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The College of Maasin

Nisi Dominus Frustra
College of Nursing and Allied Health Sciences

NCM 104-LEC DEMO

PRE-MIDTERM EXAM

Instructions: Do not write anything on this questionnaire. Write your answers on the booklet provided. Do
not make any erasure/s. A deduction of 1 point will be imposed for any erasure committed.

I. Identification:
_________________1. This enables a patient to walk and remove weight from one or both legs.
_________________2. This is the safest gait but it requires coordination.
_________________3. This is the proper standing position with crutches.
_________________4. This is lightweight metal frame with four legs.
_________________5. What do you call the loss of sensation and inability to move the upper extremities?
_________________6. This type of gait requires more balance because only two points support the body at one time.
_________________7. To use this specific gait, the client must be able to bear the entire body weight on the unaffected leg. The
two crutches and the unaffected leg bear weight alternately.
_________________8. These are made of wood or metal and often have a rubberized cap on the tip to prevent slipping.are useful
for patients who can bear weight but need support for balance.
_________________9. Thiis a break or disruption in the continuity of a bone that often affects mobility and sensation.
_________________10. In this type of fracture, the break is across the entire width of the bone in such a way that the bone is
divided into two distinct sections.
_________________11. The fracture does not divide the bone into two portions because the break is through only part of the bone.
_________________12. The skin surface over the broken bone is disrupted which causes an external wound.
_________________13. This type fracture does not extend through the skin and therefore has no visible wound.
_________________14. This is a rigid device that immobilizes the affected body part while allowing other body parts to move.
_________________15. This type of cast set in 15 minutes and can sustain weight bearing or pressure in 15 to 30 minutes.
_________________16. This type of cast can take 24 to 72 hours to dry, and weight bearing or pressure is contraindicated during
this period.
_________________17. This is defined as insufficient arterial perfusion to an extremity caused by trauma or stasis; leads to
ischemia and tissue necrosis if not reversed.
_________________18. This involves a pulling force applied through use of weights on a part of the body while a second force
called counter traction pulls in the opposite direction.
_________________19. This type of traction is applied directly to the skin, exerting indirect pull on the bone.
_________________ 20. This is the removal of necrotic or dead tissue.
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Multiple Choice: Write the corresponding letter of your answer on the booklet provided.

1. Immediately after application of a plaster of paris cast, the client asks the nurse when weight
bearing may begin. The most appropriate response by the nurse is which of the following?

a. I do not know. I will ask your physician.

b. It is all individualized based on how you feel.
c. Within 8 hours, you will be standing next to the bed.
d. Generally after 24 to 48 hours.

2. Before a client has skin traction applied, which of the following should the nurse include in the
instructions given to the client?
a. Skin traction may be used for long periods of time
b. Skin traction is applied until surgery can be performed
c. A pin will be put in the bone
d. Weights up to 45 pounds will be applied

2. Which of the following changes in a clients neurovascular assessment should be reported as a

critical sign of arterial insufficiency?
a. Pale extremity that is cool to touch
b. Hypersensation below the injury
c. Pain unrelieved by analgesic
d. Reduced motion in affected extremity

4. In planning the postoperative care for a client with a cast, the nurse would select which of the
following as an appropriate nursing diagnosis?
a. Risk for deficient fluid volume related to excess fluid loss
b. Total urinary incontinence: related to aging process
c. Constipation related to decreased mobility
d. Imbalanced nutrition: less than body requirements related to lack of knowledge of appropriate food
choices

5. The nurse is caring for a client with an open fracture. Which of the following would be the priority
to include in this clients treatment plan?
a. A high-protein diet
b. Insertion of a Foley catheter
c. Tetanus toxoid
d. Passive range-of-motion exercises

6. Which of the following neurovascular

complications should the nurse assess for after a fracture?
Select all that apply:
a. Petechiae over all extremities
b. Pallor
c. Exaggerated extremity movement
d. Decreased sensation distal to the fracture site
e. Purulent drainage at the site of an open fracture
f. Pulselessness
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7. A client with a fractured pelvis has a nursing diagnosis of impaired mobility related to bed rest,
weakness, and traction. The nurse should inform the client that the rationale for maintaining good
body alignment in the bed is to
a. decrease protein catabolism.
b. minimize the workload on the heart.
c. increase body strength and muscle mass.
d. reduce musculoskeletal strain and enhance lung expansion.

8. A client has received teaching on the use of a cane to assist with ambulation. Which of the following
statements by the client would indicate to the nurse that further teaching is needed?
a. My elbows should be slightly bent when I use the cane.
b. I should hold the cane on my unaffected side.
c. A walker would be more difficult to use than a cane.
d. While walking, I should have shoes and socks on at all times.
9. Which of the following crutch gaits should the nurse instruct the client to use who has bilateral
paralysis of the hips and legs?
a. Swing-to gait
b. Four-point gait
c. T hree-point gait
d. Two-point gait

10. Which of the following should the nurse include when instructing a client with crutches on the two-
point gait?
a. Move the right crutch followed by the left foot, then move the left crutch forward followed by the right
foot
b. Move both crutches forward together and bring the legs through beyond the crutches
c. Move the left crutch and right foot forward together, followed by moving the right crutch and the left foot
forward together
d. Move both crutches and the weaker leg forward, followed by moving the stronger leg forward

11. The nurse should include which of the following in the teaching plan for a client who has a cane
prescribed?
a. Move the cane forward 2 feet to ensure that the body weight is supported on both legs
b. Hold the cane with the hand on the weaker side of the body
c. Position the arm holding the cane so the elbow is completely straight to ensure maximum support
d. Position the cane 6 inches to the side and 6 inches to the front of the foot of the strongest leg

12. The nurse assesses that a client has lower-extremity weakness on the left. What should the nurse
observe the client doing to evaluate the clients ability to use a walker?
a. Moving both the walker and the left leg forward 6 inches, then moving the right leg while the body weight
is supported by the arms and the left leg
b. Moving both the walker and the right leg forward 6 inches, then moving the left leg while the body weight
is supported by the arms and the right leg
c. Moving the walker forward 12 inches, bearing the body weight on the arms and extremities, then walking
up to the walker
d. Moving both the walker and the left leg forward 12 inches, then moving the right leg while the body
weight is supported by the arms and the left leg
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13. A client has a pressure ulcer with a shallow, partial skin thickness, eroded area but no necrotic
areas. The nurse would treat the area with which dressing?
a. Alginate
b. Dry gauze
c. Hydrocolloid
d. No dressing is indicated

14. The nurse plans to remove the clients sutures. Which action demonstrates appropriate standards
of care? Select all that apply.
a. Use clean technique.
b. Grasp the suture at the knot with a pair of forceps.
c. Place the curved tip of the suture scissors under the suture as close to the skin as possible.
d. Pull the suture material that is visible beneath the skin during removal.
e. Remove alternate sutures first.

15. A patient has a large abdominal wound, which will require irrigation and packing after discharge
from the hospital. Which statement made by the patient indicates a need for further teaching related to
her wound irrigation?
a. Ill lie so the wound is vertical to the basin during the irrigation.
b. Ill use slow, continuous pressure while irrigating my wound.
c Ill warm the irrigation solution to body temperature before I use it.
d Ill irrigate the wound, starting at the bottom and moving to the top.

16. A patient tells the nurse that the health care provider said his sutures are coming out today. Which
nursing action is most important before removing the sutures?
a Assembling the required equipment
b Checking that there is a health care providers order for the suture removal
c Performing hand hygiene in view of the patient
d Explaining to the patient what will be happening during the suture removal

17. A patient has an extensive abdominal wound and is to have half of the staples removed and the
incision line cleaned. Which actions should the nurse take during the preparation and actual
interaction with the patient? (Select all that apply.)
a Position the patient in a semi-Fowlers position.
b Place upper tip of staple remover under staple to ease removal.
c Administer an analgesic 30 minutes before staple removal.
d Lift up on the staple when depressing the extractor handles.
e Clean the incision before removing the staples, starting at the sides next to the incision.
f Remove all of the staples at the top of the incision and leave the rest, beginning at the middle of the
incision.

18. The nurse is setting up an over-bed table with supplies to clean a wound and to replace a sterile
dressing. The nurse would need to consider that contamination exists if which situation is present?
a The sterile gloves are kept above waist level.
bThe over-bed table is positioned before any of the supplies are opened.
c The nurse pours the bottle of cleaning solution with the palm facing the label.
d The sterile glove package is dry and intact with a water stain.
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19. A patient had surgery to repair an incisional hernia. His surgical incision was approximated and
stapled at the time of the procedure.
Which type of wound healing is occurring in the surgical site?
a Primary intention
b Secondary intention
c Tertiary intention

20. In preparing to irrigate a wound, which intervention helps to reduce the risk for infection during
wound irrigation? (Select all that apply.)
a Using sterile technique
b Directing the flow of solution from healthy tissue to infected tissue
c Warming irrigation solution to body temperature
d Cleaning suture line after doing wound irrigation

21.Which of the following is not a principle of surgical asepsis?

a All items used within a sterile field must be sterile.
b If an items sterility is in doubt, the nurse can check its expiration date.
c Table drapes are part of a sterile field only at table level.
d Moisture on the sterile field contaminates the field.

22. A child with cerebral palsy can experience difficulty with movement, loss of balance, and lack of
muscle control. Which gait does the nurse instruct the parents to use for crutch walking to provide the
most support and improves balance.?
a Four-point Correct
b Three-point
c Two-point
d Swing-to gait

23. A patient is recovering from bilateral knee replacements and is prescribed bilateral partial weight
bearing. You are asked to reinforce crutch walking and know that the following crutch gait would be
most appropriate for this patient. The patient moves a crutch at the same time as the opposing leg, so
that crutch movements are similar to arm motion during normal walking.
a Two-point gait Correct
b Three-point gait
c Four-point gait
d Swing-through gait

24. A patient is in balanced-suspension skeletal traction (BSST) because of a fractured femur. What
should be included in the patients nursing care?
a Keeping the head of the bed elevated between 10 and 20 degrees to prevent hypostatic pneumonia
b Eliminating the footdrop splint if his toes are ticklish
c Teaching the patient how to use the trapeze bar Correct
d Adjusting the weights if the patient is complaining of periodic pain.

25. The nurse suspects that a patient might be developing clinical manifestations of a neurovascular
deficit after Bucks traction is applied. Which of the following neurovascular assessments is the most
significant?
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a Capillary refill of 3 seconds in the affected foot
b Diminished posterior tibial pulse of the affected foot
c Numbness and tingling in the affected foot
d Pain on passive motion of the affected foot

26. The nurse is one of several persons who witnessed a vehicle hit a pedestrian at fairly low speed on a
small street. The victim is dazed and tries to get up. The leg appears fractured. Which intervention
should the nurse take?
a. Try to reduce the fracture manually.
b. Assist the victim to get up and walk to the sidewalk.
c. Leave the victim for a few moments to call an ambulance.
d. Stay with the victim and encourage the person to remain still.

27. A client is being discharged to home after application of a plaster leg cast. Which statement
indicates that the client understands proper care of the cast?
a. I need to avoid getting the cast wet.
b. I need to cover the casted leg with warm blankets.
c. I need to use my fingertips to lift and move my leg.
d. I need to use something like a padded coat hanger end to scratch under the cast if it itches.

28. A client being measured for crutches asks the nurse why the crutches cannot rest up underneath
the arm for extra support. The nurse responds knowing that which would most likely result from this
improper crutch measurement?
a. A fall and further injury
b. Injury to the brachial plexus nerves
c. Skin breakdown in the area of the axilla
d. Impaired range of motion while the client ambulates

29. The nurse has given a client instructions about crutch safety. Which client statement indicates that
the client understands the instructions? Select all that apply.
a. I should not use someone elses crutches.
b. I need to remove any scatter rugs at home.
c. I can use crutch tips even when they are wet.
d. I need to have spare crutches and tips available.
e. When Im using the crutches my arms need to be completely straight.

30. The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of
compartment syndrome. The nurse determines that the client understands the information if the client
states that he or she should report which early symptom of compartment syndrome?
a. Cold, bluish-colored fingers
b. Numbness and tingling in the fingers
c. Pain that increases when the arm is dependent
d. Pain that is out of proportion to the severity of the fracture

31. The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least
concerned with which finding?
a. Inflammation
b. Serous drainage
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c. Pain at a pin site
d. Purulent drainage

32. The nurse is assessing the casted extremity of a client. Which sign is indicative of infection?
a. Dependent edema
b. Diminished distal pulse
c. Presence of a hot spot on the cast
d. Coolness and pallor of the extremity

33. A client with a hip fracture asks the nurse why Bucks (extension) traction is being applied before
surgery. The nurse provides a response based on which purpose of Bucks (extension) traction?
a. Allows bony healing to begin before surgery
b. Provides rigid immobilization of the fracture site
c. Lengthens the fractured leg to prevent severing of blood vessels
d. Provides comfort by reducing muscle spasms and provides fracture immobilization

34. A client has sustained a closed fracture and has just had a cast applied to the affected arm. The
client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers
an analgesic, with little relief. Which problem may be causing this pain?
a. Infection under the cast
b. The anxiety of the client
c. Impaired tissue perfusion
d. The recent occurrence of the fracture

35. Which of the following should the nurse include when instructing a client with crutches on the
four-point gait?
a. Move the right crutch followed by the left foot, then move the left crutch forward followed by the right
foot
b. Move both crutches forward together and bring the legs through beyond the crutches
c. Move the left crutch and right foot forward together, followed by moving the right crutch and the left foot
forward together
d. Move both crutches and the weaker leg forward, followed by moving the stronger leg forward

Enumeration:

1-2 Draw/Illustrate the Tripod Position.

3-4 What are the methods in measuring crutch length?
5-9 What are the 5 Ps in assessing the neurovascular status of patients with casts?
10-13 What are the 4 Ps in traction assessment?
14-17 Enumerate 4 types of wound dressing and describe each
18-20 Enumerate 3 types of skin traction and describe each
21-22 Enumerate two types of cast and describe each
23-25 Enumerate 4 types of Wound Healing
26-29 Enumerate the stages of Wound Healing
30-35 Enumerate the gaits used in ambulating using crutches and describe each
36-37. Describe the steps in using the walker.
37-40. Describe the steps in using the cane.
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Essay/Critical Thinking: Based on the scenario given, what would be the best nursing intervention? Answer
briefly.

1. While you are putting on sterile gloves in preparation for an indwelling urinary catheter insertion, your
patient, Sheri Lawrence, moves her leg. You do not think that Sheris leg touched the glove, but you are not
positive. What should you do? (3 pts)

2. You are preparing to discharge Bobby Rowden from the emergency room. Discuss the teaching you should
include for Bobby and his parents related to his injury and his plaster cast. (7 pts.)

Colossians 3:17 And whatever you do, whether in word or deed, do it all in the name of the Lord Jesus, giving thanks to
God the Father through him.