NUR 1024: NCLEX Questions on Fractures
The nurse has identified that a client who sustained an open femoral fracture is at risk for infection. Which intervention should be implemented to prevent infection? (Select all that apply.) A. Using sterile technique with dressing changes B. Assessing temperature during every shift C. Providing pain medications as indicated D. Assessing the wound for size, color, or presence of drainage E. Administering prophylactic antibiotics per order
Answer: D, E Rationale: Clients who have open fractures are at risk for infection. The nurse would assess the wound for manifestations of infection, assess vital signs, including temperature at least every 4 hours and prn, use aseptic technique to change dressings, and administer antibiotics as prescribed. Although the nurse may administer pain medications, this is not an intervention that will prevent infection.
A 4-year-old child is admitted with a radial head subluxation, or "nursemaid's elbow." Which intervention should be taught to the caregivers to prevent such injury in the future? A. Avoiding picking up children from under the arms B. Avoiding swinging children by the hands C. Avoiding sports where swinging of the arms is required D. Not allowing children to play on the jungle gym
Answers: B Rationale: This injury is one that is common in toddlers and occurs when a caregiver pulls or swings a child by the hand with a quick motion, resulting in a separation of the radiocapitellar joint. To prevent this type of injury, the caregiver should be taught not to swing or pull the child by the hands or arms. The child should be picked up from under the arms. Swinging the arms during activity such as sports or playing on a jungle gym does not cause this type of injury, so this education is not indicated.
A client is recovering from a fractured radius that occurred 7 weeks ago. Which process of bone healing should the nurse anticipate the client to be experiencing? A. Reparative phase B. Remodeling phase C. Inflammatory phase D. Bony union phase
Answer: A Rationale: The three stages of fracture healing are inflammatory, reparative, and remodeling. In the reparative phase, fibrocartilage forms a soft callus that joins the fractured bone. This phase usually lasts about 6-8 weeks after the fracture occurs. Bone union is a process that occurs and is not a phase of healing.
A client who was treated for a long bone fracture suddenly has a respiratory rate of 28 breaths/ min with an oxygen saturation of 86% on room air. The client is confused and restless. Which collaborative intervention is appropriate? A. Applying oxygen and continuing to assess respiratory status B. Intubating the client immediately C. Immediately immobilizing the pelvic area D. Administering corticosteroids as ordered
Answer: A Rationale: This client is showing signs of fat embolism syndrome (FES). Priority treatment is to administer oxygen and continue to assess respiratory status to try to prevent intubation. Approximately 50% of the clients will have to be intubated eventually, but the goal is to prevent this invasive treatment. Corticosteroids and immobilization of the injured area may reduce the risk of FES but will not treat the syndrome once it occurs.
A client sustained a radial fracture and a cast was just applied. The client states that there is unrelieved pain and numbness in the fingers on the affected side. Which intervention should be a priority? A. Notifying the healthcare provider for cast removal B. Elevating the extremity C. Preparing for fasciotomy D. Performing frequent neurovascular checks
Answer: A Rationale: Compartment syndrome occurs when edema and swelling cause increased pressure in a muscle compartment, leading to decreased blood flow and potential muscle and nerve damage. This leads to dilation of the blood vessels, causing more edema and increasing pressure in the limb. This is a medical emergency; the first step in treatment is to remove the tight cast by notifying the healthcare provider. A fasciotomy is indicated when internal pressure is causing the symptoms but would not be indicated unless the cast removal did not relieve the pressure. Neurovascular checks would be performed frequently, but cast removal is the priority. Elevating the extremity is indicated to prevent compartment syndrome, not to treat the problem if it occurs. This would actually decrease circulation to the extremity.
A client fell off a ladder and the healthcare provider suspects a fracture of the right wrist. Which manifestation should the nurse anticipate observing in the client? (Select all that apply.) A. Crepitus B. Visible deformity C. Pain D. Cyanosis of nail beds E. Absence of radial pulse
Answer: A, B, C Rationale: The manifestations of a fracture include visible deformity, swelling, pain, numbness, crepitus, hypovolemic shock, muscle spasms, or ecchymosis. A complication of a fracture, compartment syndrome, may occur if pressure from edema builds within the fascia, leading to decreased blood flow and potential muscle and nerve damage. Neurovascular changes may be noted when this occurs which can include absence of pulse and cyanosis of the nail beds.
The nurse notes that a client with a 2-day postoperative internal fixation femur fracture is a current two-pack-a-day smoker. Which complication should the nurse expect due to the client's smoking habit? (Select all that apply.) A. Osteomyelitis B. Delayed bone healing C. Higher incidence of infection D. Decreased blood circulation to bone E. Increased bone density
Answer: A, B, C, D Rationale: Evidence-based practice has demonstrated that the multiple toxins found in cigarettes may lead to delayed healing, lower bone density, and decreased circulation to the bone. This leads to increased nonunion rates and increases in other postsurgical complications.
The nurse is performing an admission assessment on an older adult male who has a suspected hip fracture. Which pre-existing situation might be found in the client? (Select all that apply.) A. Bedridden B. Over the age of 80 C. Chronic steroid use D. Wheelchair-bound E. Diabetes
Answer: A, B, D Rationale: Because of potential complications associated with hip replacement surgery, hip replacement is contraindicated for clients with limited mobility prior to the fracture, for clients at high risk of infection (steroid use, immunosuppressed), and for clients who are too ill to undergo any form of anesthesia. If diabetes is well controlled, the client would be a surgical candidate. Age is not a contraindication.
A client had a cast applied to a fractured limb, and the healthcare provider has ordered frequent neurovascular checks. Which assessment should the nurse perform? (Select all that apply.) A. Paresthesia B. Pain C. Position D. Color E. Temperature
Answer: A, B, D, E Rationale: When conducting a neurovascular assessment, the 5 Ps should be evaluated. This includes pain, pallor, pulse, paresthesia, and paralysis. Position is not part of the neurovascular assessment.
Which statement from the client regarding cast care requires additional teaching by the nurse? A. "I can use plastic shields around the cast while showering or bathing." B. "If the edges become rough and irritating, I can remove the rough edges." C. "I can apply ice to the cast and elevate my arm to prevent swelling." D. "I should never place objects in the cast to relieve itching."
Answer: B Rationale: The client should be taught to protect the cast with plastic while showering or bathing. No part of the cast, including rough edges, should be removed at any time. Ice and limb elevation may help reduce swelling, and no objects should ever be inserted into the cast for any reason.
The nurse is creating a plan of care for the presurgical care of a client with a hip fracture. Which goal would be appropriate for the diagnosis of Tissue Perfusion: Peripheral, Ineffective? A. The client will report a lowered pain score after administration of pain medications. B. The client will maintain a distal pulse in the affected extremity. C. The client's open wound will remain free from signs of infection. D. The client will maintain core body temperature that is within normal limits.
Answer: B Rationale: Tissue perfusion in the affected extremity would be assessed by performing neurovascular checks that would include the 5 Ps: pain, paresthesia, pallor, pulse, and paralysis. Core body temperature and the wound being free of infection would be appropriate for a diagnosis of Infection, Risk for. Response to pain medication would be appropriate for a diagnosis of Pain, Acute. Maintaining a pulse distal to the injury would be an appropriate goal for a diagnosis of Tissue Perfusion: Peripheral, Ineffective.
Which statement is correct regarding traction? A. Traction weights should rest either on the bed or on the floor. B. Skeletal traction may be used in conjunction with skin traction. C. Skin traction is contraindicated in older adults with frail skin. D. Skin traction is used when skeletal traction is contraindicated.
Answer: B Rationale:Skeletal traction may be used in conjunction with skin traction depending on the severity and location of the injury. Skin traction is used when only a small amount of weight is needed because skin cannot tolerate larger weights. Skin traction is contraindicated in older adults with frail skin due to increased risk of skin tearing leading to infection. Traction weights should never be placed on the bed or the floor, which will cause inadequate force on the bone and may change the alignments of the fracture causing a malunion. Weights should hang unencumbered.
The nurse is teaching an older adult client on what they need to do if they are alone and sustain a fall. Which client statement indicates a need for additional teaching? A. "I should try to keep a cell phone with me at all times." B. "If I fall, I should not move because I can cause further injury." C. "I should ask a friend or family member to check in daily." D. I should participate in an emergency alert service such as Lifeline."
Answer: B Rationale: When an older adult lives alone, measure should be taken for protection. This may involve subscribing to an emergency alert system, keeping a cell phone near them at all times, and asking friends and family members to check on them frequently. If the client falls, they should turn on their stomach or crawl to a phone to get help. They should also cover up with a blanket to stay warm if available until help arrives.
Which client should the nurse identify to be at a greater risk of fractures while reviewing their health records? (Select all that apply.) A. The client with leukemia B. The client with bone neoplasms C. The client who is malnourished D. The client with osteoporosis E. The client with hypercalcemia
Answer: B, C, D Rationale: The primary risk factors associated with bone fractures are age, presence of bone disease, bone cancer, and poor nutrition. Leukemia and hypercalcemia are not risk factors for fractures.
The nurse is explaining the use of a splint for an ulnar fracture. Which information should be included? (Select all that apply.) A. At greater risk for compartment syndrome B. May be used as a temporary measure until a cast can be applied C. Easily removed if needed D. Can be adjusted if swelling occurs E. Allows some movement of the joint
Answer: B, C, D, E Rationale: A splint provides less support than a cast does but may be used as a temporary measure before a cast is applied (to stabilize bone until swelling has subsided) and can easily be adjusted to accommodate swelling and prevent compartment syndrome. Splints do allow some movement of the joint and so may also be used during the reparative phase of healing.
The nurse who is caring for a client who has a fractured pelvis has determined that the client is experiencing acute pain. Which intervention should the nurse implement? (Select all that apply.) A. Maintaining strict bedrest until the bone is fused B. Elevating the affected extremity on a pillow C. Playing the client's favorite music D. Applying a hot pack to the site of the injury E. Supporting the extremity above and below the fracture site when moving
Answer: B, C, E Rationale: Effective pain management for this client may involve administration of pain medication, distraction, relaxation, deep breathing, ice to reduce swelling, and gentle movement while supporting the extremity above and below the fracture site to prevent displacement of bony fragments and nerve damage.
Which statement concerning bone fractures is correct? (Select all that apply.) A. "Bone fractures do not result from low bone density." B. "Bone fractures may result from repetitive forces or twisting." C. "A bone fracture can be the direct result of excess pressure in the fibrous membrane or fascia." D. "Diseases such as neoplasms do not cause bone fractures." E."The severity of a bone fracture depends on the force of the action against the bone and bone strength."
Answer: B, E Rationale: The severity of a bone fracture depends on the force of the action against the bone and bone strength. Bone fractures may result from repetitive forces like running, twisting, or a direct blow to the bone. Low bone density is often a precursor to a fracture. Diseases such as neoplasms (bone cancer) or osteoporosis may weaken the bones and result in fractures. It is compartment syndrome, not a bone fracture, which occurs when excess pressure in the space enclosed by the fascia constricts structures within the compartment, reducing circulation to muscles and nerves.
The nurse is providing discharge teaching to the family of an older adult client who was treated for a fracture after a fall. Which recommendation should the nurse include in the teaching? A. Always wear socks when ambulating. B. Use a step stool when possible. C. Start a mild exercise program. D. Remove the rubber mat from tub.
Answer: C Rationale: A mild exercise program may help to improve balance and strength. The client should wear shoes with nonslip soles when ambulating to prevent falls; socks may cause the client to slip. Use of a step stool should be avoided. Rubber mats are helpful to prevent slipping in the tub.
Which statement by the nurse describes a comminuted fracture to the client? A. The ends of the broken bones are forced together." B. The bone is breaking through the skin." C. The bone is broken into many pieces." D. A fragment of the bone is separated from the rest of the bone."
Answer: C Rationale: In a comminuted fracture, the bone is broken into many pieces. The bone fragments may cause further injury or complications. An open or compound fracture involves bone breaking through the skin. An avulsion fracture involves a fragment of bone being separated from the rest of the bone. In an impacted or buckle fracture, the ends of the broken bones are forced together.
The nurse is discussing open reduction and internal fixation with a client who is considering surgery to correct a bone fracture. Which statement by the nurse is correct? A. "Internal fixation is performed when soft tissue damage prevents external fixation." B. "A longer hospital stay will be required." C. "A metal bar will be placed outside the skin to stabilize the bone." D. "Internal fixation allows earlier return to full function."
Answer: D Rationale: The two main types of surgical repair are external fixation and internal fixation. Internal fixation allows for shorter hospital stays and earlier return to full function, as well as fewer instances of nonunion and malunion. External fixation is often performed if soft tissue damage prevents internal fixation. A metal bar is attached to pins and screws in external fixation.
