Ortho NCLEX Questions 1 PDF

A client seeks care for low back pain of 2 weeks' duration.
Which assessment finding suggests a herniated intervertebral

disk?
1. Pain radiating down the posterior

thigh
2. Back pain when the knees are

flexed
3. Atrophy of the lower leg muscles
4. Homans' sign
Correct Answer: 1 Your Answer: 1

RATIONALES: A herniated intervertebral disk may compress the spinal nerve roots, causing sciatic nerve inflammation that results in pain radiating
down the leg. Slight knee flexion should relieve, not precipitate, low back pain. If nerve root compression remains untreated, weakness or paralysis of
the innervated muscle group may result; lower leg atrophy may occur if muscles aren't used. Homans' sign is more typical of phlebothrombosis.
The nurse is teaching a client with osteomalacia how to take prescribed vitamin D supplements. The nurse stresses the importance of taking only the
prescribed amount because high doses of vitamin D can be toxic. Early signs and symptoms of vitamin D toxicity include:
1. GI upset and metallic

taste.
2. dry skin, hair loss, and inflamed mucous

membranes.
3. flushing and orthostatic hypotension.
4. sensory neuropathy and difficulty maintaining

balance.

RATIONALES: GI upset and metallic taste are early signs and symptoms of vitamin D toxicity. Such toxicity also may cause headache, weakness,
renal insufficiency, renal calculi, hypertension, arrhythmias, muscle pain, and conjunctivitis. Dry skin, hair loss, and inflamed mucous membranes
suggest vitamin A toxicity. Flushing and orthostatic hypotension (effects of vasodilation) may result from nicotinic acid and nicotinamide supplements,
used to correct niacin deficiency. Sensory neuropathy and difficulty maintaining balance suggest pyridoxine toxicity.
A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse
offer?
1. "Do all your chores in the morning, when pain and stiffness are least
pronounced."
2. "Do all your chores after performing morning exercises to loosen

up."
3. "Pace yourself and rest frequently, especially after

activities."
4. "Do all your chores in the evening, when pain and stiffness are least
pronounced."

RATIONALES: A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most
common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest
usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace herself during daily activities.
Option 1 is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Options 2 and 4 are incorrect because the
client should pace herself and take frequent rests rather than doing all chores at once.
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A 51-year-old client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults
urology. What would the nurse suspect is the most likely cause of the client's urination problem?
1. Renal calculi
2. Urinary tract
infection
3. Benign prostatic hyperplasia
4. Dehydration

RATIONALES: Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A urinary tract infection (UTI)
commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however,
because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in
urine production, not a problem with urination.
A common bone disease that usually affects middle-aged and elderly people. It's marked by inflammation of the bones, softening and thickening of the
bones, excessive bone destruction, and unorganized bone repair; the result is bowing of the long bones. The cause is unknown.
A client has acute, painful muscle spasms. The physician prescribes chlorzoxazone (Paraflex), 500 mg P.O. t.i.d. A centrally acting skeletal muscle
relaxant, chlorzoxazone commonly is used to treat:
1. muscle spasm caused by cerebral palsy.
2. chronic musculoskeletal disorder.
3. lower extremity
spasticity.
4. severe muscle
spasm.

RATIONALES: Chlorzoxazone is used to treat acute, painful musculoskeletal conditions or severe muscle spasm. Centrally acting skeletal muscle
relaxants like chlorzoxazone are ineffective in treating spasticity associated with chronic neurologic disease, such as cerebral palsy. They can treat
acute musculoskeletal disorders, not chronic ones. Chlorzoxazone and the other relaxants are used to treat spasticity of any extremity.
A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse
respond?
1. "You should ask your physician about

that."
2. "The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight
disability."
3. "You may experience progressive deterioration in all voluntary

muscles."
4. "This form of muscular dystrophy is a relatively benign disease that progresses

slowly."

RATIONALES: Muscular dystrophy causes progressive, symmetrical wasting of skeletal muscles, without neural or sensory defects. The mixed form
of the disease typically strikes between ages 30 and 50 and progresses rapidly, causing deterioration of all voluntary muscles. Because the client
asked the nurse this question directly, the nurse should answer and not simply refer the client to the physician. Limb-girdle muscular dystrophy
causes a gradual decrease in arm and pelvic muscle strength, resulting in slight disability. Facioscapulohumeral muscular dystrophy is a slowly
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progressive, relatively benign form of muscular dystrophy; it usually arises before age 10.
A group of degenerative genetic diseases characterized by weakness and the progressive atrophy of skeletal muscles with no evidence of nervous system
involvement.
The nurse is caring for a client who complains of lower back pain. Which instructions should the nurse give to the client to prevent back
injury?
1. "Bend over the object you're

lifting."
2. "Narrow the stance when lifting."
3. "Push or pull an object using your

arms."
4. "Stand close to the object you're

lifting."

RATIONALES: Standing close to an object when lifting moves the body's center of gravity closer to the object, allowing the legs, rather than the back,
to bear the weight. No one should bend over an object when lifting; instead, the back should be straight, and bending should be at the hips and
knees. When lifting, spreading the legs apart widens the base of support and lowers the center of gravity, providing better balance. Pushing or pulling
an object using the weight of the body, rather than the arms or back, prevents back strain. Using a larger number of muscle groups distributes the
workload.
A client is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the
disease?
1. "It's common in females after menopause."
2. "It's a degenerative disease characterized by a decrease in bone density."
3. "It's a congenital disease caused by poor dietary intake of milk products."
4. "It can cause pain and injury."
5. "Passive range-of-motion exercises can promote bone growth."
6. "Weight-bearing exercise should be avoided."
Correct Answer: 1,2,4 Your Answer: 1,2,4

RATIONALES: Osteoporosis is a degenerative metabolic bone disorder in which the rate of bone resorption accelerates and the rate of bone
formation decelerates, thus decreasing bone density. Postmenopausal women are at increased risk for this disorder because of the loss of estrogen.
The decrease in bone density can cause pain and injury. Osteoporosis isn't a congenital disorder; however, low calcium intake does contribute to the
disorder. Passive range-of-motion exercises may be performed but they won't promote bone growth. The client should be encouraged to participate
in weight-bearing exercise because it promotes bone growth.
The nurse is caring for a client with burns on his legs. Which nursing intervention will help to prevent
contractures?
1. Applying knee splints
2. Elevating the foot of the

bed
3. Hyperextending the client's legs
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4. Performing shoulder range-of-motion (ROM)
exercises

RATIONALES: Applying knee splints prevents leg contractures by holding the joints in a functional position. Elevating the foot of the bed doesn't
prevent contractures. Hyperextending a body part for any length of time is inappropriate; it can cause contractures. Performing shoulder ROM
exercises can prevent contractures in the shoulders but not in the legs.
Following a boating accident, a 30-year-old client with multiple fractures is admitted to a semiprivate room in a progressive care unit. The client, who
was driving the boat, is unaware that his girlfriend's 9-year-old son was killed in the accident. The client's parents instruct the nurse to prohibit phone
calls and to withhold information about the accident. During an assessment of the client, the nurse notices that the television is on and the news is
starting. It would be most appropriate for the nurse to:
1. turn the television off and tell the client it interferes with the
assessment.
2. allow the client to view the television and deal with any questions as they
come.
3. instruct the client to change the channel to a station that isn't televising the
news.
4. attempt to distract the client from watching the

television.

RATIONALES: The nurse-client relationship is built on trust, so the nurse can't withhold information from her client. She may refer the client to
another source for the information, but she can't prohibit the client from seeking information. It would be most appropriate to deal with the client's
questions as they come. Turning the television off, changing the channel, and distracting the client are all deceitful practices, which can damage a
therapeutic nurse-client relationship.
A client is diagnosed with gout. Which foods should the nurse instruct the client to
avoid?
1. Green, leafy vegetables
2. Liver
3. Cod
4. Chocolate
5. Sardines
6. Eggs
Correct Answer: 2,3,5 Your Answer: 2,3,5

RATIONALES: Clients with gout should avoid foods that are high in purines, such as liver, cod, and sardines. They should also avoid anchovies,
kidneys, sweetbreads, lentils, and alcoholic beverages — especially beer and wine. Green, leafy vegetables; chocolate; and eggs aren't high in
purines.
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The clinical nurse specialist developed clinical pathways for common orthopedic conditions. The interdisciplinary team uses these pathways
to:
1. provide a care plan for caregivers to ensure continuity of

care.
2. provide a step-by-step care plan.
3. accurately bill the client for services provided.
4. describe the pathophysiology of the diagnosis.

RATIONALES: The pathway provides a care plan that ensures continuity of care for clients with like diagnoses. Each clinical pathway is then
modified to meet individual client needs. Clinical pathways don't provide a step-by-step care plan, help bill the client, or describe the pathophysiology
of the diagnosis.
Which nursing diagnosis is a priority for the client with a traumatically amputated lower
extremity?
1. Impaired skin integrity related to effects of the

injury
2. Anticipatory grieving related to the loss of a

limb
3. Disturbed body image related to changes in the structure of a body

part
4. Risk for injury related to injury and

amputation

RATIONALES: The priority diagnosis is Risk for injury related to amputation. Patient safety takes priority. Amputation typically causes an unsteady
gait until the client receives physical therapy and learns to ambulate safely. All the nursing diagnoses listed are appropriate for a client presenting
with a traumatic amputation of an extremity.
To assess the joints, the nurse asks a client to perform various movements. As the client moves the arm away from the midline, the nurse evaluates
the ability to perform:
1. protraction.
2. retraction.
3. adduction.
4. abduction.

RATIONALES: A client performs abduction when moving a body part away from the midline. Protraction refers to drawing out or lengthening of a
body part. Retraction, the opposite of protraction, refers to drawing back or shortening of a body part. Adduction, the opposite of abduction, is
movement of a body part toward the midline.
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The nurse is teaching a female client about preventing osteoporosis. Which teaching point is
correct?
1. Obtaining an X-ray of the bones every 3 years is recommended to detect bone

loss.
2. To avoid fractures, the client should avoid strenuous

exercise.
3. The recommended daily allowance of calcium may be found in a wide variety of

foods.
4. Obtaining the recommended daily allowance of calcium requires taking a calcium

supplement.

RATIONALES: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. It's often, though
not always, possible to get the recommended daily requirement in the foods we eat. Supplements are available but not always necessary.
Osteoporosis doesn't show up on ordinary X-rays until 30% of the bone loss has occurred. Bone densitometry can detect bone loss of 3% or less.
This test is sometimes recommended routinely for women over 35 who are at risk. Strenuous exercise won't cause fractures.
A client who recently had a stroke requires a cane to ambulate. When teaching about cane use, explain that the reason for holding a cane on the
uninvolved side is to:
1. prevent leaning.
2. distribute weight away from the involved

side.
3. maintain stride length.
4. prevent
edema.

RATIONALES: Holding a cane on the uninvolved side distributes weight away from the involved side. Holding the cane close to the body prevents
leaning. Use of a cane won't maintain stride length or prevent edema.
A client is preparing for discharge from the emergency department after sustaining an ankle sprain. The client is instructed to avoid weight bearing on
the affected leg and is given crutches. After instruction, the client demonstrates proper crutch use in the hallway. What additional information is most
important to know before discharging the client?
1. Whether the client needs to navigate stairs routinely at

home
2. Whether pets are present in the

home
3. Whether the client parks his car on the

street
4. Whether the client drives a car with a stick

shift

RATIONALES: Knowing whether the client must routinely navigate steps at home is most important. If the client must navigate steps, special crutch-
walking techniques must be taught to safely navigate the stairs. Options 2, 3, and 4 can pose problems for the client; however, they aren't important
to know before discharging the client with crutches.
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A client is scheduled for a laminectomy of the L1 and L2 vertebrae. Identify the area that's involved in the client's
surgery.
The green rectangle shows the correct answer.

RATIONALES: In laminectomy, one or more of the bony laminae that cover the vertebrae are removed. There are five lumbar vertebrae and they are
numbered from top to bottom. L5 is the closest to the sacrum. Count up from the sacrum to locate L1 and L2.
The nurse should monitor the client with a pelvic fracture receiving an opium derivative, such as morphine, for what common adverse
reaction?
1. Respiratory depression
2. Diarrhea
3. High fever
4. Pupil dilation

RATIONALES: One of the most common adverse reactions to opium derivatives is decreased rate and depth of respiration, which worsens as the
dosage is increased. This may cause periodic, irregular breathing or precipitate asthmatic attacks in susceptible clients. Opium derivatives also can
cause constipation and pupil constriction. A high fever isn't an adverse reaction associated with opium derivatives.
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The nurse is teaching a client with a left fractured tibia how to walk with crutches. Which instruction is
appropriate?
1. "Use the axillae to help carry the weight."
2. "All weight should be on the

hands."
3. "Keep feet 12″ (30 cm) apart to provide stability and a wide base of
support."
4. "Take long strides to maintain maximum mobility."

RATIONALES: When using crutches, all weight should be on the hands. Constant pressure on the axillae from weight bearing can damage the
brachial plexus nerve and produce crutch paralysis. Feet should be 6″ to 8″ (15 to 20 cm) apart to provide stability and support. Short strides — not
long ones — provide safety and maximum mobility.
A 17-year-old client with a history of muscular dystrophy is admitted with aspiration pneumonia. The nurse asks the parents if the client has an advance
directive. Which response by the parents leads the nurse to believe that the parents don't understand the severity of the client's medical condition?
1. "He has pneumonia; I shouldn't have let him go to that party last
week."
2. "This is the third time he's had pneumonia in the past 6 months. I'm afraid he needs a feeding
tube."
3. "Yes, he has an advance directive."
4. "He is only 17. He doesn't need an advance

directive."

RATIONALES: Option 4 suggests that the parents don't fully understand the seriousness of their son's medical condition. Advance directives can be
used for any client who has an irreversible condition. Option 1 shows a lack of knowledge about acquiring aspiration pneumonia. Options 2 and 3
show an understanding of their son's condition.
For a client with osteoporosis, the nurse should provide which dietary
instruction?
1. "Decrease your intake of red

meat."
2. "Decrease your intake of popcorn, nuts, and

seeds."
3. "Eat more fruits to increase your potassium

intake."
4. "Eat more dairy products to increase your calcium

intake."

RATIONALES: Osteoporosis causes a severe, general reduction in skeletal bone mass. To offset this reduction, the nurse should advise the client to
increase calcium intake by consuming more dairy products, which provide about 75% of the calcium in the average diet. None of the other options
would stop osteoporosis from worsening.
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A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should
anticipate which measure?
1. Administering large doses of oral antibiotics as

prescribed
2. Instructing the client to ambulate twice daily
3. Withholding all oral intake
4. Administering large doses of I.V. antibiotics as

prescribed

RATIONALES: Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical
drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't
necessarily prohibited.
Inflammation of bone that results from a local or general infection of bone and bone marrow. The bacterial infection is caused by trauma or surgery, by
direct extension from a nearby infection, or by introduction from the bloodstream.
A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care
plan?
1. Elevating the stump for the first 24

hours
2. Maintaining the client on complete bed

rest
3. Applying heat to the stump as the client desires
4. Removing the pressure dressing after the first 8

hours

RATIONALES: Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous
pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application
would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually
remains in place for 48 to 72 hours after surgery.
A client with muscle weakness and an abnormal gait is being evaluated for muscular dystrophy. Which test or finding confirms muscular
dystrophy?
1. Electromyography
2. Muscle biopsy
3. Family history of muscular dystrophy
4. Gram stain of muscle

tissue

RATIONALES: A muscle biopsy showing fat and connective tissue deposits confirms the diagnosis of muscular dystrophy. Electromyography
commonly shows short, weak bursts of electrical activity in affected muscles; however, it isn't a conclusive test for muscular dystrophy. A family
history of muscular dystrophy only suggests the disorder. A Gram stain of muscle tissue is inconclusive.
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During a senior citizen health screening, the nurse observes a 75-year-old female with a severely increased thoracic curve, or "humpback". What is this
condition called?
1. Lordosis
2. Kyphosis
3. Scoliosis
4. Genus varum

RATIONALES: Kyphosis refers to an increased thoracic curvature of the spine, or "humpback." Lordosis is an increase in the lumbar curve or
swayback. Scoliosis is a lateral deformity of the spine. Genus varum is a bow-legged appearance of the legs.
A client undergoes a muscle biopsy. After the procedure, the nurse must keep the biopsy site elevated
for:
1. 2 to 4 hours.
2. 6 to 8 hours.
3. 12 hours.
4. 24 hours.

RATIONALES: The nurse must keep the muscle biopsy site elevated for 24 hours to reduce edema. Elevating it for a shorter period may cause
edema, worsening discomfort and increasing the risk of tissue injury.
Which of the following cells are involved in bone

resorption?
1. Chondrocytes
2. Osteoblast
s
3. Osteoclast
s
4. Osteocytes

RATIONALES: Osteoclasts carry out bone resorption by removing unwanted bone while new bone is forming in other areas. Chondrocytes are
responsible for forming new cartilage. Osteoblasts are bone-forming cells that secrete collagen and other substances. Osteocytes, derived from
osteoblasts, are the chief cells in bone tissue.
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The nurse is caring for five clients on the orthopedic unit with the help of a nursing assistant. Which task can the nurse delegate to the nursing
assistant.
1. Assisting a client to the bathroom and recording the output in the medical
record
2. Notifying the physician of a change in a client's blood

pressure
3. Auscultating and recording breath sounds in the medical

record
4. Taking a verbal report from the emergency department for a client being admitted to the orthopedic
unit

RATIONALES: The nurse can safely delegate activities of daily living such as assisting the client to the bathroom to the nursing assistant. Notifying
the physician, auscultating breath sounds, and taking report are all responsibilities that must be performed by a registered nurse.
A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client was
diagnosed with diabetes mellitus at age 12. The nurse knows that this disease predisposes the client to which musculoskeletal disorder?
1. Degenerative joint disease
2. Muscular dystrophy
3. Scoliosis
4. Paget's disease

RATIONALES: Diabetes mellitus predisposes the client to degenerative joint disease. It isn't a predisposing factor for muscular dystrophy, scoliosis,
or Paget's disease.
After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the
nurse position the client?
1. With the affected hip flexed

acutely
2. With the leg on the affected side

abducted
3. With the leg on the affected side

adducted
4. With the affected hip rotated

externally

RATIONALES: The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the
affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse
should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected
side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg)
because these positions may cause dislocation of the injured hip joint.
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A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the
postoperative care plan?
1. Performing passive range-of-motion (ROM) exercises on the client's legs once each
shift
2. Keeping a pillow between the client's legs at all times
3. Turning the client from side to side every 2

hours
4. Maintaining the client in semi-Fowler's position

RATIONALES: After hip pinning, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not
to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative
period because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to
side. After hip pinning, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position
should be avoided.
Which statement by a staff nurse on the orthopedic floor indicates the need for further staff
education?
1. "The client is receiving physical therapy twice per day so he doesn't need a continuous passive motion
device."
2. "The continuous passive motion device can decrease the development of

adhesions."
3. "Bleeding is a complication associated with the continuous passive motion

device."
4. "Monitoring skin integrity is important while the continuous passive motion device is in
place."

RATIONALES: Further staff education is needed when the nurse states that the continuous passive motion device isn't needed because the client
receives physical therapy twice per day. The continuous passive motion device should be used in conjunction with physical therapy because the
device helps prevent adhesions. Bleeding is a complication associated with the continuous passive motion device; skin integrity should be monitored
while the devise is in use.
A client has a Fiberglas cast on the right arm. Which action should the nurse include in the care
plan?
1. Keeping the casted arm warm by covering it with a light

blanket
2. Avoiding handling the cast for 24 hours or until it is

dry
3. Evaluating pedal and posterior tibial pulses every 2

hours
4. Assessing movement and sensation in the fingers of the right

hand

RATIONALES: The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting
circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast pores
to the skin below. Unlike a plaster cast, a Fiberglas cast dries quickly and can be handled without damage soon after application. The nurse should
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assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses, which are found in the legs.
A client is prescribed diazepam (Valium) to treat severe skeletal muscle spasms. During this therapy, the nurse monitors the client closely for adverse
reactions. Which adverse reaction is most likely to occur?
1. Bradycardia
2. Skin
rash
3. Hypotension
4. Sedation

RATIONALES: Most adverse reactions to diazepam and other benzodiazepines involve the central nervous system; less than 1% involve other body
systems. Therefore, the client is more likely to experience sedation than bradycardia, skin rash, or hypotension.
After a person experiences a closure of the epiphyses, which of the following is

true?
1. The bone grows in length but not

thickness.
2. The bone increases in thickness and is remodeled.
3. Both bone length and thickness

continues.
4. No further increase in bone length

occurs.

RATIONALES: After closure of the epiphyses, no further increase in bone length can occur. All of the other options are inappropriate and not related
to closure of the epiphyses.
A client is in the emergency department with a suspected fracture of the right hip. Which assessment findings would the nurse
expect?
1. The right leg is longer than the left leg.
2. The right leg is shorter than the left leg.
3. The right leg is abducted.
4. The right leg is adducted.
5. The right leg is externally rotated.
6. The right leg is internally rotated.
Correct Answer: 2,4,5 Your Answer: 2

RATIONALES: In a hip fracture, the affected leg is shorter, adducted, and externally rotated.
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A 70-year-old client with complaints of joint pain and decreased mobility comes to the orthopedic clinic. After completing the examination, the physician
suspects osteoarthritis for which he prescribes celecoxib (Celebrex). Which health team member should the nurse expect the physician to consult to
help manage this client's care?
1. Physical
therapist
2. Pain management nurse
3. Gastroenterologist
4. Home care nurse

RATIONALES: The physician should consult the physical therapist to help the client with an exercise program that increases the client's mobility and
helps with pain management. Consulting the pain management nurse isn't necessary at this time. Consulting a gastroenterologist isn't necessary
unless the client develops GI complications associated with celecoxib therapy. Home care isn't indicated at this time.
The physician diagnoses primary osteoporosis in a client who has lost bone mass. In this metabolic disorder, the rate of bone resorption accelerates
while bone formation slows. Primary osteoporosis is most common in:
1. elderly men.
2. young children.
3. young menstruating
women.
4. elderly, postmenopausal women.

RATIONALES: Although the cause of primary osteoporosis is unknown, an important contributing factor may be faulty protein metabolism resulting
from estrogen deficiency and a sedentary lifestyle. Typically, these conditions occur in elderly postmenopausal women.
After suffering a fall at home, a client is brought to the emergency department by ambulance. An X-ray confirms the diagnosis of a displaced fracture of
the neck of the left femur. Which intervention best immobilizes the client's femur and prevents complication?
1. Placing a sand bag or trochanter roll on the outside of the

leg
2. Preparing the client for surgical intervention
3. Applying Buck's traction to the leg
4. Teaching crutch walking

RATIONALES: Preparing the client for surgical intervention prevents complications and provides immediate immobilization through surgical repair.
Buck's traction, sand bags, or trochanter rolls may be used temporarily to reduce muscle spasm and pain until the client can be prepared for surgery.
Crutch walking on an unrepaired fracture is contraindicated.
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The nurse is giving instructions to a client who's going home with a cast on his leg. Which point is most
critical?
1. Using crutches
properly
2. Exercising joints above and below the cast, as

ordered
3. Avoiding walking on a leg cast without the physician's

permission
4. Reporting signs of impaired circulation

RATIONALES: Although all of these interventions are important, reporting signs of impaired circulation is the most critical. Signs of impaired
circulation must be reported to the physician immediately to prevent permanent damage. The other options reflect more long-term concerns. The
client should learn to use his crutches properly to avoid nerve damage. The client may exercise above and below the cast, as the physician orders.
The client should be told not to walk on the cast without the physician's permission.
An 88-year-old client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse
manage the client's postoperative pain?
1. Administer oral opioids as

needed.
2. Provide patient-controlled analgesia.
3. Administer pain medication through a transdermal

patch.
4. Administer analgesics around the clock.

RATIONALES: Because assessing pain medication needs in a client with end-stage dementia is difficult, analgesics should be administered around
the clock. Clients at this stage of dementia typically can't request oral pain medications when needed. They're also unable to use patient-controlled
analgesia devices. Transdermal patches are used to manage chronic pain; not postoperative pain.
The nurse is caring for an elderly female with osteoporosis. When teaching the client, the nurse should include information about which major
complication?
1. Bone fracture
2. Loss of
estrogen
3. Negative calcium balance
4. Dowager's hump

RATIONALES: Bone fracture is a major complication of osteoporosis that results when loss of calcium and phosphate increases the fragility of bones.
Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone
metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when
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repeated vertebral fractures increase spinal curvature.
Which action can the nurse on the orthopedic unit safely delegate to a licensed practical nurse
(LPN)?
1. Teaching a client receiving warfarin (Coumadin) about follow-up

care
2. Assessing the hip wound during a dry sterile dressing

change
3. Obtaining vital signs during blood

administration
4. Taking a telephone order for pain medications for a postoperative

client

RATIONALES: The nurse can safely delegate obtaining vital signs during blood administration to the LPN. Teaching the client taking warfarin follow-
up care, assessing a hip wound, and taking a telephone order are actions that must be taken by the registered nurse because they aren't within the
scope of LPN practice.
An elderly client fell and fractured the neck of his femur. Identify the area where the fracture
occurred.
The green rectangle shows the correct answer.

RATIONALES: The femur's neck connects the femur's round ball head to the shaft.
The nurse is assessing a client with possible osteoarthritis. The most significant risk factor for osteoarthritis
is:
1. congenital deformity.
2. age.
16
3. trauma.
4. obesity.

RATIONALES: Age is the most significant risk factor for developing osteoarthritis. Development of primary osteoarthritis is influenced by genetic,
metabolic, mechanical, and chemical factors. Secondary osteoarthritis usually has identifiable precipitating events such as trauma.
To help prevent osteoporosis, what should the nurse advise a young woman to
do?
1. Avoid trauma to the affected bone.
2. Encourage the use of a firm

mattress.
3. Consume at least 1,000 mg of calcium

daily.
4. Keep the serum uric acid level in the normal

range.

RATIONALES: To help prevent osteoporosis, the nurse should encourage the client to consume at least the recommended daily allowance (RDA) of
calcium. Before menopause, the RDA is 1,000 mg; after menopause, it is 1,500 mg. Because osteoporosis affects all bones, option 1 is
inappropriate. Options 2 and 4 don't relate to osteoporosis. The nurse should encourage a client with ankylosing spondylitis to sleep on a firm
mattress. The nurse should advise a client with gouty arthritis to keep the serum uric acid level in the normal range.
A client with gout is receiving probenecid (Benemid). When caring for this client, the nurse should monitor which laboratory
value?
1. Red blood cell

count
2. Serum uric acid

level
3. Hemoglobin level
4. Serum potassium level

RATIONALES: In gout, joint inflammation results from deposits of uric acid crystals. Probenecid relieves this inflammation by reducing the uric acid
level in the blood. To assess the drug's efficacy, the nurse should monitor the client's serum uric acid level. The other options don't reflect the action
or effectiveness of probenecid.
A group of disorders associated with inborn errors of metabolism that affect purine and pyrimidine use; results in increased production of uric acid or
interferes with its excretion. Manifested by hyperuricemia, recurrent acute inflammatory arthritis, deposition of urate crystals in the joints of the extremities,
and uric acid urolithiasis.
The nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a leg amputation, exercise of
the remaining limb:
1. isn't necessary.
2. should begin immediately

postoperatively.
17
3. should begin the day after
surgery.
4. begins at a rehabilitation center.

RATIONALES: Exercise should begin the day after surgery. Exercise is necessary to maintain the muscle tone of the remaining limb. Immediately
after surgery, the client usually isn't alert enough to participate and may be in too much pain. Exercise needs to begin before discharge to a
rehabilitation center.
A client comes to the outpatient department with suspected carpal tunnel syndrome. When assessing the affected area, the nurse expects to find which
abnormality that's typically associated with this syndrome?
1. Positive Tinel's sign
2. Negative Phalen's sign
3. Positive Chvostek's sign
4. Negative Trousseau's sign

RATIONALES: The nurse expects a client with carpal tunnel syndrome to exhibit a positive Tinel's sign — tingling or shocklike pain in reaction to light
percussion over the median nerve at the wrist. The client also may have a positive Phalen's sign, characterized by hand tingling with acute wrist
flexion. The nurse checks for Chvostek's sign and Trousseau's sign in a client with suspected hypocalcemia, not carpal tunnel syndrome.
A client in the surgical intensive care unit has skeletal tongs in place to stabilize a cervical fracture. Protocol dictates that pin care should be performed
each shift. When providing pin care for the client, which finding should the nurse report to the physician?
1. Crust around the pin insertion

site
2. A small amount of yellow drainage at the left pin insertion

site
3. A slight reddening of the skin surrounding the insertion

site
4. Pain at the insertion

site

RATIONALES: The nurse should report the presence of yellow drainage, which indicates the presence of infection, at the left pin insertion site. Crust
formation around the pin site is a natural response to the trauma caused by the pin insertion. Redness at the insertion site may be an early sign of
infection; the nurse should continue to monitor the area. The client may experience pain at the pin insertion sites; therefore, the nurse should
administer pain medications as prescribed. It's only necessary to notify the physician if the pain medication is ineffective.
A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in his cast
care?
1. "Cover the cast with a blanket until the cast

dries."
2. "Keep your right leg elevated above heart

level."
18
3. "Use a knitting needle to scratch itches inside the
cast."
4. "A foul smell from the cast is

normal."

RATIONALES: The leg should be elevated to promote venous return and prevent edema. The cast shouldn't 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.
\
A client is admitted to undergo lumbar laminectomy for treatment of a herniated disc. Which action should the nurse take first to promote comfort
preoperatively?
1. Help the client assume a more comfortable

position.
2. Administer hydrocodone (Vicodin) as

prescribed.
3. Provide teaching on nonpharmacologic measures to control

pain.
4. Notify the physician of the client's pain.

RATIONALES: The nurse should first help the client assume a more comfortable position. After doing so, the nurse may administer pain medication
as prescribed. Next, the nurse should assess the client's knowledge of nonpharmacologic measures to relieve pain and provide teaching as
necessary. If the client's pain isn't relieved after taking these actions, the nurse should notify the physician of the client's pain issues.
A client is undergoing an extensive diagnostic workup for suspected muscular dystrophy. The nurse knows that muscular dystrophy has many forms,
but that one assessment finding is common to all forms. Which finding belongs in this category?
1. Muscle weakness
2. Cardiac muscle
involvement
3. Pseudohypertrophy of the calf muscles
4. Muscle pain

RATIONALES: Muscle weakness is common to all forms of muscular dystrophy. Cardiac muscle involvement and pseudohypertrophy of the calf
muscles don't occur in all forms of muscular dystrophy. Muscle pain is rare with any form.
During a scoliosis screening in a college heath center, a student asks the public health nurse about the consequences of untreated scoliosis. The nurse
would be accurate by identifying one of the direct complications as:
1. osteoporosis of the
vertebra.
2. impingement on pulmonary function.
3. spontaneous spinal cord

injury.
19
4. pituitary hyposecretion.

RATIONALES: As untreated scoliosis progresses, the thoracic spinal curvature can impinge on the lungs and affect pulmonary function.
Osteoporosis, spinal cord injury, and pituitary hyposecretion aren't directly attributed to untreated scoliosis.
An X-ray of the left femur shows a fracture that extends through the midshaft of the bone and multiple splintering fragments. What is this type of
fracture called?
1. Compression fracture
2. Greenstick
fracture
3. Comminuted
fracture
4. Impacted
fracture

RATIONALES: A comminuted fracture typically is transverse the shaft of the bone and has multiple splintered bone fragments. A closed fracture
implies that the skin integrity at or near the point of fracture is intact. A greenstick fracture occurs when the bone buckles or bends and the fracture
line doesn't extend through the entire bone. An impacted fracture occurs when the distal and proximal portions of the fracture are wedged into each
other. A compression fracture occurs when a severe force presses the bone together on itself.
At a health fair, a woman, age 43, with a family history of osteoporosis asks the nurse how much calcium she should consume. The nurse tells her that
the recommended daily calcium intake for premenopausal women is:
1. 250 to 500 mg.
2. 600 to 800 mg.
3. 1,000 to 1,200 mg.
4. 1,500 to 2,000 mg.

RATIONALES: Most authorities recommend that premenopausal women consume 1,000 to 1,200 mg of calcium daily. Less than 1,000 mg may not
provide adequate protection against osteoporosis; more than 1,200 mg isn't necessary and may be harmful.
A client has a herniated disk in the region of the third and fourth lumbar vertebrae. On assessment, the nurse expects to
note:
1. hypoactive bowel sounds.
2. severe low back pain.
3. sensory deficits in one

arm.
4. weakness and atrophy of the arm

muscles.
20
RATIONALES: The most common finding in a client with a herniated lumbar disk is severe low back pain, which radiates to the buttocks, legs, and
feet — usually unilaterally. A herniated disk also may cause sensory and motor loss (such as footdrop) in the area innervated by the compressed
spinal nerve root. During later stages, it may cause weakness and atrophy of leg muscles. The condition doesn't affect bowel sounds or the arms.
On a visit to the family physician, a client complains of painful swelling on the lateral side of the great toe, at the metatarsophalangeal joint. After
determining that the swelling is a bunion, the physician injects an intra-articular corticosteroid. The client asks the nurse what causes bunions. Which
answer is correct?
1. "Bunions are congenital and can't be

prevented."
2. "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and
forth."
3. "Some bunions are congenital; others are caused by wearing shoes that are too short or
narrow."
4. "Bunions are caused by a metabolic condition called

gout."

RATIONALES: Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa
at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not
bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion.
Which nursing diagnosis is most appropriate for an elderly client with

osteoarthritis?
1. Risk for injury related to altered mobility
2. Impaired urinary elimination related to effects of

aging
3. Ineffective breathing pattern related to

immobility
4. Imbalanced nutrition: Less than body requirements related to effects of

aging

RATIONALES: Typically, a client with osteoarthritis has stiffness in large, weight-bearing joints, such as the hips. This joint stiffness alters functional
ability and range of movement, placing the client at risk for falling and injury. Therefore, Risk for injury is the most appropriate nursing diagnosis. The
other options are incorrect because osteoporosis doesn't affect urinary elimination, breathing, or nutrition.
The nurse is assisting a client with range-of-motion exercises. The nurse moves the client's leg out and away from the midline of the body. What
movement does the nurse document?
1. Pronatio
n
2. Adduction
3. Abduction
4. Supination

RATIONALES: Movement away from the body or midline is called abduction. Movement toward the midline is called adduction. Pronation is the act of
turning the hand so the palm faces downward. Supination is the act of turning the palm anteriorly.
21
A client, age 50, visits the physician for a routine checkup. The history reveals that the client was diagnosed with a spinal curvature at age 45. The
nurse knows that life-threatening complications can occur if the progressive spinal curvature exceeds 65 degrees. To assess the client's risk for such a
complication, the nurse should evaluate the severity of the curvature in which region of the spine?
1. Cervical
2. Thoracic
3. Lumbar
4. Sacral

RATIONALES: A progressive curvature of more than 65 degrees in the thoracic region of the spine may lead to cardiopulmonary failure as well as
less serious signs and symptoms, such as fatigue, back pain, decreased height, and cosmetic deformity. Although a curvature may affect any part of
the spine, life-threatening complications aren't associated with curvature of the cervical, lumbar, or sacral regions.
A client was diagnosed with chronic gouty arthritis 2 years ago. He has been taking sulfinpyrazone (Anturane), 200 mg P.O. b.i.d. as maintenance
therapy. How soon after administration of this drug does onset of action occur?
1. 30 minutes
2. 60 minutes
3. 90 minutes
4. 2 hours

RATIONALES: Sulfinpyrazone has a rapid onset of action, within 30 minutes after oral administration. It reaches its peak concentration within 1 to 2
hours and has a duration of action of 4 to 6 hours.
The nurse is performing preoperative teaching for a client who will undergo total knee replacement in the morning. The nurse includes teaching about
deep vein thrombosis (DVT) prevention. The nurse tells the client that DVT is caused primarily by:
1. postoperative physical
therapy.
2. venous
stasis.
3. warfarin (Coumadin)
therapy.
4. obesity.

RATIONALES: Clients who undergo surgery have a period of immobility that may cause venous stasis. Venous stasis may lead to DVT. Physical
therapy promotes mobility, decreasing the risk for DVT. Warfarin is used to prevent clot formation. Obesity can be a contributing factor but isn't a
direct cause of DVT.
22
The nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest
priority?
1. Assessing the extremity for neurovascular

integrity
2. Keeping the client from sliding to the foot of the

bed
3. Keeping the ropes over the center of the

pulley
4. Ensuring that the weights hang free at all

times

RATIONALES: Although all measures are correct, assessing neurovascular integrity takes priority. The pull of the traction must be continuous to
keep the client from sliding. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. The line of
pull is maintained by allowing the weights to hang free.
The charge nurse on the orthopedic unit functions to help the unit run smoothly. Which situation doesn't promote
teamwork?
1. Coordinating admissions and discharges to even the

workload
2. Directing two nurses to cover a third nurse's patients while the nurse transfers a client to the critical care
unit
3. Assisting the nurse to schedule Doppler ultrasonography for a client without discussing it with the physical
therapist
4. Asking the nursing assistant to pick up medications from the

pharmacy

RATIONALES: Option 3 doesn't promote teamwork because the nursing supervisor is scheduling Doppler ultrasonography without first coordinating
scheduling with the physical therapist. This lack of coordination may cause the client to miss a physical therapy session. Options 1, 2, and 4 promote
teamwork.
The nurse is caring for a client with lower back pain who is scheduled for myelography using metrizamide (a water-soluble contrast dye). After the test,
the nurse should place the client in which position?
1. Head of the bed elevated 45 degrees
2. Pron
e
3. Supine with feet

raised
4. Supine with the head lower than the trunk

RATIONALES: After a myelogram, positioning will depend on the dye injected. When a water-soluble dye such as metrizamide is injected, the head
of the bed is elevated to a 45-degree angle to slow the upward dispersion of the dye. The other positions are contraindicated when a water-soluble
contrast dye is used. If an air-contrast study were performed, the client should be positioned supine with the head lower than the trunk.
23
A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 — S1, which was diagnosed by magnetic resonance imaging.
Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate
postoperative period?
1. Discourage the client from doing any range-of-motion (ROM)

exercises.
2. Have the client sit up in a chair as much as

possible.
3. Logroll the client from side to

side.
4. Elevate the head of the bed to 90

degrees.

RATIONALES: Logrolling the client maintains alignment of his hips and shoulders and eliminates twisting in his operative area. Because of pressure
on the operative area, having the client sit up in a chair or with the head of the bed elevated should be allowed only for short durations of time. ROM
exercises should be encouraged to maintain muscle strength.
A home care nurse visits a client with muscular dystrophy. Which comment by the client indicates the he needs more information about an advance
directive?
1. "I'm going to the doctor to get a new brace next

week."
2. "I've got a sore on my heel where my wheelchair

rubs."
3. "My dog is my best friend. I really don't have anyone who can make decisions for me when I no longer
can."
4. "I love apple pie. I don't ever want a feeding tube when the time comes that I can't
eat."

RATIONALES: Option 4 indicates that the client needs information about advance directives. In this statement, the client is voicing his wish not to
have a feeding tube when his condition deteriorates. However, he doesn't explain that he's outlined these wishes in an advance directive. Options 1
and 2 are statements about the client's condition and his care plan. They don't indicate that the client requires more information about advance
directives. Option 3 indicates that the client needs information about obtaining a health care power of attorney.
The nurse is performing an admission assessment on a client admitted with a pelvic fracture. Which statement by the client requires the nurse to seek
more information from a legal standpoint?
1. "I'm so clumsy."
2. "I'm afraid I'll lose my job because I'm going to miss so much
work."
3. "Sometimes my husband gets so angry with

me."
4. "I'm going to need help at home after I'm

discharged."

RATIONALES: Legally, the nurse must further investigate the client's statement concerning the husband's anger. This statement suggests that the
client's injury might be caused by domestic abuse. The other statements are common and don't require further investigation from a legal standpoint
by the nurse.
24
A 78-year-old client has a history of osteoarthritis. Which signs and symptoms would the nurse expect to find on physical
assessment?
1. Joint pain, crepitus, Heberden's

nodes
2. Hot, inflamed joints; crepitus; joint pain
3. Tophi, enlarged joints, Bouchard's

nodes
4. Swelling, joint pain, and tenderness on

palpation

RATIONALES: Clinical findings for osteoarthritis include joint pain, crepitus, Heberden's nodes, Bouchard's nodes, and enlarged joints. The joint pain
occurs with movement and is relieved by rest. As the disease progresses, pain may also occur at rest. Heberden's nodes are bony growths that occur
at the distal interphalangeal joints. Bouchard's nodes involve the proximal interphalangeal joints. Tophi are deposits of sodium urate crystals that
occur in chronic gout — not osteoarthritis. Hot, inflamed joints rarely occur in osteoarthritis. Swelling, joint pain, and tenderness on palpation occur
with a sprain injury.
A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is
true?
1. A ganglion is the most common benign soft-tissue mass in the

foot.
2. A ganglion is a precursor to a primary bone

tumor.
3. Surgical excision is the treatment of choice for a

ganglion.
4. Dorsiflexion exacerbates signs and symptoms of a

ganglion.

RATIONALES: Dorsiflexion exacerbates signs and symptoms of a ganglion. A ganglion is the most common benign soft-tissue mass in the hand, not
foot. It isn't a known precursor to a primary bone tumor. To treat a ganglion, the physician aspirates the ganglion, then injects a corticosteroid into the
joint; the physician also may prescribe nonsteroidal anti-inflammatory agents. Surgical excision is necessary only if signs and symptoms persist and
the client's range of motion is impaired.
Which nursing intervention is essential in caring for a client with compartment

syndrome?
1. Keeping the affected extremity below the level of the

heart
2. Wrapping the affected extremity with a compression dressing to help decrease the
swelling
3. Removing all external sources of pressure, such as clothing and

jewelry
4. Starting an I.V. line in the affected extremity in anticipation of venogram

studies
25
RATIONALES: Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to
prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory
compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the
affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.
A client with acute osteomyelitis is to receive parenteral penicillin for 4 to 6 weeks. Before administering the first dose, the nurse asks the client about
known drug allergies. An allergy to which antibiotic or antibiotic class necessitates cautious use of penicillin?
1. Tetracyclines
2. Aminoglycosides
3. Erythromycin
4. Cephalosporins

RATIONALES: A client who is allergic to cephalosporins also may be allergic to penicillin. For the same reason, penicillin must be used cautiously in
clients who are allergic to cephamycins, griseofulvin, or penicillamine. Cross-sensitivity between penicillin and tetracyclines, aminoglycosides, and
erthyromycins hasn't been observed.
The nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new
prosthesis?
1. Keep the affected leg in a position of

adduction.
2. Use measures other than turning to prevent pressure

ulcers.
3. Prevent internal rotation of the affected

leg.
4. Keep the hip flexed by placing pillows under the client's

knee.

RATIONALES: External rotation and abduction of the hip will help prevent dislocation of a new hip joint. Internal rotation and adduction should be
avoided. Postoperative total hip replacement clients may be turned onto the unaffected side. While the hip may be flexed slightly, it shouldn't exceed
90 degrees and maintenance of flexion isn't necessary.
A client is admitted to an acute care facility with osteomyelitis. Which organism usually causes this
infection?
1. Escherichia
coli
2. Klebsiell
a
3. Pseudomona
s
4. Staphylococcus
aureus
26
RATIONALES: S. aureus is the most common cause of osteomyelitis. Less often, E. coli, Klebsiella, or Pseudomonas is the causative organism.
Proteus and Salmonella are relatively rare causes. In a few cases, osteomyelitis results from a viral or fungal infection.
The nurse is caring for a client who recently underwent a total hip replacement. The nurse
should:
1. ease the client onto a low toilet

seat.
2. allow the client's legs to be crossed at the knees when out of

bed.
3. use soft chairs when the client is sitting out of

bed.
4. limit client hip flexion when sitting.

RATIONALES: Instruct the client to limit hip flexion to 90 degrees while sitting. Supply an elevated toilet seat so that the client can sit without having
to flex his hip more than 90 degrees. Instruct the client not to cross his legs to avoid dislodging or dislocating the prosthesis. Caution the client
against sitting in chairs that are too low or too soft; these chairs increase flexion, which is undesirable.
A client is hospitalized for open reduction of a fractured femur. During postoperative assessment, the nurse monitors for signs and symptoms of fat
embolism, which include:
1. pallor and coolness of the affected

leg.
2. nausea and vomiting after eating.
3. hypothermia and
bradycardia.
4. restlessness and petechiae.

RATIONALES: Signs and symptoms of fat embolism include restlessness, petechiae, and an altered mental status. Pallor and coolness of the
affected leg are associated with a clot in the leg, not fat embolism. Nausea and vomiting after eating may be related to gastric obstruction.
Hypothermia isn't an expected result of an open reduction of a fracture. Bradycardia has no relation to fat emboli but may indicate a cardiac problem.
A client complains of excruciating pain and inflammation in the joint of the great left toe. Her serum urate level is 9 mg/dl. The physician diagnoses an
acute attack of gouty arthritis and prescribes colchicine, 1 mg P.O. as an initial dose, followed by 0.5 mg P.O. every hour (not to exceed 4 mg in 24
hours) until the pain ceases. How long after oral administration of colchicine should pain relief occur?
1. 30 to 45
minutes
27
2. 1 to 2
hours
3. 4 to 12
hours
4. 12 to 48
hours

RATIONALES: The pain that accompanies an acute gouty attack is relieved 12 to 48 hours after oral colchicine administration and 4 to 12 hours after
I.V. therapy.
A client undergoes a total hip replacement. Which statement made by the client would indicate to the nurse that the client requires further
teaching?
1. "I'll need to keep several pillows between my legs at night."
2. "I need to remember not to cross my legs. It's such a

habit."
3. "The occupational therapist is showing me how to use a sock puller to help me get
dressed."
4. "I don't know if I'll be able to get off that low toilet seat at home by
myself."

RATIONALES: To prevent hip dislocation after a total hip replacement, the client 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. Teaching the client to avoid crossing the legs also
reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees.
Which findings best correlate with a diagnosis of

osteoarthritis?
1. Joint stiffness that decreases with

activity
2. Erythema and edema over the affected

joint
3. Anorexia and weight

loss
4. Fever and malaise

RATIONALES: A characteristic feature of osteoarthritis (degenerative joint disease) is joint stiffness that decreases with activity and movement. The
other options are associated with rheumatoid arthritis, a more severe and destructive form of arthritis.
28
The nurse is caring for a client with a cast on the left arm after sustaining a fracture. Which assessment finding is most significant for this
client?
1. Fingers on the left hand are swollen and cool
2. Presence of a normal popliteal pulse
3. Cast edges are rough with skin irritation

present
4. Minimal pain in the left

arm

RATIONALES: Swollen and cool fingers on the left hand are the most significant assessment findings. They represent altered circulation to the hand
caused by the cast. A normal radial, not popliteal, pulse should be present in the left arm; the popliteal pulse is found on the leg. Skin irritation is an
abnormal assessment finding but it isn't as significant as altered circulation. Minimal pain in the left arm is expected.
After a traumatic back injury, a client requires skeletal traction. Which intervention takes
priority?
1. Monitoring the client for skin breakdown
2. Maintaining traction continuously to ensure its

effectiveness
3. Supporting the traction weights with a chair or table to prevent accidental

slippage
4. Restricting the client's fluid and fiber intake to reduce the movement required for bedpan
use

RATIONALES: The nurse must maintain skeletal traction continuously to ensure its effectiveness. The nurse should assess skin for breakdown;
however, maintaining skeletal traction takes priority. Traction weights must hang freely to be effective; they should never be supported. The nurse
should increase, not restrict, the client's fluid and fiber intake (unless contraindicated by a concurrent illness) to prevent constipation associated with
complete bed rest.
A client with a walker is being discharged from the orthopedic unit to home. The nurse must teach the client how to use a walker properly. Which
explanation demonstrates safe walker use?
1. Using the walker for support while rising from a chair
2. Adjusting the height of the walker so the arms aren't bent when the hands rest on the walker
grips
3. Moving the walker, stepping with the affected leg, then stepping with the unaffected
leg
4. Moving the walker, stepping with the unaffected leg, then stepping with the affected
leg

RATIONALES: The walker is designed to take the weight from the affected leg. Therefore, the nurse should instruct the client to move the walker,
step with the affected leg, and then step with unaffected leg. Options 1, 2, and 4 don't describe proper walker use.
29
X-rays reveal a leg fracture in a client who was brought to the emergency department after falling on ice. After a cast is applied and allowed to dry, the
nurse teaches the client how to use crutches. Which instruction should the nurse provide about climbing stairs?
1. "Place both crutches on the first step and swing both legs upward to this
step."
2. "Place the unaffected leg on the first step, followed by the crutches and the injured leg, which should move
together."
3. "Place the crutches and injured leg on the first step, followed by the unaffected
leg."
4. "Place the injured leg and the crutch on the unaffected side on the first step; the unaffected leg and crutch on the injured side
follow."

RATIONALES: When climbing stairs with crutches, the client should lead with the unaffected leg, followed by the crutches and injured leg moving
together. Any other method is incorrect and could increase the client's risk of falling.
Which of the following laboratory studies is most relevant to treating a client who has sustained a pelvic
fracture?
1. Urine myoglobin
2. Urinalysis
3. Type and crossmatch
4. Serum ethanol

RATIONALES: Because of the rich blood supply to the pelvis, fractures to this area can result in significant blood loss. Type and crossmatch is a
priority laboratory test in preparing for fluid replacement. Urinalysis and serum ethanol, although part of a trauma workup, don't alter treatment of a
pelvic fracture. Urine isn't commonly analyzed for myoglobin with this injury unless the mechanism was a crush injury; even then, urinalysis isn't as
high a priority as type and crossmatch.
A client with possible osteoarthritis is having X-rays performed on both knees. X-rays of an osteoarthritic joint
reveal:
1. enlargement of the joint space or

margin.
2. fluid deposition in joint spaces.
3. osteophyte
formation.
4. cartilage growths at weight-bearing

joints.

RATIONALES: In osteoarthritis, osteophytes form in joint spaces. Narrowing of joint spaces or margins, cystlike bony deposits in the joints, and long-
bone growths at weight-bearing areas are other X-ray findings.
30
A 72-year-old female client reports that she has lost an inch in height since menopause. The nurse explains to the client that she has a musculoskeletal
disorder. What's this disorder called?
1. Osteoarthritis
(OA)
2. Rheumatoid arthritis
(RA)
3. Paget's disease
4. Osteoporosis

RATIONALES: Osteoporosis, a degenerative disease characterized by a decrease in bone density, typically occurs in postmenopausal woman. A
client with osteoporosis may report a gradual loss in height after menopause. OA, RA and Paget's disease don't typically cause a loss in height after
menopause.
After total hip replacement, a client is receiving epidural analgesia to relieve pain. Which of the following is a nursing priority for this
client?
1. Changing the catheter site dressing every

shift
2. Assessing capillary refill time
3. Assessing for sensation in the

legs
4. Keeping the client flat in bed

RATIONALES: For epidural analgesia, a catheter is placed outside the dura mater in the epidural space. Catheter displacement, which may cause
spinal injury, is signaled by loss of motion and sensation in the legs. Therefore, the nurse should assess closely for sensation and ask about
numbness of the legs. The nurse should change the catheter site dressing every day or every other day. Capillary refill time has no bearing on
epidural analgesia. A client with an epidural catheter may ambulate and need not be confined to bed.
After total hip replacement, a client is receiving epidural analgesia to relieve pain. Which of the following is a nursing priority for this
client?
1. Changing the catheter site dressing every

shift
2. Assessing capillary refill time
3. Assessing for sensation in the

legs
4. Keeping the client flat in bed

RATIONALES: For epidural analgesia, a catheter is placed outside the dura mater in the epidural space. Catheter displacement, which may cause
spinal injury, is signaled by loss of motion and sensation in the legs. Therefore, the nurse should assess closely for sensation and ask about
31
numbness of the legs. The nurse should change the catheter site dressing every day or every other day. Capillary refill time has no bearing on
epidural analgesia. A client with an epidural catheter may ambulate and need not be confined to bed.
A client is on bed rest after sustaining injuries in a car accident. Which nursing action would help the client avoid complications of
immobility?
1. Decreasing fluid intake to ease dependent

edema
2. Turning the client every 2 hours and providing a low-air-loss

mattress
3. Raising the head of the bed to maximize the client's lung

inflation
4. Bathing and feeding the client to decrease energy

expenditure

RATIONALES: To avoid pressure ulcers in an immobilized client, the nurse must assess the skin thoroughly and use such preventive measures as
regular turning, a low-air-loss mattress, and a trapeze (if the client's condition allows). The nurse should increase, not decrease, the client's fluid
intake to help prevent renal calculi, which may result from immobility. To prevent atelectasis, another complication of immobility, having the client
cough, deep breathe, and use an incentive spirometer would be more effective than raising the head of the bed. Instead of bathing and feeding the
client, the nurse should promote independent self-care activities whenever possible to prepare the client for a return to the previous health status.
A 69-year-old client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is
correct?
1. "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen

joints."
2. "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing
joints."
3. "OA affects joints on both sides of the body. RA is usually

unilateral."
4. "OA is more common in women. RA is more common in

men."

RATIONALES: OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur
development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the
other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally.
A client is treated in the emergency department for a Colles' fracture sustained during a fall. What is a Colles'
fracture?
1. Fracture of the distal

radius
2. Fracture of the
olecranon
3. Fracture of the
humerus
4. Fracture of the carpal
32
scaphoid

RATIONALES: Colles' fracture is a fracture of the distal radius, such as from a fall on an outstretched hand. It's most common in women. Colles'
fracture doesn't refer to a fracture of the olecranon, humerus, or carpal scaphoid.
A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation,
the nurse should provide which instruction?
1. "Apply ice packs for the first 12 to 18

hours."
2. "Apply heat packs for the first 24 to 48

hours."
3. "Apply ice packs for the first 24 to 48 hours, then apply heat
packs."
4. "Apply heat packs for the first 24 hours, then apply ice packs for the next 48
hours."

RATIONALES: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply
heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from
recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective
because swelling already has occurred by that time.
A client is admitted to the orthopedic unit for treatment of a fractured right femur caused by a motor vehicle crash. He is scheduled to undergo an open
reduction internal-fixation of the right femur. The night before surgery, the nurse administers zolpidem (Ambien) as prescribed. Which statement
regarding usage of zolpidem is correct?
1. The nurse should administer the drug immediately before

bedtime.
2. The nurse should dilute it in fruit juice to improve

absorption.
3. The nurse shouldn't use the liquid if it becomes slightly

darkened.
4. Avoid administration with grapefruit juice; it interferes with

absorption.

RATIONALES: The nurse should administer the drug immediately before bedtime because the onset of action is rapid. Diluting the drug in fruit juice
doesn't improve its absorption. Zolpidem doesn't come in liquid form; its available in 5 and 10 mg tablets. Grapefruit juice doesn't interfere with
absorption.
Which of the following would the nurse identify as a

neurotransmitter?
1. Acetylcholine
2. Adenosine triphosphate (ATP)
33
3. Cholinesterase
4. Creatine phosphate

RATIONALES: Acetylcholine is a neurotransmitter contained in the axon terminal vesicles. ATP is the substance that, when broken down, provides
energy for muscle contraction. Cholinesterase is an enzyme that breaks down acetylcholine and prevents continuous stimulation of skeletal muscle.
Creatine phosphate is a substance found in muscle that, when broken down, releases energy.
A client with gouty arthritis is prescribed a low-purine diet. The nurse should instruct this client to
avoid:
1. organ
meats.
2. citrus
fruits.
3. green vegetables.
4. fresh fish.

RATIONALES: Because gouty arthritis is a disorder of purine metabolism, the client should avoid foods high in purine, such as organ meats,
anchovies, sardines, shellfish, chocolate, and meat extracts. Citrus fruits, green vegetables, and fresh fish should be included in a well-balanced diet.
A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client
has a greenstick fracture of the arm. What does this mean?
1. The fracture line extends through the entire bone

substance.
2. The fracture results from an underlying bone

disorder.
3. Bone fragments are separated at the fracture

line.
4. One side of the bone is broken and the other side is

bent.

RATIONALES: In a greenstick fracture, one side of the bone is broken and the other side is bent. A greenstick fracture also may refer to an
incomplete fracture in which the fracture line extends only partially through the bone substance and doesn't disrupt bone continuity completely. (Other
terms for greenstick fracture are willow fracture and hickory-stick fracture.) The fracture line extends through the entire bone substance in a complete
fracture. A fracture that results from an underlying bone disorder, such as osteoporosis or a tumor, is a pathologic fracture, which typically occurs with
minimal trauma. Bone fragments are separated at the fracture line in a displaced fracture.
34
A client is diagnosed with osteoporosis. Which electrolytes are involved in the development of this
disorder?
1. Calcium and sodium
2. Calcium and
phosphorous
3. Phosphorous and
potassium
4. Potassium and sodium

RATIONALES: In osteoporosis, bones lose calcium and phosphate salts, becoming porous, brittle, and abnormally vulnerable to fracture. Sodium
and potassium aren't involved in the development of osteoporosis.
When caring for a client experiencing an acute gout attack, the nurse anticipates administering which
medication?
1. allopurinol (Zyloprim)
2. colchicine
3. prednisone (Deltasone)
4. propoxyphene hydrochloride
(Darvon)

RATIONALES: The physician usually prescribes colchicine for a client experiencing an acute gout attack. This drug decreases leukocyte motility,
phagocytosis, and lactic acid production, thereby reducing urate crystal deposits and relieving inflammation. Allopurinol is used to decrease uric acid
production in clients with chronic gout. Although corticosteroids are prescribed to treat gout, the nurse wouldn't give them because they must be
administered interarticularly to this client. Propoxyphene, an opioid, may be used to treat osteoarthritis.
A client is in Buck's skin traction after fracturing the right hip. The nurse should include which action in the care
plan?
1. Removing the weights once every shift
2. Maintaining the bed in the knee-Gatch

position
3. Keeping the client in semi-Fowler's position
4. Maintaining correct body alignment

RATIONALES: Buck's traction produces realignment by exerting a pulling force on the fractured hip. Therefore, the nurse must maintain correct body
alignment. Traction should be continuous; if the weights must be removed, the nurse should apply manual traction until the weights are replaced. The
knee-Gatch position shouldn't be used because it disrupts the constant pulling force needed for alignment. The semi-Fowler's position would cause
the client to slide in the direction of the traction, defeating the purpose of traction.
35
Which is the most appropriate nursing diagnosis for a client with a strained
ankle?
1. Impaired skin
integrity
2. Impaired physical
mobility
3. Risk for deficient fluid

volume
4. Disturbed body
image

RATIONALES: Ankle strains result in pain and damage to the ligaments as well as altered physical mobility. Although the traumatic event that caused
the strain may disrupt the skin, the manifestations of a strain don't include disruption of skin integrity. Risk for deficient fluid volume is an appropriate
nursing diagnosis for a process that results in the loss of a large volume of fluid or blood. Disruptions in body image can occur if the client's livelihood
is altered because of the strain.
After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the
accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?
1. Compartment syndrome
2. Fat embolism
3. Infectio
n
4. Volkmann's ischemic
contracture

RATIONALES: Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the
injury. It occurs when fat droplets released at the fracture site enter the circulation, become lodged in pulmonary capillaries, and break down into fatty
acids. Because these acids are toxic to the lung parenchyma, capillary endothelium, and surfactant, the client may develop pulmonary hypertension.
Signs and symptoms of fat embolism include an altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae. Compartment
syndrome and infection may complicate any fracture and aren't specific to a pelvis fracture. Volkmann's ischemic contracture is a potential
complication of a hand or forearm fracture.
A client with septic arthritis of the knee is admitted to the orthopedic floor. The case manager should be consulted if which complication occurs during
hospitalization?
1. Wound drainage
2. Temperature
elevation
3. Decreased mobility
4. Allergic reaction to antibiotics

RATIONALES: The case manager should be consulted to arrange rehabilitation or home care for the client as needed if the client develops
decreased mobility, which may prevent him from caring for himself after discharge. Wound drainage is expected from an infected wound and doesn't
36
require a case management consult. Temperature elevation and an allergic reaction to antibiotics don't require a case management consult.
The nurse is teaching the client how to use a cane. Which of the following statements is most
inaccurate?
1. The client should hold the cane on the involved side.
2. The client should hold the cane close to his

body.
3. The stride length and the timing of each step should be

equal.
4. The nurse should stand behind the client to prevent

falls.

RATIONALES: The client is instructed to hold the cane on the uninvolved side, 24" to 26" from the base of the little toe. This is done to promote a
reciprocal gait pattern. The nurse should instruct the client to hold the cane close to his body to prevent leaning. The stride length and timing of each
step should be equal. To prevent falls, the nurse stands behind the client as he is learning to use the cane.
Which nursing diagnosis takes highest priority for a client with a compound
fracture?
1. Imbalanced nutrition: Less than body requirements related to

immobility
2. Impaired physical mobility related to

trauma
3. Risk for infection related to effects of

trauma
4. Activity intolerance related to weight-bearing limitations

RATIONALES: A compound fracture involves an opening in the skin at the fracture site. Because the skin is the body's first line of defense against
infection, any skin opening places the client at risk for infection. Imbalanced nutrition: Less than body requirements is rarely associated with fractures.
Although Impaired physical mobility and Activity intolerance may be associated with any fracture, these nursing diagnoses don't take precedence
because they aren't as life-threatening as infection.
Elderly clients who fall are most at risk for which injuries?
1. Wrist fractures
2. Humerus
fractures
3. Pelvic fractures
4. Cervical spine
fractures
37
RATIONALES: Elderly clients who fall often sustain pelvic and lower extremity fractures. These injuries are devastating because they can seriously
alter an elderly client's lifestyle and reduce functional independence. Wrist fractures usually occur with falls on an outstretched hand or from a direct
blow. They are commonly found in young men. Humerus fractures and cervical spine fractures aren't age-specific.
A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's
care plan?
1. Apply the traction straps

snugly.
2. Assess the client's level of

consciousness.
3. Remove the traction at least every 8

hours.
4. Teach the client how to prevent problems caused by

immobility.

RATIONALES: By teaching the client about prevention measures, the nurse can help avoid problems caused by immobility, such as hypostatic
pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal
traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removal of skeletal traction is the physician's
responsibility — not the nurse's.
The nurse is teaching a client with a long leg cast how to use crutches properly while descending a staircase. The nurse should tell the client
to:
1. advance both legs first.
2. advance the unaffected leg first.
3. advance the affected leg first.
4. advance both crutches

first.

RATIONALES: To walk down a flight of stairs, body weight is first transferred to the unaffected leg. Both crutches are then advanced to the stair
below. Body weight is transferred to the crutches as the affected leg descends. The unaffected leg is then brought down to the next step so that both
legs and crutches are all on the same step. The procedure is repeated for each step.
A 65-year-old client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for
nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain?
1. Acupuncture
2. An exercise routine that includes range-of-motion (ROM)

exercises
3. Heat therapy and nonsteroidal anti-inflammatory medications
38
(NSAIDs)
4. Cold therapy

RATIONALES: Physical and occupational therapy will most likely develop an exercise routine that includes ROM exercises to control the client's pain.
Acupuncture may help relieve the client's pain; however, it isn't within the scope of practice for physical and occupational therapists. Heat therapy
may help the client, but it's coupled with NSAIDs in this option, which goes against the client's wishes. Cold therapy aggravates joint stiffness and
causes pain.
Which of the following structures is seldom

dislocated?
1. Knee
2. Shoulder
3. Foot
4. Elbow

RATIONALES: Dislocations of the foot are rare. Dislocations of the knee, shoulder, and elbow occur more frequently than the foot.
39

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A client seeks care for low back pain of 2 weeks' duration.

Which assessment finding suggests a herniated intervertebral

1. Pain radiating down the posterior

2. Back pain when the knees are

3. Atrophy of the lower leg muscles

Correct Answer: 1 Your Answer: 1

1. GI upset and metallic

2. dry skin, hair loss, and inflamed mucous

3. flushing and orthostatic hypotension.

4. sensory neuropathy and difficulty maintaining

Correct Answer: 1 Your Answer: 1

2. "Do all your chores after performing morning exercises to loosen

3. "Pace yourself and rest frequently, especially after

Correct Answer: 3 Your Answer: 3

3. Benign prostatic hyperplasia

Correct Answer: 1 Your Answer: 1

1. muscle spasm caused by cerebral palsy.

2. chronic musculoskeletal disorder.

Correct Answer: 4 Your Answer: 4

1. "You should ask your physician about

3. "You may experience progressive deterioration in all voluntary

4. "This form of muscular dystrophy is a relatively benign disease that progresses

Correct Answer: 3 Your Answer: 3

1. "Bend over the object you're

2. "Narrow the stance when lifting."

3. "Push or pull an object using your

4. "Stand close to the object you're

Correct Answer: 4 Your Answer: 4

1. "It's common in females after menopause."

2. "It's a degenerative disease characterized by a decrease in bone density."

3. "It's a congenital disease caused by poor dietary intake of milk products."

4. "It can cause pain and injury."

5. "Passive range-of-motion exercises can promote bone growth."

6. "Weight-bearing exercise should be avoided."

Correct Answer: 1,2,4 Your Answer: 1,2,4

1. Applying knee splints

2. Elevating the foot of the

3. Hyperextending the client's legs

Correct Answer: 1 Your Answer: 1

4. attempt to distract the client from watching the

Correct Answer: 2 Your Answer: 1

1. Green, leafy vegetables

Correct Answer: 2,3,5 Your Answer: 2,3,5

1. provide a care plan for caregivers to ensure continuity of

2. provide a step-by-step care plan.

3. accurately bill the client for services provided.

4. describe the pathophysiology of the diagnosis.

Correct Answer: 1 Your Answer: 2

1. Impaired skin integrity related to effects of the

2. Anticipatory grieving related to the loss of a

3. Disturbed body image related to changes in the structure of a body

4. Risk for injury related to injury and

Correct Answer: 4 Your Answer: 3

Correct Answer: 4 Your Answer: 4

1. Obtaining an X-ray of the bones every 3 years is recommended to detect bone

2. To avoid fractures, the client should avoid strenuous

3. The recommended daily allowance of calcium may be found in a wide variety of

4. Obtaining the recommended daily allowance of calcium requires taking a calcium

Correct Answer: 3 Your Answer: 3

2. distribute weight away from the involved

3. maintain stride length.

Correct Answer: 2 Your Answer: 1

1. Whether the client needs to navigate stairs routinely at