COMPREHENSIVE NURSING CERTIFICATION &
LICENSURE EXAM REVIEW
Pediatric Musculoskeletal Nursing, Orthopedic Care, & Cast
Management
Focusing on: Care for School-Age Child with Newly Applied Fiberglass
Cast for Fractured Tibia
200 Clinical-Grade Multiple Choice Questions with Comprehensive
Rationales
Designed for NCLEX-RN and Pediatric Specialty Board
Preparation
Exam Question Bank (Questions 1 – 200)
Question 1: A nurse is planning care for a school-age child who has
a newly applied fiberglass cast for a fractured tibia. Which of the
following actions should the nurse include in the immediate
postoperative plan?
A) Use the fingertips to handle the wet or damp cast during
repositioning.
B) Elevate the affected extremity above the level of the heart
using pillows.
C) Cover the cast with a heavy thermal blanket to accelerate resin
curing.
D) Rest the damp fiberglass cast directly on a firm plastic-lined
mattress.
Rationale: Elevating the extremity above the heart level promotes
venous return and minimizes dependent edema in the immediate
, postoperative period following cast application. Fingertips can cause
indentations that create pressure points on the underlying skin (use
palms if handling is necessary, though fiberglass cures rapidly and is
porous). Covering a cast traps heat and moisture during the
exothermic curing process. Resting a cast on a flat, non-porous
surface impedes air circulation around the cast, delaying
drying/curing.
Question 2: A nurse is performing a neurovascular assessment on a
school-age child with a newly applied fiberglass leg cast. Which of
the following findings indicates acute compartment syndrome and
requires immediate provider notification?
A) Capillary refill of 2 seconds in the distal toes
B) Warm, pink toes distal to the cast edge
C) Severe pain unrelieved by prescribed opioid analgesics and
elevation
D) Active movement of the toes with mild stiffness
Rationale: Pain out of proportion to the injury and unrelieved by
analgesics is the classic, earliest hallmark symptom of acute
compartment syndrome. Capillary refill < 3 seconds and pink, warm
toes indicate adequate perfusion. Mild stiffness is expected post-
injury, but unrelenting severe pain warrants immediate surgical
intervention (fasciotomy).
Question 3: A nurse is educating the parents of a school-age child
with a new fiberglass leg cast regarding home care. Which of the
following statements by the parents indicates an understanding of
fiberglass cast maintenance?
A) 'We can use a hair dryer on the hot setting to dry the inside of the
cast if it gets wet.'
, B) 'We should check daily for rough edges and pad them with
moleskin if necessary.'
C) 'We can apply scented lotions inside the cast opening to prevent
dry skin.'
D) 'We will restrict all movement and keep the child completely on
bed rest for 6 weeks.'
Rationale: Checking daily for rough edges and padding them with
moleskin prevents skin breakdown and irritation. Hair dryers on a
hot setting can cause thermal burns beneath the cast. Lotions and
powders should never be applied inside casts because they trap
moisture and promote bacterial growth. Activity is encouraged as
tolerated once initial healing occurs; strict bed rest is unnecessary
and detrimental.
Question 4: A school-age child with a tibia fracture in a fiberglass
cast asks why fiberglass was chosen over plaster. Which of the
following is a primary advantage of fiberglass casts that the nurse
should explain?
A) Fiberglass casts are significantly heavier and provide more rigid
immobilization.
B) Fiberglass casts require 48 to 72 hours to fully cure and dry.
C) Fiberglass casts are lightweight, water-resistant, and dry much
more rapidly.
D) Fiberglass casts do not require neurovascular monitoring after
application.
Rationale: Fiberglass casts are lightweight, porous, water-resistant
(though padding underneath may still require protection), and
dry/cure within minutes to hours compared to plaster which takes 24-
72 hours. Neurovascular checks are mandatory regardless of cast
material.
, Question 5: A nurse is evaluating clinical care and safety for a
school-age child with a newly applied fiberglass cast for a fractured
tibia. In the clinical context of neurovascular assessment (Scenario
#5), which of the following nursing actions is most appropriate?
A) Maintain elevation of the affected extremity above heart level
to prevent dependent edema.
B) Keep the leg in a flat, dependent position below the heart at all
times.
C) Wash the inner lining of the fiberglass cast with soap and water
daily.
D) Disregard reports of burning sensations beneath the cast.
Rationale: Clinical Rationale for Question 5: Standard pediatric
orthopedic guidelines require vigilant monitoring of neurovascular
status, maintenance of extremity elevation to control swelling, strict
avoidance of foreign objects or moisture inside the cast, and
immediate reporting of signs indicative of compartment syndrome or
skin impairment.
Question 6: A nurse is evaluating clinical care and safety for a
school-age child with a newly applied fiberglass cast for a fractured
tibia. In the clinical context of exothermic reaction (Scenario #6),
which of the following nursing actions is most appropriate?
A) Notify the provider immediately if the child experiences
unremitting severe pain, pallor, or pulselessness.
B) Encourage vigorous running and jumping on playground
equipment.
C) Use sharp metal instruments to trim rough edges inside the cast.
D) Apply heating pads directly to the cast surface to relieve spasms.
Rationale: Clinical Rationale for Question 6: Standard pediatric
orthopedic guidelines require vigilant monitoring of neurovascular
LICENSURE EXAM REVIEW
Pediatric Musculoskeletal Nursing, Orthopedic Care, & Cast
Management
Focusing on: Care for School-Age Child with Newly Applied Fiberglass
Cast for Fractured Tibia
200 Clinical-Grade Multiple Choice Questions with Comprehensive
Rationales
Designed for NCLEX-RN and Pediatric Specialty Board
Preparation
Exam Question Bank (Questions 1 – 200)
Question 1: A nurse is planning care for a school-age child who has
a newly applied fiberglass cast for a fractured tibia. Which of the
following actions should the nurse include in the immediate
postoperative plan?
A) Use the fingertips to handle the wet or damp cast during
repositioning.
B) Elevate the affected extremity above the level of the heart
using pillows.
C) Cover the cast with a heavy thermal blanket to accelerate resin
curing.
D) Rest the damp fiberglass cast directly on a firm plastic-lined
mattress.
Rationale: Elevating the extremity above the heart level promotes
venous return and minimizes dependent edema in the immediate
, postoperative period following cast application. Fingertips can cause
indentations that create pressure points on the underlying skin (use
palms if handling is necessary, though fiberglass cures rapidly and is
porous). Covering a cast traps heat and moisture during the
exothermic curing process. Resting a cast on a flat, non-porous
surface impedes air circulation around the cast, delaying
drying/curing.
Question 2: A nurse is performing a neurovascular assessment on a
school-age child with a newly applied fiberglass leg cast. Which of
the following findings indicates acute compartment syndrome and
requires immediate provider notification?
A) Capillary refill of 2 seconds in the distal toes
B) Warm, pink toes distal to the cast edge
C) Severe pain unrelieved by prescribed opioid analgesics and
elevation
D) Active movement of the toes with mild stiffness
Rationale: Pain out of proportion to the injury and unrelieved by
analgesics is the classic, earliest hallmark symptom of acute
compartment syndrome. Capillary refill < 3 seconds and pink, warm
toes indicate adequate perfusion. Mild stiffness is expected post-
injury, but unrelenting severe pain warrants immediate surgical
intervention (fasciotomy).
Question 3: A nurse is educating the parents of a school-age child
with a new fiberglass leg cast regarding home care. Which of the
following statements by the parents indicates an understanding of
fiberglass cast maintenance?
A) 'We can use a hair dryer on the hot setting to dry the inside of the
cast if it gets wet.'
, B) 'We should check daily for rough edges and pad them with
moleskin if necessary.'
C) 'We can apply scented lotions inside the cast opening to prevent
dry skin.'
D) 'We will restrict all movement and keep the child completely on
bed rest for 6 weeks.'
Rationale: Checking daily for rough edges and padding them with
moleskin prevents skin breakdown and irritation. Hair dryers on a
hot setting can cause thermal burns beneath the cast. Lotions and
powders should never be applied inside casts because they trap
moisture and promote bacterial growth. Activity is encouraged as
tolerated once initial healing occurs; strict bed rest is unnecessary
and detrimental.
Question 4: A school-age child with a tibia fracture in a fiberglass
cast asks why fiberglass was chosen over plaster. Which of the
following is a primary advantage of fiberglass casts that the nurse
should explain?
A) Fiberglass casts are significantly heavier and provide more rigid
immobilization.
B) Fiberglass casts require 48 to 72 hours to fully cure and dry.
C) Fiberglass casts are lightweight, water-resistant, and dry much
more rapidly.
D) Fiberglass casts do not require neurovascular monitoring after
application.
Rationale: Fiberglass casts are lightweight, porous, water-resistant
(though padding underneath may still require protection), and
dry/cure within minutes to hours compared to plaster which takes 24-
72 hours. Neurovascular checks are mandatory regardless of cast
material.
, Question 5: A nurse is evaluating clinical care and safety for a
school-age child with a newly applied fiberglass cast for a fractured
tibia. In the clinical context of neurovascular assessment (Scenario
#5), which of the following nursing actions is most appropriate?
A) Maintain elevation of the affected extremity above heart level
to prevent dependent edema.
B) Keep the leg in a flat, dependent position below the heart at all
times.
C) Wash the inner lining of the fiberglass cast with soap and water
daily.
D) Disregard reports of burning sensations beneath the cast.
Rationale: Clinical Rationale for Question 5: Standard pediatric
orthopedic guidelines require vigilant monitoring of neurovascular
status, maintenance of extremity elevation to control swelling, strict
avoidance of foreign objects or moisture inside the cast, and
immediate reporting of signs indicative of compartment syndrome or
skin impairment.
Question 6: A nurse is evaluating clinical care and safety for a
school-age child with a newly applied fiberglass cast for a fractured
tibia. In the clinical context of exothermic reaction (Scenario #6),
which of the following nursing actions is most appropriate?
A) Notify the provider immediately if the child experiences
unremitting severe pain, pallor, or pulselessness.
B) Encourage vigorous running and jumping on playground
equipment.
C) Use sharp metal instruments to trim rough edges inside the cast.
D) Apply heating pads directly to the cast surface to relieve spasms.
Rationale: Clinical Rationale for Question 6: Standard pediatric
orthopedic guidelines require vigilant monitoring of neurovascular
