chapter 65

Question 1

The nurse is counselling a client about ways to prevent fractures. Which of the following
information should the nurse include?
a. Tack down throw rugs in the home.
b. Most falls happen outside the home.
c. Buy shoes that provide good support and are comfortable to wear.
d. Range-of-motion exercises should be taught by a physical therapist.

Answer 1

C
Comfortable shoes with good support will help decrease the risk for falls. Throw rugs
should be eliminated, not just tacked down. Activities of daily living provide range of
motion exercise; these do not need to be taught by a physical therapist. Falls inside the
home are responsible for many injuries.

Question 2

The nurse is caring for a client in the emergency department who is employed as a
checkout clerk in a grocery store and has a repetitive strain injury in the left elbow. Which
of the following treatment options should the nurse include in the teaching plan?
a. Surgical options
b. Elbow injections
c. Utilization of a left wrist splint
d. Modifications in arm movement

Answer 2

D
Treatment for a repetitive strain injury includes changing the ergonomics of the activity.
Elbow injections and surgery are not initial options for this type of injury. A wrist splint
might be used for hand or wrist pain.

Question 3

The nurse is providing health-promotion teaching to a client whose job involves many
hours of word processing. Which of the following actions should the nurse include in the
client teaching plan?
a. Do stretching and warm-up exercises before starting work.
b. Wrap the wrists with a compression bandage every morning.
c. Use acetaminophen instead of nonsteroidal anti-inflammatory drugs (NSAIDs) for
wrist pain.
d. Obtain a keyboard pad to support the wrist while word processing.

Answer 3

D

Repetitive strain injuries caused by prolonged times working at a keyboard can be
prevented by the use of a pad that will keep the wrists in a straight position. Stretching
exercises during the day may be helpful, but these would not be needed before starting.
Use of a compression bandage is not needed, although a splint may be used for carpal
tunnel syndrome. NSAIDs are appropriate to use to decrease swelling.

Question 4

The nurse is preparing a client for discharge from the emergency department with a
sprained wrist. Which of the following information should the nurse include?
a. Keep the wrist loosely wrapped with gauze.
b. Apply a heating pad to reduce muscle spasms.
c. Use pillows to elevate the arm above the heart.
d. Gently move the wrist through the range of motion.

Answer 4

C
Elevation of the arm will reduce the amount of swelling and pain. Compression bandages
are used to decrease swelling. For the first 24–48 hours, cold packs are used to reduce
swelling. The wrist should be rested and kept immobile to prevent further swelling or
injury.

Question 5

The nurse is caring for a client who is a baseball pitcher and had an arthroscopic repair of
a rotator cuff injury performed in same-day surgery. Which of the following information
should be included in the client’s postoperative teaching plan?
a. “You have an appointment with a physical therapist for tomorrow.”
b. “You can still play baseball but you will not be able to return to pitching.”
c. “The doctor will use the drop-arm test to determine the success of surgery.”
d. “Leave the shoulder immobilizer on for the first few days to minimize pain.”

Answer 5

A
Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent
“frozen shoulder.” A shoulder immobilizer is used immediately after the surgery, but
leaving the arm immobilized for several days would lead to loss of range of motion
(ROM). The drop-arm test is used to test for rotator cuff injury, but not after surgery. The
client may be able to return to pitching after rehabilitation.

Question 6

The nurse is caring for a client who has a cast in place after fracturing the radius and the
client asks when the cast can be removed. Which of the following information related to
the length of time that the cast will need to remain in place should the nurse tell the client?
a. Several months
b. At least 3 weeks
c. Until swelling of the wrist has resolved
d. Until x-rays show complete bony union

Answer 6

B

Bone healing starts immediately after the injury, but since ossification does not begin until
3 weeks postinjury, the cast will need to be worn for at least 3 weeks. Complete union may
take up to a year. Resolution of swelling does not indicate bone healing.

Question 7

The nurse is caring for a client who has a comminuted fracture of the right femur and has
Buck’s traction in place while waiting for surgery. Which of the following actions should
the nurse implement to assess for pressure areas on the client’s back and sacral area and to
provide skin care?
a. Loosen the traction and have the client turn onto the unaffected side.
b. Place a pillow between the client’s legs and turn gently to each side.
c. Turn the client partially to each side with the assistance of another nurse.
d. Have the client lift the buttocks by bending and pushing with the left leg.

Answer 7

D
The client can lift the buttocks off the bed by using the left leg without changing the
right-leg alignment. Turning the client will tend to move the leg out of alignment.
Disconnecting the traction will interrupt the weight needed to immobilize and align the
fracture.

Question 8

The nurse is caring for a client with a left femur fracture who has a hip spica cast applied.
Which of the following nursing interventions should be included in the plan of care?
a. Avoid placing the client in the prone position.
b. Use the cast support bar to reposition the client.
c. Ask the client about any abdominal discomfort or nausea.
d. Discuss the reasons for remaining on bed rest for several weeks.

Answer 8

C
Assessment of bowel tones, abdominal pain, and nausea and vomiting will detect the
development of cast syndrome. To avoid breakage, the support bar should not be used for
repositioning. After the cast dries, the client can begin ambulating with the assistance of
physical therapy personnel and may be turned to the prone position.

Question 9

The nurse is caring for a client who has a long-arm plaster cast applied for immobilization
of a fractured left radius. Which of the following actions should the nurse implement until
the cast has completely dried?
a. Keep the left arm in a dependent position.
b. Handle the cast with the palms of the hands.
c. Place gauze around the cast edge to pad any roughness.
d. Cover the cast with a small blanket to absorb the dampness.

Answer 9

B

Until a plaster cast has dried, placing pressure on the cast should be avoided to prevent
creating areas inside the cast that could place pressure on the arm. The left arm should be
elevated to prevent swelling. The edges of the cast may be petalled once the cast is dry,
but padding the edges before that may cause the cast to be misshapen. The cast should not
be covered until it is dry because heat builds up during drying.

Question 10

The nurse is providing discharge teaching to a client who has a short-arm plaster cast
applied. Which of the following client statements indicates a good understanding of the
discharge teaching?
a. “I can get the cast wet as long as I dry it right away with a hair dryer.”
b. “I should avoid moving my fingers and elbow until the cast is removed.”
c. “I will apply an ice pack to the cast over the fracture site for the next 24 hours.”
d. “I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast.”

Answer 10

C
Ice application for the first 24 hours after a fracture will help reduce swelling and can be
placed over the cast. Plaster casts should not get wet. The client should be encouraged to
move the joints above and below the cast. Clients should not insert objects inside the cast.

Question 11

The nurse is evaluating the crutch-walking technique of a client who is to have no weight
bearing on the right leg. Which of the following observations indicates that the client can
safely ambulate independently?
a. The client keeps the padded area of the crutch firmly in the axillary area when
ambulating.
b. The client advances the right leg and both crutches together and then advances the
left leg.
c. The client moves the left crutch with the left leg and then the right crutch with the
right leg.
d. The client uses the bedside chair to assist in balance as needed when ambulating in
the room.

Answer 11

B
When using crutches, clients are usually taught to move the assistive device and the
injured leg forward at the same time and then to move the unaffected leg. Clients are
discouraged from using furniture to assist with ambulation. The client is taught to place
weight on the hands, not in the axilla, to avoid nerve damage. If the 2- or 4-point gaits are
to be used, the crutch and leg on opposite sides move forward, not the crutch and
same-side leg.

Question 12

The nurse is caring for a client who has had an open reduction and internal fixation (ORIF)
of left lower leg fractures who indicates constant severe pain in the leg which is unrelieved
by the prescribed morphine. Pulses are faintly palpable and the foot is cool. Which of the
following actions should the nurse take next?
a. Notify the health care provider.
b. Assess the incision for redness.
c. Reposition the left leg on pillows.
d. Check the client’s blood pressure.

Answer 12

A
The client’s clinical manifestations suggest compartment syndrome and delay in diagnosis
and treatment may lead to severe functional impairment. The data do not suggest problems
with blood pressure or infection. Elevation of the leg will decrease arterial flow and
further reduce perfusion.

Question 13

The nurse is caring for a client who is on bed rest after having a complex pelvic fracture.
Which of the following assessment findings is most important to report to the health care
provider?
a. The client states that the pelvis feels unstable.
b. Abdominal distention is present and bowel tones are absent.
c. There are ecchymoses on the abdomen and hips.
d. The client complains of pelvic pain with palpation.

Answer 13

B
The abdominal distention and absent bowel tones may be due to complications of pelvic
fractures such as paralytic ileus or hemorrhage or trauma to the bladder, urethra, or colon.
Pelvic instability, abdominal pain with palpation, and abdominal bruising would be
expected with this type of injury.

Question 14

The nurse is caring for a client with Buck’s traction who had an intracapsular fracture of
the left femur. Which of the following actions should the nurse take in order to evaluate
the effectiveness of Buck’s traction?
a. Assess for hip contractures.
b. Monitor for hip dislocation.
c. Check the peripheral pulses.
d. Ask about left hip pain level.

Answer 14

D
Buck’s traction keeps the leg immobilized and reduces painful muscle spasm. Hip
contractures and dislocation are unlikely to occur in this situation. The peripheral pulses
will be assessed, but this does not help in evaluating the effectiveness of Buck’s traction.

Question 15

The nurse is preparing a client with lower leg fracture and an external fixation device in
place for discharge. Which of the following information should the nurse include in the
discharge teaching?
a. “You will need to assess and clean the pin insertion sites daily.”
b. “The external fixator can be removed during the bath or shower.”
c. “You will need to remain on bed rest until bone healing is complete.”
d. “Prophylactic antibiotics are used until the external fixator is removed.”

Answer 15

A
Pin insertion sites should be cleaned daily to decrease the risk for infection at the site. An
external fixator allows the client to be out of bed and avoid the risks of prolonged
immobility. The device is surgically placed and is not removed until the bone is stable.
Prophylactic antibiotics are not routinely given when an external fixator is used.

Question 16

The nurse is preparing to assist a client who has had an open reduction and internal
fixation (ORIF) of a hip fracture out of bed for the first time. Which of the following
actions should the nurse take first?
a. Use a mechanical lift to transfer the client from the bed to the chair.
b. Check the postoperative orders for the client’s weight-bearing status.
c. Avoid administration of pain medications before getting the client up.
d. Delegate the transfer of the client out of bed to an unregulated care provider
(UCP).

Answer 16

B
The nurse should be familiar with the weight-bearing orders for the client before
attempting the transfer. Mechanical lifts are not typically needed after this surgery. Pain
medications should be given, since the movement is likely to be painful for the client. The
RN should supervise the client during the initial transfer to evaluate how well the client is
able to accomplish this skill.

Question 17

The nurse is planning discharge teaching for a client who has had a repair of a fractured
mandible. Which of the following information should the nurse will include in the
teaching plan?
a. When and how to cut the immobilizing wires
b. Self-administration of nasogastric tube feedings
c. The use of sterile technique for dressing changes
d. The importance of including high-fibre foods in the diet

Answer 17

A
The jaw will be wired for stabilization, and the client should know what emergency
situations require that the wires be cut to protect the airway. There are no dressing changes
for this procedure. The diet is liquid, and clients are not able to chew high fibre foods.
Initially, the client may receive nasogastric tube feedings, but by discharge the client will
swallow liquid through a straw.

Question 18

After the health care provider has recommended an amputation for a client who has
ischemic foot ulcers, the client tells the nurse, “If they want to cut off my foot, they should
just shoot me instead.” Which of the following responses by the nurse is best?
a. “Many people are able to function normally with a foot prosthesis.”
b. “I understand that you are upset, but you may lose the foot anyway.”
c. “Tell me what you know about what your options for treatment are.”
d. “If you do not want the surgery, you do not have to have an amputation.”

Answer 18

C
The initial nursing action should be to assess the client’s knowledge level and feelings
about the options available. Discussion about the client’s option to not have the procedure,
the seriousness of the condition, or rehabilitation after the procedure may be appropriate
after the nurse knows more about the client’s current level of knowledge and emotional
state.

Question 19

The nurse is caring for a client who is 1 day postoperative below-the-knee amputation who
indicates pain in the amputated limb. Which of the following actions is best for the nurse
to take?
a. Explain the reasons for the phantom limb pain.
b. Administer prescribed analgesics to relieve the pain.
c. Loosen the compression bandage to decrease incisional pressure.
d. Remind the client that this phantom pain will diminish over time.

Answer 19

B
Phantom limb pain is treated like any other type of postoperative pain would be treated.
Explanations of the reason for the pain may be given, but the nurse should still medicate
the client. The compression bandage is left in place except during physical therapy or
bathing. Although the pain may decrease over time, it still requires treatment now.

Question 20

The nurse is preparing a client who had an above-the-knee amputation for discharge.
Which of the following client statements indicates that the nurse’s discharge teaching has
been effective?
a. “I should lay on my abdomen for 30 minutes three or four times a day.”
b. “I should elevate my residual limb on a pillow two or three times a day.”
c. “I should change the limb sock when it becomes soiled or stretched out.”
d. “I should use lotion on the stump to prevent drying and cracking of the skin.”

Answer 20

A
The client lies in the prone position several times daily to prevent flexion contractures of
the hip. The limb sock should be changed daily. Lotion should not be used on the stump.
The residual limb should not be elevated because this would encourage flexion
contracture.

Question 21

The nurse is preparing a client for discharge 4 days after insertion of a femoral head
prosthesis using a posterior approach. Which of the following client statements indicates a
need for additional discharge instructions?
a. “I should not cross my legs while sitting.”
b. “I will use a toilet elevator on the toilet seat.”
c. “I will have someone else put on my shoes and socks.”
d. “I can sleep in any position that is comfortable for me.”

Answer 21

D
The client needs to sleep in a position that prevents excessive internal rotation or flexion
of the hip. The other client statements indicate that the client has understood the teaching.

Question 22

Which of the following nursing actions should the nurse include in the plan of care for a
client who has had a total knee arthroplasty?
a. Avoid extension of the knee beyond 120 degrees.
b. Use a compression bandage to keep the knee flexed.
c. Start progressive knee exercises to obtain 90-degree flexion.
d. Teach about the need to avoid weight bearing for 4 weeks.

Answer 22

C
After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree
flexion of the knee. The goal for extension of the knee will be 180 degrees. A compression
bandage is used to hold the knee in an extended position after surgery. Full weight bearing
is expected before discharge.

Question 23

The nurse is caring for a client with ulnar drift caused by rheumatoid arthritis (RA) who is
scheduled for an arthroplasty of the hand. Which of the following client statements
indicates realistic expectation for the surgery?
a. “I will be able to use my fingers to grasp objects better.”
b. “I will not have to do as many hand exercises after the surgery.”
c. “This procedure will prevent further deformity in my hands and fingers.”
d. “My fingers will appear more normal in size and shape after this surgery.”

Answer 23

A
The goal of hand surgery in RA is to restore function, not to correct for cosmetic
deformity or treat the underlying process. Hand exercises will be prescribed after the
surgery.

Question 24

The nurse is providing home care instructions to a client who has multiple forearm
fractures and a long-arm cast on the right arm. Which of the following information should
the nurse include in the teaching plan?
a. Keep the hand immobile to prevent soft tissue swelling.
b. Keep the right shoulder elevated on a pillow or cushion.
c. Avoid the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for the first 48
hours after the injury.
d. Call the health care provider for increased swelling or numbness.

Answer 24

D
Increased swelling or numbness may indicate increased pressure at the injury, and the
health care provider should be notified immediately to avoid damage to nerves and other
tissues. The client should be encouraged to move the joints above and below the cast to
avoid stiffness. There is no need to elevate the shoulder, although the forearm should be
elevated to reduce swelling.
NSAIDs are appropriate to treat pain after a fracture.

Question 25

The nurse is admitting a client who has a proximal humerus fracture that is immobilized
with a left-sided long-arm cast and has a sling. Which of the following nursing
interventions will be included in the plan of care?
a. Use surgical net dressing to hang the arm from an IV pole.
b. Immobilize the fingers on the left hand with gauze dressings.
c. Assess the left axilla and change absorbent dressings as needed.
d. Assist the client in passive range of motion (ROM) for the right arm.

Answer 25

C
The axilla can become excoriated when a sling is used to support the arm, and the nurse
should check the axilla and apply absorbent dressings to prevent this. A client with a sling
would not have traction applied by hanging. The client will be encouraged to move the
fingers on the injured arm to maintain function and to help decrease swelling. The client
will do active ROM on the uninjured side.

Question 26

The nurse is caring for a client who had hip replacement surgery using the posterior
approach. Which of the following client actions requires rapid intervention by the nurse?
a. The client uses crutches with a swing-to gait.
b. The client leans over to pull shoes and socks on.
c. The client sits straight up on the edge of the bed.
d. The client bends over the sink while brushing the teeth.

Answer 26

B
Leaning over would flex the hip at greater than 90 degrees and predispose the client to hip
dislocation. The other client actions are appropriate and do not require any immediate
action by the nurse to protect the client.

Question 27

The nurse is caring for a client who has been hospitalized for 3 days with a hip fracture
who has sudden onset shortness of breath and tachypnea. The client tells the nurse, “I feel
like I am going to die!” Which of the following actions should the nurse take first?
a. Stay with the client and offer reassurance.
b. Administer the prescribed PRN oxygen at 4 L/minute.
c. Check the client’s legs for swelling or tenderness.
d. Notify the health care provider about the symptoms.

Answer 27

B
The client’s clinical manifestations and history are consistent with a fat embolus, and the
nurse’s first action should be to ensure adequate oxygenation. The nurse should offer
reassurance to the client, but meeting the physiological need for oxygen is a higher priority.
The health care provider should be notified after the oxygen is started and pulse oximetry
and assessment for fat embolus or venous thrombo-embolism (VTE) are obtained.

Question 28

The nurse is admitting a client to the emergency department after falling on the right arm
and shoulder. Which of the following findings is most important for the nurse to
communicate to the health care provider immediately?
a. There is bruising at the shoulder area.
b. The right arm appears shorter than the left.
c. There is decreased range of motion of the shoulder.
d. The client is complaining of arm and shoulder pain.

Answer 28

B
A shorter limb after a fall indicates a possible dislocation, which is an orthopedic
emergency. Bruising, pain, and decreased range of motion also should be reported, but
these do not indicate that emergent treatment is needed to preserve function.

Question 29

The nurse is caring for a client who arrives in the emergency department with ankle
swelling and severe pain after twisting the ankle playing soccer. Which of the following
prescribed collaborative interventions will the nurse implement first?
a. Wrap the ankle and apply an ice pack.
b. Administer naproxen 500 mg PO.
c. Give acetaminophen with codeine.
d. Take the client to the radiology department for x-rays.

Answer 29

A
Immediate care after a sprain or strain injury includes the application of cold and
compression to the injury to minimize swelling. The other actions should be taken after the
ankle is wrapped with a compression bandage and ice is applied.

Question 30

The nurse is caring for a client in the emergency department who has a soft tissue injury
and an open leg fracture. Which of the following actions should the nurse implement first?
a. If dislocation, apply compression bandage.
b. Realignment of the bone(s)
c. Administer tetanus with an open fracture.
d. Apply heat to the affected area.

Answer 30

C
An initial action in the emergency treatment of soft tissue injuries is to administer tetanus
if there is evidence of an open fracture. If dislocation is suspected a compression bandage
is contraindicated. The nurse would apply ice, not heat, to the affected area. Realignment
of the bone is not to be attempted.

Question 31

The nurse is caring for a client in the emergency department who is experiencing severe
pain and is diagnosed with a patellar dislocation. Which of the following actions should
the nurse implement first?
a. Applying a knee immobilizer
b. Implementing passive knee flexion
c. Limiting activity restrictions
d. Preparing the client for conscious sedation

Answer 31

D
The first goal of collaborative management is realignment of the knee to its original
anatomic position, which will require anesthesia or conscious sedation. Immobilization,
gentle range-of-motion (ROM) exercises, and discussion about activity restrictions will be
implemented after the knee is realigned.

Question 32

The nurse is caring for a client in the emergency department following a motor vehicle
accident who has massive right lower leg swelling. Which of the following actions will the
nurse take first?
a. Elevate the leg on pillows.
b. Apply a compression bandage.
c. Check leg pulses and sensation.
d. Place ice packs on the lower leg.

Answer 32

C
The initial action by the nurse will be to assess the circulation to the leg and to observe for
any evidence of injury such as fractures or dislocations. After the initial assessment, the
other actions may be appropriate based on what is observed during the assessment.

Question 33

The nurse is caring for a client in the emergency department who has possible left lower
leg fractures. Which of the following actions should the nurse implement initially?
a. Elevate the left leg.

b. Splint the lower leg.
c. Obtain information about the tetanus immunization status.
d. Check the popliteal, dorsalis pedis, and posterior tibial pulses.

Answer 33

D
The initial nursing action should be assessment of the neuro-vascular status of the injured
leg. After assessment, the nurse may need to splint and elevate the leg, based on the
assessment data. Information about tetanus immunizations should be done if there is an
open wound.

Question 34

The nurse is developing a care plan for a client with an open reduction and internal
fixation (ORIF) of an open, displaced fracture of the tibia. Which of the following nursing
diagnoses is priority?
a. Activity intolerance related to physical deconditioning
b. Risk for constipation as evidenced by electrolyte imbalance
c. Risk for impaired skin integrity as evidenced by pressure over bony prominence
d. Risk for infection as evidenced by invasive procedure

Answer 34

D
A client having an ORIF is at risk for problems such as wound infection and osteomyelitis.
After an ORIF, clients typically are mobilized starting the first postoperative day, so
problems caused by immobility are not as likely.

Question 35

The nurse is caring for a client with a fractured pelvis and on day 2 of the hospitalization
the client develops acute onset confusion. Which of the following actions should the nurse
take first?
a. Take the blood pressure.
b. Assess client orientation.
c. Check pupil reaction to light.
d. Assess the oxygen saturation.

Answer 35

D
The client’s history and clinical manifestations suggest a fat embolus. The most important
assessment is oxygenation. The other actions also are appropriate but will be done after the
nurse assesses gas exchange.

Question 36

Which of the following information obtained by the emergency department nurse when
admitting a client with a left femur fracture is most important to report to the health care
provider?
a. Bruising of the left thigh
b. Complaints of left thigh pain
c. Outward pointing toes on the left foot
d. Prolonged capillary refill of the left foot

Answer 36

D
Prolonged capillary refill may indicate complications such as arterial damage or
compartment syndrome. The other findings are typical with a left femur fracture.

Question 37

The nurse is caring for a client who has just arrived on the orthopedic unit after a right
above-the-knee amputation with an immediate prosthetic fitting. Which of the following
actions should the nurse implement first?
a. Place the client in a prone position.
b. Check the surgical site for hemorrhage.
c. Remove the prosthesis and wrap the site.
d. Keep the residual leg elevated on a pillow.

Answer 37

B
The nurse should monitor for hemorrhage after the surgery. The prosthesis will not be
removed. To avoid flexion contracture of the hip, the leg will not be elevated on a pillow.
The client is placed in a prone position after amputation to prevent hip flexion, but this
would not be done during the immediate postoperative period.

Question 38

Before assisting a client with ambulation on the day after a total hip replacement, which of
the following actions is most important for the nurse to implement?
a. Administer the ordered oral opioid pain medication.
b. Instruct the client about the benefits of ambulation.
c. Ensure that the incisional drain has been discontinued.
d. Change the hip dressing and document the wound appearance.

Answer 38

A
The client should be adequately medicated for pain before any attempt to ambulate.
Instructions about the benefits of ambulation may increase the client’s willingness to
ambulate, but decreasing pain with ambulation is more important. The presence of an
incisional drain or timing of dressing change will not affect ambulation.