RPN- Musculoskeletal _ Breast _A_

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					RPN Musculoskeletal/Breast/Menopause/Uterine Cancer

Case Study

Marie is a 60-year-old female client with history of early onset of Osteoporosis. She presents with lower
back pain started on Sunday after lifting a heavy load on Saturday. She describes her pain as radiating from
the lower back to the posterior thighs and up to the knee. She denies urinary frequency and burning
sensation on urination. She is unable to bear weight on her left foot. She took Motrin 800 mg p.o. and
applied warm soaks to the area with minimal relief.

The physician ordered Prednisone for her arthritis flare up and she may continue her Motrin as prescribed.

Questions 1 to 5 refer to this case

 1.     The PN gave appropriate health teaching to Marie. Important nursing instructions to prevent the
        undesired effect of prednisone include:
         a. Take prednisone before meals
         b. Take prednisone with water
         c. Take prednisone with food
         d. Take prednisone in the morning
  Answer: C – Prednisone is a steroid that can irritate the GI tract if taken with an empty stomach. GI
irritation can result to GI bleeding

2. Maries takes 5 mg Prednisone po QD. During her follow up visit, the nurse working in the clinic
   should assess Marie for which of the following adverse reaction of Prednisone?
     a. Tetany and tremors
     b. Anorexia and weight loss
     c. Fluid retention and weight gain
     d. Abdominal cramping and diarrhea
Answer: C – Prednisone favors retention of sodium and fluids which leads to weight gain

3.  After the acute inflammatory phase of Rheumatoid Arthritis, Marie was instructed to resume her
    regular exercises. Which of the following activities will be appropriate to the client?
       a. Brisk walking
       b. Passive exercises
       c. Active exercises
       d. Bed rest
Answer: A – brisk walking causes stress on big joints (like knees) which prevent decalcification of the
bones

4. The PN will recommend which of the following activities to Marie?
   a. Join the fitness club
   b. Join the Cooking club
   c. Join Food club
   d. Join the walking club
Answer: D – walking is one of the best exercise among people with osteoporosis.

5. During the acute stage of the inflammatory phase of Osteopororsis, which of the following nursing
   actions should be appropriately implemented to Marie?
      a. Bed rest
      b. Warm soaks for 20 minutes at least 3X/day
      c. Passive exercise to prevent joint contractions
      d. Serve nutritious and balanced diet
Answer: A – bedrest during acute inflammatory phase decreases swelling, pain, and promotes healing



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Case Study

An 80-year-old woman is hospitalized with a fractured right hip.

Questions 6 to 21 refer to this case

6.  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
Answer: D - 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.

7.  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
Answer: A – in menopause, the ovaries stop producing estrogen and lack of estrogen promotes
decalcification of the bones that can result to hip fracture

Before undergoing surgery for a fractured hip, an older adult female is placed in Buck’s traction.

8.   When changing the linen on the bed of the client in Buck’s traction, it is best for the PN 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
Answer: B - 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.

9.   Which technique is the best 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
Answer: B -.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.

10. After a successful hip replacement, how should the PN position the client’s right leg?
       a. Adducted and in neutral position
       b. Abducted and in neutral position
       c. Abducted and internally rotated
       d. Adducted and externally rotated
    Answer: B – to maintain the normal position of the trochanter to the acetabulum, the patient’s affected
    leg remain abducted and the hip in maximum extension (leg straight or neutral position)


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After the client’s fractured hip is stabilized with an open reduction and internal fixation, the PN
teaches her to perform isometric quadriceps setting exercises with her unaffected leg.

11. If the client performs this exercise correctly, the PN 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
Answer: B - 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.

After surgery, the client wears knee-high antiembolism stockings.

12. When the client asks how antiembolism stockings prevent blood clots, the PN 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
Answer: A - 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.

13. 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
Answer: A - 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.

14. On the first few hours post op, which of the following positions is best for the client to promote
    optimal ventilation?
     a. Place the client in a high Fowler’s position
     b. Place the client in a prone position with head turn to one side
     c. Turn the client to back and side lying positions alternately
     d. Encourage the client to take deep breathing exercises
Answer: C – the hip must not be flexed. These are the best positions.

15. Before turning the client onto her non operative side, the PN would first
        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
Answer: A - 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.



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16. When assisting a client onto a bedpan on the first postoperative day, the PN should instruct the client
    to
     a. turn the client towards the operative side
     b. flex both knees and slowly lift the pelvis
     c. extend both legs and pull on the trapeze to lift the pelvis
     d. flex the unoperative knee and pull on the trapeze to lift the pelvis
Answer: D – the good leg can help in carrying the weight of the patient.

17. To prevent the most common complication following this type of surgery, the PN should expect the
    physician’s order to state:
     a. Turn the client from side to side every 2 hours
     b. Apply compression stockings
     c. Encourage isometric exercises to the extremities
     d. Perform passive range of motion to the affected extremities
Answer: B – compression stockings promote good circulation and prevent blood clot formation.

18. When the client with the hip prosthesis is allowed to sit up in a chair, the PN 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
Answer: C - 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 PN 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.

19. Twelve days after the total hip replacement, a client is permitted to sit for a short period. After
     assisting the client out of bed, the PN should place the client in a
      a. soft chair with affected leg elevated out in front
      b. firm armchair with affected leg elevated on a stool
      c. firm chair with affected leg flat on the floor surface
      d. soft chair with enough pillows to keep the hip at the right angle
Answer: C—maximum extension of the replaced hip is necessary

20. The PN knows that the client understands her discharge teachings, post hip replacement, by which of
    her following statements?
     a. “I should avoid standing”
     b. “I will ask my husband to help me with my shoe laces”
     c. “I will make sure that I have enough light in my house”
     d. “I can finally do some gardening in my yard”
Answer: B—Post hip replacement, the patient should avoid flexing the newly replaced hip to prevent
displacement.

21. The PN who is doing a plan of care for the client’s discharge will take which of the following actions
    when considering the client’s lifestyle?
      a. Find out what type of community resources available for her
      b. Determine which of the family members will be available to assist with her ADL’s
      c. Refer the client to the visiting PN
      d. Give her the list of the volunteer organization in her community
Answer: A – appropriate activities must be prescribed to the patient post hip replacement




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 Case Study

 Martha is a 53-year-old woman whose menstruation has ceased a year ago. Her doctor placed her
 on hormonal replacement therapy (HRT).

 Questions 22 to 27 refer to this case

 22. Martha was experiencing periodic hot flashes and was now eager to start her therapy. Appropriate
     nursing response to the client who wanted to start the therapy:
      a. “Yes, those are signs of early menopause”
      b. “You should not start the therapy”
      c. “You do not need the therapy, your symptoms will subside over time”
      d. “The doctor must see you first”
 Answer: D – patient’s assessment by the MD is pre-requisite for HRT.

 23. Which of the following assessment are signs of early menopause?
      a. Irregular menses
      b. Hot flashes around chest, neck, and face
      c. Increase libido and increased frequency in sexual intercourse
      d. Rapid eye movement; irritability
 Answer: B—hot flashes are signs of menopause.

 24. If Martha is experiencing signs of perimenopause, the nurse would appropriately suggest:
        a. To walk around the block everyday
        b. To take calcium supplements
        c. To start HRT
        d. To perform vigorous exercises
 Answer: B – calcium supplement will maintain the calcium level

25. Martha confided to the nurse that she is also experiencing painful coitus (dyspareunia). Which of the
     following suggestions made by the PN is appropriate?
      a. Suggest regular exercise at least 3X/week
      b. Suggest hormonal replacement therapy
      c. Suggest the use of water-soluble lubricant during coitus
      d. Give the client opportunity to discuss her sexual problems
 Answer: C –vaginal lubricant lessens the discomfort from dyspareunia.

 26. Martha would like to know the possible side effects of the hormonal replacement therapy. Nursing
       response would include:
      a. Weight gain, breast, and pelvic discomfort, headache, GI disturbances, vaginal discharges
           and skin pigmentation
      b. Climacteric or perimenopausal and irregular menstruation
      c. Irritability, forgetfulness, anxiety, nervousness, and fatigue
      d. Osteoporosis and cardiovascular disease
 Answer: A – HRT contains estrogen that results to weight gain (sodium is retained), breast discomfort and
 other manifestations stated

 27. With HRT, Martha wants to know what else she should do to minimize the physiologic effects of
     menopause? The PN will appropriately suggest:
     a. That she takes 800 to 1000 mg of calcium supplements/day
     b. That she eats foods rich in calcium, protein, and take Vit. E & B complex
     c. That she performs regular exercises of at least 30 to 60 minutes per day
     d. That she receives indefinite hormonal replacement therapy to prevent osteoporosis
 Answer: C – exercise will prevent decalcification of the bones




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Case Study

Chris, 10 years old was admitted to the Pediatric unit following fall accident.

Questions 28 to 30 refer to this case

28. Chris sustains fracture on his right femur when he fell out of a tree while role-playing Tarzan. Ninety-
    degree skeletal traction has been applied. The PN’s priority goal for Chris is to
        a. relieve pain and discomfort
        b. protect from neurovascular injury
        c. prevent muscle atrophy and contractures
        d. protect from infection at the pin site
Answer: A –pain relief is the top priority for the patient.

  29. Four days after admission Chris complains of pain in his right femur. The PN should
         a. administer his prescribed PRN analgesic
         b. release one of the weights for no more than three minutes
         c. report the pain to his orthopedic surgeon
         d. assist him to use the overhead trapeze for repositioning
Answer: A – this is the most appropriate—pain relief.

  30. The doctor has ordered cleansing of the area around the insertion of the pins with Betadine
      solution and a change of antibiotic impregnated sterile gauze pad 4 times daily. On the third day
      Chris asks if he can give self-care to the pin sites. The PN should
        a. Determine that he knows the procedure, offer him the materials and observe his performance
        b. Refuse gently and explain that it is the nurse’s role to perform sterile procedures using aseptic
            technique
        c. Develop a teaching plan and start lessons at the time of the next cleansing and dressing
            change
        d. Acknowledge his interest and allow him to assist with pouring the solution and cutting the
            tape
Answer: C –this is the most efficient when teaching the patient.

Independent Questions

31. A group of women attending a woman-disease-awareness program asks the nurse when is the best
     time to start hormonal replacement therapy:
       a. Older women at the age of 52 and started menopausing
       b. Women who are no longer menstruating regardless of their age
       c. Women whose menses are irregular with undetermined bleeding
       d. Older women on birth control pills
Answer: A – HRT is started at the beginning of menopause; this is to treat hot flashes and prevents
decalcification of bones

32. Which of the following range of motion (ROM) is best for children with Juvenile Rheumatoid
    Arthritis?
      a. Bicycling
      b. Jumping rope
      c. Volley ball
      d. Painting and drawing
Answer: A –this a good exercises and enjoyable one to children.

33. Safety precautions the nurse should employ when radium that had been inserted in the vagina of a
    client is being removed include:
       a. Cleaning the radium carefully in ether or alcohol
       b. Ensuring that long forceps are available for use


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     c. Handling the radium carefully wearing foil lined rubber gloves
     d. Charting the date and hour of removal and the total time of treatment
Answer: B – long forceps are used when picking up the implant that has accidently dislodged

34. When caring for a patient who has radium implant for cancer of the cervix, the PN should
       a. Restrict visitors to a two-hour stay
       b. Store urine in a special container
       c. Wear sterile gloves and mask when administering care
       d. Avoid giving IM injections to the gluteus muscle
Answer: D – the patient with radium implant should remained on strict bedrest; IM injection on the
buttocks area should not be done as it requires movement of patient

35. The patient undergoing whole-body radiation for Hodgkin’s disease may have destruction of bone
    marrow, making it unable to function normally. As a result of this, the nurse would expect the
    patient to develop
     a. increased blood viscosity
     b. increased tendency for fractures
     c. decreased number of erythrocytes
     d. decreased susceptibility to infections
Answer: C—Radiation affects the bone marrow causing decreased RBCs.

36. Which of the following gait is appropriate to a client with a bilateral amputee?
     a. Two-point gait
     b. Three-point gait
     c. Four-point gait
     d. Swing through
Answer: B—this is the best gait for bilateral amputee

  37. When teaching a client with a hemiparesis to ambulate with a cane, the PN should instruct the
      client to
        a. Shorten the stride of the unaffected extremity
        b. Lean the body toward the cane when ambulating
        c. Advance the cane and the affected extremity simultaneously
        d. Hold it in the hand on the same side as the affected lower extremity
Answer: C –this is the proper way of using the cane.

 38. When caring for a blind client, the PN should
        a. Enter the room quietly and speak softly
        b. Touch the person gently before speaking
        c. Place objects in the same location in the room
        d. Hold the client securely by the elbow when ambulating
Answer: C – consistency is important among blind patients.

 39. A patient who was involved in motor vehicle accident sustained leg injury, and is now recovering
     from a leg injury. The PN who is giving the discharge teaching will instruct the patient the proper use
     of the crutches:
        a. The top of the crutches should reach to 1-1 ½ inches below your armpits while stand up
             straight
        b. Your weight must be carried by your armpits
        c.    Look down while walking to avoid tripping on scattered materials on the floor
Answer: A –this prevents possible damage to the axillary nerve.

 40. Phyllis Rose, 55 years old, has a lump on her right breast. She went to see her family doctor and was
     ordered a mammography. Following mammography a needle biopsy was performed which
     confirms adenocarcinoma. Right mastectomy was scheduled. One of the following is considered
     as predisposing risk factor to breast CA?


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       a. Repeated mechanical injury
       b. Excessive protein intake
       c. Used of fitting bra
       d. Menarche before age 11
Answer: D –early menarche is when the first menstrual period was experienced. Early menarche occurs
before age 11 and it is identified as predisposing factor of breast cancer.

 41. Samuel, 26 years old, S/P R knee replacement due to a broken knee sustained from a fall accident
     while playing hockey. Today he is being discharge home. The nurse who is giving the discharge
     instructions correctly assesses that Samuel is ready for discharge by which of the following patient’s
     statements?
      a. “I can go back to work in two weeks”
      b. “I can start my walking exercises”
      c. “I can play hockey in six months”
      d. “I will do rowing exercises at home”
Answer: B – walking does not promote flexion of knees. It is the best following knee surgery.

 42. Angelo 15 years old, athletic had undergone knee surgery and repair of tendons. Following the
     completion of the procedure the client states, “I feel drowsy”. Which of the following nursing
     actions can promote safety on the client?
      a. Provide walker when ambulating
      b. Put side rails up
      c. Assist the client when ambulating
      d. Ask the client to sit up in bed for 5 minutes before walking
Answer: B –patient with altered LOC (level of consciousness) is very prone to fall accident.

 43. Dorothy is a 65-year-old female who is diagnosed with Acute Rheumatoid Arthritis. Following
     her acute attack, which of the following nursing diagnosis is most appropriate for the client?
    a. “Alteration in comfort due to the acute inflammation of the client’s joints.”
    b. “Alteration in mobility due to chronic fatigue.”
    c. “Potential for skin breakdown due to bed rest.”
    d. “Potential for infection due to inflammation.”
Answer: A – acute inflammatory process is painful.

 44. A young client approaches the nurse and said, “I do not want to get pregnant anymore. I have been
     delivering babies every year. Will you please tell me about this Depo-provera (DMPA) ordered to me
     by the physician.” The PN’s best response would include:
      a. “It is a progestin given by IM injection every 3 months. Very convenient and highly
          effective in preventing pregnancy”
      b. “It may cause amenorrhea, headache, bloating, and weight gain. You may not return to
             the fertility clinic for a long time”
      c. “You may need to return to the clinic every 3 months for IM injection. You may need
              to discontinue the drug for a long time prior to getting pregnant again”
      d. “It is a combined hormonal contraception with 98.4% effective with fewer side effects. The
          drug creates a hostile environment in the uterine lining and alters tubal transport”
Answer: A—this is the best description of Depo Provera

45. A 9-year-old was rushed to the ER with fractured R ankle. Which of the following assessment data
    indicate that a serious problem has occurred?
       a. Palpable pulse, cold extremity
       b. Loss of distal pulse, cold extremity
       c. Severe pain, extremity cyanotic
       d. Loss of motor and sensation function
Answer: B—these are signs of compartment syndrome.




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 46. Accurate and best information about breast cancer can be obtained from:
     a. Breast Cancer Society
     b. Breast cancer survivor
     c. Brochures about breast cancer
     d. “Reach-for-Recovery” group
Answer: A –they have the most accurate information.

  47. If Mr. Cruz is allowed to bear weight on his affected foot, the nurse who is assisting the
        patient with his ambulation knows that the correct way of using the walker will be one of
        the following?
        a. Lift the walker and place it about 12 inches (30 cm); take a step forward with the
             injured foot, followed by the uninjured foot
        b. Lift the walker and place it about 12 inches (30cm); take a step forward with the uninjured
             foot followed by the injured foot
        c. Drag the walker about 6 to 8 inches and take a step with both legs simultaneously
        d. Drag the walker about 4 to 5 inches and take a step forward
Answer: A –this is the proper way of using walker.

  48. 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
Answer: B - 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.


Prior to her release from the emergency department, the client receives home care instructions from
the PN regarding care of her ankle injury.

  49. Besides routinely removing and reapplying the elastic bandage, it is essential that the PN 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
Answer: C- 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 client presents in the emergency room with a shoulder injury after falling from a stepladder.

  50. When the nurse assesses the client’s injuries, which finding best 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
Answer: D - A dislocation results in the temporary displacement of a bone from its normal position within
a joint. Dislocation is caused by the tearing of the ligaments that connect and hold two bone ends within a


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joint. 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.

  51. After surgery, the client experiences signs and symptoms of a fat embolism. The nurse recognizes
       that one of the first sign is
          a. respiratory distress
          b. abdominal distention
          c. difficulty swallowing
          d. swelling at the incision site
Answer: A – 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, blood streaked 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.

The PN 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.

  52. Of the following emergency measures, which one should the PN perform first?
        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
Answer: A - 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.

  53. After the arm cast has been applied, which nursing observation best 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
Answer: A - 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.

  54. Which nursing technique is best 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
Answer: A -.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. 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.




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55. Which method is best 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 nail bed 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
Answer: C - 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.

The client tells the PN that his skin itches terribly beneath the cast.

56. 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
Answer: A - Obtaining a medical order for administering an antihistamine/ antipruritic drug like
cyproheptadine (Periactin) chemically relieves the client’s itching. Distraction may also be an alternative
technique for relieving discomfort, but it takes commitment and repeated practice to be effective. The client
is cautioned against using a coat hanger or any method that scratches the skin. If the integrity of the skin is
impaired, organisms may begin to grow in the warm, dark, moist environment. Powder is not appropriate
because it can cake under the cast causing potential skin breakdown. Ice bags to the outside of the cast are
not effective in preventing itching.

57. You find a client with Osteoporosis on the floor at the sides of the bed, leg rotated inside and
    complaining of hip pain. What should the PN do?
     a. Call physician immediately
     b. Place a blanket on her, tell not to move, and call the physician
     c. Reposition leg
     d. Put her back to bed
Answer: B – the patient should not be moved to prevent any further injury

58. A patient with osteoporosis fell down from her bed. What is your nursing action to implement?
    a. Put her back to bed with the help of another nurse
    b. Put the patient back to bed by yourself
    c. Immobilize the leg with assistance from another nurse
    d. Assess the client and put her back to bed with assistance
Answer: C – the patient should be immobilized until appropriate help is secured to prevent further injury

59. Which of the following is correct about monkey bar installed in the school playground:
    a. Made of strong steel with all joints welded; each bar spaced about 1 - 1 ½ ; bar height
        about 38 to 58
    b. Made of strong plastic materials with all joints welded; each bar spaces about 1 - ½ ; bar height
        must be more than 58
    c. Made of the strongest wood with all joints welded; each bar spaced about 2 ; bar height more
        than 58
Answer: A – this is the recommended description of the monkey bar to ensure safety




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60. Post hip replacement, early ambulation is promoted to prevent complication. Which of the following
    ambulation techniques is appropriate?
        a. Instruct the patient to use walker or crutches
        b. Call the physiotherapist to teach the patient how to walk again
        c. The patient should not be allowed to weight bear
        d. The patient will be encouraged to transfer from bed to chair on the second day then
             gradually increase ambulation
Answer: D – early ambulation promotes good circulation that prevent DVT

61. When transferring from bed t chair, the post hip replaced patient should be taught to:
     a. Get out of the bed from the affected side
     b. Get out of bed from the good side
     c. Be always assisted by two nurses when getting out of bed
     d. Use abduction pillow when transferring to the chair
Answer: A - this is necessary to maintain abduction

62. After 5 months of rehabilitation from back injury, what is the best exercise that the PN will
      recommend Mr. X at home?
      a. Playing golf
      b. Gardening
      c. Stationary bicycle
      d. Swimming
Answer: D – swimming is very helpful for back pain as it does not put excess strain on the swimmer’s
back and keep the injured person physically active.

63. Peter is young athlete, preparing for the Olympic competition, injures his knee on practice. The
     doctor prescribes Ibuprofen (Advil) for pain and to reduce inflammation. Peter went for a 3-week
     therapy. On his 3rd week, he notices petechiae all over his skin, and his blood test showed a platelet
     count of 9,000mm³. The PN can expect that
     a. the patient will be able to continue therapy with this medication
     b. the dosage will be reduced from 3 to 2 tablets a day
     c. the medication will be discontinued and an alternative agent will be prescribed
     d. the lab studies will be repeated, as they are likely an error
Answer: C – petechiae are signs of bleeding, a complication of Motrin (Ibuprofen); the medication must be
discontinued

64. Mrs. Chou, an elderly Chinese immigrant, was admitted due exacerbation of her rheumatoid arthritis.
    She also has Alzheimer’s disease diagnosed 4 years ago. She complains of severe leg pain and
    generalized body ache. She confided to the nurse that she is not happy getting all these medications and
    thus she prefers non-pharmacological treatments. Which comfort measure implemented by the PN is
    appropriate?
    a. Provide relaxation technique
    b. Apply cold compresses to painful joints
    c. Teach the patient some meditation techniques
    d. Start a conversation and intentionally include humor
Answer: B – cold compresses decreases inflammation and edema through vasoconstriction, thus promoting

65. Martin, a 19-year-old skate border, has been treated for a Colle’s fracture. He is now ready to go home.
    Which of the following would be most appropriate to prevent further injury?
     a. Instruct him to refrain from skateboarding for one week
     b. Inquire about what protective gear he has for this sport
     c. Tell him that he should be more careful about the sports he chooses
     d. Tell him that he should have worn wrist guards to prevent this injury
Answer: D – Colle’s fracture is a wrist fracture and wrist guard will minimize injury



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