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Orthopedic Emergencies CEN Practice Questions - CEN Questions on Orthopedic Emergencies
Question 1.
A patient is brought to the emergency department by emergency medical services after being crushed while standing between a loading dock and a truck. The emergency nurse can anticipate which of the following injuries?
(a) Humeral head fracture
(b) Closed pelvic fracture
(c) Humeral shaft fracture
(d) Open-book pelvic fracture
Answer:
(d) Open-book pelvic fracture
Rationale:
In this scenario, the anticipated mechanism of injury would be an open-book pelvic fracture because the patient was crushed between two objects in a standing position. Because the patient was standing, it is unlikely his humerus or humeral head would be impacted by the crush. Closed pelvic fractures are generally caused by lateral compression from motor vehicle crashes.
An open-book fractur occurs when the pelvic ring is disrupted. With this injury, there is an anterior injury that creates a widened pubic symphysis and a posterior injury involving a fracture or ligamental disruption.
Question 2.
Application of a pelvic binder in the patient with an open-book pelvic fracture may:
(a) increase pain.
(b) control hemorrhage.
(c) displace the fracture.
(d) decrease blood pressure.
Answer:
(b) control hemorrhage.
Rationale:
Open book pelvic fractures have the poten-tial to bleed significantly. Application of pelvic binders (or a folded sheet) may improve alignment, control hemorrhage, and provide comfort. With placement of the binder, there may actually be an improvement in the blood pressure secondary to the hemorrhage control.
Question 3.
Which of the following statements made by a patient would indicate to the emergency nurse that the patient does NOT understand discharge instructions for a sprained ankle?
(a) “I should take the wrap off at night.”
(b) “I should keep my extremity down at all times.”
(c) “I should avoid use of my extremity.”
(d) “I should use ice for the first 48 hours, then heat.”
Answer:
(b) “I should keep my extremity down at all times.”
Rationale:
Keeping the extremity dependent can lead to additional swelling. The extremity should be elevated. Removing the wrap, resting the extremity, and using ice for swelling in the first 48 hours are all correct.
The RICE mnemonic is useful for sprains and strains.
R = Rest—Don't use it!
I = Ice—For 48 hours then heat!
C = Compression—Take the bandage off twice daily and at night!
E = Elevate—Keep it up!
Question 4.
A 16-year-old patient arrives at triage and states, “I was playing basketball, went to jump for a ball and felt a “sharp pain” in my heel.” The patient is walking flat-footed. The emergency nurse should suspect which of the following?
(a) Achilles tendon rupture
(b) Grade II ankle strain
(c) Grade III ankle sprain
(d) Calcaneus fracture
Answer:
(a) Achilles tendon rupture
Rationale:
Classic symptoms of an Achilles tendon rupture include sharp pain or “pop” in the heel, and walking flat-footed. The rupture can be precipitated by jumping or pushing off. Strains and sprains share similar signs and symptoms. Sprains, however, involve the ligament around the joint, whereas strains involve muscle or tendon. With sprain and strain there is swelling, pain, and possible joint instability depending on the grade of injury. With a calcaneal fracture, the patient would not be able to walk on the foot.
With an Achilles tendon rupture, the patient would not be able to plantar flex the foot when the posterior aspect of the lower leg is squeezed. The patient can be in a prone position or lying on their abdomen with the feet hanging off of the bed.,
Question 5.
A patient is brought to the emergency department following a motorcycle crash. Assessment reveals an open tibial fracture. Which of the following options would be the priority intervention for this patient?
(a) Contact orthopedic surgeon .
(b) Obtain an appropriate radiograph
(c) Administer prescribed intravenous antibiotics
(d) Administer a tetanus injection
Answer:
(c) Administer prescribed intravenous antibiotics
Rationale:
The standard of care for open fractures is quick administration of antibiotics. This should occur within the first hour and preferably within the first 30 minutes. The American College of Surgeons has set the standard of 30 minutes for initiation of the first anti-biotic. Obtaining an radiograph, administering tetanus vaccine, and contacting an orthopedic specialist are appropriate, but they are not as time-sensitive.
In cases of open fractures, advocate for early antibi-otic administration!
Question 6.
A patient presents to triage after a fall. The diagnosis is a contusion of the lower leg. Which of the following is a true statement regarding a contusion?
(a) Removal of the epithelium with dermis exposed
(b) Collection of blood under the skin
(c) Peeling of skin from underlying tissue
(d) Complete separation of skin from underlying tissue
Answer:
(b) Collection of blood under the skin
Rationale:
A contusion is a collection of blood under the skin. An avulsion consists of a peeling of the skin away from the associated tissue. A degloving injury is removal of or complete separation of skin from underlying tissue. An abrasion involves removal of the epithelium.
Question 7.
Which of the following is an appropriate intervention for a patient with a leg contusion?
(a) Dependent positioning of the extremity
(b) Application of pressure dressing
(c) Application of ice pack
(d) Intravenous pain medication
Answer:
(c) Application of ice pack
Rationale:
Application of ice would follow the “RICE” mnemonic along with elevation, not dependent posi-tioning for this type of injury. Intravenous pain medications would not be the preferred choice of pain control. Pressure dressings would not be utilized on this injury as it could encourage the development of compartment syndrome.
Question 8.
Which of the following would be an expected observation when assessing a patient with a suspected pelvic fracture?
(a) Internal rotation of the leg
(b) Blood at the urinary meatus
(c) Evidence of neurogenic shock
(d) Fecal incontinence
Answer:
(b) Blood at the urinary meatus
Rationale:
Blood at the urinary meatus is an indication of a pelvic fracture due to laceration or disruption of the urethra. Urinary catheter placement should be delayed pending further evaluation. Legs are usually externally rotated. Patients with pelvic fractures can bleed significantly, so they would demonstrate signs and symptoms of hypovolemic shock not neurogenic shock. Fecal incontinence would occur with a spinal cord injury, not a pelvic fracture.
If there is a disruption of the urethra, the prostate gland would either be “high-riding, ” inability to palpate, or feel “boggy. ” In this circumstance, the ED nurse should not insert a urinary catheter. Hand the catheter to the trauma surgeon or primary physician caring for the patient and have them insert it. A retrograde urethrogram should be done first before the insertion takes place in these instances.
Question 9.
A patient is brought to the emergency department after jumping off of a 25-foot bridge. Which of the following types of vertebral injuries should the emergency nurse expect according to mechanism of injury?
(a) Compression fracture
(b) Chance fracture
(c) Comminuted fracture
(d) Fracture dislocation
Answer:
(a) Compression fracture
Rationale:
Compression fractures occur with axial loading. The loading of the vertebral column can occur with diving or in this case jumping. A Chance fracture (involves fracture through the spinous process, the pedicles, and the vertebral body) is seen with hyperflexion and usually occurs in the thoracolumbar region. Comminuted (or burst) fractures are associated with vertical axial compression and fracture dislocations require extreme flexion.
Question 10.
Which of the following is NOT part of the vertebrae?
(a) Spinous process
(b) Transverse process
(c) Facet
(d) Spinal cord
Answer:
(d) Spinal cord
Question 11.
The emergency nurse is discharging a patient with a diagnosis of gout. Which of the following statements made by the patient would indicate an understanding of the discharge instructions?
(a) "I will start taking an aspirin daily. ”
(b) “I should stop exercising.”
(c) “I will drink a glass of wine daily.”
(d) “I will take Allopurinol as directed.”
Answer:
(d) “I will take Allopurinol as directed.”
Rationale:
Allopurinol is one of the main medications utilized to treat gout. Allopurinol works to reduce the production of uric acid. This along with nonsteroidal anti-inflammatory drugs, Colchicine, Probenecid, and Anturane, are medications used to treat acute gout. Both aspirin and alcohol should be avoided because they can stop the excretion of uric acid. Increasing activity may actually help decrease symptoms.
Question 12.
A patient presents to triage after recent knee surgery with a painful swollen joint. Vital signs for this patient are as follows:
Blood pressure—112/82 mm Hg
Pulse—108 beats/minute
Respirations—16 breaths/minute
Temperature—98.4° F (36.8° C)
Pulse oximetry—96% on room air
The emergency nurse suspects which of the following types of joint effusion?
(a) Blood
(b) Bursitis
(c) Gout
(d) Septic arthritis
Answer:
(a) Blood
Rationale:
A blood effusion is seen after surgery or trauma to the joint. Bursitis is from overuse and inflammation of the bursa sac. Gout is an alteration in the uric acid production, and septic arthritis is caused by bacteria entering the joint from the bloodstream, tissue, or a wound. Both gout and septic arthritis are usually associated with a fever, which this patient does not have.
Question 13.
Excessive stretching or tearing of a ligament results in which of the following processes?
(a) Dislocation
(b) Avulsion
(c) Strain
(d) Sprain
Answer:
(d) Sprain
Rationale:
A sprain occurs due to stretching or tear-ing of a ligament. A strain is stretching or tearing of the muscle or tendon. A dislocation follows an injury that creates a disruption in the joint and pulls the bones out of their normal positioning. An avulsion is a pulling or tearing away of skin, tissue, or bone.
Sprains are considered to be first, second, or third degree. This is determined based on the severity and the amount of disruption to the joint. For instance, a third-degree ankle sprain would create an unstable joint and, although not fractured, would still require a posterior splint and crutches. Follow-up with orthopedic specialty would also be necessary.
Question 14.
Femoral head necrosis is a complication of hip dislocation. To prevent this complication, reduction of the dislocation should occur within which of the following hours?
(a) 6
(b) 8
(c) 10
(d) 12
Answer:
(a) 6
Rationale:
Reduction of dislocations should be done as soon as possible and within a 6-hour timeframe. Any time over 6 hours is incorrect because the longer the dislocation remains, the greater the risk of necrosis.
Question 15.
A trauma patient arrives in the emergency department with an open ankle fracture. The emergency nurse should anticipate which of the following interventions?
(a) Irrigation of the wound
(b) Application of a traction splint
(c) Application of a dry, nonsterile dressing
(d) Administration of the appropriate tetanus dose
Answer:
(d) Administration of the appropriate tetanus dose
Rationale:
Next to early antibiotic administration, assessment and administration of tetanus immunization is a priority. Irrigation of the ankle should be done in the operating room due to potential joint involvement. Traction splints are for femur fractures and should never be placed with an open ankle fracture. The dressing should be moist and sterile.
This is a good example of reading the question care-fully! A dressing would be a good option but the type of dressing is wrong. When reading the ques-tion, be careful to read every word and make sure that you take each of those words into account.
Question 16.
Which of the following is the leading cause of injury-related mortality in the elderly?
(a) Motor vehicle crashes
(b) Pedestrian hit by vehicle
(c) Sports-related events
(d) Accidental falls
Answer:
(d) Accidental falls
Rationale:
Falls are a leading cause of death in all ages but is the number one cause in the elderly. Due to changes in perception, balance, eye sight, and hearing, they are more likely to fall. Additionally, comorbidities can complicate recovery. Motor vehicle crashes, pedestrians hit by a vehicle, and playing sports are all mechanisms of injury but not the leading cause for this population.
Question 17.
A patient presents to the emergency department with a laceration of the lower arm and states that his little finger is numb. Grip strength to his hand is decreased. This indicates damage to which of the following nerves?
(a) Median
(b) Peroneal
(c) Ulnar
(d) Radial
Answer:
(c) Ulnar
Rationale:
When the ulnar nerve is affected, grip strength can be affected as well as causing numbness to the little and ring fingers. Other manifestations include inability to have coordinated hand movement and weakness to the hand. Median nerve injury results in inability to touch the thumb to the base of the small finger.
Peroneal nerve injuries cause decreased sensation to the leg and can cause foot drop as well as a “slapping” type of gait. If the radial nerve is affected, the patient will not be able to give the “thumbs-up” sign or the “hitchhiker’s” sign.
Question 18.
A patient presents at triage and states, “I was playing racquet ball and twisted my ankle.” There is mild tenderness and swelling of the ankle and the joint is stable. How would this sprain be classified?
(a) Mild (grade I)
(b) Moderate (grade II)
(c) Severe (grade III)
(d) Extreme (grade IV)
Answer:
(a) Mild (grade I)
Rationale:
The symptoms presented are those of a minor sprain; there is no tearing and the joint is stable. A grade II sprain would involve tearing without joint instability. Grade III sprains result in an unstable joint. There is no grade IV in the grading of sprains.
Question 19.
Treatment for lower grade sprains and strains is described by the mnemonic “RICE.” The letters in this mnemonic does NOT include which of the following treatment options?
(a) Ice
(b) Rest
(c) Exercise
(d) Compression
Answer:
(c) Exercise
Rationale:
Exercise is a contraindication for a sprain. The “E” in this mnemonic stands for elevate. The “R” is for rest, “I” is for ice, and the “C” stands for compression, which would be like an Ace wrap.
Mnemonics are wonderful tools! Use them to help remember facts that help us care for our patients. The hard part is remembering which mnemonic goes with which part of the body!!
Question 20.
A patient is diagnosed with a knee dislocation after a sporting event. The emergency nurse should consider which of the following additional injuries that is common with this primary injury?
(a) Fibula fracture
(b) Saphenous vein injury
(c) Popliteal artery injury
(d) Tibial nerve injury
Answer:
(c) Popliteal artery injury
Rationale:
Popliteal artery injury is a frequent and significant high risk complication with a dislocated knee. All patients including those who relocate spontaneously before arrival to the emergency department should be assessed for this event. Some can maintain pulses for a time due to collateral flow. Fibula fracture and tibial nerve injuries are not usually associated with knee dislocation. The saphenous vein is in the lower leg away from the knee.
Question 21.
A cast is being applied to a patient who has been diagnosed with a radial fracture. When applying the cast, the emergency nurse knows the elbow should be at what angle for proper cast application?
(a) Flexed 30 degrees
(b) Flexed 45 degrees
(c) Flexed 90 degrees
(d) No flexion
Answer:
(c) Flexed 90 degrees
Rationale:
The elbow should be flexed 90 degrees for position of healing. Additionally, the wrist should remain in a neutral position and not be dependent so a sling would also be necessary. Positioning the elbow straight or less than 90 degrees would not be correct position.
Question 22.
Which of the following is considered to be a “long” bone?
(a) Carpal bone
(b) Tarsal bone
(c) Hip bone
(d) Humerus bone
Answer:
(d) Humerus bone
Rationale:
Long bones include the femur, tibia, and fibula and, in this case, the humerus, as well as the radius and ulna. Carpal (wrist bones) and tarsal bones (hindfoot and midfoot) are classified as short bones and are cube-shaped. The hip bone is classified as an irregu-lar bone and is complex-shaped.
Question 23.
Which of the following is the name for the dense tissue that attaches muscles to bone and controls movement through extension and flexion?
(a) Cartilage
(b) Tendon
(c) Ligament
(d) Skeletal
Answer:
(b) Tendon
Rationale:
Tendons are dense, fibrous tissues made up of collagen that attach bones to muscle. Cartilage provides a cushioning for bones. Cartilage also takes many forms and is commonly replaced by bone as infants and children grow. However, adults have cartilage in many places as well. Ligaments are connective tissues holding bones together at joints. Skeletal muscles are attached to the bone by tendons. Skeletal muscle allows movement through contraction.
Question 24.
A tennis player presents at triage with a swollen and painful elbow joint. The emergency nurse suspects which of the following types of joint effusion?
(a) Septic arthritis
(b) Gout
(c) Blood
(d) Bursitis
Answer:
(d) Bursitis
Rationale:
Bursitis is an inflammation of the bursa sac of a joint from overuse. Blood in the joint occurs with trauma or surgery. Gout arises from an alteration in the production of uric acid. Septic arthritis is sudden in onset and occurs from bacteria entering the joint through the blood stream, tissue, or'a puncture wound.
Septic arthritis can be caused by sexually transmit-ted illnesses such as Neisseria gonorrhoeae, and can also occur due to other infectious agents and etiologies. Some of these etiologies are as follows: intravenous illicit drug use, prosthetic joints, immunosuppression, Lyme disease, and traumatic injuries. Other organisms such as fungi and viruses can also create a septic joint.
Question 25.
Which of the following would NOT be an appropriate treatment regimen for a patient with a shoulder dislocation?
(a) Application of ice
(b) Immobilization
(c) Neurovascular assessment
(d) Application of traction splint
Answer:
(d) Application of traction splint
Rationale:
Traction splints are utilized for stabilizing long-bone fractures, most commonly the femur. Shoul-der dislocations should be immobilized with the arm close to the body with a sling. Neurovascular assessment is important for all orthopedic injuries. Ice should be applied to reduce swelling.
Here is another example of reading your questions very carefully! A traction splint would be used for a femur/hip fracture, but if there is a tibial or fibular fracture on the same leg, then it would be contra-indicated! If the patient were lying in front of you, you would know not to put a traction splint on that leg! But, in reading questions you might miss that information. Word of caution—read your questions methodically and study every word!
Question 26.
Emergency medical services brings an 8-year-old who was struck by a car impacting the bumper. The emergency nurse should anticipate which of the following injuries?
(a) Clavicle fracture
(b) Ankle fracture
(c) Femur fracture
(d) Spinal cord injury
Answer:
(c) Femur fracture
Rationale:
A femur fracture is a common injury with a school-aged child being hit by a vehicle due to bumper height. Whereas an adult may attempt to turn from an impact, children do not, thus resulting in being struck straight on. Because of the height of children, the ankle and clavicle are not points of impact with the bumper of the car. The spinal cord may be injured but not from the initial impact.
Question 27.
A radiograph demonstrates a “buckle” fracture of the arm. The emergency nurse knows this fracture is also known as which of the following types of fracture?
(a) Torus
(b) Greenstick
(c) Compression
(d) Comminuted
Answer:
(a) Torus
Rationale:
A “buckle” fracture is also known as a torus fracture. This is demonstrated by no disruption of the cortex. In a “greenstick” fracture, the cortex does show disruption on the involved side. Both torus and greenstick fractures are breaks that involve one side of the bone, but there is a difference. In compression fractures, the bone collapses onto itself, and in comminuted fractures, the bone is splintered or fragmented with two or more fragments of bone involved. This can commonly occur with gunshot wounds, but can also be direct blunt trauma.
Question 28.
A trauma patient arrives in the emergency department with an open femur fracture. There is evidence of uncontrolled bleeding. Vital signs are as follows:
Blood pressure—96/64 mm Hg
Pulse—120 beats/minute
Respirations—28 breaths/minute
Temperature—99.2° F (37.3° C)
Pulse oximetry—94% on room air
Which of the following is the priority intervention for this patient?
(a) Intravenous access
(b) Obtain a radiograph
(c) Direct pressure
(d) Traction splint
Answer:
(c) Direct pressure
Rationale:
The priority for this patient is to control the hemorrhage with direct pressure. If direct pressure does not work, consider the use of a tourniquet Establishing intravenous access should be accomplished, but active bleeding must be stopped first. A traction splint may be appropriate, but should be done after hemorrhage control. Obtaining radiographs is not a priority.
Uncontrolled hemorrhage is a leading cause of death in trauma patients. A major movement to educate the public about this potentially fatal complication is called "Stop the Bleed. ” This national campaign created for interested lay individuals teaches the basic concepts of hemorrhage control, including the use of tourniquets in appropriate circumstances.
Question 29.
A patient is transferred to a Level I 'trauma center with a crush injury to the forearm. Upon examination, the forearm is tense, has decreased sensation, and pain out of proportion to injury. Which of the following should the emergency nurse be suspicious for in this patient?
(a) Radial nerve injury
(b) Humeral fracture
(c) Brachial artery injury
(d) Compartment syndrome
Answer:
(d) Compartment syndrome
Rationale:
Crush injuries have the potential to develop compartment syndrome resulting from cellular destruction. Symptoms include tense swelling, alteration in neurovascular assessment, and pain disproportionate to the injury. Radial nerve injury would be identified by inability to demonstrate the “thumbs-up” sign. The humerus is an upper arm bone and is not noted to be involved. Brachial artery injury may cause
The arm and the leg both have multiple compartments. It depends on which compartment is involved regarding the potential loss of pulses and capillary refill time.
Question 30.
A patient is diagnosed with a scaphoid fracture. The emergency nurse knows which of the following would be appropriate treatment?
(a) Cast with the thumb in opposition
(b) Sling with arm against body
(c) Application of traction splint
(d) Cast with elbow flexed 90 degrees
Answer:
(a) Cast with the thumb in opposition
Rationale:
The scaphoid bone, also known as the navicular bone, lies between the hand and the forearm on the radial side of wrist. It is located in the anatomical snuff box. To ensure correct healing, the thumb must be placed in the correct position, or that of opposition. Application of a sling would be important for shoulder dislocations or humeral fractures. Traction splints are used to stabilize long-bone fractures. A cast with the elbow flexed 90 degrees is proper treatment for forearm fractures.
Question 31.
Which of the following statements indicates an understanding of discharge instructions after a posterior splint is placed?
(a) The patient verbalized that he can walk short distances on the splint.
(b) The patient states the need to follow up with the orthopedic surgeon.
(c) The patient states that after 1 week he should return for splint removal.
(d) The patient states they he can keep the leg dependent at all times.
Answer:
(b) The patient states the need to follow up with the orthopedic surgeon.
Rationale:
Verbalizing the need for follow-up with the orthopedist indicates understanding of the discharge instructions. The patient should not walk on the splint, return for its removal, or keep the extremity dependent. Those responses would indicate a lack of understanding of the provided instructions.
Remember that casts are not applied in the ED. Splints are placed so that there is room for swelling to occur. Casts are applied later in the process. Splints should never completely encircle the extremity!
Question 32.
A trauma patient sustained a severe crush injury to the lower extremity. When the urinary catheter is placed, the emergency nurse notes that the urine is dark brown in color. Which of the following should the nurse be most concerned about regarding this finding?
(a) Compartment syndrome
(b) Dehydration
(c) Urinary tract infection
(d) Rhabdomyolysis
Answer:
(d) Rhabdomyolysis
Rationale:
Rhabdomyolysis is a potential complication of a crush injury. As myoglobin is released, the urine injured extremity. Dehydration will decrease urine output and the color will be dark, but will be a dark amber color. A urinary tract infection causes urine color to be cloudy.
One of the major sequelae of rhabdomyolysis is renal failure! The myoglobin can actually cause an obstruction in the renal tubules and there are toxins that are released.
Question 33.
An 86-year-old patient fell and sustained a pelvic fracture. This patient is given low-molecular-weight heparin to aid in prevention of which of the following complications?
(a) Fat embolism
(b) Pulmonary edema
(c) Deep vein thrombosis
(d) Congestive heart failure
Answer:
(c) Deep vein thrombosis
Rationale:
Immobility that would be involved with an elderly patient who has sustained a pelvic fracture can cause stasis and development of a thrombus. This venous thrombosis can then progress to a pulmonary embolus. Low-molecular-weight heparin would be an appropriate preventive intervention. Pulmonary edema results from fluid overload. Congestive heart failure may develop in patients with cardiac history when over-resuscitated. Fat embolisms occur in patients who have manipulation of long-bone fractures. This can also happen with pelvic fractures, but preventive measures with low-molecular-weight heparin have not been shown to prevent this complication from fat emboli.
Question 34.
Which of the following amputations is associated with the highest rate of successful reattachment rate?
(a) Crush-like amputation
(b) Amputation from a ripping force
(c) Amputation from a blast force
(d) Guillotine-type amputation
Answer:
(d) Guillotine-type amputation
Rationale:
Guillotine-type amputations have the high-est success rate as the tissue is preserved and cleanly severed. The other injuries listed have tissue, nerve, and vessel destruction and/or loss that make reimplantation less successful.
Question 35.
A 3-year-old is presented to the triage area with complaints of not using his left arm. The father states he jerked the child’s arm to get him out of the street. The emergency nurse would suspect which of the following injuries?
(a) Shoulder dislocation
(b) Radial dislocation
(c) Elbow fracture
(d) Humeral fracture
Answer:
(b) Radial dislocation
Rationale:
Dislocation of the radial head, also known as Nurse Maid’s elbow, is a common injury in young children. It occurs as a result of an arm that is jerked or pulled, and the hallmark symptom is nonuse of the extremity by the child. Shoulder dislocations, elbow, or humeral fractures usually occur from a fall or other traumatic event. A fracture would require greater force than a simple jerking on an arm, especially in a child as the bones are more pliable.
Question 36.
A patient arrives in the emergency department with a swollen, tense forearm complaining of pain at a level of “10” on a scale of 1 to 10. This patient was discharged 4 hours before with a diagnosis of a sprained wrist. Which of the following would be the appropriate intervention at this time?
(a) Apply an ice pack to the extremity.
(b) Place the extremity at the level of the heart.
(c) Place the patient in the waiting room to wait for a “fast-track” bed.
(d) Have the patient go the urgent care center as the ED is very busy.
Answer:
(b) Place the extremity at the level of the heart.
Rationale:
Placing the affected extremity at the level of the heart would be the most appropriate action for this patient as the manifestations are consistent with compartment syndrome. Elevating the extremity would be counterproductive for the desired outcome. Ice should not be used as it will further constrict the neurovascular integrity. This patient should not wait as time is an important factor in saving this extremity. Necrosis of tissue can occur within 4 to 6 hours and the clock is already ticking by the time the patient arrives in the ED. Patients should not be sent to urgent care centers without a medical screening examination, which cannot be done by the triage nurse.
Do not get into the fiabit of underestimating potential injuries or processes because of “frequent flyers” or concern about drug seeking behavior! Assess every patient each time they come to the ED according to their chief complaint and important background information. Be cautious about being too judgmental as it may get in the way of your objectivity!
Question 37.
A trauma patient arrives in the emergency department via emergency medical services with bilateral femoral fractures. This patient has received 2 liters of lactated ringer intravenous fluids for resuscitation. Vital signs on arrival are as follows:
Blood pressure—76/40 mm Hg
Pulse—145 beats/minute
Respirations—32 breaths/minute
Temperature—99.6° F (37.5° C)
Pulse oximetry—90 % on room air
These vital signs are indicative of a shock index of 1.9. Which of the following interventions is the priority for the emergency nurse caring for this patient?
(a) Initiation of massive transfusion policy
(b) Fluid bolus of lactated ringers
(c) Place patient in Trendelenburg
(d) Place bilateral traction splints
Answer:
(a) Initiation of massive transfusion policy
Rationale:
This patient is clearly in hypovolemic shock. A femoral fracture can bleed significantly and, in this case, is multiplied due to the bilateral situation. Each fractured femur can lose 1 to 2 liters of blood. This pa-tient has already received crystalloid resuscitation and has not responded. Therefore, activation of massive transfusion protocol is appropriate. Giving additional crystalloids will dilute the already-depleted blood volume and can pop off developed clots, dilute the red blood cells which provide the oxygen-carrying capacity and dilute clotting factors as well as contribute to hypothermia. Trendelenburg is not a definitive intervention. Shock position or modified Trendelenburg would be more appropriate in the hypovolemic patient; however, it would be difficult to perform this with the sustained injuries. Splints are appropriate but correcting shock status is the highest priority.
Shock index is a great indicator for the need to initiate massive transfusion protocol. The formula for this is heart rate divided by systolic blood pressure. A reading of 0.5 to 0.7 is considered normal. Value greater than 1.5 indicates that massive transfusion policy should be started.
Question 38.
Which of the following intra compartmental pressures would be considered critical impairment?
(a) Less than 10 mm Hg
(b) 12 to 20 mm Hg
(c) 21 to 30 mm Hg
(d) Greater than 31 mm Hg
Answer:
(d) Greater than 31 mm Hg
Rationale:
Normal compartment pressure can range from less than 10 mm Hg to less than 15 or 20. These numbers are dependent on the author. Most authors will agree that measurements greater than 30 to 31 mm Hg indicates a critical level and that measures must be instituted immediately to save the limb. Another way to determine the number of criticality is to use the delta number. This number is derived by subtracting the intracompart- mental pressure from the diastolic pressure. Readings of less than 30 on this reading are indicative of compartment syndrome. Therefore, if a reading of 25 was present for the intra compartmental pressure and the blood pressure was 102/82 mm Hg, the delta number would be 57 and would rule out compartment pressure.
Question 39.
A traction splint would be used for which of the following fractures?
(a) Humeral fracture
(b) Ankle fracture
(c) Forearm fracture
(d) Femur fracture
Answer:
(d) Femur fracture
Rationale:
Traction splints are used to stabilize the femur. The other fractures benefit from splinting but not traction splints.
Question 40.
Which of the following is a common complication of a pelvic fracture?
(a) Muscle spasm
(b) Hematochezia
(c) Rhabdomyolysis
(d) Urethral injury
Answer:
(d) Urethral injury
Rationale:
Urethral injury is a common complication of a pelvic fracture. Muscle spasms are seen with femur fractures. Hematochezia is blood in the stool and should not be associated with a pelvic fracture. Rhabdomyolysis is acute destruction of muscle tissue and not a complica-tion of a pelvic fracture.
Question 41.
A patient is being sent home on muscle relaxants. Which of the following statements made by the patient is indicative of a positive understanding of the discharge instructions?
(a) “I will be able to drive while I am taking this medication.”
(b) “This will make me much more alert so that will be good.”
(c) “I understand this will make me restless and anxious.”
(d) “These pills can make me drowsy so I need to be cautious with them.”
Answer:
(d) “These pills can make me drowsy so I need to be cautious with them.”
Rationale:
Muscle relaxants have the potential to make the patient drowsy, so this statement verbalized by the patient indicates good understanding and effective education of medication side effects. If the patient understood that muscle relaxants can result in drowsiness, then driving would be contraindicated, as would stating they will be more alert. Muscle relaxants do not generally cause anxiety or restlessness.
Question 42.
Which of the following would indicate to the emergency nurse that treatment for rhabdomyolysis has been effective?
(a) Urine output is at least 100 mL/hour.
(b) The urine is getting darker in color.
(c) The creatine kinase levels are increasing.
(d) There is increased muscle pain.
Answer:
(a) Urine output is at least 100 mL/hour.
Rationale:
To clear myoglobin and preserve kidney function, urine output needs to be at least 100 mL/ hour. If urine is getting darker, fluid resuscitation is inadequate. Increasing muscle pain and creatine kinase levels also indicate the condition is not improving. Creatinine kinase levels should be decreasing. An elevated creatinine kinase level is one of the hallmark findings of rhabdomyolysis. Muscle pain, especially in the lower back, is one of the common signs.
Question 43.
The emergency department has been holding a trauma patient for several hours when the patient suddenly develops pleuritic chest pain, hypoxemia, hemoptysis, and wheezes. The emergency nurse would suspect which of the following processes?
(a) Fat embolism
(b) Deep vein thrombosis
(c) Pulmonary embolism
(d) Pneumonia
Answer:
(c) Pulmonary embolism
Rationale:
The signs in this scenario are those of pulmonary embolism. Sudden onset of shortness of breath, pleuritic chest pain, hemoptysis, and wheezing as well as signs of hypoxemia all point to the development of a pulmonary embolus. Deep vein thrombosis would manifest with symptoms of swelling, warmth, and pain in the extremity harboring the clot. A fat embolism will have symptoms of decreased mental status, respiratory distress, and a petechial rash. Pneumonia would take longer to appear and would carry a fever and cough with it.
Question 44.
Which of the following symptoms constitutes a medical emergency in' a patient with acute lower back pain with suspected herniated lumbar disc?
(a) Intermittent paresthesia
(b) Sudden incontinence
(c) Sciatic pain in legs
(d) Back pain with sneezing
Answer:
(b) Sudden incontinence
Rationale:
Incontinence Is a medical emergency, possibly indicating cauda equina syndrome. Immediate evaluation is indicated. Surgical intervention must occur in a short period of time in order to not have a negative outcome. Leg pain, intermittent paresthesias, and pain with sneezing are nonemergent symptoms of a herniated disc.
Question 45.
Which of the following is NOT a risk factor for a deep vein thrombosis?
(a) Increasing age
(b) Obesity
(c) Increased mobility
(d) Pregnancy
Answer:
(c) Increased mobility
Rationale:
A patient who is fully mobile or has increased mobility is at low risk for deep vein thrombosis because immobility is one cause of this complication. Older patients, bariatric, and pregnant patients are all at greater risk for development of deep vein thrombosis.
Question 46.
A patient comes to the emergency department with complaints of a burning and itching pain and intermittent numbness to the palm of the hand. The patient reports it is usually worse upon awakening in the morning. The emergency nurse notes decreased grip strength to the affected hand. Which of the following is the nerve most often responsible for this problem?
(a) Ulnar
(b) Median
(c) Peroneal
(d) Radial
Answer:
(b) Median
Rationale:
The median nerve is responsible for movement of the small muscles of the hand and sensation in the palm. This is the nerve involved in carpal tunnel syndrome. This nerve runs through the middle of the wrist into the hand. The space available for it in the carpal tunnel becomes minimized and symptoms then appear. The ulnar nerve allows for abduction of the fingers and supplies sensation to the little finger. The radial nerve provides the ability to extend the thumb and deliver sensation to the dorsum of the thumb. Both of these nerves can be involved in carpal tunnel syndrome, but are not the cause. The peroneal nerve is located in the foot and causes extension of the foot and great toe and sensation to the first web space.
Question 47.
Which of the following is a potential complication after manipulation of a long-bone fracture?
(a) Deep vein thrombosis
(b) Pulmonary embolism
(c) Acute respiratory distress syndrome
(d) Fat embolism
Answer:
(d) Fat embolism
Rationale:
Fat embolism is a potential complication when long bone fractures are manipulated. This complication may occur within 12 hours. This is why immediate immobilization is so important. Deep vein thrombosis develops from immobility, which may then lead to pulmonary embolism. This can then progress to adult respiratory distress syndrome.
Question 48.
Which of the following is appropriate care of an amputated part?
(a) Wrap part in dry dressing and place in a bag on ice.
(b) Wrap part with moist dressing and place the part directly on ice.
(c) Wrap part with moist dressing, place in a bag, and place the bag on ice.
(d) Wrap part with dry dressing, place in a bag, and place the bag on ice.
Answer:
(c) Wrap part with moist dressing, place in a bag, and place the bag on ice.
Rationale:
Amputated parts should be wrapped in a moist saline-soaked dressing, placed in a sealed plastic bag and placed on ice. Placing the part directly on ice could cause the part to freeze, making it unable to be reimplanted. A moist dressing prevents the tissues from drying out.
It is highly important that the amputated part be placed on ice so that reimplantation can occur after a longer period of time. If not placed on ice, this “warm ischemia" time only allows for 4 to 6 hours for reimplantation. Cool ischemia time provides a wider window of opportunity for reimplantation- up to 18 hours depending on the damage to the tissues. So, ice is good—just not directly on the ice!!!
Question 49.
A 3-year-old patient is brought to the emergency department by his parents. He fell down several steps and has a fracture of the forearm. Which of the following types of fractures would be the most concerning?
(a) Epiphyseal
(b) Transverse
(c) Greenstick
(d) Displaced
Answer:
(a) Epiphyseal
Rationale:
Fractures of the epiphyseal plate can affect healing and growth. This area is where the bones grow; thus, major problems can be expected as the child matures. Whereas the others would need proper care and healing, they are not as concerning as the sequelae that can occur with an epiphyseal plate injury.
Question 50.
Parents are told that their child has sustained a fracture with a Salter-Harris classification of type II. The emergency nurse would understand that this is a grading for which of the following types of fractures?
(a) Displaced
(b) Spiral
(c) Comminuted
(d) Epiphyseal
Answer:
(d) Epiphyseal
Rationale:
An epiphyseal plate fracture has a Salter-Harris classification. These range from 1 to 5, and those that are 3 and above will usually require surgical intervention in order to maintain blood supply to the area to avert future growth problems. A “displaced” fracture is a type of classification because fractures can be nondisplaced or displaced. All fractures can then be classified depending on whether they are open (compound) or closed and stable or unstable as well as the displacement criteria. Comminuted and spiral fractures do not have specific classifications.
When children have epiphyseal plate injuries, radiographs will often be taken of the opposite side so that providers and radiologists will understand what the area should look like at that point in the child’s growth.
Question 51.
An 82-year-old patient is brought to the emergency department by family with a concern regarding a possible fracture to his thoracic spine area after slipping in the living room and catching himself with the couch edge. He has no prior history and is on no medications. The emergency nurse knows that this patient may have fragile bones due to which of the following disease processes?
(a) Paget’s disease
(b) Osteogenesis imperfecta
(c) Legg-Perthes disease
(d) Menkes kinky hair syndrome
Answer:
(a) Paget’s disease
Rationale:
Paget’s disease causes weak and brittle bones due to an interruption in the bone recycling process in older males. This can create a situation in which pathologic fractures, fractures that occur due to weakness in the structural composition of bones, take place. Osteogenesis imperfecta is an inherited, genetic defect that causes brittle bones along with other symptoms. This condition is diagnosed at or shortly after birth and causes fractures throughout the child’s life.
Legg-Perthes disease is a disease of childhood that causes a disruption of blood supply to the hip joint. This progresses to avascular necrosis. Menkes kinky hair syn-drome is genetic defect in the utilization of copper. With this disease process the child has very sparse, brittle hair and an array of other symptoms including neuromuscular defects and weakened bones.
Question 52.
Which of the following is the proper listing of the four types of blast injuries?
(a) Primary, secondary, typical, quaternary
(b) Principle, secondary, tertiary, quaternary
(c) Principle, simple, tertiary, quaternary
(d) Primary, secondary, tertiary, quaternary
Answer:
(d) Primary, secondary, tertiary, quaternary
Rationale:
The correct classifications of blast injuries are primary, secondary, tertiary, and quaternary. Understanding these phases help the nurse determine potential injuries patients may sustain in the event of a blast event.
Blast injuries can occur with any type of explosion. The following are the four types of injuries associated with blasts or explosions.
- Primary: Initial impact—examples are blast lung, middle ear damage, tympanic membrane rupture, globe rupture, concussion.
- Secondary: Objects flying through the air—examples are penetrating injuries from pieces that were involved in the bomb or missile.
- Tertiary: Body being thrown—examples are fractures, amputations, and brain injuries.
- Quaternary: Injuries/illnesses not due to the first three types—examples are bums, asthma, chronic obstructive pulmonary disease, angina, hyperglycemia, and crush-type injuries.
Question 53.
Which of the following is the triad of symptoms that occur with fat embolism?
(a) Muffled heart tones, distended neck veins, and hypotension
(b) Decreased mental status, respiratory distress, and petechial rash
(c) Absent breath sounds, distended neck veins, and tracheal deviation
(d) Hypotension, tracheal deviation, and widened mediastinum
Answer:
(b) Decreased mental status, respiratory distress, and petechial rash
Rationale:
Decreased mental status, respiratory distress, and petechial rash are the triad of symptoms associated with fat embolism. Muffled heart tones, distended neck veins, and hypotension are known as Beck’s triad, indicating pericardial tamponade. Absent breath sounds, distended neck veins, and tracheal deviation indicate tension pneumothorax. An aortic disruption will have symptoms of hypotension, tracheal deviation to the right side, and a widened mediastinum on radiograph.
Question 54.
A caregiver brings a 6-month-old to triage and states “he fell out of the crib.” The emergency nurse suspects maltreatment when radiographs reveal which of the following types of fracture?
(a) Spiral
(b) Comminuted
(c) Avulsion
(d) Greenstick
Answer:
(a) Spiral
Rationale:
A spiral fracture results from a twisting action and should elevate the nurse’s suspicion for maltreatment. Greenstick fractures are a buckling type of fracture and are common in the pediatric population. Comminuted fractures occur when bone splinters and there are two or more fragments, and an avulsion fraction is when a small part of the bone is torn away at the point where the muscle attaches to the bone after a muscular contraction.
Question 55.
Which one of the following is NOT part of the six Ps of neurovascular checks?
(a) Pain
(b) Priapism
(c) Pallor
(d) Paresthesia
Answer:
(b) Priapism
Rationale:
Priapism is a sustained erection and is an indication of spinal cord injury, and not part of the “six Ps.” The Ps are: Pain/Pallor/Pulselessness/Paresthesias/Paralysis/Pressure. TWo more that can be added are: TemPerature and CaPillary Refill.
Question 56.
A patient presents to triage several hours after having a cast placed complaining of severe pain uncontrolled by pain medication. Which of the following would be the priority intervention for this patient?
(a) Provide pain medication
(b) Ultrasound for deep vein thrombosis
(c) Bivalve the cast immediately
(d) Check compartmental pressure
Answer:
(c) Bivalve the cast immediately
Rationale:
The most important priority intervention for this patient is to bivalve the cash Nothing can be done until the area can be visualized. Sometimes just re-moving the cast can take care of the pain. Compartment syndrome is a major concern, but the pressure cannot be checked until the cast is removed. This can be caused by an external force such as a cast and pain disproportionate to injury is an indication of this complication. Deep vein thrombosis is painful but not disproportionate. Pain control may be an issue, but again the hallmark symptom in this scenario is the report of disproportionate pain to injury.
Question 57.
Which of the following injuries is caused by a primary blast force and is commonly overlooked?
(a) Mild traumatic brain injury
(b) Ruptured tympanic membrane
(c) Intestinal rupture
(d) Pulmonary barotrauma
Answer:
(a) Mild traumatic brain injury
Rationale:
Mild traumatic brain injury is often missed as symptoms are subtle. Injuries such as ruptured tympanic membrane, pulmonary barotrauma, and intestinal rupture are usually diagnosed easily. These are all primary blast forces that affect gas-filled organs.
Question 58.
Which of the following surgical interventions is the treatment for compartment syndrome?
(a) Fasciotomy
(b) Muscle flap
(c) Debridement
(d) Amputation
Answer:
(a) Fasciotomy
Rationale:
Fasciotomy is the emergency surgical intervention for compartment syndrome to relieve the pressure and salvage the tissue and/or limb. A muscle flap may be used to reconstruct the extremity after fasciotomy. Debridement is performed as treatment for dirty wounds or necrotic tissue. Amputation may result if fasciotomy is not performed promptly.
Question 59.
A patient arrives in the emergency department via emergency medical services (EMS)with a traction splint in place. Which of the following would be the priority intervention on patient arrival?
(a) Remove the splint
(b) Assess neurovascular status
(c) Prepare patient for surgery
(d) Administer antibiotics
Answer:
(b) Assess neurovascular status
Rationale:
Assessing neurovascular status with a splint in place is important to evaluate the current status of the limb and to compare with the prior reported condition. The splint should remain in place unless directed otherwise. The patient may go to surgery but assessment of current status is priority. Administration of antibiotics would be important but the assessment of neurovascular integrity is the first priority.
One type of traction splint that is used is a HARE traction splint. Nurses who are not comfortable with application of this type of splint should practice before they need this in a trauma situation. Find someone in the department who has experience and ask for their help! The patient will be in a great deal of pain during the application, but relief is realized once traction is applied resulting in the reduction of muscle spasms and realignment of the extremity. Provide comfort to the patient during this procedure!
Question 60.
A 4-year-old is seen with a diagnosis of a distal clavicular fracture. Which of the following is a true statement regarding this patient and fracture?
(a) This is a normal fracture for this population of patients.
(b) This usually occurs in the older pediatric patient.
(c) There are usually no associated injuries with this fracture.
(d) This can be a sign of child abuse in this age group.
Answer:
(d) This can be a sign of child abuse in this age group.
Rationale:
A distal clavicular fracture can be a sign of child abuse as the perpetrator may be grabbing the child from behind. The normal fracture site associated with clavicle breaks is mid-shaft for all age groups. There can be associated subclavian vein or artery lacerations and hemo/pneumothoraces.
Question 61.
A patient arrives in the emergency department with an open fracture of the tibia and fibula with a 6" laceration and a closed femur fracture to the left leg. Which of the following would be the most important laboratory test to be ordered?
(a) Potassium
(b) Calcium
(c) Type and crossmatch
(d) Arterial blood gases
Answer:
(c) Type and crossmatch
Rationale:
Musculoskeletal injuries can cause major blood loss. In this scenario, a femoral fracture can cause the loss of at least 1 to 2 liters of blood. An as-sociated open fracture of the tibia and fibula can increase that amount of blood loss. Type and crossmatch would be important because this patient may require blood products due to the potential hemorrhage from fractures and large lacerations.
Potassium leaks may occur with significant tissue destruction, but not hemorrhage. It would be important to know the baseline of the potassium and calcium if the patient were to receive large amounts of packed red cells; however, the most important out of these options would be the type and crossmatch. Arterial blood gases may be done, but these assess respiratory/hypoxia status.
Remember that when blood products are given, elevated potassium levels can occur due to the breakdown of cells as blood products sit on the storage shelves. Knowledge of the baseline potassium level would be important. Hypocalcemia can also occur with large amounts of blood products due to the preservative citrate combined with available calcium. Watch for these electrolyte abnormalities when giving blood!
Question 62.
Which of the following injuries is most at risk for osteomyelitis?
(a) Closed fracture of the tibia and fibula
(b) Open fracture of the femur
(c) Comminuted fracture of the humerus
(d) Dislocation of the hip joint
Answer:
(b) Open fracture of the femur
Rationale:
Osteomyelitis is a potential complication of an open fracture due to the potential of contamination.
Closed fractures have no communication with the environment and carries little risk for contamination. Com-minuted fractures have splintered fragments and do not have a higher risk of contamination. The major complication of hip dislocation is femoral head necrosis.
Question 63.
Open fractures are graded using which of the following classifications?
(a) Danis-Weber
(b) Lauge-Hansen
(c) Gustilo
(d) Salter-Harris
Answer:
(c) Gustilo
Rationale:
Gustilo is the classification for open fractures. These classifications are grade I, II, and III.
Grade III fractures are further subclassified as IIIA, IIIB, and IIIC. Danis-Weber is the classification for fibula fractures. Lauge-Hanse is the classification system for ligament injury and Salter-Harris classification is for growth plate fractures.
Remember, we already talked about Salter- Harris classification! You should have been able to at least rule that one out as a potential correct answer. When you know for sure something does not match with the question, rule it out and ignore it.
That should cut dotyn the potential for answering the question incorrectly!
Question 64.
A patient with an amputation of the hand from being caught in a machine at work presents with ongoing bleeding despite direct pressure and elevation of the extremity. Which of the following is the next appropriate interventional step?
(a) Apply pressure dressing.
(b) Insert an intravenous catheter.
(c) Notify the physician.
(d) Apply a tourniquet.
Answer:
(d) Apply a tourniquet.
Rationale:
Controlling the hemorrhage is the highest priority. Application of a tourniquet would be the next step because direct pressure and elevation of the extremity has not stopped the bleeding. Application of a pressure dressing would most likely not help because direct pressure has not worked. Starting an intravenous catheter and notifying the physician are important, but hemorrhage control is the priority.
Remember that direct pressure is always the first option. Tourniquets should be used when direct pressure has not contained the bleeding, massive bleeding is occurring, the patient is exsanguinating, and there is enough of a stump left to apply the tourniquet.
Question 65.
A patient with an open fracture of the elbow is now experiencing a fever of 101.6° F (38.7° C) and has yellowish drainage from the site. Which of the following organisms would be expected for this type of infectious process?
(a) Staphylococcus aureus
(b) Escherichia coli
(c) Streptococcus agalactiae
(d) Serratia marcescens
Answer:
(a) Staphylococcus aureus
Rationale:
Osteomyelitis is an infection of the bone, most often as a result of an open fracture with direct contamination. Staphylococcus aureus is found on human skin and is the main causative bacteria. Escherichia coli and Streptococcus agalactiae are common in the gastrointestinal tract and Serratia marcescens is found in water.
Question 66.
A patient is recovering from relocation of the patella. Which of the following interventions should the emergency nurse perform before discharge?
(a) Apply local heat.
(b) Apply a knee immobilizer.
(c) Administer a tetanus shot.
(d) Call the orthopedist.
Answer:
(b) Apply a knee immobilizer.
Rationale:
The appropriate intervention after knee re-location is application of an immobilizer. Ice should be used for the first 48 hours to reduce swelling, not heat. Tetanus immunization is not indicated unless there is an open wound, and calling for orthopedic follow-up is not a priority intervention postreduction. The patient or family members should actually make this type of call because they know their own schedule. The ED nurse does not know the best time for an office visit for this patient.
Question 67.
A patient arrives At the emergency department after a motorcycle crash and is diagnosed with a forearm and femur fracture. Which of the following would be the potential least amount of blood loss that could occur for this patient?
(a) 1.0 liter
(b) 1.5 liters
(c) 3.5 liters
(d) 4.5 liters
Answer:
(b) 1.5 liters
Rationale:
Blood loss with orthopedic injuries is a huge potential. The forearm can lose from 0.5 to 1.5 liters and the femur can lose from 1.0 to 2.0 liters. Therefore, the least amount potential blood loss would be 1.5 liters.
The highest amount that could potentially lost would be 3.5 liters. A pelvic fracture could bleed out 1.5 to 4.5 liters.
Question 68.
Which of the following may be involved in a ligamentous injury of the knee?
(a) Anterior cruciate ligament
(b) Medial meniscus
(c) Deltoid ligament
(d) Anterior talofibular ligament
Answer:
(a) Anterior cruciate ligament
Rationale:
The anterior cruciate ligament is one of the commonly injured ligaments of the knee. The medial meniscus is cartilage, not a ligament. The deltoid ligament is in the shoulder and the anterior talofibular ligament is located in the ankle.
Question 69.
A patient is undergoing procedural sedation to relocate a shoulder dislocation. Which of the following is a priority assessment to be monitored during this procedure?
(a) Intravenous site
(b) Pain control
(c) Respiratory status
(d) Neurovascular status
Answer:
(c) Respiratory status
Rationale:
Priority assessment during procedural sedation is an ongoing evaluation of the patient’s respiratory status. Monitoring the intravenous site and pain control are important aspects, but respiratory status is, of course, the priority. Neurovascular status is a pre-and postprocedure assessment.
Remember!!! Airway is always the first priority! You cannot go wrong with airway!
Question 70.
The emergency nurse is aware that straw-colored effusion fluid withdrawn from a joint would most likely be which of the following types?
(a) Blood effusion
(b) Septic arthritis effusion
(c) Bursitis effusion
(d) Gout
Answer:
(c) Bursitis effusion
Rationale:
Straw-colored effusion fluid is most likely from a bursitis. A blood effusion would have bloody return of the aspirate. White blood cells would be present with septic arthritis and gout would produce urate crystals.
Question 71.
When applying a splint on a patient with an Achilles tendon rupture, in which of the following positions should the foot be placed?
(a) Plantar flexion
(b) Dorsiflexion
(c) Plantar extension
(d) Medial rotation
Answer:
(a) Plantar flexion
Rationale:
The correct position for the foot when applying a splint for an Achilles tendon rupture is plantar flexion to allow the tendon to rest and prevent further overstretching and injury. Dorsiflexion and plantar extension will result in excessive tension. The foot/ankle should not be rotated in either direction.
Question 72.
Which of the following is the most common amputation seen in the pediatric population?
(a) Small toe
(b) Foot
(c) Hand
(d) Fingertip
Answer:
(d) Fingertip
Rationale:
The fingertip is the most common amputation for children due to the finger being shut in car doors. There may be amputations of toes, hands, or feet, but these areas are not common.
Question 73.
A 16-year-old patient is seen in the emergency department with chest pain that is worse with deep inspiration. There is tenderness to the touch to the anterior right upper rib area. Which of the following would the emergency nurse expect to use for discharge information for this patient?
(a) Exercise to strengthen muscles
(b) Medication and exercise
(c) Deep breathing and medications
(d) Rest, medication, and deep breathing
Answer:
(d) Rest, medication, and deep breathing
Rationale:
This patient is demonstrating symptoms of costochondritis. Treatment for this diagnosis includes rest, medication, and deep breathing. Exercise may exacerbate symptoms. Medications and deep breathing alone are not appropriate.
Question 74.
A patient presents with a dislocated knee and decreased pedal and posterior tibialis pulses. The physician suspects vascular injury. The emergency nurse would anticipate which of the following diagnostic procedures?
(a) Vascular angiography
(b) Computed tomography (CT)
(c) Lateral knee radiograph
(d) Magnetic resonance imaging (MRI)
Answer:
(a) Vascular angiography
Rationale:
Peripheral vascular angiography is the best diagnostic test to evaluate vascular injury. Computed tomography (CT) assesses musculoskeletal trauma and surrounding organ injury. A lateral radiograph does not demonstrate vascular injury. Magnetic resonance imaging (MRI) would provide excellent information about organs and other structures but would not assist with vascular data.
Question 75.
All of the following are examples of definitive stabilization EXCEPT a/an:
(a) open reduction.
(b) traction.
(c) casting.
(d) sling.
Answer:
(d) sling.
Rationale:
A sling would allow for movement and not provide stabilization. Open reduction, traction, and casting are all forms of definitive stabilization of a fracture.
An easy one to end on! Remember to pick out the word “definitive" in this last question!
References