ORTHO: Management of Patients with Musculoskeletal Disorders

Question 1

A patient comes back to the clinic with a continued
complaint of back pain. What time frame does the nurse understand constitutes “chronic pain”?

a. 4 weeks
b. 3 months
c. 6 months
d. 1 year

Answer 1

**b. **3 months

(*Chronic pain is pain that lasts for over three months. *)

Question 2

A patient is experiencing low back pain. What position will the nurse suggest to relieve this discomfort?

a. High-Fowler’s to allow for maximum hip flexion
b. Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees
c. Prone, with a pillow under the shoulders
d. Supine, with the bed flat and a firm mattress
in place

Answer 2

**b. **Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees

(the supine sleeping position with a partial bend in knees may be beneficial for lower back pain. Since, Reclining helps reduce pressure on your spine and helps provide support on your back by creating an angle between your trunk and thighs.)

Question 3

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize?
a. Gastrocnemius
b. Latissimus dorsi
c. Quadriceps
d. Rectus abdominis

Answer 3

**c. **Quadriceps (thighs)

Question 4

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided?

a. “I will lie prone with my legs slightly elevated.”
b. “I will bend at the waist when I am lifting objects from the floor.”
c. “I will avoid prolonged sitting or walking.”
d. “Instead of turning around to grasp an object, I will twist at the waist.”

Answer 4

**c. **“I will avoid prolonged sitting or walking.”

Question 5

A patient diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. In responding to the patient, how would the nurse best describe CTS?

**a. **“CTS is a neuropathy that is characterized by bursitis and tendinitis.”
**b. **“CTS is a neuropathy that is characterized by flexion contracture of the fourth and fifth fingers.”
**c. **“CTS is a neuropathy that is characterized by compression of the median nerve at the wrist.”
**d. **“CTS is a neuropathy that is characterized by pannus formation in the shoulder.”

Answer 5

**c. **“CTS is a neuropathy that is characterized by compression of the median nerve at the wrist.”

(Carpal tunnel syndrome (CTS) is a common neurological disorder that occurs when the median nerve, which runs from your forearm into the palm of the hand, becomes pressed or squeezed at the wrist. You may feel numbness, weakness, pain in your hand and wrist, and your fingers may become swollen and useless.)

Question 6

The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as?

a. Bunion
b. Clawfoot
c. Corn
d. Hammer toe

Answer 6

c. Corn

(Corns and calluses are thick, hardened layers of skin that develop when the skin tries to protect itself against friction or pressure. They often form on feet and toes or hands and fingers.)

Question 7

A patient has been diagnosed with osteomalacia.
What common symptoms does the nurse recognize that correlate with the diagnosis?

a. Bone fractures and kyphosis
b. Bone pain and tenderness
c. Muscle weakness and spasms
d. Softened and compressed vertebrae

Answer 7

**b. **Bone pain and tenderness

Question 8

A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis?

a. Proteus
b. Pseudomonas
c. Salmonella
d. Staphylococcus aureus

Answer 8

**d. **Staphylococcus aureus

Question 9

A patient is diagnosed with osteomyelitis of the right leg. What signs and symptoms does the nurse recognize that are associated with this diagnosis?
(Select all that apply.)

a. Pain in the right leg
b. Erythema in the right leg
c. Fever
d. Leukopenia
e. Purulent drainage

Answer 9

**a. **Pain in the right leg
b. Erythema in the right leg
**c. **Fever

Question 10

A patient comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the physician orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the patient about?

a. Amitriptyline (Elavil)
b. Duloxetine (Cymbalta)
c. Gabapentin (Neurontin)
d. Cyclobenzaprine (Flexeril)

Answer 10

**b. **Duloxetine (Cymbalta)

(Duloxetine (Cymbalta) is a safe and effective first-line option for the treatment that can help with chronic lower back pain and neuropathies associated with low back pain.)

Question 11

A patient shows the nurse a round, firm nodule
on the wrist. The pain is described as aching, with some weakness of the fingers. What treatment does the nurse anticipate assisting with? (Select all that apply.)

a. Educating the patient on the use of gabapentin
b. Active range-of-motion exercises
c. Corticosteroid injections
d. Surgical excision
e. Aspiration of the cyst

Answer 11

**c. **Corticosteroid injections
**d. **Surgical excision
**e. **Aspiration of the cyst

Question 12

A patient had hand surgery to correct a Dupuytren’s contracture. What nursing intervention is a priority postoperatively?

a. Changing the dressing
b. Applying a cock-up splint and immobilization
c. Having the patient exercise the fingers to avoid future contractures
d. Performing hourly neurovascular assessments for the first 24 hours

Answer 12

**d. **Performing hourly neurovascular assessments for the first 24 hours

Question 13

A patient is diagnosed with osteogenic sarcoma.
What laboratory studies should the nurse monitor for the presence of elevation?

a. Magnesium level
b. Potassium level
c. Alkaline phosphatase
d. Troponin levels

Answer 13

c. Alkaline phosphatase

(Serum alkaline phosphatase (SALP) is commonly elevated in osteosarcoma patients.)

Question 14

The nurse is caring for a patient w/ bone metastasis from a primary breast cancer. The patient complains of muscle weakness and nausea and is voiding large amounts frequently. Cardiac dysrhythmias are observed on the telemetry monitor. What should the
nurse suspect based on these clinical manifestations?

a. Hypercalcemia
b. Hypocalcemia
c. Hypokalemia
d. Hyperkalemia

Answer 14

a. Hypercalcemia

Question 15

The hospice nurse is assigned to care for a
patient with metastatic bone cancer who wants to remain at home. What is the therapeutic goal in the care of this patient?

**a. **Prevent the patient from having to go to the hospital for care.
**b. **Relieve pain and discomfort while promoting quality of life.
**c. **Increase the activity level of the patient to prevent complications related to immobility.
d. Ensure that the family accepts the patient’s imminent death.

Answer 15

**b. **Relieve pain and discomfort while promoting quality of life.

Question 16

The major hormonal regulators of calcium homeostasis are ____ and ____.

Answer 16

• Parathyroid Hormone
• Calcitonin

Question 17

____ describes the grating, crackling sound heard over irregular joint surfaces like the knee.

Answer 17

Crepitus

Question 18

The approximate percentage of total-body calcium present in the bones is ____.

Answer 18

98%

Question 19

Red bone marrow is located in the shaft of four long and flat bones: the ____, ____, ____, and ____.

Answer 19

• Sternum
• Ilium
• Vertebrae
• Ribs

Question 20

What technique will assess for Tinel sign?

Answer 20

Tinel sign may be elicited in pts w/ carpal tunnel syndrome by percussing lightly over the median nerve, located on the inner aspect of the wrist. If the patient reports tingling, numbness, and pain, the test for Tinel sign is considered positive.