Module 23: Musculoskeletal

Which term refers to mature compact bone structures that form concentric rings of bone matrix?
a) Cancellous bone
b) Lamellae
c) Trabecula
d) Endosteum

Which description refers to an osteon?

a) Bone resorption cell
b) Microscopic functional bone unit
c) Bone-forming cell
d) Mature bone cell

Which term refers to the shaft of the long bone?

a) Lordosis
b) Epiphysis
c) Scoliosis
d) Diaphysis

What statement describes paresthesia?

a) Absence of muscle mvmt suggesting nerve damage
b) Abnormal sensations
c) Involuntary twitch of muscle fibers
d) Absence of muscle tone

Which term refers to a grating or crackling sound or sensation?

a) Crepitus
b) Callus
c) Clonus
d) Fasciculation

Which term refers to muscle tension being unchanged with muscle shortening and joint motion?
a) Contracture
b) Isotonic contraction
c) Isometric contraction
d) Fasciculation

During which stage or phase of bone healing after fracture (fx) does callus formation occur?
a) Inflammation
b) Revascularization
c) Reparative
d) Remodeling

After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new
bone reorganized into its former structural arrangement?
a) Reparative
b) Inflammation
c) Revascularization
d) Remodeling
Which nerve is assessed when the nurse asks the client to spread all fingers?
a) Radial
b) Ulnar
c) Peroneal
d) Median

Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the
toes?
a) Ulnar
b) Peroneal
c) Median
d) Radial

Which statement reflects the progress of bone healing?

a) All fx healing takes place at the same rate no matter the type of bone fx'd.
b) Serial x-rays are used to monitor the progress of bone healing.
c) The age of the client influences the rate of fx healing.
d) Adequate immobilization is essential until ultrasound shows evidence of bone formation with
ossification.

 A client is exhibiting diminished ROM, loss of flexibility, stiffness, and loss of height. The H&P findings
are associated with age-related changes of which area?
a) Ligaments
b) Bones
c) Joints
d) Muscles

Fracture healing occurs in four areas, including the

a) external soft tissue
b) fascia
c) cartilage
d) bursae

Which is an indicator of neurovascular compromise?

a) Warm skin temperature
b) Pain upon active stretch
c) Capillary refill of more than 3 seconds
d) Diminished pain

Which term refers to moving away from midline?

a) Inversion
b) Adduction
c) Abduction
d) Eversion

Which body movement involves moving toward the midline?

a) Eversion
b) Pronation
c) Adduction
d) Abduction

What is the term for lateral curving of the spine?

a) Diaphysis
b) Lordosis
c) Scoliosis
d) Epiphysis

What is the term for a rhythmic contraction of a muscle?

a) Clonus
b) Crepitus
c) Hypertrophy
d) Atrophy

Which is a circulatory indicator of peripheral neurovascular dysfunction?

a) weakness
b) paralysis
c) paresthesia
d) cool skin

An example of a flat bone is the

a) vertebra
b) sternum
c) metacarpals
d) femur

Which hormone inhibits bone resorption and increases the deposit of calcium in the bone?
a) Sex hormones
b) Growth hormones
c) Vitamin D
d) Calcitonin

Skull sutures are an example of which type of joint?

a) Amphiarthrosis
b) Synarthrosis
c) Diarthrosis
d) Aponeuroses

Which laboratory study indicates the rate of bone turnover?

a) Serum osteocalcin
b) Serum calcium
c) Urine calcium
d) Serum phosphorous

Which is a neurovascular problem caused by pressure within a muscle area that increases to such an
extent that microcirculation diminishes?
a) Fasciculation
b) Compartment syndrome
c) Remodeling
d) Hypertrophy

Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the
knee, shoulder, ankle, hip, or wrist?
a) Arthography
b) Bone densitometry
c) Meniscography
d) EMG
Which device is designed specifically to support and immobilize a body part in a desired position?
a) Continuous passive motion (CPM) device
b) Trapeze
c) Splint
d) Brace

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery?
a) Avoid placing a pillow between the legs when sleeping
b) Keep the knees together at all times
c) Bend forward only when seated in a chair
d) Never cross the affected leg when seated

The nurse teaching the client with a cast about home care includes which instruction?
a) Cover the cast with plastic or rubber
b) Keep the cast below heart level
c) Fix a broken cast by applying tape
d) Dry a wet fiberglass cast thoroughly to avoid skin problems

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery?
a) It prevents infection and controls edema and bleeding.
b) It promotes healing by immobilizing the knee joint.
c) It promotes healing by increasing circulation and movement of the knee joint.
d) It provides active ROM.

Which nursing action would help prevent DVT in a client who has had an orthopedic surgery?
a) Apply anti-embolism stockings
b) Instruct about exercise, as prescribed
c) Instruct about using client-controlled analgesia, if prescribed
d) Apply cold packs

Which type of cast encloses the truck and a lower extremity?

a) Short-leg
b) Hip spica
c) Body Cast
d) Long-leg

Which statement is accurate regarding care of a plaster cast?

a) A dry plaster cast is dull and gray
b) The cast can be dented while it is damp
c) The cast must be covered with a blanket to keep it moist during the first 24 hours
d) The cast will dry in about 12 hours

What would be an inappropriate initial pain relief measure for the client with a cast?
a) Application of a new cast
b) Administration of analgesics
c) Elevation of the involved part
d) Application of cold packs

Which would be contraindicated as a component of self-care activities for the client with a cast?
a) Do not attempt to scratch the skin under a cast
b) Cushioning rough edges of the cast with tape
c) Cover the cast with plastic to insulate it
d) Elevate the casted extremity to heart level frequently
Which is an inaccurate principle of traction?
a) The weights are not removed unless intermittent treatment is prescribed.
b) The weights must hang freely
c) The client must be in good alignment in the center of the bed
d) Skeletal traction is interrupted to turn and reposition the client.

Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle
tissue pressure?
a) Fasciotomy
b) Arthroplasty
c) Arthrodesis
d) Osteotomy

Which cleansing solution is the most effective for use in completing pin site care?
a) Betadine
b) Chlorhexidine
c)Alcohol
d) Hydrogen Peroxide

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure
of the fracture?
a) Joint arthroplasty
b) Open reduction
c) Total join arthroplasty
d) Arthrodesis

What is an inappropriate use of traction?

a) Decrease space between opposing structures
b) Reduce deformity
c) Minimize muscle spasms
d) Immobilize a fracture

Meniscectomy refers to the

a) removal of a body part
b) incision and diversion of the muscle fascia
c) replacement of one of the articular surfaces of a joint
d) excision of damaged joint fibrocartilage

Which interventions should a nurse implement as part of initial pain relief for the client with a cast?
Select all that apply.
a) Elevate the involved part
b) Administer analgesics
c) Apply cold packs
d) Provide passive ROM
e) Apply a new cast

1. A nurse is caring for an adult patient diagnosed with a back strain. What health education should
the nurse provide to this patient?
A) Avoid lifting more than one-third of body weight without assistance.
B) Focus on using back muscles efficiently when lifting heavy objects.
C) Lift objects while holding the object a safe distance from the body.
D) Tighten the abdominal muscles and lock the knees when lifting of an object.
A nurse is discussing conservative management of tendonitis with a patient. Which of the following may
be an effective approach to managing tendonitis?
A) Weight reduction
B) Use of oral opioid analgesics
C) Intermittent application of ice and heat
D) Passive range of motion exercises

3. A patient presents at a clinic complaining of pain in his heel so bad that it inhibits his ability to
walk. The patient is subsequently diagnosed with plantar fasciitis. This patients plan of care should
include what intervention?
A) Wrapping the affected area in lambs wool or gauze to relieve pressure
B) Gently stretching the foot and the Achilles tendon
C) Wearing open-toed shoes at all times
D) Applying topical analgesic ointment to plantar surface each morning

4. A nurse is providing an educational class to a group of older adults at a community senior center.
In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they
consume the recommended adequate intake of what nutrients? Select all that apply.
A) Vitamin B12
B) Potassium
C) Calcitonin
D) Calcium
E) Vitamin D

. A nurse is providing a class on osteoporosis at the local seniors center. Which of the following
statements related to osteoporosis is most accurate?
A) Osteoporosis is categorized as a disease of the elderly.
B) A nonmodifiable risk factor for osteoporosis is a persons level of activity.
C) Secondary osteoporosis occurs in women after menopause.
D) Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis.

6. A nurse is teaching a patient with osteomalacia about the role of diet. What would be the best
choice for
breakfast for a patient with osteomalacia?
A) Cereal with milk, a scrambled egg, and grapefruit
B) Poached eggs with sausage and toast
C) Waffles with fresh strawberries and powdered sugar
D) A bagel topped with butter and jam with a side dish of grapes

7. A nurse is caring for a patient with Pagets disease and is reviewing the patients most recent
laboratory
values. Which of the following values is most characteristic of Pagets disease?
A) An elevated level of parathyroid hormone and low calcitonin levels
B) A low serum alkaline phosphatase level and a low serum calcium level
C) An elevated serum alkaline phosphatase level and a normal serum calcium level
D) An elevated calcitonin level and low levels of parathyroid hormone

8. Which of the following patients should the nurse recognize as being at the highest risk for the
development of osteomyelitis?
A) A middle-age adult who takes ibuprofen daily for rheumatoid arthritis
B) An elderly patient with an infected pressure ulcer in the sacral area
C) A 17-year-old football player who had orthopedic surgery 6 weeks prior
D) An infant diagnosed with jaundice

9. A nurse is caring for a patient with a bone tumor. The nurse is providing education to help the
patient
reduce the risk for pathologic fractures. What should the nurse teach the patient?
A) Strive to achieve maximum weight-bearing capabilities.
B) Gradually strengthen the affected muscles through weight training.
C) Support the affected extremity with external supports such as splints.
D) Limit reliance on assistive devices in order to build strength.

10. A patient presents at a clinic complaining of back pain that goes all the way down the back of the leg
to
the foot. The nurse should document the presence of what type of pain?
A) Bursitis
B) Radiculopathy
C) Sciatica
D) Tendonitis

11. A patient tells the nurse that he has pain and numbness to his thumb, first finger, and second
finger of
the right hand. The nurse discovers that the patient is employed as an auto mechanic, and that the
pain is
increased while working. This may indicate that the patient could possibly have what health
problem?
A) Carpel tunnel syndrome
B) Tendonitis
C) Impingement syndrome
D) Dupuytrens contracture

12. A nurse is assessing a patient who reports a throbbing, burning sensation in the right foot. The
patient
states that the pain is worst during the day but notes that the pain is relieved with rest. The nurse
should
recognize the signs and symptoms of what health problem?
A) Mortons neuroma
B) Pescavus
C) Hallux valgus
D) Onychocryptosis

3. A nurse is reviewing the pathophysiology that may underlie a patients decreased bone density. What
hormone should the nurse identify as inhibiting bone resorption and promoting bone formation?
A) Estrogen
B) Parathyroid hormone (PTH)
C) Calcitonin
D) Progesterone

14. A patient is undergoing diagnostic testing for osteomalacia. Which of the following laboratory
results is
most suggestive of this diagnosis?
A) High chloride, calcium, and magnesium
B) High parathyroid and calcitonin levels
C) Low serum calcium and magnesium levels
D) Low serum calcium and low phosphorus level

15. An 80-year-old man in a long-term care facility has a chronic leg ulcer and states that the
area has
become increasingly painful in recent days. The nurse notes that the site is now swollen and
warm to the
touch. The patient should undergo diagnostic testing for what health problem?
A) Osteomyelitis
B) Osteoporosis
C) Osteomalacia
D) Septic arthritis

16. A patient has returned to the unit after undergoing limb-sparing surgery to remove a metastatic
bone
tumor. The nurse providing postoperative care in the days following surgery assesses for what
complication from surgery?
A) Deficient fluid volume
B) Delayed wound healing
C) Hypocalcemia
D) Pathologic fractures

17. A nurse is caring for a patient who is 12 hours postoperative following foot surgery. The nurse
assesses
the presence of edema in the foot. What nursing measure will the nurse implement to control the
edema?
A) Elevate the foot on several pillows.
B) Apply warm compresses intermittently to the surgical area.
C) Administer a loop diuretic as ordered.
D) Increase circulation through frequent ambulation.

18. A patient with diabetes is attending a class on the prevention of associated diseases. What
action should
the patient perform to reduce the risk of osteomyelitis?
A) Increase calcium and vitamin intake.
B) Perform meticulous foot care.
C) Exercise 3 to 4 times weekly for at least 30 minutes.
D) Take corticosteroids as ordered.

19. A nurse is planning the care of an older adult patient with osteomalacia. What action should the
nurse
recommend in order to promote vitamin D synthesis?
A) Ensuring adequate exposure to sunlight
B) Eating a low-purine diet
C) Performing cardiovascular exercise while avoiding weight-bearing exercises
D) Taking thyroid supplements as ordered

20. A patient presents to a clinic complaining of a leg ulcer that isnt healing; subsequent diagnostic
testing
suggests osteomyelitis. The nurse is aware that the most common pathogen to cause osteomyelitis is
what?
A) Staphylococcus aureus
B) Proteus
C) Pseudomonas
D) Escherichia coli

21. A nurse is providing care for a patient who has a recent diagnosis of Pagets disease. When
planning this patients nursing care, interventions should address what nursing diagnoses?
Select all that apply.
A) Impaired Physical Mobility
B) Acute Pain
C) Disturbed Auditory Sensory Perception
D) Risk for Injury
E) Risk for Unstable Blood Glucose

22. A nurse is caring for a patient who is being assessed following complaints of severe and
persistent low
back pain. The patient is scheduled for diagnostic testing in the morning. Which of the following
are
appropriate diagnostic tests for assessing low back pain? that apply.

A) Computed tomography (CT)

B) Angiography
C) Magnetic resonance imaging (MRI)
D) Ultrasound
E) X-ray

23. A nurse is reviewing the care of a patient who has a long history of lower back pain that has not
responded to conservative treatment measures. The nurse should anticipate the administration of what
drug?
A) Calcitonin
B) Prednisone
C) Aspirin
D) Cyclobenzaprine

24. A nurse is collaborating with the physical therapist to plan the care of a patient with
osteomyelitis. What
principle should guide the management of activity and mobility in this patient?
A) Stress on the weakened bone must be avoided.
B) Increased heart rate enhances perfusion and bone healing.
C) Bed rest results in improved outcomes in patients with osteomyelitis.
D) Maintenance of baseline ADLs is the primary goal during osteomyelitis treatment.

25. A 32-year-old patient comes to the clinic complaining of shoulder tenderness, pain, and limited
movement. Upon assessment the nurse finds edema. An MRI shows hemorrhage of the rotator cuff
tendons and the patient is diagnosed with impingement syndrome. What action should the nurse
recommend in order to promote healing?
A) Support the affected arm on pillows at night.
B) Take prescribed corticosteroids as ordered.
C) Put the shoulder through its full range of motion 3 times daily.
D) Keep the affected arm in a sling for 2 to 4 weeks.

26. A patient presents at the clinic with complaints of morning numbness, cramping, and stiffness in his
fourth and fifth fingers. What disease process should the nurse suspect?
A) Tendonitis
B) A ganglion
C) Carpal tunnel syndrome
D) Dupuytrens disease

27. A patients electronic health record notes that the patient has hallux valgus. What signs and
symptoms
would the nurse expect this patient to manifest?
A) Deviation of a great toe laterally
B) Abnormal flexion of the great toe
C) An exaggerated arch of the foot
D) Fusion of the toe joints

28. An older adult woman's current medication regimen includes alendronate (Fosamax). What outcome
would indicate successful therapy?
A) Increased bone mass
B) Resolution of infection
C) Relief of bone pain
D) Absence of tumor spread'

29. A nurse is caring for a patient who is being treated in the hospital for a spontaneous vertebral
fracture
related to osteoporosis. The nurse should address the nursing diagnosis of Acute Pain Related to
Fracture
by implementing what intervention?
A) Maintenance of high Fowlers positioning whenever possible
B) Intermittent application of heat to the patients back
C) Use of a pressure-reducing mattress
D) Passive range of motion exercises

30. A patient has been admitted to the hospital with a spontaneous vertebral fracture related to
osteoporosis. Which of the following nursing diagnoses must be addressed in the plan of care?
A) Risk for Aspiration Related to Vertebral Fracture
B) Constipation Related to Vertebral Fracture
C) Impaired Swallowing Related to Vertebral Fracture
D) Decreased Cardiac Output Related to Vertebral Fracture

31. A nursing educator is reviewing the risk factors for osteoporosis with a group of recent
graduates. What
risk factor of the following should the educator describe?
A) Recurrent infections and prolonged use of NSAIDs
B) High alcohol intake and low body mass index
C) Small frame, female gender, and Caucasian ethnicity
D) Male gender, diabetes, and high protein intake

32. A nurse is providing care for a patient who has osteomalacia. What major goal will guide the
choice of
medical and nursing interventions?
A) Maintenance of skin integrity
B) Prevention of bone metastasis
C) Maintenance of adequate levels of activated vitamin D
D) Maintenance of adequate parathyroid hormone function

33. A patient has been admitted to the medical unit for the treatment of Pagets disease. When
reviewing the
medication administration record, the nurse should anticipate what medications? Select all that apply.
A) Calcitonin
B) Bisphosphonates
C) Alkaline phosphatase
D) Calcium gluconate
E) Estrogen

34. The health care team is caring for a patient with osteomalacia. It has been determined that the
osteomalacia is caused by malabsorption. What is the usual treatment for osteomalacia caused by
malabsorption?
A) Supplemental calcium and increased doses of vitamin D
B) Exogenous parathyroid hormone and multivitamins
C) Colony-stimulating factors and calcitonin
D) Supplemental potassium and pancreatic enzymes

35. A patient with diabetes has been diagnosed with osteomyelitis. The nurse notes that the patients
right
foot is pale and mottled, cool to touch, with a capillary refill of greater than 3 seconds. The nurse
should
suspect what type of osteomyelitis?
A) Hematogenous osteomyelitis
B) Osteomyelitis with vascular insufficiency
C) Contiguous-focus osteomyelitis
D) Osteomyelitis with muscular deterioration

36. An orthopedic nurse is caring for a patient who is postoperative day one following foot surgery.
What
nursing intervention should be included in the patients subsequent care?
A) Dressing changes should not be performed unless there are clear signs of infection.
B) The surgical site can be soaked in warm bath water for up to 5 minutes.
C) The surgical site should be cleansed with hydrogen peroxide once daily.
D) The foot should be elevated in order to prevent edema.

37. A nurse is providing discharge teaching for a patient who underwent foot surgery. The nurse is
collaborating with the occupational therapist and discussing the use of assistive devices. On what
variables does the choice of assistive devices primarily depend?
A) Patients general condition, balance, and weight-bearing prescription
B) Patients general condition, strength, and gender
C) Patients motivation, age, and weight-bearing prescription
D) Patients occupation, motivation, and age

38. A patient has come to the clinic for a routine annual physical. The nurse practitioner notes a
palpable, painless projection of bone at the patients shoulder. The projection appears to be at the
distal end of the humerus. The nurse should suspect the presence of which of the following?
A) Osteomyelitis
B) Osteochondroma
C) Osteomalacia
D) Pagets disease

39. An elderly female with osteoporosis has been hospitalized. Prior to discharge, when teaching the
patient,
the nurse should include information about which major complication of osteoporosis?
A) Bone fracture
B) Loss of estrogen
C) Negative calcium balance
D) Dowagers hump

40. An older adult patient sought care for the treatment of a swollen, painful knee joint. Diagnostic
imaging
and culturing of synovial fluid resulted in a diagnosis of septic arthritis. The nurse should prioritize
which of the following aspects of care?
A) Administration of oral and IV corticosteroids as ordered
B) Prevention of falls and pathologic fractures
C) Maintenance of adequate serum levels of vitamin D
D) Intravenous administration of antibiotics

1. A nurse admits a patient who has a fracture of the nose that has resulted in a skin tear and
involvement
of the mucous membranes of the nasal passages. The orthopedic nurse is aware that this description
likely indicates which type of fracture?
A) Compression
B) Compound
C) Impacted
D) Transverse
2. A patient has sustained a long bone fracture and the nurse is preparing the patients care plan.
Which of
the following should the nurse include in the care plan?
A) Administer vitamin D and calcium supplements as ordered.
B) Monitor temperature and pulses of the affected extremity.
C) Perform passive range of motion exercises as tolerated.
D) Administer corticosteroids as ordered.

3. A nurses assessment of a patients knee reveals edema, tenderness, muscle spasms, and
ecchymosis. The patient states that 2 days ago he ran 10 miles and now it really hurts to stand up.
The nurse should plan
care based on the belief that the patient has experienced what?
A) A first-degree strain
B) A second-degree strain
C) A first-degree sprain
D) A second-degree sprain

4. A nurse is preparing to discharge a patient from the emergency department after receiving
treatment for
an ankle sprain. While providing discharge education, the nurse should encourage which of the
following?
A) Apply heat for the first 24 to 48 hours after the injury.
B) Maintain the ankle in a dependent position.
C) Exercise hourly by performing rotation exercises of the ankle.
D) Keep an elastic compression bandage on the ankle.

5. A nurse is writing a care plan for a patient admitted to the emergency department (ED) with an
open
fracture. The nurse will assign priority to what nursing diagnosis for a patient with an open fracture of
the radius?
A) Risk for Infection
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 802B)
Risk for Ineffective Role Performance
C) Risk for Perioperative Positioning Injury
D) Risk for Powerlessness

6. A nurse is caring for a patient who has suffered a hip fracture and who will require an
extended hospital
stay. The nurse should ensure that the patient does which of the following in order to prevent
common
complications associated with a hip fracture?
A) Avoid requesting analgesia unless pain becomes unbearable.
B) Use supplementary oxygen when transferring or mobilizing.
C) Increase fluid intake and perform prescribed foot exercises.
D) Remain on bed rest for 14 days or until instructed by the orthopedic surgeon.

7. A nurse is caring for a patient who has suffered an unstable thoracolumbar fracture. Which of the
following is the priority during nursing care?
A) Preventing infection
B) Maintaining spinal alignment
C) Maximizing function
D) Preventing increased intracranial pressure

8. The patient scheduled for a Syme amputation is concerned about the ability to eventually
stand on the
amputated extremity. How should the nurse best respond to the patients concern?
A) You will eventually be able to withstand full weight-bearing after the amputation.
B) You will have minimal weight-bearing on this extremity but youll be taught how to use an
assistive
device.
C) You likely will not be able to use this extremity but you will receive teaching on use of a
wheelchair.
D) You will be fitted for a prosthesis which may or may not allow you to walk.

. A patient with a simple arm fracture is receiving discharge education from the nurse. What would
the
nurse instruct the patient to do?
A) Elevate the affected extremity to shoulder level when at rest.
B) Engage in exercises that strengthen the unaffected muscles.
C) Apply topical anesthetics to accessible skin surfaces as needed.
D) Avoid using analgesics so that further damage is not masked.

10. Six weeks after an above-the-knee amputation (AKA), a patient returns to the outpatient office
for a
routine postoperative checkup. During the nurses assessment, the patient reports symptoms of
phantom
pain. What should the nurse tell the patient to do to reduce the discomfort of the phantom pain?
A) Apply intermittent hot compresses to the area of the amputation.
B) Avoid activity until the pain subsides.
C) Take opioid analgesics as ordered.
D) Elevate the level of the amputation site.

11. A nurse is caring for a patient who had a right below-the-knee amputation (BKA). The nurse
recognizes
the importance of implementing measures that focus on preventing flexion contracture of the hip and
maintaining proper positioning. Which of the following measures will best achieve these goals?
A) Encouraging the patient to turn from side to side and to assume a prone position
B) Initiating ROM exercises of the hip and knee 10 to 12 weeks after the amputation
C) Minimizing movement of the flexor muscles of the hip
D) Encouraging the patient to sit in a chair for at least 8 hours a day

12. A nurse is preparing to discharge an emergency department patient who has been fitted with a
sling to
support her arm after a clavicle fracture. What should the nurse instruct the patient to do?
A) Elevate the arm above the shoulder 3 to 4 times daily.
B) Avoid moving the elbow, wrist, and fingers until bone remodeling is complete.
C) Engage in active range of motion using the affected arm.
D) Use the arm for light activities within the range of motion.

13. The orthopedic nurse should assess for signs and symptoms of Volkmanns contracture if a patient
has
fractured which of the following bones?
A) Femur
B) Humerus
C) Radial head
D) Clavicle

14. An emergency department nurse is assessing a 17-year-old soccer player who presented with a
knee
injury. The patients description of the injury indicates that his knee was struck medially while his foot
was on the ground. The nurse knows that the patient likely has experienced what injury?
A) Lateral collateral ligament injury
B) Medial collateral ligament injury
C) Anterior cruciate ligament injury
D) Posterior cruciate ligament injury

15. A school nurse is assessing a student who was kicked in the shin during a soccer game. The area of
the
injury has become swollen and discolored. The triage nurse recognizes that the patient has likely
sustained what?
A) Sprain
B) Strain
C) Contusion
D) Dislocation

16. Radiographs of a boys upper arm show that the humerus appears to be fractured on one side and
slightly
bent on the other. This diagnostic result suggests what type of fracture?
A) Impacted
B) Compound
C) Compression
D) Greenstick

17. A nurse is performing a shift assessment on an elderly patient who is recovering after surgery for
a hip
fracture. The nurse notes that the patient is complaining of chest pain, has an increased heart rate,
and
increased respiratory rate. The nurse further notes that the patient is febrile and hypoxic, coughing,
and
producing large amounts of thick, white sputum. The nurse recognizes that this is a medical
emergency
and calls for assistance, recognizing that this patient is likely demonstrating symptoms of what
complication?
A) Avascular necrosis of bone
B) Compartment syndrome
C) Fat embolism syndrome
D) Complex regional pain syndrome

18. A young patient is being treated for a femoral fracture suffered in a snowboarding accident. The
nurses
most recent assessment reveals that the patient is uncharacteristically confused. What diagnostic
test
should be performed on this patient?
A) Electrolyte assessment
B) Electrocardiogram
C) Arterial blood gases
D) Abdominal ultrasound

19. Which of the following is the most appropriate nursing intervention to facilitate healing in a
patient who
has suffered a hip fracture?
A) Administer analgesics as required.
B) Place a pillow between the patients legs when turning.
C) Maintain prone positioning at all times.
D) Encourage internal and external rotation of the affected leg.

20. A nurse is planning the care of an older adult patient who will soon be discharged home
after treatment
for a fractured hip. In an effort to prevent future fractures, the nurse should encourage which of
the
following? Select all that apply.
A) Regular bone density testing
B) A high-calcium diet
C) Use of falls prevention precautions
D) Use of corticosteroids as ordered
E) Weight-bearing exercise

21. A patient is brought to the emergency department by ambulance after stepping in a hole and
falling. While assessing him the nurse notes that his right leg is shorter than his left leg; his right hip
is
noticeably deformed and he is in acute pain. Imaging does not reveal a fracture. Which of the
following
is the most plausible explanation for this patients signs and symptoms?
A) Subluxated right hip
B) Right hip contusion
C) Hip strain
D) Traumatic hip dislocation

22. An emergency department patient is diagnosed with a hip dislocation. The patients family is
relieved
that the patient has not suffered a hip fracture, but the nurse explains that this is still considered to
be a
medical emergency. What is the rationale for the nurses statement?
A) The longer the joint is displaced, the more difficult it is to get it back in place.
B) The patients pain will increase until the joint is realigned.
C) Dislocation can become permanent if the process of bone remodeling begins.
D) Avascular necrosis may develop at the site of the dislocation if it is not promptly resolved.

23. The surgical nurse is admitting a patient from post anesthetic recovery following the patients
below-the- knee amputation. The nurse recognizes the patients high risk for postoperative
hemorrhage and should keep which of the following at the bedside?
A) A tourniquet
B) A syringe preloaded with vitamin K
C) A unit of packed red blood cells, placed on ice
D) A dose of protamine sulfate

24. An elite high school football player has been diagnosed with a shoulder dislocation. The patient
has been
treated and is eager to resume his role on his team, stating that he is not experiencing pain. What
should
the nurse emphasize during health education?
A) The need to take analgesia regardless of the short-term absence of pain
B) The importance of adhering to the prescribed treatment and rehabilitation regimen
C) The fact that he has a permanently increased risk of future shoulder dislocations
D) The importance of monitoring for intracapsular bleeding once he resumes playing

25. A patient has presented to the emergency department with an injury to the wrist. The patient
is
diagnosed with a third-degree strain. Why would the physician order an x-ray of the wrist?
A) Nerve damage is associated with third-degree strains.
B) Compartment syndrome is associated with third-degree strains.
C) Avulsion fractures are associated with third-degree strains.
D) Greenstick fractures are associated with third-degree strains.

26. A 20 year-old is brought in by ambulance to the emergency department after being involved in a
motorcycle accident. The patient has an open fracture of his tibia. The wound is highly contaminated
and
there is extensive soft-tissue damage. How would this patients fracture likely be graded?
A) Grade I
B) Grade II
C) Grade III
D) Grade IV

27. A 25-year-old man is involved in a motorcycle accident and injures his arm. The physician
diagnoses the
man with an intra-articular fracture and splints the injury. The nurse implements the teaching plan
developed for this patient. What sequela of intra-articular fractures should the nurse describe
regarding
this patient?
A) Post-traumatic arthritis
B) Fat embolism syndrome (FES)
C) Osteomyelitis

28. A nurse is planning the care of a patient with osteomyelitis that resulted from a diabetic foot
ulcer. The
patient requires a trans metatarsal amputation. When planning the patients postoperative care,
which of
the following nursing diagnoses should the nurse most likely include in the plan of care?
A) Ineffective Thermoregulation
B) Risk-Prone Health Behavior
C) Disturbed Body Image
D) Deficient Diversion Activity

29. A patient is admitted to the orthopedic unit with a fractured femur after a motorcycle accident.
The
patient has been placed in traction until his femur can be rodded in surgery. For what early
complications should the nurse monitor this patient? Select all that apply.
A) Systemic infection
B) Complex regional pain syndrome
C) Deep vein thrombosis
D) Compartment syndrome
E) Fat embolism

30. A patient has come to the orthopedic clinic for a follow-up appointment 6 weeks after
fracturing his
ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have
contributed
to this complication?
A) Inadequate vitamin D intake
B) Bleeding at the injury site
C) Inadequate immobilization
D) Venous thromboembolism (VTE)

31. An older adult patient has fallen in her home and is brought to the emergency department by
ambulance
with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning
assessments during the patients presurgical care, the nurse should be aware of the patients
heightened
risk of what complication?
A) Osteomyelitis
B) Avascular necrosis
C) Phantom pain
D) Septicemia
32. A patient is being treated for a fractured hip and the nurse is aware of the need to implement
interventions to prevent muscle wasting and other complications of immobility. What intervention
best
addresses the patients need for exercise?
A) Performing gentle leg lifts with both legs
B) Performing massage to stimulate circulation
C) Encouraging frequent use of the overbed trapeze
D) Encouraging the patient to log roll side to side once per hour

33. A patient who has had an amputation is being cared for by a multidisciplinary rehabilitation team.
What
is the primary goal of this multidisciplinary team?
A) Maximize the efficiency of care
B) Ensure that the patients health care is holistic
C) Facilitate the patients adjustment to a new body image
D) Promote the patients highest possible level of function

34. A rehabilitation nurse is working with a patient who has had a below-the-knee amputation. The
nurse
knows the importance of the patients active participation in self-care. In order to determine the
patients
ability to be an active participant in self-care, the nurse should prioritize assessment of what
variable?
A) The patients attitude
B) The patients learning style
C) The patients nutritional status
D) The patients presurgical level of function

35. The nurse is providing care for a patient who has had a below-the-knee amputation. The nurse
enters the
patients room and finds him resting in bed with his residual limb supported on pillow. What is the
nurses
most appropriate action?
A) Inform the surgeon of this finding.
B) Explain the risks of flexion contracture to the patient.
C) Transfer the patient to a sitting position.
D) Encourage the patient to perform active ROM exercises with the residual limb.

36. A patient has returned to the postsurgical unit from the PACU after an above-the-knee
amputation of the
right leg. Results of the nurses initial postsurgical assessment were unremarkable but the
patient has
called out. The nurse enters the room and observes copious quantities of blood at the surgical
site. What
should be the nurses initial action?
A) Apply a tourniquet.
B) Elevate the residual limb.
C) Apply sterile gauze.
D) Call the surgeon.

37. A nurse in a busy emergency department provides care for many patients who present with
contusions, strains, or sprains. Treatment modalities that are common to all of these
musculoskeletal injuries include
which of the following? Select all that apply.
A) Massage
B) Applying ice
C) Compression dressings
D) Resting the affected extremity
E) Corticosteroids
F) Elevating the injured limb

38. A patient who has undergone a lower limb amputation is preparing to be discharged home. What
outcome is necessary prior to discharge?
A) Patient can demonstrate safe use of assistive devices.
B) Patient has a healed, nontender, nonadherent scar.
C) Patient can perform activities of daily living independently.
D) Patientis free of pain.

39. An older adult patient experienced a fall and required treatment for a fractured hip on the
orthopedic
unit. Which of the following are contributory factors to the incidence of falls and fractured hips among
the older adult population? Select all that apply.

A) Loss of visual acuity

B) Adverse medication effects
C) Slowed reflexes
D) Hearing loss
E) Muscle weakness

40. A patient was fitted with an arm cast after fracturing her humerus. Twelve hours after the
application of
the cast, the patient tells the nurse that her arm hurts. Analgesics do not relieve the pain. What
would be
the most appropriate nursing action?
A) Prepare the patient for opening or bi-valving of the cast.
B) Obtain an order for a different analgesic.
C) Encourage the patient to wiggle and move the fingers.
D) Petal the edges of the patients cast.