bone above and below the fracture site.It stabilizes a fracture with hardware visible outside the body.

Question 28

_____________________ applies a pull indirectly to the bone via straps attached to the skin around the structure.

Question 29

The patient has fallen and broken her leg.To keep the leg bones aligned and to reduce muscle spasms, the physician orders the patient to be placed in ____________.

Question 30

_________________ may occur when pressure within a casted extremity increases.