🎯 High-Yield Points
- Compartment syndrome: the 6 Ps — Pain, Pallor, Paresthesia, Paralysis, Pulselessness, Poikilothermia
- Fat embolism: petechiae on chest/axillae after long bone fracture — immediate emergency
- Traction: maintain correct alignment, weights hanging freely, do not remove weights
- Cast care: do not put anything inside cast; elevate for first 24-48 hours to reduce swelling
- Hip arthroplasty: avoid adduction, internal rotation, and hip flexion >90 degrees
[Concept Map: Musculoskeletal NCLEX Questions — Clinical Manifestations, Nursing Interventions, Priority Actions]
Practice Questions
Question 1
A client with a leg cast reports severe pain, numbness, and a feeling of pressure in the casted extremity. Which action does the nurse take IMMEDIATELY?
✓ Correct: Notify the provider and prepare to bivalve or cut the cast
These symptoms describe compartment syndrome — a surgical emergency where pressure within a closed muscle compartment causes ischaemia. The priority is to notify the provider immediately and prepare for cast removal (bivalving or cutting). Elevating the extremity in compartment syndrome INCREASES compartment pressure and worsens ischaemia. Do not elevate. Waiting to medicate or apply ice delays critical intervention and can result in permanent nerve and muscle damage or limb loss.
These symptoms describe compartment syndrome — a surgical emergency where pressure within a closed muscle compartment causes ischaemia. The priority is to notify the provider immediately and prepare for cast removal (bivalving or cutting). Elevating the extremity in compartment syndrome INCREASES compartment pressure and worsens ischaemia. Do not elevate. Waiting to medicate or apply ice delays critical intervention and can result in permanent nerve and muscle damage or limb loss.
Question 2
A client returns from total hip replacement surgery. Which position does the nurse maintain to prevent hip dislocation?
✓ Correct: Hip abduction with neutral rotation using an abductor pillow
Post-total hip replacement, the hip must be maintained in ABDUCTION (legs apart) with neutral rotation. An abductor pillow keeps the hip in the correct position. Prohibited movements: adduction (crossing legs), internal rotation, and hip flexion greater than 90 degrees — any of these positions can dislocate the new prosthetic hip. These precautions are typically maintained for 6-12 weeks.
Post-total hip replacement, the hip must be maintained in ABDUCTION (legs apart) with neutral rotation. An abductor pillow keeps the hip in the correct position. Prohibited movements: adduction (crossing legs), internal rotation, and hip flexion greater than 90 degrees — any of these positions can dislocate the new prosthetic hip. These precautions are typically maintained for 6-12 weeks.
Question 3
A client develops petechiae on the chest and axillae, confusion, and respiratory distress 48 hours after a femur fracture. Which complication does the nurse suspect?
✓ Correct: Fat embolism syndrome
Fat embolism syndrome classically appears 24-72 hours after long bone fractures (femur, tibia, pelvis) and presents with the triad of: petechiae on chest, axillae, and conjunctivae (pathognomonic); neurological changes (confusion, restlessness); and respiratory distress. This differentiates it from DVT/PE which do not cause petechiae. Treatment: supportive oxygen, corticosteroids, and immobilisation.
Fat embolism syndrome classically appears 24-72 hours after long bone fractures (femur, tibia, pelvis) and presents with the triad of: petechiae on chest, axillae, and conjunctivae (pathognomonic); neurological changes (confusion, restlessness); and respiratory distress. This differentiates it from DVT/PE which do not cause petechiae. Treatment: supportive oxygen, corticosteroids, and immobilisation.
Question 4
A nurse is teaching a client with osteoporosis about fall prevention. Which instruction is MOST important?
✓ Correct: Remove loose rugs and ensure adequate lighting at home
Home modification to reduce fall risk is the highest-priority osteoporosis teaching point. Removing trip hazards (loose rugs, cords), ensuring adequate lighting, using handrails, and wearing non-slip footwear are the most effective fall prevention strategies. Weight-bearing exercise (walking, resistance training) is actually recommended for osteoporosis to stimulate bone density. Calcium is best absorbed in divided doses, not just at bedtime.
Home modification to reduce fall risk is the highest-priority osteoporosis teaching point. Removing trip hazards (loose rugs, cords), ensuring adequate lighting, using handrails, and wearing non-slip footwear are the most effective fall prevention strategies. Weight-bearing exercise (walking, resistance training) is actually recommended for osteoporosis to stimulate bone density. Calcium is best absorbed in divided doses, not just at bedtime.
Question 5
A client in skeletal traction for a femur fracture asks the nurse to remove the weights because they are uncomfortable. Which response is CORRECT?
✓ Correct: Remove the weights briefly while repositioning the client
Traction weights must hang freely at all times to maintain the therapeutic tension. The weights should never rest on the bed or floor, and should never be removed without a specific provider order. The counter-traction (client's own body weight against the pull) must be maintained. Removing or resting the weights defeats the purpose of traction and can allow bone fragments to override. Address comfort through other means (pain medication, positioning assistance).
Traction weights must hang freely at all times to maintain the therapeutic tension. The weights should never rest on the bed or floor, and should never be removed without a specific provider order. The counter-traction (client's own body weight against the pull) must be maintained. Removing or resting the weights defeats the purpose of traction and can allow bone fragments to override. Address comfort through other means (pain medication, positioning assistance).
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