Fractures and Immobilization Techniques Practice Questions
20 free Fractures and Immobilization Techniques practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
A client is admitted to the emergency department with a suspected open fracture of the left tibia. Which nursing action is the priority?
- A Check the neurovascular status of the left foot.
- B Administer the prescribed opioid analgesic.
- C Cover the wound with a sterile, saline-soaked dressing.
- D Obtain a portable X-ray of the lower extremity.
Correct answer: Check the neurovascular status of the left foot.
Assessment of neurovascular status (pulses, sensation, movement, color, temperature) is the priority to ensure adequate perfusion and nerve function. While pain management and infection control are important, identifying potential circulatory or neurological compromise takes precedence.
A nurse is caring for a client with a fractured femur who was placed in Buck's traction 2 hours ago. The client reports increased pain and muscle spasms. Which action should the nurse take first?
- A Check the alignment of the weights and ropes.
- B Administer a muscle relaxant as prescribed.
- C Increase the weight of the traction by 2 lbs.
- D Reposition the client to the side-lying position.
Correct answer: Check the alignment of the weights and ropes.
If a client in traction experiences increased pain or spasms, the nurse should first ensure the equipment is functioning correctly. Weights should hang freely, and ropes should be in the pulleys to provide the correct pull for immobilization and spasm reduction.
Which assessment finding in a client with a newly applied plaster cast indicates a potential complication?
- A The cast feels warm during the first 24 hours after application.
- B Small, localized edema in the fingers after the cast is applied.
- C Paresthesia, a 'pins and needles' sensation, in the extremity.
- D The client reports mild itching under the edge of the cast.
Correct answer: Paresthesia, a 'pins and needles' sensation, in the extremity.
Paresthesia is an early sign of neurovascular compromise or compartment syndrome. While warmth is expected as plaster dries and mild edema is common with the initial injury, numbness or tingling requires immediate intervention.
A nurse is assessing a client for fat embolism syndrome (FES) following a multiple-trauma accident involving long bone fractures. Which finding is a classic manifestation of FES?
- A Petechiae over the chest and axilla.
- B Sudden onset of chest pain and hemoptysis.
- C Hyperactive bowel sounds and abdominal distension.
- D Bradycardia and hypertension.
Correct answer: Petechiae over the chest and axilla.
Petechiae on the chest, neck, and axilla are a hallmark sign of fat embolism syndrome, typically appearing 24 to 72 hours after injury. This occurs due to the occlusion of small dermal capillaries by fat globules.
The nurse is providing pin-site care for a client with an external fixator. Which observation would suggest a developing infection?
- A Serosanguinous drainage on the dressing.
- B Crusting around the pin insertion site.
- C Purulent drainage and localized warmth.
- D Mild redness around the pin for the first 48 hours.
Correct answer: Purulent drainage and localized warmth.
Purulent (pus-like) drainage, warmth, and increasing pain or swelling are signs of infection. Serosanguinous drainage and mild redness are common initially, but foul odors or yellow/green discharge indicate a need for medical review.
A client with a forearm fracture reports severe pain that is not relieved by the prescribed morphine. The nurse notes the fingers are swollen and painful during passive extension. What is the nurse's next action?
- A Notify the healthcare provider immediately.
- B Apply an ice pack and elevate the arm.
- C Administer an additional dose of pain medication.
- D Instruct the client to perform active range-of-motion exercises.
Correct answer: Notify the healthcare provider immediately.
Pain out of proportion to the injury and pain with passive stretching are hallmark early signs of compartment syndrome. This is a surgical emergency that requires immediate notification of the provider to prevent irreversible damage.
When teaching a client how to walk with crutches using a two-point gait, which instruction is correct?
- A Move the left crutch and right foot together, then the right crutch and left foot.
- B Move both crutches forward together, then swing both legs through at once.
- C Advance both crutches and the affected leg together, then move the unaffected leg forward.
- D Move the right crutch, then the left foot, then the left crutch, then the right foot, in sequence.
Correct answer: Move the left crutch and right foot together, then the right crutch and left foot.
A two-point gait involves moving the crutch and the opposite foot simultaneously. This gait requires at least partial weight-bearing on both legs and provides a more natural walking rhythm.
A client with a fractured hip is being prepared for surgery. The nurse notes the affected leg is shorter than the other and is externally rotated. How should the nurse interpret this?
- A This is a classic manifestation of a hip fracture.
- B The client is experiencing a fat embolism from the fracture.
- C The client has developed a deep vein thrombosis in the leg.
- D The fracture has spontaneously reduced on its own.
Correct answer: This is a classic manifestation of a hip fracture.
Classic signs of a hip fracture include shortening of the affected limb, external rotation, and severe pain in the groin or hip area. These findings result from the pull of the surrounding muscles on the fractured bone segments.
A nurse is caring for a client in skeletal traction. Which action is appropriate for maintaining the client's skin integrity?
- A Remove the traction weights for 10 minutes during every shift to reposition the client.
- B Ensure the client remains flat and supine at all times without turning.
- C Place a sheepskin or pressure-redistribution pad under the client's sacrum.
- D Vigorously massage the bony prominences of the affected limb each day.
Correct answer: Place a sheepskin or pressure-redistribution pad under the client's sacrum.
Clients in skeletal traction are at high risk for pressure ulcers because they are immobilized. Using pressure-redistribution surfaces is appropriate, but weights should never be removed without a specific order.
Which medication should the nurse anticipate administering to a client with a large-scale crush injury to prevent acute kidney injury?
- A Intravenous normal saline boluses.
- B Oral ibuprofen for pain relief.
- C Intravenous potassium chloride infusion.
- D Furosemide administered at a high dose.
Correct answer: Intravenous normal saline boluses.
Crush injuries release myoglobin from damaged muscles, which can clog renal tubules and lead to rhabdomyolysis. Aggressive fluid resuscitation with normal saline is essential to flush the kidneys and maintain urine output.
The nurse is instructing a client on how to use a cane for a left-sided leg weakness. Which statement indicates the client understands the instruction?
- A 'I will hold the cane in my left hand.'
- B 'I will hold the cane in my right hand.'
- C 'I will move the cane and my right leg together.'
- D 'I will keep the cane 15 inches in front of me while walking.'
Correct answer: 'I will hold the cane in my right hand.'
The cane should be held on the unaffected (strong) side to widen the base of support and reduce the load on the weak leg. It should be moved forward simultaneously with the affected (weak) leg.
A nurse is caring for a client with a newly applied fiberglass cast. Which advantage of fiberglass over plaster should the nurse explain?
- A Fiberglass is much heavier and provides better immobilization.
- B Fiberglass is waterproof and the padding never needs to stay dry.
- C Fiberglass casts reach full strength much faster than plaster.
- D Fiberglass is more adjustable if the limb continues to swell.
Correct answer: Fiberglass casts reach full strength much faster than plaster.
Fiberglass casts are lightweight and reach full weight-bearing strength within minutes (unlike plaster, which takes 24–72 hours). While the material is water-resistant, the internal padding should still be kept dry to protect the skin.
A client has a fractured pelvis following a motor vehicle accident. Which assessment is most important to perform in the first few hours?
- A Auscultate for bowel sounds.
- B Monitor for hematuria and urine output.
- C Assess for a petechial rash on the abdomen.
- D Check for a positive Homan's sign.
Correct answer: Monitor for hematuria and urine output.
Pelvic fractures carry a high risk of damage to the internal organs, specifically the bladder and urethra. Monitoring for blood in the urine and maintaining output is critical to detect urological trauma.
What is the primary purpose of a 'window' cut into a cast?
- A To allow for better air circulation and cooling.
- B To provide a space for scratching the skin if it itches.
- C To allow wound care or pulse checks under the cast.
- D To reduce the weight of the cast for the client.
Correct answer: To allow wound care or pulse checks under the cast.
Windowing a cast is done specifically to allow the nurse to assess a pulse or provide care to a wound or surgical incision that is covered by the cast material. The piece of cast removed should be saved to re-apply and prevent skin bulging.
A nurse is assessing a client with a fracture. Which 'P' of the 6 Ps represents the inability to move the extremity?
- A Pallor
- B Paresthesia
- C Paralysis
- D Poikilothermia
Correct answer: Paralysis
The 6 Ps of neurovascular assessment are Pain, Pallor, Pulselessness, Paresthesia, Paralysis (inability to move), and Poikilothermia (coolness). Paralysis is often a late sign of compartment syndrome.
A client is in the 'swing-to' gait with crutches. How should the nurse describe this movement?
- A The client advances both crutches and swings the legs forward to crutch level.
- B The client moves both crutches and then swings the legs past the level of the crutches.
- C The client moves one crutch and the opposite leg at the same time.
- D The client moves both crutches and one leg simultaneously.
Correct answer: The client advances both crutches and swings the legs forward to crutch level.
In a 'swing-to' gait, the client advances both crutches and then swings the body to the level of the crutches. In a 'swing-through' gait, the client swings the legs past the crutches.
The nurse is caring for a client with an impacted fracture. How should the nurse explain this type of break to the client?
- A The bone is broken into several fragments.
- B The bone is crushed or squeezed together.
- C One fragment of bone is driven into another.
- D The break occurs at an angle across the bone.
Correct answer: One fragment of bone is driven into another.
An impacted fracture occurs when the broken ends of the bone are forced into each other. This is common in falls from significant heights where the force is directed along the long axis of the bone.
A client with a long-leg cast reports a burning sensation over the bony prominence of the ankle. What is the nurse's best action?
- A Explain that this is a normal sensation as the bone heals.
- B Notify the provider and prepare to bivalve the cast.
- C Administer an anti-inflammatory medication.
- D Elevate the leg and apply heat to the area.
Correct answer: Notify the provider and prepare to bivalve the cast.
A burning sensation over a bony prominence is a major red flag for a pressure ulcer developing under the cast. The cast may need to be bivalved (cut in half) or windowed to inspect the skin.
Which instruction should the nurse include for a client discharged with a new arm cast?
- A 'You can use a knitting needle to scratch under the cast if it itches.'
- B 'Keep the casted arm in a dependent position to improve blood flow.'
- C 'Perform finger exercises every hour while you are awake to reduce swelling.'
- D 'If the cast gets wet, use a hair dryer on the highest heat setting to dry it.'
Correct answer: 'Perform finger exercises every hour while you are awake to reduce swelling.'
Active movement of the fingers helps reduce edema and maintain circulation. Clients should never insert objects into the cast, and heat from a hair dryer can cause skin burns.
The nurse is caring for a client with a Colles' fracture. Where should the nurse expect the client to have pain?
- A The ankle
- B The wrist
- C The hip
- D The shoulder
Correct answer: The wrist
A Colles' fracture is a fracture of the distal radius at the wrist, often caused by reaching out to break a fall. It typically results in a characteristic 'dinner fork' deformity of the wrist.