Chapter 67: Musculoskeletal Trauma and Orthopedic Surgery

Question 1

fracture of the distal tube

a. colles fracture
b. humeral shaft fracture
c. clavicular fracture
d. pelvic fracture

Answer 1

a. colles fracture

Question 2

In a Colles fracture, the styloid process of the __________ may be involved as well.

Answer 2

ulna

Question 3

What is the major complication of a Colles fracture?

Answer 3

vascular insufficiency from edema

Question 4

Which age group(s) is a humeral shaft fracture most common in?

Answer 4

young and middle-aged adults

Question 5

__________ fractures account for 85% of all clavicle fractures.

Answer 5

midshaft

Question 6

T/F

Pelvic fractures have a low mortality rate.

Answer 6

false; high

Question 7

How are pelvic fractures diagnosed?

Answer 7

x-ray and CT scan

Question 8

Which age group are hip fractures most common in?

Answer 8

older adults

Question 9

T/F

Most hip fractures result from a fall.

Answer 9

true

Question 10

What is the standard of care for a hip fracture?

Answer 10

surgery

Question 11

What is the most common surgical treatment for femoral shaft fractures?

Answer 11

placement of an intramedullary rod

Question 12

T/F

The tibia is a common site for stress fractures.

Answer 12

true

Question 13

treatment for tibial fractures

Answer 13

closed reduction followed by immobilization in a long leg cast

Question 14

A patient with a humeral fracture is returning for a 4-week checkup. The nurse explains that initial evidence of healing on x-ray is indicated by:

a. formation of callus
b. complete bony union
c. hematoma at the fracture site
d. presence of granulation tissue

Answer 14

a. formation of callus

Question 15

A patient with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when

a. the patient cannot tolerate prolonged immobilization
b. the patient cannot tolerate the surgery for a closed reduction
c. other nonsurgical methods cannot achieve adequate alignment
d. a temporary cast would be too unstable to provide normal mobility

Answer 15

c. other nonsurgical methods cannot achieve adequate alignment

Question 16

A patient with a stable, closed humeral fracture as a temporary splint with bulky padding applied with an elastic bandage. The nurse suspects early compartment syndrome when the patient has

a. increasing edema of the limb
b. muscle spams of the lower arm
c. bounding pulse at the fracture site
d. pain when passively extending fingers

Answer 16

d. pain when passively extending fingers

Question 17

The nurse would monitor a patient with a pelvic fracture for:

a. changes in urine output
b. petechiae on the abdomen
c. a palpable lump in the buttock
d. sudden increase in blood pressure

Answer 17

a. changes in urine output

Question 18

The nurse would instruct a patient with a nondisplaced fractured left radius that the cast will need to remain in place for what amount of time?

a. Two weeks

b. At least six weeks

c. Until swelling of the wrist has resolved

d. Until x-rays show complete bony union

Answer 18

b. At least six weeks

Question 19

The nurse is caring for a patient who has a pelvic fracture and an external fixation device.

Which method would the nurse use to assess pressure areas and provide skincare to the patient‘s back and sacrum?

a. Ask the patient to turn to the side independently.

b. Defer back assessment until the patient is ambulatory.

c. Have the patient lift the back and buttocks using a trapeze bar.

d. Roll the patient over to the side by pushing on the patient‘s hips.

Answer 19

c. Have the patient lift the back and buttocks using a trapeze bar.

Question 20

A patient who had open reduction and internal fixation (ORIF) of left lower leg fractures continues to report severe pain in the leg 15 minutes after receiving the prescribed IV morphine. The nurse determines pulses are faintly palpable and the foot is cool to the touch. Which action would the nurse take next?

a. Notify the health care provider.

b. Assess the incision for redness.

c. Reposition the left leg on pillows.

d. Check the patient‘s blood pressure.

Answer 20

a. Notify the health care provider.

Question 21

A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which assessment finding indicates a potential complication of the fracture?

a. The patient states the pelvis feels unstable.

b. The patient reports pelvic pain with palpation.

c. Abdomen is distended and bowel sounds are absent.

d. Ecchymoses are visible across the abdomen and hips.

Answer 21

c. Abdomen is distended and bowel sounds are absent.

Question 22

Which action would the nurse take to evaluate the effectiveness of Buck‘s traction for a patient who has a fracture of the right femur?

a. Assess for hip pain.

b. Check for contractures.

c. Palpate peripheral pulses.

d. Monitor for hip dislocation.

Answer 22

a. Assess for hip pain.

Question 23

A patient who has a right lower leg fracture will be discharged home with an external fixation device in place. Which statement would the nurse include in discharge teaching?

a. “Check and clean the pin insertion sites daily.”

b. “Remain on bed rest until bone healing is complete.”

c. “Remove the external fixator for your daily shower.”

d. “Take prophylactic antibiotics until the fixator is removed.”

Answer 23

a. “Check and clean the pin insertion sites daily.”

Question 24

A patient who has had open reduction and internal fixation (ORIF) of a hip fracture tells the nurse he is ready to get out of bed for the first time. Which action would the nurse take?

a. Check the patient‘s prescribed weight-bearing status.

b. Use a mechanical lift to transfer the patient to the chair.

c. Wean down the pain medication before getting the patient up.

d. Have the assistive personnel (AP) transfer the patient to a chair.

Answer 24

a. Check the patient‘s prescribed weight-bearing status.

Question 25

Which information would the nurse include in discharge teaching for a patient who has had a repair of a fractured mandible?

a. Administration of nasogastric tube feedings

b. How and when to cut the immobilizing wires

c. The importance of high-fiber foods in the diet

d. The use of sterile technique for dressing changes

Answer 25

b. How and when to cut the immobilizing wires

Question 26

Which information would the nurse include in discharge instructions for a patient with comminuted left forearm fractures and a long-arm cast?

a. Keep the left shoulder elevated on a pillow or cushion.

b. Avoid nonsteroidal antiinflammatory drugs (NSAIDs).

c. Call the health care provider for numbness of the hand.

d. Keep the hand immobile to prevent soft tissue swelling.

Answer 26

c. Call the health care provider for numbness of the hand.

Question 27

A patient who slipped and fell in the shower at home has a proximal left humerus fracture immobilized with a sling. Which intervention would the nurse include in the plan of care?

a. Use surgical net dressing to hang the arm from an IV pole.

b. Immobilize the fingers of the left hand with gauze dressings.

c. Assess the left axilla and change absorbent dressings as needed.

d. Assist the patient in passive range of motion (ROM) for the right arm.

Answer 27

c. Assess the left axilla and change absorbent dressings as needed.

Question 28

After being hospitalized for 2 days with a right femur fracture, a patient suddenly develops shortness of breath and tachypnea. The patient tells the nurse, “I feel like I am going to die!” Which action would the nurse take first?

a. Administer prescribed PRN O2 at 4 L/min.

b. Check the patient‘s legs for swelling or tenderness.

c. Notify the health care provider about the symptoms.

d. Stay with the patient and offer reassurance to the family.

Answer 28

a. Administer prescribed PRN O2 at 4 L/min.

Question 29

A patient arrived at the emergency department after tripping over a rug and falling at home.

Which finding would the nurse identify as most important to communicate to the health care provider?

a. There is bruising at the shoulder area.

b. The patient reports arm and shoulder pain.

c. The right arm appears shorter than the left.

d. There is decreased shoulder range of motion.

Answer 29

c. The right arm appears shorter than the left.

Question 30

A pedestrian who was hit by a car is admitted to the emergency department with possible right lower leg fractures. Which initial action would the nurse take?

a. Elevate the right leg.

b. Splint the lower leg.

c. Assess the pedal pulses.

d. Verify tetanus immunization.

Answer 30

c. Assess the pedal pulses.

Question 31

A 60-year-old patient had open reduction and internal fixation (ORIF) for an open, displaced tibial fracture. Which patient problem would the nurse identify?

a. Fatigue

b. Risk for infection

c. Activity intolerance

d. Impaired bowel elimination

Answer 31

b. Risk for infection

Question 32

The second day after admission with a fractured pelvis, a patient suddenly develops confusion. Which action would the nurse take first?

a. Take the blood pressure.

b. Check the O 2 saturation.

c. Assess patient orientation.

d. Observe for facial asymmetry.

Answer 32

b. Check the O 2 saturation.

Question 33

The nurse admits a patient to the emergency department with a left femur fracture. Which assessment finding is most important to report to the health care provider?

a. Bruising of the left thigh

b. Reports of severe thigh pain

c. Slow capillary refill of the left foot

d. Outward pointing toes on the left foot

Answer 33

c. Slow capillary refill of the left foot

Question 34

Which finding in a patient with a Colles‘ fracture of the left wrist would the nurse identify as most important to communicate immediately to the health care provider?

a. The patient reports severe pain.

b. Swelling is noted around the wrist.

c. Capillary refill to the fingers is slow.

d. The wrist has a deformed appearance.

Answer 34

c. Capillary refill to the fingers is slow.

Question 35

Which information about a patient with a lumbar vertebral compression fracture would the nurse immediately report to the health care provider?

a. Patient declines to be turned due to back pain.

b. Patient has been incontinent of urine and stool.

c. Patient reports lumbar area tenderness to palpation.

d. Patient frequently uses oral corticosteroids to treat asthma.

Answer 35

b. Patient has been incontinent of urine and stool.

Question 36

When a patient arrives in the emergency department with a facial fracture, which action would the nurse take first?

a. Assess for nasal bleeding and pain.

b. Apply ice to the face to reduce swelling.

c. Use a cervical collar to stabilize the spine.

d. Check the patient‘s alertness and orientation.

Answer 36

c. Use a cervical collar to stabilize the spine.

Question 37

After change-of-shift report, which patient would the nurse assess first?

a. Patient with a repaired mandibular fracture who is reporting facial pain

b. Patient with repaired right femoral shaft fracture who reports tightness in the calf

c. Patient with an unrepaired Colles‘ fracture who has right wrist swelling and deformity

d. Patient with an unrepaired intracapsular left hip fracture whose leg is externally rotated

Answer 37

b. Patient with repaired right femoral shaft fracture who reports tightness in the calf

Question 38

The nurse is caring for a patient who is using Buck‘s traction after a hip fracture. Which action can the nurse delegate to experienced assistive personnel (AP)?

a. Remove and reapply traction periodically.

b. Ensure the weight for the traction is hanging freely.

c. Monitor the skin under the traction boot for redness.

d. Check for intact sensation and movement in the affected leg.

Answer 38

b. Ensure the weight for the traction is hanging freely.