Musculoskeletal Practice Questions PDF

**Musculoskeletal Practice** **A. Osteoporosis** **1. Which of the following is a hallmark sign of osteoporosis?** a\. Joint swelling and tenderness\ b. Loss of height and kyphosis\ c. Heberden's and Bouchard's nodes\ d. Morning stiffness lasting more than an hour **Answer:** b. Loss of height a...

**Musculoskeletal Practice** **A. Osteoporosis** **1. Which of the following is a hallmark sign of osteoporosis?** a\. Joint swelling and tenderness\ b. Loss of height and kyphosis\ c. Heberden's and Bouchard's nodes\ d. Morning stiffness lasting more than an hour **Answer:** b. Loss of height and kyphosis\ **Rationale:** Osteoporosis leads to vertebral compression fractures, resulting in loss of height and kyphosis (Dowager's hump). **2. What is the primary pathophysiological process in osteoporosis?** a\. Overgrowth of bone and cartilage\ b. Increased osteoblastic activity\ c. Imbalance where bone resorption exceeds bone formation\ d. Deposition of calcium crystals in joints **Answer:** c. Imbalance where bone resorption exceeds bone formation\ **Rationale:** Osteoclast activity (bone breakdown) exceeds osteoblast activity (bone formation), leading to reduced bone density. **3. Which diagnostic test is considered the gold standard for osteoporosis?** a\. X-ray\ b. MRI\ c. DEXA scan\ d. Bone biopsy **Answer:** c. DEXA scan\ **Rationale:** Dual-energy X-ray absorptiometry (DEXA) is the most accurate and widely used test for diagnosing osteoporosis. **4. Which medication is commonly prescribed for osteoporosis to inhibit bone resorption?** a\. Acetaminophen\ b. Alendronate\ c. Methotrexate\ d. Hydroxychloroquine **Answer:** b. Alendronate\ **Rationale:** Alendronate is a bisphosphonate that slows bone resorption by inhibiting osteoclast activity. **B. Osteoarthritis** **5. Which of the following is a key risk factor for osteoarthritis?** a\. Autoimmune disorder\ b. Increased uric acid levels\ c. Obesity and aging\ d. Vitamin D deficiency **Answer:** c. Obesity and aging\ **Rationale:** Osteoarthritis is a degenerative joint disease influenced by mechanical wear and tear, obesity, and aging. **6. What is the primary pathological change in osteoarthritis?** a\. Erosion of articular cartilage\ b. Deposition of uric acid crystals\ c. Systemic inflammation\ d. Synovial membrane hypertrophy **Answer:** a. Erosion of articular cartilage\ **Rationale:** Osteoarthritis is characterized by progressive loss of cartilage and subsequent bone remodeling. **7. Which of the following surgical interventions is used for severe osteoarthritis?** a\. Kyphoplasty\ b. Total knee replacement (TKR)\ c. Synovectomy\ d. Fasciotomy **Answer:** b. Total knee replacement (TKR)\ **Rationale:** TKR and total hip replacement (THR) are common surgical treatments for advanced osteoarthritis. **C. Rheumatoid Arthritis (RA)** **8. Rheumatoid arthritis primarily affects which type of joint?** a\. Fibrous joints\ b. Cartilaginous joints\ c. Diarthrodial joints\ d. Synostoses **Answer:** c. Diarthrodial joints\ **Rationale:** RA is an autoimmune disorder affecting synovial joints, leading to inflammation and deformities. **9. Which of the following medications is a disease-modifying antirheumatic drug (DMARD) used in RA?** a\. Naproxen\ b. Methotrexate\ c. Acetaminophen\ d. Aspirin **Answer:** b. Methotrexate\ **Rationale:** Methotrexate is a first-line DMARD that slows the progression of RA by suppressing immune function. **D. Fractures** **10. A patient with a femur fracture suddenly develops dyspnea, petechiae, and confusion. What complication should the nurse suspect?** a\. Pulmonary embolism\ b. Fat embolism syndrome\ c. Compartment syndrome\ d. Osteomyelitis **Answer:** b. Fat embolism syndrome\ **Rationale:** Fat embolism occurs when fat globules enter circulation, leading to respiratory distress and neurologic symptoms. **11. What is a priority nursing intervention for a patient with a newly applied cast?** a\. Keep the cast covered at all times\ b. Elevate the extremity and assess neurovascular status\ c. Apply heat to prevent stiffness\ d. Remove the cast to inspect the skin **Answer:** b. Elevate the extremity and assess neurovascular status\ **Rationale:** Elevation reduces swelling, and neurovascular checks prevent complications like compartment syndrome. **E. Back Problems and Laminectomy** **12. Which of the following is a post-operative priority after a laminectomy?** a\. Encouraging early ambulation\ b. Monitoring for urinary retention and CSF leakage\ c. Applying heat therapy immediately\ d. Keeping the patient in high Fowler's position **Answer:** b. Monitoring for urinary retention and CSF leakage\ **Rationale:** CSF leakage (clear fluid at incision site) and urinary retention are complications of spinal surgery. **F. Amputations** **13. What is the most common cause of lower limb amputations?** a\. Trauma\ b. Peripheral vascular disease (PVD)\ c. Osteoporosis\ d. Congenital defects **Answer:** b. Peripheral vascular disease (PVD)\ **Rationale:** PVD, often caused by diabetes, is the leading cause of non-traumatic lower extremity amputations. **14. Which is an appropriate intervention for preventing phantom limb pain?** a\. Massaging the residual limb\ b. Keeping the limb elevated at all times\ c. Using mirror therapy\ d. Avoiding opioids **Answer:** c. Using mirror therapy\ **Rationale:** Mirror therapy helps reduce phantom limb pain by providing visual feedback. **G. Gout** **15. Which of the following lab findings is expected in a patient with gout?** a\. Increased CRP\ b. Low calcium levels\ c. Elevated uric acid levels\ d. Low hemoglobin **Answer:** c. Elevated uric acid levels\ **Rationale:** Gout is caused by hyperuricemia, leading to crystal deposits in joints. **16. What is the first-line pharmacologic treatment for an acute gout attack?** a\. Methotrexate\ b. Allopurinol\ c. Colchicine\ d. Alendronate **Answer:** c. Colchicine\ **Rationale:** Colchicine reduces inflammation in acute gout attacks, while allopurinol is used for prevention. **D. Fractures (continued)** **17. Which of the following is a sign of compartment syndrome in a patient with a cast?** a\. Diminished pain that improves with elevation\ b. Capillary refill of less than 2 seconds\ c. Pain unrelieved by analgesics and worsened by elevation\ d. Decreased sensation that resolves with repositioning **Answer:** c. Pain unrelieved by analgesics and worsened by elevation\ **Rationale:** Compartment syndrome occurs when swelling increases pressure within a closed space, compromising circulation. **18. A patient with an external fixation device should be taught to:** a\. Remove and clean the pins daily\ b. Avoid touching the pins to reduce infection risk\ c. Use sterile technique for pin care and monitor for signs of infection\ d. Loosen the screws if discomfort occurs **Answer:** c. Use sterile technique for pin care and monitor for signs of infection\ **Rationale:** Pin care is essential to prevent infection; sterile cleaning with prescribed solutions should be done regularly. **19. The priority action when assessing a patient with a suspected hip fracture is:** a\. Applying a splint\ b. Checking neurovascular status\ c. Administering pain medication\ d. Encouraging early ambulation **Answer:** b. Checking neurovascular status\ **Rationale:** A hip fracture can cause neurovascular compromise; immediate assessment prevents complications. **20. The nurse should suspect a fat embolism in a patient with a long bone fracture who develops:** a\. Bradycardia and chest pain\ b. Hypotension and bradypnea\ c. Dyspnea, petechiae, and confusion\ d. Fever and muscle spasms **Answer:** c. Dyspnea, petechiae, and confusion\ **Rationale:** Fat embolism syndrome presents with respiratory distress, neurological symptoms, and petechiae on the chest or axilla. **E. Back Problems & Laminectomy (continued)** **21. The most important post-operative intervention after a lumbar laminectomy is:** a\. Keeping the patient flat in bed for 48 hours\ b. Encouraging early ambulation\ c. Monitoring for CSF leakage and sensation changes\ d. Encouraging coughing and deep breathing without splinting **Answer:** c. Monitoring for CSF leakage and sensation changes\ **Rationale:** CSF leakage (clear drainage at the incision site) and neurological deficits require immediate intervention. **22. A patient recovering from a laminectomy should be advised to:** a\. Avoid bending, twisting, or heavy lifting\ b. Lie flat for several weeks post-op\ c. Expect worsening numbness and tingling in the legs\ d. Avoid walking to prevent spinal strain **Answer:** a. Avoid bending, twisting, or heavy lifting\ **Rationale:** These movements increase pressure on the spine and should be avoided to promote healing. **F. Amputations (continued)** **23. To prevent contractures after a below-knee amputation, the nurse should instruct the patient to:** a\. Keep the residual limb elevated at all times\ b. Lie prone several times a day\ c. Perform passive ROM exercises only\ d. Keep the stump flexed to prevent pain **Answer:** b. Lie prone several times a day\ **Rationale:** Lying prone helps stretch the hip flexors and prevents contractures. **24. A patient with an above-knee amputation reports phantom limb pain. Which intervention is most appropriate?** a\. Applying heat to the residual limb\ b. Encouraging the patient to avoid thinking about the limb\ c. Administering prescribed gabapentin\ d. Massaging the residual limb **Answer:** c. Administering prescribed gabapentin\ **Rationale:** Gabapentin is commonly used for neuropathic pain, including phantom limb pain. **G. Gout (continued)** **25. A nurse is teaching a patient with gout about dietary changes. Which food should the patient avoid?** a\. Cheese\ b. Chicken breast\ c. Organ meats\ d. Whole grains **Answer:** c. Organ meats\ **Rationale:** Organ meats are high in purines, which increase uric acid levels and worsen gout. **26. The nurse understands that a patient with chronic gout is most likely to be prescribed:** a\. Acetaminophen\ b. Naproxen\ c. Allopurinol\ d. Prednisone **Answer:** c. Allopurinol\ **Rationale:** Allopurinol reduces uric acid production, preventing gout attacks. **27. What is a common symptom of acute gout?** a\. Severe joint pain in the big toe\ b. Muscle cramps and weakness\ c. Bilateral joint swelling and stiffness\ d. Joint pain relieved by exercise **Answer:** a. Severe joint pain in the big toe\ **Rationale:** Gout typically affects the first metatarsophalangeal joint (big toe) with sudden severe pain and inflammation. **General Mobility-Related Questions** **28. A patient who had a total hip replacement should avoid:** a\. Using a raised toilet seat\ b. Crossing their legs\ c. Performing isometric exercises\ d. Using an abduction pillow **Answer:** b. Crossing their legs\ **Rationale:** Crossing legs increases the risk of hip dislocation post-THR. **29. The nurse knows that the first sign of osteoarthritis is typically:** a\. Morning stiffness lasting more than 1 hour\ b. Symmetric joint inflammation\ c. Pain that worsens with activity\ d. Joint deformities such as ulnar deviation **Answer:** c. Pain that worsens with activity\ **Rationale:** Osteoarthritis pain increases with joint use and improves with rest. **30. Which intervention is most effective in reducing fall risk for an elderly patient with osteoporosis?** a\. Using scatter rugs for better traction\ b. Encouraging weight-bearing exercise\ c. Restricting outdoor activities\ d. Encouraging bed rest **Answer:** b. Encouraging weight-bearing exercise\ **Rationale:** Weight-bearing exercise helps maintain bone density and reduces fall risk. **31. What should the nurse teach a patient taking alendronate for osteoporosis?** a\. Take the medication with food to reduce GI distress\ b. Remain upright for 30 minutes after taking it\ c. Take it at bedtime for best absorption\ d. Drink orange juice with it for better absorption **Answer:** b. Remain upright for 30 minutes after taking it\ **Rationale:** Alendronate can cause esophageal irritation, so the patient should stay upright after taking it. **D. Fractures (continued)** **32. Which statement by a patient with a cast indicates a need for further teaching?** a\. \"I will elevate my leg for the first 24-48 hours.\"\ b. \"I should report numbness or tingling in my toes.\"\ c. \"I can insert a small object to scratch inside the cast if it itches.\"\ d. \"I will keep my cast dry and clean.\" **Answer:** c. \"I can insert a small object to scratch inside the cast if it itches.\"\ **Rationale:** Inserting objects can lead to skin breakdown and infection. Instead, a cool blow-dryer can help relieve itching. **33. A patient in skeletal traction complains of severe pain unrelieved by medication. What should the nurse suspect?** a\. The patient is becoming tolerant to pain medications\ b. The weights need to be increased\ c. The weights are incorrectly applied\ d. The patient has developed compartment syndrome **Answer:** d. The patient has developed compartment syndrome\ **Rationale:** Severe pain unrelieved by medication is a hallmark sign of compartment syndrome. **34. A patient with an open fracture is at risk for which complication?** a\. Osteomyelitis\ b. Deep vein thrombosis\ c. Fat embolism syndrome\ d. Hemarthrosis **Answer:** a. Osteomyelitis\ **Rationale:** Open fractures increase the risk of infection, including osteomyelitis, due to exposure to bacteria. **E. Back Problems & Laminectomy (continued)** **35. After a spinal surgery, which assessment finding should be reported immediately?** a\. Mild headache\ b. Decreased bowel sounds\ c. Inability to move toes\ d. Pain at the incision site **Answer:** c. Inability to move toes\ **Rationale:** A new loss of motor function could indicate spinal cord compression or nerve damage. **36. What is the best sleeping position for a patient after lumbar laminectomy?** a\. Flat on the back with no pillow\ b. Side-lying with a pillow between the knees\ c. Prone with arms overhead\ d. Sitting in a recliner **Answer:** b. Side-lying with a pillow between the knees\ **Rationale:** This position maintains spinal alignment and reduces strain. **F. Amputations (continued)** **37. What is a priority intervention in the immediate post-op period for an above-knee amputation?** a\. Elevate the residual limb at all times\ b. Monitor for excessive bleeding\ c. Avoid any weight-bearing activity\ d. Keep the stump uncovered **Answer:** b. Monitor for excessive bleeding\ **Rationale:** Hemorrhage is the most immediate risk after amputation. **38. Which exercise should be encouraged for a patient with a below-knee amputation?** a\. Hip flexion stretches\ b. Upper body strengthening exercises\ c. Ankle rotation exercises\ d. Jumping jacks **Answer:** b. Upper body strengthening exercises\ **Rationale:** Strengthening the upper body helps with mobility and the use of assistive devices. **G. Gout (continued)** **39. What is a major lifestyle modification to prevent recurrent gout attacks?** a\. Increase red meat intake\ b. Reduce alcohol consumption\ c. Avoid dairy products\ d. Limit fluid intake **Answer:** b. Reduce alcohol consumption\ **Rationale:** Alcohol, especially beer, increases uric acid levels, worsening gout. **40. Which medication is used for long-term management of gout?** a\. Indomethacin\ b. Colchicine\ c. Allopurinol\ d. Naproxen **Answer:** c. Allopurinol\ **Rationale:** Allopurinol prevents uric acid buildup and is used for chronic gout management. **41. What is the best non-pharmacologic intervention for an acute gout attack?** a\. Apply heat to the joint\ b. Immobilize and elevate the joint\ c. Perform range-of-motion exercises\ d. Massage the affected area **Answer:** b. Immobilize and elevate the joint\ **Rationale:** Resting and elevating the joint reduces inflammation and pain. **General Mobility-Related Questions (continued)** **42. The nurse is preparing a teaching plan for a patient with osteoarthritis. Which statement should be included?** a\. \"You should avoid all physical activity to prevent pain.\"\ b. \"Regular weight-bearing exercise can help maintain joint function.\"\ c. \"Morning stiffness is usually relieved with rest.\"\ d. \"This condition primarily affects young adults.\" **Answer:** b. \"Regular weight-bearing exercise can help maintain joint function.\"\ **Rationale:** Exercise helps strengthen muscles around joints, improving function and reducing stiffness. **43. Which vitamin is essential for calcium absorption in osteoporosis prevention?** a\. Vitamin A\ b. Vitamin B12\ c. Vitamin C\ d. Vitamin D **Answer:** d. Vitamin D\ **Rationale:** Vitamin D helps the body absorb calcium, essential for bone health. **44. A patient taking long-term corticosteroids is at risk for which condition?** a\. Osteoarthritis\ b. Osteoporosis\ c. Gout\ d. Rheumatoid arthritis **Answer:** b. Osteoporosis\ **Rationale:** Corticosteroids increase bone resorption, leading to osteoporosis. **45. Which of the following is a symptom of hip dislocation after total hip replacement?** a\. Sudden pain and shortening of the affected leg\ b. Gradual increase in stiffness over weeks\ c. Swelling and warmth at the incision site\ d. Redness and itching around the surgical dressing **Answer:** a. Sudden pain and shortening of the affected leg\ **Rationale:** Dislocation of the prosthetic hip causes immediate pain and leg shortening. **46. Which activity should be avoided after a total knee replacement (TKR)?** a\. Walking with a walker\ b. Crossing the legs\ c. Using an elevated toilet seat\ d. Performing knee flexion exercises **Answer:** b. Crossing the legs\ **Rationale:** Crossing legs can cause knee dislocation after TKR. **47. A patient with osteoporosis asks how to prevent fractures. The nurse should recommend:** a\. Bed rest for at least 12 hours daily\ b. Daily weight-bearing exercise\ c. A diet high in phosphorus\ d. Avoiding dairy products **Answer:** b. Daily weight-bearing exercise\ **Rationale:** Weight-bearing exercise stimulates bone formation and reduces fracture risk. **48. What is the best way to evaluate effective pain management in a patient with osteoarthritis?** a\. Assess pain levels before and after intervention\ b. Monitor serum calcium levels\ c. Check for joint swelling\ d. Evaluate range of motion **Answer:** a. Assess pain levels before and after intervention\ **Rationale:** Pain assessment helps determine effectiveness of pain management strategies. **49. What is the primary goal of treatment for rheumatoid arthritis?** a\. Cure the disease\ b. Prevent joint destruction and maintain function\ c. Completely eliminate pain\ d. Avoid all physical activity **Answer:** b. Prevent joint destruction and maintain function\ **Rationale:** RA is a chronic condition with no cure, so treatment focuses on slowing progression and preserving function. **50. Which intervention is best for managing stiffness in rheumatoid arthritis?** a\. Resting in bed throughout the day\ b. Applying warm compresses and gentle exercises\ c. Taking NSAIDs only when pain is severe\ d. Avoiding movement to reduce pain **Answer:** b. Applying warm compresses and gentle exercises\ **Rationale:** Heat therapy and movement help improve circulation and reduce stiffness.