The patient has been admitted for hypertension. His blood pressure is normally in the 160/90 range. He has been on bed rest for the past few days, and the doctor has started him on a new blood pressure medication. The nurse is assisting the patient to move from the bed to the chair for breakfast, but when the patient tries to sit up
on the side of the bed, he complains of being dizzy and nauseous. The nurse lays the patient down and takes his vital signs. His pulse is 124. His blood pressure is 130/80. This blood pressure is indicative of what? Show The patient is an elderly gentleman who has been on bed rest for the
past several days. When getting the patient up, the nurse should: An appropriate technique for the nurse to use when performing range of motion (ROM) exercises is to: A patient is admitted to the medical unit following a cerebrovascular accident (CVA). Evidence of left-sided hemiparesis is noted, and the nurse will be following up on ROM and other exercises performed in
physical therapy. The nurse should correctly teach the patient and family members which of the following principles of ROM exercises? A nurse should be concerned when observing a patient performing isometric exercises if the patient is: A nurse encourages a patient to prevent venous stasis by: Antiembolic stockings (TEDs) are ordered for the patient on bed rest after surgery. The nurse explains to the patient that the primary purpose for the elastic stockings is to: When assessing
the patient for risk for DVT, the nurse should consider which of the following an indicator of increased risk? An appropriate procedure for the nurse to use when applying an elastic stocking is to: When using an SCD, the nurse should: The patient is a paraplegic who possesses good arm and hand strength. When the following devices are compared, which would be most appropriate for this patient? An appropriate way for the
nurse to measure a patient for crutches is to: The patient has been using crutches for the past 2 weeks. When she comes for her follow-up examination, she complains of tingling and numbness in her hands and upper torso. Possible causes of these symptoms are: The patient has a leg injury and is being fitted for a cane. The patient should be taught to: While ambulating, the patient becomes light-headed
and starts to fall. What should the nurse do first? When the four gaits listed below are compared, which is the most stable of the crutch gaits? The nurse is caring for a patient who has just been treated for a broken leg. She needs to teach the patient how to use crutches. Which crutch gait is most appropriate for this patient? When teaching the use of a three-point crutch gait, the nurse should instruct the patient to move: A patient with left hemiparesis is using a quad cane for ambulation. Which of the following is the correct technique for the nurse to use in
teaching the patient? The patient had a stroke and is currently immobile. The nurse realizes that
increasing mobility is critical because immobility can result in alterations in which of the following? (Select all that apply.) The nurse is caring for an immobile patient. Which of the following may help reduce the hazards associated with immobility? (Select all that apply.) The nurse is applying a CPM machine to the patient’s leg. To do so, she must: (Select all that apply.) Factors that contribute to the development of DVT are: (Select all that apply.) ____________ refers to an ability to move about freely. A person’s inability to move about freely is known as _______________. A drop in blood pressure that occurs when the patient changes position from a horizontal to a vertical position is known as _________________. A drop in blood pressure that occurs when the patient changes position from a horizontal to a vertical position is known as _________________. The patient is performing ROM exercises independently. These are known as __________ exercises. Static exercises that involve tightening or tensing of muscles without moving a body part are known as ______________. _________________ increase muscle tension but do not change the length of muscle fibers Virchow’s triad (hypercoagulability of blood, venous wall damage, and stasis of blood flow) has been found to contribute to ________________. The nurse is concerned that the patient may fall while he is ambulating. To help her maintain control while the patient walks, the nurse may apply a ______________ around the patient’s waist. Gait Belt -Booorrriiinnnggggg The nurse is concerned that the patient may fall while he is ambulating. To help her maintain control while the patient walks, the nurse may apply a ______________ around the patient’s waist. Gait Belt -Booorrriiinnnggggg According to the National Association of Orthopaedic Nurses (NAON), which of the following is possibly the most effective cleansing solution for pin-site care? 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? An expected outcome of cast application that the nurse evaluates is: 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. An appropriate technique for the nurse to implement for the patient who is being casted is to: When teaching cast care, the nurse instructs the patient to: For cast removal, which of the following instructions should the nurse provide to the patient? 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? B 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. Which type of traction does the nurse anticipate will be used for an adult patient with a fractured humerus? 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. For a patient who is to be placed in Russell’s traction, the nurse prepares the: 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. The nurse places the patient
in traction. Expected outcomes would include which of the following? While in Buck’s extension traction, the patient may be positioned on the
back: An appropriate technique for the nurse to implement for a patient who is being placed in traction is to: For a patient in traction who has skeletal pins, the nurse should: 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? In planning nursing care, the nurse knows that she will need to provide an
abduction pillow for which patient? 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.) 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.) 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.) 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.) Skeletal traction is implemented primarily for: (Select all that apply.) __________________ involves monitoring for the five Ps (pain, pallor, pulselessness, paresthesia, and paralysis). 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 ____________. 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. After application of the cast, the nurse ensures that plaster crumbs are removed and rough edges are _________ to prevent skin breakdown. When applying a plaster of Paris cast, it is important to keep the cast exposed for at least _____________ minutes. After applying a cast, the nurse should be able to insert _______ fingers between the cast and the limb. _________________ may occur when pressure within a casted extremity increases. _____________________ applies a pull indirectly to the bone via straps attached to the skin around the structure. ____________________ 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. An immobilization device used to immobilize and protect a body part is known as a ________. How do you ambulate a patient with a cane?To walk (ambulate) with a cane, the patient will hold the cane on the STRONG side. Then the patient will move the cane and weak side TOGETHER forward, and then move the strong side.
When using a cane the resident should hold the cane in the hand that is on the same side as the affected side?Which Hand Should Hold the Cane? When using a cane, you should hold it in the hand opposite of the leg that needs support. 1 This is far more efficient and helpful than holding it on your weak or injured side. Also, as you walk, you will move the cane at the same time as your weaker leg.
When ambulating a patient you should hold the gait belt with?Gait belts are applied over clothing. 3. Assist patient by standing in front of the patient, grasping each side of the gait belt, keeping back straight and knees bent. The patient should be cooperative and predictable, able to bear weight on own legs and to have good trunk control.
|