Title POST TEST-ORTHOPEDIC NURSING-MR. PALMOS.pdf ✅

POST TEST EXAMINATION ORTHOPEDIC NURSING Prepared by Mr. Alvin Palmos, RN, USRN November 2024 Philippine Nurse Licensure Examination Review NAME: SCORE: /100 INSTRUCTION: Select the correct answer for each of the following questions. Mark only one answer for each item by marking the corresponding letter of your choice on the answer sheet provided. STRICTLY NO ERASURES. Use pencil no. 2 only. 1. Which of the following areas would be included in a neurovascular assessment? a. Orientation, movement, pulses, warmth b. Capillary refill, movement, pulses, warmth c. Orientation, pupillary response, temperature, pulses d. Respiratory pattern, orientation, pulses, temperature 2. 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: 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. 3. ________ are found within the spongy bone and are responsible for building up the bone matrix. While ________, which are also found in the spongy bone, breakdown the bone matrix. a. Osteocytes, osteoclasts b. Osteoclasts, osteoblasts c. Osteocytes, osteoblasts d. Osteoblasts, osteoclasts 4. Bones play an important role in the body. Which of the following in NOT a function performed by the bones? a. Provide protection and support for the organs. b. Give the body shape. c. Secrete the hormone calcitonin and store blood cells. d. Store calcium and phosphorus. ANSWER: C - Secrete the hormone calcitonin and store blood cells. 5. Which statement by the nurse describes a comminuted fracture to the client? a. “The ends of the broken bones are forced together." b. “The bone is breaking through the skin." c. “The bone is broken into many pieces." d. “A fragment of the bone is separated from the rest of the bone." ANSWER: C - “The bone is broken into many pieces." 6. The nurse is caring for clients in an assisted living facility. Which resident would the nurse identify as being at the highest risk for the development of fractures from a fall? a. A resident who participates in resistance training exercises three times a week and takes a calcium supplement b. A resident who hikes in the woods once a week and smokes 14 cigarettes per day c. A resident who line dances twice per week and has a glass of wine with dinner d. A resident who teaches yoga four times per week and is lactose intolerant 7. A client sustained multiple fractures in a motor vehicle crash. Of the various fracture types sustained by the client, which places the client at highest risk for osteomyelitis? a. Avulsion fracture b. Open fracture c. Comminuted fracture d. Depression fracture 8. Which of the following symptoms are considered signs of a fracture? a. Tingling, coolness, loss of pulses b. Loss of sensation, redness, warmth c. Coolness, redness, new site of pain d. Redness, warmth, pain at the site of injury 9. When counseling an older patient about ways to prevent fractures, which information will the nurse include? 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. 10. A 85-year old patient has an accidental fall while going to the bathroom without assistance. It appears the patient has sustained a bone fracture to the left leg. The leg's shape is deformed and the patient is unable to move it. The patient is alert and oriented but in pain. What will you do FIRST after confirming the patient is safe and stable? a. Apply an ice pack covered with a towel to the site. b. Immobilize the fracture with a splint. c. Administer pain medication. d. Elevate the extremity above heart level. 11. The nurse is taking care of a client with multiple fractures in his leg. A plaster cast was applied. In positioning the casted leg, the nurse should: a. Keep the leg in a level position. b. Elevate the leg for 3 hours and put if flat for 1 hour. c. Keep the leg straight for 3 hours and elevate it for 1 hour. d. Elevate the leg on pillows continuously for 24 to 48 hours. 12. After change-of-shift report, which patient should the nurse assess first? a. A 42-year old patient with carpal tunnel syndrome complaining of pain b. A 64-year old patient with osteoporosis who is waiting for discharge c. A 28-year old patient with fracture complaining that the cast is tight d. A 56-year old patient with left leg amputation complaining of phantom pain 13. The nurse is assessing a client in the outpatient clinic who has a cast on for a distal humerus fracture. Which statements made by the client would be the priority to assess further? a. “I am having problems extending my fingers since this morning.”. TOP RANK REVIEW ACADEMY, INC. Page 1 | 4
b. “I can’t take any of the pain medicine because it makes me feel sick.”. c. “I have to scratch under the cast with a nail file because of the itching.”. d. “I noticed a warm spot on my cast, and a bad smell is coming from it.”. 14. A client with a recent fracture is suspected of having compartment syndrome. Assessment findings may include which of the following symptoms? a. Body-wide decrease in bone mass b. A growth in and around the bone tissue c. Inability to perform active movement, pain with passive movement d. Inability to perform passive movement, pain with active movement 15. When giving home-care instructions to a patient who has multiple forearm fractures and a long-arm cast on the right arm, which information should the nurse include? a. Keep the hand immobile to prevent soft tissue swelling. b. Call the health care provider for increased swelling or numbness. c. Keep the right shoulder elevated on a pillow or cushion. d. Avoid the use of NSAIDs for the first 48 hours after the injury. 16. The nurse in the outpatient clinic assists with the application of a cast to the left arm of a five-year old girl. After the cast is applied, the nurse should: a. Petal the edges of the cast to prevent irritation b. Elevate the client's left arm on two pillows c. Apply cool, humidified air to dry the cast d. Ask the client to move her fingers to maintain mobility 17. Compartment syndrome occurs under which of the following conditions? a. Increase in scar tissue b. Increase in bone mass c. Decrease in bone mass d. Hemorrhage into the muscle 18. The nurse is caring for a client who sustained a fractured tibia and has a cast applied to the extremity. Which of the following findings would indicate the client has developed compartment syndrome? a. The development of petechiae over the chest. b. A new onset of dyspnea and chest pain. c. Severe pain that is unrelieved by an opioid analgesic. d. Localized bone pain with a fever. 19. A 4-year-old child sustains a fall at home. After an x-ray examination, the child is determined to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child’s cast. Which statement by the parents indicates a need for further instruction? A. “The cast may feel warm as the cast dries.” B. “I can use lotion or powder around the cast edges to relieve itching.” C. “A small amount of white shoe polish can touch up a soiled white cast.” D. “If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast.” 20. 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. 21. The client who had an open femoral fracture was discharged to her home where she developed fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg. Which of the following reflects the best interpretation of these findings? a. Pulmonary emboli. b. Osteomyelitis. c. Fat emboli. d. Urinary tract infection. 22. The nurse working on an orthopedic unit is receiving report on 4 clients with recent fractures. Which client should the nurse assess first? a. Client who has a femur fracture with a rash of pin-sized red spots on the chest and increased restlessness. b. Client who has purulent drainage oozing from a skeletal traction pin insertion site and a temperature of 100.8 F (38.2 C). c. Client with a hip fracture receiving continuous IV saline with bilateral 2 + pittng log edema and a blood pressure of 176/89 mm Hg. d. Client with a rib fracture who is breathing at a rate of 23/min and is reporting 8/10 pain that is worse with inspiration. 23. A client is admitted with a pulmonary embolus. The nurse assesses restlessness, one-word dyspnea and shortness of breath with activity, tachycardia, pleuritic chest pain, and severe anxiety. Arterial blood gases indicate respiratory alkalosis and hypoxemia. When initiating the care plan, the nurse should choose which nursing diagnosis as the highest priority? a. Activity intolerance related to imbalance between oxygen supply and demand. b. Acute pain related to inspiration and inflammation of pleura. c. Anxiety related to fear of the unknown, chest pain, and dyspnea. d. Impaired gas exchange related to ventilation-perfusion imbalance. 24. A patient sustained a fracture to the femur. The patient has suddenly become confused, restless, and has a respiratory rate of 30 breaths per minute. Based on the location of fracture and the presenting symptoms, this patient may be experiencing what type of complication? a. Compartment Syndrome b. Osteomyelitis c. Fat embolism d. Hypovolemia 25. The patient suffered a fractured femur. Which of the following assessment findings should be reported immediately by the nurse? a. The patient complains of pain b. The patient appears confused c. The patient's blood pressure is 136/88 d. The patient voided using the bedpan 26. Which of the following fractures presents the greatest risk for development of fat embolism? a. Open fracture of the fibula b. Closed fracture of the femur c. Open fracture of the humerus d. Closed fracture of the clavicle 27. A client is hospitalized for open reduction of a fractured femur. During postoperative assessment, the nurse monitors for signs and symptoms of fat embolism, which include: a. Pallor and coolness of the affected leg. b. Nausea and vomiting after eating. c. Hypothermia and bradycardia. d. Restlessness and petechiae. 28. 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 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. 29. An adolescent who sustained a tibia fracture in a motor vehicle accident has a cast. What should the nurse do to help relieve the itching? a. Apply cool air under the cast with a blow-dryer. b. Use sterile applicators to scratch the itch. c. Apply cool water under the cast. TOP RANK REVIEW ACADEMY, INC. Page 2 | 4
d. Apply hydrocortisone cream under the cast using a sterile applicator. ANSWER: A - Apply cool air under the cast with a blow-dryer. 30. 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. ANSWER: C - Thick, yellow drainage from the pin sites. 31. The nurse is discussing open reduction and internal fixation with a client who is considering surgery to correct a bone fracture. Which statement by the nurse is correct? a. "A metal bar will be placed outside the skin to stabilize the bone." b. "Internal fixation allows earlier return to full function." c. "A longer hospital stay will be required." d. "Internal fixation is performed when soft tissue damage prevents external fixation." 32. When assessing a client who has been ordered skeletal traction, the findings reveal her foot is pale, cold, and her pulse is not palpable. What is the priority nursing intervention? a. Reassess the foot in twenty minutes. b. Readjust the traction. c. Administer the ordered PRN medication. d. Notify the physician. 33. Your patient is prescribed to use crutches for ambulation. The patient can bear partial weight and needs to be taught how to use the two-point gait while using crutches. Which description below best describes this type of gait with crutches? a. The patient moves both crutches forward and then moves both legs forward to the same point as the crutches. b. The patient moves the right crutch (injured side), then moves the left foot (non-injured side), then moves the left crutch (non-injured side), and then moves the right foot (injured side). c. The patient moves both the right crutch (injured side) and left foot (non-injured side) forward together, and then moves the left crutch (non-injured side) and right foot (injured side) forward together. d. The patient moves both crutches and injured leg forward together, and then moves the non-injured leg forward. 34. You’re demonstrating how to ambulate while using crutches to a group of pre-op patients, who will need to use crutches after surgery. You ask one of the group participants to demonstrate the four-point gait using the crutches. Which demonstration by the participant demonstrates they understood the demonstration you provided earlier? a. The participant moves both crutches forward and then moves both legs past the placement of the crutches. b. The participant moves both crutches and injured leg forward together, and then moves the non-injured leg forward. c. The participant moves both the right crutch and left foot forward together, and then moves the left crutch and right foot forward together. d. The participant moves the right crutch, then moves the left foot, then moves the left crutch, and then moves the right foot. 35. While your patient is ambulating with crutches he moves both crutches forward along with the injured leg and then moves the non-injured forward. When you document you will note that the patient used what type of gait while ambulating with crutches? a. Two-point gait b. Three-point gait c. Four-point gait d. Swing-to-gait 36. While using crutches the patient moves both crutches forward and then moves both legs forward past the placement of the crutches. This is known as the: a. Two-point gait b. Swing-to-gait c. Swing-through-gait d. Three-point gait 37. You're caring for a patient who has a health history of severe osteoporosis. On assessment you note the patient has severe kyphosis of the upper back. Which nursing diagnosis takes priority for this patient's care? a. Risk for skin breakdown b. Knowledge deficient regarding disease process c. Limited mobility d. Risk for falls 38. A patient is prescribed Alendronate (Fosamax) at 0800 for the treatment of osteoporosis. As the nurse you know you must administer this medication: a. On an empty stomach with a full glass of water and keep the patient upright for 30 minutes. b. Right after breakfast and to lay the patient flat (as tolerated) for 30 minutes. c. With food but to avoid giving this medication with dairy products. d. On an empty stomach with a full glass of juice or milk. Answer: A - On an empty stomach with a full glass of water and keep the patient upright for 30 minutes. 39. A patient is taking Calcitonin for osteoporosis. The patient should be monitored for? a. Hyperkalemia b. Hypokalemia c. Hypocalcemia d. Hypercalcemia 40. When taking a patient history during assessment of the musculoskeletal system, the nurse identifies an increased risk for Osteoporosis for the patient who reports: a. That a parent became much shorter with aging. b. A sprained ankle 2 years previously. c. A family history of tuberculosis. d. Taking over-the-counter (OTC) ibuprofen (Advil) for occasional aches. 41. A client has been prescribed alendronate (Fosamax) 5 mg daily for her osteoporosis. Which teaching would the nurse include to avoid side effect? a. The client should rotate injection sites during administration of medication. b. The client should monitor liver function tests frequently. c. The client should take the medication early in the morning and not lay down until breakfast. d. The client should report any vaginal bleeding. 42. Which of the following patients is at the highest risk for developing osteoporosis? a. A young male weight-lifter who drinks beer three times a week and has a stable job. b. A woman who works as a vice-president, drinks vodka five times weekly, and exercises regularly. c. A middle-aged woman of lower socioeconomic status who is a heavy smoker and drinks alcohol five times weekly. d. A retired man who drinks alcohol socially and is a non-smoker. 43. Identify the correct sequence in how rheumatoid arthritis develops: a. Development of pannus, synovitis, ankylosis b. Anklyosis, development of pannus, synovitis c. Synovitis, development of pannus, anklyosis d. Synovitis, anklyosis, development of pannus 44. Which statement is FALSE concerning rheumatoid arthritis? a. Rheumatoid arthritis most commonly affects the fingers and wrist. b. Rheumatoid arthritis is different from osteoarthritis in that it doesn't affect other systems of the body. TOP RANK REVIEW ACADEMY, INC. Page 3 | 4
c. Rheumatoid arthritis can occur at any age (20-60 year old most commonly). d. Ankylosis can occur in severe cases of rheumatoid arthritis. 45. A nurse is caring for a client diagnosed with rheumatoid arthritis (RA). Which assessment finding does the nurse expect to assess? a. Asymmetrical pain in the large weight bearing joints. b. Low back pain and stiffness that is worse in the morning. c. Pain, swelling, and redness of the great toe. d. Symmetrical pain and swelling in the small joints of the hands. 46. During a head-to-toe assessment of a patient with osteoarthritis, you note bony outgrowths on the distal interphalangeal joints. You document these findings as: a. Bouchard's Nodes b. Heberden's Nodes c. Neurofibromatosis d. Dermatofibromas 47. During a head-to-toe assessment of a patient with arthritis, you note bony outgrowths on the proximal interphalangeal joint. These outgrowths are known as __________ and occur in ______________. a. Heberden's Node, osteoarthritis b. Bouchard's Node, rheumatoid arthritis c. Heberden's Node, rheumatoid arthritis d. Bouchard's Node, osteoarthritis 48. Which of the following should the nurse assess when completing the history and physical examination of a client diagnosed with osteoarthritis? a. Anemia. b. Osteoporosis. c. Weight loss. d. Local joint pain. 49. You are providing a free clinic seminar to participants about gout. Which statement by a participant about the occurrence of gout is correct? a. "Gout attacks tend to awake the person out of their sleep in the middle of the night." b. "The pain felt with gout tends to be intense during the first 30 minutes." c. "It is best for a patient experiencing gout to tightly bandage the affected extremity." d. "Typically acute gout attacks are predictable and tend to occur once or twice a week." 50. A patient is ordered by the physician to take Allopurinol (Zyloprim) for treatment of gout. You've provided education to the patient about this medication. Which statement by the patient requires you to re-educate them about this medication? a. "This medication will help relieve the inflammation and pain during an acute attack." b. "It is important I have regular eye exams while taking this medication." c. "I will not take large doses of vitamin C supplements while taking this medication." d. "Allopurinol decreases the production of uric acid." TOP RANK REVIEW ACADEMY, INC. Page 4 | 4