Fractures (Fx)

Which of the following fractures presents the greatest risk for development of fat embolism? A) Open fx of the fibula B) Closed fx of the femur C) Open fx of the humerus D) Closed fx of the clavicle

B) Closed fx of the femur Rationale: Fat embolism syndrome may occur in conjunction with closed fractures of the long bones or pelvis. Of the closed fractures listed here, only the fracture of the femur involves a long bone, so this is the injury that presents the greatest risk for development of fat embolism syndrome

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) "If I fall, I should not move because I can cause further injury." B) "I should participate in an emergency alert service such as Lifeline." C) "I should ask a friend or family member to check in daily." D) "I should try to keep a cell pone with me at all times."

A) "If I fall, I should not move because I can cause further injury." 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 statement from the client regarding cast care requires additional teaching by the nurse? A) "If the edges become rough and irritating, I can remove the rough edges." B) "I can use plastic shields around the cast while showering or bathing." 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."

A) "If the edges become rough and irritating, I can remove the rough edges." 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 teaching a new colleague about traction. Which statement by the new colleague indicates a need for further teaching? 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 may be used to control muscle spasms." D) "Skin traction is contraindicated in older adults with frail skin."

A) "Traction weights should rest either on the bed or on the floor." Rationale: 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. Skeletal traction may be used in conjunction with skin traction depending on the severity and location of the injury. Skin traction is contraindicated in older adults with frail skin due to increased risk of skin tearing leading to infection. Skin traction may be used to control muscle spasms.

A client who was treated for a long bone fracture suddenly has a respiratory rate of 28 breaths/min with an oxygen sat 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) Immediately immobilizing the pelvic area C) Administering corticosteroids as ordered D) Intubating the client immediately

A) Applying oxygen and continuing to assess respiratory status 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.

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 maintain a distal pulse in the affected extremity. B) The client will report a lowered pain score after administration of pain medications C) The client's open would will remain free from signs of infection. D) The client will maintain core body temperature that is within normal limits

A) The client will maintain a distal pulse in the affected extremity. 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

The nurse notes that a client with a 2-day post-op 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? SATA A) Decreased blood circulation to bone B) Higher incidence of infection C) Delayed bone healing D) Osteomyelitis E) Increased bone density

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.

A client had a cast applied to a fractured limb, and the healthcare provider has ordered frequent nerovascular checks. Which assessment should the nurse perform? SATA A) Temperature B) Pain C) Paresthesia D) Position E) Color

A, B, C, E Rationale: When conducting a neurovascular assessment, the 5 Ps should be evaluated. This includes pain, pallor, paresthesia, and paralysis. Position is not part of the neurovascular assessment.

The nurse is teaching an older adult client and caregiver about appropriate ways to decrease the client's risk for falls. Which interventions are appropriate for the nurse to include in this teaching session? SATA A) Start walking for exercise several times per week B) Wear sensible shoes with good support C) Wear socks when walking in the kitchen D) Encourage the use of throw rugs throughout the home E) Make sure hallways and stairways have adequate lighting, even at night.

A, B, E Rationale: Interventions that are appropriate to decrease this client's risk for falls include wearing sensible shoes with good support when shopping and making sure hallways and stairways have adequate lighting, even at night. A mild to moderate exercise program is also beneficial, as it helps improve balance and strength, thus reducing the likelihood of falls. Nonslip footwear should be encouraged. Throw rugs should be discouraged.

The nurse is explaining the use of a splint for an ulnar fracture. Which information should be included? SATA A) Easily removed if needed B) At greater risk for compartment syndrome C) Can be adjusted if swelling occurs D) May be used as a temporary measure until a cast can be applied E) Allows some movement of the joint

A, 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.

A nurse is teaching a mother warning signs and symptoms to watch for in her child, who will be discharged with a full leg cast. Which statements by the mother indicate the need for further instruction? SATA A) "If her foot turns white and cold, I should call the physical therapist." B) "I can expect that my child will have some pain, but the medicine should help." C) "We can use a blow dryer on warm to help with the itching that my child will experience." D) "We can cut a hole in the cast if my child's foot swells until we get to the doctor's office." E) "It's okay if the plaster cast gets damp as long as I blow dry it."

A, C, D, E Rationale: The only option that indicates appropriate understanding of cast care is the mother's statement that her child may have pain that will be relieved by medication. All of the other statements indicate a need for further instruction. If the child's foot turns white and cold, the family should contact the physician. Itching may be helped by use of a blow dryer on the cool setting. Holes should not be cut in the cast, and the plaster should stay dry at all times.

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) "A metal bar will be placed outside the skin to stabilize the bone." B) "Internal fixation allows earlier return to full function." C) "A longer hospital stay will be required." D) "Internal fixation is performed when soft tissue damage prevents external fixation."

B) "Internal fixation allows earlier return to full function." 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.

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 broken into many pieces." C) "The bone is breaking through the skin." D) "A fragment of the bone is separated from the rest of the bone."

B) "The bone is broken into many pieces." 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 caring for clients in an assisted living facility. Which resident would the nurse identify as being at the highest risk for the development of fractures from a fall? A) A resident who participates in resistance training exercises three times a week and takes a calcium supplement B) A resident who hikes in the woods once a week and smokes 14 cigarettes per day C) A resident who line dances twice per week and has a glass of wine with dinner D) A resident who teaches yoga four times per week and is lactose intolerant

B) A resident who hikes in the woods once a week and smokes 14 cigarettes per day Rationale: Among older adult clients, smoking is the highest-risk behavior. Although exercise helps prevent fractures, hiking on an uneven surface can be a risk. Resistance training, line dancing, yoga, and taking a calcium supplement all decrease the risk of fracture with a fall. Consuming one glass of wine each day is not a risk factor for fractures from a fall. Lactose intolerance can lower calcium intake, although there are other sources of dietary or supplemental calcium that lactose-intolerant clients can use to reduce their fracture risk.

The nurse is providing care for a client who experienced a fracture requiring a plaster cast. Which nursing intervention is appropriate for this client. A) Prescribing opioid pain medication B) Assessing the client's neurovascular status C) Discouraging client ambulation D) Encouraging the client to keep the cast damp

B) Assessing the client's neurovascular status Rationale: It is appropriate for the nurse to assess the client's neurovascular status to monitor for compartment syndrome related to the fracture. The nurse can administer an opioid pain medication but cannot prescribe one. The nurse should encourage the client to ambulate and to keep the plaster cast dry.

A client hospitalized with an open reduction and internal fixation of a fractured femur reports right calf pain. The nurse notes that the client's right calf is 3.5cm larger than the left calf with generalized posterior erythema. The right calf is tender to touch, and the dorsalis pedis pulse is 3/4+ bilaterally. Which of the following is the priority action by the nurse? A) Use a doppler stethoscope to confirm pedal pulses. B) Notify the healthcare provider of the findings C) Prepare to apply a cast to the right leg D) Prepare to administer IV heparin.

B) Notify the healthcare provider of the findings Rationale: These findings indicate possible deep vein thrombosis (DVT). The nurse's first action upon assessing these signs and symptoms should be to notify the healthcare provider immediately. If a pedal pulse can be palpated, then a Doppler stethoscope is not needed; however, a Doppler ultrasound test may be ordered by the provider. A cast is not indicated with internal fixation. Intravenous heparin will likely be ordered after the condition is confirmed by the provider.

A client sustained multiple fractures in a motor vehicle crash. Of the various fracture types sustained by the client, which places the client at highest risk for osteomyelitis? A) Avulsion fracture B) Open fracture C) Comminuted fracture D) Depression fracture

B) Open fracture Rationale: The risk for osteomyelitis, or bone infection, is highest with an open fracture, in which the bone breaks through the skin. Comminuted, avulsion, and depression fractures are closed from the environment and present a lower risk of infection.

The x-ray of a client 14 weeks post-ulnar fracture exhibits no callus formation. Based on this data, which collaborative intervention should the nurse anticipate? A) The physical therapist will set up Buck traction. B) The surgeon will schedule a consultation with the client C) The pharmacist will educate the client about antibiotics D) The nurse will counsel the client on starting ROM exercises

B) The surgeon will schedule a consultation with the client Rationale: An ulnar fracture that does not show callus formation after 14 weeks would be classified as experiencing nonunion. Nonunions frequently require surgical correction. Buck traction, antibiotics, and exercise are not indicated for nonunion of a fracture.

Which client should the nurse identify to be at a greater risk of fractures while reviewing their health records? SATA A) The client with leukemia B) The client with osteoporosis C) The client who is malnourished D) The client with bone neoplasms E) The client with hypercalcemia

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.

Which statement concerning bone fractures is correct? SATA A) "Bone fractures do not result from low bone density." B) "Bone fractures may result from repetitive forces or twisting." C) "Diseases such as neoplasms do not cause bone fractures." D) "The severity of a bone fracture depends on the force of the action against the bone and bone strength." E) "A bone fracture can be the direct result of excess pressure in the fibrous membrane or fascia."

B, D 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 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? SATA A) Applying a hot pack to the site of the injury B) Playing the client's favorite music C) Maintaining strict bedrest until the bone is fused D) Supporting the extremity above and below the fracture site when moving E) Elevating the affected extremity on a pillow

B, D, 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.

The nurse is an orthopedic outpatient clinic expects to see several clients with fractures for follow-up. Based on the information provided below, which of the nurse's clients is at highest risk for a delayed union? A) A 20 y.o. college student with type I diabetes who sustained a fractured tibia in a bike accident. The client follows the ADA diet. B) A 62 y.o. bartender with a history of peptic ulcer disease who sustained a fractured clavicle breaking up a fight at work. During his prior visit, the client stated he was upset that his injury required him to abstain from upper body resistance training. C) A 49 y.o. teacher w/osteoporosis who sustained an open ulnar fx in a car crash. At her last visit, the client reported that she had cut down to 10 cigarettes/day. D) A 55 y.o. accountant who sustained fx's to the 4th and 5th metatarsals. The client has a hx of HTN that is well controlled w/medication.

C) A 49 y.o. teacher w/osteoporosis who sustained an open ulnar fx in a car crash. At her last visit, the client reported that she had cut down to 10 cigarettes/day. Rationale: Evaluating the risk of delayed union requires knowledge of the factors that impact bone healing. The client at greatest risk of delayed union has two factors that decrease the likelihood of proper healing: an open fracture and osteoporosis. This client also uses tobacco, which decreases blood supply to the healing bone. Although diabetes does increase the risk of delayed union, this client is young and exercised on a bicycle prior to the crash. If the client is following an ADA diet, there is adequate intake of vitamin D and calcium, which fosters bone healing. Neither peptic ulcer disease nor controlled hypertension are risks for delayed bone healing.

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) Performing frequent neurovascular checks B) Elevating the extremity C) Notifying the healthcare provider for cast removal D) Preparing for fasciotomy

C) Notifying the healthcare provider for cast removal 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.

During which phase of the fracture healing process is woven bone replaced by lamellar bone? A) Reactive phase B) Reparative phase C) Remodeling phase D) Inflammatory phase

C) Remodeling phase Rationale: In the reactive or inflammatory phase of fracture healing, a hematoma forms around the injury. Inflammatory cells then enter the wound and degrade debris and bacteria in the area. Next, in the reparative phase, fibroblasts, osteoblasts, and chondroblasts begin to secrete collagen to form fibrocartilage, which develops into a soft callus that joins the fractured bone. Once the soft callus is formed, it is replaced by woven bone through endochondral ossification, which forms a hard callus. Finally, during the remodeling phase, woven bone is replaced by highly organized lamellar bone

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) Inflammatory phase B) Bony union phase C) Reparative phase D) Remodeling phase

C) Reparative phase 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 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? SATA A) Absence of radial pulse B) Cyanosis of nail beds C) Pain D) Crepitus E) Visible deformity

C, D, E 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.

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) Not allowing children to play on the jungle gym C) Avoiding sports where swinging of the arms is required D) Avoid swinging children by the hands

D) Avoid swinging children by the hands. 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

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) Remove the rubber mat from the tub. B) Always wear socks when ambulating C) Use a step stool when possible D) Start a mild exercise program

D) Start a mild exercise program 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.

A client who is hospitalized after a left hip fx is scheduled for surgery late this afternoon. After receiving report, the nurse evaluates the Buck traction applied by a new physical therapist. Which finding would indicate that the traction is correctly applied? A) A foam boot covers the right lower leg from the knee down B) 20 lb. weights are connected to the bottom of a foam boot. C) Weights are supported by a stool at the end of the bed D) The left knee and hip are in alignment above a foam boot

D) The left knee and hip are in alignment above a foam boot Rationale: The correct placement of Buck traction permits the client's left knee and hip to align. Because Buck traction is a type of skin traction, it does not involve heavy weights; usually, 5-pound weights are used. The weights always hang free from a pulley and are never supported by a stool at the end of the bed. Also, a foam boot covers the affected leg—in this case, the left leg, not the right.

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? SATA A) Providing pain medications as indicated B) Assessing temperature during every shift C) Using sterile technique with dressing changes D) Assessing the wound for size, color, or presence of drainage E) Administering prophylactic antibiotics per order

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.