NCM 104 - MUSCULOSKELETAL QUIZ

MULTIPLE CHOICE. NO ERASURES NO SUPERIMPOSITIONS

1)
Surgery is necessary for clients with fractures that:
A)
Cannot be immobilized with a cast.

B)

Are spiral.
C)
Require direct visualization and repair.

D)

Do not heal.

2)
Clients with Paget's disease:
A)
Are often diagnosed early due to a spike in serum alkaline phosphatase.
B)
Present with a long history of various areas of bone pain and a history of pain medication abuse.
C)
Develop symptoms early and are tested by bone biopsy to diagnose the disorder.
D)
Are asymptomatic for years but can eventually develop bone pain in affected bones.

3)
A client was just diagnosed with gout. The nurse expects that the client will likely be prescribed which of the following medications? (Select all that
apply.)
A)
Acetylsalicylic acid (Aspirin)

B)

Allopurinol (Zyloprim)
C)
Prednisone (Deltasone)

D)

Colchicine (ColBenemid)

4)
After trauma to the musculoskeletal or nervous system, reflex sympathetic dystrophy can occur. The nurse would recognize this complication when:
A)
The client complains of numbness beyond a cast and toes are pale with delayed capillary refill.
B)
The client complains of leg swelling, pain, tenderness, and cramping.
C)
The client complains of persistent pain, swelling, and decreased motion.
D)
The client's cone has not healed by the usual time expected.

5)
One of the first symptoms of osteoarthritis the nurse expects to note in the assessment is:
A)
Crepitus in the joint with movement.

B)

Pain and stiffness in one or more joints.

C)
Inability to walk long distances due to fatigue.

D)

Pain when at rest.

6)
The nurse is teaching a 68-year-old female client information about dietary calcium recommendations. Which dosage should be included in the nurse's
teaching?
A)
1000 mg per day

B)

750 mg per day

C)

1500 mg per day

D)

500 mg per day

7)
A client with Paget's disease tells the nurse that she fears falling. The nurse should:
A)
Recognize that the fear of falling is silly and tell the client to think more positively about their disease.
B)
Tell the client not to worry; this fear will go away with results from proper medication.
C)
Tell the client to stay in the house where they will be safer.
D)
Recognize that the fear of falling makes the client more prone to falls and facilitate the client's expression of thoughts.

8)
The nurse assesses a client and finds that a grating sound is present when a joint is bent and straightened. The appropriate medical term that is used to
describe this finding is:
A)
Crepitation.

B)

Grating.

C)

Grinding.

D)

Joint noise.

9)
Creatine kinase (CK) is evaluated in clients who are suspected of having:
A)
Muscle disease.

B)

Gout.
C)
Juvenile rheumatoid arthritis.

D)

Bone tumors.

10)
The nurse expects to care for clients most often with which of the following types of arthritis?
A)
Rheumatoid arthritis

B)

Ankylosing spondylitis
C)
Osteoarthritis

D)

Gouty arthritis

11)
A client has a cast applied to the right lower leg. Following the cast application, the nurse is monitoring for complications. Which assessment data leads
the nurse to be concerned about a serious complication?
A)
Complaint of numbness in the right foot and toes.
B)
Itching under the cast.
C)
The right foot toes are pink, warm, and sensation is intact.
D)
General discomfort in the right lower leg.

12)
A situation that is common after amputation is phantom limb pain. How should the nurse help the client to deal with this?
A)
Explain to the client that it is not possible to feel a limb that has been removed and that it is important to get past their denial.
B)
Reorient the client to the present and explain that the limb has been amputated.
C)
Request that the physician order a referral to a psychiatrist in order to have the client deal with their limb loss.
D)
Acknowledge that phantom limb sensation and pain are not uncommon and encourage the client to talk about it.

13)
A bone scan would most likely be ordered for a client when:
A)
A client complains of new onset pain in the area of the bone.
B)
Lab tests indicate normal calcium.
C)
A muscle mass near the bone is suspected.
D)
Bone cancer is suspected.

14)
An older female adult client is seen in the clinic and is surprised to find that she is shorter than she was a few years ago. The client thinks the nurse may
have made a mistake. What is the best response by the nurse?
A)
Teach the client that osteoporosis and age-related loss of bone mass could be responsible for a decrease in height and that it would be good to talk with
the physician about this.
B)
Tell the client that she is wrong, and that nurses see this happen every day in old people.
C)
Teach the client that older adults often lose height based on poor posture, bone compression fractures, and their sedentary lifestyles.
D)
Teach the client that old people are not active enough so eventually they have a decrease in their bone mass that they could have prevented.

15)
The client is ordered to be on bed rest for two months. The nurse realizes that the client's bones will:
A)
Be affected positively by the rest and be stronger as a result.
B)
Undergo increased osteoclast activity and bone resorption.
C)
Increase their osteoblastic activity to promote ossification.
D)
Not be affected by the bed rest.

16)
A client is scheduled to have skeletal traction. The nurse realizes that:
A)
A cast will be applied to the area and a traction device will be connected to the cast.
B)
Weighted skin traction will be applied.
C)
Manual traction.
D)
A surgical pin will be inserted into a bone and the traction will be applied to the pin.

17)
Client care of an older adult with osteoporosis should:
A)
Focus on diagnosis and medical management.
B)
Focus on research related to causes and the progression of the condition.
C)
Focus on treating the development of complications and client complaints.
D)
Focus on slowing or stopping the process and preventing complications.

18)
A client comes to the clinic complaining of severe pain in the right great toe that started at night. The most probable prognosis is:
A)
A fracture of the great right toe.

B)

A strain of the great right toe.

C)
Gout.

D)

Rheumatoid arthritis.

19)
In clients who are experiencing musculoskeletal disorders and diseases, alkaline phosphatase (ALP) is assessed to:
A)
Diagnose muscle trauma.

B)

Evaluate the presence of bone diseases.

C)
Establish true calcium levels.

D)

Determine phosphorus levels.

20)
The nurse is teaching older adults about risks for musculoskeletal trauma. Strategies the nurse should include are:
A)
Avoid fire by not cooking in the kitchen when alone.
B)
Avoid injury by not using assistive devices at home.
C)
Avoid falls at home by not using throw rugs.
D)
Avoid injury in motor vehicle accidents by not driving.

21)
A young adult is seen in the clinic complaining of pain in the left wrist. There is no deformity of the wrist, the left radial pulse is strong, and there is no
history of a fall or injury. What does the nurse expect to see ordered?
A)
An x-ray of both arms to ensure there is no injury present
B)
Rest and comfort measures for several days unless pain worsens
C)
A computerized tomography (CT) scan of the wrist to check for soft tissue injury
D)
Lab work to assess calcium and phosphorus levels

22)
The client's right femur was fractured and repaired at the diaphysis. When teaching, the client asks the nurse to explain the diaphysis. The nurse's best
response is:
A)
"Irregular bones like the femur are plates of compact bone that are also called the diaphysis."
B)
"Long bones like the femur have a midportion or shaft that is also called the diaphysis."
C)
"Flat bones like the femur are disc-shaped and, in medical terms, are called the diaphysis."
D)
"Short bones like the femur are cuboid, spongy bone that, in medical terms, are called the diaphysis."

23)
A client refuses physical therapy. The nurse's initial action is:
A)
Tell the client they are allowed to refuse one time only and from now on they must go.
B)
Write a nursing note on the chart stating that the client refused.
C)
Determine why the client is refusing and then help the client process their choices.
D)
Explain that the client must cooperate or the physician will be called.

24)
The nurse is teaching a client who has gout. Which of the following should be included in the teaching?
A)
Avoid eating shellfish.

B)

Avoid drinking milk.

C)
Avoid drinking bottled water.

D)

Avoid eating cottage cheese.

25)
The nurse is teaching a client about risk factors for osteoporosis that can be changed, which include:
A)
Lifestyle.

B)

Age.

C)

Gender.

D)

Race.

26)
The nurse is assessing the client's spine, and the assessment includes an abnormal finding. The nurse should conduct further assessment by asking the
client to:
A)
Sit and then stand as the nurse observes the client from the front.
B)
Lie down on their abdomen so the nurse can look at the back more carefully.
C)
Bend over, stand tall, and stretch arms over the head.
D)
Stand, bend back slowly, then to the right and left while the nurse looks from the back.

27)
The nurse is caring for a client who was admitted following a fight. The client had several direct blows to the face. The assessment reveals normal blood
pressure (BP), elevated pulse (P-108), elevated respiratory rate (RR-24), and obvious deformity to the right side of the face. The most important priority
for client care is:
A)
Monitor the elevated respiratory rate and maintain the airway.
B)
Monitor the elevated pulse rate and look for signs of pallor.
C)
Frequently assess for facial pain and administer pain medication prn.
D)
Frequently assess the blood pressure for signs of shock and initiate IV fluids.

28)
A client is experiencing symptoms of gout. The nurse expects which of the following diagnostic test(s) will be ordered to diagnose gout? (Select all that
apply.)
A)
Serum uric acid level

B)

MRI of the right foot

C)
CT of the right foot

D)

Complete blood count (CBC)

29)
A client comes to the emergency department complaining of right knee pain after being knocked down while playing basketball. The exam reveals the
client experiences difficulty when stepping down on the right leg due to acute pain around the knee and slight swelling of the right knee. Initially, the
nurse expects that:
A)
The client will be sent home with instructions to use ice for one week.
B)
The client will be admitted to the hospital and scheduled for exploratory surgery.
C)
The client will be admitted to the hospital and seen by an orthopedic specialist.
D)
The client will be scheduled to see an orthopedic physician and a tentative appointment for a magnetic resonance imaging (MRI) scan.

30)
The nurse should assess for signs and symptoms of possible compartment syndrome after: (Select all that apply.)
A)
Cast application to a limb.

B)

Crush injury to a limb.

C)
Fasciotomy.

D)

Fat embolism.

31)
In the client who has had surgery to repair a fracture, there is a risk of fat embolus. The early sign(s) and symptom(s) of fat embolus is (are):
A)
Fever.

B)

Chest pain.
C)
Petechiae and tachycardia.

D)

Restlessness.

32)
A client is seen in the clinic for chronic low blood calcium. What effect will this have on bone health?
A)
Bone resorption will be triggered in order to increase serum calcium levels.
B)
Bone production will occur in order to help increase the blood calcium.
C)
Bones will pull the needed calcium from other body structures.
D)
Bones will not be affected because the calcium is low in the blood.

33)
The main nursing responsibility before and after applying traction to the leg is:
A)
Check for pallor.

B)

Assess for pain.

C)
Assess for paresthesia.

D)

Check the distal pulse.

34)
A 62-year-old female client is scheduled to have a DEXA exam as a screening tool. The most likely reason that the test has been ordered is:
A)
To check for fractures.

B)

To evaluate bone cancer.

C)
To check the degree of osteoporosis.

D)

To screen for osteomyelitis.

35)
The nurse is preparing a presentation about adult bone health at the local health fair. Which of the following statements should the nurse include?
A)
Strong bones depend on calcium intake and weight-bearing exercise.
B)
In order to maintain bone health, daily multivitamins are necessary.
C)
Calcium supplements are necessary for adult bone health.
D)
Avoiding obesity will guarantee healthy bones for adults.

36)
When moving a client with a fracture of the leg, the nurse should:
A)
Make sure that the extremity is supported distal to the fracture.
B)
Support the leg directly under the fracture.
C)
Support the extremity above and below the fracture.
D)
Disconnect the weights from the balanced traction setup.

37)
A client is seen in the physician's office following several tests. The test results include elevated blood calcium, elevated alkaline phosphatase, elevated
phosphorus, normal creatine kinase, and increased uptake of the radioisotope on bone scan. The nurse realizes that the most likely diagnosis is:
A)
Rheumatoid arthritis.

B)

Bone cancer.
C)
Osteoporosis.

D)

Bone spurs.

38)
The nurse is teaching about an endoscopic examination of the interior surfaces of a joint during which surgery and diagnosis can also be accomplished.
What is a correct name for this technique?
A)
Arthroscopy

B)

Arthrocentesis

C)

Arthrogenesis

D)

Arthrodonesia

39)
A client has early onset osteoarthritis of the left knee. The nurse expects which medication will be ordered?
A)
Hyaluronan (Synvisc)

B)

Meperidine (Demerol)
C)
Prednisone

D)

Ibuprofen (Motrin)

40)
The nurse is providing information to a client about Paget's disease. Which of the following statements by the client about pathophysiology of the
disease reflects understanding?
A)
"Metabolic activity is enhanced and no bone resorption occurs, followed by continuing bone formation."
B)
"Because metabolic activity is compromised, excessive bone resorption occurs followed by no bone formation."
C)
"Metabolic activity remains the same but bone resorption ceases and bones become larger."
D)
"Due to excessive metabolic activity, excessive bone resorption occurs followed by excessive bone formation."

41)
In caring for a client with an external fixator device, the nurse will:
A)
Adjust the tension on the pins whenever the client experiences pain.
B)
Explain that bathing in a tub can be resumed after three days.
C)
Cleanse pin sites per orders to reduce the chance of infection.
D)
Encourage the client to keep the limb with the external fixator very still.

42)
When caring for a client after an orthopedic leg surgery, the method that should be used for urinary elimination is:
A)
Walk to bathroom with help.

B)

Fracture bedpan.
C)
Regular bedpan.

D)

Bedside commode.

43)
The nurse should prepare the client for standard x-rays of an arm by:
A)
Finding out the client's allergies.
B)
Doing no special preparation.
C)
Cleansing the arm with antibacterial cleanser.
D)
Initiating a peripheral IV in the opposite arm.

44)
A priority nursing diagnosis to consider for every client who has undergone an above the knee amputation is:
A)
Altered Body Image

B)

Chronic Pain
C)
Altered Nutrition

D)

Risk for Infection

45)
The client is recovering from orthopedic surgery on a fractured arm. The nurse realizes that for musculoskeletal function, what type of muscle is needed?
A)
A combination of skeletal and smooth

B)

Smooth
C)
Cardiac

D)

Skeletal

46)
The client is about to have a magnetic resonance imaging (MRI) to diagnose a soft tissue abnormality of the lower leg. The nurse should immediately
notify the physician about which of the following?
A)
The client has a concern about what will be found on the MRI.
B)
The client has a history of hypertension.
C)
The client did not eat breakfast due to earlier nausea.
D)
The client has a pacemaker.

47)
Following hip replacement surgery, the client returns with an abductor splint in place. This means:
A)
The splint is only needed when the client rolls onto their side to sleep.
B)
The splint is taken off while the client sleeps.
C)
The splint will stay on except when bathing.
D)
The splint is optional after the day of surgery.

48)
When caring for older adults, the nurse realizes that an age-related change in the musculoskeletal system is:
A)
Vertebrae lengthen and thin, which leads to increased bone production.
B)
Difficulty with dexterity after age 50.
C)
Pain when ambulating due to increased bone mass and minerals.
D)
Decreased bone mass and calcium absorption, which lead to a chance for fractures.

49)
The nurse is providing nutrition education to the residents of a senior center. The presentation addresses the implication of vitamin D deficiency and low
serum levels of phosphorus. Based upon their knowledge, the nurse advises the participants that potential complications include:
A)
Osteomalacia; due to low intake of calcium and vitamin D in the diet.
B)
Tophi formation due to low intake of nutrients needed for bone formation.
C)
Osteosarcoma; due to lack of nutrients that allows mutation of cells.
D)
Osteomyelitis; due to lack of nutrients for muscle cells, which then become inflamed.

50)
A client has been very slow to recover from a fracture. The physician has ordered a treatment that will increase the migration of osteoblasts and
osteoclasts to the fracture site. The nurse realizes that this treatment is:
A)
Electrical bone stimulation.

B)

Fracture assimilation.
C)
Open reduction and manipulation.

D)

Open visualization and debridement.

51)
A 52-year-old client is prescribed raloxifene (Evista) for the treatment of osteoporosis. The nurse realizes that this drug is used with postmenopausal
women, and that it works by:
A)
Inhibiting bone loss.
B)
Preventing bone loss by mimicking what estrogen does for bone density.
C)
Inhibiting bone breakdown.
D)
Stimulating osteoblast activity and increasing bone formation.

52)
A client's gait is considered normal during assessment if:
A)
The client does not stumble, run into objects, or fall.
B)
The gait is jerky and quick, which indicates the client has excellent motor control.
C)
The gait is smooth and steady without limping.
D)
The gait is slow and deliberate as if the client is gingerly pulling one side up to meet the other.

53)
Impaired physical mobility is a major nursing diagnosis for clients with osteoarthritis (OA). Nursing activities related to this diagnosis include:
A)
Assessing the range of motion of affected joints in order to plan appropriate interventions.
B)
Assessing the need for narcotic analgesics around the clock to prevent pain in activities of daily living.
C)
Encouraging consistently high activity levels in order to prevent other problems associated with OA.
D)
Encouraging taking care of own self-care needs in order to remain more active.

54)
The following lab results would likely be seen in a client who is diagnosed with osteomalacia is diagnosed:
A)
High serum calcium, and low parathyroid hormone and alkaline phosphatase.
B)
Low or normal serum calcium, and elevated parathyroid hormone and alkaline phosphatase.
C)
Elevated serum calcium, and normal parathyroid hormone and alkaline phosphatase.
D)
Low serum calcium, and normal parathyroid hormone and alkaline phosphatase.

55)
In the RICE therapy plan, what do the abbreviations mean?
A)
Rest, ice, CT scan, and elimination of pain
B)
Rest, immobilization, CT scan, and elimination of pain
C)
Rest, ice, compression, and elevation
D)
Rest, immobilization, compression, and elevation

PREPARED BY
MARVIN MADRID
Marvinmadrid2003@yahoo.co

m
1)

2)
D

3)
B, C, D

4)
C

5)
B

6)
C

7)
D

8)
A

9)
A

10)
C

11)
A

12)
D

13)
D

14)
A

15)
B

16)
D

17)
D

18)
C

19)
B

20)
C

21)
B

22)
B

23)
C

24)
A

25)
A

26)
A

27)
A

28)
A, D

29)
D

30)
A, B

31)
C

32)
A

33)
D

34)
C

35)
A

36)
C

37)
B

38)
A

39)
D

40)
D

41)
C

42)
B

43)
B

44)
A

45)
D

46)
D

47)
C

48)
D

49)
A

50)
A

51)
B

52)
C

53)
A

54)
B

55)
C