1. Which information will the nurse teach seniors at a community recreation center about ways
to prevent fractures?
a. Tack down scatter rugs in the home.
b. Expect most falls to happen outside the home.
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.
2. A factory line worker has repetitive strain syndrome in the left elbow. The nurse will plan to
teach the patient about
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.
3. The occupational health nurse will teach the patient whose job involves many hours of typing
to
a.
b.
c.
d.
obtain a keyboard pad to support the wrist.
do stretching exercises before starting work.
wrap the wrists with compression bandages every morning.
avoid using nonsteroidal antiinflammatory drugs (NSAIDs) for pain.
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.
4. Which discharge instruction will 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.
5. A tennis player has an arthroscopic repair of a rotator cuff injury performed in same-day
surgery. When the nurse plans postoperative teaching for the patient, which information will
be included?
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.
6. The nurse will instruct the patient with a fractured left radius that the cast will need to remain
in place
a. for several months.
b. for at least 3 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.
7. A patient with a fracture of the left femoral neck has Buck’s traction in place while waiting
for surgery. To assess for pressure areas on the patient’s back and sacral area and to provide
skin care, the nurse should
a. loosen the traction and help the patient turn onto the unaffected side.
b. place a pillow between the patient’s legs and turn gently to each side.
c. have the patient lift the buttocks slightly by using a trapeze over the bed.
d. turn the patient partially to each side with the assistance of another nurse.
ANS: C
The patient can lift the buttocks slightly off the bed by using a trapeze. This will not affect the
fracture fragments on the right leg. Turning the patient will tend to move the fracture
fragments, causing pain and possible nerve impingement. Disconnecting the traction will
interrupt the weight needed to decrease muscle spasms.
8. Which nursing intervention will be included in the plan of care after a patient with a right
femur fracture has a hip spica cast applied?
a. Avoid placing the patient in prone position.
b. Ask the patient about abdominal discomfort.
c. Discuss remaining on bed rest for several weeks.
d. Use the cast support bar to reposition the patient.
ANS: B
Assessment of bowel sounds, abdominal pain, and nausea and vomiting will detect the
development of abdominal cast syndrome. To avoid breakage, the cast support bar should not
be used for repositioning. After the cast dries, the patient can begin ambulating with the
assistance of physical therapy personnel and may be turned to the prone position.
9. A patient has a long-arm plaster cast applied for fracture immobilization. Until the cast has
completely dried, the nurse should
a. keep the left arm in dependent position.
b. avoid handling the cast using fingertips.
c. place gauze around the cast edge to pad any roughness.
d. cover the cast with a small blanket to absorb the dampness.
ANS: B
Until a plaster cast has dried, using the palms rather than the fingertips to handle the cast helps
prevent creating protrusions inside the cast that could place pressure on the skin. The left arm
should be elevated to prevent swelling. The edges of the cast may be petaled once the cast is
dry, but padding the edges before that may cause the cast to be misshapen. The cast should not
be covered until it is dry because heat builds up during drying.
10. Which statement by the patient indicates a good understanding of the nurse’s teaching about a
new short-arm synthetic cast?
a. “I can get the cast wet as long as I dry it right away with a hair dryer.”
b. “I should avoid moving my fingers and elbow 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. Plaster casts should not get wet. The patient should be encouraged to
move the joints above and below the cast. Patients should not insert objects inside the cast.
11. A patient who is to have no weight bearing on the left leg is learning to walk using 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. 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. If the 2- or 4-point gaits are to be used, the crutch and leg on opposite
sides move forward, not the crutch and same-side leg.
12. A patient who has had open reduction and internal fixation (ORIF) of left lower leg fractures
continues to complain of severe pain in the leg 15 minutes after receiving the prescribed IV
morphine. 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.
13. A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which
nursing assessment finding indicates a potential complication of the fracture?
a. The patient states the pelvis feels unstable.
b. Abdomen is distended and bowel sounds are absent.
c. The patient complains of pelvic pain with palpation.
d. Ecchymoses are visible across the abdomen and hips.
ANS: B
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.
14. Which action will the nurse take in order 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.
c. Check peripheral pulses.
b. Assess for contractures.
d. Monitor for hip dislocation.
ANS: A
Buck’s traction keeps the leg immobilized and reduces 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.
15. A patient with a right lower leg fracture will be discharged home with an external fixation
device in place. Which information will the nurse teach?
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.
16. 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. Delegate the transfer to nursing assistive personnel (NAP).
d. Decrease the pain medication before getting the patient up.
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.
17. The nurse’s discharge teaching for a patient who has had a repair of a fractured mandible will
include information about
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.
18. 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 about 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.
19. The day after a having a right below-the-knee amputation, a patient complains of 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. Inform the patient that this 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.
20. 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.
21. The nurse is caring for a patient who is to be discharged from the hospital 4 days after
insertion of a femoral head prosthesis using a posterior approach. Which statement by the
patient indicates a need for additional instruction?
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.
22. Which action will 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. Surgeon orders allow
weight bearing as tolerated after this procedure; protected weight bearing is not needed.
23. 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.
24. When giving home care instructions to a patient who has comminuted left forearm fractures
and a long-arm cast, which information should the nurse include?
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.
25. A patient who slipped and fell in the shower at home has a proximal left humerus fracture
immobilized with a long-arm cast and a sling. Which nursing intervention will be included 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.
26. A patient is being discharged 4 days after hip arthroplasty using the posterior approach.
Which patient action requires intervention by the nurse?
a. The patient uses crutches with a swing-to gait.
b. The patient leans over to pull on shoes and socks.
c. The patient sits straight up on the edge of the bed.
d. The patient bends over the sink while brushing teeth.
ANS: B
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.
27. 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 O2 is a higher priority. The
health care provider should be notified after the O2 is started and pulse oximetry obtained
concerning suspected fat embolism or venous thromboembolism.
28. A patient arrived at the emergency department after tripping over a rug and falling at home.
Which finding is most important for the nurse 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.
29. A young adult arrives in the emergency department with ankle swelling and severe pain after
twisting an ankle playing basketball. Which of these prescribed interprofessional interventions
will the nurse implement first?
a. Send the patient for ankle x-rays.
b. Wrap the ankle and apply an ice pack.
c. Administer naproxen (Naprosyn) 500 mg PO.
d. Give acetaminophen with codeine (Tylenol #3).
ANS: B
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.
30. Which nursing action for a patient who has had right hip arthroplasty 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.
31. A patient who arrives at the emergency department experiencing severe left knee pain is
diagnosed with a patellar dislocation. The initial patient teaching by the nurse will focus on
the need for
a. a knee immobilizer.
c. monitored anesthesia care.
b. gentle knee flexion.
d. physical activity restrictions.
ANS: C
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.
32. After a motorcycle accident, a patient arrives in the emergency department with severe
swelling of the left lower leg. Which action will the nurse take first?
a. Elevate the leg on 2 pillows.
c. Assess leg pulses and sensation.
b. Apply a compression bandage.
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.
33. A pedestrian who was hit by a car is admitted to the emergency department with possible right
lower leg fractures. The initial action by the nurse should be to
a. elevate the right leg.
c. assess the pedal pulses.
b. splint the lower leg.
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.
34. The day after a 60-yr-old patient has open reduction and internal fixation (ORIF) for an open,
displaced tibial fracture, the nurse identifies the priority nursing diagnosis as
a. activity intolerance related to deconditioning.
b. risk for constipation related to prolonged bed rest.
c. risk for impaired skin integrity related to immobility.
d. risk for infection related to disruption of skin integrity.
ANS: D
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 other
problems caused by immobility are not as likely.
35. 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.
c. Check the O2 saturation.
b. 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 O2 saturation.
36. A patient is admitted to the emergency department with a left femur fracture. Which
information obtained by the nurse is most important to report to the health care provider?
a. Ecchymosis of the left thigh
b. Complaints 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.
37. A patient undergoes left above-the-knee amputation with an immediate prosthetic fitting.
When the patient arrives on the orthopedic unit after surgery, the nurse should
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.
38. 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.
39. When assessing for Tinel’s sign in a patient with possible right carpal tunnel syndrome, the
nurse will ask the patient about
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.
40. Which action will 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 usually recommended for pain management.
41. Which finding in a patient with a Colles’ fracture of the left wrist is most important to
communicate immediately to the health care provider?
a. Swelling is noted around the wrist.
b. The patient is reporting severe pain.
c. The wrist has a deformed appearance.
d. Capillary refill to the fingers is prolonged.
ANS: D
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.
42. Which information obtained by the nurse about a patient with a lumbar vertebral compression
fracture requires an immediate report to the health care provider?
a. Patient refuses 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.
43. When a patient arrives in the emergency department with a facial fracture, which action will
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.
44. After change-of-shift report, which patient should the nurse assess first?
a. Patient with a repaired mandibular fracture who is complaining of facial pain
b. Patient with an unrepaired intracapsular left hip fracture whose leg is externally
rotated
c. Patient with an unrepaired Colles’ fracture who has right wrist swelling and
deformity
d. Patient with repaired right femoral shaft fracture who is complaining of tightness
in the calf
ANS: D
Calf swelling after a femoral shaft fracture suggests hemorrhage and risk for 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.
45. When caring for a patient who is using Buck’s traction after a hip fracture, which action can
the nurse delegate to 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).
46. Based on the information in the accompanying figure obtained for a patient in the emergency
room, which action will the nurse take first?
History
 Age 23 years
 Right lower leg
injury
a.
b.
c.
d.
Physical Assessment
 Reports severe right
lower leg pain
 Reports feeling short
of breath
 Bone protruding
from right lower leg
Diagnostic Exams
 CBC: WBC
9400/µL; Hgb 11.6
g/dL
 Right leg x-ray; right
tibial fracture
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 about 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 O2 saturation. The other actions are also appropriate but not as important at this
time as obtaining the patient’s O2 saturation.
1. In which order will the nurse take these actions when caring for a patient in the emergency
department with a right leg fracture after a motor vehicle crash? (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.
1.A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation.
Which intervention will the nurse include in the initial plan of care?
a. Quadriceps-setting exercises
b. Immobilization of the left leg
c. Positioning the left leg in flexion
d. Assisted weight-bearing ambulation
ANS: B
Immobilization of the affected leg helps to decrease pain and reduce the risk for pathologic
fracture. Weight-bearing exercise increases the risk for pathologic fractures. Flexion of the
affected limb is avoided to prevent contractures.
2. A patient is being discharged after 1 week of IV antibiotic therapy for acute osteomyelitis in
the right leg. Which information will be included in the discharge teaching?
a. How to apply warm packs to the leg to reduce pain
b. How to monitor and care for a long-term IV catheter
c. The need for daily aerobic exercise to help maintain muscle strength
d. The reason for taking oral antibiotics for 7 to 10 days after discharge
ANS: B
The patient will be taking IV antibiotics for several months. The patient will need to recognize
signs of infection at the IV site and know how to care for the catheter during daily activities
such as bathing. IV antibiotics rather than oral antibiotics are used for acute osteomyelitis.
Patients are instructed to avoid exercise and heat application because these will increase
swelling and the risk for spreading infection.
3. A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur.
The nurse identifies a need for additional teaching related to health maintenance when the
nurse finds that the patient
a.
b.
c.
d.
is frustrated with the length of treatment required.
takes and records the oral temperature twice a day.
is unable to plantar flex the foot on the affected side.
uses crutches to avoid weight bearing on the affected leg.
ANS: C
Foot drop is an indication that the foot is not being supported in a neutral position by a splint.
Using crutches and monitoring the oral temperature are appropriate self-care activities.
Frustration with the length of treatment is not an indicator of ineffective health maintenance
of the osteomyelitis.
4. The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled
above-the-knee amputation. Which statement by a patient indicates additional patient teaching
is needed?
a. “I will need to participate in physical therapy after surgery.”
b. “I wish I did not need to have chemotherapy after this surgery.”
c. “I did not have this bone cancer until my leg broke a week ago.”
d. “I can use the patient-controlled analgesia (PCA) to manage postoperative pain.”
ANS: C
Osteogenic sarcoma may be diagnosed following a fracture, but it is not caused by the injury.
The other statements indicate patient teaching has been effective.
5. A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action will
be included in the plan of care?
a. Logroll the patient every 2 hours.
b. Assist the patient with ambulation.
c. Discuss the need for genetic testing with the patient.
d. Teach the patient about the muscle biopsy procedure.
ANS: B
Because the goal for the patient with muscular dystrophy is to keep the patient active for as
long as possible, assisting the patient to ambulate will be part of the care plan. The patient will
not require logrolling. Muscle biopsies are necessary to confirm the diagnosis but are not
necessary for a patient who already has a diagnosis. There is no need for genetic testing
because the patient already knows the diagnosis.
6. An appropriate nursing intervention for a patient who has acute low back pain and muscle
spasms is to teach the patient to
a. keep both feet flat on the floor when prolonged standing is required.
b. twist gently from side to side to maintain range of motion in the spine.
c. keep the head elevated slightly and flex the knees when resting in bed.
d. avoid the use of cold packs because they will exacerbate the muscle spasms.
ANS: C
Resting with the head elevated and knees flexed will reduce the strain on the back and
decrease muscle spasms. Twisting from side to side will increase tension on the lumbar area.
Prolonged standing will cause strain on the lumbar spine, even with both feet flat on the floor.
Alternate application of cold and heat should be used to decrease pain.
7. A patient whose employment requires frequent lifting has a history of chronic back pain. After
the nurse has taught the patient about correct body mechanics, which patient statement
indicates the teaching has been effective?
a. “I will keep my back straight when I lift above than my waist.”
b. “I will begin doing exercises to strengthen and support my back.”
c. “I will tell my boss I need a job where I can stay seated at a desk.”
d. “I can sleep with my hips and knees extended to prevent back strain.”
ANS: B
Exercises can help strengthen the muscles that support the back. Flexion of the hips and knees
places less strain on the back than keeping these joints extended. Sitting for prolonged periods
can aggravate back pain. Modifications in the way the patient lifts boxes are needed, but the
patient should not lift above the level of the elbows.
8. The nurse should reposition the patient who has just had a laminectomy and diskectomy by
a. instructing the patient to move the legs before turning the rest of the body.
b. having the patient turn by grasping the side rails and pulling the shoulders over.
c. placing a pillow between the patient’s legs and turning the entire body as a unit.
d. turning the patient’s head and shoulders first, followed by the hips, legs, and feet.
ANS: C
The spine should be kept in correct alignment after laminectomy. The other positions will
create misalignment of the spine.
9. The nurse will determine more teaching is needed if a patient with discomfort from a bunion
says, “I will
a. give away my high-heeled shoes.”
b. take ibuprofen (Motrin) if I need it.”
c. use the bunion pad to cushion the area.”
d. only wear sandals, no closed-toe shoes.”
ANS: D
The patient can wear shoes that have a wide forefoot (toe box). The other patient statements
indicate the teaching has been effective.
10. An assessment finding for a 55-yr-old patient that alerts the nurse to the presence of
osteoporosis is
a. bowed legs.
b. a loss of height.
c. the report of frequent falls.
d. an aversion to dairy products.
ANS: B
Osteoporosis occurring in the vertebrae produces a gradual loss of height. Bowed legs are
associated with osteomalacia. Low intake of dairy products is a risk factor for osteoporosis,
but it does not indicate osteoporosis is present. Frequent falls increase the risk for fractures
but are not an indicator of osteoporosis.
11. A 54-yr-old woman who recently reached menopause and has a family history of osteoporosis
is diagnosed with osteopenia following densitometry testing. In teaching the woman, the nurse
explains that
a. with a family history of osteoporosis, there is no way to prevent or slow bone
resorption.
b. estrogen replacement therapy must be started to prevent rapid progression to
osteoporosis.
c. continuous, low-dose corticosteroid treatment is effective in stopping the course of
osteoporosis.
d. calcium loss from bones can be slowed by increasing calcium intake and
weight-bearing exercise.
ANS: D
Progression of osteoporosis can be slowed by increasing calcium intake and weight-bearing
exercise. Estrogen replacement therapy is no longer routinely given to prevent osteoporosis
because of increased risk of heart disease as well as breast and uterine cancer. Corticosteroid
therapy increases the risk for osteoporosis.
12. Which menu choice by a patient with osteoporosis indicates the nurse’s teaching about
appropriate diet has been effective?
a. Pancakes with syrup and bacon
b. Whole wheat toast and fresh fruit
c. Egg-white omelet and a half grapefruit
d. Oatmeal with skim milk and fruit yogurt
ANS: D
Skim milk and yogurt are high in calcium. The other choices do not contain any high-calcium
foods.
13. The nurse evaluating effectiveness of prescribed calcitonin and ibandronate (Boniva) for a
patient with Paget’s disease will consider the patient’s
a. oral intake.
c. grip strength.
b. daily weight.
d. pain intensity.
ANS: D
Bone pain is a common early manifestation of Paget’s disease, and the nurse should assess the
pain intensity to determine if treatment is effective. The other information will also be
collected by the nurse but will not be used in evaluating the effectiveness of the therapy.
14. Which action should the nurse take before administering gentamicin (Garamycin) to a patient
with acute osteomyelitis?
a. Ask the patient about any nausea.
b. Obtain the patient’s oral temperature.
c. Review the patient’s serum creatinine.
d. Change the prescribed wet-to-dry dressing.
ANS: C
Gentamicin is nephrotoxic and can cause renal failure as reflected in the patient’s serum
creatinine. Monitoring the patient’s temperature before gentamicin administration is not
necessary. Nausea is not a common side effect of IV gentamicin. There is no need to change
the dressing before gentamicin administration.
15. Which assessment finding for a patient who has had surgical reduction of an open fracture of
the right radius requires notification of the health care provider?
a. Serous wound drainage
c. Right arm pain with movement
b. Right arm muscle spasms
d. Temperature 101.4° F (38.6° C)
ANS: D
An elevated temperature suggests possible osteomyelitis. The other clinical manifestations are
typical after a repair of an open fracture.
16. After laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness
and tingling of the right lower leg. The first action the nurse should take is to
a. report the patient’s complaint to the surgeon.
b. check the chart for preoperative assessment data.
c. check the vital signs for indications of hemorrhage.
d. turn the patient to the left to relieve pressure on the right leg.
ANS: B
The postoperative movement and sensation of the extremities should be unchanged (or
improved) from the preoperative assessment. If the numbness and tingling are new, this
information should be immediately reported to the surgeon. Numbness and tingling are not
symptoms associated with hemorrhage at the site. Turning the patient will not relieve the
numbness.
17. When administering alendronate (Fosamax) to a patient with osteoporosis, the nurse will
a. ask about any leg cramps or hot flashes.
b. assist the patient to sit up at the bedside.
c. be sure that the patient has recently eaten.
d. administer the ordered calcium carbonate.
ANS: B
To avoid esophageal erosions, the patient taking bisphosphonates should be upright for at
least 30 minutes after taking the medication. Fosamax should be taken on an empty stomach,
not after taking other medications or eating. Leg cramps and hot flashes are not side effects of
bisphosphonates.
18. Which nursing action included in the care of a patient after laminectomy can the nurse
delegate to experienced unlicensed assistive personnel (UAP)?
a. Check ability to plantar and dorsiflex the foot.
b. Determine the patient’s readiness to ambulate.
c. Log roll the patient from side to side every 2 hours.
d. Ask about pain management with the patient-controlled analgesia (PCA).
ANS: C
Repositioning a patient is included in the education and scope of practice of UAP, and
experienced UAP will be familiar with how to maintain alignment in the postoperative
patient. Evaluation of the effectiveness of pain medications, assessment of neurologic
function, and evaluation of a patient’s readiness to ambulate after surgery require higher level
nursing education and scope of practice.
19. Which action will the nurse take when caring for a patient with osteomalacia?
a. Teach about the use of vitamin D supplements.
b. Educate about the need for weight-bearing exercise.
c. Discuss the use of medications such as bisphosphonates.
d. Emphasize the importance of sunscreen use when outside.
ANS: A
Osteomalacia is caused by inadequate intake or absorption of vitamin D. Weight-bearing
exercise and bisphosphonate administration may be used for osteoporosis but will not be
beneficial for osteomalacia. Because ultraviolet light is needed for the body to synthesize
vitamin D, the patient might be taught that 20 minutes a day of sun exposure is beneficial.
20. Which action will the nurse take first when a patient is seen in the outpatient clinic with neck
pain?
a. Provide information about therapeutic neck exercises.
b. Ask about numbness or tingling of the hands and arms.
c. Suggest the patient alternate the use of heat and cold to the neck.
d. Teach about the use of nonsteroidal antiinflammatory drugs (NSAIDs).
ANS: B
The nurse’s initial action should be further assessment of related symptoms because cervical
nerve root compression will require different treatment than musculoskeletal neck pain. The
other actions may also be appropriate, depending on the assessment findings.
21. A nurse who works on the orthopedic unit has just received change-of-shift report. Which
patient should the nurse assess first?
a. Patient who reports foot pain after hammertoe surgery
b. Patient who has not voided 10 hours after a laminectomy
c. Patient with low back pain and a positive straight-leg-raise test
d. Patient with osteomyelitis who has a temperature of 100.5° F (38.1° C)
ANS: B
Difficulty in voiding may indicate damage to the spinal nerves and should be assessed and
reported to the surgeon immediately. The information about the other patients is consistent
with their diagnoses. The nurse will need to assess them as quickly as possible, but the
information about them does not indicate a need for immediate intervention.
1. Which actions will the nurse include in the plan of care for a patient with metastatic bone
cancer of the left femur (select all that apply)?
a. Monitor serum calcium.
b. Teach about the need for strict bed rest.
c. Discontinue use of sustained-release opioids.
d. Support the left leg when repositioning the patient.
e. Support family and patient as they discuss the prognosis.
ANS: A, D, E
The nurse will monitor for hypercalcemia caused by bone decalcification. Support of the leg
helps reduce the risk for pathologic fractures. Although the patient may be reluctant to
exercise, activity is important to maintain function and avoid complications associated with
immobility. Adequate pain medication, including sustained-release and rapid-acting opioids,
is needed for the severe pain often associated with bone cancer. The prognosis for metastatic
bone cancer is poor so the patient and family need to be supported as they deal with the reality
of the situation.
2. Which information will the nurse include when teaching a patient with acute low back pain
(select all that apply)?
a. Sleep in a prone position with the legs extended.
b. Keep the knees straight when leaning forward to pick something up.
c. Expect symptoms of acute low back pain to improve in a few weeks.
d. Avoid activities that require twisting of the back or prolonged sitting.
e. Use ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to relieve pain.
ANS: C, D, E
Acute back pain usually starts to improve within 2 weeks. In the meantime, the patient should
use medications such as nonsteroidal antiinflammatory drugs (NSAIDs) or acetaminophen to
manage pain and avoid activities that stress the back. Sleeping in a prone position and keeping
the knees straight when leaning forward will place stress on the back and should be avoided.
1. In which order will the nurse implement these interprofessional interventions prescribed for a
patient admitted with acute osteomyelitis with a temperature of 101.2° F? (Put a comma and a
space between each answer choice [A, B, C, D].)
a. Obtain blood cultures from two sites.
b. Administer dose of gentamicin 60 mg IV.
c. Send to radiology for computed tomography (CT) scan of right leg.
d. Administer acetaminophen (Tylenol) now and every 4 hours PRN for fever.
ANS:
A, B, D, C
The highest treatment priority for possible osteomyelitis is initiation of antibiotic therapy, but
cultures should be obtained before administration of antibiotics. Addressing the discomfort of
the fever is the next highest priority. Because the purpose of the CT scan is to determine the
extent of the infection, it can be done last.