Musculoskeletal
NCLEX® practice.

Free practice set · 3 questions

3 more free musculoskeletal NCLEX-RN® practice questions

Real questions from the same bank the app serves. Pick an answer in your head, then open the rationale to see why the correct option holds and why each other option falls short. No account needed for these.

1. Question 1 of 3 · Mobility, Injury & Orthopedic Care

   A 22-year-old male client in a skilled nursing facility is recovering from surgical repair of a femur fracture 2 days ago. He rates his pain as 8/10 on the numeric rating scale and describes it as deep and aching, worse with leg movement. He is alert, calm, and conversing pleasantly with staff. The nurse is deciding how to interpret this pain report. How should the nurse interpret the client's reported pain?

   1. AAccept the client's 8/10 rating as accurate and treat it as severe pain
   2. BDisregard the numeric rating and instead use a behavioral pain scale to score him
   3. CAssume the pain is less severe because he appears calm and is conversing normally
   4. DLower the pain score because his heart rate and blood pressure are within normal limits
   Show the answer and rationale

   Correct answer: A. Accept the client's 8/10 rating as accurate and treat it as severe pain

   The fundamental rule of pain assessment is that pain is what the client says it is. When a client can communicate, self-report on a validated tool such as the numeric rating scale is the gold standard and must be accepted at face value, even when the client appears calm, is smiling, or is conversing normally, because behavioral appearance does not reliably reflect pain intensity. This client is alert and able to self-report, so his 8/10 rating should be treated as severe pain requiring intervention, not reinterpreted based on how he looks or acts. Substituting a behavioral tool such as a sedation-based scale is reserved for clients who cannot self-report, such as those who are non-verbal, cognitively impaired, or sedated; using it here would ignore a perfectly reliable self-report and is not indicated. Similarly, normal vital signs such as heart rate and blood pressure do not rule out pain, since many clients with significant pain maintain normal vital signs, especially with chronic or opioid-tolerant pain histories. Recognizing that self-report takes priority over appearance and over vital signs is the essential first step the nurse must take before deciding on any medication or comfort intervention.

   A. Accept the client's 8/10 rating as accurate and treat it as severe pain

   Self-report on a validated scale is the gold standard for clients who can communicate. The nurse must accept and act on the stated 8/10 rating regardless of appearance.

   B. Disregard the numeric rating and instead use a behavioral pain scale to score him

   Behavioral pain scales are reserved for clients who cannot self-report, such as those who are non-verbal or sedated. This client can communicate, so substituting a behavioral tool ignores valid self-report data.

   C. Assume the pain is less severe because he appears calm and is conversing normally

   This reflects the mistaken belief that a calm or pleasant demeanor means less pain. Behavioral cues do not override a reliable self-report and can lead to undertreatment.

   D. Lower the pain score because his heart rate and blood pressure are within normal limits

   Normal heart rate and blood pressure do not indicate absence of pain. Vital signs are not a reliable substitute for self-report and should never be used to discount a stated pain level.

2. Question 2 of 3 · Nursing Leadership, Delegation & Advocacy

   A 68-year-old man with a hip fracture repair is in the ICU on contact precautions for a multidrug-resistant wound organism. His adult son, who has been at the bedside for hours, begins raising his voice at the nurse, accusing her of "letting infection spread" because staff have been slow to don gowns and gloves before entering the room. The son steps closer, clenches his fists, and points at the nurse while other visitors nearby stop and stare. The client remains stable and resting in bed. Which finding in this scenario should the nurse recognize as the cue that safety, not the content of the complaint, must be addressed immediately?

   1. AOther visitors nearby stopping to stare at the confrontation
   2. BThe son's accusation that the nurse is responsible for spreading infection
   3. CThe son stepping closer, clenching his fists, and pointing while raising his voice
   4. DThe son's belief that staff are slow to don gowns and gloves before entering
   Show the answer and rationale

   Correct answer: C. The son stepping closer, clenching his fists, and pointing while raising his voice

   The nurse must first recognize which cues signal a physical safety risk versus which cues describe the content of the dispute. Here, the son's escalating body language and physical closing of distance (stepping closer, clenched fists, pointing, raised voice) are the cues indicating that the situation could become physically unsafe. Because safety-threatening behavior always takes priority over discussing the substance of a complaint, this is the finding that must be recognized first before any communication strategy can be chosen. The son's belief about slow donning of protective equipment and his accusation about infection spread are content issues, not safety cues. These represent the topic the nurse would eventually need to acknowledge through active listening, but treating them as the primary trigger risks moving into problem-solving or taking a side before the safety concern is contained. The presence of onlookers is a contextual detail about privacy and audience, not the safety trigger itself, so focusing on the bystanders would misdirect the nurse toward involving other staff or leadership before recognizing what actually requires immediate action. Recognizing escalating physical cues as the priority finding, distinct from the emotional or informational content of the complaint, is the foundational skill the nurse needs before selecting any specific safety or de-escalation intervention.

   A. Other visitors nearby stopping to stare at the confrontation

   Bystanders stopping to stare is a privacy and environmental detail, not the safety trigger. Focusing here misses the actual escalating behavior and could prematurely shift attention toward involving other staff rather than recognizing the immediate risk.

   B. The son's accusation that the nurse is responsible for spreading infection

   The accusation itself is the emotional content of the complaint, not the safety cue. Treating the accusation as the key finding risks the nurse reacting defensively or aligning against the son rather than recognizing the physical escalation that truly requires attention first.

   C. The son stepping closer, clenching his fists, and pointing while raising his voice

   These physical behaviors (closing distance, clenched fists, pointing, raised voice) are the classic cues of escalating physical threat that require the nurse to recognize a safety risk before anything else, matching the rule that safety cues take priority over dispute content.

   D. The son's belief that staff are slow to don gowns and gloves before entering

   This is a content issue about unit practice, not a safety cue. Fixating on this detail risks jumping toward explaining or fixing donning practices before the nurse has even recognized the safety risk, reflecting premature problem-solving.

3. Question 3 of 3 · Mobility, Injury & Orthopedic Care

   The nurse is an RN licensed by the Missouri Board of Nursing in a skilled nursing facility. A 22-year-old man recovering from a pelvic fracture also manages type 1 diabetes at home. His orthopedic surgeon’s order requests removal of external-fixator pins, but facility policy addresses only dressing changes and does not state who may remove pins; the nurse has never been trained or validated for this procedure. The charge RN asks the nurse to proceed. What should the nurse do first?

   1. ARemove the pins because an RN may perform any procedure permitted to RNs in another state.
   2. BPerform the pin removal after watching a video, since the procedure is generally within RN licensure.
   3. CRemove the pins now because the orthopedic surgeon’s order makes the procedure part of the RN assignment.
   4. DReview the Missouri Nurse Practice Act and facility policy, then consult the charge RN before performing the procedure.
   Show the answer and rationale

   Correct answer: D. Review the Missouri Nurse Practice Act and facility policy, then consult the charge RN before performing the procedure.

   Review the Missouri Nurse Practice Act, facility policy, and supervising RN guidance before acting. The state Nurse Practice Act and board rules, together with facility policy, define the RN’s legal scope; the more restrictive applicable requirement controls. A provider’s order does not establish RN scope, and an RN must also be competent and validated for the procedure. The alternatives improperly assume another state’s rules apply, act before clarifying an ambiguous task, or substitute a video for documented competency. Performing a task reserved to another license, unauthorized interstate telehealth, or refusing a clearly in-scope task would likewise violate the governing scope principles.

   A. Remove the pins because an RN may perform any procedure permitted to RNs in another state.

   Scope is not automatically identical across states or settings. The Missouri RN must follow Missouri requirements and this facility’s policy, using the more restrictive rule when they differ. Applying another state’s permission without verification is unsafe.

   B. Perform the pin removal after watching a video, since the procedure is generally within RN licensure.

   A procedure may be legally permitted for an RN yet still be outside this nurse’s demonstrated competency. Watching a video does not replace education, supervised practice, or facility validation; performing the removal could harm the client and violate professional standards.

   C. Remove the pins now because the orthopedic surgeon’s order makes the procedure part of the RN assignment.

   A provider’s order authorizes the medical treatment but does not independently place the procedure within the RN’s legal scope. Because policy is silent and the task is unclear, the RN must clarify before acting rather than proceed first.

   D. Review the Missouri Nurse Practice Act and facility policy, then consult the charge RN before performing the procedure.

   This is the safest first action because the Nurse Practice Act, board rules, and facility policy govern scope, and the RN must clarify an unaddressed task before acting. The lack of training adds a separate competency concern, so consultation is required before removal.