NURS 623 FINAL EXAM - MUSCULOSKELETAL SECTION
Which of the following is true regarding scoliosis? a. functional scoliosis is flexible; it is apparent with standing and disappears with forward bending. b. functional scoliosis is fixed; the curvature shows both on standing and bending forward. c. structural scoliosis is fixed; the curvature shows both on standing and bending forward. d. functional scoliosis is permanent, whereas structural scoliosis can result from outside influences such as leg length discrepancy or muscle spasms.
A.
Which of the following statements concerning the musculoskeletal examination is true? a. the uninvolved side should be examined initially and then compared to the involved side. b. the part of the body that is causing the patient pain should be examined first. c. when possible, the patient should not be asked to perform active ROM exercises to avoid causing pain d. Radiographs should always be obtained prior to examination so as not to cause further injury to the patient.
A.
You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is: a. articular b. inflammatory c. nonarticular d. A & B.
A.
Upon assessment, the NP notes unilateral back pain that had an acute onset and increases when standing and bending. A straight leg test is negative. The most likely differential diagnosis is: a. herniated nucleus pulposus. b. muscle strain c. osteoarthritis d. spondylolisthesis
A. **I believe this is an error. I believe the correct answer is B.
Anne, age 67, sustained a fall on an outstretched hand. She presents holding her arm against her chest with her elbow flexed. Based on the specific location of her pain, you suspect a radial head fracture. The best initial strategy to assess for radial head fracture would be: a. to palpate for tenderness, swelling, and crepitus just distal to the lateral epicondyle. b. to palpate for tenderness, swelling, and crepitus along the radial wrist. c. to palpate for tenderness, swelling, and crepitus in the "anatomical snuffbox" d. to order an x-ray of the wrist.
A.
Colchicine may be used to terminate an acute attack of gouty arthritis as well as prevent recurrent episodes. The mechanism of action is to: a. interrupt the cycle of urate crystal deposition and inflammatory response. b. increase serum uric acid levels. c. potentiate the excretion of uric acid. d. inhibit the tubular reabsorption of urate, promoting the excretion of uric acid.
A.
Dan, age 49, developed osteomyelitis of the femur after a motorcycle accident. Which of the following statements about the clinical manifestations of osteomyelitis is correct? a. integumentary effects involve swelling, erythema, and warmth at the involved site. b. there is a low grade fever with intermittent chills c. musculoskeletal effects include tenderness of the entire leg. d. cardiovascular effects include bradycardia.
A.
During assessment of a client's foot, the NP nots that the foot is in alignment with the long axis of the lower leg and that weight-bearing falls on the middle of the foot, from the heel, along the midfoot, to between the second and third toes. The findings best describe: a. a normal foot b. Hallux valgus c. Talipes equinovirus d. hammertoes
A.
First-line drug therapy for acute low back pain includes the use of: a. NSAIDS b. muscle relaxants c. opioids. d. antidepressants.
A.
John, age 16, works as a stock boy at the local supermarket. He is in the office for a routine visit. You notice that he had an episode of low back pain 6 months ago from improperly lifting heavy boxes. In discussing proper body mechanics with him to prevent future injuries, you tell him: a. bend your knees and face the object straight on. b. hold boxes away from your body at arm's length c. bend and twist simultaneously as you lift. d. keep your feet firmly together.
A.
Lillian, age 70, was told that she has osteoporosis. When she asks you what this is, you respond that osteoporosis: a. develops when loss of bone occurs more rapidly than new bone growth. b. is a degenerative joint disease characterized by loss of cartilage in certain joints. c. is a chronic inflammatory disorder that affects multiple joints. d. is a bone disorder that has to do with inadequate mineralization of bones.
A.
Management of fibromyalgia would include: a. giving psychotropic drugs, such as amitriptyline (Elavil), in a low dose at bedtime. b. instructing clients to keep as busy as possible to keep their minds off the symptoms. c. using high doses of NSAIDS. d. avoiding exercise.
A.
Marsha, age 34, presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia than of chronic fatigue syndrome? a. musculoskeletal pain b. difficulty sleeping c. depression d. fatigue
A.
Stan, age 34, fractured his femur when his horse tripped over a jump. With this type of injury, you know that Stan is at risk for fat emboli. Early assessment findings for this complication include: a. fever, tachycardia, rapid respirations, and neurological manifestations. b. neurological manifestations, temperature elevation, bradycardia, and pallor c. hostility; combativeness, paresthesia, and absent peripheral pulses. d. lethargy, hypothermia, paresthesia, and absent peripheral pulses.
A.
The straight-leg-raising maneuver can be used to diagnose: a. nerve root compression b. a fractured hip c. an anterior cruciate ligament tear d. tendinitis.
A.
What part of the body is affected by Dupuyrtren's contracture? a. the fourth and fifth fingers. b. the great toe c. the tibia d. the penis
A.
When Maxwell, age 12, slid into home plate while playing baseball, he injured his ankle. The NP is trying to differentiate between a sprain and a strain. A sprain: a. is an injury to the ligaments that attach to bones in a joint. b. is an injury to the tendons that attach to the muscles in a joint. c. is an injury resulting in extensive tears of the muscles. d. is an injury that does not result in joint instability.
A.
When wrist and finger extension causes pain over the extensor carpi radialis brevis tendon, the extensor carpi radialis longus tendon, and the extensor digitorum communis, you would suspect: a. tennis elbow b. golfer's elbow c. de Quervain's disease d. intersection syndrome
A.
Which diagnostic tests are nonspecific indicators of inflammation and may be elevated in RA and polymyalgia rheumatica? a. ESR and CRP b. RA and uric acid c. CRP and fluorescent ANA test d. Fluorescent ANA test and uric acid.
A.
Which of the following can assist in the diagnosis of myasthenia gravis? a. repetitive nerve stimulation b. the presence of cogwheel rigidity c. Chvostek's sign d. Trousseau's sign
A.
Janine, age 69, has a class III case of rheumatoid arthritis. According to the American Rheumatism Association, her function would be: a. adequate for normal activities despite a handicap of discomfort or limited motion of one or more joints. b. largely or wholly incapacitated, bedridden, or confined to a wheelchair, permitting little or no self-care. c. completely able to carry on all usual duties without handicaps. d. adequate to perform only few or none of the duties of usual occupation or self-care.
D.
One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an articular structure? a. bone b. synovium c. tendons d. fascia
B
A 55 year old patient presents with complaints of paresthesias into the lateral lower arm, thumb, and middle finger. The most commonly involved nerve roots that cause the related symptoms are c6-c7. The most likely differential diagnosis would be: a. brachial plexus neuritis b. cervical radiculopathy c. peripheral polyneuropathy d. thoracic outlet syndrome
B.
Ankylosis is defined as: a. muscle shortening b. joint stiffness c. malposition of a joint d. dislocation of a joint.
B.
Anna, age 42, is pregnant and was just given a diagnosis of carpal tunnel syndrome. She is worried that this will affect her in caring for the baby. What do you tell her to do? a. don't worry; we'll find a brace that is very malleable. b. after childbirth, your carpal tunnel syndrome may resolve. c. if we do surgery now, you'll be recovered by the time the baby arrives. d. you should prepare yourself for the probability of being unable to care for your baby.
B.
Black men have a relatively low incidence of osteoporosis because they have: a. increased bone resorption. b. a higher bone mass c. wide and thick long bones d. decreased bone deposition.
B.
Carol, age 62, has swollen, bony proximal interphalangeal joints. The NP describes these as: a. heberden's nodes b. bouchard's nodes c. osler's nodes d. murphy's nodes
B.
Cass, age 67, tells the NP that she has been diagnosed with a condition that causes sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of the diagnosis, but she knows that it is cause by urate crystals that "get stuck in the joint and cause pain". Joan is on HcTz for management of her hypertension. The NP should suspect a diagnosis of: a. septic arthritis b. gout. c. rheumatoid arthritis. d. Charcot neuro-osteoarthropathy
B.
Christian, age 22, is a carpenter who is right-hand dominant. He comes to the clinic for follow-up from the emergency department where he was seen for right forearm pain. He states that he was diagnosed with right forearm tendonitis and wants the provider to explain this diagnosis to him. Patient teaching should explain that he has inflammation of one or more tendons, which are: a. the ropelike bundles of collagen fibrils that connect bone to bone b. the collagen fibers that connect muscle to bone c. the pouches of synovial fluid that cushion bone and other joint structures. d. the fibrocartilaginous disks that separate boney surfaces.
B.
In a client with osteomyelitis, you would expect levels of: a. serum calcium to be elevated. b. akaline phosphatase to be elevated. c. creatinine excretion to be elevated. d. serum phosphorous to be elevated.
B.
Jeffrey, age 16, was involved in a motor vehicle accident. He walks into the office with an obvious fracture and then collapses. What should be the first action of the NP? a. call his parents for permission to treat. b. assess for adequate airway. c. obtain head and maxillofacial CT d. assess for a septal hematoma.
B.
Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why? How do you respond? a. caffeine has no effect on osteoporosis b. a high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly. c. caffeine affects bone metabolism by altering intestinal absorption of calcium and assimilation of calcium into the bone matrix. d. caffeine increases bone resorption.
B.
Jessie, age 49, states that she thinks she has rheumatoid arthritis. Before any diagnostic tests are ordered, the NP completes a physical examination and makes a differential diagnosis of osteoarthritis rather than rheumatoid arthritis. Which clinical manifestation ruled out the RA? a. fatigue b. affected joints are swollen, cool, and bony hard on palpation c. decreased range of motion d. stiffness
B.
Joyce, age 87, broker her wrist after falling off a curb. She just had a plaster cast applied to her wrist. In instructing Joyce and her family on allowing the cast to dry properly, tell them: a. continuously elevate Joyces arm on a pillow b. change the position of Joyce's arm every hour c. position a fan near Joyce during the night to ensure even drying of the cast. d. put a blanket over the cast to absorb the dampness.
B.
June, age 67, presents with back pain with no precipitating event. The pain is located over her lower back and muscles without sciatica, and it is aggravated by sitting, standing, and certain movements. It is alleviated with rest. Palpation localizes the pain, and muscle spasms are felt. There was an insidious onset with progressive improvement. What is the most likely differential diagnosis: a. ankylosing spondylitis b. musculoskeletal strain. c. spondylolisthesis d. herniated disk
B.
Margaret, age 55, presents to you for evaluation of left hand and wrist pain and swelling after a slip and fall on the ice yesterday. On examination, you note tenderness at her "anatomical snuffbox" You know this probably indicates: a. ulnar styloid fracture b. scaphoid fracture c. hamate fracture d. radial head fracture.
B.
Mickey, age 18, is on a chemotherapeutic antibiotic for a musculoskeletal neoplasm. Which drug do you think he is taking? a. Cyclophosphamide (Cytoxan) b. Doxorubicin (Adriamycin) c. Methotrexate (Rheumatrex) d. Cisplatin (Platinol)
B.
Mike, age 42, a golf pro, has had chronic back pain for many years. His work-up reveals that it is not the result of a degenerative disk problem. His back "goes out" about twice per year, and he is out of work for about a week each time. Which of the following should the NP advise him to do: a. consider changing careers to a less physical job b. begin a planned exercise program to strengthen back muscles c. make an appointment with a neurosurgeon for a surgical consultation. d. start on a daily low-dose narcotic to take away the pain.
B.
Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which age-related change? a. Lordosis b. Dorsal kyphosis c. Scoliosis d. Kyphoscoliosis
B.
The NP has just completed a work-up on Michael, age 13, and confirmed Osgood-Schlatter disease. The initial management would be to: a. refer to orthopedics for early surgical correction. b. recommend physical therapy for quadricep strengthening exercises c. advise him to temporarily discontinue all sports activities until his growth plates have completely fused. d. tell Michael that he can resume his usual activities immediately without concern and should begin aggressive exercises to increase muscle bulk and strength.
B.
The NP suspects adolescent idiopathic scoliosis in Victoria, age 15, who is in her "growth spurt" An Adams forward-bending test is performed, and it is noted that the patient has a right-sided rib hump. What is this indicative of: a. right lumbar shifting b. right thoracic curvature c. right truncal shift. d. Spondylolysis
B.
The most widely accepted screening tool for psoriatic arthritis is the: a. ACR (American college of rheumatolgy) criteria. b. CASPAR (Classification of Psoriatic Arthritis) Criteria c. Psoriasis Area and Severity index d. Rome criteria
B.
Treatment of choice for polymyalgia rheumatica (PMR) is: a. acetaminophen or NSAIDS b. low dose steroids. c. tricyclic antidepressants. d. antibiotics
B.
When grading muscle strength on a scale of 1 to 5, a grade of 4 indicates: a. Full range of motion against gravity with full resistance. b. full ROM against gravity with some resistance. c. full ROM with gravity. d. full ROM with gravity eliminated (passive motion)
B.
When teaching Alice, age 77, to use a cane because of osteoarthritis of her left knee, an important point to stress is to tell her to: a. carry the can in the ipsilateral hand b. advance the cane with the ipsilateral leg c. make sure the cane length equals the height of the iliac crest. d. use the cane to aid in joint protection and safety.
B.
Which of the following statements is true regarding vertebrae? a. all people have only 24 vertebrae (cervical, thoracic, and lumbar) b. Due to differences in race or gender, select groups may have 23 or 25 vertebrae (cervical, thoracic, and lumbar) c. It is common to have fewer than 23 vertebrae (cervical, thoracic, and lumbar) d. It is common to have more than 25 vertebrae (cervical, thoracic, and lumbar)
B.
You are assessing Jamal, age 16, after a football injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the: a. lateral meniscus b. cruciate ligament c. medial meniscus d. collateral ligament.
B.
You are caring for a patient who has a history of psoriasis and is now showing signs of joint involvement. Seropositivity provides a definitive diagnosis of psoriatic arthritis. The initial treatment choice for management of the patient is: a. DMARDS b. NSAIDS c. tumor-necrosis factor-alpha inhibitors (TNF-a inhibitors) d. uricosuric.
B.
You are performing muscle strength testing on a patient presenting with musculoskeletal pain and find that the patient has complete ROM with gravity eliminated. Which numeric grade of muscle strength would you give this patient? a. 1 b. 2 c. 3 d. 4 e. 5
B.
Sean, a factory line worker, has osteoarthritis of the right hand. According to the American college of rheumatology (ACR), the guidelines for pharmacological treatment include: a. acetaminophen, tramadol, and intra-articular corticosteroid injections b. oral NSAIDS, Tramadol, and articular corticosteroid injections c. acetaminophen, topical capsaicin, and topical NSAIDS d. topical capsaicin, topical NSAIDS, and oral NSAIDS.
B. **This answer is not correct. Guidelines recommend: "We conditionally recommend that health professionals should use one or more of the following: Topical capsaicin Topical NSAIDs, including trolamine salicylate Oral NSAIDS"
A 13 year old obese (BMI greater than 95%) boy reports low-grade left knee pain for the past 2 months. He denies antecedent trauma but admits to frequent horseplay with his friends. The pain has progressively worsened, and he is now unable to bear weight at all on his left leg. His current complaints include left groin, thigh, and medial knee pain and tenderness. His examination demonstrates negative Drawer, Lachman, and McMurray tests; left hip with decreased internal rotation and abduction; and knee flexion causing external hip rotation. Based on the above scenario, the NP should suspect: a. a left meniscal tear. b. a left ACL tear c. a slipped capital femoral epiphysis d. osgood-schlatter disease.
C.
A coccygeal fracture is treated with: a. traction b. surgical repair c. analgesia and by use of a donut cushion when sitting d. prolonged bedrest for 6 weeks.
C.
Bursitis is an inflammatory process that may be caused by infection, trauma, repetitive motion disorders, gout, or neoplastic disease. The most common cause of septic bursitis due to infection is from which of the following: a. Mycobacterium tuberculosis b. Candida c. Staphylococcus aureus. d. streptococcus
C.
Heidi, age 29, is a nurse who has an acute episode of back pain. You have determined that it is a simple mechanical backache and order: a. bedrest for 2 days. b. muscle relaxants c. her to continue activities as the pain permits d. back-strengthening exercises.
C.
Jim, age 22, a stock boy, has an acute episode of low back pain. The NP orders an NSAID and should educate him in which of the following: a. Maintain bedrest for 3 to 4 days. b. Call the office for a narcotic medication if there is no relief with the NSAID after 24-48 hours. c. Begin lower back strengthening exercises depending on pain tolerance. d. Wear a boston brace at night.
C.
Steve, age 32, fell off a roof while shingling it. He is complaining of pain in his left hip and leg area. Other than an x-ray, what would make you suspect a fractured pelvis? a. a clicking sensation when he moves the hips b. a positive pelvic tilt test c. hematuria d. absence of distal reflexes.
C.
The knee is an example of a: a. spheroidal joint b. hinge joint c. condylar joint d. fibrous joint
C.
The most common cause of cauda equina syndrome is: a. fracture b. hematoma c. lumbar intervertebral disk herniation. d. space occupying lesion.
C.
The valgus stress test, Varus stress test, Lachman test, and Thumb test are all considered standard tests to check the integrity of the ligaments of the knee. Which test would the NP choose to assess the ACL, which is the most commonly involved structure in severe knee injury? a. Valgus stress test b. Varus stress test c. Lachman test d. Thumb sign
C.
What is the largest joint in the body? a. the hip b. the shoulder c. the knee d. the elbow.
C.
When a provider elicits a painful Finkelstein's sign he or she is testing for: a. carpal tunnel syndrone b. bursitis of the shoulder. c. de Quervain's tenosynovitis d. tennis elbow.
C.
Which of the following is NOT a management principle for an acute musculoskeletal injury that does not require emergent treatment? a. RICE b. NSAIDS or acetaminophen c. Imaging studies. d. skeletal muscle relaxants.
C.
Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain? a. decreased CRP b. hyperalbuminemia c. morning stiffness d. weight gain.
C.
A clinical manifestation of symmetric neurogenic pain may indicate: a. radiculopathy b. reflex sympathetic dystrophy c. entrapment neuropathy d. peripheral neuropathy.
D.
An NP correctly performs the obturator test when the client's leg is raised with knee flexed and the leg is internally rotated. A positive obturator sign is indicative of: a. avascular necrosis of the femoral head. b. cholecystitis c. hip bursitis. d. appendicitis.
D.
Beth, age 49, comes in with low back pain. An x-ray of the lumbosacral spine is within normal limits . Which of the following diagnoses do you explore further? a. scoliosis b. osteoarthritis c. spinal stenosis d. herniated nucleus pulposus.
D.
For an adult patient with a knee injury, the NP orders an NSAID to be taken on a routine basis for the next two weeks. Patient teaching should include which of the following: a. you may take the medication on an empty stomach as long as you eat within 2 to 3 hours of taking it b. If one pill does not seem to help, you can double the dose for subsequent doses. c. If you notice nausea/vomiting or black or bloody stools, take the next dose with a glass of milk or a full meal. d. if you have additional pain, an occasional acetaminophen is permitted in between the usual doses of the NSAID.
D.
If any limitation or any increase in range of motion occurs when assessing the musculoskeletal system, the angles of the bones should be measured using: a. Phalen's test b. skeletometry c. The Thomas test d. a goniometer.
D.
In analyzing synovial fluid, a yellow-green color may indicate which of the following: a. trauma b. gout c. a bacterial infection d. rheumatoid arthritis.
D.
Joan, age 76, has been given a diagnosis of osteoporosis confirmed with dual-energy x-ray absorptiometry (DEXA) scan. The NP has educated her about the importance of increasing calcium and vitamin D in her diet and starting a low-impact, weight-bearing exercise. The NP is also going to start the patient on medical management. Joan asks about a drug called a SERM that she heard has been shown in studies to prevent vertebral fractures. which of the following pharmacological therapies for osteoporosis is classified as a selective estrogen receptor modulator? a. Alendronate (Fosamax) b. Risedronate (Actonel) c. Salmon calcitonin d. Raloxifene (Evista)
D.
Matthew, age 52, is a chef who just severed two of his fingers with a meat cutter. You would recommend that he: a. wrap the severed fingers tightly in a dry towel for transport to the emergency department with him. b. leave the severed fingers at the scene because fingers cannot be reattached. c. immediately freeze the severed fingers for reattachment in the near future. d. pack the fingers in a saline-soaked dressing and seal in a plastic bag.
D.
Mrs. Matthews, age 71, has rheumatoid arthritis. On reviewing an x-ray of her hip, you notice that there is a marked absence of articular cartilage. What mechanism is responsible for this? a. antigen-antibody formation b. lymphocyte response c. immune complex formation d. lysosomal degradation
D.
Sandy, age 49, presents with loss of anal sphincter tone, impaired micturition, incontinence, and progressive loss of strength in the legs. You suspect cauda equina syndrome. What is your next action? a. order physical therapy. b. order a lumbar/sacral x-ray c. order extensive lab work d. refer to a neurosurgeon.
D.
To aid in the diagnosis of meniscus damage, which test should a nurse practitioner perform? a. the bulge test b. the Lachman test c. the drawer test. d. Apley's compression test.
D.
Which of the following statements is true regarding range of motion of a joint? a. the normal active ROM of a joint is greater than the passive ROM of the same joint. b. If there is a limitation of active ROM, you should not attempt passive ROM to avoid further injury to the joint. c. Active and passive ROM of a joint should be equal, full, and cause only mild discomfort. d. active and passive ROM of a joint should be equal, full, and pain-free.
D.
Which test is routinely recommended for a preparticipation sports physical? a. a CBC b. a CXR c. an ECG d. A snellen test.
D.