Med Surg II Week 4 Quiz

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, “How can I stay like this for weeks? I can’t even move!” Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis?

• Impaired Physical Mobility related to traction

• Activity Intolerance related to impaired mobility

• Deficient Diversional Activity related to prolonged hospitalization

• Ineffective Coping related to prolonged immobility

Answer explanation

The client is displaying clinical manifestations of anxiety and ineffective coping.

Brunner, 15th Ed., ch 37

The client is admitted to the hospital with a diagnosis of left femoral neck fracture. Which treatment modality would the nurse expect the health care provider to order?

• Buck's traction

• Casting

• External fixator

• Skeletal traction

Answer explanation

Fractures of the proximal femur are immobilized with Buck’s traction prior to surgical fixation.

Brunner, 15th Ed., ch 37, pg 1175

Which of the following is an inappropriate nursing diagnosis for the client following casting?

• Risk for impaired skin integrity

• Risk for impaired tissue perfusion

• Risk for knowledge deficit: procedure

• Risk for disuse syndrome

Answer explanation

The client needs adequate information before experiencing the procedure. Information about its purpose, the actual steps of the procedure, and the client’s role during and after the procedure is essential. Appropriate nursing diagnoses following the procedure would include risk for disuse syndrome, risk for impaired skin integrity, and risk for impaired tissue perfusion.

Brunner, 15th Ed., ch 37, pg 1166 - 1168

A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first?

• My cast is still wet

• My toes are stiff

• My toes are pink

• My pain is a 3.

Answer explanation

Compartment syndrome is characterized by neurovascular compromise. Stiffness of the toes may be a preliminary finding that the client is having trouble with motor function.

Brunner, 15th Ed., ch 37, pg 1169

Which is an inappropriate use of traction?

• Reduce deformity

• Decrease space between opposing structure

• Minimize muscle spasm

• Align fracture

Answer explanation

Traction is done to increase the space between opposing surfaces. Traction is used to minimize muscle spasms, to reduce, align, and immobilize fractures, and to reduce deformity.

Brunner, 15th Ed., ch 37, pg 1174

A nurse is caring for a client with osteomyelitis. What complication should the nurse consider that the client is at risk to develop?

• Impingement syndrome

• Bone abscess formation

• Metastatic bone disease

• Pathological fractures

Answer explanation

Bone abscess formation is a potential complication of osteomyelitis. Impingement syndrome is related to repetitive shoulder activities. Metastatic bone disease and pathological fractures are related to cancer.

Brunner, 15th Ed., ch 36, pg 1142

A client was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. What would not be a part of teaching plan for this condition?

• Encouraging the client to eat a healthy diet

• Application of ice

• Avoid caffeine and alcohol

• regular exercise and stress reduction

Answer explanation

Application of ice is not part of the treatment regimen. Encouraging the client to eat a healthy diet, avoiding caffeine and alcohol, regular exercise, and stress reduction are part of the teaching plan

Brunner, 15th Ed., ch 36, pg 1091

A nurse is caring for a client following removal of a Morton’s neuroma. Which nursing intervention would be most appropriate?

• Assist the client with incentive spirometry.

• Perform neurovascular assessment of the hand.

• Assess the surgical dressing.

• Assist with passive range of motion exercises.

Answer explanation

Morton's neuroma is a foot problem characterized by swelling of the median plantar nerve. The nurse will need to assess the surgical dressing. Assisting with incentive spirometry is not the most important intervention. Range of motion exercises should be active, not passive. A hand assessment is not needed with neuroma removal from the foot.

Brunner, 15th Ed., ch 36, pg 1121

Which should be included in the teaching plan for a client diagnosed with plantar fasciitis?

• The pain of plantar fasciitis diminishes with soaking the foot in warm water.

• Management of plantar fasciitis includes stretching exercises.

• Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion.

• Plantar fasciitis presents as acute-onset pain localized to the ball of the foot that occurs when pressure is placed on it and diminishes when pressure is released.

Answer explanation

Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (e.g., heel cups, arch supports), and using nonsteroidal anti-inflammatory drugs. Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced upon taking the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs.

Brunner, 15th Ed., ch 36, pg 1121

Patient education for musculoskeletal conditions for the aging is based on the understanding that there is a gradual loss of bone after a peak of bone mass at age:

• 20 years

• 30 years

• 40 years

• 50 years

Answer explanation

Bone mass peaks by about age 30, after which there is a universal and gradual loss of bone.

Brunner, 15th Ed., ch 35, pg 1098