chapter 65

Question 1

The nurse is counselling a client about ways to prevent fractures. Which of the following information should the nurse include?
a. Tack down throw 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

The nurse is caring for a client in the emergency department who is employed as a checkout clerk in a grocery store and has a repetitive strain injury in the left elbow. Which of the following treatment options should the nurse include in the teaching plan?
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

The nurse is providing health-promotion teaching to a client whose job involves many hours of word processing. Which of the following actions should the nurse include in the client teaching plan?
a. Do stretching and warm-up exercises before starting work.
b. Wrap the wrists with a compression bandage every morning.
c. Use acetaminophen 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

The nurse is preparing a client for discharge from the emergency department with a sprained wrist. Which of the following information should the nurse include?
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

The nurse is caring for a client who is a baseball pitcher and had an arthroscopic repair of a rotator cuff injury performed in same-day surgery. Which of the following information should be included in the client’s postoperative teaching plan?
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

The nurse is caring for a client who has a cast in place after fracturing the radius and the client asks when the cast can be removed. Which of the following information related to the length of time that the cast will need to remain in place should the nurse tell the client?
a. Several months
b. At least 3 weeks
c. Until swelling of the wrist has resolved
d. Until x-rays show complete bony union

Answer 6

b. At least 3 weeks

Question 7

The nurse is caring for a client who has a comminuted fracture of the right femur and has Buck’s traction in place while waiting for surgery. Which of the following actions should the nurse implement to assess for pressure areas on the client’s back and sacral area and to provide skin care?
a. Loosen the traction and have the client turn onto the unaffected side.
b. Place a pillow between the client’s legs and turn gently to each side.
c. Turn the client partially to each side with the assistance of another nurse.
d. Have the client lift the buttocks by bending and pushing with the left leg.

Answer 7

d. Have the client lift the buttocks by bending and pushing with the left leg.

Question 8

The nurse is caring for a client with a left femur fracture who has a hip spica cast applied. Which of the following nursing interventions should be included in the plan of care?
a. Avoid placing the client in the prone position.
b. Use the cast support bar to reposition the client.
c. Ask the client about any abdominal discomfort or nausea.
d. Discuss the reasons for remaining on bed rest for several weeks.

Answer 8

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

Question 9

The nurse is caring for a client who has a long-arm plaster cast applied for immobilization of a fractured left radius. Which of the following actions should the nurse implement until the cast has completely dried?
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

The nurse is providing discharge teaching to a client who has a short-arm plaster cast applied. Which of the following client statements indicates a good understanding of the 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

The nurse is evaluating the crutch-walking technique of a client who is to have no weight bearing on the right leg. Which of the following observations indicates that the client can safely ambulate independently?
a. The client keeps the padded area of the crutch firmly in the axillary area when ambulating.
b. The client advances the right leg and both crutches together and then advances the left leg.
c. The client moves the left crutch with the left leg and then the right crutch with the right leg.
d. The client uses the bedside chair to assist in balance as needed when ambulating in the room.

Answer 11

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

Question 12

The nurse is caring for a client who has had an open reduction and internal fixation (ORIF) of left lower leg fractures who indicates constant severe pain in the leg which is unrelieved by the prescribed morphine. Pulses are faintly palpable and the foot is cool. Which of the
following actions 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 client’s blood pressure.

Answer 12

a. Notify the health care provider.

Question 13

The nurse is caring for a client who is on bed rest after having a complex pelvic fracture. Which of the following assessment findings is most important to report to the health care provider?
a. The client 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 client complains of pelvic pain with palpation.

Answer 13

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

Question 14

The nurse is caring for a client with Buck’s traction who had an intracapsular fracture of the left femur. Which of the following actions should the nurse take in order to evaluate the effectiveness of Buck’s traction?
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

The nurse is preparing a client with lower leg fracture and an external fixation device in place for discharge. Which of the following information should 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 client who has had an open reduction and internal fixation (ORIF) of a hip fracture out of bed for the first time. Which of the following actions should the nurse take first?
a. Use a mechanical lift to transfer the client from the bed to the chair.
b. Check the postoperative orders for the client’s weight-bearing status.
c. Avoid administration of pain medications before getting the client up.
d. Delegate the transfer of the client out of bed to an unregulated care provider
(UCP).

Answer 16

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

Question 17

The nurse is planning discharge teaching for a client who has had a repair of a fractured mandible. Which of the following information should the nurse will include in the teaching plan?
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-fibre 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 client who has ischemic foot ulcers, the client tells the nurse, “If they want to cut off my foot, they should just shoot me instead.” Which of the following responses 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

The nurse is caring for a client who is 1 day postoperative below-the-knee amputation who indicates pain in the amputated limb. Which of the following actions 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 client that this phantom pain will diminish over time.

Answer 19

b. Administer prescribed analgesics to relieve the pain.

Question 20

The nurse is preparing a client who had an above-the-knee amputation for discharge. Which of the following client statements indicates that the nurse’s discharge teaching has been effective?
a. “I should lay on my abdomen for 30 minutes three or four times a day.”
b. “I should elevate my residual limb on a pillow two or three 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 three or four times a day.”

Question 21

The nurse is preparing a client for discharge 4 days after insertion of a femoral head prosthesis using a posterior approach. Which of the following client statements indicates a need for additional discharge instructions?
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 of the following nursing actions should the nurse include in the plan of care for a client 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

The nurse is caring for a client with ulnar drift caused by rheumatoid arthritis (RA) who is scheduled for an arthroplasty of the hand. Which of the following client statements 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

The nurse is providing home care instructions to a client who has multiple forearm fractures and a long-arm cast on the right arm. Which of the following information should the nurse include in the teaching plan?
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

The nurse is admitting a client who has a proximal humerus fracture that is immobilized with a left-sided long-arm cast and has a sling. Which of the following nursing interventions 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 client 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

The nurse is caring for a client who had hip replacement surgery using the posterior approach. Which of the following client actions requires rapid intervention by the nurse?
a. The client uses crutches with a swing-to gait.
b. The client leans over to pull shoes and socks on.
c. The client sits straight up on the edge of the bed.
d. The client bends over the sink while brushing the teeth.

Answer 26

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

Question 27

The nurse is caring for a client who has been hospitalized for 3 days with a hip fracture who has sudden onset shortness of breath and tachypnea. The client tells the nurse, “I feel like I am going to die!” Which of the following actions should the nurse take first?
a. Stay with the client and offer reassurance.
b. Administer the prescribed PRN oxygen at 4 L/minute.
c. Check the client’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/minute.

Question 28

The nurse is admitting a client to the emergency department after falling on the right arm and shoulder. Which of the following findings is most important for the nurse to communicate to the health care provider immediately?
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 client is complaining of arm and shoulder pain.

Answer 28

b. The right arm appears shorter than the left.

Question 29

The nurse is caring for a client who arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. Which of the following prescribed collaborative interventions will the nurse implement first?
a. Wrap the ankle and apply an ice pack.
b. Administer naproxen 500 mg PO.
c. Give acetaminophen with codeine.
d. Take the client to the radiology department for x-rays.

Answer 29

a. Wrap the ankle and apply an ice pack.

Question 30

The nurse is caring for a client in the emergency department who has a soft tissue injury and an open leg fracture. Which of the following actions should the nurse implement first?
a. If dislocation, apply compression bandage.
b. Realignment of the bone(s)
c. Administer tetanus with an open fracture.
d. Apply heat to the affected area.

Answer 30

c. Administer tetanus with an open fracture.

Question 31

The nurse is caring for a client in the emergency department who is experiencing severe pain and is diagnosed with a patellar dislocation. Which of the following actions should the nurse implement first?
a. Applying a knee immobilizer
b. Implementing passive knee flexion
c. Limiting activity restrictions
d. Preparing the client for conscious sedation

Answer 31

d. Preparing the client for conscious sedation

Question 32

The nurse is caring for a client in the emergency department following a motor vehicle accident who has massive right lower leg swelling. Which of the following actions 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

The nurse is caring for a client in the emergency department who has possible left lower leg fractures. Which of the following actions should the nurse implement initially?
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

The nurse is developing a care plan for a client with an open reduction and internal fixation (ORIF) of an open, displaced fracture of the tibia. Which of the following nursing diagnoses is priority?
a. Activity intolerance related to physical deconditioning
b. Risk for constipation as evidenced by electrolyte imbalance
c. Risk for impaired skin integrity as evidenced by pressure over bony prominence
d. Risk for infection as evidenced by invasive procedure

Answer 34

d. Risk for infection as evidenced by invasive procedure

Question 35

The nurse is caring for a client with a fractured pelvis and on day 2 of the hospitalization the client develops acute onset confusion. Which of the following actions should the nurse take first?
a. Take the blood pressure.
b. Assess client orientation.
c. Check pupil reaction to light.
d. Assess the oxygen saturation.

Answer 35

d. Assess the oxygen saturation.

Question 36

Which of the following information obtained by the emergency department nurse when admitting a client 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

The nurse is caring for a client who has just arrived on the orthopedic unit after a right above-the-knee amputation with an immediate prosthetic fitting. Which of the following actions should the nurse implement first?
a. Place the client 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 client with ambulation on the day after a total hip replacement, which of the following actions is most important for the nurse to implement?
a. Administer the ordered oral opioid pain medication.
b. Instruct the client 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.