Nursing Care for Clients with Casts and Traction: Preparation and Assessment | Exams Nursing

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CARING FOR CLIENTS WITH VERIFIED ANSWERS 2024

1.A client's cast is removed. The client is worried because the skin appears mottled and is

covered with a yellowish crust. What advice should the nurse give the client to address

the skin problem?

A) Consult a skin specialist.

B) Scrub the area vigorously to remove the crust.

C) Apply lotions and take warm baths or soaks.

D) Avoid exposure to direct sunlight.

Ans: C

Feedback:

The client should be advised to apply lotions and take warm baths or soaks. This will help

in softening the skin and removing debris. The client usually sheds this residue in a few

days so the client need not consult a skin specialist. It is not advisable to scrub the area

vigorously. The client need not avoid exposure to direct sunlight because the area is not

photosensitive.

2.The nurse is caring for a client who has had a fracture reduction using a cast. Which

of the following would be most important for the nurse to assess?

A) Cardiac and respiratory status

B) Renal and hepatic function

C) Sleep status

D) Sensation and mobility status

Ans: D

Feedback:

After cast application, the nurse should assess circulation, sensation, and mobility in

exposed fingers and toes every 1 to 2 hours. Assessment of cardiac, respiratory, hepatic,

and renal status would be priorities if the client experienced multiple fractures or had an

open reduction. The client's sleep status would be a low priority.

3.During the assessment of a client scheduled for orthopedic surgery, the nurse discovers

that the client was previously treated for the disorder. In such a case, what additional

data need to be collected?

A) Occurrence of complications or problems during treatment

B) Measures taken to minimize postoperative wound infection

C) Perception of the client about the previous treatment

D) Details of the medical team that handled the previous treatment

Ans: A

Feedback:

If the same disorder has been treated earlier, the nurse needs to determine and document

any complications or problems that occurred during treatment. The nurse can determine

whether the client understands the treatment or not based on the measures taken by the

client to minimize postoperative wound infection. However, this factor can be assessed

later because the nurse needs to explain the new treatment to the client. Although the

client's perceptions of the previous treatment may be helpful, this data would not be as

important. In addition, the nurse does not need to get details about the medical team that

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1.A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? A) Consult a skin specialist. B) Scrub the area vigorously to remove the crust. C) Apply lotions and take warm baths or soaks. D) Avoid exposure to direct sunlight. Ans: C Feedback: The client should be advised to apply lotions and take warm baths or soaks. This will help in softening the skin and removing debris. The client usually sheds this residue in a few days so the client need not consult a skin specialist. It is not advisable to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the area is not photosensitive. 2.The nurse is caring for a client who has had a fracture reduction using a cast. Which of the following would be most important for the nurse to assess? A) Cardiac and respiratory status B) Renal and hepatic function C) Sleep status D) Sensation and mobility status Ans: D Feedback: After cast application, the nurse should assess circulation, sensation, and mobility in exposed fingers and toes every 1 to 2 hours. Assessment of cardiac, respiratory, hepatic, and renal status would be priorities if the client experienced multiple fractures or had an open reduction. The client's sleep status would be a low priority. 3.During the assessment of a client scheduled for orthopedic surgery, the nurse discovers that the client was previously treated for the disorder. In such a case, what additional data need to be collected? A) Occurrence of complications or problems during treatment B) Measures taken to minimize postoperative wound infection C) Perception of the client about the previous treatment D) Details of the medical team that handled the previous treatment Ans: A Feedback: If the same disorder has been treated earlier, the nurse needs to determine and document any complications or problems that occurred during treatment. The nurse can determine whether the client understands the treatment or not based on the measures taken by the client to minimize postoperative wound infection. However, this factor can be assessed later because the nurse needs to explain the new treatment to the client. Although the client's perceptions of the previous treatment may be helpful, this data would not be as important. In addition, the nurse does not need to get details about the medical team that

handled the previous treatment, unless specifically asked to do so. 4.A client is scheduled for a joint replacement surgery. Which action would be most important? A) Ensure adequate fluid intake before the surgery. B) Withhold intake of solid food before the surgery. C) Withhold administration of aspirin before the surgery. D) Ensure adequate sleep before the surgery. Ans:C Feedback: If a client is scheduled for a joint replacement or other surgery, it is crucial for the nurse to withhold aspirin before surgery to reduce the risk of excessive bleeding. It is also essential to monitor the complete blood count, prothrombin time, bleeding, and clotting time to ensure that the client is able to control bleeding. The impact of fluid or solid food intake does not have as strong implications as the impact of aspirin intake before surgery. Having adequate sleep before surgery is helpful but is not the most important action. 5.A client has just undergone a leg amputation. The nurse would closely monitor the client for which of the following during the immediate postoperative period? A) Neuroma B) Hematoma C) Chronic osteomyelitis D) Unexplainable burning pain (causalgia) Ans: B Feedback: Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period. Sleeplessness, nausea, and vomiting may occur but are adverse reactions, not complications. Chronic osteomyelitis and causalgia are potential complications that are likely to arise in the late postoperative period. A neuroma occurs when the cut ends of the nerves become entangled in the healing scar. This would occur later in the postoperative course. 6.A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client? A) Advising the client to avoid red meat B) Urging her to keep the affected limb in an elevated position C) Educating the client about the effects of menopause D) Exploring factors related to the client's home environment Ans: D Feedback: Exploring factors related to the older adult client's home environment and determining a plan for continued rehabilitation before discharge is most important. The client should be

Feedback: A splint immobilizes and supports an injured body part in a functional position and is used when the condition does not require rigid immobilization, causes a large degree of swelling, or requires special skin treatment. Casts and traction provide rigid immobilization. A brace provides support, controls movement, and prevents additional injury for more long-term use.

When performing pin care, which of the following would be most appropriate? A) Clean the site, working toward the pin. B) Use an applicator only once. C) Gently remove crusts around pin sites. D) Apply an antimicrobial ointment. Ans: B, C Feedback: When performing pin care, the nurse should use at least one applicator per pin and not use an applicator more than once, cleaning the site form the pin outward. Crusts around pin sites should be gently removed. Ointment is avoided unless it is specifically ordered. 11.A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client? A) Cutting of a bivalve cast B) Cutting a cast window C) Removal of the cast D) Insertion of an external fixator Ans: B Feedback: After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. A bivalve cast is when the cast is cut in two if the leg swells or if the client is being weaned from a cast, when a sharp x-ray is needed, or as a splint for immobilizing painful joints when a client has arthritis. The cast should not be removed due to the instability of a fracture. The client's condition does not indicate an external fixator is required. 12.A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? A) Short leg cast B) Long leg cast C) Walking cast D) Hip spica cast

Ans: A Feedback: A short leg cast extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed. A walking cast is a short or long leg cast reinforced for strength. A hip spica cast encloses the trunk and a lower extremity. 13.A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? A) Arthrodesis B) Hemiarthroplasty C) Total arthroplasty D) Osteotomy Ans: C Feedback: A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplasty is the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain. 14.A client has a fractured jaw sustained in an automobile accident and has had the fracture surgically reduced and immobilized with a wire loop. What should the nurse ensure is present at the client's bedside in case of vomiting? A) Wire cutters B) A tracheostomy tray C) Ice water with a straw D) An antiemetic medication Ans: A Feedback: Ensure that wire cutters are easily accessible at the client's bedside. The nurse should be familiar with how to cut wire loops if the client vomits or chokes. A tracheostomy tray is not necessary when an airway can be obtained by cutting the wires so the client does not aspirate. If vomiting occurs, the client should have nothing by mouth. Antiemetic medication should be administered prior to the client vomiting and should not be kept at the bedside. 15.A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize?

B) Administer pain medication. C) Request an antihistamine for the allergic reaction. D) Increase the intravenous fluids for hemorrhage. Ans: A Feedback: The findings of the nurse indicate that the client may have a fat embolus, and the physician should be informed immediately. Administration of pain medication is not indicated at this time. The rash is not indicative of an allergic reaction. There is no indication that the rash is related to hemorrhage, and there is no need to increase the IV fluids.

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fracture tibia. What should the nurse inform the client prior to the cast being removed? A) The leg will look as it did prior to the cast being applied. B) The leg will look moist and will have small bumps that will go away in a few days. C) The skin may be covered with a yellowish crust that will shed in a few days. D) The leg strength is enforced by the wearing of the cast. Ans: C Feedback: Once the cast is off, the skin appears mottled and may be covered with a yellowish crust composed of accumulated body oil and dead skin. The client usually sheds this residue in a few days. The leg will not look as it did prior to the cast but will regain the same shape and status as the other leg. There should be no bumps underneath the cast. The leg may be weak and stiff for some time after the cast is removed, not stronger. 20.A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse? A) “We will need to monitor the status of the laceration to be sure it does not get infected.” B) “The arm does not require the same immobilization that a leg fracture would.” C) “You will be able to wear the splint longer than you would a cast.” D) “The splint is less expensive than the cast.” Ans: A Feedback: A splint would be used when there is special skin treatment or observation that is required. The arm fracture would require the same form of immobilization that a leg fracture does. The length of time the splint can be worn is equal to that of a cast to immobilize the fracture. The cost of the splint and cast would be similar. 21.A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client?

Select all that apply. A) Surgery will not be required. B) Muscle spasms will be relieved. C) The bones of the left leg will be aligned. D) Immobilization of the left leg will be maintained. E) Less pain medication will be required. Ans: B, C, D Feedback: Traction is used to relieve muscle spasm, align bones, and maintain immobilization when used properly. It will not replace surgery to correct the fracture. The client will still require pain medication prior to surgical correction. 22.A client sustained a stable fracture of the cervical spine and is having skeletal traction applied. What type of traction does the nurse educate the client about? A) Kirschner wires B) Thomas splint C) Steinmann pins D) Crutchfield tongs Ans: D Feedback: Crutchfield tongs are cranial tongs that are used to maintain alignment for a cervical fracture. Kirschner wires and Steinmann pins are used for the skeletal traction to attach to. A Thomas splint is used to suspend a leg in traction. 23.A client was playing softball and dislocated four of his fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as? A) Open reduction B) Closed reduction C) Open reduction with internal fixation D) External fixation Ans: B Feedback: In a closed reduction, the bone is restored to its normal position by external manipulation. A bandage, cast, or traction then immobilizes the area. In an open reduction, the bone is surgically exposed in the operating room and realigned. If internal fixation is needed to stabilize a reduced fracture, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pin. 24.A client in skeletal traction has a nursing diagnosis of Impaired Tissue Integrity: Related to puncture wound; pins. What expected outcome would be appropriate for this client? A) Assess pin sites daily.

of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for? A) Left hip arthroplasty B) Left hip arthroscopy C) Open reduction and internal fixation of the left hip. D) Closed reduction of the left hip. Ans: A Feedback: Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip.

The nurse is preparing a client for a hip replacement with the use of porous-coated cementless joint components. What does the nurse know is the benefit of this type of component? A) The component is less expensive because there is no cement used. B) The client will not reject the prosthesis because there is no cement on the prosthetics. C) It prevents the client from developing infection related to the application of cement in the joint spaces. D) It allows the bone to grow into the prosthesis and securely fix the joint replacement in place. Ans: D Feedback: Porous-coated cementless joint components are used to allow the bone to grow into the prosthesis and thus securely fix the joint replacement in place. The prosthesis is not less expensive and cost is not a factor in reconstruction. The client may still have a local or systemic reaction to the prostheses even if it does not have cement.
The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery? A) Antidysrhythmia therapy B) Antianginal therapy C) Antineoplastic therapy D) Anticoagulation therapy Ans: D Feedback: Anticoagulation therapy and early ambulation are very important for clients who have knee or hip replacement to prevent thrombus formation. The other therapy is not indicated solely for the knee or hip arthroplasty.

30.A client has had a knee replacement and will be discharged in the morning. What does the nurse understand the goal for bending the knee is by discharge? A) 15° B) 30° C) 60° D) 90° Ans: D Feedback: The goal for the client to have the ability to bend the knee 90° by discharge. The other answers are incorrect. 31.A client is scheduled for a total left knee arthroplasty in 2 weeks. When would the best time for postoperative nursing management begin? A) Before surgery B) When the client is taken to the postanesthesia care unit C) After the client returns to the room after surgery and receives pain medication D) Twenty-four hours after the procedure Ans: A Feedback: Ideally, postoperative nursing management begins before surgery with demonstrations of deep-breathing and coughing exercises and descriptions and demonstrations of the incentive spirometer. Even if the client will have postoperative physical therapy, the nurse explains and helps the client practice active and isometric leg exercises. He or she also describes other devices that may be used after surgery, such as intravenous infusions of fluid and blood, oxygen, a wound drain, elastic stockings, or roller bandages. It also is necessary to include a discussion of the possible use of traction or the CPM machine. The other options offered do not allow adequate time for instruction. 32.A patient is scheduled for hip replacement surgery in a month. Which statement made by the client demonstrates understanding for the preoperative instructions? A) “I will stop taking my antihypertensive medications prior to my surgery.” B) “I will stop taking my aspirin prior to my surgery.” C) “I will have heat packs applied to my hip immediately after surgery.” D) “I will be able to walk independently when I wake up from surgery.” Ans: B Feedback: If a client is scheduled for joint replacement or other surgery, the client should be instructed to withhold aspirin prior to the surgery as per physician's instructions. The client should not be instructed to withhold antihypertensive medications to avoid a rebound hypertension. Cold packs, not heat packs, will be applied to reduce pain and edema after surgery. The client will require physical therapy after surgery and will not be able to walk until day 2 with assistance.

Nursing Care for Clients with Casts and Traction: Preparation and Assessment, Exams of Nursing

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