- A nurse is caring for a client who has had a plaster arm cast applied. Immediately after
application, the nurse should provide what teaching to the client?
A. The cast will feel cool to touch for the first 30 minutes.
B. The cast should be wrapped snuggly with a towel until the client gets home.
C. The cast should be supported on a board while drying.
D. The cast will only have full strength when dry.
ANS: D
Rationale: A cast requires approximately 24 to 72 hours to dry, and until dry, it does not
have full strength. While drying, the cast should not be placed on a hard surface. The cast
will exude heat while it dries and should not be wrapped.
- A client is admitted to the orthopedic unit in skeletal traction for a fractured proximal
femur. Which explanation should the nurse give the client about skeletal traction?
A. “Skeletal traction temporarily stabilizes the fracture before surgery.”
B. “Weights are attached to the leg using a boot.”
C. “Traction involves passing a pin through the bone.”
D. “Light weights must be used with skeletal traction.”
ANS: C
Rationale: In skeletal traction, a metal pin or wire is passed through the bone and
traction is then applied using ropes and weights attached to the pins. Skin traction,
not
skeletal traction, stabilizes the fracture until surgery is performed and uses a boot or
Velcro to attach the ropes and weights to the leg. Skeletal traction is used when greater
weight (11 to 18 kg [25 to 40 lb]) is needed to achieve the therapeutic effect.
- A nurse is caring for a client who is postoperative day 1 following a total arthroplasty
of the right hip. How should the nurse position the client?
A. Place a pillow between the legs.
B. Turn the client on the surgical side.
C. Avoid flexion of the right hip.
D. Keep the right hip adducted at all times.
ANS: A
Rationale: The hips should be kept in abduction by a pillow placed between the legs.
When positioning the client in bed, the nurse should avoid placing the client on the
operated hip. The right hip should not be flexed more than 90 degrees to avoid
dislocation. The right hip should be maintained in an abducted position.
- A client was brought to the emergency department after a fall. The client is taken to
the operating room to receive a right hip prosthesis. In the immediate postoperative
period, what health education should the nurse emphasize?
A. “Make sure you don’t bring your knees close together.”
B. “Try to lie as still as possible for the first few days.”
C. “Try to avoid bending your knees until next week.”
D. “Keep your legs higher than your chest whenever you can.”
ANS: A
Rationale: After receiving a hip prosthesis, the affected leg should be kept abducted.
Mobility should be encouraged within safe limits. There is no need to avoid knee flexion
and the client’s legs do not need to be higher than the level of the chest.
- A client with a total hip replacement has developed decreased breath sounds What is
the nurse’s best action?
A. Place the client on bed rest.
B. Request an antitussive medication from the health care provider.
C. Encourage use of the incentive spirometer.
D. Assess for signs and symptoms of systemic infection.
ANS: C
Rationale: Atelectasis may occur in the client after surgery and can be prevented with the
use of an incentive spirometer. Since bedrest increases the risk for atelectasis and
pneumonia after surgery, the client should be encouraged to ambulate and sit up in a
chair rather than lie in bed. Since the client should be encouraged to deep breath and
cough, requesting an antitussive medication for the client would not be appropriate.
Atelectasis is not a clinical manifestation of infection.
- A nurse is caring for a client who has a leg cast. The nurse observes the client using a
pencil to scratch the skin under the edge of the cast. How should the nurse respond to
this observation?
A. Allow the client to gently scratch inside the cast with a pencil.
B. Give the client a sterile tongue depressor to use for scratching instead of the
pencil.
C. Provide a fan to blow cool air into the cast to relieve itching,
D. Obtain a prescription for a sedative, such as lorazepam, to prevent the client
from scratching.
ANS: C
Rationale: The client may receive relief from itching by using a fan or hair dryer to blow
cool air into the cast. Scratching should be discouraged using a pencil or a sterile tongue
depressor because of the risk for skin breakdown or damage to the cast. Benzodiazepines
would not be given for this purpose.
- The nurse educator on an orthopedic trauma unit is reviewing the safe and effective
use of traction with some recent nursing graduates. What principle should the educator
promote?
A. Knots in the rope should not be resting against pulleys.
B. Weights should rest against the bed rails.
C. The end of the limb in traction should be braced by the footboard of the bed.
D. Skeletal traction may be removed for brief periods to facilitate the client’s
independence.
ANS: A
Rationale: Knots in the rope should not rest against pulleys because this interferes with
traction. Weights are used to apply the vector of force necessary to achieve effective
traction and should hang freely at all times. To avoid interrupting traction, the limb in
traction should not rest against anything. Skeletal traction is never interrupted.
- The nursing care plan for a client in traction specifies regular assessments for venous
thromboembolism (VTE). When assessing a client’s lower limbs, what sign or symptom is
suggestive of deep vein thrombosis (DVT)?
A. Increased warmth of the calf
B. Decreased circumference of the calf
C. Loss of sensation to the calf
D. Pale-appearing calf
ANS: A
Rationale: Signs of DVT include increased warmth, redness, swelling, and calf
tenderness. These findings are promptly reported to the health care provider for
definitive evaluation and therapy. Signs and symptoms of a DVT do not include a
decreased circumference of the calf, a loss of sensation in the calf, or a pale-appearing
calf.
- A client with a right tibial fracture is being discharged home after having a cast applied.
What instruction should the nurse provide in relationship to the client’s cast care?
A. “Cover the cast with a blanket until the cast dries.”
B. “Keep your right leg elevated above heart level.”
C. “Use a clean object to scratch itches inside the cast.”
D. “A foul smell from the cast is normal after the first few days.”
ANS: B
Rationale: The leg should be elevated to promote venous return and prevent edema. The
cast shouldn’t be covered while drying because this will cause heat buildup and prevent
air circulation. No foreign object should be inserted inside the cast because of the risk of
cutting the skin and causing an infection. A foul smell from a cast is never normal and
may indicate an infection.
- A nurse is caring for a client who has had a total hip replacement. The nurse is
reviewing health education prior to discharge. Which of the client’s statements would
indicate to the nurse that the client requires further teaching?
A. “I’ll need to keep several pillows between my legs at night.”
B. “I need to remember not to cross my legs. It’s such a habit.”
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 the low toilet seat at home.”
ANS: D
Rationale: To prevent hip dislocation after a total hip replacement, the client must avoid
bending the hips 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 several
pillows between the legs reduces the risk of hip dislocation by preventing adduction and
internal rotation of the legs. Likewise, teaching the client to avoid crossing the legs also
reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing
the hips beyond 90 degrees.
- A client has suffered a muscle strain and is reporting pain at 6 on a 10-point scale.
The nurse should recommend what action?
A. Taking an opioid analgesic as prescribed
B. Applying a cold pack to the injured site
C. Performing passive ROM exercises
D. Applying a heating pad to the affected muscle
ANS: B
Rationale: Most pain can be relieved by elevating the involved part, applying cold packs,
and administering analgesics as prescribed. Heat may exacerbate the pain by increasing
blood circulation, and ROM exercises would likely be painful. Analgesia is likely
necessary, but NSAIDs would be more appropriate than opioids.
- A nurse is assessing the neurovascular status of a client who has had a leg cast
recently applied. The nurse is unable to palpate the client’s dorsalis pedis or posterior
tibial pulse and the client’s foot is pale. What is the nurse’s most appropriate action?
A. Warm the client’s foot and determine whether circulation improves.
B. Reposition the client with the affected foot dependent.
C. Reassess the client’s neurovascular status in 15 minutes.
D. Promptly inform the primary care provider.
ANS: D
Rationale: Signs of neurovascular dysfunction warrant immediate medical follow-up. It
would be unsafe to delay. Warming the foot or repositioning the client may be of some
benefit, but the care provider should be informed first.
- A client has just begun been receiving skeletal traction and the nurse is aware that
muscles in the client’s affected limb are spastic. How does this change in muscle tone
affect the client’s traction prescription?
A. Traction must temporarily be aligned in a slightly different direction.
B. Extra weight is needed initially to keep the limb in proper alignment.
C. A lighter weight should be initially used.
D. Weight will temporarily alternate between heavier and lighter weights.
ANS: B
Rationale: The traction weights applied initially must overcome the shortening spasms of
the affected muscles. As the muscles relax, the traction weight is reduced to prevent
fracture dislocation and to promote healing. Weights never alternate between heavy and
light.
- A nurse is caring for a client receiving skeletal traction. Due to the client’s severe
limits on mobility, the nurse has identified a risk for atelectasis or pneumonia. What
intervention should the nurse provide in order to prevent these complications?
A. Perform chest physiotherapy once per shift and as needed.
B. Teach the client to perform deep breathing and coughing exercises.
C. Administer prophylactic antibiotics as prescribed.
D. Administer nebulized bronchodilators and corticosteroids as prescribed.
ANS: B
Rationale: To prevent these complications, the nurse should educate the client about
performing deep-breathing and coughing exercises to aid in fully expanding the lungs
and clearing pulmonary secretions. Antibiotics, bronchodilators, and steroids are not
used on a preventative basis, and chest physiotherapy is unnecessary and implausible for
a client in traction.
- A client who had a total hip replacement two days ago reports new onset calf
tenderness to the nurse. Which action should the nurse take?
A. Administer pain medication.
B. Massage the client’s calf.
C. Apply antiembolic stockings.
D. Notify the health care provider.
ANS: D
Rationale: Since calf tenderness may be a sign of deep vein thrombosis (DVT), the nurse
should notify the health care provider about this finding. The nurse should not administer
pain medication since it is prescribed for surgical pain and this tenderness in the calf
should not be masked until it is evaluated. The nurse should not massage the client’s calf
as this may dislodge a thrombus. Antiembolic stockings should be worn prophylactically
to prevent DVT but are not applied to treat DVT.
- A nurse is assessing a client who is receiving traction. The nurse’s assessment
confirms that the client is able to perform plantar flexion. What conclusion can the nurse
draw from this finding?
A. The leg that was assessed is free from DVT.
B. The client’s tibial nerve is functional.
C. Circulation to the distal extremity is adequate.
D. The client does not have peripheral neurovascular dysfunction.
ANS: B
Rationale: Plantar flexion demonstrates function of the tibial nerve. It does not
demonstrate the absence of DVT and does not allow the nurse to ascertain adequate
circulation. The nurse must perform more assessments on more sites in order to
determine an absence of peripheral neurovascular dysfunction.
- A nurse is caring for an older adult client who is preparing for discharge following
recovery from a total hip replacement. What outcome must be met prior to discharge?
A. Client is able to perform ADLs independently.
B. Client is able to perform transfers safely.
C. Client is able to weight-bear equally on both legs.
D. Client is able to demonstrate full ROM of the affected hip.
ANS: B
Rationale: The client must be able to perform transfers and to use mobility aids safely.
Each of the other listed goals is unrealistic for the client who has undergone recent hip
replacement.
- A client has recently been admitted to the orthopedic unit following total hip
arthroplasty. The nurse assesses that the indwelling urinary catheter was removed one
hour ago in the post-anesthesia care unit and that the client has not yet voided. Which
action should the nurse take?
A. Inform the primary provider promptly.
B. Ask if the client needs to void.
C. Perform intermittent catheterization.
D. Obtain an order to reinsert the indwelling urinary catheter.
ANS: B
Rationale: Since the indwelling urinary catheter was removed one hour earlier, the client
would be expected to void within the next five hours (six hours after removal of the
catheter). The nurse should ask the client if there is an urge to void. If the client does not
feel the urge to void, the nurse should check periodically over the next 5 hours. Since not
voiding within one hour of catheter removal is within normal, the nurse does not need to
inform the health care provider, perform intermittent catheterization, or obtain an order
to insert an indwelling catheter.
- A 91-year-old client is slated for orthopedic surgery and the nurse is integrating
gerontologic considerations into the client’s plan of care. What intervention is most
justified in the care of this client?
A. Administration of prophylactic antibiotics
B. Total parenteral nutrition (TPN)
C. Use of a pressure-relieving mattress
D. Use of a Foley catheter until discharge
ANS: C
Rationale: Older adults have a heightened risk of skin breakdown; use of a
pressure-reducing mattress addresses this risk. Older adults do not necessarily need TPN
and the Foley catheter should be discontinued as soon as possible to prevent urinary tract
infections. Prophylactic antibiotics are not a standard infection prevention measure.
- The nurse is teaching the client on bed rest to perform quadriceps setting exercises.
Which instruction should the nurse give the client?
A. “Push the knees into the mattress.”
B. “Lie prone in bed.”
C. “Contract the buttock muscles.”
D. “Bend the knees.”
ANS: A
Rationale: To perform quadriceps setting exercises, the client lies in the supine (face up)
position with legs extended, and pushes the knees into the bed while contracting the
anterior thigh muscles. The client does not lie prone (face down), contract the buttocks,
or bend the knees.
- A nurse admits a client who has a fracture of the nose that has resulted in a skin tear
and involvement of the mucous membranes of the nasal passages. The orthopedic nurse
should plan to care for what type of fracture?
A. Compression
B. Compound
C. Impacted
D. Transverse
ANS: B
Rationale: A compound fracture involves damage to the skin or mucous membranes and
is also called an open fracture. A compression fracture involves compression of bone and
is seen in vertebral fractures. An impacted fracture occurs when a bone fragment is
driven into another bone fragment. A transverse fracture occurs straight across the bone
shaft.
- A nurse’s assessment of a client’s knee reveals edema, tenderness, muscle spasms,
and ecchymosis. The client states that 2 days ago the client ran in a long-distance race
and now it “really hurts to stand up.” The nurse should plan care based on the belief that
the client has experienced what injury?
A. A first-degree strain
B. A second-degree strain
C. A first-degree sprain
D. A second-degree sprain
ANS: B
Rationale: A second-degree strain involves tearing of muscle fibers and is manifested by
notable loss of load-bearing strength with accompanying edema, tenderness, muscle
spasm, and ecchymosis. A first-degree strain reflects tearing of a few muscle fibers and
is accompanied by minor edema, tenderness, and mild muscle spasm, without noticeable
loss of function. However, this client states a loss of function. A sprain normally involves
twisting, which is inconsistent with the client’s overuse injury.
- A nurse is writing a care plan for a client admitted to the emergency department (ED)
with an open fracture. The nurse will assign priority to what nursing diagnosis for a client
with an open fracture of the radius?
A. Risk for infection
B. Risk for ineffective role performance
C. Risk for perioperative positioning injury
D. Risk for powerlessness
ANS: A
Rationale: The client has a significant risk for osteomyelitis and tetanus due to the fact
that the fracture is open. Powerlessness and ineffective role performance are
psychosocial diagnoses that may or may not apply, and which would be superseded by
immediate physiologic threats such as infection. Surgical positioning injury is not
plausible, since surgery is not likely indicated.
- A nurse is caring for a client who has suffered an unstable thoracolumbar fracture.
What goal should the nurse prioritize during nursing care?
A. Preventing skin breakdown
B. Maintaining spinal alignment
C. Maximizing function
D. Preventing increased intracranial pressure
ANS: B
Rationale: Clients with an unstable fracture must have their spine in alignment at all
times in order to prevent neurologic damage. This is a greater threat, and higher priority,
than promoting function and preventing skin breakdown, even though these are both
valid considerations. Increased ICP is not a high risk.
