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Which of the following interventions will assist the patient with a bone
tumor to reduce the risk for pathologic fractures?

Strengthen the affected muscles through weight training

Limit the use of reliance on assistive devices

Work to achieve maximum weight-bearing capabilities

Support the affected extremity with external supports


Rationale: During nursing care, the affected extremities will be
supported and handled gently. External supports (splints) may be
used for additional protection. Prescribed weight-bearing restrictions
must be followed. Assistive devices are used to strengthen the
unaffected extremities.
2. A patient on long-term corticosteroid therapy is diagnosed with
osteoporosis. The corticosteroids are discontinued, but the patient
remains concerned about her osteoporosis and long-term prognosis.
Which of the following statements is the nurses best response to the
patients concerns regarding the corticosteroid therapys effect on her

Discontinuing the corticosteroids will halt the

progression of osteoporosis, but restoration of the lost bone
mass usually does not occur.

Now that the corticosteroids have been stopped, you

will regain the lost bone mass in about 2 months.

Studies indicate that after stopping steroid therapy you

will continue to lose bone mass for approximately 12 to 18
months, but the physician will prescribe a medication to
strengthen your bones during this period of time.

With the intake of adequate calcium and vitamin D,

you will see a rapid restoration of lost bone mass over the
next 3 to 6 months.

Rationale: When the corticosteroid therapy is discontinued, the
progression of osteoporosis is halted, but restoration of lost bone
mass usually done not occur.
3. Which of the following may be an effective approach to managing
tendonitis conservatively?

Range of motion of the affected joint

Weight reduction

Stress reduction

Intermittent application of ice and heat to the affected


Rationale: Conservative management of tendonitis includes rest of
the extremity, intermittent ice and heat to the joint, and the use of
nonsteroidal anti-inflammatory drugs to control the inflammation and
4. An orthopedic nurse instructs a patient with plantar fasciitis that the
pain associated with this condition is best relieved by:

Gently stretching the foot and the Achilles tendon

Wearing open-toed shoes

Wrapping the affected area in lamb's wool or gauze

Application of keratolytic ointment

Rationale: Plantar fasciitis leads to pain that is localized to the
anterior medial aspect of the heel and diminishes with gentle
stretching of the foot and Achilles tendon.
5. While providing an educational class to a group of older adults at a
community senior center, the nurse informs the group that the
recommended adequate intake (RAI) level of calcium daily is:

1100 mg

1000 mg

1300 mg

1200 mg


Rationale: The RAI level of calcium for adults 51 years of age and
older is 1200 mg per day. The RAI level of calcium for ages 9 to 19
years of age is 1300 mg per day. The RAI level for adults 19 to 50
years of age is 1000 mg per day.
6. Twelve hours after a patient has foot surgery, the nurse assesses the
presence of edema in the foot. Which nursing measure will the nurse
implement to control the edema?

Elevate the foot on several pillows

Apply warm compresses intermittently to the surgical


Increase circulation through frequent ambulation

Administer a diuretic

Rationale: To control the edema in the foot of a patient after foot
surgery, the nurse elevates the foot on several pillows when the
patient is sitting or lying down. Ice packs should be applied to the
surgical area intermittently during the first 24 to 48 hours after
surgery to control edema and provide some pain relief. Diuretic
therapy is not an appropriate intervention for edema related to

inflammation. Ambulation will gradually be resumed based upon the

guidelines provided by the surgeon.
7. Which of the following statements by the nurse providing information
to a patient diagnosed with osteoporosis is correct?

Secondary osteoporosis occurs in women after


A non-modifiable risk factor for osteoporosis is a

person's level of activity.

Osteoporosis is a disease of the elderly.

Slow discontinuation of your corticosteroid therapy will

halt the progression of the osteoporosis but will not restore
the lost bone mass.

Rationale: When corticosteroid therapy is discontinued, the
progression of osteoporosis is halted, but restoration of lost bone
mass does not occur. Osteoporosis is not a disease of the elderly
because its onset occurs earlier in life, when bone mass peaks and
then begins to decline. A persons level of physical activity is a
modifiable factor that influences peak bone mass. Lack of activity

increases the risk for the development of osteoporosis. Primary

osteoporosis occurs in women after menopause.
8. While performing assessments on a group of medical-surgical
patients, the nurse recognizes which of the following patients as
being at the highest risk for the development of osteomyelitis?

An elderly patient with an infected pressure ulcer in the

sacral area

A 17-year-old football player who had orthopedic

surgery 6 weeks prior

An infant diagnosed with jaundice

A middle-age adult who takes ibuprofen daily for

rheumatoid arthritis

Rationale: Patients who are at high risk of developing osteomyelitis
include those who are poorly nourished, elderly, and obese. The
elderly patient with an infected sacral pressure ulcer is at the
greatest risk for the development of osteomyelitis, as this patient has
two risk factors: age and the presence of a soft tissue infection that
has the potential to extend into the bone. The patient with

rheumatoid arthritis has one risk factor: the arthritis. The football
player 6 weeks post-surgery is beyond the window of time for the
development of a postoperative surgical wound infection. The infant
with jaundice has no identifiable risk factors.
9. While discussing pain management with a patient experiencing low
back pain, the nurse discusses modifiable risk factors. Which of the
following is a modifiable risk factor that may contribute to the
presence of low back pain?


History of a musculoskeletal disorder



Rationale: Obesity is a modifiable risk factor that may contribute to
back pain. Through proper nutritional intake, the patient will be able
to modify his weight and reduce his back pain.


The nurse caring for a patient with Pagets disease is analyzing

the patients laboratory values. Which of the following values is most

often seen in a patient with Pagets disease?
A low serum alkaline phosphatase level and a low

serum calcium level

An elevated serum alkaline phosphatase level and an

elevated serum calcium level

An elevated serum alkaline phosphatase level and a

normal serum calcium level

A normal serum alkaline phosphatase level and a low

serum calcium level

Rationale: Patients with Pagets disease have normal blood calcium
levels. Elevated serum alkaline phosphatase concentration and
urinary hydroxyproline excretion reflect the increase in osteoblastic
activity associated with this condition.

Which of the following is important information for the nurse to

provide to a group of manual laborers in a class on prevention of

back pain?

Avoid lifting more than one-third of body weight without


Focus on using back muscles during lifting

Lift objects while holding the object away from the body

Tighten the abdominal muscles and lock the knees

during the lifting of an object

Rationale: The nurse instructs the group on the safe and correct way
to lift objects using the strong quadriceps muscles of the thighs, with
minimal use of the weak back muscles. To prevent recurrence of
acute low-back pain, the nurse may instruct the group to avoid lifting
more than one-third of body weight without help. The group will be
informed to place the feet a hip width apart to provide a wide base of
support. The manual laborer should bend the knees, tighten the
abdominal muscles, and lift the object close to the body with a
smooth motion, avoiding twisting and jerking.

A patient who works as a jackhammer operator informs the nurse

at the ambulatory clinic that he is experiencing pain in his wrist at

night and has noticed numbness and weakness in the hand during

the day. Based upon this information, the nurse anticipates that the
patient will be diagnosed with:

Impingement syndrome

Carpal tunnel syndrome

Dupuytren's contracture


Rationale: The patient will most likely be diagnosed with carpel
tunnel syndrome. Patients who perform repetitive movements along
with hand exposure to cold, vibration, or extreme direct pressure are
at a greater risk of developing carpal tunnel syndrome. The patient
experiences pain, numbness, paresthesia, and possibly weakness
along the median nerve.

Which of the following breakfast options will the nurse who is

assisting a patient diagnosed with osteomalacia suggest considering

the dietary consideration associated with osteomalacia?

Waffles with fresh strawberries and powdered sugar

Fresh fruit with granola sprinkled on the fruit

Cereal with milk, a scrambled egg, and grapefruit

A bagel topped with vegetable cream cheese and a

side dish of grapes

Rationale: The nurse will assist the patient in selecting the meal
option that contains the highest dietary sources of calcium and
vitamin D. The best selection is eggs and cereal with milk, as these
foods contain calcium and vitamin D in a higher quantity than the
other menu options.

The nurse recognizes that the initial clinical and laboratory

assessment findings for bloodborne osteomyelitis present as

manifestations of:




Paget's disease

Rationale: When the infection is bloodborne, the onset is usually
sudden, often occurring with the clinical and laboratory manifestation
of sepsis. Such clinical manifestations include chills, high fever, rapid
pulse, and general malaise.

Which of the following instructions is important for the nurse to

discuss with a patient with septic arthritis preparing for discharge to


Oral antibiotic therapy will be required for 3 to 6


Range-of-motion exercises will assist in management of

the infection.

Perform aseptic dressing changes daily after your

wound care.

Episodic removal of the splint will result in an increased

comfort level.

Rationale: The nurse teaches the patient strategies to promote
healing through aseptic dressing changes and proper wound care.
The patient is encouraged to perform range-of-motion exercises after
the infection subsides. The inflamed joint is supported and
immobilized in a functional position by a splint to increase the
patients comfort. Antibiotic therapy will be required until the
symptoms disappear.
1. The nurse instructs a patient with a clavicle fracture who is wearing a
sling for support of the arm to:

Elevate the arm above the shoulder 3 to 4 times daily

Engage in active range of motion using the affected


Use the arm for light activities within the range of


Avoid moving the elbow, wrist, and fingers for about 2



Rationale: A patient with a clavicle fracture may use a sling to

support the arm and relieve the pain. The patient should not elevate
the arm above the shoulder level until the ends of the bones have
united at about 6 weeks. The nurse should encourage the patient to
exercise the elbow, wrist, and fingers. The patient may be permitted
to use the arm for light activities within the range of comfort.
Vigorous activity is limited for 3 months.
2. Upon assessment, an elderly patient who is recovering after surgery
for a hip fracture complains of chest pain and has an increased heart
rate, respiratory rate, and is febrile and hypoxic. The patient is also
coughing and producing large amounts of thick white sputum. The
nurse recognizes that this is a medical emergency and calls for
assistance because this patient is likely demonstrating symptoms
related to:

Complex regional pain syndrome

Fat embolism syndrome

Compartment syndrome

Avascular necrosis of bone


Rationale: Fat embolism syndrome occurs most frequently in young

adults and elderly patients who experience fractures of the proximal
femur (ie, hip fracture). Presenting features of fat embolism
syndrome include hypoxia, tachypnea, tachycardia, and pyrexia. The
respiratory distress response includes tachypnea, dyspnea,
wheezing, precordial chest pain, cough, large amounts of thick which
sputum, and tachycardia.
3. The priority nursing diagnosis for a patient experiencing acute
compartment syndrome is:

Risk for peripheral neurovascular dysfunction

Activity intolerance

Risk for imbalanced body temperature

Disturbed body image

Rationale: Frequent assessment of neurovascular function after a
fracture is essential and should focus on pain, paralysis,
paresthesias, pallor, and pulselessness. The priority nursing
diagnosis for compartment syndrome is risk for peripheral
neurovascular dysfunction.

4. A patient returning to the outpatient office 6 weeks after an above the

knee amputation (AKA) reports symptoms of phantom pain. To
reduce the discomfort, the nurse correctly instructs the patient to:

Apply hot compresses to the area of the amputation

Avoid rehabilitation exercises until the pain subsides

Comfortably increase his level of activity

Assess for a pulse in the extremity of the amputation

every 4 to 6 hours

Rationale: Keeping the patient active helps decrease the occurrence
of phantom pain. Early intensive rehabilitation and stump
desensitization with kneading massage brings relief. Hot compresses
should be avoided as the extreme heat can compromise the tissue
integrity of the area of healing. It is not necessary for the patient
experiencing phantom pain to assess a pulse in the affected
extremity, as the cause of the pain is unknown.
5. The orthopedic nurse is aware that a patient with a fracture of which
of the following bones is at risk for Volkmanns contracture?


Radial head



Rationale: The most serious complication of a supracondylar fracture
of the humerus is Volkmanns ischemic contracture, which results
from antecubital swelling or damage to the brachial artery.
6. An athletic patient presents to the ambulatory care facility
complaining of pain in the right knee with weight bearing. He states
that two days ago he ran 10 miles and woke up the next morning
with knee pain. Upon examination, the nurse notes edema,
tenderness, muscle spasms and, ecchymosis. Based upon these
symptoms, the nurse anticipates the patient has experienced a:

Second-degree strain

First-degree strain

Second-degree sprain

First-degree sprain

Rationale: A second-degree strain involves tearing of muscle fibers
and is manifested by notable loss of load-bearing strength with
accompanying edema, tenderness, muscle spasm, and ecchymosis.
A first-degree strain involves tearing of few muscle fibers and is
accompanied by minor edema, tenderness, and mild muscle spasm,
without noticeable loss of function. A first-degree sprain is caused by
tearing of few ligamentous fibers and is manifested by mild edema,
local tenderness, and pain that is elicited when the joint is moved,
but there is no joint instability. A second-degree sprain involves
tearing of nerve fibers and results in increased edema, tenderness,
pain with motion, joint instability, and partial loss of normal joint
7. A patient with a tibial fracture is placed in a short leg cast 4 weeks
after the removal of the leg walking cast. The nurse explains to the
patient that the short leg cast will allow for:

Knee motion

Ankle motion

Toe motion

Hip motion

Rationale: A short leg cast or brace is placed 3 to 4 weeks after the
fracture and allows for knee motion that is prevented by the long leg
walking cast.
8. A patient scheduled for a Symes amputation asks the nurse about
his ability to stand on the amputated extremity. The nurses best
response is:

You will have minimal weight bearing on this extremity

and will require the use of an assistive device.

You will be able to withstand full weight bearing on this

durable extremity after the amputation.

You will be fitted for a prosthesis and your commitment

to rehabilitation will determine your functional abilities.

You will not be able to use this extremity and will

receive teaching on use of a wheelchair.

Rationale: A Symes amputation (modified ankle disarticulation
amputation) is performed most frequently for extensive foot trauma
and produces a painless, durable extremity end that can withstand
full weight bearing.
9. While providing teaching, the nurse instructs the patient with a
simple fracture to:

Elevate the affected extremity to shoulder level

Engage in exercises that strengthen the unaffected


Expect to regain full strength and mobility in 2 to 4



Take corticosteroids as prescribed

Rationale: The nurse encourages the patient to engage in exercises

that strengthen the unaffected muscles. Corticosteroids should be
avoided, as this classification of drug inhibits the healing of fractures.
The nurse should inform the patient that fracture healing and
restoration of full strength may take months. Comfort measures may
include analgesics and elevation of the affected extremity to the
heart level.

The nurse caring for a patient with an open fracture of the radius

is developing a care plan for the patient. The nurse will assign
priority to which of the following nursing diagnoses?

Risk for activity intolerance

Risk for imbalanced nutrition, less than body


Risk for powerlessness

Risk for infection

Rationale: All of these nursing diagnoses may be pertinent to the
care of a patient with an open fracture of the radius, but the highest
priority diagnosis is risk for infection of osteomyelitis and tetanus.

The objectives of management are to prevent infection of the wound,

soft tissue, and bone and to promote healing. Another priority
diagnosis for a patient with an open fracture would be risk for
peripheral neurovascular dysfunction.

The emergency room nurse delivers a report on a patient that is

arriving on the orthopedic floor and states that the patient 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





Rationale: A compound fracture involves damage to the skin or
mucous membranes and is also called an open fracture. A
compression fracture involves compression of bone and is seen in
vertebral fractures. An impacted fracture occurs when a bone

fragment is driven into another bone fragment. A transverse fracture

occurs straight across the bone shaft.

The nurse caring for a patient who had a right extremity below the

knee amputation (BKA) 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
achieve these goals?

Minimizing movement of the flexor muscles of the hip

Initiating ROM exercises of the hip and knee 3 months

after the amputation

Encouraging the patient to turn from side to side and to

assume a prone position

Encouraging the patient to sit in the chair for at least 8

hours a day

Rationale: The nurse encourages the patient to turn from side to side
and to assume a prone position, if possible, to stretch the flexor
muscles and to prevent flexion contracture of the hip. Postoperative
ROM exercises include hip and knee exercises that are started early

because contracture deformities develop rapidly. The nurse also

discourages sitting for prolonged periods of time.

The nurse preparing the patient who has sustained a sprain of the

left ankle for discharge from the emergency room to home correctly
instructs the patient to:

Maintain the ankle in a dependent position.

Exercise hourly by performing rotation exercises of the


Apply heat for the first 24 to 48 hours after injury.

Apply an elastic compression bandage to the ankle.

Rationale: Treatment of a sprain consists of resting and elevating the
affected part, applying cold, and using a compression bandage. After
the acute inflammatory stage (usually 24 to 48 hours after injury),
heat may be applied intermittently.

The nurse is preparing a care plan for a patient who has sustained

a long bone fracture. Which intervention will the nurse include in the
care plan to enhance fracture healing?

Monitor color, temperature, and pulses of the affected


Avoid immobilization of the fracture fragments

Limit weight bearing and exercising

Administer high doses of corticosteroids

Rationale: The nurse should monitor for sufficient blood supply by
assessing the color, temperature, and pulses of the affected
extremity, as adequate blood supply enhances the healing of a
fracture. Factors that inhibit fracture healing include inadequate or
lack of immobilization of the fracture fragments and administration of
corticosteroids. Weight-bearing exercises are encouraged for
patients with long bone fractures.

To prevent the most common complication associated with a hip

fracture, the nurse will instruct the patient to:

Take the prescribed stool softener daily

Increase fluid intake

Use the prescribed oxygen with ambulation

Avoid movement of the feet and ankles

Rationale: Deep vein thrombosis (DVT) is the most common
complication related to a hip fracture. To prevent DVT, the nurse
encourages intake of fluids and ankle and foot exercises. While
respiratory complications commonly include atelectasis and
pneumonia, the use of deep-breathing exercises, changes in position
at least every 2 hours, and the use of incentive spirometry helps
prevent them. Constipation may also occur after a hip fracture but is
not the most common complication.