NCLEX-RN Study Guide

NCLEX Musculoskeletal Questions: Fractures (2026)

November 2, 2026 · 5 min read

Short answer. Musculoskeletal NCLEX questions focus on circulation. The limb that is swelling inside a cast is a vascular emergency, and the five Ps are the fastest way to recognise it before permanent damage.

What the 2026 NCLEX tests in this area

Reduction of Risk Potential: compartment syndrome, immobility complications, traction safety
Basic Care and Comfort: mobility, positioning, pain management

Key facts to know

The five Ps	Pain, pallor, pulselessness, paresthesia, paralysis
Earliest sign of compartment syndrome	Pain out of proportion that worsens with passive stretch
Hip replacement precaution	No hip flexion beyond 90 degrees, no crossing legs, no internal rotation
Traction principle	Weights hang freely and must never rest on the floor or the bed
Cast care	Keep dry, elevate, check capillary refill and report numbness or burning
Immobility risk	Deep vein thrombosis, pneumonia, pressure injury and constipation

Practice question from this chapter

The nurse is caring for a client with a fractured hip who is awaiting surgery. Which traction should the nurse anticipate for temporary immobilization?

Femur fracture in children
Temporary immobilization of fractured hip awaiting surgery
Upper arm fracture
Cervical neck pain

Show answer and rationale

Correct answer: B. Temporary immobilization of fractured hip awaiting surgery

musculoskeletal: Buck's traction temporarily immobilizes leg in fractured hip awaiting surgery.

Second practice question

A client is 1 week after cast removal for a wrist fracture and reports stiffness in the wrist. Which intervention should the nurse implement?

Keep the wrist immobilized for another week
Apply heat and avoid all movement of the wrist
Begin gentle range of motion exercises as prescribed
Avoid using the hand until it is pain free

Show answer and rationale

Correct answer: C. Begin gentle range of motion exercises as prescribed

Gentle range of motion as prescribed restores joint mobility and prevents contracture after cast removal, so it is the correct intervention. Continued immobilization, avoiding all movement, and waiting for complete pain relief all delay functional recovery.

Compartment syndrome is the item

Pain that does not match the injury, and pain that increases when you passively stretch the toes or fingers, is the earliest reliable sign. Pulselessness comes late, which is why waiting for it is the most common wrong answer. If the finding is present, the cast or dressing is loosened and the provider is notified immediately.

The exam will offer an option to elevate the limb above heart level. For compartment syndrome that can reduce arterial inflow, so keep the limb at heart level unless the order says otherwise.

Preventing the complications of immobility

Every immobilised client is at risk of clots, atelectasis, pressure injury and constipation. The correct answers cluster around early mobilisation, sequential compression devices, incentive spirometry, repositioning and adequate hydration. Age and obesity raise the risk, and the item usually mentions one of them.

Neurovascular checks are the engine

Every musculoskeletal item exists to see whether you checked circulation and sensation after the injury or the intervention. Colour, temperature, capillary refill, pulse, sensation, movement and pain, compared with the other limb, documented and repeated at intervals. A change in any one of them is a reportable finding, not something to reassess in four hours.

Then match the precaution to the intervention. Traction means free hanging weights and alignment. A cast means keep it dry, elevate for swelling and report burning or numbness. A hip replacement means no flexion beyond ninety degrees, no crossed legs and no internal rotation.

Mobility is a safety issue, not a comfort one

Immobility produces four predictable complications: clot, atelectasis, pressure injury and constipation. The exam expects prevention to be specific: sequential compression devices and early ambulation for clots, incentive spirometry for the lungs, two hourly repositioning for the skin, and hydration with fibre for the bowel.

Fall risk belongs here too. An older adult on an opioid after a fracture is at high risk, and the correct intervention is supervised mobility with the call light in reach rather than a restraint.

Frequently asked questions

What are the five Ps of compartment syndrome?

Pain, pallor, pulselessness, paresthesia and paralysis. Pain with passive stretch appears first and pulselessness appears late.

What are hip replacement precautions?

Avoid flexion beyond 90 degrees, crossed legs and internal rotation to prevent dislocation.

Should a casted limb be elevated?

Elevate for swelling after a routine injury, but in suspected compartment syndrome keep it at heart level and act immediately.

What is the priority after a fracture?

Neurovascular assessment of the affected limb, including colour, temperature, pulse, sensation and movement.

How often should neurovascular checks be done?

Per protocol, typically hourly for the first day after surgery or a casting, then decreasing as the limb stabilises. Any change in pain or sensation warrants an immediate check regardless of the usual interval.

What is the first sign of a fat embolism after a long bone fracture?

A change in mental status and new shortness of breath with a petechial rash. It appears within a day or two of the injury and deteriorates quickly.

Practise this chapter with rationales

NCLEXDeck gives you practice questions for every body system, with a rationale for the correct answer and for each distractor. Start on the free tier, no card required.

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