Question 1

The day after a having a right below-the-knee amputation,a patient complains of pain in the right foot.Which action is best for the nurse to take?

Accepted Answer

A)  Explain the reasons for the phantom limb pain. 
B)  Administer prescribed analgesics to relieve the pain. 
C)  Loosen the compression bandage to decrease incisional pressure. 
D)  Inform the patient that this phantom pain will diminish over time.

Question 2

A 48-year-old patient with a comminuted fracture of the left femur has Buck's traction in place while waiting for surgery.To assess for pressure areas on the patient's back and sacral area and to provide skin care,the nurse should

Accepted Answer

A)  loosen the traction and help the patient turn onto the unaffected side. 
B)  place a pillow between the patient's legs and turn gently to each side. 
C)  turn the patient partially to each side with the assistance of another nurse. 
D)  have the patient lift the buttocks by bending and pushing with the right leg.

Question 3

Based on the information shown in the accompanying figure and obtained for a patient in the emergency room,which action will the nurse take first?

Accepted Answer

A)  Administer the prescribed morphine 4 mg IV. 
B)  Contact the operating room to schedule surgery. 
C)  Check the patient's oxygen saturation using pulse oximetry. 
D)  Ask the patient about the date of the last tetanus immunization.

Question 4

A patient has a long-arm plaster cast applied for immobilization of a fractured left radius.Until the cast has completely dried,the nurse should

Accepted Answer

A)  keep the left arm in dependent position. 
B)  avoid handling the cast using fingertips. 
C)  place gauze around the cast edge to pad any roughness. 
D)  cover the cast with a small blanket to absorb the dampness.

Question 5

Which information obtained by the nurse about a 29-year-old patient with a lumbar vertebral compression fracture is most important to report to the health care provider?

Accepted Answer

A)  Patient refuses to be turned due to back pain. 
B)  Patient has been incontinent of urine and stool. 
C)  Patient reports lumbar area tenderness to palpation. 
D)  Patient frequently uses oral corticosteroids to treat asthma.

Question 6

A 42-year-old patient is admitted to the emergency department with a left femur fracture.Which information obtained by the nurse is most important to report to the health care provider?

Accepted Answer

A)  Ecchymosis of the left thigh 
B)  Complaints of severe thigh pain 
C)  Slow capillary refill of the left foot 
D)  Outward pointing toes on the left foot

Question 7

When doing discharge teaching for a 19-year-old patient who has had a repair of a fractured mandible,the nurse will include information about

Accepted Answer

A)  administration of nasogastric tube feedings. 
B)  how and when to cut the immobilizing wires. 
C)  the importance of high-fiber foods in the diet. 
D)  the use of sterile technique for dressing changes.

Question 8

When assessing for Tinel's sign in a patient with possible right-sided carpal tunnel syndrome,the nurse will ask the patient about

Accepted Answer

A)  weakness in the right little finger. 
B)  tingling in the right thumb and fingers. 
C)  burning in the right elbow and forearm. 
D)  tremor when gripping with the right hand.

Question 9

Which discharge instruction will the emergency department nurse include for a patient with a sprained ankle?

Accepted Answer

A)  Keep the ankle loosely wrapped with gauze. 
B)  Apply a heating pad to reduce muscle spasms. 
C)  Use pillows to elevate the ankle above the heart. 
D)  Gently move the ankle through the range of motion.

Question 10

Which action will the urgent care nurse take when caring for a patient who has a possible knee meniscus injury?

Accepted Answer

A)  Encourage bed rest for 24 to 48 hours. 
B)  Avoid palpation or movement of the knee. 
C)  Apply a knee immobilizer to the affected leg. 
D)  Administer intravenous narcotics for pain relief.

Question 11

The day after a 60-year-old patient has an open reduction and internal fixation (ORIF)for an open,displaced tibial fracture,the priority nursing diagnosis is

Accepted Answer

A)  activity intolerance related to deconditioning. 
B)  risk for constipation related to prolonged bed rest. 
C)  risk for impaired skin integrity related to immobility. 
D)  risk for infection related to disruption of skin integrity.

Question 12

After the health care provider has recommended amputation for a patient who has nonhealing ischemic foot ulcers,the patient tells the nurse that he would rather die than have an amputation.Which response by the nurse is best?

Accepted Answer

A)  "You are upset, but you may lose the foot anyway." 
B)  "Many people are able to function with a foot prosthesis." 
C)  "Tell me what you know about your options for treatment." 
D)  "If you do not want an amputation, you do not have to have it."

Question 13

A 32-year-old patient who has had an open reduction and internal fixation (ORIF)of left lower leg fractures continues to complain of severe pain in the leg 15 minutes after receiving the prescribed IV morphine.Pulses are faintly palpable and the foot is cool.Which action should the nurse take next?

Accepted Answer

A)  Notify the health care provider. 
B)  Assess the incision for redness. 
C)  Reposition the left leg on pillows. 
D)  Check the patient's blood pressure.

Question 14

A patient who is to have no weight bearing on the left leg is learning to walk using crutches.Which observation by the nurse indicates that the patient can safely ambulate independently?

Accepted Answer

A)  The patient moves the right crutch with the right leg and then the left crutch with the left leg. 
B)  The patient advances the left leg and both crutches together and then advances the right leg. 
C)  The patient uses the bedside chair to assist in balance as needed when ambulating in the room. 
D)  The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.

Question 15

A patient with a right lower leg fracture will be discharged home with an external fixation device in place.Which information will the nurse teach?

Accepted Answer

A)  "You will need to check and clean the pin insertion sites daily." 
B)  "The external fixator can be removed for your bath or shower." 
C)  "You will need to remain on bed rest until bone healing is complete." 
D)  "Prophylactic antibiotics are used until the external fixator is removed."

Question 16

A pedestrian who was hit by a car is admitted to the emergency department with possible right lower leg fractures.The initial action by the nurse should be to

Accepted Answer

A)  elevate the right leg. 
B)  splint the lower leg. 
C)  check the pedal pulses. 
D)  verify tetanus immunizations.

Question 17

A factory line worker has repetitive strain syndrome in the left elbow.The nurse will plan to teach the patient about

Accepted Answer

A)  surgical options. 
B)  elbow injections. 
C)  wearing a left wrist splint. 
D)  modifying arm movements.

Question 18

The nurse is caring for a patient who is to be discharged from the hospital 5 days after insertion of a femoral head prosthesis using a posterior approach.Which statement by the patient indicates a need for additional instruction?

Accepted Answer

A)  "I should not cross my legs while sitting." 
B)  "I will use a toilet elevator on the toilet seat." 
C)  "I will have someone else put on my shoes and socks." 
D)  "I can sleep in any position that is comfortable for me."

Question 19

When giving home care instructions to a patient who has comminuted forearm fractures and a long-arm cast on the left arm,which information should the nurse include?

Accepted Answer

A)  Keep the left shoulder elevated on a pillow or cushion. 
B)  Keep the hand immobile to prevent soft tissue swelling. 
C)  Call the health care provider for increased swelling or numbness of the hand. 
D)  Avoid nonsteroidal antiinflammatory drugs (NSAIDs) for 24 hours after the injury.

Question 20

A patient is being discharged 4 days after hip replacement surgery using the posterior approach.Which patient action requires immediate intervention by the nurse?

Accepted Answer

A)  The patient uses crutches with a swing-to gait. 
B)  The patient leans over to pull shoes and socks on. 
C)  The patient sits straight up on the edge of the bed. 
D)  The patient bends over the sink while brushing teeth.

Exam 63: Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery