Fracture/Cast Care (18 Questions)

1. M. Tremblay, a 16-year-old, was admitted 6 hours ago with a closed fracture of the left tibia and fibula following a hockey injury. A plaster cast was applied in the emergency department. He presses the call bell and tells you, "My leg is killing me. The pain medicine you gave me an hour ago didn't help at all, and now it feels like a deep, burning pressure." You check the MAR and see he received Hydromorphone 1 mg PO 60 minutes ago.

Question:
What is the nurse’s priority action? *

Administer the PRN dose of Acetaminophen to augment the opioid.

Elevate the left leg on two pillows to reduce the swelling.

Apply an ice pack directly over the fracture site to numb the area.

Perform a neurovascular assessment.

2. Mme Gagnon, 19 years old, is admitted to the trauma unit with a comminuted fracture of the right femur from a skiing accident. Twenty-four hours after admission, she suddenly becomes confused, agitated, and restless. Her respiratory rate increases to 28 breaths/min, and her oxygen saturation drops to 88%. upon assessment, you note a petechial rash on her chest and axillae.

Question:
What complication do these specific findings indicate? *

Pulmonary Embolism (from DVT).

Fat Embolism Syndrome (FES).

Hospital-Acquired Pneumonia.

Shingles.

3. Léo, age 5, has just had a long-leg plaster cast applied for a tibia fracture. The cast is still damp. You need to reposition Léo’s leg to place a pillow underneath it to prevent swelling.

Question:
Which technique must the nurse use to handle the wet cast to prevent complications? *

Use only the fingertips to lift the cast gently.

Grasp the toes and the knee to lift the leg without touching the cast.

Use the palms of the hands to support the cast.

Cover the cast with a blanket first to protect your hands.

4. Mme Roy is preparing to take her 8-year-old son, Hugo, home with a fiberglass arm cast. Hugo is already complaining that his arm itches inside the cast.

Question:
What is the correct nursing instruction regarding management of pruritus (itching)? *

"You can use a knitting needle or a ruler to gently scratch the itch, but be careful."

"Pour a small amount of baby powder or cornstarch down the cast to soothe the skin."

"Use a hair dryer on the 'cool' setting to blow air into the cast."

"Apply a moisturizing lotion to the edges of the cast so it drips down."

5. Lucas, age 10, is in skeletal traction for a complex femur fracture. You enter the room to perform your start-of-shift assessment. You observe the weights hanging at the foot of the bed.

Question:
Which observation regarding the traction equipment requires immediate intervention? *

The weights are hanging freely without touching the floor or the bed frame.

The ropes are moving smoothly through the pulleys.

The weights are resting on the floor while the child is pulled up in bed.

There is a small amount of clear serous drainage at the pin sites.

6. Mme Cloutier, 55 years old, has a cast on her right forearm for a distal radius fracture. During your assessment, you note that her fingers on the right hand are pale, cool to the touch, and she reports a "pins and needles" sensation (paresthesia). Her capillary refill is 4 seconds.

Question:
Based on these findings, which "P" of the neurovascular assessment indicates early nerve ischemia? *

Pallor.

Pulselessness.

Paresthesia.

Paralysis.

7. Baby Poirier, 2 years old, has been placed in a Hip Spica cast for a femur fracture. The cast covers the trunk from the nipple line down to the toes. Mme Poirier is feeding the child lunch.

Question:
To prevent "Cast Syndrome" (abdominal distension causing respiratory compromise or nausea), what dietary modification should the nurse suggest? *

"Encourage him to eat large meals so he sleeps longer."

"Offer small, frequent meals rather than three large ones to prevent over-distending the stomach."

"Increase the intake of gas-producing foods like beans to stimulate bowel movements."

"Use a straw for all liquids."

8. M. Fortin, 12 years old, has had a fiberglass leg cast for 2 weeks. He complains of a "weird smell" coming from the cast and points to a specific area over the ankle bone that feels "hot" when you touch the outside of the cast.

Question:
What does the presence of a "hot spot" on the cast and a foul odor suggest? *

The cast is curing and giving off heat (exothermic reaction).

The child has been sweating excessively.

This is a normal finding for fiberglass casts.

There is an underlying pressure necrosis or infection (Osteomyelitis).

9. Sophie, 7 years old, fell off the monkey bars. The X-ray confirms a fracture that crosses through the epiphyseal plate (Salter-Harris fracture) of the distal tibia. The parents ask, "Will her leg be okay?"

Question:
What is the primary long-term complication associated specifically with this type of fracture in a child? *

Chronic arthritis in the ankle joint.

Disruption of bone growth, potentially resulting in a leg length discrepancy.

High risk of fat embolism.

Permanent nerve damage causing foot drop.

10. You are caring for M. Dubé, a 20-year-old admitted with a fractured femur awaiting surgical fixation. The physician's orders include "Strict bedrest" and "Immobilize the limb."

Question:
Why is immobilization of the fractured limb the most critical nursing intervention before surgery? *

To prevent the patient from feeling pain.

To allow the bone to heal naturally without surgery.

To prevent the release of fat globules from the bone marrow into the bloodstream.

To prevent the development of deep vein thrombosis (DVT).

11.1 M. Larochelle, a 22-year-old athlete, is being discharged with a left ankle fracture. He is non-weight bearing on the left leg and uses crutches. He asks, "My bedroom is on the second floor. How do I get up the stairs safely?"

Question:
Which instruction describes the correct sequence for going up the stairs? *

"Place the crutches on the step above you first, then hop up with your good leg."

"Place your right leg on the step above you first, then bring the crutches and the injured leg up."

"Place your left leg on the step above you first, then follow with the crutches."

"Lean on the banister and hop up the stairs leaving the crutches behind."

11.2 Following the teaching session, M. Larochelle asks how to come back down the stairs to the kitchen.

Question:
Which instruction describes the correct sequence for going down the stairs? *

"Place your right leg on the step below you first."

"Move both legs and the crutches down to the next step simultaneously."

"Hold both crutches in one hand and hop down."

"Place the crutches and the left leg on the step below you first, then step down with the good leg."

12. Mme Boucher arrives at the clinic with a fractured clavicle. The physician applies a triangular sling. Before discharge, you verify that the sling is applied correctly to prevent complications.

Question:
Which observation indicates the sling is positioned correctly? *

The hand is positioned slightly lower than the elbow to allow gravity to pull blood to the fingers.

The knot is tied directly over the cervical spine to keep it centered.

The elbow is flexed at 90 degrees, and the sling extends to the fingers to support the wrist.

The sling hangs loosely so the patient can easily slide the arm in and out.

13. M. Caron, age 45, visits the clinic for a follow-up on a broken tibia. He has been using crutches for 2 weeks. You observe him walking into the exam room and notice he is resting his body weight directly on the axillary pads (armpits) while swinging his legs. He complains of "tingling and numbness" in his hands.

Question:
What complication is M. Caron likely experiencing due to improper crutch usage? *

Compartment Syndrome of the axilla.

Radial Nerve damage (Crutch Palsy).

Dislocation of the shoulder joint.

Deep Vein Thrombosis in the upper arm.

15.1 Mme Leblanc, an 82-year-old female, was admitted 6 days ago for a pelvic fracture following a fall at home. The physician ordered strict bed rest to allow the fracture to stabilize. Mme Leblanc was previously independent and alert. During your comprehensive assessment today, you note a cluster of new findings:

Respiratory: Shallow breathing with diminished breath sounds in the bases (atelectasis).
Gastrointestinal: No bowel movement for 4 days and decreased appetite (anorexia).
Musculoskeletal: Decreased muscle strength in the lower extremities and early signs of foot drop.
Integumentary: A non-blanchable red area (2 cm) on her sacrum.
Psychosocial: She appears apathetic, withdrawn, and confused about the time of day.
Vital Signs: She is afebrile (37.0°C).

Question:
Based on this cluster of multisystemic decline, what do you suspect is happening to the patient? *

Immobilization Syndrome (Disuse Syndrome).

Septic Shock.

Major Depressive Disorder.

Pulmonary Embolism.

15.2 Following your assessment of Mme Leblanc, you determine that she is suffering from the effects of Immobilization Syndrome. The physician has modified the orders to allow "activity as tolerated" starting today.

Question:
What is the priority nursing intervention to reverse these effects and prevent further complications? *

Request a prescription for a sedative to help her sleep through the night to improve her mental status.

Limit her fluid intake to 1000 mL/day to prevent fluid overload and heart failure.

Implement a schedule of active and passive Range of Motion (ROM) exercises q2h and frequent repositioning.

Insert an indwelling urinary catheter to keep her skin dry and prevent pressure ulcers.

16. You are caring for M. Gagnon, a 79-year-old patient recovering from bacterial pneumonia. He has been on bed rest for 4 days and is deconditioned. The physician has ordered: "Ambulate in the hallway 3 times daily as tolerated." M. Gagnon is eager to walk but reports feeling slightly weak in his legs. You decide to delegate this task to the PAB (Préposé aux bénéficiaires / Orderly).

Question:
To ensure the patient’s safety in case of sudden fatigue or orthostatic hypotension, what specific instruction must you give to the PAB? *

"Walk backward in front of M. Gagnon while holding his hands to guide him down the hallway."

"Wait at the far end of the hallway with a chair to give M. Gagnon a visual goal to reach."

"Hold M. Gagnon firmly by the waistband of his pants to prevent him from slipping."

"Follow closely behind M. Gagnon pushing a wheelchair, so he can sit immediately if he feels dizzy or weak."