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1. The nurse has given the client instructions about crutch safety. Which statements indicate
that the client understands the instructions? Select all that apply.
1. "I should not use someone else's crutches."
2. "I need to remove any scatter rugs at home."
3. "I can use crutch tips even when they are wet."
4. "I need to have spare crutches and tips available."
5. "When I'm using the crutches, my arms need to be completely straight."
A. 1,2,3
B. 1,2,4
C. 1,2,5
D. ALL OF THE ABOVE

2. The nurse is caring for a client being treated for fat embolus after multiple fractures. Which
data would the nurse evaluate as the most favorable indication of resolution of the fat
embolus?
A. Clear mentation
B. Minimal dyspnea
C. Oxygen saturation of 85%
D. Arterial oxygen level of 78 mm Hg

3. The nurse has conducted teaching with a client in an arm cast about the signs and symptoms
of compartment syndrome. The nurse determines that the client understands the information if
the client states that he or she should report which early symptom of compartment syndrome?
A. Cold, bluish-colored fingers
B. Numbness and tingling in the fingers
C. Pain that increases when the arm is dependent
D. Pain that is out of proportion to the severity of the fracture

4. A client with diabetes mellitus has had a right below-knee amputation. Given the client's
history of diabetes mellitus, which complication is the client at most risk for after surgery?
A. Hemorrhage
B. Edema of the residual limb
C. Slight redness of the incision
D. Separation of the wound edges

5. The nurse is caring for a client who had an above-knee amputation 2 days ago, The residual
limb was wrapped with an elastic compression bandage, which has come off. Which
immediate action should the nurse take?
A. Apply ice to the site.
B. Call the primary health care provider (PHCP).
C. Rewrap the residual limb with an elastic compression bandage.
D. Apply a dry, sterile dressing and elevate the residual limb on 1 pillow.
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6. A client is complaining of low back pain that radiates down the left posterior thigh. The nurse
should ask the client if the pain is worsened or aggravated by which factor?
A. Bed rest
B. Ibuprofen
C. Bending or lifting
D. Application of heat

7. The nurse is caring for a client who has had spinal fusion, with insertion of hardware. The
nurse would be most concerned with which assessment finding?
A. Temperature of 101.6° F (38.7° C) orally
B. Complaints of discomfort during repositioning
C. Old bloody drainage outlined on the surgical dressing
D. Discomfort during coughing and deep-breathing exercises

8. The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the
nurse expect to note in the client?
A. Calcium level of 9.0 mg/dL (2.25 mmol/L)
B. Uric acid level of 9.0 mg/dL (540 mcmol/L)
C. Potassium level of 4.1 mEg/L (4.1 mmol/L)
D. Phosphorus level of 3.1 mg/dL (1.0 mmol/L)

9. A client with a hip fracture asks the nurse about Buck's (extension) traction that is being
applied before surgery and what is involved. The nurse should provide which information to the
client?
A. Allows bony healing to begin before surgery and involves pins and screws
B. Provides rigid immobilization of the fracture site and involves pulleys and wheels
C. Lengthens the fractured leg to prevent severing of blood vessels and involves pins and
screws
D. Provides comfort by reducing muscle spasms, provides fracture immobilization, and
involves pulleys and wheels

10. An experienced nurse observes a new nurse caring for a client in skeletal traction to
stabilize a fracture of the proximal femur prior to surgery. Which observation by the
experienced nurse indicates the new nurse needs additional orientation?
A. Positions the client so the feet stay clear of the bottom of the bed
B. Checks ropes so that they are positioned in the wheel groves of the pulleys
C. Removes weights from the ropes until the weights hang freely off the bed frame
D. Performs pin site care with chlorhexidine solution twice daily

11. In preparation for total knee surgery, a 200-lb client with osteoarthritis must lose weight.
Which of the following exercises should the nurse recommend as best if the client has no
contraindications?
A. Weight lifting.
B. Walking.
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C. Aquatic exercise.
D. Tai chi exercise.

12. Prior to surgery, the nurse is instructing a client who will have a total hip replacement
tomorrow. Which of the following information is most important to include in the teaching
plan at this time?
A. Teaching how to prevent hip flexion.
B. Demonstrating coughing and deep-breathing techniques.
C. Showing the client what an actual hip prosthesis looks like.
D. Assessing the client's fears about the procedure.

13. The client has just had a total knee replacement for severe osteoarthritis. Which of the
following assessment findings should lead the nurse to suspect possible nerve damage?
A. Numbness.
B. Bleeding.
C. Dislocation.
D. Pinkness.

14. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain
and an inability to move the extremity. The nurse correctly interprets these findings as
indicating which of the following?
A. A developing infection.
B. Bleeding in the operative site.
C. Joint dislocation.
D. Glue seepage into soft tissue.

15. A client who had a total hip replacement 2 days ago has developed an infection with a fever.
The nursing diagnosis of fluid volume deficit related to diaphoresis is made. Which of the
following is the most appropriate outcome?
A. The client drinks 2.000 mL of fluid per day.
B. The client understands how to manage the incision.
C. The client's bed linens are changed as needed.
D. The client's skin remains cool throughout hospitalization.

16. After knee arthroplasty, the client has a sequential compression device (SCO), The nurse
should do which of the following?
A. Elevate the sequential compression device (SCD) on two pillows.
B. Change the settings on the SD to make the client more comfortable.
C. Stop the SCD to remove dressings and bathe the leg.
D. Discontinue the SCD when the client is ambulatory.

17. The nurse is preparing the discharge of a client who has had a knee replacement
metal joint. The nurse should instruct the client about which of the following? Select all that
apply.
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1. Notify health care providers about the joint prior to invasive procedures,
2. Avoid use of Magnetic Resonance Imaging (MRI) scans.
3. Notify airport security that the joint may set off alarms on metal detectors.
4. Refrain from carrying items weighing more than 5 Ib.
5. Limit fluid intake to 1,000 mL/day.
A. 1,2,3
B. 2,4,5
C. 1,4,5
D. 2,35

18. Following a total hip replacement, the nurse should position the client in which of the
following ways?
A. Place weights alongside of the affected extremity to keep the extremity from rotating.
B. Elevate both feet on two pillows.
C. Keep the lower extremities adducted by use of an immobilization binder around both
legs.
D. Keep the extremity in slight abduction using an abduction splint or pillows placed
between the thighs.

19. A client who had a total hip replacement 4 days ago is worried about dislocation of the
prosthesis. The nurse should respond by saying which of the following?
A. "Don't worry. Your new hip is very strong."
B. "Use of a cushioned toilet seat helps to prevent dislocation."
C. "Activities that tend to cause adduction of the hip tend to cause dislocation, so try
to avoid them"
D. "Decreasing use of the abductor pillow will strengthen the muscles to prevent
dislocation.”

20. The nurse is assessing a client who had a left hip replacement 36 hours ago. Which of the
following indicates the prosthesis is dislocated? Select all that apply.
1. The client reported a "popping" sensation in the hip.
2. The left leg is shorter than the right leg.
3. The client has sharp pain in the groin.
4. The client cannot move his right leg.
5. The client cannot wiggle the toes on the left leg.
A. 1, 2, 3
B. 2,4,5
C. 1,4,5
D. 2,3,5

21. A 76-year-old female client complains of lower back pain and is diagnosed with
osteoporosis. The nurse is aware that this client is most at risk for which condition?
A. Pain
B. Fracture
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C. Hardening of the bones

D. Increased bone matrix and remineralization

22. A 76-year-old woman with a history of osteoporosis experienced a right hip fracture and is
admitted to the hospital. The client had a total hip replacement. The most Important nursing
diagnosis for this client would be?
A. Acute pain
B. Self-care deficit
C. Risk for impaired skin integrity
D. Imbalanced nutrition: Less than body requirements

23. The nurse is teaching a client about the risk factors of osteoporosis. It is most important for
the nurse to include which factors? Select all that apply.
1. Inadequate dietary intake of calcium
2. Blood pressure medications
3. Family history
4. Smoking
5. Oral hypoglycemics
A. 1,2,3
B. 1,3,4
C. 2,3,4
D. 2,4,5

24. The nurse is teaching the client about the primary cause of osteoporosis. What is the most
important information for the nurse to provide?
A. "Alcoholism is the primary cause of osteoporosis."
B. "Malnutrition is the primary cause of osteoporosis."
C. "Hormonal imbalance is the primary cause of osteoporosis."
D. "Osteogenesis imperfecta is the primary cause of osteoporosis."

25. A 42-year-old client recently had a total hysterectomy and bilateral oophorectomy. Which of
the following responses by the client indicates that the nurse's teaching about osteoporosis has
been effective?
A. "Osteoporosis affects only women over 65 years."
B. "My risk for osteoporosis is low because I still have my thyroid gland."
C. "I'm still producing hormones, so I don't have to worry about osteoporosis.
D. "I need to take precautions to protect myself from osteoporosis because I have had
surgically induced menopause."

26. The nurse is teaching a class on primary prevention of osteoporosis. What is the most
important information for the nurse to provide?
A. Maintain the optimal calcium intake.
B. Place items within reach of the client.
C. Install bars in the bathroom to prevent falls.
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D. Use a professional alert system in the home in case a fall occurs when the client is
alone.

27. The nurse is providing discharge teaching for a client who was hospitalized with gout. The
nurse determines that teaching was effective when the client states the need to reduce the
intake of:
A. tofu
B. liver
C. tomatoes
D. blackberries

28. The nurse is planning interventions for a client with an acute gout attack. What would the
priority intervention for this client be?
A. Instruct the client on relaxation techniques and promote bed rest.
B. Instruct the client about relaxation techniques.
C. Administer prescribed analgesics.
D. Force fluids.

29. A nurse is interviewing a client who has a pattern of nonchronic gout. Which statement by
the client best describes the pattern of nonchronic gout?
A. Frequent painful attacks
B. Generally painful joints at all times
C. Painful attacks with pain-free periods
D. Painful attacks with less painful periods, but pain never subsides

30. The health care provider has prescribed a diet that limits purine-rich foods. Which of the
following foods would the nurse teach the client to avoid eating? Select all that apply.
1. Bananas, wine, and cheese
2. Milk, ice cream, vegetables, and yogurt
3.Anchovies, sardines, and kidneys.
4. Sweetbreads and lentils
5. Meat and dried fruits
A. 1,2
B. 3, 4
C. 4, 5
D. 1,3

31. Which treatments should a nurse plan for a client being seen in the clinic for a second-
degree ankle sprain?
A. Rest, elevate the extremity, apply ice, and apply a compression bandage
B. Perform range of motion to determine the extent of injury, apply heat, check
circulation
and sensation, and examine the ankle:
C. Reduce pain with moist heat, then apply ice to reduce swelling; check circulation,
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motion, and sensation; and elevate the ankle.

D. Refer the client immediately to an orthopedic surgeon, administer analgesics, control
swelling with ice, and encourage rest and elevation.

32. A college student walking with a stiff left leg visits a campus health service reporting knee
pain and a click when walking. He is concerned because sometimes his knee either "locks" or
"gives way." He thinks he twisted his knee wrong during a tennis match, but is not sure. A nurse
suspects the client has:
A. an injury of the meniscus cartilage.
B. a fracture of the lateral tibial condyle.
C. a fractured patella,
D. a lateral collateral ligament injury

33. A client is suspected of having a fat embolism following a pelvic fracture from a motor
vehicle accident. A nurse should assess for which sign that is specific to a fat emboli?
A. Dyspnea
B. Chest pain
C. Delirium
D. Petechiae

34. Which order written by a physician should be a priority for a nurse caring for a client who
sustained an unstable pelvic fracture in a motor vehicle accident?
A. Urinalysis
B. Blood alcohol level
C. Computed tomography (CT) scan of the pelvis
D. Two units of cross-matched whole blood

35. A clinic nurse has completed teaching for a client with a rotator cuff tear who is being
treated conservatively. Which client statement indicates that further teaching is needed?
A. "I received a corticosteroid injection in my shoulder to reduce the inflammation."
B. "I will be doing progressive stretching and strengthening exercises now that the pain is
controlled."
C. "I should continue taking ibuprofen (Advil@) with food for pain control."
D. "I will need an open acromioplasty surgery to repair the torn cuff after the swelling
is reduced."

36. A 28-year-old client and his spouse were involved in a motorcycle accident in which his
spouse was killed. The client, being treated in the progressive care unit for multiple rib
fractures and a broken leg, asks the nurse in which room his wife is located. Which
response is most appropriate?
A. "Your wife is not in the hospital."
B. "I'm sorry, but your wife did not survive the accident."
C. "I need to get your family so that you can talk to them about your wife."
D. "The doctor will be talking to you about your wife and where she is located."
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37. An elderly client with Alzheimer's dementia is being admitted from a postanesthesia unit
Following a hip hemiarthroplasty to treat a hip fracture. Which intervention should a nurse
initially plan for the client's pain control?
A. Apply a fentanyl (Duragesic®) transdermal patch.
B. Initiate morphine sulfate per patient-controlled analgesia (PCA) with a basal rate.
C. Administer intravenous morphine sulfate based on the client's report of pain.
D. Administer scheduled doses of morphine sulfate intravenously around the clock.

38. A diabetic client is admitted with a tentative diagnosis of osteomyelitis secondary to a

wound on the ankle. The client's ankle is painful, red, swollen, and warm, and the wound is
persistently draining. The client's temperature is 102.2°F (39°C). Based on the client's
status, which written physician's order should Na nurse plan to defer until later?
A. Obtain wound culture.
B. Administer ceftriaxone (Rocephin®) 1 g IV (intravenously) q12 hours.
C. Apply splint to immobilize ankle.
D. Begin teaching on self-administration of home IV antibiotics.

39. A nurse is assessing an elderly client in Buck's traction to temporally immobilize a fracture of
the proximal femur prior to surgery. Which finding requires the nurse to intervene
immediately?
A. Reddened area on the sacrum
B. Voiding concentrated urine, 50 mL/hr
C. Capillary refill 3 seconds, dorsiflexion and sensation intact, pedal pulses palpable
D. Lower leg secure in traction boot and ropes and pulleys and 5 lb weight hanging freely

40. A nurse is providing instructions to a client who has a plaster cast to attain adequate
molding following a fracture to the right wrist. Which statement, if made by the nurse, is
incorrect?
A. "Keep your cast uncovered while drying so that moisture can evaporate
B. "Your cast will have a musty odor and dull gray appearance until it dries. But once fu,
dry, your cast should be odorless and shiny white.
C. "Your cast will feel sticky and very warm during the drying process, but it will dry
very quickly in about 30 minutes.
D. "Support the cast by elevating it on pillows and avoid any sharp or hard surfaces,
especially while your cast is drying, because it can cause denting and pressure areas."

41. The nurse is conducting health screening for osteoporosis. Which client is at greatest risk of
developing this problem?
A. A 25-year-old woman who runs
B. A 36-year-old man who has asthma
C. A 70-year-old man who consumes excess alcohol
D. A sedentary 65-year-old woman who smokes cigarettes
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42. The nurse has given instructions to a client returning home after knee arthroscopy. Which
statement by the client indicates that the instructions are understood?
A. "I can resume regular exercise tomorrow."
B. "I can't eat food for the remainder of the day.
C. "I need to stay off the leg entirely for the rest of the day."
D. "I need to report a fever or swelling to my health care provider."

43. The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up. A leg
appears fractured. Which intervention should the nurse take?
A. Try to reduce the fracture manually.
B. Assist the victim to get up and walk to the sidewalk.
C. Leave the victim for a few moments to call an ambulance.
D. Stay with the victim and encourage him or her to remain still.

44. Which cast care instructions should the nurse provide to a client who just had a plaster cast
applied to the right forearm? Select all that apply.
1. Keep the cast clean and dry.
2. Allow the cast 24 to 72 hours to dry.
3. Keep the cast and extremity elevated.
4. Expect tingling and numbness in the extremity.
5. Use a hair dryer set on a warm to hot setting to dry the cast.
6. Use a soft, padded object that will fit under the cast to scratch the skin under the
cast.
A. 1,2,3
B. 3,4,5
C. 4,5,6
D. 1,3,4

45. The nurse is evaluating a client in skeletal traction. When evaluating the pin sites, the nurse
would be most concerned with which finding?
A. Redness around the pin sites
B. Pain on palpation at the pin sites
C. Thick, yellow drainage from the pin sites
D. Clear, watery drainage from the pin sites
46. The nurse is assessing the casted extremity of a client. Which sign is indicative of infection?
A. Dependent edema
B. Diminished distal pulse
C. Presence of a "hot spot" on the cast.
D. Coolness and pallor of the extremity

47. A client has sustained a closed fracture and has just had a cast applied to the affected arm.
The client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and
administers an analgesic, with little relief. Which problem may be causing this pain?
A. Infection under the cast
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B. The anxiety of the client

C. Impaired tissue perfusion
D. The recent occurrence of the fracture

48. The nurse is admitting a client with multiple trauma injuries to the nursing unit. The client
has a leg fracture and had a plaster cast applied. Which position would be best for the casted
leg?
A. Elevated for 3 hours, then flat for 1 hour
B. Flat for 3 hours, then elevated for 1 hour
C. Flat for 12 hours, then elevated for 12 hours
D. Elevated on pillows continuously for 24 to 48 hours

49. A client is being discharged to home after application of a plaster leg cast. Which statement
indicates that the client understands proper care of the cast?
A. "I need to avoid getting the cast wet."
B. "I need to cover the casted leg with warm blankets."
C. "I need to use my fingertips to lift and move my leg."
D. "I need to use something like a padded coat hanger end to scratch under the cast if it
itches."

50. A client being measured for crutches asks the nurse why the crutches cannot rest up
underneath the arm for extra support. The nurse responds knowing that which would most
likely result from this improper crutch measurement?
A. A fall and further injury
B. Injury to the brachial plexus nerves
C. Skin breakdown in the area of the axilla
D. Impaired range of motion while the client ambulates