True/False
• Mark a “T” if the statement is true; an “F” if the statement is false:
– A “contusion” is from a blow or blunt force trauma that causes local bleeding under the skin
– A “sprain” causes microscopic muscle tears as a result of overstretching muscles and tendons
– A “strain” refers to the wrenching or hyperextension of a joint

Multiple Response (MR)
• RICE is an acronym referring to what action is appropriate when soft tissue injury occurs?
• R=
• I=
• C=
• E=

• A temporary displacement of a bone from its normal position is called a:
– A. Whiplash
– B. Sprain
– C. Dislocation
– D. Fracture

T/F
• A dislocation usually involves tearing of the joint capsule ___
• Subluxations are partial or incomplete dislocations ___

MR
• From the list below, indicate which symptoms are usually present with a dislocation:
– A. Pain
– B. Deformity or shortening of the extremity
– C. Limitation of movement
– D. Edema

Other
• List 3 goals for nursing interventions related to dislocations:
– 1.
– 2.
– 3.

MC
• Compression of the median nerve between the carpal ligament and other structures occurs with which condition?
– A. Volkman’s contracture
– B. Fractured wrist
– C. Carpal tunnel syndrome
– D. Brachial plexus injury

MR
• Which of the following clinical manifestations would occur with carpal tunnel syndrome?
– A. Burning pain or tingling in the affected hand
– B. Inability to grasp or hold small objects
– C. Depressed appearance at the base of the thumb on the palm side
– D. Edema of the hand, wrist or fingers

Other
• List 2 diagnostic tests used to determine
Carpal Tunnel Syndrome.

MR
• Treatment of Carpal Tunnel Syndrome could include which of the following:
– A. Use of immobilizer
– B. Hydrocortisone injection
– C. ROM exercises
– D. Surgery

Other
• List 3 topics to be covered in the nurse’s patient teaching session(s):

Other
• List 5 nursing interventions for post operative care of a patient who had carpal tunnel surgery for decompression of median nerve:

MC
• When given the medical diagnosis of
“herniated nucleus pulposus”, the doctor is describing:
– A. Removal of a part of the vertebrae
– B. A traumatic injury to the vertebrae or disk in which the continuity of the tissue is disrupted
– C. Pressure on the median nerve
– D. Rupture of the fibrocartilage surrounding an intervertebral disk, releasing the nucleus pulposus that cushions the vertebrae above and below

Other
• Which 2 areas of the body are affected by a herniated nucleus pulposus?

MR
• Which of the following diagnostic tests would be used to determine nerve involvement with a herniated nucleus pulposus?
– A. Myelography
– B. EMG
– C. CT scan
– D. Physical Exam

Other
• Describe what “conservative” treatment for a herniated nucleus pulposus would involve.

MR
• Which surgeries would a physician choose that would be appropriate for treating HNP?
– A. Laminectomy
– B. Spinal fusion
– C. Diskectomy
– D. chemonucleolysis

Other
• List 2 preoperative care actions that could be performed by the nurse for a pt. awaiting a laminectomy:

MR
• Two overriding nursing goals for post operative care of the pt. who had a laminectomy include:
– A. Remove pressure on spinal nerves
– B. Provide ongoing assessment of neurological status
– C. Promote healing of operative site
– D. Reduce headaches and pain

Other
• List 5 post op nursing interventions for a pt. who had a laminectomy:

MC
• Back “precautions” for a post op laminectomy patient would include which appropriate
“bed” position:
– A. Bed position should be completely flat at all times
– B. HOB and FOB should be elevated 45⁰ at all times
– C. HOB should be flat or slightly elevated; may use a small pillow under knees prn
– D. Pt. must lie on left or right side at all times

T/F
• Pt./cgr./nurse must maintain a soft collar for cervical laminectomy ___
• For laminectomy pt., pt./cgr./nurse should ensure use of back brace as ordered ___

MR
• Maintaining good alignment post laminectomy includes:
– A. keeping back straight with movement
– B. avoid twists and turns when getting out of bed
– C. turn to side and lower legs to floor when getting out of bed
– D. use the overhead trapeze to swing out of bed

Other
• Amputations are performed for a number of reasons. List 3 reasons for performing an amputation:

MC
• One surgical technique used to treat a severed limb is called “replantation”. This refers to:
– A. using a cadaver limb and attaching it to the injured person
– B. using a healthy limb from an organ donor
– C. using the injured person’s own limb that has been kept sterile and in ice water in a plastic bag
– D. Using an artificial limb

MR
• Medical goals for managing a patient scheduled for amputation or presenting with an injury that included loss of limb would include:
– A. Measures to restore circulating blood volume
– B. Control pain
– C. Prevent wound infection
– D. Maintain adequate urinary output

Other (
.)
• List 4 items of subjective data that the nurse would obtain:

Other (
)
• List 3 items of objective data related to the affected extremity:

MC
• After surgical repair of an amputated lower extremity, one important nursing intervention would include:
– A. Ensuring sufficient visitors for moral support
– B. Coordinating with Physical Therapy
– C. Ensuring menu delivery daily
– D. Providing diversional activities

Other
• List 5 post op nursing interventions r/t amputation:

MC
• When a person experiences pain in the missing extremity as though it were still present, this is called:
– A. Nerve Track syndrome
– B. Phantom Limb pain
– C. Chronic recurrent neurovascular spasms
– D. Impulse message deficit

Other
• Why does phantom limb pain occur?

MC
• Nursing intervention related to phantom limb pain would be aimed at:
– A. Effective pain management
– B. Referral to staff psychologist
– C. Early ambulation and use of unaffected extremity
– D. Assisting pt. to adjust to a new normal

Complete
• __________ begins in physical therapy and
________ according to prosthesis situation.

Other
• Define “fracture” according to our text/lecture notes.

MR
• Identify which of the following is a type of fracture:
– A. open
– B. compound
– C. greenstick
– D. comminuted

Other
• List 6 clinical manifestations of a fracture:

MC
• Which is the most significant diagnostic test that can confirm fracture in most cases?
– A. Ultrasound
– B. Serum Calcium level
– C. Radiographic exam (xray)
– D. Palpation

Other
• List 6 interventions that a physician would do immediately once a fracture is confirmed:

MR
• For a person with a “closed” fracture, optimal reduction is obtained through:
– A. Open surgery
– B. manual manipulation (closed reduction – no surgery)
– C. Internal Fixation
– D. Traction

Other
• List 6 nursing interventions for a patient with a fracture:

Other
• List 6 items to be included in patient teaching for a patient with a fracture:

Identify the types of hip fractures:

MR
• Clinical manifestations of a hip fracture include:
– A. Severe pain at the site
– B. Inability to move the leg voluntarily
– C. Shortening and/or external rotation of the leg
– D. Sustained plantar flexion

Other
• Medical management of a hip fracture may include traction pre-operatively. Which traction is the most common one used for this purpose?
– A. skeletal traction
– B. Buck’s traction
– C. Crutchfield tongs
– D. Bryant’s traction

MR
• In preparing to repair Mrs. M’s fractured hip, the choice of fixation devise that the doctor will use depends on which 2 factors:
– A. How much mobility is hoped for post operatively for the patient
– B. The location of the fracture
– C. The potential for avascular necrosis of the femoral head and neck
– D. How much osteoporosis may be present

MR
• Before surgery, the nurse will be assessing
Mrs. M. regularly every 4 hrs. Two overriding goals will guide these assessments. These are:
– A. Preventing shock and further complications
– B. Pt. education re: ambulation post-op
– C. Maintaining proper alignment through traction and abduction of the hip when turning patient
– D. Maintaining balanced diet

Other
• Post operatively, what is the single most significant behavior to teach the patient to ensure success of the hip replacement surgery and reduce possibility of dislocation of the prosthesis?

Other
• When maintaining a patient in traction, the following should be monitored and enforced:
– Weights: ___________________
– Alignment: ________________
– Bed wheels: _______________

MC
• Mr. J. is being admitted to the hospital for a right knee arthroplasty. What will the doctor be doing?
– A. Visual exploration of the joint capsule
– B. Incision and drainage of the knee capsule
– C. Replacement of the knee joint
– D. Special physical therapy with CPM machine

MR
• Anticipated outcomes related to Knee
Arthroplasty include which of the following:
– A. restoration of motion
– B. relief of pain
– C. correction of deformity
– D. improvement of hip joint function

Other
• Post op Knee Arthroplasty nursing interventions include:
• List 6 interventions

Other
• What is “CPM”?
• Describe it’s functions and parameters.

Other
• Patient teaching for Knee Arthroplasty would include:

Other
• Post op teaching for Total Hip Arthroplasty would include:

Other
• Vertebral fractures can occur under what circumstances? List below:

MR
• Clinical manifestations of a person with a fractured vertebrae would include:
– A. Pain at the site of injury
– B. Partial or complete loss of mobility or sensation
– C. Radiographic evidence of fx. or fx. Dislocation
– D. disorientation

Other
• Along with radiographic studies, a doctor may perform a spinal tap on a person suspected of having a fractured vertebrae. What is the rationale for this?

Other
• Stable vertebral fractures would be treated conservatively by a physician. What would this include?

Other
• Treatment of unstable vertebral injuries would include:

MR
• Nursing interventions for a person with a vertebral fracture would include which of the following:
– A. log rolling for position changes
– B. neurovascular assessments
– C. using stabilization devices
– D. elevating the HOB no more than 30⁰

MR
• Patient teaching for a patient with a fractured vertebrae includes which of the following:
– A. Firm mattress
– B. Sitting straight in a firm chair, but for no more than 20-30 min. at a time
– C. Proper lifting technique
– D. Follow MD lifting restrictions
– E. Back exercises

Other
• What situations could be responsible for a fractured pelvis?

MR
• Clinical manifestations of a fracture in the pelvic area would include:
– A. inability to bear weight without discomfort
– B. pelvic tenderness and edema
– C. hematuria
– D. signs of shock/hemorrhage

Other
• List 4 diagnostic tests that can be done to determine the presence of a pelvic fracture:

Other
• Medical management is conservative unless s/sx of hemorrhage or damage to any abdominal organs are present. List 3 conservative measures:

Other
• Nursing interventions for clinical observation and assessment of a person with a diagnosis of pelvic fracture would include:
• List 7:

Other
• When working with a patient with a diagnosis of pelvic fracture, patient teaching is an important part of gaining patient cooperation and preparation for discharge. List 3 areas of information for patient teaching:

Other
• List 5 complications of fractures:
• Which is the most life-threatening complication?

MR
• Shock is due to:
– A. Blood loss
– B. Pain
– C. Fear
– D. External compression

Other
• Describe the clinical manifestations of shock:

Other
• How is the blood volume restored when a person is hemorrhaging?

Other
• Nursing responsibilities during treatment of shock would include:
• List 8 interventions

• Compartment syndrome is another complication of fractures. Within 4-6 hrs after onset, irreversible damage can be done to the area/limb involved.
• List 5 s/sx of compartment syndrome

Other
• Describe the process that occurs during compartment syndrome:

MR
• During a situation where the risk for compartment syndrome is high, nursing responsibilities and interventions include which of the following:
– A. Administration of analgesic and documentation of relief obtained or not
– B. ↑ affected limb to level of heart
– C. apply cold packs and remove constricting material
– D. Neurovascular checks frequently

MC
• A permanent contracture of the involved extremity can occur if compartment syndrome is not relieved soon enough. If it is in the upper extremity, the hand can contract and look like a claw. This is called:
– A. Trousseau’s sign
– B. Volkmann’s Contracture
– C. Brachial Plexus Deformity
– D. Atrophic spasm

MC
• When fat globules are released from the marrow of a broken bone, they enter the bloodstream and migrate to the lungs where they obstruct the blood flow. This is now a condition called:
– A. Thrombophlebitis
– B. Pulmonary Embolus
– C. Pulmonary edema
– D. Thoracic phlebitis

Other
• List 6 s/sx of a fat embolism:

Other
• Lab tests to confirm fat embolism include changes in the following tests. Indicate what the change is or what the test indicates:
– ABG’s :
– UA:
– H & H

Other
• List the treatments that may be used for fat embolism:

Other
• Describe the cause of gas gangrene and the process:

MC
• Among the clinical manifestations of gas gangrene, ‘crepitus’ may be present. This is:
– A. necrotic skin at the site of infection
– B. foul odor from the wound
– C. gas bubbles under the skin
– D. petichiae on the neck and chest

MR
• Because medical interventions would include establishing a larger wound to admit air and promote drainage, nursing interventions would include:
– A. strict aseptic technique with wound care
– B. autoclaving all contaminated equipment
– C. administration of antibiotics, analgesics
– D. excision of gangrenous tissue

MC
• When blood vessels are occluded by an embolus, the condition is known as:
– A. pulmonary embolus
– B. Phlebitis
– C. Thromboembolus
– D. Fat embolism

MR
• If the embolus travels to the lungs, which clinical manifestation(s) would the nurse expect to observe:
– A. tachypnea
– B. dyspnea
– C. sharp chest pain
– D. cough

Other
• Medical management to treat thromboembolus include anticoagulation therapy. Nursing interventions would include:
• List 7

MC
• A device that immobilizes fractures by the use of pins inserted through the bone and attached to a rigid external metal frame is called:
– A. Internal fixation device
– B. Traction
– C. Splint
– D. External fixation device

MR
• Nursing care for a patient with an external fixation device includes which of the following:
– A. pin site assessment and pin care
– B. maintain alignment
– C. frequent CMS checks
– D. pt. support and understanding

MC
• A cast or cast brace is an example of what kind of intervention to treat a fracture:
– A. traction
– B. external fixation device
– C. non-surgical intervention
– D. advanced orthopedic device

MC
• A cast is applied:
– A. after the MD has properly aligned the bone
– B. only during surgery
– C. Pre-operatively until swelling is reduced
– D. In conjunction with an internal fixation device

MR
• Nursing interventions and assessment related to a casted body part would include neurovascular checks. What actions would this assessment include?
– A. checking for the 7 P’s
– B. CMS checks
– C. Skin assessment – esp. at cast edges – skin care and cast petaling
– D. Coordination with PT for ambulation plan

MR
• When a cast is wet, it is especially important to handle it gently until dry. What actions would this include?
– A. Set up a blow dryer aimed at different parts of the cast to facilitate drying
– B. Elevate casted extremity on pillow x 24-48 hrs.
– C. Monitor and maintain shape and position of cast
– D. use the bar on a spica cast to turn the pt.

MC
• Infection prevention and early detection are crucial to healthy healing of the injured area.
What is an early sign of infection for someone with a casted body part?
– A. Foul odor
– B. Itching
– C. “Hot spot”
– D. Bulging of cast

MC
• An acute obstruction of the duodenum may occur in a patient with a hip-spica cast. The chief symptom is Nausea. This situation is called:
– A. third-spacing
– B. cast syndrome
– C. paralytic ileus
– D. gastric reflux

MC
• One nursing action to take if a patient shows signs of cast syndrome is:
– A. Give oxygen at 2 l/m immediately
– B. Give pain medication
– C. Encourage oral fluids
– D. Prone the patient and notify the charge nurse

T/F
• When a patient experiences itching (pruritis) inside the casted area, a well padded wood or wire device may be used to “scratch” the area.

MC
• A cast brace is an alternative appliance to traditional leg cast and is most effective for a fracture of the femur. The feature that provides for additional support and mobility is:
– A. Lighter weight plaster of Paris
– B. A hinge on the device
– C. Can be fit for a walker scooter
– D. Keeps swelling down

MC
• The process of putting an extremity, bone, or group of muscles under tension by means of weights and pulleys is called:
– A. traction
– B. cast brace
– C. casting
– D. pinning

Other
• List 5 functions of traction:

MC
• Which type of traction is applied directly to the bone with the use of wires or pins inserted distal to the fracture site?
– A. Crutchfield tongs
– B. Buck’s traction
– C. Russell’s traction
– D. Skeletal traction

MC
• Crutchfield traction and Halo vest-pins inserted into the skull on either side is used to:
– A. Reduce and immobilize clavicle fractures
– B. Reduce and immobilize fractures of the cervical and high thoracic vertebrae
– C. Reduce and immobilize fractures of the lower jaw
– D. Reduce and immobilize rib or sternal fx.

MR
• Skin traction differs from skeletal traction in that the weights pull on some type of padding attached to the skin below the site of the fracture. Which of the follow would be considered “skin traction”:
– A. Buck’s traction
– B. Russell’s traction
– C. Bryant’s traction
– D. External fixation device with weights

Other
• List 6 “important points” to remember when caring for a patient in tractions:

MR
• Complications of traction include which of the following:
– A. impaired circulation
– B. inadequate fracture alignment
– C. skin breakdown
– D. osteomyelitis

Other
• List 3 types of orthopedic devices related to beds and a brief description of each.

MR
• Along with casts, this device is used to secure the position of the body part being treated. It can immobilize an area without surgical intervention.
– A. crutches
– B. cane
– C. splint
– D. internal fixation

MC
• When using orthopedic devices for body part support, the most significant safety feature is:
– A. proper application and use of each device
– B. Handing a brochure re: the device to the patient to read when they get home
– C. Have the pt. watch a visual re: use of the device
– D. Give the pt. information re: who to call with follow up questions

MC
• Crutches increase mobility and assist with ambulation. The proper fit for a pair of crutches is:
– A. Pt. should be able to rest body weight comfortably on the top of the crutches
– B. Crutches should be placed 1 foot in front of pts. feet and 6 inches to each side for balance and movement
– C. Top of crutches should be 3 inches below the axilla to avoid pressure on the axilla and nerves
– D. Crutches can be placed wherever the pt. feels it is most comfortable

MC
• When crutch walking, weight should be put in/on:
– A. axilla
– B. unaffected extremity
– C. hand grips
– D. top of crutches

MC
• Hand grips should be adjusted so that the elbow is flexed no more than _____ when patient is standing in tripod position.
– A. 30 degrees
– B. 40 degrees
– C. 50 degrees
– D. 20 degrees

MR
• Walkers are used for support and balance. When instructing a patient in use of a walker, the nurse should remember which of the following to teach:
– A. Push or lift the walker forward (depending on style)
– B. Legs are brought up to the walker
– C. May move both feet forward at once with modified swing-gait move
– D. Encourage to lift head up and look forward not down at floor

MR
• When instructing a patient in the use of a cane, the nurse would teach the following:
– A. Place the cane on the unaffected side
– B. Advance the cane along with the affected side
– C. Look down at the floor or cane at all times
– D. one style of cane works for all clients

MC
• After joint replacement surgery, this machine helps prevent scar tissue formation and promotes flexibility. It is used at specific intervals with defined parameters for flexion/extension.
– A. Stryker rotation bed
– B. CPM machine
– C. ROM with pulleys and weights
– D. Circ-o-lectric bed