TCRN TCRN Musculoskeletal and Wound Care 4 — Questions and Answers
Question 1: A patient with a posterior hip dislocation is being reduced. Which post-reduction assessment is MOST critical?
- Sciatic nerve function assessment (Correct answer)
- Femoral artery pulse check
- Hip flexion range of motion
- Skin integrity over the greater trochanter
Correct answer: Sciatic nerve function assessment
The sciatic nerve is at risk with posterior hip dislocation; post-reduction assessment of sciatic nerve function (foot dorsiflexion and plantar sensation) is essential.
Question 2: During initial trauma assessment, which finding in a wound bed is MOST consistent with a high-pressure injection injury requiring urgent surgical consult?
- Small entry wound on the finger with a tense, painful digit out of proportion to appearance (Correct answer)
- Jagged laceration with visible tendon exposure
- Avulsion injury with partial-thickness skin loss
- Wound with embedded gravel and moderate contamination
Correct answer: Small entry wound on the finger with a tense, painful digit out of proportion to appearance
High-pressure injection injuries create small entry wounds but massive internal destruction requiring emergent surgical decompression to prevent amputation.
Question 3: The Parkland formula for fluid resuscitation in a burn patient with 40% TBSA burn weighing 80 kg orders how much LR in the first 8 hours?
- 6,400 mL (Correct answer)
- 3,200 mL
- 12,800 mL
- 4,800 mL
Correct answer: 6,400 mL
Parkland formula: 4 mL × kg × %TBSA = 4 × 80 × 40 = 12,800 mL total; half (6,400 mL) is given in the first 8 hours from time of injury.
Question 4: A patient returns from the OR after open tibial fracture fixation. Which assessment finding requires IMMEDIATE intervention?
- Absent dorsalis pedis pulse not present preoperatively (Correct answer)
- Pain at the surgical site rated 6/10
- Mild swelling of the ankle distal to the fixator
- Sanguineous drainage on the surgical dressing
Correct answer: Absent dorsalis pedis pulse not present preoperatively
A new absent pulse post-fixation suggests vascular injury or compression from hardware, requiring immediate vascular surgery evaluation.
Question 5: Which wound closure method is MOST appropriate for a contaminated wound sustained 10 hours ago?
- Delayed primary closure after 3-5 days of open wound management (Correct answer)
- Primary closure with interrupted nylon sutures
- Immediate closure with tissue adhesive
- Stapled closure with prophylactic antibiotics
Correct answer: Delayed primary closure after 3-5 days of open wound management
Contaminated wounds or those older than 6-8 hours are left open for delayed primary closure to reduce infection risk.
Question 6: A motorcyclist has a degloving injury of the lower leg. The degloved skin flap is pale and cool. The nurse's PRIORITY action is:
- Wrap the skin flap in saline-moistened gauze and notify the surgeon immediately (Correct answer)
- Discard the avulsed skin as it is non-viable
- Reapply the skin flap and wrap tightly to restore circulation
- Apply a tourniquet proximal to the injury to control bleeding
Correct answer: Wrap the skin flap in saline-moistened gauze and notify the surgeon immediately
Degloved skin, even if pale, should be preserved in moist sterile gauze for potential grafting while awaiting urgent surgical evaluation.
Question 7: Which finding on secondary survey MOST indicates a diaphyseal femur fracture with significant hemorrhage?
- Thigh circumference 5 cm larger than the contralateral side with hemodynamic instability (Correct answer)
- Crepitus at the fracture site only
- Ecchymosis limited to the thigh
- Shortened leg with external rotation
Correct answer: Thigh circumference 5 cm larger than the contralateral side with hemodynamic instability
A femur fracture can sequester 1-2 liters of blood; significant thigh swelling (increased circumference) combined with hemodynamic instability confirms substantial hemorrhage.
TCRN TCRN Musculoskeletal and Wound Care 4
A patient with a posterior hip dislocation is being reduced.
Which post-reduction assessment is MOST critical?