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ONC® Certification practice questions

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Question 1Orthopaedic Nursing Practice

A patient is 6 hours post total hip arthroplasty with a posterior approach. Which instruction should the nurse give to prevent dislocation?

  1. Sleep with the operative leg internally rotated and the knee straight
  2. Sit in a low recliner chair for prolonged periods to keep the hip flexed
  3. Avoid bending the hip beyond 90 degrees and avoid crossing the legs Correct answer.
  4. Keep the operative leg adducted across the midline while lying supine

Explanation

Posterior-approach hip precautions restrict hip flexion past 90 degrees, adduction across the midline, and internal rotation, because these motions direct the femoral head toward the weakened posterior capsule. An abduction pillow and neutral positioning protect the repair. Crossing the legs combines adduction and flexion and is the classic dislocating maneuver.

Question 2Orthopaedic Nursing Practice

Which finding is the earliest and most reliable indicator of compartment syndrome in a patient with a tibial shaft fracture?

  1. Pain out of proportion to the injury that worsens with passive stretch Correct answer.
  2. Loss of sensation in the entire foot
  3. Absent distal pulse
  4. Pallor of the toes

Explanation

Compartment syndrome is a clinical diagnosis in which ischemic muscle pain exceeds what the visible injury explains and intensifies when the muscle is passively stretched. Pulses usually remain palpable because the pressure is in the compartment, not the major artery, so waiting for pulselessness delays treatment. Pallor and sensory loss are later findings.

Question 3Orthopaedic Nursing Practice

A patient with a new below-knee cast reports increasing pain and the nurse notes the toes are cool and dusky. What is the priority nursing action?

  1. Notify the provider immediately for cast evaluation and possible bivalving Correct answer.
  2. Elevate the limb above heart level and reassess in one hour
  3. Apply a warm compress over the cast and document the finding
  4. Administer the prescribed opioid and reassess pain in 30 minutes

Explanation

Cool, dusky toes with escalating pain in a casted limb suggest impaired perfusion or compartment syndrome, which requires urgent provider notification so the cast can be split or bivalved. Elevation above heart level can reduce arterial inflow and worsen ischemia. Analgesia does not treat the underlying pressure.

Question 4Orthopaedic Nursing Practice

Which laboratory value is most important to monitor for a patient receiving IV gentamicin after an open fracture?

  1. Alkaline phosphatase
  2. Platelet count
  3. Serum creatinine Correct answer.
  4. Serum potassium

Explanation

Aminoglycosides such as gentamicin are nephrotoxic and ototoxic, so renal function must be tracked during therapy. A rising serum creatinine signals accumulating drug and nephron injury and may prompt dose adjustment. Potassium and platelets are not the primary monitoring parameters for this drug.

Question 5Orthopaedic Nursing Practice

A patient with a suspected hip fracture is lying with the affected leg shortened and externally rotated. Which action should the nurse take first?

  1. Apply a heating pad to the hip for comfort
  2. Perform range-of-motion exercises on the affected hip
  3. Assist the patient to walk to assess weight-bearing tolerance
  4. Keep the patient on bed rest and immobilize the limb while awaiting imaging Correct answer.

Explanation

Shortening and external rotation after a fall suggest a displaced femoral neck or intertrochanteric fracture. The limb should be kept immobile and the patient non-weight-bearing until imaging confirms the diagnosis, because movement can displace fragments and increase bleeding and pain. Early surgical fixation is the usual definitive plan.

Question 6Orthopaedic Nursing Practice

Which assessment finding is most characteristic of a fat embolism syndrome developing 24 to 72 hours after a long bone fracture?

  1. Sudden hematuria with flank pain
  2. Bradycardia with hypertension
  3. Unilateral calf swelling with a positive Homans sign
  4. Petechial rash over the chest and axillae with hypoxemia Correct answer.

Explanation

Fat embolism syndrome classically presents with the triad of respiratory distress, neurologic changes, and a petechial rash on the chest, axillae, or conjunctivae, typically 24 to 72 hours after fracture. Hypoxemia is often the earliest sign. Tachycardia, not bradycardia, is expected.

Question 7Orthopaedic Nursing Practice

A patient in skeletal traction for a femoral fracture has a new onset of confusion, tachycardia, and a temperature of 38.9 C. Which complication should the nurse suspect first?

  1. Constipation from immobility
  2. Pin site infection with possible sepsis Correct answer.
  3. Muscle atrophy from traction
  4. Disuse osteoporosis

Explanation

Skeletal traction pins breach the skin and create a direct route for bacteria into bone and soft tissue. New fever, tachycardia, and altered mental status in this setting raise concern for pin site infection progressing to sepsis and warrant prompt assessment of the sites and provider notification. Disuse changes are chronic, not acute with fever.

Question 8Orthopaedic Nursing Practice

Which statement about the use of a continuous passive motion (CPM) machine after total knee arthroplasty is accurate?

  1. The machine replaces the need for active exercise and ambulation
  2. The machine should be used only while the patient is asleep
  3. The limb should be positioned so the knee is at the machine's hinge point Correct answer.
  4. The machine should be set so the patient experiences sharp pain at the end range

Explanation

Correct alignment places the knee joint at the hinge of the CPM machine so motion is transmitted through the joint without shear or excessive strain. Range of motion settings are progressed within the patient's tolerance, not into sharp pain. CPM supplements, but does not replace, active exercise and early ambulation.

Question 9Orthopaedic Nursing Practice

Which intervention best reduces the risk of venous thromboembolism in a patient recovering from hip fracture surgery?

  1. Prescribed anticoagulant plus early mobilization and sequential compression devices Correct answer.
  2. Keeping the knees flexed on a pillow at all times
  3. Strict bed rest for the first 72 hours
  4. Massaging the calves several times per shift

Explanation

Venous thromboembolism prophylaxis after major orthopaedic surgery combines pharmacologic anticoagulation with mechanical measures and early mobilization. Ambulation restores venous return, and compression devices counter stasis while the patient is in bed. Calf massage and prolonged immobility do not prevent clot formation.

Question 10Orthopaedic Nursing Practice

A patient is being taught to use a walker after a total hip replacement. Which technique should the nurse reinforce?

  1. Lift the walker off the floor with each step to move faster
  2. Advance the operative leg and walker together while bearing full weight immediately
  3. Advance the walker first, then step into it with the operative leg leading Correct answer.
  4. Hold the walker in front and lean body weight backward while stepping

Explanation

The safe walker sequence is to move the walker forward first, then step into it, keeping the device close and all four tips on the floor. This maintains a stable base and keeps the patient's center of gravity over the support. Weight-bearing status must follow the surgeon's order rather than an assumed full weight-bearing.

Question 11Orthopaedic Nursing Practice

Which nursing measure is most appropriate for preventing skin breakdown under a plaster cast?

  1. Insert a knitting needle along the cast to scratch itchy skin
  2. Inspect the skin at the cast edges and pad bony prominences before application Correct answer.
  3. Apply lotion to the skin beneath the cast each shift
  4. Powder the skin under the cast edges daily

Explanation

Skin protection starts before the cast is applied, with padding over bony prominences, and continues with regular inspection of the skin at the cast margins for redness, maceration, or pressure. Nothing should be inserted inside a cast because it can abrade the skin and create infection risk. Moisture-trapping products under the cast promote breakdown.

Question 12Orthopaedic Nursing Practice

A patient with an external fixator for a tibial fracture has erythema, warmth, and purulent drainage at a pin site. Which action should the nurse take?

  1. Ignore the drainage because it is expected with external fixation
  2. Report the findings to the provider and obtain a wound culture as ordered Correct answer.
  3. Clean the site with alcohol and apply a tight dressing
  4. Loosen the fixator clamps to relieve pressure

Explanation

Purulent drainage with erythema and warmth at a pin site indicates infection, which can progress to osteomyelitis in an externally fixated bone. The provider should be notified and a culture obtained per orders to guide antibiotic therapy. Fixator clamps are never adjusted by nursing because alignment and stability depend on them.

Question 13Orthopaedic Nursing Practice

Which finding should the nurse report immediately in a patient who had spinal fusion surgery 12 hours ago?

  1. Mild incisional pain relieved by the prescribed analgesic
  2. Urinary retention relieved by straight catheterization
  3. Serosanguineous drainage on the dressing
  4. Clear fluid draining steadily from the incision with a headache when upright Correct answer.

Explanation

Clear, steady drainage from a spinal incision may represent a cerebrospinal fluid leak from a dural tear, and the associated postural headache supports that concern. A leak raises the risk of meningitis and requires prompt provider notification. Serosanguineous drainage and controlled pain are expected after surgery.

Question 14Orthopaedic Nursing Practice

Which statement about osteoporosis is accurate for a postmenopausal patient?

  1. Bone loss accelerates after menopause because estrogen deficiency increases osteoclast activity Correct answer.
  2. Weight-bearing exercise is contraindicated in all patients with osteoporosis
  3. Calcium supplementation alone reliably restores bone density
  4. Osteoporosis causes pain until the first fracture occurs

Explanation

Estrogen restrains osteoclast-mediated resorption, so its decline after menopause tips remodeling toward bone loss. Osteoporosis is often asymptomatic until a fragility fracture occurs. Management combines adequate calcium and vitamin D, weight-bearing and resistance exercise, fall prevention, and pharmacologic therapy when indicated.

Question 15Orthopaedic Nursing Practice

A patient with a new above-knee amputation has a rigid dressing. Which assessment is most important in the first 24 hours?

  1. Keeping the limb dependent to promote drainage
  2. Measuring the residual limb for a permanent prosthesis
  3. Checking the dressing for excessive bleeding and monitoring distal perfusion and pain Correct answer.
  4. Beginning vigorous residual limb strengthening exercises

Explanation

The immediate postoperative priority after amputation is hemorrhage control and perfusion assessment, since major vessels were ligated. The dressing is checked for saturation and the patient monitored for signs of hypovolemia. Prosthetic measurement and vigorous exercise come later in rehabilitation.

Question 16Orthopaedic Nursing Practice

Which instruction should the nurse give a patient about to undergo magnetic resonance imaging of the lumbar spine?

  1. Eat a full meal immediately before the scan to prevent nausea
  2. Remove all metal objects and report any implanted pacemaker or metal hardware Correct answer.
  3. Keep the limbs completely still but continue normal activity during the scan
  4. Expect that the scan uses ionizing radiation

Explanation

The strong magnetic field of an MRI scanner attracts ferromagnetic objects and can heat or displace implanted devices, so all metal must be removed and implants disclosed. Pacemakers and certain aneurysm clips may be contraindications. MRI uses magnetic fields and radio waves, not ionizing radiation.

Question 17Orthopaedic Nursing Practice

A patient with a Colles fracture has a new onset of severe pain, paresthesia, and pain with passive finger extension. Which action is the priority?

  1. Document the findings and continue the current plan
  2. Perform active range of motion to relieve the pressure
  3. Notify the provider for urgent evaluation of compartment pressure Correct answer.
  4. Apply ice and reassess at the next shift

Explanation

Escalating pain, paresthesia, and pain on passive stretch after a distal radius fracture point to acute compartment syndrome, a surgical emergency. The provider must be notified immediately so pressure can be assessed and fasciotomy or cast release performed if needed. Delay risks Volkmann contracture and permanent nerve damage.

Question 18Orthopaedic Nursing Practice

Which factor most increases a patient's risk for developing a pressure injury while immobilized in traction?

  1. A Braden score indicating low risk
  2. Use of an alternating pressure overlay mattress
  3. Frequent repositioning within the limits of the traction setup
  4. Moisture from incontinence combined with prolonged pressure over bony prominences Correct answer.

Explanation

Pressure injury risk rises when sustained pressure over a bony prominence is combined with moisture, friction, and shear. Incontinence macerates skin and lowers its tolerance to pressure. Low Braden scores, specialty surfaces, and repositioning all reduce risk rather than increase it.

Question 19Orthopaedic Nursing Practice

A patient receiving enoxaparin after knee arthroplasty asks why the injection is given in the abdomen. Which response is most accurate?

  1. The abdomen has fewer nerve endings than the arm
  2. The abdomen absorbs the drug faster than the thigh
  3. The abdomen provides a large, well-perfused area for subcutaneous absorption with less muscle irritation Correct answer.
  4. Abdominal injection avoids the need to rotate sites

Explanation

Enoxaparin is given subcutaneously into the fatty tissue of the abdomen, which is well perfused and allows reliable absorption while avoiding intramuscular delivery that could cause hematoma. Sites should still be rotated and the air bubble retained to clear the needle. Injections are given at least 5 cm from the umbilicus.

Question 20Orthopaedic Nursing Practice

Which finding suggests that a patient's newly applied arm cast is too tight and requires immediate intervention?

  1. Mild itching under the cast edges
  2. The patient can wiggle the fingers freely
  3. Progressive numbness and inability to extend the fingers Correct answer.
  4. Capillary refill of 2 seconds in the fingers

Explanation

Progressive numbness with loss of active finger extension indicates nerve and muscle ischemia from cast constriction or rising compartment pressure. This is an emergency requiring cast release. Normal capillary refill and preserved finger movement suggest adequate perfusion.

Question 21Orthopaedic Nursing Practice

Which position is appropriate for a patient after a total hip arthroplasty using an anterior approach?

  1. Keep the hip flexed past 90 degrees with the knee bent
  2. Avoid extremes of hip extension and external rotation Correct answer.
  3. Cross the legs to keep the hip adducted
  4. Lie prone with the hip fully extended for the first 24 hours

Explanation

Anterior-approach precautions restrict hip extension and external rotation because those motions stress the anterior capsule. Posterior precautions such as avoiding flexion past 90 degrees apply to posterior approaches, so the two sets must not be confused. The exact protocol follows the surgeon's orders.

Question 22Orthopaedic Nursing Practice

Which assessment is most important for a patient with Paget disease of bone?

  1. Testing for photosensitivity reactions
  2. Assessing for bone pain, deformity, and risk of pathologic fracture Correct answer.
  3. Monitoring for hyperkalemia
  4. Monitoring for hypoglycemia

Explanation

Paget disease causes disordered bone remodeling with expansion and weakening of bone, leading to pain, bowing deformity, and pathologic fractures. Bisphosphonates are used to control turnover. Hearing loss and nerve compression can also occur as expanded bone encroaches on foramina.

Question 23Orthopaedic Nursing Practice

A patient is being discharged after open reduction and internal fixation of an ankle fracture. Which instruction is most important to include?

  1. Bear full weight immediately without crutches
  2. Stop the prescribed anticoagulant once pain improves
  3. Remove the surgical dressing and soak the foot in warm water daily
  4. Report increasing pain, redness, or fever and keep the prescribed weight-bearing status Correct answer.

Explanation

Discharge teaching after ORIF emphasizes adhering to the prescribed weight-bearing status, keeping the incision clean and dry per orders, and recognizing signs of infection or impaired healing that require prompt reporting. Anticoagulants are continued for the prescribed duration. Soaking a fresh incision promotes infection.

Question 24Orthopaedic Nursing Practice

A patient with a new long leg cast reports a burning sensation and numbness in the toes that were not present earlier. Which interpretation is correct?

  1. The sensations indicate nerve irritation from cast pressure and require urgent evaluation Correct answer.
  2. These are expected sensations that resolve as the cast dries
  3. The patient is likely experiencing anxiety about the cast
  4. The sensations confirm that the fracture is healing normally

Explanation

New burning and numbness in the toes of a casted limb indicate nerve compression from cast pressure or a developing compartment syndrome, both of which threaten limb function. The cast must be evaluated urgently and possibly split. Expected cast sensations are mild and do not progress to numbness.

Question 25Orthopaedic Nursing Practice

Which statement about traction is correct?

  1. Traction is released during repositioning to reduce patient discomfort
  2. The ropes may touch the bed frame as long as the weights hang freely
  3. The pull must be maintained in a straight line with the weights hanging freely Correct answer.
  4. Weights should rest on the floor between adjustments

Explanation

Effective traction requires continuous pull along the prescribed line with weights hanging free and ropes centered in the pulleys without touching the bed or frame. Interrupting the pull defeats the purpose and can cause muscle spasm and loss of alignment. Weights are never removed or rested on the floor.

Question 26Orthopaedic Nursing Practice

A patient is 6 hours post total hip arthroplasty. Which assessment finding should the nurse report to the surgeon immediately?

  1. Temperature of 37.8°C (100.0°F)
  2. Complaint of pain at the surgical site rated 6/10
  3. Shortness of breath and a new petechial rash on the chest Correct answer.
  4. Serosanguineous drainage on the surgical dressing

Explanation

Fat embolism syndrome typically presents with respiratory distress, petechial rash, and neurologic changes 24–72 hours after long bone or hip surgery. The rash and dyspnea are classic early signs requiring immediate notification. Pain and serosanguineous drainage are expected postoperatively, and low-grade fever is common.

Question 27Orthopaedic Nursing Practice

A patient in balanced skeletal traction for a femoral shaft fracture asks why weights must hang freely. Which response by the nurse is most accurate?

  1. Free-hanging weights maintain constant countertraction and prevent muscle spasms. Correct answer.
  2. Weights that rest on the bed reduce the risk of compartment syndrome.
  3. Weights that touch the floor increase the risk of pin site infection.
  4. Free-hanging weights allow the patient to move more easily in bed.

Explanation

In balanced skeletal traction, weights must hang freely to maintain continuous countertraction and alignment of the fracture. If weights touch the floor or bed, traction is lost and muscle spasms or displacement can occur. The nurse should check weight position regularly.

Question 28Orthopaedic Nursing Practice

A patient had a total knee arthroplasty 8 hours ago. Which nursing action is most important to prevent venous thromboembolism?

  1. Encouraging the patient to sit in a chair for long periods
  2. Massaging the calf muscles every 2 hours
  3. Applying sequential compression devices as prescribed Correct answer.
  4. Keeping the affected leg flat and immobile

Explanation

Sequential compression devices (SCDs) promote venous return and are a standard prophylactic measure after total joint arthroplasty. They should be applied and functioning whenever the patient is in bed. Calf massage is unsafe because it can dislodge a clot, and immobility increases stasis.

Question 29Orthopaedic Nursing Practice

A patient is learning to use a walker after a total hip replacement. Which instruction should the nurse include?

  1. Hold the walker by the sides and lean forward while taking a step.
  2. Advance the walker, then step with the affected leg, then the unaffected leg. Correct answer.
  3. Move the walker forward, then step into it with the affected leg first.
  4. Lift the walker and hop on the unaffected leg to avoid bearing weight.

Explanation

The correct sequence for walker use is to move the walker forward first, then step with the affected leg, and finally bring the unaffected leg forward. This pattern provides stability and protects the surgical hip. Leaning or hopping can cause falls or dislocation.

Question 30Orthopaedic Nursing Practice

A patient with a plaster cast on the lower leg reports itching under the cast. Which action should the nurse take?

  1. Loosen the cast with a cast saw
  2. Administer prescribed oral antihistamine Correct answer.
  3. Insert a thin object to scratch the skin
  4. Apply powder around the cast edges

Explanation

Itching under a cast is common and should be managed with prescribed oral antihistamines or cool air from a hair dryer on a cool setting. Inserting objects can cause skin injury and infection. The cast should not be loosened without a prescription because it may compromise immobilization.

Question 31Orthopaedic Nursing Practice

A patient with an external fixator has purulent drainage and erythema at a pin site. Which action should the nurse take first?

  1. Cleanse the site with hydrogen peroxide and apply a tight dressing
  2. Increase the frequency of pin site care to every 2 hours
  3. Document the finding and reassess in 24 hours
  4. Notify the health care provider and obtain a wound culture Correct answer.

Explanation

Purulent drainage and erythema at a pin site suggest infection, which can progress to osteomyelitis. The nurse should notify the provider and obtain a culture as prescribed. Hydrogen peroxide is cytotoxic and tight dressings can promote infection.

Question 32Orthopaedic Nursing Practice

A patient who had spinal fusion 12 hours ago has clear drainage on the surgical dressing that forms a halo. Which action should the nurse take?

  1. Apply a pressure dressing over the site
  2. Notify the surgeon immediately Correct answer.
  3. Reinforce the dressing with additional gauze
  4. Turn the patient to a side-lying position

Explanation

Clear drainage with a halo sign after spinal surgery may indicate a cerebrospinal fluid leak. The nurse should notify the surgeon immediately and position the patient flat as prescribed. Reinforcing or applying pressure can mask the leak and increase the risk of infection.

Question 33Orthopaedic Nursing Practice

A postmenopausal patient asks how to reduce her risk of osteoporosis. Which recommendation should the nurse include?

  1. Increase weight-bearing exercise and ensure adequate calcium and vitamin D intake Correct answer.
  2. Begin long-term glucocorticoid therapy
  3. Reduce dietary protein to prevent calcium loss
  4. Limit sun exposure to prevent skin cancer

Explanation

Weight-bearing exercise and adequate calcium and vitamin D are key lifestyle measures to maintain bone density in postmenopausal women. Glucocorticoids accelerate bone loss, and avoiding sun exposure reduces vitamin D synthesis. Protein is important for bone health and should not be restricted.

Question 34Orthopaedic Nursing Practice

A patient is scheduled for an MRI of the lumbar spine. Which information is most important for the nurse to obtain?

  1. Whether the patient has eaten within the last 4 hours
  2. Whether the patient has a history of asthma
  3. Whether the patient is allergic to shellfish
  4. Whether the patient has a pacemaker or metal implants Correct answer.

Explanation

MRI uses a strong magnetic field, so the presence of a pacemaker, aneurysm clips, or other metal implants can be dangerous. The nurse must screen for these devices before the procedure. Fasting and shellfish allergy are relevant for contrast studies, not typically for MRI without contrast.

Question 35Orthopaedic Nursing Practice

A patient with a Colles fracture reports severe pain, paresthesia, and pain on passive finger extension. Which action should the nurse take first?

  1. Encourage the patient to wiggle the fingers
  2. Apply ice and elevate the arm
  3. Notify the health care provider immediately Correct answer.
  4. Administer an opioid analgesic

Explanation

These findings suggest compartment syndrome, a surgical emergency. The nurse should notify the provider immediately and prepare for possible fasciotomy. Ice, elevation, and analgesia do not relieve the underlying pressure and can delay treatment.

Question 36Orthopaedic Nursing Practice

A patient is immobilized in traction. Which factor most increases the risk of pressure injury?

  1. Frequent repositioning
  2. Use of a pressure-redistribution mattress
  3. Increased mobility in bed
  4. Shearing forces from sliding down in bed Correct answer.

Explanation

Shearing forces, which occur when the patient slides down in bed, damage deep tissue and increase pressure injury risk. Immobility itself is a major risk factor, and friction and shear compound it. Repositioning and specialized mattresses reduce risk.

Question 37Orthopaedic Nursing Practice

A patient with a new arm cast reports numbness and tingling in the fingers. Which finding should the nurse report immediately?

  1. Mild swelling at the cast edges
  2. Itching under the cast
  3. Capillary refill of 2 seconds
  4. Pale, cool fingers with decreased sensation Correct answer.

Explanation

Pale, cool fingers with decreased sensation indicate neurovascular compromise from a cast that is too tight. The nurse should report this immediately and prepare to bivalve the cast. Capillary refill of 2 seconds, mild swelling, and itching are expected findings.

Question 38Orthopaedic Nursing Practice

A patient had a total hip arthroplasty via an anterior approach. Which position should the nurse avoid?

  1. Standing with a walker
  2. Hip flexion beyond 90 degrees Correct answer.
  3. Supine with a pillow between the legs
  4. Side-lying with the operative leg abducted

Explanation

After an anterior-approach hip arthroplasty, hip flexion beyond 90 degrees is avoided to prevent dislocation. The nurse should teach the patient to avoid bending forward excessively. Supine positioning with a pillow, side-lying with abduction, and standing with a walker are generally safe.

Question 39Orthopaedic Nursing Practice

A patient with Paget disease of bone reports new-onset hearing loss. Which explanation should the nurse provide?

  1. Hearing loss is a side effect of bisphosphonate therapy.
  2. Hearing loss is unrelated to Paget disease and should be evaluated separately.
  3. Hearing loss results from compression of the auditory nerve by enlarged bone. Correct answer.
  4. Hearing loss is caused by calcium deficiency.

Explanation

Paget disease can cause bone enlargement and compression of cranial nerves, including the auditory nerve, leading to hearing loss. The nurse should report this finding to the provider. It is not a medication side effect or a direct result of calcium deficiency.

Question 40Orthopaedic Nursing Practice

A patient is being discharged after open reduction and internal fixation of an ankle fracture. Which instruction is most important?

  1. Remove the splint at night for comfort
  2. Bear full weight on the affected leg immediately
  3. Apply heat to the ankle to promote healing
  4. Keep the leg elevated and report increased pain or numbness Correct answer.

Explanation

After ORIF, the patient should keep the leg elevated to reduce swelling and report signs of neurovascular compromise or infection. Weight-bearing status must follow the surgeon's orders. Heat can increase swelling and should be avoided initially.

Question 41Orthopaedic Nursing Practice

A patient with a long leg cast reports a burning sensation and numbness in the toes. Which action should the nurse take first?

  1. Apply a warm compress to the toes
  2. Encourage the patient to move the toes
  3. Elevate the leg on pillows
  4. Check the cast for tightness and notify the provider Correct answer.

Explanation

Burning and numbness suggest neurovascular compromise from a tight cast. The nurse should assess the cast and neurovascular status and notify the provider immediately. Elevation and warmth do not relieve cast pressure and may worsen symptoms.

Question 42Orthopaedic Nursing Practice

Which statement about skin traction is correct?

  1. Skin traction is applied directly to the skin with adhesive strips or a boot. Correct answer.
  2. Skin traction requires pins inserted into the bone.
  3. Skin traction is used for long-term fracture management.
  4. Skin traction allows for more weight than skeletal traction.

Explanation

Skin traction uses adhesive strips, foam, or a boot applied to the skin to apply pull. It is used for short-term management and allows less weight than skeletal traction. Skeletal traction involves pins inserted into bone.

Question 43Orthopaedic Nursing Practice

A patient with a below-knee amputation is learning to wrap the residual limb. Which technique should the nurse teach?

  1. Wrap with figure-eight turns and equal tension throughout
  2. Wrap distally to proximally with decreasing tension Correct answer.
  3. Wrap proximally to distally with decreasing tension
  4. Wrap distally to proximally with increasing tension

Explanation

The residual limb should be wrapped distally to proximally with decreasing tension to promote shaping and prevent edema. Figure-eight turns are used, but tension must decrease proximally. Wrapping with increasing tension can cause a tourniquet effect.

Question 44Orthopaedic Nursing Practice

A patient is scheduled for a bone scan. Which instruction should the nurse provide?

  1. You should empty your bladder before the scan.
  2. You must avoid all fluids for 24 hours after the test.
  3. You will need to fast for 12 hours before the test.
  4. You will receive an injection of radioactive material and return in 2 to 4 hours for imaging. Correct answer.

Explanation

A bone scan involves an intravenous injection of a radioactive tracer, followed by a delay of 2 to 4 hours before imaging. The patient should empty the bladder before the scan to reduce radiation exposure. Fasting is not required, and hydration is encouraged.

Question 45Orthopaedic Nursing Practice

A patient with osteomyelitis is receiving IV antibiotics. Which assessment finding is most important to monitor?

  1. Dietary intake
  2. Range of motion in the affected limb
  3. Urine output
  4. Temperature and signs of sepsis Correct answer.

Explanation

Osteomyelitis can progress to sepsis, so monitoring temperature and signs of systemic infection is critical. The nurse should also assess the affected site for worsening pain, redness, and swelling. Dietary intake and range of motion are important but not the priority.

Question 46Orthopaedic Nursing Practice

A patient is recovering from a hip fracture and is at risk for delirium. Which intervention should the nurse implement?

  1. Orient the patient frequently and maintain a normal sleep-wake cycle Correct answer.
  2. Keep the room dark and quiet during the day
  3. Limit family visits to reduce stimulation
  4. Use physical restraints to prevent falls

Explanation

Delirium in older adults with hip fracture is often multifactorial. Frequent orientation, adequate lighting, and maintaining a normal sleep-wake cycle help prevent and manage delirium. Restraints and isolation can worsen confusion.

Question 47Orthopaedic Nursing Practice

A patient with a new plaster cast on the arm reports that the cast feels hot. Which action should the nurse take?

  1. Apply ice directly over the cast
  2. Elevate the arm and monitor for signs of infection Correct answer.
  3. Ignore the complaint as expected
  4. Remove the cast immediately

Explanation

A plaster cast may feel warm initially as it sets, but persistent heat, swelling, and pain may indicate infection or compartment syndrome. The nurse should elevate the arm and monitor closely. Ice directly over the cast is ineffective, and the cast should not be removed without an order.

Question 48Orthopaedic Nursing Practice

A patient is receiving continuous passive motion (CPM) after knee arthroplasty. Which nursing action is correct?

  1. Position the patient's knee at the hinge of the machine Correct answer.
  2. Set the machine to the highest tolerated flexion immediately
  3. Allow the patient to ambulate while on the machine
  4. Keep the machine running during transfers

Explanation

The patient's knee should be aligned with the CPM machine's hinge to prevent shear and injury. The machine should be stopped during transfers. Range of motion settings should follow the provider's prescription and increase gradually.

Question 49Orthopaedic Nursing Practice

A patient with a suspected hip fracture is in the emergency department. Which action should the nurse take first?

  1. Apply a traction splint
  2. Administer pain medication
  3. Assess neurovascular status of the affected leg Correct answer.
  4. Obtain a urine specimen

Explanation

Neurovascular assessment is the priority to detect compromised circulation or nerve function. The nurse should then stabilize the limb and administer analgesia as prescribed. Applying a traction splint requires an order and should not delay assessment.

Question 50Orthopaedic Nursing Practice

A patient is 24 hours postoperative after a total knee arthroplasty. Which assessment finding should the nurse report to the surgeon immediately?

  1. Pain rated 5 out of 10 that improves after prescribed analgesia
  2. Temperature of 37.9 °C (100.2 °F) in the evening
  3. Serosanguineous drainage on the dressing that is dry at the edges
  4. Calf pain with unilateral swelling and warmth Correct answer.

Explanation

Unilateral calf pain, swelling, and warmth suggest deep vein thrombosis, a common and serious complication after knee arthroplasty that requires prompt evaluation and anticoagulation. Expected postoperative findings such as mild low-grade fever, controlled incisional drainage, and pain responsive to analgesia do not warrant urgent notification.