NSG 430 Exam 3: (Latest 2026/2027 Update) Fractures, Shock, Burns,
Chest Trauma, Neurological Emergencies | Q&A | Grade A | 100% Correct
(Verified Answers) – Nursing Program
Subject: NSG 430 – Advanced Medical-Surgical / Trauma / Neurocritical Care
Source: NSG 430 Exam 3 Blueprint 2026/2027 Format: Q&A Guide with Rationale | Verified Grade A
1. What are key falls prevention teaching points for patients with gait instability or vision impairment?
Correct Answer: Age-appropriate exercise for strength/balance, adequate calcium/vitamin D, remove throw
rugs, adequate lighting, functional nonskid hard shoes, clear path to bathroom at night, avoid walking on wet
or uneven surfaces
1. Multifactorial interventions reduce fall risk by 30-40% in older adults; home safety assessment key.
2. Vitamin D 800 IU/day reduces fall risk by improving muscle strength; exercise (Tai Chi, balance training) effective.
3. Nightlights and clear pathways prevent nighttime falls; nonskid shoes reduce slip risk.
2. What are the manifestations of a fracture?
Correct Answer: Edema, swelling, pain, tenderness, muscle spasm, deformity, contusion, loss of function,
crepitation, and guarding
1. Pain from periosteal irritation and muscle spasm; deformity indicates displacement.
2. Crepitus is pathognomonic but should not be elicited intentionally (may worsen injury).
3. Loss of function and guarding suggest fracture; immediate immobilization required.
3. What are the stages of bone healing after a fracture?
Correct Answer: 1. Fracture hematoma, 2. Granulation tissue, 3. Callus formation, 4. Ossification, 5.
Consolidation, 6. Remodeling
1. Hematoma forms within 6-8 hours → inflammation. Granulation tissue (fibroblasts, capillaries) at 72 hours.
2. Soft callus (collagen, cartilage) at 2-3 weeks; hard callus (calcium) at 4-6 weeks; consolidation at 6-12 weeks.
3. Remodeling occurs over months to years, restoring original bone contour.
4. What is closed reduction care for a fracture?
Correct Answer: Nonsurgical, manual realignment of bone fragments using traction/countertraction under
local/general anesthesia, followed by immobilization (traction, cast, splint, brace)
1. Performed for displaced fractures without surgical exposure; may require sedation or anesthesia.
2. Post-reduction X-ray confirms alignment; neurovascular status assessed before and after.
3. Risks: failure of reduction, compartment syndrome, pressure injury from immobilization.
5. What is open reduction internal fixation (ORIF)?
Correct Answer: Surgical incision with internal fixation (wires, screws, pins, plates, rods, or nails) to align bone
fragments; risk for infection but allows early ambulation
1. Indicated for intra-articular fractures, failed closed reduction, or polytrauma patients.
2. Early mobilization reduces complications of immobility (DVT, pneumonia).
3. Monitor for hardware failure, infection, nonunion, and neurovascular compromise.
, 6. What are the two main types of traction and key features?
Correct Answer: Skin traction (short-term 48-72hr, 5-10 lbs, e.g., Buck's traction) and skeletal traction (long-
term, 5-45 lbs, for joint contractures/congenital hip dysplasia)
1. Skin traction applied directly to skin; monitor for skin breakdown and blisters.
2. Skeletal traction uses pin/wire in bone; pin site care with chlorhexidine to prevent infection.
3. Balance skeletal traction requires correct patient positioning, maintaining countertraction, weights off floor, HOB
elevated.
7. What are important teaching points for cast care?
Correct Answer: Apply ice first 24 hours, elevate above heart first 48 hours, exercise joints above/below cast,
use cool setting on hair dryer for itching, and do not get cast wet without HCP approval
1. Ice reduces swelling, elevation uses gravity to decrease edema; movement prevents stiffness.
2. Never insert objects inside cast (risk of skin breakdown, infection); keep cast dry.
3. Report worsening pain, numbness, pallor, or inability to move digits (signs of compartment syndrome).
8. What are the "6 Ps" of compartment syndrome?
Correct Answer: Pain (out of proportion), paresthesia, pallor, pulselessness, pressure, paralysis
1. Early signs: severe pain, pain with passive stretch, paresthesia; late signs: pallor, paralysis, pulselessness
(irreversible).
2. Do NOT elevate extremity above heart (decreases arterial pressure) or apply cold (vasoconstriction).
3. Emergency fasciotomy indicated if compartment pressure >30 mmHg; delay causes permanent damage.
9. What are the manifestations of fat embolism syndrome (FES)?
Correct Answer: Chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, mental status changes,
petechiae on neck/chest wall/axilla/head, PaO2 <60, decreased platelets, increased ESR, fat cells in
blood/urine/sputum
1. Occurs 24-72 hours after long bone fracture; triad: hypoxemia, neurologic changes, petechial rash.
2. Reposition as little as possible; immobilization prevents further emboli.
3. Management: O2 support, IV fluids, vasodilators for pulmonary vasospasm, inotropic drugs.
10. What is rhabdomyolysis and how is it assessed?
Correct Answer: Breakdown of damaged skeletal muscle releasing myoglobin into circulation, causing renal
tubule obstruction and ATN; assess urine for dark reddish-brown color
1. Causes: crush injury, prolonged immobilization, statins, alcohol, seizures.
2. Serum CK elevated >5,000-10,000 U/L; myoglobinuria (urine dipstick positive for blood but no RBCs).
3. Treatment: aggressive IV fluids (NS or LR), mannitol, urine alkalinization (bicarbonate) to prevent AKI.
11. What is the initial management for a patient with a facial fracture?
Correct Answer: Airway and ventilation (suction, tracheostomy if needed); assume cervical spine injury until
cleared by X-ray/CT; assess oral/facial injuries, ocular muscles, cranial nerves III, IV, VI
1. Facial fractures can cause airway obstruction from bleeding, edema, or displaced bone; maintain C-spine
precautions.
2. Assess for eye injury: rupture requires protective shield; vitreous humor or brown tissue on globe indicates open
globe.
3. Immobilize and stabilize, maintain airway, provide adequate nutrition, be sensitive to appearance changes.
12. What nursing management is required for a patient with a wired jaw (mandibular fracture)?
Correct Answer: Wire cutters at bedside; reassure patient they can breathe and swallow liquids normally;
keep airway patent, HOB elevated; keep tracheostomy or ET tray available; NG tube for
decompression/feeding; mouthwashes, keep lips/mucosa moist
1. Wire cutters essential for emergency airway access if vomiting occurs (prevent aspiration).
2. Liquid diet via straw or syringe; monitor for weight loss and nutritional deficiencies.
3. Oral hygiene with syringe or soft irrigation catheter prevents infection and stomatitis.
Chest Trauma, Neurological Emergencies | Q&A | Grade A | 100% Correct
(Verified Answers) – Nursing Program
Subject: NSG 430 – Advanced Medical-Surgical / Trauma / Neurocritical Care
Source: NSG 430 Exam 3 Blueprint 2026/2027 Format: Q&A Guide with Rationale | Verified Grade A
1. What are key falls prevention teaching points for patients with gait instability or vision impairment?
Correct Answer: Age-appropriate exercise for strength/balance, adequate calcium/vitamin D, remove throw
rugs, adequate lighting, functional nonskid hard shoes, clear path to bathroom at night, avoid walking on wet
or uneven surfaces
1. Multifactorial interventions reduce fall risk by 30-40% in older adults; home safety assessment key.
2. Vitamin D 800 IU/day reduces fall risk by improving muscle strength; exercise (Tai Chi, balance training) effective.
3. Nightlights and clear pathways prevent nighttime falls; nonskid shoes reduce slip risk.
2. What are the manifestations of a fracture?
Correct Answer: Edema, swelling, pain, tenderness, muscle spasm, deformity, contusion, loss of function,
crepitation, and guarding
1. Pain from periosteal irritation and muscle spasm; deformity indicates displacement.
2. Crepitus is pathognomonic but should not be elicited intentionally (may worsen injury).
3. Loss of function and guarding suggest fracture; immediate immobilization required.
3. What are the stages of bone healing after a fracture?
Correct Answer: 1. Fracture hematoma, 2. Granulation tissue, 3. Callus formation, 4. Ossification, 5.
Consolidation, 6. Remodeling
1. Hematoma forms within 6-8 hours → inflammation. Granulation tissue (fibroblasts, capillaries) at 72 hours.
2. Soft callus (collagen, cartilage) at 2-3 weeks; hard callus (calcium) at 4-6 weeks; consolidation at 6-12 weeks.
3. Remodeling occurs over months to years, restoring original bone contour.
4. What is closed reduction care for a fracture?
Correct Answer: Nonsurgical, manual realignment of bone fragments using traction/countertraction under
local/general anesthesia, followed by immobilization (traction, cast, splint, brace)
1. Performed for displaced fractures without surgical exposure; may require sedation or anesthesia.
2. Post-reduction X-ray confirms alignment; neurovascular status assessed before and after.
3. Risks: failure of reduction, compartment syndrome, pressure injury from immobilization.
5. What is open reduction internal fixation (ORIF)?
Correct Answer: Surgical incision with internal fixation (wires, screws, pins, plates, rods, or nails) to align bone
fragments; risk for infection but allows early ambulation
1. Indicated for intra-articular fractures, failed closed reduction, or polytrauma patients.
2. Early mobilization reduces complications of immobility (DVT, pneumonia).
3. Monitor for hardware failure, infection, nonunion, and neurovascular compromise.
, 6. What are the two main types of traction and key features?
Correct Answer: Skin traction (short-term 48-72hr, 5-10 lbs, e.g., Buck's traction) and skeletal traction (long-
term, 5-45 lbs, for joint contractures/congenital hip dysplasia)
1. Skin traction applied directly to skin; monitor for skin breakdown and blisters.
2. Skeletal traction uses pin/wire in bone; pin site care with chlorhexidine to prevent infection.
3. Balance skeletal traction requires correct patient positioning, maintaining countertraction, weights off floor, HOB
elevated.
7. What are important teaching points for cast care?
Correct Answer: Apply ice first 24 hours, elevate above heart first 48 hours, exercise joints above/below cast,
use cool setting on hair dryer for itching, and do not get cast wet without HCP approval
1. Ice reduces swelling, elevation uses gravity to decrease edema; movement prevents stiffness.
2. Never insert objects inside cast (risk of skin breakdown, infection); keep cast dry.
3. Report worsening pain, numbness, pallor, or inability to move digits (signs of compartment syndrome).
8. What are the "6 Ps" of compartment syndrome?
Correct Answer: Pain (out of proportion), paresthesia, pallor, pulselessness, pressure, paralysis
1. Early signs: severe pain, pain with passive stretch, paresthesia; late signs: pallor, paralysis, pulselessness
(irreversible).
2. Do NOT elevate extremity above heart (decreases arterial pressure) or apply cold (vasoconstriction).
3. Emergency fasciotomy indicated if compartment pressure >30 mmHg; delay causes permanent damage.
9. What are the manifestations of fat embolism syndrome (FES)?
Correct Answer: Chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, mental status changes,
petechiae on neck/chest wall/axilla/head, PaO2 <60, decreased platelets, increased ESR, fat cells in
blood/urine/sputum
1. Occurs 24-72 hours after long bone fracture; triad: hypoxemia, neurologic changes, petechial rash.
2. Reposition as little as possible; immobilization prevents further emboli.
3. Management: O2 support, IV fluids, vasodilators for pulmonary vasospasm, inotropic drugs.
10. What is rhabdomyolysis and how is it assessed?
Correct Answer: Breakdown of damaged skeletal muscle releasing myoglobin into circulation, causing renal
tubule obstruction and ATN; assess urine for dark reddish-brown color
1. Causes: crush injury, prolonged immobilization, statins, alcohol, seizures.
2. Serum CK elevated >5,000-10,000 U/L; myoglobinuria (urine dipstick positive for blood but no RBCs).
3. Treatment: aggressive IV fluids (NS or LR), mannitol, urine alkalinization (bicarbonate) to prevent AKI.
11. What is the initial management for a patient with a facial fracture?
Correct Answer: Airway and ventilation (suction, tracheostomy if needed); assume cervical spine injury until
cleared by X-ray/CT; assess oral/facial injuries, ocular muscles, cranial nerves III, IV, VI
1. Facial fractures can cause airway obstruction from bleeding, edema, or displaced bone; maintain C-spine
precautions.
2. Assess for eye injury: rupture requires protective shield; vitreous humor or brown tissue on globe indicates open
globe.
3. Immobilize and stabilize, maintain airway, provide adequate nutrition, be sensitive to appearance changes.
12. What nursing management is required for a patient with a wired jaw (mandibular fracture)?
Correct Answer: Wire cutters at bedside; reassure patient they can breathe and swallow liquids normally;
keep airway patent, HOB elevated; keep tracheostomy or ET tray available; NG tube for
decompression/feeding; mouthwashes, keep lips/mucosa moist
1. Wire cutters essential for emergency airway access if vomiting occurs (prevent aspiration).
2. Liquid diet via straw or syringe; monitor for weight loss and nutritional deficiencies.
3. Oral hygiene with syringe or soft irrigation catheter prevents infection and stomatitis.
