ORTHOPEDIC NURSE CERTIFICATION
EXAM QUESTIONS AND ANSWERS
100% CORRECT
Name 2 biological, 3 extrinsic, and 1 behavioral factor that can predispose a patient to a
fracture. - ANSWER-Biological:
1) Age: bone structure becomes less dense/more susceptible to injury
2) Type of bone involved: some are better equipped to handle difference stresses and
forces without injury
Extrinsic:
1) Amount of force applied
2) Angle of force applied
3) Duration of force
Behavioral:
1) Participating in adrenalin-seeking activities such as skydiving, rock-climbing, motor
cross
Describe nursing instructions that may be given to a patient in a cast. - ANSWER-1)
Cast should be kept dry.
2) Monitor the skin areas at the end of the cast.
3) Never stick anything into or under the cast to scratch or itch.
4) Alert medical care in case of tightness or increasing pain, numbness, color change,
or temperature change in areas of distal ends of cast.
5) Follow up if cast gets loose or cracks.
What is the basic anatomy of a long bone? - ANSWER-Typically has two main
components:
1) Diaphysis - makes up long shaft of bone. Outer portion is made of compact bone.
Inner layer is made of marrow.
2) Epiphyses - set at either end of long bone. Outer layer is compact bone and inner
core is spongy bone.
Periosteum - membrane that lines both externally. - contains supply of nerve fibers,
lymph, blood vessels
Give examples of tapping fracture and penetrating fracture. - ANSWER-1) Tapping -
sustained from a small force to a concentrated area. Bone will absorb this force - may or
may not be mild soft tissue display of injury.
EX: fracture of forearm when blocking a hit with a fist or bat; being kicked in lower leg
,2) Penetrating - caused by large amount of force on small area. Object of force is
usually small and soft tissue involvement is minimal.
EX: stab wound, gunshot wound
Different from crush wound because object of force is much larger.
List several factor that determine fracture-healing outcome. - ANSWER-1) Skeletal
maturity decreases healing.
- Immature skeleton increases rate and success of healing.
2) Single bone fracture has better prognosis than multi-bone fracture.
3) Big displacement that affect surrounding tissues requires more healing time.
4) Thoracic spine injury heals better than unstable lumbar/cervical spine injuries.
5) Fracture of joint surfaces are more unstable/difficult to treat.
6) Fracture with nearby unaffected support bone has good prognosis - acts as natural
splint.
Differentiate between linear, oblique, and transverse fractures. - ANSWER-LINEAR: the
fracture forms a straight line through the bone; doesn't tell if fracture line is angled or
horizontal; a linear can be oblique or transverse
OBLIQUE: fracture line that travels at an angle through the bone
TRANSVERSE: break that travels in a horizontal line through the bone.
Don't ever just say a fracture line is linear - differentiate with oblique or transverse.
Describe/give examples of following bony injuries. - ANSWER-1) CRUSH - caused by
large stress on a small area; results in multiple break lines and severe soft tissue
damage; EX: sledgehammer coming down on a finger or heavy suspended mass falling
on foot or leg
2) COMPRESSION - happens with large axial loading force; most often in vertebrae;
EX: landing on feet or butt, fall from a moderate height
3) STRESS - not sustained by one-time incident but instead with repetitive activity that
stresses a normal bone over time
Differences between plaster of Paris and fiberglass casting. - ANSWER-PLASTER OF
PARIS: slightly cheaper, molds well but is heavier and has longer drying time/setting;
not ideal for kids in an outpatient setting/upper extremity injury
Define avulsion, comminuted, and greenstick fractures. - ANSWER-AVULSION: break
that displaces a portion of bone from its usual position
, COMMINUTED: describes fracture that results in greater than 2 bony fragments; usually
describes crush injury
GREENSTICK: result of a lesser force and doesn't cause a full-thickness break; only
one side of bone is affected; not a fracture associated with displacement
4 substances that can be used surgically to enhance the healing of bone after a
fracture. - ANSWER-1) AUTOGENOUS BONE: bone graft taken from patient, usually
form iliac crest; used in small bony defects, but high rate of complications
2) ALLOGRAPHIC BONE: cadaver bone injected into a fracture site; beneficial in larger
defects, but increased infection risk
3) SYNTHETIC BONE: ceramics and sea coral; useful when injected into large fractures
that have already been surgically stabilized
4) BIOACTIVE CELLS AND PROTEIN: expensive, benefit for nonunion fractures
2 fractures only seen in the pelvic girdle - ANSWER-1) STRADDLE FRACTURE:
forcefully falling on an object in straddle position; coming down on gymnastic bar, bike
seat, being bucked by a horse; it can tranversely fracture superior and inferior pubic
rami and usually bilaterally
2) DASHBOARD FRACTURE: when knee hits dashboard and the force progresses
through the femur to the acetabulum
FIBERGLASS: more expensive, comes in different colors, molds well, lightweight,
drying time is as little as 5 minutes, more water resistant; BUT edges are more abrasive
and they tend to be hotter
How to choose? - cost, physician comfort/familiarity, joint being immobilized, injury
being treated & patient type
Discuss the 4 main types of bone. - ANSWER-1) LONG BONE: longer than they are
wide; consist of shaft (diaphysis) and head (epiphysis); EX: humerus, femur
2) SHORT BONE: cubical in shape; consist of spongy bone; EX: carpals in wrist
3) FLAT BONE: thin and flat with slight curvature; contain mostly compact bone; EX:
skull bones
4) IRREGULAR BONE: don't fit above classifications; consist of spongy bone with thin
compact outer layer; EX: vertebrae, pelvic girdle bones
EXAM QUESTIONS AND ANSWERS
100% CORRECT
Name 2 biological, 3 extrinsic, and 1 behavioral factor that can predispose a patient to a
fracture. - ANSWER-Biological:
1) Age: bone structure becomes less dense/more susceptible to injury
2) Type of bone involved: some are better equipped to handle difference stresses and
forces without injury
Extrinsic:
1) Amount of force applied
2) Angle of force applied
3) Duration of force
Behavioral:
1) Participating in adrenalin-seeking activities such as skydiving, rock-climbing, motor
cross
Describe nursing instructions that may be given to a patient in a cast. - ANSWER-1)
Cast should be kept dry.
2) Monitor the skin areas at the end of the cast.
3) Never stick anything into or under the cast to scratch or itch.
4) Alert medical care in case of tightness or increasing pain, numbness, color change,
or temperature change in areas of distal ends of cast.
5) Follow up if cast gets loose or cracks.
What is the basic anatomy of a long bone? - ANSWER-Typically has two main
components:
1) Diaphysis - makes up long shaft of bone. Outer portion is made of compact bone.
Inner layer is made of marrow.
2) Epiphyses - set at either end of long bone. Outer layer is compact bone and inner
core is spongy bone.
Periosteum - membrane that lines both externally. - contains supply of nerve fibers,
lymph, blood vessels
Give examples of tapping fracture and penetrating fracture. - ANSWER-1) Tapping -
sustained from a small force to a concentrated area. Bone will absorb this force - may or
may not be mild soft tissue display of injury.
EX: fracture of forearm when blocking a hit with a fist or bat; being kicked in lower leg
,2) Penetrating - caused by large amount of force on small area. Object of force is
usually small and soft tissue involvement is minimal.
EX: stab wound, gunshot wound
Different from crush wound because object of force is much larger.
List several factor that determine fracture-healing outcome. - ANSWER-1) Skeletal
maturity decreases healing.
- Immature skeleton increases rate and success of healing.
2) Single bone fracture has better prognosis than multi-bone fracture.
3) Big displacement that affect surrounding tissues requires more healing time.
4) Thoracic spine injury heals better than unstable lumbar/cervical spine injuries.
5) Fracture of joint surfaces are more unstable/difficult to treat.
6) Fracture with nearby unaffected support bone has good prognosis - acts as natural
splint.
Differentiate between linear, oblique, and transverse fractures. - ANSWER-LINEAR: the
fracture forms a straight line through the bone; doesn't tell if fracture line is angled or
horizontal; a linear can be oblique or transverse
OBLIQUE: fracture line that travels at an angle through the bone
TRANSVERSE: break that travels in a horizontal line through the bone.
Don't ever just say a fracture line is linear - differentiate with oblique or transverse.
Describe/give examples of following bony injuries. - ANSWER-1) CRUSH - caused by
large stress on a small area; results in multiple break lines and severe soft tissue
damage; EX: sledgehammer coming down on a finger or heavy suspended mass falling
on foot or leg
2) COMPRESSION - happens with large axial loading force; most often in vertebrae;
EX: landing on feet or butt, fall from a moderate height
3) STRESS - not sustained by one-time incident but instead with repetitive activity that
stresses a normal bone over time
Differences between plaster of Paris and fiberglass casting. - ANSWER-PLASTER OF
PARIS: slightly cheaper, molds well but is heavier and has longer drying time/setting;
not ideal for kids in an outpatient setting/upper extremity injury
Define avulsion, comminuted, and greenstick fractures. - ANSWER-AVULSION: break
that displaces a portion of bone from its usual position
, COMMINUTED: describes fracture that results in greater than 2 bony fragments; usually
describes crush injury
GREENSTICK: result of a lesser force and doesn't cause a full-thickness break; only
one side of bone is affected; not a fracture associated with displacement
4 substances that can be used surgically to enhance the healing of bone after a
fracture. - ANSWER-1) AUTOGENOUS BONE: bone graft taken from patient, usually
form iliac crest; used in small bony defects, but high rate of complications
2) ALLOGRAPHIC BONE: cadaver bone injected into a fracture site; beneficial in larger
defects, but increased infection risk
3) SYNTHETIC BONE: ceramics and sea coral; useful when injected into large fractures
that have already been surgically stabilized
4) BIOACTIVE CELLS AND PROTEIN: expensive, benefit for nonunion fractures
2 fractures only seen in the pelvic girdle - ANSWER-1) STRADDLE FRACTURE:
forcefully falling on an object in straddle position; coming down on gymnastic bar, bike
seat, being bucked by a horse; it can tranversely fracture superior and inferior pubic
rami and usually bilaterally
2) DASHBOARD FRACTURE: when knee hits dashboard and the force progresses
through the femur to the acetabulum
FIBERGLASS: more expensive, comes in different colors, molds well, lightweight,
drying time is as little as 5 minutes, more water resistant; BUT edges are more abrasive
and they tend to be hotter
How to choose? - cost, physician comfort/familiarity, joint being immobilized, injury
being treated & patient type
Discuss the 4 main types of bone. - ANSWER-1) LONG BONE: longer than they are
wide; consist of shaft (diaphysis) and head (epiphysis); EX: humerus, femur
2) SHORT BONE: cubical in shape; consist of spongy bone; EX: carpals in wrist
3) FLAT BONE: thin and flat with slight curvature; contain mostly compact bone; EX:
skull bones
4) IRREGULAR BONE: don't fit above classifications; consist of spongy bone with thin
compact outer layer; EX: vertebrae, pelvic girdle bones
