Maternal Musculoskeletal

Question 1

Which statement is accurate concerning a child’s musculoskeletal system and how it may be different from an adult’s?

a. Growth occurs in children as a result of an increase in the number of muscle fibers.
b. Infants are at greater risk for fractures because their epiphyseal plates are not fused.
c. Because soft tissues are resilient in children, dislocations and sprains are less common than in adults.
d. Their bones have less blood flow.

Answer 1

ANS: C
Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. A child’s growth occurs because of an increase in size rather than an increase in the number of the muscle fibers. Fractures in children younger than 1 year are unusual because a large amount of force is necessary to fracture their bones. A child’s bones have greater blood flow than an adult’s bones.

Question 2

When infants are seen for fractures, which nursing intervention is a priority?

a. No intervention is necessary. It is not uncommon for infants to fracture bones.
b. Assess the family’s safety practices. Fractures in infants usually result from falls.
c. Assess for child abuse. Fractures in infants are often nonaccidental.
d. Assess for genetic factors.

Answer 2

ANS: C
Fractures in infants warrant further investigation to rule out child abuse. Fractures in children younger than 1 year are unusual because of the cartilaginous quality of the skeleton; a large amount of force is necessary to fracture their bones. Safety practices are important to assess as well, but the priority is checking for child abuse. Genetic factors are a rare cause of fractures.

Question 3

Which nursing intervention is appropriate to assess for neurovascular competency in a child who fell off the monkey bars at school and hurt his arm?

a. The degree of motion and ability to position the extremity
b. The length, diameter, and shape of the extremity
c. The amount of swelling noted in the extremity and pain intensity
d. The skin color, temperature, movement, sensation, and capillary refill of the extremity

Answer 3

ANS: D
A neurovascular evaluation includes assessing skin color and temperature, ability to move the affected extremity, degree of sensation experienced, and speed of capillary refill in the extremity. The degree of motion in the affected extremity and ability to position the extremity are incomplete assessments of neurovascular competency. The length, diameter, and shape of the extremity are not assessment criteria in a neurovascular evaluation. Although the amount of swelling is an important factor in assessing an extremity, it is not a criterion for a neurovascular assessment.

Question 4

A mother whose 7-year-old child has been placed in a cast for a fractured right arm reports that the child will not stop crying even after taking acetaminophen with codeine. The child also will not straighten the fingers on the right arm. What advice by the nurse is best?

a. Take the child to the emergency department.
b. Put ice on the injury.
c. Avoid letting the child get so tired.
d. Wait another hour; if the child is still crying, call back.

Answer 4

ANS: A
Unrelieved pain and the child’s inability to extend his fingers are signs of compartment syndrome, which requires immediate attention. Placing ice on the extremity is an inappropriate action for the symptoms. Telling the mother not to let her child get tired is an inappropriate response to a concern. A child who has signs and symptoms of compartment syndrome should be seen immediately. Waiting an hour could compromise the recovery of the child.

Question 5

A 4-year-old child with a long leg cast complains of “fire” in his cast. Which action by the nurse is most appropriate?

a. Notify the provider on his or her next rounds.
b. Note the complaint in the nurse’s notes.
c. Notify the provider immediately.
d. Report the complaint to the next nurse on duty.

Answer 5

ANS: C
A burning sensation under the cast is an indication of tissue ischemia. It may be an early indication of serious neurovascular compromise, such as compartment syndrome, that requires immediate attention. The child’s symptom requires immediate attention. Notifying the physician on the next rounds is inappropriate. Charting the complaint in the nurse’s notes is an appropriate action but not the priority. The priority action is to contact the provider. Communication across shifts is important to the continuing assessment of the child; however, this symptom requires immediate evaluation, and the provider should be contacted

Question 6

When a child with a musculoskeletal injury on the foot is assessed, what is most indicative of a fracture?

a. Increased swelling after the injury is iced
b. The presence of localized tenderness distal to the site
c. The presence of an elevated temperature for 24 hours
d. The inability of the child to bear weight

Answer 6

ANS: D
An inability to bear weight on the affected extremity is indicative of a more serious injury. With a fracture, general manifestations include pain or tenderness at the site, immobility or decreased range of motion, deformity of the extremity, edema, and inability to bear weight. Although edema is often present with a fracture, it would be unusual for swelling to increase after application of ice, and this would not be most indicative of a fracture. Swelling after icing does not identify the degree of the injury. Localized tenderness along with limited joint mobility may indicate serious injury, but inability to bear weight on the extremity is a more reliable sign. Tenderness is not a usual complaint distal to the affected site. Elevated temperature is associated with infection but not a fracture.

Question 7

A child with osteomyelitis asks the nurse, “What is a ‘sed’ rate?” What is the best response for the nurse?

a. “It tells us how you are responding to the treatment.”
b. “It tells us what type of antibiotic you need.”
c. “It tells us whether we need to immobilize your extremity.”
d. “It tells us how your nerves and muscles are doing.”

Answer 7

ANS: A
The erythrocyte sedimentation rate (ESR) indicates the presence of inflammation and infectious process and is one of the best indicators of the child’s response to treatment. Although the ESR indirectly identifies whether an antibiotic is needed, the organism involved dictates the type of antibiotic and the length of treatment. The ESR does not direct whether the extremity will be immobilized. An ESR rate will not evaluate neuromuscular status.

Question 8

Which instruction is part of the discharge plan for a school-age child with osteomyelitis who is receiving home antibiotic therapy?

a. Instructions for a low-calorie diet
b. Arrange for tutoring and school work
c. Instructions for a high-fiber diet
d. Instructions to return the child to school as soon as possible

Answer 8

ANS: B
Promoting optimal growth and development in the school-age child is important. It is important to continue school work and arrange for tutoring if indicated. The child with osteomyelitis is on a high-calorie, high-protein diet. A high-fiber diet may or may not be indicated. The bone must heal before the child returns to school.

Question 9

The nurse is assessing a 14-year-old who plays football and complains of knee pain when running and climbing stairs during football practice. The nurse should anticipate which action for this condition?

a. Bedrest with range-of-motion exercises
b. Prolonged IV antibiotics
c. Electromyography
d. NSAIDs or knee immobilizer

Answer 9

ANS: D
This child most likely has Osgood-Schlatter disease, a self-limiting disorder that resolves with skeletal maturity. NSAIDs and possible knee immobilizers are the treatment. Bedrest with range of motion in indicated for Legg-Calvé-Perthes disease. IV antibiotics are used in osteomyelitis. Electromyography is used to diagnose muscular dystrophy.

Question 10

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What should the nurse suggest to remove this material?

a. Wash the area with warm water and soap.
b. Vigorously scrub the leg.
c. Apply powder to absorb the material.
d. Carefully pick the material off the leg.

Answer 10

ANS: A
Washing with soap and warm water will remove the desquamated skin and secretions. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.

Question 11

Which factor is important to include in the teaching plan for parents of a child with Legg-Calvé-Perthes disease?

a. It is an acute illness lasting 1 to 2 weeks.
b. It affects primarily adolescents.
c. There is a disturbance in the blood supply to the femoral epiphysis.
d. It is caused by a virus.

Answer 11

ANS: C
Legg-Calvé-Perthes disease is a self-limiting disease that affects the blood supply to the femoral epiphysis. The most serious problem associated is the risk of permanent deformity. The disease process usually lasts between 1 and 2 years and is a disorder of growth. Legg-Calvé-Perthes disease is seen in children between 2 and 12 years of age. Most cases occur between 4 and 9 years of age. The etiology is unknown

Question 12

What is the major concern guiding treatment for the child with Legg-Calvé-Perthes disease?

a. Avoid permanent deformity.
b. Minimize pain.
c. Maintain normal activities.
d. Encourage new hobbies.

Answer 12

ANS: A
The major concern related to Legg-Calvé-Perthes disease is to prevent an arthritic process resulting from the flattening of the femoral head of the femur when it protrudes outside the acetabulum. The pain associated with Legg-Calvé-Perthes disease decreases with increased rest, making activity restriction an important factor for these children. The priority concern for treatment is to prevent deformity. In Legg-Calvé-Perthes disease, the major concern is to prevent deformity through decreased activity. Prevention of deformity is the major concern for children with Legg-Calvé-Perthes disease, and rest is a mandatory treatment. Selected hobbies that do not require physical activity are encouraged.

Question 13

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what response by the nurse is best?

a. Traction is tried first.
b. Surgical intervention is needed.
c. Frequent, serial casting is tried first.
d. Children outgrow this condition when they learn to walk.

Answer 13

ANS: C
Serial casting is begun shortly after birth before discharge from the nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention

Question 14

Discharge planning for the child with juvenile arthritis includes the need for

a. routine ophthalmologic examinations to assess for visual problems.
b. a low-calorie diet to decrease or control weight in the less mobile child.
c. avoiding the use of NSAIDs to decrease gastric irritation.
d. immobilizing the painful joints, which is the result of the inflammatory process.

Answer 14

ANS: A
The systemic effects of juvenile arthritis can result in visual problems, making routine eye examinations important. Children with juvenile arthritis do not have problems with increased weight and often are anorexic and in need of high-calorie diets. Children with arthritis are often treated with NSAIDs. Children with arthritis can immobilize their own joints. Range-of-motion exercises are important for maintaining joint flexibility and preventing restricted movement in the affected joints.

Question 15

During painful episodes of juvenile arthritis, a plan of care should include what nursing intervention?

a. A weight-control diet to decrease stress on the joints
b. Proper positioning of the affected joints to prevent musculoskeletal complications
c. Complete bed rest to decrease stress to joints
d. High-resistance exercises to maintain muscular tone in the affected joints

Answer 15

ANS: B
Proper positioning is important to support and protect affected joints. Isometric exercises and passive range-of-motion exercises will prevent contractures and deformities. Children in pain often are anorexic and need high-calorie foods. Children with juvenile arthritis need a combination of rest and exercise. Children with juvenile arthritis need to avoid high-resistance exercises, and they benefit from low-resistance exercises, such as swimming.

Question 16

When assessing a child for an upper extremity fracture, the nurse should know that these fractures most often result from

a. automobile crashes.
b. falls.
c. physical abuse.
d. sports injuries.

Answer 16

ANS: B
The major cause of children’s fractures is falls. Because of the protection reflexes, the outstretched arm often receives the full force of the fall. Crashes, physical abuse, and sports injuries can also occur but not as often

Question 17

In caring for a child with an open fracture, the nurse should carefully assess for

a. infection.
b. osteoarthritis.
c. epiphyseal disruption.
d. periosteum thickening.

Answer 17

ANS: A
Because the skin has been broken, the child is at risk for organisms to enter the wound. The incidence of osteoarthritis does not increase with an open fracture. The chance of epiphyseal disruption is not increased with an open fracture. Periosteum thickening is part of the healing process and not a complication

Question 18

A nurse is teaching parents the difference between pediatric fractures and adult fractures. Which observation is true about pediatric fractures?

a. They seldom are complete breaks.
b. They are often open fractures.
c. They are often at the epiphyseal plate.
d. They are often the result of decreased mobility of the bones.

Answer 18

ANS: A
Pediatric fractures seldom are complete breaks. Rather, children’s bones tend to bend or buckle. Open fractures and epiphyseal plate fractures are no more common than simple fractures in children. Increased mobility of the bones prevents children from having complete fractures.

Question 19

Patient and parent education for the child who has a synthetic cast should include which of the following?

a. Applying a heating pad to the cast if the child has swelling in the affected extremity
b. Wrapping the outer surface of the cast with an Ace bandage
c. Splitting the cast if the child complains of numbness or pain
d. Covering the cast with plastic and waterproof tape to keep it dry while bathing or showering

Answer 19

ANS: D
Damp skin is more susceptible to breakdown. Cast should be kept clean and dry. To prevent swelling, elevate the extremity and apply bagged ice to the casted area. Wrapping the outer surface with an Ace bandage is not indicated. If the child complains of numbness or pain, the child should return immediately to the clinic or emergency department for an evaluation of neurovascular status.

Question 20

A 6-year-old patient who has been placed in skeletal traction has pain, edema, and fever. The nurse should assess which of the following?

a. Neurologic status
b. Range of motion of all extremities
c. Warmth at site of pain
d. Blood pressure

Answer 20

ANS: C
The most serious complication of skeletal traction is osteomyelitis. Clinical manifestations include complaints of localized pain, swelling, warmth, tenderness, or unusual odor. An elevated temperature may accompany the symptoms. Assessing neurologic status is not required. Range of motion may or may not be affected with osteomyelitis, but this child is in skeletal traction so range of motion will be limited. Blood pressure is assessed with other vital signs.

Question 21

A boy who has fractured his forearm is unable to extend his fingers. The nurse knows that this

a. is normal following this type of injury.
b. may indicate compartment syndrome.
c. may indicate fat embolism.
d. may indicate damage to the epiphyseal plate.

Answer 21

ANS: B
Swelling causes pressure to rise within the immobilizing device leading to compartment syndrome. Signs include severe pain, often unrelieved by analgesics, and neurovascular impairment. It is not uncommon in the forearm, so the inability to extend the fingers may indicate compartment syndrome. This is not normal and indicates neurovascular compromise of some type. Paresthesia or numbness or loss of feeling can indicate a serious problem and can result in paralysis. The inability to extend the fingers often indicates neurovascular compromise. Fat embolism causes respiratory distress with hypoxia and respiratory acidosis. This is not related to damage to the epiphyseal plate.

Question 22

Which term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?

a. Scoliosis
b. Ankylosis
c. Lordosis
d. Kyphosis

Answer 22

ANS: D
Kyphosis is an abnormally increased convex angulation in the curve of the thoracic spine. Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. Ankylosis is the immobility of a joint. Lordosis is an accentuation of the cervical or lumbar curvature beyond physiologic limits

Question 23

When assessing the child with osteogenesis imperfecta, the nurse should expect to observe

a. discolored teeth.
b. below-normal intelligence.
c. increased muscle tone.
d. above-average stature.

Answer 23

ANS: A
Children with osteogenesis imperfecta have incomplete development of bones, teeth, ligaments, and sclerae. Teeth are discolored because of abnormal enamel. Despite their appearance, children with osteogenesis imperfecta have normal or above-normal intelligence. The child with osteogenesis imperfecta has weak muscles and decreased muscle tone. Because of compression fractures of the spine, the child appears short.

Question 24

A nurse knows that which exercise is best for a child with juvenile arthritis?

a. Jogging
b. Tennis
c. Gymnastics
d. Swimming

Answer 24

ANS: D
The warmth of the water (especially if the pool is heated), coupled with mild resistance, makes swimming the perfect medium for strengthening and range-of-motion exercises while protecting the joints. Jogging, tennis, and gymnastics jar the hip, knee, and ankle joints and can cause joint damage.

Question 25

Juvenile arthritis should be suspected in a child who exhibits

a. frequent fractures.
b. joint swelling and pain lasting longer than 6 weeks.
c. increased joint mobility.
d. lurching and abnormal gait with limited abduction.

Answer 25

ANS: B
Intermittent joint pain lasting longer than 6 weeks is indicative of juvenile arthritis. Frequent fractures are indicative of osteogenesis imperfecta. Lurching to the affected side and an abnormal gait and limited abduction are associated with developmental dysplasia of the hip (DDH).

Question 26

When providing education for the parents of a child with Duchenne muscular dystrophy, the nurse plans to include

a. testing all female children for the disease.
b. testing the father for the presence of the trait on the Y chromosome.
c. genetic counseling for all female children.
d. testing the parents to determine the carrier.

Answer 26

ANS: C
Duchenne muscular dystrophy is a recessive sex-linked disease carried on the X chromosome, so only males are affected with the disease. Because it is a recessive X-linked disorder, females can only be carriers and do not have the disease. The disease is an X-linked recessive disorder and would not be found on the Y chromosome. The disease is a recessive X-linked disease and is always carried by the mother.

Question 27

The nurse knows that treatment of Osgood-Schlatter disease includes

a. limitation of knee bending or kneeling.
b. increasing range of motion (ROM) of the knee.
c. encouraging flexion of the hip.
d. limitation of adduction of the hip.

Answer 27

ANS: A
Limitation of knee bending or kneeling provides pain control and allows the knees to heal. Increasing ROM of the knee increases pain and exacerbates the disease. Encouraging flexion of the hip will have no effect on the process affecting the knees. Limitation of hip adduction will not help the child with Osgood-Schlatter disease.

Question 28

What is the most appropriate intervention for an adolescent with a mild scoliosis?

a. Long-term monitoring
b. Surgical intervention
c. Bracing
d. No follow-up

Answer 28

ANS: A
The child with mild scoliosis requires long-term follow-up to determine whether the curve will progress or remain stable. Surgical intervention is not needed for mild scoliosis. Mild scoliosis is not braced if it is stable. Follow-up to monitor the curve is important until skeletal maturity has occurred

Question 29

Which statement by the mother of an adolescent being discharged after spinal fusion for severe scoliosis indicates the need for further teaching?

a. “I am glad we chose surgery. Now it is all over and done.”
b. “I’ll see you in a month; we’ll be back fairly regularly.”
c. “I have to pick up some more T-shirts on the way home.”
d. “Those exercises the physical therapist showed us were not too hard.”

Answer 29

ANS: A
Spinal fusion requires long-term follow-up to assess the stability of the spinal correction. The other statements show good understanding of discharge instructions.

Question 30

Which factor should the nurse include when teaching a parent about the care of a newborn in a Pavlik harness for hip dysplasia?

a. The harness may be removed with every diaper change.
b. The harness maintains the hips in flexion, abduction, and external rotation.
c. The harness is only the first step of treatment.
d. The harness is worn for 2 weeks.

Answer 30

ANS: B
The harness is used to maintain the infant’s hips in flexion and external rotation to allow the hips (femoral head and acetabulum) to mold and grow normally. The harness must be worn for 23 hours per day and should be removed only according to the physician’s recommendation. Hips that remain unstable become progressively more deformed as maturity takes place. With early diagnosis and treatment, the Pavlik harness is often the only treatment necessary. The length of treatment is determined by radiographic documentation of the maturity of the hips.

Question 31

A priority nursing intervention when caring for a child in a Pavlik harness is

a. skin care.
b. bowel function.
c. feeding patterns.
d. respiratory function.

Answer 31

ANS: A
The child in a Pavlik harness needs special attention to skin care because the infant’s skin is sensitive and the harness may cause irritation. The harness should not affect normal bowel function in the infant. Families are typically instructed on techniques for holding and feeding. The harness should not affect feeding patterns in the infant. The harness should not affect normal respiratory function in the infant

Question 32

During a well-child visit, the nurse identifies that an 18-month-old infant is bowlegged. What action by the nurse is most appropriate?

a. Assess the infant’s diet history.
b. Document the finding in the chart.
c. Facilitate a referral to an orthopedist.
d. Perform further assessment of the musculoskeletal system.

Answer 32

ANS: B

Bowlegs are common in infants and toddlers. The nurse only needs to document the findings. No other actions are required

Question 33

A nurse is assessing cranial nerve VII. How does the nurse perform this assessment?

a. Ask the child to smile or “show your teeth.”
b. Have the child shrug shoulders against resistance.
c. Tell the child to squeeze your hands hard.
d. Instruct the child to stick out the tongue.

Answer 33

ANS: A
Cranial nerve VII (facial nerve) is assessed by having the child smile. Shrugging the shoulders against resistance is testing cranial nerve XI (spinal accessory nerve). Squeezing the hands assesses grip strength. The ability to stick out the tongue shows that cranial nerve XII (hypoglossal) is intact

Question 34

A child has a cast applied to the left forearm. Which interventions should the nurse include in the home care instructions for the parents? (Select all that apply.)

a. Keep small toys away from the cast.
b. Use a padded ruler to scratch the skin under the cast if it itches.
c. Assess the cast daily for unusual odors.
d. Elevate the extremity on pillows for the first 24 to 48 hours.
e. Numbness and tingling in the extremity are expected.

Answer 34

ANS: A, C, D
Small toys should be kept away from the cast because they can become lodged inside the cast. The cast should be inspected daily for any unusual odors, which can indicate infection. The extremity should be elevated for the first 24 to 48 hours to decrease edema. Nothing should be placed inside the cast. If numbness or tingling is experienced, the physician should be notified.

Question 35

A child is in skeletal traction. Which interventions should the nurse implement to prevent complications of immobility? (Select all that apply.)

a. Reposition the child every 2 hours.
b. Avoid use of an egg-crate or sheepskin mattress.
c. Limit fluid intake.
d. Administer stool softeners as prescribed.
e. Encourage coughing and deep breathing.

Answer 35

ANS: A, D, E
Complications of immobility can affect the skin, the gastrointestinal system, and the respiratory system. The child should be repositioned every 2 hours to prevent skin breakdown. Stool softeners should be administered to avoid constipation, and the child should cough and deep breathe to maintain respiratory function. Egg-crate or sheepskin mattresses can be useful in preventing skin breakdown, and fluids should be increased to prevent constipation, not decreased.

Question 36

What actions should the nurse perform while caring for a school-age child who sprained his ankle playing football? (Select all that apply.)

a. Turn the child every 1 to 2 hours.
b. Assist with range-of-motion exercises every 2 hours.
c. Apply ice to the affected ankle.
d. Wrap the ankle with an ACE bandage.
e. Elevate the affected extremity.

Answer 36

ANS: C, D, E
The child with a soft tissue injury in the first 6 to 12 hours is treated by controlling the swelling and reducing muscle damage. The acronym RICE summarizes the care needed: rest, ice, compression, and elevation. During the acute phase of the injury, the child is not moved frequently, and range-of-motion exercises would not be done. The child with a soft tissue injury in the first 6 to 12 hours is treated by controlling the swelling and reducing muscle damage.

Question 37

A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the
nurse should provide what teaching to the patient?
A) The cast will feel cool to touch for the first 30 minutes.
B) The cast should be wrapped snuggly with a towel until the patient gets home.
C) The cast should be supported on a board while drying.
D) The cast will only have full strength when dry.

Answer 37

Ans: D
Feedback:
A cast requires approximately 24 to 72 hours to dry, and until dry, it does not have full strength. While
drying, the cast should not be placed on a hard surface. The cast will exude heat while it dries and should
not be wrapped.

Question 38

A patient broke his arm in a sports accident and required the application of a cast. Shortly following
application, the patient complained of an inability to straighten his fingers and was subsequently
diagnosed with Volkmann contracture. What pathophysiologic process caused this complication?
A) Obstructed arterial blood flow to the forearm and hand
B) Simultaneous pressure on the ulnar and radial nerves
C) Irritation of Merkel cells in the patients skin surfaces
D) Uncontrolled muscle spasms in the patients forearm

Answer 38

Ans: A
Feedback:
Volkmann contracture occurs when arterial blood flow is restricted to the forearm and hand and results
in contractures of the fingers and wrist. It does not result from nerve pressure, skin irritation, or spasm

Question 39

A patient is admitted to the unit in traction for a fractured proximal femur and requires traction prior to
surgery. What is the most appropriate type of traction to apply to a fractured proximal femur?
A) Russells traction
B) Dunlops traction
C) Bucks extension traction
D) Cervical head halter

Answer 39

Ans: C
Feedback:
Bucks extension is used for fractures of the proximal femur. Russells traction is used for lower leg
fractures. Dunlops traction is applied to the upper extremity for supracondylar fractures of the elbow and
humerus. Cervical head halters are used to stabilize the neck.

Question 40

4. A nurse is caring for a patient who is in skeletal traction. To prevent the complication of skin breakdown
   in a patient with skeletal traction, what action should be included in the plan of care?
   A) Apply occlusive dressings to the pin sites.
   B) Encourage the patient to push up with the elbows when repositioning.
   C) Encourage the patient to perform isometric exercises once a shift.
   D) Assess the pin insertion site every 8 hours

Answer 40

Ans: D
Feedback:
The pin insertion site should be assessed every 8 hours for inflammation and infection. Loose cover
dressings should be applied to pin sites. The patient should be encouraged to use the overhead trapeze to
shift weight for repositioning. Isometric exercises should be done 10 times an hour while awake.

Question 41

5. A nurse is caring for a patient who is postoperative day 1 right hip replacement. How should the nurse
   position the patient?
   A) Keep the patients hips in abduction at all times.
   B) Keep hips flexed at no less than 90 degrees.
   C) Elevate the head of the bed to high Fowlers.
   D) Seat the patient in a low chair as soon as possible.

Answer 41

Ans: A
The hips should be kept in abduction by an abductor pillow. Hips should not be flexed more than 90
degrees, and the head of bed should not be elevated more than 60 degrees. The patients hips should be
higher than the knees; as such, high seat chairs should be used.

Question 42

While assessing a patient who has had knee replacement surgery, the nurse notes that the patient has
developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be
the priority nursing diagnosis for this patient?
A) Risk for Infection
B) Risk for Peripheral Neurovascular Dysfunction
C) Unilateral Neglect
D) Disturbed Kinesthetic Sensory Perception

Answer 42

Feedback:
The hematoma may cause an interruption of tissue perfusion, so the most appropriate nursing diagnosis
is Risk of Peripheral Neurovascular Dysfunction. There is also an associated risk for infection because
of the hematoma, but impaired neurovascular function is a more acute threat. Unilateral neglect and
impaired sensation are lower priorities than neurovascular status.

Question 43

. A patient was brought to the emergency department after a fall. The patient is taken to the operating
room to receive a right hip prosthesis. In the immediate postoperative period, what health education
should the nurse emphasize?
A) Make sure you dont bring your knees close together.
B) Try to lie as still as possible for the first few days.
C) Try to avoid bending your knees until next week.
D) Keep your legs higher than your chest whenever you can.

Answer 43

Ans: A
Feedback:
After receiving a hip prosthesis, the affected leg should be kept abducted. Mobility should be encouraged within safe limits. There is no need to avoid knee flexion and the patients legs do not need to
be higher than the level of the chest.

Question 44

A patient with a fractured femur is in balanced suspension traction. The patient needs to be repositioned
toward the head of the bed. During repositioning, what should the nurse do?
A) Place slight additional tension on the traction cords.
B) Release the weights and replace them immediately after positioning.
C) Reposition the bed instead of repositioning the patient.
D) Maintain consistent traction tension while repositioning.

Answer 44

Ans: D
Feedback:
Traction is used to reduce the fracture and must be maintained at all times, including during
repositioning. It would be inappropriate to add tension or release the weights. Moving the bed instead of
the patient is not feasible.

Question 45

A patient with a total hip replacement is progressing well and expects to be discharged tomorrow. On
returning to bed after ambulating, he complains of a new onset of pain at the surgical site. What is the
nurses best action?
A) Administer pain medication as ordered.
B) Assess the surgical site and the affected extremity.
C) Reassure the patient that pain is a direct result of increased activity.
D) Assess the patient for signs and symptoms of systemic infection.

Answer 45

Ans: B
Feedback:
Worsening pain after a total hip replacement may indicate dislocation of the prosthesis. Assessment of
pain should include evaluation of the wound and the affected extremity. Assuming hes anxious about
discharge and administering pain medication do not address the cause of the pain. Sudden severe pain is
not considered normal after hip replacement. Sudden pain is rarely indicative of a systemic infection.

Question 46

A nurse is caring for a patient who has a leg cast. The nurse observes that the patient uses a pencil to
scratch the skin under the edge of the cast. How should the nurse respond to this observation?

A) Allow the patient to continue to scratch inside the cast with a pencil but encourage him to be
cautious.
B) Give the patient a sterile tongue depressor to use for scratching instead of the pencil.
C) Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching
persists.
D) Obtain an order for a sedative, such as lorazepam (Ativan), to prevent the patient from scratching.

Answer 46

Ans: C
Feedback:
Scratching should be discouraged because of the risk for skin breakdown or damage to the cast. Most
patients can be discouraged from scratching if given a mild antihistamine, such as diphenhydramine, to
relieve itching. Benzodiazepines would not be given for this purpose.

Question 47

11. The nurse is caring for a patient who underwent a total hip replacement yesterday. What should the
    nurse do to prevent dislocation of the new prosthesis?
    A) Keep the affected leg in a position of adduction.
    B) Have the patient reposition himself independently.
    C) Protect the affected leg from internal rotation.
    D) Keep the hip flexed by placing pillows under the patients knee.

Answer 47

Ans: C
Feedback:
Abduction of the hip helps to prevent dislocation of a new hip joint. Rotation and adduction should be
avoided. While the hip may be flexed slightly, it shouldnt exceed 90 degrees and maintenance of flexion
isnt necessary. The patient may not be capable of safe independent repositioning at this early stage of
recovery

Question 48

12. A patient is complaining of pain in her casted leg. The nurse has administered analgesics and elevated
    the limb. Thirty minutes after administering the analgesics, the patient states the pain is unrelieved. The
    nurse should identify the warning signs of what complication?
    A) Subcutaneous emphysema
    B) Skin breakdown
    C) Compartment syndrome
    D) Disuse syndrome

Answer 48

Ans: C
Feedback:
Compartment syndrome may manifest as unrelenting, uncontrollable pain. This presentation of pain is
not suggestive of disuse syndrome or skin breakdown. Subcutaneous emphysema is not a complication
of casting.

Question 49

13. The nurse educator on an orthopedic trauma unit is reviewing the safe and effective use of traction with
    some recent nursing graduates. What principle should the educator promote?
    A) Knots in the rope should not be resting against pulleys.
    B) Weights should rest against the bed rails.
    C) The end of the limb in traction should be braced by the footboard of the bed.
    D) Skeletal traction may be removed for brief periods to facilitate the patients independence.

Answer 49

Ans: A
Feedback:
Knots in the rope should not rest against pulleys, because this interferes with traction. Weights are used
to apply the vector of force necessary to achieve effective traction and should hang freely at all times. To
avoid interrupting traction, the limb in traction should not rest against anything. Skeletal traction is never
interrupted.

Question 50

The orthopedic surgeon has prescribed balanced skeletal traction for a patient. What advantage is
conferred by balanced traction?
A) Balanced traction can be applied at night and removed during the day.
B) Balanced traction allows for greater patient movement and independence than other forms of
traction.
C) Balanced traction is portable and may accompany the patients movements.
D) Balanced traction facilitates bone remodeling in as little as 4 days.

Answer 50

Ans: B
Often, skeletal traction is balanced traction, which supports the affected extremity, allows for some
patient movement, and facilitates patient independence and nursing care while maintaining effective
traction. It is not portable, however, and it cannot be removed. Bone remodeling takes longer than 4
days.

Question 51

The nursing care plan for a patient in traction specifies regular assessments for venous
thromboembolism (VTE). When assessing a patients lower limbs, what sign or symptom is suggestive of
deep vein thrombosis (DVT)?
A) Increased warmth of the calf
B) Decreased circumference of the calf
C) Loss of sensation to the calf
D) Pale-appearing cal

Answer 51

Ans: A
Feedback:
Signs of DVT include increased warmth, redness, swelling, and calf tenderness. These findings are
promptly reported to the physician for definitive evaluation and therapy. Signs and symptoms of a DVT
do not include a decreased circumference of the calf, a loss of sensation in the calf, or a pale-appearing
calf.

Question 52

A nurse is providing discharge education to a patient who is going home with a cast on his leg. What
teaching point should the nurse emphasize in the teaching session?
A) Using crutches efficiently
B) Exercising joints above and below the cast, as ordered
C) Removing the cast correctly at the end of the treatment period
D) Reporting signs of impaired circulation

Answer 52

Ans: D

exercise and crutch use. The patient does not independently remove the cast.

Question 53

A patient with a right tibial fracture is being discharged home after having a cast applied. What
instruction should the nurse provide in relationship to the patients cast care?
A) Cover the cast with a blanket until the cast dries.
B) Keep your right leg elevated above heart level.
C) Use a clean object to scratch itches inside the cast.
D) A foul smell from the cast is normal after the first few days.

Answer 53

Ans: B
Feedback:
The leg should be elevated to promote venous return and prevent edema. The cast shouldnt be covered
while drying because this will cause heat buildup and prevent air circulation. No foreign object should
be inserted inside the cast because of the risk of cutting the skin and causing an infection. A foul smell
from a cast is never normal and may indicate an infection.

Question 54

18. An elderly patients hip joint is immobilized prior to surgery to correct a femoral head fracture. What is
    the nurses priority assessment?
    A) The presence of leg shortening
    B) The patients complaints of pain
    C) Signs of neurovascular compromise
    D) The presence of internal or external rotation

Answer 54

Ans: C
Feedback:
Because impaired circulation can cause permanent damage, neurovascular assessment of the affected leg
is always a priority assessment. Leg shortening and internal or external rotation are common findings
with a fractured hip. Pain, especially on movement, is also common after a hip fracture.

Question 55

A nurse is caring for a patient who has had a total hip replacement. The nurse is reviewing health
education prior to discharge. Which of the patients statements would indicate to the nurse that the patient
requires further teaching?
A) Ill need to keep several pillows between my legs at night
B) I need to remember not to cross my legs. Its such a habit.
C) The occupational therapist is showing me how to use a sock puller to help me get dressed.
D) I will need my husband to assist me in getting off the low toilet seat at home.

Answer 55

Ans: D
Feedback:
To prevent hip dislocation after a total hip replacement, the patient must avoid bending the hips beyond
90 degrees. Assistive devices, such as a raised toilet seat, should be used to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation
by preventing adduction and internal rotation of the legs. Likewise, teaching the patient to avoid
crossing the legs also reduces the risk of hip dislocation. A sock puller helps a patient get dressed
without flexing the hips beyond 90 degrees.

Question 56

A nurse is admitting a patient to the unit who presented with a lower extremity fracture. What signs and
symptoms would suggest to the nurse that the patient may have aperoneal nerve injury?
A) Numbness and burning of the foot
B) Pallor to the dorsal surface of the foot
C) Visible cyanosis in the toes
D) Inadequate capillary refill to the toes

Answer 56

Ans: A
Feedback:
Peroneal nerve injury may result in numbness, tingling, and burning in the feet. Cyanosis, pallor, and
decreased capillary refill are signs of inadequate circulation.

Question 57

21. A patient has suffered a muscle strain and is complaining of pain that she rates at 6 on a 10-point scale. The nurse should recommend what action?
    A) Taking an opioid analgesic as ordered
    B) Applying a cold pack to the injured site
    C) Performing passive ROM exercises
    D) Applying a heating pad to the affected muscle

Answer 57

Ans: B
Feedback:
Most pain can be relieved by elevating the involved part, applying cold packs, and administering
analgesics as prescribed. Heat may exacerbate the pain by increasing blood circulation, and ROM
exercises would likely be painful. Analgesia is likely necessary, but NSAIDs would be more appropriate
than opioids.

Question 58

2. A patient has had a brace prescribed to facilitate recovery from a knee injury. What are the potential
   therapeutic benefits of a brace? Select all that apply.
   A) Preventing additional injury
   B) Immobilizing prior to surgery
   C) Providing support
   D) Controlling movement
   E) Promoting bone remodeling

Answer 58

Ans: A, C, D
Feedback:
Braces (i.e., orthoses) are used to provide support, control movement, and prevent additional injury. They are not used to immobilize body parts or to facilitate bone remodeling.

Question 59

23. A nurse is assessing the neurovascular status of a patient who has had a leg cast recently applied. The
    nurse is unable to palpate the patients dorsalis pedis or posterior tibial pulse and the patients foot is pale. What is the nurses most appropriate action?
    A) Warm the patients foot and determine whether circulation improves.
    B) Reposition the patient with the affected foot dependent.
    C) Reassess the patients neurovascular status in 15 minutes.
    D) Promptly inform the primary care provider.

Answer 59

Ans: D
Signs of neurovascular dysfunction warrant immediate medical follow-up. It would be unsafe to delay. Warming the foot or repositioning the patient may be of some benefit, but the care provider should be
informed first.

Question 60

24. A physician writes an order to discontinue skeletal traction on an orthopedic patient. The nurse should
anticipate what subsequent intervention?
A) Application of a walking boot
B) Application of a cast
C) Education on how to use crutches
D) Passive range of motion exercises

Answer 60

Ans: B
Feedback:
After skeletal traction is discontinued, internal fixation, casts, or splints are then used to immobilize and
support the healing bone. The use of a walking boot, crutches, or ROM exercises could easily damage
delicate, remodeled bone.

Question 61

25. A patient has just begun been receiving skeletal traction and the nurse is aware that muscles in the
    patients affected limb are spastic. How does this change in muscle tone affect the patients traction
    prescription?
    A) Traction must temporarily be aligned in a slightly different direction.
    B) Extra weight is needed initially to keep the limb in proper alignment.
    C) A lighter weight should be initially used.
    D) Weight will temporarily alternate between heavier and lighter weights

Answer 61

Ans: B
Feedback:
The traction weights applied initially must overcome the shortening spasms of the affected muscles. As
the muscles relax, the traction weight is reduced to prevent fracture dislocation and to promote healing. Weights never alternate between heavy and light.

Question 62

26. A nurse is planning the care of a patient who will require a prolonged course of skeletal traction. When
    planning this patients care, the nurse should prioritize interventions related to which of the following risk
    nursing diagnoses?
    A) Risk for Impaired Skin Integrity
    B) Risk for Falls
    C) Risk for Imbalanced Fluid Volume
    D) Risk for Aspiration

Answer 62

Ans: A
Feedback:
Impaired skin integrity is a high-probability risk in patients receiving traction. Falls are not a threat, due
to the patients immobility. There are not normally high risks of fluid imbalance or aspiration associated
with traction.

Question 63

27. A nurse is caring for a patient receiving skeletal traction. Due to the patients severe limits on mobility,
    the nurse has identified a risk for atelectasis or pneumonia. What intervention should the nurse provide
    in order to prevent these complications?
    A) Perform chest physiotherapy once per shift and as needed.
    B) Teach the patient to perform deep breathing and coughing exercises.
    C) Administer prophylactic antibiotics as ordered.
    D) Administer nebulized bronchodilators and corticosteroids as ordered.

Answer 63

Ans: B
Feedback:
To prevent these complications, the nurse should educate the patient about performing deep-breathing
and coughing exercises to aid in fully expanding the lungs and clearing pulmonary secretions. Antibiotics, bronchodilators, and steroids are not used on a preventative basis and chest physiotherapy is
unnecessary and implausible for a patient in traction.

Question 64

28. The nurse has identified the diagnosis of Risk for Impaired Tissue Perfusion Related to Deep Vein
    Thrombosis in the care of a patient receiving skeletal traction. What nursing intervention best addresses
    this risk?
    A) Encourage independence with ADLs whenever possible.
    B) Monitor the patients nutritional status closely.
    C) Teach the patient to perform ankle and foot exercises within the limitations of traction.
    D) Administer clopidogrel (Plavix) as ordered.

Answer 64

Ans: C
Feedback:
The nurse educates the patient how to perform ankle and foot exercises within the limits of the traction
therapy every 1 to 2 hours when awake to prevent DVT. Nutrition is important, but does not directly
prevent DVT. Similarly, independence with ADLs should be promoted, but this does not confer
significant prevention of DVT, which often affects the lower limbs. Plavix is not normally used for DVT
prophylaxis.

Question 65

A patient is scheduled for a total hip replacement and the surgeon has explained the risks of blood loss
associated with orthopedic surgery. The risk of blood loss is the indication for which of the following
actions?
A) Use of a cardiopulmonary bypass machine
B) Postoperative blood salvage
C) Prophylactic blood transfusion
D) Autologous blood donation

Answer 65

Ans: D
Feedback:
Many patients donate their own blood during the weeks preceding their surgery. Autologous blood
donations are cost effective and eliminate many of the risks of transfusion therapy. Orthopedic surgery
does not necessitate cardiopulmonary bypass and blood is not salvaged postoperatively. Transfusions are
not given prophylactically.

Question 66

0. The nurse is helping to set up Bucks traction on an orthopedic patient. How often should the nurse assess
   circulation to the affected leg?
   A) Within 30 minutes, then every 1 to 2 hours
   B) Within 30 minutes, then every 4 hours
   C) Within 30 minutes, then every 8 hours
   D) Within 30 minutes, then every shift

Answer 66

Ans: A
Feedback:
After skin traction is applied, the nurse assesses circulation of the foot or hand within 15 to 30 minutes
and then every 1 to 2 hours.

Question 67

31. A nurse is assessing a patient who is receiving traction. The nurses assessment confirms that the patient
    is able to perform plantar flexion. What conclusion can the nurse draw from this finding?
    A) The leg that was assessed is free from DVT.
    B) The patients tibial nerve is functional.
    C) Circulation to the distal extremity is adequate.
    D) The patient does not have peripheral neurovascular dysfunction

Answer 67

Ans: B
Feedback:
Plantar flexion demonstrates function of the tibial nerve. It does not demonstrate the absence of DVT
and does not allow the nurse to ascertain adequate circulation. The nurse must perform more
assessments on more sites in order to determine an absence of peripheral neurovascular dysfunction.

Question 68

32. A nurse is caring for a patient in skeletal traction. In order to prevent bony fragments from moving
    against one another, the nurse should caution the patient against which of the following actions?
    A) Shifting ones weight in bed
    B) Bearing down while having a bowel movement
    C) Turning from side to side
    D) Coughing without splinting

Answer 68

Ans: C
Feedback: To prevent bony fragments from moving against one another, the patient should not turn from side to
side; however, the patient may shift position slightly with assistance. Bearing down and coughing do not
pose a threat to bone union.

Question 69

33. A nurse is caring for an older adult patient who is preparing for discharge following recovery from a
    total hip replacement. Which of the following outcomes must be met prior to discharge?
    A) Patient is able to perform ADLs independently.
    B) Patient is able to perform transfers safely.
    C) Patient is able to weight-bear equally on both legs.
    D) Patient is able to demonstrate full ROM of the affected hip.

Answer 69

Ans: B
Feedback:
The patient must be able to perform transfers and to use mobility aids safely. Each of the other listed
goals is unrealistic for the patient who has undergone recent hip replacement.

Question 70

34. A nurse is caring for a patient who is recovering in the hospital following orthopedic surgery. The nurse
    is performing frequent assessments for signs and symptoms of infection in the knowledge that the
    patient faces a high risk of what infectious complication?
    A) Cellulitis
    B) Septic arthritis
    C) Sepsis
    D) Osteomyelitis

Answer 70

Ans: D
Feedback:
Infection is a risk after any surgery, but it is of particular concern for the postoperative orthopedic
patient because of the risk of osteomyelitis. Orthopedic patients do not have an exaggerated risk of
cellulitis, sepsis, or septic arthritis when compared to other surgical patients.

Question 71

A patient is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The
patient is concerned about being on bed rest for several days after the surgery. The nurse should explain
what expectation for activity following hip replacement?
A) Actually, patients are only on bed rest for 2 to 3 days before they begin walking with assistance.
B) The physical therapist will likely help you get up using a walker the day after your surgery.
C) Our goal will actually be to have you walking normally within 5 days of your surgery.
D) For the first two weeks after the surgery, you can use a wheelchair to meet your mobility needs.

Answer 71

Ans: B
Feedback:
Patients post-THA begin ambulation with the assistance of a walker or crutches within a day after
surgery. Wheelchairs are not normally utilized. Baseline levels of mobility are not normally achieved
until several weeks after surgery, however.

Question 72

36. A patient has recently been admitted to the orthopedic unit following total hip arthroplasty. The patient
    has a closed suction device in place and the nurse has determined that there were 320 mL of output in
    the first 24 hours. How should the nurse best respond to this assessment finding?
    A) Inform the primary care provider promptly.
    B) Document this as an expected assessment finding.
    C) Limit the patients fluid intake to 2 liters for the next 24 hours.
    D) Administer a loop diuretic as ordered.

Answer 72

Ans: B
Feedback:
Drainage of 200 to 500 mL in the first 24 hours is expected. Consequently, the nurse does not need to
inform the physician. Fluid restriction and medication administration are not indicated.

Question 73

37. A nurse is reviewing a patients activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation?
    A) Straining during a bowel movement
    B) Bending down to put on socks
    C) Lifting items above shoulder level
    ) Transferring from a sitting to standing position

Answer 73

Ans: B
Feedback:
Bending to put on socks or shoes can cause hip dislocation. None of the other listed actions poses a
serious threat to the integrity of the new hip.

Question 74

A 91-year-old patient is slated for orthopedic surgery and the nurse is integrated gerontologic
considerations into the patients plan of care. What intervention is most justified in the care of this
patient?
A) Administration of prophylactic antibiotics
B) Total parenteral nutrition (TPN)
C) Use of a pressure-relieving mattress
D) Use of a Foley catheter until discharge

Answer 74

Ans: C
Feedback:
Older adults have a heightened risk of skin breakdown; use of a pressure-reducing mattress addresses
this risk. Older adults do not necessarily need TPN and the Foley catheter should be discontinued as
soon as possible to prevent urinary tract infections. Prophylactic antibiotics are not a standard infection
prevention measure.

Question 75

A nurse is emptying an orthopedic surgery patients closed suction drainage at the end of a shift. The
nurse notes that the volume is within expected parameters but that the drainage has a foul odor. What is
the nurses best action?
A) Aspirate a small amount of drainage for culturing.
B) Advance the drain 1 to 1.5 cm.
C) Irrigate the drain with normal saline.
D) Inform the surgeon of this finding.

Answer 75

Ans: D
Feedback:The nurse should promptly notify the surgeon of excessive or foul-smelling drainage. It would be
inappropriate to advance the drain, irrigate the drain, or aspirate more drainage.

Question 76

A nurse is planning the care of a patient who has undergone orthopedic surgery. What main goal should
guide the nurses choice of interventions?
A) Improving the patients level of function
B) Helping the patient come to terms with limitations
C) Administering medications safely
D) Improving the patients adherence to treatment

Answer 76

Ans: A
Feedback:
Improving function is the overarching goal after orthopedic surgery. Some patients may need to come to
terms with limitations, but this is not true of every patient. Safe medication administration is imperative, but this is not a goal that guides other aspects of care. Similarly, adherence to treatment is important, but
this is motivated by the need to improve functional status.

Question 77

1. A nurse admits a patient who has a fracture of the nose that has resulted in a skin tear and involvement
   of the mucous membranes of the nasal passages. The orthopedic nurse is aware that this description
   likely indicates which type of fracture?
   A) Compression
   B) Compound
   C) Impacted
   D) Transverse

Answer 77

Ans: B
Feedback:
A compound fracture involves damage to the skin or mucous membranes and is also called an open
fracture. A compression fracture involves compression of bone and is seen in vertebral fractures. An
impacted fracture occurs when a bone fragment is driven into another bone fragment. A transverse
fracture occurs straight across the bone shaft.

Question 78

A patient has sustained a long bone fracture and the nurse is preparing the patients care plan. Which of
the following should the nurse include in the care plan?
A) Administer vitamin D and calcium supplements as ordered.
B) Monitor temperature and pulses of the affected extremity.
C) Perform passive range of motion exercises as tolerated.
D) Administer corticosteroids as ordered.

Answer 78

Ans: B
Feedback:
The nurse should include monitoring for sufficient blood supply by assessing the color, temperature, and
pulses of the affected extremity. Weight-bearing exercises are encouraged, but passive ROM exercises
have the potential to cause pain and inhibit healing. Corticosteroids, vitamin D, and calcium are not
normally administered.

Question 79

A nurses assessment of a patients knee reveals edema, tenderness, muscle spasms, and ecchymosis. The patient states that 2 days ago he ran 10 miles and now it really hurts to stand up. The nurse should plan
care based on the belief that the patient has experienced what?
A) A first-degree strain
B) A second-degree strain
C) A first-degree sprain
D) A second-degree sprain

Answer 79

Ans: B
Feedback:
A second-degree strain involves tearing of muscle fibers and is manifested by notable loss of load- bearing strength with accompanying edema, tenderness, muscle spasm, and ecchymosis. A first-degree
strain reflects tearing of a few muscle fibers and is accompanied by minor edema, tenderness, and mild
muscle spasm, without noticeable loss of function. However, this patient states a loss of function. A
sprain normally involves twisting, which is inconsistent with the patients overuse injury

Question 80

4. A nurse is preparing to discharge a patient from the emergency department after receiving treatment for
   an ankle sprain. While providing discharge education, the nurse should encourage which of the
   following?
   A) Apply heat for the first 24 to 48 hours after the injury.
   B) Maintain the ankle in a dependent position.
   C) Exercise hourly by performing rotation exercises of the ankle.
   D) Keep an elastic compression bandage on the ankle.

Answer 80

Ans: D
Feedback:
Treatment of a sprain consists of resting and elevating the affected part, applying cold, and using a
compression bandage. After the acute inflammatory stage (usually 24 to 48 hours after injury), heat may
be applied intermittently. Rotation exercises would likely be painful.

Question 81

A nurse is writing a care plan for a patient admitted to the emergency department (ED) with an open
fracture. The nurse will assign priority to what nursing diagnosis for a patient with an open fracture of
the radius?
A) Risk for Infection
B) Risk for Ineffective Role Performance
C) Risk for Perioperative Positioning Injury
D) Risk for Powerlessness

Answer 81

Ans: A
Feedback:
The patient has a significant risk for osteomyelitis and tetanus due to the fact that the fracture is open. Powerlessness and ineffective role performance are psychosocial diagnoses that may or may not apply, and which would be superseded by immediate physiologic threats such as infection. Surgical positioning
injury is not plausible, since surgery is not likely indicated.

Question 82

A nurse is caring for a patient who has suffered a hip fracture and who will require an extended hospital
stay. The nurse should ensure that the patient does which of the following in order to prevent common
complications associated with a hip fracture?
A) Avoid requesting analgesia unless pain becomes unbearable.
B) Use supplementary oxygen when transferring or mobilizing.
C) Increase fluid intake and perform prescribed foot exercises.
D) Remain on bed rest for 14 days or until instructed by the orthopedic surgeon.

Answer 82

Ans: C
Feedback:
Deep vein thrombosis (DVT) is among the most common complications related to a hip fracture. To
prevent DVT, the nurse encourages intake of fluids and ankle and foot exercises. The patient should not
be told to endure pain; a proactive approach to pain control should be adopted. While respiratory
complications commonly include atelectasis and pneumonia, the use of deep-breathing exercises, changes in position at least every 2 hours, and the use of incentive spirometry help prevent the
respiratory complications more than using supplementary oxygen. Bed rest may be indicated in the short
term, but is not normally required for 14 days.

Question 83

A nurse is caring for a patient who has suffered an unstable thoracolumbar fracture. Which of the
following is the priority during nursing care?
A) Preventing infection
B) Maintaining spinal alignment
C) Maximizing function
D) Preventing increased intracranial pressure

Answer 83

Ans: B
Feedback:
Patients with an unstable fracture must have their spine in alignment at all times in order to prevent
neurologic damage. This is a greater threat, and higher priority, than promoting function and preventing
infection, even though these are both valid considerations. Increased ICP is not a high risk.

Question 84

8. The patient scheduled for a Syme amputation is concerned about the ability to eventually stand on the
   amputated extremity. How should the nurse best respond to the patients concern?
   A) You will eventually be able to withstand full weight-bearing after the amputation.
   B) You will have minimal weight-bearing on this extremity but youll be taught how to use an assistive
   device.
   C) You likely will not be able to use this extremity but you will receive teaching on use of a
   wheelchair.
   D) You will be fitted for a prosthesis which may or may not allow you to walk.

Answer 84

Ans: A
Feedback:
Syme amputation (modified ankle disarticulation amputation) is performed most frequently for extensive
foot trauma and produces a painless, durable extremity end that can withstand full weight-bearing. Therefore, each of the other teaching statements is incorrect.

Question 85

A patient with a simple arm fracture is receiving discharge education from the nurse. What would the
nurse instruct the patient to do?
A) Elevate the affected extremity to shoulder level when at rest.
B) Engage in exercises that strengthen the unaffected muscles.
C) Apply topical anesthetics to accessible skin surfaces as needed.
D) Avoid using analgesics so that further damage is not masked.

Answer 85

Ans: B
Feedback:
The nurse will encourage the patient to engage in exercises that strengthen the unaffected muscles. Comfort measures may include appropriate use of analgesics and elevation of the affected extremity to
the heart level. Topical anesthetics are not typically used.

Question 86

10. Six weeks after an above-the-knee amputation (AKA), a patient returns to the outpatient office for a
    routine postoperative checkup. During the nurses assessment, the patient reports symptoms of phantom
    pain. What should the nurse tell the patient to do to reduce the discomfort of the phantom pain?
    A) Apply intermittent hot compresses to the area of the amputation.
    B) Avoid activity until the pain subsides.
    C) Take opioid analgesics as ordered.
    D) Elevate the level of the amputation site.

Answer 86

Ans: C
Feedback:
Opioid analgesics may be effective in relieving phantom pain. Heat, immobility, and elevation are not
noted to relieve this form of pain.

Question 87

11. A nurse is caring for a patient who had a right below-the-knee amputation (BKA). The nurse recognizes
    the importance of implementing measures that focus on preventing flexion contracture of the hip and
    maintaining proper positioning. Which of the following measures will best achieve these goals?
    A) Encouraging the patient to turn from side to side and to assume a prone position
    B) Initiating ROM exercises of the hip and knee 10 to 12 weeks after the amputation
    C) Minimizing movement of the flexor muscles of the hip
    D) Encouraging the patient to sit in a chair for at least 8 hours a day

Answer 87

Ans: A
Feedback:
The nurse encourages the patient to turn from side to side and to assume a prone position, if possible, to
stretch the flexor muscles and to prevent flexion contracture of the hip. Postoperative ROM exercises are
started early, because contracture deformities develop rapidly. ROM exercises include hip and knee
exercises for patients with BKAs. The nurse also discourages sitting for prolonged periods of time.

Question 88

12. A nurse is preparing to discharge an emergency department patient who has been fitted with a sling to
    support her arm after a clavicle fracture. What should the nurse instruct the patient to do?
    A) Elevate the arm above the shoulder 3 to 4 times daily.
    B) Avoid moving the elbow, wrist, and fingers until bone remodeling is complete.
    C) Engage in active range of motion using the affected arm.
    D) Use the arm for light activities within the range of motion.

Answer 88

Ans: D
Feedback:
A patient with a clavicle fracture may use a sling to support the arm and relieve the pain. The patient
may be permitted to use the arm for light activities within the range of comfort. The patient should not
elevate the arm above the shoulder level until the ends of the bones have united, but the nurse should
encourage the patient to exercise the elbow, wrist, and fingers.

Question 89

13. The orthopedic nurse should assess for signs and symptoms of Volkmanns contracture if a patient has
fractured which of the following bones?
A) Femur
B) Humerus
C) Radial head
D) Clavicle

Answer 89

Ans: B
Feedback:
The most serious complication of a supracondylar fracture of the humerus is Volkmanns ischemic
contracture, which results from antecubital swelling or damage to the brachial artery. This complication
is specific to humeral fractures.

Question 90

14. An emergency department nurse is assessing a 17-year-old soccer player who presented with a knee
    injury. The patients description of the injury indicates that his knee was struck medially while his foot
    was on the ground. The nurse knows that the patient likely has experienced what injury?
    A) Lateral collateral ligament injury
    B) Medial collateral ligament injury
    C) Anterior cruciate ligament injury
    D) Posterior cruciate ligament injury

Answer 90

Ans: A
Feedback:
When the knee is struck medially, damage may occur to the lateral collateral ligament. If the knee is
struck laterally, damage may occur to the medial collateral ligament. The ACL and PCL are not typically
injured in this way.

Question 91

15. A school nurse is assessing a student who was kicked in the shin during a soccer game. The area of the
    injury has become swollen and discolored. The triage nurse recognizes that the patient has likely
    sustained what?
    A) Sprain
    B) Strain
    C) Contusion
    D) Dislocation

Answer 91

Ans: C
Feedback:
A contusion is a soft-tissue injury that results in bleeding into soft tissues, creating a hematoma and
ecchymosis. A sprain is an injury to ligaments caused by wrenching or twisting. A strain is a muscle pull
from overuse, overstretching, or excessive stress. A dislocation is a condition in which the articular
surfaces of the bones forming a joint are no longer in anatomic contact. Because the injury is not at the
site of a joint, the patient has not experienced a sprain, strain, or dislocation.

Question 92

Radiographs of a boys upper arm show that the humerus appears to be fractured on one side and slightly
bent on the other. This diagnostic result suggests what type of fracture?
A) Impacted
B) Compound
C) Compression
D) Greenstick

Answer 92

Ans: D
Feedback:
Greenstick fractures are an incomplete fracture that results in the bone being broken on one side, while
the other side is bent. This is not characteristic of an impacted, compound, or compression fracture.

Question 93

A nurse is performing a shift assessment on an elderly patient who is recovering after surgery for a hip
fracture. The nurse notes that the patient is complaining of chest pain, has an increased heart rate, and
increased respiratory rate. The nurse further notes that the patient is febrile and hypoxic, coughing, and
producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency
and calls for assistance, recognizing that this patient is likely demonstrating symptoms of what
complication?
A) Avascular necrosis of bone
B) Compartment syndrome
C) Fat embolism syndrome
D) Complex regional pain syndrome

Answer 93

Ans: C
Feedback:
Fat embolism syndrome occurs most frequently in young adults and elderly patients who experience
fractures of the proximal femur (i.e., hip fracture). Presenting features of fat embolism syndrome include
hypoxia, tachypnea, tachycardia, and pyrexia. The respiratory distress response includes tachypnea, dyspnea, wheezes, precordial chest pain, cough, large amounts of thick, white sputum, and tachycardia. Avascular necrosis (AVN) occurs when the bone loses its blood supply and dies. This does not cause
coughing. Complex regional pain syndrome does not have cardiopulmonary involvement.

Question 94

18. A young patient is being treated for a femoral fracture suffered in a snowboarding accident. The nurses
    most recent assessment reveals that the patient is uncharacteristically confused. What diagnostic test
    should be performed on this patient?
    A) Electrolyte assessment
    B) Electrocardiogram
    C) Arterial blood gases
    D) Abdominal ultrasound

Answer 94

Ans: C
Feedback:
Subtle personality changes, restlessness, irritability, or confusion in a patient who has sustained a
fracture are indications for immediate arterial blood gas studies due to the possibility of fat embolism
syndrome. This assessment finding does not indicate an immediate need for electrolyte levels, an ECG, or abdominal ultrasound.

Question 95

Which of the following is the most appropriate nursing intervention to facilitate healing in a patient who
has suffered a hip fracture?
A) Administer analgesics as required.
B) Place a pillow between the patients legs when turning.
C) Maintain prone positioning at all times.
D) Encourage internal and external rotation of the affected leg

Answer 95

Ans: B
Feedback:
Placing a pillow between the patients legs when turning prevents adduction and supports the patients
legs. Administering analgesics addresses pain but does not directly protect bone remodeling and
promote healing. Rotation of the affected leg can cause dislocation and must be avoided. Prone
positioning does not need to be maintained at all times.

Question 96

20. A nurse is planning the care of an older adult patient who will soon be discharged home after treatment
for a fractured hip. In an effort to prevent future fractures, the nurse should encourage which of the
following? Select all that apply.
A) Regular bone density testing
B) A high-calcium diet
C) Use of falls prevention precautions
D) Use of corticosteroids as ordered
E) Weight-bearing exercise

Answer 96

Ans: A, B, C, E
Feedback
Health promotion measures after an older adults hip fracture include weight-bearing exercise, promotion
of a healthy diet, falls prevention, and bone density testing. Corticosteroids have the potential to reduce
bone density and increase the risk for fractures.

Question 97

A patient is brought to the emergency department by ambulance after stepping in a hole and falling. While assessing him the nurse notes that his right leg is shorter than his left leg; his right hip is
noticeably deformed and he is in acute pain. Imaging does not reveal a fracture. Which of the following
is the most plausible explanation for this patients signs and symptoms?
A) Subluxated right hip
B) Right hip contusion
C) Hip strain
D) Traumatic hip dislocation

Answer 97

Ans: D
Feedback:
Signs and symptoms of a traumatic dislocation include acute pain, change in positioning of the joint, shortening of the extremity, deformity, and decreased mobility. A subluxation would cause moderate
deformity, or possibly no deformity. A contusion or strain would not cause obvious deformities.

Question 98

An emergency department patient is diagnosed with a hip dislocation. The patients family is relieved
that the patient has not suffered a hip fracture, but the nurse explains that this is still considered to be a
medical emergency. What is the rationale for the nurses statement?
A) The longer the joint is displaced, the more difficult it is to get it back in place.
B) The patients pain will increase until the joint is realigned.
C) Dislocation can become permanent if the process of bone remodeling begins.
D) Avascular necrosis may develop at the site of the dislocation if it is not promptly resolved.

Answer 98

Ans: D
Feedback:
If a dislocation or subluxation is not reduced immediately, avascular necrosis (AVN) may develop. Bone
remodeling does not take place because a fracture has not occurred. Realignment does not become more
difficult with time and pain would subside with time, not become wors

Question 99

The surgical nurse is admitting a patient from postanesthetic recovery following the patients below-the- knee amputation. The nurse recognizes the patients high risk for postoperative hemorrhage and should keep which of the following at the bedside?

A) A tourniquet
B) A syringe preloaded with vitamin K
C) A unit of packed red blood cells, placed on ice
D) A dose of protamine sulfate

Answer 99

Ans: A
Feedback:
Immediate postoperative bleeding may develop slowly or may take the form of massive hemorrhage
resulting from a loosened suture. A large tourniquet should be in plain sight at the patients bedside so
that, if severe bleeding occurs, it can be applied to the residual limb to control the hemorrhage. PRBCs
cannot be kept at the bedside. Vitamin K and protamine sulfate are antidotes to warfarin and heparin, but
are not administered to treat active postsurgical bleeding.

Question 100

An elite high school football player has been diagnosed with a shoulder dislocation. The patient has been
treated and is eager to resume his role on his team, stating that he is not experiencing pain. What should
the nurse emphasize during health education?
A) The need to take analgesia regardless of the short-term absence of pain
B) The importance of adhering to the prescribed treatment and rehabilitation regimen
C) The fact that he has a permanently increased risk of future shoulder dislocations
D) The importance of monitoring for intracapsular bleeding once he resumes playing

Answer 100

Ans: B
Feedback:
Patients who have experienced sports-related injuries are often highly motivated to return to their
previous level of activity. Adherence to restriction of activities and gradual resumption of activities
needs to be reinforced. Appropriate analgesia use must be encouraged, but analgesia does not
necessarily have to be taken in the absence of pain. If healing is complete, the patient does not likely
have a greatly increased risk of reinjury. Dislocations rarely cause bleeding after the healing process

Question 101

A patient has presented to the emergency department with an injury to the wrist. The patient is
diagnosed with a third-degree strain. Why would the physician order an x-ray of the wrist?
A) Nerve damage is associated with third-degree strains.
B) Compartment syndrome is associated with third-degree strains.
C) Avulsion fractures are associated with third-degree strains.
D) Greenstick fractures are associated with third-degree strains.

Answer 101

Ans: C
Feedback:
An x-ray should be obtained to rule out bone injury, because an avulsion fracture (in which a bone
fragment is pulled away from the bone by a tendon) may be associated with a third-degree strain. Nerve
damage, compartment syndrome, and greenstick fractures are not associated with third-degree strains.

Question 102

A 20 year-old is brought in by ambulance to the emergency department after being involved in a
motorcycle accident. The patient has an open fracture of his tibia. The wound is highly contaminated and
there is extensive soft-tissue damage. How would this patients fracture likely be graded?
A) Grade I
B) Grade II
C) Grade III
D) Grade IV

Answer 102

Ans: C
Feedback:
Open fractures are graded according to the following criteria. Grade I is a clean wound less than 1 cm
long. Grade II is a larger wound without extensive soft-tissue damage. Grade III is highly contaminated, has extensive soft-tissue damage, and is the most severe. There is no grade IV fracture.

Question 103

A 25-year-old man is involved in a motorcycle accident and injures his arm. The physician diagnoses the
man with an intra-articular fracture and splints the injury. The nurse implements the teaching plan
developed for this patient. What sequela of intra-articular fractures should the nurse describe regarding
this patient?
A) Post-traumatic arthritis
B) Fat embolism syndrome (FES)
C) Osteomyelitis
D) Compartment syndrome

Answer 103

Ans: A
Feedback:
Intra-articular fractures often lead to post-traumatic arthritis. Research does not indicate a correlation
between intra-articular fractures and FES, osteomyelitis, or compartment syndrome.

Question 104

28. A nurse is planning the care of a patient with osteomyelitis that resulted from a diabetic foot ulcer. The
    patient requires a transmetatarsal amputation. When planning the patients postoperative care, which of
    the following nursing diagnoses should the nurse most likely include in the plan of care?
    A)
    Ineffective Thermoregulation
    B) Risk-Prone Health Behavior
    C) Disturbed Body Image
    D) Deficient Diversion Activity

Answer 104

Ans: C
Feedback:
Amputations present a serious threat to any patients body image. None of the other listed diagnoses is
specifically associated with amputation.

Question 105

29. A patient is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The
    patient has been placed in traction until his femur can be rodded in surgery. For what early
    complications should the nurse monitor this patient? Select all that apply.
    A) Systemic infection
    B) Complex regional pain syndrome
    C) Deep vein thrombosis
    D) Compartment syndrome
    E) Fat embolism

Answer 105

Ans: C, D, E
Feedback:
Early complications include shock, fat embolism, compartment syndrome, and venous thromboemboli
(deep vein thrombosis [DVT], pulmonary embolism [PE]). Infection and CRPS are later complications
of fractures.

Question 106

A patient has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing his
ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed
to this complication?
A) Inadequate vitamin D intake
B) Bleeding at the injury site
C) Inadequate immobilization
D) Venous thromboembolism (VTE)

Answer 106

Ans: C
Feedback:
Inadequate fracture immobilization can delay or prevent union. A short-term vitamin D deficiency
would not likely prevent bone union. VTE is a serious complication but would not be a cause of
nonunion. Similarly, bleeding would not likely delay union.

Question 107

An older adult patient has fallen in her home and is brought to the emergency department by ambulance
with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning
assessments during the patients presurgical care, the nurse should be aware of the patients heightened
risk of what complication?
A) Osteomyelitis
B) Avascular necrosis
C) Phantom pain
D) Septicemia

Answer 107

Ans: B
Feedback:
Fractures of the neck of the femur may damage the vascular system that supplies blood to the head and
the neck of the femur, and the bone may become ischemic. For this reason, AVN is common in patients
with femoral neck fractures. Infections are not immediate complications and phantom pain applies patients with amputations, not hip fractures.

Question 108

32. A patient is being treated for a fractured hip and the nurse is aware of the need to implement
    interventions to prevent muscle wasting and other complications of immobility. What intervention best
    addresses the patients need for exercise?
    A) Performing gentle leg lifts with both legs
    B) Performing massage to stimulate circulation
    C) Encouraging frequent use of the overbed trapeze
    D) Encouraging the patient to log roll side to side once per hour

Answer 108

Ans: C
Feedback:
The patient is encouraged to exercise as much as possible by means of the overbed trapeze. This device
helps strengthen the arms and shoulders in preparation for protected ambulation. Independent logrolling
may result in injury due to the location of the fracture. Leg lifts would be contraindicated for the same
reason. Massage by the nurse is not a substitute for exercise.

Question 109

A patient who has had an amputation is being cared for by a multidisciplinary rehabilitation team. What
is the primary goal of this multidisciplinary team?
A) Maximize the efficiency of care
B) Ensure that the patients health care is holistic
C) Facilitate the patients adjustment to a new body image
D) Promote the patients highest possible level of function

Answer 109

Ans: D
Feedback:
The multidisciplinary rehabilitation team helps the patient achieve the highest possible level of function
and participation in life activities. The team is not primarily motivated by efficiency, the need for
holistic care, or the need to foster the patients body image, despite the fact that each of these are valid
goals.

Question 110

A rehabilitation nurse is working with a patient who has had a below-the-knee amputation. The nurse
knows the importance of the patients active participation in self-care. In order to determine the patients
ability to be an active participant in self-care, the nurse should prioritize assessment of what variable?
A) The patients attitude
B) The patients learning style
C) The patients nutritional status
D) The patients presurgical level of function

Answer 110

Ans: A
Feedback:
Amputation of an extremity affects the patients ability to provide adequate self-care. The patient is
encouraged to be an active participant in self-care. The patient and the nurse need to maintain positive
attitudes and to minimize fatigue and frustration during the learning process. Balanced nutrition and the
patients learning style are important variables in the rehabilitation process but the patients attitude is
among the most salient variables. The patients presurgical level of function may or may not affect
participation in rehabilitation.

Question 111

The nurse is providing care for a patient who has had a below-the-knee amputation. The nurse enters the
patients room and finds him resting in bed with his residual limb supported on pillow. What is the nurses
most appropriate action?
A) Inform the surgeon of this finding.
B) Explain the risks of flexion contracture to the patient.
C) Transfer the patient to a sitting position.
D) Encourage the patient to perform active ROM exercises with the residual limb.

Answer 111

Ans: B
Feedback:
The residual limb should not be placed on a pillow, because a flexion contracture of the hip may result. There is no acute need to contact the patients surgeon. Encouraging exercise or transferring the patient
does not address the risk of flexion contracture.

Question 112

36. A patient has returned to the postsurgical unit from the PACU after an above-the-knee amputation of the
    right leg. Results of the nurses initial postsurgical assessment were unremarkable but the patient has
    called out. The nurse enters the room and observes copious quantities of blood at the surgical site. What
    should be the nurses initial action?
    A) Apply a tourniquet.
    B) Elevate the residual limb.
    C) Apply sterile gauze.
    D) Call the surgeon.

Answer 112

Ans: A
Feedback:
The nurse should apply a tourniquet in the event of postsurgical hemorrhage. Elevating the limb and
applying sterile gauze are likely insufficient to stop the hemorrhage. The nurse should attempt to control
the immediate bleeding before contacting the surgeon.

Question 113

A nurse in a busy emergency department provides care for many patients who present with contusions, strains, or sprains. Treatment modalities that are common to all of these musculoskeletal injuries include
which of the following? Select all that apply.
A) Massage
B) Applying ice
C) Compression dressings
D) Resting the affected extremity
E) Corticosteroids
F) Elevating the injured limb

Answer 113

Ans: B, C, D, F
Feedback:
Treatment of contusions, strains, and sprains consists of resting and elevating the affected part, applying
cold, and using a compression bandage. Massage and corticosteroids are not used to treat these injuries.

Question 114

38. A patient who has undergone a lower limb amputation is preparing to be discharged home. What
    outcome is necessary prior to discharge?
    A) Patient can demonstrate safe use of assistive devices.
    B) Patient has a healed, nontender, nonadherent scar.
    C) Patient can perform activities of daily living independently.
    D) Patientis free of pain.

Answer 114

Ans: A
Feedback:
A patient should be able to use assistive devices appropriately and safely prior to discharge. Scar
formation will not be complete at the time of hospital discharge. It is anticipated that the patient will
require some assistance with ADLs postdischarge. Pain should be well managed, but may or may not be
wholly absent.

Question 115

An older adult patient experienced a fall and required treatment for a fractured hip on the orthopedic
unit. Which of the following are contributory factors to the incidence of falls and fractured hips among
the older adult population? Select all that apply. A) Loss of visual acuity
B) Adverse medication effects
C) Slowed reflexes
D) Hearing loss
E) Muscle weakness

Answer 115

Ans: A, B, C, E
Feedback:
Older adults are generally vulnerable to falls and have a high incidence of hip fracture. Weak quadriceps
muscles, medication effects, vision loss, and slowed reflexes are among the factors that contribute to the
incidence of falls. Decreased hearing is not noted to contribute to the incidence of falls.

Question 116

A patient was fitted with an arm cast after fracturing her humerus. Twelve hours after the application of
the cast, the patient tells the nurse that her arm hurts. Analgesics do not relieve the pain. What would be
the most appropriate nursing action?
A) Prepare the patient for opening or bivalving of the cast.
B) Obtain an order for a different analgesic.
C) Encourage the patient to wiggle and move the fingers.
D) Petal the edges of the patients cast.

Answer 116

Ans: A
Feedback:
Acute compartment syndrome involves a sudden and severe decrease in blood flow to the tissues distal
to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur. Removing or bivalving the cast is necessary to relieve pressure. Ordering different analgesics does not
address the underlying problem. Encouraging the patient to move the fingers or perform range-of-motion
exercises will not treat or prevent compartment syndrome. Petaling the edges of a cast with tape prevents
abrasions and skin breakdown, not compartment syndrome.