Med Surg 1020 Exam 3 || Solved Correctly.
A nurse performs discharge teaching for a patient after a left hip arthroplasty using the posterior
approach. Which statement indicates teaching is successful?
"Leg-raising exercises are necessary for several months."
"I should not try to drive a motor vehicle for 2 to 3 weeks."
"I will not have any restrictions now on hip and leg movements."
"Blood tests will be done weekly while taking enoxaparin (Lovenox)." correct answers Correct
Answer:
"Leg-raising exercises are necessary for several months."
Rationale:
Exercises designed to restore strength and muscle tone will be done for months after surgery. The
exercises include leg raises in supine and prone positions. Driving a car is not allowed for 4 to 6
weeks. In the posterior approach hip arthroplasties, extremes of internal rotation and 90-degree
flexion of the hip must be avoided for 4 to 6 weeks postoperatively. The knees must be kept
apart. The patient should never cross the legs or twist to reach behind. To prevent
thromboembolism, enoxaparin is administered subcutaneously and can be given at home.
Enoxaparin does not require monitoring of the patient's coagulation status.
The nurse is caring for a patient with osteoarthritis scheduled for total left knee arthroplasty.
Preoperatively, the nurse assesses for which contraindication to surgery?
Pain
Left knee stiffness
Left knee infection
Left knee instability correct answers Correct Answer:
Left knee infection
,Rationale:
The patient must be free of infection before total knee arthroplasty. An infection in the joint
could lead to even greater pain and joint instability, requiring more extensive surgery. The nurse
must assess the patient for signs of infection, such as redness, swelling, fever, and elevated white
blood cell count. Pain, knee stiffness, or instability are typical of osteoarthritis.
The patient brought to the emergency department after a car accident is diagnosed with a femur
fracture. What nursing intervention should the nurse implement at this time to decrease risk of a
fat embolus?'
Administer enoxaparin (Lovenox).
Provide range-of-motion exercises.
Apply sequential compression boots.
Immobilize the fracture preoperatively. correct answers Correct Answer:
Immobilize the fracture preoperatively.
Rationale:
The nurse immobilizes the long bone to reduce movement of the fractured bone ends and
decrease the risk of a fat embolus development before surgical reduction. Enoxaparin is used to
prevent blood clots, not fat emboli. Range of motion and compression boots will not prevent a fat
embolus in this patient.
A patient has a plaster cast applied to the right arm for a Colles' fracture. Which nursing action is
most appropriate?
Elevate the right arm on 2 pillows for 24 hours.
Apply heating pad to reduce muscle spasms and pain.
Limit movement of the thumb and fingers on the right hand.
Place arm in a sling to prevent movement of the right shoulder. correct answers Correct Answer:
Elevate the right arm on 2 pillows for 24 hours.
,Rationale:
The casted extremity should be elevated at or above heart level for 24 hours to reduce swelling
or inflammation. The cast should be supported on pillows during the drying period to prevent
denting and flattening of the cast. Ice (not heat) should be applied for the first 24 to 36 hours to
reduce swelling or inflammation. Active movement of the thumb and fingers should be
encouraged to reduce edema and increase venous return. A sling may be used to support and
protect the extremity after the cast is completely dry, but the patient should perform active
movements of the shoulder to prevent stiffness or contracture.
The nurse is caring for a patient who had a left total knee arthroplasty to relieve the pain of
severe osteoarthritis. What care would be expected postoperatively?
Progressive leg exercises to obtain 90-degree flexion
Early ambulation with full weight bearing on the left leg
Bed rest for 3 days with the left leg immobilized in extension
Immobilization of the left knee in 30-degree flexion to prevent dislocation correct answers
Correct Answer:
Progressive leg exercises to obtain 90-degree flexion
Rationale:
The patient is encouraged to engage in progressive leg exercises until 90-degree flexion is
possible; continuous passive motion also may be used based on surgeon preference. Early
ambulation is implemented, sometimes the day of surgery, but orders are likely to indicate
weight bearing as tolerated rather than full weight bearing. Immobilization and bed rest are not
indicated. The patient's knee is unlikely to dislocate.
A patient who had a long leg cast applied this morning asks to crutch walk before dinner. Which
statement explains why the nurse will decline the patient's request?
"You must ambulate with a physical therapist for the first few days."
, "The cast is not dry yet, so it may be damaged while using crutches."
"Rest, ice, compression, and elevation are in process to decrease pain."
"Excess edema and complications are prevented when the leg is elevated for 24 hours." correct
answers Correct Answer:
"Excess edema and complications are prevented when the leg is elevated for 24 hours."
Rationale:
For the first 24 hours after a lower extremity cast is applied, the leg should be elevated on
pillows above heart level to avoid excessive edema and compartment syndrome. RICE is used
for soft tissue injuries, not with long leg casts.
The nurse determines that an older adult patient recovering from left total knee arthroplasty has
impaired physical mobility from decreased muscle strength. What nursing intervention is
appropriate?
Promote vitamin C and calcium intake in the diet.
Provide passive range of motion to all the joints every 4 hours.
Keep the left leg in extension and abduction to prevent contractures.
Encourage isometric quadriceps-setting exercises at least 4 times a day. correct answers Correct
Answer:
Encourage isometric quadriceps-setting exercises at least 4 times a day.
Rationale:
Emphasis is placed on postoperative exercise of the affected leg, with isometric quadriceps
setting beginning on the first day after surgery. Vitamin C and calcium do not improve muscle
strength, but they will facilitate healing. The patient should be able to perform active range of
motion to all joints. Keeping the leg in one position (extension and abduction) may contribute to
contractures.
The nurse is caring for a patient placed in Buck's traction before open reduction and internal
fixation of a left hip fracture. Which care can be delegated to the LPN/VN?
A nurse performs discharge teaching for a patient after a left hip arthroplasty using the posterior
approach. Which statement indicates teaching is successful?
"Leg-raising exercises are necessary for several months."
"I should not try to drive a motor vehicle for 2 to 3 weeks."
"I will not have any restrictions now on hip and leg movements."
"Blood tests will be done weekly while taking enoxaparin (Lovenox)." correct answers Correct
Answer:
"Leg-raising exercises are necessary for several months."
Rationale:
Exercises designed to restore strength and muscle tone will be done for months after surgery. The
exercises include leg raises in supine and prone positions. Driving a car is not allowed for 4 to 6
weeks. In the posterior approach hip arthroplasties, extremes of internal rotation and 90-degree
flexion of the hip must be avoided for 4 to 6 weeks postoperatively. The knees must be kept
apart. The patient should never cross the legs or twist to reach behind. To prevent
thromboembolism, enoxaparin is administered subcutaneously and can be given at home.
Enoxaparin does not require monitoring of the patient's coagulation status.
The nurse is caring for a patient with osteoarthritis scheduled for total left knee arthroplasty.
Preoperatively, the nurse assesses for which contraindication to surgery?
Pain
Left knee stiffness
Left knee infection
Left knee instability correct answers Correct Answer:
Left knee infection
,Rationale:
The patient must be free of infection before total knee arthroplasty. An infection in the joint
could lead to even greater pain and joint instability, requiring more extensive surgery. The nurse
must assess the patient for signs of infection, such as redness, swelling, fever, and elevated white
blood cell count. Pain, knee stiffness, or instability are typical of osteoarthritis.
The patient brought to the emergency department after a car accident is diagnosed with a femur
fracture. What nursing intervention should the nurse implement at this time to decrease risk of a
fat embolus?'
Administer enoxaparin (Lovenox).
Provide range-of-motion exercises.
Apply sequential compression boots.
Immobilize the fracture preoperatively. correct answers Correct Answer:
Immobilize the fracture preoperatively.
Rationale:
The nurse immobilizes the long bone to reduce movement of the fractured bone ends and
decrease the risk of a fat embolus development before surgical reduction. Enoxaparin is used to
prevent blood clots, not fat emboli. Range of motion and compression boots will not prevent a fat
embolus in this patient.
A patient has a plaster cast applied to the right arm for a Colles' fracture. Which nursing action is
most appropriate?
Elevate the right arm on 2 pillows for 24 hours.
Apply heating pad to reduce muscle spasms and pain.
Limit movement of the thumb and fingers on the right hand.
Place arm in a sling to prevent movement of the right shoulder. correct answers Correct Answer:
Elevate the right arm on 2 pillows for 24 hours.
,Rationale:
The casted extremity should be elevated at or above heart level for 24 hours to reduce swelling
or inflammation. The cast should be supported on pillows during the drying period to prevent
denting and flattening of the cast. Ice (not heat) should be applied for the first 24 to 36 hours to
reduce swelling or inflammation. Active movement of the thumb and fingers should be
encouraged to reduce edema and increase venous return. A sling may be used to support and
protect the extremity after the cast is completely dry, but the patient should perform active
movements of the shoulder to prevent stiffness or contracture.
The nurse is caring for a patient who had a left total knee arthroplasty to relieve the pain of
severe osteoarthritis. What care would be expected postoperatively?
Progressive leg exercises to obtain 90-degree flexion
Early ambulation with full weight bearing on the left leg
Bed rest for 3 days with the left leg immobilized in extension
Immobilization of the left knee in 30-degree flexion to prevent dislocation correct answers
Correct Answer:
Progressive leg exercises to obtain 90-degree flexion
Rationale:
The patient is encouraged to engage in progressive leg exercises until 90-degree flexion is
possible; continuous passive motion also may be used based on surgeon preference. Early
ambulation is implemented, sometimes the day of surgery, but orders are likely to indicate
weight bearing as tolerated rather than full weight bearing. Immobilization and bed rest are not
indicated. The patient's knee is unlikely to dislocate.
A patient who had a long leg cast applied this morning asks to crutch walk before dinner. Which
statement explains why the nurse will decline the patient's request?
"You must ambulate with a physical therapist for the first few days."
, "The cast is not dry yet, so it may be damaged while using crutches."
"Rest, ice, compression, and elevation are in process to decrease pain."
"Excess edema and complications are prevented when the leg is elevated for 24 hours." correct
answers Correct Answer:
"Excess edema and complications are prevented when the leg is elevated for 24 hours."
Rationale:
For the first 24 hours after a lower extremity cast is applied, the leg should be elevated on
pillows above heart level to avoid excessive edema and compartment syndrome. RICE is used
for soft tissue injuries, not with long leg casts.
The nurse determines that an older adult patient recovering from left total knee arthroplasty has
impaired physical mobility from decreased muscle strength. What nursing intervention is
appropriate?
Promote vitamin C and calcium intake in the diet.
Provide passive range of motion to all the joints every 4 hours.
Keep the left leg in extension and abduction to prevent contractures.
Encourage isometric quadriceps-setting exercises at least 4 times a day. correct answers Correct
Answer:
Encourage isometric quadriceps-setting exercises at least 4 times a day.
Rationale:
Emphasis is placed on postoperative exercise of the affected leg, with isometric quadriceps
setting beginning on the first day after surgery. Vitamin C and calcium do not improve muscle
strength, but they will facilitate healing. The patient should be able to perform active range of
motion to all joints. Keeping the leg in one position (extension and abduction) may contribute to
contractures.
The nurse is caring for a patient placed in Buck's traction before open reduction and internal
fixation of a left hip fracture. Which care can be delegated to the LPN/VN?
