c


-. Temporarily eliminating the activity that has injured the tendons, in this case playing golf, is the
best action to take at this time. It is unnecessary to keep the hand and wrist immobile. Playing miniature golf would
continue to injure the tendon. Golfers wear gloves to prevent their skin from becoming blistered. Wearing a tight
glove does not protect the joint from injury.



 -. Ecchymosis refers to a black and blue skin discoloration caused by the rupture of small blood
vessels with bleeding into the skin. Freckled skin is evidenced as scattered small brown pigmented spots on the
skin. Mottled skin contains patchy, light-colored or blue skin color. Mottled skin is seen primarily in hypothermic
infants and dying clients. Blanched skin appears pale.





- Applying ice and elevating a swollen extremity relieves swelling. Heat is not used immediately
after the injury because it increases circulation to the injured part causing more trauma. Exercise causes pain and
further swelling in the early stage of the injury. Immobilization
is used to relieve pain and promote healing.






- When wrapping the lower extremity with an elastic bandage, bandaging starts at the metatarsals.
The metatarsal bones form the ball of the foot and instep. The toes, or phalanges, are left uncovered to assess
circulation. To relieve swelling, the injured area is wrapped distally (from the metatarsals) to proximally (the calf).
If wrapped from below the knee toward the foot, swelling would not be relieved.



 - The figure-of-eight turn is made by overlapping the roller bandage in an alternately
Prior to her release from the emergency department, the client receives home care instructions from the nurse
regarding care of her ankle injury.


 If the roller bandage is applied too tightly, venous blood and lymph are trapped in the toes,
producing a swollen appearance. The toes also may feel numb or
look blue. Rewrapping the extremity may restore or improve circulation. Sitting is not likely to disturb the
application of the bandage. The injured area will not be pain free until the swelling subsides and injured tissue
heals. Wearing a tennis shoe is not an indication for rewrapping the elastic bandage. It is unlikely that the client
will be able to wear a shoe until the swelling subsides.




- A dislocation results in the temporary displacement of a bone from its normal position within
When the nurse assesses the client¶s injury, the affected arm will look longer than the other one. Most traumatic
musculoskeletal injuries including sprains, strains, and fractures are accompanied by pain, swelling, and
compromised mobility. These, therefore, do not provide the best evidence of a dislocation.
 


 Restoring function for a dislocation involves repositioning two adjacent bones so that they are
again in contact with one another. The repositioning is done
manually by the physician with or without anesthesia. A surgical incision is necessary when doing a procedure
called an open reduction. Inserting a pin or wire is a type of internal fixation. To allow time for healing, exercise is
prescribed only after a period of stabilization The uninsured client cannot afford a commercial canvas sling. As an
alternative, the nurse teaches a family member how to apply a triangular sling made from muslin.
 


 When a triangular sling is used, the knot is tied at the side of the neck to avoid pressure on the
cervical
c


 - To immobilize a broken bone, a splint is applied so that it prevents movement of the joints above
and below the injury. The tibia is between the knee and the ankle. Therefore, it is correct to apply the splint from
below the ankle to above the knee. All other choices would not stabilize the injury correctly.
cc


- A comminuted fracture means that there are pieces, fragments, or splinters of bone in the area
where the bone was broken. An impacted fracture is one in which the bone ends are driven together. A simple or
closed fracture is one in which there is no break in the skin. A greenstick fracture is the name given to a fracture in
which there is a longitudinal split that extends partially through one side of the bone.
c


 - Hospital personnel first attempt to obtain permission from a minor client¶s parent or guardian.
Minors cannot give permission under most circumstances. If permission is obtained over the telephone, at least two
people must hear the verbal consent and co-sign as witnesses to what they heard. The physician¶s role is to explain
the procedure and the risk factors associated with the surgery. The nurse¶s responsibility is to witness the signing
of the consent. The youth leader is not an appropriate person to give consent unless there have been previous
arrangements made in case of emergency. Still, the best choice is the parent or guardian.
c 


Jewelry is removed preoperatively, itemized, identified, and locked in a secure area such as the
hospital safe. The nurse has the responsibility of documenting in the client¶s record the items that were taken and
how they are being kept secure. In some agencies the client is given a receipt for his property. If a client asks that a
wedding ring be left on, the nurse can secure it to the finger or hand with tape or a strip of gauze. Class rings,
however, generally contain multiple grooves or crevices that trap and hold microorganisms. Therefore, to reduce
the potential for infection, it is best to remove and safeguard the ring. The ring is subject to theft if left in the
bedside stand. Security guards usually are not responsible for the safekeeping of personal valuables. Another
alternative is to give the client¶s valuables to a
member of the family
c 


 A fat embolus can be seen in clients with fractures of the long bones or the pelvis and usually
occurs more frequently in young men. When the bone is broken, fat globules are released into the blood stream and
combine with the platelets. Most fat emboli travel to the pulmonary circulation. Once the emboli partially or totally
occlude blood flow through a pulmonary vessel, the client experiences dyspnea, rapid breathing and heart rate,
cyanosis, chest pain, cough, bloodstreaked sputum, and a feeling of doom. Emboli also may travel to the brain,
causing confusion, agitation, and coma. Abdominal distention and difficulty swallowing are not associated with fat
emboli. Swelling at the incision site is to be expected following surgery and does not relate to the formation of fat
emboli.
c 
 - The first step a rescuer takes is to see that the victim is breathing. Maintaining ventilation is a
priority for sustaining life. Airway, breathing, and circulation (the ABCs) are highest priority. The nurse should be
careful about moving the client until spinal cord injuries have or have not been confirmed. Observing for injuries
and covering the client with a blanket are important but only after breathing has been assessed.
c 


 The ribs enclose the lungs. This makes injuries to the pulmonary system the prime complication
associated with fractured ribs. The broken ribs may puncture the pleura and collapse a lung. One of the classic
signs of a flail chest injury is asymmetrical or paradoxical chest expansion. Dyspnea is a result. The heart also is in
the thorax but somewhat better protected in the center of the chest. Tachycardia and a weak, thready pulse, rather
than an irregular pulse rate, are more likely to indicate damage to major blood vessels. Expiratory wheezing is
associated with asthma victims, while pink, frothy sputum is generally associated with congestive heart failure

c




The best method for controlling bleeding in the case of a compound fracture is compressing the
major artery above the site of the injury. Direct pressure on the wound itself may cause additional injuries to the
soft tissue surrounding the fracture. A tourniquet is used only if all other efforts to control bleeding are
unsuccessful. If used, a tourniquet is periodically released to allow oxygenated blood to the distal tissue. Elevation
of the extremity is helpful after applying pressure on the artery but should be done with caution to prevent further
damage to the bone and soft tissue.

18. 

 The neck and back of an accident victim with a suspected spinal injury are immobilized before
transport. The victim is positioned flat on her back and secured to a rigid stretcher before being moved and
transported. Rescuers need to keep the head and spine extended and straight. Placing the client in a side-lying,
facelying, or semisitting position may cause more injury to the vertebrae or the spinal cord because of the flexion
and extra movement.

19. 

 - Typical signs of a fractured hip include external rotation and shortening of the affected leg.
Bruising may or may not be present depending on the circumstances of the fracture. Sensation is intact. Movement
results in increased pain.

20. 


 Estrogen deficiency, which occurs postmenopausally, is linked to loss of calcium from the bones.
Decreased bone mass weakens the skeletal system increasing a person¶s susceptibility for fractures. Being
overweight exerts more stress on the skeletal system, but as long as the integrity of the bones is intact, the risk for
fractures is the same as for the general population. Walking and exercising daily help keep the bones and joints
strong. Lactose intolerance is not necessarily a risk factor as long as the client gets calcium from other sources such
as vegetables.

21. 

- Isometric exercises are performed by tensing and releasing muscles. They do not involve any
appreciable movement of a joint. The quadriceps muscles are on the anterior aspect of the thigh. All of the other
options in this question describe isotonic exercises that involve joint movement.

22. 
 - Elastic stockings, known as antiembolism or thromboembolic disease (TED) hose, support the
valves within veins. The supported valves keep the blood flowing upward toward the heart. When blood moves,
rather than pools in the lower extremities, it is less likely to clot. When properly fitted, antiembolism stockings
should neither restrict arterial blood from flowing into the lower extremities nor affect blood pressure. Even though
they are tight-fitting, antiembolism stockings do not constrict the blood vessels.
23. 
 - To prevent trapping venous blood in the lower extremities, elastic stockings are applied while the
client is in a nondependent position. The best time to apply these stockings is in the morning before getting out of
bed or after elevating the legs a short time. Elastic stockings are worn almost continuously. They are removed once
per shift or once per day to assess the skin.

24. 
 - client who has a prosthesis inserted to repair a fractured hip is turned using sufficient pillows so
that the operative leg remains slightly abducted. Hip abduction prevents displacement of the fixation device.
Pointing the toes, flexing the knee, or elevating the head will not promote hip abduction.

25. 
 - When helping a client transfer from the bed to a chair, it is best to place the chair parallel to and
near the head of the bed on the client¶s stronger side. The nurse makes the distance as short as possible to promote
safety when the client is weak or may lose her balance. Transferring to a chair at the end of the bed or against a
side wall requires much more physical effort and involves safety hazards. Placing the chair perpendicularly
interferes with assisting the client.
26. 
 - In a three-point partial weight-bearing gait, the weaker leg and walker are advanced together. The
majority of the weight is supported by the hands while the stronger leg is lifted and advanced.


27. 
- When plaster combines with water, a chemical reaction takes place. Energy is given off in the
form of heat. The client is warned that his arm may feel quite warm temporarily. Steam or heat waves may even be
seen rising from the surface of the wet cast. The cast supports the broken bone, but it should not constrict the
underlying tissue or feel tight. Wet plaster does not produce a disagreeable odor. Itching is not a common
experience at the time a cast is applied.
28. 
- A wet cast is held and supported with the palms of the hands. Using the fingers is likely to cause
indentations in the cast. The inward dents create pressure areas on the underlying tissue. After the cast is applied, it
is dried while supported on a soft surface. A wet cast on a hard surface can become flattened.
29. 
 - Sharp pain is the first symptom of compartment syndrome. The pain is due to ischemia, the
impairment of arterial blood flow, caused by swelling of the surrounding muscle within the inelastic fascia.
Paralysis and sensory loss follow as nerves become damaged by compression and lack of blood supply. Muscle
spasms do not occur. The hand appears pale or white, not reddened, and feels cold related to inadequate arterial
blood. If the radial artery is assessed, the nurse finds that it is weak or absent
30. 

 A wet cast is supported along its entire length with soft pillows as it dries. The soft support
distributes the weight of the cast over a greater surface and prevents flattening of the underlying portion. Use of
pillows helps in elevating the extremity to relieve temporary swelling. A synthetic sheepskin or vinyl sheet
interferes with water evaporation from the wet plaster. An absorbent pad does not sufficiently cushion the weight
of the cast.
31. 

.Natural evaporation is the best way to dry a plaster cast. This process takes 24 to 48 hours. It
involves leaving the casted area uncovered and turning the client at frequent intervals so that the entire cast
circumference is exposed to the air. Intense heat such as with a heating blanket, hot air drying, or heat lamp
may burn the client or just dry the superficial surface of the cast.
32. 
 - The nurse assesses circulation in an extremity by performing the blanching test to determine
capillary refill time. After releasing pressure on the nailbed, the color normally returns within 2 to 3 seconds. The
assessment also is performed on the opposite extremity. If the capillary refill time is similar in both extremities, the
cast or tissue swelling is not a factor. Asking if the cast feels heavy or palpating it to feel the cast temperature are
not appropriate techniques for assessing circulation. Determining that there is space between the cast and the skin
is not a totally reliable assessment technique. If the circulation is impaired due to compartment syndrome, there
may still be room to insert a finger at the cast margins.
33. 
- Casts made of fiberglass or other synthetic materials have several advantages, one of which is that
they are lighter weight than plaster casts. A synthetic cast dries more quickly. It is more durable and not likely to
soften if the cast becomes wet. Fiberglass casts are no less flexible or less restrictive than plaster ones. The major
disadvantage is that they are more expensive than traditional
plaster casts.
34. 
 - Marking the outer margin of the drainage on the cast helps the nurse evaluate the status of the
bleeding. The nurse needs to return soon for another assessment. By comparing the subsequent size of the bloody
spot, the nurse evaluates the seriousness of the bleeding. It is important to monitor vital signs each time the
drainage is assessed. All information is documented. If the bleeding is not controlled and vital signs indicate that
the client¶s condition is changing, the physician is to be notified immediately. An ice bag is generally used to
control swelling postoperatively. In some small way it also may decrease bleeding.
35. 
 - When a client expresses a concern, it is best for the nurse to verbalize the feeling or message that
the sender conveyed. This response shows understanding and a willingness to listen. Using clichés, agreeing with
the client, stereotyping the family, or offering opinions are all nontherapeutic. They are of little help to a client who
is struggling with a personal problem.
36. 
 - Most adolescents seek to become independent of their parents and develop relationships with
nonrelatives. Developmental tasks concerned with self-identity, sexuality, testing the body¶s abilities, and learning
to control emotional behavior occur more commonly just before young adulthood.
37. 

- A hip spica cast interferes with hip flexion and assuming a sitting position. A fracture bedpan
elevates the buttocks just slightly enough for bowel elimination. Because this client cannot sit, a bedside commode,
mechanical lift, and raised toilet seat are inappropriate.

38. 
 - One of the weakest areas of a hip spica cast is at the groin area. This area tends to crack because it
is stressed when the client is turned and repositioned. The bar helps to strengthen the cast. The bar is never used for
lifting or turning, performing physical exercise, or hanging personal items.
39.  A - :
 
    
 


  

 

 
  



 







 
 



   

 





  
  



 






 


  
 





 

 


    
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40. 

- The most frequent cause of an odor from a cast is an infected wound. Infected wounds produce
purulent drainage that causes unpleasant odors as the pus accumulates. To confirm the suspicion that an infection
exists, the nurse monitors the client for a cluster of additional signs and symptoms such as an elevated temperature,
tachycardia, anorexia, and malaise. None of the other options provide foul-smelling odors.

41. 
- The piece of plaster that is removed to make a window is replaced in the opening and secured with
tape or a roller bandage. If the window remains open because the nurse disposes of the plaster piece, tissue tends to
bulge into the opening. The uneven pressure on the skin can cause it to break down.

42. 
 - Rough or crumbling edges of a plaster cast are smoothed or repaired by applying petals made
from moleskin or adhesive tape. Petals, formed in rectangular or oval pieces, are inserted on the inside of the cast
edge then folded over the outside edge of the cast. The strips are made to overlap, resembling the appearance of
flower petals. The physician usually applies more plaster strips or uses a cast cutter if needed. Trimming a cast
does not usually stop it from crumbling. Fragments of plaster are likely to continue breaking off if the nurse uses
gauze to cover the cast edge.
43. 
 - Cast syndrome, also known as superior mesenteric syndrome, causes gastrointestinal symptoms
such as abdominal distention, bloating, nausea, vomiting, and abdominal pain. The symptoms are caused by a
partial or total intestinal obstruction. Symptoms related to anxiety may also be present. The other options, if they
develop, are more likely to be caused by complications other than cast syndrome.

44. 
- The leg of the client in Buck¶s traction must remain in alignment with the pull of the traction.
This means that rather than making the bed as usual from side to side, the nurse removes and applies linen at the
top or bottom of the bed and pulls it underneath the client. A person in Buck¶s traction is not turned from side to
side or raised with a mechanical lift. A client in traction, as any other hospitalized client, has bed linen changed
whenever it is soiled, wet, or needs replacement.
45. 
 - To maintain countertraction, the client¶s foot must never press against the foot of the bed. If this
is observed, the nurse helps pull the client back up toward the head of the bed. The weights must always hang free
rather than rest on the floor or the bed. The body must be in alignment with the pull of the traction. The traction
rope must move freely within the groove of the pulley.
46. 
-.The best technique for assessing circulation among the options provided is to palpate the distal
peripheral pulse. The dorsalis pedis artery is on the top of the foot. Other pertinent circulatory assessments include
observing the skin¶s color and temperature, capillary refill time, and subjective complaints concerning pain.
Checking movement and sensation are neurologic assessment techniques. Taking the blood pressure on the thigh
rather than the arm is unnecessary
47. 
-.


48. 
 -.Two pieces of rope are sometimes spliced together with a knot to provide sufficient length for
traction. However if the knot prevents free movement over and within a pulley, it interferes with the traction¶s
effectiveness. Traction ropes are taut. Locating the trapeze above the client¶s chest facilitates its use. Traction
weights must hang freely above the floor for effective use.

49. 
- Preoperatively the traction remains applied to the client at all times, even during transport to the
operating room. Its purpose is to relieve muscle spasm and immobilize the fractured bone. If the nurse removes the
traction or the releases the weights, muscle spasms recur. Any realignment that may have been achieved with the
use of traction is jeopardized.

50. 
 - A pillow is usually contraindicated when a client is in cervical skin traction because it alters the
direction of pull. If any kind of head support is necessary, it is usually provided with a cervical or neck pillow that
fits under the nape of the neck. The other options are correct and do not require the nurse¶s attention.

51. 
 - The uppermost edge of a pelvic belt hugs the client¶s hips. The pelvic belt helps to relieve spasms
and pain in the muscles in the lumbar area. Placing the belt below the rib cage or at midabdomen does not promote
the maximum effective use. Though using pelvic belt traction will promote comfort, the location for its application
is not arbitrarily determined on that basis.

52. 
 - The tips of the pin used for skeletal traction are skewered into a block of cork or a rubber ball like
those used for playing jacks. Gauze and cotton are inadequate for preventing punctures and abrasions. Rubber
tubes may also be pierced by the pin, thus exposing the sharp tip.


53. 

. Purulent drainage is sometimes referred to as pus and indicates an infection. Purulent drainage is
a collection of fluid containing white blood cells and pathogens. The presence of white blood cells indicates that
the body is attempting to destroy and remove infecting organisms. Serous drainage is clear; it is made up of plasma
or serum. Bloody drainage indicates trauma. Mucoid drainage is sticky and transparent. It is released from mucous
membranes.

54. 
- There is a high probability that individuals who are allergic to penicillin will also exhibit a cross-
sensitivity to cephalosporins. Both of these drugs are very similar in their structure. Although everyone with a drug
sensitivity is closely observed when a new medication, especially an antibiotic, is administered, individuals with a
penicillin allergy seem to react more often to the cephalosporins than to the other types of anti-infective drugs in
this question.
55. 
- Halo skeletal traction immobilizes the vertebrae in the neck while allowing clients to assume
physical activity such as standing, sitting, and walking. Halo skeletal traction, however, restricts head movement.
Vertebral fractures proceed to heal at a standard rate regardless of whether halo traction or some other medical or
surgical management is instituted. Physical therapy is not prescribed until the vertebral fracture is stabilized and
the halo traction is removed.


56. 
 ± A client¶s ability to see straight ahead is the best sign that halo traction is keeping the neck
immobilized in a neutral position. Clients should not be able to move the neck at will while in halo traction. Clients
may experience mild neck discomfort even though halo traction is applied appropriately. The abilities to speak and
to hear are unrelated to the use of halo traction.
57. 
 - Signs that the metal rods in halo traction require readjustment include an inability to fully open
the mouth and difficulty swallowing. Postural hypotension, if it occurs, is not due to the malfunction of the halo
traction. Adult males need help with shaving because they are unable to change their head position to see areas of
the face while shaving. Irritation in the axilla that is related to the plaster vest does not indicate readjustment.
Nursing intervention, however, is needed to prevent further skin breakdown.

58. 
 - The erythrocyte sedimentation rate (ESR) is a nonspecific test that indicates the presence and
progress of an inflammatory disease. It is elevated in a number of inflammatory conditions including rheumatoid
arthritis. A PTT time is ordered to determine a person¶s ability to clot blood. It is commonly ordered when a person
is on heparin therapy. A fasting blood sugar (FBS) is performed to diagnose and evaluate the treatment of diabetes
mellitus. The BUN is a common test for assessing renal function.


59. 
 - Although some acquire juvenile arthritis, most people experience the onset of rheumatoid arthritis
early in adult life. The disease profoundly affects the ability to maintain employment during the productive years
of life.

60. 



61. 

 Aspirin has the ability to produce analgesic, antiinflammatory, and antipyretic effects. Its
analgesic and anti-inflammatory effects are probably achieved by inhibiting chemicals called prostaglandins, not
by interrupting nerve synapses. Prostaglandins increase sensitivity of peripheral pain receptors. Aspirin does not
relax skeletal muscles or stimulate the immune system.

62. 
. Taking irritating drugs with food or at mealtime helps to decrease gastric distress. Aspirin,
especially in large doses, tends to irritate the stomach mucosa, resulting in bleeding. Giving aspirin on an empty
stomach increases discomfort. Cold water and hot tea are not substances that protect the stomach or alter the
aspirin¶s acidity. The caffeine in tea actually stimulates an increase in the production of stomach acid. Enteric-
coated aspirin is needed for clients who take large doses of aspirin because the enteric coating protects the
stomach.
63. 
 - Ringing in the ears, called tinnitus, is a sign of aspirin toxicity and is seen when clients take large
amounts of salicylates on a daily basis. Clients may also report a buzzing, tinkling, or a hissing sound. Tinnitus
also can be caused by diseases or conditions affecting the ear. Dizziness, metallic tastes in the
mouth, and proteinuria are not typical symptoms of aspirin toxicity.

64. 
 - Distraction is a legitimate and often very effective method for the relief of discomfort. Watching
television is one method of distraction. There are no reports that electronic television signals are an effective
treatment for arthritis. If the client had only a slight case of arthritis, she would be likely to feel pain relief at times
other than when watching television.


a. 65. Lateral finger joints


 The proximal finger joints are affected the most in rheumatoid arthritis. There may be so much
involvement that the fingers actually turn laterally. In osteoarthritis the distal finger joints are more often
deformed. Traumatic arthritis, which is associated with a specific injury, affects any joint.

66. 
- Moist heat is more effective than forms of dry heat like a hot water bottle, electric heating pad, or
infrared heat lamp. This phenomenon is attributed to the fact that water is a better conductor of heat than air.
Whenever any form of heat is used, the nurse takes care that the client is not accidentally burned.


67. 
 - People with rheumatoid arthritis are more stiff and uncomfortable in the early morning hours after
being inactive during the hours of sleep. Therefore, it is best to allow extra time and distribute self-care activities
over later hours of the day.


68. 

- Hand deformity and muscle atrophy make it difficult to perform fine motor movement with the
fingers. Purchasing clothes that are pulled on or slipped on enables the client with rheumatoid arthritis to maintain
a degree of independence. It is important for the person with arthritis to maintain joint mobility
through exercise. Aerobic exercise, however, is unrealistic because it is likely to be too strenuous.
Clients with rheumatoid arthritis are often anemic and tire easily. Sleeping on a waterbed or moving to a
warm climate has little to no affect on the disease process.

69. 
 - During an acute attack, splints are used primarily to keep the inflamed joints somewhat inactive.
Resting the part suppresses additional stress on the diseased joints. The acute inflammation subsides with a
combination of drug therapy and the body¶s natural healing processes. A certain amount of strength and joint
flexibility is preserved by limiting the damage during the acute attack but these choices are not the most
appropriate ones. Splinting the affected fingers will not cure the disease.

70. 


Corticosteroid therapy causes sodium and water retention. The consequence of hypernatremia is
evidenced by weight gain. With an excess of fluid, blood pressure also becomes elevated and is closely monitored.
The pulse rate is not likely to change appreciably. However, the pulse may feel bounding with an increase of fluid
in the blood volume. The nurse should monitor the client¶s white blood cell count, not
the red, because corticosteroids have the potential of masking the signs of infection. The skin of a person
taking steroids undergoes various changes. However, the skin generally remains intact. The nurse may
observe that the skin becomes thin and bruises easily. The face may become edematous. There may be
increased hair growth, petechiae, redistribution of body fat, and striae. If the skin does become impaired
as a result of injury or surgery, wound healing is prolonged


71. 
 - Individuals receiving corticosteroids tend to have elevated blood sugar. Diabetics may need to
increase their dosage of insulin or oral hypoglycemic agents. Persons without diabetes also are monitored for
hyperglycemia and glucosuria. Because steroids depress the inflammatory response, they place the
client at high risk for acquiring infections. To prevent acute adrenal insufficiency, steroids are tapered and
withdrawn gradually if therapy is discontinued. Depression is common among individuals receiving
corticosteroids.

72. 
 - The mucosa of the mouth and entire gastrointestinal tract may become ulcerated as a consequence
of taking methotrexate. Therefore, it is especially important to inspect the oral cavity. This drug also causes
diarrhea and renal failure. Chest pain is not a usual side effect of methotrexate.

73. 

. - To avoid burning the skin, a heating pad is always kept on a low setting. The client is cautioned
not to turn the heat setting higher when becoming adapted to the sensation of warmth. Because of the client¶s age
and changes in his skin and sensory functioning, the risk for burns is high if the heating pad is placed directly next
to the skin. A heating pad is covered with fabric such as flannel. Heat is not applied for longer than 20 to 30
minutes at a time.

74. 


Obesity puts additional stress on weight-bearing joints and contributes to discomfort. Applying a
topical analgesic cream may improve joint mobility and help with sore muscles but does not directly relieve the
joint stress related to arthritis. Warm bath water may help with joint pain, but with the client¶s age and impaired
hip mobility, getting in and out of the tub is hazardous to his safety. Hot water can also burn the client. Physical
activity is likely to cause more discomfort to a person whose hips are affected by osteoarthritis.

75. 


A cane is always held on the unaffected side. By doing so the client can transfer or redistribute
body weight from the painful joint to the hand with the cane when taking a step. Covering the tip with a rubber
cap, wearing supportive shoes, and maintaining good posture are all appropriate techniques for using a cane.

76. 
 - Gastrointestinal side effects and the potential for bleeding are common among clients who take
nonsteroidal anti-inflammatory drugs (NSAIDs). By asking the client to identify the color of his stools, the nurse is
assessing if the drug is causing gastrointestinal bleeding. NSAIDs are not known to cause increased urination or
hand tremors. NSAIDs may or may not affect appetite depending on the amount of GI upset.

77. 

. Aspirin increases the possibility of postoperative bleeding. It interferes with the ability of
platelets to clump together, one of the first mechanisms in clot formation. Aspirin does not increase the risk of
wound infection nor does it affect the body¶s ability to heal. Aspirin is not discontinued to facilitate the assessment
of the client¶s pain. However, if the client takes aspirin for arthritis and is asked to stop it for a week, he may
demonstrate signs of joint stiffness, tenderness, swelling, and immobility.

78. 
 - An incentive spirometer helps a client measure the effectiveness of deep inhalation. It is
important postoperatively for the client to breathe deeply to open the airways and alveoli. This helps to improve
the oxygenation of blood, eliminate carbon dioxide, and prevent atelectasis and pneumonia. None of the other
options indicate the correct use of an incentive spirometer.

79. 

. Clipping the hair around the intended incisional area is preferred over shaving to avoid
microabrasions that support bacterial growth. Pressing the razor firmly or deeply onto the skin can cause cuts.
Altering the integrity of the skin because of cuts and bleeding increases the risk of postoperative wound infections.
Soap is used to decrease the numbers of transient skin organisms. For surgery, a stronger antiseptic, such as
Betadine, is usually used.


80. 
- The hip of a client who has undergone a total hip replacement (arthroplasty) is maintained in a
position of abduction, or away from the midline. Adduction is toward the midline and flexion is bending.
Extension is keeping the body part straight. If the client flexes his hip more than 90 degrees or adducts the hip, the
prosthetic femoral head may become dislocated. A triangular foam wedge is generally kept between the client¶s
legs while the client is in bed.

81. 


 A trapeze is an item that allows the client to help move and lift his body. Encouraging the client
to participate actively helps maintain muscular strength and reduces the nurse¶s effort when moving and
positioning a client. A bed cradle is used to keep bed linen off lower extremities. A bed board is used to support the
client¶s spine. Lower side rails are appropriate when maintaining the safety of a confused client or one with a
perceptual disorder.

82. 

- A trochanter roll is used to maintain the hip in a position of extension. Placing this positioning
device at the trochanter helps keep the hip from rotating outward. A footboard is used to prevent plantar flexion
and footdrop deformity. A turning sheet is used to reposition a client. A foam mattress helps to relieve pressure
from bony prominences.

83. 

 A client with a total hip replacement is instructed to avoid crossing the legs. Crossing the legs
places the hip in a position of adduction and flexion. These two positions can displace the prosthetic device.
Pointing the toes as in plantar flexion or dorsiflexion will not impair the surgical procedure. Laying flat and
standing upright are not harmful.


84. 


 Postoperatively and for an extended time afterward, a client with a total hip replacement must
avoid flexing the hip more than 90 degrees. This necessitates using a raised toilet seat. The client does not need a
wheelchair and can ambulate using a walker. The client can continue to use his own bed at home. The client is
taught techniques for transferring from bed to a chair. Therefore, a mechanical lift is unnecessary.


85. 

 - The client with a total hip replacement must avoid bending over to put on or take off socks,
pants, underwear, and shoes. Someone helps with these items of clothing or assistive devices are used. Another
approach is to modify the clothing so that the client can slip them on without flexing the hip more than 90 degrees.
No special equipment is needed for bathing. However, the client must be cautious when getting in and out of the
shower and with the water temperature. Instructing the client about home safety is also important and includes
information such as water temperature, environmental temperature, furniture placement, lighting, medication
administration, burglary protection, and fire safety. Taking vigorous walks is not appropriate immediately after
discharge. The client¶s activity levels should be increased gradually. Stool softeners are not usually included in the
client¶s discharge instructions.

86. 

- Most clients who undergo arthroscopy use crutches for a period of time following the procedure.
Because postprocedural discomfort and recovery from local anesthesia or light conscious sedation interfere with
learning and practice, it is best to teach clients how to use crutches during their preoperative preparation. Most
clients who undergo arthroscopy have already personally experienced the signs and symptoms of arthritis. Drug
teaching is postponed until the physician writes postoperative orders. Balancing rest with exercise is important, but
the physician indicates those specific orders after the procedure.

87. 
 - A CPM machine is used primarily to restore full range of joint motion. Clients with knee joint
replacement often are reluctant to exercise the operative knee actively because of pain. Discomfort usually
accompanies use of the CPM machine. Exercise tones and strengthens muscles and relieves dependent swelling by
promoting venous circulation; however, these are considered secondary benefits. It is appropriate for the nurse to
administer a prescribed analgesic before the client uses a CPM machine.

88. 

 The length of time the CPM machine is used provides additional documentation of the client¶s
response to treatment. Inspecting and documenting the appearance of the wound, the drainage on the dressing, and
the presence and quality of arterial pulses are important data to record. However, this information is more pertinent
to general physical assessment findings.

89. 

 - A resting knee extension splint (immobilizer) is worn on the operative leg until the client
demonstrates enough quadriceps strength to independently perform straight leg raising. Adecrease in pain, wound
approximation, and increase in knee flexion are positive signs of healing and rehabilitation, but they are not criteria
for discontinuing the immobilizer.

90. 


 Gout can affect any joint, but approximately 80% of the people who have gout experience
symptoms in their great toe. This makes ambulation painful.


91. 

 An elevated serum uric acid level is diagnostic among clients with gout. An elevated serum
creatinine clearance and blood urea nitrogen are indicative of renal failure. Serum calcium is elevated in
hyperparathyroidism, primary cancers such as Hodgkin¶s disease or multiple myeloma, and metastasis to the bone.


92. 


 Of all the items, a bed cradle is best for preventing the affected joints from being touched or
bumped. There is no relationship between gout and the need for an electric fan, foam mattress, or fracture bedpan
93. Answer: D ± liver is rich with uric acid.

94. 
 - Colchicine (Novocolchine) is an antigout agent used in the treatment of acute attacks and to
prevent recurrences of gout. The nurse withholds the administration of colchicine (Novocolchine) when the client
manifests adverse gastrointestinal disturbances such as nausea and vomiting, abdominal pain, or diarrhea. While
the client is receiving this drug, the nurse should frequently assess the joints for pain, mobility, and edema.
Dizziness, drowsiness, and headache are not signs of an adverse reaction related to this drug.

95. 
 - It is best to provide the greater share of fluid in the morning to compensate for the long period
without oral fluids while sleeping. Frequent urination related to increased intake will most likely occur during the
day. Providing a large volume of fluid after a meal contributes to gastrointestinal fullness or upset. Consuming
large amounts of fluid during evening hours or before bedtime usually results in nocturia and interferes with sleep.

96. 

- There is a relationship between the consumption of alcohol and the recurrence of gout symptoms.
Therefore, it is best to instruct clients with gout to abstain from drinking alcohol. Coffee, cranberry juice, and
carbonated beverages are safe to consume.

97. 


 Estrogen replacement therapy is one effective method for reducing the potential for osteoporotic
skeletal changes. Drinking coffee or beverages containing caffeine are risk factors contributing to osteoporosis and
do not delay or prevent it. Eating ice cream nightly has no correlation to the prevention of osteoporosis even
though ice cream may contain some calcium. Research is currently being conducted to determine if antacids
containing calcium have an impact onthe prevention of osteoporosis.


98. 


Clients with osteoporosis tend to present with spinal deformities such as kyphosis (dowager¶s
hump) or an inability to assume an erect posture. Although clients with osteoporosis experience swollen joints,
discomfort in sitting, and diminished energy, these conditions


99. 
 Smoking and caffeine consumption contribute to the severity of osteoporosis. Although aspirin,
carbonated beverages, and sodium are best used in moderation, they are not considered to be pathologically related
to osteoporosis. Alcohol is associated with loss of bone density. Currently it is unclear if chronic alcohol ingestion
destroys bone-forming cells, interferes with calcium absorption, or contributes to osteoporosis simply because of
its correlation with an inadequate nutritional intake. Supplemental calcium and consumption of dairy products are
therapeutic measures for individuals who are at risk for or who have acquired osteoporosis.

100. 

± nutritional diet is important for calcium in the bone and nourishment of the bone cells.

101. 

 Health-seeking behaviors and illness beliefs vary among Mexican Americans. These behaviors
and beliefs are influenced by geography, length of time spent in America, money, age, and social standing.
Because this client is an older adult and has just immigrated to United States, it is assumed that his healthseeking
behaviors are deeply related to traditional Mexican culture and health care practices. In a traditional Mexican
home, female members of the household provide medical care. Many clients will not go to the hospital or
physician until all attempts at treating the illness with home remedies have been exhausted. Because Mexican
American men are expected to be strong, the client¶s illness interferes with his ability to provide for his family.
Some Mexican Americans believe that medical technology assists the physician in curing illnesses; as the client
has been in the United States for a short time, it is unlikely that he would be aware of the medical advances in this
country. Aá randero is a faith healer. There is no evidence in this question to validate that the client no longer
believes in á randeros. Some Mexicans believe that illness is caused by the ³evil eye. ³ Evil eyes usually would be
treated by spiritual ceremonies, candles, and prayer.

102. 
 - Vitamin D is necessary for calcium absorption. Exposure to sunlight helps to convert
dehydrocholesterol in the skin and ergosterol, a plant precursor, to provitamins that eventually become vitamin D.
The beneficial and harmful effects of eating cattle injected with bovine growth hormone have not been
conclusively determined. Orange vegetables are good sources of beta carotene, a precursor of vitamin A.
Organically grown produce is not any more nutritious than others; however, there may be beneficial effects from
coincidentally eliminating the ingestion of chemical fertilizers, herbicides, and pesticides.

103. 
 - With very few exceptions, a person in shock is kept flat with the lower extremities slightly
elevated. Gravity helps to maintain blood in the area of the vital organs. Supine position is a back-lying position
but does not provide the added benefit of elevating the legs. Prone is a face-lying position. Keeping the client on
his side interferes with the emergency assessment and care.

104. 
- staying with a grief-stricken client indicates that the nurse is there for his emotional support. The
client is more likely to feel that he can depend on the nurse to be available and respond to his future needs. Leaving
an uncomfortable situation is one method health professionals use to cope with their own feelings of inadequacy.
The client will likely interpret the desertion as a sign that the nurse is not a caring individual. It is therapeutic for a
person to release his rage as long as it does not endanger him or others. Feeling angry is one of the early steps in
the grieving process. Calling the physician is not appropriate because it does not address the real problem of anger
related to the missing limb.

105. 
-. Phantom pain or sensation is a phenomenon experienced by some people who have a limb
amputated. The person feels a physical sensation in the missing limb. The feelings range from a sense that the
amputated part is still there to other sensations that cause discomfort such as pain, cramping, burning, and itching.
Referred pain is discomfort that is experienced in a location that is distant from the actual area of pathology.
Psychogenic pain is discomfort that is emotional in origin. Intractable pain is severe and unrelenting.

106. 
 - Most believe that the TENS unit generates sensations that the brain perceives in place of the
pain from the missing limb. This phenomenon is referred to as the `ate-áontrol theory. The process is compared to
a car waiting while a train crosses the highway. The impulses from the TENS unit are like the train. As long as the
TENS impulses flood the brain, the pain impulses are blocked.

107. 

 - Sitting in a chair, especially if it is done frequently or for long periods of time, is undesirable
because below the- knee amputees are prone to developing knee flexion contractures. A knee flexion contracture
interferes with wearing a prosthesis and being able to walk again. For this reason, the stump is kept in an extended
or neutral position as much as possible. The prone, supine, and standing positions provide extension of the stump.

108. 


 Almost immediately after surgery, the nurse encourages the client to lift up using the trapeze
because the muscles that most need strengthening prior to ambulating with crutches are those in the
arms, neck, shoulders, chest, and back. The client also may squeeze rubber balls and perform arm push-ups.
Doing arm push-ups involves placing the palms flat on the bed and raising the buttocks. Some health care
professionals provide the client with sawed-off crutches to use in bed to condition the same muscles needed during
ambulation. Standing at the side of the bed and transferring from the bed to chair should not be done
without assistance because of the risk for falls. The client needs to get used to balancing with one leg.

109. 

 Wrapping the stump decreases stump edema. Apermanent prosthesis is not constructed until the
stump is cone-shaped and no longer undergoing changes in size. An equal amount of compression is applied with
each turn of the roller bandage. Isotonic and isometric exercises are used to tone muscles. Range of motion
exercises maintain joint flexibility. Gauze dressings absorb blood and drainage.
110. 

 A tourniquet is kept at the bedside in the event that hemorrhage, if it should occur, cannot be
controlled with elevation of the stump and direct pressure. There ought not to be an urgent need for gauze
dressings. If the airway becomes compromised, the nurse maintains temporary patency by using the chin-lift/head
tilt maneuver. Most clients are transferred to the nursing unit from the recovery room with
oxygen already being
administered.

111.
112. 


 Malignant bone tumors cause secondary anemia if bone marrow function is disrupted. Although
primary bone tumors can spread to any organ, the bowel and
liver are not common metastatic sites. Mental status changes may be present but are not due to the location of a
bone tumor.

113. 

 The most common site for bone tumor metastasis is the lungs. If tests such as a urinalysis, spinal
tap, or blood glucose are obtained, it is for reasons other than determining if the primary tumor has metastasized.


114. 



115. 

 - Many clients feel pain radiate into their buttocks and down the leg where the herniating disk
protrudes on the spinal nerve root. The sciatic nerve is commonly affected when the herniated disk occurs between
lumbar vertebrae. The iliac crests, knees, and toes are not generally symptomatic.

116. 

- Cyclobenzaprine hydrochloride (Flexeril) is a central-acting skeletal muscle relaxant that is
used to treat muscle spasms related to the intervertebral disk. Flexeril does not reduce depression and should not be
given with alcohol or other CNS depressants. NSAIDs are given to decrease inflammation, while sedatives and
hypnotics are used to promote rest and sleep.

117

- Encouraging extra fluids and keeping clients quiet following a myelogram helps to prevent
postprocedural headaches. Drinking fluid dilutes and hastens excretion of the contrast medium used during a
myelogram. Increasing oral fluid intake aids in replacing cerebrospinal fluid withdrawn prior to or after the
procedure. Keeping the room dim relieves a spinal headache once it is manifested but is not generally done as a
standard of care following a myelogram. Food is withheld if the client becomes nauseated but it is not routinely
done. Administering sedatives at scheduled intervals following a myelogram masks early assessment of central
nervous system complications.
118. 

 - The client with a herniated disk rolls from side to side without twisting the spine. This type of
movement, called logrolling, prevents displacing bone grafts until they have become solidly fused. Holding one¶s
breath increases discomfort if it is accompanied by bearing down. Because the client cannot twist the
spine, moving the lower body and then the upper would be harmful. Likewise, raising the upper body
and hips off of the bed is contraindicated.

119. 


 Because the client has limited English-speaking ability, showing the client pictures and
diagrams is the most appropriate teaching method in this situation. Demonstrating may also help to get the point
across. Speaking slowly and looking at the client may or may not facilitate his understanding of the verbal
instructions. Looking directly at a client in some cultures is considered offensive. Similarly, writing the
instructions on paper or watching a video in English do not address the client¶s ability to understand or speak
English.
120. Answer: A












ë 
 

A male client who golfs at least three times a week has been experiencing wrist pain aggravated by movement. The
physician diagnoses his condition as tenosynovitis and recommends temporarily avoiding repetitive wrist motion.

1. Which client statement provides the jest evidence that he understands the therapeutic plan?
a. ³I should keep my hand as still as possible.´
b. ³I should stop playing golf for the time being.´
c. ³I can substitute playing miniature golf.´
d. ³I can wear a tight leather glove when golfing.´
The nurse examines a female client who slipped and fell while climbing stairs and now has swelling of her ankle
and pain on movement.
2. If the nurse documents that the client¶s ankle is eááhymotiá, it indicates that the skin is
a. freckled.
b. mottled.
c. bruised.
d. blanched.
3. While the client awaits an ankle x-ray, which nursing measure is most helpful for relieving the soft tissue
swelling?
a. Place a heating pad on the ankle.
b. Apply ice to the ankle.
c. Exercise the client¶s foot.
d. Immobilize the client¶s foot.
The ankle x-ray reveals that the bones are not fractured. The physician tells the client that she has a severely
sprained ankle.
4. When the physician directs the nurse to wrap the client¶s lower extremity with an elastic bandage, where
should the nurse je`in applying the bandage?
a. Below the knee
b. Above the ankle
c. Across the phalanges
d. At the metatarsals
5. Which technique is jest for the nurse to use when applying the elastic bandage?
a. Making figure-of-eight turns with the bandage
b. Making spiral-reverse turns with the bandage
c. Making recurrent turns with the bandage
d. Making spica turns with the bandage
6. Besides routinely removing and reapplying the elastic bandage, it is essential that the nurse instruct the
client with the sprained ankle to rewrap the bandage anytime
a. she sits for a long time.
b. her ankle feels painful.
c. her toes look swollen.
d. she wears tennis shoes.
A client presents in the emergency room with a shoulder injury after falling from a stepladder.
7. When the nurse assesses the client¶s injuries, which finding jest indicates that the client has dislocated his
shoulder?
a. The client is experiencing intense pain.
b. There is obvious swelling about the joint.
c. The client is hesitant to move his arm.
d. The affected arm is longer than the other.
The physician informs the client that he plans to correct his shoulder dislocation by manipulation.
8. When the client asks the nurse what is meant by the term manipulation, the jest explanation is that this
procedure involves
a. making an incision to realign the bones.
b. inserting a pin or wire into the joint.
c. repositioning the bone ends manually.
d. strengthening the joint with exercise.
9. Which statement made by the family member indicates the need for further teaching?
a. ³His hand should be elevated higher than the elbow.´
b. ³The knot should be tied at the back of the neck.´
c. ³His elbow should be flexed within the sling.´
d. ³The sling is used to elevate and support the arm.´
While backpacking with a youth group, a 17-year-old sustains an injury to the lower leg. A nurse who is
accompanying the group suspects a fracture of the tibia.


 10. To immobilize the suspected fracture, it is jest to apply a splint from
a. below the knee to above the hip.
b. above the knee to below the hip.
c. above the ankle to below the knee.
d. below the ankle to above the knee.
An x-ray of the injured adolescent¶s leg reveals a comminuted fracture of the distal tibia.
11. The nurse is most accurate in explaining to the client that a comminuted fracture is one in which
a. one bone end is driven into the other.
b. the bone is splintered into pieces.
c. there is no open break in the skin.
d. a portion of the bone is split away.
The teenage client will require surgery to realign the bones in his fractured tibia.
12. In this case, from whom is it most appropriate to obtain consent to perform the surgical procedure?
a. The client himself
b. The client¶s physician
c. The client¶s youth leader
d. The client¶s parent
13. The client is about to leave the floor to go to surgery but is still wearing his class ring. Which nursing
action is most correct regarding care of the client¶s valuables?
a. Put the ring in the bedside stand.
b. Tape the ring to the client¶s finger.
c. Give the ring to a security guard.
d. Take the ring to the hospital safe.
. After surgery, the client experiences signs and symptoms of a fat embolism. The nurse recognizes that one of the
Oirst signs is
e. respiratory distress.
f. abdominal distention.
g. difficulty swallowing.
h. swelling at the incision site.
A nurse stops to assist an adult female involved in a motor vehicle accident. The victim was not wearing a seat belt
and was thrown from the car.
14. Of the following emergency measures, which one should the nurse perform Oirst?
a. Check the victim¶s breathing.
b. Cover the victim with a blanket.
c. Move the victim to the curb.
d. Assess for signs of injuries.
The nurse suspects that the client has sustained rib fractures.
15. Which assessment finding jest indicates that the client is experiencing secondary complications from the
fractured ribs?
a. Pulse rate is irregular.
b. Chest expands asymmetrically.
c. Client has expiratory wheezing on auscultation.
d. Client is coughing up pink, frothy sputum.
In addition to the client¶s suspected rib fractures, the nurse sees a bone fragment protruding from the client¶s thigh
and there is profuse bleeding from the wound.
16. Which technique is most appropriate in order to control the bleeding?
a. Place a tourniquet around the leg.
b. Apply direct pressure at the wound.
c. Compress the femoral artery.
d. Elevate the injured extremity.
The nurse suspects that the accident victim also might have a broken back.
17. When emergency medical personnel arrive, the preOerred position in which the victim with a back injury is
transported is
a. side-lying.
b. face-lying.
c. back-lying.
d. semisitting.
An 80-year-old woman is hospitalized with a fractured right hip.
18. During the nurse¶s admission assessment, the most typical sign of an intertrochanteric fracture of the hip is
a. paralysis of the affected leg.
b. bruising of the affected leg.
c. lengthening of the affected leg.
d. external rotation of the leg.
 19. As the nurse reviews the client¶s medical record, which risk factor is most significant for sustaining a hip
fracture?
a. The client is postmenopausal.
b. The client is somewhat obese.
c. The client walks several blocks each day.
d. The client is lactose intolerant.
After the client¶s fractured hip is stabilized with an open reduction and internal fixation, the nurse teaches her to
perform isometric quadriceps setting exercises with her unaffected leg.
20. If the client performs this exercise correctly, the nurse will observe her
a. moving her toes toward and away from her head.
b. contracting and relaxing the muscles of her thigh.
c. lifting her lower leg up and down from the bed.
d. bending her knee and pulling her lower leg upward.
After surgery, the client wears knee-high antiembolism stockings.
21. When the client asks how antiembolism stockings prevent blood clots, the nurse most accurately explains
that the stockings
a. prevent blood from pooling in the legs.
b. reduce blood flow to the extremities.
c. keep the blood pressure lower in the legs.
d. keep the blood vessels constricted.
22. Which technique indicates that the nursing assistant caring for the client has applied the elastic stockings
correctly?
a. The nursing assistant applies the stockings before getting the client out of bed.
b. The nursing assistant applies the stockings just before helping the client do leg exercises.
c. The nursing assistant applies the stockings after noting that the client¶s legs are cool.
d. The nursing assistant applies the stockings at night prior to the client¶s bedtime.
23. Postoperatively, before turning the client with the hip prosthesis onto her nonoperative side, the nurse
would Oirst
a. place pillows between the client¶s legs.
b. have client point her toes downward.
c. flex client¶s knee on the affected side.
d. elevate the head of client¶s bed.
24. When the client with the hip prosthesis is allowed to sit up in a chair, the nurse plans to place the chair
a. at the end of the bed.
b. perpendicular to the bed.
c. parallel with the bed.
d. against a side wall.
The client with the hip prosthesis is allowed to ambulate with a walker using a three-point partial weight-bearing
gait.
25. The jest evidence that the client is performing this gait correctly is that the client advances the walker and
the operative leg while putting most of her weight on
a. the hand grips of the walker.
b. the back legs of the walker.
c. the toes of her operative leg.
d. the heel of her nonoperative leg.
A plaster arm cast will be applied to an adult male client with a compound fracture of his radius.
26. When preparing the client for the cast application, the nurse most accurately explains that
a. the cast will feel tight as it is applied.
b. his arm will feel warm as the wet plaster sets.
c. there will be a foul odor until the cast is dry.
d. he may experience itching while the cast is wet.
27. While the physician wraps the arm with rolls of wet plaster, it is most appropriate for the nurse to support
the wet cast
a. on a soft mattress.
b. on a firm surface.
c. with the tips of the fingers.
d. with the palms of the hand.
28. After the arm cast has been applied, which nursing observation jest indicates that the client is developing
compartment syndrome?
a. The client experiences severe pain.
b. The client¶s hand becomes reddened.
c. The fingers develop muscle spasms.
d. The radial pulse feels bounding.
. After the cast has been applied, what is jest to place under the wet cast?
e. Synthetic sheepskin
f. A vinyl sheet
g. An absorbent pad
h. Several pillows
29. Which nursing technique is jest for drying the wet plaster cast?
a. Leave the casted arm uncovered.
b. Apply a heating blanket to the cast.
c. Use a hair dryer to blow hot air.
d. Place a heat lamp above the cast.
30. Which method is jest for assessing the circulation of the casted extremity?
a. Ask the client if he can wiggle his fingers.
b. Feel the cast to determine if it is unusually hot cold.
c. Depress the nailbed and document the time it takes for the color to return.
d. See if there is enough room to insert a finger between the cast and the extremity.
The client with the plaster arm cast asks the nurse about casts made of synthetic materials like fiberglass.
31. The nurse most accurately states that an advantage to a fiberglass cast is that it is generally
a. less expensive.
b. more lightweight.
c. more flexible.
d. less restrictive.
In response to the nurse¶s cast care instructions, the client returns to the clinic the next day with bloody drainage
seeping through the cast.
32. After assessing the client¶s cast, what is the next action that the nurse should take?
a. Document the finding in the medical record.
b. Call the physician and report the finding.
c. Circle it with ink and write down the time.
d. Apply an ice bag over the spot of drainage.
After a 16-year-old sustains a fractured femur in a motorcycle accident, a hip spica cast is applied.
33. The client states to the nurse, ³My father is furious with me. He doesn¶t want me to ride a motorcycle.´
Which nursing response is most appropriate?
a. ³As they say, µFather knows best´
b. ³All parents want their children to be safe.´
c. ³It can be frustrating when a father and son disagree.´
d. ³I think you should obey your father¶s wishes.´
34. As the nurse plans the client¶s care, which developmental task should be kept in mind?
a. The client is searching for his sexual identity.
b. The client is testing his physical abilities.
c. The client is acquiring his own independence.
d. The client is learning to control his emotions.
35. While planning care for the client in the hip spica cast, which equipment is needed to facilitate the client¶s
bowel elimination?
a. Bedside commode
b. Fracture bedpan
c. Mechanical lift
d. Raised toilet seat
The client asks the nurse to explain the purpose of the bar that runs from the plaster on one thigh of his hip spica cast
to the other.
36. The most accurate nursing response is that the bar is used for
a. lifting and turning clients.
b. performing physical exercise.
c. strengthening the cast.
d. hanging personal items.
The client tells the nurse that his skin itches terribly beneath the cast.
37. What is the most appropriate nursing action at this time?
a. Collaborate with the physician on prescribing an antipruritic medication.
b. Provide powder for the client to sprinkle in the cast.
c. Bend a wire coat hanger so the client can scratch inside the cast.
d. Apply a commercially prepared ice bag to the outside of the cast.
After the client has had the hip spica cast for nearly 3 weeks, the nurse detects a foul odor coming from the cast.
38. The jest reason for reporting this finding promptly is that an unpleasant smell is usually a sign that
a. the plaster has dried improperly.
b. there is bleeding under the cast.
 c. the cast is disintegrating.
d. there is an infected wound.
The physician cuts a small window in the hip spica cast to inspect the underlying tissue.
39. Which nursing action is most appropriate after the piece of plaster is removed to create a window in the
cast?
a. Dispose of the piece of plaster in a plastic biohazard bag.
b. Replace the piece of plaster in the cast hole with tape.
c. Put the piece of plaster in the client¶s bedside table.
d. Send the piece of plaster to the laboratory for a culture.
40. When the rough edges on the client¶s hip spica cast edges begin to threaten the integrity of the skin, the jest
nursing action is to
a. line the cast edge with adhesive petals of moleskin.
b. apply a fresh strip of plaster to the cast edge.
c. trim the rough cast edge with a cast cutter.
d. cover the cast edge with a gauze dressing.
41. Which assessment finding suggests that the client in the hip spica cast may be developing psychological
and physiological responses to his confinement known as ³cast syndrome?´
a. The client becomes nauseated and vomits.
b. The client becomes disoriented and confused.
c. The client becomes feverish and hypotensive.
d. The client becomes dyspneic and hyperventilates.
Before undergoing surgery for a fractured hip, an older adult female is placed in Buck¶s traction.
42. When changing the linen on the bed of the client in Buck¶s traction, it is jest for the nurse to
a. roll the client from one side of the bed to the other.
b. apply the linen from the foot to the top of the bed.
c. leave the bottom sheets in place until after surgery.
d. raise the client from the bed with a mechanical lift.
43. While providing nursing care for the client in Buck¶s traction, which assessment finding indicates a need
for immediate action?
a. The traction weights are hanging above the floor.
b. The leg is in line with the pull of the traction.
c. The client¶s foot is touching the end of the bed.
d. The rope is in the groove of the traction pulley.
44. Which technique is the jest strategy for assessing the circulation in the leg in Buck¶s traction?
a. Observe if the client can wiggle or move her toes.
b. Palpate for pulsation of the dorsalis pedis artery.
c. Take the blood pressure on the leg with a thigh cuff.
d. See if the client can feel sharp and dull sensations.
An older adult man is placed in Russell¶s traction while awaiting surgery.
45. To prevent skin breakdown while the client is in Russell¶s traction, it is essential for the nurse to frequently
inspect the skin in which area?
a. Over the ischial spines
b. In the popliteal space
c. Near the iliac crests
d. At the zygomatic arch
46. The nurse enters the client¶s room to assess the traction apparatus. Which of the following interferes with
the effectiveness of the Russell¶s traction?
a. The rope is strung tautly from pulley to pulley.
b. The trapeze is hanging above the client¶s chest.
c. The rope is knotted at the location of a pulley.
d. The weight is hanging about 24 inches from the floor.
On the day of surgery, the client in Russell¶s traction is transported to the operating room in his bed.
47. When the client is transported, which nursing action is áorreát?
a. The nurse leaves the traction just as it is.
b. The nurse removes the weights during his transport.
c. The nurse rests the weights on the end of the bed.
d. The nurse takes the client¶s leg out of the traction.
A cervical halter type of skin traction is applied to a client who has experienced a whiplash injury in a motor vehicle
accident.
48. When the nurse makes rounds at the beginning of the shift, which observation requires immediate
attention?
a. The halter rests under the client¶s chin and occiput.
b. The client¶s ears are clear of the traction ropes.
 c. The weight hangs between the headboard and wall.
d. There is a soft pillow beneath the client¶s head.
An adult woman has acute low back pain for which pelvic-belt traction has been ordered intermittently throughout
the day.
49. When the nurse helps the client apply the pelvic-belt traction, it is most correct to place the top of the belt
a. just below the rib cage.
b. even with her waistline.
c. level with the iliac crest.
d. where it is most comfortable.
A client with a fractured femur is in skeletal traction with a pin through the distal femur. The affected leg is
supported by balanced suspension.
50. Which material is jest for covering the tips of the pin to prevent injuries while caring for the client in
skeletal leg traction?
a. Gauze squares
b. Cotton balls
c. Cork blocks
d. Rubber tubes
51. Which assessment finding jest indicates that the client has an infection at the pin site?
a. There is serous drainage at the pin site.
b. There is bloody drainage at the pin site.
c. There is mucoid drainage at the pin site.
d. There is purulent drainage at the pin site.
The physician orders antibiotic therapy for the client with a pin site infection.
52. If the client is allergic to penicillin, it is essential that the nurse question the medical order prior to giving
which type of antibiotic?
a. Aminoglycosides like gentamicin sulfate (Garamycin)
b. Cephalosporins like cefaclor (Ceclor)
c. Tetracyclines like doxycycline (Vibramycin)
d. Sulfonamides like trimethoprim-sulfamethoxazole (Bactrim)
An adult male client with a fracture of a cervical vertebra is put in halo skeletal traction consisting of pins inserted
into the skull that are incorporated into a vest of plaster.
53. When the client asks the purpose of this type of traction, the jest response by the nurse is
a. ³It restricts neck movement but enables physical activity.´
b. ³It allows head movement while immobilizing the spine.´
c. ³It accelerates healing by facilitating physical therapy.´
d. ³It promotes faster bone repair in a shorter span of time.´
54. Which observation provides the jest indication that the halo traction device is applied appropriately?
a. The client has full range of motion in the neck.
b. The client¶s neck pain is within a tolerable level.
c. The client can speak and hear at preinjury levels.
d. The client reports the ability to see straight ahead.
55. Which assessment finding jest indicates that the halo traction needs to be readjusted by the physician?
a. The client experiences postural hypotension.
b. The client needs assistance with shaving.
c. The client cannot open his mouth widely.
d. The client complains about irritation in the axilla.
An adult woman consults a physician about persistent joint pain and stiffness.
56. Which laboratory test, if elevated, is most diagnostic for rheumatoid arthritis?
a. Erythrocyte sedimentation rate (ESR)
b. Partial thromboplastin time (PTT)
c. Fasting blood sugar (FBS)
d. Blood urea nitrogen (BUN)
57. If the client is typical of most people with rheumatoid arthritis, the nurse can expect that the client Oirst
developed symptoms
a. in very early childhood.
b. at the onset of puberty.
c. during young adulthood.
d. after menopause.
The client with rheumatoid arthritis takes a total of 5 g of aspirin per day.
58. If each tablet contains 5 grains, how many tablets should the nurse make sure are stocked in the medicine
cart for the client in each 24-hour period?
a. 1. 5 tablets
b. 10 tablets
 c. 3. 15 tablets
d. 4. 20 tablets
The client says she is surprised the physician prescribed a common drug such as aspirin to treat her condition.
59. The nurse áorreátly explains that aspirin is one of the drugs of choice used in the treatment of rheumatoid
arthritis because it relieves discomfort and
a. stimulates the immune system.
b. relaxes skeletal muscles.
c. reduces joint inflammation.
d. interrupts nerve synapses.
The client tells the nurse that she gets an upset stomach when she takes the aspirin.
60. hich modification in the client¶s care plan is most appropriate to relieve the client¶s stomach discomfort?
a. Give aspirin before meals only.
b. Give aspirin with cold water.
c. Give aspirin with hot tea.
d. Give aspirin with food or meals.
61. Because the client takes large amounts of aspirin daily, the nurse monitors her for signs and symptoms of
aspirin toxicity. Which assessment finding jest indicates aspirin toxicity?
a. Ringing in the ears
b. Dizziness
c. Metallic taste in the mouth
d. Proteinuria
The client tells the nurse that when she watches television, her discomfort is decreased.


62. Which conclusion made by the nurse is the most accurate?
a. The client is improving due to electronic signals.
b. The client is having less pain than she thinks.
c. The client is experiencing a slight case of arthritis.
d. The client is being distracted from her pain.
63. When the nurse examines the hands of the client with rheumatoid arthritis, which finger joints are most
often affected?
a. Proximal finger joints
b. Medial finger joints
c. Distal finger joints
The physician recommends that the nurse apply heat to the hands of the older client with rheumatoid arthritis to
relieve some of her discomfort.


64. Which method is jest for the nurse to use?
a. Hot water bottle
b. Warm moist compresses
c. Electric heating pad
d. Infrared heat lamp
65. When planning care for the client, the nurse expects that she will need more time and assistance with
activities of daily living
a. in the early morning.
b. at noontime.
c. in late afternoon.
d. before bedtime.
66. Which nursing recommendation has the `reatest potential for helping the client maintain her ability to care
for herself?
a. Move to a warm climate.
b. Buy clothes that are easy to pull or slip on.
c. Enroll in an aerobic exercise class.
d. Sleep on a waterbed.
During an acute episode of rheumatoid arthritis, the physician asks the nurse to apply a splint to each of the client¶s
hands.


67. The nurse most accurately explains to the client that the primary purpose of the splints is to
a. rest the affected joints.
b. cure her joint disease.
c. improve her hand strength.
d. increase her range of motion.
The client has not responded to the usual drug therapy and now takes prednisone (Meticorten) daily.
 68. While the client with rheumatoid arthritis takes prednisone (Meticorten), the nurse should closely monitor
the client¶s
a. daily weight.
b. pulse rate.
c. red blood cell count.
d. skin integrity.
69. Which statement made by the client indicates that further instruction regarding corticosteroid therapy is
necessary?
a. ³I am susceptible to getting infections.´
b. ³I should never stop taking my medication abruptly.´
c. ³I may become very depressed and perhaps suicidal.´
d. ³I may develop low blood sugar and need glucose.´
In addition to prednisone (Meticorten), the client also takes methotrexate (Rheumatrex), a drug usually used to treat
clients with cancer.


70. Which assessment finding most likely is an adverse effect from methotrexate (Rheumatrex) therapy?
a. Constipation
b. Polyuria
c. Mouth sores
d. Chest pain
A 75-year-old man with osteoarthritis in his left hip has beentold by his physician to apply a heating pad to the area
several times a day.


71. It is essential for the nurse to instruct the client that when he uses the heating pad
a. it should be kept on the low setting.
b. he should place it directly next to the skin.
c. it should be covered with plastic.
d. he should apply it for 2 hours at a time.
72. The nurse instructs the client that stress on painful joints can be minimized by
a. maintaining normal weight.
b. applying a topical analgesic cream.
c. soaking in a tub of hot bath water.
d. becoming more physically active.
73. The client uses a cane when ambulating. When the nurse observes him walking, which assessment finding
indicates that he needs more instruction regarding the use of his cane?
a. The tip of the cane is covered with a rubber cap.
b. The client wears athletic shoes with nonskid soles.
c. The client uses the cane on his painful side.
d. The client holds his head up and looks straight ahead.
The client tells the nurse that when he is at home he takes 400 mg of ibuprofen (Motrin) four times a day.

74. To determine if a side effect is occurring, which question is most appropriate to ask a client who takes
nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen Motrin)?
a. ³Have you noticed any hand tremors?´
b. ³Are you urinating more frequently?´
c. ³Has your interest in food changed?´
d. ³What color are your stools?´
A total hip replacement (hip arthroplasty) is planned for a 70- year-old man with osteoarthritis. The physician
instructs the client to stop taking his enteric-coated aspirin (Ecotrin) 1 week prior to surgery.


75. The most accurate explanation for the physician¶s instruction is that aspirin
a. increases the risk of wound infection.
b. impairs the ability to control bleeding.
c. makes it difficult to assess his pain.
d. interferes with the ability to heal.
Before the total hip replacement, the nurse teaches the client how to use an incentive spirometer.

76. Which client statement indicates that he has a correct understanding of its use?
a. ³I should position the mouthpiece and inhale deeply.´
b. ³I should position the mouthpiece and exhale forcefully.´
c. ³I should position the mouthpiece and cough effectively.´
d. ³I should position the mouthpiece and breathe naturally.´
Just before the total hip replacement, the nurse prepares a large area of the client¶s skin for surgery.
 77. Which technique is most appropriate for the nurse to use when preparing the operative area?
a. Wash the area with soap and water.
b. Press the razor deeply into the skin while shaving.
c. Clip the hair around the intended incisional area.
d. Shave in the direction of hair growth.
78. After the client undergoes a total hip replacement, how should the nurse position the affected hip?
a. Adduction
b. Abduction
c. Flexion
d. Extension
79. Which equipment is most helpful to obtain when planning the postoperative nursing care of the client?
a. A bed cradle
b. A bed board
c. An overhead trapeze
d. Power side rails
80. Which item is jest for preventing external rotation of the operative leg when caring for the client with the
total hip replacement?
a. A footboard
b. A trochanter roll
c. A turning sheet
d. A foam mattress
The nurse caring for the client after the total hip replacement provides discharge teaching instructions regarding
positions he must temporarily avoid.


81. Which client statement indicates that he has a áorreát understanding of the restrictions he must follow?
a. The client says he should not cross his legs.
b. The client says he should not point his toes.
c. The client says he should not lay flat in bed.
d. The client says he should not stand upright.
82. When planning the client¶s discharge, it is essential that the nurse help the client obtain which item for his
home care?
a. A wheelchair
b. A hospital bed
c. A raised toilet seat
d. Amechanical lift
83. Which area of health teaching is essential to include in the discharge instructions of a client who has
undergone a total hip replacement?
a. Modifying ways of donning clothing
b. Using special equipment for bathing
c. Taking vigorous daily walks
d. Receiving a daily stool softener
A 36-year-old male client undergoes an arthroscopy of his right knee for purposes of diagnosing and treating the
joint that has been chronically painful.


84. Which nursing instruction is most appropriate for the client prior to the arthroscopy procedure?
a. The signs and symptoms of arthritis
b. The technique for using crutches
c. The side effects of drug therapy
d. The need to balance rest and exercise
A 60-year-old man with osteoarthritis will have a knee arthroplasty during which an artificial joint will replace his
natural knee joint. A continuous passive motion (CPM) machine will be used postoperatively.


85. The nursing explanation that jest describes the primary purpose of the CPM machine is that it is used to
a. strengthen leg muscles.
b. relieve foot swelling.
c. reduce surgical pain.
d. restore joint function.
86. When documenting the client¶s progress while using a CPM machine, it is essential that the documentation
indicate the degree of joint flexion, the number of cycles per minute, and the
a. condition of the sutures around the incision.
b. amount of time the client used the machine.
c. characteristics of drainage from the wound.
 d. presence and quality of arterial pulses.
87. Which evidence jest indicates that the client who had a knee arthroplasty can discontinue wearing the
resting knee extension splint (immobilizer)?
a. The client has minimal pain when ambulating.
b. The client can flex the operative knee 90 degrees.
c. The client can perform straight leg raising.
d. The client¶s surgical wound is approximated.
A 54-year-old man is being treated for gout.


88. When the nurse examines the client with gout, if he is typical of others with this condition, which structure
is most likely affected?
a. Great toe
b. Index finger
c. Sacrococcygeal vertebrae
d. Temporomandibular joint
89. If the physician orders the following laboratory tests to determine gout, the elevation of which test validates
the client¶s diagnosis?
a. Creatinine clearance
b. Blood urea nitrogen
c. Serum uric acid
d. Serum calcium
90. The client with gout experiences an acute attack. Which piece of equipment is jest for promoting his
comfort?
a. A bed cradle
b. An electric fan
c. A foam mattress
d. A fracture bedpan.


The physician orders a low-purine diet for the client with gout.


91. It is most appropriate for the nurse to consult the dietitian if the client is served
a. beets.
b. milk.
c. eggs.
d. liver.
During an acute attack of gout, the physician prescribes colchicine (Novocolchine) to be given every hour until the
client¶s pain is relieved.


92. Which is an indication that the administration of colchicine (Novocolchine) needs to be discontinued even
if the client¶s pain is unrelieved?
a. The client develops vomiting.
b. The client develops dizziness.
c. The client develops drowsiness.
d. The client develops a headache.
To reduce the potential for forming urinary stones, the nursing care plan indicates that the client with gout is to have
3000 mL of fluid daily.


93. When implementing the plan of care, the jest time to offer proportionately greater amounts of fluid to the
client is
a. before bedtime.
b. early evening.
c. in the morning.
d. mid-afternoon.
The nurse advises the client with gout to continue consuming a high intake of fluid following discharge.


94. The nurse correctly instructs the client that he should avoid which type of fluid?
a. Coffee
b. Alcohol
c. Cranberry juice
d. Carbonated drinks
A middle-aged woman asks the nurse about methods for preventing or delaying the onset of osteoporosis.


95. The nurse most accurately instructs the client that prophylaxis is often achieved by
 a. drinking four cups of coffee per day.
b. taking antacids containing calcium.
c. eating ice cream every night after dinner.
d. taking estrogen hormones postmenopausally.
96. Which assessment finding jest indicates that a client has osteoporosis?
a. The client¶s joints are swollen.
b. The client has discomfort sitting.
c. The client has a spinal deformity.
d. The client¶s energy is diminished.
97. A client diagnosed with osteoporosis receives nursing instruction regarding methods for reducing the
progression of the disorder. The nurse is correct in recommending that the client avoid
a. aspirin and carbonated beverages.
b. nicotine and sources of caffeine.
c. sodium and substances with alcohol.
d. calcium and dairy products.
A 55-year-old man has developed bone necrosis as a result of chronic osteomyelitis in the tibia of his left leg.


98. Which nursing intervention is most appropriate for preventing a pathological fracture?
a. Encourage a high fluid intake.
b. Provide a nutritional diet.
c. Support the limb during movement.
d. Relieve pressure on bony prominences.
A 68-year-old Mexican American man immigrated to the United States 3 months ago. The client comes to the
emergency department with complains of severe shoulder, elbow, and knee pain. The diagnosis of bursitis is made.


99. Which statement regarding the client¶s health-seeking behavior is most accurate?
a. Home remedies have been unsuccessful and his condition threatens his role expectations.
b. The power to cure comes from physicians and is based on advances in medical technology.
c. The client has lost faith in prayer, supernatural forces and his á randero.
d. His condition is the result of the mal de ojo (evil eye).
Aclient diagnosed with osteomalacia has been told that his condition may improve with the addition of vitamin D.


100.In addition to recommending the consumption of foods fortified with vitamin D, it is most appropriate for
the nurse to suggest that the client
a. get more direct exposure to sunlight.
b. eat meat from growth-stimulated cattle.
c. consume bright orange vegetables.
d. purchase organically grown produce.
During a farming accident, a 50-year-old man¶s arm is caught in a grain elevator. His lower left arm and hand are
crushed.


101.If the client is in shock, which body position is jest while the nurse continues to assess and care for him?
a. Prone
b. Supine
c. On his back with his legs elevated
d. On his side with his neck extended
The client is rushed to surgery where his arm is amputated above the elbow.


102.Postoperatively, the client screams obscenities at the nurse when he realizes that his forearm is missing.
Which nursing action is most appropriate at this time?
a. Leave until client works through his anger.
b. Stay quietly with client at his bedside
c. Tell client to get control of himself.
d. Call the physician and request a sedative.

Later the client says, ³I know my arm is not there, but I feel it throbbing.´


103.The most accurate explanation the nurse can give to the client is that he is experiencing
a. referred pain.
b. phantom pain.
c. psychogenic pain.
d. intractable pain.
The physician orders transcutaneous electric nerve stimulation (TENS) in the location of the discomfort on the arm
oppositethe amputation.


104.When the client asks the nurse how the TENS unit works, you respond that one of the most widely held
theories is that the sensation created by the TENS machine
a. blocks the brain¶s perception of pain impulses.
b. travels to the nerve root of the amputated arm.
c. destroys the brain¶s pain center.
d. weakens the arm¶s sensory nerves.
An older adult diabetic woman is admitted with vascular problems. Some toes on her left foot are black. She is
scheduled for a below-the-knee amputation (BKA).


105.When planning the postoperative care of the diabetic client who has had a BKA, which position is least
desirajle for this client?
a. Lying prone
b. Lying supine
c. Sitting in a chair
d. Standing to shower

The nursing team gathers to develop a plan to strengthen the muscles of the client with the BKA to prepare her for
ambulating with crutches.


106.Which activity is jest to begin implementing immediately after surgery?
a. Stand at the side of the bed.
b. Balance between parallel bars.
c. Lift herself with the trapeze.
d. Transfer from bed to chair.
The client asks the nurse why her stump is rewrapped with elastic bandages several times a day.

107.The jest explanation for stump bandaging is that it is done to

a. lengthen and tone muscles.
b. shrink and shape the stump.
c. maintain joint flexibility.
d. absorb blood and drainage.
Just before his 18th birthday, a male client is diagnosed with a cancerous bone tumor (osteogenic sarcoma) in his
femur. An above-the-knee amputation (AKA) is performed.


108.Which item is jest to keep at the bedside during the client¶s immediate postoperative period?
a. Gauze dressings
b. Rubber tourniquet
c. Oropharyngeal airway
d. Oxygen equipment
A rigid plaster shell surrounds the client¶s stump. A pylon, or temporary prosthesis, allows the client to ambulate
with crutches soon after surgery.


109.Which observation is most indicative that the client¶s crutches need further adjustment?
a. The client stands straight without bending forward.
b. Client¶s elbows are slightly flexed when standing in place.
c. The top bars of the crutches fit snugly into the axillae.
d. Client¶s wrists are hyperextended when grasping the handgrips.


110.Due to the location of a malignant bone tumor like osteogenic sarcoma, it is most appropriate for the nurse
to assess for which complication?
a. Bowel obstruction
b. Liver dysfunction
c. Mental status changes
d. Anemia
111.Which diagnostic test result should the nurse monitor when assessing for evidence of metastasis?
a. Lung scan
b. Urinalysis
c. Spinal tap
d. Blood glucose
A male construction worker has an acute onset of severe low back pain. The physician suspects that the client has a
herniated intervertebral disk in the lumbar spine.


112.When assessing the characteristics of the client¶s pain, the nurse expects that a person with a herniated disk
will have an increase in the intensity of pain when
a. eating.
b. sneezing.
c. sleeping.
d. urinating.


113.If the client with a herniated lumbar disk is typical of others with this same condition, he also will report to
the nurse that he has
a. pain radiating into the buttocks and leg.
b. tenderness over one or both iliac crests.
c. diminished sensation in one or both knees.
d. brief periods when his toes feel quite cold.
The physician prescribes 30 mg of cyclobenzaprine hydrochloride (Flexeril) orally b.i.d. for the client with the
tentative diagnosis of herniated intervertebral disk.


114.The nurse áorreátly explains to the client that this medication is used in his case to
a. reduce emotional depression.
b. relax skeletal muscles.
c. promote restful sleep.
d. relieve inflammation.
A myelogram with a water-soluble contrast dye is ordered to confirm the diagnosis of a herniated intervertebral disk.

115.After the client returns from the myelogram, it is most appropriate for the nurse to keep the client quiet and
to
a. reduce glare from bright lights.
b. withhold food and fluids for 12 hours.
c. administer sedatives every 6 hours.
d. encourage a high fluid intake.
Conservative treatment does not relieve the client¶s symptoms and physical disability. The client consents to have a
laminectomy and spinal fusion in the lumbar area of the spine.

116.Before turning the client postoperatively, which nursing instruction is most important for preventing
postoperative complications?
a. ³Hold your breath as you are turning.´
b. ³Move your lower body first then your chest.´
c. ³As you hold onto the trapeze, lift your hips off the bed.´
d. ³Let me roll you as if you were a log.´
The nurse includes principles of good body mechanics in the discharge teaching plan of the client who has
undergone spinal surgery. The client, however, is from a foreign country and speaks very little English.


117.Which teaching method provides the jest information regarding body mechanics for the non-English
speaking client?
a. Speak slowly while looking at the client.
b. Write the instructions on paper.
c. Use colorful pictures or diagrams.
d. Have the client watch a video.
118.The nurse áorreátly instructs the client that when he picks something up, he should
a. flex both his knees.
b. keep his feet together.
c. lift with arms extended.
d. bend from the waist.