TCRN TCRN Musculoskeletal and Wound Care 5 — Questions and Answers
Question 1: A patient with full-thickness circumferential burns to both lower extremities develops absent pedal pulses bilaterally. The PRIORITY intervention is:
- Prepare the patient for bilateral lower extremity escharotomy (Correct answer)
- Elevate both lower extremities above heart level
- Increase IV fluid rate to improve perfusion pressure
- Apply topical vasodilator and warm blankets
Correct answer: Prepare the patient for bilateral lower extremity escharotomy
Circumferential full-thickness burns restrict blood flow as edema develops; escharotomy releases the constricting eschar to restore distal perfusion.
Question 2: A patient with a calcaneal fracture from a fall should be assessed for which commonly associated injury?
- Lumbar burst fracture due to axial loading (Correct answer)
- Proximal fibula fracture
- Ipsilateral hip dislocation
- Cervical spine fracture
Correct answer: Lumbar burst fracture due to axial loading
The axial force transmitted during falls from height that fractures the calcaneus frequently also causes lumbar or thoracolumbar burst fractures.
Question 3: Which intervention BEST prevents pressure injury development in an intubated, sedated trauma patient?
- Repositioning every 2 hours with documentation of skin assessment (Correct answer)
- Applying prophylactic foam dressings to bony prominences only when erythema appears
- Using a standard hospital mattress with a sheepskin overlay
- Repositioning every 4 hours to minimize disruption of healing tissue
Correct answer: Repositioning every 2 hours with documentation of skin assessment
Scheduled repositioning every 2 hours remains the gold-standard pressure injury prevention strategy, combined with skin assessment documentation.
Question 4: When assessing a wound for infection, which finding is MOST concerning for systemic sepsis requiring immediate action?
- New purulent drainage with fever 38.8°C, HR 118, and WBC 18,000 (Correct answer)
- Localized erythema within 1 cm of wound edges
- Serosanguineous drainage with mild periwound warmth
- Wound dehiscence with exposed subcutaneous tissue
Correct answer: New purulent drainage with fever 38.8°C, HR 118, and WBC 18,000
Systemic signs — fever, tachycardia, and leukocytosis — combined with purulent drainage indicate sepsis from wound infection requiring immediate intervention.
Question 5: A patient has a midshaft humerus fracture. Which nerve injury should the nurse assess for?
- Radial nerve palsy causing wrist drop (Correct answer)
- Median nerve injury causing thenar atrophy
- Ulnar nerve injury causing clawing of the ring and small fingers
- Axillary nerve injury causing deltoid weakness
Correct answer: Radial nerve palsy causing wrist drop
The radial nerve spirals around the posterior humerus in the radial groove and is commonly injured in midshaft humerus fractures, causing wrist drop.
Question 6: During splint application for a distal radius fracture, the nurse notes the patient's fingers become increasingly pale and cold. The FIRST action is:
- Bivalve or remove the splint immediately and assess neurovascular status (Correct answer)
- Elevate the extremity above heart level and reassess in 15 minutes
- Apply warm blankets and loosen the ace wrap slightly
- Notify the physician before removing any part of the splint
Correct answer: Bivalve or remove the splint immediately and assess neurovascular status
Vascular compromise from a too-tight splint requires immediate removal to restore circulation; delays cause irreversible ischemic injury.
Question 7: A trauma patient with a pelvis fracture and suspected urethral injury requires urinary catheterization. The CORRECT approach is:
- Consult urology before any catheterization attempt; a suprapubic catheter may be required (Correct answer)
- Attempt gentle Foley insertion with a smaller catheter size
- Insert a three-way catheter to allow irrigation if blood is encountered
- Delay catheterization until after pelvic CT confirms bladder integrity
Correct answer: Consult urology before any catheterization attempt; a suprapubic catheter may be required
Blood at the urethral meatus or scrotal hematoma suggests urethral injury; blind catheterization can convert a partial tear to a complete rupture, requiring urology and possible suprapubic catheter.
TCRN TCRN Musculoskeletal and Wound Care 5
A patient with full-thickness circumferential burns to both lower extremities develops absent pedal pulses bilaterally.
The PRIORITY intervention is: