NUR 220 | NUR 220 Medical Surgical Nursing Exam
4 Version 2 | Questions with Correct Answers and
Expert Explanation for Each Question | Baltimore
City Community College
1. A patient with a fractured femur suddenly develops shortness of breath,
restlessness, and a petechial rash on the chest. Which complication should the nurse
suspect?
A. Deep vein thrombosis
B. Fat embolism syndrome
C. Pulmonary edema
D. Compartment syndrome
Correct Answer: B
Expert Explanation: Fat embolism syndrome typically occurs within 24 to 48 hours
after a long bone fracture. The classic triad includes respiratory distress,
neurological impairment, and a petechial rash. This rash is a distinguishing factor
from a pulmonary embolism. The nurse must prioritize oxygen administration and
notify the provider immediately. Failure to recognize these signs can lead to rapid
clinical deterioration.
,2. Which nursing intervention is a priority when caring for a client in Buck’s skin
traction?
A. Assessing skin integrity under the traction boot
B. Removing weights once per shift for range of motion
C. Ensuring the weights are resting on the floor
D. Applying a warm compress to the affected limb
Correct Answer: A
Expert Explanation: Buck’s traction is used to stabilize fractures and reduce
muscle spasms preoperatively. The nurse must assess the skin for breakdown under
the foam boot at least every 8 hours. Weights must always hang freely and never be
removed without a specific physician’s order. Maintaining proper alignment is
essential for the traction to be effective. Skin breakdown is a major complication
associated with this type of immobilization.
3. A client returns from a total hip arthroplasty. Which position is most appropriate to
prevent dislocation of the prosthesis?
A. Abduction using a wedge pillow
B. High Fowler’s position at 90 degrees
C. Adduction of the affected leg
,D. Internal rotation of the hip
Correct Answer: A
Expert Explanation: Preventing adduction is critical to keep the femoral head
within the acetabulum after surgery. An abduction pillow or wedge is typically
placed between the legs to maintain alignment. Nurses must instruct the patient to
avoid crossing their legs or bending past 90 degrees. Proper positioning minimizes
the risk of painful postoperative dislocation. Continuous monitoring of the patient’s
adherence to movement restrictions is necessary for safety.
4. Which clinical manifestation is considered an early sign of compartment syndrome?
A. Absence of a distal pulse
B. Cold and mottled skin
C. Paralysis of the limb
D. Paresthesia or tingling
Correct Answer: D
Expert Explanation: Paresthesia is often one of the first indicators of increased
pressure within a muscle compartment. Pain that is out of proportion to the injury
and unrelieved by medication is also an early sign. Pulselessness and paralysis are
late signs indicating irreversible tissue damage. Frequent neurovascular checks are
, required to catch these changes before they progress. The nurse must report these
findings immediately to facilitate an emergency fasciotomy.
5. A post-menopausal woman is diagnosed with osteoporosis. Which medication does
the nurse expect to be prescribed to inhibit bone resorption?
A. Alendronate
B. Prednisone
C. Furosemide
D. Allopurinol
Correct Answer: A
Expert Explanation: Alendronate is a bisphosphonate used to increase bone mass
and prevent fractures. It works by inhibiting the activity of osteoclasts that break
down bone tissue. Patients should take this medication with a full glass of water on
an empty stomach. They must remain upright for at least 30 minutes to prevent
esophageal irritation. Bone density monitoring is used to evaluate the effectiveness
of this pharmacological therapy.
6. A client with rheumatoid arthritis (RA) reports morning stiffness. Which instruction
should the nurse provide?
A. Avoid movement until the pain subsides
B. Apply ice packs to the joints immediately
4 Version 2 | Questions with Correct Answers and
Expert Explanation for Each Question | Baltimore
City Community College
1. A patient with a fractured femur suddenly develops shortness of breath,
restlessness, and a petechial rash on the chest. Which complication should the nurse
suspect?
A. Deep vein thrombosis
B. Fat embolism syndrome
C. Pulmonary edema
D. Compartment syndrome
Correct Answer: B
Expert Explanation: Fat embolism syndrome typically occurs within 24 to 48 hours
after a long bone fracture. The classic triad includes respiratory distress,
neurological impairment, and a petechial rash. This rash is a distinguishing factor
from a pulmonary embolism. The nurse must prioritize oxygen administration and
notify the provider immediately. Failure to recognize these signs can lead to rapid
clinical deterioration.
,2. Which nursing intervention is a priority when caring for a client in Buck’s skin
traction?
A. Assessing skin integrity under the traction boot
B. Removing weights once per shift for range of motion
C. Ensuring the weights are resting on the floor
D. Applying a warm compress to the affected limb
Correct Answer: A
Expert Explanation: Buck’s traction is used to stabilize fractures and reduce
muscle spasms preoperatively. The nurse must assess the skin for breakdown under
the foam boot at least every 8 hours. Weights must always hang freely and never be
removed without a specific physician’s order. Maintaining proper alignment is
essential for the traction to be effective. Skin breakdown is a major complication
associated with this type of immobilization.
3. A client returns from a total hip arthroplasty. Which position is most appropriate to
prevent dislocation of the prosthesis?
A. Abduction using a wedge pillow
B. High Fowler’s position at 90 degrees
C. Adduction of the affected leg
,D. Internal rotation of the hip
Correct Answer: A
Expert Explanation: Preventing adduction is critical to keep the femoral head
within the acetabulum after surgery. An abduction pillow or wedge is typically
placed between the legs to maintain alignment. Nurses must instruct the patient to
avoid crossing their legs or bending past 90 degrees. Proper positioning minimizes
the risk of painful postoperative dislocation. Continuous monitoring of the patient’s
adherence to movement restrictions is necessary for safety.
4. Which clinical manifestation is considered an early sign of compartment syndrome?
A. Absence of a distal pulse
B. Cold and mottled skin
C. Paralysis of the limb
D. Paresthesia or tingling
Correct Answer: D
Expert Explanation: Paresthesia is often one of the first indicators of increased
pressure within a muscle compartment. Pain that is out of proportion to the injury
and unrelieved by medication is also an early sign. Pulselessness and paralysis are
late signs indicating irreversible tissue damage. Frequent neurovascular checks are
, required to catch these changes before they progress. The nurse must report these
findings immediately to facilitate an emergency fasciotomy.
5. A post-menopausal woman is diagnosed with osteoporosis. Which medication does
the nurse expect to be prescribed to inhibit bone resorption?
A. Alendronate
B. Prednisone
C. Furosemide
D. Allopurinol
Correct Answer: A
Expert Explanation: Alendronate is a bisphosphonate used to increase bone mass
and prevent fractures. It works by inhibiting the activity of osteoclasts that break
down bone tissue. Patients should take this medication with a full glass of water on
an empty stomach. They must remain upright for at least 30 minutes to prevent
esophageal irritation. Bone density monitoring is used to evaluate the effectiveness
of this pharmacological therapy.
6. A client with rheumatoid arthritis (RA) reports morning stiffness. Which instruction
should the nurse provide?
A. Avoid movement until the pain subsides
B. Apply ice packs to the joints immediately
