I85PREP
⌘ K
ONC study materials
ONC study resources

ONC practice questions

One question at a time. Build your ONC understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Assessment and Diagnostic Evaluation of the Orthopaedic Patient

A patient presents with acute knee pain after a twisting injury. Which element of the history most directly guides the initial diagnostic workup?

  1. The patient's current analgesic regimen and allergies
  2. The patient's occupational lifting requirements
  3. A detailed family history of osteoarthritis in first-degree relatives
  4. Mechanism of injury with locking or giving way Correct answer.

Explanation

The mechanism distinguishes low-energy ligamentous or meniscal injury from high-energy fracture, and symptoms such as locking or giving way point to meniscal or ligamentous pathology. These details direct the physical examination maneuvers and the choice of imaging.

Question 2Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Which set of findings most suggests acute arterial insufficiency in a limb after a fracture?

  1. Warm skin, bounding pulses, and erythema
  2. Pitting edema, cyanosis, and a dull ache
  3. Pallor, pulselessness, and distal cooling Correct answer.
  4. Numbness, tingling, and weakness alone

Explanation

Arterial compromise produces the ischemic findings of pallor, pulselessness, poikilothermia, paresthesia, and pain, and these must be documented before and after any reduction or splinting. Isolated neurologic findings suggest nerve injury rather than loss of arterial inflow.

Question 3Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Standard radiographic evaluation of a suspected long-bone fracture should include which of the following?

  1. Two orthogonal views with joints above and below Correct answer.
  2. A CT scan obtained as the first-line imaging study
  3. An MRI of the entire limb before any radiograph
  4. A single anteroposterior view of the fracture site

Explanation

Two perpendicular projections are required because a fracture can be invisible or misjudged on a single view, and the joints above and below must be included to detect associated dislocations or intra-articular extension. Advanced cross-sectional imaging is reserved for specific questions after plain films.

Question 4Assessment and Diagnostic Evaluation of the Orthopaedic Patient

The Adams forward bend test is used primarily to detect which finding?

  1. Rib hump asymmetry caused by vertebral rotation Correct answer.
  2. Loss of the normal lumbar lordotic curvature
  3. A fixed flexion contracture of the hip joint
  4. A leg-length discrepancy greater than two centimeters

Explanation

With the patient bent forward, a rotational spinal deformity produces a prominence on one side of the thorax or lumbar region because the rotated vertebrae push the ribs posteriorly. This scoliometer-assessed asymmetry is the screening hallmark of adolescent idiopathic scoliosis.

Question 5Assessment and Diagnostic Evaluation of the Orthopaedic Patient

During manual muscle testing, a grade of 3/5 indicates which of the following?

  1. Active movement only when gravity is eliminated
  2. Visible muscle contraction with no joint movement
  3. Full active motion against gravity, no resistance Correct answer.
  4. Full active motion against gravity and maximal resistance

Explanation

The Medical Research Council scale grades anti-gravity movement through full range without applied resistance as 3/5, with higher grades requiring increasing resistance and lower grades reflecting movement only in a gravity-eliminated position or isolated contraction.

Question 6Assessment and Diagnostic Evaluation of the Orthopaedic Patient

A patient limps with a shortened stance phase on the painful limb. This pattern is best described as:

  1. Steppage gait
  2. Antalgic gait Correct answer.
  3. Trendelenburg gait
  4. Scissor gait

Explanation

An antalgic gait minimizes time spent on the painful extremity, producing a shortened stance phase on that side. The pattern reflects pain avoidance rather than muscle weakness or neurologic disease.

Question 7Assessment and Diagnostic Evaluation of the Orthopaedic Patient

A DXA T-score of -2.6 at the femoral neck is classified as:

  1. Osteomalacia
  2. Normal bone mineral density
  3. Osteopenia
  4. Osteoporosis Correct answer.

Explanation

The World Health Organization defines a T-score at or below -2.5 standard deviations as osteoporosis, while -1.0 to -2.5 defines low bone mass (osteopenia) and above -1.0 is normal. T-scores compare the patient with a young healthy reference population.

Question 8Assessment and Diagnostic Evaluation of the Orthopaedic Patient

The patellar tendon reflex is mediated primarily by which nerve root?

  1. L4 Correct answer.
  2. L3
  3. L5
  4. S1

Explanation

The knee jerk is the L4 reflex arc, testing the femoral nerve and quadriceps mechanism. Adjacent roots subserve other reflexes: L5 contributes to the medial hamstring reflex and S1 to the ankle jerk.

Question 9Assessment and Diagnostic Evaluation of the Orthopaedic Patient

A patient with a tibial shaft fracture reports pain out of proportion to the injury. Which finding is most characteristic of compartment syndrome?

  1. Pain with passive stretch of the compartment muscles Correct answer.
  2. Pain that decreases when the limb is elevated above heart level
  3. Immediate loss of distal pulses
  4. Cool, pale toes with delayed capillary refill

Explanation

Passive stretch of the muscles within a tense compartment reproduces ischemic pain and is the most reliable early clinical sign. Pulses are typically preserved until late in the process because arterial pressure exceeds compartment pressure.

Question 10Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Which examination maneuver is most sensitive for an acute anterior cruciate ligament tear?

  1. McMurray test with internal rotation of the tibia
  2. Valgus stress test performed in full extension
  3. Posterior drawer test performed at 90 degrees
  4. Lachman test at about 20 to 30 degrees of flexion Correct answer.

Explanation

The Lachman test is performed near 30 degrees of flexion, where the hamstrings are relatively relaxed and the joint capsule is not taut, giving the highest sensitivity for ACL disruption. The anterior drawer test is less sensitive because of hamstring guarding and secondary restraints.

Question 11Assessment and Diagnostic Evaluation of the Orthopaedic Patient

A positive McMurray test with a palpable click along the medial joint line suggests injury to:

  1. The patellofemoral articular cartilage
  2. The medial meniscus Correct answer.
  3. The quadriceps tendon
  4. The lateral collateral ligament

Explanation

Flexion with tibial rotation traps a meniscal fragment between the condyles, and extension reproduces a click at the joint line of the involved meniscus. Medial joint line findings therefore implicate the medial meniscus.

Question 12Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Which test reproduces median nerve compression symptoms by holding the wrists in maximal flexion?

  1. Tinel sign
  2. Durkan compression test
  3. Phalen test Correct answer.
  4. Finkelstein test

Explanation

The Phalen test places the wrists in full palmar flexion for about a minute, increasing carpal tunnel pressure and provoking median nerve paresthesias. It is one of several provocative tests used in suspected carpal tunnel syndrome.

Question 13Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Synovial fluid from a native knee aspirate shows 60,000 WBCs/mm3 with 90% neutrophils. This most suggests:

  1. Traumatic hemarthrosis
  2. Gouty arthritis
  3. Septic arthritis Correct answer.
  4. Osteoarthritis

Explanation

Synovial white cell counts above 50,000/mm3 with a neutrophil predominance exceeding 90% are typical of bacterial arthritis and warrant urgent drainage and antibiotics. Crystal and degenerative arthropathies generally produce lower counts.

Question 14Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Which statement about erythrocyte sedimentation rate and C-reactive protein is accurate in musculoskeletal infection?

  1. Both markers rise and fall at identical rates after treatment
  2. ESR is unaffected by patient age or anemia
  3. CRP remains elevated for weeks after clinical resolution
  4. CRP rises and normalizes more rapidly than ESR Correct answer.

Explanation

C-reactive protein responds within hours of the inflammatory stimulus and falls quickly once infection is controlled, making it the better marker for monitoring treatment response. ESR changes are sluggish and influenced by age, anemia, and immunoglobulin levels.

Question 15Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Which imaging study is most appropriate for suspected meniscal tear with normal radiographs?

  1. A radionuclide bone scan
  2. Magnetic resonance imaging without contrast Correct answer.
  3. Repeat radiographs in six weeks
  4. Diagnostic arthroscopy as the first-line study

Explanation

Noncontrast MRI is the imaging standard for internal derangement of the knee because it shows menisci, ligaments, and cartilage directly. Arthroscopy is a therapeutic and confirmatory procedure reserved for lesions identified on imaging and examination.

Question 16Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Plain radiographs of the wrist are negative after a fall, but scaphoid tenderness persists. What is the most appropriate next step?

  1. Repeat plain radiographs immediately in the emergency department
  2. Bone scan after four weeks of symptoms
  3. Ultrasound of the anatomical snuffbox
  4. CT or MRI of the wrist to detect an occult fracture Correct answer.

Explanation

Early plain films miss a substantial proportion of scaphoid fractures, and untreated fractures risk nonunion and avascular necrosis. CT or MRI performed early identifies occult fractures while allowing immobilization decisions to be made promptly.

Question 17Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Sensation over the palmar aspect of the thumb is supplied primarily by which dermatome?

  1. C8
  2. C7
  3. C5
  4. C6 Correct answer.

Explanation

The C6 dermatome covers the lateral forearm, thumb, and index finger, making it the key level to test for a C6 radiculopathy. Adjacent levels map to the shoulder region (C5), middle finger (C7), and small finger (C8).

Question 18Assessment and Diagnostic Evaluation of the Orthopaedic Patient

An ankle-brachial index of 0.7 in a patient with calf pain while walking indicates:

  1. Normal arterial circulation
  2. Venous insufficiency
  3. Critical limb ischemia requiring revascularization
  4. Moderate peripheral arterial disease Correct answer.

Explanation

An index below 0.9 defines peripheral arterial disease, with values from roughly 0.4 to 0.9 reflecting moderate to severe claudication-level disease. Values below 0.4 suggest critical limb ischemia, and an index above 1.3 suggests noncompressible vessels.

Question 19Assessment and Diagnostic Evaluation of the Orthopaedic Patient

A clinician places stacked wooden blocks beneath one foot while the standing patient's iliac crests are leveled. This maneuver is called the:

  1. Trendelenburg test
  2. Thomas test
  3. Block test Correct answer.
  4. Galeazzi test

Explanation

The block test quantifies leg-length discrepancy indirectly by determining how much elevation is needed to level the pelvis. It complements direct tape measurement from the anterior superior iliac spine to the medial malleolus.

Question 20Assessment and Diagnostic Evaluation of the Orthopaedic Patient

A child has fever and a swollen, hot knee with suspected septic arthritis. Which action is most appropriate before antibiotics are started?

  1. Obtain an MRI of the knee before any aspiration is attempted
  2. Obtain blood cultures and aspirate the joint for culture Correct answer.
  3. Start empiric antibiotics and obtain cultures afterward
  4. Delay aspiration until the C-reactive protein normalizes

Explanation

Joint aspiration before antibiotics gives the highest culture yield and identifies the organism and its sensitivities, while blood cultures add yield when joint cultures are negative. Delaying aspiration for imaging or laboratory normalization risks permanent cartilage loss.

Question 21Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Which patient with an acute ankle injury meets the Ottawa ankle rules indication for radiography?

  1. Ability to bear weight for four steps right after injury
  2. Tenderness at the posterior tip of the lateral malleolus Correct answer.
  3. Pain only with passive plantarflexion and no point tenderness
  4. Swelling over the anterior ankle without bony tenderness

Explanation

Radiographs are indicated when there is malleolar pain plus bony tenderness at the posterior edge or tip of either malleolus, or an inability to bear weight both immediately and in the emergency department. The rules are designed to reduce unnecessary films without missing fractures.

Question 22Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Which principle governs biopsy of a suspected primary bone sarcoma?

  1. The biopsy tract must be excised en bloc with the tumor Correct answer.
  2. A transverse incision across the limb is preferred for exposure
  3. The biopsy should be done at the nearest facility to avoid delay
  4. Several separate needle tracts improve diagnostic yield

Explanation

Because the biopsy tract becomes contaminated with tumor cells, it is considered part of the surgical field and must be removed with the specimen at definitive resection. Biopsies should be performed at the treating center after imaging is reviewed, using a single well-planned approach.

Question 23Assessment and Diagnostic Evaluation of the Orthopaedic Patient

A child with a painful hip is being assessed for septic arthritis. Which combination of findings is most predictive of the diagnosis?

  1. Fever of 38.6 C but able to bear weight, ESR 20, WBC 8,000
  2. Fever of 39 C, refuses to bear weight, ESR 55, WBC 15,000 Correct answer.
  3. Fever 38.0 C, weight bearing, ESR 25, WBC 9,000
  4. Afebrile and able to bear weight, ESR 45, WBC 11,000

Explanation

The Kocher criteria are fever above 38.5 C, refusal to bear weight, ESR above 40 mm/hr, and WBC above 12,000/mm3. The probability of septic arthritis rises steeply with the number of criteria present, approaching certainty when all four are met.

Question 24Assessment and Diagnostic Evaluation of the Orthopaedic Patient

A patient with a leg compartment pressure of 40 mmHg has a diastolic blood pressure of 60 mmHg. Which conclusion is correct?

  1. Fasciotomy is indicated only if absolute pressure exceeds 45 mmHg
  2. A delta pressure of 20 mmHg is reassuring and supports observation
  3. A delta pressure of 20 mmHg supports urgent fasciotomy Correct answer.
  4. Absolute pressure below 45 mmHg excludes compartment syndrome

Explanation

Perfusion of the compartment depends on the difference between diastolic blood pressure and compartment pressure, and a delta of 30 mmHg or less indicates compartment syndrome requiring fasciotomy. Using the absolute pressure alone is unreliable, particularly in hypotensive patients.

Question 25Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Six weeks after total knee arthroplasty, knee aspiration yields fluid with 2,500 WBCs/mm3 and 80% neutrophils. This is most consistent with:

  1. Gouty arthropathy
  2. Normal synovial fluid after arthroplasty
  3. Metallosis from implant wear
  4. Periprosthetic joint infection Correct answer.

Explanation

In the chronic postoperative setting, synovial leukocyte counts above roughly 1,700/mm3 with a neutrophil fraction above 65% are used as major criteria supporting periprosthetic joint infection. Normal postoperative effusions show far lower counts with mononuclear predominance.

Question 26Assessment and Diagnostic Evaluation of the Orthopaedic Patient

The Achilles tendon reflex is mediated primarily by which nerve root?

  1. S2
  2. L5
  3. S1 Correct answer.
  4. L4

Explanation

The Achilles reflex is produced by tapping the tendon and observing plantarflexion, which travels through the tibial nerve and its S1 root. L4 drives the patellar reflex, which helps separate the two levels during a root-level examination.

Question 27Assessment and Diagnostic Evaluation of the Orthopaedic Patient

Which radiographic pattern is most characteristic of osteoarthritis of the knee?

  1. Marginal erosions with periarticular osteopenia and swelling
  2. Permeative bone destruction with layered periosteal reaction
  3. Uniform joint space widening with preserved subchondral bone
  4. Asymmetric joint space narrowing with subchondral sclerosis Correct answer.

Explanation

Osteoarthritis reflects cartilage loss and reactive bone change, so the classic triad is asymmetric joint space narrowing, subchondral sclerosis, and osteophyte formation. Erosions, osteopenia, and destructive lesions point to inflammatory, metabolic, or neoplastic processes instead.

Question 28Assessment and Diagnostic Evaluation of the Orthopaedic Patient

A patient reports neck pain radiating into the ipsilateral arm. Which maneuver most directly reproduces symptoms of cervical nerve root compression?

  1. Spurling test with cervical extension and ipsilateral rotation Correct answer.
  2. Phalen test with the wrists held in maximal flexion
  3. Tinel sign by percussion over the ulnar groove at the elbow
  4. Adson maneuver with the arm extended and externally rotated

Explanation

Spurling testing narrows the neural foramen by combining extension, ipsilateral side bending, and axial compression, so it provokes radicular pain when a root is compressed. A positive result supports cervical radiculopathy rather than a peripheral entrapment neuropathy.

Question 29Assessment and Diagnostic Evaluation of the Orthopaedic Patient

During a single-leg stance test, the patient's contralateral pelvis drops. This finding most directly indicates weakness of which muscle?

  1. Quadratus lumborum
  2. Hip adductors
  3. Gluteus medius Correct answer.
  4. Iliopsoas

Explanation

The Trendelenburg sign occurs when the hip abductors, chiefly the gluteus medius, cannot hold the pelvis level during stance on the affected side. The pelvis therefore drops on the unsupported contralateral side.

Question 30Assessment and Diagnostic Evaluation of the Orthopaedic Patient

A patient with a low pretest probability of deep vein thrombosis has a negative D-dimer on a highly sensitive assay. What is the most appropriate interpretation?

  1. DVT is confirmed and anticoagulation should begin
  2. Venography is required to confirm the negative result
  3. DVT is effectively excluded; no further imaging is needed Correct answer.
  4. The result is uninformative because D-dimer is nonspecific

Explanation

A highly sensitive D-dimer has strong negative predictive value, so when pretest probability is low a negative result safely rules out DVT and avoids unnecessary ultrasound. Specificity is poor, which is why a positive result in a low-probability patient still needs imaging rather than automatic treatment.

Question 31Musculoskeletal Trauma and Fracture Management

Which vitamin is most important for collagen synthesis and cross-linking during fracture healing?

  1. Vitamin C Correct answer.
  2. Vitamin K
  3. Vitamin B12
  4. Vitamin A

Explanation

Ascorbic acid is a cofactor for the hydroxylation of proline and lysine, steps required for collagen to cross-link into a stable matrix. Without adequate vitamin C, collagen produced in the callus is weak and healing is impaired.

Question 32Musculoskeletal Trauma and Fracture Management

Which action is correct when caring for a patient who is in skeletal traction?

  1. Rest the weights on the footboard between turns
  2. Remove the weights while the patient uses a bedpan
  3. Lift the weights by hand while turning the patient
  4. Check that the weights hang free of the floor and bed Correct answer.

Explanation

Skeletal traction works only when the pull is continuous, so weights must hang freely and never touch the floor, bed frame, or headboard. Interrupting the pull allows muscle spasm and loss of fracture alignment.

Question 33Musculoskeletal Trauma and Fracture Management

A patient sprains an ankle during a soccer game. Which instruction reflects appropriate initial management?

  1. Rest, ice, compression, and elevation Correct answer.
  2. Firm massage to disperse the swelling
  3. Warm compresses for 20 minutes each hour
  4. Immediate active range of motion exercises

Explanation

Acute soft tissue injury is managed with rest, ice, compression, and elevation during the first 24 to 48 hours to limit bleeding and edema. Heat, massage, and early vigorous motion all increase swelling and tissue damage.

Question 34Musculoskeletal Trauma and Fracture Management

When teaching a patient who is non-weight-bearing on the right leg to ascend stairs with crutches, the nurse instructs the patient to move which limb first?

  1. Both crutches, then left leg
  2. Crutches with right leg, then left leg
  3. Left leg, then crutches with right leg Correct answer.
  4. Right leg, then crutches

Explanation

The rule for stairs is to lead upward with the good (uninvolved) leg and to move the crutches together with the affected leg. This keeps body weight on the sound limb while the injured leg is protected.

Question 35Musculoskeletal Trauma and Fracture Management

Which term describes a fracture in which the bone is broken into more than two fragments?

  1. Comminuted Correct answer.
  2. Oblique
  3. Spiral
  4. Greenstick

Explanation

A comminuted fracture has three or more bone fragments and often results from high-energy trauma. The other terms describe the direction of the fracture line or an incomplete fracture, not the number of fragments.

Question 36Musculoskeletal Trauma and Fracture Management

Which nursing action is appropriate for the pin sites of an external fixator?

  1. Clean per protocol and inspect for redness or drainage Correct answer.
  2. Cleanse with hydrogen peroxide and leave the sites open
  3. Apply an occlusive dressing and change it every 72 hours
  4. Scrub the pins daily to keep them free of crusts

Explanation

Pin sites are cleaned according to an aseptic protocol and inspected each shift for loosening, erythema, warmth, or purulent drainage, which suggest pin-site infection. Care must avoid cytotoxic agents and traumatic scrubbing.

Question 37Musculoskeletal Trauma and Fracture Management

Skin traction applied to a patient with a hip fracture before surgery is used primarily to do which of the following?

  1. Achieve permanent reduction of the fracture
  2. Prevent deep vein thrombosis in the leg
  3. Correct leg-length discrepancy after surgery
  4. Relieve spasm and immobilize the limb Correct answer.

Explanation

Temporary skin traction reduces muscle spasm, limits movement of the fracture fragments, and improves comfort while the patient awaits definitive fixation. It is not a definitive treatment and does not prevent thromboembolism.

Question 38Musculoskeletal Trauma and Fracture Management

Which set of assessments belongs in a neurovascular check of an injured extremity?

  1. Wound drainage, wound odor, and surrounding erythema
  2. Pulses, capillary refill, sensation, and movement Correct answer.
  3. Skin temperature, pitting edema, and joint range of motion
  4. Bilateral blood pressure, heart rate, and respiratory rate

Explanation

A neurovascular check evaluates distal perfusion and nerve function: pulses, color, warmth, capillary refill, sensation, and motor ability, compared with the unaffected limb. These findings detect arterial compromise and nerve injury early.

Question 39Musculoskeletal Trauma and Fracture Management

A patient with a femoral shaft fracture becomes confused and dyspneic 36 hours after injury, and a petechial rash appears over the chest and axillae. Which complication should the nurse suspect?

  1. Deep vein thrombosis
  2. Fat embolism syndrome Correct answer.
  3. Acute osteomyelitis
  4. Compartment syndrome

Explanation

Fat embolism syndrome classically appears 24 to 72 hours after a long bone fracture with hypoxemia, neurologic changes, and a petechial rash over the chest, axillae, and conjunctivae. The triad reflects fat globules embolizing to the lungs, brain, and skin.

Question 40Musculoskeletal Trauma and Fracture Management

Twelve hours after a tibial fracture, a patient reports severe pain that morphine does not relieve and that worsens when the nurse passively stretches the toes. Pulses remain palpable. What should the nurse do first?

  1. Elevate the leg above heart level and recheck in 1 hour
  2. Apply ice to the anterior lower leg
  3. Notify the provider immediately and prepare for further evaluation Correct answer.
  4. Administer the next scheduled dose of analgesic

Explanation

Pain out of proportion to the injury that intensifies with passive stretch is the earliest and most reliable sign of compartment syndrome, and palpable pulses do not exclude it. The provider must be notified at once because fasciotomy may be needed to prevent permanent nerve and muscle damage.

Question 41Musculoskeletal Trauma and Fracture Management

After reduction of an anterior shoulder dislocation, a patient reports numbness over the lateral aspect of the shoulder and cannot abduct the arm. Which nerve is most likely injured?

  1. Musculocutaneous nerve
  2. Radial nerve
  3. Median nerve
  4. Axillary nerve Correct answer.

Explanation

The axillary nerve passes close to the surgical neck of the humerus and the inferior shoulder capsule, making it the nerve most often injured with an anterior dislocation. Injury produces deltoid weakness and sensory loss over the lateral shoulder.

Question 42Musculoskeletal Trauma and Fracture Management

Which movement should the nurse teach a patient to avoid after reduction of a posterior hip dislocation?

  1. Hip flexion beyond 90 degrees with adduction and internal rotation Correct answer.
  2. Using an abduction pillow between the legs
  3. Standing with a walker for short distances
  4. Sleeping supine with a pillow under the knees

Explanation

A posterior dislocation is reduced through a posterior approach, so hip flexion past 90 degrees combined with adduction and internal rotation can redislocate the joint or disrupt the repair. An abduction pillow and limited ambulation are permitted and encouraged.

Question 43Musculoskeletal Trauma and Fracture Management

A patient with an unstable pelvic fracture is hypotensive. At which level should the pelvic binder be applied?

  1. At the level of the pubic symphysis
  2. At the level of the umbilicus
  3. At the level of the greater trochanters Correct answer.
  4. Over the iliac crests

Explanation

A pelvic binder is centered over the greater trochanters so that it closes the pelvic ring and reduces the volume of the retroperitoneal space. Correct placement decreases bleeding and helps restore hemodynamic stability.

Question 44Musculoskeletal Trauma and Fracture Management

Why does an intracapsular femoral neck fracture carry a high risk of avascular necrosis of the femoral head?

  1. The fracture heals with excess callus formation
  2. The fracture line crosses the joint capsule and causes infection
  3. Traction applied to the leg impairs arterial flow
  4. The blood supply to the femoral head is interrupted Correct answer.

Explanation

The femoral head is supplied largely by retinacular branches of the medial circumflex femoral artery that travel along the neck. An intracapsular fracture disrupts these vessels, so the head loses perfusion and may collapse.

Question 45Musculoskeletal Trauma and Fracture Management

A patient arrives with an open tibial fracture contaminated with soil. After bleeding is controlled, which action should the nurse take next?

  1. Obtain a wound culture before any dressing is applied
  2. Cover the wound with a sterile saline-soaked dressing Correct answer.
  3. Irrigate the wound with hydrogen peroxide
  4. Apply skin traction to the extremity

Explanation

Open fractures are covered with a sterile saline-soaked dressing to protect tissue and limit further contamination while antibiotics, tetanus prophylaxis, and surgical debridement are arranged. Cytotoxic solutions and delays for cultures or traction increase infection risk.

Question 46Musculoskeletal Trauma and Fracture Management

Which finding in a patient with an open fracture most suggests acute osteomyelitis?

  1. Mild edema around the incision
  2. Serous drainage from the wound on postoperative day 1
  3. Low-grade fever of 37.8 degrees C (100 degrees F) on the first postoperative evening
  4. Increasing bone pain, fever, and elevated C-reactive protein Correct answer.

Explanation

Acute osteomyelitis produces persistent, increasing bone pain with fever, wound drainage, and rising inflammatory markers such as CRP and ESR. Early postoperative serous drainage, mild edema, and a single low-grade fever are expected and nonspecific.

Question 47Musculoskeletal Trauma and Fracture Management

Which cluster of findings is characteristic of complex regional pain syndrome after a distal radius fracture?

  1. Painless swelling that resolves with elevation
  2. Burning pain, skin color changes, and sweating in the affected hand Correct answer.
  3. Cool, pulseless fingers with a sharp line of demarcation
  4. Clubbing of the fingers with crepitus at the wrist

Explanation

Complex regional pain syndrome causes pain out of proportion to the injury along with vasomotor and sudomotor changes such as mottled color, temperature asymmetry, and abnormal sweating. Trophic changes and allodynia may follow if it is not treated early.

Question 48Musculoskeletal Trauma and Fracture Management

Which patient factor most increases the risk of nonunion after a long bone fracture?

  1. Taking a daily multivitamin
  2. Early participation in physical therapy
  3. Current cigarette smoking Correct answer.
  4. A body mass index in the normal range

Explanation

Nicotine causes vasoconstriction and carbon monoxide reduces oxygen delivery, impairing the vascular response needed for callus formation. Smoking is one of the strongest modifiable risk factors for delayed union and nonunion.

Question 49Musculoskeletal Trauma and Fracture Management

A patient arrives with a complete traumatic amputation of a finger. Which action is correct for preserving the amputated part?

  1. Place the part directly on ice inside a plastic bag
  2. Store the part at room temperature in a sterile container
  3. Wrap in sterile gauze, seal in a bag, and place in ice water Correct answer.
  4. Soak the part continuously in cold sterile water

Explanation

The amputated part is wrapped in sterile gauze, sealed in a plastic bag, and that bag is placed in a container of ice water so the tissue cools without freezing or soaking. Cooling reduces ischemia while direct ice contact causes frostbite.

Question 50Musculoskeletal Trauma and Fracture Management

Which intervention best prevents venous thromboembolism in a patient immobilized after a hip fracture?

  1. Keeping the affected leg elevated on three pillows at all times
  2. Massaging the calf muscles every shift
  3. Applying sequential compression devices only when the patient requests them
  4. Giving prescribed anticoagulants and using mechanical prophylaxis Correct answer.

Explanation

Trauma patients with limited mobility are at high risk for thromboembolism, and prophylaxis combines prescribed pharmacologic anticoagulation with mechanical devices such as sequential compression sleeves used as ordered. Consistent use, not intermittent use, is what prevents stasis.