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NCLEX RN Exam Bank: Musculoskeletal &
Orthopedic Acute Care, Fractures, Compartment
Syndrome
Table of Contents
Subtopic 1: Acute Fracture Assessment and Early Management ....................................... 2
Subtopic 2: Compartment Syndrome—Recognition, Risk, and Management ................... 10
Subtopic 3: Orthopedic Surgical Interventions and Postoperative Care ........................... 19
Subtopic 4: Casts, Splints, and Traction Care ................................................................ 27
Subtopic 5: Infection Prevention and Management in Orthopedic Patients ...................... 35
Subtopic 6: Pain Management and Mobility in Orthopedic Patients ................................. 44
Subtopic 7: Complications of Fractures and Their Management ..................................... 52
Subtopic 8: Pediatric Orthopedic Emergencies and Special Considerations .................... 60
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Subtopic 1: Acute Fracture Assessment and Early
Management
Question 1
A nurse is assessing a client who just sustained a closed femur fracture. Which finding
should the nurse prioritize?
A. Pain at the fracture site
B. Swelling and bruising
C. Absent distal pulses
D. Inability to bear weight
Correct Answer: C. Absent distal pulses
Rationale: Absent distal pulses suggest compromised blood flow, which could indicate
impending compartment syndrome or vascular damage. This is a priority that requires
immediate intervention.
Question 2
A client presents to the ED with a suspected tibial fracture. Which intervention is
appropriate before x-ray confirmation?
A. Apply heat to reduce pain
B. Immobilize the limb using a splint
C. Encourage active range of motion
D. Elevate the limb above heart level for 30 minutes
Correct Answer: B. Immobilize the limb using a splint
Rationale: Splinting prevents further injury and reduces pain and bleeding until definitive
care can be provided. Heat and motion are contraindicated before full assessment.
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Question 3
Which assessment finding would lead the nurse to suspect fat embolism syndrome in a
patient with a long bone fracture?
A. Fever and chills
B. Hypertension and edema
C. Petechiae on chest and conjunctiva
D. Bradycardia and dry mucous membranes
Correct Answer: C. Petechiae on chest and conjunctiva
Rationale: Petechiae in these locations are a classic sign of fat embolism syndrome, along
with respiratory distress and neurological changes.
Question 4
A patient with a humeral fracture asks why their arm is being elevated. What is the most
appropriate response by the nurse?
A. "It helps the fracture heal faster."
B. "Elevation reduces swelling and pain."
C. "It helps improve circulation to the fingers."
D. "It helps with muscle strength."
Correct Answer: B. "Elevation reduces swelling and pain."
Rationale: Elevation promotes venous return and minimizes edema and discomfort during
the acute phase.
Question 5
Which of the following is the earliest sign of compartment syndrome?
A. Pulselessness
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B. Paralysis
C. Increasing pain unrelieved by opioids
D. Pallor
Correct Answer: C. Increasing pain unrelieved by opioids
Rationale: Pain out of proportion to the injury and not relieved by analgesics is typically the
first symptom of compartment syndrome.
Question 6
A nurse receives a patient with a pelvic fracture. Which action takes priority?
A. Apply ice packs
B. Monitor oxygen saturation
C. Assess for signs of internal bleeding
D. Assist to bathroom with walker
Correct Answer: C. Assess for signs of internal bleeding
Rationale: Pelvic fractures can lead to significant internal hemorrhage. Hypotension,
tachycardia, and abdominal distention must be assessed promptly.
Question 7
Which dietary teaching is best for a patient recovering from a tibial fracture?
A. High-fat, low-carb diet
B. Low-calcium, low-protein diet
C. High-protein, high-calcium diet
D. Vegan, low-sodium diet
Correct Answer: C. High-protein, high-calcium diet
NCLEX RN Exam Bank: Musculoskeletal &
Orthopedic Acute Care, Fractures, Compartment
Syndrome
Table of Contents
Subtopic 1: Acute Fracture Assessment and Early Management ....................................... 2
Subtopic 2: Compartment Syndrome—Recognition, Risk, and Management ................... 10
Subtopic 3: Orthopedic Surgical Interventions and Postoperative Care ........................... 19
Subtopic 4: Casts, Splints, and Traction Care ................................................................ 27
Subtopic 5: Infection Prevention and Management in Orthopedic Patients ...................... 35
Subtopic 6: Pain Management and Mobility in Orthopedic Patients ................................. 44
Subtopic 7: Complications of Fractures and Their Management ..................................... 52
Subtopic 8: Pediatric Orthopedic Emergencies and Special Considerations .................... 60
, 2
Subtopic 1: Acute Fracture Assessment and Early
Management
Question 1
A nurse is assessing a client who just sustained a closed femur fracture. Which finding
should the nurse prioritize?
A. Pain at the fracture site
B. Swelling and bruising
C. Absent distal pulses
D. Inability to bear weight
Correct Answer: C. Absent distal pulses
Rationale: Absent distal pulses suggest compromised blood flow, which could indicate
impending compartment syndrome or vascular damage. This is a priority that requires
immediate intervention.
Question 2
A client presents to the ED with a suspected tibial fracture. Which intervention is
appropriate before x-ray confirmation?
A. Apply heat to reduce pain
B. Immobilize the limb using a splint
C. Encourage active range of motion
D. Elevate the limb above heart level for 30 minutes
Correct Answer: B. Immobilize the limb using a splint
Rationale: Splinting prevents further injury and reduces pain and bleeding until definitive
care can be provided. Heat and motion are contraindicated before full assessment.
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Question 3
Which assessment finding would lead the nurse to suspect fat embolism syndrome in a
patient with a long bone fracture?
A. Fever and chills
B. Hypertension and edema
C. Petechiae on chest and conjunctiva
D. Bradycardia and dry mucous membranes
Correct Answer: C. Petechiae on chest and conjunctiva
Rationale: Petechiae in these locations are a classic sign of fat embolism syndrome, along
with respiratory distress and neurological changes.
Question 4
A patient with a humeral fracture asks why their arm is being elevated. What is the most
appropriate response by the nurse?
A. "It helps the fracture heal faster."
B. "Elevation reduces swelling and pain."
C. "It helps improve circulation to the fingers."
D. "It helps with muscle strength."
Correct Answer: B. "Elevation reduces swelling and pain."
Rationale: Elevation promotes venous return and minimizes edema and discomfort during
the acute phase.
Question 5
Which of the following is the earliest sign of compartment syndrome?
A. Pulselessness
, 4
B. Paralysis
C. Increasing pain unrelieved by opioids
D. Pallor
Correct Answer: C. Increasing pain unrelieved by opioids
Rationale: Pain out of proportion to the injury and not relieved by analgesics is typically the
first symptom of compartment syndrome.
Question 6
A nurse receives a patient with a pelvic fracture. Which action takes priority?
A. Apply ice packs
B. Monitor oxygen saturation
C. Assess for signs of internal bleeding
D. Assist to bathroom with walker
Correct Answer: C. Assess for signs of internal bleeding
Rationale: Pelvic fractures can lead to significant internal hemorrhage. Hypotension,
tachycardia, and abdominal distention must be assessed promptly.
Question 7
Which dietary teaching is best for a patient recovering from a tibial fracture?
A. High-fat, low-carb diet
B. Low-calcium, low-protein diet
C. High-protein, high-calcium diet
D. Vegan, low-sodium diet
Correct Answer: C. High-protein, high-calcium diet
