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Medical and Surgical Nursing (NCLEX Exams)
MSN Exam for Musculoskeletal Examination
Medical and Surgical Nursing (NCLEX Exams)

MSN Exam for Musculoskeletal Examination

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1. A client is 1 day postoperative after a total hip replacement. The client  should be placed in which of the following position?

  1. Supine
  2. Semi Fowler’s
  3. Orthopneic
  4. Trendelenburg

2. A client who has had a plaster of Paris cast applied to his forearm is  receiving pain medication. To detect early manifestations of compartment  syndrome, which of these assessments should the nurse make?

  1. Observe the color of the fingers
  2. Palpate the radial pulse under the cast
  3. Check the cast for odor and drainage
  4. Evaluate the response to analgesics

3. After a computer tomography scan with intravenous contrast medium, a  client returns to the unit complaining of shortness of breath and itching. The  nurse should be prepared to treat the client for:

  1. An anaphylactic reaction to the dye
  2. Inflammation from the extravasation of fluid during injection.
  3. Fluid overload from the volume of the infusions
  4. A normal reaction to the stress of the diagnostic procedure.

4. While caring for a client with a newly applied plaster of Paris cast, the  nurse makes note of all the following conditions. Which assessment finding  requires immedite notification of the physician?

  1. Moderate pain, as reported by the client
  2. Report, by client, the heat is being felt under the cast
  3. Presence of slight edema of the toes of the casted foot
  4. Onset of paralysis in the toes of the casted foot

5. Which of these nursing actions will best promote independence for the  client in skeletal traction?

  1. Instruct the client to call for an analgesic before pain becomes severe.
  2. Provide an overhead trapeze for client use
  3. Encourage leg exercise within the limits of traction
  4. Provide skin care to prevent skin breakdown.

6. A client presents in the emergency department after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best  support this diagnosis.

  1. The client reports pain in the affected leg
  2. A large hematoma is visible in the affected extremity
  3. The affected extremity is shortenend, adducted, and extremely  rotated
  4. The affected extremity is edematous.

7. The nurse is caring for a client with compound fracture of the tibia and  fibula. Skeletal traction is applied. Which of these priorities should the nurse  include in the care plan?

  1. Order a trapeze to increase the client’s ambulation
  2. Maintain the client in a flat, supine position at all times.
  3. Provide pin care at least every hour
  4. Remove traction weights for 20 minutes every two hours.

8. To prevent foot drop in a client with Buck’s traction, the nurse should:

  1. Place pillows under the client’s heels.
  2. Tuck the sheets into the foot of the bed
  3. Teach the client isometric exercises
  4. Ensure proper body positioning.

9. Which nursing intervention is appropriate for a client with skeletal  traction?

  1. Pin care
  2. Prone positioning
  3. Intermittent weights
  4. 5lb weight limit

10. In order for Buck’s traction applied to the right leg to be effective, the  client should be placed in which position?

  1. Supine
  2. Prone
  3. Sim’s
  4. Lithotomy

11. An elderly client has sustained intertrochanteric fracture of the hip and  has just returned from surgery where a nail plate was inserted for internal  fixation. The client has been instructed that she should not flex her hip. The  best explanation of why this movement would be harmful is:

  1. It will be very painful for the client
  2. The soft tissue around the site will be damaged
  3. Displacement can occur with flexion
  4. It will pull the hip out of alignment

12. When the client is lying supine, the nurse will prevent external rotation of  the lower extremity by using a:

  1. Trochanter roll by the knee
  2. Sandbag to the lateral calf
  3. Trochanter roll to the thigh
  4. Footboard

13. A client has just returned from surgery after having his left leg  amputated below the knee. Physician’s orders include elevation of the foot of  the bed for 24 hours. The nurse observes that the nursing assistant has  placed a pillow under the client’s amputated limb. The nursing action is to:

  1. Leave the pillow as his stump is elevated
  2. Remove the pillow and elevate the foot of the bed
  3. Leave the pillow and elevate the foot of the bed
  4. Check with the physician and clarify the orders

14. A client has sustained a fracture of the femur and balanced skeletal  traction with a Thomas splint has been applied. To prevent pressure points  from occurring around the top of the splint, the most important intervention
is to:

  1. Protect the skin with lotion
  2. Keep the client pulled up in bed
  3. Pad the top of the splint with washcloths
  4. Provide a footplate in the bed

15. The major rationale for the use of acetylsalicylic acid (aspirin) in the  treatment of rheumatoid arthritis is to:

  1. Reduce fever
  2. Reduce the inflammation of the joints
  3. Assist the client’s range of motion activities without pain
  4. Prevent extension of the disease process

16. Following an amputation, the advantage to the client for an immediate prosthesis fitting is:

  1. Ability to ambulate sooner
  2. Less change of phantom limb sensation
  3. Dressing changes are not necessary
  4. Better fit of the prosthesis

17. One method of assessing for sign of circulatory impairment in a client  with a fractured femur is to ask the client to:

  1. Cough and deep breathe
  2. Turn himself in bed
  3. Perform biceps exercise
  4. Wiggle his toes

18. The morning of the second postoperative day following hip surgery for a  fractured right hip, the nurse will ambulate the client. The first intervention is
to:

  1. Get the client up in a chair after dangling at the bedside.
  2. Use a walker for balance when getting the client out of bed
  3. Have the client put minimal weight on the affected side when getting up
  4. Practice getting the client out of bed by having her slightly flex her hips

19. A young client is in the hospital with his left leg in Buck’s traction. The  team leader asks the nurse to place a footplate on the affected side at the  bottom of the bed. The purpose of this action is to:

  1. Anchor the traction
  2. Prevent footdrop
  3. Keep the client from sliding down in bed
  4. Prevent pressure areas on the foot

20. When evaluating all forms of traction, the nurse knows the direction of  pull is controlled by the:

  1. Client’s position
  2. Rope/pulley system
  3. Amount of weight
  4. Point of friction

21. When a client has cervical halter traction to immobilize the cervical spine  counteraction is provided by:

  1. Elevating the foot of the bed
  2. Elevating the head of the bed
  3. Application of the pelvic girdle
  4. Lowering the head of the bed

22. After falling down the basement steps in his house, a client is brought to  the emergency room. His physician confirms that his leg is fractured.  Following application of a leg cast, the nurse will first check the client’s toes  for:

  1. Increase in the temperature
  2. Change in color
  3. Edema
  4. Movement

23. A 23 year old female client was in an automobile accident and is now a  paraplegic. She is on an intermittent urinary catheterization program and  diet as tolerated. The nurse’s priority assessment should be to observe for:

  1. Urinary retention
  2. Bladder distention
  3. Weight gain
  4. Bower evacuation

24. A female client with rheumatoid arthritis has been on aspirin grain TID  and prednisone 10mg BID for the last two years. The most important  assessment question for the nurse to ask related to the client’s drug therapy  is whether she has

  1. Headaches
  2. Tarry stools
  3. Blurred vision
  4. Decreased appetite

25. A 7 year old boy with a fractured leg tells the nurse that he is bored. An  appropriate intervention would be to

  1. Read a story and act out the part
  2. Watch a puppet show
  3. Watch television
  4. Listen to the radio

26. On a visit to the clinic, a client reports the onset of early symptoms of  rheumatoid arthritis. Which of the following would be the nurse most likely to  asses:

  1. Limited motion of joints
  2. Deformed joints of the hands
  3. Early morning stiffness
  4. Rheumatoid nodules

27. After teaching the client about risk factors for rheumatoid arthritis, which  of the following, if stated by the client as a risk factor, would indicate to the
nurse that the client needs additional teaching?

  1. History of Epstein-Barr virus infection
  2. Female gender
  3. Adults between the ages 60 to 75 years
  4. Positive testing for human leukocyte antigen (HLA) DR4 allele

28. When developing the teaching plan for the client with rheumatoid  arthritis to promote rest, which of the following would the nurse expect to  instruct the client to avoid during the rest periods?

  1. Proper body alignment
  2. Elevating the part
  3. Prone lying positions
  4. Positions of flexion

29. After teaching the client with severe rheumatoid arthritis about the newly  prescribed medication methothrexate (Rheumatrex 0), which of the following  statements indicates the need for further teaching?

  1. “I will take my vitamins while I am on this drug”
  2. “I must not drink any alcohol while I’m taking this drug”
  3. I should brush my teeth after every meal”
  4. “I will continue taking my birth control pills”

30. When completing the history and physical examination of a client  diagnosed with osteoarthritis, which of the following would the nurse assess?

  1. Anemia
  2. Osteoporosis
  3. Weight loss
  4. Local joint pain

31. At which of the following times would the nurse instruct the client to take  ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to  minimize gastric mucosal irritation?

  1. At bedtime
  2. On arising
  3. Immediately after meal
  4. On an empty stomach

32. When preparing a teaching plan for the client with osteoarthritis who is  taking celecoxib (Celebrex), the nurse expects to explain that the major  advantage of celecoxib over diclofenac (Voltaren), is that the celecoxib is  likely to produce which of the following?

  1. Hepatotoxicity
  2. Renal toxicity
  3. Gastrointestinal bleeding
  4. Nausea and vomiting

33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse  interprets these findings as indicating which of the following?

  1. A developing infection
  2. Bleeding in the operative site
  3. Joint dislocation
  4. Glue seepage into soft tissue
34. Which of the following would the nurse assess in a client with an  intracapsular hip fracture?
  1. Internal rotation
  2. Muscle flaccidity
  3. Shortening of the affected leg
  4. Absence of pain the fracture area
35. Which of the following would be inappropriate to include when preparing  a client for magnetic resonance imaging (MRI) to evaluate a rupture disc?
  1. Informing the client that the procedure is painless
  2. Taking a thorough history of past surgeries
  3. Checking for previous complaints of claustrophobia
  4. Starting an intravenous line at keep-open rate
36. Which of the following actions would be a priority for a client who has  been in the postanesthesia care unit (PACU) for 45 minutes after an above  the knee amputation and develops a dime size bright red spot on the ace  bondage above the amputation site?
  1. Elevate the stump
  2. Reinforcing the dressing
  3. Calling the surgeon
  4. Drawing a mark around the site
37. A client in the PACU with a left below the knee amputation complains of  pain in her left big toe. Which of the following would the nurse do first?
  1. Tell the client it is impossible to feel the pain
  2. Show the client that the toes are not there
  3. Explain to the client that the pain is real
  4. Give the client the prescribed narcotic analgesic
38. The client with an above the knee amputation is to use crutches until the  prosthesis is being adjusted. In which of the following exercises would the  nurse instruct the client to best prepare him for using crutches?
  1. Abdominal exercises
  2. Isometric shoulder exercises
  3. Quadriceps setting exercises
  4. Triceps stretching exercises
39. The client with an above the knee amputation is to use crutches until the  prosthesis is properly lifted. When teaching the client about using the  crutches, the nurse instructs the client to support her weight primarily on  which of the following body areas?
  1. Axillae
  2. Elbows
  3. Upper arms
  4. Hands
40. Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED in a stable condition with vital signs within normal  limits, alert and oriented with good coloring and an open fracture of the right  tibia. When assessing the client, the nurse would be especially alert for signs  and symptoms of which of the following?
  1. Hemorrhage
  2. Infection
  3. Deformity
  4. Shock
41. The client with a fractured tibia has been taking methocarbamol  (Robaxin), when teaching the client about this drug, which of the following  would the nurse include as the drug’s primary effect?
  1. Killing of microorganisms
  2.  Reduction in itching
  3. Relief of muscle spasms
  4. Decrease in nervousness
42. A client who has been taking carisoprodol (Soma) at home for a fractured  arm is admitted with a blood pressure of 80/50 mmHg, a pulse rate of  115bpm, and respirations of 8 breaths/minute and shallow, the nurse  interprets these finding as indicating which of the following?
  1. Expected common side effects
  2. Hypersensitivity reactions
  3. Possible habituating effects
  4. Hemorrhage from GI irritation
43. When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following first?
  1. The area proximal to the fracture
  2. The actual fracture site
  3. The area distal to the fracture
  4. The opposite extremity for baseline comparison
44. A client with fracture develops compartment syndrome. When caring for  the client, the nurse would be alert for which of the following signs of  possible organ failure?
  1. Rales
  2. Jaundice
  3. Generalized edema
  4. Dark, scanty urine
45. Which of the following would lead the nurse to suspect that a client with  a fracture of the right femur may be developing a fat embolus?
  1. Acute respiratory distress syndrome
  2. Migraine like headaches
  3. Numbness in the right leg
  4. Muscle spasms in the right thigh
46. The client who had an open femoral fracture was discharged to her  home, where she developed, fever, night sweats, chills, restlessness and  restrictive movement of the fractured leg. The nurse interprets these finding  as indicating which of the following?
  1. Pulmonary emboli
  2. Osteomyelitis
  3. Fat emboli
  4. Urinary tract infection
47. When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse interprets this as suggesting the occurrence of which  of the following as most likely?
  1. Formation of scar tissue interfering with absorption
  2. Development of pus leading to ischemia
  3. Production of bacterial growth by avascular tissue
  4. Antibiotics not being instilled directly into the bone
48. Which of the following would the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury?
  1. Homan’s sign
  2. Pain
  3. Tenderness
  4. Leg girth
49. The nurse is caring for the client who is going to have an arthogram using a contrast medium. Which of the following assessments by the nurse  are of highest priority?
  1. Allergy to iodine or shellfish
  2. Ability of the client to remain still during the procedure
  3. Whether the client has any remaining questions about the procedure
  4. Whether the client wishes to void before the procedure
50. The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of the  following nursing diagnoses for this client?
  1. Divertional activity deficit
  2. Powerlessness
  3. Self care deficit
  4. Impaired physical mobility
51. The nurse is teaching the client who is to have a gallium scan about the procedure. The nurse includes which of the following items as part of the instructions?
  1. The gallium will be injected intravenously 2 to 3 hours before the procedure
  2. The procedure takes about 15 minutes to perform
  3. The client must stand erect during the filming
  4. The client should remain on bed rest for the remainder of the day after the scan
52. The nurse is assessing the casted extremity of a client. The nurse assesses for which of the following signs and symptoms indicative of infection?
  1. Coolness and pallor of the extremity
  2. Presence of a “hot spot” on the cast
  3. Diminished distal pulse
  4. Dependent edema
53. The client has Buck’s extension applied to the right leg. The nurse plans which of the following interventions to prevent complications of the device?
  1. Massage the skin of the right leg with lotion every 8 hours
  2. Give pin care once a shift
  3. Inspect the skin on the right leg at least once every 8 hours
  4. Release the weights on the right leg for range of motion exercises daily
54. The nurse is giving the client with a left cast crutch walking instructions using the three point gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the:
  1. Left leg and right crutch then right leg and left crutch
  2. Crutches and then both legs simultaneously
  3. Crutches and the right leg then advance the left leg
  4. Crutches and the left leg then advance the right leg
55. The client with right sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the:
  1. Left hand and placing the cane in front of the left foot
  2. Right hand and placing the cane in front of the right foot
  3. Left hand and 6 inches lateral to the left foot
  4. Right hand and 6 inches lateral to the left foot
56. The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse uses a:
  1. Pillow to keep the right leg abducted during turning
  2. Pillow to keep the right leg adducted during turning
  3. Trochanter roll to prevent external rotation while turning
  4. Trochanter roll to prevent abduction while turning
57. The nurse has an order to get the client out of bed to a chair on the first postoperative day after a total knee replacement. The nurse plans to do which of the following to protect the knee joint:
  1. Apply a knee immobilizer before getting the client up and elevate the client’s surgical leg while sitting
  2. Apply an Ace wrap around the dressing and put ice on the knee while sitting
  3. Lift the client to the bedside change leaving the CPM machine in place
  4. Obtain a walker to minimize weight bearing by the client on the affected leg
58. The nurse is caring for the client who had an above the knee amputation 2days ago. The residual limb was wrapped with an elastic compression  bandage which has come off. The nurse immediately:
  1. Calls the physician
  2. Rewrap the stump with an elastic compression bandage
  3. Applies ice to the site
  4. Applies a dry sterile dressing and elevates it on a pillow
59. The nurse has taught the client with a below the knee amputation about prosthesis and stump care. The nurse evaluates that the client states to:
  1. Wear a clean nylon stump sock daily
  2. Toughen the skin of the stump by rubbing it with alcohol
  3. Prevent cracking of the skin of the stump by applying lotion daily
  4. Using a mirror to inspect all areas of the stump each day

60. The nurse is caring for a client with a gout. Which of the following laboratory values does the nurse expect to note in the client?

  1. Uric acid level of 8 mg/dl
  2. Calcium level of 9 mg/dl
  3. Phosphorus level of 3 mg/dl
  4. Uric acid level of 5 mg/dl
Answers
  1. B. Semi Fowler’s 
  2. D. Evaluate the response to analgesics
  3. A. An anaphylactic reaction to the dye
  4. D. Onset of paralysis in the toes of the casted foot 
  5. B. Provide an overhead trapeze for client use 
  6. C. The affected extremity is shortenend, adducted, and extremely rotated
  7. C. Provide pin care at least every hour 
  8. D. Ensure proper body positioning. 
  9. A. Pin care 
  10. A. Supine
  11. C. Displacement can occur with flexion 
  12. C. Trochanter roll to the thigh 
  13. B. Remove the pillow and elevate the foot of the bed 
  14. C. Pad the top of the splint with washcloths
  15. B. Reduce the inflammation of the joints 
  16. A. Ability to ambulate sooner 
  17. D. Wiggle his toes  
  18. D. Practice getting the client out of bed by having her slightly flex her hips 
  19. B. Prevent footdrop 
  20. B. Rope/pulley system
  21. B. Elevating the head of the bed 
  22. B. Change in color 
  23. B. Bladder distention 
  24. B. Tarry stools 
  25. C. Watch television 
  26. C. Early morning stiffness 
  27. C. Adults between the ages 60 to 75 years 
  28. D. Positions of flexion 
  29. D. “I will continue taking my birth control pills” 
  30. D. Local joint pain  
  31. C. Immediately after meal 
  32. C. Gastrointestinal bleeding 
  33. C. Joint dislocation 
  34. C. Shortening of the affected leg 
  35. D. Starting an intravenous line at keep-open rate 
  36. D. Drawing a mark around the site 
  37. D. Give the client the prescribed narcotic analgesic 
  38. D. Triceps stretching exercises 
  39. D. Hands 
  40. A. Hemorrhage 
  41. C. Relief of muscle spasms 
  42. A. Expected common side effects 
  43. C. The area distal to the fracture 
  44. D. Dark, scanty urine 
  45. A. Acute respiratory distress syndrome 
  46. B. Osteomyelitis 
  47. C. Production of bacterial growth by avascular tissue 
  48. A. Homan’s sign
  49. A. Allergy to iodine or shellfish 
  50. A. Divertional activity deficit 
  51. A. The gallium will be injected intravenously 2 to 3 hours before the procedure 
  52. B. Presence of a “hot spot” on the cast 
  53. C. Inspect the skin on the right leg at least once every 8 hours 
  54. D. Crutches and the left leg then advance the right leg 
  55. C. Left hand and 6 inches lateral to the left foot 
  56. A. Pillow to keep the right leg abducted during turning 
  57. A. Apply a knee immobilizer before getting the client up and elevate the client’s surgical leg while sitting 
  58. B. Rewrap the stump with an elastic compression bandage 
  59. D. Using a mirror to inspect all areas of the stump each day 
  60. A. Uric acid level of 8 mg/dl 

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