NURS 5462 COMPILED PRACTICE SCRIPT
2026 TESTED SOLUTIONS GRADED A+
⩥ Taking the History.
Answer: May or may not involve trauma, OLDCARTS
⩥ Associated symptoms—warning signs.
Answer: - History of substantial trauma—fracture, major soft tissue
injury - Hot swollen joint—infection, RA, gout - Constitutional
symptoms [fever, malaise, weight loss, fatigue]—infection, sepsis -
Focal neurological weakness—radiculopathy - Diffuse weakness—
degenerative, neoplastic disease, toxins - Neurogenic pain [burning,
numbness, paresthesia, asymmetric]—radiculopathy, entrapment,
neuropathy - Claudication—peripheral arterial/vascular, stenosis,
arteritis 4/8/201
⩥ Taking the History 2.
Answer: CHD - Medications: NSAIDS, Rx or OTC, HRT, calcium -
LMP, menstrual cycles, menopause: female athletes, post-menopausal •
PMH - Previous injury or trauma—fracture, surgeries, arthroscopy -
Cancer, arthritis, sickle cell, osteoporosis, renal or neurologic disease
⩥ Taking the History 3.
Answer: • FH - Congenital abnormalities of hip, foot - Scoliosis or back
problems - Arthritis—RA, degenerative, ankylosing spondylitis, gout -
,Genetic—osteogenesis imperfecta, hypercalciuria ▪ Personal/Social -
Work, exercise, hobbies 4/8/2018- Tobacco, alcohol, drug use
⩥ Physical Exam.
Answer: ▪ Height ▪ Weight ▪ Uncover and examine both sides ▪ Observe
gait if weight bearing joint involved ▪ Inspection - Skin—injuries or
contusions - Swelling, deformities, bruising, erythema ▪ Palpation—one
finger point tenderness - Compare non-injured to injured area - Palpate
all surfaces—bones, joints, soft tissue - Examine above and below area
of injury
⩥ ▪ Range of motion.
Answer: —active and passive - Examine above and below area of injury
- Internal and external rotation - Abduction and adduction - Document
ROM in degrees!!!
⩥ Traditional Management.
Answer: ▪ Rest ▪ Ice ▪ Compression/immobilization ▪ Elevation (RICE) ▪
Acetaminophen, NSAIDs, muscle relaxants - Oral steroids may be
considered in some cases ▪ Physical therapy, exercise ▪ The tincture of
time ▪ Manipulation, acupuncture, other [ESI, TENS, etc], conservative
Rx x4-6 weeks
⩥ NSAIDs.
,Answer: Inhibit cyclooxygenase (COX) enzyme—provide anti-
inflammatory/analgesic effects - Dose dependent - NSAIDs differ in
analgesic and anti-inflammatory effec
⩥ NSAIDs.
Answer: - Gastritis, ulceration, bleed - Impaired renal function—
NSAIDs inhibit renal prostaglandins, affecting regulation of renal blood
flow and glomerular filtration - Hypertension/Edema - Platelet inhibition
and bleeding - CV risk—potential damage to arterial wall, possible
arterial clotting - Drug interaction with ASA—they ↓ cardioprotective
benefits and ↑ risk of GI bleed 4/8/2018
⩥ Evidence: BMJ Clinical Evidence 2007; 12: 1108.
Answer: - Plateau for effectiveness; SE ↑ with dose ↑ - COX-2 ↓ risk for
PUD but ↑ risk for MI/CV events - Paracetamol similar to NSAIDs for
acute MSK pain but ↓ effective than NSAIDs for OA [Paracetamol not
used in US 2nd to risk of GU malignancy] - **PPI > H2 antagonists ↓
GI SE - Insufficient evidence whether topical NSAIDs beneficial
⩥ NSAIDs ▪ Adverse effects:.
Answer: - Gastritis, ulceration, bleed - Impaired renal function—
NSAIDs inhibit renal prostaglandins, affecting regulation of renal blood
flow and glomerular filtration - Hypertension/Edema - Platelet inhibition
and bleeding - CV risk—potential damage to arterial wall, possible
arterial clotting - **Drug interaction with ASA—they ↓ cardioprotective
benefits and ↑ risk of GI blee
, ⩥ NSAIDs ▪ Recommendations:.
Answer: - GI risk in general—nonacelated aspirin products lowest risk
[Disalsid, Trilisate]; Ibuprofen/Naproxen intermediate risk,
Diclofenac/Piroxicam/Ketorolac greatest risk ▪ Use lowest dose possible
, risk ↑ with dose ▪ Short course best ▪ Use acetaminophen when
possible - Avoid in patients > 65 yrs., H/O PUD, on steroids,
anticoagulants, ASA ▪ AGS, May, 2009: NSAIDs considered rarely and
with extreme caution; Acetaminophen, opioids best for elderly
⩥ Osteoarthritis.
Answer: ▪ Also referred to as Degenerative Joint Disease [DJD] ▪
Factors that influence DJD - Age - Heredity - Repetitive stress - Prior
joint disease - Diabetes - Weight, ▪ Common above 65 ▪ Decrease in the
repair process of the body ▪ Maximal stress to articular cartilage ▪ Worse
over weight bearing joints and large joints
⩥ Osteoarthritis 2.
Answer: ▪ Go slow, no cure ▪ Water aerobics are wonderful ▪ Use of
cane, crutches, walker when needed ▪ Physical Therapy: heat, exercise,
stretching ▪ Rest as needed ▪ Ice ▪ Stay off limb if possible ▪ TENS unit ▪
Analgesics / Anti-inflammatory ▪ May need joint replacement
⩥ Sprain.
Answer: —acute injury to ligament when joint stressed beyond normal
range of motion ➢Ligaments—surround joint, responsible for
2026 TESTED SOLUTIONS GRADED A+
⩥ Taking the History.
Answer: May or may not involve trauma, OLDCARTS
⩥ Associated symptoms—warning signs.
Answer: - History of substantial trauma—fracture, major soft tissue
injury - Hot swollen joint—infection, RA, gout - Constitutional
symptoms [fever, malaise, weight loss, fatigue]—infection, sepsis -
Focal neurological weakness—radiculopathy - Diffuse weakness—
degenerative, neoplastic disease, toxins - Neurogenic pain [burning,
numbness, paresthesia, asymmetric]—radiculopathy, entrapment,
neuropathy - Claudication—peripheral arterial/vascular, stenosis,
arteritis 4/8/201
⩥ Taking the History 2.
Answer: CHD - Medications: NSAIDS, Rx or OTC, HRT, calcium -
LMP, menstrual cycles, menopause: female athletes, post-menopausal •
PMH - Previous injury or trauma—fracture, surgeries, arthroscopy -
Cancer, arthritis, sickle cell, osteoporosis, renal or neurologic disease
⩥ Taking the History 3.
Answer: • FH - Congenital abnormalities of hip, foot - Scoliosis or back
problems - Arthritis—RA, degenerative, ankylosing spondylitis, gout -
,Genetic—osteogenesis imperfecta, hypercalciuria ▪ Personal/Social -
Work, exercise, hobbies 4/8/2018- Tobacco, alcohol, drug use
⩥ Physical Exam.
Answer: ▪ Height ▪ Weight ▪ Uncover and examine both sides ▪ Observe
gait if weight bearing joint involved ▪ Inspection - Skin—injuries or
contusions - Swelling, deformities, bruising, erythema ▪ Palpation—one
finger point tenderness - Compare non-injured to injured area - Palpate
all surfaces—bones, joints, soft tissue - Examine above and below area
of injury
⩥ ▪ Range of motion.
Answer: —active and passive - Examine above and below area of injury
- Internal and external rotation - Abduction and adduction - Document
ROM in degrees!!!
⩥ Traditional Management.
Answer: ▪ Rest ▪ Ice ▪ Compression/immobilization ▪ Elevation (RICE) ▪
Acetaminophen, NSAIDs, muscle relaxants - Oral steroids may be
considered in some cases ▪ Physical therapy, exercise ▪ The tincture of
time ▪ Manipulation, acupuncture, other [ESI, TENS, etc], conservative
Rx x4-6 weeks
⩥ NSAIDs.
,Answer: Inhibit cyclooxygenase (COX) enzyme—provide anti-
inflammatory/analgesic effects - Dose dependent - NSAIDs differ in
analgesic and anti-inflammatory effec
⩥ NSAIDs.
Answer: - Gastritis, ulceration, bleed - Impaired renal function—
NSAIDs inhibit renal prostaglandins, affecting regulation of renal blood
flow and glomerular filtration - Hypertension/Edema - Platelet inhibition
and bleeding - CV risk—potential damage to arterial wall, possible
arterial clotting - Drug interaction with ASA—they ↓ cardioprotective
benefits and ↑ risk of GI bleed 4/8/2018
⩥ Evidence: BMJ Clinical Evidence 2007; 12: 1108.
Answer: - Plateau for effectiveness; SE ↑ with dose ↑ - COX-2 ↓ risk for
PUD but ↑ risk for MI/CV events - Paracetamol similar to NSAIDs for
acute MSK pain but ↓ effective than NSAIDs for OA [Paracetamol not
used in US 2nd to risk of GU malignancy] - **PPI > H2 antagonists ↓
GI SE - Insufficient evidence whether topical NSAIDs beneficial
⩥ NSAIDs ▪ Adverse effects:.
Answer: - Gastritis, ulceration, bleed - Impaired renal function—
NSAIDs inhibit renal prostaglandins, affecting regulation of renal blood
flow and glomerular filtration - Hypertension/Edema - Platelet inhibition
and bleeding - CV risk—potential damage to arterial wall, possible
arterial clotting - **Drug interaction with ASA—they ↓ cardioprotective
benefits and ↑ risk of GI blee
, ⩥ NSAIDs ▪ Recommendations:.
Answer: - GI risk in general—nonacelated aspirin products lowest risk
[Disalsid, Trilisate]; Ibuprofen/Naproxen intermediate risk,
Diclofenac/Piroxicam/Ketorolac greatest risk ▪ Use lowest dose possible
, risk ↑ with dose ▪ Short course best ▪ Use acetaminophen when
possible - Avoid in patients > 65 yrs., H/O PUD, on steroids,
anticoagulants, ASA ▪ AGS, May, 2009: NSAIDs considered rarely and
with extreme caution; Acetaminophen, opioids best for elderly
⩥ Osteoarthritis.
Answer: ▪ Also referred to as Degenerative Joint Disease [DJD] ▪
Factors that influence DJD - Age - Heredity - Repetitive stress - Prior
joint disease - Diabetes - Weight, ▪ Common above 65 ▪ Decrease in the
repair process of the body ▪ Maximal stress to articular cartilage ▪ Worse
over weight bearing joints and large joints
⩥ Osteoarthritis 2.
Answer: ▪ Go slow, no cure ▪ Water aerobics are wonderful ▪ Use of
cane, crutches, walker when needed ▪ Physical Therapy: heat, exercise,
stretching ▪ Rest as needed ▪ Ice ▪ Stay off limb if possible ▪ TENS unit ▪
Analgesics / Anti-inflammatory ▪ May need joint replacement
⩥ Sprain.
Answer: —acute injury to ligament when joint stressed beyond normal
range of motion ➢Ligaments—surround joint, responsible for
