Deck 45: Fractures

Question 1

An older patient who sustained a fractured hip and femur in a motor vehicle accident is to be in Russell traction for several weeks.What should be the focus of care for the nurse?

A) Offering frequent distractions
B) Encouraging nutrition
C) Offering pain relief
D) Preventing deep vein thrombosis (DVT)

Answer 1

Preventing deep vein thrombosis (DVT)

Question 2

Two days after surgery for a crushed pelvis, a certified nursing assistant (CNA)reports that the patient is complaining of a shortness of breath and is demonstrating signs of confusion and restlessness.What should a nurse suspect, from these signs alone, that the patient has developed?

A) Impending shock
B) Fat embolus
C) Anxiety
D) Neurovascular compromise

Answer 2

Fat embolus

Question 3

Which assessment is of the greatest concern to a nurse when caring for a patient just admitted with a pelvic fracture?

A) Pain level rating of 8 on a scale of 1 to 10
B) No urinary output for 8 hours
C) Evidence of bruising along the patient's hips and buttocks
D) Complaints of the need for back care from resting in bed

Answer 3

No urinary output for 8 hours

Question 4

A patient who has osteomyelitis after multiple fractures inquires what the physician meant when he said that surgery would follow the antibiotic therapy.What is the nurse's most helpful reply to explain why this surgery will be performed?

A) To remove dead bone
B) To close the open draining wound
C) To close the area with casting material
D) To amputate

Question 5

A patient in a full body cast (spica)complains of nausea and abdominal distention.What potential complication should a licensed vocational nurse (LVN)suspect?

A) Constipation
B) Compartment syndrome
C) Cast syndrome
D) Shock

Question 6

What special precaution should a nurse implement when assisting with the application of a short arm plaster cast?

A) Dampen the skin to make the stockinette adhere.
B) Tape the arm before applying the stockinette.
C) Smooth the stockinette to prevent a pressure ulcer.
D) Roll the stockinette tightly above and below the margins of the cast.

Question 7

A patient has just had a plaster of Paris upper extremity cast placed because of a fractured radius.Which statement indicates that the patient understands the discharge teaching related to cast care?

A) "When I get home, I will remove some of the padding if it feels tight so my fingers don't swell."
B) "When I get home, I will wrap the cast in plastic so it will conserve the heat."
C) "When I get home, I will use a spoon handle to scratch inside if my arm itches."
D) "When I get home, I am going to rest in bed with my arm elevated above my heart."

Question 8

What should a nurse who is documenting and reporting the signs and symptoms of an infection underneath a cast include in the medical record?

A) Elevated temperature
B) Tingling and decreased sensation
C) Full pulses and absence of pain
D) Swelling and diminished motor function

Question 9

Which patient is most appropriate for a nurse to refer to home health care?

A) A married man with a laundry room on the first floor
B) A single woman with a bedroom in a rooming house
C) A student living in a college dormitory but going home to stay with parents
D) A woman staying with her daughter and son-in-law at their one-story home

Question 10

A patient with bilateral avascular necrosis of the hips is to walk with crutches using a four-point gait for 6 weeks after her bone decompression surgeries.Which statement would indicate that the patient understands this technique?

A) "The axillary bars on the crutches should support my weight when I walk."
B) "I will move both crutches and then swing my legs to the crutches-2 and 2 equals 4!"
C) "I will move my right crutch and then my left leg and then the left crutch and my right leg."
D) "I will move both crutches and then swing my legs through the crutches together."

Question 11

Assistive devices such as canes, crutches, and walkers are used for people who need to limit weight-bearing activities on joints.Which statement by a nurse best illustrates an understanding of the appropriate use of these devices?

A) "Canes provide minimal support and balance and are carried on the unaffected side."
B) "When using a cane, slide it as you go to decrease the arm strain."
C) "A three-point gait is used when walking with a walker."
D) "When using crutches, the unaffected leg goes down the steps first."

Question 12

An older woman falls down at church and immediately complains of severe pain in her left hip.Which observation is recognized as the cardinal sign of a fractured hip?

A) Shortened left leg compared with the right
B) Downward curled toes
C) Internal rotation of the left leg
D) Hematoma on the left hip

Question 13

A 78-year-old retired teacher with a history of osteoporosis has fallen in her bathroom and sustained a subcapital femoral fracture.She is scheduled for an open reduction and internal fixation (ORIF)procedure in the morning.Which type of traction will most likely be implemented?

A) Bryant
B) Buck
C) Pelvic
D) Crutchfield tongs

Question 14

What should a nurse teach an older patient with a newly casted Colles fracture?

A) Apply cool compresses to the cast.
B) Let the hand and arm dangle to increase the drainage.
C) Keep the hand immobile to reduce swelling.
D) Move the shoulders to reduce contractures.

Question 15

An older adult patient is at risk for constipation after sustaining a pelvic fracture.Which nutritional suggestion by the nurse is most appropriate?

A) Select food with high sodium content.
B) Avoid foods high in dietary fiber.
C) While immobilized, drink at least 2 to 3 L of fluids daily.
D) Include milk products at every meal.

Question 16

A patient who sustained a simple fracture of the left fibula 7 days earlier asks in what stage of bone healing he might be.What stage of healing should the nurse relay to the patient?

A) Hematoma formation
B) Ossification
C) Callus formation
D) Fibrocartilage formation

Question 17

A nurse is told that a patient has a compound comminuted fracture.What characteristic of the bone in this type of fracture causes the nurse to be concerned?

A) It is bent but not completely broken, and the bent piece protrudes through the skin.
B) It is compressed, and bone pieces protrude through the skin.
C) It is twisted, and the fragments are separated.
D) It is broken into two or more pieces, and bone fragments protrude through the skin.

Question 18

A patient with a crushed forearm cannot get pain relief with opioid medications.The injury is swollen, cool, and cyanotic, with weak distal pulses.What should the nurse suspect?

A) Compartment syndrome
B) Overwhelming infection
C) Fat embolus
D) Osteomyelitis

Question 19

Which patient problem has the highest priority after surgery for the open reduction and external fixation of an ankle?

A) Potential activity intolerance
B) Potential for infection
C) Immobility
D) constipation

Question 20

What action should a nurse implement when caring for a patient diagnosed with a compound fracture?

A) Limit narcotics for 8 hours after surgery.
B) Monitor the patient's respirations every hour.
C) Assess for pulses distal to the injury.
D) Verify that the patient is not allergic to sulfa.

Question 21

Which assessment is considered abnormal when a nurse performs a neurovascular assessment on a patient in skeletal traction?

A) Delayed capillary refill
B) Bilateral equal pulses
C) Absence of pain and swelling
D) Limb is the same color as the unaffected side

Question 22

Which characteristics are present when crutches are properly fitted? (Select all that apply.)

A) The axilla piece is 3 to 4 fingerbreadths below the axilla.
B) They fit close to the axilla for secure support.
C) They are measured and adjusted when the patient is in the tripod position.
D) Adjusted hand grips allow for a 45-degree flexion of the elbow.
E) They are padded so patient can bear weight on the axilla piece when ambulating.

Question 23

Arrange the process of stair climbing with crutches in the correct sequence: ______ (Arrange the options in the appropriate sequence.Do not separate answers with a space or punctuation.Example: ABCD.)

A)Body weight is supported with crutches.
B)Crutches are moved to the next step.
C)The affected leg moves to the next step.
D)The unaffected leg is moved to the next step.
E)Body weight is transferred to the unaffected leg.

Question 24

Which is true about a greenstick fracture?

A) Line of the fracture goes across the bone in right angles to the longitudinal axis.
B) Periosteum is not torn away from the bone.
C) Fracture is incomplete, and one side is bent.
D) Fracture occurred in one of the long bones of the body.

Question 25

A patient with a fractured pelvis says that she will not ambulate because of pain.What should a nurse inform the patient can be prevented with early ambulation?

A) Back injury
B) DVT
C) Callus formation
D) Disuse syndrome

Question 26

Which finding should produce the most concern when performing pin care for a patient with an external fixator?

A) Crusts around the pin
B) Serous drainage on the dressing
C) Purulent drainage
D) Absence of pain

Question 27

What action should a nurse implement when dealing with the weights that are applying traction to a patient?

A) Remove them to pull the patient up in bed.
B) Hold them while the patient is changing positions in bed.
C) Hold them for a few minutes if the patient complains of pain.
D) Allow them to hang freely.

Question 28

To what can delayed union of a fracture be attributed? (Select all that apply.)

A) Inadequate immobilization
B) Hormone replacement therapy
C) Long-term use of corticosteroids
D) Infection
E) Poor nutrition

Question 29

A fracture that occurs because of osteoporosis is classified as a(n)______ fracture.

Question 30

A nurse uses a diagram to show the process of a fractured bone healing.______ (Arrange the options in the appropriate sequence.Do not separate answers with a space or punctuation.Example: ABCD.)

A)Ossification
B)Hematoma
C)Fibrocartilage
D)Consolidation
E)Callus