TCRN Musculoskeletal and Wound Care Questions and Answers

Question 1

A patient with a closed tibial fracture after a motorcycle crash requires escalating doses of opioid analgesia.
Which early clinical finding is most indicative of developing acute compartment syndrome?

Accepted Answer

Pain that is out of proportion to the injury

Answer

Absence of a distal pulse

Answer

Inability to move the toes (paralysis)

Answer

A cool, pale extremity

Question 2

A patient arrives with a grossly contaminated Grade III open femur fracture. After controlling hemorrhage and ensuring hemodynamic stability, which intervention is the highest priority to prevent osteomyelitis?

Accepted Answer

Administering broad-spectrum intravenous antibiotics

Answer

Covering the wound with a saline-moistened sterile dressing

Answer

Obtaining a deep wound culture before irrigation

Answer

Immediate surgical debridement in the operating room

Question 3

A patient is extricated from a structural collapse with severe crush injuries to both lower extremities. The trauma nurse should anticipate which hallmark laboratory finding and prioritize which intervention to prevent acute kidney injury?

Accepted Answer

Elevated creatinine kinase (CK); aggressive intravenous fluid resuscitation

Answer

Hyperkalemia; administration of intravenous insulin and dextrose

Answer

Hypocalcemia; administration of calcium gluconate

Answer

Decreased hemoglobin; transfusion of packed red blood cells

Question 4

A 22-year-old involved in a skiing accident has an isolated, closed femur fracture. Forty-eight hours after the injury, the patient becomes acutely confused, develops respiratory distress, and has a petechial rash across the chest and axillae. These findings are most characteristic of which complication?

Accepted Answer

Fat Embolism Syndrome (FES)

Answer

Compartment Syndrome

Answer

Pulmonary Embolism

Answer

Rhabdomyolysis

Question 5

A patient presents with a deep, contaminated puncture wound from a farm implement. Their tetanus immunization history is unknown. According to current guidelines, what is the most appropriate prophylaxis?

Accepted Answer

Tdap vaccine and Tetanus Immune Globulin (TIG)

Answer

Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine only

Answer

Tetanus Immune Globulin (TIG) only

Answer

No immunoprophylaxis is needed if the wound is thoroughly irrigated

Question 6

A patient with a traumatic knee dislocation undergoes successful closed reduction in the emergency department. Distal pulses are strong and palpable post-reduction. What is the most critical next assessment to rule out a limb-threatening injury?

Accepted Answer

Measuring an Ankle-Brachial Index (ABI)

Answer

Obtaining post-reduction radiographs

Answer

Applying a knee immobilizer for comfort

Answer

Performing hourly passive range of motion

A patient with a closed tibial fracture after a motorcycle crash requires escalating doses of opioid analgesia.Which early clinical finding is most indicative of developing acute compartment syndrome?

A patient with a closed tibial fracture after a motorcycle crash requires escalating doses of opioid analgesia.
Which early clinical finding is most indicative of developing acute compartment syndrome?