Chapter 44: Fractures
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. 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
2. 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.
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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.”
9. 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.
10. 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)
11. 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
12. 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.
13. 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.”
14. 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.
15. 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.”
16. 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
17. 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
18. Which nursing diagnosis has the highest priority after surgery for the open reduction and
external fixation of an ankle?
a.
Risk for activity intolerance
b.
Risk for infection
c.
Risk for impaired physical mobility
d.
Risk for constipation
19. 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
20. 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.
21. 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
22. 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
23. 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.
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.
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
MULTIPLE RESPONSE
26. 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
27. 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 handgrips allow for a 45-degree flexion of the elbow.
e.
They are padded so patient can bear weight on the axilla piece when ambulating.
COMPLETION
28. A fracture that occurs because of osteoporosis is classified as a(n) _____ fracture.
OTHER
29. A nurse uses a diagram to show the process of a fractured bone healing. (Arrange the options
in the appropriate sequence. Separate letters by a comma and space as follows: A, B, C, D.)
A. Ossification
B. Hematoma
C. Fibrocartilage
D. Consolidation
E. Callus
30. Arrange the process of stair climbing with crutches in the correct sequence: (Separate letters
by a comma and space as follows: A, B, C, D.)
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.
