Iggy Exam 3

Question 1

A client has a bone density score of 2.8. What action by the nurse is best?

a. Asking the client to complete a food diary
b. Planning to teach about bisphosphonates
c. Scheduling another scan in 2 years
d. Scheduling another scan in 6 months

Answer 1

ANS: B
A T-score from a bone density scan at or lower than 2.5 indicates osteoporosis. The nurse should plan to teach
about medications used to treat this disease. One class of such medications is bisphosphonates. A food diary is
helpful to determine if the client gets adequate calcium and vitamin D, but at this point, dietary changes will
not prevent the disease. Simply scheduling another scan will not help treat the disease either.

Question 2

A nurse is assessing an older client and discovers back pain with tenderness along T2 and T3. What action
by the nurse is best?
a. Consult with the provider about an x-ray.
b. Encourage the client to use ibuprofen (Motrin).
c. Have the client perform hip range of motion.
d. Place the client in a rigid cervical collar.

Answer 2

ANS: A
Back pain with tenderness is indicative of a spinal compression fracture, which is the most common type of
osteoporotic fracture. The nurse should consult the provider about an x-ray. Motrin may be indicated but not
until there is a diagnosis. Range of motion of the hips is not related, although limited spinal range of motion
may be found with a vertebral compression fracture. Since the defect is in the thoracic spine, a cervical collar is
not needed.

Question 3

A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client
admits to not doing the prescribed exercises. What action by the nurse is best?
a. Ask the client about fear of falling.
b. Instruct the client to increase calcium.
c. Suggest other exercises the client can do.
d. Tell the client to try weight lifting.

Answer 3

ANS: A
Fear of falling can limit participation in activity. The nurse should first assess if the client has this fear and then
offer suggestions for dealing with it. The client may or may not need extra calcium, other exercises, or weight
lifting.

Question 4

The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good
option?
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a. Client with diabetes who has a serum creatinine of 0.8 mg/dL
b. Client who recently fell and has vertebral compression fractures
c. Hypertensive client who takes calcium channel blockers
d. Client with a spinal cord injury who cannot tolerate sitting up

Answer 4

ANS: D
Clients on bisphosphonates must be able to sit upright for 30 to 60 minutes after taking them. The client who
cannot tolerate sitting up is not a good candidate for this class of drug. Poor renal function also makes clients
bad candidates for this drug, but the client with a creatinine of 0.8 mg/dL is within normal range. Diabetes and
hypertension are not related unless the client also has renal disease. The client who recently fell and sustained
fractures is a good candidate for this drug if the fractures are related to osteoporosis.

Question 5

A client has been prescribed denosumab (Prolia). What instruction about this drug is most appropriate?

a. Drink at least 8 ounces of water with it.
b. Make appointments to come get your shot.
c. Sit upright for 30 to 60 minutes after taking it.
d. Take the drug on an empty stomach.

Answer 5

ANS: B
Denosumab is given by subcutaneous injection twice a year. The client does not need to drink 8 ounces of
water with this medication as it is not taken orally. The client does not need to remain upright for 30 to 60
minutes after taking this medication, nor does the client need to take the drug on an empty stomach.

Question 6

A client in a nursing home refuses to take medications. She is at high risk for osteomalacia. What action by
the nurse is best?
a. Ensure the client gets 15 minutes of sun exposure daily.
b. Give the client daily vitamin D injections.
c. Hide vitamin D supplements in favorite foods.
d. Plan to serve foods naturally high in vitamin D.

Answer 6

ANS: A
Sunlight is a good source of vitamin D, and the nursing staff can ensure some sun exposure each day. Vitamin
D is not given by injection. Hiding the supplement in food is unethical. Very few foods are naturally high in
vitamin D, but some are supplemented.

Question 7

A client is in the internal medicine clinic reporting bone pain. The clients alkaline phosphatase level is 180
units/L. What action by the nurse is most appropriate?
a. Assess the client for leg bowing.
b. Facilitate an oncology workup.
c. Instruct the client on fluid restrictions.
d. Teach the client about ibuprofen (Motrin).

Answer 7

ANS: A
This client has manifestations of Pagets disease. The nurse should assess for other manifestations such as
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bowing of the legs. Other care measures can be instituted once the client has a confirmed diagnosis.

Question 8

An older client with diabetes is admitted with a heavily draining leg wound. The clients white blood cell
count is 38,000/mm3 but the client is afebrile. What action does the nurse take first?
a. Administer acetaminophen (Tylenol).
b. Educate the client on amputation.
c. Place the client on contact isolation.
d. Refer the client to the wound care nurse.

Answer 8

ANS: C
In the presence of a heavily draining wound, the nurse should place the client on contact isolation. If the client
has discomfort, acetaminophen can be used, but this client has not reported pain and is afebrile. The client may
or may not need an amputation in the future. The wound care nurse may be consulted, but not as the first
action.

Question 9

A nurse is caring for four clients. After the hand-off report, which client does the nurse see first?

a. Client with osteoporosis and a white blood cell count of 27,000/mm3
b. Client with osteoporosis and a bone fracture who requests pain medication
c. Post-microvascular bone transfer client whose distal leg is cool and pale
d. Client with suspected bone tumor who just returned from having a spinal CT

Answer 9

ANS: C
This client is the priority because the assessment findings indicate a critical lack of perfusion. A high white
blood cell count is an expected finding for the client with osteoporosis. The client requesting pain medication
should be seen second. The client who just returned from a CT scan is stable and needs no specific
postprocedure care.

Question 10

A client has a metastatic bone tumor. What action by the nurse takes priority?

a. Administer pain medication as prescribed.
b. Elevate the extremity and apply moist heat.
c. Handle the affected extremity with caution.
d. Place the client on protective precautions.

Answer 10

ANS: C
Bones invaded by tumors are very fragile and fracture easily. For client safety, the nurse handles the affected
extremity with great care. Pain medication should be given to control pain. Elevation and heat may or may not
be helpful. Protective precautions are not needed for this client.

Question 11

A hospitalized client is being treated for Ewings sarcoma. What action by the nurse is most important?
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a. Assessing and treating the client for pain as needed
b. Educating the client on the disease and its treatment
c. Handling and disposing of chemotherapeutic agents per policy
d. Providing emotional support for the client and family

Answer 11

ANS: C
All actions are appropriate for this client. However, for safety, the nurse should place priority on proper
handling and disposal of chemotherapeutic agents.

Question 12

A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the
clients psychosocial needs?
a. Assess the clients coping skills and support systems.
b. Explain that the surgery leads to a longer life expectancy.
c. Refer the client to the social worker or hospital chaplain.
d. Reinforce physical therapy to aid with ambulating normally.

Answer 12

ANS: A
The first step in the nursing process is assessment. The nurse should assess coping skills and possible support
systems that will be helpful in this clients treatment. Explaining that a limb salvage procedure will extend life
does not address the clients psychosocial needs. Referrals may be necessary, but the nurse should assess first.
Reinforcing physical therapy is also helpful but again does not address the psychosocial needs of the client.

Question 13

A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What
explanation by the nurse is best?
a. Your feet have less blood flow, so healing is slower.
b. The bones in your feet are hard to operate on.
c. The surrounding bones and tissue are damaged.
d. Your feet bear weight so they never really heal.

Answer 13

ANS: A
The feet are the most distal to the heart and receive less blood flow than other organs and tissues, prolonging
the healing time after surgery. The other explanations are not correct.

Question 14

14. A client has scoliosis with a 65-degree curve to the spine. What action by the nurse takes priority?
    a. Allow the client to rest in a position of comfort.
    b. Assess the clients cardiac and respiratory systems.
    c. Assist the client with ambulating and position changes.
    d. Position the client on one side propped with pillows.

Answer 14

ANS: B
This degree of curvature of the spine affects cardiac and respiratory function. The nurses priority is to assess
those systems. Positioning is up to the client. The client may or may not need assistance with movement.

Question 15

15. A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first?
    a. Client taking calcium with vitamin D (Os-Cal) who reports flank pain 2 weeks ago
    b. Client taking ibandronate (Boniva) who cannot remember when the last dose was
    c. Client taking raloxifene (Evista) who reports unilateral calf swelling
    d. Client taking risedronate (Actonel) who reports occasional dyspepsia

Answer 15

ANS: C
The client on raloxifene needs to be seen first because of the manifestations of deep vein thrombosis, which is
an adverse effect of raloxifene. The client with flank pain may have had a kidney stone but is not acutely ill
now. The client who cannot remember taking the last dose of ibandronate can be seen last. The client on
risedronate may need to change medications.

Question 16

16. What information does the nurse teach a womens group about osteoporosis?
    a. For 5 years after menopause you lose 2% of bone mass yearly.
    b. Men actually have higher rates of the disease but are underdiagnosed.
    c. There is no way to prevent or slow osteoporosis after menopause.
    d. Women and men have an equal chance of getting osteoporosis.

Answer 16

ANS: A
For the first 5 years after menopause, women lose about 2% of their bone mass each year. Men have a slower
loss of bone after the age of 75. Many treatments are now available for women to slow osteoporosis after
menopause.

Question 17

17. A client with osteoporosis is going home, where the client lives alone. What action by the nurse is best?
    a. Arrange a home safety evaluation.
    b. Ensure the client has a walker at home.
    c. Help the client look into assisted living.
    d. Refer the client to Meals on Wheels.

Answer 17

ANS: A
This client has several risk factors that place him or her at a high risk for falling. The nurse should consult
social work or home health care to conduct a home safety evaluation. The other options may or may not be
needed based upon the clients condition at discharge.

Question 18

18. A client is scheduled for a bone biopsy. What action by the nurse takes priority?
    a. Administering the preoperative medications
    b. Answering any questions about the procedure
    c. Ensuring that informed consent is on the chart
    d. Showing the clients family where to wait

Answer 18

ANS: C
The priority is to ensure that informed consent is on the chart. The preoperative medications should not be
administered until the nurse is confident the procedure will occur and the client has already signed the consent,
if the medications include anxiolytics or sedatives or opioids. The provider should answer questions about the
procedure. The nurse does show the family where to wait, but this is not the priority and could be delegated.

Question 19

19. A client is admitted with a large draining wound on the leg. What action does the nurse take first?
    a. Administer ordered antibiotics.
    b. Insert an intravenous line.
    c. Give pain medications if needed.
    d. Obtain cultures of the leg wound.

Answer 19

ANS: D
The nurse first obtains wound cultures prior to administering broad-spectrum antibiotics. The nurse would
need to start the IV prior to giving the antibiotics as they will most likely be parenteral. Pain should be treated
but that is not the priority.

Question 20

20. A client has an ingrown toenail. About what self-management measure does the nurse teach the client?
    a. Long-term antibiotic use
    b. Shoe padding
    c. Toenail trimming
    d. Warm moist soaks

Answer 20

ANS: D
Treatment of an ingrown toenail includes a podiatrist clipping away the ingrown part of the nail, warm moist
soaks, and antibiotic ointment if needed. Antibiotics are not used long-term. Padding the shoes will not treat or
prevent ingrown toenails. Clients should not attempt to trim ingrown nails themselves.

Question 21

A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to
inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply.)
a. Alcohol
b. Caffeine
c. Fat
d. Carbonated beverages
e. Vitamin D

Answer 21

ANS: A, B, D, E
Dietary components that affect the development of osteoporosis include alcohol, caffeine, high phosphorus
intake, carbonated beverages, and vitamin D. Tobacco is also a contributing lifestyle factor. Fat intake does not
contribute to osteoporosis.

Question 22

A nurse is providing education to a community womens group about lifestyle changes helpful in preventing

osteoporosis. What topics does the nurse cover? (Select all that apply.)
a. Cut down on tobacco product use.
b. Limit alcohol to two drinks a day.
c. Strengthening exercises are important.
d. Take recommended calcium and vitamin D.
e. Walk 30 minutes at least 3 times a week.

Answer 22

ANS: C, D, E
Lifestyle changes can be made to decrease the occurrence of osteoporosis and include strengthening and
weight-bearing exercises and getting the recommended amounts of both calcium and vitamin D. Tobacco
should be totally avoided. Women should not have more than one drink per day.

Question 23

A client with Pagets disease is hospitalized for an unrelated issue. The client reports pain and it is not yet
time for more medication. What comfort measures can the nurse delegate to the unlicensed assistive personnel
(UAP)? (Select all that apply.)
a. Administering ibuprofen (Motrin)
b. Applying a heating pad
c. Providing a massage
d. Referring the client to a support group
e. Using a bed cradle to lift sheets off the feet

Answer 23

ANS: B, C
Comfort measures for Pagets disease include heat and massage. Administering medications and referrals are
done by the nurse. A bed cradle is not necessary.

Question 24

A client with chronic osteomyelitis is being discharged from the hospital. What information is important for
the nurse to teach this client and family? (Select all that apply.)
a. Adherence to the antibiotic regimen
b. Correct intramuscular injection technique
c. Eating high-protein and high-carbohydrate foods
d. Keeping daily follow-up appointments
e. Proper use of the intravenous equipment

Answer 24

ANS: A, C, E
The client going home with chronic osteomyelitis will need long-term antibiotic therapyfirst intravenous, then
oral. The client needs education on how to properly administer IV antibiotics, care for the IV line, adhere to the
regimen, and eat a healthy diet to encourage wound healing. The antibiotics are not given by IM injection. The
client does not need daily follow-up.

Question 25

A client is admitted with a bone tumor. The nurse finds the client weak and lethargic with decreased deep
tendon reflexes. What actions by the nurse are best? (Select all that apply.)
a. Assess the daily serum calcium level.
b. Consult the provider about a loop diuretic.
c. Institute seizure precautions for the client.
d. Instruct the client to call for help out of bed.
e. Place the client on a 1500-mL fluid restriction.

Answer 25

ANS: A, B, D
The client is exhibiting manifestations of possible hypercalcemia. This disorder is treated with increased fluids
and loop diuretics. The nurse should assess the calcium level, consult with the provider, and instruct the client
to call for help getting out of bed due to possible fractures and weakness. The client does not need seizure
precautions or fluid restrictions.

Question 26

The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form
of the disease? (Select all that apply.)
a. Draining sinus tracts
b. High fevers
c. Presence of foot ulcers
d. Swelling and redness
e. Tenderness or pain

Answer 26

ANS: A, C
Draining sinus tracts and foot ulcers are seen in chronic osteomyelitis. High fever, swelling, and redness are
more often seen in acute osteomyelitis. Pain or tenderness can be in either case.

Question 27

The nurse studying osteoporosis learns that which drugs can cause this disorder? (Select all that apply.)

a. Antianxiety agents
b. Antibiotics
c. Barbiturates
d. Corticosteroids
e. Loop diuretics

Answer 27

ANS: C, D, E
Several classes of drugs can cause secondary osteoporosis, including barbiturates, corticosteroids, and loop
diuretics. Antianxiety agents and antibiotics are not associated with the formation of osteoporosis.

Question 28

A client is suspected to have muscular dystrophy. About what diagnostic testing does the nurse educate the
client? (Select all that apply.)
a. Electromyography
b. Muscle biopsy
c. Nerve conduction studies
d. Serum aldolase
e. Serum creatinine kinase

Answer 28

ANS: A, B, D, E
Diagnostic testing for muscular dystrophy includes electromyography, muscle biopsy, serum aldolase and
creatinine kinase levels. Nerve conduction is not related to this disorder.

Question 29

A nurse assesses a client with a fracture who is being treated with skeletal traction. Which assessment
should alert the nurse to urgently contact the health provider?
a. Blood pressure increases to 130/86 mm Hg
b. Traction weights are resting on the floor
c. Oozing of clear fluid is noted at the pin site
d. Capillary refill is less than 3 seconds

Answer 29

ANS: B
The immediate action of the nurse should be to reapply the weights to give traction to the fracture. The health
care provider must be notified that the weights were lying on the floor, and the client should be realigned in
bed. The clients blood pressure is slightly elevated; this could be related to pain and muscle spasms resulting
from lack of pressure to reduce the fracture. Oozing of clear fluid is normal, as is the capillary refill time.

Question 30

A nurse coordinates care for a client with a wet plaster cast. Which statement should the nurse include when
delegating care for this client to an unlicensed assistive personnel (UAP)?
a. Assess distal pulses for potential compartment syndrome.
b. Turn the client every 3 to 4 hours to promote cast drying.
c. Use a cloth-covered pillow to elevate the clients leg.
d. Handle the cast with your fingertips to prevent indentations.

Answer 30

ANS: C
When delegating care to a UAP for a client with a wet plaster cast, the UAP should be directed to ensure that
the extremity is elevated on a cloth pillow instead of a plastic pillow to promote drying. The client should be
assessed for impaired arterial circulation, a complication of compartment syndrome; however, the nurse should
not delegate assessments to a UAP. The client should be turned every 1 to 2 hours to allow air to circulate and
dry all parts of the cast. Providers should handle the cast with the palms of the hands to prevent indentations.

Question 31

A nurse obtains the health history of a client with a fractured femur. Which factor identified in the clients
history should the nurse recognize as an aspect that may impede healing of the fracture?
a. Sedentary lifestyle
b. A 30pack-year smoking history
c. Prescribed oral contraceptives
d. Pagets disease

Answer 31

ANS: D
Pagets disease and bone cancer can cause pathologic fractures such as a fractured femur that do not achieve
total healing. The other factors do not impede healing but may cause other health risks.

Question 32

4. An emergency department nurse cares for a client who sustained a crush injury to the right lower leg. The
   client reports numbness and tingling in the affected leg. Which action should the nurse take first?
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   a. Assess the pedal pulses.
   b. Apply oxygen by nasal cannula.
   c. Increase the IV flow rate.
   d. Loosen the traction.

Answer 32

ANS: A
These symptoms represent early warning signs of acute compartment syndrome. In acute compartment
syndrome, sensory deficits such as paresthesias precede changes in vascular or motor signs. If the nurse finds a
decrease in pedal pulses, the health care provider should be notified as soon as possible. Vital signs need to be
obtained to determine if oxygen and intravenous fluids are necessary. Traction, if implemented, should never
be loosened without a providers prescription.

Question 33

A nurse assesses an older adult client who was admitted 2 days ago with a fractured hip. The nurse notes
that the client is confused and restless. The clients vital signs are heart rate 98 beats/min, respiratory rate 32
breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%. Which action should the nurse take first?
a. Administer oxygen via nasal cannula.
b. Re-position to a high-Fowlers position.
c. Increase the intravenous flow rate.
d. Assess response to pain medications.

Answer 33

ANS: A
The client is at high risk for a fat embolism and has some of the clinical manifestations of altered mental status
and dyspnea. Although this is a life-threatening emergency, the nurse should take the time to administer
oxygen first and then notify the health care provider. Oxygen administration can reduce the risk for cerebral
damage from hypoxia. The nurse would not restrain a client who is confused without further assessment and
orders. Sitting the client in a high-Fowlers position will not decrease hypoxia related to a fat embolism. The IV
rate is not related. Pain medication most likely would not cause the client to be restless.

Question 34

A trauma nurse cares for several clients with fractures. Which client should the nurse identify as at highest
risk for developing deep vein thrombosis?
a. An 18-year-old male athlete with a fractured clavicle
b. A 36-year old female with type 2 diabetes and fractured ribs
c. A 55-year-old woman prescribed aspirin for rheumatoid arthritis
d. A 74-year-old man who smokes and has a fractured pelvis

Answer 34

ANS: D
Deep vein thrombosis (DVT) as a complication with bone fractures occurs more often when fractures are
sustained in the lower extremities and the client has additional risk factors for thrombus formation. Other risk
factors include obesity, smoking, oral contraceptives, previous thrombus events, advanced age, venous stasis,
and heart disease. The other clients do not have risk factors for DVT.

Question 35

A nurse delegates care of a client in traction to an unlicensed assistive personnel (UAP). Which statement
should the nurse include when delegating hygiene care for this client?
a. Remove the traction when re-positioning the client.
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b. Inspect the clients skin when performing a bed bath.
c. Provide pin care by using alcohol wipes to clean the sites.
d. Ensure that the weights remain freely hanging at all times.

Answer 35

ANS: D
Traction weights should be freely hanging at all times. They should not be lifted manually or allowed to rest on
the floor. The client should remain in traction during hygiene activities. The nurse should assess the clients
skin and provide pin and wound care for a client who is in traction; this should not be delegated to the UAP.

Question 36

A nurse notes crepitation when performing range-of-motion exercises on a client with a fractured left

humerus. Which action should the nurse take next?
a. Immobilize the left arm.
b. Assess the clients distal pulse.
c. Monitor for signs of infection.
d. Administer prescribed steroids.

Answer 36

ANS: A
A grating sound heard when the affected part is moved is known as crepitation. This sound is created by bone
fragments. Because bone fragments may be present, the nurse should immobilize the clients arm and tell the
client not to move the arm. The grating sound does not indicate circulation impairment or infection. Steroids
would not be indicated.

Question 37

A nurse reviews prescriptions for an 82-year-old client with a fractured left hip. Which prescription should
alert the nurse to contact the provider and express concerns for client safety?
a. Meperidine (Demerol) 50 mg IV every 4 hours
b. Patient-controlled analgesia (PCA) with morphine sulfate
c. Percocet 2 tablets orally every 6 hours PRN for pain
d. Ibuprofen elixir every 8 hours for first 2 days

Answer 37

ANS: A
Meperidine (Demerol) should not be used for older adults because it has toxic metabolites that can cause
seizures. The nurse should question this prescription. The other prescriptions are appropriate for this clients
pain management.

Question 38

A nurse is caring for a client who is recovering from an above-the-knee amputation. The client reports pain
in the limb that was removed. How should the nurse respond?
a. The pain you are feeling does not actually exist.
b. This type of pain is common and will eventually go away.
c. Would you like to learn how to use imagery to minimize your pain?
d. How would you describe the pain that you are feeling?

Answer 38

ANS: D
The nurse should ask the client to rate the pain on a scale of 0 to 10 and describe how the pain feels. Although
phantom limb pain is common, the nurse should not minimize the pain that the client is experiencing by stating
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that it does not exist or will eventually go away. Antiepileptic drugs and antispasmodics are used to treat
neurologic pain and muscle spasms after amputation. Although imagery may assist the client, the nurse must
assess the clients pain before determining the best action.

Question 39

A home health nurse assesses a client with diabetes who has a new cast on the arm. The nurse notes the
clients fingers are pale, cool, and slightly swollen. Which action should the nurse take first?
a. Raise the arm above the level of the heart.
b. Encourage range of motion.
c. Apply heat to the affected hand.
d. Bivalve the cast to decrease pressure.

Answer 39

ANS: A
Arm casts can impair circulation when the arm is in the dependent position. The nurse should immediately
elevate the arm above the level of the heart, ensuring that the hand is above the elbow, and should re-assess the
extremity in 15 minutes. If the fingers are warmer and less swollen, the cast is not too tight and adjustments do
not need to be made, but a sling should be worn when the client is upright. Encouraging range of motion would
not assist the client as much as elevating the arm. Heat would cause increased edema and should not be used. If
the cast is confirmed to be too tight, it could be bivalved.

Question 40

A nurse cares for a client who had a wrist cast applied 3 days ago. The client states, The cast is loose
enough to slide off. How should the nurse respond?
a. Keep your arm above the level of your heart.
b. As your muscles atrophy, the cast is expected to loosen.
c. I will wrap a bandage around the cast to prevent it from slipping.
d. You need a new cast now that the swelling is decreased.

Answer 40

ANS: D
Often the surrounding soft tissues may be swollen considerably when the cast is initially applied. After the
swelling has resolved, if the cast is loose enough to permit two or more fingers between the cast and the clients
skin, the cast needs to be replaced. Elevating the arm will not solve the problem, and the clients muscles should
not atrophy while in a cast for 6 weeks or less. An elastic bandage will not prevent slippage of the cast.

Question 41

A nurse assesses a client with a pelvic fracture. Which assessment finding should the nurse identify as a
complication of this injury?
a. Hypertension
b. Constipation
c. Infection
d. Hematuria

Answer 41

ANS: D
The pelvis is very vascular and close to major organs. Injury to the pelvis can cause integral damage that may
manifest as blood in the urine (hematuria) or stool. The nurse should also assess for signs of hemorrhage and
hypovolemic shock, which include hypotension and tachycardia. Constipation and infection are not
complications of a pelvic fracture.

Question 42

A nurse cares for a client placed in skeletal traction. The client asks, What is the primary purpose of this
type of traction? How should the nurse respond?
a. Skeletal traction will assist in realigning your fractured bone.
b. This treatment will prevent future complications and back pain.
c. Traction decreases muscle spasms that occur with a fracture.
d. This type of traction minimizes damage as a result of fracture treatment.

Answer 42

ANS: A
Skeletal traction pins or screws are surgically inserted into the bone to aid in bone alignment. As a last resort,
traction can be used to relieve pain, decrease muscle spasm, and prevent or correct deformity and tissue
damage. These are not primary purposes of skeletal traction.

Question 43

A nurse cares for a client in skeletal traction. The nurse notes that the skin around the clients pin sites is
swollen, red, and crusty with dried drainage. Which action should the nurse take next?
a. Request a prescription to decrease the traction weight.
b. Apply an antibiotic ointment and a clean dressing.
c. Cleanse the area, scrubbing off the crusty areas.
d. Obtain a prescription to culture the drainage.

Answer 43

ANS: D
These clinical manifestations indicate inflammation and possible infection. Infected pin sites can lead to
osteomyelitis and should be treated immediately. The nurse should obtain a culture and assess vital signs. The
provider should be notified. By decreasing the traction weight, applying a new dressing, or cleansing the area,
the infection cannot be significantly treated.

Question 44

A nurse cares for a client recovering from an above-the-knee amputation of the right leg. The client reports
pain in the right foot. Which prescribed medication should the nurse administer first?
a. Intravenous morphine
b. Oral acetaminophen
c. Intravenous calcitonin
d. Oral ibuprofen

Answer 44

ANS: C
The client is experiencing phantom limb pain, which usually manifests as intense burning, crushing, or
cramping. IV infusions of calcitonin during the week after amputation can reduce phantom limb pain. Opioid
analgesics such as morphine are not as effective for phantom limb pain as they are for residual limb pain. Oral
acetaminophen and ibuprofen are not used in treating phantom limb pain.

Question 45

A nurse plans care for a client who is recovering from a below-the-knee amputation of the left leg. Which
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intervention should the nurse include in this clients plan of care?
a. Place pillows between the clients knees.
b. Encourage range-of-motion exercises.
c. Administer prophylactic antibiotics.
d. Implement strict bedrest in a supine position.

Answer 45

ANS: B
Clients with a below-the-knee amputation should complete range-of-motion exercises to prevent flexion
contractions and prepare for a prosthesis. A pillow may be used under the limb as support. Clients recovering
from this type of amputation are at low risk for infection and should not be prescribed prophylactic antibiotics.
The client should be encouraged to re-position, move, and exercise frequently, and therefore should not be
restricted to bedrest.

Question 46

An emergency department nurse triages a client with diabetes mellitus who has fractured her arm. Which
action should the nurse take first?
a. Remove the medical alert bracelet from the fractured arm.
b. Immobilize the arm by splinting the fractured site.
c. Place the client in a supine position with a warm blanket.
d. Cover any open areas with a sterile dressing.

Answer 46

ANS: A
A clients medical alert bracelet should be removed from the fractured arm before the affected extremity swells.
Immobilization, positioning, and dressing should occur after the bracelet is removed.

Question 47

A nurse assesses a client with a rotator cuff injury. Which finding should the nurse expect to assess?

a. Inability to maintain adduction of the affected arm for more than 30 seconds
b. Shoulder pain that is relieved with overhead stretches and at night
c. Inability to initiate or maintain abduction of the affected arm at the shoulder
d. Referred pain to the shoulder and arm opposite the affected shoulder

Answer 47

ANS: C
Clients with a rotator cuff tear are unable to initiate or maintain abduction of the affected arm at the shoulder.
This is known as the drop arm test. The client should not have difficulty with adduction of the arm, nor
experience referred pain to the opposite shoulder. Pain is usually more intense at night and with overhead
activities.

Question 48

A nurse cares for a client with a fractured fibula. Which assessment should alert the nurse to take
immediate action?
a. Pain of 4 on a scale of 0 to 10
b. Numbness in the extremity
c. Swollen extremity at the injury site
d. Feeling cold while lying in bed

Answer 48

ANS: B
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 429
The client with numbness and/or tingling of the extremity may be displaying the first signs of acute
compartment syndrome. This is an acute problem that requires immediate intervention because of possible
decreased circulation. Moderate pain and swelling is an expected assessment after a fracture. These findings
can be treated with comfort measures. Being cold can be treated with additional blankets or by increasing the
temperature of the room.

Question 49

After teaching a client with a fractured humerus, the nurse assesses the clients understanding. Which
dietary choice demonstrates that the client correctly understands the nutrition needed to assist in healing the
fracture?
a. Baked fish with orange juice and a vitamin D supplement
b. Bacon, lettuce, and tomato sandwich with a vitamin B supplement
c. Vegetable lasagna with a green salad and a vitamin A supplement
d. Roast beef with low-fat milk and a vitamin C supplement

Answer 49

ANS: D
The client with a healing fracture needs supplements of vitamins B and C and a high-protein, high-calorie diet.
Milk for calcium supplementation and vitamin C supplementation are appropriate. Meat would increase
protein in the diet that is necessary for bone healing. Fish, a sandwich, and vegetable lasagna would provide
less protein.

Question 50

A nurse cares for an older adult client with multiple fractures. Which action should the nurse take to
manage this clients pain?
a. Meperidine (Demerol) injections every 4 hours around the clock
b. Patient-controlled analgesia (PCA) pump with morphine
c. Ibuprofen (Motrin) 600 mg orally every 4 hours PRN for pain
d. Morphine 4 mg intravenous push every 2 hours PRN for pain

Answer 50

ANS: B
The older adult client should never be treated with meperidine because toxic metabolites can cause seizures.
The client should be managed with a PCA pump to control pain best. Motrin most likely would not provide
complete pain relief with multiple fractures. IV morphine PRN would not control pain as well as a pump that
the client can control.

Question 51

A phone triage nurse speaks with a client who has an arm cast. The client states, My arm feels really tight
and puffy. How should the nurse respond?
a. Elevate your arm on two pillows and get ice to apply to the cast.
b. Continue to take ibuprofen (Motrin) until the swelling subsides.
c. This is normal. A new cast will often feel a little tight for the first few days.
d. Please come to the clinic today to have your arm checked by the provider.

Answer 51

ANS: D
Puffy fingers and a feeling of tightness from the cast may indicate the development of compartment syndrome.
The client should come to the clinic that day to be evaluated by the provider because delay of treatment can
cause permanent damage to the extremity. Ice and ibuprofen are acceptable actions, but checking the cast is the
priority because it ensures client safety. The nurse should not reassure the client that this is normal.

Question 52

24. A nurse cares for a client who had a long-leg cast applied last week. The client states, I cannot seem to
    catch my breath and I feel a bit light-headed. Which action should the nurse take next?
    a. Auscultate the clients lung fields anteriorly and posteriorly.
    b. Administer oxygen to keep saturations greater than 92%.
    c. Check the clients blood glucose level.
    d. Ask the client to take deep breaths.

Answer 52

ANS: B
The clients symptoms are consistent with the development of pulmonary embolism caused by leg immobility
in the long cast. The nurse should check the clients pulse oximetry reading and provide oxygen to keep
saturations greater than 92%. Auscultating lung fields, checking blood glucose level, or deep breathing will not
assist this client.

Question 53

25. A nurse cares for an older adult client who is recovering from a leg amputation surgery. The client states, I
    dont want to live with only one leg. I should have died during the surgery. How should the nurse respond?
    a. Your vital signs are good, and you are doing just fine right now.
    b. Your children are waiting outside. Do you want them to grow up without a father?
    c. This is a big change for you. What support system do you have to help you cope?
    d. You will be able to do some of the same things as before you became disabled.

Answer 53

ANS: C
The client feels like less of a person following the amputation. The nurse should help the client to identify
coping mechanisms that have worked in the past and current support systems to assist the client with coping.
The nurse should not ignore the clients feelings by focusing on vital signs. The nurse should not try to make
the client feel guilty by alluding to family members. The nurse should not refer to the client as being disabled
as this labels the client and may fuel the clients poor body image.

Question 54

After teaching a client who is recovering from a vertebroplasty, the nurse assesses the clients

understanding. Which statement by the client indicates a need for additional teaching?
a. I can drive myself home after the procedure.
b. I will monitor the puncture site for signs of infection.
c. I can start walking tomorrow and increase my activity slowly.
d. I will remove the dressing the day after discharge.

Answer 54

ANS: A
Before discharge, a client who has a vertebroplasty should be taught to avoid driving or operating machinery
for the first 24 hours. The client should monitor the puncture site for signs of infection. Usual activities can
resume slowly, including walking and slowly increasing activity over the next few days. The client should keep
the dressing dry and remove it the next day.

Question 55

A nurse plans care for a client who is prescribed skeletal traction. Which intervention should the nurse
include in this plan of care to decrease the clients risk for infection?
a. Wash the traction lines and sockets once a day.
b. Release traction tension for 30 minutes twice a day.
c. Do not place the traction weights on the floor.
d. Schedule for pin care to be provided every shift.

Answer 55

ANS: D
To decrease the risk for infection in a client with skeletal traction of external fixation, the nurse should provide
routine pin care and assess manifestations of infection at the pin sites every shift. The traction lines and sockets
are external and do not come in contact with the clients skin; these do not need to be washed. Although traction
weights should not be removed or released for any period of time without a prescription, or placed on the floor,
this does not decrease the risk for infection.

Question 56

A nurse teaches a client with a fractured tibia about external fixation. Which advantages of external fixation
for the immobilization of fractures should the nurse share with the client? (Select all that apply.)
a. It leads to minimal blood loss.
b. It allows for early ambulation.
c. It decreases the risk of infection.
d. It increases blood supply to tissues.
e. It promotes healing.

Answer 56

ANS: A, B, E
External fixation is a system in which pins or wires are inserted through the skin and bone and then connected
to a ridged external frame. With external fixation, blood loss is less than with internal fixation, but the risk for
infection is much higher. The device allows early ambulation and exercise, maintains alignment, stabilizes the
fracture site, and promotes healing. The device does not increase blood supply to the tissues. The nurse should
assess for distal circulation, movement, and sensation, which can be disturbed by fracture injuries and
treatments.

Question 57

An emergency nurse assesses a client who is admitted with a pelvic fracture. Which assessments should the
nurse monitor to prevent a complication of this injury? (Select all that apply.)
a. Temperature
b. Urinary output
c. Blood pressure
d. Pupil reaction
e. Skin color

Answer 57

ANS: B, C, E
With a pelvic fracture, internal organ damage may result in bleeding and hypovolemic shock. The nurse
monitors the clients heart rate, blood pressure, urine output, skin color, and level of consciousness frequently to
determine whether shock is manifesting. It is important to monitor the urine for blood to assess whether the
urinary system has been damaged with the pelvic fracture. Changes in temperature and pupil reactions are not
directly associated with hypovolemic shock. Temperature changes are usually associated with hypo- or
hyperthermia or infectious processes. Pupillary changes occur with brain injuries, bleeds, or neurovascular
accidents.

Question 58

A nurse cares for a client with a fracture injury. Twenty minutes after an opioid pain medication is
administered, the client reports pain in the site of the fracture. Which actions should the nurse take? (Select all
that apply.)
a. Administer additional opioids as prescribed.
b. Elevate the extremity on pillows.
c. Apply ice to the fracture site.
d. Place a heating pad at the site of the injury.
e. Keep the extremity in a dependent position.

Answer 58

ANS: A, B, C
The client with a new fracture likely has edema; elevating the extremity and applying ice probably will help in
decreasing pain. Administration of an additional opioid within the dosage guidelines may be ordered. Heat will
increase edema and may increase pain. Dependent positioning will also increase edema.

Question 59

A nurse plans care for a client who is recovering from open reduction and internal fixation (ORIF) surgery
for a right hip fracture. Which interventions should the nurse include in this clients plan of care? (Select all that
apply.)
a. Elevate heels off the bed with a pillow.
b. Ambulate the client on the first postoperative day.
c. Push the clients patient-controlled analgesia button.
d. Re-position the client every 2 hours.
e. Use pillows to encourage subluxation of the hip.

Answer 59

ANS: A, B, D
Postoperative care for a client who has ORIF of the hip includes elevating the clients heels off the bed and repositioning
every 2 hours to prevent pressure and skin breakdown. It also includes ambulating the client on the
first postoperative day, and using pillows or an abduction pillow to prevent subluxation of the hip. The nurse
should teach the client to use the patient-controlled analgesia pump, but the nurse should never push the button
for the client.

Question 60

A nurse assesses a client with a cast for potential compartment syndrome. Which clinical manifestations are
correctly paired with the physiologic changes of compartment syndrome? (Select all that apply.)
a. Edema Increased capillary permeability
b. Pallor Increased blood blow to the area
c. Unequal pulses Increased production of lactic acid
d. Cyanosis Anaerobic metabolism
e. Tingling A release of histamine

Answer 60

ANS: A, C, D
Clinical manifestations of compartment syndrome are caused by several physiologic changes. Edema is caused
by increased capillary permeability, release of histamine, decreased tissue perfusion, and vasodilation. Unequal
pulses are caused by an increased production of lactic acid. Cyanosis is caused by anaerobic metabolism.
Pallor is caused by decreased oxygen to tissues, and tingling is caused by increased tissue pressure.

Question 61

A nurse teaches a client who is at risk for carpal tunnel syndrome. Which health promotion activities should
the nurse include in this clients teaching? (Select all that apply.)
a. Frequently assess the ergonomics of the equipment being used.
b. Take breaks to stretch fingers and wrists during working hours.
c. Do not participate in activities that require repetitive actions.
d. Take ibuprofen (Motrin) to decrease pain and swelling in wrists.
e. Adjust chair height to allow for good posture.

Answer 61

ANS: A, B, E
Health promotion activities to prevent carpal tunnel syndrome include assessing the ergonomics of the
equipment being used, taking breaks to stretch fingers and wrists during working hours, and adjusting chair
height to allow for good posture. The client should be allowed to participate in activities that require repetitive
actions as long as precautions are taken to promote health. Pain medications are not part of health promotion
activities.

Question 62

A nurse teaches a client about prosthesis care after amputation. Which statements should the nurse include
in this clients teaching? (Select all that apply.)
a. The device has been custom made specifically for you.
b. Your prosthetic is good for work but not for exercising.
c. A prosthetist will clean your inserts for you each month.
d. Make sure that you wear the correct liners with your prosthetic.
e. I have scheduled a follow-up appointment for you.

Answer 62

ANS: A, D, E
A client with a new prosthetic should be taught that the prosthetic device is custom made for the client, taking
into account the clients level of amputation, lifestyle (including exercise preferences), and occupation. In
collaboration with a prosthetist, the client should be taught proper techniques for cleansing the sockets and
inserts, wearing the correct liners, and assessing shoe wear. Follow-up care and appointments are important for
ongoing assessment.