Pathophysiology of the Musculoskeletal System > Pathophysiology
Exam Review
Fractures
Total Questions : 10
Showing 10 questions, Sign in for moreWhich clinical presentation should the nurse expect in this client?
Explanation
Choice A rationale:
If the client states, "I can feel a crunching sensation when I touch the area," it suggests crepitus, which is a common clinical finding in fractures.
Crepitus is caused by the rubbing of bone fragments against each other.
However, it is not specific to closed fractures and can also occur in open fractures.
Therefore, it is not the most reliable indicator of a closed fracture.
Choice B rationale:
"My skin around the fracture is warm and red" is indicative of inflammation, which can occur in response to any type of injury, including fractures.
While warmth and redness may be present in closed fractures due to the inflammatory response, they are not specific to closed fractures and can also occur in open fractures or other injuries.
This symptom alone does not confirm a closed fracture.
Choice C rationale:
"I can't move my limb due to the pain" is a key clinical presentation expected in a client with a closed fracture.
Closed fractures typically result in severe pain, swelling, and loss of function in the affected limb.
The pain and immobility are due to the disruption of the bone and surrounding tissues without any open wound.
This presentation is highly characteristic of a closed fracture.
Choice D rationale:
"The bone is sticking out of my skin" is not consistent with a closed fracture but rather suggests an open fracture.
In an open fracture, the bone pierces through the skin, leading to exposure to the external environment.
This is a distinct clinical presentation from a closed fracture and requires immediate attention for infection control and wound care.
Explanation
Choice A rationale:
Responding with "That's a closed fracture" would be incorrect because the client's statement indicates an incomplete fracture, specifically a greenstick fracture.
Greenstick fractures are incomplete fractures where the bone bends but does not break completely.
They are different from closed fractures, which involve a complete break in the bone without an open wound.
Choice B rationale:
"You may need surgery for this fracture" is not the most appropriate response in this context.
While some greenstick fractures may require surgery, the client's statement is primarily seeking clarification about the nature of the fracture.
Surgery is not the immediate concern.
Choice C rationale:
"It's common to have bruising with this fracture" would be an inaccurate response because greenstick fractures typically do not result in significant bruising.
Bruising is more common in fractures with greater displacement or soft tissue injury.
Greenstick fractures are often associated with minimal or no bruising.
Choice D rationale:
"You're correct; it's an incomplete fracture" is the most appropriate nursing response.
This response validates the client's understanding of the fracture and provides accurate information.
Greenstick fractures are indeed incomplete fractures where the bone is bent but not completely broken.
What intervention should the nurse prioritize for pain management?
Explanation
Choice A rationale:
Administering antibiotics to prevent infection is an important intervention for clients with open fractures to reduce the risk of infection.
However, in a client with an open fracture complaining of intense pain, the immediate priority should be to address their pain and provide analgesics (Choice B) to alleviate suffering and improve comfort.
Infection prevention measures can be implemented once pain management is initiated.
Choice B rationale:
Providing analgesics as prescribed is the most appropriate intervention for a client with an open fracture complaining of intense pain.
Open fractures are associated with significant pain due to the exposure of bone and soft tissues, and effective pain management is essential for the client's comfort and well-being.
Choice C rationale:
Applying a warm compress to the affected area may provide some comfort but is not the primary intervention for pain management in a client with an open fracture.
The priority should be to administer analgesics and provide appropriate wound care.
Choice D rationale:
Initiating physical therapy immediately is not the immediate priority for a client with an open fracture complaining of intense pain.
Physical therapy typically follows fracture stabilization, wound management, and pain control.
It is essential to address the client's pain and wound care needs first.
What condition is often associated with this type of fracture?
Explanation
Choice A rationale:
Osteoarthritis is a degenerative joint disease characterized by the breakdown of joint cartilage and typically affects weight-bearing joints such as the knees and hips.
While compression fractures of the vertebrae can result from osteoporosis, they are not directly associated with osteoarthritis.
Therefore, choice A is not the correct answer.
Choice B rationale:
Osteoporosis is often associated with compression fractures of the vertebrae.
Osteoporosis is a condition characterized by decreased bone density and strength, making the bones more prone to fractures, especially in the spine.
Compression fractures in the vertebrae can occur due to the weakened bone structure in individuals with osteoporosis, and they are a common complication of this condition.
Choice C rationale:
Rheumatoid arthritis is an autoimmune inflammatory disorder that primarily affects the joints, causing synovitis, joint pain, and joint deformities.
It is not directly associated with compression fractures of the vertebrae, which are typically related to bone density issues like osteoporosis.
Choice D rationale:
Greenstick fractures are incomplete fractures seen in children and adolescents, typically involving long bones.
They are not typically associated with compression fractures of the vertebrae, which are more commonly linked to osteoporosis.
Questions
The patient asks, "Why is it important to keep the cast dry?" Which response by the nurse is most appropriate?
Explanation
Choice A rationale:
Keeping the cast dry prevents itching and discomfort.
Rationale: While it's true that a wet cast can cause itching and discomfort, this response does not adequately address the importance of keeping the cast dry from a medical perspective.
It focuses on the patient's comfort rather than the potential complications associated with a wet cast.
Choice B rationale:
Moisture can weaken the cast and affect its ability to support the bone.
Rationale: This is the correct response.
Moisture can indeed weaken the cast material, causing it to lose its structural integrity and support for the fractured bone.
Choice C rationale:
Dry casts are easier to clean and maintain.
Rationale: While dry casts may be easier to clean and maintain, this response does not address the primary reason for keeping the cast dry, which is to maintain its strength and support for the bone.
Choice D rationale:
It's just a precaution; you can get the cast wet occasionally.
Rationale: This response is incorrect and could lead to the patient misunderstanding the importance of keeping the cast dry.
Getting the cast wet occasionally is not recommended, as it can weaken the cast and increase the risk of complications.
Explanation
Choice A rationale:
Don't worry; bones always heal perfectly.
Rationale: This response is overly reassuring and not entirely accurate.
While bones have the potential to heal well, they may not always heal perfectly, and it's important to monitor the healing process to ensure proper alignment.
Choice B rationale:
We'll monitor your bone healing closely to ensure it aligns correctly.
Rationale: This is the correct response.
It acknowledges the client's concern and provides assurance that the healthcare team will closely monitor the bone healing process to ensure that it aligns correctly.
This response promotes open communication and patient-centered care.
Choice C rationale:
Fractures often heal with some degree of deformity; it's normal.
Rationale: This response may unnecessarily raise concerns for the client.
While some fractures may result in slight deformities during the healing process, it's not appropriate to label this as "normal" without assessing the specific fracture and its potential outcomes.
Choice D rationale:
Proper nutrition doesn't really affect bone healing.
Rationale: This response is inaccurate.
Proper nutrition plays a significant role in bone healing, and it's essential for the nurse to educate the client about the importance of maintaining a balanced diet to support the healing process.
A nurse is educating a group of patients on fracture prevention.
Which strategies should the nurse include in the education? Select all that apply.
Explanation
Choice A rationale:
Avoiding calcium and vitamin D supplements.
Rationale: This response is incorrect.
Calcium and vitamin D supplements are often recommended to support bone health and fracture prevention, especially in individuals with dietary deficiencies.
Choice B rationale:
Removing tripping hazards at home.
Rationale: This is a correct response.
Removing tripping hazards at home can help prevent falls and subsequent fractures.
It addresses a practical aspect of fracture prevention.
Choice C rationale:
Promoting regular exercise.
Rationale: This is a correct response.
Regular exercise, particularly weight-bearing exercises, can help strengthen bones and reduce the risk of fractures.
It is an essential component of fracture prevention.
Choice D rationale:
Encouraging participation in high-risk sports.
Rationale: This response is incorrect.
Encouraging participation in high-risk sports would increase the risk of fractures, which is the opposite of fracture prevention.
Choice E rationale:
Advocating for safety measures in recreational areas.
Rationale: This is a correct response.
Advocating for safety measures in recreational areas, such as the use of protective gear, can help reduce the risk of fractures during recreational activities.
Explanation
Choice A rationale:
Blood clots are not a concern with fractures.
Rationale: This response is incorrect.
Blood clots can be a concern with fractures, especially if the patient is immobilized or has other risk factors for clot formation.
Choice B rationale:
Fractures can increase the risk of blood clots, which can be dangerous.
Rationale: This is the correct response.
Fractures can indeed increase the risk of blood clots, as immobility and injury to blood vessels can promote clot formation.
It is crucial to address this risk and educate the patient about preventive measures.
Choice C rationale:
Blood clots are only a concern if you have a family history of clotting disorders.
Rationale: This response is not entirely accurate.
While a family history of clotting disorders can increase the risk of blood clots, it is not the only factor to consider.
Choice D rationale:
Blood clots are more common in open fractures, not closed ones.
Rationale: This response is misleading.
While open fractures may have a higher risk of infection, both open and closed fractures can potentially lead to blood clot formation due to immobility and damage to blood vessels.
Which assessment findings should the nurse prioritize during the initial assessment? .
Explanation
Choice A rationale:
The patient's favorite food and drink preferences.
Rationale: The patient's food and drink preferences are not a priority during the initial assessment of a suspected fracture.
The focus should be on medical assessments and relevant clinical information.
Choice B rationale:
The patient's past travel history.
Rationale: The patient's past travel history is unrelated to the assessment of a suspected fracture and should not be prioritized during this context.
Choice C rationale:
The site and type of fracture.
Rationale: This is the correct response.
During the initial assessment of a suspected fracture, the nurse should prioritize assessing the site and type of fracture to determine the severity of the injury and the appropriate interventions.
Choice D rationale:
The patient's social media usage patterns.
Rationale: The patient's social media usage patterns are not relevant to the assessment of a suspected fracture and should not be a priority during the initial evaluation.
Questions
(Select all that apply): A nurse is assessing a client with a suspected fracture.
Which clinical assessments are important in evaluating this client's condition? Select all that apply.
Explanation
Choice A rationale:
Assessing the client's pain intensity is crucial when evaluating a client with a suspected fracture.
Pain assessment helps determine the severity of the injury, guides pain management interventions, and monitors the effectiveness of pain relief measures.
Assessing pain intensity is a standard practice in fracture evaluation.
Choice B rationale:
Monitoring pulses in the affected limb is an important clinical assessment when evaluating a client with a suspected fracture.
A decrease or absence of pulses in the affected limb can indicate vascular compromise or arterial injury, which is a critical complication of fractures.
This assessment helps in early detection of circulatory problems and guides immediate interventions.
Choice C rationale:
Checking for changes in skin color around the fracture is a valuable assessment because it can indicate compromised blood flow or nerve injury.
Pale or cyanotic skin may suggest poor circulation, while redness may be a sign of inflammation.
Monitoring skin color helps identify potential complications associated with the fracture.
Choice D rationale:
Asking about the client's dietary habits is not directly relevant to the evaluation of a suspected fracture.
While nutrition is important for overall health and healing, dietary habits do not provide immediate information about the client's current condition or the nature of the fracture.
Choice E rationale:
Evaluating the client's psychological state is important for holistic care but may not be a primary assessment when evaluating a suspected fracture.
The priority in this context is to assess physical signs and symptoms related to the fracture and any potential complications.
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