NUR 2790 FINAL EXAM QUESTUONS AND CORRECT
ANSWERS WITH EXPLANATIONS [CARE OF PATIENTS
WITH MUSCULOSKELETAL TRAUMA] 2026 NEW
CHAPTER 51: CARE OF PATIENTS WITH
MUSCULOSKELETAL TRAUMA ( MULTIPLE CHOICE
1. The nurse is evaluating the effectiveness of care for a client recovering from an injured Achilles tendon.
Which of the following would indicate that care has been effective?
a. Client states steroid injections will be helpful to reduce the amount of pain.
b. Client plANS to participate in rehabilitation for 5 to 6 months after the injury.
c. Client resumes sports activities as soon as possible.
d. Client uses heat to decrease the inflammation
and swelling from the injury. ANS: B
Evidence that care has been effective for a client recovering from an injured Achilles tendon would be that the
client plANS to participate in rehabilitation for 5 to 6 months after the injury. Steroid injections are not used
for this type of injury. Sports activities should be avoided until the injury has healed and rehabilitation is
completed. Cryotherapy, not heat, is used to decrease the inflammation and swelling from the injury.
2. Anurse 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.
A nurse coordinates care for a client with a wet plaster cast. Which statement should the nurse include
3.
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.
, 4. 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
5. 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
6. 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
7. A trauma nurse cares for severalclients 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.
8.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.
c. Provide pin care by using alcohol wipes to clean the sites.
d. Ensure that the weights remain
freely hanging at all times. ANS: D
Traction weights should be freely hanging at all times. They should not be lifted manually or allowed to rest on
the floor. The client should remain in traction during hygiene activities. The nurse should assess the clients skin
and provide pin and wound care for a client who is in traction; this should not be delegated to the UAP.
9. Anurse notes crepitation when performing range-of-motion exercises on a client with a fractured left
humerus. Which action should the nurse take next?
a. Immobilize the left arm.
b. Assess the clients distal pulse.
c. Monitor for signs of infection.
ANSWERS WITH EXPLANATIONS [CARE OF PATIENTS
WITH MUSCULOSKELETAL TRAUMA] 2026 NEW
CHAPTER 51: CARE OF PATIENTS WITH
MUSCULOSKELETAL TRAUMA ( MULTIPLE CHOICE
1. The nurse is evaluating the effectiveness of care for a client recovering from an injured Achilles tendon.
Which of the following would indicate that care has been effective?
a. Client states steroid injections will be helpful to reduce the amount of pain.
b. Client plANS to participate in rehabilitation for 5 to 6 months after the injury.
c. Client resumes sports activities as soon as possible.
d. Client uses heat to decrease the inflammation
and swelling from the injury. ANS: B
Evidence that care has been effective for a client recovering from an injured Achilles tendon would be that the
client plANS to participate in rehabilitation for 5 to 6 months after the injury. Steroid injections are not used
for this type of injury. Sports activities should be avoided until the injury has healed and rehabilitation is
completed. Cryotherapy, not heat, is used to decrease the inflammation and swelling from the injury.
2. Anurse 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.
A nurse coordinates care for a client with a wet plaster cast. Which statement should the nurse include
3.
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.
, 4. 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
5. 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
6. 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
7. A trauma nurse cares for severalclients 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.
8.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.
c. Provide pin care by using alcohol wipes to clean the sites.
d. Ensure that the weights remain
freely hanging at all times. ANS: D
Traction weights should be freely hanging at all times. They should not be lifted manually or allowed to rest on
the floor. The client should remain in traction during hygiene activities. The nurse should assess the clients skin
and provide pin and wound care for a client who is in traction; this should not be delegated to the UAP.
9. Anurse notes crepitation when performing range-of-motion exercises on a client with a fractured left
humerus. Which action should the nurse take next?
a. Immobilize the left arm.
b. Assess the clients distal pulse.
c. Monitor for signs of infection.
