1. Section Editor(s): Roberts, Dottie MSN, MACI, RN,C, ONC, CNS

Article Content

Mr. Stephen Carne, 55 years old, is hit by a car when crossing the street. A witness to the accident notes that Mr. Carne is awake and oriented and complaining of severe pain in his right leg. Mr. Carne's right leg is markedly deformed, and there is a bleeding wound on his right thigh. The witness calls 911 for assistance, and the emergency team arrives 10 minutes later.




1. The emergency treatment of Mr. Carne at the site of the accident should include:


a. applying manual traction to his right lower extremity.


b. immobilizing his right leg in the position assumed.


c. elevating his right extremity.


d. placing his right leg in normal anatomic position.


Mr. Carne is transported to the emergency department and his condition is stabilized. X-ray reveals an open comminuted (type III) fracture of the midshaft of the right femur. There is also evidence of an old healed fracture of the right tibia. Mr. Carne is transferred to the operating room for an open reduction and external fixation of the right femur.



2. In the operating room, the nurse should prepare initially for which of these procedures?


a. Soft tissue reconstruction of the wound.


b. Primary wound closure.


c. Debridement of the wound.


d. Rinsing the wound with methylprednisolone solution.


The surgery is completed and Mr. Carne is transferred to a surgical unit. His postoperative orders include morphine sulfate via a patient-controlled analgesia (PCA) pump.



3. Compared to traditional pain management, PCA has the advantage of:


a. allowing for individual titration of pain medication.


b. increasing the likelihood of adequate pain control.


c. reducing the need for nursing assessment of the patient's pain.


d. permitting family members to administer pain medication.



4. Which of these factors puts Mr. Carne at increased risk for a fat embolism?


a. His age.


b. The site of the fracture.


c. Previous fracture of the affected extremity.


d. Use of the external fixator.



5. The nurse should monitor Mr. Carne for early signs and symptoms of fat embolism syndrome, which include:


a. increased blood pressure.


b. decreased heart rate.


c. elevated mood.


d. restlessness

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