Clinical Nursing Skills And Techniques 8th Edition By Anne Griffin Perry – Test Bank

Chapter 11: Orthopedic Measures

MULTIPLE CHOICE

1. 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

ANS: C
The second group to develop clinical practice guidelines is the United States–based NAON, which indicated that chlorhexidine 2 mg/mL solution is possibly the most effective cleansing solution for pin-site care. A British consensus group of orthopedic nurse experts recommends that pin sites be cleaned only with sterile normal saline or water to remove crusts around the pins (Walker, 2007). Walker found no definitive evidence to support a pin-site dressing containing an antimicrobial agent. Several studies have found that although hydrogen peroxide is a common cleansing agent, it may cause damage to the healthy tissue surrounding the pin.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 264
OBJ: Explain nursing measures for complications from traction.
TOP: Pin-Site Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

2. 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.

ANS: C
Although the newer synthetic casts are more expensive than plaster of Paris, they can withstand contact with water without crumbling. A plaster of Paris cast has multiple rolls of open-weave cotton saturated with calcium sulfate crystals. These casts are heavier than synthetic casts and take 24 to 72 hours with no weight bearing or application of pressure while drying. Synthetic casts are lightweight, set in 15 minutes, and can sustain weight bearing or pressure in 15 to 30 minutes.

DIF: Cognitive Level: Analysis REF: Text reference: p. 251
OBJ: Explain nursing measures for complications from traction.
TOP: Comparison of Cast Material KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity

3. 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.

ANS: D
Expected outcomes after completion of the procedure: Patient initially experiences only slight edema, soreness, mild pain, and some limitation of active range of joint motion (ROJM) from being in the cast. Expected outcomes after completion of the procedure: Skin around proximal and distal cast edges remains intact without irritation, is free of pressure and friction from the cast edges, and is warm and of normal color with capillary refill of 3 seconds or less; and the patient verbalizes no abnormal or unusual sensations and is able to move the fingers or toes below the casted part. Neurovascular function to the body part is maintained.

DIF: Cognitive Level: Application REF: Text reference: p. 252
OBJ: Describe neurovascular assessments of a patient with an orthopedic injury.
TOP: Expected Outcomes KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity

4. 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

ANS: C
Administer analgesic per order before cast application: IV, 2 to 5 minutes before the procedure. This is the most effective way to reduce pain during cast application.
Alternately, you could administer analgesic by mouth (PO), 30 to 40 minutes before cast application to obtain optimal analgesic effect. If administering analgesic via IM injection, give does 20 to 30 minutes before cast application for optimal analgesic effect. Administer muscle relaxant 30 minutes before cast application if spasms are present. Often, muscle spasms are treated more effectively with skeletal muscle relaxants than with opioids.

DIF: Cognitive Level: Application REF: Text reference: p. 252
OBJ: Describe how to assist in application of casts. TOP: Preprocedure Medication
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

5. 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.

ANS: D
Assist with “finishing” by folding the stockinette or other padding down over the outer edge of the cast to provide a smooth edge. Smooth edges lessen possible skin irritation. When the cast is finished with a stockinette, later “petaling” with tape is not required when the cast is dry. Elevation and ice can be ordered, but ice would not be applied to the top of the wet cast because the weight could change the shape of the cast, causing indentations that can lead to pressure areas. Maintain elevation at or above heart level; elevation enhances venous return and decreases edema. Handle the casted extremity with palms only until the cast is dry. Fingers can cause indentations that can lead to pressure areas.

DIF: Cognitive Level: Application REF: Text reference: p. 254
OBJ: Describe how to assist in application of casts. TOP: Finishing the Cast
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

6. 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.

ANS: B
The patient must monitor neurovascular status, paying particular attention to blueness or paleness of the nails, pain, a feeling of tightness, numbness, or a tingling sensation. Caution the patient against drying a wet cast with a hair dryer; this can cause plaster to crack or the skin underneath to be damaged. The patient should avoid sticking objects down or into the cast to scratch because these objects can cause breaks in underlying skin and subsequent infection. Inform the patient to inspect the cast and petal rough edges to reduce the risk of trauma to underlying skin and the need for cast changes. Small pieces (petals) of adhesive tape 2.5 to 5.0 cm (1 to 2 inches) are cut and taped smoothly over the edge of the cast.

DIF: Cognitive Level: Comprehension REF: Text reference: pp. 254-256
OBJ: Describe elements of education for the patient with a cast and after removal of a cast.
TOP: Cast Care KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity

7. 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.

ANS: B
If the skin is intact, gently apply a cold water enzyme wash to the skin; let it stay on the skin 15 to 20 minutes. This helps dissolve or emulsify dead cells and fatty deposits on tissues and prevents injury to delicate tissue. A cast saw vibrates the cast loose; the patient will feel heat and vibration. Do not scrub the skin because this may traumatize delicate tissue and lead to skin breakdown. It may take several days before all residue is removed from the skin. Obtain a physician’s order to gently put joints through active and passive ROJM. Clarify the level of activity allowed. Joints and muscles will be stiff and weak. Activity is resumed slowly to avoid reinjury.

DIF: Cognitive Level: Comprehension REF: Text reference: pp. 257-258
OBJ: Describe elements of education for the patient with a cast and after removal of a cast.
TOP: Cast Removal KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

8. 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

ANS: C
Buck’s extension provides temporary immobilization of a hip fracture until open reduction and internal fixation (ORIF) can be performed. It also reduces muscle spasms, contractures, and dislocations and occasionally is used as an interim treatment for lumbosacral muscle spasms that cause low back pain. Bryant’s traction (called Gallows in England) is no longer used because of the risk for gravitational vascular draining of the extremities and the possible tourniquet effect of bandages, triggering vasospasms and avascular necrosis. Dunlop’s traction is a simultaneous horizontal form of Buck’s extension to the humerus with an accompanying vertical Buck’s extension to the forearm.

DIF: Cognitive Level: Analysis REF: Text reference: p. 258
OBJ: Explain the purposes of placing a patient in skin or skeletal traction.
TOP: Buck’s Traction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

9. 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

ANS: B
Dunlop’s traction is a simultaneous horizontal form of Buck’s extension to the humerus with an accompanying vertical Buck’s extension to the forearm. Bryant’s traction (called Gallows in England) is no longer used because of the risk for gravitational vascular draining of the extremities and the possible tourniquet effect of bandages, triggering vasospasms and avascular necrosis. Buck’s extension provides temporary immobilization of a hip fracture until ORIF can be performed. It also reduces muscle spasms, contractures, and dislocations and occasionally is used as an interim treatment for lumbosacral muscle spasms that cause low back pain.

DIF: Cognitive Level: Analysis REF: Text reference: p. 258
OBJ: Explain the purposes of placing a patient in skin or skeletal traction.
TOP: Dunlop’s Traction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

10. 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.

ANS: D
Russell’s traction is a modification of Buck’s extension in which Newton’s third law of motion (for each force in one direction, there is an equal force in the opposite direction) is used to double the amount of pull through the arrangement of ropes, pulleys, and weights.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 258
OBJ: Explain the purposes of placing a patient in skin or skeletal traction.
TOP: Russell’s Traction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity