Chapter 44 a Musculoskeletal Disorder

Question 1

What is the movement of an extremity away from the midline of the body called?
a. Abduction
b. Adduction
c. Flexion
d. Extension

Answer 1

a. Abduction

Question 2

What is the large, fan-shaped muscle that covers the anterior chest from the sternum to the
proximal end of the humerus and acts on the joint of the shoulder to flex, adduct, androtate?
a. Serratus anterior
b. Intercostal
c. Transversus abdominis
d. Pectoralis major

Answer 2

d. Pectoralis major

Question 3

Which instructions will the nurse reinforce for the patient before a magnetic resonance
imaging (MRI) procedure?
a. Void to completely empty the bladder.
b. Omit all citrus food for 12 hours before the procedure.
c. Remove all metal, such as jewelry, glasses, and hair clips.
d. Wear only cotton garments for the procedure.

Answer 3

c. Remove all metal, such as jewelry, glasses, and hair clips.

Question 4

The nurse reinforces instructions for the patient who is to have a unicompartmental knee
replacement that which is a major advantage of this partial knee replacement?
a. the patient will be up and walking 2 to 3 hours after the operation.
b. the kneecap is completely removed.
c. the procedure is especially helpful in the treatment of rheumatoid arthritis (RA).
d. a small titanium disk replaces the worn cartilage.

Answer 4

a. the patient will be up and walking 2 to 3 hours after the operation.

Question 5

A patient who has had a right below the knee amputation continues to complain of unpleasant sensation in the right foot. Which explanation will the nurse provide about this “phantom pain”?
a. It only exists in the mind.
b. It is a complication following an amputation and can be clarified by the surgeon.
c. It is related to the severed nerves that are still sending messages to the brain.
d. It occurs when the person becomes focused on the loss of the limb.

Answer 5

c. It is related to the severed nerves that are still sending messages to the brain.

Question 6

The patient that has a bipolar hip replacement following an intracapsular fracture has an order to be turned every 2 hours. The nurse understands that the correct nursing intervention
is to keep the legs in which position?
a. together so they do not separate while turning.
b. flexed to stabilize the prosthesis.
c. abducted so the prosthesis does not become dislocated.
d. adducted to prevent additional pain for the patient with turning.

Answer 6

c. abducted so the prosthesis does not become dislocated.

Question 7

A patient has been casted to stabilize a fracture of the right radius and ulna. The nurse assesses a capillary refill of 5 seconds and cold fingers of the right hand. Which initial intervention should the nurse deploy?
a. Notify the charge nurse of a probable compartmentsyndrome.
b. Apply a warm compress to the fingers to relieve swelling.
c. Elevate the right hand to heart level to maintain arterial pressure.
d. Cut the cast off to release constriction.

Answer 7

c. Elevate the right hand to heart level to maintain arterial pressure.

Question 8

A patient had an open reduction with internal fixation (ORIF) for a compound fracture of the left tibia and has been placed in a long leg cast. The findings by the nurse are: left foot warm/pink, pedal pulse weaker than right, capillary refill 3 seconds, and small 1 cm area of
blood on cast. Which action will the nurse take?
a. Notify charge nurse of impending compartment syndrome.
b. Document that all findings are within normal limits.
c. Inform charge nurse about probable hemorrhage.
d. Place warm compresses on left foot.

Answer 8

b. Document that all findings are within normal limits.

Question 9

When a patient recovering from a fractured tibia asks what callus formation is, the nurse provides which explanation?
a. when blood vessels of the bone are compressed.
b. a part of the bone healing process after a fracture when new bone is being formed over the fracture site.
c. the formation of a clot over the fracture site.
d. when the hematoma becomes organized and a fibrin meshwork is formed.

Answer 9

b. a part of the bone healing process after a fracture when new bone is being formed over the fracture site.

Question 10

Which patient statement indicates the need for additional teaching for a patient with rheumatoid arthritis who is taking meloxicam?
a. “I am keeping a daily record of my blood pressure.”
b. “I take aspirin before I go to bed.”
c. “I know I can take meloxicam with or without regard to meals.”
d. “I weigh every day so I will be aware of any weight gain.”

Answer 10

b. “I take aspirin before I go to bed.”

Question 11

Which should the nurse expect to see in the plan of care for a patient following a myelogram in which water-soluble dye was used?
a. Position in a semi-Fowler’s position for 8 hours
b. Place patient flat on back to compress puncture site.
c. Ambulate for brief periods to lessen postmyelogram headache.
d. Limit fluids to increase absorption of the dye.

Answer 11

a. Position in a semi-Fowler’s position for 8 hours

Question 12

Which finding would delay a computed tomography (CT)scan?
a. Patient’s allergy to shellfish or iodine
b. Patient has a suspected tumor
c. Patient’s allergy to milk products
d. Patient’s gluten intolerance

Answer 12

a. Patient’s allergy to shellfish or iodine

Question 13

Forty-eight hours after a patient sustained a fractured femur in a car accident, the nurse notes the patient has a pulse of 110, respirations at 25, labored respirations and crackles in
both lung fields. The nurse immediately reports to the charge nurse the probability of which
disorder?
a. impending pneumonia.
b. atelectasis.
c. fat embolism.
d. anxiety attack.

Answer 13

c. fat embolism.

Question 14

Which is the priority nursing intervention for a patient experiencing a fat embolism?
a. Administer oxygen
b. Increase intravenous fluids.
c. Administer analgesic medication
d. Notify the charge nurse

Answer 14

a. Administer oxygen

Question 15

A patient, age 68, has experienced an intertrochanteric fracture of the right hip. Before surgery, to provide support and comfort, an immobilizing device of which type is applied?
a. Thomas ring
b. Bryant traction
c. Russell traction
d. Buck traction

Answer 15

d. Buck traction

Question 16

Which foods should the home health nurse suggest for the patient with osteoporosis to help slow the disease?
a. Leafy green vegetables
b. Foods high in sodium
c. Tea and coffee
d. Vitamin A

Answer 16

a. Leafy green vegetables

Question 17

Which instruction will the nurse reinforce for a patient who is taking alendronate?
a. Take drug with any meal.
b. Take drug first thing in the morning.
c. Drink at least 5 oz of milk before taking drug.
d. Take drug with an antacid to avoid heartburn.

Answer 17

b. Take drug first thing in the morning.

Question 18

The patient has been diagnosed as having gouty arthritis. The patient asks the nurse to explain the cause of the inflammation of the great toe. Which is the appropriate nursing response?
a. “You have calcium oxalate deposits that are seen in gouty arthritis.”
b. “The inflammation is from small accumulations of uric acid crystals, which are called tophi.”
c. “The small nodules are not related to the arthritis condition.”
d. “You have fat deposits that are common with gouty arthritis.”

Answer 18

b. “The inflammation is from small accumulations of uric acid crystals, which are called tophi.”

Question 19

When the patient with rheumatoid arthritis reports not liking daily exercise, the nurse encouragingly reminds the patient that exercise has which benefit?
a. Keeping the joints from “freezing.”
b. Ensuring longer and better sleep.
c. Stimulating joints when done vigorously
d. When performed weekly, having greater benefits.

Answer 19

a. Keeping the joints from “freezing.”

Question 20

The nurse clarifies to a patient who is being evaluated for possible rheumatoid arthritis that the elevated erythrocyte sedimentation rate (ESR) indicates the presence of which process?
a. A chronic infection
b. Poor protein intake
c. Increased inflammatory reaction in the body.
d. A poor immune response to amicroorganism

Answer 20

c. Increased inflammatory reaction in the body.

Question 21

Which instructions should the nurse reinforce for the patient before the initiation of the hydroxychloroquine to treat joint inflammation from systemic lupus erythematosus(SLE)?
a. Report mouth ulcerations.
b. Get a chest x-ray.
c. Get an eye examination.
d. Take prophylaxis for malaria.

Answer 21

c. Get an eye examination.

Question 22

Which action should the nurse take when a patient with osteomyelitis of the right forearm is admitted with an open wound that is draining?
a. Enforce a low-calorie diet.
b. Initiate drainage and secretion precautions.
c. Frequently do passive ROM on the elbow.
d. Ambulate several times daily.

Answer 22

b. Initiate drainage and secretion precautions.

Question 23

A 16-year-old male patient presents in the emergency room with a pathologic fracture of the left femur and complains of pain on weight-bearing. These are common indicators of which
disorder?
a. osteogenic sarcoma.
b. osteoporosis.
c. rheumatoid arthritis.
d. osteochondroma.

Answer 23

a. osteogenic sarcoma.

Question 24

The 14-year-old boy who is scheduled for left leg amputation says to the nurse, “What in the world am I going to do with only one leg?” Which is the nurse’s therapeutic response?
a. “ This is a tough thing to go through”
b. “With a prosthesis, you will be as good as new.”
c. “It is way too early to be concerned about that now.”
d. “When my brother had his leg removed, he did great!”

Answer 24

a. “ This is a tough thing to go through”

Question 25

A patient has undergone a bipolar hip repair (hemiarthroplasty). Which is the appropriate instruction?
a. Sit in whatever position is most comfortable.
b. Sit in a firm, straight-backed chair at a 90-degree angle.
c. Avoid crossing the legs.
d. Begin full weight-bearing as soon as tolerated.

Answer 25

c. Avoid crossing the legs.

Question 26

The nurse explains to a patient who has had a hip replacement that warfarin is prescribed for which reason?
a. increase the red blood cells.
b. reduce the threat of hemorrhage.
c. prevent formation of emboli.
d. help stabilize the prosthesis.

Answer 26

c. prevent formation of emboli.

Question 27

Which will the nurse stress to a patient, who recently had a hip replacement, in quadriceps setting exercises?
a. Push knee down to mattress and raise heel off the bed.
b. Flex knee and extend foot.
c. Adduct leg and flex foot.
d. Lift leg and heel off the bed.

Answer 27

a. Push knee down to mattress and raise heel off the bed.

Question 28

Which will the home health nurse include monitoring for in the plan of care for an 82-year-old female with severe kyphosis from ankylosis?
a. Urinary output
b. Respiratory effort
c. Sleep cycle
d. Nutritional status

Answer 28

b. Respiratory effort

Question 29

Which will the nurse stress to a patient who has had a knee replacement and is beginning
strengthening exercises for the unaffected leg?
a. Flex the knee and flex the foot.
b. Lift the leg from the mattress and rotate the foot.
c. Pull knee to chest and extend the foot.
d. Push foot down against the footboard for a count of five.

Answer 29

d. Push foot down against the footboard for a count of five.

Question 30

The office nurse has noted the presence of an increase in lumbar curvature in a 20-year-old
female patient. What is this condition known as?
a. Scoliosis
b. Lordosis
c. Kyphosis
d. Spondylitis

Answer 30

b. Lordosis

Question 31

How is rheumatoid arthritis (RA) distinguished from osteoarthritis?
a. Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints.
b. Rheumatoid arthritis is an autoimmune, degenerative disease; osteoarthritis is a
systemic inflammatory disease.
c. People with osteoarthritis are considered to be genetically predisposed; there is no
known genetic component to rheumatoid arthritis.
d. Osteoarthritis is often caused by a virus; viruses play no part in the pathogenesis of
rheumatoid arthritis.

Answer 31

a. Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints.

Question 32

Which patient is most likely to develop osteoporosis?
a. 43-year-old African American woman
b. 57-year-old white woman
c. 48-year-old African American man
d. 62-year-old Latino woman

Answer 32

b. 57-year-old white woman

Question 33

The patient, age 58, is diagnosed with osteoporosis after densitometry testing. She has been menopausal for 5 years and has been concerned about her risk for osteoporosis because her
mother has osteoporosis. When reinforcing instructions about her osteoporosis, which information does the nurse include?
a. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
b. Estrogen replacement therapy must be started to prevent rapid progression of her
osteoporosis.
c. With a family history of osteoporosis, there is no way to prevent or slow bone
reabsorption.

Answer 33

a. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.

Question 34

Certain foods may increase the pain associated with gout. Which foods have the highest
concentration of purines?
a. Brain, liver, kidney
b. Lettuce, corn, potatoes
c. Beef, pork, chicken
d. Fruits and fruit juices

Answer 34

a. Brain, liver, kidney

Question 35

In order for a patient to flex the lower leg, which muscle must be contracted?
a. Quadriceps
b. Gastrocnemius
c. Biceps femoris
d. Rectus femoris

Answer 35

c. Biceps femoris

Question 36

Calcium is a mineral found in many foods that can slow bone loss during the aging process.
Which food is high in calcium?
a. Oranges
b. Bananas
c. Spinach
d. Eggs

Answer 36

c. Spinach

Question 37

A 56-year-old patient is being seen for osteoarthritis of the knee in the clinic. Which should the nurse recommend when discussing strengthening exercises?
a. Jogging
b. Walking rapidly on a treadmill
c. Bicycling
d. Aerobic exercises

Answer 37

c. Bicycling

Question 38

Which does prolonged bed rest put the older adult at risk for?
a. Ankylosing spondylitis
b. Pathologic fractures
c. Osteomyelitis
d. Gout

Answer 38

b. Pathologic fractures

Question 39

The nurse takes into consideration that a healing fracture progresses through several healing
stages. Which is the third healing stage?
a. Development of fibrin meshwork
b. Collagen fibers collect calcium
c. Osteoblasts home fracture site form
d. Callus

Answer 39

a. Development of fibrin meshwork

Question 40

The emergency department nurse observes for the two cardinal signs of a hip fracture in a
newly admitted patient, which are the shortening of the injured leg and the
?
rotation of that same leg.

Answer 40

external

Question 41

The division of the skeletal system that comprises the skull, hyoid, vertebral column, and thorax is the ? division.

Answer 41

axial

Question 42

A patient’s patellar-femoral cartilage has deteriorated due to arthritis. The medial and lateral cartilage is undamaged. This patient is likely to undergopartial or ?
knee replacement surgery.

Answer 42

unicompartmental

Question 43

The nurse administering the drug colchicine for gout will give 0.5 mg hourly for ? hours.

Answer 43

12

Question 44

The nurse explains that the use of the brace allows a person with a
cervical fracture to be mobile.

Answer 44

halo