Question 1
A 25-year-old male patient presents to the emergency room after a motorbike accident. He complains of severe pain and deformity of the left leg. X-rays confirm a closed tibial shaft fracture. The nurse prepares to apply a cast and educate the patient on care.
A. Elevate the leg above heart level for the first 48 hours.
B. Encourage full weight-bearing immediately to promote healing.
C. Apply heat to the site for the first 24 hours to reduce pain.
D. Perform rigorous range-of-motion exercises with the affected leg twice daily.
E. Soak the cast in water to keep the limb cool and reduce swelling.
Rationale: Elevation of the fractured limb above heart level helps reduce swelling and pain by facilitating venous return and decreasing blood flow to the site, which can help minimize inflammation. Immediate weight-bearing, applying heat, soaking the cast, and rigorous exercises are contraindicated in the initial management of a fracture as these actions can increase swelling, pain, or disrupt the healing process.
Question 2
A 58-year-old woman is diagnosed with a wrist fracture after slipping on ice. The healthcare provider decides on a conservative treatment with a plaster cast. The nurse provides education on cast care and signs of complications to watch for.
A. Expectation of a mild, dull ache is normal; report sharp or increasing pain.
B. It is normal for the skin to turn blue and cold; no need for concern.
C. Foul odor from the cast is common due to sweat accumulation.
D. Increasing numbness and tingling in the fingers is an expected finding.
E. Cast decorations with paint are encouraged to keep the mood uplifted.
Rationale: A mild, dull ache can be normal as the fracture heals, but sharp or increasing pain may indicate complications such as increased swelling leading to compartment syndrome, or cast too tight, necessitating immediate medical attention. Blue, cold skin, foul odor, and increasing numbness are signs of complications that should prompt immediate evaluation. While decorating a cast might uplift mood, care should be taken not to damage the cast or compromise skin integrity.
Question 3
A 35-year-old construction worker falls from a ladder and sustains a compound fracture of the forearm. He is immediately taken to the hospital, where emergency surgery is indicated. Post-operatively, the nurse monitors the patient for signs of infection and provides education on home care.
A. Use of sling is discouraged as it may impair circulation.
B. Inspect the surgical site daily for signs of redness, warmth, or discharge.
C. Resume heavy lifting with the affected arm after one week to strengthen the muscle.
D. Immersion of the surgical site in water is recommended for cleaning.
E. Pain management should solely consist of non-pharmacological interventions.
Rationale: Daily inspection of the surgical site for signs of infection, such as redness, warmth, or discharge, is critical in the post-operative care of a compound fracture. Using a sling, when advised by a healthcare provider, helps support the arm and does not impair circulation if used correctly. Resuming heavy lifting too soon, immersing the surgical site in water, and relying solely on non-pharmacological interventions for pain management without consulting a healthcare provider, could compromise healing and increase the risk of complications.
Question 4
A 20-year-old athlete suffers an ankle fracture during a soccer game. After reduction and immobilization, the healthcare team discusses rehabilitation and prevention of future injuries with the patient.
A. Begin high-impact exercises immediately to test the strength of the ankle.
B. Apply a cold compress to the ankle for 20 minutes every hour for the first 48 hours.
C. Avoid use of crutches as it may lead to dependency.
D. Take ibuprofen on an empty stomach to enhance its effectiveness.
E. Wear tight socks over the cast to reduce swelling.
Rationale: Applying a cold compress helps reduce swelling and pain by constricting blood vessels, which can limit internal bleeding and fluid accumulation. High-impact exercises immediately after a fracture can cause further injury. The use of crutches should be based on the healthcare provider’s recommendation to support mobility while preventing weight-bearing on the injured ankle until it is deemed safe. Taking ibuprofen should be with food or milk to prevent gastric irritation, not on an empty stomach. Wearing tight socks over a cast can impair circulation and is not recommended for reducing swelling.
Question 5
A 65-year-old female patient with osteoporosis suffers a hip fracture after a minor fall at home. Post-operatively, the healthcare team focuses on early mobilization to prevent complications. The nurse educates the patient on the importance of mobilization and safety measures.
A. Stay in bed for at least one week to ensure proper healing of the hip.
B. Use a walker or crutches for ambulation to avoid putting full weight on the hip.
C. Engage in high-intensity aerobic exercises starting immediately to regain mobility.
D. Avoid pain medication to better assess the healing process through pain levels.
E. Perform only upper body exercises until the fracture completely heals.
Rationale: Early mobilization with the assistance of a walker or crutches helps prevent complications such as deep vein thrombosis (DVT), pulmonary embolism, and muscle atrophy, without putting full weight on the healing hip. Staying in bed for extended periods increases the risk of complications. High-intensity exercises are inappropriate immediately post-fracture and should be gradually introduced as part of a rehabilitation program. Pain management is crucial for effective rehabilitation and cannot be ignored. While focusing on upper body exercises is beneficial, it is also important to engage in approved lower body exercises to promote circulation and healing.
Question 6
A 12-year-old boy sustains a greenstick fracture of the forearm while playing football. His parents are instructed on care and signs of complications to monitor at home.
A. Encourage aggressive manipulation of the arm to correct the deformity.
B. Ensure the cast remains dry and intact, checking for any cracks or wet spots.
C. Allow the child to continue playing sports to maintain strength in the arm.
D. Apply heat directly to the cast to alleviate any discomfort.
E. Ignore complaints of itching under the cast as this is an expected symptom.
Rationale: Keeping the cast dry and intact is crucial to prevent skin irritation, infection, and ensure proper healing of the fracture. Aggressive manipulation of the arm, continuing to play sports without medical clearance, applying heat directly to the cast, and ignoring complaints of itching can lead to complications. Itching is common, but persistent discomfort should be evaluated by a healthcare provider to prevent skin damage or other underlying issues.
Question 7
A 30-year-old female presents with a closed radial fracture after a biking accident. She is treated with a fiberglass cast. The nurse provides instructions on cast care and recognizes the importance of educating the patient on compartment syndrome.
A. Ignore swelling as it is a natural response to injury.
B. Report immediate, unrelenting pain or pain that worsens with elevation.
C. Assume tingling in the fingers is due to the cast being too loose.
D. Consume a high-sodium diet to promote fluid retention and healing.
E. Limit fluid intake to reduce swelling.
Rationale: Immediate, unrelenting pain or pain that worsens with elevation can be signs of compartment syndrome, a serious condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, preventing nourishment and oxygen from reaching nerve and muscle cells. Ignoring swelling, assuming tingling is due to looseness of the cast, consuming a high-sodium diet, and limiting fluid intake can all exacerbate complications and impede healing.
Question 8
An 80-year-old man with a history of osteoporosis falls and sustains a compression fracture of the lumbar spine. The healthcare team focuses on pain management and preventing further injury. The nurse educates the patient on activities to avoid.
A. Engage in regular, gentle stretching exercises to strengthen the back muscles.
B. Lift heavy objects to test the resilience of the spine.
C. Avoid bending, lifting, and twisting movements to prevent exacerbation of the fracture.
D. Participate in high-impact sports as a form of rehabilitation.
E. Use a heating pad on the highest setting for pain relief.
Rationale: Avoiding bending, lifting, and twisting movements is crucial for patients with a compression fracture of the lumbar spine to prevent to avoid weight-bearing on the injured ankle until it is deemed safe. Taking ibuprofen should be with food or milk to prevent gastrointestinal upset, not on an empty stomach. Tight socks or any constrictive material over the cast can impair circulation and are not recommended to manage swelling.
Question 9
A 45-year-old patient has undergone open reduction and internal fixation (ORIF) surgery for a complex femur fracture. During the postoperative period, the nurse emphasizes the importance of preventing deep vein thrombosis (DVT).
A. Maintain strict bed rest until the surgeon permits activity.
B. Perform ankle pumps and leg exercises as tolerated.
C. Increase intake of vitamin K-rich foods to promote blood clotting.
D. Use a heating pad directly on the surgical site to enhance blood flow.
E. Restrict fluid intake to prevent fluid overload.
Rationale: Mobilization and leg exercises, such as ankle pumps, enhance venous return and reduce the risk of DVT by preventing stasis of blood in the lower extremities. While certain periods of bed rest are necessary post-surgery, complete immobilization without any leg movement increases the risk of DVT. Increasing intake of vitamin K without medical advice can affect the efficacy of anticoagulants if used. Direct heat on the surgical site and restricting fluid intake are not recommended practices in the prevention of DVT and may actually contribute to complications.
Question 10
A 16-year-old gymnast presents with a suspected scaphoid fracture after falling on her outstretched hand during practice. The initial X-rays do not show a clear fracture, but the patient has significant tenderness in the anatomical snuffbox.
A. Dismiss the patient’s symptoms if the X-ray is negative.
B. Recommend immediate return to gymnastics to maintain physical condition.
C. Apply a thumb spica splint and schedule a follow-up in two weeks.
D. Soak the hand in hot water three times a day for pain relief.
E. Advise the use of over-the-counter creams exclusively for pain management.
Rationale: Scaphoid fractures may not be visible on initial X-rays, and tenderness in the anatomical snuffbox is a significant indicator of this injury. Immobilization with a thumb spica splint is a precautionary measure to prevent further injury and promote healing, with a follow-up appointment for re-evaluation, often including repeat imaging. Dismissing symptoms, recommending an immediate return to sports, soaking in hot water, or exclusive reliance on creams for pain management does not address the potential for a significant underlying fracture and could result in complications such as non-union or avascular necrosis.