NUR201 | NUR201 Medical Surgical Exam 4
Version 2 Questions with Correct Answers and
Expert Explanation for Each Question
1. A nurse is assessing a client with a suspected hip fracture after a fall. Which clinical
manifestation is most characteristic of this type of injury?
A. Internal rotation of the affected leg
B. Abduction and flexion of the hip joint
C. Lengthening of the affected extremity
D. Shortening and external rotation of the affected leg
Correct Answer: D
Expert Explanation: A fractured hip typically presents with the affected leg being
shorter than the unaffected one due to muscle spasms. The leg is also usually
externally rotated because the fracture disrupts the normal structural alignment.
Internal rotation is more common in posterior hip dislocations rather than
fractures. Recognizing these physical cues allows for rapid diagnosis and
immobilization to prevent further damage. The nurse should document these
findings and prepare the client for imaging studies immediately.
,2. A client is 24 hours post-operative following an open reduction internal fixation
(ORIF) of the femur. The client suddenly develops dyspnea, tachycardia, and a
petechial rash on the chest. Which complication should the nurse suspect?
A. Pulmonary embolism
B. Hypovolemic shock
C. Myocardial infarction
D. Fat embolism syndrome
Correct Answer: D
Expert Explanation: Fat embolism syndrome is a serious complication often
associated with long bone fractures where fat globules migrate to the lungs. The
presence of a petechial rash is a hallmark sign that distinguishes it from a standard
pulmonary embolism. Tachycardia and respiratory distress are common symptoms
resulting from impaired gas exchange in the pulmonary capillary beds. Immediate
nursing actions include administering oxygen and notifying the healthcare provider.
Monitoring for neurological changes is also essential as fat emboli can affect
cerebral circulation.
3. The nurse is caring for a client with a lower leg cast who reports escalating pain that
is not relieved by prescribed opioids. What is the priority nursing action?
A. Elevate the extremity above the heart level
,B. Apply a cold pack to the casted area
C. Perform a neurovascular assessment
D. Administer an additional dose of pain medication
Correct Answer: C
Expert Explanation: Escalating pain that does not respond to analgesics is a classic
early sign of compartment syndrome. The nurse must prioritize a neurovascular
assessment to check for the six Ps, including pulselessness and paresthesia.
Elevating the limb above the heart is contraindicated because it can further reduce
arterial perfusion to the ischemic tissue. Quick identification is critical to prevent
permanent muscle and nerve damage which may require a fasciotomy.
Documentation of these findings provides a baseline for surgical intervention if
necessary.
4. A nurse is providing teaching for a client starting methotrexate for rheumatoid
arthritis. Which instruction is most important to include?
A. Take the medication with a large glass of grapefruit juice
B. Expect the medication to take full effect within 24 hours
C. Report any signs of infection or unusual bruising immediately
D. Avoid all forms of exercise while on this medication
, Correct Answer: C
Expert Explanation: Methotrexate is an immunosuppressant that can cause bone
marrow suppression, increasing the risk of infection and bleeding. Clients must be
taught to monitor for fever or bruising as these signify serious side effects. This
medication is a disease-modifying antirheumatic drug (DMARD) and takes several
weeks to achieve therapeutic levels. Regular laboratory monitoring of liver enzymes
and blood counts is mandatory for safety. Proper education ensures the client
understands the risks of therapy versus the benefit of reduced joint destruction.
5. Which assessment finding would the nurse expect in a client diagnosed with
osteoarthritis (OA)?
A. Symmetrical joint swelling and systemic fever
B. Heberden’s nodes and Crepitus
C. Joint pain that diminishes after activity
D. Elevated erythrocyte sedimentation rate (ESR)
Correct Answer: B
Expert Explanation: Osteoarthritis is characterized by the degeneration of
cartilage, often resulting in bony enlargements known as Heberden’s nodes.
Crepitus is a common finding caused by bone surfaces rubbing against each other
during joint movement. Unlike rheumatoid arthritis, OA pain typically worsens with
Version 2 Questions with Correct Answers and
Expert Explanation for Each Question
1. A nurse is assessing a client with a suspected hip fracture after a fall. Which clinical
manifestation is most characteristic of this type of injury?
A. Internal rotation of the affected leg
B. Abduction and flexion of the hip joint
C. Lengthening of the affected extremity
D. Shortening and external rotation of the affected leg
Correct Answer: D
Expert Explanation: A fractured hip typically presents with the affected leg being
shorter than the unaffected one due to muscle spasms. The leg is also usually
externally rotated because the fracture disrupts the normal structural alignment.
Internal rotation is more common in posterior hip dislocations rather than
fractures. Recognizing these physical cues allows for rapid diagnosis and
immobilization to prevent further damage. The nurse should document these
findings and prepare the client for imaging studies immediately.
,2. A client is 24 hours post-operative following an open reduction internal fixation
(ORIF) of the femur. The client suddenly develops dyspnea, tachycardia, and a
petechial rash on the chest. Which complication should the nurse suspect?
A. Pulmonary embolism
B. Hypovolemic shock
C. Myocardial infarction
D. Fat embolism syndrome
Correct Answer: D
Expert Explanation: Fat embolism syndrome is a serious complication often
associated with long bone fractures where fat globules migrate to the lungs. The
presence of a petechial rash is a hallmark sign that distinguishes it from a standard
pulmonary embolism. Tachycardia and respiratory distress are common symptoms
resulting from impaired gas exchange in the pulmonary capillary beds. Immediate
nursing actions include administering oxygen and notifying the healthcare provider.
Monitoring for neurological changes is also essential as fat emboli can affect
cerebral circulation.
3. The nurse is caring for a client with a lower leg cast who reports escalating pain that
is not relieved by prescribed opioids. What is the priority nursing action?
A. Elevate the extremity above the heart level
,B. Apply a cold pack to the casted area
C. Perform a neurovascular assessment
D. Administer an additional dose of pain medication
Correct Answer: C
Expert Explanation: Escalating pain that does not respond to analgesics is a classic
early sign of compartment syndrome. The nurse must prioritize a neurovascular
assessment to check for the six Ps, including pulselessness and paresthesia.
Elevating the limb above the heart is contraindicated because it can further reduce
arterial perfusion to the ischemic tissue. Quick identification is critical to prevent
permanent muscle and nerve damage which may require a fasciotomy.
Documentation of these findings provides a baseline for surgical intervention if
necessary.
4. A nurse is providing teaching for a client starting methotrexate for rheumatoid
arthritis. Which instruction is most important to include?
A. Take the medication with a large glass of grapefruit juice
B. Expect the medication to take full effect within 24 hours
C. Report any signs of infection or unusual bruising immediately
D. Avoid all forms of exercise while on this medication
, Correct Answer: C
Expert Explanation: Methotrexate is an immunosuppressant that can cause bone
marrow suppression, increasing the risk of infection and bleeding. Clients must be
taught to monitor for fever or bruising as these signify serious side effects. This
medication is a disease-modifying antirheumatic drug (DMARD) and takes several
weeks to achieve therapeutic levels. Regular laboratory monitoring of liver enzymes
and blood counts is mandatory for safety. Proper education ensures the client
understands the risks of therapy versus the benefit of reduced joint destruction.
5. Which assessment finding would the nurse expect in a client diagnosed with
osteoarthritis (OA)?
A. Symmetrical joint swelling and systemic fever
B. Heberden’s nodes and Crepitus
C. Joint pain that diminishes after activity
D. Elevated erythrocyte sedimentation rate (ESR)
Correct Answer: B
Expert Explanation: Osteoarthritis is characterized by the degeneration of
cartilage, often resulting in bony enlargements known as Heberden’s nodes.
Crepitus is a common finding caused by bone surfaces rubbing against each other
during joint movement. Unlike rheumatoid arthritis, OA pain typically worsens with
