.
NUR 635 Musculoskeletal Nursing
Test Bank 2026/2027 | Orthopedics
Exam Prep | Verified Answers\
**1. A 55-year-old female patient asks a nurse about calcium
supplements. The nurse learns that the patient consumes two servings
of dairy products each day. The patient's serum calcium level is 9.5
mg/dL. The serum vitamin D level is 18 ng/mL. The nurse will
recommend adding _____ mg of calcium and _____ IU of vitamin D3
each day.**
- **Answer:** 600 mg of calcium once; 10,000 IU
- **Rationale:** This patient has a low vitamin D level (normal is >30
ng/mL), which is necessary for calcium absorption. Even with adequate
dietary calcium and normal serum calcium, supplementation with both
calcium and a high-dose vitamin D is needed to treat the deficiency .
**2. A patient who has developed postmenopausal osteoporosis will
begin taking alendronate [Fosamax]. The nurse will teach this patient to
take the drug:**
- **Answer:** while sitting upright with plenty of water.
,- **Rationale:** Alendronate can cause severe esophagitis and
esophageal ulcers. To minimize this risk, the patient must take it with a
full glass of water and remain sitting or standing upright for at least 30
minutes after administration .
**3. A patient is taking alendronate [Fosamax] to treat Paget disease.
The patient asks the nurse why calcium supplements are necessary. The
nurse will tell the patient that calcium supplements are necessary to:**
- **Answer:** prevent hyperparathyroidism.
- **Rationale:** Alendronate works by inhibiting bone resorption. This
rapid decrease in bone breakdown can lead to hypocalcemia, which can
trigger a compensatory increase in parathyroid hormone (secondary
hyperparathyroidism). Calcium supplements help maintain serum
calcium levels and prevent this .
**4. A patient who takes teriparatide [Forteo] administers it
subcutaneously with a prefilled pen injector. The patient asks why she
must use a new pen every 28 days when there are doses left in the
syringe. Which is the correct response by the nurse?**
- **Answer:** The drug may not be stable after 28 days.
- **Rationale:** Teriparatide is a peptide medication that can degrade
over time once the pen is in use. The manufacturer recommends
discarding the pen after 28 days to ensure the patient receives a fully
potent and stable dose .
**5. A patient reports experiencing weakness, fatigue, nausea,
vomiting, constipation, and nocturia. Total serum calcium is 10.5
,mg/dL. A dipstick urinalysis shows a positive result for protein. When
questioned, the patient reports taking vitamin D and calcium
supplements. The nurse will counsel the patient to:**
- **Answer:** stop taking vitamin D, reduce the amount of calcium,
and increase the fluid intake.
- **Rationale:** The symptoms and lab findings are consistent with
hypercalcemia, likely from excessive supplementation. The patient
should stop the vitamin D (which increases calcium absorption), reduce
calcium intake, and increase fluids to promote renal excretion of
calcium and prevent nephrolithiasis .
**6. A postmenopausal patient is at high risk for developing
osteoporosis. The patient's prescriber orders raloxifene [Evista], and
the nurse provides teaching about this drug. Which statement by the
patient indicates understanding of the teaching?**
- **Answer:** "I should walk as much as possible during long airline
flights."
- **Rationale:** Raloxifene, a selective estrogen receptor modulator
(SERM), significantly increases the risk of deep vein thrombosis (DVT).
The patient should understand the need to prevent venous stasis by
walking or moving her legs during long periods of immobility, such as
on long flights .
**7. A nurse is providing education to a patient who will begin taking
alendronate [Fosamax]. Which complication should the patient be
instructed to report immediately?**
- **Answer:** Difficulty swallowing
, - **Rationale:** Difficulty swallowing (dysphagia) can be an early sign
of esophageal irritation, ulceration, or stricture, which are known
severe adverse effects of bisphosphonates like alendronate. This
requires immediate medical evaluation .
**8. The nurse is caring for an older adult patient after a right hip open
reduction internal fixation (ORIF). The patient is taking an opioid every
6 hours as needed for pain. The nurse discusses obtaining an order
from the prescriber for which medication?**
- **Answer:** Docusate sodium [Colace]
- **Rationale:** Opioids are highly constipating. A prophylactic bowel
regimen, typically including a stool softener like docusate sodium,
should be started when opioids are initiated to prevent constipation
and fecal impaction .
**9. A patient with severe Paget disease of the bone asks the nurse
what can be done to alleviate the pain. The nurse will suggest that the
patient discuss the use of which medication with the provider?**
- **Answer:** Calcitonin-salmon [Miacalcin]
- **Rationale:** Calcitonin-salmon is noted for its analgesic effect in
Paget's disease and can provide rapid relief of bone pain, in addition to
its action on inhibiting bone resorption .
**10. A patient is about to begin treatment with isoniazid. The nurse
learns that the patient also takes phenytoin [Dilantin] for seizures. The
nurse will contact the provider to discuss:**
NUR 635 Musculoskeletal Nursing
Test Bank 2026/2027 | Orthopedics
Exam Prep | Verified Answers\
**1. A 55-year-old female patient asks a nurse about calcium
supplements. The nurse learns that the patient consumes two servings
of dairy products each day. The patient's serum calcium level is 9.5
mg/dL. The serum vitamin D level is 18 ng/mL. The nurse will
recommend adding _____ mg of calcium and _____ IU of vitamin D3
each day.**
- **Answer:** 600 mg of calcium once; 10,000 IU
- **Rationale:** This patient has a low vitamin D level (normal is >30
ng/mL), which is necessary for calcium absorption. Even with adequate
dietary calcium and normal serum calcium, supplementation with both
calcium and a high-dose vitamin D is needed to treat the deficiency .
**2. A patient who has developed postmenopausal osteoporosis will
begin taking alendronate [Fosamax]. The nurse will teach this patient to
take the drug:**
- **Answer:** while sitting upright with plenty of water.
,- **Rationale:** Alendronate can cause severe esophagitis and
esophageal ulcers. To minimize this risk, the patient must take it with a
full glass of water and remain sitting or standing upright for at least 30
minutes after administration .
**3. A patient is taking alendronate [Fosamax] to treat Paget disease.
The patient asks the nurse why calcium supplements are necessary. The
nurse will tell the patient that calcium supplements are necessary to:**
- **Answer:** prevent hyperparathyroidism.
- **Rationale:** Alendronate works by inhibiting bone resorption. This
rapid decrease in bone breakdown can lead to hypocalcemia, which can
trigger a compensatory increase in parathyroid hormone (secondary
hyperparathyroidism). Calcium supplements help maintain serum
calcium levels and prevent this .
**4. A patient who takes teriparatide [Forteo] administers it
subcutaneously with a prefilled pen injector. The patient asks why she
must use a new pen every 28 days when there are doses left in the
syringe. Which is the correct response by the nurse?**
- **Answer:** The drug may not be stable after 28 days.
- **Rationale:** Teriparatide is a peptide medication that can degrade
over time once the pen is in use. The manufacturer recommends
discarding the pen after 28 days to ensure the patient receives a fully
potent and stable dose .
**5. A patient reports experiencing weakness, fatigue, nausea,
vomiting, constipation, and nocturia. Total serum calcium is 10.5
,mg/dL. A dipstick urinalysis shows a positive result for protein. When
questioned, the patient reports taking vitamin D and calcium
supplements. The nurse will counsel the patient to:**
- **Answer:** stop taking vitamin D, reduce the amount of calcium,
and increase the fluid intake.
- **Rationale:** The symptoms and lab findings are consistent with
hypercalcemia, likely from excessive supplementation. The patient
should stop the vitamin D (which increases calcium absorption), reduce
calcium intake, and increase fluids to promote renal excretion of
calcium and prevent nephrolithiasis .
**6. A postmenopausal patient is at high risk for developing
osteoporosis. The patient's prescriber orders raloxifene [Evista], and
the nurse provides teaching about this drug. Which statement by the
patient indicates understanding of the teaching?**
- **Answer:** "I should walk as much as possible during long airline
flights."
- **Rationale:** Raloxifene, a selective estrogen receptor modulator
(SERM), significantly increases the risk of deep vein thrombosis (DVT).
The patient should understand the need to prevent venous stasis by
walking or moving her legs during long periods of immobility, such as
on long flights .
**7. A nurse is providing education to a patient who will begin taking
alendronate [Fosamax]. Which complication should the patient be
instructed to report immediately?**
- **Answer:** Difficulty swallowing
, - **Rationale:** Difficulty swallowing (dysphagia) can be an early sign
of esophageal irritation, ulceration, or stricture, which are known
severe adverse effects of bisphosphonates like alendronate. This
requires immediate medical evaluation .
**8. The nurse is caring for an older adult patient after a right hip open
reduction internal fixation (ORIF). The patient is taking an opioid every
6 hours as needed for pain. The nurse discusses obtaining an order
from the prescriber for which medication?**
- **Answer:** Docusate sodium [Colace]
- **Rationale:** Opioids are highly constipating. A prophylactic bowel
regimen, typically including a stool softener like docusate sodium,
should be started when opioids are initiated to prevent constipation
and fecal impaction .
**9. A patient with severe Paget disease of the bone asks the nurse
what can be done to alleviate the pain. The nurse will suggest that the
patient discuss the use of which medication with the provider?**
- **Answer:** Calcitonin-salmon [Miacalcin]
- **Rationale:** Calcitonin-salmon is noted for its analgesic effect in
Paget's disease and can provide rapid relief of bone pain, in addition to
its action on inhibiting bone resorption .
**10. A patient is about to begin treatment with isoniazid. The nurse
learns that the patient also takes phenytoin [Dilantin] for seizures. The
nurse will contact the provider to discuss:**
