CH. 51 Fractures and amputations
Exam/31 Questions and Answers
1.A nurse assesses a client with a fracture who is being treated with skeletal
traction. Which assessment should alert the nurse to urgently contact the
health provider?
a. Blood pressure increases to 130/86 mm Hg
b. Traction weights are resting on the floor
c. Oozing of clear fluid is noted at the pin site
d. Capillary refill is less than 3 seconds - -ANS: B
The immediate action of the nurse should be to reapply the weights to give
traction to the fracture. The health care provider must be notified that the
weights were lying on the floor, and the client should be realigned in bed.
The client's blood pressure is slightly elevated; this could be related to pain
and muscle spasms resulting from lack of pressure to reduce the fracture.
Oozing of clear fluid is normal, as is the capillary refill time.
-2. A nurse coordinates care for a client with a wet plaster cast. Which
statement should the nurse include when delegating care for this client to an
unlicensed assistive personnel (UAP)?
a. "Assess distal pulses for potential compartment syndrome."
b. "Turn the client every 3 to 4 hours to promote cast drying."
c. "Use a cloth-covered pillow to elevate the client's leg."
d. "Handle the cast with your fingertips to prevent indentations." - -ANS: C
When delegating care to a UAP for a client with a wet plaster cast, the UAP
should be directed to ensure that the extremity is elevated on a cloth pillow
instead of a plastic pillow to promote drying. The client should be assessed
for impaired arterial circulation, a complication of compartment syndrome;
however, the nurse should not delegate assessments to a UAP. The client
should be turned every 1 to 2 hours to allow air to circulate and dry all parts
of the cast. Providers should handle the cast with the palms of the hands to
prevent indentations.
-3. A nurse obtains the health history of a client with a fractured femur.
Which factor identified in the client's history should the nurse recognize as
an aspect that may impede healing of the fracture?
a. Sedentary lifestyle
b. A 30-pack-year smoking history
c. Prescribed oral contraceptives
, d. Paget's disease - -ANS: D
Paget's disease and bone cancer can cause pathologic fractures such as a
fractured femur that do not achieve total healing. The other factors do not
impede healing but may cause other health risks.
-4. An emergency department nurse cares for a client who sustained a crush
injury to the right lower leg. The client reports numbness and tingling in the
affected leg. Which action should the nurse take first?
a. Assess the pedal pulses.
b. Apply oxygen by nasal cannula.
c. Increase the IV flow rate.
d. Loosen the traction. - -ANS: A
These symptoms represent early warning signs of acute compartment
syndrome. In acute compartment syndrome, sensory deficits such as
paresthesias precede changes in vascular or motor signs. If the nurse finds a
decrease in pedal pulses, the health care provider should be notified as soon
as possible. Vital signs need to be obtained to determine if oxygen and
intravenous fluids are necessary. Traction, if implemented, should never be
loosened without a provider's prescription.
-5. A nurse assesses an older adult client who was admitted 2 days ago with
a fractured hip. The nurse notes that the client is confused and restless. The
client's vital signs are heart rate 98 beats/min, respiratory rate 32
breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%. Which action
should the nurse take first?
a. Administer oxygen via nasal cannula.
b. Re-position to a high-Fowler's position.
c. Increase the intravenous flow rate.
d. Assess response to pain medications. - -ANS: A
The client is at high risk for a fat embolism and has some of the clinical
manifestations of altered mental status and dyspnea. Although this is a life-
threatening emergency, the nurse should take the time to administer oxygen
first and then notify the health care provider. Oxygen administration can
reduce the risk for cerebral damage from hypoxia. The nurse would not
restrain a client who is confused without further assessment and orders.
Sitting the client in a high-Fowler's position will not decrease hypoxia related
to a fat embolism. The IV rate is not related. Pain medication most likely
would not cause the client to be restless.
Exam/31 Questions and Answers
1.A nurse assesses a client with a fracture who is being treated with skeletal
traction. Which assessment should alert the nurse to urgently contact the
health provider?
a. Blood pressure increases to 130/86 mm Hg
b. Traction weights are resting on the floor
c. Oozing of clear fluid is noted at the pin site
d. Capillary refill is less than 3 seconds - -ANS: B
The immediate action of the nurse should be to reapply the weights to give
traction to the fracture. The health care provider must be notified that the
weights were lying on the floor, and the client should be realigned in bed.
The client's blood pressure is slightly elevated; this could be related to pain
and muscle spasms resulting from lack of pressure to reduce the fracture.
Oozing of clear fluid is normal, as is the capillary refill time.
-2. A nurse coordinates care for a client with a wet plaster cast. Which
statement should the nurse include when delegating care for this client to an
unlicensed assistive personnel (UAP)?
a. "Assess distal pulses for potential compartment syndrome."
b. "Turn the client every 3 to 4 hours to promote cast drying."
c. "Use a cloth-covered pillow to elevate the client's leg."
d. "Handle the cast with your fingertips to prevent indentations." - -ANS: C
When delegating care to a UAP for a client with a wet plaster cast, the UAP
should be directed to ensure that the extremity is elevated on a cloth pillow
instead of a plastic pillow to promote drying. The client should be assessed
for impaired arterial circulation, a complication of compartment syndrome;
however, the nurse should not delegate assessments to a UAP. The client
should be turned every 1 to 2 hours to allow air to circulate and dry all parts
of the cast. Providers should handle the cast with the palms of the hands to
prevent indentations.
-3. A nurse obtains the health history of a client with a fractured femur.
Which factor identified in the client's history should the nurse recognize as
an aspect that may impede healing of the fracture?
a. Sedentary lifestyle
b. A 30-pack-year smoking history
c. Prescribed oral contraceptives
, d. Paget's disease - -ANS: D
Paget's disease and bone cancer can cause pathologic fractures such as a
fractured femur that do not achieve total healing. The other factors do not
impede healing but may cause other health risks.
-4. An emergency department nurse cares for a client who sustained a crush
injury to the right lower leg. The client reports numbness and tingling in the
affected leg. Which action should the nurse take first?
a. Assess the pedal pulses.
b. Apply oxygen by nasal cannula.
c. Increase the IV flow rate.
d. Loosen the traction. - -ANS: A
These symptoms represent early warning signs of acute compartment
syndrome. In acute compartment syndrome, sensory deficits such as
paresthesias precede changes in vascular or motor signs. If the nurse finds a
decrease in pedal pulses, the health care provider should be notified as soon
as possible. Vital signs need to be obtained to determine if oxygen and
intravenous fluids are necessary. Traction, if implemented, should never be
loosened without a provider's prescription.
-5. A nurse assesses an older adult client who was admitted 2 days ago with
a fractured hip. The nurse notes that the client is confused and restless. The
client's vital signs are heart rate 98 beats/min, respiratory rate 32
breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%. Which action
should the nurse take first?
a. Administer oxygen via nasal cannula.
b. Re-position to a high-Fowler's position.
c. Increase the intravenous flow rate.
d. Assess response to pain medications. - -ANS: A
The client is at high risk for a fat embolism and has some of the clinical
manifestations of altered mental status and dyspnea. Although this is a life-
threatening emergency, the nurse should take the time to administer oxygen
first and then notify the health care provider. Oxygen administration can
reduce the risk for cerebral damage from hypoxia. The nurse would not
restrain a client who is confused without further assessment and orders.
Sitting the client in a high-Fowler's position will not decrease hypoxia related
to a fat embolism. The IV rate is not related. Pain medication most likely
would not cause the client to be restless.
