ONC Sports Injuries/Orthopedic Trauma Practice Exam 50 Questions with Verified Answers
A 48-year-old athlete sustains a ruptured Achilles tendon during
... [Show More] triathlon training. In discussing the personal and medical history with the patient, the nurse should recognize which of the following as a risk factor for this injury?
a. Long distance swimming exercises
b. Ongoing treatment for gout
c. Attending a weekly spinning class
d. Antihistamine use for seasonal allergies - CORRECT ANSWER Key: b
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 591
Rationale: Risk factors associated with Achilles tendon rupture include prior history of Achilles tendonitis, previous local cortisone injections, systemic inflammatory arthritis (gout or rheumatoid arthritis), and use of fluoroquinolone antibiotics.
A patient with a ruptured Achilles tendon has undergone surgical repair and will require 6 weeks of cast immobilization. As part of the patient's discharge plan, it is MOST important for the nurse to assess the patient's ability to
a. check pedal pulse daily.
b. demonstrate plantar flexion technique.
c. ambulate with an assistive device.
d. perform the Thompson's test. - CORRECT ANSWER Key: c
Rationale: Patient discharge education following Achilles tendon repair should focus on safe, non-weight-bearing ambulation with an assistive device. Casting will immobilize the foot, preventing pedal pulse assessment or plantar flexion. Thompson's test is a diagnostic assessment for tendon rupture.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 592
A healthy 47-year-old injured the right knee while skiing. A moderate partial tear of the anterior cruciate ligament (ACL) is confirmed with MRI. The patient has opted for non- surgical treatment. Which of the following should the nurse recognize as an appropriate intervention to manage the injury?
a. Bracing and CT scan to evaluate for stress fracture
b. Prescription for pregabalin (Lyrica) and rivaroxaban (Xarelto)
c. Knee aspiration and prescription for diclofenac (Voltaren)
d. Doppler ultrasound of lower leg and enoxaparin (Lovenox) - CORRECT ANSWER Key: c
Rationale: Conservative treatment of moderate (Grade II) ACL injury includes aspiration, immobilization, cryotherapy, and NSAID treatment. Use of anticoagulants is contraindicated due to bleeding associated with the ACL injury.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 581
A softball pitcher underwent surgical repair of the right anterior cruciate ligament 3 days ago and is now being seen in the surgeon's office. Which of the following findings should the nurse identify as suspicious of infection?
a. Swelling and warmth in the lateral knee
b. Loss of appetite, constipation, and drowsiness
c. Serosanguinous drainage after exercise
d. Increased pain, new drainage, and low grade fever - CORRECT ANSWER Key: d
Rationale: Signs and symptoms of surgical site infection include increased pain, drainage, and fever. Slight drainage, local warmth, and some discharge are not unexpected during the early postoperative course.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 585
An ice skater sustains a first-degree ankle sprain. Which of the following treatments should the nurse expect to be included in the patient's plan of care?
a. Pneumatic compression boot
b. Short leg fiberglass cast
c. Elastic bandage and crutches
d. Warm compresses and massage therapy - CORRECT ANSWER Key: c
Rationale: A common treatment for first degree sprain includes the use of an elastic bandage and assisted ambulation to protect the joint while healing.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 420
A 12-year-old boy playing Pee Wee football is tackled and sustains a fracture to the left clavicle. The nurse should teach the patient and his parents about use of which of the following interventions as part of non-surgical treatment for this injury?
a. Padded sling
b. Soft abduction immobilizer
c. Sandbag between scapulae
d. Cervical collar - CORRECT ANSWER Key: a
Rationale: For a child, non-surgical, conservative treatment includes application of a sling. A soft immobilizer may be used for an adult with this injury. A sandbag is used for adult injuries of the sternoclavicular joint. A cervical collar is not indicated for this injury.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 403, Table 15.9
A Little League baseball pitcher has been diagnosed with a partial tear of the ulnar collateral ligament (UCL) of the pitching arm. The nurse should reinforce instruction on which of the following as part of a conservative course of treatment for this patient?
a. Muscle stretching exercise to loosen calcium deposits
b. Daily long-toss routine to strengthen the supraspinatus muscle
c. Shoulder immobilizer and application of cold therapy device
d. Rest between games and a limited number of pitches per game - CORRECT ANSWER Key: d
Rationale: Rest is critical, not only between games but also through limiting the number of pitches thrown per game and the number of games played.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 513
A marathon runner develops foot pain and is diagnosed with plantar fasciitis. Which of the following statements by the patient should the nurse recognize as correct concerning this condition?
a. "Plantar fasciitis is chronic, and complete resolution takes several months to a year."
b. "This condition is acute and complete resolution takes two to four weeks."
c. "Plantar fasciitis is a non-treatable condition."
d. "This condition requires both non-surgical and surgical treatment." - CORRECT ANSWER Key: a
Rationale: Patient education for plantar fasciitis should include the pathology of the disease process to help the patient understand the chronic nature of the problem. Complete resolution can take several months to a year.
Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 594
A rugby player is unable to rise and walk after experiencing an aggressive tackle. In the emergency department, the patient is diagnosed with a dislocated right hip. The nurse's assessment should be based on knowledge that which of the following structures can be affected by this injury?
a. Peroneal nerve and popliteal artery
b. Sciatic nerve and femoral head
c. Tibial nerve and popliteal artery
d. Distal femoral and proximal tibial condyles - CORRECT ANSWER Key: b
Rationale: Hip dislocation is considered a medical emergency because delayed reduction can lead to a compromised sciatic nerve and permanent disability due to possible avascular necrosis of the femoral head.
Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 418
A patient is taken to the emergency department after experiencing a knee injury during a weekend game of flag football. Magnetic resonance imaging (MRI) with MR gadolinium contrast is ordered. Which of the following should the nurse ensure is completed before the patient goes for the study?
a. Assess C-reactive protein values.
b. Cover jewelry piercings with 3-inch wide paper tape.
c. Allow the patient nothing to eat for 3 hours before the procedure.
d. Take a detailed health and renal history. - CORRECT ANSWER Key: d
Rationale: MR gadolinium is contraindicated in patients with chronic renal disease because of the risk for nephrogenic systemic fibrosis. All jewelry and piercings with metal should be removed. C-reactive protein has no bearing on this study, and the patient does not need to be NPO.
Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 72
A high school basketball player complains of severe left knee pain after falling during a game. A tear of the meniscus is suspected. The nurse should know which of the following maneuvers would be performed to assess for a meniscal tear?
a. Anterior drawer test
b. Bulge sign
c. Homan's sign
d. McMurray's sign - CORRECT ANSWER Key: d
Rationale: Common assessment findings for meniscal tears of the knee include a positive McMurray's sign; additional findings may include edema, pain with movement, and the inability to extend the knee.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 416
A runner complains of pain over the calcaneus and is diagnosed with plantar fasciitis. Consistent with this diagnosis, the nurse identifies which of the following?
a. "Start-up" pain after rest
b. Pain along the posterior tibial tendon
c. Pain with passive plantar flexion
d. Improved pain by nighttime - CORRECT ANSWER Key: a
Rationale: Pain with plantar fasciitis is often worse first thing in the morning or when taking the first few steps after rest ("start-up" pain). Pain also occurs with passive dorsiflexion and generally worsens by nighttime. Pain along the posterior tibial tendon is associated with pes planus (flatfoot).
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 594
A professional football player undergoes reconstruction of the left anterior cruciate ligament. He identifies his current pain as 4 on 0-10 intensity scale and has full movement and sensation after epidural anesthesia. Six hours after surgery, the patient is unable to void. Which of the following should the nurse identify as a risk factor for postoperative urinary retention for this patient?
a. Prior history of urinary tract infection
b. Epidural anesthesia and 800 cc intravenous fluids
c. Dehydration and electrolyte imbalance after being NPO
d. Slow progression to regular diet in PACU - CORRECT ANSWER Key: b
Rationale: Epidural anesthesia and perioperative fluids of 750 cc or more are risk factors for postoperative urinary retention. Other options are not related.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 594
A minor league baseball pitcher undergoes surgical rotator cuff repair. As the nurse prepares the patient for discharge, which statement by the patient should the nurse recognize as indicating he understands the postoperative treatment plan?
a. "I'll wear a sling and limit activities for a few months."
b. "I'll remove my sling at night to help get a good night's sleep."
c. "I will be most comfortable if I lie flat in bed."
d. "I expect to be pitching again in 4 to 6 weeks." - CORRECT ANSWER Key: a
Rationale: Following rotator cuff repair, a sling or abduction pillow will need to be worn postoperatively. Activities will be restricted; athletes are not allowed to return to sports for up to 6 months. Lying flat is usually more uncomfortable so a recliner is often preferred.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 481
A tennis player is diagnosed with lateral epicondylitis of the right arm. A tennis elbow band is recommended, and the patient asks the nurse about the benefits of this treatment. The nurse's response should be based on knowledge that the tennis elbow band
a. reduces risk of invasive iontophoresis therapy.
b. reduces inflammation and pain of extensor tendons.
c. stabilizes wrist flexor and extension mechanism.
d. stimulates transcutaneous nerve conduction. - CORRECT ANSWER Key: b
Rationale: Use of a tennis elbow band will displace the tissues on the proximal forearm, thus reducing the inflammation and pain along the extensor tendons.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 512
A gymnast diagnosed with chondromalacia patella is advised to avoid activities that worsen the pain. The nurse also should reinforce the need for the patient to perform which of the following types of exercise?
a. Gluteal sets
b. Prone leg lifts
c. Quadriceps strengthening
d. Iliotibial band stretching - CORRECT ANSWER Key: c
Rationale: Quadriceps muscle strengthening is the single most important objective of therapy for a patient with chondromalacia. Other listed exercises will not affect quadriceps strength. For example, prone leg lifts strengthen the hip extensor muscles.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 578
During a recent competition, a weight lifter says he felt a sudden burning pain in his lower back that has since resolved to tenderness. When seen in the emergency department, he is diagnosed with a second-degree muscle strain. Although he is advised to rest the injured area, he insists he wants to return to competition in the morning. Which of the following statements by the nurse should be appropriate in this situation?
a. "If you wear a weightlifting belt, you should avoid additional injury."
b. "Keep the ice pack on until you are called to compete tomorrow."
c. "You will probably be OK to compete if you feel better in the morning."
d. "If this injury is not properly treated, a more dramatic injury could occur." - CORRECT ANSWER Key: d
Rationale: Immobilization of the injured area is critical. If it is not treated properly, a more dramatic injury can occur. The patient should not compete again so quickly after experiencing a second-degree muscle strain.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 419
A high school football player experiences a right shoulder dislocation during practice and is taken to the emergency department. The nurse's assessment should be based on awareness of the risk for injury to the
a. median nerve.
b. axillary nerve.
c. ulnar nerve.
d. brachial nerve. - CORRECT ANSWER Key: d
Rationale: The brachial plexus and axillary artery are at risk for injury with shoulder dislocation. Median nerve injury is possible with wrist dislocation, and ulnar nerve and brachial artery injuries are possible with elbow dislocation.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 418
A professional hockey player diagnosed with femoroacetabular impingement (FAI) has had no success with conservative treatment. Surgery is planned. The patient asks the nurse about the purpose of the arthroscopy. The nurse's response should be based on knowledge that the goal of surgery for this condition is to
a. correct deformity of the femoral head.
b. reshape the greater trochanter of the femur.
c. remove infected bursae.
d. replace articular cartilage. - CORRECT ANSWER Key: a
Rationale: Hip arthroscopy involves reshaping the femoral head or acetabulum to correct the deformity and improve range of motion.
Reference: Hessel, J.A. (2014). Femoroacetabular impingement in athletes. Orthopaedic Nursing, 33(3), 137-141.
A high school soccer player complains of acute calf pain within 10 minutes after the start of each game. After assessment of compartment pressures by the orthopaedic physician, the patient is diagnosed with exercise-induced chronic compartment syndrome. The nurse should provide education to prepare the patient for which of the following procedures?
a. Arthroscopy
b. Ligament reconstruction
c. Fasciotomy
d. Tendon release - CORRECT ANSWER Key: c
Rationale: Although not currently emergent, the patient's condition could worsen if compartment pressures are unrelieved. An elective fasciotomy is indicated to open the affected muscle compartments.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 204
An elite long-distance runner comes to the clinic with complaint of pain and tenderness over the anteromedial knee. After a diagnosis of pes anserinus bursitis, the patient is instructed to rest the knee and avoid activities that cause pain. The nurse should recognize the next step in rehabilitation will be a stretching and conditioning program that includes which of the following?
a. Deep knee bends
b. Plyometrics
c. Lunges
d. Quadriceps sets - CORRECT ANSWER Key: d
Rationale: The strengthening and conditioning program will begin with isometric exercises (e.g., quadriceps sets) and electrical muscle stimulation, with resistive exercises later incorporated as the patient's symptoms allow.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 579
A basketball player sprains her right ankle in landing after a rebound. The nurse assists in the physical examination of the patient. The nurse should recognize which of the following maneuvers will be used to assess ligament stability?
a. Lachman test
b. Anterior drawer test
c. Abduction stress test
d. Clunk test - CORRECT ANSWER Key: b
Rationale: The anterior drawer test is performed to assess the stability of the anterior talofibular ligament at the ankle. Lachman test is used to assess damage to the anterior cruciate ligament. The abduction stress test evaluates the medial collateral ligament in the knee. The posterior clunk test is used to assess shoulder instability.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 589
A golfer for the local college team is diagnosed with medial epicondylitis. Which of the following statements by the nurse should represent appropriate self-care instructions for this patient?
a. "Apply ice for 20 minutes every 2 hours while awake."
b. "Take the prescribed opioid analgesic every 4 hours."
c. "Wear the ordered air splint when you go to bed."
d. "Begin isotonic exercises immediately as first-line treatment." - CORRECT ANSWER Key: a
Rationale: Ice can be applied for 20 minutes at a time every 2 hours, using a cross-friction massage technique. NSAIDs will be given as analgesics. An air splint is not indicated for this condition. The affected area should be rested; avoidance of repetitive activity is first-line treatment.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 512
A high school cheerleader falls during performance of a pyramid stunt at practice. Complaining of severe neck pain, she is taken to the emergency department. CT scan confirms stable fractures at cervical vertebrae 5 and 6, and the patient is placed in a halo vest. Which of the following statements by the nurse should represent appropriate instructions for this patient and her parents?
a. "Adjust the vest as needed for comfort."
b. "Clean pin sites with full-strength hydrogen peroxide."
c. "Get up with a physical therapist when you are ready to ambulate."
d. "Maintain bedrest for the first week after hospital discharge." - CORRECT ANSWER Key: c
Rationale: PT is helpful with early mobilization because the weight of the halo vest and loss of motion in the cervical spine can affect safe ambulation. Pin sites are typically cleaned with chlorhexidine, although some physicians will order half-strength hydrogen peroxide. Bedrest is not indicated for this injury. The vest should be adjusted only by a health care provider.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 470
A professional golfer is diagnosed with a torn rotator cuff and conservative treatment is discussed. Which of the following statements by the nurse should be appropriate for the patient's self-care instructions?
a. "Physical therapy will be ordered if your condition does not improve."
b. "Avoid any activity that reproduces your symptoms."
c. "Occupational therapy will be ordered to help you with dressing."
d. "Take your oral steroid medications as prescribed." - CORRECT ANSWER Key: b
Rationale: As part of conservative treatment for rotator cuff injury, the patient should avoid any activity that causes pain or reproduces symptoms. Physical therapy should be attempted in all patients with rotator cuff tears. Occupational therapy is not part of conservative treatment but may be ordered after surgery. Intraarticular steroids may be indicated but oral steroids are not ordered for patients with rotator cuff injury.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 481
An intoxicated college student punches a wall and sustains a closed boxer's fracture of the right hand. An ulnar gutter splint is applied. Which of the following should the nurse include in discharge teaching for this patient?
a. Maintenance of absorbent padding between the fingers
b. Splint removal for bathing
c. Use of opioids every 4 hours for the first 24 hours
d. Application of steroid patches to decrease swelling - CORRECT ANSWER Key: a
Rationale: Absorbent padding should be maintained between the fingers to prevent maceration due to sweating. The splint is not to be removed for bathing until directed by the physician. Because the patient was intoxicated, opioid analgesics need to be used sparingly for the first 24 hours after injury. Steroid patches are not indicated for this injury.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 534
A postmenopausal female slips on the ice outside her home and falls on her outstretched right hand. X-ray confirms a Colles' fracture, which is treated with external fixation. Based on knowledge of risks associated with this type of fracture, the nurse should be alert to deficits of which of the following nerves?
a. Psoas
b. Axillary
c. Ulnar
d. Median - CORRECT ANSWER Key: d
Rationale: Damage to the median nerve may occur because of its proximity to the fracture site in this type of injury.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 544
patient diagnosed with hallux valgus asks the nurse about appropriate foot wear. Which of the following should the nurse recommend?
a. Wide shoe with extra depth in the toe box
b. Wide, firm leather shoe
c. Compression stockings with medium width athletic shoe
d. Walking boot during the day - CORRECT ANSWER Key: a
Rationale: Nonsurgical treatment includes wearing proper footwear, which should be wide, low- heeled, have an extra depth toe box, and be made of soft leather.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 598
In preparing to discharge a patient diagnosed with a grade 3 ankle sprain, the urgent care nurse should reinforce which of the following instructions regarding the patient's weight-bearing status?
a. Weight bearing as tolerated
b. Protected weight bearing
c. Full weight bearing
d. Non weight bearing - CORRECT ANSWER Key: b
Rationale: Treatment for a grade 3 ankle sprain includes protected weight bearing (e.g., with a boot).
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 588
A 29-year-old female is diagnosed with DeQuervain's tenosynovitis. The patient asks the nurse how this condition develops. After reviewing the patient's personal and medical history, the nurse should suspect the injury is MOST likely related to
a. frozen shoulder after her surgery.
b. a recent ankle sprain.
c. prolonged marathon training.
d. repetitive lifting of her infant. - CORRECT ANSWER Key: d
Rationale: DeQuervain's is a painful tenosynovitis of the wrist. It is often called "mother's thumb" due to repetitive lifting and carrying of an infant.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 540
A patient is diagnosed with a scaphoid fracture after falling in an icy parking lot. After a cast is placed for immobilization, the patient asks the nurse how long he will have to wear the cast. Which of the following should represent the nurse's correct response concerning the average time for immobilization?
a. 2 weeks
b. 3 to 4 weeks
c. 30 days
d. 6 to 8 weeks - CORRECT ANSWER Key: d
Rationale: For a scaphoid fracture, a thumb spica short or long arm cast will be placed. Immobilization will be for 6-8 weeks.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 543
A 32-year-old male patient experienced traumatic amputation below the right knee in a motor vehicle crash. During the patient's recovery, the nurse should encourage him to stop smoking and limit coffee intake because nicotine and caffeine
a. cause vasoconstriction and delay healing.
b. cause vasodilation and increase bleeding.
c. decrease blood pressure and increase fall risk.
d. decrease balance and reduce muscle tone. - CORRECT ANSWER Key: a
Rationale: Both nicotine and caffeine cause vasoconstriction (narrowing of blood vessels) that could delay healing and increase risk for infection.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 413
An elevator mechanic and father of three children suffers multiple fractures of both upper and lower extremities in a work-related accident. What intervention by the nurse should demonstrate greatest awareness of the patient's psychosocial needs following this injury?
a. Provide privacy and minimize patient contact.
b. Request career counseling resources from the social worker.
c. Promote recovery by strict adherence to the visiting policy.
d. Spend time with the patient and involve the interprofessional team. - CORRECT ANSWER Key: d
Rationale: Nursing interventions for patients and families in crisis include provision of information, compassion, and hope. An adequate amount of time spent at the bedside can be reassuring. Clinical consults and referral to clergy, social work, and psychologists promote a larger support network.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 396
A construction worker presents with a suspected torn rotator cuff. Through shared decision making, nonsurgical management is identified as the treatment plan. Which of the following should the nurse include in patient teaching?
a. Follow up with a physical therapist and avoid aggravating activities.
b. Encourage a second opinion for surgical repair.
c. Continue with work activity even if reproduces symptoms.
d. Follow up with pain specialist for an interscalene nerve block. - CORRECT ANSWER Key: a
Rationale: Nonsurgical/conservative management of a torn rotator cuff includes physical therapy, analgesia, rest, and avoidance of aggravating activities. Also, subacromial corticosteroid injections can be used for treatment.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 481
A patient who uses a commercial ironing press for 35 hours a week has been diagnosed with carpal tunnel syndrome. The patient asks the nurse how this causes the numbness and pain he is experiencing. The nurse's response should be based on the knowledge that an enlarged ligament compresses the
a. median nerve.
b. ulnar nerve.
c. radial nerve.
d. peroneal nerve. - CORRECT ANSWER Key: a
Rationale: Carpal tunnel syndrome is caused by entrapment of the median nerve by the enlarged transverse carpal ligament. Common symptoms include numbness and tingling in the thumb, index finger, and middle and radial side of the ring finger.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 546
After tripping over a retaining wall in the garden and falling on an extended elbow, a female patient is diagnosed with a supracondylar fracture. The nurse should conduct a detailed neurovascular assessment based on awareness that displacement with this injury may cause
a. saphenous nerve weakness.
b. compartment syndrome.
c. delayed union and numbness.
d. ulnar deviation and hemarthrosis. - CORRECT ANSWER Key: b
Rationale: For a patient with a supracondylar fracture, the nurse's assessment should include a neurovascular assessment because displacement may cause compartment syndrome.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 404
A patient admitted with a hip fracture cannot be sent to surgery for fracture repair until medical clearance can be provided. When the nurse sets up Buck's traction per order, the patient's family asks why the boot is needed. The nurse's answer should be based on knowledge that Buck's traction
a. realigns fracture fragments.
b. relieves pressure over the greater trochanter.
c. decreases muscle spasms.
d. restores anatomic alignment of the leg. - CORRECT ANSWER Key: c
Rationale: Buck's traction is a type of skin traction applied at low weights to decrease spasms of muscles surrounding the fracture. The leg is not manipulated when Buck's traction is applied, so there is no intent to realign fracture fragments or restore anatomic alignment of the leg. The patient may experience pressure over the greater trochanter as a symptom of the fracture.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 551
Following open reduction and internal fixation (ORIF) of a right hip fracture, a patient receives orders to begin anticoagulation therapy. The nurse should recognize the need to review prothrombin time results for which of the following medications?
a. Fondaparinux (Arixtra)
b. Enoxaparin (Lovenox)
c. Rivaroxaban (Xarelto)
d. Warfarin (Coumadin) - CORRECT ANSWER Key: d
Warfarin is the only listed medication requiring careful monitoring of prothrombin time to ensure the drug level is therapeutic. The other medications do not require this monitoring.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 202
A patient had a long leg cast applied for a tibial plateau fracture. Within a short time after arrival on the orthopaedic unit, the patient begins to complain of unrelenting pain. The nurse should contact the physician for an order to bivalve the cast based on the patient's recognized risk of developing
a. venous thromboembolism.
b. compartment syndrome.
c. fat embolism syndrome.
d. deep vein thrombosis. - CORRECT ANSWER Key: b
Rationale: Unrelieved pain, pain with passive stretch, or pain disproportionate to the injury is an early sign of compartment syndrome. Swelling and/or unrelieved external pressure (as from a cast) can contribute to its development. Pressure must be relieved by splitting the cast.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 205
A 10-year-old child is diagnosed with osteochondritis dissecans. The child's parents are advised to modify the child's activity. The nurse should provide instruction on which of the following additional strategies for conservative management?
a. Bracing
b. Non-weight-bearing
c. Knee manipulation
d. Heat therapy - CORRECT ANSWER Key: a
Rationale: Conservative management includes modified activity coupled with immobilization via casting, bracing, or knee splinting. Partial weight-bearing should be maintained with the knee in slight flexion during ambulation.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 583
Following a motor vehicle crash, a patient is hospitalized with a nondisplaced pelvic fracture. Which of the following activity should the nurse recognize as MOST likely for this patient?
a. Strict bedrest
b. Toe-touch weight-bearing
c. Ambulation with rolling walker
d. Bed-to-chair transfers only - CORRECT ANSWER Key: c
Rationale: A patient with a nondisplaced fracture may be allowed protected weight-bearing with the use of crutches, walker, and/or wheelchair. Strict bedrest is unlikely.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 411
Following a fall during mountain climbing, a patient is sent by helicopter to the nearest trauma center. Diagnosed with multiple fractures of the right femoral shaft and tibia, the patient is to be placed in skeletal traction. Which of the following weights should the nurse expect to maintain on the patient's traction?
a. 2 pounds
b. 5 pounds
c. 10 pounds
d. 20 pounds - CORRECT ANSWER Key: d
Rationale: Skeletal traction applies force directly to the bone and allows the use of 20-30 pounds of force. Skin traction (e.g., Buck's traction) is typically limited to 5-7 pounds.
Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 112
A nurse is working with a student in caring for a patient in a long-arm cast after diagnosis with multiple forearm and humeral fractures. The student asks about the surgeon's choice of Plaster of Paris casting material. Which of the following should be the nurse's correct response?
a. "Plaster casts maintain their integrity when exposed to water."
b. "The surgeon prefers plaster for its durability."
c. "Plaster casts dry more quickly than other materials."
d. "The surgeon uses plaster for multiple cast changes." - CORRECT ANSWER Rationale: Plaster cast may be used for severely displaced fractures or when multiple cast changes are expected. Synthetic cast materials dry more quickly than Plaster of Paris, and synthetic casts maintain their integrity when exposed to water. Synthetic cast materials are also more durable than Plaster of Paris.
Reference: Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 115
A 4-year-old child is diagnosed with a pathologic tibial fracture. Based on the child's health history, the nurse should recognize the fracture is MOST likely due to osteopenia associated with which of the following chronic medical conditions?
a. Diabetes mellitus
b. Cerebral palsy
c. Juvenile arthritis
d. Myelomeningocele - CORRECT ANSWER Key: b
Rationale: Pathologic fractures often occur through osteopenic bone in children with neuromuscular disorders, such as cerebral palsy, spina bifida, osteogenesis imperfecta, and dysplasia.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 308
Physical abuse is suspected to be a factor in the diagnosed injuries of a 4-year-old admitted to the emergency department. The nurse should recognize which of the following types of fracture as the MOST likely result of abuse in a child of this age?
a. Physeal fracture
b. Hand fracture
c. Tibial fracture
d. Diaphyseal fracture - CORRECT ANSWER Key: a
Physeal (growth plate) fractures in young children are most suggestive of abuse. Lower extremity fractures (to include tibial and diaphyseal fractures) in a non- ambulatory child may suggest physical abuse. Hand and foot fractures in infants and toddlers also may suggest abuse.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 311
A patient who works for a moving company is diagnosed with a herniated lumbar disk. Conservative treatment is initiated and the nurse provides patient education about this condition. Which of the following statements should be MOST important for the nurse to include?
a. "Apply ice packs and elevate your leg if you have sudden swelling and warmth in one of your legs."
b. "I will refer you to a vocational counselor to discuss new career opportunities."
c. "I think it might be beneficial for you to discuss your feelings with a psychologist."
d. "Contact your doctor at once if you experience any progressive weakness in your legs." - CORRECT ANSWER Key: d
Rationale: Progressive neurological weakness, increased pain, incontinence of bowel and bladder, perineal and perianal numbness, and loss of rectal sphincter tone are characteristics of cauda equina syndrome. This is an emergency; the patient should be evaluated within 2-4 hours to prevent permanent nerve damage.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 455
A patient with a femoral neck fracture undergoes hemiarthroplasty. Among the strategies to decrease the risk of postoperative venous thromboembolism, the nurse should reinforce instruction on performing which of the following exercises?
a. Straight leg raises
b. Gluteal sets
c. Ankle pumps
d. Quadriceps sets - CORRECT ANSWER Key: c
Rationale: Ankle pumps cause contraction of the calf muscle, which encourages blood return to the heart. If blood is not pooling in the lower extremities, clots are less likely to develop.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 202
A farmer is brought to the emergency department after three fingers on his right hand are amputated in a machine. Paramedics have the amputated fingers, and they tell the nurse the patient was adamant about having the fingers re-implanted. How should the nurse maintain the amputated fingers to provide the best opportunity for re-implantation?
a. Place them in a sterile bag on dry ice.
b. Wrap them in sterile gauze and place in a plastic bag.
c. Keep them directly on fresh ice.
d. Place them in a sterile container and cover with saline. - CORRECT ANSWER Key: b
Rationale: On scene, amputated parts should be wrapped in gauze (either dry or moistened with saline) and placed in a plastic bag or container. The bag should not be placed directly on ice, and dry ice should never be used; the parts cannot be allowed to freeze. The nurse should maintain the fingers in the same condition.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 412
A patient whose legs had been trapped under heavy equipment for several hours is brought to the emergency department. Because of the nature of the crush injury, the nurse is concerned about development of rhabdomyolysis. Which of the following should the nurse assess carefully to determine if this complication is developing?
a. Liver function tests
b. Fingerstick glucose
c. C-reactive protein
d. Urine output - CORRECT ANSWER Key: d
Rhabdomyolysis is a result of muscle destruction from the primary crush injury, which causes a release of myoglobin and potassium that can lead to renal dysfunction and failure. Identification of this condition is based on assessment of urine output and color, along with serial blood counts.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 415
After 3 weeks in training, an 18-year-old military recruit is diagnosed with a stress fracture of the talus in his left foot. A fracture shoe is prescribed and the patient is placed on protected weight-bearing with crutches. The recruit asks the nurse how long the activity restrictions will be necessary. Which of the following should represent the nurse's correct response?
a. "Activity restrictions typically last 2-4 weeks."
b. "The bone should be healed in about 6-8 weeks."
c. "Stop using crutches in a week, but continue to use the fracture shoe."
d. "Continue protected weight-bearing for at least 4 months." - CORRECT ANSWER Key: b
Rationale: Treatment for all fractures of the foot start with resting the bone, usually 6-8 weeks.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 593 [Show Less]