LeMone/Burke/Bauldoff/Gubrud,gMedical-
SurgicalgNursingg6thgEditiongTestgBankgChapterg39
Questiong1gT
ype:gMCSA
Thegnurseginstructsgangadolescentgpatientgongthegcaregofgagspraingatghome.gWhichgpatientgstatementgindicatesgthe
gneedgforgfurtherginstruction?
1. “IgshouldgputgagheatinggpadgongmygleggasgsoongasgIggetghome.”
2. “Igshouldgavoidgweightgbearinggongthisgleggforgagcouplegofgdays.”
3. “Igshouldgmakegsuregtogkeepgthegacegbandagegongmygleg.”
4. “IgshouldgpropgthisgleggupgwhengI’mgsittinggingagchair.”
CorrectgAnswer:g1
Rationaleg1:gHeatgshouldgnotgbegappliedgtogagsprain.
Rationaleg2:gThegpatientgshouldgbeginstructedgtogrestgthegextremitygforg24–48ghours.
Rationaleg3:gThegpatientgshouldgbeginstructedgtogapplygcompressiongtogtheginjuredgextremitygforg24–48ghours.
Rationaleg4:gThegpatientgshouldgbeginstructedgtogelevategthegextremity,gwhichgreducesgpaingandgedema,gforg24–
48ghours.
GlobalgRationale:gThegpatientgshouldgbeginstructedgtogfollowgthegacronymgRICEgforgtreatmentgofgagspraingatgh
ome.gThisgincludesgrestinggthegextremity,gapplyinggcompression,gandgelevatinggthegextremity.gThesegtherapiesgs
houldgbegusedgforg24–
48ghours.gVerbalizinggthegneedgforgagheatinggpadgwouldgindicategthatgthegpatientgrequiresgadditionalginstruction.
CognitivegLevel:gAnalyzing
ClientgNeed:gPhysiologicalgIntegrity
ClientgNeedgSub:gReductiongofgRiskgPotential
QSENgCompetencies:gI.A.1.gIntegrategunderstandinggofgmultiplegdimensionsgofgpatientgcenteredgcare
AACNgEssentialsgCompetencies:gIX.9.Monitorgclientgoutcomesgtogevaluategthegeffectivenessgofgpsychobiologicalgi
nterventions
NLNgCompetencies:gContextgandgEnvironment;gPractice;gconductgpopulation-
basedgtransculturalghealthgassessmentsgandginterventions
Nursing/IntegratedgConcepts:gNursinggProcess:gEvaluation
LearninggOutcome:g1.gComparegandgcontrastgthegcauses,griskgfactors,gpathophysiology,gmanifestations,ginterpr
ofessionalgcare,gandgnursinggcaregofgcontusions,gstrains,gsprains,gjointgdislocations,gandgfractures.
MNLgLearninggOutcome:g8.1.3.gDistinguishgthegdiagnosisgandgtreatmentgofgtraumaticgmusculoskeletalginjuries.
PagegNumber:g1235
LeMone/Burke/Bauldoff/Gubrud,gMedical-
SurgicalgNursingg6thgEditiongTestgBank
Copyrightg2015gbygPearsongEducation,gInc.
,Questiong2gT
ype:gMCSA
Agpatientgwithgaglonggleggcastgisgexhibitinggsignsgofgcompartmentgsyndrome.gWhatgshouldgthegnursegpreparegtogai
dgingthegtreatmentgofgthegpatient?
1. extragpillowsgtogelevategthegcastedgextremitygabovegthegheart
2. Dopplergtogassessgthegstrengthgofgperipheralgpulses
3. strapsgtogwrapgaroundgthegbivalvedgcast
4. percussionghammergtogassessgreflexesgforgdamage
CorrectgAnswer:g3
Rationaleg1:gElevatinggthegleggabovegthegheartgwouldgcompromisegcirculation.
Rationaleg2:gAgDopplergcouldgbegusedgtogassessgpulsesgbutgthisgisgnotgagtherapeuticgtreatmentgforgcompartmentg
syndrome.
Rationaleg3:gCompartmentgsyndromegoccursgwhengexcessgpressuregingaglimitedgspacegconstrictsgthegstructuresg
withingagcompartment,greducinggcirculationgtogmusclesgandgnerves.gTreatmentgcangincludegremovinggthegcastgen
tirelygorgbivalvinggitg(splittinggitgapartgwithgagcastgcutter)gandgsecuringgthegtwogsidesgwithgstraps.
Rationaleg4:gAgpercussionghammergisgusedgtogcheckgreflexes,gbutgthisgisgnotgagtherapeuticgtreatmentgforgcompar
tmentgsyndrome.
GlobalgRationale:gCompartmentgsyndromegoccursgwhengexcessgpressuregingaglimitedgspacegconstrictsgthegstructu
resgwithingagcompartment,greducinggcirculationgtogmusclesgandgnerves.gTreatmentgcangincludegremovinggthegcastg
entirelygorgbivalvinggitg(splittinggitgapartgwithgagcastgcutter)gandgsecuringgthegtwogsidesgwithgstraps.gElevatinggtheg
leggabovegthegheartgwouldgcompromisegcirculation.gAgDopplergcouldgbegusedgtogassessgpulses,gandgagpercussiongh
ammergtogcheckgreflexes,gbutgthesegaregnotgtherapeuticgtreatmentsgforgcompartmentgsyndrome.
CognitivegLevel:gApplying
ClientgNeed:gPhysiologicalgIntegrity
ClientgNeedgSub:gReductiongofgRiskgPotential
QSENgCompetencies:gI.A.1.gIntegrategunderstandinggofgmultiplegdimensionsgofgpatientgcenteredgcaregAA
CNgEssentialsgCompetencies:gIX.8.Implementgevidence-
basedgnursingginterventionsgasgappropriategforgmanaginggthegacutegandgchronicgcaregofgpatientsgandgpromot
ingghealthgacrossgtheglifespan
NLNgCompetencies:gContextgandgEnvironment;gPractice;gconductgpopulation-
basedgtransculturalghealthgassessmentsgandginterventions
Nursing/IntegratedgConcepts:gNursinggProcess:gPlanning
LearninggOutcome:g4.gExplaingthegpathophysiology,gmanifestations,gandgrelatedgtreatmentgforgcomplicationsgofgfra
ctures:gcompartmentgsyndrome,gfatgembolismgsyndrome,gdeepgvenousgthrombosis,ginfection,gdelayedguniongandgnon
LeMone/Burke/Bauldoff/Gubrud,gMedical-
SurgicalgNursingg6thgEditiongTestgBank
Copyrightg2015gbygPearsongEducation,gInc.
,union,gandgcomplexgregionalgpaingsyndrome.
LeMone/Burke/Bauldoff/Gubrud,gMedical-
SurgicalgNursingg6thgEditiongTestgBank
Copyrightg2015gbygPearsongEducation,gInc.
, MNLgLearninggOutcome:g8.1.3.gDistinguishgthegdiagnosisgandgtreatmentgofgtraumaticgmusculoskeletalginjuries.
PagegNumber:g1241
Questiong3gT
ype:gMCSA
AgpatientgisgplacedgingBuck’sgtractiongaftergaghipgfracture.gWhatgshouldgbegincludedgingthisgpatient’sgplangofgcare?
1. providinggpingsitegcaregeverygshiftgasgprescribed
2. placinggangabductiongpillowgbetweengtheglegsgforgalignment
3. havingganothergpersongholdgthegweightsgwhengpullinggthegpatientgupgingbed
4. turninggthegpatientgtogthegunaffectedgsidegeveryg 2ghours
CorrectgAnswer:g3
Rationaleg1:gBuck’sgtractiongisgskingtraction;gnogskeletalgpinsgaregused.
Rationaleg2:gAngabductiongpillowgisgusedgpostoperatively.
Rationaleg3:gBuck’sgtractiongisgusedgpreoperativelygtogcontrolgmusclegspasms,gimmobilizegagfracturedghip,gandg
maintaingalignmentgofgangextremity.gOften,gpatientsgwillg“scoot”gdowngtowardgthegendgofgthegbed,gandgthegweight
sgaregrestinggongthegfloor.gTogavoidginjurygandgaddedgpain,gonegpersongholdsgthegweightsgwhilegthegothersgusegagli
ftgsheetgtogrepositiongthegpatient.
Rationaleg4:gAgpatientgcannotgbegturnedgwithgthisgtypegofgtherapy.
GlobalgRationale:gBuck’sgtractiongisgusedgpreoperativelygtogcontrolgmusclegspasms,gimmobilizegagfracturedghip,g
andgmaintaingalignmentgofgangextremity.gOften,gpatientsgwillg“scoot”gdowngtowardgthegendgofgthegbed,gandgthegwe
ightsgaregrestinggongthegfloor.gTogavoidginjurygandgaddedgpain,gonegpersongholdsgthegweightsgwhilegthegothersguseg
agliftgsheetgtogrepositiongthegpatient.gBuck’sgtractiongisgskingtraction;gnogskeletalgpinsgaregused.gAngabductiongpillo
wgisgusedgpostoperatively,gandgagpatientgcannotgbegturnedgwithgthisgtypegofgtherapy.
CognitivegLevel:gAnalyzing
ClientgNeed:gPhysiologicalgIntegrity
ClientgNeedgSub:gReductiongofgRiskgPotential
QSENgCompetencies:gI.A.1.gIntegrategunderstandinggofgmultiplegdimensionsgofgpatientgcenteredgcaregAA
CNgEssentialsgCompetencies:gIX.8.Implementgevidence-
basedgnursingginterventionsgasgappropriategforgmanaginggthegacutegandgchronicgcaregofgpatientsgandgpromot
ingghealthgacrossgtheglifespan
NLNgCompetencies:gContextgandgEnvironment;gPractice;gconductgpopulation-
basedgtransculturalghealthgassessmentsgandginterventions
Nursing/IntegratedgConcepts:gNursinggProcess:gImplementation
LearninggOutcome:g1.gComparegandgcontrastgthegcauses,griskgfactors,gpathophysiology,gmanifestations,ginterpr
ofessionalgcare,gandgnursinggcaregofgcontusions,gstrains,gsprains,gjointgdislocations,gandgfractures.
MNLgLearninggOutcome:g8.1.3.gDistinguishgthegdiagnosisgandgtreatmentgofgtraumaticgmusculoskeletalginjuries.
LeMone/Burke/Bauldoff/Gubrud,gMedical-
SurgicalgNursingg6thgEditiongTestgBank
Copyrightg2015gbygPearsongEducation,gInc.
SurgicalgNursingg6thgEditiongTestgBankgChapterg39
Questiong1gT
ype:gMCSA
Thegnurseginstructsgangadolescentgpatientgongthegcaregofgagspraingatghome.gWhichgpatientgstatementgindicatesgthe
gneedgforgfurtherginstruction?
1. “IgshouldgputgagheatinggpadgongmygleggasgsoongasgIggetghome.”
2. “Igshouldgavoidgweightgbearinggongthisgleggforgagcouplegofgdays.”
3. “Igshouldgmakegsuregtogkeepgthegacegbandagegongmygleg.”
4. “IgshouldgpropgthisgleggupgwhengI’mgsittinggingagchair.”
CorrectgAnswer:g1
Rationaleg1:gHeatgshouldgnotgbegappliedgtogagsprain.
Rationaleg2:gThegpatientgshouldgbeginstructedgtogrestgthegextremitygforg24–48ghours.
Rationaleg3:gThegpatientgshouldgbeginstructedgtogapplygcompressiongtogtheginjuredgextremitygforg24–48ghours.
Rationaleg4:gThegpatientgshouldgbeginstructedgtogelevategthegextremity,gwhichgreducesgpaingandgedema,gforg24–
48ghours.
GlobalgRationale:gThegpatientgshouldgbeginstructedgtogfollowgthegacronymgRICEgforgtreatmentgofgagspraingatgh
ome.gThisgincludesgrestinggthegextremity,gapplyinggcompression,gandgelevatinggthegextremity.gThesegtherapiesgs
houldgbegusedgforg24–
48ghours.gVerbalizinggthegneedgforgagheatinggpadgwouldgindicategthatgthegpatientgrequiresgadditionalginstruction.
CognitivegLevel:gAnalyzing
ClientgNeed:gPhysiologicalgIntegrity
ClientgNeedgSub:gReductiongofgRiskgPotential
QSENgCompetencies:gI.A.1.gIntegrategunderstandinggofgmultiplegdimensionsgofgpatientgcenteredgcare
AACNgEssentialsgCompetencies:gIX.9.Monitorgclientgoutcomesgtogevaluategthegeffectivenessgofgpsychobiologicalgi
nterventions
NLNgCompetencies:gContextgandgEnvironment;gPractice;gconductgpopulation-
basedgtransculturalghealthgassessmentsgandginterventions
Nursing/IntegratedgConcepts:gNursinggProcess:gEvaluation
LearninggOutcome:g1.gComparegandgcontrastgthegcauses,griskgfactors,gpathophysiology,gmanifestations,ginterpr
ofessionalgcare,gandgnursinggcaregofgcontusions,gstrains,gsprains,gjointgdislocations,gandgfractures.
MNLgLearninggOutcome:g8.1.3.gDistinguishgthegdiagnosisgandgtreatmentgofgtraumaticgmusculoskeletalginjuries.
PagegNumber:g1235
LeMone/Burke/Bauldoff/Gubrud,gMedical-
SurgicalgNursingg6thgEditiongTestgBank
Copyrightg2015gbygPearsongEducation,gInc.
,Questiong2gT
ype:gMCSA
Agpatientgwithgaglonggleggcastgisgexhibitinggsignsgofgcompartmentgsyndrome.gWhatgshouldgthegnursegpreparegtogai
dgingthegtreatmentgofgthegpatient?
1. extragpillowsgtogelevategthegcastedgextremitygabovegthegheart
2. Dopplergtogassessgthegstrengthgofgperipheralgpulses
3. strapsgtogwrapgaroundgthegbivalvedgcast
4. percussionghammergtogassessgreflexesgforgdamage
CorrectgAnswer:g3
Rationaleg1:gElevatinggthegleggabovegthegheartgwouldgcompromisegcirculation.
Rationaleg2:gAgDopplergcouldgbegusedgtogassessgpulsesgbutgthisgisgnotgagtherapeuticgtreatmentgforgcompartmentg
syndrome.
Rationaleg3:gCompartmentgsyndromegoccursgwhengexcessgpressuregingaglimitedgspacegconstrictsgthegstructuresg
withingagcompartment,greducinggcirculationgtogmusclesgandgnerves.gTreatmentgcangincludegremovinggthegcastgen
tirelygorgbivalvinggitg(splittinggitgapartgwithgagcastgcutter)gandgsecuringgthegtwogsidesgwithgstraps.
Rationaleg4:gAgpercussionghammergisgusedgtogcheckgreflexes,gbutgthisgisgnotgagtherapeuticgtreatmentgforgcompar
tmentgsyndrome.
GlobalgRationale:gCompartmentgsyndromegoccursgwhengexcessgpressuregingaglimitedgspacegconstrictsgthegstructu
resgwithingagcompartment,greducinggcirculationgtogmusclesgandgnerves.gTreatmentgcangincludegremovinggthegcastg
entirelygorgbivalvinggitg(splittinggitgapartgwithgagcastgcutter)gandgsecuringgthegtwogsidesgwithgstraps.gElevatinggtheg
leggabovegthegheartgwouldgcompromisegcirculation.gAgDopplergcouldgbegusedgtogassessgpulses,gandgagpercussiongh
ammergtogcheckgreflexes,gbutgthesegaregnotgtherapeuticgtreatmentsgforgcompartmentgsyndrome.
CognitivegLevel:gApplying
ClientgNeed:gPhysiologicalgIntegrity
ClientgNeedgSub:gReductiongofgRiskgPotential
QSENgCompetencies:gI.A.1.gIntegrategunderstandinggofgmultiplegdimensionsgofgpatientgcenteredgcaregAA
CNgEssentialsgCompetencies:gIX.8.Implementgevidence-
basedgnursingginterventionsgasgappropriategforgmanaginggthegacutegandgchronicgcaregofgpatientsgandgpromot
ingghealthgacrossgtheglifespan
NLNgCompetencies:gContextgandgEnvironment;gPractice;gconductgpopulation-
basedgtransculturalghealthgassessmentsgandginterventions
Nursing/IntegratedgConcepts:gNursinggProcess:gPlanning
LearninggOutcome:g4.gExplaingthegpathophysiology,gmanifestations,gandgrelatedgtreatmentgforgcomplicationsgofgfra
ctures:gcompartmentgsyndrome,gfatgembolismgsyndrome,gdeepgvenousgthrombosis,ginfection,gdelayedguniongandgnon
LeMone/Burke/Bauldoff/Gubrud,gMedical-
SurgicalgNursingg6thgEditiongTestgBank
Copyrightg2015gbygPearsongEducation,gInc.
,union,gandgcomplexgregionalgpaingsyndrome.
LeMone/Burke/Bauldoff/Gubrud,gMedical-
SurgicalgNursingg6thgEditiongTestgBank
Copyrightg2015gbygPearsongEducation,gInc.
, MNLgLearninggOutcome:g8.1.3.gDistinguishgthegdiagnosisgandgtreatmentgofgtraumaticgmusculoskeletalginjuries.
PagegNumber:g1241
Questiong3gT
ype:gMCSA
AgpatientgisgplacedgingBuck’sgtractiongaftergaghipgfracture.gWhatgshouldgbegincludedgingthisgpatient’sgplangofgcare?
1. providinggpingsitegcaregeverygshiftgasgprescribed
2. placinggangabductiongpillowgbetweengtheglegsgforgalignment
3. havingganothergpersongholdgthegweightsgwhengpullinggthegpatientgupgingbed
4. turninggthegpatientgtogthegunaffectedgsidegeveryg 2ghours
CorrectgAnswer:g3
Rationaleg1:gBuck’sgtractiongisgskingtraction;gnogskeletalgpinsgaregused.
Rationaleg2:gAngabductiongpillowgisgusedgpostoperatively.
Rationaleg3:gBuck’sgtractiongisgusedgpreoperativelygtogcontrolgmusclegspasms,gimmobilizegagfracturedghip,gandg
maintaingalignmentgofgangextremity.gOften,gpatientsgwillg“scoot”gdowngtowardgthegendgofgthegbed,gandgthegweight
sgaregrestinggongthegfloor.gTogavoidginjurygandgaddedgpain,gonegpersongholdsgthegweightsgwhilegthegothersgusegagli
ftgsheetgtogrepositiongthegpatient.
Rationaleg4:gAgpatientgcannotgbegturnedgwithgthisgtypegofgtherapy.
GlobalgRationale:gBuck’sgtractiongisgusedgpreoperativelygtogcontrolgmusclegspasms,gimmobilizegagfracturedghip,g
andgmaintaingalignmentgofgangextremity.gOften,gpatientsgwillg“scoot”gdowngtowardgthegendgofgthegbed,gandgthegwe
ightsgaregrestinggongthegfloor.gTogavoidginjurygandgaddedgpain,gonegpersongholdsgthegweightsgwhilegthegothersguseg
agliftgsheetgtogrepositiongthegpatient.gBuck’sgtractiongisgskingtraction;gnogskeletalgpinsgaregused.gAngabductiongpillo
wgisgusedgpostoperatively,gandgagpatientgcannotgbegturnedgwithgthisgtypegofgtherapy.
CognitivegLevel:gAnalyzing
ClientgNeed:gPhysiologicalgIntegrity
ClientgNeedgSub:gReductiongofgRiskgPotential
QSENgCompetencies:gI.A.1.gIntegrategunderstandinggofgmultiplegdimensionsgofgpatientgcenteredgcaregAA
CNgEssentialsgCompetencies:gIX.8.Implementgevidence-
basedgnursingginterventionsgasgappropriategforgmanaginggthegacutegandgchronicgcaregofgpatientsgandgpromot
ingghealthgacrossgtheglifespan
NLNgCompetencies:gContextgandgEnvironment;gPractice;gconductgpopulation-
basedgtransculturalghealthgassessmentsgandginterventions
Nursing/IntegratedgConcepts:gNursinggProcess:gImplementation
LearninggOutcome:g1.gComparegandgcontrastgthegcauses,griskgfactors,gpathophysiology,gmanifestations,ginterpr
ofessionalgcare,gandgnursinggcaregofgcontusions,gstrains,gsprains,gjointgdislocations,gandgfractures.
MNLgLearninggOutcome:g8.1.3.gDistinguishgthegdiagnosisgandgtreatmentgofgtraumaticgmusculoskeletalginjuries.
LeMone/Burke/Bauldoff/Gubrud,gMedical-
SurgicalgNursingg6thgEditiongTestgBank
Copyrightg2015gbygPearsongEducation,gInc.
