NSG 430 Exam 3: (Latest 2026/2027 Update) Fractures, Trauma, Shock,
Neurological Emergencies, Musculoskeletal Disorders | Q&A | Grade A |
100% Correct (Verified Answers) – Nursing Program
Subject: NSG 430 – Advanced Medical-Surgical / Trauma / Neuro
Source: NSG 430 Exam 3 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is a fracture?
Correct Answer: A disruption or break in the continuity of the structure of bone
1. Fractures result from trauma, pathologic processes, or repetitive stress; impaired bone healing occurs with
poor nutrition, smoking, or diabetes.
2. Classified by type, communication with external environment, and displacement.
3. Priorities: pain management, immobilization, and neurovascular assessment (6 Ps).
2. What are the two main types of fractures?
Correct Answer: Open and closed fractures (open = bone exposed through skin; closed = skin intact)
1. Open (compound) fractures have high infection risk due to contamination; require irrigation, debridement, and
IV antibiotics.
2. Closed (simple) fractures have skin intact; risk of compartment syndrome, fat embolism.
3. Open fractures are orthopaedic emergencies; surgical washout within 6-8 hours.
3. What are the two classifications of fractures based on displacement?
Correct Answer: Displaced (bone ends out of alignment) and non-displaced (bone ends remain
aligned)
1. Displaced fractures require reduction (closed or open) to restore alignment; non-displaced may be treated
with casting alone.
2. Displacement increases risk of malunion, nonunion, and neurovascular compromise.
3. Post-reduction X-rays confirm alignment; monitor for compartment syndrome.
4. What are common manifestations of fractures?
Correct Answer: Edema and swelling, pain and tenderness, muscle spasm, deformity, contusion, loss of
function, crepitation, and guarding
1. Pain from periosteal irritation and muscle spasm; deformity indicates displacement.
2. Crepitus (grating sensation) is pathognomonic but should not be elicited intentionally (can worsen injury).
3. Loss of function and guarding suggest underlying fracture; immediate immobilization.
,5. What is traction in orthopedic care?
Correct Answer: A pulling force applied to an injured or diseased body part or extremity
1. Traction aligns bone ends, reduces muscle spasm, and immobilizes fractures.
2. Skin traction (Buck's) uses adhesive tape; skeletal traction (pin/wire) allows greater weight (5-45 lb).
3. Maintain counter-traction with bed positioning; assess pin sites for infection daily.
6. What are the two most common types of traction?
Correct Answer: Skin traction and skeletal traction
1. Skin traction used for temporary immobilization (hip fractures, pre-op); limited weight (5-10 lb).
2. Skeletal traction used for femoral/tibial fractures; pin placement in bone allows higher weight.
3. Monitor skin breakdown under traction tape; pin site care with chlorhexidine prevents infection.
7. What are some complications associated with skeletal traction?
Correct Answer: Potential complications include infection, nerve damage, and circulation issues
1. Pin site infection most common; assess for redness, drainage, pain; pin care per protocol.
2. Neurovascular compromise from improper traction weight or positioning.
3. Pulmonary embolism, pressure ulcers, and contractures from prolonged immobility.
8. What is a major cause of musculoskeletal injuries in the home?
Correct Answer: Falls
1. Falls account for majority of home fractures, especially in elderly (osteoporosis) and children.
2. Prevention: remove throw rugs, adequate lighting, grab bars in bathroom, nonskid shoes.
3. Hip fractures from falls have high morbidity/mortality in older adults.
9. What preventive measures can reduce the risk of falls?
Correct Answer: Wear functional, nonskid shoes, remove throw rugs, ensure adequate lighting, and
maintain a clear path to the bathroom
1. Home safety evaluation reduces fall risk; nightlights and clear pathways prevent nighttime falls.
2. Assess for orthostatic hypotension, medication side effects (sedatives, antihypertensives), and vision problems.
3. Exercise programs (Tai Chi, balance training) reduce fall risk in elderly.
10. What dietary components are important for bone health?
Correct Answer: Adequate calcium and vitamin D
1. Calcium (1000-1200 mg/day) essential for bone mineralization; vitamin D enhances calcium absorption.
2. Sources: dairy, leafy greens, fortified foods; sunlight exposure for vitamin D synthesis.
3. Supplement if deficient; calcium with vitamin D reduces fracture risk in osteoporosis.
11. What should be assessed in the living environment to prevent musculoskeletal problems?
Correct Answer: Safety risks
1. Assess for fall hazards, adequate lighting, handrails, and assistive device fit (cane, walker).
2. Identify obstacles: loose rugs, cords, clutter, and uneven surfaces.
3. Occupational therapy home assessment recommended for high-risk patients.
,12. What public education strategies can help reduce the risk of musculoskeletal injury?
Correct Answer: Follow safety precautions, wear seat belts, avoid distracted driving, and use protective
athletic equipment
1. Seat belts reduce MVC fractures by 50%; helmets prevent head and facial fractures.
2. Distracted driving (texting) increases crash risk; workplace safety for heavy lifting.
3. Sport-specific protective gear (pads, helmets, mouthguards) prevents fractures and dislocations.
13. What is the primary cause of the majority of fractures?
Correct Answer: Traumatic injuries
1. High-velocity trauma (MVC, falls from height) causes most fractures; low-energy falls in elderly.
2. Pathologic fractures occur with minimal trauma due to underlying bone disease (osteoporosis, tumor).
3. Mechanism of injury guides assessment for associated injuries (pelvic fractures → internal bleeding).
14. What are pathologic fractures?
Correct Answer: Fractures that occur secondary to a disease process, such as cancer or osteoporosis
1. Osteoporosis most common cause (vertebral compression, hip fractures).
2. Metastatic bone lesions (breast, lung, prostate) weaken bone; may require prophylactic fixation.
3. Paget disease, osteomalacia, and osteogenesis imperfecta also cause pathologic fractures.
15. What are the two most common materials used for casts?
Correct Answer: Plaster of Paris and fiberglass
1. Plaster: inexpensive, molds well, but heavy, not waterproof, takes 24-72 hours to fully dry.
2. Fiberglass: lightweight, waterproof (with liner), radiolucent, dries in 20-30 minutes.
3. Fiberglass preferred for upper extremities and early weight-bearing; plaster for initial reduction.
16. What is the initial step in applying a cast?
Correct Answer: Cover the affected part with stockinette and padding
1. Stockinette protects skin edges; cotton padding over bony prominences prevents pressure sores.
2. Padding thickness affects fit; too little padding risks skin breakdown, too much allows loosening.
3. Wet cast support with palms (not fingertips) to avoid indentations that cause pressure injury.
17. How long does it take for plaster of Paris to set?
Correct Answer: It sets in 15 minutes but needs 36 to 72 hours before weight bearing
1. Plaster sets via exothermic reaction; heat can burn skin (never cover drying cast).
2. Complete drying takes 24-72 hours; weight bearing only after cast is fully dry and provider approval.
3. Fiberglass weight-bearing possible immediately after setting (except lower extremity walking casts).
18. What should not be done to a cast to prevent burns?
Correct Answer: Do not cover the cast; it risks burns and delayed drying
1. Covering a wet plaster cast traps heat from exothermic reaction, causing thermal injury.
2. Cast should be exposed to air on a non-porous surface; turn q2h for even drying.
3. Fiberglass generates less heat but still should not be covered while drying.
, 19. What is a common supportive device for upper extremity injuries?
Correct Answer: A sling
1. Sling supports arm weight, reduces pain, and promotes healing of shoulder/clavicle fractures.
2. Proper fit: elbow at 90°, wrist slightly higher than elbow; remove for ROM exercises.
3. Assess for skin breakdown under sling; padding at neck prevents pressure on brachial plexus.
20. What is the purpose of elevating an extremity after injury?
Correct Answer: To reduce edema by keeping it above heart level
1. Elevation uses gravity to promote venous and lymphatic drainage, reducing swelling.
2. Extremity placed above heart level for first 24-48 hours post-injury or surgery.
3. Monitor distal pulses, capillary refill, and sensation; excessive elevation may compromise arterial flow.
21. What are signs of compartment syndrome to observe for?
Correct Answer: Increased pressure, pain or burning in specific areas, and neurovascular changes (6
Ps)
1. Compartment syndrome: pain out of proportion to injury, pain with passive stretch, paresthesias.
2. Late signs: pallor, paralysis, pulselessness (ischemic damage already occurred).
3. Emergency fasciotomy required within 6 hours to prevent permanent muscle/nerve damage.
22. What is external fixation used for?
Correct Answer: To apply traction, compress fragments, and immobilize reduced fragments in complex
fractures
1. External fixator provides rigid stabilization for open fractures with severe soft tissue injury.
2. Allows access to wounds for debridement while maintaining fracture alignment.
3. Pin site care critical to prevent osteomyelitis; chlorhexidine or half-strength peroxide per protocol.
23. What is internal fixation?
Correct Answer: Surgical realignment of bony fragments using devices like pins, plates, and rods
1. Open reduction internal fixation (ORIF) allows anatomic alignment and early mobilization.
2. Hardware: screws, plates, intramedullary nails, K-wires; may be removed after healing.
3. Post-op monitor for infection, hardware failure, DVT, and neurovascular status.
24. What are the six Ps of compartment syndrome?
Correct Answer: Pain, pressure, paresthesia, pallor, paralysis, and pulselessness
1. Pain (out of proportion, passive stretch) is earliest sign; paresthesia indicates nerve ischemia.
2. Paralysis, pallor, pulselessness are late signs (irreversible damage after 4-6 hours).
3. Check compartment pressures if suspected (normal <10 mmHg; >30 mmHg indicates fasciotomy).
25. What is the primary concern with open fractures?
Correct Answer: High risk of infection due to devitalized and contaminated tissue
1. Open fractures have up to 50% infection risk if not treated promptly; osteomyelitis is devastating.
2. Emergency irrigation and debridement within 6-8 hours; IV antibiotics (cephalosporin + aminoglycoside).
3. Tetanus prophylaxis if indicated; delayed primary closure often preferred.
Neurological Emergencies, Musculoskeletal Disorders | Q&A | Grade A |
100% Correct (Verified Answers) – Nursing Program
Subject: NSG 430 – Advanced Medical-Surgical / Trauma / Neuro
Source: NSG 430 Exam 3 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is a fracture?
Correct Answer: A disruption or break in the continuity of the structure of bone
1. Fractures result from trauma, pathologic processes, or repetitive stress; impaired bone healing occurs with
poor nutrition, smoking, or diabetes.
2. Classified by type, communication with external environment, and displacement.
3. Priorities: pain management, immobilization, and neurovascular assessment (6 Ps).
2. What are the two main types of fractures?
Correct Answer: Open and closed fractures (open = bone exposed through skin; closed = skin intact)
1. Open (compound) fractures have high infection risk due to contamination; require irrigation, debridement, and
IV antibiotics.
2. Closed (simple) fractures have skin intact; risk of compartment syndrome, fat embolism.
3. Open fractures are orthopaedic emergencies; surgical washout within 6-8 hours.
3. What are the two classifications of fractures based on displacement?
Correct Answer: Displaced (bone ends out of alignment) and non-displaced (bone ends remain
aligned)
1. Displaced fractures require reduction (closed or open) to restore alignment; non-displaced may be treated
with casting alone.
2. Displacement increases risk of malunion, nonunion, and neurovascular compromise.
3. Post-reduction X-rays confirm alignment; monitor for compartment syndrome.
4. What are common manifestations of fractures?
Correct Answer: Edema and swelling, pain and tenderness, muscle spasm, deformity, contusion, loss of
function, crepitation, and guarding
1. Pain from periosteal irritation and muscle spasm; deformity indicates displacement.
2. Crepitus (grating sensation) is pathognomonic but should not be elicited intentionally (can worsen injury).
3. Loss of function and guarding suggest underlying fracture; immediate immobilization.
,5. What is traction in orthopedic care?
Correct Answer: A pulling force applied to an injured or diseased body part or extremity
1. Traction aligns bone ends, reduces muscle spasm, and immobilizes fractures.
2. Skin traction (Buck's) uses adhesive tape; skeletal traction (pin/wire) allows greater weight (5-45 lb).
3. Maintain counter-traction with bed positioning; assess pin sites for infection daily.
6. What are the two most common types of traction?
Correct Answer: Skin traction and skeletal traction
1. Skin traction used for temporary immobilization (hip fractures, pre-op); limited weight (5-10 lb).
2. Skeletal traction used for femoral/tibial fractures; pin placement in bone allows higher weight.
3. Monitor skin breakdown under traction tape; pin site care with chlorhexidine prevents infection.
7. What are some complications associated with skeletal traction?
Correct Answer: Potential complications include infection, nerve damage, and circulation issues
1. Pin site infection most common; assess for redness, drainage, pain; pin care per protocol.
2. Neurovascular compromise from improper traction weight or positioning.
3. Pulmonary embolism, pressure ulcers, and contractures from prolonged immobility.
8. What is a major cause of musculoskeletal injuries in the home?
Correct Answer: Falls
1. Falls account for majority of home fractures, especially in elderly (osteoporosis) and children.
2. Prevention: remove throw rugs, adequate lighting, grab bars in bathroom, nonskid shoes.
3. Hip fractures from falls have high morbidity/mortality in older adults.
9. What preventive measures can reduce the risk of falls?
Correct Answer: Wear functional, nonskid shoes, remove throw rugs, ensure adequate lighting, and
maintain a clear path to the bathroom
1. Home safety evaluation reduces fall risk; nightlights and clear pathways prevent nighttime falls.
2. Assess for orthostatic hypotension, medication side effects (sedatives, antihypertensives), and vision problems.
3. Exercise programs (Tai Chi, balance training) reduce fall risk in elderly.
10. What dietary components are important for bone health?
Correct Answer: Adequate calcium and vitamin D
1. Calcium (1000-1200 mg/day) essential for bone mineralization; vitamin D enhances calcium absorption.
2. Sources: dairy, leafy greens, fortified foods; sunlight exposure for vitamin D synthesis.
3. Supplement if deficient; calcium with vitamin D reduces fracture risk in osteoporosis.
11. What should be assessed in the living environment to prevent musculoskeletal problems?
Correct Answer: Safety risks
1. Assess for fall hazards, adequate lighting, handrails, and assistive device fit (cane, walker).
2. Identify obstacles: loose rugs, cords, clutter, and uneven surfaces.
3. Occupational therapy home assessment recommended for high-risk patients.
,12. What public education strategies can help reduce the risk of musculoskeletal injury?
Correct Answer: Follow safety precautions, wear seat belts, avoid distracted driving, and use protective
athletic equipment
1. Seat belts reduce MVC fractures by 50%; helmets prevent head and facial fractures.
2. Distracted driving (texting) increases crash risk; workplace safety for heavy lifting.
3. Sport-specific protective gear (pads, helmets, mouthguards) prevents fractures and dislocations.
13. What is the primary cause of the majority of fractures?
Correct Answer: Traumatic injuries
1. High-velocity trauma (MVC, falls from height) causes most fractures; low-energy falls in elderly.
2. Pathologic fractures occur with minimal trauma due to underlying bone disease (osteoporosis, tumor).
3. Mechanism of injury guides assessment for associated injuries (pelvic fractures → internal bleeding).
14. What are pathologic fractures?
Correct Answer: Fractures that occur secondary to a disease process, such as cancer or osteoporosis
1. Osteoporosis most common cause (vertebral compression, hip fractures).
2. Metastatic bone lesions (breast, lung, prostate) weaken bone; may require prophylactic fixation.
3. Paget disease, osteomalacia, and osteogenesis imperfecta also cause pathologic fractures.
15. What are the two most common materials used for casts?
Correct Answer: Plaster of Paris and fiberglass
1. Plaster: inexpensive, molds well, but heavy, not waterproof, takes 24-72 hours to fully dry.
2. Fiberglass: lightweight, waterproof (with liner), radiolucent, dries in 20-30 minutes.
3. Fiberglass preferred for upper extremities and early weight-bearing; plaster for initial reduction.
16. What is the initial step in applying a cast?
Correct Answer: Cover the affected part with stockinette and padding
1. Stockinette protects skin edges; cotton padding over bony prominences prevents pressure sores.
2. Padding thickness affects fit; too little padding risks skin breakdown, too much allows loosening.
3. Wet cast support with palms (not fingertips) to avoid indentations that cause pressure injury.
17. How long does it take for plaster of Paris to set?
Correct Answer: It sets in 15 minutes but needs 36 to 72 hours before weight bearing
1. Plaster sets via exothermic reaction; heat can burn skin (never cover drying cast).
2. Complete drying takes 24-72 hours; weight bearing only after cast is fully dry and provider approval.
3. Fiberglass weight-bearing possible immediately after setting (except lower extremity walking casts).
18. What should not be done to a cast to prevent burns?
Correct Answer: Do not cover the cast; it risks burns and delayed drying
1. Covering a wet plaster cast traps heat from exothermic reaction, causing thermal injury.
2. Cast should be exposed to air on a non-porous surface; turn q2h for even drying.
3. Fiberglass generates less heat but still should not be covered while drying.
, 19. What is a common supportive device for upper extremity injuries?
Correct Answer: A sling
1. Sling supports arm weight, reduces pain, and promotes healing of shoulder/clavicle fractures.
2. Proper fit: elbow at 90°, wrist slightly higher than elbow; remove for ROM exercises.
3. Assess for skin breakdown under sling; padding at neck prevents pressure on brachial plexus.
20. What is the purpose of elevating an extremity after injury?
Correct Answer: To reduce edema by keeping it above heart level
1. Elevation uses gravity to promote venous and lymphatic drainage, reducing swelling.
2. Extremity placed above heart level for first 24-48 hours post-injury or surgery.
3. Monitor distal pulses, capillary refill, and sensation; excessive elevation may compromise arterial flow.
21. What are signs of compartment syndrome to observe for?
Correct Answer: Increased pressure, pain or burning in specific areas, and neurovascular changes (6
Ps)
1. Compartment syndrome: pain out of proportion to injury, pain with passive stretch, paresthesias.
2. Late signs: pallor, paralysis, pulselessness (ischemic damage already occurred).
3. Emergency fasciotomy required within 6 hours to prevent permanent muscle/nerve damage.
22. What is external fixation used for?
Correct Answer: To apply traction, compress fragments, and immobilize reduced fragments in complex
fractures
1. External fixator provides rigid stabilization for open fractures with severe soft tissue injury.
2. Allows access to wounds for debridement while maintaining fracture alignment.
3. Pin site care critical to prevent osteomyelitis; chlorhexidine or half-strength peroxide per protocol.
23. What is internal fixation?
Correct Answer: Surgical realignment of bony fragments using devices like pins, plates, and rods
1. Open reduction internal fixation (ORIF) allows anatomic alignment and early mobilization.
2. Hardware: screws, plates, intramedullary nails, K-wires; may be removed after healing.
3. Post-op monitor for infection, hardware failure, DVT, and neurovascular status.
24. What are the six Ps of compartment syndrome?
Correct Answer: Pain, pressure, paresthesia, pallor, paralysis, and pulselessness
1. Pain (out of proportion, passive stretch) is earliest sign; paresthesia indicates nerve ischemia.
2. Paralysis, pallor, pulselessness are late signs (irreversible damage after 4-6 hours).
3. Check compartment pressures if suspected (normal <10 mmHg; >30 mmHg indicates fasciotomy).
25. What is the primary concern with open fractures?
Correct Answer: High risk of infection due to devitalized and contaminated tissue
1. Open fractures have up to 50% infection risk if not treated promptly; osteomyelitis is devastating.
2. Emergency irrigation and debridement within 6-8 hours; IV antibiotics (cephalosporin + aminoglycoside).
3. Tetanus prophylaxis if indicated; delayed primary closure often preferred.
