Fractures

Question 1

The nurse is educating a client on the proper use of crutches. The nurse asks the client to walk a few steps with the crutches. The client puts the crutches under his arms and rests the pads on his axilla. The clients arms are at a 30 degree angle and his hands are lightly resting at the grips by his side. Before the client takes a step, the nurse stops him to re-educate the client on his placement under his axilla. The client asks why he can’t rest his body weight on the pads under his armpits. What is the best explaination for the nurse to give?
A. “If you put constant pressure on the nerve in your underarm you can cause paralysis in the arm.”
B. “If you put your weight all in your underarm, you can bruise your underarms.”
C. “If you put all your weight there it can cause a muscle strain and then you won’t be able to use your crutches to walk anywhere.”
D. “Because that is how you are supposed to do it. It is the best position for your body.”

Answer 1

Ans: A

Rationale
If a client supports their weight on their underarms instead of on their hands they are at risk for crutch palsy, where the paralysis happens below the point of the nerve that has been receiving the pressure

Question 2

A client has a left ulnar fracture. Which of the following findings would concern the nurse?
A. Pulses are +1 bilaterally
B. No open break in the skin
C. Swelling at the break site
D. Capillary refill of about 5 seconds

Answer 2

Ans: D

Rationale
Neurovascular assessment of a client with a fracture should include the following: skin color, skin temperature, movement of anything below the injury (fingers, toes), sensation, pulses, capillary refill, and the pain level. A capillary refill of longer than 3 seconds should be concerning. Swelling is normal and finding a pulse is a good thing as well as no break in the skin.

Question 3

A nurse is educating a client on prevention of compartment syndrome. What does the nurse need to include? Select All That Apply.
A. Elevation of extremity 
B. Applying ice 
C. Applying heat
D. Compression wrapping
E. Daily stretches

Answer 3

Ans: A,B

Prevention of compartment syndrome includes keeping the extremity elevated and icing the extremity.

Question 4

A client with a femur fracture is being assessed by the nurse. The nurse is concerned about a fat embolism and knows to monitor for which of the following signs and symptoms of fat embolism? Select All That Apply.
A. Tachypnea 
B. Tachycardia 
C. Restlessness 
D. Hypotension 
E. Fever

Answer 4

Ans: A,B,C,D

Rationale
A fat embolism can occur with long bone fractures. The s/sx are tachycardia, tachypnea, hypotension and restlessness. A temperature would not be due to a fat embolism

Question 5

Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply.

1. Keep the cast clean and dry.
2. Allow the cast 24 to 72 hours to dry.
3. Keep the cast and extremity elevated.
4. Expect tingling and numbness in the extremity.
5. Use a hair dryer set on a warm to hot setting to dry the cast.
6. Use a soft padded object that will fit under the cast to scratch the skin under the cast.

Answer 5

Ans: 1,2,3

Question 6

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?

1. Infection under the cast
2. The anxiety of the client
3. Impaired tissue perfusion
4. The recent occurrence of the fracture

Answer 6

Ans: 3

Question 7

The nurse is admitting a client with multiple trauma to the nursing unit. The client has a leg fracture and had a plaster cast applied. Which position would be best for the casted leg?

1. Flat for 12 hours, then elevated for 12 hours.
2. Elevated for 3 hours and then flat for 1 hour.
3. Flat for 3 hours and then elevated for 1 hour.
4. Elevated on pillows continuously for 24 to 48 hours.

Answer 7

Ans: 4

Question 8

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?

1. A fall and further injury
2. Injury to the brachial plexus nerves
3. Skin breakdown in the area of the axilla
4. Impaired range of motion while the client ambulates

Answer 8

Ans: 2

Question 9

The nurse has given a client instructions about crutch safety. Which client statement indicates that the client understands the instructions? Select all that apply.

1. “I should not use someone else’s crutches
2. “I need to remove any scatter rugs at home.”
3. “I can use crutch tips even when they are wet.
4. “I need to have spare crutches and tips available.
5. “When I’m using the crutches my arms need to be completely straight.”

Answer 9

Ans: 124

Question 10

The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data would the nurse evaluate as the most favorable indication of resolution of the fat embolus?

1. Clear mentation
2. Minimal dyspnea
3. Oxygen saturation of 85%
4. Arterial oxygen level of 78 mm Hg

Answer 10

Ans: 1

Question 11

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?

1. Cold, bluish-colored fingers
2. Numbness and tingling in the fingers
3. Pain that increases when the arm is dependent
4. Pain that is out of proportion to the severity of the fracture

Answer 11

Ans: 2

Question 12

A client with diabetes mellitus has had a right below-knee amputation. Given the client’s history
of diabetes mellitus, which should the nurse
fically observe in the postoperative period?

1. Hemorrhage
2. Edema of the residual limb
3. Slight redness of the incision
4. Separation of the wound edges

Answer 12

Ans: 4

Question 13

The nurse is caring for a client who had an above knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which immediate action should the nurse take?

1. Apply ice to the site.
2. Call the health care provider (HCP)
3. Apply a dry sterile dressing and elevate it on one pillow.
4. Rewrap the residual limb with an elastic compression bandage.

Answer 13

Ans: 4

Question 14

A client with a hip fracture asks the nurse why Buck’s (extension) traction is being applied before surgery. The nurse provides a response based on which purpose of Buck’s (extension) traction?

1. Allows bony healing to begin before surgery
2. Provides rigid immobilization of the fracture site
3. Lengthens the fractured leg to prevent severing of blood vessels
4. Provides comfort by reducing muscle spasms and provides fracture immobilization

Answer 14

Ans: 4

Question 15

A patient with an open fracture of the left tibia and soft tissue damage underwent a surgical reduction and fixation of the tibia with debridement of nonviable tissue and drain placement. When assessing the patient during the postoperative period, the nurse will be most concerned about

a. fever with chills and night sweats.
b. light yellow drainage from the wound.
c. pain on movement of the affected limb.
d. muscle spasms around the affected bone.

Answer 15

Answer: A
Rationale: Fever, chills, and night sweats are suggestive of osteomyelitis. The other clinical manifestations are typical after a fracture repair.