Final Test Session

2nd Professional BSN,4 year Programme

Subject: Adult Health Nursing II

Topic: Unit I (Orthopaedic Nursing)

Name:_______________ Roll No._____________ Date:_____________ Total Marks:65

(Objective Section)

Encircle the correct answer:

1. An expected outcome of cast application that the nurse evaluates is:

a. Skin irritation at the cast edges
b. Decreased capillary refill and pallor
c. Tingling and numbness distal to the cast
d. Slight edema, soreness, and limitation of range of motion
2. An appropriate technique for the nurse to implement for the client who is being cast is to:
a. Apply ice to the top of the cast
b. Maintain the extremity below heart level
c. Handle the wet cast with the fingertips
d. Fold the stockinette or padding over the outer cast edges.
3. For cast removal, the nurse correctly instructs the client that:
a. Discomfort will be felt from the cast saw.
b. An enzyme wash may be applied to intact skin.
c. The skin will be scrubbed very well after the removal.
d. Aggressive range-of-motion exercises will be performed after removal.
4. A nurse anticipates that the type of traction that will be used for a 32-lb child with a fractured
femur is:
a. Bryant’s traction
b. Dunlop’s traction
c. Weil sling
d. Buck’s extension traction
5. A nurse anticipates that the type of traction that will be used for an adult client with a
fractured humerus is:
a. Bryant’s traction
b. Dunlop’s traction
c. Weil sling
d. Buck’s extension traction
6. For a client who is to be placed in Russell’s traction, the nurse prepares the:
a. Occipital area
 b. Arm and forearm
c. Back and abdomen
d. Lower extremities
7. An appropriate technique for the nurse to implement for a client being placed in traction is to:
a. Apply a traction boot tightly
b. Drop the weights after the traction is attached
c. Assess the neurovascular status every 1 to 2 hours for the first day
d. Shave the hair off the area where the traction is to be placed
8. While in Buck's extension traction, the client may be positioned:
a. On the back, with the knees flexed 45 degrees.
b. On the back, turning to the unaffected side for 10- to 15-minute periods.
c. On the back, with the buttocks slightly elevated off the bed.
d. On the back, with the bed tilted toward the side that is opposite the traction.
9. For a client with a fractured femur, a nurse is alert to the possibility of a fat embolus. The
nurse specifically watches for:
a. Bradypnea
b. Restlessness
c. Bradycardia
d. Hypertension
10. For a client in traction who has skeletal pins, a nurse should:
a. Use povidone-iodine to cleanse the pin site.
b. Apply antiseptic ointment and cover with a split dressing.
c. Use hydrogen peroxide as a rinse before a dressing is applied.
d. Do both pin sites at the same time, with the same swab and solution.
11. Injury to the popliteal artery in fracture lower end of femur is often due to?
a. Distal fragment pressing the artery
b. Proximal fragment pressing the artery
c. Tight plaster
d. Hematoma
12. During the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution
should the patient use to protect the ankle joints?
a. Voidance of all walking
b. Bedrest with foot elevated
c. Rom exercises
d. Use of ankle splints
13. Which of the following is the definitive diagnostic test for juvenile idiopathic/rheumatoid
arthritis?
a. There is no definitive test
b. Rheumatoid factor (RF)
c. Human leukocyte antigen (HLA) B 27
d. Erythrocyte sedimentation rate (ESR)
14. 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
15. 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
16. A patient with osteoporosis has been advised to increase the amount of calcium in her diet.
Which food provides the most calcium?
a. An 8- oz glass of milk
b. An ounce of cheddar cheese
c. A half cup of raw broccoli
d. A 4- ounce salmon croquette
17. Which of the following instructions should be included for the patient taking calcium
supplements?
a. The patient should take her calcium with meals
b. The patient should take all her daily calcium supplements at one time
c. The patient should take her calcium supplement after meals to prevent stomach upset
d. The patient can use calcium- based antacids for supplement.
18. 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
19. 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
20. The patient who has completed radiation therapy treatments for a form of cancer is at high
risk for developing:
a. Osteomalacia
b. Osteosarcoma
c. Paget's disease of the bone
d. Osteochondroma
21. An expected outcome of an older patient with acute osteomyelitis is:
a. Pain
b. Fatigue
c. Low-grade fever
d. Elevated leukocyte count
22. Which findings indicates a need for further assessment of the patient scheduled for a
magnetic resonance imaging (MRI)?
a. The patient is an insulin- dependent diabetic
b. The patient refuses a corner bed
c. The patient is allergic to shellfish
d. The patient has a history of asthma
23. The primary defect in osteomalacia is a deficiency in which vitamin?
a. B12
b. D
c. E
d. C
24. The nurse has educated a patient with low back pain about techniques to relieve the back
pain and prevent further complications. What statement by the patient shows understanding
of the education the nurse provided?
a. "I will lie down prone with my legs slightly elevated."
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."
25. 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
26. 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
27. 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
28. 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."
c. "How long have you had back pain?"
d. "Have you ever had magnetic resonance imaging to find a cause for your back pain?"
29. Which of the following is characterized by an increased forward curvature of the thoracic
spine?
a. Lordosis
 b. Kyphosis
c. Scoliosis
d. Crepitus
30. Most back pain is self-limited and resolves within __ weeks with analgesics, rest, stress
reduction, and relaxation.
a. 1
b. 2
c. 3
d. 4
31. 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
32. 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
d. Misalignment of the affected extremity
33. 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
34. 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
35. A patient with a total knee replacement returns from surgery. Which findings 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
36. 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
37. A patient complains of tingling and numbness in his right leg following application of a long leg
cast. The patient's discomfort is most likely the result of:
 a. Reduced venous return
b. Bone healing
c. Arterial insufficiency
d. Nerve compression
38. Which activity is most appropriate for a three- year old with a cast?
a. Barbie doll and accessories
b. Toy telephone
c. Coloring book and crayons
d. Puzzles
39. Most common cause of pathological fracture in a child is
a. Malignancy
b. Bone cyst
c. Fibrous dysplasia
d. Paget's disease
40. A lady presents with a history of fracture radius, which was put on plaster of paris casts for 4
weeks. After that she developed swelling of hands with shiny skin. What is the most likely
diagnosis.
a. Rupture of extensor pollicis longus tendon
b. Myositis ossificans
c. Reflex sympathetic dystrophy
d. Malunion.
41. Common injury to baby is
a. Fracture humerus
b. Fracture clavicle
c. Fracture radius-ulna
d. Fracture femur
42. A patient develops compartment syndrome (swelling, pain and numbness) following
manipulation and plaster for fracture of both bones of leg. What is the best treatment?
a. Split the plaster
b. Infusion of law molecular weight dextran
c. Elevate the leg after splitting the plaster
d. Do operative decompression of fascial compartment
43. Patient with supracondylar fracture following reduction presented with claw hand. The likely
diagnosis is
a. Volkmann's ischaemic contracture
b. Median nerve injury
c. Ulnar nerve injury
d. Dupuytrens contracture
44. Volkmann's ischemic contracture mostly involves
a. Flexor digitorum superficialis
b. Pronator teres
c. Flexor digitorum profundus .
d. Flexor carpi radialis longus
45. Pathognomic sign of traumatic fracture
a. Swelling
 b. Tenderness
c. Redness
d. Crepitus
46. Treatment of Acute myositis Ossificans is
a. Active mobilization
b. Passive mobilization
c. Infra Red therapy
d. Immobilization
47. Stiffness in knee is maximum when traction is at
a. Skin
b. lower end femur
c. upper end tibia
d. calcaneum
48. Intramedullary fixation is ideal in a case of fracture of shaft of femur when there is
a. A transverse fracture
b. A compound fracture
c. Soft tissue interposition between the fractured ends
d. Such a fracture in a child
49. The last step in the healing of a fracture is
a. Hematoma formation
b. Consolidation
c. Remodelling
d. Callus formation
50. Patient comes with fracture of femur in an acute accident, the first thing to do is
a. Secure airway and treat the shock
b. Splinting
c. Physical examination
d. X-Rays

(Subjective Section)
1. Write down the pre and post operative care for a patient undergoing musculoskeletal surgeries
2. Write down the nursing intervention for a patient with a spontaneous vertebral fracture
3. Define different types of fractures