1.

FIGURE 1 REPRESENTS WHAT TYPE OF BONE FRACTURE:

THIS IS A FRACTURE THAT IS SLANTED ACROSS THE BONE A. “IT IS REALLY ITCHY INSIDE MY CAST!”
SHAFT.
B. “MY PAIN IS SO SEVERE THAT IT HURTS TO STRETCH OR
A. TRANSVERSE FRACTURE ELEVATE MY ARM.”

B. SPIRAL FRACTURE C. “I CAN FEEL MY FINGERS AND MOVE THEM.”

C. OBLIQUE FRACTURE D. “I’VE BEEN USING ICE PACKS TO REDUCE SWELLING.””

D. COMPOUND FRACTURE THE ANSWER IS B. THIS STATEMENT IS VERY CONCERNING

AND MAY REPRESENT A CONDITION CALLED COMPARTMENT
THE ANSWER IS C. THIS IS KNOWN AS AN OBLIQUE SYNDROME. COMPARTMENT SYNDROME IS WHERE THE
FRACTURE. NERVES AND BLOOD VESSELS ARE BECOMING COMPROMISED
DUE TO INCREASING PRESSURE IN THE COMPARTMENTS
2. FIGURE 2 REPRESENTS WHAT TYPE OF BONE FRACTURE: WITHIN THE FASCIA (REMEMBER FASCIA DOESN’T EXPAND, SO
THE FRACTURED BONE IS BROKEN INTO MANY FRAGMENTS (3 IF THERE IS BUILDING PRESSURE WITHIN THE
OR MORE). COMPARTMENTS OF MUSCLE FROM BLEEDING ETC. IT WILL
COMPROMISE CIRCULATION AND NERVE FUNCTION).
A. OPEN FRACTURE REMEMBER TO MONITOR THE 6 P’S. (PAIN, PALLOR,
PARALYSIS, PARESTHESIA, PULSELESSNESS (LATE SIGN),
B. GREENSTICK FRACTURE POIKILOTHERMIA)

C. OBLIQUE FRACTURE 7. WHAT IS A LATE SIGN OF COMPARTMENT SYNDROME?

D. COMMINUTED FRACTURE A. PARALYSIS

THE ANSWER IS D. THIS IS KNOWN AS A COMMINUTED B. PAIN

FRACTURE
C. PARETHESIA
3. FIGURE 3 REPRESENTS WHAT TYPE OF BONE FRACTURE:
THIS A FRACTURED BONE THAT BREAKS THROUGH THE SKIN. D. PULSELESSNESS

A. CLOSED FRACTURE THE ANSWER IS D. PULSELESSNESS IS A LATE SIGN OF

COMPARTMENT SYNDROME.
B. COMPOUND FRACTURE
8. SELECT ALL THE SIGNS AND SYMPTOMS THAT WILL
C. GREENSTICK FRACTURE PRESENT IN COMPARTMENT SYNDROME?

D. TRANSVERSE FRACTURE A. CAPILLARY REFILL LESS THAN 2 SECONDS

THE ANSWER IS B. THIS IS KNOWN AS A COMPOUND B. PALLOR

FRACTURE (ALSO CALLED AN OPEN FRACTURE).
C. PAIN RELIEF WITH MEDICATION
4. YOU’RE CARING FOR A PATIENT WHO HAS EXPERIENCED A
FRACTURE TO THE RIGHT ARM THAT IS REPRESENTED IN D. FEELING OF TINGLING IN THE EXTREMITY
FIGURE 3. WHAT NURSING INTERVENTION WILL YOU TAKE
WITH THIS TYPE OF FRACTURE? E. AFFECTED EXTREMITY FEELS COOLER TO THE TOUCH THAN
THE UNAFFECTED EXTREMITY
A. COVER THE FRACTURE WITH A STERILE DRESSING
THE ANSWERS ARE B, D, AND E. THESE SYMPTOMS MAY
B. PLACE THE ARM BELOW THE HEART LEVEL. PRESENT WITH COMPARTMENT SYNDROME. OPTION A AND C
ARE NORMAL FINDINGS. REMEMBER IN COMPARTMENT
C. ATTEMPT BONE REDUCTION BY MANUALLY READJUSTING SYNDROME NERVE AND BLOOD VESSEL FUNCTION IS BEING
THE BONE. COMPROMISED, SO EXPECT SIGNS AND SYMPTOMS THAT
OCCUR WHEN THESE STRUCTURES ARE AFFECTED.
D. PLACE A TIGHT COMPRESSION BANDAGE OVER THE
FRACTURE. 9. YOUR PATIENT IS 2 HOURS POST-OP FROM A CAST
PLACEMENT ON THE RIGHT LEG. THE PATIENT HAS FAMILY IN
THE ANSWER IS A. FIGURE 3 REPRESENTS A COMPOUND THE ROOM. WHICH ACTION BY THE SIGNIFICANT OTHER
FRACTURE (ALSO CALLED AN OPEN FRACTURE). DUE TO THE REQUIRES YOU TO RE-EDUCATE THE PATIENT AND FAMILY
NATURE OF THIS FRACTURE, THE PATIENT IS AT MAJOR RISK ABOUT CAST CARE?
FOR INFECTION BECAUSE THE SKIN IS NO LONGER INTACT.
THEREFORE, THE NURSE SHOULD COVER THE FRACTURE SITE A. GENTLY MOVING THE CAST WITH THE FINGERTIPS OF THE
WITH A STERILE DRESSING. NEVER ATTEMPT A BONE HANDS EVERY 2 HOURS TO HELP WITH DRYING.
REDUCTION. IN ADDITION, AVOID A TIGHT COMPRESSION
BANDAGE DUE TO THE DEVELOPMENT OF ISCHEMIA. INSTEAD, B. POSITIONING THE CAST AT HEART LEVEL WITH PILLOWS.
YOU WOULD WANT TO IMMOBILIZE THE EXTREMITIES AND
SPLINT IT. C. CHECKING THE COLOR AND TEMPERATURE OF THE RIGHT
FOOT.
5. A 85 YEAR OLD PATIENT HAS AN ACCIDENTAL FALL WHILE
GOING TO THE BATHROOM WITHOUT ASSISTANCE. IT D. USING A HAIR DRYER ON THE COOL SETTING TO HELP
APPEARS THE PATIENT HAS SUSTAINED A BONE FRACTURE TO WITH DRYING.
THE LEFT LEG. THE LEG’S SHAPE IS DEFORMED AND THE
PATIENT IS UNABLE TO MOVE IT. THE PATIENT IS ALERT AND THE ANSWER IS A. THE CAST SHOULD ALWAYS BE MOVED
ORIENTED BUT IN PAIN. WHAT WILL YOU DO FIRST AFTER WITH THE PALMS OF THE HANDS (NOT FINGER TIPS) DURING
CONFIRMING THE PATIENT IS SAFE AND STABLE? THE DRYING PERIOD TO PREVENT DENT FORMATION BECAUSE
THIS CAN CAUSE THE DEVELOPMENT OF ULCERS UNDER THE
A. APPLY AN ICE PACK COVERED WITH A TOWEL TO THE SITE. SKIN WHERE THE DENTS DEVELOP.

B. IMMOBILIZE THE FRACTURE WITH A SPLINT. 10. A PATIENT SUSTAINED A FRACTURE TO THE FEMUR. THE
PATIENT HAS SUDDENLY BECOME CONFUSED, RESTLESS, AND
C. ADMINISTER PAIN MEDICATION. HAS A RESPIRATORY RATE OF 30 BREATHS PER MINUTE.
BASED ON THE LOCATION OF FRACTURE AND THE
D. ELEVATE THE EXTREMITY ABOVE HEART LEVEL. PRESENTING SYMPTOMS, THIS PATIENT MAY BE
EXPERIENCING WHAT TYPE OF COMPLICATION?
THE ANSWER IS B. AFTER CONFIRMING THE PATIENT IS SAFE
AND STABLE, THE NURSE WOULD IMMOBILIZE THE FRACTURE A. COMPARTMENT SYNDROME
WITH A SPLINTING DEVICE. THIS WILL PREVENT THE
ACCIDENTAL MOVEMENT OF THE EXTREMITY BY THE PATIENT. B. OSTEOMYELITIS
IMMOBILIZATION IS IMPORTANT BECAUSE IT PREVENTS
FURTHER PAIN OR BLEEDING ALONG WITH MORE DAMAGE C. FAT EMBOLISM
THAT CAN OCCUR TO THE SURROUNDING TISSUES. IN
ADDITION, IF A BONE IS NOT IMMOBILIZED BUT MOVED AFTER D. HYPOVOLEMIA
IT HAS BEEN FRACTURED THIS CAN AFFECT THE HEALING
PROCESS. THE ANSWER IS C. PATIENTS WHO EXPERIENCE A FRACTURE
OF THE LONG BONES (SUCH AS THE FEMUR) ARE AT RISK FOR
6. WHICH STATEMENT BY A PATIENT, WHO JUST RECEIVED A A FAT EMBOLISM. THE PATIENT WILL BECOME CONFUSED AND
CAST ON THE RIGHT ARM FOR A FRACTURE, REQUIRES YOU RESTLESS ALONG WITH AN ABNORMAL RESPIRATORY STATUS.
TO NOTIFY THE PHYSICIAN IMMEDIATELY?
11. WHICH ASSESSMENT FINDING FOUND WHILE ASSESSING A A NURSE IS CARING FOR A PATIENT WHO IS IN SKELETAL
PATIENT WITH A FRACTURE WHO HAS TRACTION REQUIRES TRACTION. TO PREVENT THE COMPLICATION OF SKIN
IMMEDIATE INTERVENTION? BREAKDOWN IN A PATIENT WITH SKELETAL TRACTION, WHAT
ACTION SHOULD BE INCLUDED IN THE PLAN OF CARE?
A. THE WEIGHTS ARE FREELY HANGING ON THE FLOOR. A) APPLY OCCLUSIVE DRESSINGS TO THE PIN SITES.
B) ENCOURAGE THE PATIENT TO PUSH UP WITH THE ELBOWS
B. PIN SITES ARE FREE FROM DRAINAGE. WHEN REPOSITIONING.
C) ENCOURAGE THE PATIENT TO PERFORM ISOMETRIC
C. PATIENT USES THE OVERHEAD TRAPEZE BAR TO MOVE EXERCISES ONCE A SHIFT.
AROUND IN THE BED. D) ASSESS THE PIN INSERTION SITE EVERY 8 HOURS.
D) ASSESS THE PIN INSERTION SITE EVERY 8 HOURS.
D. PATIENT’S EXTREMITIES HAVE A CAPILLARY REFILL OF LESS
THAN 2 SECONDS. THE PIN INSERTION SITE SHOULD BE ASSESSED EVERY 8
HOURS FOR INFLAMMATION AND INFECTION. LOOSE COVER
THE ANSWER IS A. WEIGHTS USED FOR TRACTION SHOULD DRESSINGS SHOULD BE APPLIED TO PIN SITES. THE PATIENT
FREELY HANG BUT NOT ON THE FLOOR. ALL THE OTHER SHOULD BE ENCOURAGED TO USE THE OVERHEAD TRAPEZE
OPTIONS ARE EXPECTED FINDINGS. TO SHIFT WEIGHT FOR REPOSITIONING. ISOMETRIC
EXERCISES SHOULD BE DONE 10 TIMES AN HOUR WHILE
12. A 5 YEAR OLD HAS A FRACTURE OF THE RIGHT UPPER AWAKE.
ARM. THE X-RAY SHOWED THAT ONE SIDE OF THE BONE IS
BENT WHILE THE OTHER IS BROKEN. THIS KNOWN AS A
__________ FRACTURE? A NURSE IS CARING FOR A PATIENT WHO IS POSTOPERATIVE
DAY 1 RIGHT HIP REPLACEMENT. HOW SHOULD THE NURSE
A. SPIRAL POSITION THE PATIENT?
A) KEEP THE PATIENTS HIPS IN ABDUCTION AT ALL TIMES.
B. GREENSTICK B) KEEP HIPS FLEXED AT NO LESS THAN 90 DEGREES.
C) ELEVATE THE HEAD OF THE BED TO HIGH FOWLERS.
C. OBLIQUE D) SEAT THE PATIENT IN A LOW CHAIR AS SOON AS POSSIBLE.
A) KEEP THE PATIENTS HIPS IN ABDUCTION AT ALL TIMES.
D. TRANSVERSE
THE HIPS SHOULD BE KEPT IN ABDUCTION BY AN ABDUCTOR
THE ANSWER IS B. THIS IS A GREENSTICK FRACTURE. THESE PILLOW. HIPS SHOULD NOT BE FLEXED MORE THAN 90
TYPES OF FRACTURES ARE MORE COMMON IN THE PEDIATRIC DEGREES, AND THE HEAD OF BED SHOULD NOT BE ELEVATED
POPULATION BECAUSE THEIR BONES TEND TO BE MORE MORE THAN 60 DEGREES. THE PATIENTS HIPS SHOULD BE
FLEXIBLE AND THE PERIOSTEUM IS STRONGER THAN AN HIGHER THAN THE KNEES; AS SUCH, HIGH SEAT CHAIRS
ADULT. SHOULD BE USED.

A NURSE IS CARING FOR A PATIENT WHO HAS HAD A PLASTER

ARM CAST APPLIED. IMMEDIATELY POSTAPPLICATION, THE WHILE ASSESSING A PATIENT WHO HAS HAD KNEE
NURSE SHOULD PROVIDE WHAT TEACHING TO THE PATIENT? REPLACEMENT SURGERY, THE NURSE NOTES THAT THE
A) THE CAST WILL FEEL COOL TO TOUCH FOR THE FIRST 30 PATIENT HAS DEVELOPED A HEMATOMA AT THE SURGICAL
MINUTES. SITE. THE AFFECTED LEG HAS A DECREASED PEDAL PULSE.
B) THE CAST SHOULD BE WRAPPED SNUGGLY WITH A TOWEL WHAT WOULD BE THE PRIORITY NURSING DIAGNOSIS FOR
UNTIL THE PATIENT GETS HOME. THIS PATIENT?
C) THE CAST SHOULD BE SUPPORTED ON A BOARD WHILE A) RISK FOR INFECTION
DRYING. B) RISK FOR PERIPHERAL NEUROVASCULAR DYSFUNCTION
D) THE CAST WILL ONLY HAVE FULL STRENGTH WHEN DRY. C) UNILATERAL NEGLECT
D) THE CAST WILL ONLY HAVE FULL STRENGTH WHEN DRY. D) DISTURBED KINESTHETIC SENSORY PERCEPTION
B) RISK FOR PERIPHERAL NEUROVASCULAR DYSFUNCTION
A CAST REQUIRES APPROXIMATELY 24 TO 72 HOURS TO DRY,
AND UNTIL DRY, IT DOES NOT HAVE FULL STRENGTH. WHILE THE HEMATOMA MAY CAUSE AN INTERRUPTION OF TISSUE
DRYING, THE CAST SHOULD NOT BE PLACED ON A HARD PERFUSION, SO THE MOST APPROPRIATE NURSING DIAGNOSIS
SURFACE. THE CAST WILL EXUDE HEAT WHILE IT DRIES AND IS RISK OF PERIPHERAL NEUROVASCULAR DYSFUNCTION.
SHOULD NOT BE WRAPPED. THERE IS ALSO AN ASSOCIATED RISK FOR INFECTION
BECAUSE OF THE HEMATOMA, BUT IMPAIRED
NEUROVASCULAR FUNCTION IS A MORE ACUTE THREAT.
A PATIENT BROKE HIS ARM IN A SPORTS ACCIDENT AND UNILATERAL NEGLECT AND IMPAIRED SENSATION ARE LOWER
REQUIRED THE APPLICATION OF A CAST. SHORTLY PRIORITIES THAN NEUROVASCULAR STATUS.
FOLLOWING APPLICATION, THE PATIENT COMPLAINED OF AN
INABILITY TO STRAIGHTEN HIS FINGERS AND WAS
SUBSEQUENTLY DIAGNOSED WITH VOLKMANN A PATIENT WAS BROUGHT TO THE EMERGENCY DEPARTMENT
CONTRACTURE. WHAT PATHOPHYSIOLOGIC PROCESS CAUSED AFTER A FALL. THE PATIENT IS TAKEN TO THE OPERATING
THIS COMPLICATION? ROOM TO RECEIVE A RIGHT HIP PROSTHESIS. IN THE
A) OBSTRUCTED ARTERIAL BLOOD FLOW TO THE FOREARM IMMEDIATE POSTOPERATIVE PERIOD, WHAT HEALTH
AND HAND EDUCATION SHOULD THE NURSE EMPHASIZE?
B) SIMULTANEOUS PRESSURE ON THE ULNAR AND RADIAL A) MAKE SURE YOU DONT BRING YOUR KNEES CLOSE
NERVES TOGETHER.
C) IRRITATION OF MERKEL CELLS IN THE PATIENTS SKIN B) TRY TO LIE AS STILL AS POSSIBLE FOR THE FIRST FEW
SURFACES DAYS.
D) UNCONTROLLED MUSCLE SPASMS IN THE PATIENTS C) TRY TO AVOID BENDING YOUR KNEES UNTIL NEXT WEEK.
FOREARM D) KEEP YOUR LEGS HIGHER THAN YOUR CHEST WHENEVER
A) OBSTRUCTED ARTERIAL BLOOD FLOW TO THE FOREARM YOU CAN.
AND HAND A) MAKE SURE YOU DONT BRING YOUR KNEES CLOSE
TOGETHER.
VOLKMANN CONTRACTURE OCCURS WHEN ARTERIAL BLOOD
FLOW IS RESTRICTED TO THE FOREARM AND HAND AND AFTER RECEIVING A HIP PROSTHESIS, THE AFFECTED LEG
RESULTS IN CONTRACTURES OF THE FINGERS AND WRIST. IT SHOULD BE KEPT ABDUCTED. MOBILITY SHOULD BE
DOES NOT RESULT FROM NERVE PRESSURE, SKIN IRRITATION, ENCOURAGED WITHIN SAFE LIMITS. THERE IS NO NEED TO
OR SPASMS. AVOID KNEE FLEXION AND THE PATIENTS LEGS DO NOT NEED
TO BE HIGHER THAN THE LEVEL OF THE CHEST.

A PATIENT IS ADMITTED TO THE UNIT IN TRACTION FOR A

FRACTURED PROXIMAL FEMUR AND REQUIRES TRACTION A PATIENT WITH A FRACTURED FEMUR IS IN BALANCED
PRIOR TO SURGERY. WHAT IS THE MOST APPROPRIATE TYPE SUSPENSION TRACTION. THE PATIENT NEEDS TO BE
OF TRACTION TO APPLY TO A FRACTURED PROXIMAL FEMUR? REPOSITIONED TOWARD THE HEAD OF THE BED. DURING
A) RUSSELLS TRACTION REPOSITIONING, WHAT SHOULD THE NURSE DO?
B) DUNLOPS TRACTION A) PLACE SLIGHT ADDITIONAL TENSION ON THE TRACTION
C) BUCKS EXTENSION TRACTION CORDS.
D) CERVICAL HEAD HALTER B) RELEASE THE WEIGHTS AND REPLACE THEM IMMEDIATELY
C) BUCKS EXTENSION TRACTION AFTER POSITIONING.
C) REPOSITION THE BED INSTEAD OF REPOSITIONING THE
BUCKS EXTENSION IS USED FOR FRACTURES OF THE PATIENT.
PROXIMAL FEMUR. RUSSELLS TRACTION IS USED FOR LOWER D) MAINTAIN CONSISTENT TRACTION TENSION WHILE
LEG FRACTURES. DUNLOPS TRACTION IS APPLIED TO THE REPOSITIONING.
UPPER EXTREMITY FOR SUPRACONDYLAR FRACTURES OF THE D) MAINTAIN CONSISTENT TRACTION TENSION WHILE
ELBOW AND HUMERUS. CERVICAL HEAD HALTERS ARE USED REPOSITIONING.
TO STABILIZE THE NECK.
TRACTION IS USED TO REDUCE THE FRACTURE AND MUST BE
MAINTAINED AT ALL TIMES, INCLUDING DURING
REPOSITIONING. IT WOULD BE INAPPROPRIATE TO ADD
TENSION OR RELEASE THE WEIGHTS. MOVING THE BED A) KNOTS IN THE ROPE SHOULD NOT BE RESTING AGAINST
INSTEAD OF THE PATIENT IS NOT FEASIBLE. PULLEYS.
B) WEIGHTS SHOULD REST AGAINST THE BED RAILS.
C) THE END OF THE LIMB IN TRACTION SHOULD BE BRACED
A PATIENT WITH A TOTAL HIP REPLACEMENT IS PROGRESSING BY THE FOOTBOARD OF THE BED.
WELL AND EXPECTS TO BE DISCHARGED TOMORROW. ON D) SKELETAL TRACTION MAY BE REMOVED FOR BRIEF
RETURNING TO BED AFTER AMBULATING, HE COMPLAINS OF A PERIODS TO FACILITATE THE PATIENTS INDEPENDENCE.
NEW ONSET OF PAIN AT THE SURGICAL SITE. WHAT IS THE A) KNOTS IN THE ROPE SHOULD NOT BE RESTING AGAINST
NURSES BEST ACTION? PULLEYS.
A) ADMINISTER PAIN MEDICATION AS ORDERED.
B) ASSESS THE SURGICAL SITE AND THE AFFECTED KNOTS IN THE ROPE SHOULD NOT REST AGAINST PULLEYS,
EXTREMITY. BECAUSE THIS INTERFERES WITH TRACTION. WEIGHTS ARE
C) REASSURE THE PATIENT THAT PAIN IS A DIRECT RESULT OF USED TO APPLY THE VECTOR OF FORCE NECESSARY TO
INCREASED ACTIVITY. ACHIEVE EFFECTIVE TRACTION AND SHOULD HANG FREELY AT
D) ASSESS THE PATIENT FOR SIGNS AND SYMPTOMS OF ALL TIMES. TO AVOID INTERRUPTING TRACTION, THE LIMB IN
SYSTEMIC INFECTION. TRACTION SHOULD NOT REST AGAINST ANYTHING. SKELETAL
B) ASSESS THE SURGICAL SITE AND THE AFFECTED TRACTION IS NEVER INTERRUPTED.
EXTREMITY.

WORSENING PAIN AFTER A TOTAL HIP REPLACEMENT MAY THE ORTHOPEDIC SURGEON HAS PRESCRIBED BALANCED
INDICATE DISLOCATION OF THE PROSTHESIS. ASSESSMENT SKELETAL TRACTION FOR A PATIENT. WHAT ADVANTAGE IS
OF PAIN SHOULD INCLUDE EVALUATION OF THE WOUND AND CONFERRED BY BALANCED TRACTION?
THE AFFECTED EXTREMITY. ASSUMING HES ANXIOUS ABOUT A) BALANCED TRACTION CAN BE APPLIED AT NIGHT AND
DISCHARGE AND ADMINISTERING PAIN MEDICATION DO NOT REMOVED DURING THE DAY.
ADDRESS THE CAUSE OF THE PAIN. SUDDEN SEVERE PAIN IS B) BALANCED TRACTION ALLOWS FOR GREATER PATIENT
NOT CONSIDERED NORMAL AFTER HIP REPLACEMENT. MOVEMENT AND INDEPENDENCE THAN OTHER FORMS OF
SUDDEN PAIN IS RARELY INDICATIVE OF A SYSTEMIC TRACTION.
INFECTION. C) BALANCED TRACTION IS PORTABLE AND MAY ACCOMPANY
THE PATIENTS MOVEMENTS.
D) BALANCED TRACTION FACILITATES BONE REMODELING IN
A NURSE IS CARING FOR A PATIENT WHO HAS A LEG CAST. AS LITTLE AS 4 DAYS.
THE NURSE OBSERVES THAT THE PATIENT USES A PENCIL TO B) BALANCED TRACTION ALLOWS FOR GREATER PATIENT
SCRATCH THE SKIN UNDER THE EDGE OF THE CAST. HOW MOVEMENT AND INDEPENDENCE THAN OTHER FORMS OF
SHOULD THE NURSE RESPOND TO THIS OBSERVATION? TRACTION.
A) ALLOW THE PATIENT TO CONTINUE TO SCRATCH INSIDE
THE CAST WITH A PENCIL BUT ENCOURAGE HIM TO BE OFTEN, SKELETAL TRACTION IS BALANCED TRACTION, WHICH
CAUTIOUS. SUPPORTS THE AFFECTED EXTREMITY, ALLOWS FOR SOME
B) GIVE THE PATIENT A STERILE TONGUE DEPRESSOR TO USE PATIENT MOVEMENT, AND FACILITATES PATIENT
FOR SCRATCHING INSTEAD OF THE PENCIL. INDEPENDENCE AND NURSING CARE WHILE MAINTAINING
C) ENCOURAGE THE PATIENT TO AVOID SCRATCHING, AND EFFECTIVE TRACTION. IT IS NOT PORTABLE, HOWEVER, AND IT
OBTAIN AN ORDER FOR AN ANTIHISTAMINE IF SEVERE CANNOT BE REMOVED. BONE REMODELING TAKES LONGER
ITCHING PERSISTS. THAN 4 DAYS.
D) OBTAIN AN ORDER FOR A SEDATIVE, SUCH AS LORAZEPAM
(ATIVAN), TO PREVENT THE PATIENT FROM SCRATCHING.
C) ENCOURAGE THE PATIENT TO AVOID SCRATCHING, AND THE NURSING CARE PLAN FOR A PATIENT IN TRACTION
OBTAIN AN ORDER FOR AN ANTIHISTAMINE IF SEVERE SPECIFIES REGULAR ASSESSMENTS FOR VENOUS
ITCHING PERSISTS. THROMBOEMBOLISM (VTE). WHEN ASSESSING A PATIENTS
LOWER LIMBS, WHAT SIGN OR SYMPTOM IS SUGGESTIVE OF
SCRATCHING SHOULD BE DISCOURAGED BECAUSE OF THE DEEP VEIN THROMBOSIS (DVT)?
RISK FOR SKIN BREAKDOWN OR DAMAGE TO THE CAST. MOST A) INCREASED WARMTH OF THE CALF
PATIENTS CAN BE DISCOURAGED FROM SCRATCHING IF GIVEN B) DECREASED CIRCUMFERENCE OF THE CALF
A MILD ANTIHISTAMINE, SUCH AS DIPHENHYDRAMINE, TO C) LOSS OF SENSATION TO THE CALF
RELIEVE ITCHING. BENZODIAZEPINES WOULD NOT BE GIVEN D) PALE-APPEARING CALF
FOR THIS PURPOSE. A) INCREASED WARMTH OF THE CALF

SIGNS OF DVT INCLUDE INCREASED WARMTH, REDNESS,

THE NURSE IS CARING FOR A PATIENT WHO UNDERWENT A SWELLING, AND CALF TENDERNESS. THESE FINDINGS ARE
TOTAL HIP REPLACEMENT YESTERDAY. WHAT SHOULD THE PROMPTLY REPORTED TO THE PHYSICIAN FOR DEFINITIVE
NURSE DO TO PREVENT DISLOCATION OF THE NEW EVALUATION AND THERAPY. SIGNS AND SYMPTOMS OF A DVT
PROSTHESIS? DO NOT INCLUDE A DECREASED CIRCUMFERENCE OF THE
A) KEEP THE AFFECTED LEG IN A POSITION OF ADDUCTION. CALF, A LOSS OF SENSATION IN THE CALF, OR A PALE-
B) HAVE THE PATIENT REPOSITION HIMSELF INDEPENDENTLY. APPEARING CALF.
C) PROTECT THE AFFECTED LEG FROM INTERNAL ROTATION.
D) KEEP THE HIP FLEXED BY PLACING PILLOWS UNDER THE
PATIENTS KNEE. A NURSE IS PROVIDING DISCHARGE EDUCATION TO A PATIENT
C) PROTECT THE AFFECTED LEG FROM INTERNAL ROTATION. WHO IS GOING HOME WITH A CAST ON HIS LEG. WHAT
TEACHING POINT SHOULD THE NURSE EMPHASIZE IN THE
ABDUCTION OF THE HIP HELPS TO PREVENT DISLOCATION OF TEACHING SESSION?
A NEW HIP JOINT. ROTATION AND ADDUCTION SHOULD BE A) USING CRUTCHES EFFICIENTLY
AVOIDED. WHILE THE HIP MAY BE FLEXED SLIGHTLY, IT B) EXERCISING JOINTS ABOVE AND BELOW THE CAST, AS
SHOULDNT EXCEED 90 DEGREES AND MAINTENANCE OF ORDERED
FLEXION ISNT NECESSARY. THE PATIENT MAY NOT BE C) REMOVING THE CAST CORRECTLY AT THE END OF THE
CAPABLE OF SAFE INDEPENDENT REPOSITIONING AT THIS TREATMENT PERIOD
EARLY STAGE OF RECOVERY. D) REPORTING SIGNS OF IMPAIRED CIRCULATION
D) REPORTING SIGNS OF IMPAIRED CIRCULATION

A PATIENT IS COMPLAINING OF PAIN IN HER CASTED LEG. THE

NURSE HAS ADMINISTERED ANALGESICS AND ELEVATED THE REPORTING SIGNS OF IMPAIRED CIRCULATION IS CRITICAL;
LIMB. THIRTY MINUTES AFTER ADMINISTERING THE SIGNS OF IMPAIRED CIRCULATION MUST BE REPORTED TO
ANALGESICS, THE PATIENT STATES THE PAIN IS UNRELIEVED. THE PHYSICIAN IMMEDIATELY TO PREVENT PERMANENT
THE NURSE SHOULD IDENTIFY THE WARNING SIGNS OF WHAT DAMAGE. FOR THIS REASON, THIS EDUCATION IS A PRIORITY
COMPLICATION? OVER EXERCISE AND CRUTCH USE. THE PATIENT DOES NOT
A) SUBCUTANEOUS EMPHYSEMA INDEPENDENTLY REMOVE THE CAST.
B) SKIN BREAKDOWN
C) COMPARTMENT SYNDROME
D) DISUSE SYNDROME A PATIENT WITH A RIGHT TIBIAL FRACTURE IS BEING
C) COMPARTMENT SYNDROME DISCHARGED HOME AFTER HAVING A CAST APPLIED. WHAT
INSTRUCTION SHOULD THE NURSE PROVIDE IN RELATIONSHIP
COMPARTMENT SYNDROME MAY MANIFEST AS UNRELENTING, TO THE PATIENTS CAST CARE?
UNCONTROLLABLE PAIN. THIS PRESENTATION OF PAIN IS NOT A) COVER THE CAST WITH A BLANKET UNTIL THE CAST DRIES.
SUGGESTIVE OF DISUSE SYNDROME OR SKIN BREAKDOWN. B) KEEP YOUR RIGHT LEG ELEVATED ABOVE HEART LEVEL.
SUBCUTANEOUS EMPHYSEMA IS NOT A COMPLICATION OF C) USE A CLEAN OBJECT TO SCRATCH ITCHES INSIDE THE
CASTING. CAST.
D) A FOUL SMELL FROM THE CAST IS NORMAL AFTER THE
FIRST FEW DAYS.
THE NURSE EDUCATOR ON AN ORTHOPEDIC TRAUMA UNIT IS B) KEEP YOUR RIGHT LEG ELEVATED ABOVE HEART LEVEL.
REVIEWING THE SAFE AND EFFECTIVE USE OF TRACTION WITH
SOME RECENT NURSING GRADUATES. WHAT PRINCIPLE THE LEG SHOULD BE ELEVATED TO PROMOTE VENOUS
SHOULD THE EDUCATOR PROMOTE? RETURN AND PREVENT EDEMA. THE CAST SHOULDNT BE
COVERED WHILE DRYING BECAUSE THIS WILL CAUSE HEAT
BUILDUP AND PREVENT AIR CIRCULATION. NO FOREIGN C) PROVIDING SUPPORT
OBJECT SHOULD BE INSERTED INSIDE THE CAST BECAUSE OF D) CONTROLLING MOVEMENT
THE RISK OF CUTTING THE SKIN AND CAUSING AN INFECTION. E) PROMOTING BONE REMODELING
A FOUL SMELL FROM A CAST IS NEVER NORMAL AND MAY A) PREVENTING ADDITIONAL INJURY
INDICATE AN INFECTION. C) PROVIDING SUPPORT
D) CONTROLLING MOVEMENT

AN ELDERLY PATIENTS HIP JOINT IS IMMOBILIZED PRIOR TO

SURGERY TO CORRECT A FEMORAL HEAD FRACTURE. WHAT IS BRACES (I.E., ORTHOSES) ARE USED TO PROVIDE SUPPORT,
THE NURSES PRIORITY ASSESSMENT? CONTROL MOVEMENT, AND PREVENT ADDITIONAL INJURY.
A) THE PRESENCE OF LEG SHORTENING THEY ARE NOT USED TO IMMOBILIZE BODY PARTS OR TO
B) THE PATIENTS COMPLAINTS OF PAIN FACILITATE BONE REMODELING.
C) SIGNS OF NEUROVASCULAR COMPROMISE
D) THE PRESENCE OF INTERNAL OR EXTERNAL ROTATION
C) SIGNS OF NEUROVASCULAR COMPROMISE A NURSE IS ASSESSING THE NEUROVASCULAR STATUS OF A
PATIENT WHO HAS HAD A LEG CAST RECENTLY APPLIED. THE
BECAUSE IMPAIRED CIRCULATION CAN CAUSE PERMANENT NURSE IS UNABLE TO PALPATE THE PATIENTS DORSALIS
DAMAGE, NEUROVASCULAR ASSESSMENT OF THE AFFECTED PEDIS OR POSTERIOR TIBIAL PULSE AND THE PATIENTS FOOT
LEG IS ALWAYS A PRIORITY ASSESSMENT. LEG SHORTENING IS PALE. WHAT IS THE NURSES MOST APPROPRIATE ACTION?
AND INTERNAL OR EXTERNAL ROTATION ARE COMMON A) WARM THE PATIENTS FOOT AND DETERMINE WHETHER
FINDINGS WITH A FRACTURED HIP. PAIN, ESPECIALLY ON CIRCULATION IMPROVES.
MOVEMENT, IS ALSO COMMON AFTER A HIP FRACTURE. B) REPOSITION THE PATIENT WITH THE AFFECTED FOOT
DEPENDENT.
C) REASSESS THE PATIENTS NEUROVASCULAR STATUS IN 15
A NURSE IS CARING FOR A PATIENT WHO HAS HAD A TOTAL MINUTES.
HIP REPLACEMENT. THE NURSE IS REVIEWING HEALTH D) PROMPTLY INFORM THE PRIMARY CARE PROVIDER.
EDUCATION PRIOR TO DISCHARGE. WHICH OF THE PATIENTS D) PROMPTLY INFORM THE PRIMARY CARE PROVIDER.
STATEMENTS WOULD INDICATE TO THE NURSE THAT THE
PATIENT REQUIRES FURTHER TEACHING? SIGNS OF NEUROVASCULAR DYSFUNCTION WARRANT
A) ILL NEED TO KEEP SEVERAL PILLOWS BETWEEN MY LEGS IMMEDIATE MEDICAL FOLLOW-UP. IT WOULD BE UNSAFE TO
AT NIGHT. DELAY. WARMING THE FOOT OR REPOSITIONING THE PATIENT
B) I NEED TO REMEMBER NOT TO CROSS MY LEGS. ITS SUCH A MAY BE OF SOME BENEFIT, BUT THE CARE PROVIDER SHOULD
HABIT. BE INFORMED FIRST.
C) THE OCCUPATIONAL THERAPIST IS SHOWING ME HOW TO
USE A SOCK PULLER TO HELP ME GET DRESSED.
D) I WILL NEED MY HUSBAND TO ASSIST ME IN GETTING OFF A PHYSICIAN WRITES AN ORDER TO DISCONTINUE SKELETAL
THE LOW TOILET SEAT AT HOME. TRACTION ON AN ORTHOPEDIC PATIENT. THE NURSE SHOULD
D) I WILL NEED MY HUSBAND TO ASSIST ME IN GETTING OFF ANTICIPATE WHAT SUBSEQUENT INTERVENTION?
THE LOW TOILET SEAT AT HOME. A) APPLICATION OF A WALKING BOOT
B) APPLICATION OF A CAST
C) EDUCATION ON HOW TO USE CRUTCHES
I NEED TO REMEMBER NOT TO CROSS MY LEGS. ITS SUCH A D) PASSIVE RANGE OF MOTION EXERCISES
HABIT.THE OCCUPATIONAL THERAPIST IS SHOWING ME HOW B) APPLICATION OF A CAST
TO USE A SOCK PULLER TO HELP ME GET DRESSED. I WILL
NEED MY HUSBAND TO ASSIST ME IN GETTING OFF THE LOW AFTER SKELETAL TRACTION IS DISCONTINUED, INTERNAL
TOILET SEAT AT HOME.D FIXATION, CASTS, OR SPLINTS ARE THEN USED TO
FEEDBACK: IMMOBILIZE AND SUPPORT THE HEALING BONE. THE USE OF A
TO PREVENT HIP DISLOCATION AFTER A TOTAL HIP WALKING BOOT, CRUTCHES, OR ROM EXERCISES COULD
REPLACEMENT, THE PATIENT MUST AVOID BENDING THE HIPS EASILY DAMAGE DELICATE, REMODELED BONE.
BEYOND 90 DEGREES. ASSISTIVE DEVICES, SUCH AS A RAISED
TOILET SEAT, SHOULD BE USED TO PREVENT SEVERE HIP
FLEXION. USING AN ABDUCTION PILLOW OR PLACING A PATIENT HAS JUST BEGUN BEEN RECEIVING SKELETAL
SEVERAL PILLOWS BETWEEN THE LEGS REDUCES THE RISK OF TRACTION AND THE NURSE IS AWARE THAT MUSCLES IN THE
HIP DISLOCATION BY PREVENTING ADDUCTION AND INTERNAL PATIENTS AFFECTED LIMB ARE SPASTIC. HOW DOES THIS
ROTATION OF THE LEGS. LIKEWISE, TEACHING THE PATIENT CHANGE IN MUSCLE TONE AFFECT THE PATIENTS TRACTION
TO AVOID CROSSING THE LEGS ALSO REDUCES THE RISK OF PRESCRIPTION?
HIP DISLOCATION. A SOCK PULLER HELPS A PATIENT GET A) TRACTION MUST TEMPORARILY BE ALIGNED IN A SLIGHTLY
DRESSED WITHOUT FLEXING THE HIPS BEYOND 90 DEGREES. DIFFERENT DIRECTION.
B) EXTRA WEIGHT IS NEEDED INITIALLY TO KEEP THE LIMB IN
PROPER ALIGNMENT.
A NURSE IS ADMITTING A PATIENT TO THE UNIT WHO C) A LIGHTER WEIGHT SHOULD BE INITIALLY USED.
PRESENTED WITH A LOWER EXTREMITY FRACTURE. WHAT D) WEIGHT WILL TEMPORARILY ALTERNATE BETWEEN
SIGNS AND SYMPTOMS WOULD SUGGEST TO THE NURSE HEAVIER AND LIGHTER WEIGHTS.
THAT THE PATIENT MAY HAVE A PERONEAL NERVE INJURY? B) EXTRA WEIGHT IS NEEDED INITIALLY TO KEEP THE LIMB IN
A) NUMBNESS AND BURNING OF THE FOOT PROPER ALIGNMENT.
B) PALLOR TO THE DORSAL SURFACE OF THE FOOT
C) VISIBLE CYANOSIS IN THE TOES D) INADEQUATE CAPILLARY THE TRACTION WEIGHTS APPLIED INITIALLY MUST OVERCOME
REFILL TO THE TOES THE SHORTENING SPASMS OF THE AFFECTED MUSCLES. AS
A) NUMBNESS AND BURNING OF THE FOOT THE MUSCLES RELAX, THE TRACTION WEIGHT IS REDUCED TO
PREVENT FRACTURE DISLOCATION AND TO PROMOTE
PERONEAL NERVE INJURY MAY RESULT IN NUMBNESS, HEALING. WEIGHTS NEVER ALTERNATE BETWEEN HEAVY AND
TINGLING, AND BURNING IN THE FEET. CYANOSIS, PALLOR, LIGHT.
AND DECREASED CAPILLARY REFILL ARE SIGNS OF
INADEQUATE CIRCULATION.
A NURSE IS PLANNING THE CARE OF A PATIENT WHO WILL
REQUIRE A PROLONGED COURSE OF SKELETAL TRACTION.
A PATIENT HAS SUFFERED A MUSCLE STRAIN AND IS WHEN PLANNING THIS PATIENTS CARE, THE NURSE SHOULD
COMPLAINING OF PAIN THAT SHE RATES AT 6 ON A 10-POINT PRIORITIZE INTERVENTIONS RELATED TO WHICH OF THE
SCALE. THE NURSE SHOULD RECOMMEND WHAT ACTION? FOLLOWING RISK NURSING DIAGNOSES?
A) TAKING AN OPIOID ANALGESIC AS ORDERED A) RISK FOR IMPAIRED SKIN INTEGRITY
B) APPLYING A COLD PACK TO THE INJURED SITE B) RISK FOR FALLS
C) PERFORMING PASSIVE ROM EXERCISES C) RISK FOR IMBALANCED FLUID VOLUME
D) APPLYING A HEATING PAD TO THE AFFECTED MUSCLE D) RISK FOR ASPIRATION
B) APPLYING A COLD PACK TO THE INJURED SITE A) RISK FOR IMPAIRED SKIN INTEGRITY

MOST PAIN CAN BE RELIEVED BY ELEVATING THE INVOLVED IMPAIRED SKIN INTEGRITY IS A HIGH-PROBABILITY RISK IN
PART, APPLYING COLD PACKS, AND ADMINISTERING PATIENTS RECEIVING TRACTION. FALLS ARE NOT A THREAT,
ANALGESICS AS PRESCRIBED. HEAT MAY EXACERBATE THE DUE TO THE PATIENTS IMMOBILITY. THERE ARE NOT
PAIN BY INCREASING BLOOD CIRCULATION, AND ROM NORMALLY HIGH RISKS OF FLUID IMBALANCE OR ASPIRATION
EXERCISES WOULD LIKELY BE PAINFUL. ANALGESIA IS LIKELY ASSOCIATED WITH TRACTION.
NECESSARY, BUT NSAIDS WOULD BE MORE APPROPRIATE
THAN OPIOIDS.
A NURSE IS CARING FOR A PATIENT RECEIVING SKELETAL
TRACTION. DUE TO THE PATIENTS SEVERE LIMITS ON
A PATIENT HAS HAD A BRACE PRESCRIBED TO FACILITATE MOBILITY, THE NURSE HAS IDENTIFIED A RISK FOR
RECOVERY FROM A KNEE INJURY. WHAT ARE THE POTENTIAL ATELECTASIS OR PNEUMONIA. WHAT INTERVENTION SHOULD
THERAPEUTIC BENEFITS OF A BRACE? SELECT ALL THAT THE NURSE PROVIDE IN ORDER TO PREVENT THESE
APPLY. COMPLICATIONS?
A) PREVENTING ADDITIONAL INJURY A) PERFORM CHEST PHYSIOTHERAPY ONCE PER SHIFT AND AS
B) IMMOBILIZING PRIOR TO SURGERY NEEDED.
B) TEACH THE PATIENT TO PERFORM DEEP BREATHING AND A) SHIFTING ONES WEIGHT IN BED
COUGHING EXERCISES. B) BEARING DOWN WHILE HAVING A BOWEL MOVEMENT
C) ADMINISTER PROPHYLACTIC ANTIBIOTICS AS ORDERED. C) TURNING FROM SIDE TO SIDE
D) ADMINISTER NEBULIZED BRONCHODILATORS AND D) COUGHING WITHOUT SPLINTING
CORTICOSTEROIDS AS ORDERED. C) TURNING FROM SIDE TO SIDE
B) TEACH THE PATIENT TO PERFORM DEEP BREATHING AND
COUGHING EXERCISES. TO PREVENT BONY FRAGMENTS FROM MOVING AGAINST ONE
ANOTHER, THE PATIENT SHOULD NOT TURN FROM SIDE TO
TO PREVENT THESE COMPLICATIONS, THE NURSE SHOULD SIDE; HOWEVER, THE PATIENT MAY SHIFT POSITION SLIGHTLY
EDUCATE THE PATIENT ABOUT PERFORMING DEEP- WITH ASSISTANCE. BEARING DOWN AND COUGHING DO NOT
BREATHING AND COUGHING EXERCISES TO AID IN FULLY POSE A THREAT TO BONE UNION.
EXPANDING THE LUNGS AND CLEARING PULMONARY
SECRETIONS. ANTIBIOTICS, BRONCHODILATORS, AND
STEROIDS ARE NOT USED ON A PREVENTATIVE BASIS AND A NURSE IS CARING FOR AN OLDER ADULT PATIENT WHO IS
CHEST PHYSIOTHERAPY IS UNNECESSARY AND IMPLAUSIBLE PREPARING FOR DISCHARGE FOLLOWING RECOVERY FROM A
FOR A PATIENT IN TRACTION. TOTAL HIP REPLACEMENT. WHICH OF THE FOLLOWING
OUTCOMES MUST BE MET PRIOR TO DISCHARGE?
A) PATIENT IS ABLE TO PERFORM ADLS INDEPENDENTLY.
THE NURSE HAS IDENTIFIED THE DIAGNOSIS OF RISK FOR B) PATIENT IS ABLE TO PERFORM TRANSFERS SAFELY.
IMPAIRED TISSUE PERFUSION RELATED TO DEEP VEIN C) PATIENT IS ABLE TO WEIGHT-BEAR EQUALLY ON BOTH
THROMBOSIS IN THE CARE OF A PATIENT RECEIVING LEGS.
SKELETAL TRACTION. WHAT NURSING INTERVENTION BEST D) PATIENT IS ABLE TO DEMONSTRATE FULL ROM OF THE
ADDRESSES THIS RISK? AFFECTED HIP.
A) ENCOURAGE INDEPENDENCE WITH ADLS WHENEVER B) PATIENT IS ABLE TO PERFORM TRANSFERS SAFELY.
POSSIBLE.
B) MONITOR THE PATIENTS NUTRITIONAL STATUS CLOSELY. THE PATIENT MUST BE ABLE TO PERFORM TRANSFERS AND
C) TEACH THE PATIENT TO PERFORM ANKLE AND FOOT TO USE MOBILITY AIDS SAFELY. EACH OF THE OTHER LISTED
EXERCISES WITHIN THE LIMITATIONS OF TRACTION. GOALS IS UNREALISTIC FOR THE PATIENT WHO HAS
D) ADMINISTER CLOPIDOGREL (PLAVIX) AS ORDERED. UNDERGONE RECENT HIP REPLACEMENT.
C) TEACH THE PATIENT TO PERFORM ANKLE AND FOOT
EXERCISES WITHIN THE LIMITATIONS OF TRACTION.
A NURSE IS CARING FOR A PATIENT WHO IS RECOVERING IN
THE NURSE EDUCATES THE PATIENT HOW TO PERFORM THE HOSPITAL FOLLOWING ORTHOPEDIC SURGERY. THE
ANKLE AND FOOT EXERCISES WITHIN THE LIMITS OF THE NURSE IS PERFORMING FREQUENT ASSESSMENTS FOR SIGNS
TRACTION THERAPY EVERY 1 TO 2 HOURS WHEN AWAKE TO AND SYMPTOMS OF INFECTION IN THE KNOWLEDGE THAT THE
PREVENT DVT. NUTRITION IS IMPORTANT, BUT DOES NOT PATIENT FACES A HIGH RISK OF WHAT INFECTIOUS
DIRECTLY PREVENT DVT. SIMILARLY, INDEPENDENCE WITH COMPLICATION?
ADLS SHOULD BE PROMOTED, BUT THIS DOES NOT CONFER A) CELLULITIS
SIGNIFICANT PREVENTION OF DVT, WHICH OFTEN AFFECTS B) SEPTIC ARTHRITIS
THE LOWER LIMBS. PLAVIX IS NOT NORMALLY USED FOR DVT C) SEPSIS
PROPHYLAXIS. D) OSTEOMYELITIS
D) OSTEOMYELITIS

A PATIENT IS SCHEDULED FOR A TOTAL HIP REPLACEMENT INFECTION IS A RISK AFTER ANY SURGERY, BUT IT IS OF
AND THE SURGEON HAS EXPLAINED THE RISKS OF BLOOD PARTICULAR CONCERN FOR THE POSTOPERATIVE
LOSS ASSOCIATED WITH ORTHOPEDIC SURGERY. THE RISK OF ORTHOPEDIC PATIENT BECAUSE OF THE RISK OF
BLOOD LOSS IS THE INDICATION FOR WHICH OF THE OSTEOMYELITIS. ORTHOPEDIC PATIENTS DO NOT HAVE AN
FOLLOWING ACTIONS? EXAGGERATED RISK OF CELLULITIS, SEPSIS, OR SEPTIC
A) USE OF A CARDIOPULMONARY BYPASS MACHINE ARTHRITIS WHEN COMPARED TO OTHER SURGICAL PATIENTS.
B) POSTOPERATIVE BLOOD SALVAGE
C) PROPHYLACTIC BLOOD TRANSFUSION
D) AUTOLOGOUS BLOOD DONATION A PATIENT IS BEING PREPARED FOR A TOTAL HIP
D) AUTOLOGOUS BLOOD DONATION ARTHROPLASTY, AND THE NURSE IS PROVIDING RELEVANT
EDUCATION. THE PATIENT IS CONCERNED ABOUT BEING ON
MANY PATIENTS DONATE THEIR OWN BLOOD DURING THE BED REST FOR SEVERAL DAYS AFTER THE SURGERY. THE
WEEKS PRECEDING THEIR SURGERY. AUTOLOGOUS BLOOD NURSE SHOULD EXPLAIN WHAT EXPECTATION FOR ACTIVITY
DONATIONS ARE COST EFFECTIVE AND ELIMINATE MANY OF FOLLOWING HIP REPLACEMENT?
THE RISKS OF TRANSFUSION THERAPY. ORTHOPEDIC A) ACTUALLY, PATIENTS ARE ONLY ON BED REST FOR 2 TO 3
SURGERY DOES NOT NECESSITATE CARDIOPULMONARY DAYS BEFORE THEY BEGIN WALKING WITH ASSISTANCE.
BYPASS AND BLOOD IS NOT SALVAGED POSTOPERATIVELY. B) THE PHYSICAL THERAPIST WILL LIKELY HELP YOU GET UP
TRANSFUSIONS ARE NOT GIVEN PROPHYLACTICALLY. USING A WALKER THE DAY AFTER YOUR SURGERY.
C) OUR GOAL WILL ACTUALLY BE TO HAVE YOU WALKING
NORMALLY WITHIN 5 DAYS OF YOUR SURGERY.
THE NURSE IS HELPING TO SET UP BUCKS TRACTION ON AN D) FOR THE FIRST TWO WEEKS AFTER THE SURGERY, YOU
ORTHOPEDIC PATIENT. HOW OFTEN SHOULD THE NURSE CAN USE A WHEELCHAIR TO MEET YOUR MOBILITY NEEDS.
ASSESS CIRCULATION TO THE AFFECTED LEG? B) THE PHYSICAL THERAPIST WILL LIKELY HELP YOU GET UP
A) WITHIN 30 MINUTES, THEN EVERY 1 TO 2 HOURS USING A WALKER THE DAY AFTER YOUR SURGERY.
B) WITHIN 30 MINUTES, THEN EVERY 4 HOURS
C) WITHIN 30 MINUTES, THEN EVERY 8 HOURS PATIENTS POST-THA BEGIN AMBULATION WITH THE
D) WITHIN 30 MINUTES, THEN EVERY SHIFT ASSISTANCE OF A WALKER OR CRUTCHES WITHIN A DAY
A) WITHIN 30 MINUTES, THEN EVERY 1 TO 2 HOURS AFTER SURGERY. WHEELCHAIRS ARE NOT NORMALLY
UTILIZED. BASELINE LEVELS OF MOBILITY ARE NOT NORMALLY
AFTER SKIN TRACTION IS APPLIED, THE NURSE ASSESSES ACHIEVED UNTIL SEVERAL WEEKS AFTER SURGERY,
CIRCULATION OF THE FOOT OR HAND WITHIN 15 TO 30 HOWEVER.
MINUTES AND THEN EVERY 1 TO 2 HOURS.

A PATIENT HAS RECENTLY BEEN ADMITTED TO THE

A NURSE IS ASSESSING A PATIENT WHO IS RECEIVING ORTHOPEDIC UNIT FOLLOWING TOTAL HIP ARTHROPLASTY.
TRACTION. THE NURSES ASSESSMENT CONFIRMS THAT THE THE PATIENT HAS A CLOSED SUCTION DEVICE IN PLACE AND
PATIENT IS ABLE TO PERFORM PLANTAR FLEXION. WHAT THE NURSE HAS DETERMINED THAT THERE WERE 320 ML OF
CONCLUSION CAN THE NURSE DRAW FROM THIS FINDING? OUTPUT IN THE FIRST 24 HOURS. HOW SHOULD THE NURSE
A) THE LEG THAT WAS ASSESSED IS FREE FROM DVT. BEST RESPOND TO THIS ASSESSMENT FINDING?
B) THE PATIENTS TIBIAL NERVE IS FUNCTIONAL. A) INFORM THE PRIMARY CARE PROVIDER PROMPTLY.
C) CIRCULATION TO THE DISTAL EXTREMITY IS ADEQUATE. B) DOCUMENT THIS AS AN EXPECTED ASSESSMENT FINDING.
D) THE PATIENT DOES NOT HAVE PERIPHERAL C) LIMIT THE PATIENTS FLUID INTAKE TO 2 LITERS FOR THE
NEUROVASCULAR DYSFUNCTION. NEXT 24 HOURS.
B) THE PATIENTS TIBIAL NERVE IS FUNCTIONAL. D) ADMINISTER A LOOP DIURETIC AS ORDERED.
B) DOCUMENT THIS AS AN EXPECTED ASSESSMENT FINDING.
PLANTAR FLEXION DEMONSTRATES FUNCTION OF THE TIBIAL
NERVE. IT DOES NOT DEMONSTRATE THE ABSENCE OF DVT DRAINAGE OF 200 TO 500 ML IN THE FIRST 24 HOURS IS
AND DOES NOT ALLOW THE NURSE TO ASCERTAIN ADEQUATE EXPECTED. CONSEQUENTLY, THE NURSE DOES NOT NEED TO
CIRCULATION. THE NURSE MUST PERFORM MORE INFORM THE PHYSICIAN. FLUID RESTRICTION AND
ASSESSMENTS ON MORE SITES IN ORDER TO DETERMINE AN MEDICATION ADMINISTRATION ARE NOT INDICATED.
ABSENCE OF PERIPHERAL NEUROVASCULAR DYSFUNCTION.

A NURSE IS REVIEWING A PATIENTS ACTIVITIES OF DAILY

A NURSE IS CARING FOR A PATIENT IN SKELETAL TRACTION. LIVING PRIOR TO DISCHARGE FROM TOTAL HIP REPLACEMENT.
IN ORDER TO PREVENT BONY FRAGMENTS FROM MOVING THE NURSE SHOULD IDENTIFY WHAT ACTIVITY AS POSING A
AGAINST ONE ANOTHER, THE NURSE SHOULD CAUTION THE POTENTIAL RISK FOR HIP DISLOCATION?
PATIENT AGAINST WHICH OF THE FOLLOWING ACTIONS? A) STRAINING DURING A BOWEL MOVEMENT
B) BENDING DOWN TO PUT ON SOCKS D. GENERALIZED JOINT STIFFNESS THAT IS WORSE IN THE
C) LIFTING ITEMS ABOVE SHOULDER LEVEL EARLY MORNING
D) TRANSFERRING FROM A SITTING TO STANDING POSITION ANS: B
B) BENDING DOWN TO PUT ON SOCKS THE FUNCTIONAL ASSESSMENT HELPS NURSES AND
THERAPISTS MEASURE HOW FUNCTIONAL THE CLIENT IS WITH
BENDING TO PUT ON SOCKS OR SHOES CAN CAUSE HIP ACTIVITIES OF DAILY LIVING, INCLUDING DRESSING. THE
DISLOCATION. NONE OF THE OTHER LISTED ACTIONS POSES A OCCUPATIONAL THERAPIST CAN ASSIST THE CLIENT TO
SERIOUS THREAT TO THE INTEGRITY OF THE NEW HIP. EXPLORE CLOTHING OPTIONS THAT ARE EASIER TO MANAGE
WITH ARTHRITIC FINGERS. THE OTHER FINDINGS WOULD NOT
NECESSARILY NEED TO BE SHARED WITH THE OCCUPATIONAL
A 91-YEAR-OLD PATIENT IS SLATED FOR ORTHOPEDIC THERAPIST FOR THE TREATMENT PLAN.
SURGERY AND THE NURSE IS INTEGRATED GERONTOLOGIC
CONSIDERATIONS INTO THE PATIENTS PLAN OF CARE. WHAT
INTERVENTION IS MOST JUSTIFIED IN THE CARE OF THIS
PATIENT? THE NURSE IS CARING FOR A CLIENT WHO IS TO HAVE A
A) ADMINISTRATION OF PROPHYLACTIC ANTIBIOTICS COMPUTED TOMOGRAPHY (CT) SCAN OF THE LEG. WHICH
B) TOTAL PARENTERAL NUTRITION (TPN) ASSESSMENT QUESTION DOES THE NURSE ASK THE CLIENT
C) USE OF A PRESSURE-RELIEVING MATTRESS BEFORE THE PROCEDURE?
D) USE OF A FOLEY CATHETER UNTIL DISCHARGE A. "DO YOU HAVE ANY METAL CLIPS, PLATES, OR PINS IN
C) USE OF A PRESSURE-RELIEVING MATTRESS YOUR BODY?"
B. "HAVE YOU HAD ANYTHING TO EAT OR DRINK IN THE LAST
OLDER ADULTS HAVE A HEIGHTENED RISK OF SKIN 6 HOURS?"
BREAKDOWN; USE OF A PRESSURE-REDUCING MATTRESS C. "DO YOU HAVE SOMEONE TO DRIVE YOU HOME AFTER THE
ADDRESSES THIS RISK. OLDER ADULTS DO NOT NECESSARILY PROCEDURE?"
NEED TPN AND THE FOLEY CATHETER SHOULD BE D. "DO YOU HAVE ANY ALLERGIES TO SHRIMP, SCALLOPS, OR
DISCONTINUED AS SOON AS POSSIBLE TO PREVENT URINARY OTHER SEAFOOD?"
TRACT INFECTIONS. PROPHYLACTIC ANTIBIOTICS ARE NOT A ANS: D
STANDARD INFECTION PREVENTION MEASURE. IV CONTRAST THAT CONTAINS IODINE MAY BE REQUIRED FOR
CT SCANS TO RULE OUT MALIGNANCY. THE CLIENT SHOULD
BE ASSESSED FOR ALLERGY TO SHELLFISH, WHICH CONTAIN
A NURSE IS EMPTYING AN ORTHOPEDIC SURGERY PATIENTS HIGH AMOUNTS OF IODINE. THE OTHER QUESTIONS ARE NOT
CLOSED SUCTION DRAINAGE AT THE END OF A SHIFT. THE RELEVANT WHEN A CT SCAN IS TO BE OBTAINED.
NURSE NOTES THAT THE VOLUME IS WITHIN EXPECTED
PARAMETERS BUT THAT THE DRAINAGE HAS A FOUL ODOR.
WHAT IS THE NURSES BEST ACTION? THE NURSE IS ASSESSING A CLIENT WHO REPORTS SEVERE
A) ASPIRATE A SMALL AMOUNT OF DRAINAGE FOR KNEE PAIN AFTER A FALL. WHICH QUESTION DOES THE NURSE
CULTURING. ASK TO DETERMINE THE RADIATION OF THE PAIN?
B) ADVANCE THE DRAIN 1 TO 1.5 CM. A. "WHAT MAKES THE PAIN BETTER OR WORSE?"
C) IRRIGATE THE DRAIN WITH NORMAL SALINE. B. "ARE YOU ABLE TO BEAR ANY WEIGHT ON THE KNEE AT
D) INFORM THE SURGEON OF THIS FINDING. ALL?"
D) INFORM THE SURGEON OF THIS FINDING. C. "DOES THE PAIN MOVE TO ANOTHER AREA FROM YOUR
KNEE?"
THE NURSE SHOULD PROMPTLY NOTIFY THE SURGEON OF D. "HOW WOULD YOU RATE THE PAIN ON A SCALE OF 1 TO
EXCESSIVE OR FOUL-SMELLING DRAINAGE. IT WOULD BE 10?"
INAPPROPRIATE TO ADVANCE THE DRAIN, IRRIGATE THE ANS: C
DRAIN, OR ASPIRATE MORE DRAINAGE. TO DETERMINE RADIATION OF THE PAIN, THE NURSE ASKS
THE CLIENT IF THE PAIN MOVES TO ANOTHER AREA FROM THE
KNEE. THE OTHER QUESTIONS ADDRESS THE AMOUNT,
A NURSE IS PLANNING THE CARE OF A PATIENT WHO HAS FUNCTIONAL IMPACT, AND ALLEVIATING OR AGGRAVATING
UNDERGONE ORTHOPEDIC SURGERY. WHAT MAIN GOAL FACTORS OF THE PAIN.
SHOULD GUIDE THE NURSES CHOICE OF INTERVENTIONS?
A) IMPROVING THE PATIENTS LEVEL OF FUNCTION
B) HELPING THE PATIENT COME TO TERMS WITH LIMITATIONS WHICH INSTRUCTION DOES THE NURSE GIVE TO THE CLIENT
C) ADMINISTERING MEDICATIONS SAFELY BEFORE HE OR SHE HAS ELECTROMYOGRAPHY (EMG)?
D) IMPROVING THE PATIENTS ADHERENCE TO TREATMENT A. "MAKE SURE THAT YOU HAVE SOMEONE TO DRIVE YOU
A) IMPROVING THE PATIENTS LEVEL OF FUNCTION HOME AFTER THE TEST."
B. "DO NOT EAT OR DRINK ANYTHING FOR AT LEAST 6 HOURS
IMPROVING FUNCTION IS THE OVERARCHING GOAL AFTER BEFORE THE TEST."
ORTHOPEDIC SURGERY. SOME PATIENTS MAY NEED TO COME C. "YOU WILL HAVE TO AVOID HEAVY LIFTING FOR 24 HOURS
TO TERMS WITH LIMITATIONS, BUT THIS IS NOT TRUE OF FOLLOWING THE TEST."
EVERY PATIENT. SAFE MEDICATION ADMINISTRATION IS D. "DO NOT TAKE YOUR CYCLOBENZAPRINE (FLEXERIL) ON
IMPERATIVE, BUT THIS IS NOT A GOAL THAT GUIDES OTHER THE 2 DAYS BEFORE THE TEST."
ASPECTS OF CARE. SIMILARLY, ADHERENCE TO TREATMENT IS ANS: D
IMPORTANT, BUT THIS IS MOTIVATED BY THE NEED TO ELECTROMYOGRAPHY (EMG) TESTING MEASURES NERVE
IMPROVE FUNCTIONAL STATUS. SIGNAL TRANSMISSION TO AND THROUGH MUSCLES.
SKELETAL MUSCLE RELAXANTS SUCH AS FLEXERIL CAN
AFFECT TEST RESULTS AND SHOULD BE AVOIDED FOR AT
LEAST 2 DAYS BEFORE THE TEST. THE OTHER INSTRUCTIONS
ARE NOT RELEVANT BEFORE EMG TESTING.

WHICH POSTOPERATIVE ORDER DOES THE NURSE CLARIFY THE NURSE IS CARING FOR A CLIENT WITH PROSTATE
WITH THE SURGEON BEFORE DISCHARGING THE CLIENT WHO CANCER. WHICH LABORATORY FINDING INDICATES TO THE
JUST HAD ARTHROSCOPIC SURGERY ON THE RIGHT KNEE? NURSE THAT THE CANCER HAS METASTASIZED TO THE BONE?
A. KEEP THE RIGHT LEG ELEVATED ON A SOFT PILLOW FOR 12 A. SERUM CALCIUM, 21.6 MG/DL
HOURS. B. CREATINE KINASE, 55 U/ML
B. MAINTAIN NON-WEIGHT BEARING BY RIGHT LEG FOR 48 C. ALKALINE PHOSPHATASE, 45 IU/ML
HOURS. D. LACTATE DEHYDROGENASE, 120 U/L
C. USE ICE ON THE KNEE FOR 24 HOURS. ANS: A
D. ADMINISTER TWO TABLETS OF OXYCODONE/APAP (TYLOX) METASTASIS OF TUMOR TO BONE RESULTS IN RELEASE OF
EVERY 4 HOURS FOR PAIN. CALCIUM INTO THE BLOODSTREAM, CAUSING AN ELEVATION
ANS: D OF THE SERUM CALCIUM LEVEL (NORMAL RANGE, 9 TO 10.5
EACH TABLET OF TYLOX HAS 5 MG OXYCODONE WITH 500 MG MG/DL). THE OTHER LABORATORY VALUES ARE WITHIN
ACETAMINOPHEN. IF THE CLIENT TOOK TWO TABLETS EVERY NORMAL LIMITS AND DO NOT INDICATE METASTASIS TO THE
4 HOURS, THE CLIENT WOULD INGEST A TOTAL OF 6000 MG BONE.
OF ACETAMINOPHEN, WELL OVER THE SAFE MAXIMUM DOSE
OF 4000 MG IN 24 HOURS. THE REST OF THE ORDERS ARE
APPROPRIATE. THE NURSE IS CARING FOR A CLIENT WHO PRESENTS WITH
ACHY JAW PAIN. WHICH ASSESSMENT TECHNIQUE DOES THE
NURSE USE TO DETERMINE WHETHER THE CLIENT HAS
AN OCCUPATIONAL THERAPIST IS TREATING A CLIENT WITH INFLAMMATION OF THE TEMPOROMANDIBULAR JOINT (TMJ)?
RHEUMATOID ARTHRITIS. WHICH ASSESSMENT FINDING IN A. CHECKING FOR DECAYED, FRACTURED, LOOSE, OR
THE CLIENT DOES THE NURSE SHARE WITH THE MISSING TEETH
OCCUPATIONAL THERAPIST? B. OBSERVING THE JAW JOINT AS THE CLIENT CHEWS A PIECE
A. DIFFICULTY SLEEPING BECAUSE OF PAIN IN THE KNEES AND OF FOOD
ELBOWS C. PALPATING THE JOINT DURING MOVEMENT FOR
B. DIFFICULTY TYING SHOELACES AND DOING ZIPPERS ON TENDERNESS OR CREPITUS
CLOTHING D. OBSERVING FOR ASYMMETRIC JOINT PROTRUSION WHEN
C. SWOLLEN KNEES WITH CREPITUS AND LIMITED RANGE OF THE CLIENT'S MOUTH IS CLOSED
MOTION ANS: C
THE TEMPOROMANDIBULAR JOINTS ARE BEST ASSESSED BY MOTION. IN ADDITION, FALLS INCREASE AS THE RESULT OF
PALPATION WHILE THE CLIENT OPENS HIS OR HER MOUTH. KYPHOTIC POSTURE, WIDENED GAIT, AND AN ALTERATION IN
THE OTHER ASSESSMENT TECHNIQUES ARE NOT EFFECTIVE THE CENTER OF GRAVITY, CREATING AN UNSTEADY WALKING
FOR ASSESSING POSSIBLE TMJ INFLAMMATION. PATTERN. INCREASED BONY PROMINENCES ARE OBSERVED IN
THE OLDER ADULT BECAUSE LESS SOFT TISSUE IS PRESENT
TO CUSHION THE BONE, AND PRESSURE ULCERS ARE A
THE NURSE IS CARING FOR A CLIENT WHO IS ABLE TO FLEX THREAT.
THE RIGHT ARM FORWARD WITHOUT DIFFICULTY OR PAIN BUT
IS UNABLE TO ABDUCT THE ARM BECAUSE OF PAIN AND THE BONE CELLS THAT FUNCTION IN THE RESORPTION OF
MUSCLE SPASMS. WHICH CONDITION DOES THE NURSE BONE TISSUE ARE CALLED
SUSPECT BASED ON THESE ASSESSMENT FINDINGS?
A. DISLOCATED ELBOW A. OSTEOIDS.
B. LESION IN THE ROTATOR CUFF
C. OSTEOARTHRITIS OF THE SHOULDER B. OSTEOCYTES.
D. ATROPHY OF THE SUPRASPINATUS MUSCLE
ANS: B C. OSTEOCLASTS.
ROTATOR CUFF LESIONS MAY CAUSE LIMITED RANGE OF
MOTION AND PAIN AND MUSCLE SPASM DURING ABDUCTION, D. OSTEOBLASTS.
WHEREAS FORWARD FLEXION STAYS FAIRLY NORMAL. THE CORRECT ANSWER: C
ASSESSMENT FINDINGS ARE NOT CONSISTENT WITH THE RATIONALE: OSTEOCLASTS PARTICIPATE IN BONE
OTHER CONDITIONS. REMODELING BY ASSISTING IN THE BREAKDOWN OF BONE
TISSUE.

THE NURSE IS ASSESSING A CLIENT WHO IS SUSPECTED OF

HAVING MUSCULAR DYSTROPHY. WHICH STATEMENT BY THE WHILE PERFORMING PASSIVE RANGE OF MOTION FOR A
CLIENT INDICATES THAT MORE TEACHING MAY BE NEEDED PATIENT, THE NURSE PUTS THE ANKLE JOINT THROUGH THE
ABOUT THE CREATINE KINASE (CK) TEST THAT THE HEALTH MOVEMENTS OF (SELECT ALL THAT APPLY)
CARE PROVIDER HAS ORDERED?
A. "THE LASIX THAT I TOOK THIS MORNING MAY AFFECT THE A. FLEXION AND EXTENSION.
TEST RESULTS."
B. "THE CK TEST IS 90% ACCURATE IN DEMONSTRATING B. INVERSION AND EVERSION.
MUSCLE TRAUMA OR INJURY."
C. "THE LEVEL OF CK WILL BE DECREASED WITH SKELETAL C. PRONATION AND SUPINATION
MUSCLE DISEASE."
D. "WHEN MUSCLE IS DAMAGED, CK ISOENZYMES ARE D. FLEXION, EXTENSION, ABDUCTION, AND ADDUCTION.
RELEASED OVER TIME."
ANS: C E. PRONATION, SUPINATION, ROTATION, AND
ALL OF THE STATEMENTS ARE CORRECT, EXCEPT THAT THE CIRCUMDUCTION.
LEVEL OF CREATINE KINASE WILL INCREASE WITH ANY CORRECT ANSWERS: A, B
SKELETAL MUSCLE DAMAGE. RATIONALE: COMMON MOVEMENTS THAT OCCUR AT THE
ANKLE INCLUDE INVERSION, EVERSION, FLEXION, AND
EXTENSION.
A CLIENT HAS CANCER AND A PACEMAKER, AND SUFFERS
FROM CLAUSTROPHOBIA. WHICH DIAGNOSTIC TEST IS THE
BEST INDICATOR OF THE CLIENT'S BONE METASTASIS? TO PREVENT MUSCLE ATROPHY, THE NURSE TEACHES THE
A. MAGNETIC RESONANCE IMAGING (MRI) PATIENT WITH A LEG IMMOBILIZED IN TRACTION TO PERFORM
B. ARTHROGRAM (SELECT ALL THAT APPLY)
C. ULTRASOUND
D. THALLIUM BONE SCAN A. FLEXION CONTRACTIONS.
ANS: D
BECAUSE THE CLIENT HAS A PACEMAKER AND B. TETANIC CONTRACTIONS.
CLAUSTROPHOBIA, MRI WOULD NOT BE AN OPTION AS A
DIAGNOSTIC TEST. THE ARTHROGRAM IS AN X-RAY USED TO C. ISOTONIC CONTRACTIONS.
VISUALIZE BONE CHIPS AND TORN LIGAMENTS WITHIN A
JOINT. ULTRASOUND IS USED TO ASSESS SOFT TISSUE D. ISOMETRIC CONTRACTIONS.
DISORDERS, TRAUMATIC JOINT INJURIES, AND
OSTEOMYELITIS. THE THALLIUM BONE SCAN IS IDEAL FOR E. EXTENSION CONTRACTIONS.
OBTAINING INFORMATION ABOUT THE EXTENT OF BONE CORRECT ANSWER: D
CANCER SUCH AS OSTEOSARCOMA OR BONY METASTASES. RATIONALE: ISOMETRIC CONTRACTIONS INCREASE THE
TENSION WITHIN A MUSCLE BUT DO NOT PRODUCE
MOVEMENT. REPEATED ISOMETRIC CONTRACTIONS MAKE
WHICH CLIENT DOES THE NURSE ASSESS FIRST AT THE START MUSCLES GROW LARGER AND STRONGER. MUSCULAR
OF THE NURSING SHIFT? ATROPHY (I.E., DECREASE IN SIZE) OCCURS WITH THE
A. CLIENT WANTING TO KNOW INFORMATION ABOUT A ABSENCE OF CONTRACTION THAT RESULTS FROM
MAGNETIC RESONANCE IMAGING (MRI) TEST SCHEDULED IN 3 IMMOBILITY.
HOURS
B. CLIENT WHO IS VERBALIZING MILD DISCOMFORT AFTER AN
ELECTROMYOGRAPHY (EMG) A PATIENT WITH TENDONITIS ASKS WHAT THE TENDON DOES.
C. CLIENT WHO REPORTS INCREASED PAIN AND SWELLING THE NURSE'S RESPONSE IS BASED ON THE KNOWLEDGE THAT
AFTER AN ARTHROSCOPY TENDONS
D. CLIENT WHO REFUSES TO DRINK MORE FLUIDS AFTER A
NUCLEAR MEDICINE SCAN A. CONNECT BONE TO MUSCLE.
ANS: C
THE CLIENT WHO SHOULD BE THE FIRST PRIORITY IS THE ONE B. PROVIDE STRENGTH TO MUSCLE.
WHO IS REPORTING INCREASED PAIN AND SWELLING AFTER
ARTHROSCOPY; THIS COULD INDICATE COMPLICATIONS FROM C. LUBRICATE JOINTS WITH SYNOVIAL FLUID.
THE SURGERY. THE CLIENT WITH MILD DISCOMFORT AFTER
AN EMG SHOULD BE ASSESSED FOR PAIN, BUT MILD D. RELIEVE FRICTION BETWEEN MOVING PARTS.
DISCOMFORT IS COMMON FOR THIS PROCEDURE. PAIN CORRECT ANSWER: A
MEDICATION CAN THEN BE ADMINISTERED. AFTER A NUCLEAR RATIONALE: TENDONS ARE COMPOSED OF DENSE, FIBROUS
MEDICINE SCAN, THE CLIENT MUST INCREASE FLUIDS TO CONNECTIVE TISSUE THAT CONTAINS BUNDLES OF CLOSELY
FLUSH OUT THE RADIOISOTOPE USED IN THE SCAN. THE PACKED COLLAGEN FIBERS ARRANGED IN THE SAME PLANE
NURSE COULD THEN VISIT WITH THE CLIENT WHO HAD FOR ADDITIONAL STRENGTH. THEY CONNECT THE MUSCLE
QUESTIONS ABOUT THE UPCOMING MRI. SHEATH TO ADJACENT BONE.

THE NURSE IS PERFORMING A MEDICAL HISTORY AND THE INCREASED RISK FOR FALLS IN THE OLDER ADULT IS
PHYSICAL ASSESSMENT ON AN OLDER CLIENT. WHICH MOST LIKELY DUE TO
COMMON FINDINGS IN THE OLDER CLIENT ARE RELATED TO
THE MUSCULOSKELETAL SYSTEM? (SELECT ALL THAT APPLY.) A. CHANGES IN BALANCE.
A. DECREASE IN BONE DENSITY
B. DECREASE IN FALLS DUE TO LACK OF ACTIVITY B. DECREASE IN BONE MASS.
C. ATROPHY OF THE MUSCLE TISSUE
D. DECREASE IN BONE PROMINENCE C. LOSS OF LIGAMENT ELASTICITY.
E. DEGENERATION OF CARTILAGE
F. REDUCED RANGE OF MOTION OF THE JOINTS D. EROSION OF ARTICULAR CARTILAGE.
ANS: A, C, E, F CORRECT ANSWER: A
IN THE OLDER ADULT, COMMON FINDINGS INCLUDE A RATIONALE: AGING CAN CAUSE CHANGES IN A PERSON'S
DECREASE IN BONE DENSITY, ATROPHY OF MUSCLE TISSUE, SENSE OF BALANCE, MAKING THE PERSON UNSTEADY, AND
CARTILAGE DEGENERATION, AND A DECREASE IN RANGE OF PROPRIOCEPTION MAY BE ALTERED. THE RISK FOR FALLS
ALSO INCREASES IN OLDER ADULTS PARTLY BECAUSE OF A PATIENT WAS INJECTED AT 9:00 AM, THE PROCEDURE
LOSS OF STRENGTH. SHOULD BE DONE AT 11:00 AM. 10:00 AM WOULD BE TOO
EARLY; 1:00 PM AND 9:30 PM WOULD BE TOO LATE.

WHILE OBTAINING SUBJECTIVE ASSESSMENT DATA RELATED

TO THE MUSCULOSKELETAL SYSTEM, IT IS PARTICULARLY A 54-YEAR-OLD PATIENT IS ABOUT TO HAVE A BONE SCAN. IN
IMPORTANT TO ASK A PATIENT ABOUT OTHER MEDICAL TEACHING THE PATIENT ABOUT THIS PROCEDURE, THE NURSE
PROBLEMS SUCH AS SHOULD INCLUDE WHAT INFORMATION?

A. HYPERTENSION. A. TWO ADDITIONAL FOLLOW-UP SCANS WILL BE REQUIRED.

B. THERE WILL BE ONLY MILD PAIN ASSOCIATED WITH THE
B. THYROID PROBLEMS. PROCEDURE.
C. THE PROCEDURE TAKES APPROXIMATELY 15 TO 30
C. DIABETES MELLITUS. MINUTES TO COMPLETE.
D. THE PATIENT WILL BE ASKED TO DRINK INCREASED FLUIDS
D. CHRONIC BRONCHITIS. AFTER THE PROCEDURE.
CORRECT ANSWER: C D
RATIONALE: THE NURSE SHOULD QUESTION THE PATIENT
ABOUT PAST MEDICAL PROBLEMS BECAUSE CERTAIN PATIENTS ARE ASKED TO DRINK INCREASED FLUIDS AFTER A
ILLNESSES ARE KNOWN TO AFFECT THE MUSCULOSKELETAL BONE SCAN TO AID IN EXCRETION OF THE RADIOISOTOPE, IF
SYSTEM DIRECTLY OR INDIRECTLY. THESE DISEASES INCLUDE NOT CONTRAINDICATED BY ANOTHER CONDITION. NO
TUBERCULOSIS, POLIOMYELITIS, DIABETES MELLITUS, FOLLOW-UP SCANS AND NO PAIN ARE ASSOCIATED WITH
PARATHYROID PROBLEMS, HEMOPHILIA, RICKETS, SOFT BONE SCANS THAT TAKE 1 HOUR OF LYING SUPINE.
TISSUE INFECTION, AND NEUROMUSCULAR DISABILITIES.

MUSCULOSKELETAL ASSESSMENT IS AN IMPORTANT

WHEN GRADING MUSCLE STRENGTH, THE NURSE RECORDS A COMPONENT OF CARE FOR PATIENTS ON WHAT TYPE OF
SCORE OF 3, WHICH INDICATES LONG-TERM THERAPY?

A. NO DETECTION OF MUSCULAR CONTRACTION. A. CORTICOSTEROIDS

B. Β-ADRENERGIC BLOCKERS
B. A BARELY DETECTABLE FLICKER OF CONTRACTION. C. ANTIPLATELET AGGREGATORS
D. CALCIUM-CHANNEL BLOCKERS
C. ACTIVE MOVEMENT AGAINST FULL RESISTANCE WITHOUT A
FATIGUE.
CORTICOSTEROIDS ARE ASSOCIATED WITH AVASCULAR
D. ACTIVE MOVEMENT AGAINST GRAVITY BUT NOT AGAINST NECROSIS AND DECREASED BONE AND MUSCLE MASS. Β-
RESISTANCE. BLOCKERS, CALCIUM-CHANNEL BLOCKERS, AND
CORRECT ANSWER: D ANTIPLATELET AGGREGATORS ARE NOT COMMONLY
RATIONALE: MUSCLE STRENGTH SCORE OF 3 INDICATES ASSOCIATED WITH DAMAGE TO THE MUSCULOSKELETAL
ACTIVE MOVEMENT ONLY AGAINST GRAVITY AND NOT SYSTEM.
AGAINST RESISTANCE (SEE TABLE 62-4).

A FEMALE PATIENT WITH A LONG-STANDING HISTORY OF

A NORMAL ASSESSMENT FINDING OF THE MUSCULOSKELETAL RHEUMATOID ARTHRITIS HAS SOUGHT CARE BECAUSE OF
SYSTEM IS INCREASING STIFFNESS IN HER RIGHT KNEE THAT HAS
CULMINATED IN COMPLETE FIXATION OF THE JOINT. THE
A. NO DEFORMITY OR CREPITATION. NURSE WOULD DOCUMENT THE PRESENCE OF WHICH
PROBLEM?
B. MUSCLE AND BONE STRENGTH OF 4.
A. ATROPHY
C. ULNAR DEVIATION AND SUBLUXATION. B. ANKYLOSIS
C. CREPITATION
D. ANGULATION OF BONE TOWARD MIDLINE. D. CONTRACTURE
CORRECT ANSWER: A B
RATIONALE: NORMAL PHYSICAL ASSESSMENT FINDINGS OF
THE MUSCULOSKELETAL SYSTEM INCLUDE NORMAL SPINAL ANKYLOSIS IS STIFFNESS OR FIXATION OF A JOINT, WHEREAS
CURVATURES; NO MUSCLE ATROPHY OR ASYMMETRY; NO CONTRACTURE IS REDUCED MOVEMENT AS A CONSEQUENCE
JOINT SWELLING, DEFORMITY, OR CREPITATION; NO OF FIBROSIS OF SOFT TISSUE (MUSCLES, LIGAMENTS, OR
TENDERNESS ON PALPATION OF MUSCLES AND JOINTS; FULL TENDONS). ATROPHY IS A FLABBY APPEARANCE OF MUSCLE
RANGE OF MOTION OF ALL JOINTS WITHOUT PAIN OR LAXITY; LEADING TO DECREASED FUNCTION AND TONE. CREPITATION
AND MUSCLE STRENGTH SCORE OF 5. IS A GRATING OR CRACKLING SOUND THAT ACCOMPANIES
MOVEMENT.

A PATIENT IS SCHEDULED FOR AN ELECTROMYOGRAM (EMG).

THE NURSE EXPLAINS THAT THIS DIAGNOSTIC TEST INVOLVES THE NURSE IS PERFORMING A MUSCULOSKELETAL
ASSESSMENT OF AN 81-YEAR-OLD FEMALE PATIENT WHOSE
A. INCISION OR PUNCTURE OF THE JOINT CAPSULE. MOBILITY HAS BEEN PROGRESSIVELY DECREASING IN RECENT
MONTHS. HOW SHOULD THE NURSE BEST ASSESS THE
B. INSERTION OF SMALL NEEDLES INTO CERTAIN MUSCLES. PATIENT'S RANGE OF MOTION (ROM) IN THE AFFECTED LEG?

C. ADMINISTRATION OF A RADIOISOTOPE BEFORE THE A. OBSERVE THE PATIENT'S UNASSISTED ROM IN THE
PROCEDURE. AFFECTED LEG.
B. PERFORM PASSIVE ROM, ASKING THE PATIENT TO REPORT
D. PLACEMENT OF SKIN ELECTRODES TO RECORD MUSCLE ANY PAIN.
ACTIVITY. C. ASK THE PATIENT TO LIFT PROGRESSIVE WEIGHTS WITH
CORRECT ANSWER: B THE AFFECTED LEG.
RATIONALE: ELECTROMYOGRAPHY (EMG) IS AN EVALUATION D. MOVE BOTH OF THE PATIENT'S LEGS FROM A SUPINE
OF ELECTRICAL POTENTIAL ASSOCIATED WITH SKELETAL POSITION TO FULL FLEXION.
MUSCLE CONTRACTION. SMALL-GAUGE NEEDLES ARE A
INSERTED INTO CERTAIN MUSCLES AND ATTACHED TO LEADS
THAT RECORD ELECTRICAL ACTIVITY OF MUSCLE. RESULTS PASSIVE ROM SHOULD BE PERFORMED WITH EXTREME
PROVIDE INFORMATION RELATED TO LOWER MOTOR NEURON CAUTION AND MAY BE BEST AVOIDED WHEN ASSESSING
DYSFUNCTION AND PRIMARY MUSCLE DISEASE. OLDER PATIENTS. OBSERVING THE PATIENT'S ACTIVE ROM IS
MORE ACCURATE AND SAFE THAN ASKING THE PATIENT TO
LIFT WEIGHTS WITH HER LEGS.
A 54-YEAR-OLD PATIENT ADMITTED WITH CELLULITIS AND
PROBABLE OSTEOMYELITIS RECEIVED AN INJECTION OF
RADIOISOTOPE AT 9:00 AM BEFORE A BONE SCAN. THE IN REVIEWING BONE REMODELING, WHAT SHOULD THE
NURSE SHOULD PLAN TO SEND THE PATIENT FOR THE BONE NURSE KNOW ABOUT THE INVOLVEMENT OF BONE CELLS?
SCAN AT WHAT TIME?
A. OSTEOCLASTS ADD CANALICULI.
A. 9:30 PM B. OSTEOBLASTS DEPOSIT NEW BONE.
B. 10:00 AM C. OSTEOCYTES ARE MATURE BONE CELLS.
C. 11:00 AM D. OSTEONS CREATE A DENSE BONE STRUCTURE.
D. 1:00 PM B
C
BONE REMODELING IS ACHIEVED WHEN OSTEOCLASTS
A TECHNICIAN USUALLY ADMINISTERS A CALCULATED DOSE REMOVE OLD BONE AND OSTEOBLASTS DEPOSIT NEW BONE.
OF A RADIOISOTOPE 2 HOURS BEFORE A BONE SCAN. IF THE OSTEOCYTES ARE MATURE BONE CELLS, AND OSTEONS OR
HAVERSIAN SYSTEMS CREATE A DENSE BONE STRUCTURE,
BUT THESE ARE NOT INVOLVED WITH BONE REMODELING.
THE HOME CARE NURSE VISITS AN 84-YEAR-OLD WOMAN
WITH PNEUMONIA AFTER HER DISCHARGE FROM THE
WHEN WORKING WITH PATIENTS, THE NURSE KNOWS THAT HOSPITAL. WHICH ASSESSMENT FINDING WOULD THE NURSE
PATIENTS HAVE THE MOST DIFFICULTIES WITH DIARTHRODIAL EXPECT BECAUSE OF AGE-RELATED CHANGES IN THE
JOINTS. WHICH JOINTS ARE INCLUDED IN THIS GROUP OF MUSCULOSKELETAL SYSTEM?
JOINTS (SELECT ALL THAT APPLY)?
A. POSITIVE STRAIGHT-LEG-RAISING TEST
A. HINGE JOINT OF THE KNEE B. MUSCLE STRENGTH IS SCALE GRADE 3/5
B. LIGAMENTS JOINING THE VERTEBRAE C. LATERAL S-SHAPED CURVATURE OF THE SPINE
C. FIBROUS CONNECTIVE TISSUE OF THE SKULL D. FINGERS DRIFT TO THE ULNAR SIDE OF THE FOREARM
D. BALL AND SOCKET JOINT OF THE SHOULDER OR HIP B
E. CARTILAGINOUS CONNECTIVE TISSUE OF THE PUBIS JOINT
A, D DECREASED MUSCLE STRENGTH IS AN AGE-RELATED CHANGE
OF THE MUSCULOSKELETAL SYSTEM CAUSED BY DECREASED
THE DIARTHRODIAL JOINTS INCLUDE THE HINGE JOINT OF THE NUMBER AND SIZE OF THE MUSCLE CELLS. THE OTHER
KNEE AND ELBOW, THE BALL AND SOCKET JOINT OF THE ASSESSMENT FINDINGS INDICATE MUSCULOSKELETAL
SHOULDER AND HIP, THE PIVOT JOINT OF THE RADIOULNAR ABNORMALITIES. A POSITIVE STRAIGHT-LEG-RAISING TEST
JOINT, AND THE CONDYLOID, SADDLE, AND GLIDING JOINTS INDICATES NERVE ROOT IRRITATION FROM INTERVERTEBRAL
OF THE WRIST AND HAND. THE LIGAMENTS AND DISK PROLAPSE AND HERNIATION. AN ULNAR DEVIATION OR
CARTILAGINOUS CONNECTIVE TISSUE JOINING THE DRIFT INDICATES RHEUMATOID ARTHRITIS DUE TO TENDON
VERTEBRAE AND PUBIS JOINT AND THE FIBROUS CONNECTIVE CONTRACTURE. SCOLIOSIS IS A LATERAL CURVATURE OF THE
TISSUE OF THE SKULL ARE SYNARTHROTIC JOINTS SPINE.

AN 82-YEAR-OLD PATIENT IS FRUSTRATED BY HER FLABBY THE NURSE ADMITS A 55-YEAR-OLD FEMALE WITH MULTIPLE
BELLY AND RIGID HIPS. WHAT SHOULD THE NURSE TELL THE SCLEROSIS TO A LONG-TERM CARE FACILITY. WHICH FINDING
PATIENT ABOUT THESE FRUSTRATIONS? IS OF MOST IMMEDIATE CONCERN TO THE NURSE?

A. "YOU SHOULD GO ON A DIET AND EXERCISE MORE TO FEEL A. ATAXIC GAIT

BETTER ABOUT YOURSELF." B. RADICULAR PAIN
B. "SOMETHING MUST BE WRONG WITH YOU BECAUSE YOU C. SEVERE FATIGUE
SHOULD NOT HAVE THESE PROBLEMS." D. URINARY RETENTION
C. "YOU HAVE ARTHRITIS AND NEED TO GO ON A
NONSTEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS)."
D. "DECREASED MUSCLE MASS AND STRENGTH AND AN ATAXIC GAIT IS A STAGGERING, UNCOORDINATED GAIT.
INCREASED HIP RIGIDITY ARE NORMAL CHANGES OF AGING." FALL RISK IS THE HIGHEST IN INDIVIDUALS WITH GAIT
D INSTABILITY OR VISUAL OR COGNITIVE IMPAIRMENTS. THE
OTHER SIGNS AND SYMPTOMS (E.G., FATIGUE, URINARY
THE MUSCULOSKELETAL SYSTEM'S NORMAL CHANGES OF RETENTION, RADICULAR PAIN) MAY ALSO OCCUR IN THE
AGING INCLUDE DECREASED MUSCLE MASS AND STRENGTH; PATIENT WITH MULTIPLE SCLEROSIS AND NEED TO BE
INCREASED RIGIDITY IN THE HIPS, NECK, SHOULDERS, BACK, MANAGED, BUT ARE NOT THE PRIORITY.
AND KNEES; DECREASED FINE MOTOR DEXTERITY; AND
SLOWED REACTION TIMES. GOING ON A DIET AND
EXERCISING WILL HELP BUT NOT STOP THESE CHANGES. A 57-YEAR-OLD POSTMENOPAUSAL WOMAN IS SCHEDULED
TELLING THE PATIENT "SOMETHING MUST BE WRONG WITH FOR DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA). WHICH
YOU..." WILL NOT BE HELPFUL TO THE PATIENT'S STATEMENT, IF MADE BY THE PATIENT TO THE NURSE,
FRUSTRATIONS. INDICATES UNDERSTANDING OF THE PROCEDURE?

A. "THE BONE DENSITY IN MY HEEL WILL BE MEASURED."

A 50-YEAR-OLD PATIENT IS REPORTING A SORE SHOULDER B. "THIS PROCEDURE WILL NOT CAUSE ANY PAIN OR
AFTER RAKING THE YARD. THE NURSE SHOULD SUSPECT DISCOMFORT."
WHICH PROBLEM? C. "I WILL NOT BE EXPOSED TO ANY RADIATION DURING THE
PROCEDURE."
A. BURSITIS D. "I WILL NEED TO REMOVE MY HEARING AIDS BEFORE THE
B. FASCIITIS PROCEDURE."
C. SPRAINED LIGAMENT B
D. ACHILLES TENDONITIS
A DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA) IS PAINLESS
AND MEASURES THE BONE MASS OF SPINE, FEMUR,
BURSITIS IS COMMON IN ADULTS OVER AGE 40 AND WITH FOREARM, AND TOTAL BODY WITH MINIMAL RADIATION
REPETITIVE MOTION, SUCH AS RAKING. PLANTAR FASCIITIS EXPOSURE. A QUANTITATIVE ULTRASOUND (QUS) EVALUATES
FREQUENTLY OCCURS AS A STABBING PAIN AT THE HEEL DENSITY, ELASTICITY, AND STRENGTH OF BONE USING
CAUSED BY STRAINING THE LIGAMENT THAT SUPPORTS THE ULTRASOUND OF THE CALCANEUS (HEEL). MAGNETIC
ARCH. ACHILLES TENDONITIS IS AN INFLAMMATION OF THE RESONANCE IMAGING WOULD REQUIRE REMOVAL OF
TENDON THAT ATTACHES THE CALF MUSCLE TO THE HEEL OBJECTS SUCH AS HEARING AIDS THAT HAVE METAL PARTS.
BONE, NOT THE SHOULDER, AND CAUSES PAIN WITH
WALKING OR RUNNING. A SPRAINED LIGAMENT OCCURS
WHEN A LIGAMENT IS STRETCHED OR TORN FROM A DIRECT A 42-YEAR-OLD MAN WHO IS SCHEDULED FOR AN
INJURY OR SUDDEN TWISTING OF THE JOINT, NOT REPETITIVE ARTHROCENTESIS ARRIVES AT THE OUTPATIENT SURGERY
MOTION. UNIT AND STATES, "I DO NOT WANT THIS PROCEDURE DONE
TODAY." WHICH RESPONSE BY THE NURSE IS MOST
APPROPRIATE?
A 63-YEAR-OLD WOMAN HAS BEEN TAKING PREDNISONE
(DELTASONE) DAILY FOR SEVERAL YEARS AFTER A KIDNEY A. "WHEN WOULD YOU LIKE TO RESCHEDULE THE
TRANSPLANT TO PREVENT ORGAN REJECTION. WHAT IS MOST PROCEDURE?"
IMPORTANT FOR THE NURSE TO ASSESS? B. "TELL ME WHAT YOUR CONCERNS ARE ABOUT THIS
PROCEDURE."
A. STAGGERING GAIT C. "THE PROCEDURE IS SAFE, SO WHY SHOULD YOU BE
B. RUPTURED TENDON WORRIED?"
C. BACK OR NECK PAIN D. "THE PROCEDURE IS NOT PAINFUL BECAUSE AN
D. TARDIVE DYSKINESIA ANESTHETIC IS USED."
C B

OSTEOPOROSIS WITH RESULTANT FRACTURES IS A FREQUENT THE NURSE SHOULD USE THERAPEUTIC COMMUNICATION TO
AND SERIOUS COMPLICATION OF SYSTEMIC CORTICOSTEROID DETERMINE THE PATIENT'S CONCERN ABOUT THE
THERAPY. THE RIBS AND VERTEBRAE ARE AFFECTED THE PROCEDURE. THE NURSE SHOULD NOT PROVIDE FALSE
MOST, AND PATIENTS SHOULD BE OBSERVED FOR SIGNS OF REASSURANCE. IT IS NOT APPROPRIATE FOR THE NURSE TO
COMPRESSION FRACTURES (BACK AND NECK PAIN). ASSUME THE PATIENT IS CONCERNED ABOUT PAIN OR TO
PHENYTOIN (DILANTIN) IS AN ANTISEIZURE MEDICATION. AN ASSUME THE PATIENT IS ASKING TO RESCHEDULE THE
ADVERSE EFFECT OF PHENYTOIN IS AN ATAXIC (OR PROCEDURE.
STAGGERING) GAIT. A RARE ADVERSE EFFECT OF
CIPROFLOXACIN (CIPRO) AND OTHER FLUOROQUINOLONES IS
TENDON RUPTURE, USUALLY OF THE ACHILLES TENDON. THE
HIGHEST RISK IS IN PEOPLE AGE 60 AND OLDER AND IN
PEOPLE TAKING CORTICOSTEROIDS. ANTIPSYCHOTICS AND
ANTIDEPRESSANTS MAY CAUSE TARDIVE DYSKINESIA, WHICH
IS CHARACTERIZED BY INVOLUNTARY MOVEMENTS OF THE
TONGUE AND FACE.