Nurs418: Fractures
Consolidation can occur up to ___ year after fracture.
1
The callus formation phase of fracture healing appears by the end of week ___?
2
Ossification of the callus occurs __ weeks to __ months after fracture until healed.
3, 6
The granulation tissue phase of fracture healing occurs during days ___-___ after injury.
3-14
Fracture hematoma develops in the first ____ hours.
72
A patient has a new order for MRI to evaluate for left femur osteomyelitis after a hip replacement surgery. Which information indicates that the nurse should consult with the HCP before scheduling the MRI? A. pt. has a pacemaker B. pt. is claustrophobic C. pt. wears a hearing aid D. pt. is allergic to shellfish
A.
A patient with a fractured femur experiences the complication of malunion. The nurse recognizes that what happens with this complication? A. The fracture heals in an unsatisfactory position. B. The facture fails to heal properly despite treatment. C. Fracture healing progresses more slowly than expected. D. Loss of bone substances occurs as a result of immobilization.
A.
A patient with a fractured hip has an anterior ORIF of the fracture. What should the nurse plan to do post-op? A. get the pt. up and to the chair on the 1st post-op day B. ambulate the pt. with partial weight bearing by discharge C. keep the leg abductor pillow on the pt. even while bathing D. position the pt. only on the back and nonoperative side
A.
Fracture involving the bone in the line of its axis. A. Linear B. Oblique C. Transverse D. Longitudinal E. Spiral
A.
Fracture with more than 2 fragments. The smaller fragments appear to be floating. A. Comminuted B. Oblique C. Greenstick D. Spiral
A.
Heals in timeframe, but in unsatisfactory position. A. Malunion B. Angulation C. Pseudoarthrosis D. Myositis ossificans
A.
If needed, which surgical treatment will the nurse first prepare the patient for in the presence of compartment syndrome? A. Fasciotomy B. Amputation C. Internal fixation D. Release of tendons
A.
The patient had a fracture. At 3 weeks to 6 months there is clinical union, and this is the first stage of healing that is sufficient to prevent movement of the facture site when the bones are greatly stressed. How is this stage of fracture healing documented? A. Ossification B. Remodeling C. Consolidation D. Callus formation
A.
This is the non-surgical, manual realignment of bone fragments. A. Fracture Reduction (Closed) B. Fracture Reduction (Open) C. Fracture Immobilization D. Open Fractures E. Electrical Bone Growth Stimulation
A.
What is a disadvantage of open reduction and internal fixation (ORIF) of a fracture compared to closed reduction? A. Infection B. Skin irritation C. Nerve impairment D. Complications of immobility.
A.
When is a fat embolism most likely to occur? a. 24 to 48 hours following a fractured tibia b. 36 to 72 hours following a skull fracture c. 4 to 5 days following a fractured femur d. 5 to 6 days following a pelvic fracture
A.
The x-ray shows that the patient's fracture is at the remodeling stage. What characteristics of the fracture healing process are happening at this stage (select all that apply)? a. Radiologic union b. Absorption of excess cells c. Return to preinjury strength and shape d. Semisolid blood clot at the ends of fragments e. Deposition and absorption of bone in response to stress f. Unorganized network of bone woven around fracture parts
A. B. C. E.
What steps of fracture healing require complete immobilization (select all that apply)? A. Granulation tissue (inflammatory) B. Remodeling (remodeling) C. Callus formation - soft callus D. Consolidation E. Fracture hematoma F. Ossification - hard callus
A. C. E.
A nondisplaced fracture remains in alignment or position; which types are nondisplaced fractures (select all that apply)? A. Transverse B. Comminuted C. Oblique D. Spiral E. Greenstick
A. D. E.
A patient is admitted with an open fracture of the tibia following a bicycle accident. During the assessment of the patient, about what specifically should the nurse question the patient? A. Any previous injuries to the leg. B. The status of a tetanus immunization. C. The use of ABX in the last month. D. Whether the injury was exposed to dirt or gravel.
B.
A patient is brought to the ED with an injured lower left leg following a fall while rock climbing. The nurse identifies the presence of a fracture based on what cardinal sign of fracture? A. Muscle spasms B. Obvious deformity C. Edema and swelling D. Pain and tenderness
B.
A patient is discharged from the outpatient clinic following application of a synthetic fiberglass long arm cast for a fractured ulna. Before discharge, the nurse instructs the patient to do what? A. Never get the cast wet B. Move the shoulder and fingers frequently C. Place tape petals around the edges of the cast when it is dry D. Use a sling to support the arm at waist level for the first 48 hours
B.
Abnormal position in relation to midline of structure (type of malunion). A. Malunion B. Angulation C. Pseudoarthrosis D. Myositis ossificans
B.
The line of the fracture extends across and down the bone. A. Comminuted B. Oblique C. Greenstick D. Spiral
B.
This is the surgical correction of bone alignment through incision. A. Fracture Reduction (Closed) B. Fracture Reduction (Open) C. Fracture Immobilization D. Open Fractures E. Electrical Bone Growth Stimulation
B.
A displaced fracture has separated ends and is out of position; which types are displaced fractures (select all that apply)? A. Transverse B. Comminuted C. Oblique D. Spiral E. Greenstick
B. C.
The line of fracture extends in a spiral direction along the bone shaft. A. Linear B. Oblique C. Transverse D. Longitudinal E. Spiral
E.
A patient with a fractured tibia accompanied by extensive soft tissue damage initially has a splint applied and held in place with an elastic bandage. What early sign should alert the nurse that the patient is developing compartment syndrome? A. Paralysis of the toes B. Absence of peripheral pulses C. Distal pain unrelieved by opioid analgesics D. Skin over the injury site is blanched with the bandage is removed
C.
A patient with an extracapsular hip fracture is admitted to the ortho unit and placed in Buck's traction. The nurse explains that the purpose of this traction is to do what? A. Pull bone fragments back into alignment B. Immobilize the leg until healing is complete C. Reduce pain and muscle spasms before surgery D. Prevent damage to the blood vessels at the fracture site
C.
A spontaneous fracture at the site of a diseased bone. A. Greenstick B. Comminuted C. Pathologic D. Stress
C.
An incomplete fracture with one side splintered and the other side is bent. A. Transverse B. Spiral C. Greenstick
C.
Nonunion at fracture site in which a false joint is formed with abnormal movement at site. A. Malunion B. Angulation C. Pseudoarthrosis D. Myositis ossificans
C.
The cast might be removed once the callus hardens, this occurs during which phase of fracture healing? A. Granulation tissue B. Callus formation C. Ossification D. Consolidation
C.
The line of the fracture extends across the bone shaft at a right angle to the longitudinal axis. A. Linear B. Oblique C. Transverse D. Longitudinal E. Spiral
C.
The nurse suspects a fat embolism rather than a pulmonary embolism from a venous thrombosis when the patient with a fracture develops what? A. Tachycardia and dyspnea B. A sudden onset of chest pain C. Petechiae around the neck and upper chest D. Electrocardiographic changes and decreased PaO2
C.
The patient with osteoporosis had a spontaneous hip fracture. How should the nurse document this before the x-ray results return? A. open fracture B. oblique fracture C. pathologic fracture D. greenstick fracture
C.
To assess for neurologic status in a patient with a fractured humerus, what should the nurse ask the patient to do? a. Evert, invert, dorsiflex, and plantar flex the foot. b. Abduct, adduct, and oppose the fingers and pronate and supinate the hand. c. Assess the location, quality, and intensity of pain below the site of the injury. d. Assess the color, temperature, capillary refill, peripheral pulses, and presence of edema in the extremity.
C.
A young pt. with a fractured femur has a hip spica cast applied. While the cast is drying, what is most important for the nurse to do? A. Elevate the legs above the level of the heart for 24 hours. B. Turn the pt. to both sides and prone to supine every 2 hours. C. Cover the cast with a light blanket to avoid chilling from evaporation. D. Assess the patient frequently for abdominal pain, nausea, and vomiting.
D.
Calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury. A. Malunion B. Angulation C. Pseudoarthrosis D. Myositis ossificans
D.
The patient has fallen in the bathroom of the hospital room and reports pain in the upper right arm and elbow. Before splinting the injury, the nurse knows that the priority management of a possible fracture should include which action? A. Elevation of the arm B. Application of ice to the site C. Notification of the HCP D. Neurovascular checks below the site of injury
D.
Place the steps of fracture healing in the correct order: A. Granulation tissue (inflammatory) B. Remodeling (remodeling) C. Callus formation - soft callus D. Consolidation E. Fracture hematoma F. Ossification - hard callus (reparative)
E. A. C. F. D. B.
(True or False) The pain related to compartment syndrome can be managed by analgesics.
False
What are the 6 P's representing the clinical manifestations of compartment syndrome?
Pain, pressure, paresthesia, pallor, paralysis, and pulselessness
This is muscle damage which causes the release of myoglobin which precipitates and causes obstruction in the renal tubules, resulting in AKI and acute tubular necrosis.
Rhabdomyolysis
What immunization would be most critical to administer to a patient with a fracture?
TDAP
(True of False) Hypovolemic shock is a medical emergency.
True
(True or False) Fat embolism syndrome (FES) contributes to the mortality rates of fractures.
True
What law represents the idea that bone remodels due to physical loading stress?
Wolff's
This is a complication of fractures that occurs when there is increased pressure within the muscle compartment. It is usually associated with trauma fractures esp. long bones, extensive soft tissue damage, and crushing injuries.
compartment syndrome
Severe blood loss from open fractures or puncture of vital organs is what complication of open fractures?
hypovolemic shock
A patient is experiencing Fat Embolism Syndrome (FES) when systematic fat globules from fracture are distributed into tissues, lungs, and other organs after traumatic skeletal injury. It is most common in long bones, ribs, tibia, and pelvis. What are the triad symptoms that occur with this complication?
hypoxemia, changes in LOC, and petechial rash
What should you do when you find someone with a fracture?
immobilize where it lies
Urine color would present as which color if a patient is experiencing Rhabdomyolysis?
reddish-brown
What is the most common fracture of someone who jogs?
stress
This is used to prevent or reduce pain and muscle spasms RT lower back pain or cervical sprain (whip lash).
traction
