Muskoskeletal Q's

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A nurse is educating a patient about the differences between osteoarthritis (OA) and rheumatoid arthritis (RA). Which statement by the patient indicates a need for further teaching?

  • a) "RA is an autoimmune disease while OA is due to wear and tear."

  • b) "Joint deformities are more common with OA than RA."

  • c) "RA affects the synovial membrane while OA affects the cartilage."

  • d) "Morning stiffness lasts longer in RA compared to OA."

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1

A nurse is educating a patient about the differences between osteoarthritis (OA) and rheumatoid arthritis (RA). Which statement by the patient indicates a need for further teaching?

  • a) "RA is an autoimmune disease while OA is due to wear and tear."

  • b) "Joint deformities are more common with OA than RA."

  • c) "RA affects the synovial membrane while OA affects the cartilage."

  • d) "Morning stiffness lasts longer in RA compared to OA."

Answer: b) "Joint deformities are more common with OA than RA."

Rationale: Joint deformities are more commonly associated with RA due to the autoimmune attack on the synovial joints.

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2

(SATA) Which of the following are risk factors for osteoarthritis?

a) Obesity

b) Age

c) Smoking

d) Previous joint injury

e) Female gender

Answer: a) Obesity, b) Age, d) Previous joint injury, e) Female gender

Rationale: Age, obesity, previous joint injury, and female gender are all risk factors for OA. Smoking is more associated with RA.

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3

Which diagnostic test would be most appropriate for detecting the presence of rheumatoid factor in a client suspected of having rheumatoid arthritis?

a) X-ray

b) Bone density test

c) Erythrocyte sedimentation rate (ESR)

d) Serum rheumatoid factor (RF) test

Answer: d) Serum rheumatoid factor (RF) test

Rationale: The serum rheumatoid factor test is used specifically to detect the presence of RF, an antibody found in many people with RA.

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4

A nurse is differentiating between the clinical manifestations of OA and RA. Which of the following is more commonly associated with OA?

  • a) Symmetrical joint involvement

  • b) Nodules on the fingers

  • c) Joint pain worsened with activity and relieved with rest

  • d) Red, warm, swollen joints

Answer: c) Joint pain worsened with activity and relieved with rest

Rationale: Joint pain that is exacerbated by activity and relieved with rest is characteristic of OA.

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5

Which statement about rheumatoid arthritis is true?

a) It primarily affects the weight-bearing joints.

b) It is caused by the erosion of cartilage.

c) The small joints of the hands and feet are often the first to be affected.

d) It is most commonly diagnosed in the elderly

Answer: c) The small joints of the hands and feet are often the first to be affected.

Rationale: RA often begins by affecting the smaller joints, especially those of the hands and feet.

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6

A nurse is reviewing the medical record of a patient with an autoimmune musculoskeletal disorder. Which disease does this patient most likely have?

a) Rheumatoid arthritis

b) Osteoarthritis

c) Gout

d) Osteoporosis

Answer: a) Rheumatoid arthritis

Rationale: Rheumatoid arthritis is an autoimmune disorder where the immune system attacks the synovial joints.

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7

(SATA) Which of the following are potential complications of inflammatory musculoskeletal disorders?

a) Ankylosis

b) Uric acid stone formation

c) Subluxation

d) Joint deformity

e) Joint sepsis

Answer: a) Ankylosis, c) Subluxation, d) Joint deformity, e) Joint sepsis

Rationale: These are potential complications of inflammatory musculoskeletal disorders. Uric acid stone formation is associated with gout

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8

A patient presents with joint pain, a butterfly rash across the cheeks and nose, and reports of fatigue. What is the most likely diagnosis?

a) Rheumatoid arthritis

b) Osteoarthritis

c) Systemic lupus erythematosus (SLE)

d) Lyme disease

Answer: c) Systemic lupus erythematosus (SLE)

Rationale: SLE is a connective tissue disorder that can cause a characteristic butterfly rash, joint pain, and fatigue.

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9

A nurse is caring for a patient with a degenerative musculoskeletal disorder. Which intervention is most appropriate for this patient?

a) Encouraging high-impact exercises

b) Administering immunosuppressive drugs

c) Providing joint protection techniques

d) Offering high-purine diet

Answer: c) Providing joint protection techniques

Rationale: For degenerative disorders like osteoarthritis, it's crucial to protect the joint from further damage. Joint protection techniques can help achieve this.

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10

Which of the following is a primary focus of nursing care for patients with inflammatory musculoskeletal disorders?

  • a) Strengthening exercises

  • b) Pain management

  • c) Bone density screening

  • d) Dietary modification to avoid purine-rich foods

Answer: b) Pain management

Rationale: While all options are essential for various musculoskeletal disorders, pain management is a primary focus for patients with inflammatory conditions.

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11

A patient who has undergone a total hip replacement is at risk for which of the following post-operative complications?

a) Chest pain

b) Dislocation of the new joint

c) Early-onset dementia

d) Hyperglycemia

Answer: b) Dislocation of the new joint

Rationale: Post-operative hip dislocation is a possible complication after total hip replacement. The new joint may become unstable and dislocate if the leg is positioned incorrectly.

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12

(SATA) After a total knee replacement, which nursing interventions should be initiated to prevent complications?

a) Encourage leg exercises to promote circulation

b) Monitor for signs of infection

c) Place a pillow under the knee to maintain flexion

d) Administer prophylactic antibiotics (if ordered)

e) Monitor for signs of deep vein thrombosis (DVT)

Answer: a) Encourage leg exercises to promote circulation, b) Monitor for signs of infection, d) Administer prophylactic antibiotics, e) Monitor for signs of deep vein thrombosis (DVT)

Rationale: Leg exercises, prophylactic antibiotics, monitoring for infection, and monitoring for DVT are all appropriate interventions after knee replacement. A pillow should not be placed under the knee as it may hinder extension and lead to complications.

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13

A nurse is teaching a patient about post-operative care after a hip replacement. Which statement by the patient indicates understanding? (posterior approach)

a) "I should avoid bending my hip more than 90 degrees."

b) "I can cross my legs whenever I want."

c) "I can sleep on my operated side immediately after surgery."

d) "I should twist my body to reach objects beside me."

Answer: a) "I should avoid bending my hip more than 90 degrees."

Rationale: After hip replacement, patients should avoid flexing the hip more than 90 degrees to prevent dislocation.

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14

Which position is contraindicated following a total hip replacement?

a) Supine with abduction pillow between the legs

b) Side-lying with a pillow between the legs

c) Sitting with legs crossed at the knees

d) Elevated head of bed to 45 degrees

Answer: c) Sitting with legs crossed at the knees

Rationale: Crossing the legs can lead to hip dislocation after a total hip replacement.

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15

A patient has just returned from surgery after a total knee replacement. What is the priority nursing action?

a) Assessing the surgical site for drainage

b) Monitoring blood pressure and heart rate

c) Administering pain medication

d) Encouraging ambulation

Answer: b) Monitoring blood pressure and heart rate

Rationale: Immediately after surgery, it's essential to monitor vital signs to detect any early signs of complications. Other actions are also important but monitoring vital signs is the immediate priority.

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16

Which patient is at the highest risk for developing osteoporosis?

a) A 40-year-old male who runs marathons

b) A 30-year-old female who takes oral contraceptives

c) A 55-year-old postmenopausal female who drinks alcohol daily

d) A 20-year-old male who plays basketball

Answer: c) A 55-year-old postmenopausal female who drinks alcohol daily

Rationale: Postmenopausal women are at increased risk for osteoporosis due to decreased estrogen levels. Additionally, excessive alcohol consumption is a known risk factor for osteoporosis.

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17

Which of the following is a modifiable risk factor for osteoporosis?

a) Age

b) Family history of osteoporosis

c) Sedentary lifestyle

d) Genetic predisposition

Answer: c) Sedentary lifestyle

Rationale: A sedentary lifestyle is a modifiable risk factor, meaning it can be changed. Regular weight-bearing exercise can help prevent osteoporosis.

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18

(SATA) Which of the following medications increase the risk of osteoporosis?

a) Glucocorticoids

b) Antiseizure medications

c) Heparin

d) Thyroid hormone in excessive doses

e) Beta-blockers

Answer: a) Glucocorticoids, b) Antiseizure medications, c) Heparin, d) Thyroid hormone in excessive doses

Rationale: Long-term use of glucocorticoids, antiseizure medications, heparin, and excessive thyroid hormone can increase the risk of osteoporosis.

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19

Osteoporosis is often referred to as a "silent disease" because:

a) It primarily affects individuals who are mute

b) It's a rare disease, so it's hardly ever discussed

c) There are no symptoms until a fracture occurs

d) Patients are advised to remain silent and immobile

Answer: c) There are no symptoms until a fracture occurs

Rationale: Osteoporosis often doesn't produce symptoms until a bone breaks. Many individuals are unaware they have the disease until they suffer a fracture.

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20

A nurse is providing patient education on preventing osteoporosis. Which of the following dietary recommendations should the nurse provide?

a) Increase intake of caffeine and salt

b) Consume adequate calcium and vitamin D

c) Focus on a low-protein diet

d) Limit fluid intake to prevent fluid overload

Answer: b) Consume adequate calcium and vitamin D

Rationale: Calcium and vitamin D are crucial for bone health and can help prevent osteoporosis.

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21

A patient presents to the emergency department with a swollen, painful ankle after twisting it during a basketball game. Which injury does the nurse suspect?

a) Contusion

b) Strain

c) Sprain

d) Fracture

Answer: c) Sprain

Rationale: A sprain involves injury to the ligaments surrounding a joint and commonly occurs with twisting movements.

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22

(SATA) Which of the following are clinical manifestations of a fracture?

a) Deformity of the limb

b) Crepitus

c) Bluish discoloration of the skin

d) Limited movement of the affected area

e) Muscle spasm

Answer: a) Deformity of the limb, b) Crepitus, d) Limited movement of the affected area, e) Muscle spasm

Rationale: These are common symptoms of a fracture. Bluish discoloration could be seen in a contusion or with compromised blood flow, but is not specific to fractures.

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23

A nurse is providing discharge teaching for a patient with a sprained wrist. Which statement by the patient indicates the need for further education?

a) "I should apply ice to reduce the swelling."

b) "I will keep my wrist elevated as much as possible."

c) "I should use heat immediately to increase blood flow."

d) "I will take the pain medications as prescribed."

Answer: c) "I should use heat immediately to increase blood flow."

Rationale: Initially, cold is applied to reduce swelling for sprains. Heat can be applied later in the healing process, but not immediately.

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24

Which of the following injuries involves an overstretching or tearing of muscle fibers?

a) Contusion

b) Strain

c) Sprain

d) Dislocation

Answer: b) Strain

Rationale: A strain is an injury to a muscle or tendon, whereas a sprain involves ligaments. Contusions are bruises, and dislocations involve displacement of bones in a joint.

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25

A patient with a joint dislocation would most likely exhibit which of the following?

a) A visible lump in the muscle

b) Loss of bone density

c) Altered shape of the joint

d) Reddish-blue skin discoloration

Answer: c) Altered shape of the joint

Rationale: A dislocation involves displacement of the bone ends in a joint, leading to an altered or deformed appearance of the joint.

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26

The primary purpose of skin traction is to:

a) Correct bone deformities.

b) Decrease muscle spasms.

c) Realign bone fragments.

d) Stimulate bone healing.

Answer: b) Decrease muscle spasms

Rationale: Skin traction is used primarily to decrease muscle spasms and provide temporary immobilization. It doesn't have the strength to realign bone fragments or correct deformities.

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27

A nurse is caring for a patient with skeletal traction. Which of the following is an essential nursing intervention?

a) Ensure weights are resting on the floor.

b) Frequently remove and reapply traction.

c) Monitor for signs of infection at the pin sites.

d) Encourage the patient to lift the weights for exercise.

Answer: c) Monitor for signs of infection at the pin sites.

Rationale: Skeletal traction involves pins or wires inserted into the bone. It's crucial to monitor pin sites for signs of infection. Weights should hang freely and not rest on the floor.

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28

(SATA) What are the primary goals of external fixation devices?

a) Immobilize bone fragments

b) Reduce muscle spasms

c) Compress fracture fragments

d) Allow for wound care

e) Stabilize damaged soft tissues

Answer: a) Immobilize bone fragments, c) Compress fracture fragments, d) Allow for wound care, e) Stabilize damaged soft tissues

Rationale: External fixation devices stabilize fractures, allow for wound care, compress fracture fragments, and immobilize bone fragments. They do not primarily aim to reduce muscle spasms.

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29

A patient in skin traction complains of increased pain. Which is the most appropriate nursing intervention?

  • a) Remove the traction to relieve the pain.

  • b) Add more weight to the traction.

  • c) Check the alignment and positioning of the traction.

  • d) Advise the patient to use deep breathing exercises.

Answer: c) Check the alignment and positioning of the traction.

Rationale: If a patient complains of increased pain, the nurse should first check the alignment and positioning of the traction to ensure it's applied correctly.

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30

What is a potential complication of prolonged use of skeletal traction?

a) Hyperactivity

b) Joint stiffness

c) Increased bone density

d) Enhanced muscle tone

Answer: b) Joint stiffness

Rationale: Prolonged immobilization from skeletal traction can lead to joint stiffness due to lack of movement.

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31

A nurse is assessing a patient with a femur fracture. Which of the following findings would alert the nurse to the possibility of a fat embolism?

a) Decreased urine output

b) Petechiae on the chest

c) Increased blood pressure

d) Localized redness at the fracture site

Answer: b) Petechiae on the chest

Rationale: Fat embolism syndrome can manifest as petechiae over the chest, neck, and anterior axillary folds. It is a rare but severe complication of long bone fractures.

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32

(SATA) The nurse recognizes that which of the following are complications associated with long bone fractures?

a) Compartment syndrome

b) Osteoarthritis

c) Deep vein thrombosis (DVT)

d) Fat embolism

e) Bone spur

Answer: a) Compartment syndrome, c) Deep vein thrombosis (DVT), d) Fat embolism

Rationale: Compartment syndrome, DVT, and fat embolism are complications associated with long bone fractures. Osteoarthritis is a chronic joint condition, and bone spurs are bony projections along joint margins.

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33

Which of the following assessment findings would indicate the development of compartment syndrome in a patient with a tibial fracture?

  • a) Warmth and redness at the fracture site

  • b) Severe pain that is not relieved by pain medication

  • c) Intermittent claudication

  • d) Frequent muscle spasms

Answer: b) Severe pain that is not relieved by pain medication

Rationale: One of the earliest signs of compartment syndrome is severe pain that is out of proportion to the injury and is not relieved by pain medication.

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34

A nurse is assessing a patient with a recent femur fracture for signs of deep vein thrombosis (DVT). Which clinical manifestation would be suggestive of this complication?

  • a) Swelling and warmth in the calf area

  • b) Numbness and tingling in the affected leg

  • c) Bluish discoloration of the toes

  • d) Sharp pain upon foot dorsiflexion

Answer: a) Swelling and warmth in the calf area

Rationale: Swelling, warmth, and often redness in the calf can be indicative of a DVT.

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35

A patient with a long bone fracture has been immobilized for an extended period. Which assessment finding would alert the nurse to the risk of a pulmonary embolism?

a) Wheezing and prolonged expiration

b) Sharp, stabbing chest pain and dyspnea

c) Barking cough and sore throat

d) Prolonged capillary refill time

Answer: b) Sharp, stabbing chest pain and dyspnea

Rationale: A pulmonary embolism, which can originate from a DVT in a patient with prolonged immobilization, may manifest as sharp, stabbing chest pain and sudden onset dyspnea.

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36

A nurse is formulating a care plan for a patient with a pelvic fracture. Which nursing diagnosis is most appropriate for this patient?

a) Ineffective coping related to chronic pain

b) Risk for infection related to surgical pin insertion

c) Impaired physical mobility related to musculoskeletal injury

d) Risk for aspiration related to decreased level of consciousness

Answer: c) Impaired physical mobility related to musculoskeletal injury

Rationale: A patient with a pelvic fracture will have impaired mobility due to pain, discomfort, and necessary immobilization.

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37

(SATA) When planning care for a patient with multiple rib fractures, which interventions should the nurse include in the plan of care?

a) Encouraging deep breathing and coughing exercises

b) Administering pain medication as prescribed

c) Positioning the patient in Trendelenburg's position

d) Providing pillow support for splinting during coughing

e) Restricting fluid intake to prevent fluid overload

Answer: a) Encouraging deep breathing and coughing exercises, b) Administering pain medication as prescribed, d) Providing pillow support for splinting during coughing

Rationale: For patients with rib fractures, it's crucial to ensure adequate ventilation and prevent atelectasis or pneumonia. This is achieved by pain control, deep breathing, coughing exercises, and splinting the chest when coughing.

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38

Which of the following nursing interventions is essential for a patient with a compound fracture of the tibia?

a) Applying a warm compress to the site

b) Monitoring for signs of infection

c) Encouraging weight-bearing on the affected leg

d) Elevating the leg above heart level at all times

Answer: b) Monitoring for signs of infection

Rationale: A compound fracture, also known as an open fracture, involves a break in the skin and exposure of the bone. This greatly increases the risk for infection.

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39

In a patient with musculoskeletal trauma, what is the primary reason for frequently assessing neurovascular status of the affected extremity?

a) To determine the need for surgical intervention

b) To identify potential compartment syndrome

c) To assess for potential bone infection

d) To evaluate the healing process of the fracture

Answer: b) To identify potential compartment syndrome

Rationale: Frequent neurovascular assessments (checking for pain, paresthesia, pallor, pulselessness, and paralysis) can help identify the early signs of compartment syndrome, a serious complication that requires prompt intervention.

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40

A patient with musculoskeletal trauma complains of severe pain despite being administered pain medications. What is the most appropriate nursing intervention?

a) Instruct the patient to engage in diversional activities

b) Reassure the patient that the pain will subside soon

c) Re-assess the site of injury and report findings

d) Encourage the patient to meditate for relaxation

Answer: c) Re-assess the site of injury and report findings

Rationale: While non-pharmacological interventions can be helpful, any change or increase in pain requires thorough assessment to rule out complications such as compartment syndrome or other issues.

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