NCLEX-RN
Musculoskeletal RN NCLEX Questions Questions
Question 1 of 5
Which of the following best describes an appropriate outcome for a 75-yr-old patient with a history of Huntington's disease, which has developed contractures?
Correct Answer: C
Rationale: For a patient with Huntington's disease and contractures, participating in range of motion exercises is an appropriate outcome to help maintain joint mobility and reduce the severity of contractures. Monitoring for skin breakdown is important but not the primary outcome. Independent repositioning may not be feasible due to the progressive nature of Huntington's, and verbalizing effects is less actionable than active intervention.
Extract:
The following scenario applies to the next 1 items
The nurse cares for a client who sustained a femur fracture twelve hours ago
Item 1 of 1
Nurses’ Notes
Client reports shortness of breath and stated, ‘something is not right.’ The client was assessed to have a respiratory rate of 25/min and oxygen saturation of 90% while on room air. Lung sounds had bilateral crackles throughout, and respirations were labored. Chest pain was reported that worsened with breathing. An emergent 12-lead electrocardiogram was obtained, and it was observed that the client had reddish-purple spots on their torso. A rapid response was called.
Question 2 of 5
The client is demonstrating signs and symptoms of
Correct Answer: C
Rationale: Fat embolism syndrome is likely after a femur fracture, with symptoms like shortness of breath, bilateral crackles, chest pain, and petechiae on the torso. Pulmonary embolism and myocardial infarction are less directly tied to fractures, and compartment syndrome affects the limb.
Extract:
The following scenario applies to the next 1 items
The nurse in the emergency department (ED) is caring for a 62-year-old female client.
Item 1 of 1
Triage Note
1211: The client was brought to the ED by her neighbor, who was concerned about her increasing pain and immobility. The client's neighbor reported that the client called her a few hours ago, asking her to go to the ED because of increasing pain and the inability to perform her activities of daily living. History of osteoporosis, hypertension, and gout. She reports that she recently started seeing a rheumatologist because of persistent fatigue, low-grade fevers, and lack of appetite. Vital signs: T 99.7° F (37.6° C), P 82, RR 16, BP 134/76, pulse oximetry reading 98% on room air. Pain rated 7/10 on the Numerical Rating Scale, which is described as throbbing of both feet, especially in her toes. She also reports having stiffness in her wrists and fingers that starts in the morning and persists throughout the day. Triage assessment: the client is alert and fully oriented to person, place, and situation. Peripheral pulses 2+. Clear lung sounds bilaterally. Swollen, errythemic toes that are warm and tender to touch. She does not recall her weight but reports significant weight loss over the past three months.
Question 3 of 5
For each assessment finding below, click to specify if the finding is consistent with the disease process of osteoarthritis, acute gout flare, or rheumatoid arthritis. Each finding may support more than 1 disease process.
| Assessment Findings | Gout flare | Rheumatoid arthritis | Osteoarthritis |
|---|---|---|---|
| Low-grade fever | |||
| Weight loss | |||
| Redness and warmth of the affected joint | |||
| Morning joint stiffness in the wrists that lasts throughout the day | |||
| Pain with movement in the affected joint | |||
| Reduced range of motion in the affected joint | |||
| Pain level |
Correct Answer: A: Rheumatoid Arthritis, Acute Gout Flare, B: Rheumatoid Arthritis, C: Rheumatoid Arthritis, Acute Gout Flare, D: Rheumatoid Arthritis, E: Osteoarthritis, Rheumatoid Arthritis, Acute Gout Flare, F: Osteoarthritis, Rheumatoid Arthritis, Acute Gout Flare, G: Osteoarthritis, Rheumatoid Arthritis, Acute Gout Flare
Rationale: Seen in inflammatory conditions; not typical in osteoarthritis. Chronic systemic inflammation may lead to unintentional weight loss. Indicates joint inflammation; osteoarthritis does not usually present with warmth or redness. Stiffness >1 hour, especially in small joints, is classic for RA. Movement worsens pain in all these conditions, though the cause differs. All limit ROM due to stiffness, inflammation, or damage. Pain is a shared feature, though severity and timing vary.
Extract:
The nurse in the medical-surgical unit is caring for a newly admitted client.
Item 4 of 6
History and Physical
1930: Client is a 45-year-old male who has a one-and-a-half-week history of pain, redness, and swelling in his right foot. He reported that the symptoms began after he accidentally cut his foot while walking barefoot in his backyard. Over the next few days, he developed pain and swelling around the cut, accompanied by redness and warmth. He went to urgent care two days later and was diagnosed with cellulitis in his right foot. He was prescribed antibiotics but could not afford the treatment. Three days ago, the pain escalated and was described as throbbing and constant, with a severity rating of 7/10 on the Numerical Pain Rating Scale. He states, "the pain is now in the bone of my foot; I don't know how else to describe it." He also noted occasional fever 101°F (38.3°C), chills, and general malaise. On physical examination, his right foot was erythematous, swollen, and warm to the touch. A 3 cm ulcer was noted on the plantar aspect of the right foot, with moderate purulent discharge present. The ulcer appeared deep, and palpation of the surrounding tissue elicited tenderness. There was limited range of motion in the right ankle due to pain. The distal pulses were palpable 2+, and there were signs of neuropathy in the feet (decreased sensation to light touch and pinprick). He has a medical history of uncontrolled diabetes mellitus (type two), obesity, peripheral neuropathy in all extremities, hypertension, hyperlipidemia, and epilepsy.
Consultation
Infectious Disease Consultation
2050: Client was evaluated and I strongly suspect osteomyelitis in his right foot. Labs are pending. Agree with admission and will follow closely.
Question 4 of 5
The nurse plans care for this client. For each potential intervention, click to specify whether the intervention is indicated or not indicated for the client.
| Potential Orders | Indicated | Not Indicated |
|---|---|---|
| Warm compress to the client's right foot | ||
| Serum complete blood count (CBC) | ||
| Serum blood cultures | ||
| Administration of prescribed pain medication | ||
| Magnetic Resonance Imaging (MRI) | ||
| Intravenous fluids: Dextrose 5% in water (D5W) |
Correct Answer: A: Not Indicated, B: Indicated, C: Indicated, D: Indicated, E: Indicated, F: Indicated
Rationale: A: Warm compresses may worsen inflammation and infection. B: CBC monitors infection and inflammation. C: Blood cultures identify systemic infection. D: Pain medication addresses severe pain. E: MRI confirms osteomyelitis. F: IV fluids support hydration and antibiotic delivery.
Extract:
Question 5 of 5
The nurse is caring for a client being admitted to the medical-surgical unit with an acute flare of gout. After performing medication reconciliation, which medication does the nurse suspect could have triggered the acute gout flare? See the exhibit.
Correct Answer: A
Rationale: Hydrochlorothiazide, a thiazide diuretic, can increase serum uric acid levels by reducing renal excretion, potentially triggering an acute gout flare. Temazepam, rosuvastatin, and escitalopram do not significantly affect uric acid levels or gout.