NCLEX Musculoskeletal & Trauma questions
The PrepScore bank has 84 Musculoskeletal & Trauma questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Take action and Recognize cues, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Fracture types + 6P assessment, hip arthroplasty + dislocation precautions, compartment syndrome, traction + casting, rheumatoid vs osteoarthritis, osteoporosis, amputation + phantom limb, low back + sciatica, fat embolism, MSK multi-patient priority.
Three worked questions
Q1. The trauma nurse evaluates for compartment syndrome. Which findings SUGGEST compartment syndrome? Select all that apply.
- A. PAIN out of proportion to injury (esp on passive stretch — earliest, most sensitive sign)
- B. PARESTHESIA (sensory deficit; early sign)
- C. PALLOR (capillary refill prolonged; late sign)
- D. PULSELESSNESS (very late sign — irreversible damage by this point)
- E. PARALYSIS (very late sign)
- F. Pressure: measure compartment pressure > 30 mmHg or delta < 30 (delta = DBP - compartment P)
Show answer and rationale
Answer: PAIN out of proportion to injury (esp on passive stretch — earliest, most sensitive sign)PARESTHESIA (sensory deficit; early sign)PALLOR (capillary refill prolonged; late sign)PULSELESSNESS (very late sign — irreversible damage by this point)PARALYSIS (very late sign)Pressure: measure compartment pressure > 30 mmHg or delta < 30 (delta = DBP - compartment P)
Compartment syndrome 6 Ps: pain (earliest) + paresthesia + pallor + pulselessness (late) + paralysis (late) + pressure measurement (gold standard for confirmation).
Q2. The clinic nurse provides osteoporosis prevention/management education. Which interventions SUPPORT management? Select all that apply.
- A. Weight-bearing + resistance exercise (builds bone density)
- B. Calcium 1000-1200 mg/day + vitamin D 800-1000 IU/day (diet + supplements)
- C. Bisphosphonates for confirmed osteoporosis (T-score < -2.5) or high-risk (FRAX); take on empty stomach + remain upright × 30 min
- D. Fall prevention (home safety, balance training, vision, medication review)
- E. Smoking cessation + limit alcohol; alternatives: denosumab, romosozumab, teriparatide for selected
- F. Sedentary lifestyle (OPPOSITE — weight-bearing protective)
Show answer and rationale
Answer: Weight-bearing + resistance exercise (builds bone density)Calcium 1000-1200 mg/day + vitamin D 800-1000 IU/day (diet + supplements)Bisphosphonates for confirmed osteoporosis (T-score < -2.5) or high-risk (FRAX); take on empty stomach + remain upright × 30 minFall prevention (home safety, balance training, vision, medication review)Smoking cessation + limit alcohol; alternatives: denosumab, romosozumab, teriparatide for selected
Osteoporosis: weight-bearing + Ca/vit D + bisphosphonates (or alternatives) + fall prevention + smoking/alcohol cessation. Sedentary is opposite.
Q3. The trauma nurse evaluates for compartment syndrome. Which features SUPPORT compartment syndrome (6 P's)? Select all that apply.
- A. PAIN out of proportion to injury (esp on passive stretch — earliest, most sensitive)
- B. PARESTHESIA (sensory deficit; early)
- C. PALLOR (capillary refill prolonged; late sign)
- D. PULSELESSNESS (very late sign — irreversible damage by this point)
- E. PARALYSIS (very late sign)
- F. PRESSURE: > 30 mmHg or delta (DBP - compartment P) < 30 mmHg confirms
Show answer and rationale
Answer: PAIN out of proportion to injury (esp on passive stretch — earliest, most sensitive)PARESTHESIA (sensory deficit; early)PALLOR (capillary refill prolonged; late sign)PULSELESSNESS (very late sign — irreversible damage by this point)PARALYSIS (very late sign)PRESSURE: > 30 mmHg or delta (DBP - compartment P) < 30 mmHg confirms
6 Ps of compartment syndrome.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
Neurovascular 6P: Pain (out of proportion + opioid-resistant), Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia. Pain unrelieved by opioids is the EARLIEST reliable cue. Action: notify provider STAT, bivalve cast, position AT heart level (NOT above — elevation worsens ischemia), prep fasciotomy. Open fracture = IV antibiotics + tetanus + OR within 6 hr.
Posterior approach: NO hip flexion > 90°, NO adduction past midline, NO internal rotation. Use abductor pillow, raised toilet, long-handled reacher. Anterior approach: AVOID hyperextension + external rotation + adduction; can flex > 90°. Dislocation signs: severe pain, shortened + internally rotated leg (posterior dislocation). Always pair with DVT prophylaxis (SCDs + anticoagulant + early ambulation).
Femur/pelvis fracture 24-72 hr post → respiratory (hypoxia, dyspnea) + neuro (confusion, restlessness) + petechial rash (upper body, axilla, conjunctiva). Treatment is SUPPORTIVE: supplemental O2, mechanical ventilation if needed, fluids, hemodynamic support. NO specific antidote. Anticoagulation does NOT treat FES (vs PE — clot vs fat). Differentiate from PE.
Weights must hang FREELY — never on floor, bed, or in staff hands. Ropes in pulley grooves, knots secure. NEVER remove weights without provider order (only exception: life-threatening emergency like CPR). Pin site: small clear serous = normal; PURULENT + erythema + warmth + tenderness = infection. Cleanse per protocol (chlorhexidine or saline). Use trapeze for repositioning, neurovascular checks, prevent pressure injuries.
RA: bilateral SYMMETRIC small joints (MCP/PIP/wrist), morning stiffness > 1 hr improving with activity, systemic features, RF + anti-CCP + ESR/CRP elevated. Treat early with DMARDs (methotrexate first-line + folate). OA: ASYMMETRIC weight-bearing joints (knee/hip/DIP — Heberden's), < 30 min stiffness, worse with activity, labs normal. Symptomatic: acetaminophen → topical NSAID → injection → replacement.
Alendronate/risedronate: take in MORNING on EMPTY stomach + FULL glass of water + remain UPRIGHT (sit/stand) ≥ 30 min + no food / other meds / calcium for ≥ 30 min after. Adverse: esophagitis, jaw osteonecrosis (notify dentist before invasive work), atypical femur fractures, hypocalcemia. Add calcium 1000-1200 mg + vit D 800-1000 IU + weight-bearing exercise + fall prevention.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Musculoskeletal & Trauma questions does the bank have?
84 multiple-choice items, plus 10 unfolding cases in the Musculoskeletal & Trauma pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Take action and Recognize cues, though every step appears.
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