AMSN Musculoskeletal and Orthopedic Conditions 1 — Questions and Answers
Question 1: A patient returns from surgery for an open reduction and internal fixation (ORIF) of the femur. The nurse assesses the 5 Ps of neurovascular status. Which finding requires immediate intervention?
- Mild swelling at the operative site
- Pulselessness and pallor of the affected extremity (Correct answer)
- Pain rated 6/10 managed with opioids
- Bruising around the incision site
Correct answer: Pulselessness and pallor of the affected extremity
Pulselessness and pallor indicate arterial compromise or compartment syndrome, which are surgical emergencies requiring immediate action.
Question 2: A patient with a hip replacement is being repositioned by the nurse. Which action should be AVOIDED to prevent hip dislocation?
- Keeping the operative leg abducted
- Adducting the leg across the midline (Correct answer)
- Keeping the head of the bed below 90 degrees
- Using a wedge pillow between the legs
Correct answer: Adducting the leg across the midline
After total hip arthroplasty, adduction beyond midline, extreme flexion >90°, and internal rotation are the three movements most likely to cause dislocation.
Question 3: A patient in a long leg cast complains of intense pain when the nurse passively extends the toes. This finding is most consistent with:
- Expected post-operative pain
- Compartment syndrome (Correct answer)
- Deep vein thrombosis
- Wound infection
Correct answer: Compartment syndrome
Pain with passive stretch of muscles in a casted extremity is a hallmark sign of compartment syndrome, an orthopedic emergency.
Question 4: Which laboratory value is most important to monitor following a total joint replacement due to intraoperative blood loss?
- Serum potassium
- Hemoglobin and hematocrit (Correct answer)
- Serum creatinine
- White blood cell count
Correct answer: Hemoglobin and hematocrit
Hemoglobin and hematocrit are monitored post-arthroplasty to detect significant blood loss requiring transfusion.
Question 5: A patient with rheumatoid arthritis (RA) is prescribed methotrexate. The nurse should teach the patient to avoid:
- Calcium-rich foods
- Alcohol and NSAIDs (Correct answer)
- Weight-bearing exercise
- Vitamin D supplements
Correct answer: Alcohol and NSAIDs
Alcohol combined with methotrexate greatly increases hepatotoxicity risk; NSAIDs increase methotrexate toxicity by reducing renal clearance.
Question 6: A patient with osteoporosis is starting alendronate (Fosamax). The nurse should instruct the patient to:
- Take it with a full meal to prevent nausea
- Take it with a full glass of water and remain upright for 30 minutes (Correct answer)
- Crush the tablet for easier swallowing
- Take it at bedtime for best absorption
Correct answer: Take it with a full glass of water and remain upright for 30 minutes
Bisphosphonates like alendronate must be taken with a full glass of water, and the patient must remain upright for at least 30 minutes to prevent esophageal irritation and ulceration.
AMSN Musculoskeletal and Orthopedic Conditions 1
A patient returns from surgery for an open reduction and internal fixation (ORIF) of the femur.
The nurse assesses the 5 Ps of neurovascular status.
Which finding requires immediate intervention?