The Client with Hip Fracture

1. Which of the following would the nurse assess in a client with an intracapsular hip
fracture?
a. Internal rotation
b. Muscle flaccidity
c. Shortening of affected leg
d. Absence of pain in the fracture area
2. When developing the plan of care for an older adult client with a hip fracture, which
of the following chronic health problems would the nurse be least likely to assess in
the client?
a. Hypertension
b. Cardiac decompression
c. Pulmonary disease
d. Multiple sclerosis
3. When teaching a client with an extracapsular hip fracture scheduled for surgical
internal fixation with the insertion of a pin, the nurse bases the teaching on the
understanding that this surgical repair is the treatment of choice for which of the
following reasons?
a. Hemorrhage at the fracture site is prevented
b. Neurovascular impairment risk is decreased
c. The risk for infection at the site is lessened
d. The client is able to be mobilized sooner
4. A client with an extracapsular hip fracture returns to the nursing unit after internal
fixation and pin insertion with a drainage tube at the incision site. Her husband asks,
“why does she have this tube inserted in her hip?” Which of the following responses
by the nurse demonstrates understanding of the primary purpose for this drainage
tube?
a. “The tube helps us to detect a wound infection early on.”
b. “This way we won’t have to irrigate the wound.”
c. “Fluid won’t be allowed to accumulate at the site.”
d. “We have a way to administer antibiotics into the wound.”
5. When assessing a client who has just received a femoral head prosthesis, which of
the following would alert the nurse to the possibility of neurologic impairment in the
affected extremity?
a. Decreased distal pulse
b. Inability to move
c. Diminished capillary refill
d. Coolness to the touch
6. A client with a hip fracture has undergone surgery for insertion of a femoral head
prosthesis. Which of the following activities would the nurse instruct the client to
avoid?
a. Crossing the legs while sitting down
b. Sitting on a raised commode seat
c. Using an abductor splint while lying on the side
d. Rising straight from a chair to a standing position
7. The nurse encourages the client who has had a femoral head prosthesis placement to
use which of the following types of chairs to sit in during the first 6 to 8 weeks after
surgery?
a. A desk-type swivel chair
b. A padded upholstered chair
c. A high-backed chair with armrest
d. A recliner with an attached footrest
8. While assessing the home environment of an elderly client who is using crutches
during the post-operative recovery phase after hip pinning, which of the following
would pose the greatest hazard to the client as a risk for falling at home?
a. A 4-year old cocker spaniel
b. Scatter rugs
c. Snack tables
 d. Rocking chairs

Answers:
1. C. with an intracapsular hip fracture, the affected leg is shorter than the unaffected
leg because of the muscle spasms and external rotation. The client also experiences
severe pain in the region of the fracture.
2. D. multiple sclerosis would be the least likely chronic health problem for an older
adult with a hip fracture. Typically, multiple sclerosis is considered a severe crippling
disorder of young adults. Hypertension is a common chronic health problem in older
adults. Cardiac decompensation is common in older adults; it arises from cardiac
musculature changes and age-related changes in the heart. This comorbid condition
an complicate the treatment and care when the older adult experiences a hip
fracture. Pulmonary disease commonly arises from age-related changes in the
respiratory system. These comorbid conditions can complicate the treatment and care
when the older adult experiences a hip fracture.
3. D. insertion of a pin for the internal fixation of a extracapsular fractured hip provides
good fixation of the fracture. The fracture site is stabilized and fractured bone ends
are well approximated. As a result, the client is able to be mobilized sooner, thus
reducing the risks of complications related to immobility. Internal fixation with a pin
insertion does not prevent hemorrhage or decrease the risk for neurovascular
impairment, potential complications associated with any joint or bone surgery. It does
not lessen the client’s risk for infection at the site.
4. C. The primary purpose of the drainage tube is to prevent fluid accumulation in the
wound. Fluid when it accumulates creates dead space. Elimination of the dead space
by keeping the wound free of fluid greatly enhances wound healing and helps prevent
abscess formation. Although the characteristics of the drainage from the tube, such as
a change in color or appearance, may suggest a possible infection, this is not the
tube’s primary purpose. The drainage tube does not eliminate the need for wound
irrigation or provide a way to instill antibiotics into the wound.
5. B. Being unable to move the affected leg suggests neurologic impairment. A decrease
in the distal pulse, diminished capillary refill, and coolness to touch of the affected
extremity suggests vascular compromise.
6. A. Any activity or position that causes flexion, adduction, or internal rotation of greater
than 90 degrees should be avoided until the soft tissue surrounding the prosthesis has
stabilized, at approximately 6 weeks. Crossing the feet while sitting down can lead to
dislocation of the femoral head from the hip socket. Sitting on a raised commode seat
prevents hip flexion and adduction. Using an abductor splint while side-lying keeps
the hip joint in abduction, thus preventing adduction and possible dislocation. Rising
straight from a chair to a standing position is acceptable for this client because this
action avoids hip flexion, adduction, and internal rotation of greater than 90 degrees.
7. C. A high-backed straight chair with armrests is recommended to help keep the
client in the best possible alignment after surgery for a femoral head prosthesis
placement. Use of this type of chair helps to prevent dislocation of the prosthesis
from the socket. A desk-type swivel chair, padded upholstered chair, or recliner should
be avoided because it does not provide for good body alignment and can cause the
overly flexed femoral head to dislocate.
8. B. Although pets and furniture such as snack tables and rocking chairs may pose a
problem, scatter rugs are the single greatest hazard in the home, especially for
elderly people who are unsure and unsteady with walking. Falls have been found to
account for almost half the accidental deaths that occur in the home. The risk for falls
is further compounded by the client’s need for crutches.
1. A client is treated in the emergency department for acute muscle strain in the left
leg caused by trying a new exercise. During discharge preparation, the nurse should
provide which instruction?
a. Apply ice packs for the first 12 to 18 hours
b. Apply heat packs for the first 24-48 hours
c. Apply ice packs for the first 24 to 48 hours, then apply heat packs
d. Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours
C. The nurse should instruct the client to apply ice packs to the injured area for the first
24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote
reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours
may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would
worsen, not ease swelling. Applying ice 48 hours after the injury would be less effective
because swelling already has occurred by that time.

2. The nurse is caring for a client who recently underwent a total hip replacement. The
nurse should
a. Ease the client onto a low toilet seat
b. Allow the client’s legs to be crossed at the knees when out of bed
c. Use soft chair when the client is sitting out of bed
d. Limit client hip flexion when sitting
D. Instruct the client to limit hip flexion to 90 degrees while sitting. Supply an elevated
toilet seat so that the client can sit without having to flex his hip more than 90 degrees.
Instruct the client not to cross his legs to avoid dislodging or dislocating the prosthesis.
Caution the client against sitting in chairs that are too low or too soft, these chairs
increase flexion, which is undesirable.

3. A client is admitted to an acute care facility with osteomyelitis. Which organism

usually causes this infection?
a. Eschericial coli
b. Klebsiella
c. Pseudomonas
d. Staphylococcus aureus
D. S. Aureus is the most common cause of osteomyelitis. Less often E. coli, Klebsiella or
Pseudomonas is the causative organism. Proteus and Salmonella are relatively rare
causes. In a few cases osteomyelitis results from a viral or fungal infection.

4. Which of the following nursing interventions is essential in caring for a client with
compartment syndrome?
a. Keeping the affected extremity below the level of the heart
b. Wrapping the affected extremity with a compression dressing to help decrease the
swelling
c. Removing all external sources of pressure, such as clothing and jewelry
d. Starting an I.V. line in the affected extremity in anticipation of venogram studies
C. Nursing measures should include removing all clothing, jewelry, and external forms of
pressure (such as dressings or casts) to prevent constriction and additional tissue
compromise. The extremity should be maintained at the heart level (further elevation
may increase circulatory compromise, whereas a dependent position may increase
edema). A compression wrap, which increases tissue pressure, could further damage the
affected extremity. There is no indication that diagnostic studies would require I.V. access
in the affected extremity.
5. The nurse is caring for a client with lower back pain who is scheduled for
myelography using metrizamide (a water-soluble contrast dye). After the test, the
nurse should place the client in which position?
a. Head of the bed elevated 45 degrees
b. Prone
c. Supine with feet raised
d. Supine with the head lower than the trunk
A. After a myelogram, positioning will depend on the dye injected. When a water
soluble dye such as metrizamide is injected, the head of the bed is elevated to a
45-degree angle to slow the upward dispersion of the dye. The other positions are
contraindicated when a water soluble contrast dye is used. If an air-contrast study
were performed, the client should be positioned supine with the head lower than
the trunk.
6. X rays reveal a leg fracture in a client who was brought to the emergency
department after falling on ice. After a cast is applied and allowed to dry, the nurse
teaches the client how to use the crutches. Which instruction should the nurse provide
about climbing stairs?
a. Place both crutches on the first step and swing both legs upward to this step
b. Place the unaffected leg on the first step, followed by the crutches and the injured
leg, which should move together.
c. Place the crutches and injured leg on the first step, followed by the unaffected leg
d. Place the injured leg and the crutch on the unaffected side on the first step, the
unaffected leg and crutch on the injured side follows.
B. When climbing stairs with crutches, the client should lead with the unaffected leg,
followed by the crutches and injured leg moving together. Any other method is
incorrect and could increase the client’s risk of falling.
7. A client is brought to the emergency department after injuring the right arm in a
bicycle accident. The orthopedic surgeon tells the nurse that the client has a
greenstick fracture of the arm. What does that mean?
a. The fracture line extends through the entire bone substance
b. The fracture results from an underlying bone disorder
c. Bone fragments are separated at the fracture line
d. One side of the bone is broken and the other side is bent
D- In a greenstick fracture, one side of the bone is broken and the other side is
bent. A greenstick fracture also may refer to an incomplete fracture in which the fracture
line extends only partially through the bone substance and doesn’t disrupt bone
continuity completely. Other terms for greenstick fracture are willow fracture and hickory
stick fracture. The fracture line extends through the entire bone substance in a complete
fracture. A facture that results from an underlying bone disorder such as osteoporosis or
a tumor, is a pathologic fracture, which typically occurs with minimal trauma. Bone
fragments are separated at the fracture line in a displaced fracture.

8. The nurse is teaching a client with a long leg cast how to use crutches properly while
descending a staircase. The nurse should tell the client to:
a. Advance both legs first
b. Advance the unaffected leg first
c. Advance the affected leg first
d. Advance both crutches first
D – To walk down a flight of stairs, body weight is first transferred to the unaffected leg.
Both crutches are then advanced to the stair below. Body weight is transferred to the
crutches as the affected leg descends. The unaffected leg is then brought down to the
next step so that both legs and crutches are all on the same step. The procedure is
repeated for each step.

9. After surgery to treat a hip fracture, a client returns from the post anesthesia care
unit to the medical surgical unit. Post-operatively, how should the nurse position the
client?
a. With the affected hip flexed acutely
 b. With the leg on the affected side abducted
c. With the leg on the affected side adducted
d. With the affected hip rotated externally
B- The nurse must keep the leg on the affected side abducted at all times after
hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or
an A-frame between the legs helps maintain abduction and reminds the client not to
cross the legs. The nurse should avoid acutely flexing the client’s affected side (such as
by moving it toward the midline), or externally rotating the affected hip (such as by
removing support along the outer side of the leg) because these positions may cause
dislocation of the injured hip joint.

10. The nurse is caring for a client who underwent a total hip replacement. What should
the nurse and other caregivers do to prevent dislocation of the new prosthesis?
a. Keep the affected leg in a position of adduction
b. Use measures other than turning to prevent pressure ulcers
c. Prevent internal rotation of the affected leg
d. Keep the hip flexed by placing pillows under the client’s knee
C. External rotation and abduction of the hip will help prevent dislocation of a new
hip joint. Internal rotation and adduction should be avoided. Post-operative total
hip replacement clients may be turned onto the unaffected side. While the hip may
be flexed slightly. It shouldn’t exceed 90 degrees and maintenance of flexion isn’t
necessary

11. An x-ray of the left femur shows a fracture that extends through the midshaft of the
bone and multiple splintering fragments. What is this type of fracture called?
a. Compression fracture
b. Greenstick fracture
c. Comminuted fracture
d. Impacted fracture
C – a comminuted fracture typically is transverse at the shaft of the bone and has
multiple splintered bone fragments. A closed fracture implies that the skin integrity at or
near the point of fracture is intact. A greenstick fracture occurs when the bone buckles
or bends and the fracture line doesn’t extend through the entire bone. An impacted
fracture occurs when the distal and proximal portions of the fracture are wedged into
each other. A compression fracture occurs when a severe force presses the bone
together on itself.

12. A client is hospitalized for open reduction of a fractured femur. During post-operative
assessment, the nurse monitors for signs and symptoms of fat embolism, which
include:
a. Pallor and coolness of the affected leg
b. Nausea and vomiting after eating
c. Hypothermia and bradycardia
d. Restlessness and petechiae
D- signs and symptoms of fat embolism include restlessness, petechiae, and an altered
mental status. Pallor and coolness of the affected leg are associated with a clot in the
leg, not fat embolism. Nausea and vomiting after eating may be related to gastric
obstruction. Hypothermia isn’t an expected result of an open reduction of a fracture.
Bradycaria has no relation to fat emboli but may indicate a cardiac problem.

13. A client is in a Buck’s skin traction after fracturing the right hip. The nurse should
include which action in the plan of care?
a. Removing the weights once every shift
b. Maintaining the bed in a knee gatch position
c. Keeping the client in semi-fowler’s position
d. Maintaining correct body alignment
D – Buck’s traction produces realignment by exerting a pulling force on the fracture
hip. Therefore, the nurse must maintain correct body alignment. Traction should be
 continuous; if the weights must be removed, the nurse should apply manual traction
until the weights are replaced. The knee-gatch position shouldn’t be used because it
disrupts the constant pulling force needed for alignment. Semi-Fowler’s position would
cause the client to slide in the direction of the traction, defeating the purpose of
traction.

14. A client has a fiberglass cast on the right arm. Which action should the nurse include
in the plan of care?
a. Keeping the casted arm warm by covering it with a light blanket
b. Avoiding handling the cast for 24 hours or until it is dry
c. Evaluating the pedal and posterior tibial pulses every 2 hours
d. Assessing movement and sensation in the fingers of the right hand
D – The nurse should assess a casted arm every 2 hours for finger movement and
sensation to make sure the cast isn’t restricting circulation. To reduce the risk of skin
breakdown, the nurse should leave a casted arm uncovered, which allows air to
circulate through the cast pores to the skin below. Unlike a plaster cast, a Fiberglass
cast dries quickly and can be handled without damage soon after application. The
nurse should assess the brachial and radial pulses distal to the cast – not pedal and
posterior tibial pulses, which are found in the legs.
15. To assess the joints, the nurse asks a client to perform various movements. As the
client moves the arm away from the midline, the nurse evaluates the ability to
perform:
a. Protraction
b. Retraction
c. Adduction
d. Abduction
D – A client performs abduction when moving a body part away from the midline.
Protraction refers to drawing out or lengthening of a body part. Retraction, the opposite of
protraction, refers to drawing back or shortening of a body part. Adduction, the opposite of
abduction, is movement of a body part toward the midline.

The Client with Hip Fracture

1. Three hours ago, a client was thrown from a car into a ditch, and he is now admitted
to the emergency department in a stable condition with vital signs within normal
limits, alert and oriented with good coloring and an open fracture of the right tibia.
When assessing the client, the nurse would be especially alert for signs and
symptoms of which of the following?
a. Hemorrhage
b. Infection
c. Deformity
d. Shock
2. The client with a fractured tibia has been taking methocarbamol (Robaxin). When
teaching the client about this drug, which of the following would the nurse include as
the drug’s primary effect?
a. Killing of microorganisms
b. Reduction in itching
c. Relief of muscle spasms
d. Decrease in nervousness
3. A client who has been taking caripsoprodol (Soma) at home for a fractured arm is
admitted with a blood pressure of 80/50 mgHg, a pulse rate of 115 bpm, and
respirations of 8 breaths/min and shallow. The nurse interprets these findings as
indicating which of the following?
a. Expected common side effects
b. Hypersensitivity reaction
c. Possible habituating effect
d. Hemorrhage from gastrointestinal irritation
 4. When admitting a client with a fractured extremity, the nurse would focus the
assessment on which of the following first?
a. The area proximal to the fracture
b. The actual fracture site
c. The area distal to the fracture
d. The opposite extremity for baseline comparison
5. Regardless of the type of cast material used, the nurse identifies a knowledge deficit
when the client makes which of the following statements about the care of his cast?
a. I’ll elevate the cast above my heart initially
b. I’ll exercise my joints above and below the cast
c. I can pull out cast padding to scratch inside the cast
d. I’ll apply ice for 10 minutes to control edema for the first 24 hours
6. Which of the following interventions would be least appropriate for a client who is in
a double hip spica cast?
a. Encouraging the intake of cranberry juice
b. Advising the client to eat large amounts of cheese
c. Establishing regular times for elimination
d. Having the client dangle at the bedside
7. When preparing the teaching plan for a client about crutch walking using a two-point
gait pattern, which of the following would the nurse include?
a. Advance a crutch on one side and then advance the opposite foot; repeat on the
opposite side
b. Advance a crutch on one side and simultaneously advance and bear weight on the
opposite foot; repeat on the opposite side
c. Advance both crutches together and then follow by lifting both lower extremities to
the level of the crutches
d. Advance both crutches together and then follow by lifting both lower extremities
past the level of the crutches
8. The client returns from surgery after debridement of an open fracture of the tibia. The
wound was left open, and a three-way drainage system was left in place. Which of
the following would the nurse expect to assess?
a. Results of culture and sensitivity testing of the wound
b. Presence of a pressure dressing over the wound
c. Complaints of increased pain from exposed nerve endings
d. Hypotension resulting from additional vessel bleeding
9. A client who crashed her motorcycle suffered a tibial fracture that required casting.
Approximately 5 hours later, the client begins to complain of increasing pain distal to
the left tibial fracture despite the morphine injection administered 30 minutes
previously. The nurse’s next action should be to assess for which of the following?
a. Presence of a distal pulse
b. Pain with a pain rating scale
c. Vital sign changes
d. Potential for drug tolerance
10. A client with a fracture develops compartment syndrome. When caring for the client,
the nurse would be alert for which of the following signs of possible organ failure?
a. Rales
b. Jaundice
c. Generalized edema
d. Dark, scanty, urine

Answers:
1. B. because of the degree of contamination of the open fracture and the time that has
passed since the accident, the risk for infection is very high. Therefore, the nurse
would be especially alert for signs and symptoms of possible existing infection or
early signs of infection, such as debris in the wound site, temperature abnormalities,
results of laboratory studies such as complete blood count and would culture and
sensitivities, or heat or redness around or in the wound. Because the client’s vital
signs and cdardiovascular status are stable at this time, hemorrhage is not the
 primary concern. The client is talking coherently at this point, so his mentation does
not suggest that he is in shock. However, assessment for signs and symptoms of
hemorrhage and shock would certainly be ongoing. The fracture would be corrected
by surgery as soon as possible, thereby minimizing the risk for deformity.
2. C. Methocarbamol (Robaxin) is a muscle relaxant and acts primarily to relieve muscle
spasms. It has no effect on microorganisms, does not reduce itching, and has no
effect on decreasing nervousness.
3. C. Hypotension, tachycardia, and depressed respirations are signs of high levels of
ingestion of muscle relaxants, and the client may be developing a habit of taking this
drug for a prolonged period. The potential for abuse should be considered when large
doses of a muscle relaxant such as Soma are taken for prolonged periods. Expected
common side effects would include drowsiness, fatigue, lassitude, blurred vision,
headache, ataxia, weakness, and gastrointestinal (GI) upset. Hemorrhage from GI
irritation is not associated with this drug. Hypersensitivity reactions would be
manifested by pruritus and skin rashes.
4. C. The nursing assessment is first focused on the region distal to the fracture for
neurovascular injury or compromise. When a nerve or blood vessel is severed or
obstructed at the actual fracture site, innervations to the nerve or blood flow to the
vessel is disrupted below the site, therefore, the area distal to the fracture site is the
area of compromised neurologic input or vascular flow and return, not the area above
the fracture site or the fracture site itself. The nurse may assess the opposite
extremity at the area proximal to the fracture site for a baseline comparison of pulse
quality, color, temperature, size and so on, but the comparison would be made after
the initial neurovascular assessment.
5. C. Clients should not pull out cast padding to scratch inside the cast because of the
hazard of skin breakdown and subsequent potential for infection. Clients are
encouraged to elevate the casted extremity above the level of the heart to reduce
edema and to exercise or move the joints above and below the cast to promote and
maintain flexibility and muscle strength. Applying ice for 10 minutes during the first 24
hours helps to reduce edema.
6. B. The client in a double hip spica cast should avoid eating foods that can be
constipating, such as cheese. Rather, fresh fruits and vegetable should be encouraged
and the client should be encouraged to drink at least 2500 ml/day. Drinking cranberry
juice or foods high in ascorbic acid, which helps to keep urine acidic and thereby
avoids the development of renal calculi, is encouraged. The client should be
encouraged to establish regular times for elimination to promote regularity in bowel
and bladder habits. The client will develop orthostatic hypotension unless the
circulatory system is reconditioned slowly through dangling and standing exercises.
7. B. A 2-point gain involves partial weight bearing on each foot, with each crutch
advancing simultaneously with the opposing leg.
8. A. The wound was left open with a 3-way drainage system in place to irrigate the
debrided wound with normal saline or an antibiotic. Before the debridement, a sample
of the wound would be taken for culture and sensitivity testing so that an organism-
specific antibiotic could be administered to prevent possible serious sequelae of
osteomyelitis. Therefore, the nurse would assess the results of the culture and
sensitivity report. A pressure dressing would not be applied to an open wound. Rather,
a wet-to-dry dressing most likely would be used. There should not be increased pain
related to the exposure of nerve endings in the subcutaneous tissue of the wound
that was left open to the environment. The bleeding of vessels should be controlled
as it would have been if the wound had been closed. Therefore, additional vessel
bleeding should not be a problem.
9. A. The nurse should assess the client’s ability to move her toes and for the presence
of distal pulses, including a neurovascular assessment of the area below the cast.
Increasing pain unrelieved by usual analgesics and occurring 4 to 12 hours after the
onset of casing or trauma may be the first sign of compartment syndrome, which can
lead to permanent damage to nerves and muscles. Although the nurse can use a pain
rating scale or assess for changes in vital signs the objectively assess the client’s
pain, the client’s complaints suggest early and important signs of compartment
 syndrome requiring immediate intervention. The nurse should not confuse these signs
with the potential for drug tolerance. This assessment might be appropriate once the
suspicion of compartment syndrome has been ruled out.
10. D. The client with compartment syndrome may release myoglobin from damaged
muscle cell into the circulation. This becomes trapped in the renal tubules, resulting in
dark, scanty urine, possibly leading to acute renal failure. Rales may suggest
respiratory complications, jaundice suggests liver failure; and generalized edema may
suggest heart failure. However, these are not associated with compartment syndrome.

The Client with a Femoral Fracture

1. After determining that a client with a fractured right femur has not had any
immunizations since childhood, which of the following biologic products would the
nurse administer to provide the client with passive immunity for tetanus?
a. Tetanus toxoid
b. Tetanus antigen
c. Tetanus vaccine
d. Tetanus antitoxin
2. After teaching the client with a femoral fracture about treatment with skeletal traction,
which of the following, if stated by the client as a purpose, would indicate the need
for additional teaching?
a. To align injured bones
b. To provide long-term pull
c. To apply 25 pounds of traction
d. To pull weight with a boot
3. The nurse is planning care for the client with a femoral fracture who is in balanced
suspension traction. Which of the following would the nurse be least likely to include
in the plan of care?
a. Use of fracture bedpan
b. Checks for redness over the ischial tuberosity
c. Elevation of the head of bed no more than 25 degrees
d. Personal hygiene with a complete bed bath
4. Which of the following nursing assessments for a client in balanced suspension
traction using a half-ring Thomas splint with a Pearson attachment that suspends the
lower extremity and applies direct skeletal traction for a hip fracture would be
inappropriate?
a. Greater trochanter skin checks
b. Pin site inspection
c. Neurovascular checks proximal to the splint
d. Foot movement evaluation
5. The client in balanced suspension traction is transported to surgery for closed
reduction and internal fixation of his fractured femur. When transporting the client to
the operating room, which of the following would the nurse do?
a. Transfer the client to a cart with manually suspended traction
b. Call the surgeon to request an order for temporarily removing the traction
c. Send the client on his bed with extra help to stabilize the traction
d. Remove the traction and send the client on a cart
6. When caring for the client with a Pearson attachment on the traction setup, the nurse
understand that the purpose of this attachment is to accomplish which of the
following?
a. Support the lower portion of the leg
b. Support the thigh and upper leg
c. Allow attachment of the skeletal pin
d. Prevent flexion deformities in the ankle and foot
7. Which of the following would lead the nurse to suspect that a client with a fracture of
the right femur may be developing a fat embolus?
a. Acute respiratory distress syndrome
b. Migraine-like headaches
c. Numbness in the right leg
d. Muscle spasms in the right thigh
8. The client with a fracture femur is upset and agitated about her injury and its
treatment. She says, “How can I stay like this for weeks? I can’t even move!” Based
on these data, the nurse would identify which of the following as the most
appropriate nursing diagnosis?
a. Impaired physical mobility related to traction
b. Ineffective coping related to prolonged immobility
c. Deficient diversional activity related to prolonged hospitalization
d. Acitivity intolerance related to impaired mobility
9. The client asks the nurse what his activity limitations are while he is in Buck’s
traction. Which of the following responses by the nurse would be most appropriate?
a. You can sit up whenever you want
b. You must lie flat on your back most of the time
c. You can turn you body
d. You must lie on your stomach
10. Because a client has a Thomas splint, the nurse would need to assess the client
regularly for which of the following?
a. Signs of skin pressure in the groin area
b. Evidence of decreased breath sounds
c. Skin breakdown behind the heel
d. Urinary retention
11. The client has a nursing diagnosis of Self-Care Deficit Level II related to the
confinement of traction. Which of the following would indicate a successful outcome
for this diagnosis?
 a. The client assists as much as possible in his care, demonstrating increased
participation over time
b. The client allows the nurse to complete his care in an efficient manner without
interfering
c. The client allows his wife to assume total responsibility for his care
d. The client allows his wife to complete his care to promote feelings of usefulness
12. The client who had an open femoral fracture was discharged to her home, where she
developed fever, night sweats, chills, restlessness, and restrictive movement of the
fracture leg. The nurse interprets these findings as indicating which of the following?
a. Pulmonary emboli
b. Osteomyelitis
c. Fat emboli
d. Urinary tract infection
13. When antibiotics are not producing the desired outcome for a client with
osteomyelitis, the nurse interprets this as suggesting the occurrence of which of the
following as most likely?
a. Formation of scar tissue interfering with absorption
b. Development of pus leading to ischemia
c. Production of bacterial growth by avascular tissue
d. Antibiotics’ not being instilled directly into the bone

Answers:
1. D. Passive immunity for tetanus is provided in the form of tetanus antitoxin or tetanus
immune globlulin. An antitoxin is an antibody of the toxin of an organism.
Administering tetanus toxoid, antigen, or vaccine would provide active immunity by
stimulating the body to produce its own antibodies.
2. D. Skeletal traction is not used to pull weight with a boot. Skeletal traction involves
the insertion of a wire or a pin into the bone to maintain a pull of 5 to 45 pounds on
the area, promoting proper alignment of the fractured bones over a long term.
3. D. The client with a femoral fracture in balanced suspension traction should not be
given a complete bed bath. Rather, the client is encouraged to participate in self-care
and movement in bed, such as with a trapeze triangle. Use of a fracture bedpan is
appropriate. A fraction bedpan is lower, and it is easier for the client to move on and
off the bedpan without altering the line of traction. Checking for areas of redness or
pressure over all areas in contact with the traction or bed, including the ischial
tuberosity, is important to prevent possible skin breakdown. The client should be
positioned so that the feet do not press against the footboard. Therefore, elevating
the head of the bed no more than 25 degrees is recommended to keep the client
from moving down in the bed.
4. C. Neurovascular checks should be performed distal or past the site of the splint, not
proximal or above the site of the splint, at least @ 4 hours. An injury or compromise
to the peripheral nervous innervations or blood flow will reflect a change on the site
of the splint after the pathway from the heart and brain. Checking the skin over the
greater trochanter is appropriate because the half-ring of the Thompson splint can
slide around the greater trochanter area where the traction is applied; it should be
checked routinely along with other areas at high risk for pressure necrosis, such as
the fibial head, ischial tuberosity, malleoli, and hamstring tendons. Inspecting the pin
site is appropriate because any drainage or redness might indicate an infection in the
bone in which the pin is inserted. Immediate treatment is imperative to avoid
osteomyelitis and possible loss of the limb. Evaluation of the foot for movement is
important to obtain neuromuscular-vascular data for assessment in comparison with
the baseline data of the affected extremity and with the opposite extremity to detect
any compromise of the client’s condition.
5. C. The nurse should send the client to the operating room on his bed with extra help
to keep the traction from moving to maintain the femur in the proper alignment
before surgery. Transferring the client to a cart with manually suspended traction is
inappropriate because doing so places the client at risk for additional trauma to the
 surrounding neurovascular and soft tissues, as would removing the traction. The
surgeon need not be called, because the decision about transferring the client is an
independent nursing action.
6. A. The Pearson attachment supports the lower leg and provides increased stability in
the overall traction setup. It also makes it easier to maintain correct alignment. It
does not support the thigh and upper leg or prevent flexion deformities in the ankle
and foot. It is not attached to the skeletal pin.
7. A. Fat emboli usually result in symptoms of acute respiratory distress syndrome, such
as apprehension, chest pain, cyanosis, dyspnea, tachypnea, tachycardia, and decreased
partial pressure of arterial oxygen resulting from poor oxygen exchange. Migraine-like
headaches are not a symptom of a fat embolism, but mental confusion, memory loss,
and a headache from poor exchange may be seen with central nervous system
involvement. Numbness in the right leg is a peripheral neurovascular response that
most likely is related to the femoral fracture. Muscle spasms in the right thigh are a
symptom of a neuromuscular response affecting the local muscle around the femoral
fracture site.
8. B. Based on the client’s statements, ineffective coping is the most appropriate nursing
diagnosis, because the client is voicing frustration about the current situation and her
inability to move. The nurse should seek ways to help the client adjust to and cope
with her present state of immobility. Emphasis should be placed on what the client
can do to care for herself, such as participating in her daily care and exercises to
maintain muscle strength, to help her maintain some control over her situation.
9. A. The client can sit up in bed, remaining in supine position so that an even,
sustained amount of traction is maintained under the bandage used in the Buck’s
traction. Maintenance of even, sustained traction strap might slip and cause
compression or stress on the nerves or vascular tracts, resulting in permanent
damage. The client does not have to remain flat but ay adjust the head of the bed to
varying degrees of elevation which remaining in the supine position. The client should
not turn his body to another position, because the bandage may slip.
10. A. The nurse should assess for signs of skin pressure in the groin area because the
Thomas splint, which is a half ring that slips over the thigh and suspends the lower
extremity in direct skeletal traction, may cause discomfort, pressure, or skin irritation
in the groin. The nurse always assesses respirations as part of routine vital signs, but
assessing for evidence of decreased breath sounds is not a routine assessment
related directly to the Thomas splint. The head of the bed can be elevate to facilitate
breathing, but not more than 25 degrees to avoid continually moving the client toward
the foot of the bed from the weight of the traction. The nurse always assesses for
pressure areas on dependent parts, but assessing for skin breakdown behind the heel
is not a routine assessment related directly to the Thomas splint in which the heel is
free of any contact with padding or metal parts of the Pearson attachment for the
balanced suspension traction. The client who is in a Thomas splint is able to use a
bedpan, especially the fracture bedpan for a female client and the urinal for a male
to urinate. Urinary incontinence should not be a special assessment directly related to
the Thomas splint, but it may be a client-specific assessment.
11. A. The client’s assisting as much as possible in his care and increasing participation
over time indicate that the client has accomplished self-care by gaining a sense of
control. If the client lets the nurse complete his care without interfering, his behavior
would indicate passivity, possible from denial or depression. If the client allows his
wife to assume total responsibility for his care or to complete his care, he still has a
self-care deficit and a successful outcome has not been reached.
12. B. Fever, night sweats, chills, restlessness, and restrictive movement of the fractured
leg are clinical manifestations of osteomyelitis, which is a pyogenic bone infection
caused by bacteria, usually staphylococcus, a virus or a fungus. The bone is
inaccessible to macrophages and antibodies for protection against infections so an
infection in this site can become serious quickly. The client with a pulmonary or fat
embolus would develop symptoms of pulmonary compromise, such as shortness of
 breath, chest pain, angina, and mental confusion. Symptoms of urinary tract infection
would include pain over the suprapubic, groin or back region with fever and chills,
with no restrictive movement of the leg.
13. A. With osteomyelitis, scar tissue forms because of the continuing presence of the
infecting organism, usually Staphylococcus aureus. Subsequently, pus and bacteria
collect to form avascular tissue. This scar tissue does not absorb the antibiotics. The
scar tissue or devitalized (dead) tissue must be scraped from the bone so that
antibiotic irrigation can be instituted to clear up the chronic osteomyelitis.