NLE Musculoskeletal Nursing — Musculoskeletal Assessment and DiagnosticsExam Answer Templates

Marks

1

Topic

Functional Anatomy Review

Difficulty

easy

Template Id

T1

Examiner Tip

The contrast between osteoblasts and osteoclasts is a classic NLE paired question. Always remember: 'blast = build, clast = crush (resorb).' Stating both in a 1-mark answer is acceptable and shows depth.

Model Answer

Osteoblasts are bone-building cells responsible for the formation and mineralization of new bone tissue.

Question Type

very_short_answer

Answer Structure

• Line 1: Name the cell type and state its function clearly [1 mark]

Scoring Breakdown

Common Mark Deductions

• Confusing osteoblasts (build bone) with osteoclasts (resorb/break down bone)
• Writing an incomplete answer such as 'they make bone' without specifying the process of mineralization or new bone formation

Key Phrases To Include

• osteoblasts
• bone-building
• bone formation
• mineralization

Marks

2

Topic

Functional Anatomy Review

Difficulty

easy

Template Id

T2

Examiner Tip

Memory aid for Filipino students: 'Tendon — Tightens (muscle pull); Ligament — Links (bones together).' Use this mnemonic and state both directions of connection for full marks.

Model Answer

A tendon connects muscle to bone, allowing muscle contractions to produce joint movement. A ligament connects bone to bone, providing stability to joints and limiting excessive movement.

Question Type

short_answer

Answer Structure

• Line 1: Define tendon and state what it connects [1 mark]
• Line 2: Define ligament and state what it connects [1 mark]

Scoring Breakdown

Common Mark Deductions

• Reversing the definitions — writing that tendons connect bone to bone and ligaments connect muscle to bone
• Omitting the functional significance (e.g., not mentioning joint stability for ligaments)

Key Phrases To Include

• tendon
• muscle to bone
• ligament
• bone to bone
• joint stability

Marks

2

Topic

Functional Anatomy Review

Difficulty

easy

Template Id

T3

Examiner Tip

The three joint classifications — synarthrodial (immovable), amphiarthrodial (slightly movable), and diarthrodial (freely movable) — frequently appear as matching or multiple-choice items. In a written answer, citing the correct examples and the synovial membrane feature will always earn full marks.

Model Answer

Three examples of diarthrodial (synovial) joints are: (1) knee, (2) hip, and (3) shoulder. A key characteristic of synovial joints is that they have a synovial membrane that secretes synovial fluid to lubricate and reduce friction within the joint, allowing free movement.

Question Type

short_answer

Answer Structure

• Line 1: Name three correct examples of synovial joints [1 mark]
• Line 2: State one characteristic feature (e.g., synovial membrane, free movement, synovial fluid) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing synarthrodial (skull sutures) or amphiarthrodial (vertebrae) joints instead of diarthrodial joints
• Stating only the joint names without any characteristic feature

Key Phrases To Include

• diarthrodial
• synovial joints
• synovial membrane
• synovial fluid
• freely movable

Marks

2

Topic

Neurovascular Assessment

Difficulty

medium

Template Id

T4

Examiner Tip

In any musculoskeletal scenario question, the words 'increasing pain' and 'tingling/numbness' should immediately trigger your response: neurovascular check + compartment syndrome. Always name the complication you are preventing — examiners reward clinical reasoning, not just the action.

Model Answer

Priority action: The nurse performs an immediate, thorough neurovascular check of the affected extremity, assessing the 5 Ps — pain, pallor, pulselessness, paresthesia, and paralysis — distal to the cast. Rationale: Increasing pain and paresthesia (tingling) are the earliest warning signs of compartment syndrome, a condition in which rising pressure within a fascial compartment compromises perfusion and can cause irreversible nerve and muscle damage within hours if not reported and treated promptly.

Question Type

short_answer

Answer Structure

• Line 1: State the priority nursing action clearly (neurovascular check / assess the 5 Ps) [1 mark]
• Line 2: Provide the clinical rationale, naming compartment syndrome and the risk of irreversible damage [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'reassure the patient' as the priority — this is not the immediate safety action
• Failing to name compartment syndrome as the clinical concern
• Not explaining why the action is urgent (time-sensitive nature of compartment syndrome)

Key Phrases To Include

• neurovascular check
• 5 Ps
• compartment syndrome
• paresthesia
• earliest warning sign
• report immediately

Marks

3

Topic

Neurovascular Assessment

Difficulty

medium

Template Id

T5

Examiner Tip

This is a 3-mark staple in musculoskeletal nursing. The trick is to memorize all six and to flag Pain as EARLY and Pulselessness and Paralysis as LATE. Examiners often award bonus credit for mentioning pain on passive stretch — it demonstrates clinical depth.

Model Answer

The six Ps of neurovascular assessment are: 1. Pain — increasing, unrelenting pain or pain out of proportion to the injury; the earliest and most sensitive sign of compartment syndrome; pain on passive stretch of fingers or toes is a classic indicator. 2. Pallor — pale, dusky, or cyanotic skin color; assess capillary refill (normal is less than 3 seconds). 3. Pulselessness — diminished or absent distal pulse; this is a late and ominous sign indicating severely compromised arterial flow. 4. Paresthesia — numbness or tingling sensation in the affected extremity, indicating nerve compression or ischemia. 5. Paralysis — inability to move the digits (fingers or toes); a late sign indicating significant neuromuscular compromise. 6. Poikilothermia — abnormal coolness of the affected extremity compared to the opposite limb, indicating poor perfusion.

Question Type

short_answer

Answer Structure

• Point 1: Pain — name and describe, noting it is the earliest sign [0.5 mark]
• Point 2: Pallor — name and describe, include capillary refill [0.5 mark]
• Point 3: Pulselessness — name and describe as a late sign [0.5 mark]
• Point 4: Paresthesia — name and describe [0.5 mark]
• Point 5: Paralysis — name and describe as a late sign [0.5 mark]
• Point 6: Poikilothermia — name and describe [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Listing only 4–5 Ps without the sixth (Poikilothermia) — this is frequently missed
• Not distinguishing which signs are early (Pain, Paresthesia) versus late (Pulselessness, Paralysis)
• Omitting the passive stretch component for Pain assessment

Key Phrases To Include

• pain on passive stretch
• earliest sign
• capillary refill less than 3 seconds
• pulselessness late sign
• paresthesia
• paralysis late sign
• poikilothermia
• coolness

Marks

3

Topic

Principles of Casts

Difficulty

medium

Template Id

T6

Examiner Tip

Cast care questions almost always include a trap about palm versus fingertip support. Write it explicitly. For 3-mark questions, the safest approach is three well-explained interventions with rationale rather than six interventions with no rationale.

Model Answer

Nursing care for a patient with a new plaster cast: 1. Support the wet cast using the palms of the hands, not the fingertips, to prevent denting that could create internal pressure points and pressure ulcers. 2. Elevate the casted extremity above the level of the heart for the first 24–48 hours and apply ice as ordered to minimize swelling and reduce the risk of circulatory compromise within the cast. 3. Perform frequent neurovascular checks (every 1–2 hours initially) distal to the cast, assessing the 5 Ps — pain, pallor, pulselessness, paresthesia, and paralysis. 4. Allow the cast to air dry completely (plaster takes 24–72 hours); do not cover it with blankets while wet, as this traps heat and slows drying. 5. Instruct the patient never to insert objects into the cast to relieve itching, as this breaks the skin and can lead to infection under the cast.

Question Type

short_answer

Answer Structure

• Point 1: Palm support for wet cast — state action and rationale [1 mark]
• Point 2: Elevation above heart level and ice application — state action and rationale [1 mark]
• Point 3: Neurovascular checks / patient teaching about no objects in cast — state action and rationale [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating 'support with fingers' instead of palms — this is a classic wrong answer
• Omitting the rationale for each intervention — examiners expect action + reason
• Failing to include any patient teaching component

Key Phrases To Include

• palms of the hands
• not fingertips
• elevate above heart level
• 24–48 hours
• neurovascular checks distal to cast
• never insert objects
• air dry

Marks

2

Topic

Assistive Devices and Gait Training

Difficulty

easy

Template Id

T7

Examiner Tip

Cane use is intuitive once you understand the principle: the cane acts as a surrogate for the weak leg on the opposite side, creating a wider base of support. Memorize: 'Cane on the STRONG side, moves WITH the WEAK leg.'

Model Answer

The patient should hold the cane in the left hand (the strong, unaffected side — opposite to the operated right knee). The walking pattern is: advance the cane and the weak (right) leg together simultaneously, then transfer weight through the cane as the right leg accepts partial weight, then step forward with the strong (left) leg. This pattern maximizes stability and reduces load on the affected knee.

Question Type

short_answer

Answer Structure

• Line 1: State cane is held on the strong/unaffected/left side — with brief rationale [1 mark]
• Line 2: Describe the walking sequence (cane + weak leg advance together, then strong leg) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating the cane is held on the affected (right) side — this is the most common error
• Omitting the walking pattern sequence

Key Phrases To Include

• strong side
• unaffected side
• opposite hand
• cane and weak leg advance together
• stability

Marks

2

Topic

Principles of Traction

Difficulty

medium

Template Id

T8

Examiner Tip

For patient communication questions, the NLE rewards answers that include both the 'what' (action/rule) and the 'why' (rationale). A complete answer demonstrates therapeutic communication AND clinical knowledge simultaneously.

Model Answer

The nurse explains: 'The weights in skeletal traction must hang freely and continuously to maintain the constant pulling force needed to keep the broken bone fragments in proper alignment and to prevent muscle spasm. Removing the weights — even briefly — can cause the bone ends to shift, disrupting healing, increasing pain, and potentially causing re-injury. The weights can only be adjusted or removed with a specific physician's order.'

Question Type

short_answer

Answer Structure

• Line 1: Explain the therapeutic purpose of traction weights (alignment, fracture reduction, muscle spasm relief) [1 mark]
• Line 2: State that weights cannot be removed without a physician's order and explain the risk of removal [1 mark]

Scoring Breakdown

Common Mark Deductions

• Giving a vague response such as 'it is doctor's orders' without explaining the clinical reason
• Not mentioning the risk of removing weights (bone shifting, re-injury)

Key Phrases To Include

• hang freely
• maintain alignment
• muscle spasm
• physician's order
• bone displacement
• continuous pull

Marks

3

Topic

Diagnostic Studies — Imaging

Difficulty

medium

Template Id

T9

Examiner Tip

The NLE loves X-ray vs. MRI comparisons. A memory hook: 'X-ray = eXamines bones; MRI = Manages soft tissue Revelations.' For the nursing responsibility, the MRI metal screening is the most high-yield safety point and should always be included.

Model Answer

Plain radiography (X-ray) best visualizes bony structures — including fractures, dislocations, and bone alignment. Nursing responsibility: confirm the patient is not pregnant and remove all metal objects from the area of examination before the procedure. Magnetic resonance imaging (MRI) best visualizes soft tissue structures — including ligaments, tendons, cartilage, intervertebral discs, and tumors. It is also used for osteomyelitis. Nursing responsibility: screen the patient for all metal implants (pacemakers, cochlear implants, surgical clips) and remove all external metal objects before entering the MRI suite, as the powerful magnetic field can cause serious injury. Warn the patient about the enclosed space and loud noise during the scan.

Question Type

short_answer

Answer Structure

• Line 1: X-ray — state what it best shows (bony structures/fractures) [0.5 mark] + nursing responsibility (confirm not pregnant, remove metal) [0.5 mark]
• Line 2: MRI — state what it best shows (soft tissue) [0.5 mark] + nursing responsibility (screen for metal implants, remove external metal) [0.5 mark]
• Line 3 (bonus depth): Mention specific examples for each (e.g., 'ligaments, cartilage' for MRI) and explain the rationale for the MRI metal screening [1 mark]

Scoring Breakdown

Common Mark Deductions

• Mixing up what X-ray and MRI best visualize (e.g., saying MRI shows bone better than X-ray)
• Listing the nursing responsibility without the rationale in a 3-mark question
• Forgetting to mention pregnancy screening for X-ray

Key Phrases To Include

• X-ray best for bony structures
• MRI best for soft tissue
• screen for metal implants
• pacemaker contraindicated
• confirm not pregnant
• remove all metal objects

Marks

3

Topic

Diagnostic Studies — Invasive Procedures

Difficulty

medium

Template Id

T10

Examiner Tip

Procedure-based questions in the NLE follow the before-during-after framework. Arthroscopy post-care is especially high-yield: neurovascular check + compression + ice + elevation + patient teaching. Memorize these four post-procedure actions as a cluster.

Model Answer

Before arthroscopy: — Verify informed consent has been obtained and documented. — Keep the patient NPO (nothing by mouth) as ordered prior to the procedure, which is performed under anesthesia. — Conduct a baseline neurovascular assessment of the affected extremity. During arthroscopy: — The nurse in the circulating role ensures the sterile field is maintained and that the patient's safety and positioning are monitored. After arthroscopy: — Perform and document frequent neurovascular checks distal to the operative site. — Apply a compression dressing and ice to control postoperative swelling as ordered. — Elevate the extremity to reduce edema. — Instruct the patient to report signs of complications: increasing pain, fever, swelling, or redness at the incision site. — Reinforce activity restrictions as ordered by the surgeon.

Question Type

short_answer

Answer Structure

• Pre-procedure: consent, NPO, baseline neurovascular assessment [1 mark]
• Post-procedure: neurovascular checks, compression dressing, ice, elevation [1 mark]
• Post-procedure patient teaching: report fever, increasing pain, swelling; activity restrictions [1 mark]

Scoring Breakdown

Common Mark Deductions

• Omitting the pre-procedure NPO requirement (anesthesia is used — this is a safety-critical point)
• Providing only pre-procedure or only post-procedure care without both
• Forgetting patient discharge teaching (report fever, increasing swelling)

Key Phrases To Include

• informed consent
• NPO
• neurovascular checks
• compression dressing
• ice and elevation
• report fever
• increasing pain or swelling
• activity restrictions

Marks

3

Topic

Physical Assessment — Gait

Difficulty

medium

Template Id

T11

Examiner Tip

Gait assessment is tested within the context of fall prevention in the NLE. Always link your gait finding to a nursing concern — the examiner wants to see you apply the assessment, not just describe it.

Model Answer

The two phases of the normal gait cycle are: 1. Stance phase — the period when the foot is in contact with the ground and bears the body's weight. It accounts for approximately 60% of the gait cycle. 2. Swing phase — the period when the foot is lifted off the ground and moving forward to take the next step. Abnormal gait example: Antalgic gait — the patient shortens the stance phase on the painful limb to minimize the time spent bearing weight on it. It is clinically significant because it indicates pain in the affected lower extremity (from fracture, arthritis, or injury) and is associated with an increased risk for falls. It should prompt thorough pain assessment and fall-risk evaluation by the nurse.

Question Type

short_answer

Answer Structure

• Point 1: Stance phase — define correctly [0.5 mark] + include clinical detail (weight-bearing, 60% of cycle) [0.5 mark]
• Point 2: Swing phase — define correctly [0.5 mark]
• Point 3: One abnormal gait (antalgic, shuffling, or wide-based ataxic) — name, describe, and state clinical significance [1.5 marks]

Scoring Breakdown

Common Mark Deductions

• Reversing stance and swing phase definitions
• Naming an abnormal gait without describing its mechanism or clinical significance
• Not mentioning fall-risk assessment, which is a key nursing concern with abnormal gait

Key Phrases To Include

• stance phase
• weight-bearing
• foot on ground
• swing phase
• antalgic gait
• shortened stance phase
• fall risk

Marks

2

Topic

Diagnostic Studies — Imaging

Difficulty

medium

Template Id

T12

Examiner Tip

Bone scan nursing care has two high-yield, unique points that distinguish it from other imaging: (1) encourage fluids and (2) expect a 2–3 hour wait. These are the most commonly tested nursing actions for this procedure.

Model Answer

Purpose: A bone scan uses an intravenous radioactive tracer (technetium-99m) that accumulates in areas of increased bone turnover. It is used to detect tumors, osteomyelitis (bone infection), or occult (hidden) fractures. Areas of increased tracer uptake appear as 'hot spots' on the scan. Nursing responsibilities: 1. After the tracer is injected, encourage the patient to drink adequate fluids to distribute the tracer throughout the body and promote its excretion through the kidneys, reducing radiation exposure to the bladder. 2. Inform the patient that there will be a delay of 2–3 hours between the tracer injection and the actual scanning, and reassure the patient that the dose of radioactivity is very small and poses minimal health risk.

Question Type

short_answer

Answer Structure

• Line 1: State the purpose of bone scan (detect tumors, infection, fractures using radioactive tracer) [1 mark]
• Line 2: State two specific nursing responsibilities (encourage fluids + explain 2–3 hour delay/reassure about radiation) [1 mark — 0.5 per responsibility]

Scoring Breakdown

Common Mark Deductions

• Describing bone scan as an X-ray or CT scan — it is a nuclear medicine study
• Omitting the instruction to encourage fluids, which is a specific and testable nursing action for bone scans
• Not mentioning the 2–3 hour delay, which is important for patient teaching

Key Phrases To Include

• technetium-99m
• radioactive tracer
• hot spots
• osteomyelitis
• encourage fluids
• 2–3 hour delay
• minimal radiation

Marks

2

Topic

Physical Assessment — Inspection and Palpation

Difficulty

easy

Template Id

T13

Examiner Tip

The key grade to memorize for the NLE is Grade 3 — movement against gravity but not resistance. This differentiates partial from full motor function and is the most commonly tested point on the scale.

Model Answer

The 0–5 muscle strength grading scale assesses voluntary muscle contraction and the ability to produce joint movement against various levels of resistance. The three grades are: — Grade 0: No muscle contraction is visible or palpable; complete paralysis. — Grade 3: The muscle can move the joint through its full range of motion against gravity but cannot overcome any additional resistance. — Grade 5: Normal muscle strength; the muscle can move the joint through its full range of motion against full resistance without fatigue.

Question Type

short_answer

Answer Structure

• Line 1: State what the scale assesses (voluntary muscle contraction, movement against gravity/resistance) [0.5 mark]
• Line 2: Describe Grade 0 correctly [0.5 mark]
• Line 3: Describe Grade 3 correctly (movement against gravity only) [0.5 mark]
• Line 4: Describe Grade 5 correctly (full resistance, normal) [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Confusing Grade 3 and Grade 4 (Grade 4 = movement against some but not full resistance; Grade 3 = gravity only)
• Not stating what the scale measures — the examiner needs context

Key Phrases To Include

• 0 = no contraction
• 3 = against gravity only
• 5 = full resistance
• muscle strength
• voluntary contraction

Marks

5

Topic

Assistive Devices and Gait Training

Difficulty

hard

Template Id

T14

Examiner Tip

For a 5-mark long answer, examiners expect organized sections, clinical rationale for each action, and a nursing responsibility component. The mnemonic 'up with the good, down with the bad' must appear verbatim — it is the examiner's confirmation that you know the rule. Always close a 5-mark answer with a documentation or patient safety note to earn the final mark.

Model Answer

I. Correct Fitting of Crutches: Crutches must be properly fitted to ensure safety and prevent brachial nerve injury. The axillary pad of the crutch should be positioned 2–3 finger-widths (approximately 5 cm) below the axilla, with the patient standing upright. The handgrip should be positioned so the elbow is slightly flexed (approximately 20–30 degrees) when the hand rests on it. Weight must always be borne through the hands/handgrips, NOT through the axilla. Leaning on the axillary bar compresses the radial and brachial nerves, causing 'crutch palsy' (weakness or numbness in the hands and arms). II. Stair Climbing with Crutches — Guiding Principle: 'Up with the good, down with the bad.' Going UP the stairs: 1. Position the strong (right) leg on the first step. 2. Push up through the handgrips and bring the crutches and the weak (left) leg up to the same step. 3. Repeat this sequence: strong leg leads going up. Going DOWN the stairs: 1. Lower the crutches and the weak (left) leg down to the next step first. 2. Then bring the strong (right) leg down to the same step. 3. Repeat: crutches and weak leg lead going down. III. Nursing Safety Considerations: — Always supervise the patient during initial stair training and stand behind the patient going up, and in front going down, to prevent falls. — Assess the environment for fall hazards: wet floors, loose rugs, poor lighting. — Document the patient's ability to perform the technique safely before discharge, in accordance with the documentation standards under RA 9173 (Philippine Nursing Act of 2002).

Question Type

long_answer

Answer Structure

• Section I: Correct crutch fitting — axillary pad 2–3 finger-widths below axilla, elbow slightly flexed, weight on hands NOT axilla, rationale for crutch palsy [2 marks]
• Section II: Stair climbing — 'up with the good, down with the bad' rule stated explicitly, step-by-step sequence for going up AND going down [2 marks]
• Section III: Nursing safety responsibilities — supervision positioning, fall-hazard assessment, documentation [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating the wrong stair rule — e.g., 'weak leg goes up first' or 'crutches always go first regardless of direction'
• Not explaining the rationale for axillary clearance (brachial nerve injury / crutch palsy) — this is worth marks in a 5-mark answer
• Omitting the nurse's positioning during stair supervision
• Writing a 5-mark answer with only 2–3 bullet points — insufficient depth for the mark value

Key Phrases To Include

• 2–3 finger-widths below axilla
• weight on hands not axilla
• crutch palsy
• brachial nerve
• up with the good down with the bad
• strong leg leads up
• crutches and weak leg lead down
• supervise
• document

Marks

5

Topic

Principles of Traction

Difficulty

hard

Template Id

T15

Examiner Tip

A 5-mark traction question demands three organized sections. The immobility section should name at least 4 complications — each with a nursing action. Examiners are counting the number of valid clinical points. In Philippine board exams, referencing RA 9173 in the context of nurse accountability always adds credibility to a long answer.

Model Answer

Skeletal traction applies a pulling force directly to a bone through a surgically inserted pin or wire, allowing heavier and longer-term traction for fracture reduction and alignment. Nursing care is guided by three core principles: I. Weight Maintenance and Alignment: — Traction weights must hang freely at all times and must never rest on the floor, the bed frame, or any surface. Contact with a surface eliminates the therapeutic pulling force and disrupts fracture alignment. — Weights are never added, reduced, or removed without a specific physician's order — even temporarily for patient comfort or repositioning. — Ropes must remain in the grooves of the pulleys, and knots must be secure to maintain the direction and continuity of pull. — The patient's body serves as countertraction; ensure proper body alignment with the patient in the center of the bed and the affected extremity in the prescribed position. II. Pin-Site Care: — Skeletal traction pins penetrate the skin and bone, creating a direct route for microorganisms to enter the body and cause osteomyelitis (bone infection). — Perform pin-site care using aseptic (sterile) technique, as ordered — typically cleaning around the pin with normal saline or as per institutional protocol. — Assess each pin site at every shift for signs of infection: redness (erythema), warmth, purulent drainage, swelling, or pin loosening. Report any of these findings immediately. III. Prevention of Immobility Complications: Patients in long-term traction are at high risk for the following complications, which the nurse must actively prevent: 1. Pressure injury — reposition within traction limits, use pressure-relieving mattresses, and assess skin over bony prominences every shift. 2. Deep vein thrombosis (DVT) — perform ankle pumps and other prescribed exercises; administer anticoagulants as ordered; apply compression stockings if ordered. 3. Hypostatic pneumonia — encourage deep breathing exercises (diaphragmatic breathing and use of incentive spirometry) every 1–2 hours. 4. Constipation — encourage adequate fluid intake, high-fiber diet, and use of ordered stool softeners. 5. Muscle atrophy — encourage isometric exercises of the immobilized muscles as allowed. In the Philippine health care context, nurses practicing under RA 9173 (Philippine Nursing Act of 2002) are accountable for independent and collaborative nursing actions in traction care, including accurate documentation of pin-site assessment, neurovascular checks, and patient response to the traction device.

Question Type

long_answer

Answer Structure

• Section I: Weight maintenance — hang freely, no contact with surface, no removal without order, rope on pulley, countertraction/alignment [1.5 marks]
• Section II: Pin-site care — aseptic technique, what to assess (redness, drainage, loosening), report to physician [1.5 marks]
• Section III: Immobility complications — name and describe at least 4 (pressure injury, DVT, pneumonia, constipation), with preventive nursing actions [1.5 marks]
• Conclusion: Documentation, RA 9173 accountability reference [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Stating weights 'should not be too heavy' without addressing the principle that they must hang freely — missing the key point
• Omitting pin-site care entirely — this is a unique and high-risk aspect of skeletal traction
• Naming only 1–2 immobility complications for a 5-mark question — insufficient depth
• Not providing preventive nursing actions for each complication named

Key Phrases To Include

• hang freely
• never touch the floor
• no removal without physician order
• aseptic technique
• pin-site infection
• osteomyelitis
• pressure injury
• deep vein thrombosis
• hypostatic pneumonia
• incentive spirometry
• isometric exercises