NCLEX-PN Test #16 3

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?

Accepted Answer

Notify the provider before replacing the weight — do not reattach without an order

Answer

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?

Accepted Answer

"Elevate the casted arm above heart level and report numbness, tingling, or color changes."

Answer

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?

Accepted Answer

Alendronate (Fosamax) — a bisphosphonate

Answer

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?

Accepted Answer

Take prescribed anti-inflammatory medications and perform gentle range-of-motion exercises during morning warm-up

Answer

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?

Accepted Answer

The affected leg is shortened and externally rotated

Answer

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.

NCLEX Practice Test

NCLEX Practice Test

NCLEX-PN Test #16 3