Question 1

The nurse is planning discharge teaching for a client who has had a repair of a fractured mandible. Which of the following information should the nurse will include in the teaching plan?

Accepted Answer

A) When and how to cut the immobilizing wires 
B) Self-administration of nasogastric tube feedings 
C) The use of sterile technique for dressing changes 
D) The importance of including high-fibre foods in the diet

Question 2

The nurse is developing a care plan for a client with an open reduction and internal fixation (ORIF) of an open, displaced fracture of the tibia. Which of the following nursing diagnoses is priority?

Accepted Answer

A) Activity intolerance related to physical deconditioning 
B) Risk for constipation as evidenced by electrolyte imbalance 
C) Risk for impaired skin integrity as evidenced by pressure over bony prominence 
D) Risk for infection as evidenced by invasive procedure

Question 3

The nurse is caring for a client who is a baseball pitcher and had an arthroscopic repair of a rotator cuff injury performed in same-day surgery. Which of the following information should be included in the client's postoperative teaching plan?

Accepted Answer

A) "You have an appointment with a physical therapist for tomorrow." 
B) "You can still play baseball but you will not be able to return to pitching." 
C) "The doctor will use the drop-arm test to determine the success of surgery." 
D) "Leave the shoulder immobilizer on for the first few days to minimize pain."

Question 4

The nurse is caring for a client with ulnar drift caused by rheumatoid arthritis (RA) who is scheduled for an arthroplasty of the hand. Which of the following client statements indicates realistic expectation for the surgery?

Accepted Answer

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

Question 5

The nurse is caring for a client in the emergency department who has a soft tissue injury and an open leg fracture. Which of the following actions should the nurse implement first?

Accepted Answer

A) If dislocation, apply compression bandage. 
B) Realignment of the bone(s) 
C) Administer tetanus with an open fracture. 
D) Apply heat to the affected area.

Question 6

The nurse is caring for a client who has been hospitalized for 3 days with a hip fracture who has sudden onset shortness of breath and tachypnea. The client tells the nurse, "I feel like I am going to die!" Which of the following actions should the nurse takefirst?

Accepted Answer

A) Stay with the client and offer reassurance. 
B) Administer the prescribed PRN oxygen at 4 L/minute. 
C) Check the client's legs for swelling or tenderness. 
D) Notify the health care provider about the symptoms.

Question 7

Which of the following nursing actions should the nurse include in the plan of care for a client who has had a total knee arthroplasty?

Accepted Answer

A) Avoid extension of the knee beyond 120 degrees. 
B) Use a compression bandage to keep the knee flexed. 
C) Start progressive knee exercises to obtain 90-degree flexion. 
D) Teach about the need to avoid weight bearing for 4 weeks.

Question 8

Which of the following information obtained by the emergency department nurse when admitting a client with a left femur fracture is most important to report to the health care provider?

Accepted Answer

A) Bruising of the left thigh 
B) Complaints of left thigh pain 
C) Outward pointing toes on the left foot 
D) Prolonged capillary refill of the left foot

Question 9

The nurse is caring for a client who is 1 day postoperative below-the-knee amputation who indicates pain in the amputated limb. Which of the following actions 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) Remind the client that this phantom pain will diminish over time.

Question 10

After the health care provider has recommended an amputation for a client who has ischemic foot ulcers, the client tells the nurse, "If they want to cut off my foot, they should just shoot me instead." Which of the following responses by the nurse is best?

Accepted Answer

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

Question 11

The nurse is providing health-promotion teaching to a client whose job involves many hours of word processing. Which of the following actions should the nurse include in the client teaching plan?

Accepted Answer

A) Do stretching and warm-up exercises before starting work. 
B) Wrap the wrists with a compression bandage every morning. 
C) Use acetaminophen instead of nonsteroidal anti-inflammatory drugs (NSAIDs) for wrist pain. 
D) Obtain a keyboard pad to support the wrist while word processing.

Question 12

The nurse is preparing a client for discharge from the emergency department with a sprained wrist. Which of the following information should the nurse include?

Accepted Answer

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

Question 13

The nurse is preparing a client with lower leg fracture and an external fixation device in place for discharge. Which of the following information should the nurse include in the discharge teaching?

Accepted Answer

A) "You will need to assess and clean the pin insertion sites daily." 
B) "The external fixator can be removed during the 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 14

The nurse is caring for a client in the emergency department following a motor vehicle accident who has massive right lower leg swelling. Which of the following actions will the nurse take first?

Accepted Answer

A) Elevate the leg on pillows. 
B) Apply a compression bandage. 
C) Check leg pulses and sensation. 
D) Place ice packs on the lower leg.

Question 15

The nurse is caring for a client with Buck's traction who had an intracapsular fracture of the left femur. Which of the following actions should the nurse take in order to evaluate the effectiveness of Buck's traction?

Accepted Answer

A) Assess for hip contractures. 
B) Monitor for hip dislocation. 
C) Check the peripheral pulses. 
D) Ask about left hip pain level.

Question 16

The nurse is caring for a client who has had an open reduction and internal fixation (ORIF) of left lower leg fractures who indicates constant severe pain in the leg which is unrelieved by the prescribed morphine. Pulses are faintly palpable and the foot is cool. Which of the following actions 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 client's blood pressure.

Question 17

The nurse is providing discharge teaching to a client with a sprained right ankle. Which of the following information should be included in the teaching plan? (Select all that apply.)

Accepted Answer

A) Elevate the limb. 
B) Use nonsteroidal anti-inflammatory drugs as required. 
C) Apply warm moist heat for 45 minutes, three times per day. 
D) Use an elastic bandage on the ankle during activity 
E) Use ice alternating with heat 48 hours after the injury.

Question 18

Before assisting a client with ambulation on the day after a total hip replacement, which of the following actions is most important for the nurse to implement?

Accepted Answer

A) Administer the ordered oral opioid pain medication. 
B) Instruct the client about the benefits of ambulation. 
C) Ensure that the incisional drain has been discontinued. 
D) Change the hip dressing and document the wound appearance.

Question 19

The nurse is preparing a client who had an above-the-knee amputation for discharge. Which of the following client statements indicates that the nurse's discharge teaching has been effective?

Accepted Answer

A) "I should lay on my abdomen for 30 minutes three or four times a day." 
B) "I should elevate my residual limb on a pillow two or three times a day." 
C) "I should change the limb sock when it becomes soiled or stretched out." 
D) "I should use lotion on the stump to prevent drying and cracking of the skin."

Question 20

The nurse is caring for a client who is on bed rest after having a complex pelvic fracture. Which of the following assessment findings is most important to report to the health care provider?

Accepted Answer

A) The client states that the pelvis feels unstable. 
B) Abdominal distention is present and bowel tones are absent. 
C) There are ecchymoses on the abdomen and hips. 
D) The client complains of pelvic pain with palpation.

Exam 65: Nursing Management Musculo-skeletal Trauma and Orthopedic Surgery