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Orthopedic NCLEX Questions and Verified Rationalized
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- A retired 66- year- old female patient is being evaluated for osteoporosis as part of a yearly physical exam. The patient states that she is a smoker, watches television for most of the day, and has been hospitalized twice with fractures within the last year. Based on this information, the nurse suspects which condition? A. Low bone mass leading to increased bone fragility B.Degeneration of the articular cartilage C.Recurrent attacks of acute arthritis D.Personality changes caused by chronic nature of illness: A. Low bone mass leading to increased bone fragility ' Low bone mass, structural deterioration of bone tissue leading to bone fragility, and increased susceptibility to fractures are seen with osteoporosis. The patient also has risk factors associated with osteoporosis: smoking, sedentary lifestyle, and being female and menopausal. Degenerative changes are associated with frequent exacerbations of arthritis. There is no indication of personality change in this patient.
- The nurse determines that a 55- year-old female patient is experiencing menopause and is also at risk for osteoporosis. What foods other than milk can the nurse suggest to this patient to increase calcium intake? A. Seafood, wheat, corn, green vegetables
B. Chicken vegetables, green vegetables, pasta, broccoli C. Green vegetables, sardines, salmon with bone, molasses D. Fresh fruits, English muffins, black beans, asparagus: Answer C is correct. Women of menopausal age are at risk for osteoporosis, and foods high in calcium should be encouraged. A diet with green vegetables, sardines, salmon with bone, and molasses provides high- quality calcium and is recommended for a patient experiencing menopause in order to decrease the risk of osteoporosis. A diet with seafood, wheat, corn, and green vegetables is more concentrated in carbohydrates than proteins containing more calcium. A diet with chicken, green vegetables, sar- dines, and broccoli contains some calcium but is lower than the other option. Foods such as fresh fruits, English muffins, black beans, and asparagus are inadequate in calcium.
- A patient with osteoporosis has been advised to increase the amount of calcium in her diet. Which food provides the most calcium? An 8- oz glass of milk An ounce of cheddar cheese A half cup of raw broccoli
an example of a selective estrogen receptor modulator that is used to treat osteoporosis, and which also reduces the risk of invasive breast cancer. Calcitonin (Miacalcin) is dispensed as a nasal spray.
- The nurse is caring for a patient with osteoporosis who is being discharged on alendronate (Fosamax). Which statement would indicate effective teach- ing? A. "I should take the medication immediately before bed" B. "I should remain in an upright position for 30 minutes after taking the medication" C. "The medication is more effective if I take it with milk or dairy products" D. If I skip a dose, I can take two tablets the next time": Answer: B- Rationale should remain upright for 30 mins.
- How long does a patient taking bisphosphonates need to stay upright after administration?
A. 10 minutes B. 20 minutes C. 30 minutes D. 120 minutes: 30 minutes Bisphosphonates are administered on arising in the morning with a full glass of water on an empty stomach, and the patient must stay upright for 30 to 60 minutes.
- When caring for a client with hypocalcemia, the nurse should assess for: A. A decreased level of consciousness B. Tetany C. Bradycardia D. Respiratory Depression: Answer B is correct. The most common complication of hypocalcemia is overstimulation of the nerves and muscles. Tetany, which can progress to convulsions, indicated that the patient's condition is worsening. Answer A is incorrect because a decreased level of consciousness is not associated with hypocalcemia. Tachycardia, not bradycardia, is associated with hypocalcemia, mak- ing answer C incorrect. Answer D is incorrect because respiratory depression is not directly related to hypocalcemia.
- A patient has been diagnosised with osteomalacia. What symptoms does the nurse recognize that correlate with the diagnosis? A. Bone fractures and kyphosis B. Bone pain and tenderness C. Muscle Weakness and spasms D. Softened and compressed vertebrae: Rationale: Answer B is correct.
- The patient who is taking alendronate (Fosamax) is at high risk
B. Osteosarcoma C. Paget's disease of the bone D. Osteochondroma: Answer: B Rationale: Patients who have received radiation for other forms of cancer are at high risk for developing osteosarcoma. Osteomalacia is caused by a vitamin D deficiency. Paget's disease is a metabolic disorder of bone remodeling. Osteochondroma is a benign bone tumor that has its onset in childhood
- An expected outcome of an older patient with acute osteomyelitis is: A. Pain B. Fatigue C. Low-grade fever D. Elevated leukocyte count: Answer: C Rationale: Common presenting symptoms of osteomyelitis are pain, fever, edema, elevated leukocyte count, fatigue, and general malaise. However, older adults may not have an extreme temperature elevation because of lower core body temperature and compromised immune system that occur with normal aging.
- Certain transdermal patches must be removed before an MRI is performed because they can cause burns. True False: True. Rationale:Transdermal patches (eg, NicoDerm, Transderm Nitro, Transderm Scopo- lamine, and Catapres-TTS) that have a thin layer of aluminized backing must be removed before an
MRI because they can cause burns
- A patient is admitted for an MRI, a CT scan, and a myelogram.Which of the following medication orders should be questioned for the patient who is to have a myelogram? A. Ampicillin 250mg PO q6H B. Motrin 400mg PO q4h PRN for headache C. Seconal 50mg HS PRN sleep D. Darvon 65mg PO q4h for pain: Rationale: Answer C is correct. Seconal is a barbiturate, and CNS depressants and stimulants, as well as phenothiazines, should not be given for 48 hours prior to a mylegram because they decrease the sizure threshold. Ampicillin is an antibiotic, Motrin is an NSAID, and Darvon is an analgesic, so they can all be given, making answers A,B, and D wrong.
- Which findings indicates a need for further assessment of the patient scheduled for a magnetic resonance imaging (MRI)?
B. "I will bend at the waist when I am lifting objects from the floor." C. "I will avoid prolonged sitting or walking." D. "Instead of turning around to grasp an object, I will twist at the waist.": An- swer C
- What findings can be identified with the use of radiography of the spine? A. Fracture, dislocation, infection, osteoarthritis, or scoliosis B. Infections, tumors, and bone marrow abnormalities C. Soft tissue lesions adjacent to the vertebral column D. Spinal nerve root disorders: A. Fracture, dislocation, infection, osteoarthritis, or scoliosis Radiography of the spine may demonstrate a fracture, dislocation, infection, os-
teoarthritis, or scoliosis. Bone scan and blood studies may disclose infections, tu- mors, and bone marrow abnormalities. Computed tomography is useful in identifying soft tissue lesions adjacent to the vertebral column. An electromyogram is used to evaluate spinal nerve root disorders.
- The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine What does the nurse understand this common finding is known as? A.Lordosis B.Scoliosis C.Osteoporosis D.Kyphosis: Rationale: Answer D is correct.
- The nurse observes that an 18 - year- old female patient has asymmetry of the shoulders and hips, and the hem of her dress is uneven. The nurse suspects that the patient may be presenting with which disorder? A. Congenital hip dislocation B. Scoliosis C. Fractured tibia D. Degenerative disc disease: Rationale: Answer B is correct. A classic sign of scoliosis is asymmetrical dress or skirt hem caused by unevenness of affected shoulder and hip, due to a lateral curvature of the spine.The spinal deformity causes the asymmetry. Congenital hip dislocation is diagnosed during infancy. Signs of a fractured tibia would include painful ambulation, not unevenness of the shoulder and hip. Degenerative disc disease is typically experienced by older adults and causes a uniform decline in height.
- An important question to ask a patient with low back pain is: A. "How does your back pain affect your activities of daily living?" B. "Tell me about your pain and what interventions are helpful in managing your pain."
D. Crepitus: Kyphosis Rationale: Common deformities of the spine include kyphosis, which is an increased forward curvature of the thoracic spine.
- Most back pain is self-limited and resolves within weeks with anal- gesics, rest, stress reduction, and relaxation. A. 1 B. 2 C. 3 D. 4: D. 4 Rationale: Most back pain is self-limited and resolves within 4 weeks with analgesics, rest, stress reduction, and relaxation.
- The physician orders Rocephin 2g in 100ml to infuse over 45 mins for a post-op total hip patient. The IV is to infuse via a macro drip (10 gtts per ml). The nurse should set the IV rate at: A. 12 gtts/min B. 22 gtts/min C. 32 gtts/min D. 42 gtts/min: Rationale: Answer B is correct. The total to be infused (100ml) divided by the total time in minutes (45 minutes) times the drip factor (10gtt) equals 22 gtts per minute. The other answers are mathematically incorrect.
- The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? Select all that apply. A.Checking the urine for hematuria B.Palpating peripheral pulses in both lower extremities C.Testing the stool
for occult blood D.Assessing level of consciousness E.Assessing pupillary response: Rationale: Correct answer is A,B, and C
- While horseback riding a patient fell from the hose sustaining a pelvic fracture. What complications should the nurse know to monitor for that are common to pelvic fractures? A. Paresthesia and ischemia B. Hemorrhage and shock C. Paralytic ileus and a lacerated urethra D. Thrombophlebitis and infection: Answer B
- Which of the following findings is most typical of a client with a fractured hip? A. Pain in the hip and affected leg B. Diminished sensation in the affected leg C. Absence of pedal and femoral pulses in the affected extremity
- The nurse is performing a post-op assessment of an elderly patient with a total hip repair. Although he has not requested medication for pain, the nurse suspects that the patient's discomfort is severe and prepares to administer pain medication. Which of the following signs would not support the nurse's assessment of acute post- op pain? A. Increased blood pressure B. Inability to concentrate C. Dilated pupils D. Decreased heart rate: Rationale: Answer D is correct. The patient in acute pain experiences physiological arousal similar to the fight or flight response- for example, an increased (not decreased) heart rate, an increased BP, and dilated pupils. Answers A,B, and C are wrong because increased BP, inability to concentrate, and dilated pupils are reactions to pain. The question asks which does not support as assessment of post-op pain, so answer D is correct.
- To prevent dislocation of a hip prosthesis following a total hip replacement, the nurse should: A. Maintain the patient's affected leg in an adducted position B. Maintain the patient's affected hip in a flexed position C. Tell the patient to remain in supine position D. Place an abduction pillow between the patient's leg: Rationale: Answer D is correct. The patient's leg should be maintained in an abducted position to prevent dislocation of the prosthesis. This is accomplished by the use of an abduction pillow. Answers A and B will increase the likelihood of dislocation of the prosthesis; therefore, they are incorrect. Answer C is unnecessary; therefore, it is incorrect.
- The nurse at an orthopedic joint clinic is preparing pre-operative teaching for a patient scheduled for total hip replacement surgery. Which would be included in the teaching plan? A. Avoid sitting in a chair B. Make sure that commode seats are at low levels C. Avoid crossing the legs when sitting D. Physical Therapy will assist with adduction exercises: Rationale: Answer C is correct. The patient with joint hip replacement should avoid adduction of the legs and flexion of the hips greater than 90 degrees to ensure continued placement of the prosthetic joint. It is recommended for these patients to use recliners for seating instead of straight chairs., therefore A is incorrect. Commode seats will have to be raised and abduction of the legs is required, making B and D incorrect choices.
- The nurse is preparing a teaching plan for a patient who is being dis- charged following a total hip replacement.The nurse would include which part of the following
C. Decrease the pain associated with early ambulation D. Alleviate lactic acid production in the leg muscles: Answer B is correct. The primary purpose of the continuous passive motion machine is to promote flexion of the artificial joint. Answers A,C, and D do not describe the purpose of the CPM machine; therefore, they are incorrect.
- A patient with a total knee replacement returns from surgery. Which find- ings require immediate nursing intervention? A. The is 30ml bloody drainage from the surgical drain B. The continuous passive motion machine is set on 90 - degree flexion C. The patient is unable to ambulate to the bathroom D. The patient is complaining of muscle spasm: Answer B is correct. The CPM machine should not be set at 90-degree flexion until the fifth postoperative day. Answers A, C, and D are expected findings and do not require immediate nursing intervention, so they are incorrect
- Is the following statement True or False? Testing for crepitus can produce further tissue damage and should be avoid- ed.: True Testing for crepitus can produce further tissue damage and should be avoided.
- An elderly patient with a fractured hip is placed in Buck's traction. The primary purpose for Buck's traction for the patient is: A. To decrease muscle spasm B. To prevent the need for surgery C. To alleviate the pain associated with the fracture D. To prevent bleeding associated with the hip fractures: Rationale: Answer A is correct.
Buck's traction is a skin traction used to decrease muscle spasms. Buck's traction will not prevent the need for surgery, making answer B wrong. It also will not alleviate the pain associated with the fracture or prevent bleeding, so answers C and D are wrong.
- Is the following statement true or false? The nurse must never remove weights from skeletal traction unless a life- threatening situation occurs.: True The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs. Removal of the weights completely defeats their purpose and may result in injury to the patient.
