ANSWER AND RATIONALE

MUSCOLOSKELETAL

1. A patient reports all of the following symptoms.

Which of these symptoms would indicate to the
nurse a serious complication of systemic lupus
erythematosus?
a. Fatigue c. Joint pain
b. Hematuria d. Oral ulcers
2. Which of the following disorders would a nurse
expect to identify when assessing a patient who us
experiencing afternoon slumps, carbohydrate
craving and weight gain during the fall and winter
months that disappear in spring and summer?
a. Major depressive disorder c. Dysthymic disorder
b. Seasonal affective disorder d. Bipolar Disorder
1. B. Systemic lupus erythematosus ( SLE) is
characterized by alternating periods of remissions
and exarcerbations. Normal symptoms of SLE
include microscopic hematuria, that the patient
would not see. Therefore, if the patient reports
hematuria, it should be considered a serious
complication
2. B. People with seasonal affective disorder report a
craving for, and increased consumption of,
carbohydrates, weight gain, fatigue and irritability
during the winter months. A reversal of these
symptoms occurs in the spring and summer, with
elation, increased social activity, decreased appetite
and weight loss occurring

3. A 12-year-old girl has a long leg cast applied to her

left leg. She is being instructed in crutch-walking 3. D. The axilla should not rest on the crutches. Such
with no weight bearing on her left leg. Which of the pressure may cause discomfort and nerve damage.
following observations indicates that the girl needs The weight of the body should be borne by the
further teaching? hands. The girl needs further instruction in this area
a. She is using the three-point gait
b. Her elbows are slightly flexed
c. She places the crutches approximately six to
eight inches (15 to 20 cm) in front of her with
each step
d. She is supporting her weight on the axillary
bars and hand pieces of the crutches

4. Diazepam ( Valium) is prescribed for a patient with

low back pain. The desired therapeutic action of 4. D. Diazepam ( Valium) is prescribed for a
valium in this situation is to patient with low back pain to decrease
a. reduce anxiety levels muscle spasms
b. eliminate pain sensation
c. suppress the inflammatory process
d. lessen muscle spasticity

5. A patient who has a spinal cord transection is in

spinal shock. On assessment, the nurse would expect 5.
the patient to describe which of the following
findings ion the lower extremities?
a. Loss of sensation c. Excessive diaphoresis
b. Complaints of tingling d. Constant tremors
A. A patient with a spinal cord transection
has no movement or feeling below the level
of the injury

6. A six-year-old child has a short arm cast placed on

the right extremity. While assessing the fingers 6. D. Capillary refill greater than two seconds
during immediate period after casting, a nurse would indicates vascular compromise or pressure
report which of the following finding? from the immobilizing device
a. Mild enema
b. Pain on movement
c. Slight coolness of the cast when touched
d. Capillary refill greater than three seconds
7. Which of the following medications would a nurse
have available when administering an injection of
heparin sodium to a patient?
a. Naloxone hydrochloride (narcan)
b. Protamine sulfate
c. Phytonadione ( aquaMEPHYTON) 8. C. Massaging the patient’s back and buttocks
d. Phentolamine mesylate ( Regitine) frequently promotes skin integrity and should be
included in the care of a patient in traction

8. To promote the skin integrity of a patient who is in

Russell’s traction, which of the following measures
should be included in the care plan?
a. Having the patient lie on the right side for 20
minutes every two to three hours
b. Placing pillows under the patient’s sacral and
scapular areas
c. Massaging the patient’s back and buttocks
frequently
d. Applying an antiseptic solution to the 9. D. Bowel retraining is established by providing a
patient’s bony prominences after bathing consistent time for evacuation each day

9. The bowel retraining program for a patient who has

had cerebrovascular accident should include which
of the following measures?
a. Checking for impaction daily
b. Increasing the intake of milk products
c. Utilizing incontinent pads until control is
achieved
d. Establishing a consistent time for elimination 10. D. Tapazole is used to decrease iodine use and
inhibit the synthesis of thyroid hormones. Therefore,
metabolic activity will be decreased if the treatment
10. A patient who has hyperthyroidism is taking is effective
methimazole (Tapazole) and attends the clinic
regularly. To evaluate the effectiveness of Tapazole
therapy, the nurse should consider which of the
following questions?
a. Has the patient’s vision improved?
b. Has the patient’s appetite improved?
c. Has the patient’s need for sleep decreased?
d. Has the patient’s pulse rate decreased?
11. A. Multiple diapers can be sued prior to surgery to
effectively separate the child’s legs and hold the legs
11. Prior to surgery for correction of congenital hip in an abducted, externally rotated position
dysplasia in four-month-old infant, which of the
following home care instructions would a nurse
include in the teaching plan for the infant’s family?
a. “ Apply double diapers when changing the
infant.”
b. “ Perform passive range-of-motion on the
lower extremities.”
c. “ Support the legs in an adducted position with
pillows during sleep.”
d. “ Avoid placing the infant in upright position.”

12. A. Alteration in skin integrity is the priority nursing

12. A 12-year-old child who has been diagnosed with diagnosis. Skin excoriation can occur if the leather
scoliosis is to be treated with a Milwaukee brace. To and plastic pads of the brace touch the child’s skin.
which of the following nursing diagnoses would a The brace can be worn over a tee shirt
nurse give priority?
a. Skin integrity c. Impaired gas exchange
b. Self-care deficit d. Sleep pattern disturbance

7. B. Protamine sulfate is the antidote for heparin

toxicity and overdose 13. Which of the following guidelines should a nurse
include in the teaching plan for a patient who has
Osteoarthritis?
 a. Achieve ideal body weight 14. C. This statement indicates a need for further
b. Increase daily calcium intake to 1500 mg teaching. The child should have sensation while the
c. Maintain a high-fiber diet cast is in place. Observation such as pain, swelling,
d. Sleep at least 10 hours each day discoloration of the exposed portions, lack of
pulsation and warmth and the inability to move the
exposed part are reported immediately
14. A six-year-old child who sustained a fracture has a
long leg cast applied to the left leg. Which of the
following statements, if made by a parent, would
indicate the need for further teaching?
a. “ I will call the clinic if my child complains of
sudden pain on his foot.”
b. “ I will check the skin temperature of my
child’s toes at least once a day.”
c. “ I should not expect my child to have 15. B. Restraints encircle the limbs, placing the patient
sensation in the toes while the cast is on.” at risk for circulation being restricted to the distal
d. “ I should not let my child put anything inside areas of the extremities. Checking the patients
the cast to relieve itching.” circulation every 15-30 minutes will allow the nurse
to adjust the restraints before injury form decreased
blood flow occurs. The nurse must document the
15. A nurse places a patient in four-point restraints time of the check and the degree of capillary refill
following orders from a physician. Which of the
following measures should the nurse in the patient’s
care of plan?
a. Socialize with other patients once a shift 16. A. The long term goal is to have the patient return to
b. Check circulation periodically full function in approximately three months
c. Provide stimulating diversional activities
d. Assess rectal temperature frequently

16. A nurse conducts discharge teaching with a patient

who is in cervical traction with a halo apparatus.
Which of the following statements indicates that the
patient needs further instructions?
a. “ I will need to wear the halo for several
months.” 17. B. Because dislocation of a total hip prosthesis is a
b. “ I should remove the halo when I shower.” possible complication of the surgery, the patient’s
c. “ I plan to take a walk every day.” legs are to be kept away from the middle of the
d. “ I will continue my previous diet.” body, or abducted. To ensure that abduction is
maintained and the prosthesis does not dislocate, the
17. A patient who has had a right hip replacement patient is instructed to keep an abduction pillow
should be instructed to carry out which of the between the legs
following techniques when turning in bed?
a. Bring both knees to the chest before turning
b. Keep an abductor wedge between the legs
c. Maintain flexion of the affected hip
d. Move the affected leg with the unaffected foot
18. D. The patient should be assisted into the prone
position every three to four hours for 20 to 30-
18. Which of the following nursing measures is minute periods, This is necessary to prevent hip
appropriate when caring for a patient who has flexion contractures
undergone a right, above-the-knee amputation?
a. Ambulating the patient in the hallway with
crutches
b. Placing the patient in a chair during waking
hours
c. Keeping the patient’s stump elevated on a pillow
d. Encouraging the patient to lie prone in bed

13. A. Nutritional counseling for weight reduction may
be necessary to eliminate excessive strain on the
joints of a patient with osteoarthritis.
19. If a patient were to develop thrombophlebitis at an
intravenous infusion site, which of the following
early findings should the nurse expect to observe?
a. Pallor and swelling
b. Erythema and heat
c. Mottling and coolness
d. Leakage of fluid and numbness
20. Which of the following measures should be included
in the care plan of a patient whose left leg is in
traction?
a. Checking the feet for the presence of ankle
clonus
b. Noting the color of the toenails after applying
temporary pressure
c. Assessing the femoral arteries for equality of
pulses 21. A. Following a hip replacement, the patient’s
d. Precussing the knee for a patellar reflex affected hip should be placed in extension, with an
abduction wedge between his legs

21. Following a hip replacement, the patient should have

the affected hip placed in which of these positions?
a. Extended, with a wedge between the legs
b. Flexed, with the knee supported on sandbags
c. Elevated, with pillows under the leg from the
knee to the ankle
d. Rotated externally, with a trochanter roll in place

22. D. Scoliosis is a complex spinal deformity that

22. A 15-year old boy has undergone a spinal includes curvature of the spine. It can be congenital
instrumentation at the level of T4 to T5 for scoliosis. but more commonly develops during the growth
Because there is an order to maintain strict bed rest, spurt of early adolescence. To maintain proper body
a nurse should use which of the following alignment after surgery, the patient should avoid
techniques when repositioning the boy? twisting movements that can cause indwelling
a. Assist the patient in pulling himself up with the instruments to twist the spine. Log-rolling is
overhead trapeze bar preferred when moving the child.
b. Turn the patient’s head to one side, then have
him reach for the rail to turn
c. Place the bed in Trendelenburg position, then
have the boy roll to one side
d. Use an assistant and logroll the patient to the
desired side

23. A. Following a lumbar laminectomy, the patient

23. A nurse would assess a patient who has undergone a should wear anti-embolism stockings or another
lumbar laminectomy for which of the following anti-embolism device to prevent deep vein
post-surgical complications? thrombosis
a. Deep vein thrombosis c. Intemittent
claudification
b. Urinary frequency d. Flank pain

24. A. A long-term goal for a 30-year-old man who is

24. A physician tells a 30-year-old man who had an unable to return to construction work would be to
above the knee amputation that he will not be able to develop alternate vocational skills
return to his construction work. Which of the
following long-term goals would be an appropriate
expectation of the man?
a. He will develop alternative vocational skills
b. He will acknowledge his loss
c. He will identify his areas of interest
d. He will engage in occupational therapy

19. B. Thrombophlebitis is the formation of a clot with
inflammation of a vein. Clinical manifestation s are
tenderness, redness and warmth. Edema may oir
may not occur
25. A patient with hypothyroidism is to receive
levothyroxine sodium ( Synthroid), 75 mcg by IV
push. The medication available is labeled 200
,cg/10ml. Which of the following doses is the correct
amount?
a. 5.0 ml b. 3.75ml c. 4.75ml d. 2.5 ml

20. B. Patients in traction should be assessed for nerve

and circulatory disturbances. To check for capillary
filling times, the patient’s nail beds are compressed
to produce blanching and assessed for return of color
 3.75ml = dose

26. A patient who has vascular insufficiency of the 26. C. Activity intolerance should be addressed as a
lower extremities experiences intermittent priority. The pain of intermittent claudification is
claudification. To which of the following nursing alleviated by cessation of activity
diagnoses would a nurse give priority?
a. Ineffective thermoregulation
b. Non-compliance with treatment plan
c. Activity intolerance
d. Alteration in the body image

Opportunities are often disguised as hard

work, so most people fail to recognize
them.
-Ann Landers

25. The formula for this calculation is as follows

Desired amount x volume = dose

Available amount

75 mcg x 10 ml = dose

x 750 = dose
200