Chapter 11: Orthopedic Measures

Chapter 11: Orthopedic Measures

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

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