NCLEX-PN Test #16 3 — Questions and Answers
Question 1: A client in skeletal traction for a femur fracture calls out that a traction weight fell off. What is the priority nursing action?
- Reattach the weight immediately to restore traction
- Notify the provider before replacing the weight — do not reattach without an order (Correct answer)
- Remove all traction and apply a splint temporarily
- Document the finding and check again in one hour
Correct answer: Notify the provider before replacing the weight — do not reattach without an order
Traction weights must never be removed, added, or replaced without a provider order, as repositioning or interrupting traction can displace the fracture and cause neurovascular injury. The nurse must notify the provider immediately while ensuring the client is not moving the extremity unnecessarily.
Question 2: A client has a new cast for a fractured wrist. Which discharge instruction is most important?
- "Wet the cast daily with a damp cloth to keep it from cracking."
- "Elevate the casted arm above heart level and report numbness, tingling, or color changes." (Correct answer)
- "Insert a ruler under the cast if itching occurs to scratch inside."
- "The cast is waterproof — you can shower normally."
Correct answer: "Elevate the casted arm above heart level and report numbness, tingling, or color changes."
Neurovascular assessment is the most critical component of cast care. The 6 P's of compartment syndrome (Pain, Pressure, Pallor, Paralysis, Paresthesia, Pulselessness) must be reported immediately. Elevating the extremity reduces swelling. Inserting objects under the cast can cause wounds and infections. Plaster casts are not waterproof.
Question 3: The PN is caring for a client with osteoporosis. Which medication most directly increases bone density?
- Calcium carbonate (Tums)
- Vitamin D3 (cholecalciferol)
- Alendronate (Fosamax) — a bisphosphonate (Correct answer)
- Calcitonin nasal spray
Correct answer: Alendronate (Fosamax) — a bisphosphonate
Bisphosphonates (alendronate, risedronate) inhibit osteoclast activity, reducing bone resorption and increasing bone mineral density. They are the most effective pharmacological agents for preventing osteoporotic fractures. Calcium and vitamin D are necessary supplements but do not independently increase bone density in established osteoporosis.
Question 4: A client with rheumatoid arthritis reports morning stiffness that lasts 2–3 hours. Which recommendation should the nurse make for morning stiffness management?
- Immobilize the affected joints with splints until stiffness resolves
- Apply cold packs to inflamed joints before morning activities
- Take prescribed anti-inflammatory medications and perform gentle range-of-motion exercises during morning warm-up (Correct answer)
- Rest completely until stiffness resolves before beginning any activity
Correct answer: Take prescribed anti-inflammatory medications and perform gentle range-of-motion exercises during morning warm-up
RA morning stiffness is caused by inflammatory fluid accumulation during sleep inactivity. Management includes taking medications (NSAIDs, DMARDs) as prescribed and performing gentle ROM exercises to mobilize joints and decrease stiffness. Warm showers before exercise can also help. Cold therapy and complete rest worsen stiffness.
Question 5: The nurse is assessing a client with a hip fracture. Which assessment finding is most characteristic of a femoral neck fracture?
- The affected leg appears lengthened and in external rotation
- The affected leg is shortened and externally rotated (Correct answer)
- Bilateral leg shortening with internal rotation
- Severe back pain with sciatic radiation
Correct answer: The affected leg is shortened and externally rotated
Femoral neck (hip) fracture presents with: (1) shortening of the affected leg (due to muscle spasm pulling the leg upward), (2) external rotation of the leg, and (3) inability to bear weight. Pain is in the groin or hip area. This presentation with an elderly osteoporotic patient after a fall is the classic scenario.
Question 6: A client with gout is having an acute attack affecting the great toe. Which nursing intervention provides immediate relief?
- Apply direct heat to the affected joint
- Keep the joint in a dependent position to promote venous drainage
- Rest the joint, apply ice, and elevate the affected extremity (Correct answer)
- Encourage vigorous exercise to prevent further uric acid crystal deposition
Correct answer: Rest the joint, apply ice, and elevate the affected extremity
Acute gout management: rest the affected joint (no weight-bearing), apply ice to reduce inflammation and pain, and elevate the extremity to decrease swelling. Colchicine, NSAIDs, or corticosteroids are prescribed for acute attacks. Heat worsens inflammation; exercise during acute attack increases pain and joint damage.
NCLEX-PN Test #16 3
A client in skeletal traction for a femur fracture calls out that a traction weight fell off.
What is the priority nursing action?