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Question 1

When counseling an older patient about ways to prevent fractures, which information will the nurse include?

a. Tack down scatter rugs in the home.
b. Most falls happen outside the home.
c. Buy shoes that provide good support and are comfortable to wear.
d. Range-of-motion exercises should be taught by a physical therapist.

Answer 1

c. Buy shoes that provide good support and are comfortable to wear.

Question 2

A checkout clerk in a grocery store has repetitive strain syndrome in the left elbow. The nurse will plan to teach the patient about

a. surgical options.
b. elbow injections.
c. utilization of a left wrist splint.
d. modifications in arm movement.

Answer 2

d. modifications in arm movement.

Question 3

When working with a patient whose job involves many hours of word processing, the nurse will teach the patient about the need to

a. do stretching and warm-up exercises before starting work.
b. wrap the wrists with a compression bandage every morning.
c. use acetaminophen (Tylenol) instead of nonsteroidal anti-inflammatory drugs (NSAIDs) for wrist pain.
d. obtain a keyboard pad to support the wrist while word processing.

Answer 3

d. obtain a keyboard pad to support the wrist while word processing.

Question 4

Which information will the nurse include when discharging a patient with a sprained wrist from the emergency department?

a. Keep the wrist loosely wrapped with gauze.
b. Apply a heating pad to reduce muscle spasms.
c. Use pillows to elevate the arm above the heart.
d. Gently move the wrist through the range of motion.

Answer 4

c. Use pillows to elevate the arm above the heart.

Question 5

A 20-year-old baseball pitcher 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 have an appointment with a physical therapist for tomorrow.”
b. “You can still play baseball but you will not be able to return to pitching.”
c. “The doctor will use the drop-arm test to determine the success of surgery.”
d. “Leave the shoulder immobilizer on for the first few days to minimize pain.”

Answer 5

a. “You have an appointment with a physical therapist for tomorrow.”

Question 6

A patient who has a cast in place after fracturing the radius asks when the cast can be removed. The nurse will instruct the patient 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.

Answer 6

b. for at least 3 weeks

Question 7

A patient with a comminuted fracture of the right femur 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 have the patient turn onto the unaffected side.
b. place a pillow between the patient’s legs and turn gently to each side.
c. turn the patient partially to each side with the assistance of another nurse.
d. have the patient lift the buttocks by bending and pushing with the left leg.

Answer 7

d. have the patient lift the buttocks by bending and pushing with the left leg.

Question 8

After a patient with a left femur fracture has a hip spica cast applied, which nursing intervention will be included in the plan of care?

a. Avoid placing the patient in the prone position.
b. Use the cast support bar to reposition the patient.
c. Ask the patient about any abdominal discomfort or nausea.
d. Discuss the reasons for remaining on bed rest for several weeks.

Answer 8

c. Ask the patient about any abdominal discomfort or nausea.

Question 9

A patient has a long-arm plaster cast applied for immobilization of a fractured left radius. Until the cast has completely dried, the nurse should

a. keep the left arm in a dependent position.
b. handle the cast with the palms of the hands.
c. place gauze around the cast edge to pad any roughness.
d. cover the cast with a small blanket to absorb the dampness.

Answer 9

b. handle the cast with the palms of the hands.

Question 10

After a patient has a short-arm plaster cast applied in the emergency department, which statement by the patient indicates a good understanding of the nurse’s discharge teaching?

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 for the next 24 hours.”
d. “I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast.”

Answer 10

c. “I will apply an ice pack to the cast over the fracture site for the next 24 hours.”

Question 11

Which of the following observations made by the nurse who is evaluating the crutch-walking technique of a patient who is to have no weight bearing on the right leg indicates that the patient can safely ambulate independently?

a. The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.
b. The patient advances the right leg and both crutches together and then advances the left leg.
c. The patient moves the left crutch with the left leg and then the right crutch with the right leg.
d. The patient uses the bedside chair to assist in balance as needed when ambulating in the room.

Answer 11

b. The patient advances the right leg and both crutches together and then advances the left leg.

Question 12

A patient who has had an open reduction and internal fixation (ORIF) of left lower leg fractures complains of constant severe pain in the leg, which is unrelieved by the prescribed morphine. Pulses are faintly palpable and the foot is cool. 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.

Answer 12

a. Notify the health care provider.

Question 13

When the nurse is caring for a patient who is on bed rest after having a complex pelvic fracture, which assessment finding is most important to report to the health care provider?

a. The patient states that the pelvis feels unstable.
b. Abdominal distention is present and bowel tones are absent.
c. There are ecchymoses on the abdomen and hips.
d. The patient complains of pelvic pain with palpation.

Answer 13

b. Abdominal distention is present and bowel tones are absent.

Question 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 left femur?

a. Assess for hip contractures.
b. Monitor for hip dislocation.
c. Check the peripheral pulses.
d. Ask about left hip pain level.

Answer 14

d. Ask about left hip pain level

Question 15

A patient with lower leg fracture has an external fixation device in place and is scheduled for discharge. Which information will the nurse include in the discharge teaching?

a. “You will need to assess and clean the pin insertion sites daily.”
b. “The external fixator can be removed during the bath or shower.”
c. “You will need to remain on bed rest until bone healing is complete.”
d. “Prophylactic antibiotics are used until the external fixator is removed.”

Answer 15

a. “You will need to assess and clean the pin insertion sites daily.”

Question 16

The nurse is preparing to assist a patient who has had an open reduction and internal fixation (ORIF) of a hip fracture out of bed for the first time. Which action should the nurse take?

a. Use a mechanical lift to transfer the patient from the bed to the chair.
b. Check the postoperative orders for the patient’s weight-bearing status.
c. Avoid administration of pain medications before getting the patient up.
d. Delegate the transfer of the patient out of bed to nursing assistive personnel (NAP).

Answer 16

b. Check the postoperative orders for the patient’s weight-bearing status.

Question 17

When doing discharge teaching for a patient who has had a repair of a fractured mandible, the nurse will include information about

a. when and how to cut the immobilizing wires.
b. self-administration of nasogastric tube feedings.
c. the use of sterile technique for dressing changes.
d. the importance of including high-fiber foods in the diet.

Answer 17

a. when and how to cut the immobilizing wires.

Question 18

After the health care provider has recommended an amputation for a patient who has ischemic foot ulcers, the patient tells the nurse, “If they want to cut off my foot, they should just shoot me instead.” Which response by the nurse is best?

a. “Many people are able to function normally with a foot prosthesis.”
b. “I understand that you are upset, but you may lose the foot anyway.”
c. “Tell me what you know about what your options for treatment are.”
d. “If you do not want the surgery, you do not have to have an amputation.”

Answer 18

c. “Tell me what you know about what your options for treatment are.”

Question 19

On the first postoperative day, a patient with a below-the-knee amputation complains of pain in the amputated limb. Which action is best for the nurse to take?

a. Explain the reasons for the phantom limb pain.
b. Administer prescribed analgesics to relieve the pain.
c. Loosen the compression bandage to decrease incisional pressure.
d. Remind the patient that this phantom pain will diminish over time.

Answer 19

b. Administer prescribed analgesics to relieve the pain

Question 20

Which statement by a patient who has had an above-the-knee amputation indicates that the nurse’s discharge teaching has been effective?

a. “I should lay on my abdomen for 30 minutes 3 or 4 times a day.”
b. “I should elevate my residual limb on a pillow 2 or 3 times a day.”
c. “I should change the limb sock when it becomes soiled or stretched out.”
d. “I should use lotion on the stump to prevent drying and cracking of the skin.”

Answer 20

a. “I should lay on my abdomen for 30 minutes 3 or 4 times a day.”

Question 21

A patient is to be discharged from the hospital 4 days after insertion of a femoral head prosthesis using a posterior approach. A statement by the patient that indicates a need for additional discharge instructions is

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.”

Answer 21

d. “I can sleep in any position that is comfortable for me.”

Question 22

Which nursing action will the nurse include in the plan of care for a patient who has had a total knee arthroplasty?

a. Avoid extension of the knee beyond 120 degrees.
b. Use a compression bandage to keep the knee flexed.
c. Start progressive knee exercises to obtain 90-degree flexion.
d. Teach about the need to avoid weight bearing for 4 weeks.

Answer 22

c. Start progressive knee exercises to obtain 90-degree flexion

Question 23

A patient with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for an arthroplasty of the hand. Which patient statement to the nurse indicates realistic expectation for the surgery?

a. “I will be able to use my fingers to grasp objects better.”
b. “I will not have to do as many hand exercises after the surgery.”
c. “This procedure will prevent further deformity in my hands and fingers.”
d. “My fingers will appear more normal in size and shape after this surgery.”

Answer 23

a. “I will be able to use my fingers to grasp objects better.”

Question 24

When giving home care instructions to a patient who has multiple forearm fractures and a long-arm cast on the right arm, which information should the nurse include?

a. Keep the hand immobile to prevent soft tissue swelling.
b. Keep the right shoulder elevated on a pillow or cushion.
c. Avoid the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for the first 48 hours after the injury.
d. Call the health care provider for increased swelling or numbness.

Answer 24

d. Call the health care provider for increased swelling or numbness.

Question 25

A patient who has a proximal humerus fracture that is immobilized with a left-sided long-arm cast and a sling is admitted to the medical-surgical unit. 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 on 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.

Answer 25

c. Assess the left axilla and change absorbent dressings as needed.

Question 26

A patient has hip replacement surgery using the posterior approach. Which patient action requires rapid intervention by the nurse?

a. The patient uses crutches with a swing-to gait.
b. The patient leans over to pull shoes and socks on.
c. The patient sits straight up on the edge of the bed.
d. The patient bends over the sink while brushing the teeth.

Answer 26

b. The patient leans over to pull shoes and socks on.

Question 27

A patient who has been hospitalized for 3 days with a hip fracture has sudden onset 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 the prescribed PRN oxygen at 4 L/min.
c. Check the patient’s legs for swelling or tenderness.
d. Notify the health care provider about the symptoms.

Answer 27

b. Administer the prescribed PRN oxygen at 4 L/min.

Question 28

A patient is seen at the urgent care center after falling on the right arm and shoulder. 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 right arm appears shorter than the left.
c. There is decreased range of motion of the shoulder.
d. The patient is complaining of arm and shoulder pain.

Answer 28

b. The right arm appears shorter than the left.

Question 29

A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. Which of these prescribed collaborative interventions will the nurse implement first?

a. Wrap the ankle and apply an ice pack.
b. Administer naproxen (Naprosyn) 500 mg PO.
c. Give acetaminophen with codeine (Tylenol #3).
d. Take the patient to the radiology department for x-rays.

Answer 29

a. Wrap the ankle and apply an ice pack.

Question 30

When planning care for a patient who has had hip replacement surgery, which nursing action can the nurse delegate to experienced nursing assistive personnel (NAP)?

a. Teach quadriceps-setting exercises.
b. Reposition the patient every 1 to 2 hours.
c. Assess for skin irritation on the patient’s back.
d. Determine the patient’s pain level and tolerance.

Answer 30

b. Reposition the patient every 1 to 2 hours.

Question 31

A patient in the emergency department who is experiencing severe pain is diagnosed with a patellar dislocation. The initial patient teaching by the nurse will focus on the need for

a. a knee immobilizer.
b. gentle knee flexion.
c. activity restrictions.
d. monitored anesthesia care (conscious sedation).

Answer 31

d. monitored anesthesia care (conscious sedation).

Question 32

Following a motor vehicle accident, a patient arrives in the emergency department with massive right lower leg swelling. Which action will the nurse take first?

a. Elevate the leg on pillows.
b. Apply a compression bandage.
c. Check leg pulses and sensation.
d. Place ice packs on the lower leg.

Answer 32

c. Check leg pulses and sensation

Question 33

A patient is admitted to the emergency department with possible left lower leg fractures. The initial action by the nurse should be to

a. elevate the left leg.
b. splint the lower leg.
c. obtain information about the tetanus immunization status.
d. check the popliteal, dorsalis pedis, and posterior tibial pulses.

Answer 33

d. check the popliteal, dorsalis pedis, and posterior tibial pulses.

Question 34

In developing a care plan for a patient with an open reduction and internal fixation (ORIF) of an open, displaced fracture of the tibia, the priority nursing diagnosis is

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.

Answer 34

d. risk for infection related to disruption of skin integrity.

Question 35

The second day after admission with a fractured pelvis, a patient develops acute onset confusion. Which action should the nurse take first?

a. Take the blood pressure.
b. Assess patient orientation.
c. Check pupil reaction to light.
d. Assess the oxygen saturation.

Answer 35

d. Assess the oxygen saturation.

Question 36

Which information obtained by the emergency department nurse when admitting a patient with a left femur fracture is most important to report to the health care provider?

a. Bruising of the left thigh
b. Complaints of left thigh pain
c. Outward pointing toes on the left foot
d. Prolonged capillary refill of the left foot

Answer 36

d. Prolonged capillary refill of the left foot

Question 37

A patient undergoes a right above-the-knee amputation with an immediate prosthetic fitting. When the patient first arrives on the orthopedic unit after surgery, the nurse should

a. place the patient in a prone position.
b. check the surgical site for hemorrhage.
c. remove the prosthesis and wrap the site.
d. keep the residual leg elevated on a pillow.

Answer 37

b. check the surgical site for hemorrhage.

Question 38

Before assisting a patient with ambulation on the day after a total hip replacement, which action is most important for the nurse to take?

a. Administer the ordered oral opioid pain medication.
b. Instruct the patient about the benefits of ambulation.
c. Ensure that the incisional drain has been discontinued.
d. Change the hip dressing and document the wound appearance.

Answer 38

a. Administer the ordered oral opioid pain medication.