CMSRN Neurological and Musculoskeletal Care 2 — Questions and Answers
Question 1: A patient with a hip fracture is being assessed for neurovascular status. Which assessment finding requires immediate reporting?
- Capillary refill of 2 seconds
- Sensation intact to light touch
- Absent distal pulse and pallor in the affected extremity (Correct answer)
- Mild swelling at the fracture site
Correct answer: Absent distal pulse and pallor in the affected extremity
Absent pulse and pallor indicate arterial compromise to the limb, which is a vascular emergency requiring immediate intervention to prevent limb loss.
Question 2: Which precaution is essential for a patient who has undergone a posterior total hip replacement?
- Avoid abduction of the hip beyond 15 degrees
- Do not flex the hip beyond 90 degrees (Correct answer)
- Keep the knee fully extended at all times
- Avoid weight bearing on both legs
Correct answer: Do not flex the hip beyond 90 degrees
Posterior hip precautions prohibit hip flexion beyond 90 degrees, adduction past midline, and internal rotation to prevent dislocation of the prosthesis.
Question 3: A patient with a long-bone fracture of the femur suddenly develops petechiae on the chest and axillae, confusion, and dyspnea 24 hours post-injury. What complication does the nurse suspect?
- Pulmonary embolism from DVT
- Fat embolism syndrome (Correct answer)
- Compartment syndrome
- Disseminated intravascular coagulation
Correct answer: Fat embolism syndrome
Fat embolism syndrome presents with the classic triad of petechiae (especially on upper body), respiratory distress, and neurological changes 24–72 hours after long-bone fracture.
Question 4: A patient post-total knee replacement complains of calf pain, warmth, and swelling. The priority nursing action is to:
- Elevate the leg and apply a heating pad
- Perform a Homan's sign test vigorously
- Notify the provider and avoid massaging or manipulating the extremity (Correct answer)
- Encourage ambulation to promote circulation
Correct answer: Notify the provider and avoid massaging or manipulating the extremity
These symptoms suggest deep vein thrombosis; the extremity should not be massaged or manipulated, and the physician must be notified to arrange imaging and anticoagulation.
Question 5: When assessing a patient's cast for compartment syndrome, the nurse monitors for which primary symptom?
- Itching under the cast
- Pain unrelieved by opioids and out of proportion to the injury (Correct answer)
- Mild warmth at the cast edges
- Skin discoloration at the cast rim
Correct answer: Pain unrelieved by opioids and out of proportion to the injury
Pain that is disproportionate to the injury and unrelieved by analgesics is the earliest and most significant symptom of compartment syndrome.
Question 6: A patient with Parkinson's disease is at high risk for which priority nursing diagnosis?
- Impaired urinary elimination
- Risk for aspiration related to dysphagia (Correct answer)
- Fluid volume excess
- Hypothermia
Correct answer: Risk for aspiration related to dysphagia
Parkinson's disease causes rigidity and bradykinesia that impair swallowing, placing patients at high risk for aspiration and aspiration pneumonia.
CMSRN Neurological and Musculoskeletal Care 2
A patient with a hip fracture is being assessed for neurovascular status.
Which assessment finding requires immediate reporting?