NCLEX Questions Musculoskeletal

Extract:

Question 1 of 5

The nurse advises the client on the need for maintenance of the bandage. When should the nurse advise the client with a sprained ankle to rewrap the elastic bandage?

Correct Answer: C

Rationale: Swollen toes indicate compromised circulation or inadequate compression, necessitating rewrapping to ensure proper fit and pressure. Pink toes suggest normal circulation, pain may not always indicate bandage issues, and joint stiffness is expected with a sprain but not directly related to bandage maintenance.

Question 2 of 5

Which action by the nurse would be most appropriate for a child newly diagnosed with Reye's syndrome?

A. Determining if the child had a bacterial infection recently B. Placing the child in a private room with droplet precautions C. Taking the child to the unit's play area to interact with others D. Assessing for signs of bleeding and for prolonged bleeding time

Correct Answer: D

Rationale: Assessing for bleeding is critical in Reye's syndrome due to liver dysfunction and potential coagulopathy.

Question 3 of 5

The client has Buck's traction to temporarily immobilize a fracture of the proximal femur prior to surgery. Which assessment finding requires the nurse to intervene immediately?

A. Reddened area at the client's coccygeal area B. Voiding concentrated urine at 50 mL per hour C. Capillary refill 3 seconds, pedal pulses palpable D. Ropes, pulleys intact; 5-lb weight hangs freely

Correct Answer: A

Rationale: A. A reddened sacrum is the first sign of a pressure ulcer that is caused by pressure or friction and shear. Shear results from the weight of the skin traction pulling the client to the foot of the bed and then sliding back up in bed. Immediate interventions are required before it develops into a stage II ulcer.

Question 4 of 5

The physician orders passive range-of-motion (ROM) exercises for an elderly client on bed rest. Which statement regarding the performance of ROM exercises is correct?

A. ROM exercises should be completed independently with verbal cues from the nurse. B. Force may be needed during ROM exercises to achieve maximum benefit. C. Support should be maintained to the proximal and distal areas of the joint during movement. D. ROM exercises should be performed until the client verbalizes discomfort.

Correct Answer: C

Rationale: Supporting the proximal and distal areas of the joint during passive ROM exercises ensures controlled, safe movement, preventing injury. Independent completion, force, or continuing until discomfort risks harm.

Question 5 of 5

The nurse writes a concept of 'impaired mobility' for a client diagnosed with a fractured right hip. Which would the nurse include in the plan of care? Select all that apply.

A. Request a physical therapy referral. B. Administer enoxaparin (Lovenox) subcutaneously. C. Utilize a gait belt when ambulating the client. D. Assess the client’s pain levels on a 1-to-10 scale. E. Provide a high-carbohydrate, high-fat, high-sodium diet.

Correct Answer: A,B,C,D

Rationale: PT referral, enoxaparin, gait belt, and pain assessment promote mobility and prevent complications in hip fracture. High-carb/fat/sodium diet is inappropriate.

NCLEX Questions Musculoskeletal | Nurselytic

Nurselytic

NCLEX-PN

NCLEX-PN