Title WORKBOOK - ORTHO (KEY) ✅

COMPREHENSIVE PHASE WORKBOOK ORTHO NOVEMBER 2024 Philippine Nurse Licensure Examination Review SITUATION: Rogelio is a long jump athlete. However, after a long jump, he suddenly slipped forward fracturing his right arm. 1. To immobilize the affected part, a plaster cast was applieD. How should a wet cast be handled? I. Handle it using fingers or toes II. Never insert needle inside of the cast III. Handle it only with the palm of the hand IV. Drying time of 15 minutes V. Get a dry towel and cover the whole cast VI. Monitor for signs of infection like “hot spots” VII.Light scratching of skin inside the cast to lessen itching allowed A. 3 and 4 only B. 3, 4 and 6 C. 1, 5, and 7 D. 3 only 2. You are currently monitoring Rogelio after an arm cast has been applieD. Which of the following is most important to assess? A. Check the cast for soft spots B. Check the temperature of the body C. Check the skin temperature below the cast D. Turn him every 2 hours and support the cast 3. Which patient behavior shows that Rogelio learned cast care incorrectly? I. “Cover the cast with a blanket until the cast dries.” II. “Keep your right leg above the heart level initially.” III. “Use a knitting needle to scratch inches inside the cast.” IV. “A foul smelling from the cast is normal.” A. 1 and 3 only B. Except 2 C. 1 and 4 only D. 2 only 4. Which of the following is not an INAPPROPRIATE nursing action when caring with an arm cast? I. Support newly casted extremity with the palms of the hand II. Keep the casted extremity dependent on the mattress III. Promote dryness of the cast by exposing the casted extremity IV. Do neurovascular assessment on the affected extremity A. 2 only B. All are correct C. 1, 3 and 4 D. 3 and 4 5. Because of Rogelio’s arm cast, Nurse Fiona monitors for signs of poor blood circulation in the extremity. She looks for: A. Foul odor B. “Hot spots” C. Poikilothermia D. Increased temperature 6. Nurse Fiona monitors Rogelio’s cast after a day. Which of the following signs would lead her to suspect an infection? I. Coolness and pallor of the extremity II. Presence of "hot shots" on the cast III. Diminished distal pulse IV. Foul smelling odor A. 1, 2 and 4 B. Except 1,2 and 3 C. 2 and 4 D. 2 and 3 7. Which of the following necessitates bivalving the cast or excising the fascia? A. Pulselessness B. Pain C. Pallor D. None of the above 8. Rogelio has undergone fasciotomy immediately. The nurse prepares to provide which type of wound care of the fasciotomy site? A. Dry sterile dressings B. Moist sterile saline dressings C. Hydrocolloid dressings D. 1⁄2 strength betadine dressings SITUATION: You are currently a nurse in an orthopedic ward. 9. Lia, age 4, has a fractured femur and is in Bryant’s traction. To evaluate correct application of the traction the nurse should note that: A. Lia’s sacrum is prone for pressure ulcer B. Lia’s buttocks are raised slightly C. Lia’s leg is at 45° angle to the bed D. Lia can move the unaffected leg freely I. It temporarily immobilizes the fracture II. It decreases muscle spasticity III. It promotes realignment IV. It uses a knee sling to maintain leg position A. 1, 2 and 3 B. 1 and 4 C. 2, 3 and 4 D. 4 only 10. Because the client is in traction and is immobile, she is assigned a nursing diagnosis of potential constipation related to limited mobility. Which nursing measure would be LEAST EFFECTIVE for the diagnosis? A. Forcing fluids (3L or more daily) B. Ordering prune juice daily C. Changing the patient's position every 2 hours D. Encouraging the patient to eat high fiber foods 11. Nurse Valerie is performing pin site care on a client in Ilizarov fixator. Which finding would the nurse not expect to be NORMAL when assessing the pin sites? I. Redness and swelling around the pin sites II. Loose pin site III. Purulent drainage from the pin sites IV. Serosanguinous drainage from the pin sites A. 1 and 3 B. 3 and 4 C. 4 only D. 1, 2 and 3 12. Lucia is a swimming coach. While observing swimmers in the pool, she suddenly slipped causing a fractured femur. Which nursing intervention has the highest priority? A. Assessing the extremity for neurovascular integrity B. Keeping the client from sliding to the foot of the bed TOP RANK REVIEW ACADEMY, INC. Page 1 | 4
C. Keeping the ropes over the center of the pulley D. Ensuring that the weights hang freely at all times 13. A client is placed in Buck's traction after fracture of the right femur. Which statements are FALSE about Buck's traction, except? I. It temporarily immobilizes the fracture II. It decreases muscle spasticity III. It promotes realignment IV. It uses a knee sling to maintain leg position A. 1, 2 and 3 B. 1 and 4 C. 2, 3 and 4 D. 4 only SITUATION: Bianca is a victim of hit and run. Due to an unsalvageable injury, an above-knee-amputation was necessary. 14. The crutch gait, the nurse should teach the client after AKA is the: A. Tripod crutch gait B. Three-point gait C. Four-point gait D. Swing – to crutch gait 15. While attending Bianca who has just been amputated, you hear her say, “My life ends here. There is no hope.” Which of the following would be your MOST therapeutic response? A. “Do you want to go outside?” B. “Tell me more about how you’re feeling.” C. “Be thankful instead that you are alive.” D. “You have to deal with the consequences. Everything will be alright.” 16. While monitoring the patient post-operatively, you observed that although the stump was dry, an hour later, a small amount of bloody drainage was noticed. Prioritize your nursing action: A. Reinforce the dressing B. Change the dressing C. Mark the area of the drainage D. Notify the doctor 17. Another patient in the ward is Maria who is suffering from a rare bone cancer affecting her entire foot not exceeding the ankle area. An amputation is scheduled to prevent the spread of cancer. Which type of amputation will be performed? A. Syme’s amputation B. Below-knee-amputation C. Ankle Disarticulation D. Both A and C SITUATION: Cecile L is a world renowned pianist. However, she was diagnosed with Carpal Tunnel Syndrome necessitating surgery to relieve nerve compression. 18. The most important aspect of postoperative nursing assessment for Cecile L is: A. Urinary and bowel function B. Circulation to the right hand C. Level of consciousness D. Pain tolerance 19. During the early post-operative period, the nurse should teach Cecile L to: A. Keep both arms elevated and immobile B. Use his right hand as much as possible C. Perform active ROM exercises with his right arm and wrist D. Periodically make a fist with his right hand 20. When assessing the affected area, the nurse expects to find which abnormality in the following tests? I. Wrist compression II. Phalen’s III. Chvostek’s IV. Tinel’s A. 1 only B. 1, 2 and 4 C. 2 and 4 only D. All are correct 21. Cecile L asks you what modality she can use to relieve the symptoms associated with carpal tunnel syndrome? A. Doing isotonic hand exercises B. Applying an ice pack C. Wearing a sling D. Wearing a hand splint 22. Cecile L verbalized to the nurse that she feels sad that she cannot play the piano like she used to before. You reply that: A. That’s just how life is B. “You are old enough to feel sad, c’mon” C. “You can share to me your concerns, I am here to listen.” D. “I’ll ask the doctor if I can sedate you” 23. Walter is a 56 year old taxi driver with rheumatoid arthritis. The following are characteristic manifestations of Rio: A. Joint pain, tophi and crepitus B. Joint pain, ulnar drift and elevated ESR C. Heberden's nodes, elevated serum uric acid level D. Unilateral affectation of joints, localized swelling, body malaise 24. Walter was prescribed with methotrexate. Which of the following laboratory finding should you watch out for? A. Increase in Rheumatoid factor B. Decrease RBC C. Increase in blood glucose D. Decrease in erythrocyte sedimentation rate (ESR) 25. He is now being treated with prednisone (Deltasone). Which of the following can occur with long-term prednisone therapy? A. Breast and uterine cancer B. Osteoporosis and diabetes mellitus C. Deep vein thrombosis (DVT), pulmonary embolus, and stroke D. Weight loss and lactose intolerance 26. Belinda is a 76 year old patient with rheumatoid arthritis. Which nursing diagnosis is most appropriate for the patient knowing that she lives alone on a 2 – storey house? A. Safety B. Risk for injury C. Airway D. Nutrition 27. Joseph, a 65 year old businessman, had difficulty ambulating due to a swollen hallux. He has been diagnosed with gout and has been prescribed with Indomethacin for pain. Which of the following instructions should you give to a client taking this drug? A. Bleeding isn’t a problem with this drug B. Take with meal to avoid an upset stomach C. Take on an empty stomach to increase absorption D. Don’t take at bedtime because they may cause excitement 28. Before seeing the client, you were made aware that a diagnosis of gout was given. Where would you expect uric acid crystals (tophi) to affect which joint FIRST? A. Great toe B. Metatarsophalangeal C. Ears D. Knee Joint 29. A client is diagnosed with gout. Which foods should the nurse instruct the client to avoid? A. Green, leafy vegetables B. Eggs C. Sardines D. Chocolate 30. Marissa is a street vendor for 50 years. Her low back pain is tentatively diagnosed as having a herniated intervertebral TOP RANK REVIEW ACADEMY, INC. Page 2 | 4

B. An ounce of cheddar cheese C. A half cup of raw broccoli D. A 4- ounce salmon croquette 47. Carmen was taking alendronate. However, the nurse should warn her that she is at high risk for developing which disorder? A. Cardiovascular disease B. Breast cancer C. Inflammation of the esophagus D. Stroke 48. Amalia, a patient with multiple myeloma has completed radiation therapy treatments for a form of cancer is at high risk for developing: A. Osteomalacia B. Osteosarcoma C. Paget's disease of the bone D. Osteochondroma 49. Satur was diagnosed with hypoparathyroidism. When caring for a client with hypocalcemia, the nurse should assess for: A. A decreased level of consciousness B. Tetany C. Bradycardia D. Respiratory Depression 50. Pablo was taking bisphosphonates and as a nurse you need to advise him that he needs to stay upright after administration for how long? A. 10 minutes B. 20 minutes C. 30 minutes D. 120 minutes TOP RANK REVIEW ACADEMY, INC. Page 4 | 4