NUR 2790 FINAL EXAM
Final Exam Questions (NUR 2790)
CHAPTER 51: CARE OF PATIENTS WITH MUSCULOSKELETAL TRAUMA
MULTIPLE CHOICE
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 clients 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.
Weights should not be removed without a prescription. They should not be lifted manually or
allowed to rest on the floor. Weights should be freely hanging at all times. Inspect the skin Q8H
for S/S of irritation or inflammation. Remove the belt or boot that is used for skin traction Q8H
to inspect under the device.
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 clients 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 clients 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. Pagets disease
ANS: D
Pagets 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.
Causes of Pathological Fractures:
Osteogenesis imperfecta
Rickets
Osteomalacia
Osteoporosis
Hyperparathyroidism
Cushing’s syndrome
Paget’s disease: a chronic form of osteitis (osteitis deformans) of unknown cause
affecting older people, causing thickening and hypertrophy (enlargement) of the long
bones and deformity of the flat bones
Neoplasms
Cystic bone disease
Primary benign bone tumor
Primary malignant bone tumor
Infection
Irradiation
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
providers prescription.
Acute Compartment Syndrome: condition in which increased pressure within one or more
compartments reduces circulation to the area (commonly in the lower leg tibial fractures and
forearm)
Can begin 6 to 8 hrs after an injury or take up to 2 days to appear
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 clients 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-Fowlers 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-Fowlers 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.
Fat Embolism Syndrome (FES): a fracture complication in which fat globules are released
from the yellow bone marrow into the bloodstream within 12 to 48 hrs after an injury
Hip fracture patients are at highest risk (24 to 72 hrs after injury or surgery)
95% of FE come from the long bones
May be misdiagnosed as a PE from a blood clot
Early S/S: hypoxemia, dyspnea, tachypnea
Later S/S: headache, lethargy, agitation, confusion, decreased LOC, seizures, vision
changes, retinal hemorrhage, mild thrombocytopenia
Last S/S: petechiae (macular, measles-like rash) classic manifestation
Treatment: bedrest, gentle handling, oxygen, IV hydration, steroid therapy, fracture
immobilization
6. A trauma nurse cares for several clients with fractures. Which client should the nurse identify
as at highest risk for developing deep vein thrombosis?
a. An 18-year-old male athlete with a fractured clavicle
b. A 36-year old female with type 2 diabetes and fractured ribs
c. A 55-year-old woman prescribed aspirin for rheumatoid arthritis
d. A 74-year-old man who smokes and has a fractured pelvis
ANS: D
Deep vein thrombosis (DVT) as a complication with bone fractures occurs more often when
fractures are sustained in the lower extremities and the client has additional risk factors for
thrombus formation. Other risk factors include obesity, smoking, oral contraceptives, previous
thrombus events, advanced age, venous stasis (stasis of blood caused by venous congestion),
prolonged immobility, surgical procedure longer than 30 mins, cancer or chemotherapy, and
heart disease. The other clients do not have risk factors for DVT.
7. A nurse delegates care of a client in traction to an unlicensed assistive personnel (UAP).
Which statement should the nurse include when delegating hygiene care for this client?
a. Remove the traction when re-positioning the client.
b. Inspect the clients skin when performing a bed bath.
Final Exam Questions (NUR 2790)
CHAPTER 51: CARE OF PATIENTS WITH MUSCULOSKELETAL TRAUMA
MULTIPLE CHOICE
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 clients 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.
Weights should not be removed without a prescription. They should not be lifted manually or
allowed to rest on the floor. Weights should be freely hanging at all times. Inspect the skin Q8H
for S/S of irritation or inflammation. Remove the belt or boot that is used for skin traction Q8H
to inspect under the device.
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 clients 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 clients 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. Pagets disease
ANS: D
Pagets 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.
Causes of Pathological Fractures:
Osteogenesis imperfecta
Rickets
Osteomalacia
Osteoporosis
Hyperparathyroidism
Cushing’s syndrome
Paget’s disease: a chronic form of osteitis (osteitis deformans) of unknown cause
affecting older people, causing thickening and hypertrophy (enlargement) of the long
bones and deformity of the flat bones
Neoplasms
Cystic bone disease
Primary benign bone tumor
Primary malignant bone tumor
Infection
Irradiation
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
providers prescription.
Acute Compartment Syndrome: condition in which increased pressure within one or more
compartments reduces circulation to the area (commonly in the lower leg tibial fractures and
forearm)
Can begin 6 to 8 hrs after an injury or take up to 2 days to appear
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 clients 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-Fowlers 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-Fowlers 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.
Fat Embolism Syndrome (FES): a fracture complication in which fat globules are released
from the yellow bone marrow into the bloodstream within 12 to 48 hrs after an injury
Hip fracture patients are at highest risk (24 to 72 hrs after injury or surgery)
95% of FE come from the long bones
May be misdiagnosed as a PE from a blood clot
Early S/S: hypoxemia, dyspnea, tachypnea
Later S/S: headache, lethargy, agitation, confusion, decreased LOC, seizures, vision
changes, retinal hemorrhage, mild thrombocytopenia
Last S/S: petechiae (macular, measles-like rash) classic manifestation
Treatment: bedrest, gentle handling, oxygen, IV hydration, steroid therapy, fracture
immobilization
6. A trauma nurse cares for several clients with fractures. Which client should the nurse identify
as at highest risk for developing deep vein thrombosis?
a. An 18-year-old male athlete with a fractured clavicle
b. A 36-year old female with type 2 diabetes and fractured ribs
c. A 55-year-old woman prescribed aspirin for rheumatoid arthritis
d. A 74-year-old man who smokes and has a fractured pelvis
ANS: D
Deep vein thrombosis (DVT) as a complication with bone fractures occurs more often when
fractures are sustained in the lower extremities and the client has additional risk factors for
thrombus formation. Other risk factors include obesity, smoking, oral contraceptives, previous
thrombus events, advanced age, venous stasis (stasis of blood caused by venous congestion),
prolonged immobility, surgical procedure longer than 30 mins, cancer or chemotherapy, and
heart disease. The other clients do not have risk factors for DVT.
7. A nurse delegates care of a client in traction to an unlicensed assistive personnel (UAP).
Which statement should the nurse include when delegating hygiene care for this client?
a. Remove the traction when re-positioning the client.
b. Inspect the clients skin when performing a bed bath.
