RHEUMATOID ARTHRITIS

1. On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse
should conduct a focused assessment for:

■ 1. Limited motion of joints.

■ 2. Deformed joints of the hands.

■ 3. Early morning stiffness.

■ 4. Rheumatoid nodules.

2. A client with rheumatoid arthritis states, “I can’t do my household chores without becoming tired. My
knees hurt whenever I walk.” Which nursing diagnosis would be most appropriate?

■ 1. Activity intolerance related to fatigue and pain.

■ 2. Self-care defi cit related to increasing joint pain.

■ 3. Ineffective coping related to chronic pain.

■ 4. Disturbed body image related to fatigue and joint pain.

3. Of the clients listed below, who is at risk for developing rheumatoid arthritis (RA)? Select all that apply.

■ 1. Adults between the ages of 20 and 50 years.

■ 2. Adults who have had an infectious disease with the Epstein-Barr virus.

■ 3. Adults that are of the male gender.

■ 4. Adults who possess the genetic link, specifically HLA-DR4.

■ 5. Adults who also have osteoarthritis.

4. A client is in the acute phase of rheumatoid arthritis. Which of the following should the nurse identify
as lowest priority in the plan of care?

■ 1. Relieving pain.

■ 2. Preserving joint function.

■ 3. Maintaining usual ways of accomplishing tasks.

■ 4. Preventing joint deformity

5. The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which of the
following client statements indicates that the client still has a knowledge defi cit?

■ 1. “I can use heat and cold as often as I want.”

■ 2. “With heat, I should apply it for no longer than 20 minutes at a time.”

■ 3. “Heat-producing liniments can be used with other heat devices.”

■ 4. “Ten to 15 minutes per application is the maximum time for cold applications.”

6. The client with rheumatoid arthritis tells the nurse, “I have a friend who took gold shots and had a
wonderful response. Why didn’t my physician let me try that?” Which of the following responses by the
nurse would be most appropriate?

■ 1. “It’s the physician’s prerogative to decide how to treat you. The physician has chosen what is best
for your situation.”

■ 2. “Tell me more about your friend’s arthritic condition. Maybe I can answer that question for you.”

■ 3. “That drug is used for cases that are worse than yours. It wouldn’t help you, so don’t worry about
it.”

■ 4. “Every person is different. What works for one client may not always be effective for another.”

7. The teaching plan for the client with rheumatoid arthritis includes rest promotion. Which of the
following would the nurse expect to instruct the client to avoid during rest periods?

■ 1. Proper body alignment.

■ 2. Elevating the part.

■ 3. Prone lying positions.

■ 4. Positions of fl exion.

8. After teaching the client with rheumatoid arthritis about measures to conserve energy in activities of
daily living involving the small joints, which of the following, if stated by the client, would indicate the
need for additional teaching?

■ 1. Pushing with palms when rising from a chair.

■ 2. Holding packages close to the body.

■ 3. Sliding objects.

■ 4. Carrying a laundry basket with clinched fi ngers and fi sts

9. After teaching the client with severe rheumatoid arthritis about prescribed methotrexate
(Rheumatrex), which of the following statements indicates the need for further teaching?

■ 1. “I will take my vitamins while I’m on this drug.”

■ 2. “I must not drink any alcohol while I’m taking this drug.”

■ 3. “I should brush my teeth after every meal.”

■ 4. “I will continue taking my birth control pills.”

10. A 25-year-old client taking hydroxychloroquine (Plaquenil) for rheumatoid arthritis reports diffi culty
seeing out of her left eye. Correct interpretation of this assessment fi nding indicates which of the
following?
■ 1. Development of a cataract.

■ 2. Possible retinal degeneration.

■ 3. Part of the disease process.

■ 4. A coincidental occurrence

11. A client with rheumatoid arthritis tells the nurse, “I know it is important to exercise my joints so that I
won’t lose mobility, but my joints are so stiff and painful that exercising is diffi cult.” Which of the
following responses by the nurse would be most appropriate?

■ 1. “You are probably exercising too much. Decrease your exercise to every other day.”

■ 2. “Tell the physician about your symptoms. Maybe your analgesic medication can be increased.”

■ 3. “Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy.”

■ 4. “Take a warm tub bath or shower before exercising. This may help with your discomfort.”

12. Which of the following statements should the nurse include in the teaching session when preparing
a client for arthrocentesis? Select all that apply.

■ 1. “A local anesthetic agent may be injected into the joint site for your comfort.”

■ 2. “A syringe and needle will be used to withdraw fl uid from your joint.”

■ 3. “The procedure, although not painful, will provide immediate relief.”

■ 4. “We’ll want you to keep your joint active after the procedure to increase blood fl ow.”

■ 5. “You will need to wear a compression bandage for several days after the procedure.”

OSTEOARTHRITIS

13. A client with osteoarthritis will undergo an arthrocentesis on his painful edematous knee. What
should be included in the nursing plan of care? Select all that apply.

■ 1. Explain the procedure.

■ 2. Administer preoperative medication 1 hour before surgery.

■ 3. Instruct the client to immobilize the knee for 2 days after the surgery.

■ 4. Assess the site for bleeding.

■ 5. Offer pain medication

14. A postmenopausal client is scheduled for a bone-density scan. To plan for the client’s test, what
should the nurse communicate to the client?

■ 1. Request that the client remove all metal objects on the day of the scan.
■ 2. Instruct the client to consume foods and beverages with a high content of calcium for 2 days
before the test.

■ 3. Inform the client that she will need to ingest 600 mg of calcium gluconate by mouth for 2 weeks
before the test.

■ 4. Tell the client that she should report any signifi cant pain to her physician at least 2 days before the
test

15. A physician orders a lengthy X-ray examination for a client with osteoarthritis. Which of the
following actions by the nurse would demonstrate client advocacy?

■ 1. Contact the X-ray department and ask the technician if the lengthy session can be divided into
shorter sessions.

■ 2. Contact the physician to determine if an alternative examination could be scheduled.

■ 3. Provide a dose of acetaminophen (Tylenol).

■ 4. Cancel the examination because of the hard X-ray table.

16. Which of the following should the nurse assess when completing the history and physical
examination of a client diagnosed with osteoarthritis?

■ 1. Anemia.

■ 2. Osteoporosis.

■ 3. Weight loss.

■ 4. Local joint pain.

17. A client with osteoporosis needs education about diet and ways to increase bone density. Which of
the following should be included in the teaching plan? Select all that apply.

■ 1. Maintain a diet with adequate amounts of vitamin D, as found in fortifi ed milk and cereals.

■ 2. Choose good calcium sources, such as fi gs, broccoli, and almonds.

■ 3. Use alcohol in moderation because a moderate intake has no known negative effects.

■ 4. Try swimming as a good exercise to maintain bone mass.

■ 5. Avoid the use of high-fat foods, such as avocados, salad dressings, and fried foods.

18. Which of the following statements indicates that the client with osteoarthritis understands the
effects of capsaicin (Zostrix) cream?

■ 1. “I always wash my hands right after I apply the cream.”

■ 2. “After I apply the cream, I wrap my knee with an elastic bandage.”

■ 3. “I keep the cream in the cabinet above the stove in the kitchen.”

■ 4. “I also use the same cream when I get a cut or a burn.”

19. At which of the following times should the nurse instruct the client to take ibuprofen (Motrin),
prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?

■ 1. At bedtime.

■ 2. On arising.

■ 3. Immediately after a meal.

■ 4. On an empty stomach.

20. The client diagnosed with osteoarthritis states, “My friend takes steroid pills for her rheumatoid
arthritis. Why don’t I take steroids for my osteoarthritis?” Which of the following is the best explanation?

■ 1. Intra-articular corticosteroid injections are used to treat osteoarthritis.

■ 2. Oral corticosteroids can be used in osteoarthritis.

■ 3. A systemic effect is needed in osteoarthritis.

■ 4. Rheumatoid arthritis and osteoarthritis are two similar diseases.

21. After teaching a group of clients with osteoarthritis about using regular exercise, which of the
following client statements indicates effective teaching?

■ 1. “Performing range-of-motion exercises will increase my joint mobility.”

■ 2. “Exercise helps to drive synovial fl uid through the cartilage.”

■ 3. “Joint swelling should determine when to stop exercising.”

■ 4. “Exercising in the outdoors year-round promotes joint relaxation.”

HIP FRACTURE

22. A client in a double hip spica cast is constipated. The surgeon cuts a window into the cast. Which of
the following outcomes should the nurse anticipate?

■ 1. The window will allow the nurse to palpate the superior mesenteric artery.

■ 2. The window will allow the surgeon to manipulate the fracture site.

■ 3. The window will allow the nurses to reposition the client.

■ 4. The window will provide some relief from pressure due to abdominal distention as a result of
constipation.

23. A client has an intracapsular hip fracture. The nurse should conduct a focused assessment to detect:

■ 1. Internal rotation.

■ 2. Muscle fl accidity.
■ 3. Shortening of the affected leg.

■ 4. Absence of pain in the fracture area

24. The nurse is developing the plan of care for an older adult client with a hip fracture. Which of the
following chronic health problems would the nurse be least likely to assess in the client?

■ 1. Hypertension.

■ 2. Cardiac decompensation.

■ 3. Pulmonary disease.

■ 4. Multiple sclerosis.

25. When teaching a client with an extracapsular hip fracture scheduled for surgical internal fi xation
with the insertion of a pin, the nurse bases the teaching on the understanding that this surgical repair is
the treatment of choice. Which of the following explains the reason?

■ 1. Hemorrhage at the fracture site is prevented.

■ 2. Neurovascular impairment risk is decreased.

■ 3. The risk of infection at the site is lessened.

■ 4. The client is able to be mobilized sooner

26. A client with an extracapsular hip fracture returns to the nursing unit after internal fi xation and pin
insertion with a drainage tube at the incision site. Her husband asks, “Why does she have this tube
inserted in her hip?” Which of the following responses would be best?

■ 1. “The tube helps us to detect a wound infection early on.”

■ 2. “This way we won’t have to irrigate the wound.”

■ 3. “Fluid won’t be allowed to accumulate at the site.”

■ 4. “We have a way to administer antibiotics into the wound.”

27. A client had a posterolateral total hip replacement 2 days ago. What should the nurse include in the
client’s plan of care? Select all that apply.

■ 1. When using a walker, encourage the client to point the toes inward.

■ 2. Position a pillow between the legs to maintain abduction.

■ 3. Allow the client to be in the supine position or in the lateral position on the unoperated side.

■ 4. Do not allow the client to bend down to tie or slip on shoes.

■ 5. Place ice on the incision after physical therapy

28. Which information should the nurse include when performing discharge teaching with a client who
had an anterolateral approach for a total hip replacement? Select all that apply.
■ 1. Avoid turning the toes or knee outward.

■ 2. Use an abduction pillow between the legs when in bed.

■ 3. Use an elevated toilet seat and shower chair.

■ 4. Do not extend the operative leg backwards.

■ 5. Restrict motion for 2 weeks after surgery.

29. The nurse is assessing a client for neurologic impairment after a total hip replacement. Which of the
following would indicate impairment in the affected extremity?

■ 1. Decreased distal pulse.

■ 2. Inability to move.

■ 3. Diminished capillary refi ll.

■ 4. Coolness to the touch.

30. A client with a hip fracture has undergone surgery for insertion of a femoral head prosthesis. Which
of the following activities should the nurse instruct the client to avoid?

■ 1. Crossing the legs while sitting down.

■ 2. Sitting on a raised commode seat.

■ 3. Using an abductor splint while lying on the side.

■ 4. Rising straight from a chair to a standing position

31. The nurse advises the client who has had a femoral head prosthesis placement on the type of chair
to sit in during the fi rst 6 to 8 weeks after surgery. Which would be the correct type to recommend?

■ 1. A desk-type swivel chair.

■ 2. A padded upholstered chair.

■ 3. A high-backed chair with armrests.

■ 4. A recliner with an attached footrest.

32. The nurse is assessing the home environment of an elderly client who is using crutches during the
postoperative recovery phase after hip pinning. Which of the following would pose the greatest hazard
to the client as a risk for falling at home?

■ 1. A 4-year-old cocker spaniel.

■ 2. Scatter rugs.

■ 3. Snack tables.

■ 4. Rocking chairs
JOINT REPLACEMENT SURGERY

33. In preparation for total knee surgery, a 200-lb client with osteoarthritis must lose weight. Which of
the following exercises should the nurse recommend as best if the client has no contraindications?

■ 1. Weight lifting.

■ 2. Walking.

■ 3. Aquatic exercise.

■ 4. Tai chi exercise.

34. Prior to surgery, the nurse is instructing a client who will have a total hip replacement tomorrow.
Which of the following information is most important to include in the teaching plan at this time?

■ 1. Teaching how to prevent hip fl exion.

■ 2. Demonstrating coughing and deep-breathing techniques.

■ 3. Showing the client what an actual hip prosthesis looks like.

■ 4. Assessing the client’s fears about the procedure.

35. The client has just had a total knee replacement for severe osteoarthritis. Which of the following
assessment fi ndings should lead the nurse to suspect possible nerve damage?

■ 1. Numbness.

■ 2. Bleeding.

■ 3. Dislocation.

■ 4. Pinkness.

36. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an
inability to move the extremity. The nurse correctly interprets these fi ndings as indicating which of the
following?

■ 1. A developing infection.

■ 2. Bleeding in the operative site.

■ 3. Joint dislocation.

■ 4. Glue seepage into soft tissue.

37. A client who had a total hip replacement 2 days ago has developed an infection with a fever. The
nursing diagnosis of fl uid volume defi cit related to diaphoresis is made. Which of the following is the
most appropriate outcome?

■ 1. The client drinks 2,000 mL of fl uid per day.

■ 2. The client understands how to manage the incision.

■ 3. The client’s bed linens are changed as needed.

■ 4. The client’s skin remains cool throughout hospitalization.

38. After knee arthroplasty, the client has a sequential compression device (SCD). The nurse should do
which of the following?

■ 1. Elevate the sequential compression device (SCD) on two pillows.

■ 2. Change the settings on the SCD to make the client more comfortable.

■ 3. Stop the SCD to remove dressings and bathe the leg.

■ 4. Discontinue the SCD when the client is ambulatory.

39. The nurse is preparing the discharge of a client who has had a knee replacement with a metal joint.
The nurse should instruct the client about which of the following? Select all that apply.

■ 1. Notify health care providers about the joint prior to invasive procedures.

■ 2. Avoid use of Magnetic Resonance Imaging (MRI) scans.

■ 3. Notify airport security that the joint may set off alarms on metal detectors.

■ 4. Refrain from carrying items weighing more than 5 lb.

■ 5. Limit fl uid intake to 1,000 mL/day.

40. Following a total hip replacement, the nurse should position the client in which of the following
ways?

■ 1. Place weights alongside of the affected extremity to keep the extremity from rotating.

■ 2. Elevate both feet on two pillows.

■ 3. Keep the lower extremities adducted by use of an immobilization binder around both legs.

■ 4. Keep the extremity in slight abduction using an abduction splint or pillows placed between the
thighs

41. Following a total hip replacement, the nurse should do which of the following? Select all that apply.

■ 1. With the aid of a coworker, turn the client from the supine to the prone position every 2 hours.

■ 2. Encourage the client to use the overhead trapeze to assist with position changes.

■ 3. For meals, elevate the head of the bed to 90 degrees.

■ 4. Use a fracture bedpan when needed by the client.

■ 5. When the client is in bed, prevent thromboembolism by encouraging the client to do toe-pointing
exercises.

42. A client is to have a total hip replacement. The preoperative plan should include which of the
following? Select all that apply.
■ 1. Administer antibiotics as prescribed to ensure therapeutic blood levels.

■ 2. Apply leg compression device.

■ 3. Request a trapeze be added to the bed.

■ 4. Teach isometric exercises of quadriceps and gluteal muscles.

■ 5. Demonstrate crutch walking with a 3-point gait.

■ 6. Place Buck’s traction on the bed.

43. The nurse is teaching the client to administer enoxaparin (Lovenox) following a total hip
arthroplasty? The nurse should instruct the client about which of the following? Select all that apply.

■ 1. Report promptly any diffi culty breathing, rash, or itching.

■ 2. Notify the health care provider of unusual bruising.

■ 3. Avoid all aspirin-containing medications.

■ 4. Wear or carry medical identifi cation.

■ 5. Expel the air bubble from the syringe before the injection.

■ 6. Remove needle immediately after medication is injected.

44. A client who had a total hip replacement 4 days ago is worried about dislocation of the prosthesis.
The nurse should respond by saying which of the following?

■ 1. “Don’t worry. Your new hip is very strong.”

■ 2. “Use of a cushioned toilet seat helps to prevent dislocation.”

■ 3. “Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them.”

■ 4. “Decreasing use of the abductor pillow will strengthen the muscles to prevent dislocation.”

45. The nurse is assessing a client who had a left hip replacement 36 hours ago. Which of the following
indicates the prosthesis is dislocated? Select all that apply.

■ 1. The client reported a “popping” sensation in the hip.

■ 2. The left leg is shorter than the right leg.

■ 3. The client has sharp pain in the groin.

■ 4. The client cannot move his right leg.

■ 5. The client cannot wiggle the toes on the left leg.

46. A client who has had a total hip replacement has a dislocated hip prosthesis. The nurse should fi rst?

■ 1. Stabilize the leg with Buck’s traction.

■ 2. Apply an ice pack to the affected hip.

■ 3. Position the client toward the opposite side of the hip.

■ 4. Notify the orthopedic surgeon.

47. The nurse is planning care for a group of clients who have had total hip replacement. Of the clients
listed below, which is at highest risk for infection and should be assessed fi rst?

■ 1. A 55-year-old client who is 6 feet tall and weighs 180 lb.

■ 2. A 90-year-old who lives alone.

■ 3. A 74-year-old who has periodontal disease with periodontitis.

■ 4. A 75-year-old who has asthma and uses an inhaler.

48. The nurse has established a goal with a client to improve mobility following hip replacement. Which
of the following is a realistic outcome at the time of discharge from the surgical unit?

■ 1. The client can walk throughout the entire hospital with a walker.

■ 2. The client can walk the length of a hospital hallway with minimal pain.

■ 3. The client has increased independence in transfers from bed to chair.

■ 4. The client can raise the affected leg 6 inches with assistance.

49. The nurse is assessing a client’s left leg for neurovascular changes following a total left knee
replacement. Which of the following are expected normal fi ndings? Select all that apply.

■ 1. Reduced edema of the left knee.

■ 2. Skin warm to touch.

■ 3. Capillary refi ll response.

■ 4. Moves toes.

■ 5. Pain absent.

■ 6. Pulse on left leg weaker than right leg

50. On the evening of surgery for total knee replacement, a client wants to get out of bed. To safely assist
the client the nurse should do which of the following?

■ 1. Encourage the client to apply full weightbearing.

■ 2. Order a walker for the client.

■ 3. Place a straight-backed chair at the foot of the bed.

■ 4. Apply a knee immobilizer.

51. When preparing a client for discharge from the hospital after a total knee replacement, the nurse
should include which of the following information in the discharge plan? Select all that apply.
■ 1. Report signs of infection to health care provider.

■ 2. Keep the affected leg and foot on the fl oor when sitting in a chair.

■ 3. Remove anti-embolism stockings when sleeping.

■ 4. The physical therapist will encourage progressive ambulation with use of assistive devices.

■ 5. Change the dressing daily.

52. Following a total joint replacement, which of the following complications has the greatest likelihood
of occurring?

■ 1. Deep vein thrombosis (DVT).

■ 2. Polyuria.

■ 3. Intussception of the bowel.

■ 4. Wound evisceration

AMPUTATION DUE TO PERIPHERAL VASCULAR DISEASE

71. Which of the following should the nurse identify as the least likely factor contributing to a client’s
peripheral vascular disease?

■ 1. Uncontrolled diabetes mellitus for 15 years.

■ 2. A 20-pack-year history of cigarette smoking.

■ 3. Current age of 39 years.

■ 4. A serum cholesterol concentration of 275 mg/dL.

72. A client has severe arterial occlusive disease and gangrene of the left great toe. Which of the
following fi ndings is expected?

■ 1. Edema around the ankle.

■ 2. Loss of hair on the lower leg.

■ 3. Thin, soft toenails.

■ 4. Warmth in the foot.

73. A client with absent peripheral pulses and pain at rest is scheduled for an arterial Doppler study of
the affected extremity. When preparing the client for this test, the nurse should:

■ 1. Have the client sign a consent form for the procedure.

■ 2. Administer a pretest sedative as appropriate.

■ 3. Keep the client tobacco-free for 30 minutes before the test.

■ 4. Wrap the client’s affected foot with a blanket.

74. The client with peripheral arterial disease says, “I’ve really tried to manage my condition well.” Which
of the following should the nurse determine as appropriate for this client?

■ 1. Resting with the legs elevated above the level of the heart.

■ 2. Walking slowly but steadily for 30 minutes twice a day.

■ 3. Minimizing activity as much and as often as possible.

■ 4. Wearing antiembolism stockings at all times when out of bed

75. Which of the following should the nurse include in the teaching plan for a client with arterial insuffi
ciency to the feet that is being managed conservatively?

■ 1. Daily lubrication of the feet.

■ 2. Soaking the feet in warm water.

■ 3. Applying antiembolism stockings.

■ 4. Wearing fi rm, supportive leather shoes.

76. A client says, “I hate the idea of being an invalid after they cut off my leg.” Which of the following
would be the nurse’s most therapeutic response?

■ 1. “At least you will still have one good leg to use.”

■ 2. “Tell me more about how you’re feeling.”

■ 3. “Let’s fi nish the preoperative teaching.”

■ 4. “You’re lucky to have a wife to care for you.”

77. The client asks the nurse, “Why can’t the physician tell me exactly how much of my leg he’s going to
take off? Don’t you think I should know that?” On which of the following should the nurse base the
response?

■ 1. The need to remove as much of the leg as possible.

■ 2. The adequacy of the blood supply to the tissues.

■ 3. The ease with which a prosthesis can be fi tted.

■ 4. The client’s ability to walk with a prosthesis.

78. A client who has had an above-the-knee amputation develops a dime-sized bright red spot on the
dressing after 45 minutes in the postanesthesia recovery unit. The nurse should:

■ 1. Elevate the stump.

■ 2. Reinforce the dressing.

■ 3. Call the surgeon.

■ 4. Draw a mark around the site.

79. A client in the postanesthesia care unit with a left below-the-knee amputation has pain in her left big
toe. Which of the following should the nurse do fi rst?

■ 1. Tell the client it is impossible to feel the pain.

■ 2. Show the client that the toes are not there.

■ 3. Explain to the client that her pain is real.

■ 4. Give the client the prescribed opioid analgesic.

80. The client with an above-the-knee amputation is to use crutches while his prosthesis is being
adjusted. In which of the following exercises should the nurse instruct the client to best prepare him for
using crutches?

■ 1. Abdominal exercises.

■ 2. Isometric shoulder exercises.

■ 3. Quadriceps setting exercises.

■ 4. Triceps stretching exercises

81. The nurse teaches a client about using the crutches, instructing the client to support her weight
primarily on which of the following body areas?

■ 1. Axillae.

■ 2. Elbows.

■ 3. Upper arms.

■ 4. Hands.

82. The client is to be discharged on a low-fat, low-cholesterol, low-sodium diet. Which of the following
should be the nurse’s fi rst step in planning the dietary instructions?

■ 1. Determining the client’s knowledge level about cholesterol.

■ 2. Asking the client to name foods that are high in fat, cholesterol, and salt.

■ 3. Explaining the importance of complying with the diet.

■ 4. Assessing the client’s and family’s typical food preferences

FRACTURES

83. A client has a leg immobilized in traction. Which of the following activities demonstrated by the client
indicate that the client understands actions to take to prevent muscle atrophy?

■ 1. The client adducts the affected leg every 2 hours.

■ 2. The client rolls the affected leg away from the body’s midline twice per day.

■ 3. The client performs isometric exercises to the affected extremity three times per day.

■ 4. The client asks the nurse to add a 5-lb weight to the traction for 30 minutes/day.

84. The client with a fractured tibia has been taking methocarbamol (Robaxin). Which of the following
indicate that the drug is having the intended effect?

■ 1. Lack of infection.

■ 2. Reduction in itching.

■ 3. Relief of muscle spasms.

■ 4. Decrease in nervousness.

85. When developing a teaching plan for a client who is prescribed acetaminophen (Tylenol) for muscle
pain, which information should the nurse expect to include? Select all that apply.

■ 1. The drug can be used if the person is allergic to aspirin.

■ 2. Acetaminophen does not affect platelet aggregation.

■ 3. This drug causes little or no gastric distress.

■ 4. Acetaminophen exerts a strong antiinfl ammatory effect.

■ 5. The client should have the International Normalized Ratio (INR) checked regularly.

86. A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a
blood pressure of 80/50 mm Hg, a pulse rate of 115 bpm, and respirations of 8 breaths/minute and
shallow. The nurse interprets these fi ndings as indicating which of the following?

■ 1. Expected common adverse effects.

■ 2. Hypersensitivity reaction.

■ 3. Possible habituating effect.

■ 4. Hemorrhage from gastrointestinal irritation.

87. When admitting a client with a fractured extremity, the nurse should fi rst focus the assessment on
which of the following?

■ 1. The area proximal to the fracture.

■ 2. The actual fracture site.

■ 3. The area distal to the fracture.

■ 4. The opposite extremity for baseline comparison.

88. Which of the following client statements identifi es a knowledge defi cit about cast care?

■ 1. “I’ll elevate the cast above my heart initially.”

■ 2. “I’ll exercise my joints above and below the cast.”

■ 3. “I can pull out cast padding to scratch inside the cast.”

■ 4. “I’ll apply ice for 10 minutes to control edema for the fi rst 24 hours.”

89. Which of the following interventions would be least appropriate for a client who is in a double hip
spica cast?

■ 1. Encouraging the intake of cranberry juice.

■ 2. Advising the client to eat large amounts of cheese.

■ 3. Establishing regular times for elimination.

■ 4. Having the client dangle at the bedside.

90. The nurse prepares a teaching plan for a client about crutch walking using a two-point gait pattern.
Which of the following should the nurse include?

■ 1. Advance a crutch on one side and then advance the opposite foot; repeat on the opposite side.

■ 2. Advance a crutch on one side and simultaneously advance and bear weight on the opposite foot;
repeat on the opposite side.

■ 3. Advance both crutches together and then follow by lifting both lower extremities to the level of the
crutches.

■ 4. Advance both crutches together and then follow by lifting both lower extremities past the level of
the crutches

91. A client returned from surgery with a debrided open tibial fracture and has a three-way drainage
system. The nurse should fi rst:

■ 1. Review the results of culture and sensitivity testing of the wound.

■ 2. Look for the presence of a pressure dressing over the wound.

■ 3. Determine if the client has increased pain from exposed nerve endings.

■ 4. Check the client’s blood pressure for hypotension resulting from additional vessel bleeding.

92. A client has a tibial fracture that required casting. Approximately 5 hours later, the client has
increasing pain distal to the left tibial fracture despite the morphine injection administered 30 minutes
previously. Which of the following should be the nurse’s next assessment?

■ 1. Presence of a distal pulse.

■ 2. Pain with a pain rating scale.

■ 3. Vital sign changes.

■ 4. Potential for drug tolerance.

93. A client with a fracture develops compartment syndrome. Which of the following signs should alert
the nurse to impending organ failure?

■ 1. Crackles.

■ 2. Jaundice.

■ 3. Generalized edema.

■ 4. Dark, scanty urine.

FEMORAL FRACTURE

94. A client with a fractured right femur has not had any immunizations since childhood. Which of the
following biologic products should the nurse administer to provide the client with passive immunity for
tetanus?

■ 1. Tetanus toxoid.

■ 2. Tetanus antigen.

■ 3. Tetanus vaccine.

■ 4. Tetanus antitoxin.

95. After teaching the client with a femoral fracture about the purpose of treatment with skeletal
traction, which of the following, if stated by the client, would indicate the need for additional teaching?

■ 1. To align injured bones.

■ 2. To provide long-term pull.

■ 3. To apply 25 lb of traction.

■ 4. To pull weight with a boot.

96. The nurse is planning care for the client with a femoral fracture who is in balanced suspension
traction. Which of the following would the nurse be least likely to include in the plan of care?

■ 1. Use of a fracture bedpan.

■ 2. Checks for redness over the ischial tuberosity.

■ 3. Elevation of the head of bed no more than 25 degrees.

■ 4. Personal hygiene with a complete bed bath

97. A client is in balanced suspension traction using a half-ring Thomas splint with a Pearson attachment
that suspends the lower extremity and applies direct skeletal traction for a hip fracture. Which of the
following nursing assessments would not be appropriate?
■ 1. Greater trochanter skin checks.

■ 2. Pin site inspection.

■ 3. Neurovascular checks proximal to the splint.

■ 4. Foot movement evaluation.

98. The client in balanced suspension traction is transported to surgery for closed reduction and internal
fi xation of his fractured femur. Which of the following should the nurse do when transporting the client
to the operating room?

■ 1. Transfer the client to a cart with manually suspended traction.

■ 2. Call the surgeon to request an order to temporarily remove the traction.

■ 3. Send the client on his bed with extra help to stabilize the traction.

■ 4. Remove the traction and send the client on a cart.

99. A client has a Pearson attachment on the traction setup. Which of the following is the purpose of
this attachment?

■ 1. To support the lower portion of the leg.

■ 2. To support the thigh and upper leg.

■ 3. To allow attachment of the skeletal pin.

■ 4. To prevent fl exion deformities in the ankle and foot.

100. Which of the following should lead the nurse to suspect that a client with a fracture of the right
femur may be developing a fat embolus?

■ 1. Acute respiratory distress syndrome.

■ 2. Migraine-like headaches.

■ 3. Numbness in the right leg.

■ 4. Muscle spasms in the right thigh.

101. The client with a fractured femur is upset and agitated about her injury and its treatment. She says,
“How can I stay like this for weeks? I can’t even move!” Which of the following is the most appropriate
nursing diagnosis?

■ 1. Impaired physical mobility related to traction.

■ 2. Ineffective coping related to prolonged immobility.

■ 3. Defi cient diversional activity related to prolonged hospitalization.

■ 4. Activity intolerance related to impaired mobility

102. The client asks the nurse what his activity limitations are while he is in Buck’s traction. The nurse
should tell the client:

■ 1. “You can sit up whenever you want.”

■ 2. “You must lie fl at on your back most of the time.”

■ 3. “You can turn your body.”

■ 4. “You must lie on your stomach.”

103. Because a client has a Thomas splint, the nurse should assess the client regularly for which of the
following?

■ 1. Signs of skin pressure in the groin area.

■ 2. Evidence of decreased breath sounds.

■ 3. Skin breakdown behind the heel.

■ 4. Urine retention.

104. The client has a nursing diagnosis of Self-care defi cit related to the confi nement of traction. Which
of the following would indicate a successful outcome for this diagnosis?

■ 1. The client assists as much as possible in his care, demonstrating increased participation over time.

■ 2. The client allows the nurse to complete his care in an effi cient manner without interfering.

■ 3. The client allows his wife to assume total responsibility for his care.

■ 4. The client allows his wife to complete his care to promote feelings of usefulness.

105. 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. Which of the
following refl ects the best interpretation of these fi ndings?

■ 1. Pulmonary emboli.

■ 2. Osteomyelitis.

■ 3. Fat emboli.

■ 4. Urinary tract infection.

106. The nurse is planning care for a client with osteomyelitis. The client is taking an antibiotic, but the
infection has not resolved. The nurse should advise the client to do which of the following?

■ 1. Use herbal supplements.

■ 2. Eat a diet high in protein and vitamins C and D.

■ 3. Ask the health care provider for a change of antibiotics.

■ 4. Encourage frequent passive range-of-motion to the affected extremity.

DAVISS SAGOL TANAN MUSCOLOSKELETAL TOPICS

792. A nurse should teach a client, following a diagnostic arthroscopy, to: SELECT ALL THAT APPLY.

1. elevate the involved extremity for 24 to 48 hours.

2. apply ice continually for 24 hours.

3. report severe joint pain immediately to the physician.

4. resume usual activities to help reduce swelling.

5. treat pain with a mild analgesic such as acetaminophen (Tylenol®).

793. Which treatments should a nurse plan for a client being seen in the clinic for a second-degree
ankle sprain?

1. Rest, elevate the extremity, apply ice, and apply a compression bandage.

2. Perform range of motion to determine the extent of injury, apply heat, check circulation and
sensation, and examine the ankle.

3. Reduce pain with moist heat, then apply ice to reduce swelling; check circulation, motion, and
sensation; and elevate the ankle.

4. Refer the client immediately to an orthopedic surgeon, administer analgesics, control swelling with
ice, and encourage rest and elevation

795. A college student walking with a stiff left leg visits a campus health service reporting knee pain and
a click when walking. He is concerned because sometimes his knee either “locks” or “gives way.” He
thinks he twisted his knee wrong during a tennis match, but is not sure. A nurse suspects the client has:

1. an injury of the meniscus cartilage.

2. a fracture of the lateral tibial condyle.

3. a fractured patella.

4. a lateral collateral ligament injury

796. A client is suspected of having a fat embolism following a pelvic fracture from a motor vehicle
accident. A nurse should assess for which sign that is specific to a fat emboli?

1. Dyspnea

2. Chest pain

3. Delirium

4. Petechiae
797. Which order written by a physician should be a priority for a nurse caring for a client who
sustained an unstable pelvic fracture in a motor vehicle accident?

1. Urinalysis

2. Blood alcohol level

3. Computed tomography (CT) scan of the pelvis

4. Two units of cross-matched whole blood

798. A licensed practical nurse is reporting observations and cares to a registered nurse (RN). Based on
the report, which client should the RN assess immediately?

1. The client, 2 hours following a total knee replacement, who has 100 mL bloody drainage in the suction
container of an autotransfusion drainage system

2. The client with a crush injury to the arm who was given another analgesic and a skeletal muscle
relaxant for throbbing, unrelenting pain

3. The client in a new body cast who was turned every 2 hours and supported with waterproof pillows

4. The client with an external fixator on the left leg, having serous drainage from the pin sites

799. A clinic nurse has completed teaching for a client with a rotator cuff tear who is being treated
conservatively. Which client statement indicates that further teaching is needed?

1. “I received a corticosteroid injection in my shoulder to reduce the inflammation.”

2. “I will be doing progressive stretching and strengthening exercises now that the pain is controlled.”

3. “I should continue taking ibuprofen (Advil®) with food for pain control.”

4. “I will need an open acromioplasty surgery to repair the torn cuff after the swelling is reduced.”

800. Which findings should a nurse expect when assessing a client diagnosed with a left femoral neck
fracture? SELECT ALL THAT APPLY.

1. Left leg is abducted.

2. Left leg is externally rotated.

3. Left leg is shorter than right leg.

4. Pain in the lateral side of the left knee.

5. Pain in the groin area

802. A 28-year-old client and his spouse were involved in a motorcycle accident in which his spouse was
killed. The client, being treated in the progressive care unit for multiple rib fractures and a broken leg,
asks the nurse in which room his wife is located. Which response is most appropriate?

1. “Your wife is not in the hospital.”

2. “I’m sorry, but your wife did not survive the accident.”
3. “I need to get your family so that you can talk to them about your wife.”

4. “The doctor will be talking to you about your wife and where she is located.”

803. An elderly client with Alzheimer’s dementia is being admitted from a postanesthesia unit following
a hip hemiarthroplasty to treat a hip fracture. Which intervention should a nurse initially plan for the
client’s pain control?

1. Apply a fentanyl (Duragesic®) transdermal patch.

2. Initiate morphine sulfate per patient-controlled analgesia (PCA) with a basal rate.

3. Administer intravenous morphine sulfate based on the client’s report of pain.

4. Administer scheduled doses of morphine sulfate intravenously around the clock.

804. A diabetic client is admitted with a tentative diagnosis of osteomyelitis secondary to a wound on
the ankle. The client’s ankle is painful, red, swollen, and warm, and the wound is persistently draining.
The client’s temperature is 102.2°F (39°C). Based on the client’s status, which written physician’s order
should a nurse plan to defer until later?

1. Obtain wound culture.

2. Administer ceftriaxone (Rocephin®) 1 g IV (intravenously) q12 hours.

3. Apply splint to immobilize ankle.

4. Begin teaching on self-administration of home IV antibiotics.

805. A nurse is assessing an elderly client in Buck’s traction to temporally immobilize a fracture of the
proximal femur prior to surgery. Which finding requires the nurse to intervene immediately?

1. Reddened area on the sacrum

2. Voiding concentrated urine, 50 mL/hr

3. Capillary refill 3 seconds, dorsiflexion and sensation intact, pedal pulses palpable

4. Lower leg secure in traction boot and ropes and pulleys and 5 lb weight hanging freely

806. A nurse is providing instructions to a client who has a plaster cast to attain adequate molding
following a fracture to the right wrist. Which statement, if made by the nurse, is incorrect?

1. “Keep your cast uncovered while drying so that moisture can evaporate.”

2. “Your cast will have a musty odor and dull gray appearance until it dries. But once fully dry, your cast
should be odorless and shiny white.”

3. “Your cast will feel sticky and very warm during the drying process, but it will dry very quickly in about
30 minutes.”

4. “Support the cast by elevating it on pillows and avoid any sharp or hard surfaces, especially while your
cast is drying, because it can cause denting and pressure areas.”
808. A male client has been in a body cast for the past 2 days to treat numerous broken vertebrae from a
fall. The client is reporting dyspnea, vomiting, epigastric pain, and abdominal distention. Which action
demonstrates the best clinical judgment by a nurse?

1. Immediately notifies the client’s physician of these findings

2. Initiates oxygen at 2 liters per nasal cannula to relieve the dyspnea

3. Places ice packs around the cast to reduce the abdominal distention

4. Administers ondansetron (Zofran®), the prescribed antiemetic on the client’s MA

809. An experienced nurse observes a new nurse caring for a client in skeletal traction to stabilize a
fracture of the proximal femur prior to surgery. Which observation by the experienced nurse indicates
the new nurse needs additional orientation?

1. Positions the client so the feet stay clear of the bottom of the bed

2. Checks ropes so that they are positioned in the wheel groves of the pulleys

3. Removes weights from the ropes until the weights hang freely off the bed frame

4. Performs pin site care with chlorhexidine solution twice daily

810. A client diagnosed with osteoarthritis, tells a clinic nurse about the inability to ambulate and staying
on bedrest because of hip stiffness. In addition to teaching the client measures to reduce joint stiffness,
which referral for the client should the nurse plan to discuss with the health-care provider?

1. Psychiatrist

2. Social worker

3. Physical therapist

4. Arthritis Foundation

811. A client is admitted for a total hip arthroplasty for chronic degenerative joint disease of the left hip.
A nurse documents during the admission assessment that the client uses alternative therapies for
osteoarthritis treatment. The evidence for this documentation would include the client stating: SELECT
ALL THAT APPLY

1. taking ibuprofen (Advil®) every 4 to 6 hours for pain control.

2. wearing a copper bracelet continuously.

3. taking glucosamine sulfate 1,000 mg daily.

4. applying magnets to the hip joint and securing with an ace wrap.

5. sleeping on the unaffected hip with a pillow between the legs.

812. Which nursing action should be implemented on the second postoperative day for a client who
received a right total hip replacement (THR) with a cemented prosthesis?

1. Assisting the client to the bathroom, which has an elevated toilet seat, using a walker and partial
weight bearing of the right leg

2. Removing the Hodgkin’s splint, which maintained leg alignment during the night, and positioning
pillows to adduct the client’s right leg

3. Reinfusing the returns from a Stryker® wound autotransfusion drainage system, which has collected
400 mL in the past 24 hours

4. Assisting the client to get out of bed on the left side so the client can stand to use the urinal

813. To prevent dislocation of the hip prosthesis following total hip replacement, a nurse should plan to:
SELECT ALL THAT APPLY.

1. place pillows or a wedge pillow between the client’s legs to keep them adducted.

2. use a fracture bedpan and instruct the client to flex the unaffected hip and use the trapeze to lift the
pelvis while the nurse places the pan.

3. prevent hip flexion by not elevating the head of the bed more than 90 degrees.

4. place a pillow between the client’s knees when initially assisting the client out of bed.

5. elevate both of the client’s legs when sitting in the wheelchair to decrease swelling.

814. One month after discharge, a client who had a left total hip replacement calls a clinic reporting
acute constant pain in the left groin and hip area and feeling like the left leg is shorter than the right. A
nurse advises the client to come to the clinic immediately suspecting:

1. wound infection.

2. deep vein thrombosis (DVT).

3. dislocation of the prosthesis.

4. aseptic loosening of the prosthesis.

815. To prevent circulatory complications after a right total knee replacement, a nurse should ensure
that the client is:

1. flexing both feet and exercising uninvolved joints every hour while awake.

2. using the continuous passive motion device (CPM) every 2 hours for 30 minutes.

3. assisted up to a chair as soon as the effects of anesthesia have worn off.

4. using the trapeze to lift the buttocks off the bed and then rotating each leg intermittently.

816. A nurse assesses a client 4 hours after a left total knee replacement. The client has a knee
immobilizer in place with medial and lateral ice packs that have warmed. The surgical extremity’s
neurovascular status is intact and vital signs stable. A Stryker® wound drain, an autotransfusion
drainage system, has 350 mL drainage collected. The client reports pain at a level 3, which is tolerable,
and denies nausea. The client has not voided since before surgery. Which interventions should the
nurse plan to implement at this time? SELECT ALL THAT APPLY.

1. Notify the client’s physician.

2. Reinfuse the salvaged blood loss.

3. Remove the immobilizer and place a pillow behind the client’s knee to create a 90-degree knee
flexion.

4. Stand the client at the bedside to facilitate bladder emptying.

5. Place the affected extremity in a continuous passive motion device (CPM) to begin early motion.

6. Replace the ice packs in the knee immobilizer.

817. Which priority nursing diagnosis should a nurse document in the plan of care for a client following
a C5–C6 anterior cervical discectomy?

1. Potential ineffective breathing pattern

2. Potential impaired tissue perfusion

3. Risk for infection

4. Impaired skin integrity

820. A nurse assesses a client 6 hours postoperatively following a lumbar spinal fusion. The client is
experiencing a headache rated at 8 out of 10 but denies nausea. The neurovascular status of the lower
extremities is intact, and the vital signs are within the normal range. The client log rolls with
assistance. The lungs have fine crackles in the left base. The back dressing has a dime-sized bloody spot
surrounded by a moderate amount of clear yellowish drainage. Which nursing action demonstrates the
nurse’s best clinical judgment?

1. Administering morphine sulfate intravenously

2. Encouraging coughing and deep breathing

3. Reinforcing the incisional dressing

4. Notifying the client’s physician

821.Which action should a nurse plan in the care of the client who had a surgical repair of a right
Dupuytren’s contracture?

1. Elevating the right lower extremity above the level of the heart

2. Assisting the client with bathing, dressing, grooming, and toileting

3. Instructing the client on obtaining proper fitting shoes

4. Frequent rewrapping of the elastic bandage on the right extremity to decrease edema
822. A clinic nurse suspects that a client may have developed osteomyelitis 3 months following a left
shoulder arthroplasty. Which findings on assessment prompted the nurse’s conclusion? SELECT ALL THAT
APPLY.

1. Sudden onset of chills

2. Temperature 103°F (39.4°C)

3. Bradycardia

4. Report by the client of a pulsating pain in the area that intensifies with movement

5. Painful, swollen area on the left shoulder

823. To which client should a nurse plan to provide teaching about genetic resources?

1. Client who had an ankle fracture secondary to a boating accident

2. Client who had a ganglion removed from the dorsum of the wrist

3. Client who had a surgical repair of a fracture due to osteoporosis

4. Client who had a total knee replacement due to degenerative joint disease

824. When analyzing the serum laboratory report for a client diagnosed with lung cancer that has
metastasized to the pelvic bone, which finding should a nurse anticipate?

1. Elevated calcium

2. Decreased hemoglobin

3. Elevated creatinine (Scr)

4. Elevated creatine kinase (CK)

825. A nurse reads the chart of a 25-year-old male and notes that he has been diagnosed with an
osteosarcoma of the distal femur. Which statement indicates the nurse’s correct interpretation of the
client’s diagnosis?

1. The tumor originated elsewhere in the client’s body and metastasized to the bone.

2. Osteosarcoma is the most common and most often fatal primary malignant bone tumor.

3. The only treatment for osteosarcoma is a leg amputation well above the tumor growth.

4. Osteosarcoma is a nonmalignant growth that can be excised and the bone replaced with a bone graft

826. A nurse reports to a physician that a 75-year-old client continues to experience phantom limb pain
following an above-the-knee amputation (AKA) despite nursing interventions of distraction and
administering the prescribed morphine sulfate. Which interventions to minimize the altered sensory
perceptions should the nurse anticipate that the physician might prescribe? SELECT ALL THAT APPLY.

1. Local anesthetic to the residual limb

2. Transcutaneous electrical nerve stimulation (TENS)

3. A beta-blocker medication such as atenolol (Tenormin®)

4. An antiseizure medication such as oxcarbazepine (Trileptal®)

5. Reducing the client’s activity level until the sensations resolve 6. A different analgesic, such as
meperidine hydrochloride (Demerol®)

827. A client, with a lower leg amputation, is experiencing edema, so a nursing assistant (NA) elevates
the client’s residual left limb on pillows. What is the most appropriate action by the nurse when
observing that the client’s leg has been elevated?

1. Thank the NA for being so observant and intervening appropriately.

2. Remove the pillows, raise the foot of the bed, and inform the NA that the limb should not be elevated
on pillows because it could cause a flexion contracture.

3. Inform the NA that this was the correct action at this time in the client’s recovery, but once the client’s
incision heals the leg should not be elevated.

4. Report the incident to the surgeon and tell the NA to complete a variance report because the client’s
leg should not have been elevated

SAUNDERS SAGOL TOPICS

1. A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction
temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis
pulse is absent on the right foot. Which action would the nurse take?

1. Administer an analgesic.
2. Release the skin traction.
3. Apply ice to the extremity.
4. Notify the primary health care provider (PHCP).

2. A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of
care and would include which intervention?

1. Ensure that all ropes are outside the pulleys.

2. Ensure that the weights are resting lightly on the floor.
3. Restrict diversional and play activities until the child is out of traction.
4. Check the primary health care provider’s (PHCP’s) prescriptions for the amount of weight to be
applied.

3. A 4-year-old child sustains a fall at home. After an x-ray examination, the child is determined to have a
fractured arm, and a plaster cast is applied. The nurse provides instructions to the parents regarding care
for the child’s cast. Which statement by the parents indicates a need for further instruction?

1. “The cast may feel warm as the cast dries.”

2. “I can use lotion or powder around the cast edges to relieve itching.”
3. “A small amount of white shoe polish can touch up a soiled white cast.”
 4. “If the cast becomes wet, a blow-dryer set on the cool setting may be used to dry the cast.”

4. The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is
experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform
range of-motion exercises at this time. The nurse would make which response?

1. “Avoid all exercise during painful periods.”

2. “Range-of-motion exercises must be performed every day.”
3. “Have the child perform simple isometric exercises during this time.”
4. “Administer additional pain medication before performing range-of-motion exercises.”

5. A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to
have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of
these findings, the nurse would take which action?

1. Administer an antiemetic.
2. Increase the intravenous fluids.
3. Place the child in a left lateral position.
4. Notify the primary health care provider (PHCP).

6. The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace.
Which statement by the parents indicates a need for further instruction?

1. “I will encourage my child to perform prescribed exercises.”

2. “I will have my child wear soft fabric clothing under the brace.”
3. “I need to apply lotion under the brace to prevent skin breakdown.”
4. “I need to avoid the use of powder because it will cake under the brace.”

7. The nurse is assisting a primary health care provider (PHCP) in the examination of a 3-week-old infant
with developmental dysplasia of the hip. What test or sign would the nurse expect the PHCP to assess?

1. Babinski’s sign
2. The Moro reflex
3. Ortolani’s maneuver
4. The palmar-plantar grasp

8. A 1-month-old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On
assessment, the nurse understands that which finding would be noted in this condition?

1. Limited range of motion in the affected hip

2. An apparent lengthened femur on the affected side
3. Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and
hips flexed
4. Symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended
against the examining table

9. Parents bring their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot made at
birth. Which statement by the parents indicates a need for further teaching regarding this disorder?

1. “Treatment needs to be started as soon as possible.”

 2. “I realize my infant will require follow-up care until fully grown.”
3. “I need to bring my infant back to the clinic in 1 month for a new cast.”
4. “I need to come to the clinic every week with my infant for the casting.”

10. The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast
applied to the left forearm. Which instructions would be included on the list? Select all that apply.

1. Use the fingertips to lift the cast while it is drying.

2. Keep small toys and sharp objects away from the cast.

3. Use a padded ruler or another padded object to scratch the skin under the cast if it itches.

4. Place a heating pad on the lower end of the cast and over the fingers if the fingers feel cold.

5. Elevate the extremity on pillows for the first 24 to 48 hours after casting to prevent swelling.

6. Contact the primary health care provider (PHCP) if the child complains of numbness or tingling in the
extremity

SAUNDERS SAGOL TOPICS

1. The nurse is conducting health screening for osteoporosis. Which client is at greatest risk of
developing this problem?

1. A 25-year-old client who runs

2. A 36-year-old client who has asthma
3. A 70-year-old client who consumes excess alcohol
4. A sedentary 65-year-old client who smokes cigarettes

2. The nurse has given instructions to a client who sustained a ligament injury who is returning home
after knee arthroscopy. Which statement by the client indicates that the instructions are understood?

1. “I can resume regular exercise tomorrow.”

2. “I can’t eat food for the remainder of the day.”
3. “I need to stay off the leg entirely for the rest of the day.”
4. “I need to report a fever, redness around my incisions, or persistent drainage to my health care
provider.”

3. The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up. A leg appears
fractured. Which intervention would the nurse take?

1. Try to reduce the fracture manually.

2. Assist the victim to get up and walk to the sidewalk.
3. Leave the victim for a few moments to call an ambulance.
4. Stay with the victim and encourage the victim to remain still.

4. Which cast care instructions would the nurse provide to a client who just had a plaster cast applied to
the right forearm? Select all that apply.
 1. Keep the cast clean and dry.
2. Allow the cast 24 to 72 hours to dry.
3. Keep the cast and extremity elevated.
4. Expect tingling and numbness in the extremity.
5. Use a hair dryer set on a warm to hot setting to dry the cast.
6. Use a soft, padded object that will t under the cast to scratch the skin under the cast.

5. The nurse is evaluating a client in skeletal traction. When evaluating the pin sites, the nurse would be
most concerned with which finding?

1. Redness around the pin sites

2. Pain on palpation at the pin sites
3. Thick, yellow drainage from the pin sites
4. Clear, watery drainage from the pin sites

6. The nurse is assessing the casted extremity of a client. Which sign is indicative of infection?

1. Dependent edema
2. Diminished distal pulse
3. Presence of a “hot spot” on the cast
4. Coolness and pallor of the extremity

7. A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client
is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an
analgesic, with little relief. Which problem may be causing this pain?

1. Infection under the cast

2. The anxiety of the client
3. Impaired tissue perfusion
4. The recent occurrence of the fracture

8. The nurse is admitting a client with multiple trauma injuries to the nursing unit. The client has a leg
fracture and had a plaster cast applied. Which position would be best for the casted leg?

1. Elevated for 3 hours, then at for 1 hour

2. Flat for 3 hours, then elevated for 1 hour
3. Flat for 12 hours, then elevated for 12 hours
4. Elevated on pillows continuously for 24 to 48 hours

9. A client is being discharged to home after application of a plaster leg cast. Which statement indicates
that the client understands proper care of the cast?

1. “I need to avoid getting the cast wet.”

2. “I need to cover the casted leg with warm blankets.”
3. “I need to use my fingertips to lift and move my leg.”
4. “I need to use something like a padded coat hanger end to scratch under the cast if it itches.”
10. A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the
arm for extra support. The nurse responds, knowing that which would most likely result from this
improper crutch measurement?

1. A fall and further injury

2. Injury to the brachial plexus nerves
3. Skin breakdown in the area of the axilla
4. Impaired range of motion while the client ambulates

11. The nurse has given the client instructions about crutch safety. Which statements indicate that the
client understands the instructions? Select all that apply.

1. “I would not use someone else’s crutches.”

2. “I need to remove any scatter rugs at home.”
3. “I can use crutch tips even when they are wet.”
4. “I need to have spare crutches and tips available.”
5. “When I’m using the crutches, my arms need to be completely straight

12. The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data
would the nurse evaluate as the most favorable indication of resolution of the fat embolus?

1. Clear mentation
2. Minimal dyspnea
3. Oxygen saturation of 85%
4. Arterial oxygen level of 78 mm Hg

13. The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of
compartment syndrome. The nurse determines that the client understands the information if the client
states that they will report which early symptom of compartment syndrome?

1. Cold, bluish-colored fingers

2. Numbness and tingling in the fingers
3. Pain that increases when the arm is dependent
4. Pain that is out of proportion to the severity of the fracture

14. A client with diabetes mellitus has had a right below-knee amputation. Given the client’s history of
diabetes mellitus, which complication is the client at most risk for after surgery?

1. Hemorrhage
2. Edema of the residual limb
3. Slight redness of the incision
4. Separation of the wound edges

15. The nurse is caring for a client who had an above-knee amputation 2 days ago. The residual limb was
wrapped with an elastic compression bandage, which has come off. Which immediate action would the
nurse take?

1. Apply ice to the site.

2. Call the primary health care provider (PHCP).
 3. Rewrap the residual limb with an elastic compression bandage.
4. Apply a dry, sterile dressing, and elevate the residual limb on one pillow.

16. A client is complaining of low back pain that radiates down the left posterior thigh. The nurse would
ask the client if the pain is worsened or aggravated by which factor?

1. Bed rest
2. Ibuprofen
3. Bending or lifting
4. Application of heat

17. The nurse is caring for a client who has had spinal fusion, with insertion of hardware. The nurse
would be most concerned with which assessment finding?

1. Temperature of 101.6° F (38.7° C) orally

2. Complaints of discomfort during repositioning
3. Old bloody drainage outlined on the surgical dressing
4. Discomfort during coughing and deep-breathing exercises

18. The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse
expect to note in the client?

1. Calcium level of 9.0 mg/dL (2.25 mmol/L)

2. Uric acid level of 9.0 mg/dL (540 mcmol/L)
3. Potassium level of 4.1 mEq/L (4.1 mmol/L)
4. Phosphorus level of 3.1 mg/dL (1.0 mmol/L)

19. A client with a hip fracture asks the nurse what is involved with Buck’s (extension) traction, which is
being applied before surgery. The nurse would provide which information to the client?

1. Allows bony healing to begin before surgery and involves pins and screws
2. Provides rigid immobilization of the fracture site and involves pulleys and wheels
3. Lengthens the fractured leg to prevent severing of blood vessels and involves pins and screws
4. Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves
pulleys and wheels