Fracture Types
This type of fracture occurs when the bone breaks through the skin
a. greenstick
b. open
c. closed
d. complex
b. open fracture
What is the first intervention when dealing with a patient who has a fracture?
a. Wrap the break with ice
b. Immobilize the fracture
c. X-ray the fracture
d. Elevate the break
B: IMMOBILIZE THE FRACTURE
These are all important interventions, but when dealing with an acute break, the first thing you should do is immobilize and splint the fracture. You want to do this to prevent any further displacement of bone and prevent any more tissue injury. You NEVER want to attempt to reduce the bone.
A nurse is caring for a patient with a fractured pelvis who is receiving a continuous infusion of morphine sulfate for pain management. The nurse should monitor the patient for signs of:
a. hypokalemia
b. hyperglycemia
c. hypercalcema
d. respiratory depression
D. RESPIRATORY DEPRESSION
Morphine is an opioid. You should monitor for respiratory depression, as this is can be a dangerous side effect or opioids.
This complication occurs when excess pressure is present in the muscle compartments of the fascia. For example, a patient with a cast that is too tight may have increased pressure within the compartments.
a. fat embolism syndrome
b. DVT
c. muscular dystrophy
d. compartment syndrome
d. compartment syndrome
This fracture is slanted across the bone shaft
a. open
b. closed
c. transverse
d. oblique
d. oblique fracture
Which is NOT part of the RICE acronym?
a. Rest
b. Isometric exercises
c. Compression
d. Elevation
The RICE acronym stands for rest, ice, compression, and elevation.
A nurse is providing education to a patient with a fractured femur about the importance of nutrition in bone healing. Which of the following statements by the patient indicates a need for further teaching?
a. "I should increase my intake of foods rich in calcium and vitamin D."
b. "Protein is not essential for bone healing, so I don't need to worry about it."
c. "Including leafy green vegetables in my diet can help with bone healing."
d. "I will make sure to drink plenty of water to stay hydrated during the healing process."
b. "Protein is not essential for bone healing, so I don't need to worry about it."
Protein is extremely important for wound healing, so you would want to reeducate this patient.
A patient is diagnosed with osteomyelitis due to an open femoral fracture. Which is the priority intervention of the nurse?
a. massage the limb
b. counsel patient on impending amputation of limb
c. administer IV antibiotics as ordered
d. prep the patient for surgical debridement
c. administer IV antibiotics as ordered
The priority and first treatment is to administer IV antibiotics. You do not want to massage the limb as this could cause increased spread of the infection. B is incorrect because although it is possible to require amputation due to osteomyelitis, it would be a worst case scenario and would not be a priority. D is incorrect because surgical debridement is a treatment for osteomyelitis, but it is not the first treatment or priority.
This type of fracture is incomplete and more common in pediatric patients
a. open
b. communicated
c. greenstick
d. stress
c. greenstick fracture
Which intervention is important specifically for compound fractures?
a. X-ray the bone
b. Manage pain
c. Cover with ace bandage
d. Cover with sterile dressing
D. COVER WITH STERILE DRESSING
A compound fracture means that the bone has broken through the skin. Therefore, this is a high risk for infection and osteomyelitis. You want to cover the area with sterile dressing to prevent any further bacteria from entering the site.
A patient with a fractured wrist is prescribed ibuprofen for pain management. The nurse should instruct the patient to:
a. Take ibuprofen on an empty stomach to enhance absorption.
b. Avoid concurrent use of calcium supplements to prevent drug interactions.
c. Report any signs of gastrointestinal bleeding such as black, tarry stools.
d. Take ibuprofen with milk to reduce the risk of gastric irritation.
c. Report any signs of gastrointestinal bleeding such as black, tarry stools.
A side effect of ibuprofen is GI bleeding. You would instruct the patient to observe for black tarry stool as this is a sign of a GI bleed.
The older adult patient who is admitted to the hospital following a hip fracture asks the nurse, "Why are you giving me heparin when I am here for a fall?" Which is the best response by the nurse?
a. "Heparin stimulated bone growth, which could speed up the healing process."
b. "You may not move around as much while your hip fracture heals. Heparin prevents blood clots from forming, which can be a serious risk after a fracture."
c. "Heparin helps to decrease the swelling around your hip, which will aid in the healing process."
d. "Heparin is a blood thinner, which will improve mobility in time."
b. "You may not move around as much while your hip fracture heals. Heparin prevents blood clots from forming, which can be a serious risk after a fracture."
Immobility related DVT's are a risk for patients after a fracture. Heparin is typically given for DVT prophylaxis.
This type of fracture can occur due to trauma such as falls. With this fracture, the bone is broken into many fragments.
a. greenstick
b. comminuted
c. transverse
d. oblique
b. comminuted
You have a patient presenting to the ED with a left tibial compound fracture after a motor vehicle accident. He is currently taking Humalog, Warfarin, Lipitor, and Aspirin. Which labs would be beneficial to know with this patient?
a. PT/INR
b. Bilirubin
c. Amylase
d. Ammonia
A. PT/INR
If the patient has a compound fracture, that means the bone has broken through the skin. Therefore, this patient is at risk for bleeding. It would be important to know the patient's PT/INR, as they could be at a higher risk for bleeding due to warfarin.
Which patient is at the highest risk for altered wound healing?
a. 85 year old smoker with type 2 diabetes mellitus
b. 16 year old boy with ADHD
c. 35 year old with a nondisplaced fracture
d. 4 year old girl with no significant medical history
A. 85 YEAR OLD SMOKER WITH TYPE 2 DIABETES MELLITUS
Some risk factors for altered fracture healing include advanced age, poor nutrition, smoking, lack of blood supply to the area, displaced fractures, and infection. An older adult who smokes and has diabeted mellitus would most be the most likely to have altered fracture healing.
A patient with a fractured pelvis developed fat embolism syndrome. Which assessment finding is a hallmark characteristic of FES?
a. bradycardia
b. petechiae over the chest and axilla
c. increased capillary refill
d. hypertension
b. petechiae over the chest and axilla
This type of fracture occurs from a twisting injury and is a red flag for abuse in children
a. spiral
b. greenstick
c. comminuted
d. oblique
a. spiral fracture
A patient with a fracture has a Buck's traction device. Which assessment would require immediate intervention?
a. The patient reports a 3/10 on the pain scale
b. The patient uses their overhead trapeze bar to move around in bed
c. The weights are on the floor
d. The patient has bilateral pedal pulses +3
C. THE WEIGHTS ARE ON THE FLOOR
When using a traction device, the weights should be freely hanging and NOT on the floor.
A patient with a greenstick fracture in the left humerus is prescribed an NSAID for pain management. Which of the following should the nurse monitor for?
a. renal impairment
b. cardiovascular impairment
c. hypoglycemia
d. hypertension
A. RENAL IMPAIRMENT
NSAIDs have been associated with acute kidney injury. Therefore, the nurse should monitor for any renal impairment. The number one indicator is urine output.
Which assessment finding(s) is the earliest indicator of compartment syndrome?
a. paresthesia and pain
b. pulselessness and cold
c. paralysis
d. pallor
a. paresthesia and pain
Paresthesia (pins and needles) and pain are the earliest signs of compartment syndrome. Pulselessness is the late sign.