Chapter 45: Fractures

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

ANS: B
These are the classic symptoms of a fat embolus that has escaped from the crushed marrow.

DIF: Cognitive Level: Analysis REF: p. 881 OBJ: 3 | 6

TOP: Complications: Fat Embolism
KEY: Nursing Process Step: Assessment| Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.

ANS: D
Movement of the shoulders will help decrease the threat of contracture from immobility.

DIF: Cognitive Level: Comprehension REF: p. 891 OBJ: 7

TOP: Colles Fracture KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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

ANS: A
After the antibiotic has controlled the infection in the bone, surgery will be performed to
remove the dead bone.

DIF: Cognitive Level: Comprehension REF: p. 882 OBJ: 4

TOP: Osteomyelitis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
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

ANS: A
Compartment syndrome may occur after a massive injury or an inappropriately tight cast. The
tissues become swollen to the point that they cut off their own circulation.

DIF: Cognitive Level: Analysis REF: p. 882 OBJ: 3

TOP: Compartment Syndrome KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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

ANS: C
Callus formation occurs at the end of the first week after injury.

DIF: Cognitive Level: Comprehension REF: p. 880 OBJ: 2

TOP: Healing Process of Fractures KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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

ANS: B
The absence of urinary output could indicate a perforated bladder.

DIF: Cognitive Level: Analysis REF: p. 896 OBJ: 3

TOP: Pelvic Fracture KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
 ANS: A
The classic sign of a fractured hip is a shortened limb on the affected side, with an externally
rotated limb.

DIF: Cognitive Level: Comprehension REF: p. 896 OBJ: 1

TOP: Fractured Hip KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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.”
ANS: D
Resting with the limb elevated above the heart helps prevent swelling.

DIF: Cognitive Level: Comprehension REF: p. 887 OBJ: 5

TOP: Cast Care KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Psychosocial Integrity: Physiological Adaptation

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.

ANS: C
The stockinette is smoothed on the limb before applying the casting material to help reduce
the threat of a pressure ulcer.

DIF: Cognitive Level: Application REF: p. 885 OBJ: 5

TOP: Cast Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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)

ANS: D
 DVT is a threat for the person who is going to experience lengthy periods of inactivity.
Although nutrition, pain relief, and boredom will be nursing concerns as well, the prevention
of DVT is the priority.

DIF: Cognitive Level: Application REF: p. 893 OBJ: 3 | 5

TOP: Long-Term Complications of Fractures
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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

ANS: B
Buck traction is used to stabilize the fracture. The other options are not applicable.

DIF: Cognitive Level: Application REF: p. 888 OBJ: 5

TOP: Traction KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.

ANS: D
A compound comminuted fracture is a severe fracture with the bone broken in two or more
pieces, with the pieces broken into small fragments and a portion of the bone protruding
through the skin.

DIF: Cognitive Level: Comprehension REF: p. 879 OBJ: 1

TOP: Fracture Types KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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.”

ANS: C
This option describes the correct sequence for a four-point gait, which allows bearing of
weight and one foot to be placed in front of the other.

DIF: Cognitive Level: Comprehension REF: p. 889 OBJ: 5

TOP: Crutch Walking KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Psychosocial Integrity: Physiological Adaptation

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.

ANS: C
Assessing for pulses distal to the injury is performed to monitor for inadequate circulation.

DIF: Cognitive Level: Application REF: p. 884 OBJ: 6

TOP: Care of the Patient after Surgery for a Fracture
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.”

ANS: A
“Canes provide minimal support and balance and are carried on the unaffected side” is the
only true statement.

DIF: Cognitive Level: Comprehension REF: p. 890 OBJ: 5

TOP: Assistive Devices KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Psychosocial Integrity: Basic Care and Comfort

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

ANS: B
The patient will need help with laundry and other activities of daily living.
 DIF: Cognitive Level: Analysis REF: p. 891 OBJ: 6
TOP: Nursing Assessment of a Patient with a Fracture
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

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

ANS: A
Elevated temperature on the affected extremity may be a symptom of an infection under the
cast.

DIF: Cognitive Level: Application REF: p. 893 OBJ: 3

TOP: Complications of a Fracture KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

18. Which patient problem has the highest priority after surgery for the open reduction and
external fixation of an ankle?
a. Potential activity intolerance
b. Potential for infection
c. Immobility
d. constipation

ANS: B
Potential for infection would have the highest priority because bone infections are serious
complications.

DIF: Cognitive Level: Analysis REF: p. 892 OBJ: 6

TOP: Post-operative care KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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

ANS: C
Cast syndrome is an uncommon complication for a person in a spica cast, in which
compression of a portion of the duodenum occurs between the mesenteric artery and the spinal
column.

DIF: Cognitive Level: Analysis REF: p. 885 OBJ: 6

TOP: Cast Syndrome KEY: Nursing Process Step: Assessment
 MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.

ANS: C
During periods of immobilization, a daily fluid intake of 2 to 3 L is recommended to promote
bowel and bladder function. Food with sodium causes fluid retention. Dietary fiber helps
diminish constipation.

DIF: Cognitive Level: Application REF: p. 893 OBJ: 6

TOP: Nutrition Concepts with Fractures KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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

ANS: C
Purulent drainage is the only abnormal finding.

DIF: Cognitive Level: Comprehension REF: p. 884 OBJ: 5 | 6

TOP: Pin Care KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

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

ANS: A
Delayed capillary refill reflects possible inadequate circulation.

DIF: Cognitive Level: Comprehension REF: p. 891 OBJ: 5 | 6

TOP: Traction KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.

ANS: D
Weights must always hang freely to prevent complications.

DIF: Cognitive Level: Application REF: p. 887 OBJ: 5 | 6

TOP: Traction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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.

ANS: C
Greenstick fractures are most commonly seen in children, with the bone broken on one side
but only bent on the other.

DIF: Cognitive Level: Knowledge REF: p. 879 OBJ: 1

TOP: Fracture Healing KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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

ANS: B
Early ambulation, although painful, avoids many of the complications of immobility such as
DVT, constipation, and atrophy.

DIF: Cognitive Level: Comprehension REF: p. 882 OBJ: 3 | 5

TOP: Early Ambulation with Fractured Pelvis
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

MULTIPLE RESPONSE

1. 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

ANS: A, D, E
 Delayed union can be caused by inadequate immobilization, infection, poor nutrition, and
poor alignment of the bone fragments.

DIF: Cognitive Level: Knowledge REF: p. 882 OBJ: 3

TOP: Delayed Union KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

2. 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 hand grips allow for a 45-degree flexion of the elbow.
e. They are padded so patient can bear weight on the axilla piece when ambulating.

ANS: A, C
Crutches should allow for 3 to 4 fingerbreadths between the axilla and the axilla piece, the
crutches should be adjusted when the patient is in the tripod position, the elbow flexion should
be adjusted for a 30-degree flexion, and the weight should not be borne on the axilla because
of the possibility of nerve damage.

DIF: Cognitive Level: Comprehension REF: p. 888 OBJ: 5

TOP: Crutch Adjustment KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

COMPLETION

1. A fracture that occurs because of osteoporosis is classified as a(n) ______ fracture.

ANS:
pathological

A fracture that occurs as a result of a tumor of another pathologic condition is classified as a

pathologic fracture.

DIF: Cognitive Level: Knowledge REF: p. 879 OBJ: 3

TOP: Pathological Fracture KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

2. A nurse uses a diagram to show the process of a fractured bone healing. ______ (Arrange the
options in the appropriate sequence. Do not separate answers with a space or punctuation.
Example: ABCD.)
a. Ossification
b. Hematoma
c. Fibrocartilage
d. Consolidation
e. Callus

ANS:
 BCEAD

The sequence of healing is hematoma, fibrocartilage, callus, ossification, and consolidation.

DIF: Cognitive Level: Comprehension REF: p. 880 OBJ: 2

TOP: Bone Healing KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. Arrange the process of stair climbing with crutches in the correct sequence: ______ (Arrange
the options in the appropriate sequence. Do not separate answers with a space or
punctuation. Example: ABCD.)
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.

ANS:
ADEBC

When climbing steps on crutches, the body weight is supported with the crutches. While the
unaffected leg is moved to the next step, the body weight is transferred to the unaffected leg;
while the crutches are moved up, the affected leg moves up.

DIF: Cognitive Level: Comprehension REF: p. 889 OBJ: 5

TOP: Stair Climbing with Crutches KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A