LeMone/Burke/Bauldoff/Gubrud, Medical- j
Surgical Nursing 6th Edition Test Bank Chapter 39
j j j j j j j
Questionj1jT
ype:jMCSA
Thejnursejinstructsjanjadolescentjpatientjonjthejcarejofjajsprainjatjhome.jWhichjpatientjstatementjindicatesjthejneedjfor
jfurtherjinstruction?
1. “IjshouldjputjajheatingjpadjonjmyjlegjasjsoonjasjIjgetjhome.”
2. “Ijshouldjavoidjweightjbearingjonjthisjlegjforjajcouplejofjdays.”
3. “Ijshouldjmakejsurejtojkeepjthejacejbandagejonjmyjleg.”
4. “IjshouldjpropjthisjlegjupjwhenjI’mjsittingjinjajchair.”
CorrectjAnswer:j1
Rationalej1:jHeatjshouldjnotjbejappliedjtojajsprain.
Rationalej2:jThejpatientjshouldjbejinstructedjtojrestjthejextremityjforj24–48jhours.
Rationalej3:jThejpatientjshouldjbejinstructedjtojapplyjcompressionjtojthejinjuredjextremityjforj24–48jhours.
Rationalej4:jThejpatientjshouldjbejinstructedjtojelevatejthejextremity,jwhichjreducesjpainjandjedema,jforj24–48jhours.
GlobaljRationale:jThejpatientjshouldjbejinstructedjtojfollowjthejacronymjRICEjforjtreatmentjofjajsprainjatjhome.jTh
isjincludesjrestingjthejextremity,japplyingjcompression,jandjelevatingjthejextremity.jThesejtherapiesjshouldjbejusedjf
orj24–48jhours.jVerbalizingjthejneedjforjajheatingjpadjwouldjindicatejthatjthejpatientjrequiresjadditionaljinstruction.
CognitivejLevel:jAnalyzing
ClientjNeed:jPhysiologicaljIntegrity
ClientjNeedjSub:jReductionjofjRiskjPotential
QSENjCompetencies:jI.A.1.jIntegratejunderstandingjofjmultiplejdimensionsjofjpatientjcenteredjcare
AACNjEssentialsjCompetencies:jIX.9.Monitorjclientjoutcomesjtojevaluatejthejeffectivenessjofjpsychobiologicaljinterv
entions
NLNjCompetencies:jContextjandjEnvironment;jPractice;jconductjpopulation-
basedjtransculturaljhealthjassessmentsjandjinterventions
Nursing/IntegratedjConcepts:jNursingjProcess:jEvaluation
LearningjOutcome:j1.jComparejandjcontrastjthejcauses,jriskjfactors,jpathophysiology,jmanifestations,jinterprofess
ionaljcare,jandjnursingjcarejofjcontusions,jstrains,jsprains,jjointjdislocations,jandjfractures.
MNLjLearningjOutcome:j8.1.3.jDistinguishjthejdiagnosisjandjtreatmentjofjtraumaticjmusculoskeletaljinjuries.
PagejNumber:j1235
LeMone/Burke/Bauldoff/Gubrud,jMedical-SurgicaljNursingj6thjEditionjTestjBank
Copyrightj2015jbyjPearsonjEducation,jInc.
,Questionj2jT
ype:jMCSA
Ajpatientjwithjajlongjlegjcastjisjexhibitingjsignsjofjcompartmentjsyndrome.jWhatjshouldjthejnursejpreparejtojaidjinjthejtr
eatmentjofjthejpatient?
1. extrajpillowsjtojelevatejthejcastedjextremityjabovejthejheart
2. Dopplerjtojassessjthejstrengthjofjperipheraljpulses
3. strapsjtojwrapjaroundjthejbivalvedjcast
4. percussionjhammerjtojassessjreflexesjforjdamage
CorrectjAnswer:j3
Rationalej1:jElevatingjthejlegjabovejthejheartjwouldjcompromisejcirculation.
Rationalej2:jAjDopplerjcouldjbejusedjtojassessjpulsesjbutjthisjisjnotjajtherapeuticjtreatmentjforjcompartmentjsyndrom
e.
Rationalej3:jCompartmentjsyndromejoccursjwhenjexcessjpressurejinjajlimitedjspacejconstrictsjthejstructuresjwithinj
ajcompartment,jreducingjcirculationjtojmusclesjandjnerves.jTreatmentjcanjincludejremovingjthejcastjentirelyjorjbival
vingjitj(splittingjitjapartjwithjajcastjcutter)jandjsecuringjthejtwojsidesjwithjstraps.
Rationalej4:jAjpercussionjhammerjisjusedjtojcheckjreflexes,jbutjthisjisjnotjajtherapeuticjtreatmentjforjcompartmentjsy
ndrome.
GlobaljRationale:jCompartmentjsyndromejoccursjwhenjexcessjpressurejinjajlimitedjspacejconstrictsjthejstructuresjwi
thinjajcompartment,jreducingjcirculationjtojmusclesjandjnerves.jTreatmentjcanjincludejremovingjthejcastjentirelyjorjbi
valvingjitj(splittingjitjapartjwithjajcastjcutter)jandjsecuringjthejtwojsidesjwithjstraps.jElevatingjthejlegjabovejthejheartjwo
uldjcompromisejcirculation.jAjDopplerjcouldjbejusedjtojassessjpulses,jandjajpercussionjhammerjtojcheckjreflexes,jbutjt
hesejarejnotjtherapeuticjtreatmentsjforjcompartmentjsyndrome.
CognitivejLevel:jApplying
ClientjNeed:jPhysiologicaljIntegrity
ClientjNeedjSub:jReductionjofjRiskjPotential
QSENjCompetencies:jI.A.1.jIntegratejunderstandingjofjmultiplejdimensionsjofjpatientjcenteredjcarejAACNjE
ssentialsjCompetencies:jIX.8.Implementjevidence-
basedjnursingjinterventionsjasjappropriatejforjmanagingjthejacutejandjchronicjcarejofjpatientsjandjpromotingjhea
lthjacrossjthejlifespan
NLNjCompetencies:jContextjandjEnvironment;jPractice;jconductjpopulation-
basedjtransculturaljhealthjassessmentsjandjinterventions
Nursing/IntegratedjConcepts:jNursingjProcess:jPlanning
LearningjOutcome:j4.jExplainjthejpathophysiology,jmanifestations,jandjrelatedjtreatmentjforjcomplicationsjofjfractures
:jcompartmentjsyndrome,jfatjembolismjsyndrome,jdeepjvenousjthrombosis,jinfection,jdelayedjunionjandjnonunion,jandjc
LeMone/Burke/Bauldoff/Gubrud,jMedical-SurgicaljNursingj6thjEditionjTestjBank
Copyrightj2015jbyjPearsonjEducation,jInc.
,omplexjregionaljpainjsyndrome.
LeMone/Burke/Bauldoff/Gubrud,jMedical-SurgicaljNursingj6thjEditionjTestjBank
Copyrightj2015jbyjPearsonjEducation,jInc.
, MNLjLearningjOutcome:j8.1.3.jDistinguishjthejdiagnosisjandjtreatmentjofjtraumaticjmusculoskeletaljinjuries.
PagejNumber:j1241
Questionj3jT
ype:jMCSA
Ajpatientjisjplacedj injBuck’sjtractionjafterjajhipjfracture.jWhatjshouldjbejincludedjinjthisjpatient’sjplanjofjcare?
1. providingjpinjsitejcarejeveryjshiftjasjprescribed
2. placingjanjabductionjpillowjbetweenjthejlegsjforjalignment
3. havingjanotherjpersonjholdjthejweightsjwhenjpullingjthejpatientjupjinjbed
4. turningjthejpatientjtojthejunaffectedjsidejeveryj 2jhours
CorrectjAnswer:j3
Rationalej1:jBuck’sjtractionjisjskinjtraction;jnojskeletaljpinsjarejused.
Rationalej2:jAnjabductionjpillowjisjusedjpostoperatively.
Rationalej3:jBuck’sjtractionjisjusedjpreoperativelyjtojcontroljmusclejspasms,jimmobilizejajfracturedjhip,jandjmaintain
jalignmentjofjanjextremity.jOften,jpatientsjwillj“scoot”jdownjtowardjthejendjofjthejbed,jandjthejweightsjarejrestingjonjth
ejfloor.jTojavoidjinjuryjandjaddedjpain,jonejpersonjholdsjthejweightsjwhilejthejothersjusejajliftjsheetjtojrepositionjthejpat
ient.
Rationalej4:jAjpatientjcannotjbejturnedjwithjthisjtypejofjtherapy.
GlobaljRationale:jBuck’sjtractionjisjusedjpreoperativelyjtojcontroljmusclejspasms,jimmobilizejajfracturedjhip,jandjma
intainjalignmentjofjanjextremity.jOften,jpatientsjwillj“scoot”jdownjtowardjthejendjofjthejbed,jandjthejweightsjarejresting
jonjthejfloor.jTojavoidjinjuryjandjaddedjpain,jonejpersonjholdsjthejweightsjwhilejthejothersjusejajliftjsheet jtojrepositionjth
ejpatient.jBuck’sjtractionjisjskinjtraction;jnojskeletaljpinsjarejused.jAnjabductionjpillowjisjusedjpostoperatively,jandjajpa
tientjcannotjbejturnedjwithjthisjtypejofjtherapy.
CognitivejLevel:jAnalyzing
ClientjNeed:jPhysiologicaljIntegrity
ClientjNeedjSub:jReductionjofjRiskjPotential
QSENjCompetencies:jI.A.1.jIntegratejunderstandingjofjmultiplejdimensionsjofjpatientjcenteredjcarejAACNjE
ssentialsjCompetencies:jIX.8.Implementjevidence-
basedjnursingjinterventionsjasjappropriatejforjmanagingjthejacutejandjchronicjcarejofjpatientsjandjpromotingjhea
lthjacrossjthejlifespan
NLNjCompetencies:jContextjandjEnvironment;jPractice;jconductjpopulation-
basedjtransculturaljhealthjassessmentsjandjinterventions
Nursing/IntegratedjConcepts:jNursingjProcess:jImplementation
LearningjOutcome:j1.jComparejandjcontrastjthejcauses,jriskjfactors,jpathophysiology,jmanifestations,jinterprofessi
onaljcare,jandjnursingjcarejofjcontusions,jstrains,jsprains,jjointjdislocations,jandjfractures.
MNLjLearningjOutcome:j8.1.3.jDistinguishjthejdiagnosisjandjtreatmentjofjtraumaticjmusculoskeletaljinjuries.
LeMone/Burke/Bauldoff/Gubrud,jMedical-SurgicaljNursingj6thjEditionjTestjBank
Copyrightj2015jbyjPearsonjEducation,jInc.
Surgical Nursing 6th Edition Test Bank Chapter 39
j j j j j j j
Questionj1jT
ype:jMCSA
Thejnursejinstructsjanjadolescentjpatientjonjthejcarejofjajsprainjatjhome.jWhichjpatientjstatementjindicatesjthejneedjfor
jfurtherjinstruction?
1. “IjshouldjputjajheatingjpadjonjmyjlegjasjsoonjasjIjgetjhome.”
2. “Ijshouldjavoidjweightjbearingjonjthisjlegjforjajcouplejofjdays.”
3. “Ijshouldjmakejsurejtojkeepjthejacejbandagejonjmyjleg.”
4. “IjshouldjpropjthisjlegjupjwhenjI’mjsittingjinjajchair.”
CorrectjAnswer:j1
Rationalej1:jHeatjshouldjnotjbejappliedjtojajsprain.
Rationalej2:jThejpatientjshouldjbejinstructedjtojrestjthejextremityjforj24–48jhours.
Rationalej3:jThejpatientjshouldjbejinstructedjtojapplyjcompressionjtojthejinjuredjextremityjforj24–48jhours.
Rationalej4:jThejpatientjshouldjbejinstructedjtojelevatejthejextremity,jwhichjreducesjpainjandjedema,jforj24–48jhours.
GlobaljRationale:jThejpatientjshouldjbejinstructedjtojfollowjthejacronymjRICEjforjtreatmentjofjajsprainjatjhome.jTh
isjincludesjrestingjthejextremity,japplyingjcompression,jandjelevatingjthejextremity.jThesejtherapiesjshouldjbejusedjf
orj24–48jhours.jVerbalizingjthejneedjforjajheatingjpadjwouldjindicatejthatjthejpatientjrequiresjadditionaljinstruction.
CognitivejLevel:jAnalyzing
ClientjNeed:jPhysiologicaljIntegrity
ClientjNeedjSub:jReductionjofjRiskjPotential
QSENjCompetencies:jI.A.1.jIntegratejunderstandingjofjmultiplejdimensionsjofjpatientjcenteredjcare
AACNjEssentialsjCompetencies:jIX.9.Monitorjclientjoutcomesjtojevaluatejthejeffectivenessjofjpsychobiologicaljinterv
entions
NLNjCompetencies:jContextjandjEnvironment;jPractice;jconductjpopulation-
basedjtransculturaljhealthjassessmentsjandjinterventions
Nursing/IntegratedjConcepts:jNursingjProcess:jEvaluation
LearningjOutcome:j1.jComparejandjcontrastjthejcauses,jriskjfactors,jpathophysiology,jmanifestations,jinterprofess
ionaljcare,jandjnursingjcarejofjcontusions,jstrains,jsprains,jjointjdislocations,jandjfractures.
MNLjLearningjOutcome:j8.1.3.jDistinguishjthejdiagnosisjandjtreatmentjofjtraumaticjmusculoskeletaljinjuries.
PagejNumber:j1235
LeMone/Burke/Bauldoff/Gubrud,jMedical-SurgicaljNursingj6thjEditionjTestjBank
Copyrightj2015jbyjPearsonjEducation,jInc.
,Questionj2jT
ype:jMCSA
Ajpatientjwithjajlongjlegjcastjisjexhibitingjsignsjofjcompartmentjsyndrome.jWhatjshouldjthejnursejpreparejtojaidjinjthejtr
eatmentjofjthejpatient?
1. extrajpillowsjtojelevatejthejcastedjextremityjabovejthejheart
2. Dopplerjtojassessjthejstrengthjofjperipheraljpulses
3. strapsjtojwrapjaroundjthejbivalvedjcast
4. percussionjhammerjtojassessjreflexesjforjdamage
CorrectjAnswer:j3
Rationalej1:jElevatingjthejlegjabovejthejheartjwouldjcompromisejcirculation.
Rationalej2:jAjDopplerjcouldjbejusedjtojassessjpulsesjbutjthisjisjnotjajtherapeuticjtreatmentjforjcompartmentjsyndrom
e.
Rationalej3:jCompartmentjsyndromejoccursjwhenjexcessjpressurejinjajlimitedjspacejconstrictsjthejstructuresjwithinj
ajcompartment,jreducingjcirculationjtojmusclesjandjnerves.jTreatmentjcanjincludejremovingjthejcastjentirelyjorjbival
vingjitj(splittingjitjapartjwithjajcastjcutter)jandjsecuringjthejtwojsidesjwithjstraps.
Rationalej4:jAjpercussionjhammerjisjusedjtojcheckjreflexes,jbutjthisjisjnotjajtherapeuticjtreatmentjforjcompartmentjsy
ndrome.
GlobaljRationale:jCompartmentjsyndromejoccursjwhenjexcessjpressurejinjajlimitedjspacejconstrictsjthejstructuresjwi
thinjajcompartment,jreducingjcirculationjtojmusclesjandjnerves.jTreatmentjcanjincludejremovingjthejcastjentirelyjorjbi
valvingjitj(splittingjitjapartjwithjajcastjcutter)jandjsecuringjthejtwojsidesjwithjstraps.jElevatingjthejlegjabovejthejheartjwo
uldjcompromisejcirculation.jAjDopplerjcouldjbejusedjtojassessjpulses,jandjajpercussionjhammerjtojcheckjreflexes,jbutjt
hesejarejnotjtherapeuticjtreatmentsjforjcompartmentjsyndrome.
CognitivejLevel:jApplying
ClientjNeed:jPhysiologicaljIntegrity
ClientjNeedjSub:jReductionjofjRiskjPotential
QSENjCompetencies:jI.A.1.jIntegratejunderstandingjofjmultiplejdimensionsjofjpatientjcenteredjcarejAACNjE
ssentialsjCompetencies:jIX.8.Implementjevidence-
basedjnursingjinterventionsjasjappropriatejforjmanagingjthejacutejandjchronicjcarejofjpatientsjandjpromotingjhea
lthjacrossjthejlifespan
NLNjCompetencies:jContextjandjEnvironment;jPractice;jconductjpopulation-
basedjtransculturaljhealthjassessmentsjandjinterventions
Nursing/IntegratedjConcepts:jNursingjProcess:jPlanning
LearningjOutcome:j4.jExplainjthejpathophysiology,jmanifestations,jandjrelatedjtreatmentjforjcomplicationsjofjfractures
:jcompartmentjsyndrome,jfatjembolismjsyndrome,jdeepjvenousjthrombosis,jinfection,jdelayedjunionjandjnonunion,jandjc
LeMone/Burke/Bauldoff/Gubrud,jMedical-SurgicaljNursingj6thjEditionjTestjBank
Copyrightj2015jbyjPearsonjEducation,jInc.
,omplexjregionaljpainjsyndrome.
LeMone/Burke/Bauldoff/Gubrud,jMedical-SurgicaljNursingj6thjEditionjTestjBank
Copyrightj2015jbyjPearsonjEducation,jInc.
, MNLjLearningjOutcome:j8.1.3.jDistinguishjthejdiagnosisjandjtreatmentjofjtraumaticjmusculoskeletaljinjuries.
PagejNumber:j1241
Questionj3jT
ype:jMCSA
Ajpatientjisjplacedj injBuck’sjtractionjafterjajhipjfracture.jWhatjshouldjbejincludedjinjthisjpatient’sjplanjofjcare?
1. providingjpinjsitejcarejeveryjshiftjasjprescribed
2. placingjanjabductionjpillowjbetweenjthejlegsjforjalignment
3. havingjanotherjpersonjholdjthejweightsjwhenjpullingjthejpatientjupjinjbed
4. turningjthejpatientjtojthejunaffectedjsidejeveryj 2jhours
CorrectjAnswer:j3
Rationalej1:jBuck’sjtractionjisjskinjtraction;jnojskeletaljpinsjarejused.
Rationalej2:jAnjabductionjpillowjisjusedjpostoperatively.
Rationalej3:jBuck’sjtractionjisjusedjpreoperativelyjtojcontroljmusclejspasms,jimmobilizejajfracturedjhip,jandjmaintain
jalignmentjofjanjextremity.jOften,jpatientsjwillj“scoot”jdownjtowardjthejendjofjthejbed,jandjthejweightsjarejrestingjonjth
ejfloor.jTojavoidjinjuryjandjaddedjpain,jonejpersonjholdsjthejweightsjwhilejthejothersjusejajliftjsheetjtojrepositionjthejpat
ient.
Rationalej4:jAjpatientjcannotjbejturnedjwithjthisjtypejofjtherapy.
GlobaljRationale:jBuck’sjtractionjisjusedjpreoperativelyjtojcontroljmusclejspasms,jimmobilizejajfracturedjhip,jandjma
intainjalignmentjofjanjextremity.jOften,jpatientsjwillj“scoot”jdownjtowardjthejendjofjthejbed,jandjthejweightsjarejresting
jonjthejfloor.jTojavoidjinjuryjandjaddedjpain,jonejpersonjholdsjthejweightsjwhilejthejothersjusejajliftjsheet jtojrepositionjth
ejpatient.jBuck’sjtractionjisjskinjtraction;jnojskeletaljpinsjarejused.jAnjabductionjpillowjisjusedjpostoperatively,jandjajpa
tientjcannotjbejturnedjwithjthisjtypejofjtherapy.
CognitivejLevel:jAnalyzing
ClientjNeed:jPhysiologicaljIntegrity
ClientjNeedjSub:jReductionjofjRiskjPotential
QSENjCompetencies:jI.A.1.jIntegratejunderstandingjofjmultiplejdimensionsjofjpatientjcenteredjcarejAACNjE
ssentialsjCompetencies:jIX.8.Implementjevidence-
basedjnursingjinterventionsjasjappropriatejforjmanagingjthejacutejandjchronicjcarejofjpatientsjandjpromotingjhea
lthjacrossjthejlifespan
NLNjCompetencies:jContextjandjEnvironment;jPractice;jconductjpopulation-
basedjtransculturaljhealthjassessmentsjandjinterventions
Nursing/IntegratedjConcepts:jNursingjProcess:jImplementation
LearningjOutcome:j1.jComparejandjcontrastjthejcauses,jriskjfactors,jpathophysiology,jmanifestations,jinterprofessi
onaljcare,jandjnursingjcarejofjcontusions,jstrains,jsprains,jjointjdislocations,jandjfractures.
MNLjLearningjOutcome:j8.1.3.jDistinguishjthejdiagnosisjandjtreatmentjofjtraumaticjmusculoskeletaljinjuries.
LeMone/Burke/Bauldoff/Gubrud,jMedical-SurgicaljNursingj6thjEditionjTestjBank
Copyrightj2015jbyjPearsonjEducation,jInc.
