LPN Medical-Surgical Nursing: Musculoskeletal and Neurological 2 — Questions and Answers
Question 1: A patient with a hip fracture is placed in Buck's traction preoperatively. What is the primary purpose of this intervention?
- To reduce the fracture permanently
- To relieve muscle spasm and maintain alignment (Correct answer)
- To increase blood flow to the affected limb
- To prevent deep vein thrombosis
Correct answer: To relieve muscle spasm and maintain alignment
Buck's traction is used preoperatively to reduce muscle spasm, decrease pain, and maintain alignment of the fractured hip prior to surgical repair.
Question 2: A patient returns from surgery for an open reduction internal fixation (ORIF) of a femur fracture. Which assessment finding requires the most immediate nursing action?
- Mild incisional pain rated 4/10
- Capillary refill of 4 seconds in the affected foot (Correct answer)
- Slight swelling around the surgical site
- Temperature of 37.8°C on postoperative day 1
Correct answer: Capillary refill of 4 seconds in the affected foot
Capillary refill greater than 3 seconds indicates impaired perfusion, which is a sign of neurovascular compromise requiring immediate intervention.
Question 3: A nurse is caring for a patient with a newly applied plaster cast on the forearm. What instruction should the nurse provide regarding cast care?
- Submerge the cast in water to relieve itching
- Use a blunt object to scratch inside the cast
- Elevate the arm above heart level for 24–48 hours (Correct answer)
- Apply lotion around the cast edges daily
Correct answer: Elevate the arm above heart level for 24–48 hours
Elevating the casted extremity above heart level reduces swelling and prevents complications such as compartment syndrome in the first 24–48 hours.
Question 4: Which position is contraindicated for a patient who has just undergone a total hip replacement via the posterior approach?
- Supine with legs abducted
- Lateral on the unaffected side with a pillow between knees
- Hip flexion greater than 90 degrees (Correct answer)
- Legs in neutral rotation with toes pointing up
Correct answer: Hip flexion greater than 90 degrees
Hip flexion beyond 90 degrees risks dislocation of the prosthesis following posterior approach total hip replacement.
Question 5: A patient with a long leg cast reports sudden, severe pain in the casted leg that is unrelieved by opioid analgesia. What condition should the nurse suspect first?
- Opioid tolerance
- Compartment syndrome (Correct answer)
- Cast abrasion
- Wound infection
Correct answer: Compartment syndrome
Pain unrelieved by analgesics is the hallmark early warning sign of compartment syndrome, a surgical emergency requiring immediate notification of the provider.
Question 6: An LPN is caring for a patient with osteoporosis who sustained a vertebral compression fracture. Which nursing intervention is the highest priority?
- Administering calcium supplements as ordered
- Implementing fall prevention measures (Correct answer)
- Encouraging ambulation to prevent bone loss
- Teaching the patient about bisphosphonate therapy
Correct answer: Implementing fall prevention measures
Fall prevention is the highest priority to prevent additional vertebral or other fractures, as the patient is at extreme risk for further injury.
Question 7: A patient with rheumatoid arthritis reports that joint stiffness is worst upon awakening. How should the nurse advise the patient to manage this symptom?
- Apply ice packs to affected joints in the morning
- Rest the joints and avoid movement until stiffness resolves
- Perform gentle range-of-motion exercises and take a warm shower (Correct answer)
- Increase the dose of anti-inflammatory medication in the evening
Correct answer: Perform gentle range-of-motion exercises and take a warm shower
Warm showers and gentle ROM exercises help reduce morning stiffness in rheumatoid arthritis by warming joints and improving synovial fluid distribution.
LPN Medical-Surgical Nursing: Musculoskeletal and Neurological 2
A patient with a hip fracture is placed in Buck's traction preoperatively.
What is the primary purpose of this intervention?