NUR 1024: NCLEX Questions on Fractures

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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.


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