TEST MEDICALSURGICAL NURSING: SURGICAL

1. Non mechanical obstruction is also known as paralytic ileus or

adynamic ileus.
A.T
B. F
2. Hypovolemia is a common complication of intestinal obstruction.
A.T
B. F
3. An obstruction high in the small intestine often results in metabolic
acidosis.
A.T
B. F
4. Intussusception is twisting of the intestine.
A.T
B. F
5. Volvulus is telescoping of a segment of the intestine within itself.
A.T
B. F
6. Hypokalemia is the most common electrolyte disturbance that
predispose the patient to intestinal obstruction.
A.T
B. F
7. Intestinal obstruction due to phytobezoar is a mechanical
obstruction.
A.T
 B. F
8. Ileus is a paralytic or functional variety of obstruction.
A.T
B. F
9. In order, the main clinical signs of bowel obstruction include nausea
or vomiting, colicky abdominal pain, and blockage of gas or stool.
A.T
B. F
10. Nausea and vomiting may be caused from anesthetic agents or
narcotics, delayed gastric emptying, slowed peristalsis, resumption
of oral intake too soon after surgery.
A.T
B. F
11. Which key feature does the nurse most likely find when performing
a physical assessment on the patient with a small-bowel obstruction?
A. Visible peristaltic waves in the upper and middle abdomen.
B. Minimal or no vomiting.
C. No major fluid and electrolyte imbalances.
D. Metabolic acidosis.
12. Crohn’s disease can cause a mechanical obstuction.
A.T
B. F
13. What does nursing care of the patient with intestinal obstruction
who reports discomfort in the early diagnostic period consist of?
A. Administration of opioid analgesics.
B. Placing the patient in a semi-Fowler’s position.
C. Providing the patient with fluids.
 D. Offering the patient semi-soft food.
14. Which intervention apply to patients with fluid volume deficit
related to an intestinal obstruction?
A. Provide frequent mouth care with lenom glycerin swabs.
B. Offer ice chips to suck on before surgery.
C. Offer a small glass of water.
D. Assess for edema from third spacing.
15. Which observation of the patient with an intestinal obstruction
does the nurse report immediately?
A. Urinary output of 1000ml in an 8 hour period.
B. The patient’s request for something to drink.
C. Abdominal pain changing from colicky to constant
discomfort.
D. The patient who is changing positions frequently.
16. Which discharge information does the nurse include for the patient
who has had an intestinal obstruction caused by fecal impaction?
A. Encourage the patient to report abdominal distention, nausea
or vomiting, and constipation.
B. Provide the patient a written description of a low-fiber diet.
C. Remind the patient to limit activity.
D. Remind the patient to decrease fluid intake.
17. The nurse is teaching the patient about colostomy care. Which
information does the nurse include in the teaching plan?
A. The stoma will eanlarge within 6 to 8 weeks of surgery.
B. Use a moisturizing soap to cleanse the area around the stoma.
C. Place the colostomy bag on the skin when the skin sealant is
still damp.
 D. An antifungal cream or powder can be used if a fungal rash
develops.
18. Which statement about the care of the patient wiwht a colostomy is
correct?
A. A healthy stoma should be dry.
B. The stoma should protrude about 5cm from the abdominal
wall.
C. When palpating the stoma, it should feel firm.
D. A slight amount of edema is normal in the initial
postoperative period.
19. The nurse immediately reports to surgeon all but which
sign/symptom related to a colostomy?
A. Liquid stool immediately postoperatively.
B. Unusual bleeding.
C. Signs of ischemia and necrosis.
D. Mucocutaneous separation.
20. After colostomy surgery, which intervention does the nurse
employ?
A. Cover the stoma with a dry, sterile dressing.
B. Apply a pouch system as soon as possible.
C. Make a hole in the pouch for gas to escape.
D. Watch for the colostomy to start functioning day 1.
21.Patients with pancreatitis often have Turner's sign
which is a gray-blue discoloration of the abdomen and
periumbilical area.
A.T
B. F
22.The pain of acute pancreatitis is often described as
intense, boring and continuous.
A. T
B. F

23.Typically, a patient is diagnosed with acute pancreatitis

after presenting with severe abdominal pain in the mid-
epigastric area or left upper quadrant.

A. T
B. F

24. Abdominal pain is the prominal symptom of

pancreatitis.
A. T
B. F

25. Anticholinergics are given to increase vagal

stimulation, motility and pancreatic flow.

A. T
B. F

26. Pain management for acute pancreatitis should begin

with rapid infusion of opioids by means of patient-
controlled analgesia (PCA)

A. T
B. F

27. Helping the patient to assume a supine position

 decreases the abdominal pain of pancreatitis.

A. T
B. F

28. Patients in the early stages of acute pancreatitis are

usually maintained on NPO status

A. T
B. F

29. What is the priority nursing diagnosis for acute pancreatisis?

A. Risk for deficient fluid volume related to abnormal and

normal routines.

B. Nausea related to pancreatic disease.

C. Risk for infection related to necrotic pancreatic tissue.

D. Acute pain related to biologic and injury agents

30. Which diagnostic test is the most accurate in verifying a

diagnosis of acute pancreatitis?

A. Trypsine

B. Lipase

C. Alkaline phosphatase

D. Alanine aminotransferase
31.The patient with acute pancreatitis is at risk for the development
of paralytic (adynamic) ileus. Which action provides the nurse
with the best indication of bowel function?

A. Observing contents of the nasogastric drainage

B. Auscultation of bowel sounds

C. Asking the patient if he or she has passed flatus or had a stool

D. Obtaining a computed tomography (CT) scan of the abdomen

with contrast medium

32. Which drug is contraindicated for the patient with paralytic

ileus?

A. Ranitidine (Zantac)

B. Cefuroxime (Zinacef)

C. Papaverine (Pavabid)

D. Dicyclomine (Bentyl)

33. The nurse has instructed the patient in the recovery phase of
acute pancreatitis about diet therapy. Which statement by the
patient indicates that teaching has been successful?

A."I will eat the ususaly three meals a day that I am used to".

B."I am eating tacos for my first meal back home".

C."I will avoid eating chocolate".

D.I will limit the amount of protein in my diet".

 The surgical intervention for acute pancreatitis may be
indicated:

34. If complications of pancreatitis such as pancreatic

pseudocyst and abscess appear may necessitate surgical
drainage.
A. T
B. F
35.If pancreatitis is caused by biliary tract obstruction, the
physician may perform a laparotomy (abdominal
exploration) for common bile duct exploration and the
release of obstruction.
A. T
B. F
A postoperative plan of care for clients undergoing a surgical
intervention
36. Monitors drainage tubes for patency by assessing for
kinks in the tubes.
A. T
B. F
37.Maintain the ordered drain suction pressure and system
integrity.
A. T
B. F
38.Records the output amount from the drain and describes
the character of the drainage.
A. T
 B. F
39.Provides meticulous skin care and dressing changes,
assesses for further deterioration of the tissue.
A. T
B. F
40.Collaborate with an enterostomal therapist (ET) for
measures to promote skin integrity.
A. T
B. F

41. Pertitonitis is caused by contamination of the peritoneal cavity

by bacterias or chemicals.
A. T
B. F
42.Continuous ambulatory peritoneal analysis can cause peritonitis.
A. T
B. F
43.White blood cell counts are often decreased with peritonitis.
A. T
B. F
44.Abdominal wall rigidity is a classic finding in patient with
peritonitis.
A. T
B. F
45.The fluid shift that occurs in peritonitis may result in which of
following?
A. Intracellular fluid moving into the peritoneal cavity
 B. Significant increase in circular volume
C. Eventual renal failure and electrolyte imbalance
D. Increased bowel motility caused by increased fluid volume
46. The source of inflammation in peritonitis rarely comes from
A. Gastrointestinal tract
B. Internal reproductive organs
C. The bloodstream
D. Abdominal gunshot wound
47. A rare cause of peritonitis is
A. Appendicitis
B. Perforated peptic ulcer
C. Peritoneal dialysis
D. Bowel perforation secondary to cancer, penetrating wound

48. Which complication is not due to peritonitis:

A. Adhesion of small intestine
B. Abscess formation
C. Intraabdominal haemorrhage
D. Paralytic ileus
49. The respiratory problems that may accompany peritonitis are
aresult of which factor?
A. Associated pain interfering with ventilation
B. Decreased pressure against the diaphragm
C. Fluid shifts to thoracic cavity
D. Decreased oxygen demands related to the infectious process
50. Which nursing intervention is part of nonsurgical management
for the patient with peritonitis?
 A. Monitor weekly weight and intake and output
B. Insert a nasogastric tube to decompress the stomuch
C. Order a breakfast tray when the patient is hungry
D. Administer NSAIDs for pain
51. What are the cardinal signs of peritonitis?
A. Fever and headache
B. Dizziness and vomiting
C. Abdominal pain and tenderness
D. Nausea and loss of appetite
52. Which character of abdominal pain is not observed in peritonitis
A. Constant and diffuse
B. Intermittent
C. More intense near the site of inflammation
D. Movement aggravates pain
53. Which assessment is not priority in diagnostic of peritonitis
A. Blood cell count
B. Abdominal x-ray
C. CT scan of the abdomen
D. Peritoneal lavage

54. Nursing intervention for the patient with peritonitis

preoperatively don’t include
A. Give broad-spectrum antibiotics
B. Give foods when the patient arrive at hospital
C. Place the patient on bed rest
D. Obtain a history and assess the abdomen
 55. Nursing intervention for the patient with peritonitis
postoperatively don’t include
A. Assess vital signs
B. Monitor the fluid and electrolyte balance
C. Immobilize the patient on the bed
C. Report any manifestation of sepsis

56. The nurse is instructing the patient about home care after an
exploratory laparotomy for peritonitis. Which statement by the
patient indicates that teaching has been effective?
A. “It is normal for the incision site to be warm”
B. “I will stop taking the antibiotics if diarrhea develops”
C. “I will call the health care provider for a temperature greater
than 38oC”
D. “I will resume activity with my bowling league this week for
exercise”

57. The patient is a 65-years-old man who sustained a neck injury

during a fall. He has a medical diagnosis of anterior cord syndrome
and a nursing diagnosis of Disturbed Sensory Perception. The nurse
assesses the patient expecting to observe which type of motor and
sensory findings below the level of injury?
A. No motor functions; no sensation to touch, position, and
vibration.
B. Partial motor function; full sense of pain and temperature.
C. Independent movement; no sense of pain or touch.
D. No independent movement; full sense of touch or position.
58. The patient with a cervical neck injury is able to spontaneously
move the legs when attempting to move himself in bed, but he is not
using or moving his arms or hands. What is this observation
consistent with?
A. Anterior cord syndrome.
B. Posterior cord syndrome.
C. Central cord syndrome.
D. Brown-Sequard syndrome.

59. The patient involved in a high-speed motor vehicle accident

with sustained multiple injuries and active bleeding is transported
to the emergency department by ambulance with immobilization
devices in place. There is a high probability of cervical spine
fracture; the patient has altered mental status and extremities are
flaccid. What is the priority assessment for this patient?
A. Check the mental status using the Glasgow Coma scale.
B. Assess the respiratory pattern and ensure a patent airway.
C. Observe for intra-abdominal bleeding and homorrhage.
D. Assess for loss of motor function and sensation.

60. The emergency department nurse is assessing and monitoring

the patient with a gunshot wound to the middle of the back. Because
the patient is at risk for spinal shock, what does the nurse monitor
for ?
A. Decreased blood pressure, bradycardia, and flaccid paralysis.
B. Tachycardia and a change in the level of consciousness.
 C. Decreased respiratory rate and loss of sensation to pain and
touch.
D. Paralytic ileus and loss of bowel and bladder function.

61. Which neurologic assessment technique does the nurse use to

test the patient for proprioceptive function?
A. Touch the skin with a clean safety pin and ask whether it is a
sharp or dull sensation.
B. Ask the patient to elevate both arms off the bed and extend
wrists and fingers.
C. Have the patient close the eyes and move the toes up or down;
the patient identifies the positions.
D. Have the patient sit with the legs dangling; use a reflex
hammer to test reflex responses.

62. The patient with an upper spinal cord injury is at risk for
autonomic dysreflexia. Which nursing diagnosis is the priority for
this patient ?
A. Risk for Ineffective Tissue Perfusion, Cerebral.
B. Nausea.
C. Acute Pain, Headache.
D. Impaired Physical Mobility.

63. The nurse is caring for the patient with a recent spinal cord
injury (SCI). Which intervention does the nurse use to target and
prevent the potential SCI complication of autonomic dysreflexia?
A. Frequently perform passive ROM exercises.
 B. Keep the room warm and control environmetal stimuli.
C. Keep the patient immobilizied with neck back braces.
D. Monitor urinary output and check for bladder distention.

64. What is the potential adverse outcome of autonomic dysreflexia

in the patient with a spinal cord injury?
A. Heat stroke.
B. Paralytic ileus.
C. Hypertensive crisis.
D. Aspiration and pneumonia.

65. After suffering an SCI, the patient develops autonomic

dysfunction, icluding a neurgenic bladder. Which nursing diagnosis
is the priority for this condition?
A. Risk for Infection: urinary tract.
B. Risk for Fluid Volume Deficit: polyuria.
C. Risk for Self-Care Deficit: toileting.
D. Risk for Urinary Incontinence: urge.

66. The nurse and the nursing assistant are working together to
bathe and reposition the patient who is in a halo fixator device.
Which action by the nursing student causes the supervising nurse to
intervene?
A. Uses the log roll technique to clean the patient’s back and
buttocks.
B. Turns the patient by pulling on the top of the halo device.
C. Positions the patient with the heath and neck in alignment.
 D. Supports the head and neck area during the repositioning.

67. The nurse is caring for several patients with SCIs. Which task is
best to delegate to the nursing assistant?
A. Encourage use of incentive spirometry; evaluate the patient ‘s
ability to use it correctly.
B. Log roll the patient; maintain proper body alignment and
place a bedpan for toileting.
C. Check for skin breakdown under the immobilization devices
during bathing.
D. Insert a Foley catheter and report the amount and color of the
urine.

68. The patient with an SCI has paraplegia and paraparesis. The
nurse has identified a nursing diagnosis of Impaired Physical
Mobility. The nurse assesses the calf area of both legs for swelling,
tenderness, redness, or possible to the patient ‘s increased risk for
which condition?
A. Contractures of joints.
B. Bone fractures.
C. Pressure ulcers.
D. Deep vein thrombosis.

69. The nurse is caring for the patient who has been in a long-term
care facility for several months following an SCI. The patient has
had issues with urinary retention and subsequent overflow
 incontinence, and a bladder retraining program was recently
initiated. Which is an expected outcome of the training program ?
A. Demonstrates a predictable pattern of voiding.
B. Is able to independently catheterize himself.
C. Pours warm water over perineum to stimulate voiding.
D. Takes bethanechol chloride (Urecholine) 1 hour before
voiding.

70.Paralysis of lateral gaze indicates a lesion of cranial nerve

A. II
B. III
C. IV
D. VI

71.A primary brain injury is caused by

A. ICP
B. An external force
C. An abnormal growth of brain tissue
D. An internal force

72.A 16 year-old football player is confused after being struck in the

head by another player. He states he does not remember much of
what happened, just waking up in the hospital about two hours
after being hit. This client most likely is suffering from:

A. Concussion
B. Moderate brain injury
 C. Severe brain injury
D. Locked-in syndrome

73.The nurse is education a group of 7 years old children on

preventing brain injury. One of the most important things to tell
them is to:

A. Always wear a helmet when riding your bike, skatebroard on

inline skates.
B. Always wear knee and arm pads when riding your bike,
skatebroard or inline skates.
C. Look both ways before crossing the street
D. Always wear supportive shoes when playing outdoors.

74.A client is admitted to the intensive care unit following a fall

down a flight. Upon assessment, the client responds only to pain
by withdrawing his hand, and he curses frequently. Using the
Glassgow Coma Scale, the nurse rates this patient as a:

A. 15
B. 4
C. 12
D. 9

75.A common medication given to help decrease ICP is:

A. Aspirin
B. Ibuprofen
C. Lasix
 D. Mannitol

76.The most important nursing diagnosis when caring for a client

with an open skull fracture is

A.Risk for infection

B.Risk for impaired skin intergrity
C.Risk for impaired physical mobility
D.Risk for impaired swallowing : aspiration

77.The consensual pupillary response is tested by:

A. Asking the client if he or she has trouble closinghis or her eyes

B. Directing a light toward one eye and observingthe pupil on the
opposite side
C. Instructing the client to cover one while youobserve the
opposite eye for extraocularmovements
D. Evaluating the ability of the client’s eyes toconverge

78.Which factor is most likely to depress nerve cell activity in the

patient with a neurologic disorder?
A. Metabolic alkalosis
B. IV infusion of theophylline
C. Drinking too much coffee
D. Low oxygen saturation and hypoxia

79. Which statement about the Glasgow Coma Scale (GCS) is correct?
A.It is a thorough neurologic assessment tool.
 B. It establishes a baseline for eye opening and motor and verbal
response.
C. It establishes a baseline cognitive function.
D. A score of 15 indicates serious neurologic impairment with
poor prognosis

80. The nurse is assessing several patients using the GCS. Which
factors indicate the most serious neurologic presentation based
on the GCS information?
A. Eye opening to sound, localizes pain confused conversation
B. Eye opening to sound, obeys commands, inappropriate words
C. Eye opening spontaneous, obeys commands, confused
conversation.
D. Eye opening to pain, abnormal flexion, incomprehensible
sounds

81. The nurse performing neurologic checks every 4 hours for the
patient who sustained a head injury. Which early sign indicate a
decline in neurologic status?
A. Nonreactive, dilated pupil
B. Change in level of consciousness
C. Decorticate posturing
D. Loss of remote memory

82. A nurse is caring for a client who was recently admitted to the
emergency department following ahead-on motor vehicle crash.
The client is unresponsive, has spontaneous respirations of 22/min,
anda laceration on his forehead that is bleeding. Which of the
following is the priority nursing action atthis time?
A. Keep neck stabilized.
B. Insert NG tube.
C. Monitor pulse and blood pressure frequently.
D. Establish IV access and start fluid replacement.

83. A nurse is caring for a client who has just been admitted from
surgery for the evacuation of a subduralhematoma. Which of the
following is the priority assessment?
A. Glasgow Coma Scale
B. Cranial nerve function
C. Oxygen saturation level
D. Pupillary response

84. A client who has increased ICP has been prescribed mannitol
(Osmitrol) IV. For which of the following side effects should the
nurse monitor?
A. Hyperglycemia
B. Hyponatremia
C. Hypervolemia
D. Oliguria

85. The lesions in the chest cage that it can be seen in chest trauma:

A. Pneumothorax - haemothorax, lung contusion, chest flail

B Lung contusion, flail chest, liver lesion
 C Haemothorax - pneumothorax, lung contusion, femur fracture
D Chest flail, blood clots in the brain, intestinal rupture

86. List 6 life-threatening chest injuries in chest trauma:

A. Airway obstruction, pneumothorax tension, cardiac

tamponade, open pneumothorax (sucking chest wound), flail
chest, massive haemothorax.
B. Airway obstruction, pneumothorax tension, cardiac
tamponade, open pneumothorax (sucking chest wound), flail
chest, massive haemothorax
C. cardiac tamponade, open pneumothorax (sucking chest
wound), clavicle fracture, airway obstructive, flail chest, rib
fracture

87. Physical therapy of respiratory system should be taken

A. Sitting up early, stimulates coughing, clapping shaking, breathing

exercise (blowing balls)
B. Fowler posture, breathing exercise, stimulates coughing
C. Not eat and drink, stomach tube, blowing balls
D. Clapping shaking, stomach tube, completely immobile, infusion

88. The most important issue when caring for patients after drainage of
the pleural cavity:

A. To ensure good nutrition for the patient, lying motionless

B. Body hygiene, mental stability to patients
C. The physical therapy as soon as possible and ensure good drainage
 system
D. Antibiotics for patients, enhancing health, anti-pain

89. Flail chest is :

A. Rib fracture

B. Fracture of two ribs and more

C. Fracture of three ribs and more
D. Fracture of three consecutive ribs and more, each fractured rib has
two fracture positions

90. The steps in the planning and implementation of care plans chest
injuries, chest wounds and flail chest:

A. Receiving patients, management of shock, prepare to drain pleural

B. Prevent and management of shock, management of respiratory
failure, control infection, make preparation for patient, prepare
drainage of pleural
C. Management of respiratory failure, control pain, prepare drainage of
pleural, management of shock
D. Management of shock, control infection, make preparation for
patient, prepare drainage of pleural

91. Monitor circulation need follow

A. Monitor pulse, blood pressure, number of drainage, skin color,
mucous, blood formula test; monitor bleeding at the other location &
call doctor.
B. Monitor breathing; chest tube, color skin, mucosa; ultrasound;
monitor bleeding at the other location & call doctor.
C. Monitor respiratory; chest tube, computerized tomography of chest,
 blood biochemical tests; monitor bleeding at the other location & call
doctor.
D. Monitor pulse, chest tube; respiration, blood tests, check the open
chest wound.

92. Counters skills of breathing per minute

A. See the up and down mobile of chest per minute
B. Listen to the lung sound per minute
C. See the up and down mobile of abdominal wall per minute
D. To hand on the abdominal wall and count the number of mobile of
the abdominal wall per minute

93 . Chest trauma: operative indication in all cases

A. T

B. F

94 . Principles for chest tube: closed, continuous suction and one-way,

sterile

A. T

B. F

95.Respiratory physical therapy plays an important role in postoperative

care to chest tube

A. T

B. F

96 . All flail chest cases are treated with mechanical ventilation method
 A. T

B. F

97 . Rib fractures with chest tube, especially the elderly: respiratory

physical therapy and nursing care is not required

A. T

B. F

98 . Pain symptom is always show in chest wounds

A. T

B. F

99. Tension pneumothorax (valve pneumothorax) management of

emergencies like the other type of pneumothorax

A. T

B. F

100 . Need replacement pleural drainage bottle daily for nursing care
chest tube

A. T

B. F

101 . Clotted blood and retained haemothorax never show in the chest
wound

A. T

B. F
102 . All chest wounds should always indicate operation to manage
injuries

A. T

B. F

103 . Respiratory physical therapy need: patients always lie in bed and
not be taken analgesics

A. T

B. F

104. A nurse is caring for a client who has a compound fracture of

the right forearm that was recently casted. Which of following is an
early sign of neurovascular compromise?

A. Paresthesia.

B. Pulselessness

C. Paralysis

D. Polar.

105.A nurse is stabilizing for a client who has a compound fracture

of the right arm. Which did he/she have to do before?

A. Elevate the limb and apply ice.

B. Place the client in supine position.
C. Cover open wounds with a sterile dressing.
 D. Remove clothing and jewelry near injury.

106.Casts secure the arm fracture in order to:

A. Prevent further injury, reduce pain, and promote circulation.
B. Prevent further injury, reduce pain, and correct a deformity.
C. Reduce pain, promote circulation, and correct a deformity.
D. Prevent further injury, reduce pain, promote healing and
correct a deformity.

107.Use the short- arm cast for:

A. Distal radial fracture.
B. Fracture of ulna.
C. Fracture of radia.
D. Fracture of the thumb.

108.Use the long- arm cast for:

A. Fracture of humeral shaft.
B. Fracture of distal humerus.
C. Fracture of proximal humerus.
D. Fracture of humeral head.

109.The 3 disadvantages of exteral fixation for the arm, except:

A. Pin site infection.
B. Potential overwhelming appearance.
C. Early mobilization.
D. Noncompliance.
110.A nurse is caring for client who had open reduction and
internal fixation for the radius 7 days ago. Which of following is
a sign of infection:
A. Swelling at the site of incision.
B. Erythema and edema at the site of incision.
C. Loss of function.
D. Loss of sensation.

111.A nurse is caring for a client who has fracture of the right
forearm that was recently casted. The client complains of more
pain after cast. What action should the nurse do?
A. Remove cast and reassessment.
B. Change another cast and reassessment.
C. Loosening cast and reassessment.
D. Remove cast and use another immobilizer.

112.An indication of traction for the arm fracture exclude:

A. Type of traction.
B. Traction time.
C. Traction weight.
D. Pin site care.

113.Traction is more effective than cast in:

A. Decreasing pain.
B. Decreasing muscle spasm.
C. Preventing neurovascular injury.
D. Promoting circulation.
114.The most valuable sign to diagnose radius fracture is:
A. Swelling.
B. Crepitus.
C. Pain.
D. Tenderness.

115. The most valuable sign to diagnose humerus fracture is:

A. Loss of forearm function.
B. Deformity of the arm.
C. Arm bruising
D. Swelling.

116.The most effective of procedure to diagnose arm fracture is:

A. Two view x-rays.
B. Bone scan.
C. MRI.
D. Ultrasound.

117.A nurse is caring for a client who has fracture of the right arm
that was recently applied standard side-arm skeletal traction.
The client complains of more pain after traction. What action
should the nurse do?
A. Maintain body alignment and realign.
B. Remove weights.
C. Stop traction.
D. Give some analgesics to the client.
118.A nurse is caring for a client who has fracture of the right arm
that was recently applied standard side-arm skeletal traction.
The client complains of severe pain after traction. What action
should the nurse do?
A. Reduce some weights of traction.
B. Remove traction, apply cast.
C. Notify this problem to provider.
D. Give some analgesics and muscle relaxants to the client.

119. What makes for displaced fractures?

A. Large muscle groups spasm
B. Disrupted muscles
C. Fractures fragments
D. Broken bone size

120. How many stages occur during bone healing?

A. 4
B. 5
C. 6
D. 3

121. What time period the stage 3 takes place?

A. 1-3 days
B. 3 days to 2 weeks
 C. 2-6 weeks
D. 6 weeks to 1 years

122. “Callus formation” occurs in:

A. stage 1
B. stage 2
C. stage 3
D. stage 4

123. “Fibrocartilage formation” occurs in:

A. stage 1
B. stage 2
C. stage 3
D. stage 4
124. Which of the following is the UNFAVORABLE factors for bone
healing process?

A. Minimal damage to soft tissue

B. Anatomic reduction possible

C. Effective immobilization
D. Fragments widely separated

125. Which of the following is the FAVORABLE factors for bone

healing process?

A. Fragments distracted by traction

B. Severe comminuted fracture
C. Bone loss from injury or surgical excision
 D. Anatomic reduction possible

126. The following factors AFFECT the bone healing process, except:
A. Weight bearing on long bones
B. Location
C. Sex
D. Decreased blood supply

127. Which of the following is the most significant signs of fracture?

A. Bruising

B. Muscle spasm
C. Abnormal mobility and crepitus
D. Pain

128. Which of the following is the GOALS of medical management:

A. Discover all injuries

B. Reduction and stabilization of the fracture
C. Monitoring for complications
D. a+b+c

129. Which of the following is INCORRECT?

A. Assessment and treatment are performed simultaneously

B. During primary assessment, the rescuer forcuses on airway
management, bleeding, and manifestations of the shock
C. Any potentially life-threatening injuries must be stabilized
immediately
 D. An injured client should be moved althought the current
location is not safe

130. Which of the following is the GOALS of reduction?

A. To restore alignment, position, and length

B. To make sure that the bone have been broken
C. To permit the client can walk
D. To rescue the client from shock

131. Which of the following is INCORRECT for closed reduction?

A. To perform closed reduction, a health care provider applies

manual traction to move the fracture fragments and restore bone
alignment
B. Closed reduction should be performed as soon as possible
C. Fracture reduction is an emergency procedure
D. An immobilization device must be applied after x-ray

132. Which of the following is INCORRECT for closed reduction?

A. The immobilizer most commonly used after closed reduction

is a traction
B. The immobilizer most commonly used after closed reduction
is a cast
C. The immobilizer most commonly used after closed reduction
is a polymer of plaster
D. Cast are used for prevention or correction of deformity;
maintenance; support; and protection of realigned bone
133. Which of the following is CORRECT for Open Reduction and
Internal Fixation?

A. The surgeon makes an incision and realigns the fracture

fragments under direct visualization
B. Realignment of the fracture fragments without any incision
C. Open reduction is usually performed in combination with
internal fixation by plates, screws, nails, wires
D. Internal fixation provides essential immobilization and helps
to prevent deformity, but it is not a substitute for bone healing

134. Which of the following is NOT complication after fracture?

A. Blood Vessel injury

B. Nerve injury
C. Brain-sick
D. Compartment Syndrome

135. Which of the following NEEDN’T in care of the client in a Cast?

A. Neurovascular Assessment
B. Assessment of Pain
C. Assessment of the Cast
D. Assessment of the Knee Movement

136. Which statement best describes the preoperative period?

 A. It begins when the patient makes the appointment with the
surgeon to discuss the need for surgery.

B. It is the time during which the patient receives education and

testing related to the impending surgery.

C. It is a time during which the patient’s need for surgery and

willingness to have it is established

D. It begins when the patient is scheduled for surgery and ends

at the time of transfer to the surgical suite.

137. The patient is scheduled for resection of nerve roots. What

type of surgery is this?
A. Palliative
B. Restorative
C. Diagnostic
D. Ablative

138. Specify whether the urgency of the surgery is elective (EL),

urgent (U), or emergent (EM):A22-year- old nursing student is
scheduled for an appendectomy.
A. EL
B. U
C. EM
139. Specify whether the urgency of the surgery is elective (EL),
urgent (U), or emergent (EM):A 77 year-old woman is scheduled for
a total knee replacement.
A. EL
 B. U
C. EM

140. Specify whether the urgency of the surgery is elective (EL),

urgent (U), or emergent (EM): A 55 year – old man is scheduled for
a colon resection due to a small bowel obstruction.
A. EL
B. U
C. EM

141. The nurse screens the preoperative patient for conditions that
may increase the risk for complications during the perioperative
period.
Which condition is a possible risk factor
A. The patient is 70 years old and obese.
B. The procedure planned is a bunionectomy
C. The patient is 5 feet tall and weighs 100 pounds.
D. The surgery is planned as an ambulatory/same – day surgical
procedure
142. The nurse functions as the patient advocate by reporting to the
surgeon and anesthesiology personnel any abnormalities found on
the physical assessment.
A. T
B. F
143.Throughout the physical assessment, the nurse focuses on the
problem areas identified from the patient’s history that are limited
to body systems affected directly by the surgical procedure.
A. T
B. F

144. In the preoperative setting, the nurse is functioning as a

patient advocate when the patient’s home environment, self-care
capabilities, and support systems are assessed and used in the
discharge planning process.
A. T
B. F

145. As a patient advocate, the nurse can provide the patient

with educational materials appropriate to the patient’s ability
to learn.
A. T
B. F

146. When the nurse evaluates preoperative laboratory test values,

only abnormal values related to the surgery need to be reported to
the surgeon and anesthesia ology personnel.
A. T
B. F
 147. Patients who have had minor outpatient surgery do not
usually require discharge planning.
A. T
B. F

148. Which statement is true regarding the patient who has given
consent for a surgical procedure?

A. Information necessary to understand the nature of and reason

for the surgery has been provided.
B. The length of stay in the hospital has been preapproved by the
managed care provider.
C. Information about the surgeon’s experience has been
provided.
D. The nurse has provided detailed information about the
surgical procedure.

149. Which statement best describes the collaborative roles of the

nurse and surgeon when obtaining the informed consent?
A. The nurse is responsible for having the in-formed consent
form on the chart for the physician to witness.
B. The nurse may serve as a witness that the patient has been
informed by the physician before surgery is performed.
C. The nurse may serve as witness to the patient’s signature after
the physician has the consent form signed before preoperative
sedation is given and before surgery is performed.
 D. The nurse has no duties regarding the consent form if the
patient has signed the informed consent form for the physician,
even if the patient then asks additional questions about the
surgery.

150. The nurse has received the patient in the holding area who is
scheduled for a left breast biopsy. What is the priority safety
measure for this patient before surgery?

A. Ensure the patient knows who will be per-forming the

surgery.
B. Ask the patient to mark the site with a marker.
C. Instruct the patient to perform leg exercises to prevent a deep
vein thrombosis.
D. Determine who the support persons are for the patient.

151. The diabetic patient is scheduled for surgery in the morning.

Which procedure does the nurse expect on the morning of surgery?
A. Usual dose of insulin will be given to maintain the patient’s
blood glucose level.
B. Increased dose of insulin will be given to offset the physical
stress caused by the procedure.
C. Modified dose of insulin will be given, based on the patient’s
blood glucose.
D. No insulin will be given because the patient is NPO.

152.What percentage of all hospital trauma admissions involve renal

trauma?

A. Approximately 3%

B. Approximately 10%.
C. Approximately 13%.
D. Approximately 20%.

153.What is the key clinical symptom of the kidney trauma?

A. Flank pain

B. Hematuria (gross or microscopic)

C. Abdominal distention
D. Fever

154.What is the following finding on clinical examination indicating

possible renal involvement ?

A. Fever
B. Flank ecchymoses or abdominal mass
C. Flank pain
D. Abdominal distention

155.True or False: The presence or absence of hematuria is not a

good indicator of traumatic injury

A. T

B.F
156.True or False: Hematuria is a hallmark sign of renal trauma, but
is neither sensitive nor specific enough for differentiating minor
and major injuries

A. T

B.F

157.A small cortical laceration in the kidney with a small perirenal

hematoma would be classified as what grade injury?

A. Grade I

B. Grade II

C. Grade III

D. Grade IV

158.A renal parachymal laceration extending through the contex

into the renal medulla would be classified as what grade injury?

A. Grade I

B. Grade II

C. Grade III

D. Grade IV

159.What are the indications for imaging of the kidneys following

blunt trauma?

A. Gross hematuria or microhematuria combined with shock

B. Rib fracture
C. Microhematuria without signs of shock
D. Abdominal distention
 160.Staging of renal trauma is best accomplished with what
radiographic test?

A. Ultrasonography
B. Standard intravenous pyelography
C. CT scanner
D. Magnetic resonance imaging

161. What is the absolute indications for renal exploration

following blunt trauma?
A. An expanding or pulsatile retroperitoneal hematoma or Grade
V vascular renal injuries
B. Flank pain
C. Abdominal distention
D. Grade III trauma

162.What is the difference between compact bone and spongy

bone?
A. They have different bone marrow.
B. They are made of different materials.
C. They have different sizes of bone cells.
D. They have different arrangement of bone cells.

163. What makes bones so strong?

A. Silica
B. Cartilage
 C. Blood and marrow
D. Calcium and phosphorous

164. Which of the following statement is INCORRECT?

A. Bone is where most blood cells are made.
B. Bone serves as a storehouse for various minerals.
C. Bone is a dry and non-living supporting structure.
D. Bone protects and supports the body and its organs.

165. What is the last stage in the repair of a fracture?

A. Bony callus
B. Hematoma
C. Inflammation
D. Fibrocartilage callus

166. The cells that tear down and remodel bone are the ……………….
A. Osteoblasts
B. Osteocytes
C.Osteoclasts
D. Macrophages

167. Which of the following describes bone remodeling?

  A. plastic surgery after an accident
  B. bone growth through adolescence
  C. joint replacement
  D. deposition and absorption of bone minerals
168. Bone-forming cells are called ……………...
  A. osteoblast
  B. osteoclasts
  C.osteons
  D.osteocytes

169. The bone marrow that produces blood cells is found in ……………....
  A. compact bone
  B. strong bones
  C. spongy bone
  D. developing bone

170. Which of the following is NOT a function of the skeletal system?

  A. support
  B. protection
  C. synthesis of growth hormones
  D. manufacture of red blood cells

171. Which of the following should be examined with the patient in the
seated position?
A. Lower extremities.
B. Lumbar spine.
C. Upper extremities.
D. Leg strength.
172. Which of the following techniques is utilized in a general
musculoskeletal examination?
A. Hot vs. cold contrast.
B. Sharp vs. dull contrast.
C. Range of motion.
  D. Percussion.
173. Which nerve root supplies an Achilles reflex and sensation of the
lateral foot?
A. S1.
B. L5.
C. L4.
D. L3.
174. Which of the following describes passive flexion of the hip?
A. Gently move the leg so that the ankle crosses over the
opposite knee.
B. Gently roll the leg inward and outward.
C. Gently move the leg away from the midline.
D. Gently bring the knee to the chest while patient is supine.

175. Which of the following when compressed or deficient, exhibiting a

hyperactive anal reflex and dysfunctional bladder?
A.T12, L1.
B. L1, L2, L3.
C. L2, L3, L4.
D. L5.

176. What is a key factor in assessing the elderly?

 A. Simple language can be understood most easily.
B. Elderly injuries are due to falls.
  C. Injuries are the result of normal physiologic changes and
cannot be prevented.
D. Ability to perform activities of daily living is necessary for self-
care.

177. Which of the following is significant related to neurovascular

status?
A.Comparison between extremities is not necessary when
assissing the operative limb.
B. Always elevate the extremity above the level of the heart.
C. Treatment of neurovascular compromise may include cast or
splint removal, resolution of edema, or emergency fasciotomy.
D. It´s necessary to assess capillary refill, pulses, and sensation
but not color, movement, temperature.

178. What of the following is accurate about the immovility effects to

the integumentary system?
A. Redness at a site for 60 minutes or more after pressure has
been removed indicates that a pressure area is developing.
B. Scar tissue and skin grafts are the same risk for breakdown as
normal areas of the skin.
C. Children present the highest risk for pressure ulcers.
D. The sacrum and heels are most susceptible to the effects of
shear.
179. Which of the following is a sound respiratory factor related to
patient position changes?
A. Supine position permits gravity to pull mucus to dependent
areas of the lung.
B. Deep inspiration and rapid exhalation required for coughing
are attainable in any position.
C. Counter-resistance of chair or bed increases chest expansion.
D. Total lung capacity decreases with advancing age.

180. Which of the following is the most common sign of cardiac

deconditioning from immobility?
A. Tachycardia.
B. Diaphoresis.
C. Nausea.
D. Postural hypotension.

181. Which of the following is true about musculoskeletal effects of

immobility?
A. Decreased muscle mass is related to increased stress on
muscle.
B. Immobility decreases muscle load, activity, and protein
synthesis and also increases protein breakdown, resulting in muscle
disuse atrophy.
C. Immobilized muscle loses about 1% of its original strength per
day and varies with degree of immobility.
 D. Muscle atrophies more quickly in a stretched position than if
held in a shortened position.

182. Which of the following factors is associated with disuse

osteoporosis seen in immobilized patients?
A. Osteoporosis is common proximal to fracture sites.
B. Only muscle contraction promotes blood flow into and out of
bone.
C. Bone formation is enhanced, and, within a short period of
time, the situation is reveresed with early mobilization.
D. Osteoporosis is not common in paralyzed people.

183. Which of the following is considered an immobility influence on

the urinary system?
A. The renal pelvis may not empty completely into the ureters.
B. Excessive stretch of bladder muscle may enhance the
sensation to void.
C. Kidney excretes less amounts of minerals and salts.
D. Excretion of calcium is decreased 2 days after mobility begins,
leading to stone formation.

184. Which of the following is conducive to preventing pressure ulcer

formation?
A. Reposition every hour while in a chair.
B. Head of bed should be elevated to reduce pressure on the
upper extremity pressure points.
 C. Use of dynamic support if patient cannot assume various
positions.
D. Use the Braden Scale only after the formation of a pressure
ulcer.

185. Which of the following is a common therapeutic modality for

problem prevention in a body system?
A. Discourage use of a hyperinflation device.
B. Perform p hysical therapy on only the affected extremity.
C. Encourage a high calorie diet.
D. Duplicate normal prehospital routine as much as possible.

186. Which of the following should occure after a pressure ulcer is

detected?
A. Make all attempts to keep the area pressure reduced.
B. Provide diet low in carbohydrates and fats.
C. Remove pressure through repositioning, bridging, support
devices, and specialized beds.
D. Monitoring should occur no more often than Q 8hrs to reduce
the risk of infection.

187. Which of the following increases the risk of orthostatic

hypotension?
A. Urinary retention.
B. Diaphoresis.
C. Coumadin.
D. Cefazolin.
188. Which of the following is accurate related to addiction and
tolerance?
A. Tolerance is a psychological dependence on the use of
substances or activities for their psychic effects that is characterized by
complusive use.
B. Tolerance is needed for increased dosage of a drug for acute
pain management.
C. Addiction easily occurs in people taking drugs for acute pain
management.
D. Addiction occurs when a reduced effect is observed with a
constant dose.
189. Which of the following characterizes chronic pain?
A. Arising from injured peripheral or central neural structures.
B. Follows acute injury or disease.
C. Resulting from the ongoing activation of primary afferent
neurons by various stimuli.
D. Associated with malignancy (ongoing painful process such
as cancer or RA) or no malignancy (tissue injury is non-progressive or
healed (phantom limb or fibromyalgia).

190. Which of the following are considered physiological effects that

are associated with unrelieved pain?
A. Increased gastric and bowel motility.
B. Decreased heart rate, decreased cardiac output, hypotension.
C. Decreased cortisol, decreased epinephrine, decreased
glucagon.
 D. Muscle spasm, impaired muscle function, fatigue, immobility.

191. Which of the following is a misconception related to pain

management?
A. People usually do not become addicted to narcotics while in
the hospital.
B. Active Children can be in pain.
C. It is best to wait as long as possible to get/take pain
medication
D. The elderly do not have less pain sensitivity.

192. Which of the following is a principle of pain management?

A. The health care provider is the expert
B. A generic pain management plan fits each
disorder/disease/procedure.
C. Combine analgesics for greater effect and fewer side effects
than larger doses of a single medication.
D. Meperidine has the least side effects of IV narcotics.

193. Which of the following is a consideration for managing pain in a

patient with an active addiction?
A. A person with an addictive disease may be relatively pain
intolerant.
B. It is not necessary to consult an addiction or pain specialist to
manage pain of a patient with an addictive disease.
C. Opioid use should be avoided in the patient with an addictive
disease.
 D. Mixed opioid agonists/antagonists are approved for use in a
patient with an addictive disease.

194. Which of the following is a barrier related to the health care team
regarding effective pain management in the elderly?
A. Seniors don´t want to use unfamiliar technology such as PCA
pumps.
B. Failure to express pain means absence of pain.
C. Fear of being bothersome or distracting.
D. Everything is being done that can be done.

195. Which of the following is considered an effective

nonpharmacologic intervention for chronic pain?
A. Formulate a partnership which demonstrates that the health
care team is in charge of methods to reduce pain.
B. Heat is used instead of cold since warmth is a reassuring
quality.
C. Relaxation techniques help to reduce anxiety/tension, which
aggravate pain.
D. Pain is a serious thing, so humor should be avoided.
196. Which of the following is accurate related to routes of
administration for analgesics?
A. Intramuscular (IM) is route of choice because of even dose
absorption.
B. Epidural infusion should be by continuous infusion only.
C. Transdermal route is effective for acute as well as chronic
pain.
 D. Subcutaneous route can be used if no IV access, but absorption
is slower.

197. Which of the following is important to remember about NSAID

use?
A. NSAIDs are contraindicted in patients with chronic renal
failure or aspirin allergy.
B. Cox 2 inhibitors affect platelet aggregation the same way as
other NSAIDs
C. Like other NSAIDs, Keterolac is only given orally.
D. Side effects include only nausea, anorexia, and gastritis.

198. Which of the following is accurate regarding equianalgesic

dosage?
A. Two medications are considered equianalgesic if they are used
by the same route.
B. Use of equianalgesic dosages increases the probability that
dose route or drug changes will be accomplished without loss of pain
control.
C. A drug is more effective if it is more potent than another drug.
D. Most opioids do not contain the same level of effectiveness.

199. Which of the following is a safety precaution related to epidural

analgesia?
A. One RN is required to set up and program an epidural pump.
 B. Nurses need to be certified during their orientation period to
set up and program epidural pumps and to set dosages and
parameters.
C. Pumps can be used interchangeably between IV and epidural
infusions.
D. No other analgesics, hypnotics, or sedatives in addition to the
epidural dosage are to be administered unless written by the MD
responsible for the infusion.

200. Which of the following is necessary related to administration of IV

conscious sedation?
A. Monitor blood pressure, respiratory rate, and O2 saturation
every 10-15 minutes.
B. The assigned nurse should care for no more than one other
patient besides the one receiving IV conscious sedation.
C. Assess level of consciousness and mental status, skin color
and condition, pain status every 5 minutes.
D. Patient may drive self home after having met all post-
procedural criteria.

201. Which of the following is accurate related to pain management in

special populations?
A. Start analgesics at 1/3 the usual adult dosage for children.
B. Pain perception decreases with age.
C. Opioids are not too strong to use in the elderly.
D. There is no accurate way of assessing pain in the cognitively
impaired patient.
202. Complications after orthopaedic surgical procedures are related
to a patient’s:
A. Age, race, and medication use.
B. Age, ethnicity, and wound infection.
C. Age, co-morbidity, and mechanism of injury.
D. Open or closed injury, language barrier, and obesity.

203. Transient, fluctuation in cognition, consciousness, and

misperceptions in medically ill patients are primary signs and
symptoms of:
A. Delirium.
B. Fat embolism.
C. Deep vein thrombosis.
D. Pulmonary embolism.

204. On the third post-operative day after a total knee replacement the
nurse notices that 64-year-old Mr. Albert has not eaten much of his
lunch. He has no appetite and even though he is passing flatus, he feels
bloated. He has not had a bowel movement since surgery. Bowel
sounds are present. Which of the following complications is most
likely.
A. Depression.
B. Constipation.
C. Paralytic ileus.
D. Bowel obstruction.
205. The primary etiologic factors for pressure sores are:
A. Age and dehydration.
B. Incontinence and depression.
C. Decreased sensation and nutritional status.
D. Pressure over bony prominences and shearing forces.

206. After eating lunch on the first postoperative day after a rodding of
his fractured femur, 43-year old Bob Suppa complains of chest pain
and shortness of breath. He is apprehensive and restless. Vital signs
are: temperature of 100 degrees Fahrenheit, respiratory rate 22
breaths/minute, heart rate 96 beats/minute and regular. Which of the
following is most likely the explanation for his symptoms?
A. Hemorrhage.
B. Pulmonary embolism.
C. Myocardial infarction.
D. Deep vein thrombosis.

207. External pneumatic compression and graduated compression

stockings are used in the prevention of which of the following
complications?
A. fat embolism.
B. deep vein thrombosis.
C. pressure ulcer on the heel.
D. pressure ulcer on the heel.

208. The following factors: low preoperative platelet count, acetabular

and pelvic fracture, pre-operative use of aspirin to manage arthritic
pain, and a 3 hours surgical procedure, all increase the risk of which of
the following postoperative complications?
A. Deep vein thrombosis.
B. Fat embolism.
C. Hemorrhage.
D. Infection.

209. Nursing interventions to decrease the occurrence of post-

operative wound infection include:
A. Provide adequate analgesia, maintain hydration, assess and
provide for nutritional needs, and use aseptic technique with dressing
changes.
B. Keep the room cool to avoid overheating, assess and provide
for nutritional needs, and use aseptic technique with dressing changes.
C. Keep blood pressure on the high side to maintain perfusion,
tolerate slight hyperglycemia to avoid the likelihood of an insulin
reaction in a diabetic, and minimize fluid intake.
D. Encourage oral fluids over solids to enhance circulatory
volume, keep patient warm to avoid vasoconstriction, minimize use of
analgesics so that increased pain associated with infection will be
easily recognizable.

210. Which of the following patients is at greatest rick of developing

FES?
A. Patient with a forearm fracture.
B. Patient with a tibia fracture, with immediate closed reduction
and cast.
 C. Patient with a femur fracture with delayed open reduction
internal fixation.
D. Patient with a hemiarthroplasty.

211. Women with a history of motion sickness and no history of

tobacco use who receive opioid analgesics in the immediate
postoperative period are at increased risk for:
A. Infection at the surgical site.
B. Hospital acquired pneumonia.
C. Postoperative urinary retention.
D. Postoperative nausea and vomiting.

212. Consistently keeping the head of the bed at 30-45 degrees is an

important intervention to prevent which of the following
complications in patients on mechanical ventilators?
A. Delirium.
B. Pulmonary embolism.
C. Ventilator acquired pneumonia.
D. Postoperative nausea and vomiting.

213. Mr. Smith, 61 years old, had bilateral total knee replacements. On
postoperative day #1 he was confused and short of breath. His oxygen
saturations fluctuated between 68% and 91%. In addition, Mr. Smith
developed a petechial rash on his neck. Which of the following most
likely explain his symptoms?
A. Fat embolism
B. Pulmonary embolism
 C. Myocardial infarction
D. Hospital acquired pneumonia

214. Johnny, a 7-year-old child, fell off his bicycle and sustained a right
radial/ulna fracture. His fractures were closed reduced and a cast was
applied from his wrist to above his elbow. After one day Johnny
complained repeatedly of “lots of pain” despite the pain medication his
parents gave him His crying became more intense, and he developed
numbness and tingling in his hand. Johnny’s parents brought him back
to the hospital and he was diagnosed with:
A. A nonunion.
B. Being a “cry baby.”
C. A severe contusion.
D. Compartment syndrome.

215. Which of the following actions should a nurse do first if concerned

about signs and symptoms of compartment syndrome in a patient with
a tibia fracture?
A. Send blood tests.
B. Inform the physician.
C. Administer pain medication.
D. Test the urine for myoglobin.

216. Your patient, a 61-year-old obese woman with a 40-pack year

history of smoking, has been diagnosed with a delayed union of the
right tibia. Which of the following measures is likely to make the
biggest difference in successful healing of her fracture?
 A. Monitoring her oxygen saturation regularly.
B. Weekly weights to facilitate efforts at weight loss.
C. Successful participation in a smoking cessation program.
D. Maintaining partial weight bearing for a minimum of 3
months.

217. Which of the following is not a presenting symptom for a person

with a fractured hip?
A. Leg length discrepancy.
B. Affected leg externally rotated.
C. Pain and discoloration in the area.
D. Affected leg is adducted.

218. A patient is diagnosed with an intertrochanteric fracture. This is

located:
A. Within the joint capsule.
B. Between the trochanters.
C. Below the lesser trochanter.
D. In the femoral neck.

219. Which of the following is not an appropriate nursing intervention?

A. Monitor his pain level and administer medications as need.
B. Instruct the patient on the proper gait for walker/crutches.
C. Teaching the patient about weight-bearing activity
restrictions.
D. Make discharge plans with the patient’s family to prevent
stress for the patient
220. The physician's operative note indicates a primary total hip
arthroplasty was performed. This means:
A. The head and neck of the femur and acetabulum were
replaced.
B. Only one component of a total joint replacement was replaced.
C. The patient had a hip replacement previously.
D. The joint was totally excised due the arthritis pathology.

221. Which finding from the patient history and physical examination
would most likely be the indication leading to arthroplasty surgery?
A. Anterior thigh pain radiating toward the knee, increasing
overtime.
B. Decreased range of motion in the joint and increased pain.
C. Shortening of the affected extremity.
D. The patient needs to take ASA after his daily walks.

222. In teaching the patient about hip precautions, which of the

following is not appropriate?
A. Don't sit in a low chair.
B. Don't sit with legs crossed.
C. Don't flex the hip more than 90 degrees.
D. Don't keep the extremity in neutral alignment or slightly
abducted
223. When transferring a post arthoplasty patient back to bed the
patient complains of acute groin and hip pain and says they felt
something "pop." What should the nurse anticipate?
A. Subluxation.
B. Dislocation.
C. Infection.
D. Fracture.

224. Which of the following is a true statement regarding a femoral

osteotomy?
A. Late-stage arthritis present with joint congruency.
B. Procedure realigns the acetabulum with the femur.
C. Used for a mid-age adult as an alternative to an immediate
total hip arthroplasty.
D. It is a permanent, long-term treatment option for most
patients.

225. A 30-year-old female presents to the emergency room after a

motor vehicle crash with the following symptoms: severe pain to the
right lower extremity and inability to move it; bruising, swelling, and
deformity mid-thigh with an open wound; and leg length discrepancy.
Which of the following is a likely diagnosis?
A. Closed femur fracture.
B. Extracapsular hip fracture.
C. Dislocated hip.
D. Open femur fracture.
226. Which statement is true regarding pelvic fractures?
A. Pelvic fractures are always unstable.
B. Additional abdominal trauma is unlikely with severe fractures.
C. There are no major blood vessels of concern in the pelvic area.
D. Pelvic fractures can result in high-volume blood loss.

227. The patient requires revision of the total hip replacement he had
implanted 12 years ago. Prior to insertion of the revision components
it is most important to:
A. Assess ROM
B. Rule out infection
C. Keep the patient immobilized
D. Advise the patient not to flex the hip > 90 degrees.

228. The patient had decreased ROM after his first total hip arthoplasty
because of heterotrophic ossification in the hip flexor muscles.
Following the revision total hip arthroplasty the patient should:
A. Begin physical therapy with aggressive ROM
B. Disregard THR restrictions completely
C. Undergo postoperative radiation
D. Take aspirin prophylactically for two weeks

229. The patient tells the surgeon that he would like the minimally
invasive procedure for his total hip replacement. The surgeon explains
that he is not a candidate because:
A. His BMI is 25
B. He has a fixed flexion contracture of 15 degrees*
 C. The etiology of his hip disease is osteonecrosis
D. He is physically active

230. Which of the following is CONTRAINDICATED for the operative

leg following hip replacement surgery?
A. Adduction
B. Abduction
C. Hip flexion 90
D. External rotation