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 c. Weight
loss
b. Osteoporosis 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 c.
Immediately after meal
b. On arising 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
c. Shortening of the
affected leg
b. Muscle flaccidity
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 c.
Generalized edema
b. Jaundice 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 a vascular 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
c. Tenderness
b. Pain
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
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