ORTHO c.

Presence of slight edema of the toes of the casted foot

d. Onset of paralysis in the toes of the casted foot

5. Which of these nursing actions will best promote

1. A client is 1 day postoperative after a total hip
independence for the client in skeletal traction?
replacement. The client should be placed in which of the

following position? a. Instruct the client to call for an analgesic before pain becomes

severe.
a. Supine
b. Provide an overhead trapeze for client use
b. Semi Fowlers
c. Encourage leg exercise within the limits of traction
c. Orthopneic
d. Provide skin care to prevent skin breakdown.
d. Trendelenburg

6. A client presents in the emergency department after

2. A client who has had a plaster of Paris cast applied to his
falling from a roof. A fracture of the femoral neck is
forearm is receiving pain medication. To detect early
suspected. Which of these assessments best support this
manifestations of compartment syndrome, which of these
diagnosis.
assessments should the nurse make?

a. The client reports pain in the affected leg

a. Observe the color of the fingers
b. A large hematoma is visible in the affected extremity
b. Palpate the radial pulse under the cast
c. The affected extremity is shortened, adducted, and extremely
c. Check the cast for odor and drainage
rotated
d. Evaluate the response to analgesics
d. The affected extremity is edematous.

3. After a computer tomography scan with intravenous

7. The nurse is caring for a client with compound fracture of
contrast medium, a client returns to the unit complaining of
the tibia and fibula. Skeletal traction is applied. Which of
shortness of breath and itching. The nurse should be
these priorities should the nurse include in the care plan?
prepared to treat the client for:

a. Order a trapeze to increase the clients ambulation

a. An anaphylactic reaction to the dye
b. Maintain the client in a flat, supine position at all times.
b. Inflammation from the extravasation of fluid during injection.
c. Provide pin care at least every hour
c. Fluid overload from the volume of the infusions
d. Remove traction weights for 20 minutes every two hours.
d. A normal reaction to the stress of the diagnostic procedure.

8. To prevent foot drop in a client with Bucks traction, the

4. While caring for a client with a newly applied plaster of
nurse should:
Paris cast, the nurse makes note of all the following

conditions. Which assessment finding a. Place pillows under the clients heels.

requires immediate notification of the physician? b. Tuck the sheets into the foot of the bed

c. Teach the client isometric exercises

a. Moderate pain, as reported by the client
d. Ensure proper body positioning.
b. Report, by client, the heat is being felt under the cast
9. Which nursing intervention is appropriate for a client with pillow under the clients amputated limb. The nursing action

skeletal traction? is to:

a. Pin care a. Leave the pillow as his stump is elevated

b. Prone positioning b. Remove the pillow and elevate the foot of the bed

c. Intermittent weights c. Leave the pillow and elevate the foot of the bed

d. 5lb weight limit d. Check with the physician and clarify the orders

10. In order for Bucks traction applied to the right leg to be 14. A client has sustained a fracture of the femur and

effective, the client should be placed in which position? balanced skeletal traction with a Thomas splint has been

applied. To prevent pressure points from occurring around

a. Supine
the top of the splint, the most important intervention is to:
b. Prone

c. Sims a. Protect the skin with lotion

d. Lithotomy b. Keep the client pulled up in bed

c. Pad the top of the splint with washcloths

11. An elderly client has sustained
d. Provide a footplate in the bed
intertrochanteric fracture of the hip and has just returned

from surgery where a nail plate was inserted for internal 15. The major rationale for the use of acetylsalicylic acid

fixation. The client has been instructed that she should not (aspirin) in the treatment of rheumatoid arthritis is to:

flex her hip. The best explanation of why this movement

a. Reduce fever
would be harmful is:
b. Reduce the inflammation of the joints

a. It will be very painful for the client c. Assist the clients range of motion activities without pain

b. The soft tissue around the site will be damaged d. Prevent extension of the disease process

c. Displacement can occur with flexion

16. Following an amputation, the advantage to the client for
d. It will pull the hip out of alignment
an immediate prosthesis fitting is:

12. When the client is lying supine, the nurse will prevent
a. Ability to ambulate sooner
external rotation of the lower extremity by using a:
b. Less change of phantom limb sensation

a. Trochanter roll by the knee c. Dressing changes are not necessary

b. Sandbag to the lateral calf d. Better fit of the prosthesis

c. Trochanter roll to the thigh

17. One method of assessing for sign of circulatory
d. Footboard
impairment in a client with a fractured femur is to ask the

13. A client has just returned from surgery after having his client to:

left leg amputated below the knee. Physicians orders

a. Cough and deep breathe
include elevation of the foot of the bed for 24 hours. The
b. Turn himself in bed
nurse observes that the nursing assistant has placed a
c. Perform biceps exercise 22. After falling down the basement steps in his house, a

d. Wiggle his toes client is brought to the emergency room. His physician

confirms that his leg is fractured. Following application of a

18. The morning of the second postoperative day following
leg cast, the nurse will first check the clients toes for:
hip surgery for a fractured right hip, the nurse will ambulate

the client. The first intervention is to: a. Increase in the temperature

b. Change in color
a. Get the client up in a chair after dangling at the bedside.
c. Edema
b. Use a walker for balance when getting the client out of bed
d. Movement
c. Have the client put minimal weight on the affected side when

getting up 23. A 23 year old female client was in an automobile

d. Practice getting the client out of bed by having her slightly flex accident and is now a paraplegic. She is on an intermittent

her hips urinary catheterization program and diet as tolerated. The

nurses priority assessment should be to observe for:

19. A young client is in the hospital with his left leg in

Bucks traction. The team leader asks the nurse to place a a. Urinary retention

footplate on the affected side at the bottom of the bed. The b. Bladder distention

purpose of this action is to: c. Weight gain

d. Bower evacuation
a. Anchor the traction

b. Prevent footdrop 24. A female client with rheumatoid arthritis has been on

c. Keep the client from sliding down in bed aspirin grain TID and prednisone 10mg BID for the last two

d. Prevent pressure areas on the foot years. The most important assessment question for the

nurse to ask related to the clients drug therapy is whether

20. When evaluating all forms of traction, the nurse knows
she has
the direction of pull is controlled by the:

a. Headaches
a. Clients position
b. Tarry stools
b. Rope/pulley system
c. Blurred vision
c. Amount of weight
d. Decreased appetite
d. Point of friction

25. A 7 year old boy with a fractured leg tells the nurse that
21. When a client has cervical halter traction to immobilize
he is bored. An appropriate intervention would be to
the cervical spine counteraction is provided by:

a. Read a story and act out the part

a. Elevating the foot of the bed
b. Watch a puppet show
b. Elevating the head of the bed
c. Watch television
c. Application of the pelvic girdle
d. Listen to the radio
d. Lowering the head of the bed
26. On a visit to the clinic, a client reports the onset of early 30. When completing the history and physical examination

symptoms of rheumatoid arthritis. Which of the following of a client diagnosed with osteoarthritis, which of the

would be the nurse most likely to asses: following would the nurse assess?

a. Limited motion of joints a. Anemia

b. Deformed joints of the hands b. Osteoporosis

c. Early morning stiffness c. Weight loss

d. Rheumatoid nodules d. Local joint pain

27. After teaching the client about risk factors 31. At which of the following times would the nurse instruct

for rheumatoid arthritis, which of the following, if stated by the client to take ibuprofen (Motrin), prescribed for left hip

the client as a risk factor, would indicate to the nurse that pain secondary to osteoarthritis, to minimize gastric

the client needs additional teaching? mucosal irritation?

a. History of Epstein-Barr virus infection a. At bedtime

b. Female gender b. On arising

c. Adults between the ages 60 to 75 years c. Immediately after meal

d. Positive testing for human leukocyte antigen (HLA) DR4 allele d. On an empty stomach

28. When developing the teaching plan for the client 32. When preparing a teaching plan for the client

with rheumatoid arthritis to promote rest, which of the with osteoarthritis who is taking celecoxib (Celebrex), the

following would the nurse expect to instruct the client to nurse expects to explain that the major advantage of

avoid during the rest periods? celecoxib over diclofenac (Voltaren), is that the celecoxib is

likely to produce which of the following?

a. Proper body alignment

b. Elevating the part a. Hepatotoxicity

c. Prone lying positions b. Renal toxicity

d. Positions of flexion c. Gastrointestinal bleeding

d. Nausea and vomiting

29. After teaching the client with severe rheumatoid

arthritis about the newly prescribed 33. After surgery and insertion of a total joint prosthesis, a

medication methotrexate (Rheumatrex O), which of the client develops severe sudden pain and an inability to move

following statements indicates the need for further the extremity. The nurse interprets these findings as

teaching? indicating which of the following?

a. I will take my vitamins while I am on this drug a. A developing infection

b. I must not drink any alcohol while Im taking this drug b. Bleeding in the operative site

c. I should brush my teeth after every meal c. Joint dislocation

d. I will continue taking my birth control pills d. Glue seepage into soft tissue
34. Which of the following would the nurse assess in a client a. Abdominal exercises

with an intracapsular hip fracture? b. Isometric shoulder exercises

c. Quadriceps setting exercises

a. Internal rotation
d. Triceps stretching exercises
b. Muscle flaccidity

c. Shortening of the affected leg 39. The client with an above the knee amputation is to use

d. Absence of pain the fracture area crutches until the prosthesis is properly lifted. When

teaching the client about using the crutches, the nurse

35. Which of the following would be inappropriate to include
instructs the client to support her weight primarily on which
when preparing a client for magnetic resonance imaging
of the following body areas?
(MRI) to evaluate a rupture disc?

a. Axillae
a. Informing the client that the procedure is painless
b. Elbows
b. Taking a thorough history of past surgeries
c. Upper arms
c. Checking for previous complaints of claustrophobia
d. Hands
d. Starting an intravenous line at keep-open rate

40. Three hours ago a client was thrown from a car into a
36. Which of the following actions would be a priority for a
ditch, and he is now admitted to the ED in a stable condition
client who has been in the postanesthesia care unit (PACU)
with vital signs within normal limits, alert and oriented with
for 45 minutes after an above the knee amputation and
good coloring and an open fracture of the right tibia. When
develops a dime size bright red spot on the
assessing the client, the nurse would be especially alert for
ace bandage above the amputation site?
signs and symptoms of which of the following?

a. Elevate the stump

a. Hemorrhage
b. Reinforcing the dressing
b. Infection
c. Calling the surgeon
c. Deformity
d. Drawing a mark around the site
d. Shock

37. A client in the PACU with a left below the knee

41. The client with a fractured tibia has been
amputation complains of pain in her left big toe. Which of
taking methocarbamol (Robaxin), when teaching the client
the following would the nurse do first?
about this drug, which of the following would the nurse

include as the drugs primary effect?

a. Tell the client it is impossible to feel the pain

b. Show the client that the toes are not there

a. Killing of microorganisms
c. Explain to the client that the pain is real
b. Reduction in itching
d. Give the client the prescribed narcotic analgesic
c. Relief of muscle spasms

d. Decrease in nervousness
38. The client with an above the knee amputation is to use

crutches until the prosthesis is being adjusted. In which of

42. A client who has been taking carisoprodol (Soma) at
the following exercises would the nurse instruct the client
home for a fractured arm is admitted with a blood
to best prepare him for using crutches?
pressure of 80/50 mmHg, a pulse rate of 115 bpm, and
respirations of 8 breaths/minute and shallow, the a. Pulmonary emboli

nurse interprets these finding as indicating which of the b. Osteomyelitis

following? c. Fat emboli

d. Urinary tract infection

a. Expected common side effects

b. Hypersensitivity reactions 47. When antibiotics are not producing the desired outcome

c. Possible habituating effects for a client with osteomyelitis, the nurse interprets this as

d. Hemorrhage from GI irritation suggesting the occurrence of which of the following as most

likely?
43. When admitting a client with a fractured extremity, the

nurse would focus the assessment on which of the following a. Formation of scar tissue interfering with absorption

first? b. Development of pus leading to ischemia

c. Production of bacterial growth by avascular tissue

a. The area proximal to the fracture
d. Antibiotics not being instilled directly into the bone
b. The actual fracture site

c. The area distal to the fracture 48. Which of the following would the nurse use as the best

d. The opposite extremity for baseline comparison method to assess for the development of deep vein

thrombosis in a client with a spinal cord injury?

44. A client with fracture develops compartment syndrome.

When caring for the client, the nurse would be alert for a. Homans sign

which of the following signs of possible organ failure? b. Pain

c. Tenderness
a. Rales
d. Leg girth
b. Jaundice

c. Generalized edema 49. The nurse is caring for the client who is going to have an

d. Dark, scanty urine arthogram using a contrast medium. Which of the following

assessments by the nurse are of highest priority?

45. Which of the following would lead the nurse to suspect

that a client with a fracture of the right femur may be a. Allergy to iodine or shellfish

developing a fat embolus? b. Ability of the client to remain still during the procedure

c. Whether the client has any remaining questions about the

a. Acute respiratory distress syndrome
procedure
b. Migraine like headaches
d. Whether the client wishes to void before the procedure
c. Numbness in the right leg

d. Muscle spasms in the right thigh 50. The client immobilized skeletal leg traction complains of

being bored and restless. Based on these complaints, the

46. The client who had an open femoral fracture was
nurse formulates which of the following nursing diagnoses
discharged to her home, where she developed, fever, night
for this client?
sweats, chills, restlessness and restrictive movement of the

fractured leg. The nurse interprets these finding as a. Diversional activity deficit

indicating which of the following? b. Powerlessness

c. Self care deficit c. Crutches and the right leg then advance the left leg

d. Impaired physical mobility d. Crutches and the left leg then advance the right leg

51. The nurse is teaching the client who is to have a gallium 55. The client with right sided weakness needs to learn how

scan about the procedure. The nurse includes which of the to use a cane. The nurse plans to teach the client to position

following items as part of the instructions? the cane by holding it with the:

a. The gallium will be injected intravenously 2 to 3 hours before the a. Left hand and placing the cane in front of the left foot

procedure b. Right hand and placing the cane in front of the right foot

b. The procedure takes about 15 minutes to perform c. Left hand and 6 inches lateral to the left foot

c. The client must stand erect during the filming d. Right hand and 6 inches lateral to the left foot

d. The client should remain on bed rest for the remainder of the
56. The nurse is repositioning the client who has returned to
day after the scan
the nursing unit following internal fixation of a fractured

52. The nurse is assessing the casted extremity of a client. right hip. The nurse uses a:

The nurse assesses for which of the following signs and

a. Pillow to keep the right leg abducted during turning
symptoms indicative of infection?
b. Pillow to keep the right leg adducted during turning

a. Coolness and pallor of the extremity c. Trochanter roll to prevent external rotation while turning

b. Presence of a hot spot on the cast d. Trochanter roll to prevent abduction while turning

c. Diminished distal pulse

57. The nurse has an order to get the client out of bed to a
d. Dependent edema
chair on the first postoperative day after a total knee

53. The client has Bucks extension applied to the right leg. replacement. The nurse plans to do which of the following to

The nurse plans which of the following interventions to protect the knee joint:

prevent complications of the device?

a. Apply a knee immobilizer before getting the client up and

a. Massage the skin of the right leg with lotion every 8 hours elevate the clients surgical leg while sitting

b. Give pin care once a shift b. Apply an Ace wrap around the dressing and put ice on the knee

c. Inspect the skin on the right leg at least once every 8 hours while sitting

d. Release the weights on the right leg for range of motion c. Lift the client to the bedside change leaving the CPM machine in

exercises daily place

d. Obtain a walker to minimize weight bearing by the client on the

54. The nurse is giving the client with a left cast crutch
affected leg
walking instructions using the three point gait. The client is

allowed touchdown of the affected leg. The nurse tells the 58. The nurse is caring for the client who had an above the

client to advance the: knee amputation two (2) days ago. The residual limb was

wrapped with an elastic compression bandage which has

a. Left leg and right crutch then right leg and left crutch
come off. The nurse immediately:
b. Crutches and then both legs simultaneously
a. Calls the physician

b. Rewrap the stump with an elastic compression bandage

c. Applies ice to the site

d. Applies a dry sterile dressing and elevates it on a pillow

59. The nurse has taught the client with a below the knee

amputation about prosthesis and stump care. The nurse

evaluates that the client states to:

a. Wear a clean nylon stump sock daily

b. Toughen the skin of the stump by rubbing it with alcohol

c. Prevent cracking of the skin of the stump by applying lotion daily

d. Using a mirror to inspect all areas of the stump each day

60. The nurse is caring for a client with a gout. Which of the

following laboratory values does the nurse expect to note in

the client?

a. Uric acid level of 8 mg/dl

b. Calcium level of 9 mg/dl

c. Phosphorus level of 3 mg/dl

d. Uric acid level of 5 mg/dl

Answers

Here are the answers for the exam.

Unfortunately, rationales are not given. If you
need clarifications or have disputes, please
direct them to the comments section and well
be glad to give you an explanation.

1. b. Semi Fowlers
2. d. Evaluate the response to analgesics
3. a. An anaphylactic reaction to the dye
4. d. Onset of paralysis in the toes of the
casted foot
5. b. Provide an overhead trapeze for client
use
6. c. The affected extremity is shortened,
adducted, and extremely rotated
7. c. Provide pin care at least every hour
8. d. Ensure proper body positioning.
9. a. Pin care
10. a. Supine
11. c. Displacement can occur with flexion
12. c. Trochanter roll to the thigh
13. b. Remove the pillow and elevate the foot
of the bed
14. c. Pad the top of the splint with washcloths
15. b. Reduce the inflammation of the joints
16. a. Ability to ambulate sooner
17. d. Wiggle his toes
18. d. Practice getting the client out of bed by
having her slightly flex her hips
19. b. Prevent footdrop
20. b. Rope/pulley system
21. b. Elevating the head of the bed
22. b. Change in color
23. b. Bladder distention
24. b. Tarry stools
25. c. Watch television
26. c. Early morning stiffness
27. c. Adults between the ages 60 to 75 years
28. d. Positions of flexion
29. d. I will continue taking my birth control
pills
30. d. Local joint pain
31. c. Immediately after meal
32. c. Gastrointestinal bleeding
33. c. Joint dislocation
34. c. Shortening of the affected leg
35. d. Starting an intravenous line at keep-
open rate
36. d. Drawing a mark around the site
37. d. Give the client the prescribed narcotic
analgesic
38. d. Triceps stretching exercises
39. d. Hands
40. a. Hemorrhage
41. c. Relief of muscle spasms
42. a. Expected common side effects
43. c. The area distal to the fracture
44. d. Dark, scanty urine
45. a. Acute respiratory distress syndrome
46. b. Osteomyelitis
47. c. Production of bacterial growth by
avascular tissue
48. a. Homans sign
49. a. Allergy to iodine or shellfish
50. a. Divertional activity deficit
51. a. The gallium will be injected
intravenously 2 to 3 hours before the
procedure
52. b. Presence of a hot spot on the cast
53. c. Inspect the skin on the right leg at least
once every 8 hours
54. d. Crutches and the left leg then advance
the right leg
55. c. Left hand and 6 inches lateral to the left
foot
56. a. Pillow to keep the right leg abducted
during turning
57. a. Apply a knee immobilizer before getting
the client up and elevate the clients surgical
leg while sitting
58. b. Rewrap the stump with an elastic
compression bandage
59. d. Using a mirror to inspect all areas of the
stump each day
60. a. Uric acid level of 8 mg/dl