NURS 4700: FINAL EXAM | 240 QUESTIONS | WITH
COMPLETE SOLUTIONS.
What are fractures? Answer - A *disruption* or *break* in the continuity of
bone.
What is a transverse fracture? Answer - The line of the fracture extends across
the bone shaft at a right angle to the longitudinal axis, break *STRAIGHT
ACROSS* bone.
What is a spiral fracture? Answer - The line of the fracture extends in a
*SPIRAL DIRECTION* along the bone shaft, broken by twisting/diagonal source.
What is a greenstick fracture? Answer - An incomplete fracture with one side
splintered/broken and the other side bent, *COMMON IN CHILDREN*.
What is a comminuted fracture? Answer - A fracture with two or more
fragments (i.e., "*SHATTERED*"), the smaller fragments appear to be floating.
What is an oblique fracture? Answer - The line of the fracture extends
*ACROSS* and *DOWN* the bone, maybe displaced or non-displaced.
What is a pathologic fracture? Answer - A spontaneous fracture at the site of a
*DISEASE* and/or *INFECTED* bone.
,What is a stress fracture? Answer - Occurs in normal or abnormal bone that is
subject to *REPEATED STRESS*, such as from jogging or running.
What is an impacted fracture? Answer - The broken ends of the bone are
*JAMMED* together by the force of the injury, broken ends jammed together.
What is a compression fracture? Answer - Occurs when the bone
*COLLAPSES*, particularly in short bones such as vertebrae in the spine,
decreased bone mass in elderly.
What are the clinical manifestations of fractures? Answer - -*Edema* and
*swelling* (r/t soft tissue injury around fracture).
-*Pain* and *tenderness* (on palpation).
-*Muscle spasm* (i.e., body's effort trying to keep alignment).
-*Deformity* (not obvious right away).
-*Ecchymosis* (bruising)/*contusion*.
-*Loss of function* and *crepitation* (i.e., crunchy sound).
What is included in the fracture assessment: overview? Answer - -*Health
history*: past health (e.g., PVD, elderly), medications, surgery/treatments.
-*General* (pain) and *integumentary*.
-*Cardiovascular*: good function = good blood flow.
-*Neurovascular*: sensory changes.
-*Musculoskeletal*: issues with walking, guarding, and/or splinting.
What is included in the fracture assessment: specific? Answer - -*Hip, proximal
femur*: shortening with *EXTERNAL ROTATION* of leg (if present, do not move
patient - immobilize).
,-*Femur* (mid-shaft, distal): possible shortening with internal or external
rotation of leg.
What are CMS (neurovascular) checks? Answer - 1) *CIRCULATION* (color):
distal pulses (pedal), temperature (cool), capillary refill time (<3 seconds).
2) *MOTION* (mobility): ROM distal to fracture, muscle spasms (good indicator
of body's attempt to realign).
3) *SENSATION* (neurologic injury): pain and/or acute tenderness, loss of
sensation to body parts.
What are alternate neurovascular assessment methods? Answer - -*CTMPS*:
Color, Temperature, Mobility, Pain, Sensation.
-*5 P'S OF FRACTURE ASSESSMENT*: Pain, Pulselessness, Pallor, Paresthesia,
Paralysis.
What is fracture management: initial? Answer - -*Initial care*: Airway,
Breathing, Circulation (ABCs).
-*IMMOBILIZE* with cast or splint; compound fractures (sterile dressing on
open wound [or cleanest material available]).
-*Neurovascular exam*: check for pulse and sensation before wrapping or
elevating extremity.
What is fracture management: medications/pharmacological therapy? Answer
- -*Pain*: narcotics for short-term use (*PERCOCET* 5mg/325mg).
-*Muscle spasms*: muscle relaxants (e.g., Soma, Flexeril, Robaxin), side effect
includes drowsiness.
-*Open fracture*: *ANTIBIOTICS* (e.g., cephalosporin [Kefzol, Ancef]) and
*TETANUS TOXOID* (if it has been >5 years). *START ON ANTIBIOTICS AND
ASSESS PATIENT'S LAST TETANUS SHOT!*
, What is fracture management: diet/nutritional therapy? Answer - *Good
nutrition* (to promote healing): protein, vitamins (B, C, D), calcium,
phosphorus, magnesium, fluids and fiber (to prevent constipation r/t
immobility and analgesics).
What is fracture management: reduction? Answer - *Reduction*: moving bone
back into alignment. May be conducted open (surgical), closed (manual
manipulation), and/or traction.
What is the purpose of traction? Types? Answer - 1) *Purpose*: reduce
fracture and immobilize, decrease muscle spasm and pain, and prevent soft
tissue damage.
2) *Types*:
-*Skin* (e.g., Buck's and Russell's): commonly used for hip fractures, align
before surgery (medically stable). Attached weights 5-10 lbs, *MUST HANG OFF
BED!* Assess for skin breakdown.
-*Skeletal* (e.g., Balanced Suspension, Cervical and Halo): pins are surgically
implanted, watch for s/sx of infection.
What is nursing management for traction? Answer - -*Maintain traction*:
straight alignment; pulleys not obstructed, ropes move freely in pulleys; knots
secure, ropes not fraying; assure weights hang freely and are securely fastened;
maintain weights as ordered.
-Monitor *CMS* of the affected extremity: Circulation, Motion, and Sensation.
-*Inspect skin* (frequently for skin breakdown): skeletal traction...monitor pin
insertion sites for infection.
-*Encourage movement* (of unaffected body areas): and use of blood thinners
(e.g., LMWH) to prevent blood clots.
-*Diet*: increase fluids and fiber r/t constipation.
COMPLETE SOLUTIONS.
What are fractures? Answer - A *disruption* or *break* in the continuity of
bone.
What is a transverse fracture? Answer - The line of the fracture extends across
the bone shaft at a right angle to the longitudinal axis, break *STRAIGHT
ACROSS* bone.
What is a spiral fracture? Answer - The line of the fracture extends in a
*SPIRAL DIRECTION* along the bone shaft, broken by twisting/diagonal source.
What is a greenstick fracture? Answer - An incomplete fracture with one side
splintered/broken and the other side bent, *COMMON IN CHILDREN*.
What is a comminuted fracture? Answer - A fracture with two or more
fragments (i.e., "*SHATTERED*"), the smaller fragments appear to be floating.
What is an oblique fracture? Answer - The line of the fracture extends
*ACROSS* and *DOWN* the bone, maybe displaced or non-displaced.
What is a pathologic fracture? Answer - A spontaneous fracture at the site of a
*DISEASE* and/or *INFECTED* bone.
,What is a stress fracture? Answer - Occurs in normal or abnormal bone that is
subject to *REPEATED STRESS*, such as from jogging or running.
What is an impacted fracture? Answer - The broken ends of the bone are
*JAMMED* together by the force of the injury, broken ends jammed together.
What is a compression fracture? Answer - Occurs when the bone
*COLLAPSES*, particularly in short bones such as vertebrae in the spine,
decreased bone mass in elderly.
What are the clinical manifestations of fractures? Answer - -*Edema* and
*swelling* (r/t soft tissue injury around fracture).
-*Pain* and *tenderness* (on palpation).
-*Muscle spasm* (i.e., body's effort trying to keep alignment).
-*Deformity* (not obvious right away).
-*Ecchymosis* (bruising)/*contusion*.
-*Loss of function* and *crepitation* (i.e., crunchy sound).
What is included in the fracture assessment: overview? Answer - -*Health
history*: past health (e.g., PVD, elderly), medications, surgery/treatments.
-*General* (pain) and *integumentary*.
-*Cardiovascular*: good function = good blood flow.
-*Neurovascular*: sensory changes.
-*Musculoskeletal*: issues with walking, guarding, and/or splinting.
What is included in the fracture assessment: specific? Answer - -*Hip, proximal
femur*: shortening with *EXTERNAL ROTATION* of leg (if present, do not move
patient - immobilize).
,-*Femur* (mid-shaft, distal): possible shortening with internal or external
rotation of leg.
What are CMS (neurovascular) checks? Answer - 1) *CIRCULATION* (color):
distal pulses (pedal), temperature (cool), capillary refill time (<3 seconds).
2) *MOTION* (mobility): ROM distal to fracture, muscle spasms (good indicator
of body's attempt to realign).
3) *SENSATION* (neurologic injury): pain and/or acute tenderness, loss of
sensation to body parts.
What are alternate neurovascular assessment methods? Answer - -*CTMPS*:
Color, Temperature, Mobility, Pain, Sensation.
-*5 P'S OF FRACTURE ASSESSMENT*: Pain, Pulselessness, Pallor, Paresthesia,
Paralysis.
What is fracture management: initial? Answer - -*Initial care*: Airway,
Breathing, Circulation (ABCs).
-*IMMOBILIZE* with cast or splint; compound fractures (sterile dressing on
open wound [or cleanest material available]).
-*Neurovascular exam*: check for pulse and sensation before wrapping or
elevating extremity.
What is fracture management: medications/pharmacological therapy? Answer
- -*Pain*: narcotics for short-term use (*PERCOCET* 5mg/325mg).
-*Muscle spasms*: muscle relaxants (e.g., Soma, Flexeril, Robaxin), side effect
includes drowsiness.
-*Open fracture*: *ANTIBIOTICS* (e.g., cephalosporin [Kefzol, Ancef]) and
*TETANUS TOXOID* (if it has been >5 years). *START ON ANTIBIOTICS AND
ASSESS PATIENT'S LAST TETANUS SHOT!*
, What is fracture management: diet/nutritional therapy? Answer - *Good
nutrition* (to promote healing): protein, vitamins (B, C, D), calcium,
phosphorus, magnesium, fluids and fiber (to prevent constipation r/t
immobility and analgesics).
What is fracture management: reduction? Answer - *Reduction*: moving bone
back into alignment. May be conducted open (surgical), closed (manual
manipulation), and/or traction.
What is the purpose of traction? Types? Answer - 1) *Purpose*: reduce
fracture and immobilize, decrease muscle spasm and pain, and prevent soft
tissue damage.
2) *Types*:
-*Skin* (e.g., Buck's and Russell's): commonly used for hip fractures, align
before surgery (medically stable). Attached weights 5-10 lbs, *MUST HANG OFF
BED!* Assess for skin breakdown.
-*Skeletal* (e.g., Balanced Suspension, Cervical and Halo): pins are surgically
implanted, watch for s/sx of infection.
What is nursing management for traction? Answer - -*Maintain traction*:
straight alignment; pulleys not obstructed, ropes move freely in pulleys; knots
secure, ropes not fraying; assure weights hang freely and are securely fastened;
maintain weights as ordered.
-Monitor *CMS* of the affected extremity: Circulation, Motion, and Sensation.
-*Inspect skin* (frequently for skin breakdown): skeletal traction...monitor pin
insertion sites for infection.
-*Encourage movement* (of unaffected body areas): and use of blood thinners
(e.g., LMWH) to prevent blood clots.
-*Diet*: increase fluids and fiber r/t constipation.
