NCLEX-Style Exam on Musculoskeletal Disorders - PDF

**NCLEX-Style Exam: Musculoskeletal Disorders** **Osteoporosis** 1. **Which of the following is a characteristic feature of osteoporosis?**\ a) Increased bone density\ b) Increased osteoblast activity\ c) Decreased bone mass and deterioration of bone tissue\ d) Increased calci...

**NCLEX-Style Exam: Musculoskeletal Disorders** **Osteoporosis** 1. **Which of the following is a characteristic feature of osteoporosis?**\ a) Increased bone density\ b) Increased osteoblast activity\ c) Decreased bone mass and deterioration of bone tissue\ d) Increased calcium levels in bones\ **Answer:** c) Decreased bone mass and deterioration of bone tissue\ **Rationale:** Osteoporosis is characterized by excessive bone resorption, leading to fragile bones. 2. **A patient is diagnosed with osteoporosis. Which diagnostic test is considered the gold standard for diagnosing this condition?**\ a) X-ray\ b) CT scan\ c) Dual-energy X-ray absorptiometry (DEXA)\ d) MRI\ **Answer:** c) Dual-energy X-ray absorptiometry (DEXA)\ **Rationale:** DEXA measures bone mineral density and is the best tool for diagnosing osteoporosis. 3. **Which of the following are risk factors for osteoporosis? (Select All That Apply)**\ a) Postmenopausal status\ b) Sedentary lifestyle\ c) High calcium intake\ d) Smoking\ e) Long-term corticosteroid use\ **Answer:** a, b, d, e\ **Rationale:** Risk factors include hormonal changes, inactivity, smoking, and corticosteroid use. 4. **Which medication is commonly prescribed for osteoporosis treatment?**\ a) Methotrexate\ b) Alendronate\ c) Etanercept\ d) Acetaminophen\ **Answer:** b) Alendronate\ **Rationale:** Alendronate is a bisphosphonate that reduces bone resorption. **Osteoarthritis (OA)** 5. **Which symptom is most characteristic of osteoarthritis?**\ a) Symmetrical joint swelling\ b) Pain that worsens with activity and improves with rest\ c) Systemic inflammation\ d) Positive rheumatoid factor\ **Answer:** b) Pain that worsens with activity and improves with rest\ **Rationale:** OA is degenerative, unlike RA, which has systemic inflammation. 6. **Which findings are expected in a patient with osteoarthritis? (Select All That Apply)**\ a) Heberden's nodes\ b) Swan neck deformity\ c) Bouchard's nodes\ d) Crepitus\ **Answer:** a, c, d\ **Rationale:** Swan neck deformity is a feature of RA, whereas Heberden's and Bouchard's nodes, along with crepitus, are OA-related. 7. **What is the primary goal of total knee arthroplasty (TKA)?**\ a) Cure osteoarthritis\ b) Relieve pain and restore joint function\ c) Improve bone density\ d) Prevent future fractures\ **Answer:** b) Relieve pain and restore joint function\ **Rationale:** TKA replaces damaged joints to restore mobility and reduce pain. **Rheumatoid Arthritis (RA)** 8. **Which feature differentiates RA from OA?**\ a) Unilateral joint involvement\ b) Presence of systemic inflammation\ c) Pain relief with activity\ d) Cartilage overgrowth\ **Answer:** b) Presence of systemic inflammation\ **Rationale:** RA is autoimmune and affects multiple joints systemically. 9. **Which medications are used to treat RA? (Select All That Apply)**\ a) Methotrexate\ b) NSAIDs\ c) Corticosteroids\ d) Hydroxychloroquine\ **Answer:** a, b, c, d\ **Rationale:** These drugs help manage inflammation and disease progression. 10. **What are early symptoms of RA?**\ a) Joint deformities\ b) Warm, swollen joints with morning stiffness\ c) Asymptomatic bone loss\ d) Limited joint movement due to pain\ **Answer:** b) Warm, swollen joints with morning stiffness\ **Rationale:** These early signs differentiate RA from other joint disorders. **Fractures** 11. **What is the priority assessment in a patient with a femur fracture?**\ a) Range of motion\ b) Capillary refill and pulses\ c) Pain level\ d) Presence of crepitus\ **Answer:** b) Capillary refill and pulses\ **Rationale:** Neurovascular checks ensure blood supply is intact. 12. **Which complication is most concerning with a long bone fracture?**\ a) Fat embolism\ b) Hypertension\ c) Hypocalcemia\ d) Deep vein thrombosis\ **Answer:** a) Fat embolism\ **Rationale:** Fat embolism syndrome can be fatal and occurs in long bone fractures. 13. **Which are signs of compartment syndrome? (Select All That Apply)**\ a) Severe pain unrelieved by medication\ b) Pallor\ c) Pulselessness\ d) Decreased sensation\ **Answer:** a, b, c, d\ **Rationale:** These are the classic "6 P's" of compartment syndrome. **Back Problems/Laminectomy** 14. **Which intervention is essential after a laminectomy?**\ a) Encouraging early ambulation\ b) Keeping the patient in high Fowler's position\ c) Logrolling the patient\ d) Applying heat to the surgical site\ **Answer:** c) Logrolling the patient\ **Rationale:** Logrolling maintains spinal alignment and prevents injury. 15. **What is the primary goal of laminectomy surgery?**\ a) Cure arthritis\ b) Relieve pressure on spinal nerves\ c) Strengthen vertebral bones\ d) Prevent spinal infection\ **Answer:** b) Relieve pressure on spinal nerves\ **Rationale:** Laminectomy decompresses the spinal cord to relieve pain. **Amputations** 16. **Which is a major post-amputation complication?**\ a) Gout\ b) Phantom limb pain\ c) Osteoarthritis\ d) RA flare-ups\ **Answer:** b) Phantom limb pain\ **Rationale:** This is a common post-amputation experience. 17. **What is an important nursing intervention for a patient with a new prosthesis?**\ a) Applying tight compression bandages\ b) Elevating the residual limb indefinitely\ c) Encouraging early weight-bearing\ d) Teaching proper skin care\ **Answer:** d) Teaching proper skin care\ **Rationale:** Preventing infection and irritation at the prosthesis site is crucial. **Gout** 18. **What is the primary cause of gout?**\ a) Increased uric acid levels\ b) Decreased calcium intake\ c) Low phosphorus levels\ d) Joint hypermobility\ **Answer:** a) Increased uric acid levels\ **Rationale:** Uric acid crystal deposits in joints trigger inflammation. 19. **Which food should a patient with gout avoid?**\ a) Green vegetables\ b) Red meat\ c) Dairy products\ d) Citrus fruits\ **Answer:** b) Red meat\ **Rationale:** Purine-rich foods (red meat, alcohol) increase uric acid. 20. **Which are clinical signs of acute gout? (Select All That Apply)**\ a) Red, swollen joints\ b) Pain in the big toe\ c) Joint deformities\ d) High fever\ **Answer:** a, b, c\ **Rationale:** Gout commonly affects the big toe and causes swelling and joint damage. **Fractures (Continued)** 21. **A patient with a closed femur fracture is placed in traction. What is the nurse's priority action?**\ a) Remove traction weights if pain occurs\ b) Ensure the weights hang freely\ c) Apply heat to the affected limb\ d) Keep the patient in Trendelenburg position\ **Answer:** b) Ensure the weights hang freely\ **Rationale:** Traction must remain in place and uninterrupted to maintain bone alignment. 22. **A patient with a cast reports severe pain unrelieved by medication. What is the nurse's next action?**\ a) Apply heat to the affected area\ b) Encourage movement of the limb\ c) Notify the healthcare provider immediately\ d) Elevate the extremity above heart level\ **Answer:** c) Notify the healthcare provider immediately\ **Rationale:** Severe pain unrelieved by medication is a sign of compartment syndrome, a medical emergency. 23. **Which intervention is essential for a patient with an external fixation device?**\ a) Encourage weight-bearing immediately\ b) Perform frequent pin care\ c) Remove crusting around pin sites\ d) Keep pins tightly bandaged\ **Answer:** b) Perform frequent pin care\ **Rationale:** Proper pin care prevents infection at the insertion site. 24. **Which of the following are complications of fractures? (Select All That Apply)**\ a) Fat embolism\ b) Osteomyelitis\ c) Compartment syndrome\ d) Hypertension\ **Answer:** a, b, c\ **Rationale:** Fractures can lead to fat embolism, bone infection (osteomyelitis), and compartment syndrome. 25. **A patient with a hip fracture is scheduled for surgery. What is the priority nursing intervention preoperatively?**\ a) Encourage early ambulation\ b) Place the patient in a high Fowler's position\ c) Maintain proper alignment of the leg\ d) Apply heat therapy\ **Answer:** c) Maintain proper alignment of the leg\ **Rationale:** Proper alignment prevents further injury before surgery. **Post-Operative Care: Total Knee & Hip Replacement** 26. **A patient is post-op from a total hip replacement (THR). What movement should they avoid?**\ a) Abduction of the hip\ b) Hip flexion greater than 90 degrees\ c) Using an abduction pillow\ d) Moving the hip slightly outward\ **Answer:** b) Hip flexion greater than 90 degrees\ **Rationale:** Excessive hip flexion can cause dislocation post-surgery. 27. **Which of the following are essential post-op interventions for a total knee replacement (TKR)? (Select All That Apply)**\ a) Use of a continuous passive motion (CPM) machine\ b) Avoiding weight-bearing for 6 months\ c) Early ambulation\ d) Regular use of anticoagulants\ **Answer:** a, c, d\ **Rationale:** CPM machines improve mobility, early ambulation prevents complications, and anticoagulants reduce clot risk. 28. **Which complication should the nurse monitor for in a post-op total hip replacement patient?**\ a) Deep vein thrombosis\ b) Hypercalcemia\ c) Hypertension\ d) Liver failure\ **Answer:** a) Deep vein thrombosis\ **Rationale:** Immobility increases the risk of clot formation post-op. 29. **A patient post-TKR asks why they need to wear sequential compression devices (SCDs). The nurse's best response is:**\ a) \"They prevent muscle atrophy.\"\ b) \"They reduce swelling in your leg.\"\ c) \"They help prevent blood clots.\"\ d) \"They stabilize your knee joint.\"\ **Answer:** c) \"They help prevent blood clots.\"\ **Rationale:** SCDs promote venous return and reduce the risk of DVTs. **Back Problems & Laminectomy** 30. **Which patient statement indicates a need for further teaching after a laminectomy?**\ a) \"I will use a firm mattress for back support.\"\ b) \"I will avoid twisting movements.\"\ c) \"I can drive myself home tomorrow.\"\ d) \"I will logroll when changing positions.\"\ **Answer:** c) \"I can drive myself home tomorrow.\"\ **Rationale:** Driving should be avoided immediately post-surgery. 31. **A patient post-laminectomy reports new onset numbness in their leg. What is the nurse's priority action?**\ a) Encourage ambulation\ b) Notify the healthcare provider\ c) Administer pain medication\ d) Apply heat therapy\ **Answer:** b) Notify the healthcare provider\ **Rationale:** Numbness may indicate nerve compression or damage. 32. **Which intervention is important for a post-op laminectomy patient? (Select All That Apply)**\ a) Monitor for urinary retention\ b) Logroll the patient when repositioning\ c) Encourage heavy lifting\ d) Assess for signs of infection\ **Answer:** a, b, d\ **Rationale:** Urinary retention, spinal misalignment, and infection are key post-op concerns. **Amputations & Prosthesis Care** 33. **Which statement by a patient post-amputation requires further teaching?**\ a) \"I should elevate my stump continuously to prevent swelling.\"\ b) \"I will check my residual limb for skin breakdown daily.\"\ c) \"I may experience phantom limb pain.\"\ d) \"I will use a limb sock before putting on my prosthesis.\"\ **Answer:** a) \"I should elevate my stump continuously to prevent swelling.\"\ **Rationale:** Continuous elevation can cause contractures. 34. **Which interventions should be included in the care of a patient with a new lower limb prosthesis? (Select All That Apply)**\ a) Gradual weight-bearing\ b) Inspecting the residual limb daily\ c) Avoiding lotion on the residual limb\ d) Wearing a prosthetic sock\ **Answer:** a, b, c, d\ **Rationale:** Proper skin care and gradual adaptation to the prosthesis are important. **Gout Management** 35. **Which dietary instruction should be given to a patient with gout?**\ a) Increase red meat intake\ b) Limit purine-rich foods\ c) Drink less water to prevent overhydration\ d) Increase dairy product consumption\ **Answer:** b) Limit purine-rich foods\ **Rationale:** Purine-rich foods increase uric acid levels, worsening gout. 36. **Which medications are used for acute gout attacks? (Select All That Apply)**\ a) Allopurinol\ b) Colchicine\ c) NSAIDs\ d) Methotrexate\ **Answer:** b, c\ **Rationale:** Colchicine and NSAIDs reduce inflammation during acute attacks. 37. **Which statement indicates understanding of gout management?**\ a) \"I will drink plenty of fluids to help eliminate uric acid.\"\ b) \"I should avoid dairy products to prevent flare-ups.\"\ c) \"I will increase my alcohol intake to reduce uric acid levels.\"\ d) \"Gout only affects my joints and not my kidneys.\"\ **Answer:** a) \"I will drink plenty of fluids to help eliminate uric acid.\"\ **Rationale:** Hydration prevents uric acid crystal formation. **Final Questions: General Musculoskeletal Concepts** 38. **Which intervention helps prevent osteoporosis?**\ a) Increased intake of calcium and vitamin D\ b) Prolonged bed rest\ c) Avoiding weight-bearing exercises\ d) Decreasing dairy intake\ **Answer:** a) Increased intake of calcium and vitamin D\ **Rationale:** Calcium and vitamin D maintain bone health. 39. **What is the primary treatment goal for osteoarthritis?**\ a) Cure the disease\ b) Reduce joint pain and improve function\ c) Prevent systemic complications\ d) Reduce autoimmune response\ **Answer:** b) Reduce joint pain and improve function\ **Rationale:** OA management focuses on symptom control. **Fracture Complications & Post-Operative Care** 40. **Which of the following patients is at highest risk for developing a fat embolism?**\ a) A 76-year-old patient with a wrist fracture\ b) A 55-year-old patient with a rib fracture\ c) A 30-year-old patient with a femur fracture\ d) A 65-year-old patient with osteoporosis\ **Answer:** c) A 30-year-old patient with a femur fracture\ **Rationale:** Fat embolism syndrome is most commonly associated with **long bone fractures**, particularly the **femur**. 41. **Which of the following is a sign of a fat embolism?**\ a) Sudden confusion and petechiae on the chest\ b) Decreased urine output and hypertension\ c) Bradycardia and jaundice\ d) Hypothermia and bradycardia\ **Answer:** a) Sudden confusion and petechiae on the chest\ **Rationale:** Fat embolism syndrome can cause **neurological impairment**, **petechiae**, and **respiratory distress**. **Osteoarthritis & Rheumatoid Arthritis** 42. **A patient with osteoarthritis asks about non-pharmacologic pain relief strategies. Which intervention should the nurse recommend?**\ a) Avoiding all physical activity\ **b) Applying cold packs before exercise\ c) Using heat therapy to relax stiff joints\ **d) Taking NSAIDs on an empty stomach\ **Answer:** c) Using heat therapy to relax stiff joints, b) Applying cold packs before exercise\ **Rationale:** **Heat therapy** can improve blood flow and relieve **joint stiffness** in **OA**. 43. **Which statement by a patient with rheumatoid arthritis (RA) indicates they need more teaching?**\ a) \"I should perform range-of-motion exercises every day.\"\ b) \"I will apply ice to my joints before exercise.\"\ c) \"I should take my methotrexate only when I feel symptoms.\"\ d) \"I will take breaks to avoid overexertion.\"\ **Answer:** c) \"I should take my methotrexate only when I feel symptoms.\"\ **Rationale:** **Methotrexate** should be taken **regularly**, even when symptoms improve, to prevent disease progression. **Gout & Amputation Care** 44. **A patient is diagnosed with chronic tophaceous gout. What complications should the nurse assess for? (Select All That Apply)**\ a) Joint deformities\ b) Kidney stones\ c) Osteoporosis\ d) Hypertension\ **Answer:** a, b\ **Rationale:** **Tophaceous gout** leads to **joint damage** and increases the risk of **kidney stones** due to uric acid accumulation. 45. **A patient with a below-knee amputation is experiencing phantom limb pain. Which intervention is most appropriate?**\ a) Apply a heating pad to the residual limb\ b) Administer prescribed gabapentin\ c) Tell the patient that the pain is not real\ d) Avoid touching the residual limb\ **Answer:** b) Administer prescribed gabapentin\ **Rationale:** **Gabapentin** (Neurontin) is effective in treating **neuropathic pain**, including **phantom limb pain**.