Ortho 6

1.A retired 66- year- old female patient is being evaluated for osteoporosis as part of a yearly physical
exam. The patient states that she is a smoker, watches television for most of the day, and has been
hospitalized twice with fractures within the last year. Based on this information, the nurse suspects
which condition?

A.Low bone mass leading to increased bone fragility

B.Degeneration of the articular cartilage
C.Recurrent attacks of acute arthritis
D.Personality changes caused by chronic nature of illness

A. Low bone mass leading to increased bone fragility. Low bone mass, structural deterioration of bone
tissue leading to bone fragility, and increased susceptibility to fractures are seen with osteoporosis. The
patient also has risk factors associated with osteoporosis: smoking, sedentary lifestyle, and being female
and menopausal. Degenerative changes are associated with frequent exacerbations of arthritis. There is
no indication of personality change in this patient.

2. The nurse determines that a 55- year-old female patient is experiencing menopause and is also at risk
for osteoporosis. What foods other than milk can the nurse suggest to this patient to increase calcium
intake?

A. Seafood, wheat, corn, green vegetables

B. Chicken vegetables, green vegetables, pasta, broccoli
C. Green vegetables, sardines, salmon with bone, molasses
D. Fresh fruits, English muffins, black beans, asparagus

Answer C is correct. Women of menopausal age are at risk for osteoporosis, and foods high in calcium
should be encouraged. A diet with green vegetables, sardines, salmon with bone, and molasses provides
high- quality calcium and is recommended for a patient experiencing menopause in order to decrease
the risk of osteoporosis. A diet with seafood, wheat, corn, and green vegetables is more concentrated in
carbohydrates than proteins containing more calcium. A diet with chicken, green vegetables, sardines,
and broccoli contains some calcium but is lower than the other option. Foods such as fresh fruits, English
muffins, black beans, and asparagus are inadequate in calcium.

3. A patient with osteoporosis has been advised to increase the amount of calcium in her diet. Which
food provides the most calcium?

An 8- oz glass of milk
An ounce of cheddar cheese
A half cup of raw broccoli
A 4- ounce salmon croquette

Answer A is correct. An 8-ounce glass of milk contains 290mg of calcium. Answers B, C, and D contain
lesser amounts; therefore, they are incorrect. (Note: An ounce of cheddar cheese contains 205 mg of
calcium; half a cup of raw broccoli contains 175mg of calcium; and 4 ounces of salmon croquette
contains 165 mg of calcium).
4. Which of the following instructions should be included for the patient taking calcium supplements?

A.The patient should take her calcium with meals

B.The patient should take all her daily calcium supplements at one time
C.The patient should take her calcium supplement after meals to prevent stomach upset
D.The patient can use calcium- based antacids for supplement.

Rationale: Answer D is correct. Many people prefer to supplement their calcium intake with calcium-
based antacids. If calcium supplements are used, they should be administered 30 minutes before meals
to maximize absorption, so answer A is wrong. Calcium absorption is better if it is administered
throughout the day rather than in a single dose, making answer B wrong. Calcium supplements do not
cause stomach upset, so answer C is wrong.

5. Alendronate (Fosamax) is ordered for a patient with osteoporosis. Which information should the
nurse teach the patient about the medication?

A. Acts as a selective estrogen receptor modulator

B. Reduces risk of invasive breast cancer
C. May be obtained as a nasal spray
D. Inhibits bone resorption

D. Alendronate (Fosamax), a bisphosphonate, is a potent inhibitor of bone resorption that preserves

bone mass and increases bone density. Raloxifene (Evista) is an example of a selective estrogen receptor
modulator that is used to treat osteoporosis, and which also reduces the risk of invasive breast cancer.
Calcitonin (Miacalcin) is dispensed as a nasal spray.

6. The nurse is caring for a patient with osteoporosis who is being discharged on alendronate (Fosamax).
Which statement would indicate effective teaching?

A. "I should take the medication immediately before bed"

B. "I should remain in an upright position for 30 minutes after taking the medication"
C. "The medication is more effective if I take it with milk or dairy products"
D. If I skip a dose, I can take two tablets the next time"

Answer: B- Rationale should remain upright for 30 mins.

7. How long does a patient taking bisphosphonates need to stay upright after administration?

A. 10 minutes
B. 20 minutes
C. 30 minutes
D. 120 minutes

30 minutes. Bisphosphonates are administered on arising in the morning with a full glass of water on an
empty stomach, and the patient must stay upright for 30 to 60 minutes.

8. When caring for a client with hypocalcemia, the nurse should assess for:
A. A decreased level of consciousness
B. Tetany
C. Bradycardia
D. Respiratory Depression

Answer B is correct. The most common complication of hypocalcemia is overstimulation of the nerves
and muscles. Tetany, which can progress to convulsions, indicated that the patient's condition is
worsening. Answer A is incorrect because a decreased level of consciousness is not associated with
hypocalcemia. Tachycardia, not bradycardia, is associated with hypocalcemia, making answer C
incorrect. Answer D is incorrect because respiratory depression is not directly related to hypocalcemia.

9. A patient has been diagnosised with osteomalacia. What symptoms does the nurse recognize that
correlate with the diagnosis?
A. Bone fractures and kyphosis
B. Bone pain and tenderness
C. Muscle Weakness and spasms
D. Softened and compressed vertebrae

Rationale: Answer B is correct.

10. The patient who is taking alendronate (Fosamax) is at high risk for developing which disorder?

A. Cardiovascular disease
B. Breast cancer
C. Inflammation of the esophagus
D. Stroke

Answer: C
Rationale: Esophagitis and esophageal ulcers have been reported with use of all of the bisphosphonates.
The other answer selections apply to hormone replacement therapy.

11. The patient who has completed radiation therapy treatments for a form of cancer is at high risk for
developing:

A. Osteomalacia
B. Osteosarcoma
C. Paget's disease of the bone
D. Osteochondroma

Answer: B
Rationale: Patients who have received radiation for other forms of cancer are at high risk for developing
osteosarcoma. Osteomalacia is caused by a vitamin D deficiency. Paget's disease is a metabolic disorder
of bone remodeling. Osteochondroma is a benign bone tumor that has its onset in childhood

12. An expected outcome of an older patient with acute

osteomyelitis is:

A. Pain
B. Fatigue
C. Low-grade fever
D. Elevated leukocyte count

Answer: C
Rationale: Common presenting symptoms of osteomyelitis are pain, fever, edema, elevated leukocyte
count, fatigue, and general malaise. However, older adults may not have an extreme temperature
elevation because of lower core body temperature and compromised immune system that occur with
normal aging.

13. Certain transdermal patches must be removed before an MRI is performed because they can cause
burns.

True
False

True.
Rationale: Transdermal patches (eg, NicoDerm, Transderm Nitro, Transderm Scopolamine, and
Catapres-TTS) that have a thin layer of aluminized backing must be removed before an MRI because
they can cause burns

14. A patient is admitted for an MRI, a CT scan, and a myelogram. Which of the following medication
orders should be questioned for the patient who is to have a myelogram?

A. Ampicillin 250mg PO q6H

B. Motrin 400mg PO q4h PRN for headache
C. Seconal 50mg HS PRN sleep
D. Darvon 65mg PO q4h for pain

Rationale: Answer C is correct. Seconal is a barbiturate, and CNS depressants and stimulants, as well as
phenothiazines, should not be given for 48 hours prior to a mylegram because they decrease the sizure
threshold. Ampicillin is an antibiotic, Motrin is an NSAID, and Darvon is an analgesic, so they can all be
given, making answers A,B, and D wrong.

15. Which findings indicates a need for further assessment of the patient scheduled for a magnetic
resonance imaging (MRI)?

A. The patient is an insulin- dependent diabetic

B. The patient refuses a corner bed
C. The patient is allergic to shellfish
D. The patient has a history of asthma

An MRI requires the patient to be confined in a small enclosure for a period of time. The patient's
refusal to accept the corner bed could indicate claustrophobia, so the patient needs further assessment.
An MRI is not contraindicated for patients with diabetes or asthma; therefore, answers A and D are
incorrect. Answer C is incorrect because no contrast medium is used.

17. The prevalence of osteoporosis in women aged more than 80 years is 50%.
True
False

True.
Rationale: The prevalence of osteoporosis in women aged more than 80 years is 50%.

18. The primary defect in osteomalacia is a deficiency in which vitamin?

A. B12
B. D
C. E
D. C
b. D

Rationale: The primary defect in osteomalacia is a deficiency of activated vitamin D, which promotes
calcium absorption from the GI tract and facilitates mineralization of bone.

19. The nurse has educated a patient with low back pain about techniques to relieve the back pain and
prevent further complications. What statement by the patient shows understanding of the education
the nurse provided?

A. "I will lie down prone with my legs slightly elevated."

B. "I will bend at the waist when I am lifting objects from the floor."
C. "I will avoid prolonged sitting or walking."
D. "Instead of turning around to grasp an object, I will twist at the waist."

Answer C

20. What findings can be identified with the use of radiography of the spine?

A. Fracture, dislocation, infection, osteoarthritis, or scoliosis

B. Infections, tumors, and bone marrow abnormalities
C. Soft tissue lesions adjacent to the vertebral column
D. Spinal nerve root disorders

A. Fracture, dislocation, infection, osteoarthritis, or scoliosis

Radiography of the spine may demonstrate a fracture, dislocation, infection, osteoarthritis, or scoliosis.
Bone scan and blood studies may disclose infections, tumors, and bone marrow abnormalities.
Computed tomography is useful in identifying soft tissue lesions adjacent to the vertebral column. An
electromyogram is used to evaluate spinal nerve root disorders.

21. The nurse is performing an assessment on an older adult patient and observes the patient has an
increased forward curvature of the thoracic spine What does the nurse understand this common finding
is known as?

A.Lordosis
B.Scoliosis
C.Osteoporosis
D.Kyphosis

Rationale: Answer D is correct.

22. The nurse observes that an 18- year- old female patient has asymmetry of the shoulders and hips,
and the hem of her dress is uneven. The nurse suspects that the patient may be presenting with which
disorder?

A. Congenital hip dislocation

B. Scoliosis
C. Fractured tibia
D. Degenerative disc disease

Rationale: Answer B is correct. A classic sign of scoliosis is asymmetrical dress or skirt hem caused by
unevenness of affected shoulder and hip, due to a lateral curvature of the spine. The spinal deformity
causes the asymmetry. Congenital hip dislocation is diagnosed during infancy. Signs of a fractured tibia
would include painful ambulation, not unevenness of the shoulder and hip. Degenerative disc disease is
typically experienced by older adults and causes a uniform decline in height.

23. An important question to ask a patient with low back pain is:

A. "How does your back pain affect your activities of daily living?"
B. "Tell me about your pain and what interventions are helpful in managing your pain."
C. "How long have you had back pain?"
D. "Have you ever had magnetic resonance imaging to find a cause for your back pain?"

Answer: B
Rationale: The primary concern for patients with back pain is continuous pain. Obtaining a thorough
assessment of the patient's pain level and effective interventions to treat pain is an important element
of the nursing assessment.

24. Which of the following is characterized by an increased forward curvature of the thoracic spine?

A. Lordosis
B. Kyphosis
C. Scoliosis
D. Crepitus

Kyphosis
Rationale: Common deformities of the spine include kyphosis, which is an increased forward curvature
of the thoracic spine.

25. Most back pain is self-limited and resolves within __ weeks with analgesics, rest, stress reduction,
and relaxation.

A. 1
B. 2
C. 3
D. 4
D. 4

Rationale: Most back pain is self-limited and resolves within 4 weeks with analgesics, rest, stress
reduction, and relaxation.

26. The physician orders Rocephin 2g in 100ml to infuse over 45 mins for a post-op total hip patient. The
IV is to infuse via a macro drip (10 gtts per ml). The nurse should set the IV rate at:

A. 12 gtts/min
B. 22 gtts/min
C. 32 gtts/min
D. 42 gtts/min

Rationale: Answer B is correct. The total to be infused (100ml) divided by the total time in minutes (45
minutes) times the drip factor (10gtt) equals 22 gtts per minute. The other answers are mathematically
incorrect.

27. The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture
should be included? Select all that apply.

A.Checking the urine for hematuria

B.Palpating peripheral pulses in both lower extremities
C.Testing the stool for occult blood
D.Assessing level of consciousness
E.Assessing pupillary response

Rationale: Correct answer is A,B, and C

28. While horseback riding a patient fell from the hose sustaining a pelvic fracture. What complications
should the nurse know to monitor for that are common to pelvic fractures?

A. Paresthesia and ischemia

B. Hemorrhage and shock
C. Paralytic ileus and a lacerated urethra
D. Thrombophlebitis and infection

Answer B

29. Which of the following findings is most typical of a client with a fractured hip?

A. Pain in the hip and affected leg

B. Diminished sensation in the affected leg
C. Absence of pedal and femoral pulses in the affected extremity
D. Misalignment of the affected extremity
Answer D is correct. The most typical sign of a fractured hip is misalignment. Pain, paresthesia, and
pulselessness are characteristics associated with all fractures, so answers A,B,C, are wrong.

30. An elderly female is admitted with a fractured right femoral neck. Which assessment finding is
expected?

A. Free movement of the right leg

B. Abduction of the right leg
C. Internal rotation of the right hip
D. Shortening of the right leg

Rationale: Answer D is correct. The symptoms of this fracture include shortened, adducted, and external
rotation. Answer A is incorrect because the patient usually is unable to move the leg due to pain.
Answer B is incorrect because the symptom is adduction, not abduction. Answer C is wrong because it's
external rotation, not internal rotation.

31. A patient with an open reduction and internal fixation for a fractured hip is to being ambulation. The
hip was repaired using a compression plate and screws. The patient will most likely begin ambulation
with:

A. Full weight bearing on the affected leg

B. Nonweight bearing on the affected leg
C. Toe touch weight bearing on the affected leg
D. Weight bearing as tolerated on the affected leg

Answer C is correct. The patient with ORIF of a fractured hip will begin ambulation with toe touch
weight bearing on the affected leg. Answer A is incorrect because it places to much weight on the newly
repaired hip. Answer B is incorrect because the patient allowed to bear minimal weight on the affected
leg. Answer D is incorrect because it can place too much or too little pressure on the newly repaired hip.

32. The nurse is performing a post-op assessment of an elderly patient with a total hip repair. Although
he has not requested medication for pain, the nurse suspects that the patient's discomfort is severe and
prepares to administer pain medication. Which of the following signs would not support the nurse's
assessment of acute post- op pain?

A. Increased blood pressure

B. Inability to concentrate
C. Dilated pupils
D. Decreased heart rate

Rationale: Answer D is correct. The patient in acute pain experiences physiological arousal similar to the
fight or flight response- for example, an increased (not decreased) heart rate, an increased BP, and
dilated pupils. Answers A,B, and C are wrong because increased BP, inability to concentrate, and dilated
pupils are reactions to pain. The question asks which does not support as assessment of post-op pain, so
answer D is correct.

33. To prevent dislocation of a hip prosthesis following a total hip replacement, the nurse should:
A. Maintain the patient's affected leg in an adducted position
B. Maintain the patient's affected hip in a flexed position
C. Tell the patient to remain in supine position
D. Place an abduction pillow between the patient's leg

Rationale: Answer D is correct. The patient's leg should be maintained in an abducted position to
prevent dislocation of the prosthesis. This is accomplished by the use of an abduction pillow. Answers A
and B will increase the likelihood of dislocation of the prosthesis; therefore, they are incorrect. Answer C
is unnecessary; therefore, it is incorrect.

34. The nurse at an orthopedic joint clinic is preparing pre-operative teaching for a patient scheduled for
total hip replacement surgery. Which would be included in the teaching plan?

A. Avoid sitting in a chair

B. Make sure that commode seats are at low levels
C. Avoid crossing the legs when sitting
D. Physical Therapy will assist with adduction exercises

Rationale: Answer C is correct. The patient with joint hip replacement should avoid adduction of the legs
and flexion of the hips greater than 90 degrees to ensure continued placement of the prosthetic joint. It
is recommended for these patients to use recliners for seating instead of straight chairs., therefore A is
incorrect. Commode seats will have to be raised and abduction of the legs is required, making B and D
incorrect choices.

35. The nurse is preparing a teaching plan for a patient who is being discharged following a total hip
replacement. The nurse would include which part of the following content as a part of the teaching
plan? Select all that apply

A. Avoid low, cushioned chairs

B. Use a device that raises toilet seat
C. Avoid bending greater than 90 degrees
D. Turn at the waist to reach objects
E. Do not cross the legs

Rationale: A,B,C,E are correct. Following a total hip replacement, the patient must be instructed to avoid
activities such as sitting in low, cushioned chairs; crossing legs; and using a standard- height toilet. These
activities cause adduction of the less or greater than 90 degrees' flexion at the hip, leading to possible
dislocation. Turning at the waist violates principles of general body mechanics.

36. The primary purpose for using a continuous passive movement (CPM) apparatus for a patient with a
total knee repair is to help:

A. Prevent contractures
B. Promote flexion of the artificial joint
C. Decrease the pain associated with early ambulation
D. Alleviate lactic acid production in the leg muscles
Answer B is correct. The primary purpose of the continuous passive motion machine is to promote
flexion of the artificial joint. Answers A,C, and D do not describe the purpose of the CPM machine;
therefore, they are incorrect.

37. A patient with a total knee replacement returns from surgery. Which findings require immediate
nursing intervention?

A. The is 30ml bloody drainage from the surgical drain

B. The continuous passive motion machine is set on 90-degree flexion
C. The patient is unable to ambulate to the bathroom
D. The patient is complaining of muscle spasm

Answer B is correct. The CPM machine should not be set at 90-degree flexion until the fifth
postoperative day. Answers A, C, and D are expected findings and do not require immediate nursing
intervention, so they are incorrect

38. Is the following statement True or False?

Testing for crepitus can produce further tissue damage and should be avoided.
True

Testing for crepitus can produce further tissue damage and should be avoided.

39. An elderly patient with a fractured hip is placed in Buck's traction. The primary purpose for Buck's
traction for the patient is:

A. To decrease muscle spasm

B. To prevent the need for surgery
C. To alleviate the pain associated with the fracture
D. To prevent bleeding associated with the hip fractures

Rationale: Answer A is correct. Buck's traction is a skin traction used to decrease muscle spasms. Buck's
traction will not prevent the need for surgery, making answer B wrong. It also will not alleviate the pain
associated with the fracture or prevent bleeding, so answers C and D are wrong.

40. Is the following statement true or false?

The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs.
True

The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs.
Removal of the weights completely defeats their purpose and may result in injury to the patient.

41. A patient complains of tingling and numbness in his right leg following application of a long leg cast.
The patient's discomfort is most likely the result of:

A. Reduced venous return

B. Bone healing
C. Arterial insufficiency
D. Nerve compression

Rationale: Answer D is correct. Numbness and tingling in a n extremity immobilized by a cast are most
likely the result of nerve compression. Answer A is incorrect because reduced venous return results in
swelling in the extremity. Answer B is incorrect because numbness and tingling are not associated with
bone healing. Answer C is incorrect because arterial insufficiency results in diminished or absent pulses
in the extremity.

42. Which activity is most appropriate for a three- year old with a cast?

A. Barbie doll and accessories

B. Toy telephone
C. Coloring book and crayons
D. Puzzles

Rationale: Answer B is correct. The toy telephone is large enough that it cannot be placed beneath the
cast, and it promotes social and language development. Answers A,C, and D contain small pieces that
can be placed beneath the cast, so they are incorrect.