NURS 842 Musculoskeletal Disorders
Chapter 4: Care of the Patient with a Musculoskeletal Disorder
MULTIPLE CHOICE
1. What is the movement of an extremity away from the midline of the body called?
a. Abduction
b. Adduction
c. Flexion
d. Extension
ANS: A
Abduction is movement of an extremity away from the midline of the body.
DIF: Cognitive Level: Knowledge REF: Page 114, Box 4-2
OBJ: 6 TOP: Movements KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
2. What is the large, fan-shaped muscle that covers the anterior chest from the sternum to the
proximal end of the humerus and acts on the joint of the shoulder to flex, adduct, and rotate?
a. Serratus anterior
b. Intercostal
c. Transversus abdominis
d. Pectoralis major
ANS: D
Pectoralis major is the large, fan-shaped muscle that covers the anterior chest and is an
adductor muscle, which will cause the shoulder to flex.
DIF: Cognitive Level: Knowledge REF: Page 116, Figure 4-4
OBJ: 4 TOP: Muscle functions
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
3. What should the nurse instruct the patient before a magnetic resonance imaging (MRI)
procedure?
a. Void to completely empty the bladder
b. Omit all citrus food for 12 hours before the procedure
c. Remove all metal, such as jewelry, glasses, and hair clips
d. Wear only cotton garments for the procedure
ANS: C
MRI procedures require that the patient remove all metal because it will become magnetized.
DIF: Cognitive Level: Application REF: Page 116 OBJ: 7
TOP: Diagnostic examinations KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
,4. The nurse instructs the patient who is to have a unicompartmental knee replacement that a
major advantage of this partial knee replacement is that:
a. the patient will be up and walking 2 to 3 hours after the operation.
b. the kneecap is completely removed.
c. the procedure is especially helpful in the treatment of rheumatoid arthritis.
d. a small titanium disk replaces the worn cartilage.
ANS: A
Unicompartmental knee arthroplasty is also referred to as partial knee replacement in which
the worn cartilage is replaced with a plastic disk. It is not as invasive as a full knee
replacement and does not disturb the kneecap so that the patient can be up and walking in 2 to
3 hours after surgery. It is not recommended for RA patients.
DIF: Cognitive Level: Comprehension REF: Page 136 OBJ: 13
TOP: Unicompartmental knee replacement
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
5. A patient who has had a right below the knee amputation continues to complain of unpleasant
sensation in the right foot. What can the nurse explain about this “phantom pain”?
a. It only exists in the mind.
b. It is a complication following an amputation and can be clarified by the surgeon.
c. It is related to the severed nerves that are still sending messages to the brain.
d. It occurs when the person becomes focused on the loss of the limb.
ANS: C
Phantom pain (pain felt in the missing extremity as if it were still present) may occur and be
frightening to the patient. Phantom pain occurs because the nerve tracts that register pain in
the amputated area continue to send a message to the brain (this is normal).
DIF: Cognitive Level: Analysis REF: Page 169 OBJ: 21
TOP: Phantom pain KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
6. The patient that has a bipolar hip replacement following an intracapsular fracture has an order
to be turned every 2 hours. The nurse understands that the correct nursing intervention is to
keep the legs:
a. together so they do not separate while turning.
b. flexed to stabilize the prosthesis.
c. abducted so the prosthesis does not become dislocated.
d. adducted to prevent additional pain for the patient with turning.
ANS: C
Nursing interventions also involve postoperative maintenance of leg abduction by using an
abduction splint for 7 to 10 days to prevent dislocation of the prosthesis.
, DIF: Cognitive Level: Application REF: Page 142, Figure 4-13
OBJ: 14 TOP: Maintaining abduction
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
7. A patient has been casted to stabilize a fracture of the right radius and ulna. The nurse assesses
a capillary refill of 5 seconds and cold fingers of the right hand. Which initial intervention
should the nurse deploy?
a. Notify the charge nurse of a probable compartment syndrome
b. Apply a warm compress to the fingers to relieve swelling
c. Elevate the right hand to heart level to maintain arterial pressure
d. Cut the cast off to release constriction
ANS: C
The nurse should first elevate the right hand to heart level and notify the charge nurse.
Permanent damage can occur in as little time as 6 hours.
DIF: Cognitive Level: Analysis REF: Page 150 OBJ: 19
TOP: Compartment syndrome KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
8. A patient had an open reduction with internal fixation (ORIF) for a compound fracture of the
left tibia and has been placed in a long leg cast. The assessments by the nurse are: left foot
warm/pink, pedal pulse weaker than right, capillary refill 3 seconds, and small 1 cm area of
blood on cast. What should the nurse do?
a. Notify charge nurse of impending compartment syndrome
b. Document that all assessments are within normal limits
c. Inform charge nurse about probable hemorrhage
d. Place warm compresses on left foot
ANS: B
All of the assessments are within normal limits. A small amount of blood on the cast is
expected and should be monitored.
DIF: Cognitive Level: Analysis REF: Page 172 OBJ: 19
TOP: Compound fracture KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
9. When a patient recovering from a fractured tibia asks what callus formation is, the nurse
tells her it is:
a. when blood vessels of the bone are compressed.
b. a part of the bone healing process after a fracture when new bone is being formed
over the fracture site.
c. the formation of a clot over the fracture site.
d. when the hematoma becomes organized and a fibrin meshwork is formed.
ANS: B
Chapter 4: Care of the Patient with a Musculoskeletal Disorder
MULTIPLE CHOICE
1. What is the movement of an extremity away from the midline of the body called?
a. Abduction
b. Adduction
c. Flexion
d. Extension
ANS: A
Abduction is movement of an extremity away from the midline of the body.
DIF: Cognitive Level: Knowledge REF: Page 114, Box 4-2
OBJ: 6 TOP: Movements KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
2. What is the large, fan-shaped muscle that covers the anterior chest from the sternum to the
proximal end of the humerus and acts on the joint of the shoulder to flex, adduct, and rotate?
a. Serratus anterior
b. Intercostal
c. Transversus abdominis
d. Pectoralis major
ANS: D
Pectoralis major is the large, fan-shaped muscle that covers the anterior chest and is an
adductor muscle, which will cause the shoulder to flex.
DIF: Cognitive Level: Knowledge REF: Page 116, Figure 4-4
OBJ: 4 TOP: Muscle functions
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
3. What should the nurse instruct the patient before a magnetic resonance imaging (MRI)
procedure?
a. Void to completely empty the bladder
b. Omit all citrus food for 12 hours before the procedure
c. Remove all metal, such as jewelry, glasses, and hair clips
d. Wear only cotton garments for the procedure
ANS: C
MRI procedures require that the patient remove all metal because it will become magnetized.
DIF: Cognitive Level: Application REF: Page 116 OBJ: 7
TOP: Diagnostic examinations KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
,4. The nurse instructs the patient who is to have a unicompartmental knee replacement that a
major advantage of this partial knee replacement is that:
a. the patient will be up and walking 2 to 3 hours after the operation.
b. the kneecap is completely removed.
c. the procedure is especially helpful in the treatment of rheumatoid arthritis.
d. a small titanium disk replaces the worn cartilage.
ANS: A
Unicompartmental knee arthroplasty is also referred to as partial knee replacement in which
the worn cartilage is replaced with a plastic disk. It is not as invasive as a full knee
replacement and does not disturb the kneecap so that the patient can be up and walking in 2 to
3 hours after surgery. It is not recommended for RA patients.
DIF: Cognitive Level: Comprehension REF: Page 136 OBJ: 13
TOP: Unicompartmental knee replacement
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
5. A patient who has had a right below the knee amputation continues to complain of unpleasant
sensation in the right foot. What can the nurse explain about this “phantom pain”?
a. It only exists in the mind.
b. It is a complication following an amputation and can be clarified by the surgeon.
c. It is related to the severed nerves that are still sending messages to the brain.
d. It occurs when the person becomes focused on the loss of the limb.
ANS: C
Phantom pain (pain felt in the missing extremity as if it were still present) may occur and be
frightening to the patient. Phantom pain occurs because the nerve tracts that register pain in
the amputated area continue to send a message to the brain (this is normal).
DIF: Cognitive Level: Analysis REF: Page 169 OBJ: 21
TOP: Phantom pain KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
6. The patient that has a bipolar hip replacement following an intracapsular fracture has an order
to be turned every 2 hours. The nurse understands that the correct nursing intervention is to
keep the legs:
a. together so they do not separate while turning.
b. flexed to stabilize the prosthesis.
c. abducted so the prosthesis does not become dislocated.
d. adducted to prevent additional pain for the patient with turning.
ANS: C
Nursing interventions also involve postoperative maintenance of leg abduction by using an
abduction splint for 7 to 10 days to prevent dislocation of the prosthesis.
, DIF: Cognitive Level: Application REF: Page 142, Figure 4-13
OBJ: 14 TOP: Maintaining abduction
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
7. A patient has been casted to stabilize a fracture of the right radius and ulna. The nurse assesses
a capillary refill of 5 seconds and cold fingers of the right hand. Which initial intervention
should the nurse deploy?
a. Notify the charge nurse of a probable compartment syndrome
b. Apply a warm compress to the fingers to relieve swelling
c. Elevate the right hand to heart level to maintain arterial pressure
d. Cut the cast off to release constriction
ANS: C
The nurse should first elevate the right hand to heart level and notify the charge nurse.
Permanent damage can occur in as little time as 6 hours.
DIF: Cognitive Level: Analysis REF: Page 150 OBJ: 19
TOP: Compartment syndrome KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
8. A patient had an open reduction with internal fixation (ORIF) for a compound fracture of the
left tibia and has been placed in a long leg cast. The assessments by the nurse are: left foot
warm/pink, pedal pulse weaker than right, capillary refill 3 seconds, and small 1 cm area of
blood on cast. What should the nurse do?
a. Notify charge nurse of impending compartment syndrome
b. Document that all assessments are within normal limits
c. Inform charge nurse about probable hemorrhage
d. Place warm compresses on left foot
ANS: B
All of the assessments are within normal limits. A small amount of blood on the cast is
expected and should be monitored.
DIF: Cognitive Level: Analysis REF: Page 172 OBJ: 19
TOP: Compound fracture KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
9. When a patient recovering from a fractured tibia asks what callus formation is, the nurse
tells her it is:
a. when blood vessels of the bone are compressed.
b. a part of the bone healing process after a fracture when new bone is being formed
over the fracture site.
c. the formation of a clot over the fracture site.
d. when the hematoma becomes organized and a fibrin meshwork is formed.
ANS: B
