Examl 4:l NSGl 320/l NSG320l (Latestl 2025/l
2026l Update)l Adultl Healthl Nursingl Il
Completel Guide|l Questionsl &l Answers|l
Gradel A|l 100%l Correctl (Verifiedl
Solutions)-l GCU
Q:l hipl fracture
Answer:
-commonl inl OA
-resultl ofl falls
-fracturel inl thel upperl 1/3l ofl thel femur
MANIFESTATIONS
-severel painl andl tenderness,l externall rotation,l musclel spasm,l shorteningl ofl extremityl
-displacedl femorall head->disruptsl bloodl tol femorall head->avascularl necrosis
CARE
wel wantl immediatel surgery
1.l initial:l
-immobilizationl wl bucksl traction:l tol stabilizel ptl forl surgery,l tol decreasel musclel spasmsl
forl 24-48l hours
2.l surgery:
-closedl reductionl wl percutaneousl pinningl (CRPP)
-repairl wl internall fixation
-replacel femorall headl wl prosthesisl (hemil arthroplasty)
PREl OP
-teachingl inl thel ED
-mayl havel tol waitl tilll stable
-beginl dischargel planningl bcl ofl shortl hospitall stayl (3-4l days)
-managel painl andl musclel spasms:l musclel relaxants,l analgesia,l positioning,l traction
POSTl OP
-vitall signs,l I&O,l respiratoryl (coughl andl deepl breathe),l neurovascularl assessment,l assessl
forl bleeding
-dontl layl onl operativel side,l maintainl limbl alignmentl
-elevatel legl forl edema
-maintainl abduction
-usel trapezel barl tol reposition
-workl wl PT,l ambulationl typicallyl firstl dayl postl op
-weightl baringl activity
,-do:l placel pillowl bwl legs,l sitl onl chairl inl shower,l elevatedl toiletl seat
-dont:l adductl hipl (bringl kneesl together),l crossl legs,l flexl hipl morel thanl 90l degreesl
AMBULATORYl CARE
-rehabl ifl livel alone
-homel healthl carel nursel wl PT
-exercises:l swimmingl andl stationaryl cycling,l avoidl highl impactl activityl
-homel safetyl tol avoidl falls:l betterl lighting,l railsl onl stairsl andl shower,l removel trippingl
hazards
Q:l arthroplasty
Answer:
reconstruction/replacementl ofl al jointl tol relievel pain,l correctl deformity,l andl improvel
ROM
-types:l reshaping,l replacementl ofl partl ofl joint,l orl totall replacement
TOTALl HIPl ARTHROPLASTY
-decreasesl painl andl improvesl functioningl inl al fracturedl hipl orl deterioratingl jointl
-replacel balll andl socketl wl prosthesis:
>cement:l bondsl tol thel bonel tol holdl inl place
>cementless:l bonel tissuel growsl intol prosthesis.l goodl forl young,l activel peoplel wl goodl
bonel healthl
TOTALl KNEEl ARTHROPLASTY
-indicated:l severel deteriorationl ofl cartilagel andl unrelievedl painl andl instability
-postl op:
>kneel immobilizationl inl extensionl wl compressionl dressing
>painl managementl importantl forl rehab
>physicall therapy:l exercisesl tol progressl tol 90l degreel flexion.l Activel ROMl orl contl
passivel machinel motion.l earlyl ambulationl wl fulll weightl baringl beforel discharge.
Q:l nursingl carel arthroplasty
Answer:
PREl OP
-patientl freel of:l infection,l acutel jointl inflammation,l skinl breakdown
-explainl postl opl info:l VTEl prophylaxis,l mobilization,l hydration,l PT
POSTl OP
-neurovascularl assessmentsl
-givel anticoagulantl andl antibiotics:l teachl theml tol contl itl atl home,l coagulantl studiesl
-VTEl prophylaxis:l hydration,l earlyl ambulation,l anticoagulants,l shorterl surgeryl time
-painl management:l analgesia
,-exercisel andl mobilityl
AP
-assistl wl hydration,l elimination,l andl hygienel needs
-maintainl bodyl positionl andl assistl wl ambulation
-intakel andl output
-reportl tol nursel ifl tingling,l pain,l decreasedl sensation
Q:l osteomyelitis
Answer:
severel infectionl ofl thel bone,l bonel marrow,l andl surroundingl softl tissue
-typicallyl causedl byl S.l Aureusl
-riskl factors:l oldl age,l debilitation,l hemodialysis,l sicklel celll disease,l IVl drugl use
ACUTEl OSTEOMYELITIS
-lessl thanl 1l month
-local:l constantl painl thatl isl worsel wl activityl andl unrelievedl byl rest,l swelling,l
tenderness,l warmth,l restrictedl movement
-systemic:l fever,l chills,l nightl sweats,l malaise,l nausea,l restless
-late:l drainagel froml skin,l sinuses,l fracturel site
CHRONICl OSTEOMYELITIS
-greaterl thanl 1l monthl orl doesn'tl respondl tol antibioticsl
-itl isl eitherl continuousl andl persistentl orl recurrentl wl periodsl ofl exacerbationl andl
remission
-lessl systemicl signs,l morel locall signs
-granulationl tissuel turnsl intol avascularl scarl tissuel
DIAGNOSE
-culture
-bonel orl softl tissuel biopsy
-WBCl count
-bonel scan,l MRI,l xray,l CTl scan
-increasedl cl reactivel protein
Q:l osteomyelitisl treatment
Answer:
ACUTEl
-prolongedl antibioticl treatment:l
>IVl antibioticsl mayl havel tol continuel atl homel forl 4-6l weeks,l somel mayl needl itl forl 3-
6l mo
-softl tissuel abscessl orl ulcerationl needl debridementl orl drainagel
, CHRONIC
-surgicall removall ofl poorlyl perfusedl tissuel andl deadl bonel
-extendedl antibioticl use:
>orall fluoroquinolonel forl 6-8l weeks
>IVl antibioticsl forl acutel mustl bel followedl wl 4-8l weeksl ofl oral
HEALTHl PROMOTION
-treatl otherl concurrentl infections
-educatel atl riskl peoplel ofl s/s
ACUTEl CARE
-immobilizationl andl carefull handlingl ofl limb
-bedl restl initially
-meds:l nsaids,l musclel relaxants,l opioids
-teachl theml abtl sidel effectsl ofl antibiotics
-contactl precautions
-sterilel dressingl changesl
-teachl theml nonl drugl painl managementl
AP
-carefull handlingl ofl limb
-assistl wl activel ROMl ofl unaffectedl limbl andl passivel ROMl ofl adjacentl jointsl tol thel
affectedl partl
AMBULATORY
-takel fulll coursel ofl antibiotics
Q:l osteoporosis
Answer:
chronic,l progressivel metabolicl bonel diseasel characterizedl byl lowl bonel massl andl
deteriorationl ofl bonel tissue->l fragilel bone
RISKl FACTORS
-women,l increasingl age,l lowl bodyl weight
-familyl history,l smoking,l alc
-lowl Cal andl Vitl D
-lowl estrogenl andl testosterone
-sedentaryl lifestylel
MANIFESTATIONS
-mcl inl thel hips,l wrists,l andl spine
-backl pain
-spontaneousl fractures
-late:l lossl ofl heightl andl kyphosisl (humpedl spine)
DIAGNOSIS
-xl rayl studiesl dontl detectl untill 25-40%l ofl bonel Cal isl lost
-bonel minerall density:l testl wl DEXAl (duall energyl xrayl absorptiometry)
2026l Update)l Adultl Healthl Nursingl Il
Completel Guide|l Questionsl &l Answers|l
Gradel A|l 100%l Correctl (Verifiedl
Solutions)-l GCU
Q:l hipl fracture
Answer:
-commonl inl OA
-resultl ofl falls
-fracturel inl thel upperl 1/3l ofl thel femur
MANIFESTATIONS
-severel painl andl tenderness,l externall rotation,l musclel spasm,l shorteningl ofl extremityl
-displacedl femorall head->disruptsl bloodl tol femorall head->avascularl necrosis
CARE
wel wantl immediatel surgery
1.l initial:l
-immobilizationl wl bucksl traction:l tol stabilizel ptl forl surgery,l tol decreasel musclel spasmsl
forl 24-48l hours
2.l surgery:
-closedl reductionl wl percutaneousl pinningl (CRPP)
-repairl wl internall fixation
-replacel femorall headl wl prosthesisl (hemil arthroplasty)
PREl OP
-teachingl inl thel ED
-mayl havel tol waitl tilll stable
-beginl dischargel planningl bcl ofl shortl hospitall stayl (3-4l days)
-managel painl andl musclel spasms:l musclel relaxants,l analgesia,l positioning,l traction
POSTl OP
-vitall signs,l I&O,l respiratoryl (coughl andl deepl breathe),l neurovascularl assessment,l assessl
forl bleeding
-dontl layl onl operativel side,l maintainl limbl alignmentl
-elevatel legl forl edema
-maintainl abduction
-usel trapezel barl tol reposition
-workl wl PT,l ambulationl typicallyl firstl dayl postl op
-weightl baringl activity
,-do:l placel pillowl bwl legs,l sitl onl chairl inl shower,l elevatedl toiletl seat
-dont:l adductl hipl (bringl kneesl together),l crossl legs,l flexl hipl morel thanl 90l degreesl
AMBULATORYl CARE
-rehabl ifl livel alone
-homel healthl carel nursel wl PT
-exercises:l swimmingl andl stationaryl cycling,l avoidl highl impactl activityl
-homel safetyl tol avoidl falls:l betterl lighting,l railsl onl stairsl andl shower,l removel trippingl
hazards
Q:l arthroplasty
Answer:
reconstruction/replacementl ofl al jointl tol relievel pain,l correctl deformity,l andl improvel
ROM
-types:l reshaping,l replacementl ofl partl ofl joint,l orl totall replacement
TOTALl HIPl ARTHROPLASTY
-decreasesl painl andl improvesl functioningl inl al fracturedl hipl orl deterioratingl jointl
-replacel balll andl socketl wl prosthesis:
>cement:l bondsl tol thel bonel tol holdl inl place
>cementless:l bonel tissuel growsl intol prosthesis.l goodl forl young,l activel peoplel wl goodl
bonel healthl
TOTALl KNEEl ARTHROPLASTY
-indicated:l severel deteriorationl ofl cartilagel andl unrelievedl painl andl instability
-postl op:
>kneel immobilizationl inl extensionl wl compressionl dressing
>painl managementl importantl forl rehab
>physicall therapy:l exercisesl tol progressl tol 90l degreel flexion.l Activel ROMl orl contl
passivel machinel motion.l earlyl ambulationl wl fulll weightl baringl beforel discharge.
Q:l nursingl carel arthroplasty
Answer:
PREl OP
-patientl freel of:l infection,l acutel jointl inflammation,l skinl breakdown
-explainl postl opl info:l VTEl prophylaxis,l mobilization,l hydration,l PT
POSTl OP
-neurovascularl assessmentsl
-givel anticoagulantl andl antibiotics:l teachl theml tol contl itl atl home,l coagulantl studiesl
-VTEl prophylaxis:l hydration,l earlyl ambulation,l anticoagulants,l shorterl surgeryl time
-painl management:l analgesia
,-exercisel andl mobilityl
AP
-assistl wl hydration,l elimination,l andl hygienel needs
-maintainl bodyl positionl andl assistl wl ambulation
-intakel andl output
-reportl tol nursel ifl tingling,l pain,l decreasedl sensation
Q:l osteomyelitis
Answer:
severel infectionl ofl thel bone,l bonel marrow,l andl surroundingl softl tissue
-typicallyl causedl byl S.l Aureusl
-riskl factors:l oldl age,l debilitation,l hemodialysis,l sicklel celll disease,l IVl drugl use
ACUTEl OSTEOMYELITIS
-lessl thanl 1l month
-local:l constantl painl thatl isl worsel wl activityl andl unrelievedl byl rest,l swelling,l
tenderness,l warmth,l restrictedl movement
-systemic:l fever,l chills,l nightl sweats,l malaise,l nausea,l restless
-late:l drainagel froml skin,l sinuses,l fracturel site
CHRONICl OSTEOMYELITIS
-greaterl thanl 1l monthl orl doesn'tl respondl tol antibioticsl
-itl isl eitherl continuousl andl persistentl orl recurrentl wl periodsl ofl exacerbationl andl
remission
-lessl systemicl signs,l morel locall signs
-granulationl tissuel turnsl intol avascularl scarl tissuel
DIAGNOSE
-culture
-bonel orl softl tissuel biopsy
-WBCl count
-bonel scan,l MRI,l xray,l CTl scan
-increasedl cl reactivel protein
Q:l osteomyelitisl treatment
Answer:
ACUTEl
-prolongedl antibioticl treatment:l
>IVl antibioticsl mayl havel tol continuel atl homel forl 4-6l weeks,l somel mayl needl itl forl 3-
6l mo
-softl tissuel abscessl orl ulcerationl needl debridementl orl drainagel
, CHRONIC
-surgicall removall ofl poorlyl perfusedl tissuel andl deadl bonel
-extendedl antibioticl use:
>orall fluoroquinolonel forl 6-8l weeks
>IVl antibioticsl forl acutel mustl bel followedl wl 4-8l weeksl ofl oral
HEALTHl PROMOTION
-treatl otherl concurrentl infections
-educatel atl riskl peoplel ofl s/s
ACUTEl CARE
-immobilizationl andl carefull handlingl ofl limb
-bedl restl initially
-meds:l nsaids,l musclel relaxants,l opioids
-teachl theml abtl sidel effectsl ofl antibiotics
-contactl precautions
-sterilel dressingl changesl
-teachl theml nonl drugl painl managementl
AP
-carefull handlingl ofl limb
-assistl wl activel ROMl ofl unaffectedl limbl andl passivel ROMl ofl adjacentl jointsl tol thel
affectedl partl
AMBULATORY
-takel fulll coursel ofl antibiotics
Q:l osteoporosis
Answer:
chronic,l progressivel metabolicl bonel diseasel characterizedl byl lowl bonel massl andl
deteriorationl ofl bonel tissue->l fragilel bone
RISKl FACTORS
-women,l increasingl age,l lowl bodyl weight
-familyl history,l smoking,l alc
-lowl Cal andl Vitl D
-lowl estrogenl andl testosterone
-sedentaryl lifestylel
MANIFESTATIONS
-mcl inl thel hips,l wrists,l andl spine
-backl pain
-spontaneousl fractures
-late:l lossl ofl heightl andl kyphosisl (humpedl spine)
DIAGNOSIS
-xl rayl studiesl dontl detectl untill 25-40%l ofl bonel Cal isl lost
-bonel minerall density:l testl wl DEXAl (duall energyl xrayl absorptiometry)
