lOMoARcPSD| 57911371
MED SURG NURSING FINAL EXAM AND ACTUAL TEST WITH
VERIFIED QUESTIONS AND ANSWERS LATEST UPDATED
RATED PDF
A nurse is caring for a client who has a fractured hip and was placed in Buck's
traction 4 hr ago. Which of the following actions should the nurse take?
a. Inspect the client's skin underneath the boot every 12 hr
b. Encourage the client to perform dorsiflexion of the affected extremity every 2
hr
, lOMoARcPSD| 57911371
c. Remove the weights from the traction while repositioning the client in bed
d. Loosen the ropes if the client reports muscle spasms in the affected extremity
B. Encourage the client to perform dorsiflexion of the affected extremity every 2 hr ---
The nurse should encourage the client to perform dorsiflexion of the affected extremity
every 2 hours to assess if the client is experiencing nerve damage. Weakness of
dorsiflexion can indicate peroneal nerve damage. If this occurs, the nurse should notify
the provider immediately.
Incorrect Answers:
A. The nurse should inspect the client's skin underneath the boot for irritation, increased
swelling, and skin breakdown every 8 hours.
C. The weights should never be removed without a prescription from the provider. The
purpose of the weights is to decrease muscle spasms as a result of the hip fracture.
D. The ropes of the traction should never be loosened. This can affect the traction and
increase the client's muscle spasms.
A nurse is caring for a client who has a fractured right hip. Which of the following
types of traction should the nurse expect the client to have prior to hip
arthroplasty surgery?
a. Balanced skeletal traction
b. Pelvic belt
c. Pelvic sling
d. Buck's traction
D. Buck's traction---Buck's traction is used prior to hip arthroplasty to maintain alignment
and prevent muscle spasms prior to surgery.
Incorrect Answers:
A. Balanced skeletal traction is used to stabilize fractures of the femur or pelvis, not the
hip. Skeletal traction involves the surgical insertion of pins, tongs, wires, or screws; this
is sometimes used to stabilize long bone and vertebral fractures. B. A pelvic belt is used
to treat back pain and does not provide traction prior to hip arthroplasty.
C. A pelvic sling is used to stabilize pelvic fractures, not hip fractures.
A nurse is caring for a client with a hip fracture who has Buck's extension
traction in place. Which of the following pieces of information should the nurse
give the client about this type of traction? (Select all that apply.)
a. "You'll have considerably less pain with the traction in place."
2 CHAPTER 1
)
, lOMoARcPSD| 57911371
b. "You'll have the traction in place for a week or so."
c. "The traction will help decrease muscle spasms."
d. "The weights act as a pulling force to keep your leg and hip still."
e. "We have to make sure the weights are just barely touching the floor."
A. "You'll have considerably less pain with the traction in place."
C. "The traction will help decrease muscle spasms."
D. "The weights act as a pulling force to keep your leg and hip still."
Pain is usually more severe without the traction. Buck's extension traction uses weights
to help decrease muscle spasms. Typically, 2.3 to 5.5 kg (5 to 10 lb) of force helps
stabilize the hip and leg preoperatively.
A nurse is caring for a client who is scheduled to undergo surgery to repair an
open hip fracture. In which of the following positions should the nurse plan to
place the client postoperatively?
a. With the leg on the affected side adducted
b. With the hip externally rotated on the affected side
c. With the leg on the affected side abducted
d. With the hip flexed to 90° on the affected side
C. With the leg on the affected side abducted---The nurse should plan to place the client
with the leg abducted on the affected side postoperatively. Adduction or external
rotation of the leg will cause the hip to dislocate.
A nurse is assessing a client who has a fractured left femur and is in skeletal
traction. Which of the following findings should the nurse report to the provider?
a. Ecchymosis of the thigh
b. Serous drainage at the pin site
c. Chest petechiae
d. Muscle spasms in the left leg
C. Chest petechiae--- The nurse should identify chest petechiae as an indication of fat
embolism syndrome. Clients who have fractures of the long bones such as the femur
are at increased risk of fat emboli. Fat emboli typically occur 12 to 48 hours after the
injury when fat droplets from the marrow enter into the systemic circulation and are
deposited in the lungs. The nurse should immediately notify the provider because the
client could progress to acute respiratory failure.
A nurse is preparing to care for a client who is in balanced skeletal traction to
stabilize a femur fracture. Which of the following actions should the nurse include
in the client's plan of care?
a. Offering the client a diet high in fluid and fiber
b. Encouraging active range of motion of the affected leg
c. Removing the weights prior to repositioning the client
d. Inspecting pin sites every 24 hr for drainage
A. Offering the client a diet high in fluid and fiber---- A client who is immobile is at risk of
constipation. The nurse should encourage a diet high in fluid and fiber to promote
gastrointestinal function.
MED SURG NURSING FINAL EXAM AND ACTUAL TEST WITH
VERIFIED QUESTIONS AND ANSWERS LATEST UPDATED
RATED PDF
A nurse is caring for a client who has a fractured hip and was placed in Buck's
traction 4 hr ago. Which of the following actions should the nurse take?
a. Inspect the client's skin underneath the boot every 12 hr
b. Encourage the client to perform dorsiflexion of the affected extremity every 2
hr
, lOMoARcPSD| 57911371
c. Remove the weights from the traction while repositioning the client in bed
d. Loosen the ropes if the client reports muscle spasms in the affected extremity
B. Encourage the client to perform dorsiflexion of the affected extremity every 2 hr ---
The nurse should encourage the client to perform dorsiflexion of the affected extremity
every 2 hours to assess if the client is experiencing nerve damage. Weakness of
dorsiflexion can indicate peroneal nerve damage. If this occurs, the nurse should notify
the provider immediately.
Incorrect Answers:
A. The nurse should inspect the client's skin underneath the boot for irritation, increased
swelling, and skin breakdown every 8 hours.
C. The weights should never be removed without a prescription from the provider. The
purpose of the weights is to decrease muscle spasms as a result of the hip fracture.
D. The ropes of the traction should never be loosened. This can affect the traction and
increase the client's muscle spasms.
A nurse is caring for a client who has a fractured right hip. Which of the following
types of traction should the nurse expect the client to have prior to hip
arthroplasty surgery?
a. Balanced skeletal traction
b. Pelvic belt
c. Pelvic sling
d. Buck's traction
D. Buck's traction---Buck's traction is used prior to hip arthroplasty to maintain alignment
and prevent muscle spasms prior to surgery.
Incorrect Answers:
A. Balanced skeletal traction is used to stabilize fractures of the femur or pelvis, not the
hip. Skeletal traction involves the surgical insertion of pins, tongs, wires, or screws; this
is sometimes used to stabilize long bone and vertebral fractures. B. A pelvic belt is used
to treat back pain and does not provide traction prior to hip arthroplasty.
C. A pelvic sling is used to stabilize pelvic fractures, not hip fractures.
A nurse is caring for a client with a hip fracture who has Buck's extension
traction in place. Which of the following pieces of information should the nurse
give the client about this type of traction? (Select all that apply.)
a. "You'll have considerably less pain with the traction in place."
2 CHAPTER 1
)
, lOMoARcPSD| 57911371
b. "You'll have the traction in place for a week or so."
c. "The traction will help decrease muscle spasms."
d. "The weights act as a pulling force to keep your leg and hip still."
e. "We have to make sure the weights are just barely touching the floor."
A. "You'll have considerably less pain with the traction in place."
C. "The traction will help decrease muscle spasms."
D. "The weights act as a pulling force to keep your leg and hip still."
Pain is usually more severe without the traction. Buck's extension traction uses weights
to help decrease muscle spasms. Typically, 2.3 to 5.5 kg (5 to 10 lb) of force helps
stabilize the hip and leg preoperatively.
A nurse is caring for a client who is scheduled to undergo surgery to repair an
open hip fracture. In which of the following positions should the nurse plan to
place the client postoperatively?
a. With the leg on the affected side adducted
b. With the hip externally rotated on the affected side
c. With the leg on the affected side abducted
d. With the hip flexed to 90° on the affected side
C. With the leg on the affected side abducted---The nurse should plan to place the client
with the leg abducted on the affected side postoperatively. Adduction or external
rotation of the leg will cause the hip to dislocate.
A nurse is assessing a client who has a fractured left femur and is in skeletal
traction. Which of the following findings should the nurse report to the provider?
a. Ecchymosis of the thigh
b. Serous drainage at the pin site
c. Chest petechiae
d. Muscle spasms in the left leg
C. Chest petechiae--- The nurse should identify chest petechiae as an indication of fat
embolism syndrome. Clients who have fractures of the long bones such as the femur
are at increased risk of fat emboli. Fat emboli typically occur 12 to 48 hours after the
injury when fat droplets from the marrow enter into the systemic circulation and are
deposited in the lungs. The nurse should immediately notify the provider because the
client could progress to acute respiratory failure.
A nurse is preparing to care for a client who is in balanced skeletal traction to
stabilize a femur fracture. Which of the following actions should the nurse include
in the client's plan of care?
a. Offering the client a diet high in fluid and fiber
b. Encouraging active range of motion of the affected leg
c. Removing the weights prior to repositioning the client
d. Inspecting pin sites every 24 hr for drainage
A. Offering the client a diet high in fluid and fiber---- A client who is immobile is at risk of
constipation. The nurse should encourage a diet high in fluid and fiber to promote
gastrointestinal function.
