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 c. Sim's
b. Prone 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
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
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
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 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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