NSG-430 EXAM 3 | COMPREHENSIVE NURSING STUDY GUIDE,
PRACTICE QUESTIONS & ANSWERS 2026/2027
fractures - ANS ✔✔-A fracture is a disruption or break in the continuity of the structure of bone.
-Although traumatic injuries account for the majority of fractures, some fractures are secondary to a
disease process (such as pathologic fractures from cancer or osteoporosis).
Complications of Fracture Healing:
-Delayed union:
•Fracture healing progresses more slowly than expected.
•Healing eventually occurs.
-Nonunion:
•Fracture fails to heal despite treatment.
•No x-ray evidence of callus formation.
-Malunion:
•Fracture heals in expected time but in unsatisfactory position, possibly resulting in deformity or
dysfunction.
-Angulation:
•Fracture heals in abnormal position in relation to midline of structure (type of malunion).
-Pseudoarthrosis:
•Type of nonunion occurring at fracture site in which a false joint is formed with abnormal movement at
site.
-Refracture:
•New fracture occurs at original fracture site.
-Myositis ossificans:
•Deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle
injury.
Clinical Manifestations:
-The clinical manifestations of fracture include immediate localized pain, decreased function, and
inability to bear weight on or use the affected part.
-The patient guards and protects the extremity against movement.
-Obvious bone deformity may not be present.
-If a fracture is suspected, the extremity is immobilized in the position in which it is found.
-Unnecessary movement increases soft tissue damage and may convert a closed fracture to an open
fracture or create further injury to adjacent nerves and blood vessels.
Interprofessional Care:
-The overall goals of fracture treatment are:
(1) Anatomic realignment of bone fragments through reduction
(2) Immobilization to maintain realignment, and
(3) Restoration of normal or near-normal function of the injured part.
Clo
traction - ANS ✔✔-Traction is used to:
,(1) Prevent or reduce pain and muscle spasm (e.g., whiplash, unrepaired hip fracture)
(2) Immobilize a joint or part of the body
(3) Reduce a fracture or dislocation
(4) Treat a pathologic joint condition (e.g., tumor, infection)
-Traction devices apply a pulling force on a fractured extremity to attain realignment, while
countertraction pulls in the opposite direction.
-The two most common types of traction are skin traction and skeletal traction.
Skin Traction:
-Skin traction is generally used for short-term treatment (48 to 72 hours) until skeletal traction or surgery
is possible.
-Tape, boots, or splints are applied directly to the skin to maintain alignment, primarily to help diminish
muscle spasms in the injured extremity.
-The traction weights are usually limited to 5 to 10 lbs (2.3 to 4.5 kg).
-A Buck's traction boot is a type of skin traction used preoperatively for the patient with a hip fracture to
reduce muscle spasms
Buck's traction is used to immobilize a fracture, prevent hip flexion contractures, and reduce muscle
spasms.
-In skin traction, regular assessment of the skin is a priority because pressure points and skin breakdown
may develop quickly.
-Assess key pressure points every 2 to 4 hours.
Skeletal Traction:
-Skeletal traction, generally in place for longer periods than skin traction, is used to align injured bones
and joints or to treat joint contractures and congenital hip dysplasia.
-It provides a long-term pull that keeps the injured bones and joints aligned.
-To apply skeletal traction, the surgeon inserts a pin or wire into the bone, and weights are attached to
align and immobilize the injured body part.
-Weight for skeletal traction ranges from 5 to 45 lbs (2.3 to 20.4 kg).
-The use of too much weight can result in delayed union or nonunion.
-The major complication
vertebral immobilization - ANS ✔✔-The body jacket brace is used for immobilization and support for
stable spine injuries of the thoracic or lumbar spine.
-The brace goes around the chest and abdomen, extending from above the nipple line to the pubis.
-After application of the brace, assess the patient for the development of superior mesenteric artery
syndrome (cast syndrome).
•This condition occurs if the brace is applied too tightly, which results in compression of the superior
mesenteric artery against the duodenum.
•The patient generally complains of abdominal pain, abdominal pressure, nausea, and vomiting.
•Assess the abdomen for decreased bowel sounds (a window in the brace may be left over the
umbilicus).
•Treatment includes gastric decompression with a nasogastric (NG) tube and suction.
-Assessment also includes monitoring respiratory status, bowel and bladder function, and areas of
pressure over the bony prominences, especially the iliac crest.
-The brace may need to be adjusted or removed if any complications occur.
,lower extremity immobilization - ANS ✔✔-After the application of a lower extremity cast or dressing, the
extremity should be elevated on pillows above heart level for the first 24 hours.
-After the initial phase, a casted extremity should not be placed in a dependent position because of the
possibility of excessive edema.
-After cast application, observe for signs of compartment syndrome and increased pressure, especially in
the heel, anterior tibia, head of fibula, and malleoli.
-This increased pressure is manifested by pain or burning in these areas.
-Prefabricated knee and ankle splints and immobilizers are used in many settings.
-This type of immobilization is easy to apply and remove, which permits close observation of the affected
joint for signs of swelling and skin breakdown.
-Depending on the injury, removal of the splint or immobilizer facilitates ROM of the affected joint and
faster return to function.
external fixation - ANS ✔✔-An external fixator is a metallic device composed of metal pins that are
inserted into the bone and attached to external rods to stabilize the fracture while it heals.
-The external fixator is attached directly to the bones by percutaneous transfixing pins or wires.
-It can be used to apply traction or to compress fracture fragments and immobilize reduced fragments
when the use of a cast or other traction is not appropriate.
-The external device holds fracture fragments in place similar to a surgically implanted internal device.
-External fixation is often used in an attempt to salvage extremities that otherwise might require
amputation.
-Because the use of an external device is a long-term process, ongoing assessment for pin loosening and
infection is critical.
-Infection (indicated by exudate, erythema, tenderness, and pain) may require removal of the device.
-Pus oozing out of the hole, redness, swelling, elevated temperature, and elevated WBC indicates
infection
-Instruct the patient and caregiver about meticulous pin care.
-Although each physician has a protocol for pin care cleaning, chlorhexidine 2mg/ml is often used.
-Water and peroxide is used for pin site care
internal fixation - ANS ✔✔-Internal fixation devices (pins, plates, intramedullary rods, and metal and
bioabsorbable screws) are surgically inserted to realign and maintain position of bony fragments.
-These metal devices are biologically inert and made from stainless steel, vitallium, or titanium.
-Proper alignment and bone healing are evaluated regularly by x-rays.
facial fractures - ANS ✔✔-Traumatic injury:
falls, MVA, sports (eye-globe rupture, orbital fracture (blow-out)
-Airway maintenance, suctioning, positioning
-Tracheostomy to by-pass obstruction
-Facial and cervical injuries often occur together
-Treat as cervical spine injury present until proven negative
-Neuro assessment:
GCS, LOC, EOMs, pupillary response, grips and pushes
Types of Facial Fractures:
-Frontal bone: rapid edema that may mask underlying fractures
-Periorbital bone: possible frontal sinus involvement, entrapment of ocular muscles
-Nasal bone: displacement of nasal bones, nosebleed (epistaxis)
, -Zygomatic arch: depression of cheek bone (zygomatic arch) and entrapment of ocular muscles
-Maxilla: segmental motion (instability) of maxilla and tooth fracture at socket
-Mandible: tooth fractures, bleeding, limited motion of mandible
Immobilization:
-Maxillary: more stable usually
-Mandibular: unstable
•Splinted to maxilla to stabilize
•Intermaxillary fixation
Postoperative Care:
-Airway and nausea/vomiting management are priorities
-Elevate HOB, turn to side to maintain airway
-Oral hygiene
-Communication
-Pain management
-Nutrition
-Safety concerns at bedside
•Scissors, wire cutters: remove if concerns with breathing or airway, provide home teaching
•Emergency tracheostomy kit
•Suction set up with Jonker tip
•NG tube if persisting vomitus
•Antiemetics
•Method of communicating
amputation - ANS ✔✔-Removal of an extremity by trauma or surgery
-Goal of surgery:
preserve the greatest extremity length and function while removing all infected, pathologic, or ischemic
tissue.
-Goals of nursing care: pain management,
maximum rehabilitation potential, ability to cope with body image changes
Indications for Amputation:
-Circulatory impairment from PVD
-Traumatic or thermal injury
-Osteomyelitis
-Malignant tumors
-Extremity infection
-Aging Adults:
highest incidence of amputation for treatment of PVD, atherosclerosis, or diabetes
-Assessment and stabilization are priority: mechanism of injury, blood loss, shock
Post Op:
-Watch for hemorrhaging
-Blood loss
-Phantom pain
PRACTICE QUESTIONS & ANSWERS 2026/2027
fractures - ANS ✔✔-A fracture is a disruption or break in the continuity of the structure of bone.
-Although traumatic injuries account for the majority of fractures, some fractures are secondary to a
disease process (such as pathologic fractures from cancer or osteoporosis).
Complications of Fracture Healing:
-Delayed union:
•Fracture healing progresses more slowly than expected.
•Healing eventually occurs.
-Nonunion:
•Fracture fails to heal despite treatment.
•No x-ray evidence of callus formation.
-Malunion:
•Fracture heals in expected time but in unsatisfactory position, possibly resulting in deformity or
dysfunction.
-Angulation:
•Fracture heals in abnormal position in relation to midline of structure (type of malunion).
-Pseudoarthrosis:
•Type of nonunion occurring at fracture site in which a false joint is formed with abnormal movement at
site.
-Refracture:
•New fracture occurs at original fracture site.
-Myositis ossificans:
•Deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle
injury.
Clinical Manifestations:
-The clinical manifestations of fracture include immediate localized pain, decreased function, and
inability to bear weight on or use the affected part.
-The patient guards and protects the extremity against movement.
-Obvious bone deformity may not be present.
-If a fracture is suspected, the extremity is immobilized in the position in which it is found.
-Unnecessary movement increases soft tissue damage and may convert a closed fracture to an open
fracture or create further injury to adjacent nerves and blood vessels.
Interprofessional Care:
-The overall goals of fracture treatment are:
(1) Anatomic realignment of bone fragments through reduction
(2) Immobilization to maintain realignment, and
(3) Restoration of normal or near-normal function of the injured part.
Clo
traction - ANS ✔✔-Traction is used to:
,(1) Prevent or reduce pain and muscle spasm (e.g., whiplash, unrepaired hip fracture)
(2) Immobilize a joint or part of the body
(3) Reduce a fracture or dislocation
(4) Treat a pathologic joint condition (e.g., tumor, infection)
-Traction devices apply a pulling force on a fractured extremity to attain realignment, while
countertraction pulls in the opposite direction.
-The two most common types of traction are skin traction and skeletal traction.
Skin Traction:
-Skin traction is generally used for short-term treatment (48 to 72 hours) until skeletal traction or surgery
is possible.
-Tape, boots, or splints are applied directly to the skin to maintain alignment, primarily to help diminish
muscle spasms in the injured extremity.
-The traction weights are usually limited to 5 to 10 lbs (2.3 to 4.5 kg).
-A Buck's traction boot is a type of skin traction used preoperatively for the patient with a hip fracture to
reduce muscle spasms
Buck's traction is used to immobilize a fracture, prevent hip flexion contractures, and reduce muscle
spasms.
-In skin traction, regular assessment of the skin is a priority because pressure points and skin breakdown
may develop quickly.
-Assess key pressure points every 2 to 4 hours.
Skeletal Traction:
-Skeletal traction, generally in place for longer periods than skin traction, is used to align injured bones
and joints or to treat joint contractures and congenital hip dysplasia.
-It provides a long-term pull that keeps the injured bones and joints aligned.
-To apply skeletal traction, the surgeon inserts a pin or wire into the bone, and weights are attached to
align and immobilize the injured body part.
-Weight for skeletal traction ranges from 5 to 45 lbs (2.3 to 20.4 kg).
-The use of too much weight can result in delayed union or nonunion.
-The major complication
vertebral immobilization - ANS ✔✔-The body jacket brace is used for immobilization and support for
stable spine injuries of the thoracic or lumbar spine.
-The brace goes around the chest and abdomen, extending from above the nipple line to the pubis.
-After application of the brace, assess the patient for the development of superior mesenteric artery
syndrome (cast syndrome).
•This condition occurs if the brace is applied too tightly, which results in compression of the superior
mesenteric artery against the duodenum.
•The patient generally complains of abdominal pain, abdominal pressure, nausea, and vomiting.
•Assess the abdomen for decreased bowel sounds (a window in the brace may be left over the
umbilicus).
•Treatment includes gastric decompression with a nasogastric (NG) tube and suction.
-Assessment also includes monitoring respiratory status, bowel and bladder function, and areas of
pressure over the bony prominences, especially the iliac crest.
-The brace may need to be adjusted or removed if any complications occur.
,lower extremity immobilization - ANS ✔✔-After the application of a lower extremity cast or dressing, the
extremity should be elevated on pillows above heart level for the first 24 hours.
-After the initial phase, a casted extremity should not be placed in a dependent position because of the
possibility of excessive edema.
-After cast application, observe for signs of compartment syndrome and increased pressure, especially in
the heel, anterior tibia, head of fibula, and malleoli.
-This increased pressure is manifested by pain or burning in these areas.
-Prefabricated knee and ankle splints and immobilizers are used in many settings.
-This type of immobilization is easy to apply and remove, which permits close observation of the affected
joint for signs of swelling and skin breakdown.
-Depending on the injury, removal of the splint or immobilizer facilitates ROM of the affected joint and
faster return to function.
external fixation - ANS ✔✔-An external fixator is a metallic device composed of metal pins that are
inserted into the bone and attached to external rods to stabilize the fracture while it heals.
-The external fixator is attached directly to the bones by percutaneous transfixing pins or wires.
-It can be used to apply traction or to compress fracture fragments and immobilize reduced fragments
when the use of a cast or other traction is not appropriate.
-The external device holds fracture fragments in place similar to a surgically implanted internal device.
-External fixation is often used in an attempt to salvage extremities that otherwise might require
amputation.
-Because the use of an external device is a long-term process, ongoing assessment for pin loosening and
infection is critical.
-Infection (indicated by exudate, erythema, tenderness, and pain) may require removal of the device.
-Pus oozing out of the hole, redness, swelling, elevated temperature, and elevated WBC indicates
infection
-Instruct the patient and caregiver about meticulous pin care.
-Although each physician has a protocol for pin care cleaning, chlorhexidine 2mg/ml is often used.
-Water and peroxide is used for pin site care
internal fixation - ANS ✔✔-Internal fixation devices (pins, plates, intramedullary rods, and metal and
bioabsorbable screws) are surgically inserted to realign and maintain position of bony fragments.
-These metal devices are biologically inert and made from stainless steel, vitallium, or titanium.
-Proper alignment and bone healing are evaluated regularly by x-rays.
facial fractures - ANS ✔✔-Traumatic injury:
falls, MVA, sports (eye-globe rupture, orbital fracture (blow-out)
-Airway maintenance, suctioning, positioning
-Tracheostomy to by-pass obstruction
-Facial and cervical injuries often occur together
-Treat as cervical spine injury present until proven negative
-Neuro assessment:
GCS, LOC, EOMs, pupillary response, grips and pushes
Types of Facial Fractures:
-Frontal bone: rapid edema that may mask underlying fractures
-Periorbital bone: possible frontal sinus involvement, entrapment of ocular muscles
-Nasal bone: displacement of nasal bones, nosebleed (epistaxis)
, -Zygomatic arch: depression of cheek bone (zygomatic arch) and entrapment of ocular muscles
-Maxilla: segmental motion (instability) of maxilla and tooth fracture at socket
-Mandible: tooth fractures, bleeding, limited motion of mandible
Immobilization:
-Maxillary: more stable usually
-Mandibular: unstable
•Splinted to maxilla to stabilize
•Intermaxillary fixation
Postoperative Care:
-Airway and nausea/vomiting management are priorities
-Elevate HOB, turn to side to maintain airway
-Oral hygiene
-Communication
-Pain management
-Nutrition
-Safety concerns at bedside
•Scissors, wire cutters: remove if concerns with breathing or airway, provide home teaching
•Emergency tracheostomy kit
•Suction set up with Jonker tip
•NG tube if persisting vomitus
•Antiemetics
•Method of communicating
amputation - ANS ✔✔-Removal of an extremity by trauma or surgery
-Goal of surgery:
preserve the greatest extremity length and function while removing all infected, pathologic, or ischemic
tissue.
-Goals of nursing care: pain management,
maximum rehabilitation potential, ability to cope with body image changes
Indications for Amputation:
-Circulatory impairment from PVD
-Traumatic or thermal injury
-Osteomyelitis
-Malignant tumors
-Extremity infection
-Aging Adults:
highest incidence of amputation for treatment of PVD, atherosclerosis, or diabetes
-Assessment and stabilization are priority: mechanism of injury, blood loss, shock
Post Op:
-Watch for hemorrhaging
-Blood loss
-Phantom pain
