MCQs on Fractures
Expected time to complete : 25 minutes
Question 1:
When counseling an older patient about ways to prevent fractures, which information will the nurse include?
1. Tacking down scatter rugs in the home is recommended.
2. Occasional weight-bearing exercise will improve muscle and bone strength.
3. Most falls happen outside the home.
4. Buying shoes that provide good support and are comfortable to wear is recommended.
Correct Answer: 4
Rationale: Comfortable shoes with good support will help to decrease the risk for falls. Scatter rugs should be completely eliminated, not just tacked down. Regular, not occasional, weight-bearing exercise is needed to improve strength. Most falls in the elderly happen inside the home.
Question 2:
Which surgical procedure is used to relieve the pressure on the median nerve?
1. Open reduction and internal fixation
2. Carpal tunnel release
3. Arthroplasty
4. Knee replacement
Correct Answer: 2
Rationale: Carpal tunnel syndrome involves the compression of the median nerve. A carpal tunnel release is a surgical procedure that cuts the transverse carpal ligament to relieve the pressure on this nerve.
Question 3:
A patient is seen at the urgent care center after falling on the right arm and shoulder. It will be most important for the nurse to determine?
1. whether there is bruising at the shoulder area.
2. whether the right arm is shorter than the left.
3. the amount of pain the patient is experiencing.
4. how much range of motion (ROM) is present.
Correct Answer: 2
Rationale: A shorter limb after a fall indicates a possible dislocation or severe displaced fracture, which is an orthopedic emergency. The nurse will expect bruising and pain, which are lower priority than assessing for joint/bone displacement. Active ROM should not be tested until a fracture is ruled out.
Question 4:
What is known as a fracture with bending and splintering?
1. Complete fracture
2. Comminuted fracture
3. Greenstick fracture
4. Pott’s fracture
Correct Answer: 3
Rationale: A greenstick fracture is an incomplete fracture in which the bone bends and splinters/cracks on one side, similar to how a green branch of a tree breaks. It is most commonly seen in children because their bones are softer and more flexible.
Question 5:
In which bone the Hangman’s fracture occurs?
1. The distal end of the radius
2. The distal part of the fibula
3. Pedicle of C-2 cervical vertebrae
4. Neck of femur
Correct Answer: 3
Rationale: A Hangman’s fracture is a bilateral fracture of the pars interarticularis (or pedicle) of the C2 cervical vertebra (the axis). It is often caused by severe hyperextension of the head and neck.
Question 6:
What is known as the fibrous membrane covering the bone?
1. Periosteum
2. Epiphysis
3. Diaphysis
4. Medullary Cavity
Correct Answer: 1
Rationale: The periosteum is a dense layer of vascular fibrous connective tissue enveloping the bones except at the surfaces of the joints. It is crucial for bone growth, repair, and nutrition.
Question 7:
When working with a patient whose job involves many hours of word processing, the nurse will teach the patient about the need to
1. do stretching and warm-up exercises before starting work.
2. wrap the wrists with a compression bandage every morning.
3. use acetaminophen (Tylenol) instead of NSAIDs for wrist pain.
4. obtain a keyboard pad to support the wrist while word processing.
Correct Answer: 4
Rationale: Repetitive strain injuries caused by prolonged times working at a keyboard can be prevented by using a pad to keep the wrists in a neutral, straight position. Compression bandages are not preventative, and NSAIDs treat inflammation rather than prevent the mechanical strain.
Question 8:
A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. All of the following orders are written by the health care provider. Which one will the nurse act on first?
1. Administer naproxen 500 mg PO.
2. Wrap the ankle and apply an ice pack.
3. Give acetaminophen with codeine
4. Take the patient to the radiology department for x-rays.
Correct Answer: 2
Rationale: Immediate care after a sprain, strain, or suspected fracture includes RICE (Rest, Ice, Compression, Elevation) to minimize swelling, bleeding, and pain. The nurse should wrap the ankle and apply ice first, before sending the patient to radiology or waiting for oral analgesics to take effect.
Question 9:
What is the other name of hairline fracture?
1. Comminuted fracture
2. Pathological fracture
3. Oblique fracture
4. Stress fracture
Correct Answer: 4
Rationale: A stress fracture, often referred to as a hairline fracture, is a tiny crack in a bone caused by repetitive stress or force, often from overuse (like long-distance running).
Question 10:
The following things affect bone healing after fracture except?
1. Age of the person
2. Underlying bone pathology
3. Bone type
4. Arthroscopy
Correct Answer: 4
Rationale: Arthroscopy is a minimally invasive diagnostic and surgical procedure used to examine joint interiors. It does not biologically alter or affect the physiological rate of bone healing. Age, bone type, and underlying pathologies (like osteoporosis) directly impact how fast a fracture heals.
Question 11:
What is the other name of necrotizing fasciitis?
1. Flesh-eating disease
2. Psoriasis
3. Seborrhea
4. Cellulitis
Correct Answer: 1
Rationale: Necrotizing fasciitis is a severe, life-threatening bacterial infection that rapidly destroys tissue under the skin, earning the common name “flesh-eating disease.”
Question 12:
While testing the patient’s muscle strength, the nurse finds that the patient can flex the arms when no resistance is applied but is unable to flex when the nurse applies light resistance. The nurse should documents the patient’s muscle strength as level
1. Level 1
2. Level 2
3. Level 3
4. Level 4
Correct Answer: 3
Rationale: Muscle strength grading goes from 0 to 5. Level 3 indicates that the patient can complete full range of motion against gravity but cannot maintain it against any added resistance. Level 1 is a slight trace/flicker of contraction, Level 2 is active movement when gravity is eliminated, and Level 4 is active movement with some resistance.
Question 13:
Which type of bone fracture that is caused by a disease which leads to the weakness of the bone?
1. Compound fracture
2. Colle’s fracture
3. Pathological fracture
4. Greenstick fracture
Correct Answer: 3
Rationale: A pathological fracture occurs when a bone breaks in an area weakened by another disease process, such as osteoporosis, bone tumors, or infections, rather than trauma.
Question 14:
Which of the following is not a complication of fractures?
1. Vascular injury.
2. Nerve injury
3. Compartment syndrome.
4. Stroke
Correct Answer: 4
Rationale: Stroke is a neurological event typically caused by cerebral ischemia or hemorrhage. Complications directly associated with long bone fractures include compartment syndrome, nerve injury, vascular injury, fat embolism, and osteomyelitis.
Question 15:
What is the purpose of traction?
1. Increase the muscle spasm
2. Reduce the infection
3. Immobilize the fractured part
4. All of the above
Correct Answer: 3
Rationale: Traction applies a pulling force to a fractured extremity to align the bone fragments, immobilize the fractured part, and reduce (not increase) muscle spasms. It has no effect on reducing infections.
Question 16:
A patient with kyphosis is scheduled for dual-energy x-ray absorptiometry (DEXA) testing. The nurse will plan to
1. start an intravenous line.
2. screen the patient for shellfish allergies.
3. teach the patient that DEXA is noninvasive.
4. give an oral sedative.
Correct Answer: 3
Rationale: DEXA testing is a painless and noninvasive scan used to measure bone mineral density. No IV access or contrast medium (like iodine, related to shellfish allergies) is required, and no sedation is needed.
Question 17:
A patient with a fractured femur suddenly develops tachypnea, tachycardia, altered mental status, and a petechial rash on the chest 24 hours post-injury. Which complication should the nurse suspect?
1. Pulmonary Embolism
2. Compartment Syndrome
3. Fat Embolism Syndrome (FES)
4. Hypovolemic Shock
Correct Answer: 3
Rationale: The classic triad of Fat Embolism Syndrome (FES) consists of hypoxemia, neurological abnormalities, and a petechial rash. It typically occurs 12 to 72 hours after fractures of long bones (like the femur) or the pelvis.
Question 18:
An elderly patient is brought to the emergency department after a fall. The nurse suspects a fractured right hip. Which clinical manifestations are classically expected?
1. The right leg is longer and internally rotated.
2. The right leg is shorter and externally rotated.
3. The right leg is shorter and internally rotated.
4. The right leg is longer and externally rotated.
Correct Answer: 2
Rationale: A fractured hip characteristically presents with shortening and external rotation of the affected extremity due to muscle spasms pulling on the unanchored bone fragments.
Question 19:
A patient has a newly applied plaster cast on the right forearm. Which action by the nurse is correct when handling the wet cast?
1. Handle the cast with the fingertips only.
2. Cover the cast entirely with a blanket to keep it warm.
3. Handle the cast using the palms of the hands.
4. Use a hair dryer on the “hot” setting to dry it quickly.
Correct Answer: 3
Rationale: A wet plaster cast should be handled with the palms of the hands to prevent indentations that could cause pressure ulcers underneath the cast. It should be air-dried; covering it traps moisture, and using forced heat can burn the patient and dry the outside while leaving the inside wet.
Question 20:
A patient with a tibial fracture is complaining of severe, unrelenting leg pain that is not relieved by opioid analgesics. The pain worsens with passive stretching of the toes. The nurse should immediately prepare for which intervention?
1. Application of heat to the leg
2. Preparing the patient for a fasciotomy
3. Elevating the leg above heart level
4. Administering a higher dose of opioids
Correct Answer: 2
Rationale: Unrelenting pain out of proportion to the injury that worsens with passive stretch is the hallmark early sign of Compartment Syndrome. This is a surgical emergency requiring a fasciotomy to relieve the pressure and save the limb.
Question 21:
A nursing officer is positioning a patient post-total hip arthroplasty. Which position prevents prosthetic dislocation?
1. Hip adduction
2. Hip abduction
3. Hip flexion >90°
4. Internal rotation
Correct Answer: 2
Rationale: Postoperative care following a posterior-approach total hip replacement requires keeping the operative extremity in an abducted position (away from the midline). This position keeps the femoral head securely inside the acetabular socket. Adduction past the midline, internal rotation, and hip flexion greater than 90° must be strictly avoided to prevent dislocation.
Question 22:
Which type of fracture involves the bone being broken into three or more fragments?
1. Spiral fracture
2. Oblique fracture
3. Comminuted fracture
4. Transverse fracture
Correct Answer: 3
Rationale: A comminuted fracture is one in which the bone splinters or breaks into multiple (three or more) pieces.
Question 23:
The nurse is caring for a patient in skeletal traction. Which nursing action is a priority for preventing complications?
1. Removing the weights for 10 minutes every shift
2. Performing pin site care according to facility policy
3. Allowing the traction weights to rest on the floor during repositioning
4. Maintaining the patient in a prone position
Correct Answer: 2
Rationale: Skeletal traction involves pins inserted directly into the bone. Pin site care is critical to prevent osteomyelitis (bone infection). Weights must never be removed or allowed to rest on the floor, as they must maintain continuous, free-hanging traction.
Question 24:
A patient has sustained a Colles’ fracture. The nurse understands that this type of fracture involves which bone?
1. Proximal humerus
2. Distal radius
3. Proximal femur
4. Distal fibula
Correct Answer: 2
Rationale: A Colles’ fracture is a break in the distal radius (wrist) usually characterized by a backward/dorsal displacement of the hand, classically occurring when a person tries to break a fall with an outstretched hand.
Question 25:
A nurse is teaching a patient how to use crutches on the stairs. Which instruction is correct when going UP the stairs?
1. Move both crutches up first, followed by the affected leg, then the unaffected leg.
2. Step up with the affected leg first, followed by the crutches.
3. Step up with the unaffected (good) leg first, followed by the affected leg and crutches.
4. Move the crutches and the unaffected leg simultaneously.
Correct Answer: 3
Rationale: The mnemonic is “Up with the Good, Down with the Bad.” When going up stairs, the patient should step up with the strong/unaffected leg first, as it does the work of lifting the body.
Question 26: Which clinical finding is a late sign of compartment syndrome?
1. Pulselessness
2. Paresthesia (numbness and tingling)
3. Pain with passive movement
4. Pressure in the compartment
Correct Answer: 1
Rationale: The “5 Ps” of compartment syndrome are Pain, Pallor, Pulselessness, Paresthesia, and Paralysis. Pain and paresthesia are early signs. Pulselessness and paralysis are late, ominous signs indicating significant tissue ischemia and possible irreversible nerve and muscle damage.
Question 27: A child is brought in with a spiral fracture of the humerus. Which action is the highest priority for the nurse?
1. Assess the child for signs of child abuse.
2. Apply a tourniquet above the fracture.
3. Apply warm compresses to the arm.
4. Prepare for immediate amputation.
Correct Answer: 1
Rationale: Spiral fractures are caused by a twisting force. While they can happen in sports, a spiral fracture in a young child is a major red flag for physical abuse (non-accidental trauma), requiring thorough assessment and reporting.
Question 28: A patient is in Buck’s traction while awaiting hip surgery. The nurse knows that Buck’s traction is classified as:
1. Skeletal traction
2. Skin traction
3. Halo traction
4. Manual traction
Correct Answer: 2
Rationale: Buck’s traction is a form of skin traction used temporarily to immobilize a fracture, prevent muscle spasms, and relieve pain before surgery. It does not use pins into the bone.
Question 29: What is the defining characteristic of an open (compound) fracture?
1. The bone is crushed into many pieces.
2. The fracture line is straight across the bone shaft.
3. The bone breaks through the skin, creating an external wound.
4. One fragment is firmly driven into another fragment.
Correct Answer: 3
Rationale: In an open or compound fracture, the broken bone pierces the skin, exposing the bone to the external environment. This significantly increases the risk of severe infection, such as osteomyelitis.
Question 30: When providing first aid for a suspected fracture at the scene of an accident, what is the initial priority?
1. Attempt to push the bone back into place.
2. Apply a tight tourniquet immediately.
3. Immobilize the joint above and below the fracture in the position it was found.
4. Elevate the extremity rapidly.
Correct Answer: 3
Rationale: To prevent further soft tissue, nerve, and vascular damage, a suspected fracture should be splinted/immobilized in the exact position it was found. Attempting to reduce it without medical imaging and analgesia can cause severe injury.
Question 31: Which medication should the nurse anticipate administering to a patient post-operatively after a fracture repair to prevent Deep Vein Thrombosis (DVT)?
1. Enoxaparin (Lovenox)
2. Cefazolin (Ancef)
3. Ketorolac (Toradol)
4. Famotidine (Pepcid)
Correct Answer: 1
Rationale: Enoxaparin is a low-molecular-weight heparin used prophylactically to prevent DVT in immobile or post-orthopedic surgery patients.
Question 32: A fracture in which one bone fragment is forcefully driven into another is called an:
1. Avulsion fracture
2. Impacted fracture
3. Oblique fracture
4. Transverse fracture
Correct Answer: 2
Rationale: In an impacted fracture, the ends of the fractured bone are jammed together by the force of the injury.
Question 33: A 10-year-old child sustains a fracture near the ends of the long bone. The nurse is concerned because fractures in this area can cause premature closure and affect future bone growth. What is this anatomical area called?
1. Diaphysis
2. Epiphyseal plate (Growth plate)
3. Medullary cavity
4. Articular cartilage
Correct Answer: 2
Rationale: The epiphyseal plate is the area of growing tissue near the ends of long bones in children and adolescents. A fracture here can lead to unequal limb length or deformity if not treated carefully.
Question 34: The term “Delayed Union” in fracture healing refers to:
1. A bone that heals in a deformed or incorrect anatomical position.
2. A fracture that fails to heal despite treatment.
3. A fracture that takes significantly longer to heal than expected.
4. A bone that breaks again after healing.
Correct Answer: 3
Rationale: Delayed union is when the fracture healing progresses much slower than the normal physiological timeframe. Non-union is when it completely fails to heal, and malunion is when it heals in an abnormal position.
Question 35: A patient with an open fracture of the tibia is prescribed prophylactic antibiotics. What is the primary reason for this?
1. To reduce the inflammation around the fracture site.
2. To prevent Osteomyelitis.
3. To prevent Fat Embolism Syndrome.
4. To enhance calcium absorption in the bone.
Correct Answer: 2
Rationale: Open fractures expose the bone and deep tissues to environmental bacteria, putting the patient at extremely high risk for osteomyelitis (bone infection), which can be limb-threatening.
Question 36: A patient with a right ankle sprain is instructed to walk with a cane. In which hand should the patient hold the cane?
1. The right hand
2. The left hand
3. Either hand, whatever is comfortable
4. Both hands alternately
Correct Answer: 2
Rationale: The cane should be held on the unaffected (strong) side—in this case, the left hand. This allows the cane to support weight simultaneously with the affected (right) leg to widen the base of support and reduce stress on the injury.
Question 37: Pott’s fracture specifically involves which anatomical region?
1. Distal radius
2. Distal humerus
3. Bimalleolar fracture of the ankle
4. Clavicle
Correct Answer: 3
Rationale: A Pott’s fracture affects the ankle, specifically involving fractures of the distal fibula and medial malleolus of the tibia, often combined with ligament tearing.
Question 38: Which of the following phases of fracture healing is characterized by the formation of a fibrocartilaginous network?
1. Hematoma formation
2. Soft callus formation
3. Hard callus (ossification)
4. Bone remodeling
Correct Answer: 2
Rationale: During soft callus formation (days to weeks after injury), a fibrocartilaginous network forms a bridge between the bone fragments before it is calcified into a hard bony callus.
Question 39: A patient with a pelvic fracture requires close monitoring. What is the most immediate life-threatening complication the nurse must assess for?
1. Hypovolemic shock due to internal hemorrhage
2. Paralytic ileus
3. Bladder rupture
4. Osteoarthritis
Correct Answer: 1
Rationale: The pelvis houses major blood vessels. A fractured pelvis can lacerate these vessels, leading to massive, life-threatening retroperitoneal or intra-abdominal bleeding and rapid hypovolemic shock.
Question 40: A patient complains of a “pins and needles” sensation and numbness distal to a new cast. The nurse should identify this as which “P” of compartment syndrome?
1. Pain
2. Pallor
3. Paresthesia
4. Paralysis
Correct Answer: 3
Rationale: Paresthesia describes abnormal sensations like tingling, numbness, or “pins and needles,” which indicates nerve compression or irritation.
Question 41: A nurse assessing a patient with a fractured rib notes a “crackling” sound and sensation when palpating the skin around the injury. How should this finding be documented?
1. Crepitus
2. Stridor
3. Subcutaneous emphysema
4. Both 1 and 3
Correct Answer: 4
Rationale: In a rib fracture, air can leak into the tissues (subcutaneous emphysema), creating a crackling sensation (crepitus). Crepitus is also the term used when broken bone ends rub together.
Question 42: What is the primary advantage of a fiberglass cast compared to a traditional Plaster of Paris cast?
1. Fiberglass casts can be molded more easily to severe deformities.
2. Fiberglass casts dry quickly, are lighter, and are water-resistant.
3. Fiberglass casts are cheaper and easier to remove.
4. Fiberglass casts are easily broken down by body heat.
Correct Answer: 2
Rationale: Fiberglass casts harden and dry within 15–30 minutes, are much lighter, and do not break down when they get wet (though the padding inside must remain dry), whereas plaster can take 24–72 hours to fully dry and is very heavy.
Question 43: Which orthopedic device consists of metal pins inserted into the bone and attached to a metal frame located outside the body?
1. Internal fixation
2. Buck’s traction
3. External fixator
4. Cast brace
Correct Answer: 3
Rationale: An external fixator holds fractures stable with pins drilled into the bone that connect to a rigid metal framework on the outside of the limb.
Question 44: A patient with a fracture is placed in Russell’s traction. The nurse knows that this traction differs from Buck’s traction because it:
1. Uses a sling under the knee, suspending the leg.
2. Requires pins to be inserted into the tibia.
3. Is used exclusively for cervical spine injuries.
4. Wraps around the patient’s pelvis.
Correct Answer: 1
Rationale: Russell’s traction is a type of skin traction for lower extremity fractures that uses a knee sling in addition to pulling longitudinally, creating a two-directional pull to support the leg.
Question 45: Avascular necrosis (AVN) is a common complication associated with fractures of which specific bone?
1. Clavicle
2. Femoral neck
3. Tibial shaft
4. Ulna
Correct Answer: 2
Rationale: A femoral neck fracture can severely disrupt the precarious blood supply to the head of the femur. Without blood, the bone tissue dies, leading to avascular necrosis.
Question 46: A patient with a fractured clavicle is most likely to be treated with which of the following?
1. Hip spica cast
2. Figure-eight bandage or sling
3. External fixator
4. Halo vest
Correct Answer: 2
Rationale: Most clavicle (collarbone) fractures are managed conservatively by immobilizing the shoulder to keep it pulled back and supported, utilizing a figure-eight splint or a simple arm sling.
Question 47: The nurse is observing the drainage from a patient’s external fixator pin sites. Which type of drainage indicates a complication requiring immediate notification to the physician?
1. A small amount of clear, serous fluid
2. Mild crusting around the pin
3. Thick, purulent (yellow/green) drainage
4. A drop of serosanguinous fluid
Correct Answer: 3
Rationale: Serous drainage and slight crusting are normal inflammatory responses to the pins. Purulent drainage, especially if accompanied by redness or fever, is a sign of clinical infection and requires immediate medical attention.
Question 48: Which dietary modification is most critical for a patient recovering from a long bone fracture?
1. High protein, high calcium, high vitamin D
2. Low carbohydrate, low fat, low sodium
3. High potassium, low calcium, high fiber
4. Fluid restriction to prevent edema
Correct Answer: 1
Rationale: Bone repair requires significant metabolic resources. A diet high in protein is required for tissue repair, and high calcium/vitamin D is required for bone ossification and callus formation.
Question 49: A patient requires the use of a walker for ambulation after a pelvic fracture. Which sequence of movement is correct?
1. Move the walker and the affected leg forward simultaneously, then step up with the unaffected leg.
2. Step with the unaffected leg first, move the walker, then step with the affected leg.
3. Move the walker forward, step forward with the affected leg, then step forward with the unaffected leg.
4. Step forward with both legs, then push the walker forward.
Correct Answer: 3
Rationale: The correct sequence for a walker is: lift and advance the walker, step forward with the weak/affected leg (putting weight on the arms of the walker), and then step forward with the strong/unaffected leg.
Question 50: The physician instructs the nurse to elevate a patient’s fractured limb above the level of the heart. What is the primary physiological purpose of this intervention?
1. To increase arterial blood flow to the bone.
2. To promote venous return and decrease edema.
3. To stretch the muscles and prevent contractures.
4. To reduce the risk of a pulmonary embolism.
Correct Answer: 2
Rationale: Elevating an extremity above the level of the heart uses gravity to drain venous blood and lymphatic fluid back toward the central circulation, effectively reducing swelling and edema around the fracture site.