CHAPTER 46 – MUSCULOSKELETAL &
CONNECTIVE TISSUE DISORDERS
QUESTIONS AND ANSWERS WITH
RATIONELS
Section 1: Multiple Choice (Questions 1-60)
1. A nurse is assessing a patient with suspected osteoporosis. Which finding is the most significant
early indicator of this disease?
a) Kyphosis
b) Acute back pain after sneezing
c) Loss of height
d) A previously undiagnosed fracture
Correct Answer: d) A previously undiagnosed fracture
Rationale: Osteoporosis is often called the "silent disease" because it is frequently asymptomatic until a
fracture occurs. While kyphosis (dowager's hump) and loss of height are late signs, an incidental fracture
found on x-ray is often the first definitive indicator.
2. A patient with rheumatoid arthritis (RA) is prescribed methotrexate. Which statement by the
patient indicates a need for further teaching?
a) "I will take folic acid supplements as prescribed."
b) "I will drink at least 2-3 liters of fluid per day."
c) "I will avoid large crowds and people who are sick."
d) "I can have a glass of wine with dinner to help me relax."
Correct Answer: d) "I can have a glass of wine with dinner to help me relax."
Rationale: Methotrexate is hepatotoxic and immunosuppressive. Alcohol consumption significantly
increases the risk of liver damage and should be strictly avoided. Hydration helps prevent renal toxicity,
folic acid helps mitigate side effects, and avoiding crowds minimizes infection risk.
3. The nurse is caring for a patient 24 hours after a total hip arthroplasty. Which position is
contraindicated for this patient?
a) Supine with an abductor pillow between the legs
,b) Semi-Fowler's with legs elevated on a pillow
c) Lying on the non-operative side with a pillow between the legs
d) Lying on the operative side with legs straight
Correct Answer: d) Lying on the operative side with legs straight
Rationale: Lying on the operative side is generally avoided in the early postoperative period to prevent
dislocation. The patient should maintain hip precautions: no adduction past midline, no flexion > 90
degrees, and no internal rotation. An abductor pillow maintains the hip in abduction, which is safe.
4. A patient is diagnosed with gout. Which dietary choice would the nurse identify as most likely to
exacerbate this condition?
a) Baked salmon
b) Spinach salad
c) Beef liver and onions
d) Fresh cherries
Correct Answer: c) Beef liver and onions
Rationale: Gout results from hyperuricemia. Purine-rich foods, such as organ meats (liver, kidney),
sardines, and anchovies, break down into uric acid and exacerbate symptoms. Cherries may help lower
uric acid. Spinach is high in oxalates but not as directly linked to acute gout as purines.
5. A nurse is performing a neurovascular assessment on a patient in a cast for a tibial fracture. Which
finding should be reported to the healthcare provider immediately?
a) Capillary refill of 2 seconds
b) Toes that are warm and pink
c) Patient report of pain rated 3/10
d) Patient report of paresthesia in the toes
Correct Answer: d) Patient report of paresthesia in the toes
Rationale: Paresthesia (numbness or tingling) is an early sign of compartment syndrome or nerve
compression. It indicates potential neurovascular compromise. Pain (unless disproportionate) and
normal capillary refill are expected findings.
6. The nurse is teaching a patient about alendronate (Fosamax) for osteoporosis. What is the most
important instruction regarding administration?
a) Take the medication with milk to prevent stomach upset.
b) Remain upright for at least 30 minutes after taking the medication.
c) Take the medication at bedtime for optimal absorption.
d) Chew the tablet thoroughly before swallowing.
Correct Answer: b) Remain upright for at least 30 minutes after taking the medication.
Rationale: Alendronate can cause severe esophageal irritation and ulceration if it refluxes back into the
esophagus. Patients must take it with a full glass of water on an empty stomach and remain sitting or
standing for 30 minutes to ensure it reaches the stomach and to prevent esophagitis.
, 7. A patient with systemic lupus erythematosus (SLE) presents with a butterfly rash, joint pain, and
fatigue. Which diagnostic test is most specific for SLE?
a) Rheumatoid factor (RF)
b) Antinuclear antibody (ANA)
c) Anti-double-stranded DNA (anti-dsDNA)
d) Erythrocyte sedimentation rate (ESR)
Correct Answer: c) Anti-double-stranded DNA (anti-dsDNA)
Rationale: While ANA is sensitive (positive in most SLE patients), it is not specific. Anti-dsDNA is highly
specific for SLE and its presence often correlates with disease activity, particularly lupus nephritis.
8. A patient has a fiberglass cast applied to the forearm. The nurse should instruct the patient to:
a) Use a coat hanger to scratch inside the cast if it itches.
b) Keep the cast dry and do not submerge it in water.
c) Cover the cast with plastic wrap permanently to keep it clean.
d) Place a heating pad over the cast to promote drying.
Correct Answer: b) Keep the cast dry and do not submerge it in water.
Rationale: Fiberglass casts are water-resistant but not waterproof; the lining remains absorbent.
Submerging the cast can lead to skin maceration and infection. Patients should never insert objects into
the cast. Heat should not be applied as it can burn the skin under the cast.
9. Which assessment finding is most indicative of a fat embolism syndrome (FES) in a patient with a
long bone fracture?
a) Hypoglycemia and bradycardia
b) Petechial rash on the chest and axillae
c) Hypertension and bounding pulses
d) Hypocalcemia and muscle spasms
Correct Answer: b) Petechial rash on the chest and axillae
Rationale: FES is a serious complication of long bone fractures. The classic triad includes hypoxemia,
neurologic changes (confusion), and a petechial rash that typically appears in the upper chest, axillae,
and conjunctiva.
10. The nurse is caring for a patient with a newly applied plaster cast. Which technique is most
appropriate when handling the cast during the drying phase?
a) Support the cast with the palms of the hands, not the fingertips.
b) Place the cast on a hard, flat surface to dry evenly.
c) Cover the cast with a blanket to speed up the drying process.
d) Apply heat lamps to accelerate drying.
Correct Answer: a) Support the cast with the palms of the hands, not the fingertips.
Rationale: Plaster casts take 24-72 hours to dry completely. Using fingertips can create indentations that
act as pressure points, potentially causing skin breakdown. The cast should be supported on pillows with
the palms, allowing air circulation to dry it. Heat and covering slow drying or risk burns.
CONNECTIVE TISSUE DISORDERS
QUESTIONS AND ANSWERS WITH
RATIONELS
Section 1: Multiple Choice (Questions 1-60)
1. A nurse is assessing a patient with suspected osteoporosis. Which finding is the most significant
early indicator of this disease?
a) Kyphosis
b) Acute back pain after sneezing
c) Loss of height
d) A previously undiagnosed fracture
Correct Answer: d) A previously undiagnosed fracture
Rationale: Osteoporosis is often called the "silent disease" because it is frequently asymptomatic until a
fracture occurs. While kyphosis (dowager's hump) and loss of height are late signs, an incidental fracture
found on x-ray is often the first definitive indicator.
2. A patient with rheumatoid arthritis (RA) is prescribed methotrexate. Which statement by the
patient indicates a need for further teaching?
a) "I will take folic acid supplements as prescribed."
b) "I will drink at least 2-3 liters of fluid per day."
c) "I will avoid large crowds and people who are sick."
d) "I can have a glass of wine with dinner to help me relax."
Correct Answer: d) "I can have a glass of wine with dinner to help me relax."
Rationale: Methotrexate is hepatotoxic and immunosuppressive. Alcohol consumption significantly
increases the risk of liver damage and should be strictly avoided. Hydration helps prevent renal toxicity,
folic acid helps mitigate side effects, and avoiding crowds minimizes infection risk.
3. The nurse is caring for a patient 24 hours after a total hip arthroplasty. Which position is
contraindicated for this patient?
a) Supine with an abductor pillow between the legs
,b) Semi-Fowler's with legs elevated on a pillow
c) Lying on the non-operative side with a pillow between the legs
d) Lying on the operative side with legs straight
Correct Answer: d) Lying on the operative side with legs straight
Rationale: Lying on the operative side is generally avoided in the early postoperative period to prevent
dislocation. The patient should maintain hip precautions: no adduction past midline, no flexion > 90
degrees, and no internal rotation. An abductor pillow maintains the hip in abduction, which is safe.
4. A patient is diagnosed with gout. Which dietary choice would the nurse identify as most likely to
exacerbate this condition?
a) Baked salmon
b) Spinach salad
c) Beef liver and onions
d) Fresh cherries
Correct Answer: c) Beef liver and onions
Rationale: Gout results from hyperuricemia. Purine-rich foods, such as organ meats (liver, kidney),
sardines, and anchovies, break down into uric acid and exacerbate symptoms. Cherries may help lower
uric acid. Spinach is high in oxalates but not as directly linked to acute gout as purines.
5. A nurse is performing a neurovascular assessment on a patient in a cast for a tibial fracture. Which
finding should be reported to the healthcare provider immediately?
a) Capillary refill of 2 seconds
b) Toes that are warm and pink
c) Patient report of pain rated 3/10
d) Patient report of paresthesia in the toes
Correct Answer: d) Patient report of paresthesia in the toes
Rationale: Paresthesia (numbness or tingling) is an early sign of compartment syndrome or nerve
compression. It indicates potential neurovascular compromise. Pain (unless disproportionate) and
normal capillary refill are expected findings.
6. The nurse is teaching a patient about alendronate (Fosamax) for osteoporosis. What is the most
important instruction regarding administration?
a) Take the medication with milk to prevent stomach upset.
b) Remain upright for at least 30 minutes after taking the medication.
c) Take the medication at bedtime for optimal absorption.
d) Chew the tablet thoroughly before swallowing.
Correct Answer: b) Remain upright for at least 30 minutes after taking the medication.
Rationale: Alendronate can cause severe esophageal irritation and ulceration if it refluxes back into the
esophagus. Patients must take it with a full glass of water on an empty stomach and remain sitting or
standing for 30 minutes to ensure it reaches the stomach and to prevent esophagitis.
, 7. A patient with systemic lupus erythematosus (SLE) presents with a butterfly rash, joint pain, and
fatigue. Which diagnostic test is most specific for SLE?
a) Rheumatoid factor (RF)
b) Antinuclear antibody (ANA)
c) Anti-double-stranded DNA (anti-dsDNA)
d) Erythrocyte sedimentation rate (ESR)
Correct Answer: c) Anti-double-stranded DNA (anti-dsDNA)
Rationale: While ANA is sensitive (positive in most SLE patients), it is not specific. Anti-dsDNA is highly
specific for SLE and its presence often correlates with disease activity, particularly lupus nephritis.
8. A patient has a fiberglass cast applied to the forearm. The nurse should instruct the patient to:
a) Use a coat hanger to scratch inside the cast if it itches.
b) Keep the cast dry and do not submerge it in water.
c) Cover the cast with plastic wrap permanently to keep it clean.
d) Place a heating pad over the cast to promote drying.
Correct Answer: b) Keep the cast dry and do not submerge it in water.
Rationale: Fiberglass casts are water-resistant but not waterproof; the lining remains absorbent.
Submerging the cast can lead to skin maceration and infection. Patients should never insert objects into
the cast. Heat should not be applied as it can burn the skin under the cast.
9. Which assessment finding is most indicative of a fat embolism syndrome (FES) in a patient with a
long bone fracture?
a) Hypoglycemia and bradycardia
b) Petechial rash on the chest and axillae
c) Hypertension and bounding pulses
d) Hypocalcemia and muscle spasms
Correct Answer: b) Petechial rash on the chest and axillae
Rationale: FES is a serious complication of long bone fractures. The classic triad includes hypoxemia,
neurologic changes (confusion), and a petechial rash that typically appears in the upper chest, axillae,
and conjunctiva.
10. The nurse is caring for a patient with a newly applied plaster cast. Which technique is most
appropriate when handling the cast during the drying phase?
a) Support the cast with the palms of the hands, not the fingertips.
b) Place the cast on a hard, flat surface to dry evenly.
c) Cover the cast with a blanket to speed up the drying process.
d) Apply heat lamps to accelerate drying.
Correct Answer: a) Support the cast with the palms of the hands, not the fingertips.
Rationale: Plaster casts take 24-72 hours to dry completely. Using fingertips can create indentations that
act as pressure points, potentially causing skin breakdown. The cast should be supported on pillows with
the palms, allowing air circulation to dry it. Heat and covering slow drying or risk burns.
