1
HESI Specialty Exam Bank on Musculoskeletal Trauma, Fractures & Joint
Replacement
Table of Contents
Subtopic 1: Initial Assessment and Emergency Management of
Musculoskeletal Trauma...................................................................................2
Subtopic 2: Types of Fractures and Their Clinical Presentations......................9
Subtopic 3: Fracture Healing, Delayed Union, and Nonunion.........................17
Subtopic 4: Complications of Fractures and Orthopedic Surgery...................25
Subtopic 5: Orthopedic Surgical Interventions and Postoperative Care.........32
Subtopic 6: Rehabilitation, Mobility Aids, and Patient Education...................40
Subtopic 7: Complications of Musculoskeletal Injuries and Surgeries............48
Subtopic 8: Pediatric and Geriatric Considerations in Orthopedic Trauma and
Recovery........................................................................................................56
Subtopic 9: Pre- and Post-Operative Nursing Management in Orthopedic
Surgery..........................................................................................................63
Subtopic 10: Long-Term Recovery, Rehabilitation Outcomes, and Lifestyle
Modifications..................................................................................................71
, 2
Subtopic 1: Initial Assessment and Emergency
Management of Musculoskeletal Trauma
Question 1:
A 32-year-old male arrives at the emergency department after a motorcycle
accident. He presents with an open fracture of the tibia with severe bleeding.
What is the nurse’s immediate priority?
A. Apply a splint
B. Control the bleeding with direct pressure
C. Start an IV line for fluid resuscitation
D. Assess the range of motion of the limb
Correct Answer: B
Rationale: The priority in trauma care follows the ABCs. Uncontrolled
bleeding threatens life and must be managed first with direct pressure.
Stabilization and other assessments follow after hemorrhage control.
Question 2:
Which clinical sign suggests neurovascular compromise in a limb with
suspected fracture?
A. Local swelling
B. Absent distal pulses
C. Decreased capillary refill under 2 seconds
D. Ecchymosis around the injury site
Correct Answer: B
Rationale: Absent distal pulses indicate compromised circulation, requiring
urgent intervention to prevent ischemia and potential limb loss.
Question 3:
, 3
Which is the most appropriate initial nursing action for a patient with a
suspected cervical spine injury after a fall?
A. Begin chest compressions
B. Remove the patient’s helmet
C. Stabilize the cervical spine and maintain airway
D. Check for signs of bruising
Correct Answer: C
Rationale: Cervical spine stabilization is crucial to prevent spinal cord injury.
Airway maintenance must occur with spinal precautions.
Question 4:
During the secondary assessment of a trauma patient with musculoskeletal
injury, the nurse should prioritize:
A. Administering pain medication
B. Sending the patient to imaging
C. Assessing for deformities, edema, and crepitus
D. Encouraging movement to assess joint function
Correct Answer: C
Rationale: Physical examination for deformity and signs of trauma helps
identify fractures and soft tissue damage. Pain control follows.
Question 5:
In a trauma setting, what assessment finding would require the most
immediate action by the nurse?
A. Swollen and bruised forearm
B. Pain level rated 8/10
C. Arm held in a guarded position
D. Cold, pale foot with no pulse
, 4
Correct Answer: D
Rationale: This indicates arterial occlusion or compartment syndrome, which
is a surgical emergency.
Question 6:
Which intervention is appropriate before moving a patient with a suspected
pelvic fracture?
A. Apply heat to relax the muscles
B. Place a pelvic binder or sheet wrap
C. Elevate the legs to reduce swelling
D. Encourage ambulation to assess function
Correct Answer: B
Rationale: Pelvic binders stabilize the pelvis and reduce bleeding risk before
definitive imaging or surgical intervention.
Question 7:
Which musculoskeletal trauma is at highest risk of causing fat embolism
syndrome?
A. Wrist fracture
B. Rib fracture
C. Femur fracture
D. Shoulder dislocation
Correct Answer: C
Rationale: Long bone fractures, particularly the femur, are commonly
associated with fat embolism due to marrow fat entering circulation.
Question 8:
What symptom is most suggestive of fat embolism syndrome (FES)?
HESI Specialty Exam Bank on Musculoskeletal Trauma, Fractures & Joint
Replacement
Table of Contents
Subtopic 1: Initial Assessment and Emergency Management of
Musculoskeletal Trauma...................................................................................2
Subtopic 2: Types of Fractures and Their Clinical Presentations......................9
Subtopic 3: Fracture Healing, Delayed Union, and Nonunion.........................17
Subtopic 4: Complications of Fractures and Orthopedic Surgery...................25
Subtopic 5: Orthopedic Surgical Interventions and Postoperative Care.........32
Subtopic 6: Rehabilitation, Mobility Aids, and Patient Education...................40
Subtopic 7: Complications of Musculoskeletal Injuries and Surgeries............48
Subtopic 8: Pediatric and Geriatric Considerations in Orthopedic Trauma and
Recovery........................................................................................................56
Subtopic 9: Pre- and Post-Operative Nursing Management in Orthopedic
Surgery..........................................................................................................63
Subtopic 10: Long-Term Recovery, Rehabilitation Outcomes, and Lifestyle
Modifications..................................................................................................71
, 2
Subtopic 1: Initial Assessment and Emergency
Management of Musculoskeletal Trauma
Question 1:
A 32-year-old male arrives at the emergency department after a motorcycle
accident. He presents with an open fracture of the tibia with severe bleeding.
What is the nurse’s immediate priority?
A. Apply a splint
B. Control the bleeding with direct pressure
C. Start an IV line for fluid resuscitation
D. Assess the range of motion of the limb
Correct Answer: B
Rationale: The priority in trauma care follows the ABCs. Uncontrolled
bleeding threatens life and must be managed first with direct pressure.
Stabilization and other assessments follow after hemorrhage control.
Question 2:
Which clinical sign suggests neurovascular compromise in a limb with
suspected fracture?
A. Local swelling
B. Absent distal pulses
C. Decreased capillary refill under 2 seconds
D. Ecchymosis around the injury site
Correct Answer: B
Rationale: Absent distal pulses indicate compromised circulation, requiring
urgent intervention to prevent ischemia and potential limb loss.
Question 3:
, 3
Which is the most appropriate initial nursing action for a patient with a
suspected cervical spine injury after a fall?
A. Begin chest compressions
B. Remove the patient’s helmet
C. Stabilize the cervical spine and maintain airway
D. Check for signs of bruising
Correct Answer: C
Rationale: Cervical spine stabilization is crucial to prevent spinal cord injury.
Airway maintenance must occur with spinal precautions.
Question 4:
During the secondary assessment of a trauma patient with musculoskeletal
injury, the nurse should prioritize:
A. Administering pain medication
B. Sending the patient to imaging
C. Assessing for deformities, edema, and crepitus
D. Encouraging movement to assess joint function
Correct Answer: C
Rationale: Physical examination for deformity and signs of trauma helps
identify fractures and soft tissue damage. Pain control follows.
Question 5:
In a trauma setting, what assessment finding would require the most
immediate action by the nurse?
A. Swollen and bruised forearm
B. Pain level rated 8/10
C. Arm held in a guarded position
D. Cold, pale foot with no pulse
, 4
Correct Answer: D
Rationale: This indicates arterial occlusion or compartment syndrome, which
is a surgical emergency.
Question 6:
Which intervention is appropriate before moving a patient with a suspected
pelvic fracture?
A. Apply heat to relax the muscles
B. Place a pelvic binder or sheet wrap
C. Elevate the legs to reduce swelling
D. Encourage ambulation to assess function
Correct Answer: B
Rationale: Pelvic binders stabilize the pelvis and reduce bleeding risk before
definitive imaging or surgical intervention.
Question 7:
Which musculoskeletal trauma is at highest risk of causing fat embolism
syndrome?
A. Wrist fracture
B. Rib fracture
C. Femur fracture
D. Shoulder dislocation
Correct Answer: C
Rationale: Long bone fractures, particularly the femur, are commonly
associated with fat embolism due to marrow fat entering circulation.
Question 8:
What symptom is most suggestive of fat embolism syndrome (FES)?
