1. A client is 1 day postoperative after a total hip replacement.

The client  should be placed in which

of the following position?
A. Supine
B. Semi Fowler’s
C. Orthopneic
D. Trendelenburg
2. A client who has had a plaster of Paris cast applied to his forearm is  receiving pain medication. To
detect early manifestations of compartment  syndrome, which of these assessments should the nurse
make?
A. Observe the color of the fingers
B. Palpate the radial pulse under the cast
C. Check the cast for odor and drainage
D. Evaluate the response to analgesics
3. After a computer tomography scan with intravenous contrast medium, a  client returns to the unit
complaining of shortness of breath and itching. The  nurse should be prepared to treat the client for:
A. An anaphylactic reaction to the dye
B. Inflammation from the extravasation of fluid during injection.
C. Fluid overload from the volume of the infusions
D. A normal reaction to the stress of the diagnostic procedure.
4. While caring for a client with a newly applied plaster of Paris cast, the  nurse makes note of all the
following conditions. Which assessment finding  requires immedite notification of the physician?
A. Moderate pain, as reported by the client
B. Report, by client, the heat is being felt under the cast
C. Presence of slight edema of the toes of the casted foot
D. Onset of paralysis in the toes of the casted foot
5. Which of these nursing actions will best promote independence for the  client in skeletal traction?
A. Instruct the client to call for an analgesic before pain becomes severe.
B. Provide an overhead trapeze for client use
C. Encourage leg exercise within the limits of traction
D. Provide skin care to prevent skin breakdown.
6. A client presents in the emergency department after falling from a roof. A fracture of the femoral
neck is suspected. Which of these assessments best  support this diagnosis.
A. The client reports pain in the affected leg
B. A large hematoma is visible in the affected extremity
 C. The affected extremity is shortenend, adducted, and extremely  rotated
D. The affected extremity is edematous.
7. The nurse is caring for a client with compound fracture of the tibia and  fibula. Skeletal traction is
applied. Which of these priorities should the nurse  include in the care plan?
A. Order a trapeze to increase the client’s ambulation
B. Maintain the client in a flat, supine position at all times.
C. Provide pin care at least every hour
D. Remove traction weights for 20 minutes every two hours.
8. To prevent foot drop in a client with Buck’s traction, the nurse should:
A. Place pillows under the client’s heels.
B. Tuck the sheets into the foot of the bed
C. Teach the client isometric exercises
D. Ensure proper body positioning.
9. Which nursing intervention is appropriate for a client with skeletal  traction?
A. Pin care
B. Prone positioning
C. Intermittent weights
D. 5lb weight limit
10. In order for Buck’s traction applied to the right leg to be effective, the  client should be placed in
which position?
A. Supine
B. Prone
C. Sim’s
D. Lithotomy
11. An elderly client has sustained intertrochanteric fracture of the hip and  has just returned from
surgery where a nail plate was inserted for internal  fixation. The client has been instructed that she
should not flex her hip. The  best explanation of why this movement would be harmful is:
A. It will be very painful for the client
B. The soft tissue around the site will be damaged
C. Displacement can occur with flexion
D. It will pull the hip out of alignment
12. When the client is lying supine, the nurse will prevent external rotation of  the lower extremity by
using a:
A. Trochanter roll by the knee
 B. Sandbag to the lateral calf
C. Trochanter roll to the thigh
D. Footboard
13. A client has just returned from surgery after having his left leg  amputated below the knee.
Physician’s orders include elevation of the foot of  the bed for 24 hours. The nurse observes that the
nursing assistant has  placed a pillow under the client’s amputated limb. The nursing action is to:
A. Leave the pillow as his stump is elevated
B. Remove the pillow and elevate the foot of the bed
C. Leave the pillow and elevate the foot of the bed
D. Check with the physician and clarify the orders
14. A client has sustained a fracture of the femur and balanced skeletal  traction with a Thomas splint
has been applied. To prevent pressure points  from occurring around the top of the splint, the most
important intervention
is to:
A. Protect the skin with lotion
B. Keep the client pulled up in bed
C. Pad the top of the splint with washcloths
D. Provide a footplate in the bed
15. The major rationale for the use of acetylsalicylic acid (aspirin) in the  treatment of rheumatoid
arthritis is to:
A. Reduce fever
B. Reduce the inflammation of the joints
C. Assist the client’s range of motion activities without pain
D. Prevent extension of the disease process
16. Following an amputation, the advantage to the client for an immediate prosthesis fitting is:
A. Ability to ambulate sooner
B. Less change of phantom limb sensation
C. Dressing changes are not necessary
D. Better fit of the prosthesis
17. One method of assessing for sign of circulatory impairment in a client  with a fractured femur is to
ask the client to:
A. Cough and deep breathe
B. Turn himself in bed
C. Perform biceps exercise
D. Wiggle his toes
18. The morning of the second postoperative day following hip surgery for a  fractured right hip, the
nurse will ambulate the client. The first intervention is
to:
A. Get the client up in a chair after dangling at the bedside.
B. Use a walker for balance when getting the client out of bed
C. Have the client put minimal weight on the affected side when getting up
D. Practice getting the client out of bed by having her slightly flex her hips
19. A young client is in the hospital with his left leg in Buck’s traction. The  team leader asks the
nurse to place a footplate on the affected side at the  bottom of the bed. The purpose of this action is
to:
A. Anchor the traction
B. Prevent footdrop
C. Keep the client from sliding down in bed
D. Prevent pressure areas on the foot
20. When evaluating all forms of traction, the nurse knows the direction of  pull is controlled by the:
A. Client’s position
B. Rope/pulley system
C. Amount of weight
D. Point of friction
21. When a client has cervical halter traction to immobilize the cervical spine  counteraction is
provided by:
A. Elevating the foot of the bed
B. Elevating the head of the bed
C. Application of the pelvic girdle
D. Lowering the head of the bed
22. After falling down the basement steps in his house, a client is brought to  the emergency room.
His physician confirms that his leg is fractured.  Following application of a leg cast, the nurse will
first check the client’s toes  for:
A. Increase in the temperature
B. Change in color
C. Edema
D. Movement
23. A 23 year old female client was in an automobile accident and is now a  paraplegic. She is on an
intermittent urinary catheterization program and  diet as tolerated. The nurse’s priority assessment
should be to observe for:
 A. Urinary retention
B. Bladder distention
C. Weight gain
D. Bower evacuation
24. A female client with rheumatoid arthritis has been on aspirin grain TID  and prednisone 10mg
BID for the last two years. The most important  assessment question for the nurse to ask related to the
client’s drug therapy  is whether she has
A. Headaches
B. Tarry stools
C. Blurred vision
D. Decreased appetite
25. A 7 year old boy with a fractured leg tells the nurse that he is bored. An  appropriate intervention
would be to
A. Read a story and act out the part
B. Watch a puppet show
C. Watch television
D. Listen to the radio
26. On a visit to the clinic, a client reports the onset of early symptoms of  rheumatoid arthritis. Which
of the following would be the nurse most likely to  asses:
A. Limited motion of joints
B. Deformed joints of the hands
C. Early morning stiffness
D. Rheumatoid nodules
27. After teaching the client about risk factors for rheumatoid arthritis, which  of the following, if
stated by the client as a risk factor, would indicate to the
nurse that the client needs additional teaching?
A. History of Epstein-Barr virus infection
B. Female gender
C. Adults between the ages 60 to 75 years
D. Positive testing for human leukocyte antigen (HLA) DR4 allele
28. When developing the teaching plan for the client with rheumatoid  arthritis to promote rest, which
of the following would the nurse expect to  instruct the client to avoid during the rest periods?
A. Proper body alignment
B. Elevating the part
C. Prone lying positions
 D. Positions of flexion
29. After teaching the client with severe rheumatoid arthritis about the newly  prescribed medication
methothrexate (Rheumatrex 0), which of the following  statements indicates the need for further
teaching?
A. “I will take my vitamins while I am on this drug”
B. “I must not drink any alcohol while I’m taking this drug”
C. I should brush my teeth after every meal”
D. “I will continue taking my birth control pills”
30. When completing the history and physical examination of a client  diagnosed with osteoarthritis,
which of the following would the nurse assess?
A. Anemia
B. Osteoporosis
C. Weight loss
D. Local joint pain
31. At which of the following times would the nurse instruct the client to take  ibuprofen (Motrin),
prescribed for left hip pain secondary to osteoarthritis, to  minimize gastric mucosal irritation?
A. At bedtime
B. On arising
C. Immediately after meal
D. On an empty stomach
32. When preparing a teaching plan for the client with osteoarthritis who is  taking celecoxib
(Celebrex), the nurse expects to explain that the major  advantage of celecoxib over diclofenac
(Voltaren), is that the celecoxib is  likely to produce which of the following?
A. Hepatotoxicity
B. Renal toxicity
C. Gastrointestinal bleeding
D. Nausea and vomiting
33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an
inability to move the extremity. The nurse  interprets these findings as indicating which of the
following?
A. A developing infection
B. Bleeding in the operative site
C. Joint dislocation
D. Glue seepage into soft tissue
34. Which of the following would the nurse assess in a client with an  intracapsular hip fracture?
 A. Internal rotation
B. Muscle flaccidity
C. Shortening of the affected leg
D. Absence of pain the fracture area
35. Which of the following would be inappropriate to include when preparing  a client for magnetic
resonance imaging (MRI) to evaluate a rupture disc?
A. Informing the client that the procedure is painless
B. Taking a thorough history of past surgeries
C. Checking for previous complaints of claustrophobia
D. Starting an intravenous line at keep-open rate
36. Which of the following actions would be a priority for a client who has  been in the postanesthesia
care unit (PACU) for 45 minutes after an above  the knee amputation and develops a dime size bright
red spot on the ace  bondage above the amputation site?
A. Elevate the stump
B. Reinforcing the dressing
C. Calling the surgeon
D. Drawing a mark around the site
37. A client in the PACU with a left below the knee amputation complains of  pain in her left big toe.
Which of the following would the nurse do first?
A. Tell the client it is impossible to feel the pain
B. Show the client that the toes are not there
C. Explain to the client that the pain is real
D. Give the client the prescribed narcotic analgesic
38. The client with an above the knee amputation is to use crutches until the  prosthesis is being
adjusted. In which of the following exercises would the  nurse instruct the client to best prepare him
for using crutches?
A. Abdominal exercises
B. Isometric shoulder exercises
C. Quadriceps setting exercises
D. Triceps stretching exercises
39. The client with an above the knee amputation is to use crutches until the  prosthesis is properly
lifted. When teaching the client about using the  crutches, the nurse instructs the client to support her
weight primarily on  which of the following body areas?
A. Axillae
B. Elbows
 C. Upper arms
D. Hands
40. Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED in a
stable condition with vital signs within normal  limits, alert and oriented with good coloring and an
open fracture of the right  tibia. When assessing the client, the nurse would be especially alert for
signs  and symptoms of which of the following?
A. Hemorrhage
B. Infection
C. Deformity
D. Shock
41. The client with a fractured tibia has been taking methocarbamol  (Robaxin), when teaching the
client about this drug, which of the following  would the nurse include as the drug’s primary effect?
A. Killing of microorganisms
B.  Reduction in itching
C. Relief of muscle spasms
D. Decrease in nervousness
42. A client who has been taking carisoprodol (Soma) at home for a fractured  arm is admitted with a
blood pressure of 80/50 mmHg, a pulse rate of  115bpm, and respirations of 8 breaths/minute and
shallow, the nurse  interprets these finding as indicating which of the following?
A. Expected common side effects
B. Hypersensitivity reactions
C. Possible habituating effects
D. Hemorrhage from GI irritation
43. When admitting a client with a fractured extremity, the nurse would focus the assessment on
which of the following first?
A. The area proximal to the fracture
B. The actual fracture site
C. The area distal to the fracture
D. The opposite extremity for baseline comparison
44. A client with fracture develops compartment syndrome. When caring for  the client, the nurse
would be alert for which of the following signs of  possible organ failure?
A. Rales
B. Jaundice
C. Generalized edema
D. Dark, scanty urine
45. Which of the following would lead the nurse to suspect that a client with  a fracture of the right
femur may be developing a fat embolus?
A. Acute respiratory distress syndrome
B. Migraine like headaches
C. Numbness in the right leg
D. Muscle spasms in the right thigh
46. The client who had an open femoral fracture was discharged to her  home, where she developed,
fever, night sweats, chills, restlessness and  restrictive movement of the fractured leg. The nurse
interprets these finding  as indicating which of the following?
A. Pulmonary emboli
B. Osteomyelitis
C. Fat emboli
D. Urinary tract infection
47. When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse
interprets this as suggesting the occurrence of which  of the following as most likely?
A. Formation of scar tissue interfering with absorption
B. Development of pus leading to ischemia
C. Production of bacterial growth by avascular tissue
D. Antibiotics not being instilled directly into the bone
48. Which of the following would the nurse use as the best method to assess for the development of
deep vein thrombosis in a client with a spinal cord injury?
A. Homan’s sign
B. Pain
C. Tenderness
D. Leg girth
49. The nurse is caring for the client who is going to have an arthogram using a contrast medium.
Which of the following assessments by the nurse  are of highest priority?
A. Allergy to iodine or shellfish
B. Ability of the client to remain still during the procedure
C. Whether the client has any remaining questions about the procedure
D. Whether the client wishes to void before the procedure
50. The client immobilized skeletal leg traction complains of being bored and restless. Based on these
complaints, the nurse formulates which of the  following nursing diagnoses for this client?
A. Divertional activity deficit
B. Powerlessness
 C. Self care deficit
D. Impaired physical mobility
51. The nurse is teaching the client who is to have a gallium scan about the procedure. The nurse
includes which of the following items as part of the instructions?
A. The gallium will be injected intravenously 2 to 3 hours before the procedure
B. The procedure takes about 15 minutes to perform
C. The client must stand erect during the filming
D. The client should remain on bed rest for the remainder of the day after the scan
52. The nurse is assessing the casted extremity of a client. The nurse assesses for which of the
following signs and symptoms indicative of infection?
A. Coolness and pallor of the extremity
B. Presence of a “hot spot” on the cast
C. Diminished distal pulse
D. Dependent edema
53. The client has Buck’s extension applied to the right leg. The nurse plans which of the following
interventions to prevent complications of the device?
A. Massage the skin of the right leg with lotion every 8 hours
B. Give pin care once a shift
C. Inspect the skin on the right leg at least once every 8 hours
D. Release the weights on the right leg for range of motion exercises daily
54. The nurse is giving the client with a left cast crutch walking instructions using the three point gait.
The client is allowed touchdown of the affected leg. The nurse tells the client to advance the:
A. Left leg and right crutch then right leg and left crutch
B. Crutches and then both legs simultaneously
C. Crutches and the right leg then advance the left leg
D. Crutches and the left leg then advance the right leg
55. The client with right sided weakness needs to learn how to use a cane. The nurse plans to teach the
client to position the cane by holding it with the:
A. Left hand and placing the cane in front of the left foot
B. Right hand and placing the cane in front of the right foot
C. Left hand and 6 inches lateral to the left foot
D. Right hand and 6 inches lateral to the left foot
56. The nurse is repositioning the client who has returned to the nursing unit following internal
fixation of a fractured right hip. The nurse uses a:
 A. Pillow to keep the right leg abducted during turning
B. Pillow to keep the right leg adducted during turning
C. Trochanter roll to prevent external rotation while turning
D. Trochanter roll to prevent abduction while turning
57. The nurse has an order to get the client out of bed to a chair on the first postoperative day after a
total knee replacement. The nurse plans to do which of the following to protect the knee joint:
A. Apply a knee immobilizer before getting the client up and elevate the client’s surgical leg
while sitting
B. Apply an Ace wrap around the dressing and put ice on the knee while sitting
C. Lift the client to the bedside change leaving the CPM machine in place
D. Obtain a walker to minimize weight bearing by the client on the affected leg
58. The nurse is caring for the client who had an above the knee amputation 2days ago. The residual
limb was wrapped with an elastic compression  bandage which has come off. The nurse immediately:
A. Calls the physician
B. Rewrap the stump with an elastic compression bandage
C. Applies ice to the site
D. Applies a dry sterile dressing and elevates it on a pillow
59. The nurse has taught the client with a below the knee amputation about prosthesis and stump care.
The nurse evaluates that the client states to:
A. Wear a clean nylon stump sock daily
B. Toughen the skin of the stump by rubbing it with alcohol
C. Prevent cracking of the skin of the stump by applying lotion daily
D. Using a mirror to inspect all areas of the stump each day
60. The nurse is caring for a client with a gout. Which of the following laboratory values does the
nurse expect to note in the client?
A. Uric acid level of 8 mg/dl
B. Calcium level of 9 mg/dl
C. Phosphorus level of 3 mg/dl
D. Uric acid level of 5 mg/dl
Answers
1. B. Semi Fowler’s 
2. D. Evaluate the response to analgesics
3. A. An anaphylactic reaction to the dye
4. D. Onset of paralysis in the toes of the casted foot 
5. B. Provide an overhead trapeze for client use 
6. C. The affected extremity is shortenend, adducted, and extremely rotated
7. C. Provide pin care at least every hour 
8. D. Ensure proper body positioning. 
9. A. Pin care 
10. A. Supine
11. C. Displacement can occur with flexion 
12. C. Trochanter roll to the thigh 
13. B. Remove the pillow and elevate the foot of the bed 
14. C. Pad the top of the splint with washcloths
15. B. Reduce the inflammation of the joints 
16. A. Ability to ambulate sooner 
17. D. Wiggle his toes  
18. D. Practice getting the client out of bed by having her slightly flex her hips 
19. B. Prevent footdrop 
20. B. Rope/pulley system
21. B. Elevating the head of the bed 
22. B. Change in color 
23. B. Bladder distention 
24. B. Tarry stools 
25. C. Watch television 
26. C. Early morning stiffness 
27. C. Adults between the ages 60 to 75 years 
28. D. Positions of flexion 
29. D. “I will continue taking my birth control pills” 
30. D. Local joint pain  
31. C. Immediately after meal 
32. C. Gastrointestinal bleeding 
33. C. Joint dislocation 
34. C. Shortening of the affected leg 
35. D. Starting an intravenous line at keep-open rate 
36. D. Drawing a mark around the site 
37. D. Give the client the prescribed narcotic analgesic 
38. D. Triceps stretching exercises 
39. D. Hands 
40. A. Hemorrhage 
41. C. Relief of muscle spasms 
42. A. Expected common side effects 
43. C. The area distal to the fracture 
44. D. Dark, scanty urine 
45. A. Acute respiratory distress syndrome 
46. B. Osteomyelitis 
47. C. Production of bacterial growth by avascular tissue 
48. A. Homan’s sign
49. A. Allergy to iodine or shellfish 
50. A. Divertional activity deficit 
51. A. The gallium will be injected intravenously 2 to 3 hours before the procedure 
52. B. Presence of a “hot spot” on the cast 
53. C. Inspect the skin on the right leg at least once every 8 hours 
54. D. Crutches and the left leg then advance the right leg 
55. C. Left hand and 6 inches lateral to the left foot 
56. A. Pillow to keep the right leg abducted during turning 
57. A. Apply a knee immobilizer before getting the client up and elevate the client’s
surgical leg while sitting 
 58. B. Rewrap the stump with an elastic compression bandage 
59. D. Using a mirror to inspect all areas of the stump each day 
60. A. Uric acid level of 8 mg/dl 

1. You are initiating a nursing care plan for a patient with osteoporosis. All of these nursing
interventions apply to the nursing diagnosis Risk for Falls. Which  intervention should you delegate to
the nursing assistant?
A. Identify environmental factors that increase risk for falls.
B. Monitor gait, balance, and fatigue level with ambulation.
C. Collaborate with physical therapy to provide patient with walker.
 D. Assist the patient with ambulation to bathroom and in halls.
2. You are preparing to teach a newly diagnosed patient with osteoporosis about strategies to prevent
falls. Which of these points will you be sure to include? (Choose all that apply.)
A. Wear a hip protector when ambulating.
B. Remove throw rugs and other obstacles at home.
C. Exercise will help build your strength.
D. You should expect a few bumps and bruises when you go home.
E. When you are tired, you should rest.
3. You discover all of these assessment findings when admitting a patient with Paget’s disease. Which
finding indicates that the physician should be notified?
A. The patient has bowing of both legs and the knees are asymmetric.
B. The base of the patient’s skull is invaginated (platybasia).
C. The patient is only 5 feet tall and weighs 120 pounds.
D. The patient’s skull is soft, thick, and larger than normal.
4. As charge nurse you observe the LPN/LVN providing all of these interventions for the patient with
Paget’s disease. Which action requires that you intervene?
A. Administers 600 mg of ibuprofen to the patient
B. Encourages the patient to perform PT recommended exercises
C. Applies ice and gentle massage to the patient’s lower extremities
D. Reminds the patient to drink milk and eat cottage cheese
5. As charge nurse you are making assignments for the day shift. Which patient would you assign to
the nurse who has been pulled from the post-anesthesia care unit (PACU) for the day?
A. A 35-year-old patient with osteomyelitis who needs teaching prior to hyperbaric oxygen
therapy
B. A 62-year-old patient with osteomalacia who is being discharged to a long-term care facility
C. A 68-year-old patient with osteoporosis and a new orthotic device whose knowledge of use of
this device must be assessed.
D. A 72-year-old patient with Paget’s disease who has just returned from surgery for total knee
replacement
6. You delegate taking vital signs to an experienced nursing assistant. The patient has been diagnosed
with osteomyelitis. Which vital sign do you want the nursing assistant to report immediately?
A. Temperature 99.90 F
B. Blood pressure 136/80
C. Heart rate 96/minute
D. Respiratory rate 24/minute
7. You are working with a nursing assistant to provide care for six patients. At the beginning of the
shift, you carefully tell the nursing assistant what patient interventions and tasks she will be expected
to perform. To be sure that your communication is appropriate you refer to the 4 C’s. List the 4 C’s
below.
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
8. You are providing nursing care for a patient with carpal tunnel syndrome (CTS) who is preparing
for surgery. Which intervention should you delegate to the nursing assistant?
A. Initiate placement of a splint for immobilization during the day.
B. Assess the patient’s wrist and hand for discoloration and brittle nails.
C. Assist the patient with daily self-care measures such as bathing and eating.
D. Test the patient for painful tingling in the four digits of the hand.
9. You deserve the nursing assistant performing all of these interventions for the patient with CTS.
Which action requires that you intervene immediately?
A. Arrange the patient’s lunch tray and cut the meat.
B. Provide warm water and assist the patient with a bath.
C. Replace the patient’s splint in hyperextension position.
D. Remind the patient not to lift very heavy objects.
10.The patient is scheduled for endoscopic carpal tunnel release surgery in the morning. What key
point will you be sure to teach the patient?
A. Pain and numbness will be experienced for several days to weeks.
B. Immediately after surgery, the patient will no longer need assistance.
C. After surgery, the dressing will be large with dots of drainage
D. After surgery, the pain and paresthesia will no longer be present.
11. As charge nurse you assign the nursing care of a patient who has just returned form open carpal
tunnel release surgery to an experienced LPN/LVN, who will perform under the supervision of an
RN. Which of the following instructions will you provide for the LPN/LVN? (Choose all that apply.)
A. Check the patient’s vital signs every 15 minutes in the first hour.
B. Check the dressing for drainage and tightness.
C. Elevate the patient’s hand above the heart.
D. The patient will no longer need pain medication.
E. Check the neurovascular status of the fingers every hour.
12.You are preparing the post-operative CTS patient for discharge. Which information is important to
provide to this patient?
A. The surgical procedure is a cure for CTS.
 B. Hand movements will be restricted for 4 – 6 weeks after surgery.
C. Frequent pain medication dosages will no longer be necessary.
D. Notify the physician immediately for any pain or discomfort.
13.During discharge preparations, a patient with osteoporosis makes all of these statements. Which
statement indicates to you that the patient needs additional teaching?
A. “I take my ibuprofen every morning as soon as I get up.”
B. “My daughter removed all of the throw rugs in my home.”
C. “My husband helps me every afternoon with range-of-motion exercises.”
D. “I rest in my recliner chair every day for at least an hour.”
14.The patient suffered a fractured femur. Which of the following would you tell the nursing assistant
to report immediately?
A. The patient complains of pain.
B. The patient appears confused.
C. The patient’s blood pressure is 136/88.
D. The patient voided using the bedpan.
15.After change-of-shift report, which patient should the nurse assess first?
A. A 42-year-old patient with carpal tunnel syndrome complaining of pain
B. A 64-year-old patient with osteoporosis who is waiting for discharge
C. A 28-year-old patient with fracture complaining that the cast is tight
D. A 56-year-old patient with left leg amputation complaining of phantom pain
16.A patient with a fractured fibula is receiving skeletal traction and has skeletal pins in place. You
instruct the nursing assistant to immediately report which of the following?
A. The patient wants to change position in bed.
B. There is a small amount of clear fluid on the pin sites.
C. The traction weights are resting on the floor.
D. The patient is complaining of pain and muscle spasm.
17.A patient with a fracture of the right ankle has a nursing diagnosis of Impaired Physical Mobility.
As charge nurse you observe a new graduate RN perform all of these interventions. For which action
should you intervene?
A. Encourages the patient to go from lying to standing position
B. Administers pain medication prior to beginning exercises
C. Explains to the patient and family the purpose of the exercise program
D. Reminds the patient about correct usage of crutches
18.The charge nurse assigns the nursing care of a patient who is 1 day post-operative after a left
below-the-knee amputation to an experienced LPN/LVN, what will you describe as the major focus
for care today?
A. To attain pain control for phantom pain.
B. To monitor for signs of sufficient tissue perfusion.
C. To assist the patient to ambulate as soon as possible.
D. To elevate the residual limb when the patient is supine.
19.A patient with a right above-the-knee amputation has phantom limb pain (PLP) and asks you why.
What is your best response?
A. “Phantom limb pain is not explained or predicted by any one theory.”
B. “Phantom limb pain occurs because your body thinks you leg is still present.”
C. “Phantom limb pain will not interfere with your activities of daily living.”
D. “Phantom limb pain is not real pain, but is remembered pain.”
20.During morning care, the patient with a below-the-knee amputation asks the nursing assistant
about prostheses. How should you instruct the nursing assistant to respond?
A. “You should get a prosthesis so that you can walk again.”
B. “Wait and ask your doctor that question next time he comes in.”
C. “It’s too soon to be worrying about getting a prosthesis.”
D. “I’ll ask the nurse to come in and discuss this with you.”
21.During assessment of a patient with fractures of the medial ulna and radius, you find all of the
following data. Which assessment finding should you report to the physician immediately?
A. The patient complains of pressure and pain.
B. The cast is in place and is dry and intact.
C. The skin is pink and warm to touch.
D. The patient can move all fingers and thumb.
Answers and Rationales
1. ANSWER D – Assisting with activities of daily living is within the scope of the nursing
assistant’s practice. The other three interventions require additional educational preparation
and are within the scope of practice of licensed nurses. Focus: Delegation/supervision
2. ANSWERS A, B, C & E – The purpose of the teaching is to help the patient prevent falls.
The hip protector can prevent hip fractures if the patient falls. Throw rugs and obstacles in the
home increase the risk for falls. Patients who are tired are also more likely to fall. Exercise
helps to strengthen muscles and improve coordination. Focus: Prioritization
3. ANSWER B – Platybasia (basilar skull invagination) causes brain stem manifestations that
threaten life. Patients with Paget’s disease are usually short and often have bowing of the long
bones that results in asymmetric knees or elbow deformities. Their skull is typically soft,
thick and enlarged. Focus:Prioritization
4. ANSWER C – Application of heat, not ice, is the appropriate measure to help reduce the
patient’s pain. Ibuprofen is useful to manage mild to moderate pain. Exercise prescribed by
the PT is non-impact in nature and provides strengthening for the patient. A diet rich in
calcium promotes bone health. Focus: Delegation/supervision
5. ANSWER D – The PACU nurse is very familiar with the assessment skills necessary to
monitor a newly post-operative patient. The other patients need care from nurses familiar with
musculoskeletal-related nursing care, to provide teaching, assessment, and report to the long-
term care facility. Focus: Assignment
6. ANSWER A – An elevated temperature indicates infection and inflammation. This patient
needs IV antibiotic therapy. The other vital signs are normal or high normal results. Focus:
Delegation/Supervision
7. ANSWER Clear, Concise, Correct, and Complete – The 4 Cs of communication help the
nurse ensure that the nursing assistant understands what is being said and does not confuse the
nurse’s directions; that directions are according to policies, procedures, job descriptions, and
the law; and that the nursing assistant has all the information to complete the tasks assigned.
Focus: Delegation/supervision
8. ANSWER C – Placing a splint for the first time is appropriate to the scope of practice for
physical therapists. Assessing and testing for paresthesia are not within the scope of practice
for nursing assistants. Assistance with activities of daily living is within the scope of practice
for a nursing assistant. Focus: Delegation/supervision
9. ANSWER C – When a patient with CTS has a splint used for immobilization of the wrist, it is
placed either in the neutral position or in slight extension. The other interventions are correct
and are within the scope of practice for a nursing assistant. Nursing assistants may remind
patients about elements of their care plans such as avoiding heavy lifting. Focus:
Delegation/supervision
10. ANSWER A – Post-operative pain and numbness occur for a longer period of time with
endoscopic carpal tunnel release than with the open procedure. Patients often need assistance
post-operatively, even after they are discharged. The dressing from the endoscopic procedure
is usually very small and there should not be a lot of drainage. Focus: Prioritization
11. ANSWERS A, B, C & E – Post-operatively, patients with OCTR surgery have pain and
numbness. Their discomfort may last for weeks to months. All of the other directions are
appropriate to the post-operative care for this patient. It is important or monitor for drainage,
tightness, and neurovascular changes. Raising the hand/wrist above the heart reduces the
swelling form surgery, and this is often done for several days. Focus: Assignment,
delegation/supervision
12. ANSWER B – Hand movements, including heavy lifting, may be restricted for 4- 6 weeks
after surgery. Patients experience discomfort for weeks to months after surgery. The surgery
is not always a cure. In some cases, CTS may recur months to years after surgery. Focus:
Prioritization
13. ANSWER A – Ibuprofen can cause abdominal discomfort or pain and gastrointestinal
ulceration. I such cases, it should be given with meals or milk. Removal of throw rugs helps
prevent falls. Range-of-motion exercises and rest are important strategies for coping with
osteoporosis. Focus: Prioritization
14. ANSWER B – Fat embolism syndrome is a serious complication that is often the result of
fractures of long bones. The earliest manifestation of this is altered mental status caused by
low arterial oxygen level. The nurse would want to know about and treat the pain, but it is not
life threatening. The nurse would also want to know about the blood pressure and that the
patient voided; however, neither of these pieces of information is urgent. Focus:
Prioritization, delegation/supervision
15. ANSWER C – The patient with the tight cast is at risk for circulation impairment and
peripheral nerve damage. While all of the other patients’ concerns are important and the nurse
will want to see them as soon as possible, none of their concerns is urgent. Focus:
Prioritization
16. ANSWER C – When the weights are resting on the floor, they are not exerting pulling force
to provide reduction and alignment, or to prevent muscle spasm. The weights should  always
hang freely. Attending to the weights may reduce the patient’s pain and spasm. With skeletal
 pins, a small amount of clear fluid drainage is expected. It is important to inspect the traction
system after a patient changes position because position changes may  alter the traction.
Focus: Delegation/supervision, prioritization
17. ANSWER A – Moving from a lying position to a sitting position, then a standing position
allows the patient to establish balance prior to standing. Administering pain medication prior
to exercising decreases pain with exercise. Explanations about the purpose of the exercise
program and proper use of crutches are appropriate interventions with this patient. Focus:
Delegation/supervision
18. ANSWER B – Monitoring for sufficient tissue perfusion is the priority at this time. Phantom
pain is a concern, but is more common is patients with above-the-knee amputations. Early
ambulation is a goal, but at this time, the patient is more likely to be engaged in muscle-
strengthening exercises. Elevation of the residual limb on a pillow is controversial because it
may promote knee flexion contracture. Focus: Delegation/supervision
19. ANSWER A – There are three theories being researched with regard to PLP. The peripheral
nervous system theory implies that sensations remain as a result of severing peripheral nerves
during the amputation. The central nervous system theory states that PLP results from a loss
of inhibitory signals that are generated through afferent impulses from the amputated limb.
The psychological theory helps predict and explain PLP in that stress, anxiety, and depression
often trigger or worsen an episode of PLP. Focus: Prioritization
20. ANSWER D – The patient is indicating an interest in learning about prostheses. The
experienced nurse can initiate discussion and begin educating the patient. Certainly the
physician can also discuss prostheses with the patient, but the patient’s wish to learn should
receive a quick response. The nurse can then notify the physician about the patient’s request.
Focus: Delegation/supervision
21. ANSWER A – Pressure and pain may be due to increased compartment pressure and indicate
the serious complication of acute compartment syndrome. This is urgent. If not  treated,
cyanosis, tingling, numbness, paresis, and severe pain occur. Focus: Prioritization