Musculoskeletal Practice Questions
21. Which of the following are management techniques for soft tissue injuries? A. Compression with wet elastic bandage. B. Elevation of the extremity. C. Ice immediately (max 1 hour at a time). D. Rest the injured part. E. Immobilization and support.
A. Compression with wet elastic bandage. B. Elevation of the extremity. D. Rest the injured part. E. Immobilization and support.
A patient is scheduled for an electromyography (EMG) to evaluate diffuse or localized muscle weakness. What question should the nurse ask the patient before the test? "When did you last eat or drink?" "Do you take any antianxiety medications?" "What herbal over-the-counter medicines do you take?" "Did you take your cyclobenzaprine (Flexeril) this morning?"
"Did you take your cyclobenzaprine (Flexeril) this morning?"
Which statement by the patient regarding lifestyle changes to prevent osteoporosis indicates a need for further teaching by the nurse? "I'm going to continue having my DXA scans as my doctors orders." "I'll drink only half a glass of wine occasionally to help me sleep." "I plan to increase calcium and vitamin D foods in my diet." "I'm going to jog every day for at least 30 minutes."
"I'm going to jog every day for at least 30 minutes."
32. Patient is prescribed predisone 5mg three times a day. We only have 10mg tablets on hand. How much is given at one dose?
0.5 tablet
33. Patient is prescribed 0.5mgs of colchicine for relief of acute gout attack. The nurse has 1mg tab of colchicine available. How many tabs will be given?
0.5 tablet
During a community education program the nurse is asked about the risk of a woman breaking a bone due to osteoporosis after age 50. The nurse knows which of the following is the risk? 1 in 2 women 1 in 5 women 1 in 7 women 1 in 10 women
1 in 2 women.
29. Which of the following symptom(s) is indicative of a fat embolism?A. Confusion B. Pain at site of fracture C. Chest pain D. Fever E. Petechiae
A. Confusion C. Chest pain E. Petechiae
Doctor orders 7.5mg of flexeril. You have 5mg tablets available. How many tablets do you give the patient?
1.5 tablets
Cefazolin 500mg IVPB in 50mL D5W to infuse over 25 minutes. Calculate ml/hr to set the infusion pump.
120 mL/hr
Which nursing intervention is most effective in preventing transfer of an organism from the wound of a patient with osteomyelitis to other patients? A. Contact Precautions B. Restriction of visitors C. Irrigating the wound as needed D. Leaving the wound open to air
A. Contact Precautions
A patient with osteoporosis is prescribed 500mgs of calcium carbonate. You have available 250mg tablets. How many tables will you give?
2 tablets
A patient is prescribed morphine 30mgs PO every 8 hours for pain. You have 15mg tablets available. How many tablets will you give?
2 tabs
The patient with gout is prescribed allopurinol 800mg. Available is 400mg tablets. How many tablets should the patient take? Round to the nearest tenth.
2 tabs
Calculate input for this patient diagnosed with osteoporosis. Patient reported drinking 12oz of orange juice, 4oz of milk, and 6oz of water. What is the input in mL?
660 mL
A 7-year-old child sustains a fractured femur in a bicycle accident. The admission x-ray films reveal evidence of fractures of other long bones in various stages of healing. What does the nurse suspect as the cause of the fracture? A. Child abuse B. Vitamin D deficiency C. Osteogenesis imperfecta D. Inadequate calcium intake
A. Child abuse
A patient has an order for morphine 3mL IVP. The floor only has 1mL morphine vials. How many vials will you administer?
3 vials
A 40-year-old patient, Trace, has been diagnosed with osteoporosis. He was 5ft. 7in. at diagnosis and is now 5ft. 2in. How many inches did he shrink?
5 in
The patient with osteomyelitis is prescribed IV vancomycin at 15mg/kg every 8 hours. The patient weighs 140 kgs. How many miligrams will the patient receive in 24 hours?
6300 mgs
18. When educating a patient about risk factors for primary osteoporosis, which statement by the client indicates a need for further teaching? A. "Even though my mother has osteoporosis, it is highly unlikely that I will have it too." B. "I will be sure to eat a well-balanced diet to make sure I get proper nutrition." C. "I will limit my intake of carbonated beverages." D. "Since I am 50-years-old, my risk for osteoporosis increases."
A. "Even though my mother has osteoporosis, it is highly unlikely that I will have it too."
22. Which of the following would require further education for a patient going home with a leg cast? A. "When I get home, I am going to take a bath." B. "If my leg itches, I won't stick anything in my cast to itch it." C. "If I start having numbness and tingling in my affected extremity, I will call my physician." D. "I should be able to walk out of here, right?" E. "If I start having intense pain in my affected extremity, I will just take some Tylenol."
A. "When I get home, I am going to take a bath." D. "I should be able to walk out of here, right?" E. "If I start having intense pain in my affected extremity, I will just take some Tylenol."
1. A nurse in the ER has four (4) patients from a multiple vehicle accident. Which patient is the highest priority? A. 36-year old man with confusion, chest pain, and a femur fracture. B. 28-year old female with contusion on the forearm and BP of 160/110. C. 40-year old female with a head laceration and headache, who is alert and oriented x 4. D. 14-year old female with high anxiety, crying, and hyperventilating.
A. 36-year old man with confusion, chest pain, and a femur fracture.
While assessing an older adult client admitted 2 days ago with a fractured hip, the nurse notes that the client is confused, tachypneic, and restless. Which is the nurse's first action? A. Administer oxygen via nasal cannula. B. Apply restraints and ask for a sitter. C. Slow the IV flow rate. D. Discontinue the pain medication.
A. Administer oxygen via nasal cannula.
20. What patient would most likely be diagnosed with scoliosis? A. An adolescent female age 10. B. An adolescent male age 13. C. An elderly female age 69. D. An elderly male age 65.
A. An adolescent female age 10.
A nurse is assisting a physician during the examination of an infant with developmental dysplasia of the hip. The physician performs an Ortolani maneuver. The nurse is aware that this maneuver is performed to: A. Assess for hip instability. B. Assess for movement of the feet. C. Push the femoral head out of the acetabulum. D. Ensure that hyperextension and full range of motion exists.
A. Assess for hip instability.
15. A client who sustained a crush injury to the right lower leg reports numbness and tingling of the affected extremity. The skin of the right leg appears pale. Which is the nurse's first intervention? A. Assess pedal pulses. B. Apply oxygen via nasal cannula. C. Increase the IV flow rate. D. Document the finding.
A. Assess pedal pulses.
A patient who has sustained a crush injury to the right lower leg reports numbness and tingling of the affected extremity. The skin of the right leg appears pale. Which is the nurse's first intervention? A. Assess pedal pulses. B. Administer pain medication as ordered. C. Increase the IV flow rate. D. Document the finding.
A. Assess pedal pulses.
26. When assessing a patient's gait, what does the nurse inspect? A. Balance B. Ease of stride C. Length of stride D. Steadiness E. Level of consciousness
A. Balance B. Ease of stride C. Length of stride D. Steadiness
27. Which of the following are is seen with compartment syndrome?A. Bradycardia B. Perforation C. Pallor D. Paralysis E. Pulselessness
A. Bradycardia C. Pallor D. Paralysis E. Pulselessness
6. What is an objective sign/symptom of compartment syndrome? A. Capillary refill >3 seconds B. Sharp pain C. Numbness D. Pain with movement
A. Capillary refill >3 seconds
31. Your patient had a total hip replacement. What education should the nurse provide? A. Do not cross legs. B. Place legs together (adducted) C. Keep legs apart (abducted) D. No leaning forward. E. Sit in a chair upright 90°several hours a day.
A. Do not cross legs. C. Keep legs apart (abducted) D. No leaning forward.
The home care nurse is visiting a patient with diabetes who has a new cast on the arm. On assessment, the nurse finds the patient's fingers to be pale, cool, and slightly swollen. Which is the nurse's first intervention? A. Elevate the arm above the level of the heart. B. Encourage active and passive range of motion. C. Apply heat to the affected hand. D. Place a window or bivalve the cast.
A. Elevate the arm above the level of the heart.
25. A client is in Buck's traction. What intervention(s) is/are needed to prevent complications of this device? A. Ensure weights are free hanging at all times. B. Elevate head of the bed ≥35°. C. Evaluate traction ropes for tightness. D. Place client on side of unaffected leg. E. Perform regular pulse checks on limb in traction.
A. Ensure weights are free hanging at all times. C. Evaluate traction ropes for tightness. E. Perform regular pulse checks on limb in traction.
28. A patient is diagnosed with osteomyelitis. What are the treatment options? A. IV antibiotics B. Surgical debridement C. Amputation D. Prednisone shot
A. IV antibiotics B. Surgical debridement C. Amputation
30. Your patient is a smoker. What would you educate them about on the effects of tobacco smoking on musculoskeletal health? A. Nicotine causes muscle atrophy. B. Smoking could delay fracture healing. C. Smoking cigarettes can cause bone mineral density. D. Nicotine contributes to deterioration in joint cartilage. E. Smoking cigarettes has no effect on your musculoskeletal health.
A. Nicotine causes muscle atrophy. B. Smoking could delay fracture healing. C. Smoking cigarettes can cause bone mineral density. D. Nicotine contributes to deterioration in joint cartilage.
A child has a right femur fracture caused by a motor vehicle accident and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedal pulse is absent on the right foot. What action should the nurse take? A. Notify the physician. B. Administer an analgesic. C. Release the skin traction. D. Apply ice to the extremity.
A. Notify the physician.
4. An open fracture could possible lead to which complication? A. Osteomyelitis B. Osteoporosis C. Osteomalacia D. Gout
A. Osteomyelitis
The nurse is caring for a patient with prostate cancer. Which laboratory finding indicates to the nurse that the cancer has metastasized to the bone? A. Serum calcium, 21.6 mg/dL B. Creatine kinase, 55 U/mL C. White Blood Count, 6,000 mcL D. Lactate dehydrogenase, 120 U/L
A. Serum calcium, 21.6 mg/dL
24. The nurse will assess for which acute complication(s) for an open fracture? A. Shock B. Increased ICP C. Infection D. Fat embolism E. Bradycardia
A. Shock C. Infection D. Fat embolism
7. A patient is preparing for an arthroscopy. During the assessment, the nurse notices the patient is not able to flex her knee. What response does the nurse expect from the health care provider? A. The patient is unable to continue with the exam. B. Administer Flexeril to relax the muscle in the knee. C. Elevate the leg for 30 minutes and then reassess. D. Continue to prepare the patient for the exam.
A. The patient is unable to continue with the exam.
Which patient is at highest risk for the development of plantar fasciitis? A. Young adult runner B. Adolescent swimmer C. Older adult client who walks with a cane D. Adult client confined to a wheelchair
A. Young adult runner
A nurse is performing a musculoskeletal assessment of an older adult living independently. What normal physiologic changes of aging does the nurse expect? Select all that apply. Muscle atrophy Slowed movement Scoliosis Arthritis Widened gait
ABDE
The nurse knows that a patient with crush injuries to the lower extremities is at high risk for what complication? Bradycardia Hypotension Acute kidney injury Spinal nerve injury
Acute kidney injury.
Which additional assessment data will the nurse collect from an older Euro-American (white) woman to determine the patient's risk for osteoporosis? Select all that apply. Tobacco use, especially smoking Alcohol use every day Exercise and activity level Dietary intake of vitamin D Use of calcium supplements Medication history
All answers are correct
Which of the following are functions of the skeletal system: (Select all that apply). Provides a framework for the body Allows the body to be weight bearing or upright Supports the surrounding tissues Protects vital organs Manufacturers blood cells in red bone marrow Provides storage for mineral salts
All answers are correct
5. An older adult male is admitted to the ED follow a motor vehicle accident with a fractured hip. During your assessment, your find petechiae over his neck and chest. He is experiencing dyspnea and chest pain and becomes restless and confused. The nurse understands that the client is experiencing: A. Compartment syndrome B. Osteomyelitis C. Fat embolism syndrome D. Avascular necrosis
C. Fat embolism syndrome
A young girl has just injured her ankle at school. In addition to calling the child's parents, the most appropriate, immediate action by the school nurse is to: Apply ice. Observe for edema and discoloration. Encourage child to assume a comfortable position. Obtain parental permission for administration of acetaminophen or aspirin.
Apply ice.
The nurse is caring for a patient immediately after a bunionectomy. What is the nurse's priority action? Relieve or reduce the patient's pain. Assess neurovascular status in the affected foot. Apply a hot compress to the surgical area. Check the surgical dressing for intactness.
Assess neurovascular status in the affected foot.
23. What medication(s) are used to treat gout arthritis? A. Interferon beta B. Allopurinol C. Colchicine D. Indomethacin E. Methotrexate
B. Allopurinol C. Colchicine D. Indomethacin
When providing care for a patient who has had a debridement for osteomyelitis, which intervention is most important for the nurse to implement? A. Assess the white blood cell count. B. Assess circulation in the distal extremities. C. Administer pain medication. D. Monitor temperature.
B. Assess circulation in the distal extremities.
A patient is seen at the clinic with the medical diagnosis of osteomalacia. When taking the patient's history, what does the nurse assess for? A. Arm and leg strength B. Dietary intake of vitamin D C. Dietary intake of vitamin C D. Exercise habits
B. Dietary intake of vitamin D
The nurse is caring for a patient who has sustained blunt trauma to the forearm. The nurse assesses the patient for which early sign of compartment syndrome? A. Warm skin at the site of injury B. Escalating pain in the fingers C. Rapid capillary refill in affected hand D. Bounding radial pulse in the injured arm
B. Escalating pain in the fingers
A client who has had an above-knee amputation of the right leg reports pain in the right foot. Which priority medication does the nurse administer? A. IV morphine B. 650 mg of acetaminophen C. IV calcitonin D. 600 mg of ibuprofen
C. IV calcitonin
After an above-the-knee amputation of a right leg, a patient reports pain in the right foot. The nurse should inform the patient that phantom limb pain is the result of what? A. Tactile illusions associated with severed blood vessels B. Nerve endings in the limb that are still intact and react to stimuli C. An unconscious phenomenon to aid with grieving over the lost body part D. Hallucinations secondary to emotional symptoms associated with the distress of amputation
B. Nerve endings in the limb that are still intact and react to stimuli
14. The nurse is caring for a client with a fractured fibula. Which assessment prompts immediate action by the nurse? A. Reported pain of 4 on a scale of 0 to 10. B. Numbness and tingling in the extremity. C. Swollen extremity where the injury occurred. D. Report of being cold in bed.
B. Numbness and tingling in the extremity.
The nurse is rounding on assigned orthopedic patients. The patient with which type of fracture requires immediate interventions to prevent infection? A. Fractured clavicle B. Open fracture of the tibia C. Simple fracture of the wrist D. Compression fracture of a vertebra
B. Open fracture of the tibia
The nurse is caring for a client with a lesion in the area of the tibia that is swollen and tender and are most likely associated with osteochondroma. Which problem is the highest priority for nursing care for this patient? A. Need for increased calories related to increased metabolism B. Pain management related to physical injury C. Compromised self-care related to weakness D. Self-care related to skeletal impairment
B. Pain management related to physical injury
The nurse assesses a patient with a below-knee amputation. Which assessment of the skin flap requires immediate action? A. Pink and warm to the touch B. Pale and cool to the touch C. Dark pink and dry to the touch D. Pink and slightly moist to the touch
B. Pale and cool to the touch
3. What is the most common fracture seen in child abuse? A. Compound B. Spiral C. Open D. Osteomyelitis
B. Spiral
A patient has a fracture and is being treated with skeletal traction. Which assessment causes the nurse to take immediate action? A. The patient's blood pressure is 130/86 mm Hg. B. The traction weights are resting on the floor. C. Slight oozing of clear fluid is noted at the pin site. D. Capillary refill of the extremity is less than 3 seconds.
B. The traction weights are resting on the floor.
A middle-aged patient has a tight cast on the left lower leg. Which assessment finding would prompt the nurse to assess further for compartment syndrome? Diminished pulses Discoloration of some of the toes Tingling sensation of the upper leg Pain more intense than expected based on initial injury
Pain more intense than expected based on initial injury
A patient for whom skin traction is planned asks for an explanation regarding the purpose of this type of traction. Which is the nurse's best response? A. "It aids in realigning the bone." B. "It prevents low back pain." C. "It decreases muscle spasms that occur with a fracture." D. "It prevents injury to the skin as a result of the fracture."
C. "It decreases muscle spasms that occur with a fracture."
17. Which level of amputation has better results in circulation and post-operative healing of the affected limb? A. Above the knee amputation B. Mid foot amputation C. Below the knee amputation D. Syme amputation
C. Below the knee amputation
A patient who had a long-leg cast applied last week reports to the clinic nurse, "I can't seem to catch my breath and I feel a bit lightheaded." Which is the priority action of the nurse? A. Listen to the patient's lungs and check the patients's blood glucose level. B. Give the patient 10 L of oxygen via nasal cannula and reposition. C. Check the patient's pulse oximetry and arrange emergency transfer to the hospital. D. Reassure the patient that it takes much more effort to move with a long-leg cast.
C. Check the patient's pulse oximetry and arrange emergency transfer to the hospital.
12. What type of fracture causes bone fragments to damage other organs or tissues? A. Simple B. Open C. Complicated D. Comminuted
C. Complicated
A patient has a fractured humerus and is experiencing anxiety with difficulty breathing. The nurses assess a petechial rash on the patient's trunk. Which of the following is most likely the cause of the symptoms? A. Allergic reaction to the pain medications B. Pulmonary embolism C. Fat embolism D. Tired from physical therapy
C. Fat embolism
13. A patient is in the hospital due to a condition of dissolution and absorption of bone. What is the cause of this and where is it located?A. Osteoblast, deep part of bone, yellow marrow. B. Osteoclast, short bone. C. Osteoclast, deep part of bone, yellow marrow. D. Osteoblast, deep part of bone, red marrow.
C. Osteoclast, deep part of bone, yellow marrow.
9. While examining a 4-year-old child, the nurse notes blue sclerae and recurrent fractures. This could be indicative of which of the following? A. Marfan Syndrome B. Vitamin D deficienty C. Osteogenesis Imperfecta D. A liver problem
C. Osteogenesis Imperfecta
Which patient does the nurse assess first at the start of the nursing shift? A. Patient wanting to know information about a magnetic resonance imaging (MRI) test scheduled in 3 hours. B. Patient who is verbalizing mild discomfort after an electromyography (EMG) C. Patient who reports increased pain and swelling after an arthroscopy D. Patient who refuses to drink more fluids after a nuclear medicine scan
C. Patient who reports increased pain and swelling after an arthroscopy
A patient has a compound fracture of the femur. The nurse should assess the patient for the typical signs and symptoms of a fat embolus. In comparison to thromboembolism, which unique clinical indicator can help the nurse identify a fat embolus? A. Anxiety B. Restlessness C. Pinpoint red spots on the chest D. Decreased arterial oxygen level
C. Pinpoint red spots on the chest
8. The nurse knows that hematopoiesis occurs in what part of the musculoskeletal system? A. Long bone B. Collagen C. Red marrow D. Yellow marrow
C. Red marrow
11. A patient with osteoporosis has been started on a calcium with vitamin D supplement. Which would you advise the patient to do? A. Eat leafy green vegetables. B. Take on an empty stomach. C. Take with 6-8 ounces of water. D. Avoid exercise while taking the supplement.
C. Take with 6-8 ounces of water.
Which ethnic group of women typically has the least amount of bone density? Asian Caucasian Native American African American
Caucasian
A patient returns to the post-anesthesia care unit (PACU) after an arthroscopy to repair a knee injury. What is the nurse's priority when caring for this patient? Perform passive range-of-motion exercises. Keep the affected leg immobilized. Ensure that the patient uses the patient-controlled analgesia pump. Check the neurovascular status of the affected leg and foot.
Check the neurovascular status of the affected leg and foot.
10. A patient presents with fat embolism syndrome. Which statement by the patient requires further teaching from the nurse? A. "I will monitor myself for dyspnea." B. "I will notify the health care provider of chest pain." C. "I will tell my significant other to watch for signs and symptoms of altered mental status." D. "I will move my fractured limb every hour."
D. "I will move my fractured limb every hour."
2. You receive a patient from surgery after a below the knee amputation. The client asks if they may rest their affected limb on a few pillows. What is your best response? A. "I cannot put your limb on a pillow, but I can get you a pillow so that you can." B. "Yes, I can elevate your leg on some pillows." C. "Why do you want to elevate your leg?" D. "No. Keeping your leg flat on the bed promotes healing and good venous flow to the leg."
D. "No. Keeping your leg flat on the bed promotes healing and good venous flow to the leg."
The nurse is conducting health screening for osteoporosis. Which patient is at greatest risk for developing this disorder? A. A 25-year-old woman who runs. B. A 36-year-old who has asthma. C. A 60-year-old man who consumes excess alcohol. D. A sedentary 65-year-old woman who smokes cigarettes.
D. A sedentary 65-year-old woman who smokes cigarettes.
You are initiating a nursing care plan for a patient with osteoporosis. All of these nursing interventions apply to the diagnosis Risk for falls. Which intervention should you delegate to the UAP? A. Identifying environmental factors that increase risk for falls B. Monitoring gate, balance, and fatigue level with ambulation C. Collaborating with the physical therapist to provide the patient with a walker D. Assisting the patient with ambulation to the bathroom and in the halls
D. Assisting the patient with ambulation to the bathroom and in the halls
16. When counseling an older patient about ways to prevent fractures, which information will the nurse include? A. Tacking down scatter rugs in the house. B. Occasional weight-bearing exercise will improve muscle and bone strength. C. Most falls happen outside the home. D. Buy shoes that provide good support and are comfortable to wear.
D. Buy shoes that provide good support and are comfortable to wear.
A patient with a surgical above-the-knee amputation asks why the residual limb needs to be wrapped with an elastic bandage. The nurse explains the purpose is to do what? A. Limit the formation of blood clots. B. Decrease the phantom limb sensation. C. Prevent hemorrhage and cover the incision. D. Support the soft tissue and minimize swelling.
D. Support the soft tissue and minimize swelling.
Which symptom specifically in older patients presenting with acute osteomyelitis would require immediate nursing intervention? Pain Fatigue Low-grade fever Elevated leukocyte count
Pain.
A patient recently diagnosed with primary bone cancer states, "My life is over. I'll never get married now!" What is the nurse's best action at this time? Refer to the patient to a clergy member or spiritual leader. Ask the patient what is meant by that statement. Listen while the patient expresses feelings. Provide hope that marriage will happen.
Listen while the patient expresses feelings.
The nurse is taking a patient for testing to determine the extent of injury sustained to the patient's knee when a fall occurred at work. The nurse explains that which diagnostic test best demonstrates musculoskeletal and soft tissue damage? Standard x-rays Electromyography (EMG) Computed tomography (CT) Magnetic resonance imaging (MRI)
MRI
Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)? Aspirin Corticosteroids Cytotoxic drugs such as methotrexate Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
The nurse knows that a patient with Paget's disease is at greatest risk for developing which complication? Kidney stones Cardiac failure Chronic fatigue syndrome Pathologic bone fractures
Pathologic bone fractures
The nurse is caring for a client with an external fixator placed on the leg five days ago. What does the nurse assess for first? Alteration in skin integrity Impaired motor action Acute pain Signs of infection
Signs of infection
