Chapter 45: Fractures Chapter 46: Amputations

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Two days after surgery for a crushed pelvis, a certified nursing assistant (CNA) reports that the patient is complaining of a shortness of breath and is demonstrating signs of confusion and restlessness. Which complication should a nurse suspect, from these signs alone, that the patient has developed?

Fat embolus

Which information should a nurse teach an older patient with a newly casted Colles fracture?

Move the shoulders to reduce contractures.

A patient who has osteomyelitis after multiple fractures inquires what the physician meant when he said that surgery would follow the antibiotic therapy. Which response is the nurse's most helpful reply to explain why this surgery will be performed?

To remove dead bone.

A patient with a crushed forearm cannot get pain relief with opioid medications. The injury is swollen, cool, and cyanotic, with weak distal pulses. Which complication should the nurse suspect?

Compartment syndrome

A patient who sustained a simple fracture of the left fibula 7 days earlier asks in what stage of bone healing he might be. Which stage of healing should the nurse relay to the patient?

callus formation

Which assessment is of the greatest concern to a nurse when caring for a patient just admitted with a pelvic fracture?

No urinary output for 8 hours

An older woman falls down at church and immediately complains of severe pain in her left hip. Which observation is recognized as the cardinal sign of a fractured hip?

Shortened left leg compared with the right

A patient has just had a plaster of Paris upper extremity cast placed because of a fractured radius. Which statement indicates that the patient understands the discharge teaching related to cast care?

"When I get home, I am going to rest in bed with my arm elevated above my heart."

Which special precaution should a nurse implement when assisting with the application of a short arm plaster cast?

Smooth the stockinette to prevent a pressure ulcer.

An older patient who sustained a fractured hip and femur in a motor vehicle accident is to be in Russell traction for several weeks. Which intervention should be the focus of care for the nurse?

Preventing deep vein thrombosis (DVT)

A 78-year-old retired teacher with a history of osteoporosis has fallen in her bathroom and sustained a subcapital femoral fracture. She is scheduled for an open reduction and internal fixation (ORIF) procedure in the morning. Which type of traction will most likely be implemented?

Buck

A nurse is told that a patient has a compound comminuted fracture. Which characteristic of the bone in this type of fracture causes the nurse to be concerned?

It is broken into two or more pieces, and bone fragments protrude through the skin.

A patient with bilateral avascular necrosis of the hips is to walk with crutches using a four-point gait for 6 weeks after her bone decompression surgeries. Which statement would indicate that the patient understands this technique?

"I will move my right crutch and then my left leg and then the left crutch and my right leg."

Which action should a nurse implement when caring for a patient diagnosed with a compound fracture?

Assess for pulses distal to the injury.

Assistive devices such as canes, crutches, and walkers are used for people who need to limit weight-bearing activities on joints. Which statement by a nurse best illustrates an understanding of the appropriate use of these devices?

"Canes provide minimal support and balance and are carried on the unaffected side."

Which patient is most appropriate for a nurse to refer to home health care?

A single woman with a bedroom in a rooming house

Which information should a nurse who is documenting and reporting the signs and symptoms of an infection underneath a cast include in the medical record?

elevated temperature

Which patient problem has the highest priority after surgery for the open reduction and external fixation of an ankle?

Potential for infection

A patient in a full body cast (spica) complains of nausea and abdominal distention. Which potential complication should a licensed vocational nurse (LVN) suspect?

Cast syndrome

An older adult patient is at risk for constipation after sustaining a pelvic fracture. Which nutritional suggestion by the nurse is most appropriate?

While immobilized, drink at least 2 to 3 L of fluids daily.

Which finding should produce the most concern when performing pin care for a patient with an external fixator?

purulent drainage

Which assessment is considered abnormal when a nurse performs a neurovascular assessment on a patient in skeletal traction?

Delayed capillary refill

Which action should a nurse implement when dealing with the weights that are applying traction to a patient?

Allow them to hang freely.

Which statement is true about a greenstick fracture?

Fracture is incomplete, and one side is bent.

A patient with a fractured pelvis says that she will not ambulate because of pain. Which complication should a nurse inform the patient can be prevented with early ambulation?

DVT

A nurse uses a diagram to show the process of a fractured bone healing. What is the correct sequence of healing for the diagram?

Hematoma, fibrocartilage, callus, ossification, consolidation

To which situation can delayed union of a fracture be attributed? (Select all that apply.)

Inadequate immobilization, Infection, Poor nutrition

Which characteristics are present when crutches are properly fitted? (Select all that apply.)

The axilla piece is 3 to 4 fingerbreadths below the axilla., They are measured and adjusted when the patient is in the tripod position.

A fracture that occurs because of osteoporosis is classified as a(n)___fracture.

pathological

A nurse is aware that a patient who is having his leg amputated is also having a prosthesis fitted during at the same time as the surgery. Which fact should the preoperative teaching plan include?

A rigid dressing will be applied to accommodate the prosthesis.

A patient asks when he should expect to be up and walking after his below-the-knee amputation. Which time period describes when the nurse should assure him that most people with amputations can fully bear weight?

3 months

A nurse is conducting a safety seminar and reminds the audience that upper extremity amputations are most frequently caused by trauma. Which population has the highest incidence of this type of amputation?

young men

An 80-year-old man with diabetes has had vascular problems with his feet and lower legs for 10 years and is scheduled for a left below-the-knee amputation. Which remark by the patient indicates an understanding of the procedure?

"If this heals well, how long until I get a prosthesis?"

Which routine preoperative diagnostic tests are appropriate for a patient anticipating a below-the-knee amputation?

Pulse volume recording and white blood cell (WBC) count

Which site describes where the limb is severed with an elbow disarticulation?

Through the elbow joint

A patient with peripheral vascular disease (PVD) and diabetes asks what he can do to help prevent an amputation. Which of the following is the best response of the nurse?

"Stopping smoking would help prevent vasoconstriction."

Which statement correctly identifies why a closed amputation is usually performed?

To create a weight-bearing residual limb

What controls the movement with a myoelectrically controlled prosthesis?

Patient's muscle movement and the prosthesis

A patient who had a below-the-knee amputation 24 hours earlier is complaining of burning pain in his left foot. Which intervention is most appropriate for the nurse to implement?

Medicate the patient with the prescribed pain remedy.

During the admission of a patient scheduled for an amputation, a patient relates that she is a practicing Orthodox Jew. Which arrangements are appropriate for the nurse to make for this patient?

The amputated part should be buried.

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