ATI Medical-Surgical Musculoskeletal Quiz
30 Questions and Answers Comprehensive
Nursing Exam.
MODULE I: FRACTURES & COMPLICATIONS (Questions 1–8)
Q1. A nurse is caring for a client who sustained a tibial fracture 12 hours ago. The client reports
severe pain (8/10) that is unrelieved by morphine. The nurse notes pallor and paresthesia of the
foot. Which action should the nurse take FIRST?
A. Administer additional morphine
B. Elevate the extremity above heart level
C. Notify the provider immediately
D. Apply ice to the extremity
Correct Answer: C
Rationale: These signs indicate compartment syndrome (pain out of proportion to injury
unrelieved by opioids, paresthesia, pallor). This is a surgical emergency requiring fasciotomy. Do
NOT elevate the extremity (reduces arterial pressure and worsens ischemia). Additional
morphine will not relieve ischemic pain. Ice may worsen vasoconstriction. ATI Critical Action:
Immediate provider notification is priority.
Q2. A client with a fractured femur develops sudden onset of dyspnea, petechiae on the chest,
and confusion 36 hours post-injury. The nurse suspects:
A. Compartment syndrome
B. Fat embolism syndrome
C. Deep vein thrombosis
D. Osteomyelitis
Correct Answer: B
Rationale: Fat embolism syndrome (FES) presents with the classic triad: hypoxemia (dyspnea,
tachypnea), neurologic changes (confusion, agitation), and petechial rash (upper chest, axillae,
conjunctiva, hard palate). Onset is typically 24–72 hours after long bone or pelvic fracture. ATI
High-Yield: Recognize this classic presentation immediately.
, Q3. A nurse is caring for a client with an open fracture of the radius. Which intervention is the
PRIORITY?
A. Administer tetanus prophylaxis
B. Cover the wound with a sterile saline dressing
C. Perform a neurovascular assessment
D. Prepare the client for surgical irrigation and debridement
Correct Answer: C
Rationale: While all options are appropriate, the priority is the neurovascular assessment (5
P's: Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia). Open fractures carry high
risk for vascular injury and compartment syndrome. Assess circulation and nerve function first,
then cover the wound (B), administer tetanus (A), and prepare for OR (D). ATI Priority
Framework: Life/limb-threatening conditions first.
Q4. A nurse is providing discharge teaching to a client with a new fiberglass cast on the left arm.
Which statement by the client indicates a need for further teaching?
A. "I will keep the cast elevated on a pillow for the first 48 hours."
B. "I can use a coat hanger to scratch under the cast if it itches."
C. "I should report any foul odor or drainage from the cast."
D. "I will avoid getting the cast wet by using a plastic bag when showering."
Correct Answer: B
Rationale: Never insert objects under a cast (risk of skin breakdown, infection, and pressure
injury). Itching can be relieved by directing cool air from a hair dryer on the cool setting.
Fiberglass casts dry quickly (not 24–48 hours like plaster). Foul odor/drainage indicates infection
and must be reported. Keeping the cast dry prevents breakdown of the padding.
Q5. A client in Buck's traction for a hip fracture reports severe pain in the affected leg. The nurse
notes the foot is cool and capillary refill is 4 seconds. Which action should the nurse take FIRST?
A. Reposition the client for comfort
B. Increase the traction weight
C. Assess the traction setup for malalignment
D. Notify the provider immediately
Correct Answer: D
Rationale: Cool skin and delayed capillary refill (>3 seconds) indicate compromised circulation.
30 Questions and Answers Comprehensive
Nursing Exam.
MODULE I: FRACTURES & COMPLICATIONS (Questions 1–8)
Q1. A nurse is caring for a client who sustained a tibial fracture 12 hours ago. The client reports
severe pain (8/10) that is unrelieved by morphine. The nurse notes pallor and paresthesia of the
foot. Which action should the nurse take FIRST?
A. Administer additional morphine
B. Elevate the extremity above heart level
C. Notify the provider immediately
D. Apply ice to the extremity
Correct Answer: C
Rationale: These signs indicate compartment syndrome (pain out of proportion to injury
unrelieved by opioids, paresthesia, pallor). This is a surgical emergency requiring fasciotomy. Do
NOT elevate the extremity (reduces arterial pressure and worsens ischemia). Additional
morphine will not relieve ischemic pain. Ice may worsen vasoconstriction. ATI Critical Action:
Immediate provider notification is priority.
Q2. A client with a fractured femur develops sudden onset of dyspnea, petechiae on the chest,
and confusion 36 hours post-injury. The nurse suspects:
A. Compartment syndrome
B. Fat embolism syndrome
C. Deep vein thrombosis
D. Osteomyelitis
Correct Answer: B
Rationale: Fat embolism syndrome (FES) presents with the classic triad: hypoxemia (dyspnea,
tachypnea), neurologic changes (confusion, agitation), and petechial rash (upper chest, axillae,
conjunctiva, hard palate). Onset is typically 24–72 hours after long bone or pelvic fracture. ATI
High-Yield: Recognize this classic presentation immediately.
, Q3. A nurse is caring for a client with an open fracture of the radius. Which intervention is the
PRIORITY?
A. Administer tetanus prophylaxis
B. Cover the wound with a sterile saline dressing
C. Perform a neurovascular assessment
D. Prepare the client for surgical irrigation and debridement
Correct Answer: C
Rationale: While all options are appropriate, the priority is the neurovascular assessment (5
P's: Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia). Open fractures carry high
risk for vascular injury and compartment syndrome. Assess circulation and nerve function first,
then cover the wound (B), administer tetanus (A), and prepare for OR (D). ATI Priority
Framework: Life/limb-threatening conditions first.
Q4. A nurse is providing discharge teaching to a client with a new fiberglass cast on the left arm.
Which statement by the client indicates a need for further teaching?
A. "I will keep the cast elevated on a pillow for the first 48 hours."
B. "I can use a coat hanger to scratch under the cast if it itches."
C. "I should report any foul odor or drainage from the cast."
D. "I will avoid getting the cast wet by using a plastic bag when showering."
Correct Answer: B
Rationale: Never insert objects under a cast (risk of skin breakdown, infection, and pressure
injury). Itching can be relieved by directing cool air from a hair dryer on the cool setting.
Fiberglass casts dry quickly (not 24–48 hours like plaster). Foul odor/drainage indicates infection
and must be reported. Keeping the cast dry prevents breakdown of the padding.
Q5. A client in Buck's traction for a hip fracture reports severe pain in the affected leg. The nurse
notes the foot is cool and capillary refill is 4 seconds. Which action should the nurse take FIRST?
A. Reposition the client for comfort
B. Increase the traction weight
C. Assess the traction setup for malalignment
D. Notify the provider immediately
Correct Answer: D
Rationale: Cool skin and delayed capillary refill (>3 seconds) indicate compromised circulation.
