Question 1

A patient with lower-leg fractures has an external fixation device in place and is scheduled for discharge. Which information will the nurse include in the discharge teaching?

Accepted Answer

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

Question 2

A patient undergoes a right below-the-knee amputation with an immediate prosthetic fitting. When the patient is returned to the nursing unit, the nurse should

Accepted Answer

A)  check the surgical site for hemorrhage. 
B)  take the patient's vital signs frequently. 
C)  keep the residual leg elevated on a pillow. 
D)  place the patient in a prone position.

Question 3

On the first postoperative day, a patient with a below-the-knee amputation complains of pain in the amputated limb. An appropriate action by the nurse is to

Accepted Answer

A)  administer prescribed opioids to relieve the pain. 
B)  explain the reasons for phantom limb pain. 
C)  loosen the compression bandage to decrease incisional pressure. 
D)  remind the patient that this phantom pain will diminish over time.

Question 4

A patient is admitted to the emergency department with possible fractures of the bones of the left lower extremity. The initial action by the nurse should be to

Accepted Answer

A)  splint the lower leg. 
B)  elevate the left leg. 
C)  check the popliteal, dorsalis pedis, and posterior tibial pulses. 
D)  obtain information about the patient's tetanus immunization status.

Question 5

A patient with an intracapsular fracture of the left femur is placed in Buck's traction before surgery for a hip replacement. The patient asks why traction is necessary when surgery is planned. The nurse's response to the patient is based on the knowledge that traction

Accepted Answer

A)  will help prevent flexion contractures of the affected hip. 
B)  is necessary to prevent displacement of the fracture. 
C)  will decrease the incidence of painful muscle spasms 
D)  is used to maintain the leg in the external rotation position.

Question 6

The health care provider initially orders bed rest for a patient with an open-book pelvic fracture. Which assessment data obtained by the nurse are most important to report to the health care provider?

Accepted Answer

A)  The bowel tones are absent. 
B)  There is an unusual amount of pelvic movement. 
C)  The patient complains of level 4 abdominal pain on a 10-point pain scale. 
D)  There is bruising of the abdomen.

Question 7

A patient in the emergency department is diagnosed with a patellar dislocation. The initial patient teaching by the nurse will focus on the need for

Accepted Answer

A)  conscious sedation. 
B)  a knee immobilizer. 
C)  gentle knee flexion. 
D)  cast application.

Question 8

A 20-year-old baseball pitcher has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included?

Accepted Answer

A)  "You have an appointment with a physical therapist for tomorrow." 
B)  "Leave the shoulder immobilizer on for the first few days to minimize pain." 
C)  "The doctor will use the drop-arm test to determine the success of the procedure." 
D)  "You should try to find a different position to play on the baseball team."

Question 9

A patient is admitted with facial injuries after a bicycle accident and has a repair of a fractured mandible. When doing postoperative teaching, the nurse will include information about

Accepted Answer

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

Question 10

A 22-year-old patient started an exercise regimen 2 months ago that includes running 3 to 4 miles a day. The patient tells the nurse, "I enjoy my daily runs, but now I have shin splints." Which response by the nurse is appropriate?

Accepted Answer

A)  "You may be increasing your running time too quickly and need to cut back a little bit." 
B)  "You need to have x-rays of your lower legs to be sure you do not have stress fractures." 
C)  "You should expect some leg pain while running." 
D)  "You should try speed-walking rather than running."

Question 11

A patient hospitalized with multiple fractures 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 a dependent position. 
B)  handle the cast with the palms of the hands. 
C)  place gauze around the cast edge to pad any roughness. 
D)  cover the cast with a small blanket to absorb the dampness.

Question 12

When counseling an older patient about ways to prevent fractures, which information will the nurse include?

Accepted Answer

A)  Tacking down scatter rugs in the home is recommended. 
B)  Occasional weight-bearing exercise will improve muscle and bone strength. 
C)  Most falls happen outside the home. 
D)  Buying shoes that provide good support and are comfortable to wear is recommended.

Question 13

A patient with severe ulnar drift caused by rheumatoid arthritis (RA) is scheduled for an arthroplasty of the right hand and fingers. The nurse determines that the patient has realistic expectations of the outcome of surgery when the patient says,

Accepted Answer

A)  "I will be able to use my fingers to grasp objects better." 
B)  "My fingers will appear normal in size and shape after this surgery." 
C)  "This procedure will prevent further deformity in my hands and fingers." 
D)  "I will not have to do as many hand exercises after the surgery."

Question 14

After falling at home, a patient is admitted to the emergency department, where x-rays confirm the presence of an extracapsular fracture of the femur. When assessing the patient, the nurse would expect to find

Accepted Answer

A)  bruising of the left hip and thigh. 
B)  numbness in the left leg and hip. 
C)  outward pointing toes on the left leg. 
D)  weak or nonpalpable left leg pulses.

Question 15

A patient with a fractured radius asks when the cast can be removed. The nurse will instruct the patient that the cast can be removed only after the bone

Accepted Answer

A)  is strong enough to stand mild stress. 
B)  union is complete on the x-ray. 
C)  fragments are fully fused. 
D)  healing has started.

Question 16

A patient is seen at the urgent care center after falling on the right arm and shoulder. It will be most important for the nurse to determine

Accepted Answer

A)  whether there is bruising at the shoulder area. 
B)  whether the right arm is shorter than the left. 
C)  the amount of pain the patient is experiencing. 
D)  how much range of motion (ROM) is present.

Question 17

A patient is to be discharged from the hospital 4 days after undergoing a total hip arthroplasty. A statement by the patient that indicates a need for additional discharge instructions is

Accepted Answer

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

Question 18

When getting a patient from the bed into the chair for the first time since having an ORIF of a hip fracture, the nurse should

Accepted Answer

A)  use a mechanical lift to transfer the patient from the bed to the chair. 
B)  assist the patient to use a walker with partial weight bearing to assist in transfer to the chair. 
C)  have the patient use crutches with a swing-through gait to transfer. 
D)  ask a nursing assistant to help the patient to stand at the bedside and pivot to the chair.

Question 19

A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. All of the following orders are written by the health care provider. Which one will the nurse act on first?

Accepted Answer

A)  Administer naproxen (Naprosyn) 500 mg PO. 
B)  Wrap the ankle and apply an ice pack. 
C)  Give acetaminophen with codeine (Tylenol #3). 
D)  Take the patient to the radiology department for x-rays.

Exam 63: Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery