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Nclex Musculoskeletal Questions

Question: A nurse is performing a musculoskeletal assessment on an older adult living independently. What normal physiologic changes of aging does the nurse expect? (Select all that apply.)
a. Muscle atrophy
b. Slowed movement
c. Scoliosis
d. Arthritis
e. Widened gait

Answer: A,B,D,E

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Question: A client returns to the postanesthesia care unit (PACU) after an arthroscopy to prepare a knee injury. What is the nurse's priority when caring for this client?

a. Perform passive range-of-motion exercises.
b. Keep the affected leg immobilized.
c. Ensure that the patient uses the patient-controlled analgesia (PCA) pump.
d. Check the neurovascular status of the affected leg and foot.

Answer: D

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Question: A client who has a plaster leg splint reports a painful pressure sensation under the elastic wrap that is holding the splint in place. What is the nurse's best initial action?

a. Remove the splint to reduce skin pressure.
b. Perform a neurovascular assessment.
c. Report the client's concern to the primary health care provider.
d. Inspect the skin under the elastic bandage.

Answer: B.

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Question: A client has a synthetic cast placed for a right wrist fracture in the emergency room. What priority health teaching is important for the nurse to provide for this client before returning home? (Select all that apply.)

a. "Keep your right arm below the level of your heart as often as possible."
b. "Use an ice pack for the first 24 hours to decrease tissue swelling."
c. "Move the fingers of the right hand frequently to promote blood flow."
d. "Report coolness or discoloration of your right hand to your doctor."
e. "Don't place any device under the case to scratch the skin if it itches."

Answer: B,C,D,E

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Question: A client who had an elective below-the-knee amputation (BKA) reports pain in the foot that was amputated last week. What is the nurse's most appropriate response to the client's pain?

a. "The pain will go away after the swelling decreases."
b. "That's phantom limb pain and every amputee has that."
c. "Your foot has been amputated, so it's in your head."
d. "On a scale of 0 to 10, how would you rate your pain?"

Answer: D.

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Question: What is the nurse's priority when doing an admission for a client who returned directly from the operating suite after a carpal tunnel repair?

a. Monitor vital signs, including pulse oximetry.
b. Check the surgical dressing to ensure it is intact.
c. Assess neurovascular assessment in the affected arm.
d. Monitor intake and output.

Answer: A.

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Question: The nurse plans to use which tool to measure joint range of motion (ROM)?
A. Doppler device
B. Goniometer
C.Reflex hammer
D. Tonometer

Answer: B.

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Question: A nursing student is studying the skeletal system. Which statement best indicates to the nursing instructor that the student understands a normal physiologic function of the skeletal system?
A."Volkmann's canals connect osteoblasts and osteoclasts."
B. "In the deepest layer of the periosteum is the cortex, which consists of dense, compact bone tissue."
C. "The matrix of the bone is where deposits of calcium and magnesium are present."
D. "Hematopoiesis occurs in the red marrow, which is where blood cells are produced."

Answer: D.

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Question: The nurse is completing an admission assessment on a client scheduled for arthroscopic knee surgery. Which information will be most essential for the nurse to report to the health care provider?
A. Knee pain at a level of 9 (0-to-10 scale)
B. Warm, red, and swollen knee
C. Allergy to shellfish and iodine
D. Previous surgery on the other knee

Answer: B.

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Question: Which client information is most essential for the nurse to report to the health care provider before a client with knee pain undergoes magnetic resonance imaging (MRI)?
A. Daily use of aspirin
B. Swollen and tender knee
C. Presence of a permanent pacemaker
D. History of claustrophobia

Answer: C.

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Question: When assessing a female client, the nurse learns that the client has several risk factors for osteoporosis. Which risk factor will be the priority for client teaching?
A. Low calcium and vitamin D intake
B. Postmenopausal status
C. Positive family history
D. Previous use of steroids

Answer: A.

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Question: Which aspect of postoperative management will the nurse plan to discuss with a client about to undergo an arthroscopic repair of the knee?
A. Physical therapy for exercises
B. Pharmacy for client medications
C. Dietitian for nutrition
D. Social work for care coordination

Answer: A.

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Question: An older adult client with diabetes who had arthroscopic surgery on the right knee the previous day has a red, swollen, and painful right knee. The nurse anticipates that the health care provider will request which type of medication?
A.Antibiotic
B. Anticoagulant
C. Opioid analgesic
D. Corticosteroid

Answer: A.

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Question: A client is suspected of having muscular dystrophy (MD). Which laboratory test result does the nurse anticipate with this disease?
A. Decreased serum creatine kinase (CK) level
B. Moderately elevated aspartate aminotransferase (AST)
C. Decreased alkaline phosphatase (ALP)
D. Decreased skeletal muscle creatine kinase (CK-MM) level

Answer: B.

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Question: The charge nurse in the hospital-based day surgery center is making client assignments for the staff. Which client is most appropriate to assign to a nurse who has floated from the general surgical unit?
A. Young adult who has just been admitted for surgery after sustaining an ankle fracture
B. Adult who needs teaching about quadriceps-setting exercises after knee arthroscopy
C. Middle-aged adult who will require a pneumatic tourniquet applied before knee surgery
D. Older adult who has undergone arthroscopic surgery of the shoulder under local anesthesia

Answer: D.

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Question: A client is scheduled to undergo closed magnetic resonance imaging (MRI) without contrast medium. Which information does the nurse give to the client before the test?
A. "It will be important to lie still in a reclined position for 20 minutes."
B. "Do not eat or drink for 8 hours before the test."
C. "You can have the MRI if you have an internal pacemaker."
D. "All jewelry and clothing with zippers or metal fasteners must be removed."

Answer: D.

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Question: The nurse is conducting a musculoskeletal history in an older adult client who requires a caregiver to perform all activities of daily living (ADLs). Which level of functioning does the nurse record in the client's history using Gordon's Functional Health Patterns?
A.Level 0
B.Level II
C. Level III
D. Level IV

Answer: D.

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Question: The nurse is conducting a musculoskeletal history in an older adult client who requires a caregiver to perform all activities of daily living (ADLs). Which level of functioning does the nurse record in the client's history using Gordon's Functional Health Patterns?
A. Level
B. Level II
C. Level III
D. Level IV

Answer: D.

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Question: A 65-year-old female client has chronic hip pain and muscle atrophy from an arthritic disorder. Which musculoskeletal assessment finding does the nurse expect to see in the client?
A. Antalgic gait
B. Midswing gait
C. Narrow-based stance
D. No lurch in gait

Answer: A.

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Question: Care of the older adult may be affected by which physiologic change in the musculoskeletal system?
A. Regeneration of cartilage
B. Decreased range of motion (ROM)
C. Increased bone density
D. Narrower gait

Answer: B.

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Question: The nurse is attempting to perform a quick assessment of a client's hip discomfort. The client is sitting upright in a wheelchair. What is the nurses initial action?
A.Have the client flex and extend the foot on the affected side.
B.Flex and extend the client's knee to assess for discomfort.
C.Ask the client to stand from the wheelchair and transfer to the bed.
D. Perform passive abduction and adduction of the client's hips.

Answer: B.

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Question: The nurse is reviewing the medication history for a client scheduled for a left total hip replacement. The nurse plans to contact the health care provider if the client is taking which medication?
A. Acetaminophen (Tylenol) for pain relief
B. Bupropion (Wellbutrin) for smoking cessation
C. Magnesium hydroxide (Milk of Magnesia) to treat heartburn
D. Prednisone (Deltasone) to treat asthma

Answer: D.

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Question: Which diagnostic test requires the nurse to know whether the client is allergic to iodine-based contrast?
A.Arthroscopy
B.Computed tomography (CT)
C. Electromyography (EMG)
D. Tomography

Answer: B.

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Question: The nurse is using a common scale to grade a client's muscle strength. The client is able to complete range of motion (ROM) only with gravity eliminated. Which grade does the nurse document in this client's record?
A. 0
B. 1
C. 2
D. 3

Answer: C.

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Question: The ambulatory surgery post anesthesia care unit (PACU) nurse has just received report about clients who had arthroscopic surgery. Which client will the nurse plan to assess first?
A. Young adult client who has been in the PACU for 30 minutes after left knee arthroscopy under local anesthesia
B. Adult client who had a synovial biopsy of the right knee under local anesthesia and has been in the PACU for 20 minutes
C. Adult client who has multiple right knee incisions for repair of torn cartilage and arrived in the PACU an hour ago
D. Middle-aged adult client who returned to the PACU 25 minutes ago after left knee arthroscopic surgery under epidural anesthesia

Answer: D.

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Question: Which information about a client who was admitted with a pelvic fracture after being crushed by a tractor is most important for the nurse to assess to monitor for serious complications from this type of injury?
A. Skin to evaluate lacerations and abrasions.
B. Lungs for bilateral normal breath sounds
C. Pain score and level of alertness
D. Urine dipstick for the presence of red blood cells.

Answer: D.

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Question: A client with peripheral vascular disease will undergo a Syme amputation. What will the nurse teach this patient when providing education about this procedure?
A. "You will be able to bear weight without needing a prosthesis."
B. "This type of procedure results in more pain than others."
C. "The surgeon will remove both the foot and ankle."
D. "This is an above-the-knee type of amputation."

Answer: A.

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Question: The client has sustained a traumatic amputation of the left arm after a machine accident. In what order should the following nursing actions be taken? 1. Apply direct pressure to the amputated site. 2. Elevate the extremity above the client's heart. 3. Assess the client for breathing problems. 4. Examine the amputation site.
A. 2, 4, 3, 1
B. 3, 4, 1, 2
C. 1, 4, 3, 2
D. 4, 1, 2, 3

Answer: B.

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Question: A client sustains a fracture of one arm and the provider applies a plaster cast to the extremity. What will the nurse teach the client to do during the first 24 hours after discharge from the emergency department?
A. Monitor neuromuscular status for decreased circulation and sensation in the extremity.
B. Apply a heating pad for 15 to 20 minutes four times daily to help with pain.
C. Check the fit of the cast by inserting a tongue blade between the cast and the skin.
D. Keep the cast covered with a soft towel to help it to dry quickly.

Answer: A.

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Question: A client sustains a fracture of one arm and the provider applies a plaster cast to the extremity. What will the nurse teach the client to do during the first 24 hours after discharge from the emergency department?
A. Monitor neuromuscular status for decreased circulation and sensation in the extremity.
B. Apply a heating pad for 15 to 20 minutes four times daily to help with pain.
C. Check the fit of the cast by inserting a tongue blade between the cast and the skin.
D. Keep the cast covered with a soft towel to help it to dry quickly.

Answer: A.

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Question: An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client?
A. Keep the client's heels off the bed at all times.
B. Reposition the client every 3 to 4 hours.
C. Administer preventive pain medication before deep-breathing exercises.
D. Prohibit the use of antiembolic stockings.

Answer: A.

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Question: A client has a grade III open fracture of the right tibia. To prevent infection, which intervention does the nurse implement?
A. Apply bacitracin (Neosporin) ointment to the site daily with a sterile cotton swab.
B. Use strict aseptic technique when cleaning the site.
C. Leave the site open to the air to keep it dry.
D. Assist the client to shower daily and pat the wound site dry.

Answer: B.

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Question: A client is in skeletal traction. Which nursing intervention ensures proper care of this client?
A. Ensure that weights are placed on the floor.
B. Ensure that pins are not loose and tighten as needed.
C. Inspect the skin at least every 8 hours.
D. Remove the traction weights only for bathing.

Answer: C.

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Question: An older adult client has multiple tibia and fibula fractures of the left extremity after a motor vehicle crash. Which pain medication does the nurse anticipate will be requested for this client?
A. Cyclobenzaprine (Flexeril)
B. Ibuprofen (Advil)
C. Meperidine (Demerol)
D. Patient-controlled analgesia (PCA) with morphine

Answer: D.

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Question: Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture?
A. "A callus is quickly deposited and transformed into bone."
B. "A hematoma forms at the site of the fracture."
C. "Cellular and vascular proliferation surround the fracture site."
D. "Granulation tissue reabsorbs the hematoma and deposits new bone."

Answer: B.

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Question: A rock climber has sustained an open fracture of the right tibia after a 20-foot (6 meter) fall. The nurse plans to assess the client for which potential complications?
Select all that apply.
A. Acute compartment syndrome (ACS)
B. Fat embolism syndrome (FES)
C. Congestive heart failure
D. Urinary tract infection (UTI)
E. Osteomyelitis

Answer: A,B, E

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Question: The nurse performs a neurovascular assessment on a client with closed multiple fractures of the right humerus who is experiencing increased pain even with maximum ordered doses of morphine. The nurse notes distal capillary refill of 3 seconds and coolness of the hand and fingers. The client reports numbness of the hand and is unable to wiggle the thumb. Which nursing action is indicated?
A. Elevate the extremity.
B. Apply an ice pack to the extremity.
C. Reposition the extremity and recheck in 15-20 minutes.
D. Notify the provider of these findings.

Answer: D.

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Question: A client undergoes a surgical amputation of a lower extremity after a motor vehicle crash. The client's vital signs are stable. What is a priority nursing action in the early postoperative period to help prevent complications in this client?
A. Fitting the client with a prosthetic device
B. Inspecting the limb stump daily for signs of skin breakdown
C. Positioning and range-of-motion of the affected extremity
D. Teaching the client and family how to apply shrinker stockings

Answer: C.

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Question: Which nursing action does the nurse on the orthopedic unit plan to delegate to unlicensed assistive personnel (UAP)?
A. Removing the wound drain for a client who had an open reduction of a hip fracture 3 days ago.
B. Assessing for bruising on a client who is receiving warfarin (Coumadin) to prevent deep vein thrombosis.
C. Teaching a client with a right ankle fracture how to use crutches when transferring and ambulating.
D. Checking the vital signs for a client who was admitted after a total knee replacement 3 hours ago.

Answer: D.

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Question: The nurse anticipates providing collaborative care for a client with a traumatic amputation of the right hand with which health care team members?
Select all that apply.
A. Occupational therapist
B. Physical therapist
C. Psychologist
D. Respiratory therapist
E. Speech therapist

Answer: A,B,C

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Question: Which intervention does the nurse suggest to a client who has undergone a leg amputation to help cope with loss of the limb?
A. Talking with an amputee close to the client's age who has a similar amputation
B. Drawing a picture of how the client sees him- or herself
C. Talking with a psychiatrist about the amputation
D. Engaging in diversional activities to avoid focusing on the amputation

Answer: A.

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Question: A client is recovering from an above-the-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure?
A. "My spouse will be the only person to change my dressing."
B. "I can't believe that this has happened to me. I can't stand to look at it."
C. "I do not want any visitors while I'm in the hospital."
D. "It will take me some time to get used to this."

Answer: D.

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Question: The nurse admits an older adult client who sustained a left hip fracture and is in considerable pain. The nurse anticipates that the client will be placed in which type of traction prior to surgical repair?
A. Balanced skin traction
B. Buck's traction
C. Overhead traction
D. Plaster traction

Answer: B.

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Question: A client has undergone an elective below-the-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse instructs the client to notify the health care provider immediately if which change occurs?
A. Observation of a large amount of serosanguineous or bloody drainage
B. Mild to moderate pain controlled with prescribed analgesics
C. Absence of erythema and tenderness at the surgical site
D. Ability to flex and extend the right knee

Answer: A.

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Question: A client with a fracture asks the nurse about the difference between an open fracture and a simple fracture. Which statement by the nurse is correct?
A. "Simple fracture involves a break in the bone, with skin contusions."
B. "An open fracture does not extend through the skin."
C. "Simple fracture has an increased risk for infection and emboli."
D. "An open fracture involves a break in the bone, with damage to the skin."

Answer: D.

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Question: A client has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction does the nurse include in this client's teaching plan?
A. "Use pain medication as prescribed to control pain."
B. "Clean the pin site when any drainage is noticed."
C. "Wear the same clothing that is normally worn."
D. "Apply bacitracin (Neosporin) if signs or symptoms of infection develop around pin sites."

Answer: A.

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Question: The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information does the nurse include in the teaching plan?
A. "Avoid contact sports."
B. "Avoid rigorous exercise."
C. "Wear helmets when riding a motorcycle."
D. "Avoid driving in inclement weather."

Answer: C.

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Question: A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment?
A. Surgical repair of the rotator cuff
B. Prescribed exercises of the affected arm
C. Activity limitations for the affected arm
D. Patient-controlled analgesia with morphine

Answer: A.

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Question: Which signs and symptoms would be expected in a patient who has a first-degree ankle sprain?
Select all that apply.
A. Tenderness
B. Severe pain
C. Loss of function
D. Minimal swelling
E. Diminished pulses

Answer: A & D.

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Question: Which factors could increase the risk for developing compartment syndrome?
Select all that apply.
A. Edema
B. Active bleeding
C. Application of a half cast
D. Restrictive arm splint
E. Intravenous (IV) infiltration

Answer: A, B, D,E

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Question: What are the phases of compartment syndrome?

Answer: Swelling of the arm
Occlusion of the arm arteries and veins
Death of the arm tissue
Muscle and nerve damage
Eruption of fibrotic tissue

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Question: The nurse is caring for a patient who has swelling on the right forearm after a fall. Which order by the health care provider should the nurse anticipate next?
A. Obtain STAT X-ray
B. Administer intravenous morphine
C. Apply warm compress on the right forearm
D. Start intravenous (IV) infusion with normal saline

Answer: A.

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Question: When caring for a patient with right ankle swelling, the nurse notes edema, bruising, and decreased movement of the foot. Which acute actions should the nurse take?
Select all that apply.
A. Elevate the extremity
B. Assess the patient's urine output
C. Perform passive range of motion (ROM)
D. Conduct a baseline neurovascular examination
E. Educate the patient and family about strengthening exercises

Answer: A &D

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Question: A patient diagnosed with compartment syndrome begins to complain of left flank pain. The nurse notes dark red urine. Which action would the nurse take to manage this patient's symptoms?
A. Increase fluid intake
B. Provide a cold compress
C. Elevate the affected limb above the head
D. Increase traction weight on the affected limb

Answer: A.

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Question: Which signs and symptoms would the nurse find in a patient with compartment syndrome?
Select all that apply.
A. Erythema
B. 1+ pulses
C. Warmth at the affected site
D. Pain not relieved by morphine
E. Tingling sensation of the fingers

Answer: B, D, E

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Question: Which manifestation can be seen in a patient with a third-degree back strain?
A. Mild edema
B. Pain and pallor
C. Active bleeding
D. Complete loss of function

Answer: D.

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Question: Which injuries are susceptible to compartment syndrome?
Select all that apply.
A. Fractured rib
B. Orbital fracture
C. Upper arm fracture
D. Basilar skull fracture
E Third-degree ankle strain

Answer: C & E.

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Question: When caring for a patient with a right leg fracture, the patient reports pain not relieved by analgesic and tingling of the toes. The nurse also notes diminished pedal pulses and swelling above the dressing. Which action should the nurse take?
A. Loosen the dressing
B. Maintain the traction weight
C. Prepare for emergency decompression
D. Immediately inform the health care provider

Answer: A.

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Question: A patient with an upper arm fracture is diagnosed with compartment syndrome. After the health care provider cuts the cast, the nurse notes continued swelling, absent radial pulse, pallor, and cool skin. Which initial action should the nurse take?
A. Begin preoperative checklist
B. Raise the fractured arm above the head
C. Obtain samples for urinalysis and serum creatinine
D. Continue doing the neurovascular examination until patient is stable

Answer: A.

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Question: A patient presents with bilateral leg pain, abdominal pain, and difficulty breathing after a motor vehicle accident. The nurse notes obvious deformities to the bilateral lower legs, bruising to the chest, and abrasions on the chest, abdomen, and arms. Which actions should the nurse perform while assessing the severity of the patient's injuries?
Select all that apply.
A. Auscultate lung sounds
B. Assess peripheral pulses
C. Assess capillary refill time
D. Start intravenous (IV) infusion with dextrose in 5% water
E. Prepare patient for computed tomography (CT) scan

Answer: A,B,C

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Question: While caring for a patient after a third-degree ankle sprain, the nurse notes the patient can bear weight on the affected foot without discomfort. Which actions would the nurse consider?
Select all that apply.
A. Teach strengthening exercises for the ankle
B. Assess neurovascular status of affected extremity
C. Teach patient to continue applying ice packs at home
D. Check X-ray finding with the patient to see if there is no fracture
E. Perform passive range-of-motion (ROM) exercises on the affected foot

Answer: A & B

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Question: A patient presents at the emergency department and is found to have a closed fracture of the humerus. Which description is consistent with this type of fracture?
A.The skin remains intact.
B.The skin is broken while the bone is exposed.
C.The line of the fracture extends across the bone shaft.
D. The line of the fracture extends in a twisting direction.

Answer: A.

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Question: Which conditions can increase the risk for fractures?
Select all that apply.
A. Diabetes
B. Bone cyst
C.Hypertension
D.Osteoporosis
E. Metastatic cancer

Answer: B,D,E

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Question: The nurse is caring for a patient with swelling, discoloration, and obvious deformity to the right forearm after a fall. Which order should the nurse anticipate from the health care provider?
A.Administer cephalosporin
B.Prepare for STAT closed reduction
C.Obtain an X-ray of the right arm
D. Obtain a computed tomography (CT) scan of the right arm

Answer: C.

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Question: The nurse is caring for a patient with a right humeral fracture after a skating accident. Which type of splint would the nurse use for this patient?
A.Cylinder
B. Sugar tong
C. Long arm splint
D.Short arm splint

Answer: C.

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Question: After identifying Ms. Fielding's rib fractures, which potential signs and symptoms should the nurse monitor to detect related injuries?
Select all that apply.
A.Hemoptysis
B.High blood pressure
C.Low oxygen saturation
D. Right lower quadrant pain
E. Random blood sugar of 120

Answer: A & C

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Question: Ms. Fielding reports shortness of breath. The nurse notes shallow, labored breathing. Which intervention is priority for the nurse to take while Ms. Fielding is in the emergency unit?
A. Prepare patient for CT scan
B. Encourage increased oral fluids
C. Administer supplemental oxygen
D. Administer intravenous (IV) morphine

Answer: C.

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Question: The nurse is caring for a patient with a suspected arm fracture. The nurse notes an increased risk for fracture based on which patient statement?
A. "I am a strict vegetarian."
B. "I have two pet dogs at home."
C. "I use daily inhaled steroids for asthma."
D. "I worked out 3 or 4 times a week before the injury."

Answer: C.

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Question: After a motor vehicle accident, a patient presents with a deformity to the leg with decreased pedal pulses. The fibula protrudes from the lateral aspect of the leg. How should the nurse classify the fracture?
A. Open
B. Spiral
C. Closed
D. Displaced
E. Incomplete

Answer: A & D

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Question: A nurse is reviewing the medical history of a patient with a pathologic fracture of the hip. Which condition may be a cause for the fracture of this patient?
A. Breast cancer
B. Lactose intolerance
C. Rheumatoid arthritis
D. Systemic lupus erythematosus (SLE)

Answer: A.

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Question: A patient who fractured the humerus 5 weeks prior presents for a follow-up X-ray. Which result should the nurse expect to find on the X-ray?
A. Soft tissue damage
B. Fracture still evident
C. Joint union complete
D. Distance between bone fragments decreasing

Answer: B.

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Question: A patient is undergoing a noninvasive electrical bone growth stimulation on a nonunion fracture of the spine after a spinal fusion surgery that was performed 6 months ago. Which action should the nurse take?
A. Check if the electrode is implanted in the bone fragment.
B. Ensure that treatment is administered while patient is sleeping.
C. Assist patient in walking while in treatment for at least three times for 15 minutes.
D. Check if the external power supply is inserted properly through the skin and bone.

Answer: B.

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Question: The nurse is caring for a patient after an open reduction of a hip fracture that requires immobilization. Which form of immobilization would the nurse anticipate?
A. Skin traction
B. Skeletal traction
C. Internal fixation
D. External fixation

Answer: B.

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Question: The nurse is caring for a patient who reports having severe pain and decreased movement after an ankle dislocation. After verifying the prescription and patient allergies, which medication would the nurse safely administer to this patient?
A. Morphine
B. Cyclobenzaprine
C. Acetaminophen/codeine
D. Oxycodone/acetaminophen

Answer: A.

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Question: A patient with a pelvic fracture is non-weight bearing and is unable to ambulate. Which dietary modifications should the nurse anticipate for this patient?
Select all that apply.
A. Increase dietary fiber
B. Limit oral fluid intake
C. Increase iron-rich foods
D. Increase calcium-rich foods
E. Decrease protein-rich foods

Answer: A & D

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Question: The nurse is caring for a patient with a right leg deformity who reports numbness of the toes and plantar aspect of the foot. On further assessment, the nurse notes no pedal pulse and cool skin. Which action should the nurse take next after notifying the provider?
A. Prepare for reduction and splint
B. Start IV infusion with normal saline
C. Prepare the patient for a STAT X-ray
D. Elevate the right leg and apply ice pack

Answer: A.

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Question: The nurse is caring for a patient with a short leg cast who reports itching and burning inside the cast. Which actions would the nurse perform?
Select all that apply.
A. Assess capillary refill of the toes
B. Apply ice on the affected leg for 2 days
C. Immobilize joints above and below the cast
D. Report the symptoms to the health care provider
E. Teach the patient to use cool setting of hair dryer for itching

Answer: A, D, E

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Question: The nurse is caring for a patient who underwent an open hip fracture reduction. The patient reports having pain that radiates down the leg. Which actions should the nurse take?
Select all that apply.
A. Assess for muscle spasm
B. Administer pain medication
C. Massage the surrounding muscles
D. Assess vital signs and capillary refill
E. Report symptoms immediately to health care provider

Answer: A, B, D

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Question: The nurse is caring for a patient with an open arm fracture after a horse riding accident. Which actions are important for the nurse to take?
Select all that apply.
A. Splint the arm
B. Administer IV antibiotics
C. Assess capillary refill of fingers
D. Assess airway and cervical spine
E. Administer antitetanus as prescribed
F. Apply heating pads on the affected areas

Answer: B, C, D,E

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