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NSG 3280 Unit 7: Musculoskeletal Practice
Questions
Question 1 A nurse is assessing a patient who experienced a ligament injury during a sporting event. The patient reports severe pain and the nurse notes significant instability in the affected joint. Based on the classification system for ligament injuries, which grade does the nurse anticipate the physician will assign? A. Grade 1 B. Grade 2 C. Grade 3 D. Micro failure Question 2 A 45-year-old construction worker sustained a crush injury to the lower leg. Examination reveals an unstable fracture with multiple bone fragments and a wound greater than 2 cm that is visibly contaminated with dirt and gravel. The orthopedic team classifies this as an Open Fracture Grade III. Which findings justify the assignment of this specific wound classification? A. The presence of multiple bone fragments. B. The wound size is greater than 1 cm. C. The fracture is unstable and comminuted. D. The presence of high contamination. E. Significant soft tissue damage is involved. Question 3 (Select All That Apply) The nurse is educating a student about the specialized structure of the joint capsule. Which functions or characteristics should the nurse highlight regarding the inner layer (synovial membrane)? A. It is less vascular than the outer layer. B. It contains the majority of the joint's nerves. C. It produces hyaluronic acid for lubrication. D. It synthesizes matrix collagen, the structural protein. E. It lines the joint cavity.
Question 4 A pediatric patient, age 6, is brought to the clinic after a fall. The X-ray reveals an incomplete break where the bone cortex has buckled but the fracture does not extend across the entire bone. Which two fracture types are specifically associated with this description or are usually seen in children? A. Spiral and Avulsion B. Greenstick and Longitudinal C. Greenstick and Incomplete D. Comminuted and Impacted Question 5 A nurse is reviewing the results of a patient's CT scan following severe blunt trauma to the thigh. The nurse notes documentation suggesting calcification of the muscle tissue (myositis ossificans). This complication is a direct result of which initial pathological process following blunt trauma? A. Decreased range of motion (ROM) B. Hemorrhage of the muscle belly C. Increased vascularity of the bursa D. Decreased contractibility of the muscle Question 6 When discussing the pathophysiology of different bone types, the nurse explains that the cortical bone is structurally optimized for which mechanical stress, and where is a fracture most likely to occur under tension? A. Decreased tolerance for compression; fracture occurs in the interior of the bone. B. Built for compression and shear; fracture occurs on the convex side. C. Spongy and lattice-like; fracture occurs under rotational force. D. Built for tension and bending; fracture occurs on the concave side.
Question 10 A nurse is examining an X-ray of a patient who suffered a crush injury. The image shows a fracture where excessive force has driven one fragment of bone into another. This fracture type is known as: A. Comminuted B. Stress C. Depressed D. Impacted Question 11 A patient sustained a complex tibial fracture 8 months ago. Despite ongoing treatment, the patient continues to experience bone pain, and recent imaging confirms the fracture site has not healed. Which fracture complication is defined by a lack of healing after 6 months? A. Delayed Union B. Malunion C. Nonunion D. Osteonecrosis Question 12 A patient who had a long bone fracture 48 hours ago begins to exhibit sudden shortness of breath (SOB), tachypnea, and petechiae across the chest, followed by altered mental status. The nurse recognizes these findings as the classic triad associated with which life-threatening complication? A. Compartment Syndrome B. Osteomyelitis C. Fat Embolism Syndrome (FES) D. Osteonecrosis Question 13 (SATA) A nurse is caring for a patient admitted with osteomyelitis. The patient is a child under 16 who recently had a blunt
trauma where a hematoma formed. Which clinical manifestations should the nurse expect to assess? A. Fever B. Pain at the infected site (at rest) C. Increased appetite (anorexia) D. Malaise E. Night sweats Question 14 A patient is diagnosed with osteomyelitis resulting from a severe infected tooth. The nurse understands that the pathogen most likely reached the bone through which route of infection? A. Hematogenous B. Contiguous C. Direct introduction D. Blunt trauma Question 15 A patient with a cast reports excruciating pain in the lower leg, unrelieved by narcotics, and the nurse notes worsening edema and decreased blood flow distal to the injury. The priority intervention is based on the understanding that the underlying pathology is most likely: A. Bone ischemia leading to bone death due to blood vessel occlusion. B. Inflammation and edema increasing pressure within the restrictive fascia. C. Release of fat particles into the bloodstream lodging in the lungs. D. Improper alignment of bone fragments due to premature weight bearing. Question 16 (SATA) A patient is recovering from a fracture. The nurse notes several risk factors in the patient's chart that may contribute to Delayed Union. Which factors are associated with delayed bone healing (3– months)?
Question 20 Osteonecrosis (avascular necrosis) is identified on a patient's imaging. The nurse understands that this process involves bone ischemia and death primarily due to which mechanical or circulatory event? A. Pathogen introduction via an open wound. B. Blood vessel occlusion related to the fracture. C. Hyperuricemia leading to crystal deposition. D. Excessive bone resorption followed by disorganized formation. Question 21 A 75-year-old postmenopausal woman with a small, thin build is diagnosed with osteoporosis. The nurse explains the underlying pathophysiology as a primary imbalance between bone-forming and bone- resorbing cells. This imbalance involves: A. Decreased osteoblast activity and increased osteoclast activity. B. Increased osteoblast activity and decreased osteoclast activity. C. Excessive bone resorption followed by excessive, but disorganized, bone formation. D. Deficits in the mineralization of newly formed bone. Question 22 (SATA) A patient with severe Paget Disease is reporting new onset symptoms. Due to the tendency of this disorder to affect the skull, which neurological or sensory manifestations should the nurse assess for that signal cranial nerve compression? A. Facial paralysis B. Vertigo C. Hypercalcemia D. Deafness E. Bowing of weight-bearing structures
Question 23 A patient with a history of chronic intestinal issues resulting in poor absorption is diagnosed with osteomalacia. the nurse understands that the primary deficit leading to this condition is: A. Decreased estrogen levels B. A lack of the enzyme uricase. C. Vitamin D deficiency D. Excessive bone trauma Question 24 Rickets is the pediatric form of osteomalacia. A distinguishing feature seen in children with Rickets is the inability of cartilage in the growing epiphyses to calcify. This leads to which specific orthopedic manifestations? A. Heberden’s nodes B. Knocked knees and bowed legs C. Rib or chest hump when bending over D. Spinal rotation (structural scoliosis) Question 25 (SATA) A nurse is conducting a health history for an elderly male suspected of having osteoporosis. Which elements from his history serve as risk factors for this condition? A. White race B. Corticosteroid use C. Physical inactivity D. Small, thin build E. Hyperuricemia Question 26 (SATA) When teaching the parents of an adolescent with severe scoliosis about the potential long-term complications, the nurse should include information regarding which body systems being affected?
The nurse understands that the use of which medication class is a known risk factor for the patient’s likely underlying diagnosis? A. Beta-blockers B. Thyroid supplements C. Penicillins D. Uricase inhibitors Question 30 The nurse is reviewing the chart of a 68-year-old patient diagnosed with the most common primary bone tumor. The chart notes a slow-growing malignancy involving excessive plasma cells in the marrow of the thoracic vertebrae. This presentation is consistent with: A. Osteosarcoma B. Ewing sarcoma C. Multiple myeloma D. Chondrosarcoma Question 31 (SATA) A 16-year-old male is diagnosed with osteosarcoma of the proximal tibia. The nurse must counsel the family about the rapid progression and typical metastasis route of this malignancy. Which statements are accurate? A. It is the most common primary bone tumor. B. It involves the formation of bone by tumor cells, leading to cortex destruction. C. It most commonly metastasizes to the lungs. D. Consistent, progressive limb pain is a common symptom. E. It is often mistaken for osteomyelitis. Question 32 A 5-year-old male is diagnosed with Duchenne Muscular Dystrophy (DMD). The nurse explains to the parents that the underlying pathology is related to an X-linked genetic mutation resulting in:
A. Decreased levels of the protein dystrophin, leading to slower degeneration. B. Complete lack of the protein dystrophin, leading to inflammation and muscle fiber necrosis. C. Round cell tumors causing soft tissue masses over affected areas. D. Excessive plasma cells accumulating in the marrow. Question 33 A nurse is reviewing the diagnostic results for two patients. Patient A, an elderly male with a history of chronic corticosteroid use and smoking, shows decreased bone width and porous bone on imaging. Patient B, a 30-year-old female with severe intestinal issues causing malabsorption, shows bowing of weight-bearing structures on X-ray. The nurse concludes that the primary difference in the underlying pathophysiology of these two bone disorders is: A. Patient A has excessive bone resorption followed by excessive, disorganized bone formation, while Patient B has bone infection spread via the bloodstream. B. Patient A has decreased osteoblast activity and increased osteoclast activity, while Patient B has deficits in the mineralization of newly formed bone. C. Patient A has cortical surface failure due to repetitive stress, while Patient B has complete tearing of ligaments causing instability. D. Patient A has excessive plasma cells in the marrow, while Patient B has inflammation due to uric acid crystals. Question 34 A mother notes that her 4-year-old son has enlarged calf muscles despite a progressive loss of strength and frequent falls. The nurse identifies the enlarged calf muscles (due to fat cell infiltration and muscle degeneration) as a key manifestation of which disorder? A. Becker Muscular Dystrophy B. Paget Disease C. Duchenne Muscular Dystrophy D. Osteoid Osteoma Question 35 A 35-year-old female is diagnosed with a Giant Cell Tumor (Osteoclastoma) of the distal radius. The nurse counsels her that this tumor
A. It develops slowly. B. It can develop secondary to an osteochondroma. C. It is typically a painful tumor due to rapid growth. D. It is cartilage-forming. E. Common locations include the pelvis and ribs. Question 39 The nurse is reviewing an X-ray of a patient’s femur showing a benign, cartilage-forming tumor located in the metaphysis. The patient reports no symptoms. This description aligns with which benign tumor? A. Chondroma B. Osteochondroma C. Multiple myeloma D. Giant cell tumor Question 40 A patient presents with bony enlargements at the distal finger joints (Bouchard’s nodes) and reports crepitus with movement and morning stiffness. The patient's history includes obesity. These findings are most indicative of: A. Psoriatic Arthritis B. Gout C. Osteoarthritis (OA) D. Neuropathic Osteoarthropathy Question 41 A nurse is assessing a patient with gout who reports severe pain in the great toe. Which phase precedes this acute attack? A. Intercritical phase B. Chronic tophaceous gout C. Asymptomatic phase (hyperuricemia) D. Recovery phase Question 42 (SATA) Which of the following are considered potential triggers for an acute gout attack? A. Trauma
B. Alcohol (ETOH) C. Surgery D. Poor nutrition (low Ca/Vit D) E. Illness Question 43 A patient with a history of Crohn’s disease presents with inflammatory arthritis affecting only a few joints in an asymmetric pattern. The nurse suspects Enteropathic Arthritis, understanding that the mechanism involves: A. Immune system attacking joint tissue triggered by psoriasis. B. Gut inflammation allowing bacteria to enter the blood/lymph and trigger an autoimmune attack on the joints. C. Joint damage due to decreased pain response (sensation loss). D. Uric acid crystals forming in the joints due to enzyme deficiency. Question 44 A nurse is developing a care plan for a patient diagnosed with Neuropathic Osteoarthropathy (Charcot Joint). The nurse understands that this condition results from: A. Systemic inflammation leading to synoviocyte formation. B. Excessive osteophyte formation at the joint margins. C. Decreased pain sensation preventing the patient from stopping injurious activity. D. Chronic soft tissue trauma leading to hemorrhage and myositis ossificans. Question 45 (SATA) Which of the following conditions are listed in the sources as risk factors for developing Neuropathic Osteoarthropathy (Charcot Joint)? A. Diabetes B. Peripheral nerve injuries C. Pernicious anemia D. Tuberculosis E. Multiple sclerosis
NSG 3280 Unit 7: Musculoskeletal ANSWERS
Question 1 A nurse is assessing a patient who experienced a ligament injury during a sporting event. The patient reports severe pain and the nurse notes significant instability in the affected joint. Based on the classification system for ligament injuries, which grade does the nurse anticipate the physician will assign? A. Grade 1 B. Grade 2 C. Grade 3 D. Micro failure Answer: C. Grade 3 Rationale: A Grade 3 ligament injury is characterized by a complete tear accompanied by instability. Grade 1 injuries involve no instability, while Grade 2 injuries are severe but only a partial tear, still exhibiting instability. Micro failure precedes total failure but is not a grading classification. Question 2 A 45-year-old construction worker sustained a crush injury to the lower leg. Examination reveals an unstable fracture with multiple bone fragments and a wound greater than 2 cm that is visibly contaminated with dirt and gravel. The orthopedic team classifies this as an Open Fracture Grade III. Which findings justify the assignment of this specific wound classification? A. The presence of multiple bone fragments. B. The wound size is greater than 1 cm. C. The fracture is unstable and comminuted. D. The presence of high contamination. E. Significant soft tissue damage is involved. Answer: C, D, E Rationale: Open Fracture Wound Classification III requires specific, severe criteria: High contamination , a fracture that is usually unstable and comminuted , and significant soft tissue damage. Option A (multiple bone fragments) is not a criteria for a Grade III. Option B (Wound greater than 1 cm) is characteristic of Grade II, but Grade III supersedes this based on contamination and instability criteria. This question requires the
differentiation of the specific severity markers used to distinguish Grade III from the less severe classifications. Question 3 (Select All That Apply) The nurse is educating a student about the specialized structure of the joint capsule. Which functions or characteristics should the nurse highlight regarding the inner layer (synovial membrane)? A. It is less vascular than the outer layer. B. It contains the majority of the joint's nerves. C. It produces hyaluronic acid for lubrication. D. It synthesizes matrix collagen, the structural protein. E. It lines the joint cavity. Answer: C, D, E Rationale: The inner layer (synovial membrane) lines the joint cavity, is vascular, makes hyaluronic acid for lubrication, and produces matrix collagen. The outer layer is less vascular but has more nerves. Question 4 A pediatric patient, age 6, is brought to the clinic after a fall. The X-ray reveals an incomplete break where the bone cortex has buckled but the fracture does not extend across the entire bone. Which two fracture types are specifically associated with this description or are usually seen in children? A. Spiral and Avulsion B. Greenstick and Longitudinal C. Greenstick and Incomplete D. Comminuted and Impacted Answer: C. Greenstick and Incomplete Rationale: A Greenstick fracture is defined as an incomplete break, usually seen in kids. An Incomplete fracture is when the bone cortex buckles or cracks but the fracture does not
go across the entire bone. While Greenstick is an incomplete break, the
general description matches the definition of an incomplete fracture. Question 5 A nurse is reviewing the results of a patient's CT scan following severe blunt trauma to the thigh. The nurse notes documentation suggesting calcification of the muscle tissue (myositis ossificans). This complication is a direct result of which initial pathological process following blunt trauma?
bone. An Oblique fracture also results from rotational force but is a angle fracture that does not spiral around the bone. Question 8 A patient is placed in prolonged immobilization following a severe joint capsule injury. The nurse understands that this intervention, while necessary for healing, carries specific risks for joint degeneration. Which sequence correctly describes the adverse effects of immobilization on the joint capsule and cartilage? A. Decreased mobility decreased synovial fluid flow joint degeneration B. Increased vascularity fibrous tissue formation cartilage compression C. Capsule thickening increased joint nutrition contracture of muscle D. Decreased synovial fluid flow increased joint nutrition decreased ROM Answer: A. Decreased mobility decreased synovial fluid flow joint degeneration Rationale: Immobilization leads to decreased mobility, contracture of muscle, and decreased synovial fluid flow, resulting in cartilage compression and distention. Immobilization also leads to decreased joint nutrition, which causes joint degeneration. Question 9 A patient presents with pain and swelling at the elbow. History reveals repetitive forceful movements in their occupation. The physician diagnoses bursitis. The nurse understands that the function of the bursa is primarily related to which mechanisms? A. Guiding joint motion and preventing excess movement. B. Synthesizing structural protein and lining the joint cavity. C. Increasing lubrication and decreasing friction. D. Providing sole responsibility for joint stability. Answer: C. Increasing lubrication and decreasing friction. Rationale: The responsibilities of the bursae, which are fluid-filled sacs, include increasing lubrication and decreasing friction. Inflammation (bursitis) often occurs due to wear and tear from repetitive movements or trauma. Question 10 A nurse is examining an X-ray of a patient who suffered a crush injury. The image shows a fracture where excessive force has driven one fragment of bone into another. This fracture type is known as: A. Comminuted
B. Stress C. Depressed D. Impacted Answer: D. Impacted Rationale: An Impacted fracture occurs when excessive force drives one fragment into another. A Comminuted fracture involves multiple fracture lines and bone fragments. Depressed is an extent of fracture where the fragment is displaced below the level of the bone surface (like the skull). Question 11 A patient sustained a complex tibial fracture 8 months ago. Despite ongoing treatment, the patient continues to experience bone pain, and recent imaging confirms the fracture site has not healed. Which fracture complication is defined by a lack of healing after 6 months? A. Delayed Union B. Malunion C. Nonunion D. Osteonecrosis Answer: C. Nonunion. Rationale: Nonunion is defined as a fracture that has not healed after 6 months. A related cause is decreased blood supply. Delayed Union involves persistent bone pain 3-6 months after the fracture. Malunion is when the bone appears deformed due to improper alignment. Osteonecrosis relates to impaired circulation leading to bone death. Question 12 A patient who had a long bone fracture 48 hours ago begins to exhibit sudden shortness of breath (SOB), tachypnea, and petechiae across the chest, followed by altered mental status. The nurse recognizes these findings as the classic triad associated with which life-threatening complication? A. Compartment Syndrome B. Osteomyelitis C. Fat Embolism Syndrome (FES) D. Osteonecrosis Answer: C. Fat Embolism Syndrome (FES) Rationale: Fat Embolism Syndrome usually occurs 24-72 hours after a fracture, especially of long
