Fracture Types
An elderly client with osteoporosis develops a fracture after bending forward to pick up an object. Which type of fracture is most likely?
A. Stress (fatigue) fracture
B. Compression fracture
C. Comminuted fracture
D. Pathological fracture
Answer: B
Rationale: Compression fractures occur when cancellous (spongy) bone collapses under load — common in older adults with osteoporosis. Pathological fractures (D) also occur with disease processes, but compression is most common in vertebral osteoporosis
A nurse is caring for a client with a new plaster leg cast. Which action is MOST appropriate in the first 24 hours?
A. Handle the cast with the palms of the hands until dry
B. Elevate the casted extremity above the heart on plastic pillows
C. Use fingertips to gently smooth indentations in the cast
D. Cover the cast with a warm blanket to speed drying
Answer: A
Rationale: Plaster casts must be handled with palms, not fingertips, to avoid indentations → pressure sores. Plastic should not be used (use cloth pillows). Heat and blankets trap moisture and delay drying
Which of the following must be included in every traction prescription?
A. Type of traction, amount of weight, and whether it can be removed for nursing care
B. Type of cast, presence of skin breakdown, and drainage amount
C. Patient’s age, type of fracture, and skin integrity status
D. Type of fracture, nutritional needs, and pain control method
Answer: A
Rationale: A traction prescription must specify type, amount of weight, and whether it can be removed for nursing care. The other factors are part of assessment, not the prescription itself
Which finding is the earliest and most reliable indicator of compartment syndrome?
A. Absent peripheral pulses
B. Severe pain unrelieved by opioids
C. Cool, pale skin over the extremity
D. Paralysis of the affected limb
Answer: B
Rationale: Pain out of proportion/unrelieved by opioids is the earliest sign. Pulses may still be present early. Pallor and paralysis are later signs
Which clinical finding is most consistent with a first-degree strain?
A. Complete separation of the muscle from the tendon
B. Mild inflammation with little bleeding, swelling, and tenderness
C. Severe bruising and total loss of muscle function
D. Fracture of the bone at the muscle attachment site
Answer: B
Rationale: A first-degree strain is mild — minimal bleeding, swelling, and tenderness. Severe separation and total loss of function describe third-degree strains
A young athlete presents with a tibial fracture after repeated marathon training. What type of fracture is most likely?
A. Comminuted fracture
B. Stress fracture
C. Pathological fracture
D. Complete fracture
Answer: B
Rationale: Stress (fatigue) fractures result from repetitive strain and overuse (sports, military training). Comminuted is multiple fragments, pathological occurs in diseased bone, and complete divides the bone into two separate parts
Which finding should be reported immediately in a client with a cast?
A. Slight edema and mild pain relieved by elevation
B. Patient reports itching under the cast
C. Foul odor and increased drainage from the cast
D. The client uses a hair dryer on cool setting for itching relief
Answer: C
Rationale: Foul odor and drainage suggest infection under the cast — report immediately. Mild edema and itching are common. Hair dryer (cool air) is safe, but foreign objects must never be inserted
A patient in halo traction needs to be repositioned. Which nursing action is correct?
A. Move the patient in sections to avoid discomfort
B. Log-roll the patient as a unit without applying pressure to the rods
C. Support only the head while other staff turns the body
D. Remove the halo device briefly to allow a smoother turn
Answer: B
Rationale: Patients in halo traction must be moved as a unit, avoiding pressure on rods to prevent loosening of pins. The device is never removed outside of surgery
A patient with a new cast reports numbness and tingling in their toes. Which nursing action is PRIORITY?
A. Reassure the patient that tingling is normal
B. Elevate the leg on pillows above heart level
C. Notify the provider immediately
D. Massage the toes to improve circulation
Answer: C
Rationale: Neurovascular compromise = emergency. Tingling/paresthesia may indicate compartment syndrome. Elevating too high worsens ischemia. Massage can cause tissue damage
A patient has a second-degree sprain. Which intervention is MOST appropriate?
A. Immediate surgical repair of the ligament
B. Casting and non-weight-bearing for 6–8 weeks
C. Immobilization and partial weight-bearing as tolerated
D. No treatment is required; resume activity as tolerated
Answer: C
Rationale: A second-degree sprain involves partial tearing → needs immobilization and limited weight-bearing. Surgical repair is usually for third-degree injuries
A child presents with a fracture in which the bone bends on one side and breaks on the other. Which type is this?
A. Spiral fracture
B. Greenstick fracture
C. Simple fracture
D. Open fracture
Answer: B
Rationale: Greenstick fractures occur in children due to pliable bones — incomplete fractures with bending on one side. Spiral fractures (A) suggest twisting injuries, often suspicious in child abuse
A patient with a fiberglass cast asks how it differs from plaster. Which response by the nurse is correct?
A. “It’s lighter, stronger, water-resistant, and dries faster than plaster.”
B. “It’s heavier but more durable and dries in 24–48 hours.”
C. “It’s weaker and cannot withstand weight bearing.”
D. “It requires special padding to prevent skin breakdown.”
Answer: A
Rationale: Fiberglass casts are lighter, stronger, water-resistant, and dry within 30 minutes. Plaster is heavy, not water-resistant, and takes 24–72 hours to dry
Which nursing intervention is correct for pin-site care in a client with skeletal traction?
A. Use one sterile cotton swab for all pins to save supplies
B. Cleanse with chlorhexidine, using one swab per pin
C. Soak the entire site in antiseptic solution for 30 minutes
D. Cover the pin sites with occlusive dressings
Answer: B
Rationale: Pin care should be done with chlorhexidine (per provider/facility protocol), using one sterile swab per pin to avoid cross-contamination. Occlusive dressings and soaking are not recommended
Which intervention is most appropriate if compartment syndrome is suspected?
A. Apply ice packs and rewrap the cast
B. Loosen or cut the cast/dressing per provider order
C. Encourage ambulation to improve blood flow
D. Elevate the limb above heart level to decrease swelling
Answer: B
Rationale: The immediate step is to loosen/cut cast (univalve/bivalve) or dressing to relieve pressure. Ice/elevation may worsen ischemia. Ambulation is unsafe
Which type of injury MOST often requires surgical repair?
A. Mild tendon inflammation
B. Second-degree muscle strain
C. Third-degree strain with ruptured muscle or tendon separation
D. First-degree ligament sprain
Answer: C
Rationale: Third-degree strains (ruptured tendon or complete muscle separation) require surgical repair. First- and second-degree injuries are usually managed conservatively
A client involved in a car accident presents with a fracture where bone fragments are not aligned. Which type of fracture is this?
A. Displaced fracture
B. Non-displaced fracture
C. Open fracture
D. Comminuted fracture
Answer: A
Rationale: Displaced fractures occur when bone fragments are out of alignment. Non-displaced fractures maintain alignment. Comminuted involves multiple pieces, while open fractures break through the skin
A patient complains of a “hot spot” under their cast. What complication should the nurse suspect, and what action should be taken?
A “hot spot” under a cast suggests infection beneath the cast. The nurse should assess for drainage, odor, fever, and notify the provider immediately.
What is the major risk of external fixation, and what nursing interventions help prevent it?
The major risk is pin-site infection leading to osteomyelitis. Nursing interventions: perform frequent pin care, use aseptic technique, monitor for redness, swelling, odor, drainage, and educate the patient about infection signs
Which statement BEST explains the ischemia–edema cycle in compartment syndrome?
A. Increased blood flow reduces swelling, restoring perfusion
B. Edema raises pressure, reducing blood flow, which causes more edema
C. Muscle swelling improves circulation to the extremity
D. Decreased pressure in the compartment enhances oxygen delivery
Answer: B
Rationale: In compartment syndrome, edema raises pressure → decreased perfusion → ischemia → more swelling → worsening cycle. Options A, C, D incorrectly describe improved circulation
A nurse is teaching a client about caring for a new ankle sprain. Which statement indicates correct understanding?
A. “I should apply heat for the first 24 hours to reduce swelling.”
B. “I will rest, ice, compress, and elevate my ankle.”
C. “I should keep my foot in a dependent position to promote circulation.”
D. “I will avoid using compression wraps because they increase swelling.”
Answer: B
Rationale: The correct approach is RICE: Rest, Ice, Compression, Elevation. Heat is avoided initially because it increases swelling. Dependent positioning worsens edema
A patient with known bone cancer presents with a sudden femur fracture after stepping off a curb. Which best describes this fracture?
A. Compression fracture
B. Stress fracture
C. Pathological fracture
D. Complete fracture
Answer: C
Rationale: Pathological fractures occur when bones weakened by disease (cancer, osteoporosis) fracture with minimal trauma. Compression fractures are common in vertebrae, stress fractures are from overuse, and complete fractures describe bone alignment, not cause
A client with a fresh arm cast reports severe pain that is not relieved by opioid analgesics. What is the nurse’s priority action, and why?
The nurse should suspect compartment syndrome and notify the provider immediately. Unrelieved pain is the earliest and most reliable sign, and delayed treatment can lead to permanent nerve and muscle damage.
A client with a comminuted femur fracture is placed in external fixation. What are two important nursing assessments besides pin-site care that should be performed regularly?
Neurovascular checks of the affected extremity (pulse, sensation, movement, color, cap refill).
Skin integrity assessment around the device and extremity.
Other considerations: monitor for fat embolism, provide DVT prevention (SCDs, stockings), elevate the extremity
A client with a tibial fracture develops compartment syndrome. Which interventions should the nurse anticipate?
A. Encourage ambulation and apply warm compresses
B. Elevate the leg above the heart and apply ice
C. Loosen or bivalve the cast and prepare for fasciotomy
D. Administer diuretics to reduce compartment pressure
Answer: C
Rationale: The priority treatment is to relieve pressure by loosening/bivalving the cast or surgical fasciotomy. Ambulation, ice, elevation, or diuretics do not resolve the underlying problem and may worsen ischemia
A 22-year-old basketball player presents to the clinic after rolling his ankle. The nurse notes severe swelling, ecchymosis, and the ankle joint is unstable. The patient is unable to bear weight and describes the pain as “tearing.” Based on these findings, which is the MOST likely diagnosis?
A. First-degree sprain – stretching of ligaments with mild tenderness and no joint instability
B. Second-degree sprain – partial ligament tear with moderate swelling and some joint stability
C. Third-degree sprain – complete ligament rupture with marked swelling and joint instability
D. Avulsion fracture – bone fragment torn off with tendon/ligament, visible only on imaging
Answer: C
Third-degree sprain (C): The key findings here — severe pain, gross swelling, ecchymosis, joint instability, and inability to bear weight — are consistent with a complete ligament rupture. The description of pain as “tearing” further supports a severe ligament injury.
First-degree sprain (A): Only involves stretching of ligaments → mild pain/tenderness, little to no swelling, and stable joint. This is far too mild for the presentation.
Second-degree sprain (B): A partial tear → moderate swelling and some joint instability, but usually the patient can still bear some weight. The case stem describes severe instability and inability to walk, ruling this out.
Avulsion fracture (D): A tricky distractor. Avulsion fractures can mimic severe sprains, but they are confirmed only on imaging (x-ray/MRI). The question stem gives no imaging results, only clinical findings that match ligament rupture.