1.A 36 year old year old female who complains of weight gain, facial hair, absent menstruation and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by A) An ectopic corticotrophin secreting tumor B) Adrenal carcinoma C) Corticotropin –secreting pituitary adenoma D) An inborn error of metabolism ANSWER: C 2.Parathyroid hormone has which of the following effects on the kidney? A) Stimulation of calcium reabsorption and phosphate excretion B) Stimulation of phosphate reabsorption and calcium excretion C) Increased absorption and secretion of Vitamin E D) Increased absorption of Vitamin E and excretion of Vitamin D ANSWER: A 3.A patient with a tentative diagnosis of hyperosmolar hyperglycemia nonketotic syndrome has a history of Type 11 diabetes that is being controlled with an oral diabetic agent. Which of the following is the most important laboratory test confirming this disorder? A) Serum potassium level B) Serum sodium level C) Arterial blood gas values D) Serum osmolality ANSWER: D 4.A female client was noticed to have large hands and hoarse voice. Laboratory exam showed hyperglycemia. What would be the most probable cause? A) Acromegaly B) Type 1 Diabetes mellitus C) Hyperthyroidism D) Deficient Growth hormone ANSWER: A 5. A client is diagnosed with SIADH. A diuretic therapy was orderd. If the client does not comply with the recommended treatment, which complication will arise? A) Cerebral edema B) Hypoglycemic shock C) Severe hypovolemic shock D) Tetany ANSWER: A 6. A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports the diagnosis of Addison's disease? A) Blood urea nitrogen level of 12 mg/dl B) Blood glucose level of 90 mg/dl C) Serum sodium level of 134mg/dl D) Serum potassium level of 5-8 mEq/l ANSWER: D 7.A client with Addison's disease comes to the clinic for a follow up. When assessing the client, the nurse should stay alert for signs and symptoms of A) Calcium and phosphorus abnormalities B) Chloride and magnesium abnormalities C) Sodium and chloride abnormalities D) Sodium and protein abnormalities ANSWER: C 8.Which of the following is the most common cause of hyperaldosteronism? A) Excessive Na intake B) Pituitary adenoma C) Deficiency of potassium intake D) Adrenal adenoma ANSWER: D 9.The nurse expects to note an elevated serum glucose level in a client with hyperosmolar, hyperglycemic nonketotic syndrome. What other abnormality finding should the nurse anticipate? A) Elevated serum creatinine level B) Serum ketone bodies C) Serum alkalosis D) Below normal potassium level ANSWER: D 10. On the third day after partial thyroidectomy , the client exhibits muscle twitching and hyperirritability of the nervous system. Which life threatening electrolyte disturbance is exhibited by the client? A) Hypocalcemia B) Hyponatremia C) Hyperkalemia D) Hypermagnesemia ANSWER: A 11.A 68 year old client has been complaining of sleeping more, increased urination, anorexia, weakness , depression and bone pain. Which would be the disorder? A) Diabetes Mellitus B) Diabetes Insipidus C) Hyperthyroidism D) Hyperparathyroidism ANSWER: D 12. Which of the following is a result of Hypoparathyroidism? A) Tetanus B) Tetany C) Hypercalcemia D) Hyperphosphatemia ANSWER: B 13.Mrs. Pecson, a school teacher was experiencing loss of weight , inspite of increased appetite. She has been irritable and with slight tremor of her hanD) Laboratory tests results showed a toxic goiter with exophthalmos. What is the positive sign of exophthalmos? A) Poor retention of memory B) Inability to distinguish colors C) Poor reflexes D) Protrusion of the eyeballs ANSWER: D 14.The client is being evaluated for hypothyroidism. What would be the signs of hypothyroidism? A) Exopthalamus anfd conjunctival redness B) Flushed, warm moist skin C) Systolic murmur at the left sternal border D) Decreased body temperature and cold intolerance ANSWER: D 15.An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squaD) Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia A) Thyroid storm B) Cretinism C) Hashimoto's thyroiditis D) Myxedema coma ANSWER: D 16.Which of the following would indicate to the nurse that the client's condition is deteriorating? A) An increase in pulse rate and respirations B) Cold skin and episodes of chills C) Difficulty in arousing the client for medications D) Client complains of palpitations ANSWER: C 17.Aling Dora is a known diabetic and has been in and out of the hospital for a check up especially her blood sugar. She is aware that diabetes is a lifetime condition, which is affecting the metabolism of; A Carbohydrates B) Fats C) Proteins D) All of the above ANSWER: D 18. Which of the following would the nurse expect to assess in an elderly client with Hashimoto's thyroiditis? A) Weight loss and increase appetite B) Weight loss, increased urination and increased thirst C) Weight gain, decreased appetite and constipation D) Weight gain, increased creatinine and pinkish-red urine ANSWER: C 19.Which of the following laboratory test results would suggests to the nurse that a client has a corticotrophin- secreting pituitary adenoma? A) High corticotrophin and low cortisol levels B) Low corticotrophin and high cortisol levels C) High corticotrophin and high cortisol levels D) Low corticotrophin and low cortisol levels ANSWER: C 20. Early in the morning, a client had a subtotal thyroidectomy, the nurse assess the client who has nausea, temperature of 40 degree centigrade, tachycardia and extreme restlessness. What is the most likely diagnosis? A) Diabetic ketoacidosis B) Thyroid crisis C) Hyperglycemia D) Tetany ANSWER: B 21. When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamines, the nurse is most likely to detect which vital signs? A) A blood pressure of 130/70 mm Hg B) Blood glucose level of 130 mg/dl C) Bradycardia D) Blood pressure of 178/98 mm Hg ANSWER: D 22.A client was diagnosed with Diabetes Mellitus 1 14 years ago is admitted to the ward with abdominal pain. On admission client's glucose level is 470 mg/dl. Which finding is likely to accompany this glucose level? A) Cool, moist skin B) Rapid thready pulse C) Arm and legs trembling D) Slow shallow respirations ANSWER: B 23.A client with severe head trauma sustained in a car accident is admitted to the intensive care unit, thirty six hours later, the client's urine output suddenly rises above 200 ml/hour, leaving the nurse to suspect diabetes insipidus. Which laboratory findings suspect the nurse's suspicion of diabetes insipidus? A) Above normal urine and serum osmolality levels B) Below normal urine osmolality level, below normal serum osmo;a;ity level C) Above normal urine osmolality level, below normal serum osmolality level D) Below normal urine osmolality level, above normal serum osmolality level ANSWER: D 24.A 21 year old woman is admitted to the hospital for an arthrotomy on the morning of surgery her urine was 1+ for sugar and acetone. The nurse knows that acetunuria develops in diabetes due to; A) Excessive oxidation of fatty acids for energy, which increases ketones in glomerular filtrate. B) Osmotic diuresis, accompanying elevation in serum-glucose levels, which decreases exchange of electrolytes in renal tubules. C) Failure of sodium- hydrogen ion exchange mechanism in the real tubules to secrete excess hydrogen ions D) Increased volatile H+ ions and decreased nonvolatile H+ ions in the glomerular filtrate. ANSWER: A 25.On the evening of her first postop day, a client who is a known diabetic, began to complain of increasing nauseA) Her face was flushed, she appeared lethargic, and her vital signs were BP 108/78, pulse 100, respirations 24 and deep. Intake 2100 cc/ IV. Urine output 2000cC) The nurse recognizes that the client's vital signs and urine output reflect. A) Increased ADH release in response to physiologic stress of surgery B) Decreased ECF volume due to osmotic diuresis C) A hypo-osmolar fluid imbalance D) Circulatory overload ANSWER: B 26. A preterm infant was admitted to the neonatal intensive care unit. Three days after formula feeding was started, residual milk from feeding tube increaseD) Baby developed abdominal distention,bloody stools, apnea, and bradycardiA) The nurse should suspect A) Intraventricular hemorrhage B) Necrotizing entercolitis C) Meconium aspiration syndrome D) Esophageal atresia ANSWER: B 27. A client asks why vagotomy is being done, in conjunction with subtotal gastrectomy. This is done because the vagus nerve: A) Stimulates increased gastric motility, thereby preventing the movement of HCL out of the stomach. B) Decreases gasteic motility, thereby preventing the movement of HCL out of the stomach. C) Stimulates both increased gastric secretion and gastric motility. D) Stimulates decreased gastric secretion, thereby increasing nausea and ANSWER: C 28.Most common complication of peptic ulcer is: A) Perforation B) Hemorrhage C) Infection D) Pyloric obstruction ANSWER: B 29.Which of the following is a manifestation of perforation of the bowel? A) Dilated loops B) Pneumatosis intestinalis C) Pneumoperitonium D) Deep crypts on the intestinal mucosa ANSWER: C 30. Following surgery the nurse must observe for signs of pernicious anemia, which may be a problem after gastrectomy because: A) The extrinsic factor is produced in the stomach B) The extrinsic factor is absorbed in the antral portion of the stomach C) The intrinsic factor is produced in the stomach D) Decreased hydrochloric acid production inhibits Vitamin B12 reabsorption ANSWER: C 31. The nurse tells a client that dumping syndrome is a significant problem for: A) 70-80% of client having gastrectomies B) 50% of clients having gastrectomies C) 25% of clients having gastrectomies D) 5-10% of clients having gastrectomies ANSWER: D 32.Dumping syndrome is characterized by the urge to defecate, borborygmi, diaphoresis, dizziness, and weakness. The following are true of dumping syndrome except A) There is rapid emptying of the gastric contents to duodenum B) The gastric contents are hypertonic C) There is shifting of fluids from intravascular compartment to the intestinal lumen D) There is hyperglycemia ANSWER: D 33.Which of the following inflammatory bowel diseases result in rectal fistulas? A) Chron's disease B) Ulcerative colitis C) Irritable bowel syndrome D) Amoebic colitis ANSWER: A 34.The initial event in the development of appendicitis A) Ulceration of mucosa of appendix B) Obstruction of the lumen of the appendix C) Edema of the appendix D) Distention of the appendix ANSWER: A 36. If after surgery, the patient's abdomen becomes distended and no bowel sounds are appreciated, what would be the most suspected complication? A) Intussusception B) Paralytic ileus C) Hemorrhage D) Ruptured colon ANSWER: B 37.A mother who brings a 6 week old infant into the clinic reports that the baby has been spitting up for about three weeks. The vomittus has become more frequent and projectile since yesterday. The child has gained only one pound since birth and suspects that the chills may have pyloric stenosis. Which of the following assessments would confirm a diagnosis of pyloric stenosis? A) Immediate postfeeding vomiting B) Bile-stained vomitus C) An axillary temperature of 38oC D) A refusal to eat ANSWER: A 38. Which of the following segments in the muscle layer in Hirschprung's disease is aganglionic? A) The proximal portion of the dilated colon B) The dilated portion C) The distal portion of dilated colon D) The ilium ANSWER: C 39.Hirschprung's disease will result in what characteristics stool? A) Tarry and tenacious stools B) Currant jellylike C) Frothy and foul smelling D) Ribbon like ANSWER: D 40.The nurse knows that the function of the gallbladder is to: A) Synthesize and manufacture bile B) Collect, concentrate, and store bile C) Collect and dilute bile D) Regulate bile flow into the duodenum ANSWER: B 41. If bile flow into the duodenum is obstructed, absorption of fat soluble vitamins is reduceD) Which of the following complications would you therefore observed for? A) Peripheral neuritis B) Scurvy C) Increased bleeding tendencies D) Macrocytic anemia ANSWER: C 42. Besides jaundice of the sclera and skin, what other clinical parameters might indicate biliary obstruction in the client? A) Increased systolic and diastolic pressures B) Frequent eructation between meals C) Darkened urine and clay colored stools D) Longitudinal ridging of the fingernails ANSWER: C 43. Hepatitis B is transmitted through: A) Air B) Blood or plasma transfusion C) Food and water D) Contaminated spoons, forks and plates ANSWER: B 44. In the pre-ecteric phase of jaundice, what will make you suspect of hepatitis? A) Clay –colored stools B) Anorexia C) Jaundice D) Pruritus ANSWER: A 45. Which of the health factors is often associated with gallstones? A) Constipation B) Obesity C) Lack of exercise D) Eating yellow colored foods ANSWER: B 46. Although the exact etiology of pancreatitis is unknown, which of these factors is most recognized as the causative factor? A Excessive intake of alcohol B) Excessive intake of fats C) Formation of gall stones D) Use of oral contraceptives ANSWER: A 47. Among women, the most common cause of acute pancreatitis is A) Biliary tract disease B) Obesity C) Use of oral contraceptives D) Alcoholism ANSWER: A 48.Serum enzymes that is secreted and release by the pancreas which causes autodigestion of the gland and results to edema is: A) Pepsin B) Trypsin C) HCL D) Bile ANSWER: B 49. In advanced cirrhosis of the liver, the patient suffers from ascites which is a result of: A) Increased levels of aldosterone B) Portal hypertension and decreased serum albumin C) Portal hypertension, decreased capillary permeability and obstruction of hepatic duct D) Increased excretion of sodium and increased obstruction of lymphatic channels. ANSWER: B 51. For a client wih cirrhosis, deterioration of hepatic function is best indicated by A) Fatigue and muscle weakness B) Difficulty in arousal C) nausea and anorexia D) weight gain ANSWER: B 51.A client is undergoing an extensive diagnostic workup for suspected muscular dystrophy. The nurse knows that muscular dystrophy, has many forms but that one assessment is common to all forms. Which finding is common to all forms. Which finding belong in this category. A) muscle weakness B) cardiac muscle involvement C) pseudohypertrophy of the calf muscles D) muscle pain ANSWER: A 52,A client's left leg is in a skeletal traction with a Thomas leg splint and Pearson attachment .Which intervention should the nurse include in the client's plan of care? A) Apply traction straps snugly. B) Assess the client's level of consciousness C) Remove the traction at least every 8 hours D) Teach the client how to prevent problems caused by immobility ANSWER: D 53.Which of these findings best correlates with a diagnosis of osteoarthritis? A) Joint stiffness that decreases with activity B) Erythema and edema over the affected joint C) Anorexia and weight loss D) Fever and malaise ANSWER: A 54.A client has sustained a right tibial frature and has just had a cast applieD) Which instruction should the nurse provide in his cast care? A) Cover the cast with a blanket until the cast dries B) Keep your right leg elevated above the heart level C) Use a knitting needle to scratch itches inside the cast D) A foul smell from the cast is normal ANSWER: B 55.The nurse should monitor the client with a pelvic fracture receiving an opium derivative such as morphine for what common adverse reaction? A) Respiratory depression B) Diarrhea C) High fever D) Pupil dilation ANSWER: a 56.A client with gouty arthritis is prescribed a low purine diet.The nurse should instruct this client to avoid A) organ meats B) citrus fruits C) green vegetables D) fresh fish ANSWER: A 57.A client is admitted to the orthopedic unit for treatment of a fractured right femur caused by a motor vehicle crash.He is scheduled undergo an open reduction internal-fixation of the right femur.The night before surgery.The nurse administers 250 mg glutethimide as prescribeD) Which statement regarding glutethimide is correct? A) Th nurse should store the drug in a light light-resistant B) The nurse should dilute it in a fruit juice to improve absorption C) The nurse should not use the liquid if it becomes slightly darkened D) The nurse should unused portions of the drug immediately after use ANSWER: A 58.A client seeks care for low back pain of 2 weeks duration.Which assessment finding suggests an herniated intervertbral disk? A) Pain radiating down the posterior thigh B) Back pain when the knees ar flexed C) Atrophy of the lower leg muscles D) Homan's sign ANSWER: A 59.A client undergoes a total hip replacement.Which statement made by the client would indicate to the nurse that the client requires further teaching? A) The need to keep several pillows between my legs at night B) I need to remember not to cross my legs at night C) The occupational therapist is teaching me how to use a sock puller to help me get dressed D) I don't know if ill be able to get ff that low toilet bowl at home by myself ANSWER: D 60. After surgery to treat a hip fracture, a client returns from the post anesthesia care unit to the medical surgical unit. Postoperatively, how should the nurse position the client? A) With the affected hip flexed acutely B) With the leg on the affected side abducted C) With the leg on the affected side adducted D) With the affected hip rotated externally ANSWER: B 61.A client recently had a total hip replacement.As a result of intraoperative blood loss,postoperative serum hemoglobin levels and hematocrit are low.The physician prescribes two units of packed red blood cells.During the infusion of the first unit of blood,the client develops a transfusion reaction and experiences. Urticaria, itching and bronchospasm.Which antihistamine would the physician likely prescribe for this type 1 hypersensitivity reaction? A) trifenamine citrate B) astemizole C) cyclizine D) chlorpheniramine maleate ANSWER: D 62.The nurse is caring for a client who recently underwent a total hip replacement.The nurse should A) ease the client into a low toilet seat B) Allow the client's knees to be crossed when out of bed C) Use soft chairs when the client is out of bed D) Limit client hip flexion when sitting ANSWER: D 63.The nurse is caring for a client who underwent a total hip replacement.What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? A) Keep the affected leg in a position of adduction B) Use measures other than turning to prevent pressure ulcers C) Prevent internal rotation of the affected leg D) Keep the hip flexed by placing the pillows under the client's knee ANSWER: C 64.Which of the following is the most appropriate nursing diagnosis of a strained ankle? A) Impaired skin integrity B) Impaired physical mobility C) Risk for fluid volume deficit D) Body image disturbance ANSWER: B 65.A 75 year old client has a history of osteoarthritis.What signs and symptoms would the nurse expect to find on physical assessment? A) Joint pain,crepitus,Heberden's nodes B) Hot inflamed joints,crepitus,joint pain C) Tophi,enlarged joints,Bouchards nodes D) Swelling , joint pain and tenderness on palpation ANSWER: A 66.The nurse is caring for a client who complains of a lower back pain.Which instructions should the nurse give to the client to prevent back injury A) Bend over the object you're lifting B) Narrow the stance when lifting C) Push or pull the object using your arms D) Stand close to the you're lifting ANSWER: D 67.A client has acute muscle spasm.The physician prescribes chlorzoraxone 500 mg p.o.tiD) A centrally acting skeletal muscle relaxant chlorzoraxone is used A) Muscle spasm caused by cerebral palsy B) Chronic musculoskeletal disorder C) Lower extremity spasticity D) Severe muscle spasm. ANSWER: D 68.A client with gout is receiving probeneciD) When caring for this client,the nurse should monitor which laboratory values? A) red blood cell count B) Srum uric acid level C) Hemoglobin level D) Serum potassium level ANSWER: B 69.After a car accident,a client is admitted in an acute care facility with multiple traumatic injuries.Including a fractured pelvis.For 24-48 hours after the accident, the nurse must monitor the client closely for which potential of a fractured pelvis? A) compartment syndrome B) Fat embolism C) Infection D) Volkman's ischemic contracture ANSWER: B 70.A client who recently had a cerebrovascular accident requires a cane to ambulate.When teaching about cane use,explain that the reason for holding cane on the uninvolved side is to A) prevent leaning B) destribute weight away from the involved side C) maintain stride length D) prevent edem ANSWER: B 71.Following a boating accident, a 30 year old client with multiple fractures is admitted to a semi private room in a progressive care unit. The client who was driving the boat,is unaware that his girlfriends 9 year old son was killed in the accident.The client's parents instructs the nurse to prohibit phone calls and withhold information about the accident.During assessment of the client,the nurse notices that the television is on and the news is starting.It would be most appropriate for the nurse to A) Turn the television off and tell the client it interferes with the assessment B) Allows the client to view the television and deal with any questions as they come C) Instruct the client to change the channel to a channel that is not televising the news D) Attempt to destract the client from watching television ANSWER: C 72.The nurse is caring for a client with burns on his legs.Which nursing intervention will help o prevent contractures? A) Applying knee splints B) Elevating the foot of the bed C) Hyperextending the client's legs D) Performing shoulder range –of-motions exercises ANSWER: A 73.The physician diagnoses primary osteoporosis in a client who has lost bone mass.In this metabolic disorder,the rate of bone resorption accelerates while bone formation slows.Primary osteoporosis is most common in A) elderly men B) young children C) young menstruating women D) elderly postmenopausal women ANSWER: D 74.A client is scheduled for laminectomy to repair an herniated intervertebral disC) A) When developing a postoperative plan of care, the nurse should include which action? B) Placing the client in semi-fowler's position C) Maintaining bed rest for 72 hours after the laminectomy D) Turning the client from side to side,using the logroll technique ANSWER: D 75.A client is admitted with acute osteomyelitis that developed after an open fracture of the femur.When planning the client's care,the client should include which measure? A) Administering large doses of oral antibiotics as prescribed B) Instructing the client to ambulate twice daily C) Witholding all oral intake D) Administering large doses of IV antibiotics as prescribed ANSWER: D 76.A client comes to the emergency department complaining of pain in the right leg.When obtaining the history, the nurse learns that the client has diabetes mellitus at age 12.The nurse knows that the client is predisposed to what musculoskeletal disorder? A) Degenerative joint disease B) Muscular dystrophy C) Scoliosis D) Paget's disease ANSWER: D 77.A 69 year old client asks the nurse what the difference is between osteoarthritis(OA) and rheumatoid arthritis(RA).Which response is correct? A) OA is a noninflammatory joint disease.RA is characterized by inflammed swollen joints B) OA and RA are very similar.OA affects the smaller joints and RA affects the larger weight bearing joints C) OA affects joints on both sides of the body.RA is usually unilateral D) OA is more common in women and RA is more common in men ANSWER: A 78.A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores.Which suggestion should the nurse offer? A) Do all your chores in the morning when pain and stiffness are least pronounced B) Do all your chores after performing exercises to loosen it up C) Pace yourself and rest frequently,especially after activities D) Do all your chores in the evening when pain and stiffnes are least pronounced ANSWER: C 79.A client age 50,visits the physician for a routine checkup.The history reveals that the client was diagnosed with a spinal curvature at age 45.The nurse knows that life threatening complications can occur if the progressive spinal curvature exceeds 65 degrees. To assess the client's risk for such a complication,the nurse should evaluate the severity of the curvature in which region of the spine? A) Cervical B) Thoracic C) Lumbar D) Sacral ANSWER: B 80.After a person experiences a closure of his epiphysis, which of the following is true? A) The bone grows in length but not in thickness B) The bone increases in thickness and is remodeled C) Both bone length and thickness continue D) No further in bone length occurs ANSWER: D 81.A client seeks medical attention for a ganglion.Which statement about this musculoskeletal disorder is true? A) A ganglion is the most common soft tissue of the foot B) A ganglion is a precursor to a primary bone tumor C) Surgical excision is the treatment of choice for the ganglion D) Dorsiflexion exacerbates signs and symptoms of a ganglion ANSWER: D 82.During a senior citizen health screening ,the nurse observes a 75 year old female with a severely increased thoracic curve or humpback.What is this condition called? A) Lordosis B) Kyphosis C) Scoliosis D) Genus Varum ANSWER: B 83.A client in Buck's skin traction after fracturing the right hip.The nurse should include which plan of care? A) Removing the weights once very stiff B) Maintaining the bed in a knee –gatch position C) Keeping the client in a semi-fowler's position D) Maitaining correct boy alignment ANSWER: D 84.A client with acute osteomyelitis is to receive parenteral penicillin for 4-5 weeks.Before administering the first dose,the nurse asks the client about known drug allergies.An allergy to which antibiotic or antibiotic class necessitates cautious use of penicillin? A) tetracyclines B) Aminoglycosides C) Erythromycin D) Cephalosporin ANSWER: D 85.On a visit to a family physician, a client complains of painful swelling on the lateral side of the great toe,at the metatarsophalangeal joint. After determining that the swelling is a bunion,the physician injects an intra-articular corticosteroiD) The nurse asks what causes bunions?Which ANSWER: is correct? A) Bunions are congenital and can't be prevented B) Bunions may be a result of wearing shoes too big,causing friction when the feet slip back and forth C) Some bunions are congenital,others are caused by wearing shoes that are too short and narrow D) Bunions are caused by a metabolic condition called gout ANSWER: D 86.A client is admitted to an acute care facility with osteomyelitis.Which organism usually causes this infection? A) Escherichia coli B) Klebsiella C) Pseudomonas D) Staphylococcus Aureus ANSWER: D 87.An Xray of the lef femur shows a fracture that extends through the midshaft of the bone and multiple splintering fragments A) Compression fracture B) Greenstick fracture C) Comminuted fracture D) Impacted fracture ANSWER: C 88.Which of the following structures is seldom dislocated? A) Knee B) shoulder C) Foot D) Elbow ANSWER: C 89.Which of the following would the nurse identify as a neurotransmitter? A) Acetylcholine B) Adenosine Triphosphate C) Cholinesterase D) Creatinine phosphate ANSWER: A 90.Elderly clients who fall are most at risk for which of the following injuries? A) Wrist fractures B) Humerus fractures C) Pelvic fractures D) Cervical spine fractures ANSWER: C 91.The nurse is caring for an elderly female with osteoporosis.When teaching the client, the nurse should include information about which major complication? A) Bone fracture B) Loss of estrogen C) Negative Calcium balance D) Dowager's hump ANSWER: A 92.What nursing diagnosis is most appropriate of a woman with osteoarthritis? A) Risk for injury related to altered mobility B) Atered urinary elimination related to effects of aging C) Ineffective breathing pattern related to immobility D) Altered nutrition less than body requirements related to effects of aging ANSWER: A 93.The nurse is assessing a client with possible osteoarthritis.The most significant risk factor for osteoarthritis is A) Congenital deformity B) Age C) Trauma D) Obesity ANSWER: B 94.A client is treated in the emergency department for a Colle's fracture sustained during a fall.What is a Colle's fracture? A) Fracture of the distal radius B) Fracture of the olecranon C) Fracture of the humerus D) Fracture of the carpal scaphoid ANSWER: A 95.At a health fair,a woman age 43,with a family history of osteoporosis asks the nurse how much calcium she should consume.The nurse tell her that the recommended daily calcium intake for premenopausal women is A) 250 to 500 mg B) 600 to 500 mg C) 1000 to 1200 mg D) 1500 to 2000 mg ANSWER: C 96.A client has a fiberglass cast on the right arm.Which action should the nurse include in the plan of care? A) Keeping the casted arm warm by covering it with a light blanket B) Avoiding handling the cast for 24 hours until it is dry C) Evaluating pedal and posterior tibial pulses every two hours D) Assessing movement and sensation in the fingers of the right hand ANSWER: D 98. The nurse is caring for a client with a cast on the left arm. Which assessment finding is most significant for this client? A) A normal capillary refill in the big toe B) Presence of a normal popliteal pulse C) Intact skin around the cast edges D) Ability to move all toes ANSWER: C 99.A client is admitted with severe pain in the knees. Which form of arthritis is characterized by urate deposits and joint pain,usually in the feet and legs, and occurs primarily in men over 30 ? A) Septic arthritis B) Traumatic arthritis C) Intermittent arthritis D) Gouty arthritis ANSWER: D 100.When waiting for a client experiencing an acute gout attack,the nurse anticipates which medication? A) allopurinol B) cochicine C) prednisone D) propoxyphene HCL ANSWER: B 101.The nurse is teaching a client with a left fractured tibia how to walk with crutches.Which instruction is appropriate? A) Use the axilla to help carry the weight B) All weight should be on the hands C) Keep feet 30 cm apart to provide stability and a wide base of support D) Take long strides to maintain mobility ANSWER: B 102.The nurse is caring for a client placed in traction to treat a fractured femur.Which nursing intervention has the highest priority? A) Assessing the extremity for neurovascular integrity B) Keeping the client from sliding to the foot of the bed C) Keeping the ropes over the center of the pully D) Ensuring that the weights hang free at all times ANSWER: A 103.A client who recently had a cerebrovascular accident requires a cane to ambulate.When teaching about cane use,explain that the reason for holding the cane on the uninvolved side is to A) Prevent leaning B) Distribute the weight away from the uninvolved side C) Maintain stride length D) Prevent edema ANSWER: B 104.A client is brought to the emergency deprtment after injuring the right arm in a bicycle accident.The orthopedic surgeon tells the nurse that the client has a green stick fracture of the arm. What thus this mean? A) The fracture line extends through the entire bone substance B) The fracture results from an underlying bone disorder C) Bone fragments are separated at the fracture line D) One side of the bone is broken, the other side is bent ANSWER: D 105.After total hip replacement, a client is receiving epidural anesthesia to relieve pain.Which of the following is a nursing priority for this client? A) Changing the catheter site dressing after every shift B) Assessing capillary refill time C) Assessing for sensation in the legs D) Keeping the client flat in bed ANSWER: C 106. A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? A) Apply ice packs for the first 24 to 48 hours B) Apply heat packs for the first 24 to 48 hours C) Apply ice packs for the first 24 to 48 hours the heat packs D) Apply heat packs for the first 24 hours then ice packs for the next 48 hours ANSWER: C 107.A client with possible osteoarthritis is having X-rays performed in both knees.x-rays of an osteoarthitic joints reveal A) Enlargement of the joint spaces or margin B) Fluid deposition in joint spaces C) Osteophyte formation D) Cartilage growths at weight bearing joints ANSWER: C 108.A client is prescribed diazepam to treat a severe skeletal muscle spasms. During the therapy,the nurse monitors the client closely for adverse reactions.Which adverse reactions are most likely to occur? A) Bradycardia B) Skin rash C) Hypotension D) Sedation ANSWER: D 109.Which of the following interventions is essential in a client with carpal tunnel syndrome? A) Keeping the affected extremity below the level of the heart B) Wrapping the affected extremity with a compression dressing to help decrease the swelling C) Removing all sources of pressures,such as clothing and jewelry D) Starting an IV line in the affected extremity in anticipation of venogram studies ANSWER: C 110.The nurse is developing a teaching plan for a client who must undergo above the knee amputation of the left leg.After amputation exercise of the remaining leg. A) Isnt necessary B) Should begin immediately postoperatively C) Should begin shortly after surgery D) Begins at a rehabilitation center ANSWER: C 111.The nurse is teaching a female client about preventing osteoporosis.Which of the following teaching points is correct? A) Obtaining xray of the bones every 3 years is recommended to detect bone loss B) To avoid fractures,the client should avoid strenuous exercises C) The recommended daily requirement of calcium may be found in a wide variety of foods D) Obtaining the recommended daily allowance of calcium requires taking calcium supplements ANSWER: C 112.A client is diagnosed with osteoporosis.Which electrolytes are involved in this disorder? A) Calcium and sodium B) Calcium and phosphorous C) Phosphorous and potassium D) Potassium and sodium ANSWER: B 113.A client has herniated intervertebral disk in the region of fourth and fifth lumbar vertebrA) On assessment,the nurse expects to note. A) Hypoactive bowel sounds B) Severe low back pain C) Sensory deficits in one arm D) Weakness and atrophy of the arm muscles ANSWER: B 114.A client with gangrene of the left foot is scheduled for below the knee amputation.When planning preoperative care.The nurse should assign highest priority to which nursing diagnosis? A) Altered nutrition related to stress B) Impaired physical mobility related to effects of surgery C) Body image disturbance related to loss of body part D) Knowledge deficit related to denial ANSWER: C 115.A client complains of excruciating pain and inflammation of the great toe.Her serum urate level is 9mg/dl.The physician diagnosis an acute attack of gouty arthritis and prescribes cochicine, 1 mg p.o. as an initial dose, followed by 0.5 mg p.o. every hour not to exceed 4 mg in 24 hours until the pain ceases.How long after oral administration should pain relief occur? A) 30 to 45 minutes B) 1 to 2 hours C) 4 to 12 hours D) 12 to 48 hours ANSWER: D 116.Before a client undergoes arthroscopy the nurse reviews the assessment findings for contraindications for the procedure.Which finding is a contraindication? A) Joint pain B) joint deformity C) Joint flexion of less than 50% D) Joint stiffness ANSWER: C 117.A client is hospitalized for open reduction of a fractured femur.During postoperative assessment,the nurse monitor for signs and symptoms of fat embolism which include A) Pallor and coldness of the affected leg B) Nausea and vomiting after eating C) Hypothermia and bradycardia D) Restlessness and petechiae ANSWER: D 118.Which of the following laboratory studies is most relevant to treating a client who has sustained a pelvic fracture? A) Urine myoglobin B) Urinalysis C) Type and cross match D) Serum ethanol ANSWER: C 119.The nurse is managing the client wwith osteoarthritis.Appropriate treatment strategies for osteoarthritis include A) Administration of narcotics for pain control B) Bed rest for painful exacerbations C) Administration nonsteroidal anti inflammatory drugs D) Vigorous physical therapy of the joints ANSWER: C 120. A client comes to the outpatient department with suspected carpal tunnel syndrome.When assessing the afftected area,the nurse is expected to find which abnormality typically associated with this syndrome A) Positive Tinel's sign B) Negative Phalen's sign C) Positive Chvosteks sign D) Negative Trousseu's sign ANSWER: A 121.Which of the following cells are involved in bone resorption A) Chondrocytes B) Osteoblasts C) Osteoclasts D) Osteocytes ANSWER: C