LIPPINCOTT: MUSCULOSKELETAL
The Client with Rheumatoid Arthritis
1. On a visit to the clinic, a client reports the onset of
early symptoms of rheumatoid
arthritis. The nurse should conduct a focused
assessment for:.
1. Limited motion of joints.
2. Deformed joints of the hands.
3. Early morning stiffness.
4. Rheumatoid nodules.
2. A client with rheumatoid arthritis states, “I can't do
my household chores without
becoming tired. My knees hurt whenever I walk.”
Which goal for this client should take
priority?.
1. Conserve energy.
2. Adapt self-care skills.
3. Develop coping skills.
4. Adapt body image.
3. Of the clients listed below, who is at risk for
developing rheumatoid arthritis
(RA)? Select all that apply.
1. Adults between the ages of 20 and 50 years.
2. Adults who have had an infectious disease with the
Epstein-Barr virus.
3. Adults who are of the male gender.
4. Adults who possess the genetic link, specifically
HLA-DR4.
5. Adults who also have osteoarthritis.
4. A client is in the acute phase of rheumatoid arthritis.
In which order of priority
should the nurse establish the following goals?
1. Relieving pain.
2. Preserving joint function.
3. Maintaining usual ways of accomplishing tasks.
4. Preventing joint deformity.
1, 4, 2, 3
5. The nurse teaches a client about heat and cold
treatments to manage arthritis pain.
Which of the following client statements indicates
that the client still has a knowledge
deficit?.
1. “I can use heat and cold as often as I want.”
2. “With heat, I should apply it for no longer than 20
minutes at a time.”
3. “Heat-producing liniments can be used with other
heat devices.”
4. “Ten to fifteen minutes per application is the
maximum time for cold
applications.”
6. The client with rheumatoid arthritis tells the nurse, “I
have a friend who took
gold shots and had a wonderful response. Why didn't
my physician let me try that?”
Which of the following responses by the nurse would
be most appropriate?.
1. “It's the physician's prerogative to decide how to
treat you. The physician has
chosen what is best for your situation.”
2. “Tell me more about your friend's arthritic condition.
Maybe I can answer that
question for you.”
3. “That drug is used for cases that are worse than
yours. It wouldn't help you, so
don't worry about it.”
4. “Every person is different. What works for one client
may not always be
effective for another.”
7. The teaching plan for the client with rheumatoid
arthritis includes rest promotion.
Which of the following would the nurse expect to
instruct the client to avoid during rest
periods?.
1. Proper body alignment.
2. Elevating the part.
3. Prone lying positions.
4. Positions of flexion.
8. After teaching the client with rheumatoid arthritis
about measures to conserve
energy in activities of daily living involving the small
joints, which of the following, if
stated by the client, would indicate the need for
additional teaching?.
1. Pushing with palms when rising from a chair.
2. Holding packages close to the body.
3. Sliding objects.
4. Carrying a laundry basket with clinched fingers
and fists.
9. After teaching the client with severe rheumatoid
arthritis about prescribed
methotrexate, which of the following statements
indicates the need for further teaching?.
1. “I will take my vitamins while I'm on this drug.”
2. “I must not drink any alcohol while I'm taking this
drug.”
3. “I should brush my teeth after every meal.”
4. “I will continue taking my birth control pills.”
10. A 25-year-old client taking hydroxychloroquine
(Plaquenil) for rheumatoid
arthritis reports difficulty seeing out of the left eye.
Correct interpretation of this
assessment finding indicates which of the following?.
1. Development of a cataract.
2. Possible retinal degeneration.
3. Part of the disease process.
4. A coincidental occurrence.
11. A client with rheumatoid arthritis tells the nurse, “I
know it is important to
exercise my joints so that I won't lose mobility, but my
joints are so stiff and painful that
exercising is difficult.” Which of the following
responses by the nurse would be most
appropriate?.
1. “You are probably exercising too much. Decrease
your exercise to every other
day.”
2. “Tell the physician about your symptoms. Maybe
your analgesic medication can
be increased.”
3. “Stiffness and pain are part of the disease. Learn to
cope by focusing on
activities you enjoy.”
4. “Take a warm tub bath or shower before exercising.
This may help with your
discomfort.”
12. Which of the following statements should the
nurse include in the teaching
session when preparing a client for arthrocentesis?
Select all that apply.
1. “A local anesthetic agent may be injected into the
joint site for your comfort.”
2. “A syringe and needle will be used to withdraw
fluid from your joint.”
3. “The procedure, although not painful, will provide
immediate relief.”
4. “We'll want you to keep your joint active after the
procedure to increase blood
flow.”
5. “You will need to wear a compression bandage for
several days after the
procedure.”
The Client with Osteoarthritis
13. A client with osteoarthritis will undergo an
arthrocentesis on a painful,
edematous knee. What should be included in the
nursing plan of care? Select all that
apply.
1. Explain the procedure.
2. Administer preoperative medication 1 hour before
surgery.
3. Instruct the client to immobilize the knee for 2 days
after the surgery.
4. Assess the site for bleeding.
5. Offer pain medication.
14. A postmenopausal client is scheduled for a bonedensity scan. The nurse should
instruct the client to:.
1. Remove all metal objects on the day of the scan.
2. Consume foods and beverages with a high
content of calcium for 2 days before
the test.
3. Ingest 600 mg of calcium gluconate by mouth for 2
weeks before the test.
4. Report any significant pain to the physician at least
2 days before the test.
15. A physician prescribes a lengthy x-ray
examination for a client with
osteoarthritis. Which of the following actions by the
nurse would demonstrate client
advocacy?.
1. Contact the x-ray department and ask the
technician if the lengthy session can be
divided into shorter sessions.
2. Contact the physician to determine if an
alternative examination could be
scheduled.
3. Provide a dose of acetaminophen (Tylenol).
4. Cancel the examination because of the hard x-ray
table.
16. Which of the following should the nurse assess
when completing the history and
physical examination of a client diagnosed with
osteoarthritis?.
1. Anemia.
2. Osteoporosis.
3. Weight loss.
4. Local joint pain.
17. Which of the following should be included in the
teaching plan for a client with
osteoporosis? Select all that apply.
1. Maintain a diet with adequate amounts of vitamin
D, as found in fortified milk
and cereals.
2. Choose good calcium sources, such as figs,
broccoli, and almonds.
3. Use alcohol in moderation because a moderate
intake has no known negative
effects.
4. Try swimming as a good exercise to maintain bone
mass.
5. Avoid the use of high-fat foods, such as avocados,
salad dressings, and fried
foods.
18. Which of the following statements indicates that
the client with osteoarthritis
understands the effects of capsaicin (Zostrix) cream?.
1. “I always wash my hands right after I apply the
cream.”
2. “After I apply the cream, I wrap my knee with an
elastic bandage.”
3. “I keep the cream in the cabinet above the stove
in the kitchen.”
4. “I also use the same cream when I get a cut or a
burn.”
19. At which of the following times should the nurse
instruct the client to take
ibuprofen (Motrin), prescribed for left hip pain
secondary to osteoarthritis, to minimize
gastric mucosal irritation?.
1. At bedtime.
2. On arising.
3. Immediately after a meal.
4. On an empty stomach.
4. The client is able to be mobilized sooner.
20. The client diagnosed with osteoarthritis states, “My
friend takes steroid pills
for her rheumatoid arthritis. Why don't I take steroids
for my osteoarthritis?” Which of
the following is the best explanation?.
1. Intra-articular corticosteroid injections are used to
treat osteoarthritis.
2. Oral corticosteroids can be used in osteoarthritis.
3. A systemic effect is needed in osteoarthritis.
4. Rheumatoid arthritis and osteoarthritis are two
similar diseases.
25. A client with an extracapsular hip fracture returns
to the nursing unit after
internal fixation and pin insertion with a drainage
tube at the incision site. Her husband
asks, “Why does she have this tube inserted in her
hip?” Which of the following
responses would be best?.
1. “The tube helps us to detect a wound infection
early on.”
2. “This way we won't have to irrigate the wound.”
3. “Fluid won't be allowed to accumulate at the site.”
4. “We have a way to administer antibiotics into the
wound.”
21. After teaching a group of clients with
osteoarthritis about using regular
exercise, which of the following client statements
indicates effective teaching?.
1. “Performing range-of-motion exercises will increase
my joint mobility.”
2. “Exercise helps to drive synovial fluid through the
cartilage.”
3. “Joint swelling should determine when to stop
exercising.”
4. “Exercising in the outdoors year-round promotes
joint relaxation.”
The Client with a Hip Fracture
22. A client in a double hip spica cast is constipated.
The surgeon cuts a window
into the cast. Which of the following outcomes should
the nurse anticipate?.
1. The window will allow the nurse to palpate the
superior mesenteric artery.
2. The window will allow the surgeon to manipulate
the fracture site.
3. The window will allow the nurses to reposition the
client.
4. The window will provide some relief from pressure
due to abdominal distention
as a result of constipation.
23. A client has an intracapsular hip fracture. The
nurse should conduct a focused
assessment to detect:.
1. Internal rotation.
2. Muscle flaccidity.
3. Shortening of the affected leg.
4. Absence of pain in the fracture area.
24. When teaching a client with an extracapsular hip
fracture scheduled for surgical
internal fixation with the insertion of a pin, the nurse
bases the teaching on the
understanding that this surgical repair is the
treatment of choice. Which of the following
explains the reason?.
1. Hemorrhage at the fracture site is prevented.
2. Neurovascular impairment risk is decreased.
3. The risk of infection at the site is lessened.
26. A client with a hip fracture has undergone surgery
for insertion of a femoral
head prosthesis. Which of the following activities
should the nurse instruct the client to
avoid?.
1. Crossing the legs while sitting down.
2. Sitting on a raised commode seat.
3. Using an abductor splint while lying on the side.
4. Rising straight from a chair to a standing position.
27. The nurse is caring for an older adult male who
had open reduction internal
fixation (ORIF) of the right hip 24 hours ago. The client
is now experiencing shortness
of breath and reports having “tightness in my chest.”
The nurse reviews the recent lab
results. The nurse should report which of the following
lab results to the physician?.
1. Hematocrit (Hct): 40% (0.4).
2. Serum glucose: 120 mg/dL (6.7 mmol/L).
3. Troponin: 1.4 mcg/L (1.4 μg/L).
4. Erythrocyte sedimentation rate (ESR): 22 mm/h.
28. The nurse advises the client who has had a
femoral head prosthesis placement
on the type of chair to sit in during the first 6 to 8
weeks after surgery. Which would be
the correct type to recommend?.
1. A desk-type swivel chair.
2. A padded upholstered chair.
3. A high-backed chair with armrests.
4. A recliner with an attached footrest.
29. The nurse is to apply a sequential compression
device (intermittent pneumatic
compression). Identify the area of the compression
device that is placed on the client's
Calf.
The aircell should be centered on the back of the
client's calf.
30. The nurse is assessing the home environment of an
elderly client who is using
crutches during the postoperative recovery phase
after hip pinning. Which of the
following would pose the greatest hazard to the
client as a risk for falling at home?.
1. A 4-year-old cocker spaniel.
2. Scatter rugs.
3. Snack tables.
4. Rocking chairs.
The Client Having Hip or Knee Replacement Surgery
31. A frail elderly client with a hip fracture is to use an
alternating air pressure
mattress to prevent pressure ulcers while recovering.
The nurse is assisting the client's
family to place the mattress (see below). The nurse
should instruct the family to:
1. Turn the mattress over so the air cells face the
mattress of the bed, and cover the
mattress with a bed sheet.
2. Put a thick pad over the pressure mattress to
prevent soiling, and place the bed
sheet on top of the pad.
3. Make the bed with the bed sheet on top of the
pressure mattress.
4. Make the bed, and then remove the pillow to
allow full use of the mattress on the
neck.
32. A client had a posterolateral total hip
replacement 2 days ago. What should the
nurse include in the client's plan of care? Select all
that apply.
1. When using a walker, encourage the client to
keep the toes pointing inward.
2. Position a pillow between the legs to maintain
abduction.
3. Allow the client to be in the supine position or in
the lateral position on the
unoperated side.
4. Do not allow the client to bend down to tie or slip
on shoes.
5. Place ice on the incision after physical therapy.
33. Which information should the nurse include when
performing discharge
teaching with a client who had an anterolateral
approach for a total hip replacement?
Select all that apply.
1. Avoid turning the toes or knee outward.
2. Use an abduction pillow between the legs when in
bed.
3. Use an elevated toilet seat and shower chair.
4. Do not extend the operative leg backwards.
5. Restrict motion for 2 weeks after surgery.
34. The nurse is assessing a client for neurologic
impairment after a total hip
replacement. Which of the following would indicate
impairment in the affected
extremity?.
1. Decreased distal pulse.
2. Inability to move.
3. Diminished capillary refill.
4. Coolness to the touch.
35. In preparation for total knee surgery, a 200-lb
(90.7-kg) client with
osteoarthritis must lose weight. Which of the following
exercises should the nurse
recommend as best if the client has no
contraindications?.
1. Weight lifting.
2. Walking.
3. Aquatic exercise.
4. Tai chi exercise.
36. Prior to surgery, the nurse is instructing a client
who will have a total hip
replacement tomorrow. Which of the following
information is most important to include
in the teaching plan at this time?.
1. Teaching how to prevent hip flexion.
2. Demonstrating coughing and deep-breathing
techniques.
3. Showing the client what an actual hip prosthesis
looks like.
4. Assessing the client's fears about the procedure.
37. The client has just had a total knee replacement
for severe osteoarthritis. Which
of the following assessment findings should lead the
nurse to suspect possible nerve
damage?.
1. Numbness.
2. Bleeding.
3. Dislocation.
4. Pinkness.
38. After surgery and insertion of a total hip prosthesis,
a client develops severe
sudden pain and an inability to move the extremity.
The nurse interprets these findings
as indicating which of the following?.
1. A developing infection.
2. Bleeding in the operative site.
3. Joint dislocation.
4. Glue seepage into soft tissue.
39. A client who had a total hip replacement 2 days
ago has developed an infection
with a fever and profuse diaphoresis. The nurse
establishes a goal to reduce the fluid
deficit. Which of the following is the most appropriate
outcome?.
1. The client drinks 2,000 mL of fluid per day.
2. The client understands how to manage the incision.
3. The client's bed linens are changed as needed.
4. The client's skin remains cool throughout
hospitalization.
40. After knee arthroplasty, the client has a
sequential compression device (SCD).
The nurse should do which of the following?.
1. Elevate the SCD on two pillows.
2. Change the settings on the SCD to make the client
more comfortable.
3. Stop the SCD to remove dressings and bathe the
leg.
4. Discontinue the SCD when the client is ambulatory.
every 2 hours.
2. Encourage the client to use the overhead trapeze
to assist with position changes.
3. For meals, elevate the head of the bed to 90
degrees.
4. Use a fracture bedpan when needed by the client.
5.
When
the
client
is
in
bed,
prevent
thromboembolism by encouraging the client to
do toe-pointing exercises.
41. A client returns from the first session of scheduled
physical therapy sessions
following total knee replacement surgery. The nurse
assesses that the client's knee is
swollen, slightly erythematous, and painful. The client
rates the pain as 7 out of 10 and
has not had any scheduled or PRN pain medication
today. Which of the following are
appropriate nursing interventions? Select all that
apply.
1. Gently massage the area to increase circulation to
reduce pain.
2. Administer pain medication as prescribed.
3. Elevate the leg and apply a cold pack.
4. Notify the physician.
5. Call physical therapy to cancel the next treatment.
45. A client is to have a total hip replacement. The
preoperative plan should
include which of the following? Select all that apply.
1. Administer antibiotics as prescribed to ensure
therapeutic blood levels.
2. Apply leg compression device.
3. Request a trapeze be added to the bed.
4. Teach isometric exercises of quadriceps and
gluteal muscles.
5. Demonstrate crutch walking with a 3-point gait.
6. Place Buck's traction on the bed.
42. The nurse is preparing a client who has had a
knee replacement with a metal
joint to go home. The nurse should instruct the client
about which of the following?
Select all that apply.
1. Notify health care providers about the joint prior to
invasive procedures.
2. Avoid use of magnetic resonance imaging (MRI)
scans.
3. Notify airport security that the joint may set off
alarms on metal detectors.
4. Refrain from carrying items weighing more than 5
lb (2.3 kg).
5. Limit fluid intake to 1,000 mL/day.
43. Following a total hip replacement, the nurse
should position the client in which
of the following ways?.
1. Place weights alongside the affected extremity to
keep the extremity from
rotating.
2. Elevate both feet on two pillows.
3. Keep the lower extremities adducted by use of an
immobilization binder around
both legs.
4. Keep the extremity in slight abduction using an
abduction splint or pillows
placed between the thighs.
44. Following a total hip replacement, the nurse
should do which of the following?
Select all that apply.
1. With the aid of a coworker, turn the client from the
supine to the prone position
46. The laboratory notifies the nurse that a client who
had a total knee replacement
3 days ago and is receiving heparin has an activated
partial thromboplastin time (aPTT)
of 75 seconds. After verifying the values, the nurse
calls the physician. The nurse should
anticipate receiving a prescription for:.
1. Protamine sulfate.
2. Vitamin K.
3. Warfarin (Coumadin).
4. Packed red blood cells.
47. The nurse is teaching the client to administer
enoxaparin (Lovenox) following a
total hip replacement. The nurse should instruct the
client about which of the following?
Select all that apply.
1. Report promptly any difficulty breathing, rash, or
itching.
2. Notify the health care provider of unusual bruising.
3. Avoid all aspirin-containing medications.
4. Wear or carry medical identification.
5. Expel the air bubble from the syringe before the
injection.
6. Remove needle immediately after medication is
injected.
48. A client who had a total hip replacement 4 days
ago is worried about
dislocation of the prosthesis. The nurse should
respond by saying which of the
following?.
1. “Don't worry. Your new hip is very strong.”
2. “Use of a cushioned toilet seat helps to prevent
dislocation.”
3. “Activities that tend to cause adduction of the hip
tend to cause dislocation, so try
to avoid them.”
4. “Decreasing use of the abductor pillow will
strengthen the muscles to prevent
dislocation.”
49. The nurse is assessing a client who had a left hip
replacement 36 hours ago.
Which of the following indicates the prosthesis is
dislocated? Select all that apply.
1. The client reported a “popping” sensation in the
hip.
2. The left leg is shorter than the right leg.
3. The client has sharp pain in the groin.
4. The client cannot move the right leg.
5. The client cannot wiggle the toes on the left leg.
50. A client who has had a total hip replacement has
a dislocated hip prosthesis.
The nurse should first:
1. Stabilize the leg with Buck's traction.
2. Apply an ice pack to the affected hip.
3. Position the client toward the opposite side of the
hip.
4. Notify the orthopedic surgeon.
51. The nurse is planning care for a group of clients
who have had total hip
replacement. Of the clients listed below, which is at
highest risk for infection and
should be assessed first?.
1. A 55-year-old client who is 6 feet (180 cm) tall and
weighs 180 lb (81.7 kg).
2. A 90-year-old who lives alone.
3. A 74-year-old who has periodontal disease with
periodontitis.
4. A 75-year-old who has asthma and uses an inhaler.
52. The nurse has established a goal with a client to
improve mobility following
hip replacement. Which of the following is a realistic
outcome at the time of discharge
from the surgical unit?.
1. The client can walk throughout the entire hospital
with a walker.
2. The client can walk the length of a hospital hallway
with minimal pain.
3. The client has increased independence in transfers
from bed to chair.
4. The client can raise the affected leg 6 inches (15.2
cm) with assistance.
53. The nurse is assessing a client's left leg for
neurovascular changes following a
total left knee replacement. Which of the following
are expected normal findings? Select
all that apply.
1. Reduced edema of the left knee.
2. Skin warm to touch.
3. Capillary refill response.
4. Moves toes.
5. Pain absent.
6. Pulse on left leg weaker than right leg.
54. On the evening of surgery for total knee
replacement, a client wants to get out of
bed. To safely assist the client, the nurse should do
which of the following?.
1. Encourage the client to apply full weight bearing.
2. Prescribe a walker for the client.
3. Place a straight-backed chair at the foot of the
bed.
4. Apply a knee immobilizer.
55. When preparing a client for discharge from the
hospital after a total knee
replacement, the nurse should include which of the
following information in the
discharge plan? Select all that apply.
1. Report signs of infection to health care provider.
2. Keep the affected leg and foot on the floor when
sitting in a chair.
3. Remove antiembolism stockings when sleeping.
4. The physical therapist will encourage progressive
ambulation with use of
assistive devices.
5. Change the dressing daily.
56. Following a total joint replacement, which of the
following complications has
the greatest likelihood of occurring?.
1. Deep vein thrombosis (DVT).
2. Polyuria.
3. Intussusception of the bowel.
4. Wound evisceration.
The Client with a Herniated Disk
57. The nurse is observing a client who is recovering
from back strain lift a box as
shown below. What should the nurse do?
1. Praise the client for using correct body mechanics.
2. Suggest to the client that she put both knees on
the floor before attempting to lift
the box.
3. Advise the client to bend from the waist rather
than stretching her back in this
position.
4. Inform the client that she should keep her back
straight by squatting with both
knees parallel.
58. Which of the following activities should the nurse
instruct the client with low
back pain to avoid?.
1. Keeping light objects below the level of the elbows
when lifting.
2. Leaning forward while bending the knees.
3. Exceeding the prescribed exercise program.
4. Sleeping on the side with legs flexed.
59. A client attempting to get out of bed stops
midway because of low back pain
radiating down to the right heel and lateral foot.
What should the nurse do in order of
priority from first to last?
1. Apply a warm compress to the client's back.
2. Notify the physician.
3. Assist the client to lie down.
4. Administer the prescribed celecoxib (Celebrex).
3, 4, 1, 2
65. Immediately after a lumbar laminectomy, the
nurse administers ondansetron
hydrochloride (Zofran) to the client as prescribed. The
nurse determines that the drug is
effective when which of the following is controlled?.
1. Muscle spasms.
2. Nausea.
3. Shivering.
4. Dry mouth.
60. A client with a ruptured intervertebral disc at L4–
L5 stands with a flattened
spine slightly tilted forward and slightly flexed to the
affected side. The nurse interprets
this finding as indicating which of the following?.
1. Motor changes.
2. Postural deformity.
3. Alteration of reflexes.
4. Sensory changes.
66. After a laminectomy, the client states, “The
physician said that I can do anything
I want to.” Which of the following client-stated
activities indicates the need for further
teaching?.
1. Drying the dishes.
2. Sitting outside on firm cushions.
3. Making the bed walking from side to side.
4. Sweeping the front porch.
61. Which of the following positions would be most
comfortable for a client with a
ruptured disc at L5–S1 right?.
1. Prone.
2. Supine with the legs flexed.
3. High Fowler's.
4. Right Sims'.
67. The nurse is developing the discharge teaching
plan for a client after a lumbar
laminectomy L4–L5 who will be returning to work in 6
weeks. Which of the following
actions should the nurse encourage the client to
avoid?.
1. Placing one foot on a step stool during prolonged
standing.
2. Sleeping on the back with support under the knees.
3. Maintaining average body weight for height.
4. Sitting whenever possible.
62. The client with a herniated intervertebral disc
scheduled for a myelogram asks
the nurse about the procedure. The nurse explains
that radiographs will be taken of the
client's spine after an injection of which of the
following?.
1. Sterile water.
2. Normal saline solution.
3. Liquid nitrogen.
4. Radiopaque dye.
63. Which of the following would not be appropriate
to include when preparing a
client for magnetic resonance imaging (MRI) to
evaluate a ruptured disc?.
1. Informing the client that the procedure is painless.
2. Taking a thorough history of past surgeries.
3. Checking for previous claustrophobia.
4. Starting an IV line at keep-open rate.
64. A client who has numbness from the back of the
left buttock to the dorsum of the
foot and big toe is scheduled to undergo a
laminectomy. The operative consent form
states “a left lumbar laminectomy of L3–L4.” Which of
the following should the nurse
do next?.
1. Have the client sign the consent form.
2. Call the surgeon.
3. Change the consent form.
4. Review the client's history.
68. A male client underwent a spinal fusion yesterday.
Which of the following
nursing assessments should alert the nurse to the
development of a possible
complication?.
1. Lateral rotation of the head and neck.
2. Clear yellowish fluid on the dressing.
3. Use of the standing position to void.
4. Nonproductive cough.
69. The nurse is assisting a client who has had a spinal
fusion apply a back brace.
In which order of priority should the nurse assist the
client applying the brace?
1. Have the client in a side-lying position.
2. Verify the prescriptions for the settings forthe brace.
3. Ask the client to stand with arms held away from
the body.
4. Assist the client to log roll and rise to a sitting
position.
2, 1, 3, 4
70. After the nurse teaches a client about wearing a
back brace after a spinal fusion,
which of the following client statements indicates
effective teaching?.
1. “I will apply lotion before putting on the brace.”
2. “I will be sure to pad the area around my iliac
crest.”
3. “I can use baby powder under the brace to
absorb perspiration.”
4. “I should wear a thin cotton undershirt under the
brace.”
71. The nurse develops a teaching plan for a client
scheduled for a spinal fusion.
Which of the following should the nurse include?.
1. The client typically experiences more pain at the
donor site than at the fusion site.
2. The surgeon will apply a simple gauze dressing to
the donor site.
3. Neurovascular checks are unnecessary if the fibula
is the donor site.
4. The client's level of activity restriction is determined
by the amount of pain.
72. A client who has had a lumbar laminectomy with
a spinal fusion is sitting in a
chair. Which of the following is the correct position for
this client?.
1. On the floor with the feet flat.
2. On a low footstool.
3. In any comfortable position with legs uncrossed.
4. On a high footstool so the feet are level with the
chair seat.
73. The nurse develops a plan of care for a client in
the initial postoperative period
following a lumbar laminectomy. Which of the
following activities is contraindicated?.
1. Assisting with daily hygiene activities.
2. Lying flat in bed.
3. Walking in the hall.
4. Sitting all afternoon in her room.
74. Which of the following exercises should the nurse
advise the client to avoid
after a lumbar laminectomy?.
1. Knee-to-chest lifts.
2. Hip tilts.
3. Sit-ups.
4. Pelvic tilts.
The Client with an Amputation due to Peripheral
Vascular Disease
75. Which of the following factors contributes to a risk
for amputation in a client
with peripheral vascular disease? Select all that
apply.
1. Uncontrolled diabetes mellitus for 15 years.
2. A 20-pack-year history of cigarette smoking.
3. Current age of 39 years.
4. A serum cholesterol concentration of 275 mg/dL
(15.3 mmol/L).
5. Work that requires prolonged standing.
76. A client has severe arterial occlusive disease and
gangrene of the left great toe.
Which of the following findings is expected?.
1. Edema around the ankle.
2. Loss of hair on the lower leg.
3. Thin, soft toenails.
4. Warmth in the foot.
77. A client with absent peripheral pulses and pain at
rest is scheduled for an
arterial Doppler study of the affected extremity.
When preparing the client for this test,
the nurse should:.
1. Have the client sign a consent form for the
procedure.
2. Administer a pretest sedative as appropriate.
3. Keep the client tobacco-free for 30 minutes before
the test.
4. Wrap the client's affected foot with a blanket.
78. Which of the following is most helpful to promote
circulation for the client with
peripheral arterial disease?.
1. Resting with the legs elevated above the level of
the heart.
2. Walking slowly but steadily for 30 minutes twice a
day.
3. Minimizing activity as much and as often as
possible.
4. Wearing antiembolism stockings at all times when
out of bed.
79. Which of the following should the nurse include in
the teaching plan for a client
with arterial insufficiency to the feet that is being
managed conservatively?.
1. Daily lubrication of the feet.
2. Soaking the feet in warm water.
3. Applying antiembolism stockings.
4. Wearing firm, supportive leather shoes.
80. A client says, “I hate the idea of being an invalid
after they cut off my leg.”
Which of the following would be the nurse's most
therapeutic response?.
1. “At least you will still have one good leg to use.”
2. “Tell me more about how you're feeling.”
3. “Let's finish the preoperative teaching.”
4. “You're lucky to have a wife to care for you.”
81. The client asks the nurse, “Why can't the physician
tell me exactly how much of
my leg he's going to take off? Don't you think I should
know that?” On which of the
following should the nurse base the response?.
1. The need to remove as much of the leg as possible.
2. The adequacy of the blood supply to the tissues.
3. The ease with which a prosthesis can be fitted.
4. The client's ability to walk with a prosthesis.
82. A client who has had an above-the-knee
amputation develops a dime-sized
bright red spot on the dressing after 45 minutes in the
postanesthesia recovery unit. The
nurse should:.
1. Elevate the stump.
2. Reinforce the dressing.
3. Call the surgeon.
4. Draw a mark around the site.
83. A client in the postanesthesia care unit with a left
below-the-knee amputation
has pain in the left big toe. Which of the following
should the nurse do first?.
1. Tell the client it is impossible to feel the pain.
2. Show the client that the toes are not there.
3. Explain to the client that the pain is real.
4. Give the client the prescribed opioid analgesic.
84. The client with an above-the-knee amputation is
to use crutches while the
prosthesis is being adjusted. Which of the following
exercises will best prepare the
client for using crutches?.
1. Abdominal exercises.
2. Isometric shoulder exercises.
3. Quadriceps setting exercises.
4. Triceps stretching exercises.
85. The nurse teaches a client about using crutches,
instructing the client to support
the weight primarily on which of the following body
areas?.
1. Axillae.
2. Elbows.
3. Upper arms.
4. Hands.
86. The client is to be discharged on a low-fat, lowcholesterol, low-sodium diet.
Which of the following should be the nurse's first step
in planning the dietary
instructions?.
1. Determining the client's knowledge level about
cholesterol.
2. Asking the client to name foods that are high in fat,
cholesterol, and salt.
3. Explaining the importance of complying with the
diet.
4. Assessing the client's and family's typical food
preferences.
The Client with Fractures
87. A client has a leg immobilized in traction. Which
of the following activities
demonstrated by the client indicate that the client
understands actions to take to prevent
muscle atrophy?.
1. The client adducts the affected leg every 2 hours.
2. The client rolls the affected leg away from the
body's midline twice per day.
3. The client performs isometric exercises to the
affected extremity three times per
day.
4. The client asks the nurse to add a 5-lb (2.3-kg)
weight to the traction for 30
min/day.
88. The client with a fractured tibia has been taking
methocarbamol (Robaxin).
Which of the following indicate that the drug is
having the intended effect?.
1. Lack of infection.
2. Reduction in itching.
3. Relief of muscle spasms.
4. Decrease in nervousness.
89. When developing a teaching plan for a client
who is prescribed acetaminophen
(Tylenol) for muscle pain, which information should
the nurse expect to include? Select
all that apply.
1. The drug can be used if the person is allergic to
aspirin.
2. Acetaminophen does not affect platelet
aggregation.
3. This drug causes little or no gastric distress.
4. Acetaminophen exerts a strong anti-inflammatory
effect.
5. The client should have the international normalized
ratio (INR) checked regularly.
90. A client who has been taking hydrocodone with
acetaminophen at home for 6
weeks following a fractured tibia is admitted with a
blood pressure of 80/50 mm Hg, a
pulse rate of 115 bpm, and respirations of 8 breaths
per minute and shallow. The nurse
interprets these findings as indicating which of the
following?.
1. Expected common adverse effects of the
hydrocodone.
2. Hypersensitivity reaction to the acetaminophen.
3. Possible habituating effect of the long-term drug
use.
4. Hemorrhage from gastrointestinal irritation
associated with the pain medication.
91. When admitting a client with a fractured
extremity, the nurse should first focus
the assessment on which of the following?.
1. The area proximal to the fracture.
2. The actual fracture site.
3. The area distal to the fracture.
4. The opposite extremity for baseline comparison.
92. Which of the following client statements identifies
a knowledge deficit about
cast care?.
1. “I'll elevate the cast above my heart initially.”
2. “I'll exercise my joints above and below the cast.”
3. “I can pull out cast padding to scratch inside the
cast.”
4. “I'll apply ice for 10 minutes to control edema for
the first 24 hours.”
2. Jaundice.
3. Generalized edema.
4. Dark, scanty urine.
93. Which of the following interventions would be
least appropriate for a client
who is in a double hip spica cast?.
1. Encouraging the intake of cranberry juice.
2. Advising the client to eat large amounts of cheese.
3. Establishing regular times for elimination.
4. Having the client dangle at the bedside.
98. A client with a fractured right femur has not had
any immunizations since
childhood. Which of the following biologic products
should the nurse administer to
provide the client with passive immunity for tetanus?.
1. Tetanus toxoid.
2. Tetanus antigen.
3. Tetanus vaccine.
4. Tetanus antitoxin.
94. The nurse prepares a teaching plan for a client
about crutch walking using a
two-point gait pattern. Which of the following should
the nurse include?.
1. Advance a crutch on one side and then advance
the opposite foot; repeat on the
opposite side.
2. Advance a crutch on one side and simultaneously
advance and bear weight on the
opposite foot; repeat on the opposite side.
3. Advance both crutches together and then follow
by lifting both lower extremities
to the level of the crutches.
4. Advance both crutches together and then follow
by lifting both lower extremities
past the level of the crutches.
95. A client returned from surgery with a debrided
open tibial fracture and has a
three-way drainage system. The nurse should first:.
1. Review the results of culture and sensitivity testing
of the wound.
2. Look for the presence of a pressure dressing over
the wound.
3. Determine if the client has increased pain from
exposed nerve endings.
4. Check the client's blood pressure for hypotension
resulting from additional
vessel bleeding.
96. A client has a tibial fracture that required casting.
Approximately 5 hours later,
the client has increasing pain distal to the left tibial
fracture despite the morphine
injection administered 30 minutes previously. Which
of the following should be the
nurse's next assessment?.
1. Presence of a distal pulse.
2. Pain with a pain rating scale.
3. Vital sign changes.
4. Potential for drug tolerance.
97. A client with a fracture develops compartment
syndrome. Which of the
following signs should alert the nurse to impending
organ failure?.
1. Crackles.
The Client with a Femoral Fracture
99. After teaching the client with a femoral fracture
about the purpose of treatment
with skeletal traction, which of the following, if stated
by the client, would indicate the
need for additional teaching?.
1. To align injured bones.
2. To provide long-term pull.
3. To apply 25 lb (11.3 kg) of traction.
4. To pull weight with a boot.
100. The nurse is planning care for the client with a
femoral fracture who is in
balanced suspension traction. Which of the following
would the nurse be least likely to
include in the plan of care?.
1. Use of a fracture bedpan.
2. Checks for redness over the ischial tuberosity.
3. Elevation of the head of bed no more than 25
degrees.
4. Personal hygiene with a complete bed bath.
101. A client is in balanced suspension traction using
a half-ring Thomas splint
with a Pearson attachment that suspends the lower
extremity and applies direct skeletal
traction for a hip fracture. Which of the following
nursing assessments would not be
appropriate?.
1. Greater trochanter skin checks.
2. Pin site inspection.
3. Neurovascular checks proximal to the splint.
4. Foot movement evaluation.
102. The client in balanced suspension traction is
transported to surgery for closed
reduction and internal fixation of a fractured femur.
Which of the following should the
nurse do when transporting the client to the
operating room?.
1. Transfer the client to a cart with manually
suspended traction.
2. Call the surgeon to request a prescription to
temporarily remove the traction.
3. Send the client on the bed with extra help to
stabilize the traction.
4. Remove the traction and send the client on a cart.
103. A client has a Pearson attachment on the
traction setup. Which of the following
is the purpose of this attachment?.
1. To support the lower portion of the leg.
2. To support the thigh and upper leg.
3. To allow attachment of the skeletal pin.
4. To prevent flexion deformities in the ankle and foot.
104. Which of the following indicates that a client
with a fracture of the right femur
may be developing a fat embolus?.
1. Acute respiratory distress syndrome.
2. Migraine-like headaches.
3. Numbness in the right leg.
4. Muscle spasms in the right thigh.
105. Which of the following is the priority for a client
with a fractured femur who
is in traction at this time?.
1. Prevent effects of immobility while in traction.
2. Develop skills to cope with prolonged immobility.
3. Choose appropriate diversional activities during
the prolonged recovery.
4. Adapt to inactivity from the impaired mobility.
106. The client asks the nurse what the activity
limitations are while in Buck's
traction. The nurse should tell the client:.
1. “You can sit up whenever you want.”
2. “You must lie flat on your back most of the time.”
3. “You can turn your body.”
4. “You must lie on your stomach.”
107. When a client has a Thomas splint, the nurse
should assess the client regularly
for which of the following?.
1. Signs of skin pressure in the groin area.
2. Evidence of decreased breath sounds.
3. Skin breakdown behind the heel.
4. Urine retention.
108. The client in traction for a fractured femur is
having difficulty managing selfcare activities. Which
of the following would indicate a successful outcome
of a goal of
promoting independence for this client?.
1. The client assists as much as possible in care,
demonstrating increased
participation over time.
2. The client allows the nurse to complete care in an
efficient manner without
interfering.
3. The client allows the spouse to assume total
responsibility for care.
4. The client accepts that self-care is not possible
while in traction.
109. The client with an open femoral fracture was
discharged to the home and
developed fever, night sweats, chills, restlessness, and
restrictive movement of the
fractured leg. Which of the following reflects the best
interpretation of these findings?.
1. Pulmonary emboli.
2. Osteomyelitis.
3. Fat emboli.
4. Urinary tract infection.
110. The nurse is planning care for a client with
osteomyelitis. The client is taking
an antibiotic, but the infection has not resolved. The
nurse should advise the client to do
which of the following?.
1. Use herbal supplements.
2. Eat a diet high in protein and vitamins C and D.
3. Ask the health care provider for a change of
antibiotics.
4. Encourage frequent passive range of motion to
the affected extremity.
The Client with a Spinal Cord Injury
111. A client is being admitted with a spinal cord
transection at C7. Which of the
following assessments take priority upon the client's
arrival? Select all that apply.
1. Reflexes.
2. Bladder function.
3. Blood pressure.
4. Temperature.
5. Respirations.
112. When planning to move a person with a possible
spinal cord injury, the nurse
should direct the team to:.
1. Limit movement of the arms by wrapping them
next to the body.
2. Move the person gently to help reduce pain.
3. Immobilize the head and neck to prevent further
injury.
4. Cushion the back with pillows to ensure comfort.
113. The nurse is caring for a client with a spinal cord
injury. The client is
experiencing blurred vision and has a blood pressure
of 204/102 mm Hg. What should
the nurse do first?.
1. Position the client on the left side.
2. Control the environment by turning the lights off
and decreasing stimulation for
the client.
3. Check the client's bladder for distention.
4. Administer pain medications.
114. The nurse is taking care of a client with a spinal
cord injury. The extent of the
client's injury is shown below. Which of the following
findings is expected when
assessing this client?
1. Inability to move his arms.
2. Loss of sensation in his hands and fingers.
3. Dysfunction of bowel and bladder.
4. Difficulty breathing.
4. “The movements occur from muscle reflexes that
can't be initiated or controlled
by the brain.”
115. When the client has a cord transection at T4,
which of the following is the
primary focus of the nursing assessment?.
1. Renal status.
2. Vascular status.
3. Gastrointestinal function.
4. Biliary function.
121. The client with a spinal cord injury asks the nurse
why the dietitian has
recommended to decrease the total daily intake of
calcium. Which of the following
responses by the nurse would provide the most
accurate information?.
1. “Excessive intake of dairy products makes
constipation more common.”
2. “Immobility increases calcium absorption from the
intestine.”
3. “Lack of weight bearing causes demineralization
of the long bones.”
4. “Dairy products likely will contribute to weight
gain.”
116. When assessing the client with a cord
transection above T5 for possible
complications, which of the following should the
nurse expect as least likely to occur?.
1. Diarrhea.
2. Paralytic ileus.
3. Stress ulcers.
4. Intra-abdominal bleeding.
117. The nurse is planning to teach the client with
spinal cord injury and
intermittent
nasogastric
suctioning
about
interventions to protect the integumentary
system. The nurse should tell the client to:.
1. Eat enough calories to maintain desired weight.
2. Stay in cool environments to avoid sweating.
3. Stay in warm environments to avoid chilling.
4. Eat low-sodium foods to avoid edema.
118. Which of the following should the nurse use as
the best method to assess for
the development of deep vein thrombosis in a client
with a spinal cord injury?.
1. Homans' sign.
2. Pain.
3. Tenderness.
4. Leg girth.
119. During the period of spinal shock, the nurse
should expect the client's bladder
function to be which of the following?.
1. Spastic.
2. Normal.
3. Atonic.
4. Uncontrolled.
120. After 1 month of therapy, the client in spinal
shock begins to experience
muscle spasms in the legs, and calls the nurse in
excitement to report the leg movement.
Which of the following responses by the nurse would
be the most accurate?.
1. “These movements indicate that the damaged
nerves are healing.”
2. “This is a good sign. Keep trying to move all the
affected muscles.”
3. “The return of movement means that eventually
you should be able to walk
again.”
122. As a first step in teaching a woman with a spinal
cord injury and quadriplegia
about her sexual health, the nurse assesses her
understanding of her current sexual
functioning. Which of the following statements by the
client indicates she understands
her current ability?.
1. “I won't be able to have sexual intercourse until the
urinary catheter is removed.”
2. “I can participate in sexual activity but might not
experience orgasm.”
3. “I can't have sexual intercourse because it causes
hypertension, but other sexual
activity is okay.”
4. “I should be able to participate in sexual activity,
but I will be infertile.”
123. A client with a spinal cord injury who has been
active in sports and outdoor
activities talks almost obsessively about his past
activities. In tears, one day he asks the
nurse, “Why can't I stop talking about these things? I
know those days are gone forever.”
Which of the following responses by the nurse
conveys the best understanding of the
client's behavior?.
1. “Be patient. It takes time to adjust to such a
massive loss.”
2. “Talking about the past is a form of denial. We
have to help you focus on today.”
3. “Reviewing your losses is a way to help you work
through your grief and loss.”
4. “It's a simple escape mechanism to go back and
live again in happier times.”
Managing Care Quality and Safety
124. Four days after surgery for internal fixation of a
C3–C4 fracture, a nurse is
moving a client from the bed to the wheelchair. The
nurse is checking the wheelchair for
correct features for this client. Which of the following
features of the wheelchair are
appropriate for the needs of this client? Select all
that apply.
1. Back at the level of the client's scapula.
2. Back and head that are high.
3. Seat that is lower than normal.
4. Seat with firm cushions.
5. Chair controlled by the client's breath.
125. The nurse is documenting care of a client who is
restrained in bed with
bilateral wrist restraints. Following assessment of the
restraints, the nurse's
documentation should include which of the following?
Select all that apply.
1. Nutrition and hydration needs.
2. Capillary refill.
3. Continued need for restraints.
4. Need for medication.
5. Skin integrity.
126. The nurse on an orthopedic unit is instituting a
falls prevention program.
Which of the following personnel should be involved
in the program? Select all that
apply.
1. Registered nurses.
2. Physicians.
3. Unlicensed personnel.
4. Housekeeping services.
5. Family members.
6. Client.
127. The nurse unit manager is making rounds on a
team of clients and notices a
client who is wearing red slipper socks and a colorcoded armband that indicates the
client is at risk for falling walking down the hall
unassisted. The nurse should do which
of the following first?.
1. Encourage the client to keep walking until he
becomes tired.
2. Walk with the client back to his room and assist him
to get in bed.
3. Accompany the client while using the lapel
microphone to call for the unlicensed
nursing personnel (UAP) to walk with the client.
4. Instruct the client to walk only in his room.
128. The physician has prescribed 5 mg Coumadin
(warfarin) orally for a
hospitalized client. In planning care for this client, the
nurse should verify that which of
the following services have been contacted? Check
all that apply.
1. Pharmacy.
2. Dietary.
3. Laboratory.
4. Discharge planning.
5. Chaplain.
129. The nurse on the orthopedic unit is going to
lunch and is conducting a “handoff” to the charge
nurse. The goal of the “hand-off” communication is
to do which of the
following?.
1. To ensure the charge nurse understands that the
nurse is going to lunch.
2. To be sure the charge nurse assigns someone else
to take care of the client.
3. To provide accurate information about client's
care to the next caregiver.
4. To provide in-depth information about the client's
history.
130. The client has been diagnosed with septic
arthritis in a hip joint. Which of the
following are desired outcomes from a client-focused
teaching plan? Select all that
apply.
1. Report pain that is severe enough to limit activities.
2. Discuss how to take prescribed medications.
3. Describe how the application of a heating pad set
on “high” readily resolves
edema.
4. Describe the septic arthritis physiologic process.
5. Explain the importance of supporting the affected
joint.
6. Describe how to use ambulatory aids and assistive
devices.
131. The nurse should perform passive range-ofmotion (ROM) exercises on which
of the following clients? A client: Select all that apply.
1. Who has septic joints.
2. Who has temporary loss of sensation.
3. Who is unconsciousness.
4. Who has plantar flexion of the foot.
5. Who has supination of the hand