Which nursing action does the nurse on the orthopedic unit plan to delegate to unlicensed
assistive personnel (UAP)?
A. Remove the wound drain for a client who had an open reduction of a hip fracture 3
days ago.
B. Assess for bruising on a client who is receiving warfarin (Coumadin) to prevent deep
vein thrombosis.
C. Teach a client with a right ankle fracture how to use crutches when transferring and
ambulating.
D. Check the vital signs for a client who was admitted after a total knee replacement 3
hours ago.
The nurse refers a client with an amputation and the client's family to which community
resource?
A. American Amputee Society (AAS)
B. Amputee Coalition of America (ACA)
C. Community Workers for Amputees (CWA)
D. National Amputee of America Society (NAAS)
A client is brought to the emergency department via ambulance after a motor vehicle
crash. What condition does the nurse assess for first?
A. Bleeding
B. Head injury
C. Pain
D. Respiratory distress
A client has a grade III compound fracture of the right tibia. To prevent infection, which
intervention does the nurse implement?
A. Apply bacitracin (Neosporin) ointment to the site daily with a sterile cotton swab.
B. Use strict aseptic technique when cleaning the site.
C. Leave the site open to the air to keep it dry.
D. Assist the client to shower daily and pat the wound site dry.
The nurse is instructing a local community group about ways to reduce the risk for
musculoskeletal injury. What information does the nurse include in the teaching plan?
A. "Avoid contact sports."
B. "Avoid rigorous exercise."
C. "Wear helmets when riding a motorcycle."
D. "Avoid driving in inclement weather."
An older adult client has had an open reduction and internal fixation of a fractured right
hip. Which intervention does the nurse implement for this client?
A. Keep the client's heels off the bed at all times.
B. Re-position the client every 3 to 4 hours.
C. Administer preventive pain medication before deep-breathing exercises.
D. Prohibit the use of antiembolic stockings.
A client is recovering from an above-the-knee amputation resulting from peripheral
vascular disease. Which statement indicates that the client is coping well after the
procedure?
A. "My spouse will be the only person to change my dressing."
B. "I can't believe that this has happened to me. I can't stand to look at it."
C. "I do not want any visitors while I'm in the hospital."
D. "It will take me some time to get used to this.
Which intervention does the nurse suggest to a client with a leg amputation to help cope
with loss of the limb?
A. Talking with an amputee close to the client's age who has had the same type of
amputation
B Drawing a picture of how the client sees him- or herself
C Talking with a psychiatrist about the amputation
D Engaging in diversional activities to avoid focusing on the amputation
A client with a fracture asks the nurse about the difference between a compound fracture
and a simple fracture. Which statement by the nurse is correct?
A "Simple fracture involves a break in the bone, with skin contusions."
B "Compound fracture does not extend through the skin."
C "Simple fracture is accompanied by damage to the blood vessels."
D "Compound fracture involves a break in the bone, with damage to the skin."
Which statement indicates to the nursing instructor that the nursing student understands
the normal healing process of bone after a fracture?
A "A callus is quickly deposited and transformed into bone."
B "A hematoma forms at the site of the fracture."
C "Calcium and vascular proliferation surround the fracture site."
D "Granulation tissue reabsorbs the hematoma and deposits new bone."
A client's left arm is placed in a plaster cast. Which assessment does the nurse perform
before the client is discharged?
A Assess that the cast is dry.
B Ensure that the client has 4 × 4 gauze to take home for placement between the cast and
the skin.
C Check the fit of the cast by inserting a tongue blade between the cast and the skin.
D Ensure that the capillary refill of the left fingernail beds is longer than 3 seconds.
A client is in skeletal traction. Which nursing intervention ensures proper care of this
client?
A Ensure that weights are attached to the bed frame or placed on the floor.
B Ensure that pins are not loose, and tighten as needed.
C Inspect the skin at least every 8 hours.
D Remove the traction weights only for bathing.
An older adult client has multiple tibia and fibula fractures of the left lower extremity
after a motor vehicle crash. Which pain medication does the nurse anticipate will be
requested for this client?
A Cyclobenzaprine (Flexeril)
B Ibuprofen (Advil)
C Meperidine (Demerol)
D Patient-controlled analgesia (PCA) with morphine
The nurse prepares to perform a neurovascular assessment on a client with closed
multiple fractures of the right humerus. Which technique does the nurse use?
A Inspect the abdomen for tenderness and bowel sounds.
B Auscultate lung sounds.
C Assess the level of consciousness and ability to follow commands.
D Assess sensation of the right upper extremity.
A client has sustained a fracture of the left tibia. The extremity is immobilized using an
external fixation device. Which postoperative instruction does the nurse include in this
client's teaching plan?
A "Use pain medication as prescribed to control pain."
B "Clean the pin site when any drainage is noticed."
C "Wear the same clothing that is normally worn."
D "Apply bacitracin (Neosporin) if signs or symptoms of infection develop around pin
sites."
A client has undergone an elective below-the-knee amputation of the right leg as a result
of severe peripheral vascular disease. In postoperative care teaching, the nurse instructs
the client to notify the health care provider if which change occurs?
A Observation of a large amount of serosanguineous or bloody drainage
B Mild to moderate pain controlled with prescribed analgesics
C Absence of erythema and tenderness at the surgical site
D Ability to flex and extend the right knee
A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that
the client will receive which immediate conservative treatment?
A Surgical repair of the rotator cuff
B Prescribed exercises of the affected arm
C Immobilizer for the affected arm
D Patient-controlled analgesia with morphine
The nurse admits an older adult client who sustained a left hip fracture and is in
considerable pain. The nurse anticipates that the client will be placed in which type of
traction?
A Balanced skin traction
B Buck's traction
C Overhead traction
D Plaster traction
A client with a compound fracture of the left femur is admitted to the emergency
department after a motorcycle crash. Which action is most essential for the nurse to take
first?
A Check the dorsalis pedis pulses.
B Immobilize the left leg with a splint.
C Administer the prescribed analgesic.
D Place a dressing on the affected area.
Which information about a client who was admitted with pelvic and bilateral femoral
fractures after being crushed by a tractor is most important for the nurse to report to the
health care provider?
A Thighs have multiple oozing abrasions.
B Serum potassium level is 7 mEq/L.
C The client is describing pain as level 4 (0-to-10 scale).
D Hemoglobin level is 12.0 g/dL.
The client has sustained a traumatic amputation of the left arm after a machine accident.
In what order should the following nursing actions be taken?
1. Apply direct pressure to the amputated site.
2. Elevate the extremity above the client's heart.
3. Assess the client for breathing problems.
4. Examine the amputation site.
A 2, 4, 3, 1
B 3, 4, 1, 2
C 1, 4, 3, 2
D 4, 1, 2, 3
The nurse anticipates providing collaborative care for a client with a traumatic
amputation of the right hand with which health care team members? (Select all that
apply.)
A Occupational therapist Correct
B Physical therapist Correct
C Psychologist Correct
D Respiratory therapist
E Speech therapist
A rock climber has sustained an open fracture of the right tibia after a 20-foot fall. The
nurse plans to assess the client for which potential complications? (Select all that apply.)
A Acute compartment syndrome (ACS)
B Fat embolism syndrome (FES)
C Congestive heart failure
D Urinary tract infection (UTI)
E Osteomyelitis
A client has a fracture and is being treated with skeletal traction. Which assessment
causes the nurse to take immediate action?
a. The client's blood pressure is 130/86 mm Hg.
b. The traction weights are resting on the floor.
c. Slight oozing of clear fluid is noted at the pin site.
d. Capillary refill of the extremity is less than 3 seconds.
A client has been diagnosed with carpal tunnel syndrome. Which intervention does the
nurse question in the treatment of this injury?
a. Ibuprofen 600 mg three times a day with meals
b. Weekly injections of a corticosteroid by the physician
c. Morphine 30 mg to be taken orally every 4 hours
d. Use of a hand brace or splint during the day
The nurse is caring for a client with a fractured femur. Which factor in the client's history
may impede healing of the fracture?
a. A sedentary lifestyle
b. A history of smoking
c. Oral contraceptive use
d. Paget's disease
A client who has sustained a crush injury to the right lower leg reports numbness and
tingling of the affected extremity. The skin of the right leg appears pale. Which is the
nurse's first intervention?
a. Assess pedal pulses.
b. Apply oxygen by nasal cannula.
c. Increase the IV flow rate.
d. Document the finding.
While assessing an older adult client admitted 2 days ago with a fractured hip, the nurse
notes that the client is confused, tachypneic, and restless. Which is the nurse's first
action?
a. Administer oxygen via nasal cannula.
b. Apply restraints and ask for a sitter.
c. Slow the IV flow rate.
d. Discontinue the pain medication.
The nurse is caring for several clients with fractures. Which client does the nurse
consider at highest risk for developing deep vein thrombosis?
a. Middle-aged woman with a fractured ankle taking aspirin for rheumatoid arthritis
b. Young adult male athlete with a fractured clavicle
c. Female with type 2 diabetes with fractured ribs
d. Older man who smokes and has a fractured pelvis
The nurse is rounding on assigned orthopedic clients. The client with which type of
fracture requires immediate interventions to prevent infection?
a. Fractured clavicle
b. Open fracture of the tibia
c. Simple fracture of the wrist
d. Compression fracture of a vertebra
The nurse is performing an assessment on a client admitted with a fractured left humerus.
When the client moves the extremity, the nurse notes the presence of a grating sound.
Which is the nurse's best intervention?
a. Immobilize the arm.
b. Perform range of motion.
c. Monitor for other signs of infection.
d. Administer steroids.
The nurse is caring for a client with a pelvic fracture. Which is the nurse's priority action
to prevent complications?
a. Monitor temperature daily.
b. Insert a urethral catheter.
c. Monitor blood pressure frequently.
d. Turn the client every 2 hours.
A client who had a plaster cast applied to the right arm 3 weeks ago presents to the clinic
with an erythrocyte sedimentation rate (ESR) that has increased from 15 to 25 mm/hr.
Which is the nurse's best action?
a. Repeat this laboratory assessment in 4 hours.
b. Have the cast reapplied.
c. Evaluate temperature and vital signs.
d. Obtain blood for a platelet count.
The home care nurse is visiting a client with diabetes who has a new cast on the arm. On
assessment, the nurse finds the client's fingers to be pale, cool, and slightly swollen.
Which is the nurse's first intervention?
a. Elevate the arm above the level of the heart.
b. Encourage active and passive range of motion.
c. Apply heat to the affected hand.
d. Place a window or bivalve the cast.
A client who had a wrist cast applied 3 days ago calls from home, reporting that the cast
is loose enough to slide off. How does the nurse respond?
a. "Keep your arm above the level of your heart."
b. "As your muscles atrophy, the cast is expected to loosen."
c. "Wrap an elastic bandage around the cast to prevent it from slipping."
d. "You need a new cast now that the swelling is decreased."
The nurse is assessing a client with a body cast. Which assessment finding indicates a
complication that must be reported to the health care provider?
a. Blood pressure, 130/85 mm Hg
b. Urinary output, 40 mL/hr
c. Redness around the edges of the cast
d. Vomiting after meals
A client for whom skeletal traction is planned asks for an explanation regarding the
purpose of this type of traction. Which is the nurse's best response?
a. "It aids in realigning the bone."
b. "It prevents low back pain."
c. "It decreases muscle spasms that occur with a fracture."
d. "It prevents injury to the skin as a result of the fracture."
The nurse notes that the skin around the client's skeletal traction pin site is swollen, red,
and crusty, with dried drainage. Which is the nurse's priority intervention?
a. Decrease the traction weight.
b. Apply a new dressing.
c. Cleanse the area, scrubbing off the crusty areas.
d. Culture the drainage.
The nurse is caring for a client with an external fixator in place on the leg. What does the
nurse assess for first?
a. Alteration in skin integrity
b. Impaired motor action
c. Acute pain
d. Signs of infection
The nurse is teaching a client who has left leg weakness to walk with a cane. Which gait
training technique is correct?
a. Place the cane in the client's left hand and move the cane forward, followed by moving
the left leg one step forward.
b. Place the cane in the client's left hand and move the cane forward, followed by moving
the right leg one step forward.
c. Place the cane in the client's right hand and move the cane forward, followed by
moving the left leg one step forward.
d. Place the cane in the client's right hand and move the cane forward, followed by
moving the right leg one step forward.
A client asks why a plaster cast is not applied to the fractured clavicle. Which is the
nurse's best response?
a. "Plaster will make the area too heavy for movement."
b. "A splint or a bandage is sufficient to keep the bones in alignment."
c. "Cloth braces are less likely to disrupt circulation."
d. "Fractures to the upper body always heal more quickly."
The nurse assesses a client with a below-knee amputation. Which assessment of the skin
flap requires immediate action?
a. Pink and warm to the touch
b. Pale and cool to the touch
c. Dark pink and dry to the touch
d. Pink and slightly moist to the touch
A client who has had an above-knee amputation of the right leg reports pain in the right
foot. Which priority medication does the nurse administer?
a. IV morphine
b. 650 mg of acetaminophen
c. IV calcitonin
d. 600 mg of ibuprofen
The nurse is caring for a client 3 days after a below-knee amputation. Which is a priority
intervention?
a. Muscle-strengthening exercises
b. Use of a very soft bed mattress
c. Placing a pillow between the client's knees
d. Placing the client in high Fowler's position
The nurse is caring for clients with above-knee amputations. Which client does the nurse
treat first?
a. Client who reports phantom limb pain
b. Client who reports cramping
c. Client who does not want to move the leg
d. Client with regional pain syndrome
The nurse is caring for a client after arthroscopy surgery. Which intervention is a
postoperative priority for this client?
a. Passive range of motion on the involved knee
b. Active range of motion on the involved knee
c. Straight leg raises with the involved leg
d. Immobilization of the leg
The client is being assessed for rotator cuff injury. Which physical assessment finding is
consistent with this type of injury?
a. The client is unable to maintain adduction of the affected arm at the shoulder for longer
than 30 seconds.
b. The client is able to raise the affected arm to shoulder height but feels pain on doing
this maneuver.
c. The client is unable to initiate or maintain abduction of the affected arm at the
shoulder.
d. The client has referred pain to the shoulder and arm opposite the affected shoulder.
The nurse is caring for a client with a fractured fibula. Which assessment prompts
immediate action by the nurse?
a. Reported pain of 4 on a scale of 0 to 10
b. Numbness and tingling in the extremity
c. Swollen extremity where the injury occurred
d. Reports of being cold in bed
A client has a fractured humerus. Which dietary choice indicates that the client
understands the nutrition needed to assist in healing the fracture?
a. Skim milk, vitamin D supplements, and fish
b. Soy milk, vitamin B supplements, and bacon, lettuce, and tomato sandwich
c. Whole milk, vitamin A supplements, and vegetable lasagna
d. Low-fat milk, vitamin C supplements, and roast beef
The nurse is caring for an older adult client with multiple fractures. How does the nurse
manage pain in this client?
a. Meperidine (Demerol) injections every 4 hours rather than PRN
b. Patient-controlled analgesia (PCA) pump with morphine
c. Ibuprofen (Motrin) 600 mg every 4 hours
d. IV morphine PRN
A client has an arm cast and reports that it feels really tight and the fingers are puffy.
What is the nurse's best response?
a. "Elevate your arm on two pillows and apply ice to the cast."
b. "Continue to take ibuprofen (Motrin) until the swelling subsides."
c. "It is normal for a new cast to feel a little tight for the first few days."
d. "Please come to the clinic today to have your arm checked by the health care
provider."
A client who had a long-leg cast applied last week reports to the clinic nurse, "I can't
seem to catch my breath and I feel a bit lightheaded." Which is the priority action of the
nurse?
a. Listen to the client's lungs and check the client's blood glucose level.
b. Give the client 2 L of oxygen via nasal cannula and check vital signs.
c. Check the client's pulse oximetry and arrange emergency transfer to the hospital.
d. Reassure the client that it takes much more effort to move with a long-leg cast.
A client has left-sided weakness. Which action by the client indicates that additional
teaching about proper cane use is needed?
a. Holding the cane in the right hand
b. Advancing the cane while the right leg moves forward
c. Stepping forward first with the right leg when ambulating
d. Flexing the elbow 15 to 20 degrees when holding the cane
The nurse is caring for an older adult client who had leg amputation surgery the previous
day. During the admission assessment, the client tells the nurse, "I don't want to live with
only one leg, so I should have died during the surgery." Which is the nurse's best
response?
a. "Your vital signs are good, and you are doing just fine right now."
b. "Your children are waiting outside and do not want to lose their parent."
c. "Remember that you are still the same person inside, with a missing body part."
d. "You will be able to do some of the same things as before you became disabled."
A client has a fractured tibia and is asking the nurse about external fixation. What are
some advantages for the use of external fixation for the immobilization of fractures?
(Select all that apply.)
a. Leads to minimal blood loss
b. Allows for early ambulation
c. Decreases the risk of infection
d. Increases blood supply to tissues
e. Provides visualization of bone ends
f. Promotes healing
An older woman is admitted after falling down the stairs. Which assessment findings
require immediate intervention? (Select all that apply.)
a. Blood pressure, 80/50 mm Hg
b. Potassium, 6.0 mEq/L
c. Dark brown urine
d. Heart rate, 90 beats/min
e. Urine output, 50 mL/hr
A client with a new fracture reports pain in the site of the fracture. An opioid pain
medication was administered 20 minutes ago. Which is the nurse's best intervention?
(Select all that apply.)
a. Administration of additional opioids
b. Elevation of the extremity
c. Application of ice
d. Application of heat
e. Keeping the extremity in a dependent position
When evaluating for hypovolemic shock, the nurse should be aware of which of the
following clinical manifestations?
a) Hypertension
b) Bradycardia
c) Bounding pulse
d) Hypotension
The nurse should include which intervention in the postoperative care plan?
a) Keeping a pillow between the client's legs at all times
b) Turning the client from side to side every 2 hours
c) Maintaining the client in semi-Fowler's position
d) Performing passive range-of-motion (ROM) exercises on the client's legs once each
shift
The post-amputation client is seen by the home health nurse. One client outcome
included preventing exposure to infection. Which finding would indicate to the nurse that
this outcome was met?
a) Decreased need for pain
medication
b) Absence of fever
c) Decreased activity tolerance
d) Increased participation in selfcare
A 13-year-old client is brought to the emergency department. The client's mother reports
that the client was struck with a baseball bat on his upper arm while diving for a pitched
ball. After diagnostic tests are completed, the physician reassures the mother that her
son's humerus is not broken but he has suffered another type of injury. What type of
injury would you expect the physician to diagnose?
a) Sprain
b) Strain
c) Contusion
d) Subluxation
A client undergoes a total hip replacement. Which statement made by the client indicates
to the nurse that the client requires further teaching?
a) "The occupational therapist is
showing me how to use a sock puller to help me get dressed."
b) "I'll need to keep several pillows between my legs at night."
c) "I need to remember not to cross my legs. It's such a habit."
d) "I don't know if I'll be able to get off that low toilet seat at home by myself."
Which discharge instruction should a nurse give a client who's had surgery to repair a hip
fracture?
a) "Don't flex your hip more than 60 degrees, don't cross your legs, and have someone
help you put your shoes on."
b) "Don't flex your hip more than 120 degrees, don't cross your legs, and have someone
help you put your shoes on."
c) "Don't flex your hip more than 90 degrees, don't cross your legs, and have someone
help you put your shoes on."
d) "Don't flex your hip more than 30 degrees,
A 17-year-old high school junior was involved in a motor-vehicle collision and brought
to the ED via squad. His left arm was severely traumatized in the accident and he was
taken immediately to surgery. He is admitted to the ICU where you practice nursing and
the physician has ordered close monitoring for compartment syndrome. What
musculoskeletal structure does compartment syndrome affect?
a) Nerve
b) All options are correct
c) Bone
d) Ligament
Which of the following may occur if a client experiences compartment syndrome in an
upper extremity?
a) Volkmann's contracture
b) Callus
c) Subluxation
d) Whiplash injury
When joint manipulation is unsuccessful for a client, he is taken to surgery for surgical
repair of his hip injury. He is brought to the ICU where you practice nursing for
postoperative recovery. In addition to the regular assessments prescribed by policy, what
assessment is completed every 30 minutes for several hours?
a) Neurological
b) Neurovascular
c) Orientation
d) Head-to-toe
Which nursing intervention is appropriate for minimizing muscle spasms in the client
with a hip fracture?
a) Assist the client with use of a trapeze.
b) Maintain the internal fixator.
c) Apply a soft compression dressing.
d) Maintain Buck's traction.
Choice Multiple question - Select all answer choices that apply.
A bone graft may be used for which of the following reasons? Select all that apply.
a) Improvement of motion
b) Defect filling
c) Stimulation of bone healing
d) Joint stabilization
e) Reduction of a fracture
A nurse is caring for a client who underwent a total hip replacement. What should the
nurse and other caregivers do to prevent dislocation of the new prosthesis?
a) Prevent internal rotation of the affected leg.
b) Keep the hip flexed by placing pillows under the client's knee.
c) Use measures other than turning to prevent pressure ulcers.
d) Keep the affected leg in a position of adduction.
A 39-year-old client has been brought to the ED by his teammates. The client was
fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in
significant pain. After radiographs indicated intact but malpositioned bones, what would
you expect the physician to diagnose?
a) Fracture
b) Strain
c) Sprain
d) Dislocation
A client is treated in the emergency department for acute muscle strain in the left leg
caused by trying a new exercise. During discharge preparation, the nurse should provide
which instruction?
a) "Apply ice packs for the first 24 to 48 hours, then apply heat packs."
b) "Apply heat packs for the first 24 to 48 hours."
c) "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours."
d) "Apply ice packs for the first 12 to 18 hours."
Which nursing intervention is essential in caring for a client with compartment
syndrome?
a) Wrapping the affected extremity with a compression dressing to help decrease the
swelling
b) Starting an I.V. line in the affected extremity in anticipation of venogram studies
c) Keeping the affected extremity below the level of the heart
d) Removing all external sources of pressure, such as clothing and jewelry
A client with a fracture develops compartment syndrome that requires surgical
intervention. The nurse would most likely prepare the client for which of the following?
a) Amputation
b) Joint replacement
c) Bone graft
d) Fasciotomy
Which of the following is a factor that inhibits fracture healing?
a) Vitamin D
b) Maximum bone fragment
contact
c) Local malignancy
d) Exercise
Which of the following is a term used to describe a soft tissue injury produced by a blunt
force?
a) Sprain
b) Hematoma
c) Contusion
d) Strain
Which of the following are general nursing measures for a patient with a fracture
reduction?
a) Promoting intake of omega-3 fatty acids
b) Encourage participation in ADLs
c) Examining the abdomen for enlarged liver or spleen
d) Assisting with intake of immune-enhancing tube feeding formulas
A 39-year-old softball player has been brought to the ED by his teammates. The client
was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is
in significant pain. After radiographs indicate intact yet malpositioned bones, what repair
would you expect the physician to perform?
a) Analgesia and immobilization
b) Joint manipulation and immobilization
c) Heat and immobilization
d) Ice and immobilization
Which of the following is an inaccurate clinical manifestation of a fracture?
a) Lengthening
b) Deformity
c) Pain
d) Crepitus
Elderly clients who fall are most at risk for which injuries?
a) Cervical spine fractures
b) Pelvic fractures
c) Wrist fractures
d) Humerus fractures
Which assessment findings would cause the nurse to suspect compartment syndrome
after casting of the leg?
a) Warm, pink foot and ability to move toes of affected leg
b) Low-grade fever, dyspnea, tachycardia, and crackles
c) Increased capillary refill and bounding pulses in affected leg
d) Complaints of numbness and tingling in toes of affected leg
A client sustains an injury to the ligaments surrounding a joint. The nurse identifies this
as which of the following?
a) Fracture
b) Strain
c) Sprain
d) Contusion
A nurse suspects that a client with a recent fracture has compartment syndrome.
Assessment findings may include:
a) body-wide decrease in bone mass.
b) inability to perform active movement and pain with passive movement.
c) a growth in and around the bone tissue.
d) inability to perform passive movement and pain with active movement.
In a patient with a dislocation, the nurse should initially perform neurovascular
assessments a minimum of every 15 minutes until stable. Which of the following
complications do the assessments help the nurse to monitor in the patient?
a) Compartment syndrome
b) GI bleeding
c) Ganglion cysts
d) Carpal tunnel syndrome
A client who suffers an injury in a local high school hockey game presents with left
shoulder pain. The client cannot move the left arm, and the left shoulder is lower than the
right shoulder. The nurse recognizes the client most likely has a:
a) Clavicle fracture
b) Dislocated elbow
c) Dislocated shoulder
d) Cervical injury
A 45-year-old softball player arrives at the emergency department following his injury
while sliding into a base during a game. After his examination and radiographs, the
physician diagnoses muscle strain and prescribes appropriate treatment. What does the
physician mean with the term "strain"?
a) Stretched or pulled beyond capacity
b) Subluxation of a joint
c) Injuries to ligaments surrounding a joint
d) Injury resulting from a blow or blunt trauma
Which of the following terms refers to a fracture in which one side of a bone is broken
and the other side is bent?
a) Avulsion
b) Oblique
c) Greenstick
d) Spiral
The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a
patient who has sustained a fracture. The nurse suspects which complication?
a) Fat embolism syndrome
b) Hypovolemic shock
c) Reflex sympathetic dystrophy syndrome
d) Compartment syndrome
If a dislocation is not treated promptly, tissue death due to anoxia can occur. This would
be documented as which of the following?
a) Heterotopic ossification
b) Osteomyelitis
c) Subluxation
d) Avascular necrosis (AVN)
A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right
hip. The nurse should include which intervention in the postoperative care plan?
a) Keeping a pillow between the client's legs at all times
b) Maintaining the client in semi-Fowler's position
c) Turning the client from side to side every 2 hours
d) Performing passive range-of-motion (ROM) exercises on the client's legs once each
shift
A client presents to the emergency department with an open fracture. What is the first
action the nurse should take?
a) Assess the client's vital signs and determine allergies.
b) Cover the exposed bone with sterile dressing.
c) Perform a neurovascular assessment of the affected extremity.
d) Assist the physician with reduction of the fracture.
A client with arterial insufficiency undergoes below-knee amputation of the right leg.
Which action should the nurse include in the postoperative care plan?
a) Maintaining the client on complete bed rest
b) Elevating the stump for the first 24 hours
c) Removing the pressure dressing after the first 8 hours
d) Applying heat to the stump as the client desires
Which of the following may occur if a client experiences compartment syndrome in an
upper extremity?
a) Subluxation
b) Callus
c) Volkmann's contracture
d) Whiplash injury
1. A patient is arriving to the orthopedic floor from the emergency room. While
giving report to the floor nurse, the emergency room nurse states that the patient
has a fracture of the nose that has resulted in a skin tear and involvement of the
mucous membranes of the nasal passages. The orthopedic nurse is aware that this
description likely indicates which type of fracture?
A) Compression
B) Compound
C) Impacted
D) Transverse
2. A patient has sustained a long bone fracture. The nurse is preparing a care plan
for this patient. Which intervention should the nurse include in the care plan to
enhance fracture healing?
A) Limit weight-bearing and exercising
B) Monitor color, temperature, and pulses of the affected extremity
C) Avoid immobilization of the fracture fragments
D) Administration of high doses of corticosteroids
3. The nurse is assessing a patient's right knee. The assessment shows edema,
tenderness, muscle spasms, and ecchymosis. The patient states that 2 days ago he
ran 10 miles and now it hurts to stand up. Based upon these symptoms, the nurse
bases her teaching upon the fact that she anticipates the patient has experienced
what?
A) A first-degree strain
B) A second-degree strain
C) A first-degree sprain
D) A second-degree sprain
4. The nurse is preparing the patient for discharge from the emergency room to
home after incurring a sprain to the left ankle. While providing discharge
teaching, the nurse is correct when they instruct the patient to what?
A) Apply heat for the first 24 to 48 hours after injury
B) Maintain the ankle in a dependent position
C) Exercise hourly by performing rotation exercises of the ankle
D) Apply an elastic compression bandage to the ankle
5. The nurse is writing a care plan for a patient admitted to the Emergency
Department (ED) with an open fracture. The nurse will assign priority to what
nursing diagnosis for a patient with an open fracture of the radius?
A) Risk for infection
B) Risk for activity intolerance
C) Risk for imbalanced nutrition: less than body requirements
D) Risk for powerlessness
6. While caring for a patient with a hip fracture, the nurse will instruct the patient to
do what to prevent the most common complication associated with a hip fracture?
A) Take the prescribed stool softener daily.
B) Use the prescribed oxygen with ambulation.
C) Increase fluid intake.
D) Avoid movement of the feet and ankles
9. A patient with a simple fracture is involved in discharge teaching with their nurse.
What would the nurse instruct the patient to do?
A) Elevate the affected extremity to shoulder level.
B) Engage in exercises that strengthen the unaffected muscles.
C) Take corticosteroids as prescribed.
D) Expect to regain full strength and mobility in 2 to 4 weeks.
10. Six weeks after an above the knee (AKA) amputation, a patient returns to the
outpatient office for a routine postoperative check up. During the nurse's assessment, the
patient reports symptoms of phantom pain. What would the nurse correctly tell the patient
to do to reduce the discomfort of the phantom pain?
A) Apply hot compresses to the area of the amputation.
B) Avoid rehabilitation exercises until the pain subsides.
C) Comfortably increase their level of activity.
D) Assess for a pulse in the extremity of the amputation every 4 to 6 hours.
11. The nurse is caring for a patient who had a right extremity below the knee amputation
(BKA). The nurse recognizes the importance of implementing measures that focus on
preventing flexion contracture of the hip and maintaining proper positioning. Which of
the following measures will achieve these goals?
A) Encouraging the patient to turn from side to side and to assume a prone position
B) Initiating ROM exercises of the hip and knee 3 months after the amputation
C) Minimizing movement of the flexor muscles of the hip
D) Encouraging the patient to sit in the chair for at least 8 hours of the day
7. A clinic nurse is caring for a patient who has a tibial fracture. The patient has just
had a long-leg walking cast removed and a short leg cast applied. The nurse
explains to the patient that the short leg cast will allow for what?
A) Ankle motion
B) Knee motion
C) Hip motion
D) Toe motion
12. You are caring for a patient wearing a sling to support her arm after a clavicle
fracture. What would the nurse instructs the patient to do?
A) Elevate the arm above the shoulder 3 or 4 times daily.
B) Avoid moving the elbow, wrist, and fingers for about 2 months.
C) Engage in active range of motion using the affected bone.
D) Use the arm for light activities within the range of motion.
8. The patient scheduled for a Syme amputation in the morning is concerned about
the ability to stand on the amputated extremity. The patient asks the nurse about
his ability to stand after surgery. What is the nurse's best response to this
question?
A) "You will be able to withstand full weight-bearing on this durable extremity
after the amputation."
B) "You will have minimal weight-bearing on this extremity and will require the
use of an assistive device."
C) "You will not be able to use this extremity and will receive teaching on use of
a wheelchair."
D) "You will be fitted for a prosthesis and your commitment to rehabilitation will
determine your functional abilities."
14. The nurse at the pediatrian's office is assessing a 17-year-old soccer player who
presented to the clinic stating that he sustained an injury that resulted in the knee being
struck medially while his foot is firmly planted on the ground. The nurse knows that the
patient likely has experienced what?
A) Lateral collateral ligament injury
B) Medial collateral ligament injury
C) Anterior cruciate ligament injury
D) Posterior cruciate ligament injury
15. A 16-year-old girl is taken to the emergency department after being kicked in the
lower leg during a volleyball match. The leg area has become swollen and discolored.
The triage nurse recognizes that the patient has likely sustained what?
A) Sprain
B) Strain
C) Contusion
D) Dislocation
17. The nurse is performing a shift assessment on an elderly patient who is recovering
after surgery for a hip fracture. The nurse notes that the patient is complaining of chest
pain, has an increased heart rate and respiratory rate. The nurse further notes that the
patient is febrile and hypoxic, coughing and producing large amounts of thick white
sputum. The nurse recognizes that this is a medical emergency and calls for assistance, as
she recognizes that this patient is likely demonstrating symptoms related to what?
A) Avascular necrosis of bone
B) Compartment syndrome
C) Fat embolism syndrome
D) Complex regional pain syndrome
22. The nursing instructor is discussing dislocations and subluxations with the beginning
nursing students. Why would the instructor tell the students that dislocation and
subluxations are medical emergencies and need to be reduced immediately?
A) The longer the joint is misplaced, the harder it is to get it back in place
B) Because the pain is so bad
C) The longer the joint is misplaced, the more difficult it is to apply splints to immobilize
the extremity
D) Avascular necrosis may develop
23. According to the U.S. Department of Labor, occupation-related musculoskeletal
disorders are illnesses or injuries of what? (Mark all that apply.)
A) Nerves
B) Cartilage
C) Tendons
D) Arteries
E) Veins
13. The orthopedic nurse is precepting a graduate nurse. They are caring for four fracture
patients. The orthopedic nurse asks the graduate nurse which of their patients is at an
increased risk for Volkmann's contracture. What should the graduate nurse respond?
A) Femur
B) Humerus
C) Radial head
D) Clavicle
24. A hockey player is brought to the emergency department after a game because of an
injury. He is complaining of not being able to move his left arm, and his left arm appears
longer than his right arm. The triage nurse suspects the hockey player has what?
A) Dislocated left shoulder
B) Fractured left clavicle
C) Dislocated left elbow
D) Fractured left humerus
25. A patient has presented to the emergency department with an injury to the wrist. The
patient is diagnosed with a third-degree strain. Why would the physician order an x-ray
of the wrist?
A) Nerve damage is associated with third-degree strains.
B) Compartment syndrome is associated with third-degree strains.
C) Avulsion fractures are associated with third-degree strains.
D) Greenstick fractures are associated with third-degree strains.
26. A 12-year-old boy is brought in by ambulance to the emergency department after
being involved in an accident while participating in a BMX race. The boy has an open
fracture of his tibia. The wound is highly contaminated and there is extensive soft tissue
damage. What grade fracture would this be considered?
A) Grade I
B) Grade II
C) Grade III
D) Grade IV
27. A 25-year-old male is involved in a motorcycle accident and injures his arm. The
physician diagnoses the man with an intra-articular fracture and splints the injury. When
the man comes back for his 6-week checkup the nurse implements the teaching plan she
has developed for this patient. What sequelae of intra-articular fractures would the nurse
be sure to inform the patient about?
A) Post-traumatic arthritis
B) Post-traumatic nerve damage
C) Post-traumatic stress syndrome
D) Post-traumatic compartment syndrome
28. A 65-year-old female patient has fallen and injured her ankle. Radiographs show that
the woman has a trimalleolar fracture. The physician informs the woman that she needs
surgery to repair her ankle. What type of internal fixation device would be used to hold
the malleolus of the tibia in place?
A) Plate
B) Wire
C) Screw
D) Rod
16. Radiographs were ordered for a 10-year-old boy who had his right upper arm injured.
The radiographs show that the humerus appears to be fractured on one side and slightly
bent on the other. What type of fracture is this an example of?
A) Impacted
B) Compound
C) Compression
D) Greenstick
29. A 29-year-old male is admitted to the orthopedic unit with a fractured femur after
running his motorcycle into a bridge abutment. The patient has been placed in traction
until his femur can be rodded in surgery. What early complications would the nurse have
to monitor this patient for? (Mark all that apply.)
A) Alteration in elimination
B) Alteration in personality
C) Deep vein thrombosis
D) Compartment syndrome
E) Fat embolism
30. The patient is 6 weeks post-ORIF of his ankle when he comes to the orthopedic clinic
for a follow-up appointment. The physician informs the patient that the bones in his ankle
have not grown back together. What type of complication is this considered?
A) Late complication
B) Early complication
C) Minor complication
D) Major complication
31. A 77-year-old female has fallen in her home and is brought to the emergency
department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the
neck of the left femur. What complication is common in fractures of the neck of the
femur?
A) Osteoporosis
B) Avascular necrosis
C) Nonadherance of bones
D) Septicemia
19. iWhich of the following is the most appropriate nursing intervention for the nursing
diagnosis of Impaired physical mobility related to fractured hip?
A) Administer analgesics as required.
B) Place pillow between legs when turning.
C) Monitor vital signs.
D) Assess wound appearance.
33. Patients who have had amputations are cared for by a multidisciplinary rehabilitation
team. What does the multidisciplinary team do for patients who are amputees?
A) Ensure top quality health care
B) Provide holistic health care
C) Assist in preventing complications
D) Help achieve the highest possible level of function
34. A rehabilitation nurse is working with a patient who is an amputee. The nurse knows
that it is important for a patient who is an amputee to be an active participant is self-care.
What do the nurse and patient need to maintain during the learning process?
A) Positive attitudes
B) Balanced nutrition
C) Optimal mobility
D) Family support
20. A patient with a fractured left femur is being cared for by an orthopedic nurse. The
nurse would know that what signs indicate potential fat emboli?
A) Increased partial pressure of arterial oxygen (PaÓ), reduced sensation in left leg or
foot
B) Left leg pain, dyspnea
C) Bradycardia, skin bruises
D) Cyanosis, decreased PaÓ
35. You are caring for a patient who has had an amputation. What nursing action would
you be least likely to perform with this type of patient?
A) Teaching the patient self-care activities
B) Placing the residual limb on a pillow
C) Promoting mobility
D) Teaching the patient how to wrap the stump
21. A 55-year-old male is brought to the emergency department by ambulance after
stepping in a hole and falling. While assessing him the nurse notes that his right leg is
shorter than his left leg; his right hip is deformed and he is in acute pain. What would the
nurse suspect has happened to this patient?
A) Subluxated right hip
B) Fractured right hip
C) Right pelvic fracture
D) Traumatic dislocation of right hip
36. Your patient is returned from the PACU after an AKA of the right leg. You know to
monitor for postoperative bleeding. Put your actions in the correct order that you would
perform them if postoperative bleeding occurs after an amputation.
A. Apply tourniquet that is kept at the bedside to affected limb.
B. Monitor vital signs.
C. Apply a pressure dressing.
D. Call the surgeon.
37. A patient is a BKA amputee who is to be discharged in 48 hours. You are going over
discharge teaching with this patient. You review what factors with this patient?
A) Exercise
B) Nutrition
C) Support groups
D) Mobility aids
38. As an amputee a patient is being assessed prior to being discharged home. What is an
expected patient outcome the nurse would assess for?
A) Patient exhibits healed, nontender, nonadherent scar
B) Patient can stand for at least 2 hours
C) Patient eats three nutritious meals daily
D) Patient exercises 30 minutes weekly
39. An elderly woman with a fractured hip is being cared for on your unit. What are
contributory factors in the incidence of falls and fractured hips? (Mark all that apply.)
A) Living alone
B) TIAs
C) Emboli
D) Decreased hearing
E) General frailty
40. The patient was placed in a long arm cast after fracturing her humerus. Twelve hours
after the application of the cast, the patient tells the nurse that her arm hurts. Analgesics
do not relieve the pain. What would be the most appropriate nursing action?
A) Preparing the patient for cast removal or bivalving of the cast
B) Obtaining an order for a different pain medication
C) Encouraging the patient to wiggle and move the fingers
D) Petaling the edges of his cast
18. A 28-year-old man with a fractured humerus calls the nurse into his room. Upon
assessment, the nurse finds the patient to be tachycardic, pale, and confused. The nurse
suspects the patient may be experiencing which of the following complications?
A) Disseminated intravascular coagulopathy
B) Compartment syndrome
C) Fat emboli
D) Deep vein thrombosis