Q1. A patient presents to the emergency department with a suspected femur fracture. The nurse notes that the bone has broken through the skin. Which type of fracture should the nurse document?
A) Greenstick fracture
B) Closed fracture
C) Open (Compound) fracture
D) Stress fracture
Rationale:
Correct Answer (C): An Open or Compound fracture is one where the broken bone pierces the skin, creating an external wound. This type carries a high risk of infection (osteomyelitis).
Option A: Greenstick fractures occur mostly in children where the bone bends and breaks only on one side.
Option B: In a closed (simple) fracture, the bone is broken, but the skin remains intact.
Option D: A stress fracture is a small crack in the bone often caused by overuse or repetitive activity.
Q2. A patient is in skeletal traction for a hip fracture. Which nursing intervention is a priority to prevent a common complication of immobility?
A) Increasing caffeine intake
B) Encouraging deep breathing and coughing exercises
C) Keeping the weights on the floor to rest the limb
D) Restricting fluid intake to 1 liter per day
Rationale:
Correct Answer (B): Patients in traction are at high risk for atelectasis and pneumonia due to immobility. Deep breathing and coughing help maintain clear lungs.
Option A: Caffeine can interfere with rest and doesn't prevent immobility complications.
Option C: Weights must always hang freely; if they touch the floor, the traction is no longer effective.
Option D: Fluid intake should be increased, not restricted, to prevent urinary tract infections and constipation.
Q3. 24 hours after a long bone fracture, a patient suddenly develops dyspnea, tachycardia, and petechiae on the chest and neck. The nurse suspects which life-threatening complication?
A) Hypovolemic shock
B) Compartment syndrome
C) Fat Embolism Syndrome (FES)
D) Deep Vein Thrombosis (DVT)
Rationale:
Correct Answer (C): Fat Embolism is a classic complication of long bone fractures (like the femur). The triad of respiratory distress, tachycardia, and a petechial rash is a hallmark sign.
Option A: Hypovolemic shock would involve low blood pressure and bleeding, but petechiae are not a typical sign.
Option B: Compartment syndrome involves severe pain and loss of pulse in the affected limb, not a systemic rash.
Option D: DVT causes leg swelling and pain; while it can lead to pulmonary embolism, it doesn't typically cause a petechial rash.
Q4. While performing a neurovascular assessment on a patient with a leg cast, the nurse notes that the patient has "unrelieved pain" despite medication and "pain with passive stretching." What is the immediate nursing action?
A) Apply a warm compress to the cast
B) Elevate the limb above heart level and notify the physician
C) Administer another dose of pain medication
D) Tell the patient to wait for the medication to work
Rationale:
Correct Answer (B): These are early signs of Compartment Syndrome. The physician must be notified immediately as this is a surgical emergency (may require a fasciotomy).
Option A: Heat can increase swelling and worsen the pressure inside the compartment.
Option C: If the pain is "unrelieved" by opioids, giving more will not fix the underlying pressure problem.
Option D: Delaying treatment in compartment syndrome can lead to permanent nerve damage or limb loss.
Q5. A nurse is providing discharge instructions to a patient with a new plaster cast. Which statement by the patient indicates a need for further teaching?
A) "I will use a blow dryer on a cool setting if I have an itch."
B) "I will keep the cast dry and cover it with plastic while bathing."
C) "I can use a knitting needle to scratch under the cast if it itches."
D) "I will report any numbness or tingling in my fingers immediately."
Rationale:
Correct Answer (C): Patients should never insert objects like knitting needles or hangers under a cast, as this can break the skin and cause an infection that cannot be seen.
Option A: Using a cool-air dryer is a safe way to relieve itching.
Option B: Plaster casts lose their strength if they get wet, so keeping them dry is essential.
Option D: Numbness and tingling are signs of impaired circulation and must be reported.
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