MEDICAL-SURGICAL NURSING 2025-2026
MUSCULOSKELETAL SYSTEM EXAM WITH QUESTIONS, ANSWERS &
RATIONALES
NCLEX PREP
All answers and Rationales are in RED
A client has had a below-the-knee amputation of the leg. What is important for the nurse to consider
when providing postoperative care for a client who had an amputation of a lower extremity?
1. Strict bed rest is maintained for at least several days.
2. The residual limb should not be elevated for the first 24 hours.
3. Hemorrhage rarely occurs during the early postoperative period.
4. Primary healthcare providers usually change the dressing on the residual limb within 48 hours.
2 - The residual limb should not be elevated for the first 24 hours.
Elevation of the residual limb helps prevent edema; however, should not be done on the first 24 hours and
continued elevation may lead to hip contractures. The client usually is out of bed on the second postoperative
day. Hemorrhage and infection are the two most common complications. The dressing usually is a pressure
dressing and is not changed this soon postoperatively.
The nurse is caring for a client with rheumatoid arthritis. When should the nurse expect the client to
experience the most pain and limited movement of the joints?
1. After assistive exercise
2.When the room is cool
3.During the evening hours
4.In the morning on awakening
4 - In the morning on awakening
Inactivity over an extended time increases stiffness and pain in joints. The client typically has morning stiffness,
or gel phenomenon. Assistive exercises help maintain joint mobility. Whether the room is cool is not a factor;
cold applications may decrease joint discomfort. The pain is not as severe in the evening as in the morning.
A client with rheumatoid arthritis asks the nurse about ways to decrease morning stiffness. What should
the nurse suggest?
1.Wearing loose but warm clothing
2.Planning a short rest break periodically
3.Avoiding excessive physical stress and fatigue
4.Taking a hot tub bath or shower in the morning
,4 - Taking a hot tub bath or shower in the morning
Moist heat increases circulation and decreases muscle tension, which help relieve chronic stiffness. Although
wearing loose but warm clothing is advisable for someone with arthritis, it does not relieve morning stiffness.
Inactivity promotes stiffness. The practice of avoiding excessive physical stress and fatigue is related to muscle
fatigue, not to stiffness of joints.
An x-ray film indicates that an older client has a fractured femur. The client asks the nurse, "Will I be
able to walk again?" What is the best response by the nurse?
1
"I have no idea because only time will tell."
2
"You only broke a bone. It could have been worse."
3
"You’ll walk again. This is a common issue in older people."
4
"Tell me more about your concerns about being able to walk."
4 - "Tell me more about your concerns about being able to walk."
The phrase "Tell me more" shows interest in the client's concerns, is nonjudgmental, and encourages expression
and exploration of feelings. First the client's feelings must be explored before providing a direct answer that
may cut off communication. The responses "I have no idea" and "You only broke a bone. It could have been
worse" places the client on the defensive; it is demeaning to the client and discourages further communication.
The general response "You'll walk again. This is a common issue in older people" dismisses the client's
concerns; the client is not recognized as an individual whose injury is a traumatic and personal event.
Which hormone promotes bone resorption in a client?
1
Estrogen
2
Calcitonin
3
Growth hormone
4
Parathyroid hormone (PTH)
4 - Parathyroid hormone (PTH)
When serum calcium levels are lowered, secretion of PTH increases and stimulates bones to promote
osteoclastic activity, which promotes bone resorption. Estrogens stimulate osteoblastic (bone-building) activity
and inhibit PTH. Calcitonin inhibits bone resorption and increases the renal excretion of calcium and
,phosphorus as needed to maintain balance in the body. Growth hormones secreted by the anterior lobe of the
pituitary gland are responsible for increasing bone length.
Which hormones are involved in building and maintaining healthy bone tissue? Select all that apply.
1
Insulin
2
Thyroxine
3
Glucocorticoids
4
Growth hormone
5
Parathyroid hormone
1 - Insulin
4 - Growth hormone
Insulin works together with growth hormone to increase bone length, which helps to build and maintain healthy
bone tissue. Thyroxine increases the rate of protein synthesis in all types of tissues. Glucocorticoids regulate
protein metabolism to reduce or intensify the organic matrix of bone. Parathyroid hormone secretion stimulates
bones to promote osteoclastic activity and release calcium into the blood when serum calcium levels are
lowered.
The nurse is providing discharge teaching to a 30-year-old client who was hospitalized for exacerbation of
rheumatoid arthritis. Which statement by the client indicates correct understanding of the treatment
plan?
1
"I will plan to rest in bed for the next 2 weeks."
2
"I will only take my medications when I am having joint pain."
3
"When I exercise, I will reduce the number of repetitions when I have pain."
4
"When I get out of bed, I will push off with my fingers rather than the palms of my hands."
3 - "When I exercise, I will reduce the number of repetitions when I have pain."
The amount of exercise and number of repetitions should be reduced to prevent further joint damage if the client
is experiencing increased pain. Activity should be balanced with rest. Medications should not be discontinued
without consulting the primary healthcare provider. Pushing off with fingers may cause further damage to the
phalangeal joints.
, Which type of joint is present in the client's shoulders?
1
Pivotal
2
Saddle
3
Condyloid
4
Spheroidal
4 - Spheroidal
The spheroidal joint is a ball and socket joint that provides flexion, extension, adduction, abduction, and
circumduction in the shoulders and hips. The pivotal joint provides rotation in the atlas and axis, and at the
proximal radioulnar joint. The saddle joint, which is at the carpometacarpal joint of the thumb, provides flexion,
extension, abduction, adduction, and circumduction of the thumb-finger. The condyloid joint is a wrist joint
between the radial and carpals; it provides flexion, extension, abduction, adduction, and circumduction.
Which musculoskeletal system change is associated in older adult clients?
1
Decreased in height
2
Decreased neck rigidity
3
Increased fine-motor dexterity
4
Increased range of motion (ROM)
1 - Decreased in height
Loss of height and deformity and shortening of the trunk are common in older adults due to vertebral
compression and degeneration. Rigidity in the neck, shoulders, back, hips, and knees increases with age due to
loss of elasticity in ligaments, tendons, and cartilage. A decline in fine-motor dexterity occurs in the older adult
due to slow impulse conduction along motor units. Range of motion (ROM) is limited in the older adult due to
cartilage erosion, increased friction between the bones, and overgrowth of bone around joint margins.
Which diagnostic study is used to detect deep vein thrombosis in the client's lower extremities?
1
Thermography
2
Plethysmography
3
Duplex venous doppler
4
Somatosensory evoked potential
MUSCULOSKELETAL SYSTEM EXAM WITH QUESTIONS, ANSWERS &
RATIONALES
NCLEX PREP
All answers and Rationales are in RED
A client has had a below-the-knee amputation of the leg. What is important for the nurse to consider
when providing postoperative care for a client who had an amputation of a lower extremity?
1. Strict bed rest is maintained for at least several days.
2. The residual limb should not be elevated for the first 24 hours.
3. Hemorrhage rarely occurs during the early postoperative period.
4. Primary healthcare providers usually change the dressing on the residual limb within 48 hours.
2 - The residual limb should not be elevated for the first 24 hours.
Elevation of the residual limb helps prevent edema; however, should not be done on the first 24 hours and
continued elevation may lead to hip contractures. The client usually is out of bed on the second postoperative
day. Hemorrhage and infection are the two most common complications. The dressing usually is a pressure
dressing and is not changed this soon postoperatively.
The nurse is caring for a client with rheumatoid arthritis. When should the nurse expect the client to
experience the most pain and limited movement of the joints?
1. After assistive exercise
2.When the room is cool
3.During the evening hours
4.In the morning on awakening
4 - In the morning on awakening
Inactivity over an extended time increases stiffness and pain in joints. The client typically has morning stiffness,
or gel phenomenon. Assistive exercises help maintain joint mobility. Whether the room is cool is not a factor;
cold applications may decrease joint discomfort. The pain is not as severe in the evening as in the morning.
A client with rheumatoid arthritis asks the nurse about ways to decrease morning stiffness. What should
the nurse suggest?
1.Wearing loose but warm clothing
2.Planning a short rest break periodically
3.Avoiding excessive physical stress and fatigue
4.Taking a hot tub bath or shower in the morning
,4 - Taking a hot tub bath or shower in the morning
Moist heat increases circulation and decreases muscle tension, which help relieve chronic stiffness. Although
wearing loose but warm clothing is advisable for someone with arthritis, it does not relieve morning stiffness.
Inactivity promotes stiffness. The practice of avoiding excessive physical stress and fatigue is related to muscle
fatigue, not to stiffness of joints.
An x-ray film indicates that an older client has a fractured femur. The client asks the nurse, "Will I be
able to walk again?" What is the best response by the nurse?
1
"I have no idea because only time will tell."
2
"You only broke a bone. It could have been worse."
3
"You’ll walk again. This is a common issue in older people."
4
"Tell me more about your concerns about being able to walk."
4 - "Tell me more about your concerns about being able to walk."
The phrase "Tell me more" shows interest in the client's concerns, is nonjudgmental, and encourages expression
and exploration of feelings. First the client's feelings must be explored before providing a direct answer that
may cut off communication. The responses "I have no idea" and "You only broke a bone. It could have been
worse" places the client on the defensive; it is demeaning to the client and discourages further communication.
The general response "You'll walk again. This is a common issue in older people" dismisses the client's
concerns; the client is not recognized as an individual whose injury is a traumatic and personal event.
Which hormone promotes bone resorption in a client?
1
Estrogen
2
Calcitonin
3
Growth hormone
4
Parathyroid hormone (PTH)
4 - Parathyroid hormone (PTH)
When serum calcium levels are lowered, secretion of PTH increases and stimulates bones to promote
osteoclastic activity, which promotes bone resorption. Estrogens stimulate osteoblastic (bone-building) activity
and inhibit PTH. Calcitonin inhibits bone resorption and increases the renal excretion of calcium and
,phosphorus as needed to maintain balance in the body. Growth hormones secreted by the anterior lobe of the
pituitary gland are responsible for increasing bone length.
Which hormones are involved in building and maintaining healthy bone tissue? Select all that apply.
1
Insulin
2
Thyroxine
3
Glucocorticoids
4
Growth hormone
5
Parathyroid hormone
1 - Insulin
4 - Growth hormone
Insulin works together with growth hormone to increase bone length, which helps to build and maintain healthy
bone tissue. Thyroxine increases the rate of protein synthesis in all types of tissues. Glucocorticoids regulate
protein metabolism to reduce or intensify the organic matrix of bone. Parathyroid hormone secretion stimulates
bones to promote osteoclastic activity and release calcium into the blood when serum calcium levels are
lowered.
The nurse is providing discharge teaching to a 30-year-old client who was hospitalized for exacerbation of
rheumatoid arthritis. Which statement by the client indicates correct understanding of the treatment
plan?
1
"I will plan to rest in bed for the next 2 weeks."
2
"I will only take my medications when I am having joint pain."
3
"When I exercise, I will reduce the number of repetitions when I have pain."
4
"When I get out of bed, I will push off with my fingers rather than the palms of my hands."
3 - "When I exercise, I will reduce the number of repetitions when I have pain."
The amount of exercise and number of repetitions should be reduced to prevent further joint damage if the client
is experiencing increased pain. Activity should be balanced with rest. Medications should not be discontinued
without consulting the primary healthcare provider. Pushing off with fingers may cause further damage to the
phalangeal joints.
, Which type of joint is present in the client's shoulders?
1
Pivotal
2
Saddle
3
Condyloid
4
Spheroidal
4 - Spheroidal
The spheroidal joint is a ball and socket joint that provides flexion, extension, adduction, abduction, and
circumduction in the shoulders and hips. The pivotal joint provides rotation in the atlas and axis, and at the
proximal radioulnar joint. The saddle joint, which is at the carpometacarpal joint of the thumb, provides flexion,
extension, abduction, adduction, and circumduction of the thumb-finger. The condyloid joint is a wrist joint
between the radial and carpals; it provides flexion, extension, abduction, adduction, and circumduction.
Which musculoskeletal system change is associated in older adult clients?
1
Decreased in height
2
Decreased neck rigidity
3
Increased fine-motor dexterity
4
Increased range of motion (ROM)
1 - Decreased in height
Loss of height and deformity and shortening of the trunk are common in older adults due to vertebral
compression and degeneration. Rigidity in the neck, shoulders, back, hips, and knees increases with age due to
loss of elasticity in ligaments, tendons, and cartilage. A decline in fine-motor dexterity occurs in the older adult
due to slow impulse conduction along motor units. Range of motion (ROM) is limited in the older adult due to
cartilage erosion, increased friction between the bones, and overgrowth of bone around joint margins.
Which diagnostic study is used to detect deep vein thrombosis in the client's lower extremities?
1
Thermography
2
Plethysmography
3
Duplex venous doppler
4
Somatosensory evoked potential
