1. A nurse is providing instructions to a client receiving Baclofen (Lioresal).

Which of the following would

be included in the teaching plan?

A. Limit fluid intake.

B. Hold the medication if diarrhea occurs.

C. Restrict alcohol intake.

D. Notify the physician if weakness occurs.

2. A nurse is analyzing the laboratory studies on a client receiving Dantrolene Sodium (Dantrium). Which
of the following laboratory test would identify an adverse effect associated with the use of the
medication?

A. Blood urea nitrogen.

B. Creatinine.

C. Liver function test.

D. Triglyceride.

3. A nurse is caring for a client who is receiving Cyclobenzaprine hydrochloride (Flexeril) for the
treatment of muscle spasm. Which of the following medical condition is contraindicated with the use of
the medication?

A. Diabetes Mellitus.

B. Angle-closure glaucoma.

C. Emphysema.

D. Urinary tract infection.

4. A client is receiving Methocarbamol (Robaxin) as an adjunct to physical therapy for the relief of painful
muscle discomfort. Which of the following is not true regarding with the use of the medication?
A. The parenteral form causes hypotension and bradycardia when given rapidly.

B. The medicine can cause the urine to turn into brown, black or green.

C. The use of a cold or allergy medicine will lessen the side effects of the medication.

D. The parenteral form is contraindicated in clients with liver damage.

5. Allopurinol (Zyloprim) is prescribed for a client for the treatment of gout. And the nurse is providing
medication instructions. The nurse tells the client to?

A. Take the medication on an empty stomach.

B. To limit the use of vitamin C.

C. A rash is a normal side effect of the medication.

D. The effect of the medication will happen immediately.

6. A client is prescribed Colchicine. After taking three doses, the client complaints of nausea, vomiting,
and loose bowel stools. Which of the following should the client do?

A. Skip the next dose, and take the another dose.

B. Withhold the medication and the physician is notified.

C. Continue taking the medication as these symptoms will go away.

D. Cut in half the next dosage.

7. Colchicine is prescribed for a client with gout. The nurse reviews the client’s record, knowing that this
medication would be used in caution in which of the following medical condition?

A. Behcet disease.

B. Aplastic Anemia.
C. Amyloidosis.

D. Familial Mediterranean fever (FMF).

8. A client taking probenecid is complaining of gout pain. Which of the following medication should the
nurse expect to be administered?

A. Acetaminophen (Tylenol).

B. Aspirin (Ecotrin).

C. Orphenadrine (Norflex).

D. Tizanidine (Zanaflex).

9. Gold sodium thiomalate is prescribed to a client with rheumatoid arthritis. Which of the following side
effects indicates an overdosage of the medication?

A. Flushing.

B. Dizziness.

C. Joint pain.

D. Metallic taste.

10. Gold salt toxicity can be reversed using which medication?

A. Acetaminophen.

B. Dimercaprol.

C. Calcium salts.

D. Hydroxycobalamin.
11. Adalimumab (Humira) is given to a client for the treatment of rheumatoid arthritis. Which of the
following side effect is associated with the medication?

A. Numbness.

B. Diarrhea.

C. Urinary retention.

D. Weight gain.

12. A client receiving Azathioprine (Imuran) complains of hair loss. The nurse tells the client that?

A. Hair loss is irreversible.

B. Hair loss is uncommon.

C. Hair loss is temporary.

D. Hair loss is a sign of toxicity.

13. The client is about to start the treatment for juvenile rheumatoid arthritis. Before the administration
of etanercept (Enbrel), it is important for the nurse to:

A. Ask for an allergy to latex.

B. Ask the client to postpone vacation trip abroad.

C. Tell the client to not miss due vaccination while on treatment.

D. To avoid people with a recent injection of etanercept.

14. A nurse is giving medicinal instructions to a female client receiving Leflunomide (Arava). Which of the
following is an appropriate instruction with the use of the medication?

A. To use an effective form of birth control while on the treatment.

B. Breastfeeding does not have to be stopped during the treatment.

C. To use cholestyramine to lessen the side effects.

D. It may take 3-5 days to notice any improvement while taking leflunomide.

15. A client with rheumatoid arthritis is receiving Hydroxychloroquine (Plaquenil) in the recent months.
The nurse tells the client to visit which of the following while on the treatment?

A. Dentist.

B. Ophthalmologist.

C. Pulmonologist.

D. Endocrinologist.

16. A client has just been prescribed with Methotrexate (Trexall) for the treatment of rheumatoid
arthritis who did not respond to any other treatment. An important reminder for the client is to?

A. Clay-colored stool is a normal response of the treatment.

B. Pregnancy is not contraindicated with the use of the medication.

C. Strict hand washing.

D. Get a daily source of sunlight during the day.

17. A client who is taking Methotrexate (Trexall) ask the nurse on what is the appropriate activity while
taking the medication. The nurse advise the client to play which activity?

A. Basketball.

B. Ice hockey.

C. Football.

D. Tennis.
18. The nurse is reviewing the client’s history who is about to take Methotrexate. Which of the following
drugs can be safely administered together with methotrexate?

A. Tetracycline.

B. Folic Acid.

C. Sulfamethoxazole.

D. Phenytoin.

19. Alendronate (Fosamax) is given to a client with osteoporosis. The nurse advises the client to?

A. Take the medication in the morning with meals.

B. Take the medication 2 hours before bedtime.

C. Take the medication with a glass of water after rising in the morning.

D. Take the medication during lunch.

20. A client with osteoporosis is asking the nurse regarding the use of Salmon calcitonin (Miacalcin) nasal
spray. The nurse tells the client to do the following, except?

A. Delivery system contains enough medication for at least 30 doses. Discard any unused solution after
30 doses.

B. If you do not feel the spray while using it, repeat the dose on the other nostrils.

C. Miacalcin is usually given as one spray per day into only one of your nostrils.

D. Take extra vitamin D while you are using Miacalcin.

Answers and Rationale:

1. Answer: C. Restrict alcohol intake.

Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and
other central nervous system depressants because baclofen potentiates the depressant activity of these
agents.

Option A: Limiting fluid intake is not necessary, but the client should be warned that urinary retention
occurs.

Option B: Constipation rather than diarrhea is a side effect.

Option D: Weakness is related to a CNS effect that is prevalent during the early phase of the treatment
and diminishes with continued medication use.

2. Answer: C. Liver function test.

Liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver
function test should be performed before and during the duration of the treatment.

Options A and B assesses the kidney function.

Option D is not related to the use of the medication.

3. Answer: B. Angle-closure glaucoma.

Cyclobenzaprine hydrochloride (Flexeril) has an anticholinergic effect, so it is used in caution with

patients with angle-closure glaucoma, urinary retention, and increased intraocular pressure.

4. Answer: C. The use of a cold or allergy medicine will lessen the side effects of the medication.

Methocarbamol is a muscle relaxant. Medicines such as cold or allergy medicine, sedatives, narcotic pain
medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety add to the
sleepiness caused by methocarbamol.
5. Answer: B. To limit the use of vitamin C.

Instruct the client not to take larger doses of Vitamin C while taking allopurinol because kidney stones
may occur.

Option A: Allopurinol is taken with a meal or with a milk.

Option C: This is a sign of hypersensitivity so the physician should be notified immediately.

Option D: A full therapeutic effect usually takes 1 week or longer.

6. Answer: B. Withhold the medication and the physician is notified.

If gastrointestinal symptoms occur (nausea, vomiting, diarrhea and abdominal pain), the medication is
withheld and the physician is notified.

Options A and D: Cutting in half and skipping the next dose will not give the assurance of avoiding these
symptoms.

Option C: These side effects are signs of overdosage that can be fatal.

7. Answer: B. Aplastic Anemia.

Colchicine is contraindicated in patients with a known hypersensitivity to the drug, in those with serious
gastrointestinal, renal, hepatic, or cardiac disorders, and in those with blood dyscrasias such as aplastic
anemia.

Options A, C, and D all have joint pain as one of the symptoms, so the use of colchicine helps in reducing
the inflammation of the joint.

8. Answer: A. Acetaminophen (Tylenol).

The concurrent use of antigout medications and aspirin causes an increase in the uric acid level in the
body; The client should be instructed to use acetaminophen (Tylenol) if prescribed rather than aspirin.
Options C and D are skeletal muscle relaxant medications.

9. Answer: D. Metallic taste.

Gold sodium thiomalate toxicity signs are pruritus, diarrhea, dermatitis, stomatitis, and metallic taste.

Options A and B: Flushing and dizziness are the side effects that may occur soon after the injection.

Option C: Increased joint pain may occur 1-2 days after the injection.

10. Answer: B. Dimercaprol.

Dimercaprol is used to treat arsenic, gold, or mercury poisoning.

Option A is an analgesic/antipyretic.

Option C is the antidote for fluoride ingestion.

Option D is the antidote for cyanide poisoning.

11. Answer: A. Numbness.

Adalimumab (Humira) has been associated with neurological side effects such as numbness, tingling,
dizziness, visual disturbances, and weakness in the legs).

Options B, C, and D are not associated with the use of medication.

12. Answer: C. Hair loss is temporary.

Temporary hair loss may occur. Normal hair growth will return after treatment has ended.

13. Answer: A. Ask for an allergy to latex.

Before using etanercept, tell the physician or the nurse for any allergy to latex or natural dry rubber that
can be found in the prefilled syringes or autoinjectors form of the medication.

14. Answer: A. To use an effective form of birth control while on the treatment.

Use an effective form of birth control to avoid pregnancy while taking leflunomide because of its
teratogenic effect.

Option B: The medicine can be excreted in the human milk.

Option C: Cholestyramine decreases leflunomide’s effectiveness.

Option D: It may take 4 weeks or more to notice any improvement while taking leflunomide.

15. Answer: B. Ophthalmologist.

Plaquenil can adversely affect the eyes such as retinal damage. Clients taking this medicine should be
seen by an ophthalmologist at least once a year.

16. Answer: C. Strict hand washing.

Clients taking Methotrexate are more likely to get infections or may worsen any current infections.
Therefore, hand washing will help to prevent the spread of infection.

Option A is a sign of a liver toxicity and the physician should be notified of it.

Option B: Pregnancy is not allowed during the treatment.

Option D: Photosensitivity may happen during the treatment so the client is advised to wear sunscreen
or any protective gear against the sunlight.

17. Answer: D. Tennis.

Avoid contact sports or other situations where bruising or injury could occur because the medication can
lower the number of platelets, which are necessary for proper blood clotting.

Options A, B, and C are all contact sports.

18. Answer: B. Folic Acid

Clients who take folic acid supplements lowered the risk of GI problems and mouth sores brought about
by the use of methotrexate.

Option A may decrease intestinal absorption of methotrexate.

Options C and D: Methotrexate is partially bound to serum albumin, and toxicity may be increased
because of displacement by certain drugs, such as salicylates, phenylbutazone, phenytoin, and
sulfonamides.

19. Answer: C. Take the medication with a glass of water after rising in the morning.

Alendronate needs to be taken with a glass of water after rising in the morning in order to prevent
gastrointestinal effects.

20. Answer: B. If you do not feel the spray while using it, repeat the dose on the other nostrils.

Miacalcin spray delivers a fine mist into the nose. Even if the client does not feel the spray while using it,
the medication is still being absorbed by the nasal passages.

Option A: Discard any unused solution after 30 doses because spray may not deliver correct dose.

Option C: Use the other nostril the next day and continue alternating back and forth for each daily dose.

Option D: Vitamin D helps in treating osteoporosis by helping in maintaining healthy bones.

1. Mr. and Mrs. Andrews’ child was diagnosed with Duchenne’s muscular dystrophy; which of the
following usually is the first indication of the condition?

A. Inability to suck in the newborn

B. Lateness in walking in the toddler

C. Difficulty running in the preschooler

D. Decreasing coordination in the school-age child

2. A spica cast was put on Baby Betty after an unfortunate incident to immobilize her hips and thighs;
which of the following is the priority nursing action immediately after application?

A. Keep the cast dry and clean.

B. Cover the perineal area.

C. Elevate the cast.

D. Perform neurovascular checks.

3. Veronica is a 14-year-old girl who wears a brace for structural scoliosis; which of the following
statements indicate effective use of the brace?

A. “I sure am glad that I only have to wear this awful thing at night.”

B. “I’m really glad that I can take this thing off whenever I get tired.”

C. “I wonder if I can take the brace off when I go to the homecoming dance.”

D. “I’ll look forward to taking this thing off to take my bath every day.”
4. Which of the following is the most common permanent disability in childhood?

A. Scoliosis

B. Muscular dystrophy

C. Cerebral palsy

D. Developmental dysplasia of the hip (DDH)

5. Among toddlers and children up to age five, femur fractures usually result from a low energy fall. In
most cases, the orthopedic surgeon realigns the fracture using fluoroscopy or x-ray imaging as a guide
and immobilizes the leg in a type of cast called a spica cast. Approximately how many weeks does it take
for a fractured femur to heal in a 3-year-old?

A. 2 weeks

B. 4 weeks

C. 8 weeks

D. 10 weeks

6. Nurse Cheryl is assessing Fred, a 14-year-old boy who had scoliosis; besides checking neurologic status
directly after Harrington rod instrumentation and spinal fusion, she should be regarded with which of
the following factors?

A. Comfort level

B. Dietary tolerance

C. Physical therapy needs

D. Understanding of the procedure

7. When a child injures the epiphyseal plate from a fracture, the damage may result in which of the
following?

A. Rheumatoid arthritis

B. Permanent nerve damage

C. Osteomyelitis

D. Bone growth disruption

8. Mrs. Lodge’s child requires the use of Pavlik harness; which of the following would Nurse Betty do to
best assess the mother’s ability to care for her child?

A. Demonstrate to the mother how to remove and reapply the device.

B. Have the mother remove and reapply the harness before discharge.

C. Have the mother verbalize the purpose for using the device.

D. Request a home health care nurse visit after discharge.

9. Nurse Kevin is assessing a newborn for developmental dysplasia of the hip (DDH); he would expect to
assess which of the following?

A. Characteristic limp

B. Ortolani’s sign

C. Symmetrical gluteal folds

D. Trendelenburg‘s signs

10. Mrs. Cooper is concerned about her 4-month-old son’s unusual condition; which of the following
statements made by her would indicate that the child may have cerebral palsy?
A. “He holds his left leg so stiff that I have a hard time putting on his diapers.”

B. “My baby won’t lift his head up and look at me; he’s so floppy.”

C. “My baby’s left hip tilts when I pull him to standing position.”

D. “I’m very worried because my baby has not rolled all the way over yet.”

11. You have learned that in babies and children with developmental dysplasia (dislocation) of the hip
(DDH), the hip joint has not formed normally. Which of the following is the most common form of DDH?

A. Acetabular dysplasia

B. Dislocation

C. Preluxation

D. Subluxation

12. Incomplete development of teeth, bones, and ligaments is the result of:

A. Congenital hip dysplasia

B. Duchenne’s muscular dystrophy

C. Osteogenesis imperfecta

D. Osteomyelitis

13. Reggie is a teenager suffering from osteomyelitis; the nurse would expect which of the following
symptoms? Select all that apply.

A. Fever

B. Irritability

C. Pallor
D. Tenderness

E. Swelling

14. Match the traction methods to their corresponding descriptions:

1. Buck’s traction

2. Russell’s traction

3. Bryant’s traction

A. legs in an extended position

B. leg extended, knee flexed

C. hips flexed 90degrees, both legs

A. 1C, 2B, 3A

B. 1B, 2A, 3C

C. 1A, 2B, 3C

D. 1A, 2C, 3B

15. Neurovascular assessment for a fracture patient includes: Select all that apply.

A. Prosthesis

B. Polyps

C. Pain

D. Pallor

E. Pulselessness
F. Paresthesia

G. Paralysis

H. Poikilothermia

Answers and Rationale

1. Answer: C. Difficulty running in the preschooler

Option C: Usually, sign and symptoms of Duchenne’s muscular dystrophy are not noticed until ages 3 to 5
years. Typically weakness starts with the pelvic girdle, evidenced as difficulty running in the preschooler.
Duchenne’s muscular dystrophy usually is not diagnosed in the infant or toddler period.

Option A: Sucking is not the first sign of Duchenne’s muscular dystrophy.

Option B: Sign and symptoms of muscular dystrophy are not noticed until ages 3 to 5 years.

2. Answer: D. Perform neurovascular checks.

Option D: Neurovascular assessment is always a priority in the assessment of a freshly applied cast to
ensure adequate circulation and neurologic function and prevent complications or injury.

Options A, B, and C: Keeping the cast dry and clean, covering the perineal area to prevent wetness and
soiling, and elevating the cast to prevent or minimize edema are all important, but these are not the
priority immediately after a cast applied.

3. Answer: D. “I’ll look forward to taking this thing off to take my bath every day.”

Option D: The brace should be dropped for simply 1 hour of every 24-hour period for hygiene and skin
care.

Option A: Wearing the brace at night would be true only following radiologic studies indicate the spine
has bone marrow maturity and the adolescent has been weaned from off whenever 1 to 2 years.

Option B: Taking the brace off whenever tired indicates poor understanding of the brace.

Option C: Although physical appearance and social activities with peers are significant, the brace should
not be excluded during these times.
4. Answer: C. Cerebral palsy

Option C: Cerebral palsy is the most common permanent disability of childhood. Cerebral palsy is a group
of disabilities caused by injury or insult to the brain either before or during birth, or in early infancy.

Options A and D: Scoliosis and DDH should not cause permanent disability.

Option B: Muscular dystrophy is a group of disorders that cause progressive degeneration and weakness
of skeletal muscles.

5. Answer: B. 4 weeks

Option B: The approximate healing time for a fractured femur during childhood is 4 weeks.

6. Answer: A. Comfort level

Option A: Instrumentation and spinal fusion cause considerable pain. Therefore, the adolescent needs
vigorous pain management, which involves assessment, administration of pain medication, and
evaluation of the response. In the immediate postoperative period, the child is conscious of sensation
and surroundings.

Option B: Typically, shortly after surgery, the adolescent will not be taking anything by mouth.

Option C: Physical therapy is not an urgent postoperative goal at this time. However, it may be
appropriate later on in the postoperative period.

Option D: Assessment and understanding of the procedure is a preoperative nursing responsibility.

7. Answer: D. Bone growth disruption

Option D: The epiphyseal plate is a significant region of bone growth. Hence, any disruption may result in
limb shortening.

Option A: Rheumatoid arthritis is a collagen disease with an autoimmune component, with no

relationship to fractures.

Options B and C: Nerve damage and osteomyelitis may occur with any fracture, but growth disruption is
a primary concern at the epiphyseal plate.

8. Answer: B. Have the mother remove and reapply the harness before discharge.
Option B: Having the mother remove and reapply the harness before discharge allows the nurse to
directly observe the mother’s method and comfort level. It also provides time for reinstruction if needed.

Option A: Although the nurse’s demonstration is a good teaching method, it does not permit evaluation
of the mother’s routine.

Option C: Verbalization is significant to allow the nurse to assess the mother’s understanding, but it does
not allow evaluation of the mother’s psychomotor skills.

Option D: Requesting a home visit is further means of evaluation but does not provide instant feedback.

9. Answer: B. Ortolani’s sign

Option B: Ortolani’s sign is felt and heard when newborn‘s or neonate’s hip is flexed and abducted.

Option A: A characteristic limp would be noted in the ambulatory child.

Option C: Asymmetrical gluteal folds would be noted in DDH.

Option D: Trendelenburg‘s sign is noted in the weight-bearing child when the child stands on the affected
hip and the pelvis tilts downward on the normal side instead of upward.

10. Answer: B. “My baby won’t lift his head up and look at me; he’s so floppy.”

Option B: Hypotonia or floppy infant is an early manifestation of cerebral palsy. Typically, the infant lifts
his head to 90-degree angle by age 4 months with only a partial head lag by age 2 months.

Option A: Although rigidity and tenseness are possible signs cerebral palsy, a limitation in one leg
suggests DDH.

Option C: Tilting of the hip is an indication of developmental dysplasia of the hip (DDH).

Option D: Rolling completely over usually does not occur until the infant is age 6 months.

11. Answer: D. Subluxation

Option D: DDH is a group of congenital abnormalities of the hip joints, which includes subluxation,
dislocation, and preluxation. Of the types of congenital hip abnormalities, subluxation is the most
common.

Options A and C: Preluxation, also known as acetabular dysplasia, is the mildest form.
Option B: Dislocation is complete displacement of the femoral head out of the acetabulum.

12. Answer: C. Osteogenesis imperfecta

Option C: Osteogenesis imperfecta (OI), also known as brittle bone disease, is a group of genetic
disorders that principally affect the bones. It results in bones that break quickly. The severity may be mild
to severe. Other symptoms may include problems with the teeth, loose joints, a blue tinge to the whites
of the eye, short height, hearing loss, and breathing problems.

Option A: Congenital hip dislocation (CHD) occurs when a child is born with an unstable hip. It is caused
by abnormal formation of the hip joint during the early stages of fetal development. CHD is also known
as Developmental Dysplasia of the Hip (DDH).

Option B: Duchenne muscular dystrophy (DMD) is a genetic condition marked by progressive weakening
of voluntary muscles. DMD worsens more rapidly than other types of muscular dystrophy.

Option D: A bone infection, also called osteomyelitis, can result when bacteria or fungi penetrate a bone.
In children, bone infections usually occur in the long bones of the arms and legs. In adults, they usually
appear in the hips, spine, and feet.

13. Answer: A, B, D, and E

Options A, B, D, and E: The symptoms for acute and chronic osteomyelitis are very similar and include
fever, irritability, fatigue, nausea, tenderness, redness (not pallor in option C), and warmth in the area of
the infection, swelling around the affected bone, and lost range of motion.

14. Answer: C. 1A, 2B, 3C

Buck’s traction is a type of skin traction with the legs in an extended position. It is used primarily for
short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone
deformities such as Legg-Calvé-Perthes disease.

Russell’s traction uses skin traction on the lower leg and a padded sling under the knee. The combination
of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes
the hips and knees in a flexed position.

Bryant’s traction is skin traction with the legs flexed at a 90-degree angle at the hip.

15. Answer: C, D, E, F, G, and H

Options C, D, E, F, G, and H: When damage occurs to a muscle or muscle group within the fascial
compartment, the resulting swelling and bleeding can create an increased pressure that, if left
untreated, can choke off circulation, eventually leading to localized cellular hypoxia and death. The six P’s
of compartment syndrome for warning signs to watch for are Pain, Pallor, Pulselessness, Paresthesia,
Paralysis, and Poikilothermia.