NSG 430 EXAM 3
1. A patient arrived at the emergency department after tripping over a rug andfalling at home.
Which finding would the nurse identify as most important to communicate tothe health care
provider?
a. There is bruising at the shoulder area.
b. The patient reports arm and shoulder pain.
c. The right arm appears shorter than the left.
d. There is decreased shoulder range of motion.: The right arm appears shorterthan the left.
A shorter limb after a fall indicates a possible dislocation, which is an orthopedic
emergency.
Bruising, pain, and decreased range of motion should also be reported, but thesedo not
indicate emergent treatment is needed to preserve function.
2. A young adult arrives in the emergency department with ankle swellingand severe pain
after
twisting the ankle playing basketball. Which prescribed action will the nurseimplement first?
a. Send the patient for ankle x-rays.
b. Give acetaminophen with codeine.
c. Administer oral naproxen (Naprosyn).
d. Elevate the ankle and apply an ice pack.: Elevate the ankle and apply an icepack.
Immediate care after a sprain or strain injury includes elevation and application ofcold to
minimize swelling. The other actions would be taken after the ankle is elevated andice is
applied.
3. For a patient who has had right hip arthroplasty, which nursing action canthe nurse
delegate
to experienced assistive personnel (AP)?
a. Reposition the patient every 1 to 2 hours.
b. Assess for skin irritation on the patient's back.
c. Teach the patient quadriceps-setting exercises.
,d. Determine the patient's pain intensity and tolerance.: Reposition the patientevery 1 to 2
hours.
Repositioning of orthopedic patients is within the scope of practice of AP after theyhave been
trained and evaluated in this skill. The other actions should be done by licensednursing staff
members.
4. A patient who arrives at the emergency department with severe left kneepain is diagnosed
with a patellar dislocation. Which information would the nurse plan to teachthe patient first?
a. Use of a knee immobilizer
b. Monitored anesthesia care
c. Physical activity restrictions
d. Performance of gentle knee flexion: Monitored anesthesia care
The first goal of interprofessional management is realignment of the knee to itsoriginal
anatomic position, which will require anesthesia or monitored anesthesia care,formerly called
conscious sedation. Immobilization, gentle range-of-motion exercises, and discus-sion about
activity restrictions will be implemented after the patella is realigned.
5. After a motorcycle accident, a patient arrives in the emergency departmentwith severe
swelling of the left lower leg. Which action would the nurse take first?
a. Elevate the leg on 2 pillows.
b. Apply a compression bandage.
c. Assess leg pulses and sensation.
d. Place ice packs on the lower leg.: Assess leg pulses and sensation.
The initial action by the nurse will be to assess circulation to the leg and observe forany
evidence of injury such as fractures or dislocations. After the initial assessment, theother
actions may be appropriate based on what is observed during the assessment.
6. A pedestrian who was hit by a car is admitted to the emergency departmentwith possible
right
lower leg fractures. Which initial action would the nurse take?
,a. Elevate the right leg.
b. Splint the lower leg.
c. Assess the pedal pulses.
d. Verify tetanus immunization.: Assess the pedal pulses.
The initial nursing action should be assessment of the neurovascular condition ofthe injured
leg. After assessment, the nurse may need to splint and elevate the leg based onthe
assessment data. Information about tetanus immunizations should be obtained ifthere is an
open wound.
7. A 60-yr-old patient had open reduction and internal fixation (ORIF) for anopen, displaced
tibial fracture. Which patient problem would the nurse identify?
a. Fatigue
b. Risk for infection
c. Activity intolerance
d. Impaired bowel elimination: Risk for infection
A patient having ORIF after an open fracture is at risk for problems such as woundinfection
and osteomyelitis. After ORIF, patients typically are mobilized starting the firstpostoperative
day, so risks of immobility such as fatigue, deconditioning, and constipation are notas likely.
8. The second day after admission with a fractured pelvis, a patient suddenlydevelops
confusion. Which action would the nurse take first?
a. Take the blood pressure.
b. Check the O2 saturation.
c. Assess patient orientation.
d. Observe for facial asymmetry.: Check the O2 saturation.
The patient's history and clinical manifestations suggest a fat embolism. The mostimportant
assessment is oxygenation. The other actions are also appropriate but will be doneafter the
nurse assesses O2 saturation.
9. The nurse admits a patient to the emergency department with a left femurfracture. Which
, assessment finding is most important to report to the health care provider?
a. Bruising of the left thigh
b. Reports of severe thigh pain
c. Slow capillary refill of the left foot
d. Outward pointing toes on the left foot: Slow capillary refill of the left foot
Prolonged capillary refill may indicate complications such as compartment syn-drome.
Bruising, pain, and rotation are typical with a femur fracture.
10. A patient undergoes left above-the-knee amputation with an immediateprosthetic fitting.
Which action would the nurse take when the patient arrives on the orthopedicunit after
surgery?
a. Assess the surgical site for hemorrhage.
b. Remove the prosthesis and wrap the site.
c. Place the patient in a side-lying position.
d. Keep the residual limb elevated on a pillow.: Assess the surgical site forhemorrhage.
The nurse should monitor for postoperative hemorrhage. The prosthesis will not beremoved.
To avoid flexion contracture of the hip, the leg should not be elevated on a pillow orflexed in
a side lying position.
11. The nurse is preparing to assist a patient with ambulation 2 days after totalhip arthroplasty.
Which action is most important for the nurse to take?
a. Observe output from the surgical drain.
b. Administer prescribed pain medication.
c. Instruct the patient about benefits of early ambulation.
d. Change the dressing and document the wound appearance.: Administerprescribed pain
medication.
The patient should be adequately medicated for pain before any attempt to ambu-late.
Instructions about the benefits of ambulation may increase the patient's willingnessto
ambulate but decreasing pain with ambulation is more important. The presence ofan
1. A patient arrived at the emergency department after tripping over a rug andfalling at home.
Which finding would the nurse identify as most important to communicate tothe health care
provider?
a. There is bruising at the shoulder area.
b. The patient reports arm and shoulder pain.
c. The right arm appears shorter than the left.
d. There is decreased shoulder range of motion.: The right arm appears shorterthan the left.
A shorter limb after a fall indicates a possible dislocation, which is an orthopedic
emergency.
Bruising, pain, and decreased range of motion should also be reported, but thesedo not
indicate emergent treatment is needed to preserve function.
2. A young adult arrives in the emergency department with ankle swellingand severe pain
after
twisting the ankle playing basketball. Which prescribed action will the nurseimplement first?
a. Send the patient for ankle x-rays.
b. Give acetaminophen with codeine.
c. Administer oral naproxen (Naprosyn).
d. Elevate the ankle and apply an ice pack.: Elevate the ankle and apply an icepack.
Immediate care after a sprain or strain injury includes elevation and application ofcold to
minimize swelling. The other actions would be taken after the ankle is elevated andice is
applied.
3. For a patient who has had right hip arthroplasty, which nursing action canthe nurse
delegate
to experienced assistive personnel (AP)?
a. Reposition the patient every 1 to 2 hours.
b. Assess for skin irritation on the patient's back.
c. Teach the patient quadriceps-setting exercises.
,d. Determine the patient's pain intensity and tolerance.: Reposition the patientevery 1 to 2
hours.
Repositioning of orthopedic patients is within the scope of practice of AP after theyhave been
trained and evaluated in this skill. The other actions should be done by licensednursing staff
members.
4. A patient who arrives at the emergency department with severe left kneepain is diagnosed
with a patellar dislocation. Which information would the nurse plan to teachthe patient first?
a. Use of a knee immobilizer
b. Monitored anesthesia care
c. Physical activity restrictions
d. Performance of gentle knee flexion: Monitored anesthesia care
The first goal of interprofessional management is realignment of the knee to itsoriginal
anatomic position, which will require anesthesia or monitored anesthesia care,formerly called
conscious sedation. Immobilization, gentle range-of-motion exercises, and discus-sion about
activity restrictions will be implemented after the patella is realigned.
5. After a motorcycle accident, a patient arrives in the emergency departmentwith severe
swelling of the left lower leg. Which action would the nurse take first?
a. Elevate the leg on 2 pillows.
b. Apply a compression bandage.
c. Assess leg pulses and sensation.
d. Place ice packs on the lower leg.: Assess leg pulses and sensation.
The initial action by the nurse will be to assess circulation to the leg and observe forany
evidence of injury such as fractures or dislocations. After the initial assessment, theother
actions may be appropriate based on what is observed during the assessment.
6. A pedestrian who was hit by a car is admitted to the emergency departmentwith possible
right
lower leg fractures. Which initial action would the nurse take?
,a. Elevate the right leg.
b. Splint the lower leg.
c. Assess the pedal pulses.
d. Verify tetanus immunization.: Assess the pedal pulses.
The initial nursing action should be assessment of the neurovascular condition ofthe injured
leg. After assessment, the nurse may need to splint and elevate the leg based onthe
assessment data. Information about tetanus immunizations should be obtained ifthere is an
open wound.
7. A 60-yr-old patient had open reduction and internal fixation (ORIF) for anopen, displaced
tibial fracture. Which patient problem would the nurse identify?
a. Fatigue
b. Risk for infection
c. Activity intolerance
d. Impaired bowel elimination: Risk for infection
A patient having ORIF after an open fracture is at risk for problems such as woundinfection
and osteomyelitis. After ORIF, patients typically are mobilized starting the firstpostoperative
day, so risks of immobility such as fatigue, deconditioning, and constipation are notas likely.
8. The second day after admission with a fractured pelvis, a patient suddenlydevelops
confusion. Which action would the nurse take first?
a. Take the blood pressure.
b. Check the O2 saturation.
c. Assess patient orientation.
d. Observe for facial asymmetry.: Check the O2 saturation.
The patient's history and clinical manifestations suggest a fat embolism. The mostimportant
assessment is oxygenation. The other actions are also appropriate but will be doneafter the
nurse assesses O2 saturation.
9. The nurse admits a patient to the emergency department with a left femurfracture. Which
, assessment finding is most important to report to the health care provider?
a. Bruising of the left thigh
b. Reports of severe thigh pain
c. Slow capillary refill of the left foot
d. Outward pointing toes on the left foot: Slow capillary refill of the left foot
Prolonged capillary refill may indicate complications such as compartment syn-drome.
Bruising, pain, and rotation are typical with a femur fracture.
10. A patient undergoes left above-the-knee amputation with an immediateprosthetic fitting.
Which action would the nurse take when the patient arrives on the orthopedicunit after
surgery?
a. Assess the surgical site for hemorrhage.
b. Remove the prosthesis and wrap the site.
c. Place the patient in a side-lying position.
d. Keep the residual limb elevated on a pillow.: Assess the surgical site forhemorrhage.
The nurse should monitor for postoperative hemorrhage. The prosthesis will not beremoved.
To avoid flexion contracture of the hip, the leg should not be elevated on a pillow orflexed in
a side lying position.
11. The nurse is preparing to assist a patient with ambulation 2 days after totalhip arthroplasty.
Which action is most important for the nurse to take?
a. Observe output from the surgical drain.
b. Administer prescribed pain medication.
c. Instruct the patient about benefits of early ambulation.
d. Change the dressing and document the wound appearance.: Administerprescribed pain
medication.
The patient should be adequately medicated for pain before any attempt to ambu-late.
Instructions about the benefits of ambulation may increase the patient's willingnessto
ambulate but decreasing pain with ambulation is more important. The presence ofan
