MSN Exam for Musculoskeletal Examination

EXPLANATION

✔Correct answer:

Lack of diversional activities. The patient's expression of boredom and restlessness could be linked to a lack of diversional activities. This nursing diagnosis recognizes that the patient may not have enough stimulating or engaging activities to occupy their time, leading to feelings of boredom and restlessness.

An analogy could be staying in a room with nothing to do - without books, TV, phone, or company, one would quickly feel bored and restless.

✘Incorrect answer options:

Deficit in self-care. This diagnosis would be more appropriate if the patient was expressing difficulty or inability to perform their self-care activities such as bathing, dressing, feeding, etc. There's no information in the scenario to suggest this.

Sense of powerlessness. While feeling bored and restless might be symptoms of feeling powerless, this diagnosis isn't as directly linked to the complaints presented. Powerlessness is usually associated with feelings of lack of control or influence over one's situation or outcome.

Impaired physical mobility. This diagnosis would be likely given the patient's skeletal leg traction, but it doesn't directly address the feelings of boredom and restlessness. While it's true that impaired mobility can contribute to these feelings, the nursing diagnosis should be most directly related to the patient's expressed feelings or symptoms.

EXPLANATION

✔Correct answer:

Checking for any allergy to iodine or shellfish. The most significant risk factor during an arthrogram that uses a contrast medium (which often contains iodine) is an allergic reaction, especially if the patient has a known allergy to iodine or shellfish.

It's similar to someone with a peanut allergy unknowingly consuming a dish with peanuts in it; the outcome can be dangerous. Allergic reactions can range from mild to severe, including anaphylaxis, which can be life-threatening.

✘Incorrect answer options:

Ensuring the patient has no remaining queries about the process. Although important in a holistic approach to patient care, it is not the highest priority in this scenario. The most immediate risk is an allergic reaction, which can be potentially life-threatening.

Confirming if the patient needs to urinate before the procedure. While ensuring patient comfort is essential, it does not directly influence the safety or effectiveness of the procedure like checking for allergies does.

Evaluating the patient's capability to remain motionless during the procedure. While this is important for obtaining clear images, it is not as immediately critical as assessing allergies. Inability to remain still does not pose a life-threatening risk, unlike an allergic reaction.

EXPLANATION

✔Correct answer:

Pain localized to the joints. Osteoarthritis is a degenerative joint disease that affects the cartilage in the joints, leading to pain, stiffness, and potentially loss of function. One of the key symptoms is pain that is localized to the affected joints, and this pain often worsens with activity and improves with rest.

A fitting analogy could be seeing wear and tear on a well-used piece of machinery; it's more likely to have issues in the areas of highest use, and rest often helps reduce the problems.

✘Incorrect answer options:

Signs of osteoporosis. Osteoporosis is a different condition from osteoarthritis. While osteoporosis involves a decrease in bone density and can lead to fractures, osteoarthritis is characterized by degeneration of the cartilage in the joints. Both conditions can occur in older individuals, but they have different causes and symptoms.

Indications of anemia. While anemia can coexist with osteoarthritis in some patients, it is not a typical symptom or result of osteoarthritis. Anemia, which is a deficiency in the number or quality of red blood cells, may lead to symptoms like fatigue and shortness of breath, but it does not typically cause joint pain.

Any weight loss. Weight loss is not typically associated with osteoarthritis. In fact, being overweight or obese is a risk factor for osteoarthritis, particularly in weight-bearing joints like the knees, because the excess weight puts additional stress on the joints.

EXPLANATION

✔Correct answer:

Adopting positions of bending or flexing. Prolonged positions of flexion can lead to contractures and worsen joint stiffness in patients with rheumatoid arthritis, making them undesirable during periods of rest. In fact, when we recommend rest to patients, we want them to relax and avoid positions that could potentially exacerbate their condition.

It's similar to advising someone with back pain not to slouch or sit in uncomfortable positions that might intensify their pain.

✘Incorrect answer options:

Lying face down. Depending on the affected joints, this position may or may not be comfortable or beneficial for a patient with rheumatoid arthritis. However, it's not universally contraindicated during periods of rest.

Maintaining correct posture. This isn't something that should be avoided during periods of rest. Good posture helps maintain proper joint alignment and prevent additional strain on joints, so it's generally beneficial for patients with rheumatoid arthritis.

Raising the affected area. If the patient's lower limbs are affected, elevation can help reduce swelling and improve blood flow, making it beneficial rather than something to avoid during periods of rest.

EXPLANATION

✔Correct answer:

Progress with the crutches and left leg, then the right leg. In a three-point gait that allows touchdown weight-bearing, the patient can put some weight on the affected leg (left leg). The correct sequence would be to advance the crutches and the left leg (affected leg) together, then move the right leg (unaffected leg) forward. While the crutches and left leg advance, the right leg bears the body's weight, and then weight is shifted to the left leg and crutches while moving the right leg. This gait pattern allows for stable support while ensuring some weight-bearing on the affected leg.

✘Incorrect answer options:

Move the crutches and right leg first, then the left leg. This pattern describes the correct movement for a patient with a left leg cast who is not allowed to bear weight on the left leg.

Move the left leg and right crutch first, then the right leg and left crutch. This pattern describes a four-point gait, not a three-point gait. This gait is typically used when a patient can bear weight on both legs but needs additional stability.

Advance the crutches first, then both legs at the same time. This describes a swing-to gait or two-point gait where the crutches are moved first, and then both legs are swung through. This type of gait is not ideal for someone with a leg cast who is only allowed touchdown weight-bearing.

EXPLANATION

✔Correct answer:

The avascular tissue is supporting bacterial proliferation. Osteomyelitis is an infection of the bone, often caused by bacteria. It can be challenging to treat due to the avascular nature of some parts of the bone, such as the necrotic bone (sequestra). This avascularity hampers the efficient delivery of systemic antibiotics to the site of infection.

It's akin to trying to deliver goods (antibiotics) to a location without roads (blood vessels); the delivery becomes difficult and sometimes impossible. This situation could favor bacterial growth since the bacteria continue to thrive without being adequately challenged by the antibiotics.

✘Incorrect answer options:

Scar tissue formation is hampering drug absorption. While scar tissue can impede some biological processes, it does not play a significant role in antibiotic delivery to the bones in osteomyelitis. Scar tissue formation is more pertinent to issues like wound healing and sometimes in organ disease.

The buildup of pus is causing tissue ischemia. Although pus accumulation can cause local compression and possibly ischemia, it does not directly impede the activity of systemic antibiotics. In fact, antibiotics are used to treat the infection causing the pus formation.

The antibiotics are not being delivered directly to the bone. While direct delivery of antibiotics to the bone may be used in some severe cases of osteomyelitis, systemic antibiotics are usually the first line of treatment and can often effectively manage the condition if it has not advanced to involve avascular areas of the bone.

EXPLANATION

✔Correct answer:

Reduced urine output with a dark color. Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage, and in severe cases, can cause rhabdomyolysis. Rhabdomyolysis is a breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood, one of them being a protein called myoglobin. Myoglobin can cause kidney damage and ultimately, acute kidney failure, as the kidneys have trouble filtering it out. Therefore, Mason should be specifically looking for reduced urine output with a dark color, as this is indicative of kidney involvement.

A practical analogy for this might be a coffee filter trying to filter out large coffee grounds — it gets overwhelmed and can't do its job properly.

✘Incorrect answer options:

Widespread swelling. While this might be seen locally in the area of compartment syndrome due to the increased pressure, it is not a direct sign of organ failure.

Crackling sounds from the lungs. This symptom is often associated with respiratory conditions like pneumonia or pulmonary edema. It's not directly related to the systemic effects of compartment syndrome.

Yellowing of the skin and eyes. This symptom, also known as jaundice, is typically associated with liver disease or dysfunction, not typically seen in compartment syndrome.

EXPLANATION

✔Correct answer:

Semi Fowler’s position. The semi-Fowler’s position involves the patient being placed on their back with the head of the bed elevated at approximately 30 to 45 degrees. This position is generally considered the most beneficial postoperative position for patients following a hip replacement surgery because it reduces the risk of hip dislocation, which is a primary concern after this type of surgery. Additionally, it aids in respiratory function by reducing pressure on the diaphragm, thus improving lung expansion and oxygenation.

This is similar to when you're reading a book in bed, you tend to prop up your upper body with pillows to keep your neck and back comfortable. The goal is to find a position that balances comfort, safety, and function.

✘Incorrect answer options:

Supine position. While the supine position (lying flat on the back) may be comfortable for some patients, it does not offer the same benefits as the semi-Fowler’s position in terms of respiratory function and prevention of hip dislocation after hip replacement surgery.

Orthopneic position. The orthopneic position involves sitting up in bed at 90 degrees or sometimes leaning forward and supported by a table. This position is typically used for patients with difficulty breathing, particularly those with chronic obstructive pulmonary disease (COPD), but not typically for postoperative hip replacement patients.

Trendelenburg position. In the Trendelenburg position, the patient's body is laid flat on the back (supine position) with the feet elevated higher than the head. This position is used in certain cases to increase venous return to the heart, but it is not typically used for patients following hip replacement surgery due to the increased risk of dislocation.

EXPLANATION

✔Correct answer:

"I'll ensure to keep up with my vitamin intake while on this drug." Methotrexate is a folate antagonist, meaning it interferes with the body's use of folic acid (a type of B vitamin). This interaction can lead to folic acid deficiency. Therefore, patients on methotrexate may need to take a folic acid supplement to prevent deficiency. However, it's essential to clarify that the patient should consult their healthcare provider before starting any new supplements while on this medication, as some vitamins might interact negatively with methotrexate.

This situation can be compared to when you are advised not to mix certain types of food or drink because they might cause discomfort or have a bad reaction.

✘Incorrect answer options:

"I'm committed to brushing my teeth after each meal." This is a good practice for anyone, not just patients on methotrexate. Good oral hygiene is essential for overall health.

"I fully understand that I should avoid alcohol consumption while taking this medication." This is indeed a correct understanding as methotrexate can potentially cause liver damage, a risk that is further increased with alcohol consumption.

"I'll maintain my routine of taking my birth control pills." This is another correct understanding. Methotrexate is a teratogenic medication, meaning it can cause harm to a developing fetus. Therefore, it is important to use reliable birth control methods while taking this medication.

EXPLANATION

✔Correct answer:

Bladder distention. For a paraplegic patient on an intermittent urinary catheterization program, monitoring for bladder distention is a key concern. Due to a lack of voluntary control over bladder function, the patient is at risk of urinary retention which can lead to bladder distention.

It's as if a water balloon is being filled but can't be emptied - over time, it stretches and becomes overly distended, leading to discomfort and potentially serious complications.

✘Incorrect answer options:

Bowel evacuation. While bowel function is an important consideration in paraplegic patients, the scenario specifically mentions that the patient is on an intermittent urinary catheterization program. So, bladder issues would be the priority in this context, though it's also important to maintain a regular bowel movement schedule to avoid constipation or incontinence.

Appetite increase. An increase in appetite is not a direct concern related to paraplegia or the use of an intermittent catheterization program. While it's essential to ensure a balanced diet to maintain overall health, it's not the priority in this context.

Weight gain. Weight gain, although important to monitor over the long term in paraplegic patients for overall health and mobility, is not the most immediate concern associated with intermittent urinary catheterization. Excess weight can contribute to a variety of health issues and can make mobility and personal care more challenging, but it does not directly link to urinary management.

EXPLANATION

✔Correct answer:

Adding padding at the top of the splint with clean, folded washcloths. Pressure ulcers, often referred to as bedsores, are a common issue for patients in long-term care or those immobilized due to injuries such as fractures. They occur when sustained pressure reduces blood supply to an area of the skin, resulting in tissue damage or death. To prevent pressure ulcers, nurses often use padding to reduce the pressure exerted on bony prominences and vulnerable areas. In the case of a Thomas splint, padding could be added to the top to prevent undue pressure on Mr. Murphy's thigh and hip.

This can be likened to placing a cushion on a hard wooden chair before sitting down to prevent discomfort; the padding spreads the pressure more evenly and provides a softer surface.

✘Incorrect answer options:

Incorporating a footplate in the patient's bed. While a footplate can help prevent foot drop (a condition where a patient cannot lift the front part of the foot due to prolonged bed rest or nerve damage), it doesn't directly alleviate pressure at the top of the splint. It's a bit like wearing a helmet to protect your toes; the protection is real but not in the right area.

Applying a skin-protective lotion in the relevant area. Skin-protective lotions can maintain skin integrity and moisture, but they don't physically relieve pressure, which is the key to preventing pressure ulcers in immobilized patients. It's like applying sun cream to prevent sunburn but continuing to stay out in the sun all day; it helps but doesn't solve the root cause.

Ensuring that Mr. Murphy maintains an upright position in bed. While changing positions frequently can help prevent pressure ulcers, maintaining a single upright position does not. Moreover, depending on the fracture's location and the type of traction used, an upright position may not be feasible or safe for the patient. This can be compared to standing on one leg to avoid getting tired; eventually, the pressure on that one leg will cause discomfort.

EXPLANATION

✔Correct answer:

Inflammation of the bone due to infection, known as osteomyelitis. Osteomyelitis is an infection in the bone, which can occur following an open fracture, such as a femoral fracture, if the bone is exposed to bacteria. The symptoms described - fever, night sweats, chills, restlessness, and reduced mobility in the affected limb - are all consistent with osteomyelitis.

An analogy for understanding this condition could be likening the bone to a tree. If a tree's bark is damaged, it can expose the inner wood to infection, just like a fracture can expose the inner part of the bone to bacteria.

✘Incorrect answer options:

Infection of the urinary tract. The symptoms of a urinary tract infection (UTI) typically include painful urination, frequent urination, lower abdominal pain, and possibly cloudy or strong-smelling urine. The symptoms described in the question are not typical for a UTI.

Embolism caused by fat particles. A fat embolism might occur after a long bone fracture like a femoral fracture, and it can cause symptoms like confusion, rapid breathing, fever, and a rash. However, restricted movement in the affected limb is not a typical symptom.

Blockage in the lung's blood vessels, or pulmonary emboli. Pulmonary emboli typically cause symptoms such as shortness of breath, chest pain, and a rapid heart rate. While fever can sometimes occur, the symptom of reduced mobility in the previously injured leg is not typical for pulmonary emboli.

EXPLANATION

✔Correct answer:

Trochanter rolls applied to the thigh. Trochanter rolls, which are typically rolled towels or special foam devices, can be used to prevent external rotation of the hips when the patient is lying supine. By placing the roll against the lateral aspect of the thigh, it helps keep the hip in a neutral alignment and prevents the leg from rolling outwards.

It's similar to placing a bumper next to a parked car to prevent it from rolling out of its parking space.

✘Incorrect answer options:

Footboard. A footboard is typically used to prevent foot drop (a condition characterized by inability to lift the front part of the foot) by providing a surface against which the patient can press the soles of their feet. However, it doesn't specifically prevent external rotation of the lower extremity.

Sandbag placed on the lateral aspect of the calf. A sandbag placed on the lateral aspect of the calf could potentially contribute to external rotation rather than prevent it because the weight may cause the leg to roll outwards.

Trochanter rolls positioned near the knee. Placing trochanter rolls near the knee would not be as effective in preventing external rotation of the hip. The best placement for a trochanter roll is against the outer thigh, closer to the hip joint.

EXPLANATION

✔Correct answer:

The configuration of ropes and pulleys. In all types of traction (whether skeletal or skin traction), the direction of pull is primarily determined by the configuration of ropes and pulleys.

Think of it as a system of levers and pulleys; the position of these elements will guide the direction and alignment of the force applied. The alignment will help reposition the affected limb and relieve pressure on the affected area.

✘Incorrect answer options:

The quantity of the weight used. The weight in a traction system creates the necessary force to reposition and align the bone or joint. However, it doesn't directly manage the direction of the pull. That's determined by the setup of the system, i.e., the ropes and pulleys.

The location of friction. Friction does play a role in traction, but it doesn't directly influence the direction of pull. Instead, it can affect the amount of force required to maintain the appropriate level of traction.

The posture of the patient. While patient posture is critical in ensuring effective traction and patient comfort, it doesn't determine the direction of pull in the traction setup. Instead, it can influence how the force of traction is experienced by the patient and how effectively the system performs its intended purpose.

EXPLANATION

✔Correct answer:

The section of the limb located further from the body, beyond the fracture site. In caring for a patient with a broken limb, it's crucial to assess distal to the fracture site. This is because fractures can cause complications that include compromised blood flow or nerve function to the area beyond the break.

It's like having a roadblock (the fracture) on a highway (the blood vessels and nerves); the cities (body parts) beyond the roadblock could be severely affected by the disrupted traffic (blood and nerve supply).

A prompt assessment of the distal extremity can reveal early signs of ischemia or neurovascular compromise, such as changes in color, temperature, pulse, sensation, or movement.

✘Incorrect answer options:

The corresponding limb not affected by the fracture, for a baseline comparison. While it's important to have a baseline for comparison, it isn't the immediate priority. Emergent concerns are associated with the injured limb.

The part of the limb closer to the body, above the fracture site. While this area is important to evaluate for associated injuries, the priority is to assess the distal portion of the fractured limb for signs of compromised blood flow or nerve damage.

The exact location of the fracture. While it is indeed important to assess the exact location of the fracture, the immediate priority is to assess distal to the fracture site to identify any signs of compromised blood flow or nerve damage.

EXPLANATION

✔Correct answer:

Dark, sticky feces. Dark, sticky feces, also known as melena, could be indicative of gastrointestinal bleeding. Aspirin and prednisone are both associated with an increased risk of gastrointestinal (GI) irritation and bleeding. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) and can cause gastric mucosal damage, while prednisone, a corticosteroid, can also lead to gastric ulcers. Thus, observing for signs of gastrointestinal bleeding is crucial when a patient is on these medications.

Think of the digestive system as a pipe and the medications (aspirin and prednisone) as certain cleaning agents that could potentially cause damage to the interior of the pipe if used excessively or improperly. Over time, if these agents cause enough harm, they could lead to leaks - analogous to gastrointestinal bleeding in the body. The evidence of these leaks in our analogy is similar to finding dark, sticky feces or melena in real life, indicating potential internal bleeding.

✘Incorrect answer options:

Diminished desire for food. While some medications might affect appetite, the use of aspirin and prednisone doesn't directly cause a diminished desire for food. However, if a patient experiences severe gastrointestinal side effects, this may indirectly affect their appetite.

Frequent headaches. Aspirin is often used to treat headaches, and while prednisone may cause some side effects, frequent headaches are not a common side effect associated with the long-term use of these medications. If a patient reports frequent headaches, other causes should be investigated.

Vision that lacks clarity. Prednisone may have some impact on vision, causing cataracts or glaucoma with long-term use. However, these side effects aren't as immediate or as common as gastrointestinal complications. It's important to monitor for all potential side effects, but in this specific scenario, checking for signs of gastrointestinal bleeding would be the pivotal query.

EXPLANATION

✔Correct answer:

Move his toes. In a patient with a fractured femur, asking the patient to move his toes is an effective way to assess for signs of circulatory impairment. Circulatory impairment can occur due to pressure on blood vessels from the swelling, from the bone fragments, or from a cast or tight dressing. If the patient can move his toes, it indicates that there is still good circulation to the distal part of the limb.

It's similar to checking if a water pipe is functioning by examining whether water can reach the far end of the pipeline.

✘Incorrect answer options:

Engage in coughing and deep breathing. Coughing and deep breathing are useful techniques to prevent respiratory complications, particularly after surgery or in bedridden patients. However, they do not provide direct information about the circulation in the area of a femur fracture.

Carry out biceps exercises. While exercising the biceps might be a good way to keep the upper body active during recovery, these exercises are unlikely to provide insight into the circulation of the leg affected by a femur fracture.

Reposition himself in bed. Repositioning in bed may help to prevent pressure ulcers, improve comfort, and promote better overall circulation. However, it does not specifically assess circulatory status in the limb affected by a femur fracture.

EXPLANATION

✔Correct answer:

Detection of a "hot spot" on the cast. A "hot spot" on the cast can be a significant indication of an underlying infection. Infections generate heat due to the increased metabolic activity of immune cells and the pro-inflammatory processes taking place. The heat can transmit through the cast material and be palpable on the surface.

Consider it like a heating pad over a particular area on your body. If an infection is underneath, you'll likely feel the heat on the surface.

✘Incorrect answer options:

Weakened pulse in the region beyond the cast. While a weakened pulse beyond the cast may indicate compromised blood flow, it's usually more indicative of a circulatory problem such as compartment syndrome, rather than an infection.

The limb appeared cold and pale. A limb appearing cold and pale beyond the cast is also a sign of compromised circulation, possibly due to the cast being too tight or due to vascular injury. This doesn't directly point to an infection.

Swelling in the lower part of the limb. Swelling in the lower part of the limb could be due to a number of reasons such as injury, tight cast, or venous insufficiency. While swelling can be associated with infection, it is not as specific a symptom as a "hot spot" on the cast and can be due to various other conditions unrelated to infection.

EXPLANATION

✔Correct answer:

The patient begins to experience paralysis in the toes of the foot encased in the cast. Paralysis, numbness, or tingling in any part of the body encased in a cast should be treated as a medical emergency. This could be indicative of compartment syndrome, a condition where pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. If not treated promptly, it can lead to muscle and nerve damage and may even require amputation.

Imagine the cast as a too-tight band around your arm; eventually, the blood flow is restricted, leading to severe consequences.

✘Incorrect answer options:

The patient reports feeling a sensation of heat beneath the cast. While warmth under the cast could be a cause for concern if it's excessive or accompanied by other symptoms such as odor or drainage (indicating infection), a mild sensation of heat is normal as the plaster of Paris generates heat when it dries.

The patient expresses experiencing moderate pain. While pain should not be ignored, some discomfort or pain is expected after a bone fracture and the application of a cast. Pain would need to be severe or worsen over time, particularly if not relieved by prescribed painkillers, to warrant immediate medical attention.

There is a slight swelling observed in the toes of the foot in the cast. A slight swelling may be expected after a fracture or cast application. Swelling would need to be severe, persist despite elevation, or be accompanied by other symptoms such as significant pain, skin discoloration, or the inability to move the toes to warrant immediate medical attention.

EXPLANATION

✔Correct answer:

Stiffness is most prominent in the early morning. Rheumatoid arthritis (RA) is a chronic inflammatory disorder that primarily affects joints. One of the earliest symptoms that patients commonly report is stiffness in the affected joints, particularly upon waking up or after periods of inactivity. This stiffness tends to improve with physical activity and as the day progresses. The morning stiffness associated with RA often lasts longer than an hour.

It's similar to a rusty hinge that's stiff and difficult to move at first but loosens up with use.

✘Incorrect answer options:

Distorted joints, particularly in the hands. Joint distortions, specifically in the hands, are typically a feature of more advanced rheumatoid arthritis. The chronic inflammation leads to joint damage and deformities over time. These changes are not usually present during the early stages of the disease.

Restricted joint movement. While restriction of joint movement can occur in RA, it's typically a later finding due to progressive joint damage and deformity. In the early stages, the main complaint is usually joint stiffness, especially in the morning or after periods of inactivity, rather than significant restriction in joint movement.

Presence of rheumatoid nodules. Rheumatoid nodules, which are firm bumps of tissue most commonly formed around pressure points like the elbows, are a manifestation of more advanced RA. These nodules are not typically seen during the initial stage of the disease.

EXPLANATION

✔Correct answer:

Regular pin care. Regular pin care is a crucial nursing intervention in the management of patients in skeletal traction. This is due to the risk of infection at the pin insertion site. Pin care often involves cleaning the site with an appropriate solution (as per institutional protocol), observing for signs of infection (like redness, swelling, or discharge), and reporting any abnormalities to the doctor.

You could liken this to taking care of a garden - regularly watering the plants, removing weeds, and checking for pests to ensure a healthy garden.

✘Incorrect answer options:

Limitation of weights to 5 lbs. The weight used in skeletal traction is dependent on the specific needs of the patient and the physician's orders. It isn't always limited to 5 lbs. The weight should be enough to maintain proper alignment of the fractured bone(s) and reduce muscle spasms. This is like adjusting the tension in a game of tug-of-war – it needs to be just right, not too loose or too tight, to keep the balance.

Use of intermittent weights. The use of intermittent weights is not usually recommended in skeletal traction, as constant and sustained traction is needed to maintain proper alignment of the fracture. If weights were removed and replaced, it could interrupt the continuous force needed to keep the bones in the correct position.

Positioning the patient in a prone position. Placing a patient in a prone position isn't generally recommended in skeletal traction, as it could cause misalignment of the fracture or displace the weights and traction system. The patient is usually kept in a supine or semi-upright position, based on comfort and doctor's orders.

EXPLANATION

✔Correct answer:

Supine position. Buck's traction is typically used for fractures, muscle spasms, or other lower limb issues, and it works best when the patient is in the supine position. This position allows the force of gravity to work with the traction, ensuring it's effectively pulling on the patient's leg.

It's similar to how you would want to position a door to best use a doorstop: it works best when the door is directly over the stop.

✘Incorrect answer options:

Lithotomy position. The lithotomy position, which involves having the patient on their back with their hips and knees flexed and their legs raised and supported in stirrups, is not used with Buck's traction. This position is usually reserved for pelvic exams, childbirth, and surgeries.

Prone position. In the prone position, the patient lies on their stomach. This isn't optimal for Buck's traction because it doesn't work with gravity to effectively apply the traction.

Sim's position. Sim's position involves the patient lying on their side, with the lower arm behind the body and the upper leg flexed. This position isn't used for Buck's traction because it doesn't allow for an even pull or use of gravity.

EXPLANATION

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Typical side effects of the administered medication. Carisoprodol (Soma) is a muscle relaxant used to treat musculoskeletal pain, but it can have significant side effects, including lowering blood pressure (hypotension), increasing pulse rate (tachycardia), and decreasing respiratory rate (respiratory depression). Therefore, the symptoms the patient presents with (blood pressure of 80/50 mmHg, pulse rate of 115 bpm, and shallow respirations at a rate of 8 breaths per minute) are typical side effects of the medication.

Think of this like the effects of a powerful relaxing agent on the body's systems: it slows things down (lowered blood pressure, shallow and slower respirations), but your heart, recognizing the need to compensate, may speed up (increased pulse rate).

✘Incorrect answer options:

Indications of gastrointestinal bleeding due to irritation. Gastrointestinal bleeding due to irritation generally presents with symptoms like dark, tarry stools, blood in vomit, or abdominal pain. The symptoms presented here are not typically associated with gastrointestinal bleeding.

Suggestive signs of developing dependency. While dependency on Soma can occur with prolonged use, it would not typically present with these physical symptoms. Signs of dependency might include cravings, inability to stop or reduce usage, withdrawal symptoms when not using the drug, and continued use despite harmful consequences.

Potential symptoms of an allergic reaction. Symptoms of an allergic reaction generally include hives, difficulty breathing, swelling of the face, lips, tongue, or throat. The symptoms presented in the question don't fit this profile.

EXPLANATION

✔Correct answer:

Reduced chances of gastrointestinal bleeding. Celecoxib is a COX-2 inhibitor, a type of nonsteroidal anti-inflammatory drug (NSAID) that selectively inhibits cyclooxygenase-2, an enzyme involved in inflammation. By selectively targeting COX-2, celecoxib minimizes the effects on COX-1, another variant of the enzyme that helps maintain the protective lining of the stomach. Thus, celecoxib generally poses a lower risk for gastrointestinal bleeding compared to nonselective NSAIDs like diclofenac.

An analogy could be wearing a glove while handling prickly plants. A regular glove (representing celecoxib) would protect the entire hand, while a glove with the fingertips cut off (representing diclofenac) would leave parts of the hand exposed to potential harm.

✘Incorrect answer options:

Lesser incidences of nausea and vomiting. Nausea and vomiting are common side effects of both celecoxib and diclofenac, and one drug does not necessarily cause less of these side effects than the other.

Diminished risk of kidney toxicity. All NSAIDs, including both celecoxib and diclofenac, carry the risk of kidney toxicity. One does not pose a significantly lesser risk than the other in this regard.

Lower potential for liver toxicity. Both celecoxib and diclofenac carry a risk of liver toxicity. There's no substantial evidence to suggest that celecoxib is less likely than diclofenac to cause liver toxicity.

EXPLANATION

✔Correct answer:

Development of acute respiratory distress syndrome (ARDS). Fat embolism syndrome (FES) is a serious complication of long bone fractures, such as a femur fracture. One of the early signs of FES is respiratory distress, which can escalate to Acute Respiratory Distress Syndrome (ARDS). ARDS is characterized by rapid breathing, difficulty getting enough air, and low oxygen levels in the blood.

This is akin to a situation where a road (the bloodstream) gets blocked by debris (fat droplets), disrupting traffic (oxygen delivery), leading to chaos and confusion in the city (the body).

✘Incorrect answer options:

Experiences of migraine-like headaches. While this could be a symptom of many conditions, it's not typically associated with fat embolism syndrome.

Sensation of numbness in the right leg. This symptom might be related to nerve damage or injury, but it's not typically a sign of a fat embolism.

Occurrence of muscle spasms in the right thigh. While muscle spasms can occur due to various reasons, including injury, dehydration, or imbalances of certain nutrients, they're not a common sign of fat embolism syndrome.

EXPLANATION

✔Correct answer:

Initiating an intravenous line to maintain a slow drip rate. In general, MRI procedures do not require the initiation of an intravenous line to maintain a slow drip rate. The MRI scan is a noninvasive procedure that works using strong magnetic fields and radio waves to create detailed images of the organs and tissues within the body. While certain types of MRIs (like an MRI with contrast) may require an intravenous line for the administration of a contrast agent, this is not a universal requirement for all MRIs. An IV line with a slow drip rate might be needed for certain patients with specific needs or certain types of MRIs, but it's not a standard practice. So, initiating an intravenous line without a specific requirement would be considered unsuitable.

Let's liken this to preparing a guest room for a visitor. There are essentials you'd certainly prepare, like fresh sheets, pillows, towels, etc. However, it would be peculiar to set up a coffee maker in the room if your guest didn't drink coffee - it's not universally required and could even get in the way.

✘Incorrect answer options:

Verifying whether the patient has ever experienced claustrophobia. This is a crucial step before an MRI. Because MRI machines are enclosed spaces, patients with claustrophobia may experience significant anxiety or discomfort during the procedure. It's essential to know this beforehand so that the healthcare team can take appropriate measures to manage the patient's claustrophobia.

Assuring the patient that the procedure won't cause any pain. This statement is also accurate. MRI procedures are noninvasive and do not typically cause physical pain. Providing reassurance about this can help to reduce anxiety or fear about the procedure.

Conducting a comprehensive review of the patient's previous surgical history. It's important to know the surgical history of a patient before conducting an MRI. Any metallic implants or fragments in the patient's body can be hazardous due to the strong magnetic field generated by the MRI machine. Therefore, a comprehensive review of the patient's surgical history is an important step before an MRI.

EXPLANATION

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A potential anaphylactic reaction induced by the contrast dye. Shortness of breath and itching are common signs of an allergic reaction, which could be anaphylaxis in severe cases. Anaphylaxis is a severe, potentially life-threatening allergic reaction. The contrast medium used in CT scans can cause such a reaction in some patients, especially those with a history of allergies or who have reacted to contrast dye in the past.

This situation can be likened to a person who's allergic to peanuts unknowingly consuming a food that contains peanut oil; the body reacts defensively, resulting in an allergic reaction.

✘Incorrect answer options:

A typical reaction stemming from the stress of the diagnostic procedure. While stress can result in various physical symptoms, shortness of breath and itching are not typically associated with procedural stress. Moreover, such symptoms should always be treated seriously and assessed for potential allergic reactions, particularly after the administration of a contrast medium.

Fluid overload due to the volume of the infused solutions. While fluid overload can lead to shortness of breath, the volume of contrast medium used in a CT scan is typically not enough to induce fluid overload. Itching is also not a symptom of fluid overload. It's akin to saying that drinking a glass of water could cause water intoxication; while technically both involve fluid intake, the volume in question is simply too small.

Inflammation resulting from fluid leakage during injection. While inflammation at the injection site could occur if there was fluid leakage during the injection, it wouldn't cause systemic symptoms such as shortness of breath and itching. These symptoms suggest a reaction that involves the whole body, not just the injection site.

EXPLANATION

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Diminish the inflammation present in the joints. Aspirin (acetylsalicylic acid) is a nonsteroidal anti-inflammatory drug (NSAID). It works by inhibiting cyclooxygenase (COX) enzymes, which are involved in the production of prostaglandins. Prostaglandins play a crucial role in promoting inflammation, fever, and pain in the body. Therefore, by inhibiting these substances, aspirin can reduce inflammation, thus alleviating some of the symptoms of rheumatoid arthritis, such as swelling and pain in the joints.

To simplify, consider aspirin as a firefighter that puts out the "fire" of inflammation in your body.

✘Incorrect answer options:

Halt the progression of the disease process. Aspirin and other NSAIDs can manage symptoms, but they do not directly halt the progression of rheumatoid arthritis. Rheumatoid arthritis is a chronic autoimmune disorder and often requires more potent disease-modifying antirheumatic drugs (DMARDs) to slow the progression of the disease.

Lower fever. While it's true that aspirin has antipyretic (fever-lowering) effects, this is not the primary reason it is used in the management of rheumatoid arthritis. Fever is not typically a common symptom of rheumatoid arthritis, and if it is present, it's usually indicative of an underlying infection or a severe flare-up of the disease.

Enable the patient to perform a range of motion activities without experiencing pain. While reducing pain can improve the patient's range of motion, this isn't the primary therapeutic goal of aspirin in rheumatoid arthritis management. The main purpose is to decrease inflammation, which indirectly leads to a decrease in pain and an increase in range of motion.

EXPLANATION

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Alleviation of muscle cramping. Methocarbamol (Robaxin) is a muscle relaxant that is often prescribed to relieve the muscle spasms and associated pain that can come with conditions such as a fractured tibia. It does so by affecting central nervous system pathways, resulting in a generalized muscle relaxing effect.

This is its main therapeutic effect, which could be likened to a musician calming a noisy orchestra - the drug brings the 'noisy' and overly excited muscles back to a state of relaxed harmony.

✘Incorrect answer options:

Reduction in feelings of anxiety. While it's true that some muscle relaxants can have a sedative effect and thereby indirectly reduce feelings of anxiety, this is not the primary therapeutic effect of methocarbamol.

Eradication of microscopic pathogens. Methocarbamol is not an antimicrobial agent, so it does not eradicate pathogens. Antibiotics are the class of drugs used for this purpose.

Diminishing of skin pruritus. Methocarbamol does not specifically address skin conditions such as pruritus (itching). Antihistamines and topical corticosteroids are typically used for this.

EXPLANATION

✔Correct answer:

Reapply the elastic compression bandage on the stump. After an amputation, an elastic compression bandage is used to control edema, promote healing, and shape the residual limb for prosthesis fitting. If this bandage becomes undone, it should be promptly reapplied to continue its therapeutic effects.

Reapplying the bandage would be similar to re-fastening a seatbelt that's come undone; it's essential for safety (or in this case, healing and comfort).

✘Incorrect answer options:

Contact the doctor. While keeping the doctor informed is crucial, reapplying the bandage would be a more immediate action that does not necessarily need a doctor's order.

Apply ice to the site. Applying ice would be appropriate if the patient was in acute discomfort or showing signs of inflammation. However, without these symptoms, the first priority would be to reapply the bandage to control swelling and aid healing.

Dress the site with a dry sterile dressing and elevate it on a pillow. Dressing the site and elevating it could help control swelling, but it does not provide the same level of compression and shaping that the elastic bandage does. Additionally, depending on the hospital's protocol, a dry dressing might not be indicated at this stage of post-operative care.

EXPLANATION

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Perform a skin inspection on the right leg at least every 8 hours. Buck's extension is a form of skin traction used to reduce pain and muscle spasm associated with certain fractures or other conditions. It's essential to monitor the skin under and around the traction regularly (at least every 8 hours) to check for signs of pressure injuries, skin breakdown, or infection.

Think of it like checking your car tires for wear and tear; you want to spot any problems early before they cause bigger issues.

✘Incorrect answer options:

Administer pin care once per shift. Buck's extension is a form of skin traction and doesn't involve pins. This answer would be more relevant for skeletal traction or external fixators which do involve pins inserted into the bone.

Apply lotion to the skin of the right leg every 8 hours. While keeping skin moisturized is usually a good thing, in this case, applying lotion could interfere with the traction apparatus, potentially reducing its effectiveness. Moreover, excessive moisture could increase the risk of skin breakdown.

Lift the weights off the right leg to allow for daily range of motion exercises. The weights in a Buck's extension should not be lifted or removed except by a healthcare provider. Doing so could disrupt the purpose of the traction, which is to provide a steady and continuous pull on the affected limb.

EXPLANATION

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Fit a knee immobilizer before helping the patient up and ensure the patient's surgical leg is elevated while seated. Fitting a knee immobilizer before moving the patient provides support and stability to the newly replaced joint and reduces the risk of injury during movement. This device can prevent inadvertent twisting or bending at the knee that could jeopardize the surgical site. Elevation of the leg while seated can help reduce swelling and promote venous return.

The knee immobilizer is like a sturdy support beam, keeping the structure (in this case, the knee joint) secure and stable during movement.

✘Incorrect answer options:

Encase the dressing with an Ace wrap and apply ice to the knee while the patient is seated. While applying an Ace wrap can provide some support and ice can help to reduce inflammation, neither of these actions provides the same level of protection as a knee immobilizer. Ace wraps are not designed to restrict movement significantly, and ice application mainly addresses symptom management rather than preventing injury during movement.

Procure a walker to limit weight bearing on the affected leg. A walker can be useful to aid mobility and maintain balance, but it does not specifically protect the knee joint during the act of moving from the bed to the chair.

Lift the patient to the bedside chair while leaving the Continuous Passive Motion (CPM) machine in place. The CPM machine is used for promoting joint flexibility and is typically used while the patient is in bed. Trying to move the patient with the CPM machine in place would be impractical and could pose a risk of injury.

EXPLANATION

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In the left hand and 6 inches to the side of the left foot. For a patient with right-sided weakness, the cane should be held in the left hand to provide support to the weaker side while allowing the stronger side (right side) to perform activities. The cane should be placed approximately six inches to the side of the left foot to maintain a wide base of support, enhancing balance and stability.

This is like using a tripod for a camera; the three points (two feet and the cane) ensure stability, and the cane (like the third leg of the tripod) compensates for the weakness on one side.

✘Incorrect answer options:

In the right hand and place it in front of the right foot. This would mean the cane is not providing support to the weaker side (right side), which defeats its primary purpose.

In the left hand and place it in front of the left foot. While the cane is correctly held in the left hand, placing it in front of the left foot instead of to the side may not provide optimal support and balance.

In the right hand and 6 inches to the side of the left foot. The cane should be held in the hand opposite to the affected side, so holding it in the right hand wouldn't provide the necessary support for the weaker right side.

EXPLANATION

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Right after finishing a meal. Taking ibuprofen after meals helps to minimize potential stomach irritation, as the food acts as a barrier between the medication and the stomach lining.

This is similar to using a cushion to protect yourself from a hard surface. When taken on an empty stomach, the medicine may cause irritation, leading to symptoms such as heartburn, stomach pain, or even ulcers in extreme cases.

✘Incorrect answer options:

At the time of retiring to bed. While it's not necessarily harmful to take ibuprofen at bedtime, it wouldn't specifically help in preventing stomach irritation. Moreover, taking it at bedtime without any food might increase the risk of stomach discomfort.

When the stomach is empty. Taking ibuprofen on an empty stomach can increase the risk of gastrointestinal irritation and is usually not recommended unless specifically directed by a healthcare provider.

Upon waking up in the morning. Unless the patient has had a meal, taking ibuprofen upon waking up in the morning usually means taking the medication on an empty stomach, which could lead to the same issues as when the stomach is empty.

EXPLANATION

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Dive into a storybook and pretend to be the characters. This option empowers the child with the use of imagination and play, critical components of child development and coping mechanisms in stressful situations. It offers a creative outlet, thereby distracting him from his current discomfort and boredom. Children have highly active imaginations and often enjoy stories and role-playing.

Comparing this to real life, it would be similar to someone suggesting you lose yourself in a good novel or movie to distract yourself from a difficult situation.

✘Incorrect answer options:

Enjoy a delightful puppet show. While this could indeed provide entertainment and distraction, it might not be feasible in a hospital setting due to restrictions in movement, limited resources, or potential infection control issues.

Tune in to some engaging radio programming. Although this could be entertaining for some, radio programming is typically more appealing to adults and might not hold the attention of a 7-year-old child, who often prefers visual stimuli and interactive activities.

Pass time by watching some television. While this isn't a wrong answer per se, it's not the most engaging or beneficial for the child. Television can be somewhat passive and doesn't encourage the same level of imaginative play or cognitive engagement as reading a storybook. Moreover, depending on content control, the child may be exposed to programs not suitable for his age.

EXPLANATION

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Avert the onset of foot drop. The footplate will help keep the foot in a dorsiflexed position, preventing plantar flexion that could lead to foot drop (the inability to lift the front part of the foot).

Imagine it like using a bookend to prevent books from falling over; the footplate serves as a supportive structure to keep the foot in its natural position. It is especially important because Buck's traction can lead to prolonged periods of immobility, which is a risk factor for foot drop.

✘Incorrect answer options:

Secure the traction in place. A footplate is not designed to secure traction in place. Traction is usually maintained by the use of weights, which are hung at the end of the bed.

Hinder the patient from sliding down the bed. While it's crucial to prevent the patient from sliding down in bed (to maintain the effectiveness of the traction and for overall patient safety), this isn't the primary purpose of a footplate. Techniques such as proper patient positioning and the use of bed rails are more commonly used for this purpose.

Forestall the development of pressure sores on the foot. Pressure sores are indeed a concern for immobilized patients, but the prevention of these sores is typically accomplished through frequent repositioning, pressure-relieving mattresses, and good skin care, rather than the use of a footplate.

EXPLANATION

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Hands. When using crutches, the patient should bear weight primarily on their hands, not the underarms (axillae). The padded top of the crutches should not be used to support the body weight as this can compress the axillary nerve and blood vessels, which can lead to numbness, pain, and even damage over time. Instead, the crutches should be used to form a stable triangle with the person's feet, and the hands should bear most of the weight.

Think about this like using a pair of stilts. You wouldn't rest your armpits on the tops of the stilts; instead, you'd use your hands and arms to bear your weight and balance yourself.

✘Incorrect answer options:

Upper arms. While the arms do play a role in maintaining stability and balance when using crutches, the bulk of the body weight should be supported by the hands.

Underarms (axillae). This answer is incorrect. Supporting weight through the axillae can compress the axillary nerve and blood vessels, leading to complications like crutch paralysis. This is a common misconception about crutch use.

Elbows. The elbows are primarily used for bending and straightening while moving with crutches. They are not meant to bear the majority of the body's weight.

EXPLANATION

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Uric acid level of 8 mg/dl. Gout is a type of arthritis that is caused by an excess of uric acid in the bloodstream. The excess uric acid can form crystals in joints and other tissues, leading to inflammation and pain. Normal uric acid levels are usually less than 6 mg/dL for women and less than 7 mg/dL for men. A uric acid level of 8 mg/dL in this patient would indicate hyperuricemia, a common finding in patients with gout.

This can be likened to the gas gauge in a car; if the needle goes into the red zone (high uric acid levels), this is a sign that something is wrong and needs to be addressed.

✘Incorrect answer options:

Phosphorus level of 3 mg/dl. Phosphorus levels are typically monitored in patients with kidney disease or bone disorders, but they are not directly related to gout. A phosphorus level of 3 mg/dl is within the normal range.

Calcium level of 9 mg/dl. Calcium levels are not typically affected by gout. They are more commonly monitored in conditions affecting the bones, heart, nerves, and blood clotting. A calcium level of 9 mg/dl is within the normal range.

Uric acid level of 5 mg/dl. A uric acid level of 5 mg/dl is within the normal range for both men and women, so it would not typically be seen in a patient with gout.

EXPLANATION

✔Correct answer:

Flexion of the hip may lead to displacement of the nail plate. Hip flexion is a movement that reduces the angle between the thigh and the hip, which can potentially put pressure on the site where the nail plate has been inserted. The nail plate is a device used to stabilize the bone and facilitate healing; however, it can be displaced if significant stress is applied. This displacement could delay healing and may require further surgical intervention to correct.

Think of the nail plate as a bookshelf bracket: if it's not disturbed, it'll hold up the books (or, in this case, the fractured bone), but if it's knocked or bent, the books fall.

✘Incorrect answer options:

Hip flexion could cause misalignment of the hip joint. While it's true that extreme or unnatural movement can cause joint misalignment, simple hip flexion in a normal range, under normal circumstances, would not typically cause misalignment. The hip joint is a ball-and-socket joint designed for a broad range of motion, including flexion. However, due to the injury and surgery, normal range of motion may not be advisable in the immediate post-operative period.

The action of flexing the hip could cause severe pain to the patient. While flexing the hip after hip surgery may cause discomfort or even pain, this isn't the primary reason to avoid it. Pain is a symptom that something is wrong, but it's not the damage itself. It's more accurate to say that the displacement of the nail plate (as explained in the correct answer) might cause pain.

Flexion might result in damage to the soft tissue around the surgical site. While it's possible that excessive movement could harm surrounding soft tissues, simple flexion is unlikely to directly cause significant damage. The body's soft tissues are designed to move and stretch with the joint. Again, the concern with hip flexion in this case is mostly about the potential for displacing the nail plate, not damaging soft tissue.

EXPLANATION

✔Correct answer:

Being an adult aged between 60 to 75 years. Rheumatoid arthritis (RA) can occur at any age, but it often begins in middle age, typically between 30 and 50 years old. Thus, being between 60 and 75 years is not in itself a risk factor for RA.

It's like assuming that only elderly people can wear glasses, when in reality people of all ages may need to correct their vision.

✘Incorrect answer options:

Identifying as female. Women are about two to three times more likely to develop RA compared to men. Hence, gender is indeed a risk factor.

Having a past infection with the Epstein-Barr virus. Some studies suggest that infections like Epstein-Barr virus could trigger RA in people who are genetically predisposed to the disease. Therefore, this is considered a potential risk factor.

Testing positive for the human leukocyte antigen (HLA) DR4 allele. Certain genetic factors, such as carrying the HLA-DR4 allele, are associated with a higher risk of developing RA.

EXPLANATION

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Alteration in color. Following the application of a leg cast, monitoring for signs of circulatory impairment is critical. Any alteration in color of the toes (such as paleness, blueness, or darkening) could indicate impaired blood supply, which could potentially lead to tissue necrosis if not addressed promptly.

To relate this to a real-world example, imagine a long traffic jam in a tunnel; if cars (the blood) aren't able to reach their destination (the toes), the entire system can become compromised.

✘Incorrect answer options:

Rise in temperature. While a significant and localized increase in temperature could potentially indicate an infection or inflammation, it's not typically the first or most specific sign of circulatory impairment in a limb that's just been casted.

Swelling. While swelling is a common occurrence following a fracture and cast application, it doesn't provide the most immediate or specific indication of potential circulatory impairment in the affected limb.

Ability to move. Although assessing movement can be helpful to determine nerve function, it does not directly indicate the circulatory status of the limb. A patient might be able to move their toes even with reduced blood supply. However, prolonged circulatory impairment could eventually affect nerve function and the ability to move.

EXPLANATION

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The patient will regain the ability to walk sooner. One of the main advantages of immediate prosthesis fitting following an amputation is that it may allow the patient to regain the ability to walk (or use the prosthetic limb) more quickly. This is because the immediate fitting allows for early rehabilitation and training on using the prosthesis, which can help the patient adapt to the device sooner.

You can imagine it like learning to ride a bike; the earlier you start training with the right equipment, the sooner you'll be able to ride independently.

✘Incorrect answer options:

The prosthesis will fit better. The fit of a prosthesis depends more on careful measuring, molding, and fitting procedures than on the timing of when it's first fitted. A well-fit prosthesis is crucial for comfort and functionality, and this can be achieved whether the prosthesis fitting is immediate or delayed.

The patient will experience less phantom limb sensation. Phantom limb sensation (the feeling that the amputated limb is still present) is a common experience after amputation and is believed to be related to the brain and nerve signals, rather than the presence or absence of a prosthesis. Immediate prosthesis fitting doesn't necessarily reduce this sensation.

Dressing changes become unnecessary. Even with an immediate prosthesis, dressing changes may still be necessary to maintain cleanliness and monitor the surgical site for signs of infection or healing complications. The need for dressing changes depends on the wound healing process, not on the fitting of the prosthesis.

EXPLANATION

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They plan to utilize a mirror for daily inspections of all areas of the stump. After a below-the-knee amputation, a crucial aspect of self-care involves regularly inspecting the stump for signs of infection or skin breakdown. Using a mirror helps visualize hard-to-see areas, thus preventing unnoticed complications.

Consider it akin to using rear-view mirrors while driving; just as these mirrors assist in detecting unseen vehicles, a handheld mirror aids in identifying concealed skin issues.

✘Incorrect answer options:

They commit to wearing a clean nylon stump sock every day. Nylon is not the best material for stump socks because it doesn't allow the skin to breathe well, which can increase the risk of sweating, skin breakdown, and infection. Instead, wool or cotton stump socks are typically recommended.

They aim to harden the skin of the stump by rubbing it with alcohol. Alcohol should not be used on the skin of the stump, as it can cause dryness and skin irritation. Instead, washing with mild soap and water is recommended.

They will work to avoid skin cracking on the stump by daily application of lotion. While it's important to prevent skin cracking, excessive use of lotion can lead to skin softening and break down, which can increase the risk of skin problems. Therefore, lotion use should be minimal and as recommended by healthcare professionals.

EXPLANATION

✔Correct answer:

Isometric shoulder exercises. When using crutches, the patient will rely heavily on their upper body strength, particularly the strength of the shoulder muscles. Isometric shoulder exercises can help to build this strength. These exercises involve contraction of the shoulder muscles without any significant movement, similar to pushing against a wall. Therefore, Nurse Ella would recommend isometric shoulder exercises to the patient to build strength and endurance necessary for using crutches.

✘Incorrect answer options:

Abdominal exercises. While having a strong core can be beneficial for overall stability and balance, abdominal exercises are not the most relevant for preparing a patient to use crutches. The main muscles used when utilizing crutches are the muscles in the shoulders, arms, and hands.

Quadriceps setting exercises. Quadriceps exercises can be beneficial for individuals recovering from knee-related surgeries or injuries. However, in this case, the patient is preparing to use crutches due to an above-the-knee amputation, so strengthening the quadriceps isn't the top priority.

Triceps stretching exercises. While the triceps muscles are involved in the use of crutches, they are not the primary muscles used. Strengthening exercises (like isometric exercises) would likely be more beneficial than stretching exercises in preparing to use crutches.

EXPLANATION

✔Correct answer:

Extract the pillow and proceed to elevate the foot of the bed. After a below-the-knee amputation, it is important to avoid flexion contracture, a condition in which the muscles shorten and become tight, limiting range of motion. The best way to prevent flexion contracture is to discourage elevation of the residual limb on a pillow, particularly for prolonged periods.

The reasoning behind this is akin to keeping a spring in its extended position to preserve its flexibility. If you keep a spring coiled up for an extended period, it could permanently lose some of its ability to stretch.

✘Incorrect answer options:

Retain the pillow as it elevates the patient's stump. While it may seem beneficial to elevate the stump to reduce swelling, doing so with a pillow can increase the risk of a hip flexion contracture, as the hip is maintained in a flexed position. It's like folding a piece of paper; if it stays folded for too long, it will retain that fold.

Consult the physician to clarify the orders. There is no need for clarification of orders. The physician's order is clear, and the nurse's understanding aligns with established post-operative care for amputations.

Preserve the pillow in place and also elevate the foot of the bed. Similar to retaining the pillow as it elevates the patient's stump, maintaining the pillow while elevating the bed can contribute to the development of a flexion contracture.

EXPLANATION

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Offering an overhead trapeze for the patient's use. In the context of promoting patient autonomy, offering an overhead trapeze stands out as a powerful tool. It assists the patient in changing positions, moving within the bed, and performing some activities independently, therefore enhancing the patient's control over his or her situation.

It's like giving someone a ladder when they need to reach a high shelf; it enables them to do it themselves instead of relying on others.

✘Incorrect answer options:

Delivering skin care to avert skin breakdown. While providing skin care is a critical nursing intervention in the management of patients in skeletal traction, it's generally carried out by the nurse and doesn't directly promote patient autonomy. This is more of a passive action for the patient, similar to having someone apply sunscreen to your back - it's necessary, but you're not the one doing it.

Guiding the patient to request an analgesic before pain becomes severe. While this action is crucial in pain management, it encourages patients to be proactive about their pain but doesn't promote physical independence or enhance their ability to perform activities of daily living independently. It's more about empowering the patient to communicate their needs effectively.

Motivating the patient to perform leg exercises within the constraints of the traction. Although this is an essential nursing action, especially for preventing complications such as deep vein thrombosis, it doesn't enhance patient independence as much as offering an overhead trapeze does. While exercises can improve strength and circulation, they do not directly enhance the patient's ability to perform activities of daily living independently.

EXPLANATION

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Guarantee appropriate body positioning of the patient. Correct body positioning is crucial to prevent foot drop, a condition that can develop if a patient's foot is not supported properly in the correct alignment. This includes ensuring that the foot is in a neutral position and not pressing against any hard surfaces.

It's like placing a book on a shelf correctly; if the book is not aligned correctly, it can eventually tilt or fall.

✘Incorrect answer options:

Tightly tuck the bed sheets into the foot of the bed. Tight bed sheets can actually contribute to the development of foot drop, as they may exert pressure on the foot and push it into plantar flexion (downward position). This is akin to wearing a pair of shoes that are too tight and restrict movement.

Position pillows beneath the patient's heels. While it is essential to prevent pressure ulcers, placing pillows under the patient's heels can contribute to the foot being held in a downward position, promoting foot drop. It's similar to placing an object under a seesaw on a playground; it can tilt the seesaw in the wrong direction.

Educate the patient about the benefits of isometric exercises. Isometric exercises are beneficial for overall muscle strength but they may not directly prevent foot drop. These exercises involve contraction of muscles without significant movement of the body part, such as pushing against a wall.

EXPLANATION

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Dislocation of the joint. Sudden, severe pain and an inability to move the limb following a joint replacement surgery often suggest a possible dislocation of the joint.

This situation is similar to a car engine suddenly seizing up – a sudden, unexpected stop usually indicates a serious problem. This is often a medical emergency and should be evaluated immediately.

✘Incorrect answer options:

An emerging infection. While an infection could certainly cause pain and potentially limit mobility, it usually wouldn't cause the sudden, intense pain described in this scenario. Infections generally develop over time and would be accompanied by other signs, such as redness, warmth, and possible fever.

Hemorrhage at the surgical site. Although a hemorrhage could cause severe pain, it's more likely to present with swelling, a rapid increase in pain, and potentially a drop in blood pressure or increase in heart rate due to blood loss. The ability to move the limb wouldn't necessarily be impacted directly by a hemorrhage, at least not in the same immediate and dramatic way as with a dislocation.

Seepage of adhesive into the soft tissue. Adhesive seepage isn't a typical complication of joint replacement surgery. The prosthetic joints are usually cemented or press-fit into place rather than being secured with a traditional adhesive. This option is therefore unlikely.

EXPLANATION

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The gallium will be administered via an intravenous route 2 to 3 hours prior to the procedure. A gallium scan is a nuclear medicine test that uses a radioactive substance known as gallium to identify areas of inflammation, infection, or tumors in the body. The gallium is typically administered intravenously, typically 2-3 days before the actual imaging, not 2-3 hours, but for the purpose of this question, we'll assume it's the closest answer. Once injected, gallium is taken up by areas of active inflammation or abnormal cell growth. Over the course of a few days, the gallium accumulates in these areas, enabling them to be detected during the scan.

Think of it as planting a seed (gallium) into the ground (the body). It takes a few days for the seed to sprout (accumulate in active inflammation areas or tumors) and once it sprouts, you can spot it easily (detected during the scan).

✘Incorrect answer options:

The patient will need to maintain an upright posture during the imaging process. While some imaging procedures might require the patient to maintain a specific posture, a gallium scan is not one of them. Patients are typically lying down during the scan, which can take several hours and sometimes even days, requiring multiple imaging sessions.

The scan's duration will be approximately 15 minutes. Contrary to this statement, a gallium scan is not a quick procedure. It can take several hours to complete and sometimes is conducted over multiple days. This is due to the fact that the gallium needs time to accumulate in the areas of active inflammation or abnormal cell growth.

The patient should stay on bed rest for the rest of the day following the scan. Following a gallium scan, patients typically can go about their normal activities unless otherwise advised by their healthcare provider. Therefore, this option is not accurate.

EXPLANATION

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Validate the patient's experience by affirming that her pain is real. This patient appears to be experiencing a phenomenon known as phantom limb pain, which is the sensation of pain coming from a limb that is no longer present. This pain is very real to the person experiencing it, and it's believed to result from the brain's attempts to "reorganize" following the loss of the limb. As a nurse, the best initial response would be to validate the patient's experience, affirming that her pain is real and it's a known phenomenon following amputation. This supports a trusting relationship, encourages open communication about the pain, and can reduce anxiety and fear.

Imagine you're trying to tune in to your favorite radio station, but it's suddenly gone off-air. You might still hear static or interference because your radio is trying to find that signal. The brain does something similar when a limb is lost; it's still trying to connect to a 'signal' that's not there, leading to phantom limb pain.

✘Incorrect answer options:

Administer the prescribed narcotic pain reliever to the patient. While it might eventually be necessary to administer pain medication, the first step should be to validate the patient's experience. After validation, assessing the pain further and managing it accordingly would be the correct step.

Insist to the patient that feeling pain in the absent toe is impossible. This would be incorrect and potentially harmful. It's essential to acknowledge and validate a patient's subjective experiences, especially pain. This approach might make the patient feel dismissed and could harm the therapeutic relationship.

Physically demonstrate to the patient that her toes are no longer present. While it's important to orient patients to their physical status postoperatively, this approach could be seen as dismissive or insensitive. The nurse's priority should be to affirm and validate the patient's pain, and then engage in sensitive, patient-centered education about phantom limb pain.

EXPLANATION

✔Correct answer:

Carry out pin care at a minimum frequency of once every hour. Proper pin care is crucial for preventing infection at the pin sites. Clean the pin sites regularly with soap, water, or saline, preferably every hour. Additionally, closely monitor the pin sites for signs of infection like redness, swelling, or drainage. Consistent and diligent pin care is vital to minimize infection, reduce inflammation, and facilitate proper healing.

This practice can be likened to regularly cleaning and dressing a wound to prevent infection and promote healing.

✘Incorrect answer options:

Take off traction weights for a 20-minute interval every two hours. Removing the weights from skeletal traction is not generally recommended unless directed by a physician or in an emergency situation. The weights are crucial for maintaining the necessary force to align the bone properly. Imagine trying to straighten a bent tree trunk with a rope and weights – if you remove the weights regularly, the tree wouldn't straighten.

Arrange for a trapeze to enhance the patient's mobility. Although a trapeze bar can enhance a patient's mobility in bed, this isn't the primary concern when managing a patient with skeletal traction. The trapeze bar is important, but it's not as crucial as ensuring the cleanliness and care of the pin site.

Keep the patient in a flat, supine position at all times. A flat, supine position is often recommended for a patient with skeletal traction, but the position can be modified for comfort, to improve circulation, and prevent complications such as pressure ulcers. Just as you would adjust your position in bed to stay comfortable, patients can also adjust their position within the parameters set by the doctor.

EXPLANATION

✔Correct answer:

The involved limb appears shorter, drawn inward (adducted), and excessively rotated. In a femoral neck fracture, a classic presentation includes the affected leg appearing shorter and turned inward (adducted) and rotated. This occurs due to the pull of the surrounding muscles, which results in a deformity.

It's like a broken stick that no longer aligns properly and seems shorter because it's bent or twisted.

✘Incorrect answer options:

The involved limb is noticeably swollen. While swelling may occur in the event of a femoral neck fracture, it is not the most definitive sign of this specific fracture. Swelling can happen in any injury, from a simple sprain to a severe break, so it's not the most reliable indicator of a femoral neck fracture.

The patient experiences pain in the affected leg. Pain in the affected leg is a common symptom of any lower limb injury, not specifically indicative of a femoral neck fracture. Just like you would experience pain if you bumped your shin or twisted your ankle, pain alone is not definitive for a femoral neck fracture.

A substantial bruise (hematoma) is visible on the affected limb. A hematoma or bruise might be present, but it's not the most indicative sign of a femoral neck fracture. Similar to swelling, bruising can occur with any kind of injury to the tissues under the skin.

EXPLANATION

✔Correct answer:

The affected leg appears shorter. In the case of an intracapsular hip fracture, the leg on the affected side typically appears shorter compared to the unaffected side. This is due to the disruption of the hip joint, leading to a change in the orientation of the limb. This shortening, coupled with the leg being externally rotated (toes pointed outward), is a classic clinical presentation of a hip fracture.

Consider a broken mechanical joint in a toy figure. If the upper part of the joint is displaced and angled differently due to the damage, it makes the entire limb appear shorter.

✘Incorrect answer options:

Flaccidity in the surrounding muscles. Following a fracture, the muscles surrounding the area might become tense and painful due to the inflammation and damage. Flaccidity, or muscle weakness, is not a typical finding in the acute phase of a hip fracture.

Lack of pain in the area of the fracture. A hip fracture would typically cause significant pain, making it difficult for the person to bear weight on the affected leg. Therefore, a lack of pain would be an atypical observation in the case of a hip fracture.

Inward turning of the leg. Contrary to this option, hip fractures more commonly lead to external rotation of the affected leg, not inward turning. This happens because the muscles attached to the thigh bone (femur) tend to pull it into a position of comfort, which is usually with the leg turned outwards.