Musculoskeletal System

1. An 83-year-old woman is admitted to the surgical ward after falling out of her bed. The orthopaedist requests that the patient be prepared for surgery to repair her fractured femur. The LPN notes that the patient has a history of hypercholesterolemia and experienced a post-operative myocardial infarction (following a heart valve replacement) two years. Given the patient’s age and heart condition, the postoperative risks are considered high. Given the patient’s condition, which of following interventions should be done in postoperative care? *
2. On the first day of his knee prosthesis surgery, a 65-year-old man is found standing in his room at night during one of the LPN’s usual rounds. He is pacing around his room, completely disoriented. He has removed his urinary catheter, his IV solution, and his controlled analgesia (PCA). The blood at the IV site has not coagulated, and the patient refuses to let the LPN touch him to stop the bleeding. He refuses to listen, raises his voice, and tells the LPN to leave him alone while making fists. The LPN insists on placing a dressing at the site of the bleeding. The patient takes his chair and throws it at the window. Which intervention would not be appropriate to attenuate the patient’s disruptive behaviour? *
3. Mr. Louis Dufresne, 27, was admitted after a left tibial fracture from a motorcycle accident. He underwent closed reduction and casting earlier this morning. When the LPN enters the room, Louis reports “deep pressure pain” in the leg that does not improve with elevation. His skin around the cast is pale and cool to the touch, with capillary refill over 4 seconds. His vital signs are: BP 138/88, HR 112, RR 22, SpO₂ 98%, T 36.8°C. He says the pain is “way worse than before” and rates it 9/10, even after receiving analgesics. The physician’s orders include: neurovascular checks q1h, acetaminophen-codeine PRN, and leave cast intact unless instructed otherwise. Which intervention should the LPN prioritize? *
4. Mrs. Jeanne Morissette, 81, underwent a left hip hemiarthroplasty following a fall at home. She is now 4 hours post-op and appears confused, trying to move her operated leg across the midline. She reports mild nausea but denies pain. Her vitals are stable: BP 132/74, HR 88, RR 18, SpO₂ 96%, T 36.6°C. The LPN notices that her abduction pillow has slipped out and she is attempting to flex her hip. Physician’s orders: hip precautions, abductor pillow at all times, assist ambulation tomorrow, analgesics PRN. What is the LPN’s PRIORITY? *
5. Mr. Samuel Beaudoin, 59, was admitted with osteomyelitis of the right foot secondary to uncontrolled diabetes. He reports chills, deep bone pain, and fatigue. His foot appears swollen, warm, and draining yellow exudate. His vitals: T 38.5°C, HR 110, BP 126/80, RR 20, SpO₂ 97%. The physician has ordered: IV vancomycin, wound culture before first antibiotic, elevate limb, and blood glucose monitoring. Which action must the LPN do FIRST? *
6. Mrs. Sylvie Arsenault, 72, with known osteoporosis, is admitted after slipping in the shower but having no fracture. She is embarrassed and tries to ambulate alone to prove she is fine. She moves with a shuffling gait and holds onto furniture for balance. Vitals stable. Orders: assist with ambulation, fall precautions, vitamin D/calcium supplements, physiotherapy evaluation. What is the LPN’s priority? *
7. Mr. Marc Lavoie, 34, is 2 hours post-left knee arthroscopy. He reports new swelling and burning pain in the joint. The LPN notes increasing drainage on the surgical dressing. Vitals: BP 118/70, HR 104, T 37.1°C, RR 20, SpO₂ 99%. Orders: ice to knee, neurovascular checks, analgesics, reinforce dressing PRN. What should the LPN do first? *
8. Mrs. Caroline Monet, 62, with long-standing rheumatoid arthritis, reports severe morning stiffness in her hands, making it difficult to perform hygiene care. Her joints appear swollen and warm. Orders: warm compresses, gentle ROM, NSAIDs, assist with ADLs. The LPN should FIRST: *
9. Mr. Jonathan Meloche, 44, injured his back lifting heavy equipment at work. He now has spasms and limited mobility. Vitals stable. Orders: heat therapy, analgesics, encourage proper body mechanics, avoid twisting. What is the priority teaching? *
10. Mr. Pierre Côté, 69, is on day 2 after total knee replacement. He reports new calf tenderness and mild swelling. His calf is warm on palpation.
Vitals: BP 130/78, HR 102, RR 20, T 37.5°C. Orders: heparin injections, ambulate with walker, leg exercises, ice knee. What should the LPN do? *
11. Ms. Lucie Martel, 24, has a full arm cast for a distal radius fracture. She complains of itching inside and attempts to insert a pen underneath. Orders: cast precautions, neurovascular checks, ice for swelling. The LPN should: *
12. Mr. Dany Rousseau, 58, presents with painful swelling of the right big toe. The joint is red, hot, and extremely tender. Orders: colchicine, low-purine diet, elevate limb, increase fluids. What should the LPN do? *
13. Mrs. Anne-Marie Savard with osteoarthritis, 71, states her knee pain worsens by evening. Orders: heat, weight reduction, assistive devices, exercise program. What is the LPN's appropriate teaching to the patient? *
14. Mrs. Reina Dubois, 84, is bedridden after a hip fracture awaiting surgery.
Orders: ROM, compression stockings, heparin, turn q2h. What should the LPN do? *
15. Mr. Victor Rivard, 38, suffered a shoulder dislocation playing hockey. He now wears an immobilizing sling. Orders: ice, neurovascular checks, avoid abduction, NSAIDs. What is the LPN's most important teaching to the patient? *
16. Ms. Chloe Pagé, 33, reports widespread pain and profound fatigue. Orders: gentle exercise, sleep hygiene, heat, stress reduction. What important teaching the LPN should mention? *
17. Mr. Édouard Lapierre, 56, was admitted after a motor vehicle collision that resulted in a right femoral shaft fracture. He is now in skeletal traction and has been on the orthopedic unit for two days. When the LPN enters the room for morning care, she observes that the pin sites show mild serous drainage, but the surrounding skin is pink without notable warmth. Édouard reports mild discomfort around the pin area but denies fever or chills. The traction setup appears stable, and the weights are hanging beside the bed, but the patient mentions that earlier a visitor tried moving them “to help him sit better.” The physician’s orders include: clean pin sites per protocol, monitor for signs of infection, ensure traction weights remain free-hanging. What is the most appropriate LPN intervention? *
18. Mr. Lucien Caron, 61, is now 24 hours postoperative after a right below-knee amputation related to severe peripheral arterial disease. He tells the LPN that he is feeling “strange pains,” describing episodes of phantom limb sensations. He also expresses anxiety about how the wound will heal and whether he’ll be able to use a prosthesis later on. On assessment, the incision is clean with minimal serosanguinous drainage. Swelling is present, as expected on postoperative day one.
The physician’s orders include: apply compression bandage, assist with ROM exercises, provide pain management as needed, and position the patient prone periodically to prevent flexion contractures. What is the best nursing intervention at this time? *
19. Ms. Patricia Leduc, 29, arrives at the clinic after twisting her left ankle on uneven pavement during a morning jog. She reports immediate swelling and difficulty bearing weight. On assessment, the ankle is swollen, tender, and warm but shows no deformity. She is anxious because she has a marathon planned next month. The physician identifies a Grade I sprain. Orders include: apply rest, ice, compression, elevation (RICE), reassess pain, and teach home care. What is the most appropriate initial intervention? *
20. Mr. Jérémie Tanguay, 33, presents to the orthopedic unit after twisting his right knee during a soccer game. He reports knee locking, difficulty extending the leg fully, and sharp medial joint line pain. His MRI is scheduled later today. The physician has ordered a knee brace, crutch teaching, and ice intermittently to reduce swelling. The LPN observes the patient attempting to hop short distances without using the crutches provided, stating that he “doesn’t really know how to use them.” What intervention should the LPN prioritize? *
21. Ms. Rosalie Tremblay, 17, is undergoing treatment for osteosarcoma of the left tibia. She has been admitted due to worsening bone pain that interferes with sleep. She appears restless and tearful, rating her pain as 8/10. Her parents are at the bedside and express concern about her discomfort. Orders include: administer prescribed opioid analgesics, offer non-pharmacologic comfort measures, elevate the affected limb, and follow oncology recommendations. What is the most appropriate intervention? *
22. Mr. Thierry Allard, 41, has a known diagnosis of ankylosing spondylitis and reports increasing stiffness, especially on waking. He explains that he works at a desk job and tends to slouch due to mid-back discomfort. On assessment, his posture shows early thoracic kyphosis. He expresses fear that his back will “freeze” permanently. Orders include: daily posture and stretching exercises, heat to manage stiffness, use of a firm mattress, and a physiotherapy mobility plan. What teaching should the LPN reinforce? *