Chapter 62: Musculoskeletal Trauma and Orthopedic Surgery
Harding: Lewis’s Medical-Surgical Nursing, 11th Edition
MULTIPLE CHOICE
1. What should the nurse include when teaching older adults at a community recreation center about ways to prevent fractures?
a. Tack down scatter rugs on the floor in the home.
b. Expect most falls to happen outside the home in the yard.
c. Buy shoes that provide good support and are comfortable to wear.
d. Get instruction in range-of-motion exercises from a physical therapist.
ANS: C
Comfortable shoes with good support will help decrease the risk for falls. Scatter rugs should be eliminated, not just tacked down.
Activities of daily living provide range-of-motion exercise; these do not need to be taught by a physical therapist. Falls inside the
home are responsible for many injuries.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
2. A factory line worker has repetitive strain syndrome in the left elbow. What topic should the nurse plan to include in patient
teaching?
a. Surgical options
b. Elbow injections
c. Wearing a left wrist splint
d. Modifying arm movements
ANS: D
Treatment for repetitive strain syndrome includes changing the ergonomics of the activity. Elbow injections and surgery are not
initial options for this type of injury. A wrist splint might be used for hand or wrist pain.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Planning
3. What should the occupational health nurse advise a patient whose job involves many hours of typing?
a. Obtain a keyboard pad to support the wrist.
b. Do stretching exercises before starting work.
c. Wrap the wrists with compression bandages every morning.
d. Avoid using nonsteroidal antiinflammatory drugs (NSAIDS).
ANS: A
Repetitive strain injuries caused by prolonged work at a keyboard can be prevented by using a pad to keep the wrists in a straight
position. Stretching exercises during the day may be helpful, but these would not be needed before starting work. Use of a
compression bandage is not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are appropriate to decrease
swelling.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
4. Which discharge instruction should the emergency department nurse include for a patient with a sprained ankle?
a. Keep the ankle loosely wrapped with gauze.
b. Apply a heating pad to reduce muscle spasms.
c. Use pillows to elevate the ankle above the heart.
d. Gently move the ankle through the range of motion.
ANS: C
Elevation of the leg will reduce swelling and pain. Compression bandages are used to decrease swelling. For the first 24 to 48
hours, cold packs are used to reduce swelling. The ankle should be rested and kept immobile to prevent further swelling or injury.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
5. A tennis player has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. Which information will the nurse
include in postoperative teaching?
a. “You will not be able to serve a tennis ball again.”
b. “You will begin work with a physical therapist tomorrow.”
c. “Keep the shoulder immobilizer on for the first 4 days to minimize pain.”
d. “The surgeon will use the drop arm test to determine the success of surgery.”
ANS: B
Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent “frozen shoulder.” A shoulder
immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of range of
motion. The drop arm test is used to test for rotator cuff injury but not after surgery. The patient may be able to return to tennis
after rehabilitation.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
Copyright © 2020, Elsevier Inc. All Rights Reserved.
TOP: Nursing Process: Planning
1
6. The nurse should instruct a patient with a nondisplaced fractured left radius that the cast will need to remain in place for what
amount of time?
a. Two weeks
b. At least six weeks
c. Until swelling of the wrist has resolved
d. Until x-rays show complete bony union
ANS: B
Bone healing starts immediately after the injury, but because ossification does not begin until 3 weeks after injury, the cast will
need to be worn for at least 3 weeks. Complete union may take up to 1 year. Resolution of swelling does not indicate bone healing.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
7. The nurse is caring for a patient who has a pelvic fracture and an external fixation device. How should the nurse perform
assessment of pressure areas and provide skin care to the patient’s back and sacrum?
a. Ask the patient to turn to the side independently.
b. Defer back assessment until the patient is ambulatory.
c. Have the patient lift the back and buttocks using a trapeze.
d. Roll the patient over to the side by pushing on the patient’s hips.
ANS: C
The patient can lift the back slightly off the bed by using a trapeze. The patient may find it very difficult to turn to the side without
assistance while in a fixator device. Delaying assessment and skin care may put the patient at risk for an undetected pressure injury.
Pushing on the patient’s hips may cause additional injury.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment
8. Which patient statement indicates understanding of the nurse’s teaching about a new short-arm synthetic cast?
a. “I can remove the cast in 4 weeks using industrial scissors.”
b. “I should avoid moving my fingers until the cast is removed.”
c. “I will apply an ice pack to the cast over the fracture site off and on for 24 hours.”
d. “I can use a cotton-tipped applicator to rub lotion on any dry areas under the
cast.”
ANS: C
Ice application for the first 24 hours after a fracture will help reduce swelling and can be placed over the cast. The cast is typically
removed in the outpatient setting. The patient should be encouraged to move the joints above and below the cast. Patients should
not insert objects inside the cast.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Evaluation
9. A patient who is to have no weight bearing on the left leg is learning to use crutches. Which observation by the nurse indicates the
patient can safely ambulate independently?
a. The patient moves the right crutch with the right leg and then the left crutch with
the left leg.
b. The patient advances the left leg and both crutches together and then advances the
right leg.
c. The patient uses the bedside chair to assist in balance as needed when ambulating
in the room.
d. The patient keeps the padded area of the crutch firmly in the axillary area when
ambulating.
ANS: B
Patients are usually taught to move the crutches and the injured leg forward at the same time and then to move the unaffected leg. If
the 2- or 4-point gait is to be used, the crutch and leg on opposite sides move forward, not the crutch and same-side leg.
Patients are discouraged from using furniture to assist with ambulation. The patient is taught to place weight on the hands, not in
the axilla, to avoid brachial plexus damage.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Safe and Effective Care Environment
TOP: Nursing Process: Evaluation
10. A patient who had open reduction and internal fixation (ORIF) of left lower leg fractures continues to report severe pain in the leg
15 minutes after receiving the prescribed IV morphine. The nurse determines pulses are faintly palpable and the foot is cool to the
touch. Which action should the nurse take next?
a. Notify the health care provider.
b. Assess the incision for redness.
c. Reposition the left leg on pillows.
d. Check the patient’s blood pressure.
ANS: A
The patient’s clinical manifestations suggest compartment syndrome and delay in diagnosis and treatment may lead to severe
functional impairment. The data do not suggest problems with blood pressure or infection. Elevation of the leg will decrease
arterial flow and further reduce perfusion.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
Copyright © 2020, Elsevier Inc. All Rights Reserved.
2
11. A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which assessment finding should indicate to the
nurse a potential complication of the fracture?
a. The patient states the pelvis feels unstable.
b. The patient reports pelvic pain with palpation.
c. Abdomen is distended, and bowel sounds are absent.
d. Ecchymoses are visible across the abdomen and hips.
ANS: C
The abdominal distention and absent bowel sounds may be due to complications of pelvic fractures such as paralytic ileus or
hemorrhage or trauma to the bladder, urethra, or colon. Pelvic instability, abdominal pain with palpation, and abdominal bruising
would be expected with this type of injury.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
12. Which action should the nurse take to evaluate the effectiveness of Buck’s traction for a patient who has an intracapsular fracture of
the right femur?
a. Assess for hip pain.
b. Check for contractures.
c. Palpate peripheral pulses.
d. Monitor for hip dislocation.
ANS: A
Buck’s traction is used to reduce painful muscle spasm. Hip contractures and dislocation are unlikely to occur in this situation. The
peripheral pulses will be assessed, but this does not help in evaluating the effectiveness of Buck’s traction.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Evaluation
13. A patient with a right lower leg fracture will be discharged home with an external fixation device in place. Which statement should
the nurse including in discharge teaching?
a. “Check and clean the pin insertion sites daily.”
b. “Remove the external fixator for your shower.”
c. “Remain on bed rest until bone healing is complete.”
d. “Take prophylactic antibiotics until the fixator is removed.”
ANS: A
Pin insertion sites should be cleaned daily to decrease risk for infection at the site. An external fixator allows the patient to be out
of bed and avoid the risks of prolonged immobility. The device is surgically placed and is not removed until the bone is stable.
Prophylactic antibiotics are not routinely given during external fixator use.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
14. A patient who has had open reduction and internal fixation (ORIF) of a hip fracture tells the nurse he is ready to get out of bed for
the first time. Which action should the nurse take?
a. Check the patient’s prescribed weight-bearing status.
b. Use a mechanical lift to transfer the patient to the chair.
c. Decrease the pain medication before getting the patient up.
d. Have the unlicensed assistive personnel (UAP) transfer the patient.
ANS: A
The nurse should be familiar with the weight-bearing orders for the patient before attempting the transfer. Mechanical lifts are not
typically needed after this surgery. Pain medications should be given because the movement is likely to be painful for the patient.
The registered nurse (RN) should supervise the patient during the initial transfer to evaluate how well the patient is able to
accomplish the transfer.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
15. Which information should the nurse include in discharge teaching for a patient who has had a repair of a fractured mandible?
a. Administration of nasogastric tube feedings
b. How and when to cut the immobilizing wires
c. The importance of high-fiber foods in the diet
d. The use of sterile technique for dressing changes
ANS: B
The jaw will be wired for stabilization, and the patient should know what emergency situations require the wires to be cut to protect
the airway. There are no dressing changes for this procedure. The diet is liquid, and patients are not able to chew high-fiber foods.
Initially, the patient may receive nasogastric tube feedings, but by discharge, the patient will swallow liquid through a straw.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
Copyright © 2020, Elsevier Inc. All Rights Reserved.
3
16. After the health care provider recommends amputation for a patient who has nonhealing ischemic foot ulcers, the patient tells the
nurse that he would rather die than have an amputation. Which response by the nurse is best?
a. “You are upset, but you may lose the foot anyway.”
b. “Many people are able to function with a foot prosthesis.”
c. “Tell me what you know about your options for treatment.”
d. “If you do not want an amputation, you do not have to have it.”
ANS: C
The initial nursing action should be to assess the patient’s knowledge and feelings about the available options. Discussion of the
patient’s option to refuse the procedure, seriousness of the condition, or rehabilitation after the procedure may be appropriate after
the nurse knows more about the patient’s current knowledge and emotional state.
DIF: Cognitive Level: Analyze (analysis)
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity
17. The day after a having a right below-the-knee amputation, a patient reports pain in the missing right foot. Which action is most
important for the nurse to take?
a. Explain the reasons for the pain.
b. Administer prescribed analgesics.
c. Reposition the patient to assure good alignment.
d. Tell the patient that the pain will diminish over time.
ANS: B
Acute phantom limb sensation is treated as any other type of postoperative pain would be treated. Explanations of the reason for the
pain may be given, but the nurse should still medicate the patient. Alignment is important but is unlikely to relieve the pain.
Although the pain may decrease over time, it currently requires treatment.
DIF: Cognitive Level: Analyze (analysis)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
18. Which statement by a patient who has had an above-the-knee amputation indicates the nurse’s discharge teaching has been
effective?
a. “I should elevate my residual limb on a pillow 2 or 3 times a day.”
b. “I should lie flat on my abdomen for 30 minutes 3 or 4 times a day.”
c. “I should change the limb sock when it becomes soiled or each week.”
d. “I should use lotion on the stump to prevent skin drying and cracking.”
ANS: B
The patient lies in the prone position several times daily to prevent flexion contractures of the hip. The limb sock should be
changed daily. Lotion should not be used on the stump. The residual limb should not be elevated because this would encourage hip
flexion contracture.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Evaluation
19. A patient is to be discharged from the hospital 4 days after insertion of a femoral head prosthesis using a posterior approach. Which
patient statement to the nurse indicates that additional teaching is needed?
a. “I should not cross my legs while sitting.”
b. “I will use a toilet elevator on the toilet seat.”
c. “I will have someone else put on my shoes and socks.”
d. “I can sleep in any position that is comfortable for me.”
ANS: D
The patient needs to sleep in a position that prevents excessive internal rotation or flexion of the hip. The other patient statements
indicate the patient has understood the teaching.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Evaluation
20. Which action should the nurse include in the plan of care for a patient who had a cemented right total knee arthroplasty?
a. Avoid extension of the right knee beyond 120 degrees.
b. Use a compression bandage to keep the right knee flexed.
c. Teach about the need to avoid weight bearing for 4 weeks.
d. Start progressive knee exercises to obtain 90-degree flexion.
ANS: D
After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree flexion of the knee. The goal for
extension of the knee will be 180 degrees. A compression bandage is used to hold the knee in an extended position after surgery.
Protected weight bearing is typically not ordered after this procedure.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
Copyright © 2020, Elsevier Inc. All Rights Reserved.
TOP: Nursing Process: Planning
4
21. A high school teacher with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for arthroplasty of several joints in the left
hand. Which patient statement to the nurse indicates a realistic expectation for the surgery?
a. “This procedure will correct the deformities in my fingers.”
b. “I will not have to do as many hand exercises after the surgery.”
c. “I will be able to use my fingers with more flexibility to grasp things.”
d. “My fingers will appear more normal in size and shape after this surgery.”
ANS: C
The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process. Hand
exercises will be prescribed after the surgery.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Evaluation
22. Which information should the nurse include in discharge instructions for a patient with comminuted left forearm fractures and a
long-arm cast?
a. Keep the left shoulder elevated on a pillow or cushion.
b. Avoid nonsteroidal antiinflammatory drugs (NSAIDs).
c. Call the health care provider for numbness of the hand.
d. Keep the hand immobile to prevent soft tissue swelling.
ANS: C
Increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified
immediately to avoid damage to nerves and other tissues. The patient should be encouraged to move the joints above and below the
cast to avoid stiffness. There is no need to elevate the shoulder, although the forearm should be elevated to reduce swelling.
NSAIDs are appropriate to treat mild to moderate pain after a fracture.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
23. A patient who slipped and fell in the shower at home has a proximal left humerus fracture immobilized with a sling. Which
intervention should the nurse include in the plan of care?
a. Use surgical net dressing to hang the arm from an IV pole.
b. Immobilize the fingers of the left hand with gauze dressings.
c. Assess the left axilla and change absorbent dressings as needed.
d. Assist the patient in passive range of motion (ROM) for the right arm.
ANS: C
The axilla can become excoriated when a sling is used to support the arm, and the nurse should check the axilla and apply
absorbent dressings to prevent this. A patient with a sling would not have traction applied by hanging. The patient will be
encouraged to move the fingers on the injured arm to maintain function and to help decrease swelling. The patient will do active
ROM on the uninjured side.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Planning
24. A patient is being discharged 4 days after hip arthroplasty using the posterior approach. Which patient action requires intervention
by the nurse?
a. Using crutches with a swing-to gait
b. Sitting upright on the edge of the bed
c. Leaning over to pull on shoes and socks
d. Bending over the sink while brushing teeth
ANS: C
Leaning over would flex the hip at greater than 90 degrees and predispose the patient to hip dislocation. The other patient actions
are appropriate and do not require any immediate action by the nurse to protect the patient.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
25. After being hospitalized for 3 days with a right femur fracture, a patient suddenly develops shortness of breath and tachypnea. The
patient tells the nurse, “I feel like I am going to die!” Which action should the nurse take first?
a. Stay with the patient and offer reassurance.
b. Administer prescribed PRN O2 at 4 L/min.
c. Check the patient’s legs for swelling or tenderness.
d. Notify the health care provider about the symptoms.
ANS: B
The patient’s clinical manifestations and history are consistent with a pulmonary embolism, and the nurse’s first action should be to
ensure adequate oxygenation. The nurse should offer reassurance to the patient but meeting the physiologic need for O 2 is a higher
priority. The health care provider should be notified after the O 2 is started and pulse oximetry obtained concerning suspected fat
embolism or venous thromboembolism.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
Copyright © 2020, Elsevier Inc. All Rights Reserved.
5
26. A patient arrived at the emergency department after tripping over a rug and falling at home. Which finding should the nurse
identify as most important to communicate to the health care provider?
a. There is bruising at the shoulder area.
b. The patient reports arm and shoulder pain.
c. The right arm appears shorter than the left.
d. There is decreased shoulder range of motion.
ANS: C
A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency. Bruising, pain, and decreased range
of motion should also be reported, but these do not indicate emergent treatment is needed to preserve function.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
27. A young adult arrives in the emergency department with ankle swelling and severe pain after twisting an ankle playing basketball.
Which prescribed action will the nurse implement first?
a. Send the patient for ankle x-rays.
b. Administer naproxen (Naprosyn).
c. Give acetaminophen with codeine.
d. Wrap the ankle and apply an ice pack.
ANS: D
Immediate care after a sprain or strain injury includes application of cold and use of compression to minimize swelling. The other
actions should be taken after the ankle is wrapped with a compression bandage and ice is applied.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
28. For a patient who has had right hip arthroplasty, which nursing action can the nurse delegate to experienced unlicensed assistive
personnel (UAP)?
a. Reposition the patient every 1 to 2 hours.
b. Assess for skin irritation on the patient’s back.
c. Teach the patient quadriceps-setting exercises.
d. Determine the patient’s pain intensity and tolerance.
ANS: A
Repositioning of orthopedic patients is within the scope of practice of UAP after they have been trained and evaluated in this skill.
The other actions should be done by licensed nursing staff members.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation
TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
29. A patient who arrives at the emergency department with severe left knee pain is diagnosed with a patellar dislocation. What should
be the nurse’s initial focus for patient teaching?
a. Use of a knee immobilizer
b. Monitored anesthesia care
c. Physical activity restrictions
d. Performance of gentle knee flexion
ANS: B
The first goal of interprofessional management is realignment of the knee to its original anatomic position, which will require
anesthesia or monitored anesthesia care, formerly called conscious sedation. Immobilization, gentle range-of-motion exercises, and
discussion about activity restrictions will be implemented after the patella is realigned.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
30. After a motorcycle accident, a patient arrives in the emergency department with severe swelling of the left lower leg. Which action
should the nurse take first?
a. Elevate the leg on 2 pillows.
b. Apply a compression bandage.
c. Assess leg pulses and sensation.
d. Place ice packs on the lower leg.
ANS: C
The initial action by the nurse will be to assess circulation to the leg and observe for any evidence of injury such as fractures or
dislocations. After the initial assessment, the other actions may be appropriate based on what is observed during the assessment.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
Copyright © 2020, Elsevier Inc. All Rights Reserved.
6
31. A pedestrian who was hit by a car is admitted to the emergency department with possible right lower leg fractures. What initial
action should the nurse take?
a. Elevate the right leg.
b. Splint the lower leg.
c. Assess the pedal pulses.
d. Verify tetanus immunization.
ANS: C
The initial nursing action should be assessment of the neurovascular condition of the injured leg. After assessment, the nurse may
need to splint and elevate the leg based on the assessment data. Information about tetanus immunizations should be obtained if
there is an open wound.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
32. A 60-yr-old patient had open reduction and internal fixation (ORIF) for an open, displaced tibial fracture, What should the nurse
identify as the priority patient problem?
a. Acute pain
b. Risk for infection
c. Activity intolerance
d. Risk for constipation
ANS: B
A patient having ORIF is at risk for problems such as wound infection and osteomyelitis. After ORIF, patients typically are
mobilized starting the first postoperative day, so the problems caused by immobility are not as likely. Pain management is
important, but the most important action is to prevent infection.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Analysis
MSC: NCLEX: Physiological Integrity
33. The second day after admission with a fractured pelvis, a patient suddenly develops confusion. Which action should the nurse take
first?
a. Take the blood pressure.
b. Check the O2 saturation.
c. Assess patient orientation.
d. Observe for facial asymmetry.
ANS: C
The patient’s history and clinical manifestations suggest a fat embolism. The most important assessment is oxygenation. The other
actions are also appropriate but will be done after the nurse assesses O 2 saturation.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
34. A patient is admitted to the emergency department with a left femur fracture. Which assessment finding by the nurse is most
important to report to the health care provider?
a. Bruising of the left thigh
b. Reports of severe thigh pain
c. Slow capillary refill of the left foot
d. Outward pointing toes on the left foot
ANS: C
Prolonged capillary refill may indicate complications such as compartment syndrome. The other findings are typical with a left
femur fracture.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
35. A patient undergoes left above-the-knee amputation with an immediate prosthetic fitting. What should the nurse do when the
patient arrives on the orthopedic unit after surgery?
a. Assess the surgical site for hemorrhage.
b. Remove the prosthesis and wrap the site.
c. Place the patient in a side-lying position.
d. Keep the residual limb elevated on a pillow.
ANS: A
The nurse should monitor for postoperative hemorrhage. The prosthesis will not be removed. To avoid flexion contracture of the
hip, the leg will not be elevated on a pillow. Unless contraindicated, the patient will be placed in a prone position for 30 minutes
several times a day to prevent hip flexion contracture.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
Copyright © 2020, Elsevier Inc. All Rights Reserved.
7
36. Before assisting a patient with ambulation 2 days after total hip arthroplasty, which action is most important for the nurse to take?
a. Observe output from the surgical drain.
b. Administer prescribed pain medication.
c. Instruct the patient about benefits of early ambulation.
d. Change the dressing and document the wound appearance.
ANS: B
The patient should be adequately medicated for pain before any attempt to ambulate. Instructions about the benefits of ambulation
may increase the patient’s willingness to ambulate but decreasing pain with ambulation is more important. The presence of an
incisional drain or timing of dressing change will not affect ambulation.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
37. A patient has possible right carpal tunnel syndrome. What symptom should the nurse expect with a positive Tinel’s sign?
a. Weakness in the right little finger
b. Burning in the right elbow and forearm
c. Tremor when gripping with the right hand
d. Tingling in the right thumb and index finger
ANS: D
Testing for Tinel’s sign will cause tingling in the thumb and first three fingers of the affected hand in patients who have carpal
tunnel syndrome. The median nerve does not innervate the right little finger or elbow and forearm. Tremor is not associated with
carpal tunnel syndrome.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
38. Which action should the urgent care nurse take for a patient with a possible knee meniscus injury?
a. Encourage bed rest for 24 to 48 hours.
b. Apply an immobilizer to the affected leg.
c. Avoid palpation or movement of the knee.
d. Administer intravenous opioids for pain management.
ANS: B
A knee immobilizer may be used for several days after a meniscus injury to stabilize the knee and minimize pain. Patients are
encouraged to ambulate with crutches. The knee is assessed by flexing, internally rotating, and extending the knee (McMurray’s
test). The pain associated with a meniscus injury will not typically require IV opioid administration. Nonsteroidal antiinflammatory
drugs (NSAIDs) are recommended for pain management.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
39. Which finding in a patient with a Colles’ fracture of the left wrist should the nurse identify as most important to communicate
immediately to the health care provider?
a. The patient reports severe pain.
b. Swelling is noted around the wrist.
c. Capillary refill to the fingers is slow.
d. The wrist has a deformed appearance.
ANS: C
Swelling, pain, and deformity are common findings with a Colles’ fracture. Prolonged capillary refill indicates decreased
circulation and risk for ischemia. This is not an expected finding and should be immediately reported.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
40. Which information about a patient with a lumbar vertebral compression fracture should the nurse immediately report to the health
care provider?
a. Patient declines to be turned due to back pain.
b. Patient has been incontinent of urine and stool.
c. Patient reports lumbar area tenderness to palpation.
d. Patient frequently uses oral corticosteroids to treat asthma.
ANS: B
Changes in bowel or bladder function indicate possible spinal cord compression and should be reported immediately because
surgical intervention may be needed. The other findings are also pertinent but are consistent with the patient’s diagnosis and do not
require immediate intervention.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
Copyright © 2020, Elsevier Inc. All Rights Reserved.
8
41. When a patient arrives in the emergency department with a facial fracture, which action should the nurse take first?
a. Assess for nasal bleeding and pain.
b. Apply ice to the face to reduce swelling.
c. Use a cervical collar to stabilize the spine.
d. Check the patient’s alertness and orientation.
ANS: C
Patients who have facial fractures are at risk for cervical spine injury and should be treated as if they have a cervical spine injury
until this is ruled out. The other actions are also necessary, but the most important action is to prevent cervical spine injury.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
42. After change-of-shift report, which patient should the nurse assess first?
a. Patient with a repaired mandibular fracture who is reporting facial pain.
b. Patient with repaired right femoral shaft fracture who reports tightness in the calf.
c. Patient with an unrepaired Colles’ fracture who has right wrist swelling and
d.
deformity.
Patient with an unrepaired intracapsular left hip fracture whose leg is externally
rotated.
ANS: B
Calf swelling after a femoral shaft fracture suggests possible DVT or compartment syndrome. The nurse should assess the patient
rapidly and then notify the health care provider. The other patients have symptoms that are typical for their injuries but do not
require immediate intervention.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients
TOP: Nursing Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment
43. The nurse is caring for a patient who is using Buck’s traction after a hip fracture. Which action can the nurse delegate to
experienced unlicensed assistive personnel (UAP)?
a. Remove and reapply traction periodically.
b. Ensure the weight for the traction is hanging freely.
c. Monitor the skin under the traction boot for redness.
d. Check for intact sensation and movement in the affected leg.
ANS: B
UAP can be responsible for maintaining the integrity of the traction after it has been established. The RN should assess the
extremity and assure manual traction is maintained if the traction device has to be removed and reapplied. Assessment of skin
integrity and circulation should be done by the registered nurse (RN).
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation
TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
44. Based on the information in the accompanying figure obtained for a patient in the emergency room, which action should the nurse
take first?
a.
b.
c.
d.
Administer the prescribed morphine 4 mg IV.
Contact the operating room to schedule surgery.
Check the patient’s O2 saturation using pulse oximetry.
Ask the patient the date of the last tetanus immunization.
ANS: C
Because fat embolism can occur with tibial fracture, the nurse’s first action should be to check the patient’s O 2 saturation. The other
actions are also appropriate but not as important at this time as obtaining the patient’s O 2 saturation.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
Copyright © 2020, Elsevier Inc. All Rights Reserved.
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OTHER
1. In which order should the nurse complete actions when caring for a patient in the emergency department who has a right leg
fracture? (Put a comma and a space between each answer choice [A, B, C, D, E, F].)
a. Obtain x-rays.
b. Check pedal pulses.
c. Assess lung sounds.
d. Take blood pressure.
e. Apply splint to the leg.
f. Administer tetanus prophylaxis.
ANS:
C, D, B, E, A, F
The initial actions should be to ensure adequate airway, breathing, and circulation. This should be followed by checking the
neurovascular condition of the leg (before and after splint application). Application of a splint to immobilize the leg should be done
before sending the patient for x-ray examination. The tetanus prophylaxis is the least urgent of the actions.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
Copyright © 2020, Elsevier Inc. All Rights Reserved.
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