Question 1. Cass, age 67, tells the nurse practitioner (NP) that she has been diagnosed with a condition that causes sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of the diagnosis, but she knows it is caused by urate crystals that “get stuck ...
, Musculoskeletal Problems
Question 1. Cass, age 67, tells the nurse practitioner (NP) that she has been diagnosed with a condition that causes
sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of the diagnosis,
but she knows it is caused by urate crystals that “get stuck in the joint and cause pain.” She is on hydrochlorothiazide
(HCTZ) for management of her hypertension. The NP should suspect a diagnosis of:
Gout
Question 2. Marsha, age 34, presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome,
which have many similarities. Which of the following is more characteristic of fibromyalgia than of chronic
fatigue syndrome?
Davis Edge Questions Week 5, 6, & 7
Musculoskeletal pain.
- Musculoskeletal pain is not characteristic of chronic fatigue syndrome; rather, it is characteristic of
fibromyalgia. The musculoskeletal pain, usually an achy muscle pain that may be localized or involve the entire
body, is usually gradual in onset, although the onset may occasionally be sudden, such as after a viral illness.
Question 3. Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which age-related change?
Dorsal kyphosis.
- Dorsal kyphosis, an exaggerated convexity of the thoracic curvature, typically accompanies the aging process.
Question 4. The valgus stress test, varus stress test, Lachman test, and thumb sign are all considered standard tests to
check the integrity of the ligaments of the knee. Which test would the nurse practitioner choose to assess the anterior
cruciate ligament (ACL), which is the most commonly involved structure in severe knee injury?
Lachman test.
- The Lachman test assesses the ACL.
Question 5. For an adult patient with a knee injury, the nurse practitioner orders a nonsteroidal anti-inflammatory
drug (NSAID) to be taken on a routine basis for the next 2 weeks. Patient teaching should include which of the
following?
“If you have additional pain, an occasional acetaminophen (Tylenol) is permitted in between the usual doses of
the NSAID.”
- If the client is having additional pain, acetaminophen (Tylenol) may be taken in conjunction with an NSAID
because it is not an NSAID and will not potentiate gastric bleeding.
Question 6. You are assessing Jamal, age 16, after a football injury to his right knee. You elicit a positive
anterior/posterior drawer sign. This test indicates an injury to the:
Cruciate ligament.
- Positive anterior and posterior drawer signs indicate injury to the anterior cruciate ligament and posterior cruciate
ligament, respectively. The drawer and Lachman tests are utilized to assess for cruciate ligament injury.
,Question 7. Steve, age 32, fell off a roof while shingling it. He is complaining of pain in his left hip and leg area.
Other than an x-ray, what would make you suspect a fractured pelvis?
Hematuria.
- If a client has a fractured pelvis, a test for hematuria will usually prove positive. A fracture of the pelvis usually
results in hypovolemia due to a generally significant associated blood loss. Surrounding blood vessels rupture, which
results in a large retroperitoneal hematoma and shock. Pelvic fractures also commonly injure the urinary bladder or
urethra. A client with a fracture in several locations of the pelvis may need a pneumatic antishock garment to control
the blood loss and stabilize the pelvis. Only x-ray studies will confirm the diagnosis.
Question 8. During assessment of a client’s foot, the nurse practitioner notes that the foot is in alignment with the
long axis of the lower leg and that weight-bearing falls on the middle of the foot from the heel, along the midfoot, to
between the second and third toes. These findings best describe:
A normal foot.
- If you note during your assessment of your client’s foot that the foot is in alignment with the long axis of the lower
leg and that weight-bearing falls on the middle of the foot from the heel, along the midfoot, to between the second and
third toes, you would diagnose a normal foot.
Question 9. Beth, age 49, comes in with low back pain. An x-ray of the lumbosacral spine is within normal limits.
Which of the following diagnoses do you explore further?
Herniated nucleus pulposus.
- A plain x-ray will not show a herniated nucleus pulposus or a muscle strain. It will show spondylolisthesis, scoliosis,
osteoarthritis, and spinal stenosis. Note that x-rays of the spine are not indicated in low back pain unless the cause of
the pain is thought to be bony in origin or traumatic in nature or there is a need to rule out systemic disease.
Question 10. The nurse practitioner suspects adolescent idiopathic scoliosis in Victoria, age 15, who is in her
“growth spurt.” An Adams forward bend test is performed, and it is noted that the patient has a right-sided rib hump.
What is this indicative of?
Right thoracic curvature.
- When you have a client bend forward to assess the spine (ie, the Adams forward bend test) and you note a right-
sided rib hump, this is indicative of a right thoracic curve. Adolescent idiopathic scoliosis is defined as a lateral spinal
curvature of greater than 10 degrees with no determined pathologic cause. Management consists of the 3 Os:
observation, orthosis, and operation.
Question 11. Jim, age 22, a stock boy, has an acute episode of low back pain. The nurse practitioner orders a
nonsteroidal anti-inflammatory drug (NSAID) and should educate him in which of the following?
Beginning lower back strengthening exercises depending on pain tolerance.
- Years ago, muscle relaxants and bed rest were the treatments of choice for low back pain. Studies have now shown
that resuming normal activity within the limits imposed by the pain has an effect as good as, if not better than, 2 days
of bed rest. The key here is letting pain be your guide. Exercise should begin as soon as possible after the acute
injury and be directed at building endurance and stamina, with consideration given to one’s pain tolerance.
Question 12. Joyce, age 87, broke her wrist after falling off a curb. She just had a plaster cast applied to her wrist. In
instructing Joyce and her family on allowing the cast to dry properly, tell them to:
Change the position of Joyce’s arm every hour.
, - Instructions to the client and family on how to allow a cast to dry properly should include advising them to change
the position of the casted extremity every hour. In this case, Joyce’s arm should be repositioned frequently to prevent
indentations in the cast itself (caused by continuous placement on a pillow) and to ensure drying of all surfaces of
the cast.
Question 13. When teaching Alice, age 77, to use a cane because of osteoarthritis of her left knee, an important
point to stress is:
Advancing the cane with the ipsilateral (affected) leg.
- When teaching clients about using a cane, tell them to advance the cane with the ipsilateral (affected) leg.
Question 14. Hilda, age 73, presents with a complaint of low back pain. Red flags in her history of a minor fall,
osteopenia, and prolonged steroid use for systemic lupus erythematosus suggest the possibility of which of the
following serious underlying conditions as the cause of her low back pain?
Spinal fracture.
- The red flags for spinal fracture include major trauma or direct blow to the back in an adult, a minor fall or heavy
lifting in a potentially osteoporotic or elderly person, prolonged steroid use, and age greater than 70.
Question 15. Anne Marie states she has a maternal history of rheumatoid disease, but she has never been affected.
Today she presents with complaints of dryness of the eyes and mouth. What is the most likely diagnosis?
Sjögren syndrome
- Sjögren syndrome, which affects the salivary and lacrimal glands, causes clients to have dry eyes and mouths. It
is an inflammatory disease of the exocrine glands and may be an isolated entity or may be associated with other
rheumatic diseases, such as rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE).
Question 16. Sandra, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. The
nurse practitioner’s next step is to:
Try neutral position wrist splinting and order an oral nonsteroidal anti-inflammatory drug (NSAID).
- For the client who has just been given a diagnosis of carpal tunnel syndrome, your next step is to try neutral
position wrist splinting and order an oral NSAID. For symptoms of less than 10 months’ duration, conservative
treatment should be tried first.
Question 17. A 55-year-old patient is able to complete range of motion (ROM) against gravity with some resistance.
The nurse practitioner would assign which of the following numerical grades to this manual muscle testing
description?
4
- Complete ROM against gravity with some resistance is given a numerical grade of 4 and described as good
muscle strength.
Question 18. Paul has a malignant fibrosarcoma of the femur. He recently had surgery and is now on radiation
therapy. You want to order a test to determine the extent of the tumor invasion of the surrounding tissues and the
response of the bone tumor to the radiation. Which of the following tests should you order?
A magnetic resonance imaging (MRI) scan.
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