This is a quiz that contains NCLEX review questions for bone fractures. As a nurse providing care to a patient with a fracture, it is important to know the signs and symptoms, nursing management for casts and traction, complications, patient education, and treatment for this condition. In the previous NCLEX review series, I explained about other musculoskeletal disorders you may be asked about on the NCLEX exam, so be sure to check out those reviews and quizzes as well. Don’t forget to watch the bone fractures lecture before taking the quiz. 
(NOTE: When you hit submit, it will refresh this same page. Scroll down to see your results.) 1. Figure 1 represents what type of bone fracture: This is a fracture that is slanted across the bone shaft. A. Transverse Fracture B. Spiral Fracture C. Oblique Fracture D. Compound Fracture The answer is C. This is known as an oblique fracture. 2. Figure 2 represents what type of bone fracture: The fractured bone is broken into many fragments (3 or more). A. Open Fracture B. Greenstick Fracture C. Oblique Fracture D. Comminuted Fracture The answer is D. This is known as a comminuted fracture 3. Figure 3 represents what type of bone fracture: This a fractured bone that breaks through the skin. A. Closed Fracture B. Compound Fracture C. Greenstick Fracture D. Transverse Fracture The answer is B. This is known as a compound fracture (also called an open fracture). 4. You’re caring for a patient who has experienced a fracture to the right arm that is represented in Figure 3. What nursing intervention will you take with this type of fracture? A. Cover the fracture with a sterile dressing B. Place the arm below the heart level. C. Attempt bone reduction by manually readjusting the bone. D. Place a tight compression bandage over the fracture. The answer is A. Figure 3 represents a compound fracture (also called an open fracture). Due to the nature of this fracture, the patient is at major risk for infection because the skin is no longer intact. Therefore, the nurse should cover the fracture site with a sterile dressing. NEVER attempt a bone reduction. In addition, avoid a tight compression bandage due to the development of ischemia. Instead, you would want to immobilize the extremities and splint it. 5. A 85 year old patient has an accidental fall while going to the bathroom without assistance. It appears the patient has sustained a bone fracture to the left leg. The leg’s shape is deformed and the patient is unable to move it. The patient is alert and oriented but in pain. What will you do FIRST after confirming the patient is safe and stable? A. Apply an ice pack covered with a towel to the site. B. Immobilize the fracture with a splint. C. Administer pain medication. D. Elevate the extremity above heart level. The answer is B. After confirming the patient is safe and stable, the nurse would immobilize the fracture with a splinting device. This will prevent the accidental movement of the extremity by the patient. Immobilization is important because it prevents further pain or bleeding along with more damage that can occur to the surrounding tissues. In addition, if a bone is not immobilized but moved after it has been fractured this can affect the healing process. 6. Which statement by a patient, who just received a cast on the right arm for a fracture, requires you to notify the physician immediately? A. “It is really itchy inside my cast!” B. “My pain is so severe that it hurts to stretch or elevate my arm.” C. “I can feel my fingers and move them.” D. “I’ve been using ice packs to reduce swelling.”” The answer is B. This statement is very concerning and may represent a condition called compartment syndrome. Compartment syndrome is where the nerves and blood vessels are becoming compromised due to increasing pressure in the compartments within the fascia (remember fascia doesn’t expand, so if there is building pressure within the compartments of muscle from bleeding etc. it will compromise circulation and nerve function). Remember to monitor the 6 P’s. (pain, pallor, paralysis, paresthesia, pulselessness (late sign), poikilothermia) 7. What is a late sign of compartment syndrome? A. Paralysis B. Pain C. Parethesia D. Pulselessness The answer is D. Pulselessness is a late sign of compartment syndrome. 8. Select all the signs and symptoms that will present in compartment syndrome? A. Capillary refill less than 2 seconds B. Pallor C. Pain relief with medication D. Feeling of tingling in the extremity E. Affected extremity feels cooler to the touch than the unaffected extremity The answers are B, D, and E. These symptoms may present with compartment syndrome. Option A and C are normal findings. Remember in compartment syndrome nerve and blood vessel function is being compromised, so expect signs and symptoms that occur when these structures are affected. 9. Your patient is 2 hours post-op from a cast placement on the right leg. The patient has family in the room. Which action by the significant other requires you to re-educate the patient and family about cast care? A. Gently moving the cast with the fingertips of the hands every 2 hours to help with drying. B. Positioning the cast at heart level with pillows. C. Checking the color and temperature of the right foot. D. Using a hair dryer on the cool setting to help with drying. The answer is A. The cast should always be moved with the palms of the hands (NOT finger tips) during the drying period to prevent dent formation because this can cause the development of ulcers under the skin where the dents develop. 10. A patient sustained a fracture to the femur. The patient has suddenly become confused, restless, and has a respiratory rate of 30 breaths per minute. Based on the location of fracture and the presenting symptoms, this patient may be experiencing what type of complication? A. Compartment Syndrome B. Osteomyelitis C. Fat embolism D. Hypovolemia The answer is C. Patients who experience a fracture of the long bones (such as the femur) are at risk for a fat embolism. The patient will become confused and restless along with an abnormal respiratory status. 11. Which assessment finding found while assessing a patient with a fracture who has traction requires immediate intervention? A. The weights are freely hanging on the floor. B. Pin sites are free from drainage. C. Patient uses the overhead trapeze bar to move around in the bed. D. Patient’s extremities have a capillary refill of less than 2 seconds. The answer is A. Weights used for traction should freely hang but NOT on the floor. All the other options are expected findings. 12. A 5 year old has a fracture of the right upper arm. The x-ray showed that one side of the bone is bent while the other is broken. This known as a __________ fracture? A. Spiral B. Greenstick C. Oblique D. Transverse The answer is B. This is a greenstick fracture. These types of fractures are more common in the pediatric population because their bones tend to be more flexible and the periosteum is stronger than an adult. More NCLEX Quizzes Don’t forget to tell your friends about this quiz by sharing it your Facebook, Twitter, and other social media. 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Distal radius fractures can be reset either with surgery (open reduction) or without it (closed reduction). This article discusses the recovery process for both approaches, plus the pain management tactics that can be used for all patients. Managing Pain During RecoveryDuring recovery, these pain management techniques can be used for patients:
See Video: How to Make a Gel Ice Pack After a closed (nonsurgical) resetting, the cast will be kept on for about 6 weeks. Patients will need to keep casts and splints dry by avoiding baths or swimming, and showering with a plastic bag covering it. If the fracture has been reset, patients may need to return for periodic X-rays to make sure the bone is healing correctly. After the cast is removed, it’s normal for the wrist to be stiff for 1 to 2 months. For some patients—such as those who are older, have osteoarthritis, or were victims of a high energy break such as from a car accident— this stiffness may last up to 2 years. Patients may still be advised to wear a soft wrist splint at night for 1 to 2 weeks after the cast is removed to stabilize the wrist and help patients sleep better. Regardless of the approach used to treat a distal radius fracture, physical therapy is essential to the recovery process. Some of the goals of physical therapy include:
The wrist and arm should be functional for most activity by 8 to 10 weeks after surgery. After about 3 to 6 months, most patients can resume heavier wrist or arm activity and sports. Open Reduction RecoveryAfter a surgical procedure such as external fixation or internal plate fixation, a cast will not be necessary. Dressing will be applied until wounds heal and a splint is worn to stabilize the wrist. For an external fixation, the wrist will be in a splint for 10 days to allow pain and swelling to subside. The external fixator is usually removed at 6 weeks, and any additional Kirschner wire pins can be removed 2 weeks later. In the case of an internal plate procedure, the wound is dressed in a bandage and patients wear a splint for 6 weeks. The wrist should remain immobile for 1 week until the sutures are removed, but after that patients can begin mobility exercises. A course of physical therapy will be prescribed to help patients restore range of motion, decrease swelling, and rebuild strength. As with all procedures to treat an injury, there are some potential complications that can occur. The chances for the following complications vary based on the condition of the patient and the treatment approach used. Patients should ask their physicians for specific information about their own risk for certain complications. Possible complications of a distal radius fracture can include, but are not limited to:
See Soft Tissues of the Wrist In some cases—such as when the bone heals out of alignment (malunion) or there is tendon damage from an internal plate—a second surgery may be needed to correct the problem. Most people who experience a distal radius fracture are able to recover well and return to the full scope of their former activities. |
A patient with a fractured radius asks when the cast can be removed
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