NR 511 FINAL EXAM PRACTICE QUESTIONS
Sean, a factory line worker, has osteoarthritis (OA) of the right hand. According to the American College of
Rheumatology (ACR), the guidelines for pharmacologic treatment include:
1. Acetaminophen, tramadol, and intra-articular corticosteroid injections.
2. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and articular corticosteroid injections.
3. Acetaminophen, topical capsaicin, and topical nonsteroidal anti-inflammatory drugs (NSAIDs).
4. Topical capsaicin, topical nonsteroidal anti-inflammatory drugs (NSAIDs), and oral NSAIDs.
Rationales
Option 1:
Acetaminophen, oral nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and intra-articular corticosteroid
injections are recommended for initial management of hip OA.
Option 2:
Acetaminophen, oral NSAIDs, tramadol, and intra-articular corticosteroid injections are recommended for initial
management of hip OA.
Option 3:
The ACR conditionally recommends acetaminophen, oral NSAIDs, topical NSAIDs, tramadol, and intra-articular
corticosteroid injections for OA of the knee.
Option 4:
Topical capsaicin, topical NSAIDs, oral NSAIDs, and tramadol are recommended by the ACR for the treatment of OA
of the hand.
Margaret, age 55, presents to you for evaluation of left hand and wrist pain and swelling after a slip and fall on
the ice yesterday. On examination, you note tenderness at her “anatomical snuffbox.” You know this probably
indicates a(n):
1. Ulnar styloid fracture.
2. Scaphoid fracture.
3. Hamate fracture.
4. Radial head fracture.
Rationales
Option 1:
An ulnar styloid fracture would produce tenderness at the distal ulna.
Option 2:
There is tenderness over the “anatomical snuffbox” in a scaphoid (aka navicular) fracture, the most common injury
of the carpal bones. Poor blood supply puts the scaphoid bone at risk of avascular necrosis; therefore, wrist pain
and tenderness in the anatomical snuffbox, even without history of antecedent trauma, warrant a wrist x-ray.
, Option 3:
A fracture of the hook of the hamate is an uncommon injury seen in golfers and players of racket sports that
involves pain and tenderness on the ulnar side of the palm.
Option 4:
A radial head fracture would result in pain at the elbow joint where the radial head lies proximal to the distal
humerus. Be sure not to confuse the radial head (proximal end of the radius) with the radial styloid (distal end of
the radius at the wrist).
Jim, age 22, a stock boy, has an acute episode of low back pain. The nurse practitioner orders a nonsteroidal
anti-inflammatory drug (NSAID) and should educate him in which of the following?
1. Maintaining moderate bed rest for 3 to 4 days.
2. Calling the office for narcotic medication if there is no relief with the NSAID after 24 to 48 hours.
3. Beginning lower back strengthening exercises depending on pain tolerance.
4. Wearing a Boston brace at night.
Rationales
Option 1:
Years ago, muscle relaxants and bed rest were the treatments of choice for low back pain. Studies have now shown
that resuming normal activity within the limits imposed by the pain has an effect as good as, if not better than, 2
days of bed rest.
Option 2:
NSAIDs, not narcotics, are generally the first-line medication treatment of low back pain and have no risk of opioid
dependency.
Option 3:
Years ago, muscle relaxants and bed rest were the treatments of choice for low back pain. Studies have now shown
that resuming normal activity within the limits imposed by the pain has an effect as good as, if not better than, 2
days of bed rest. The key here is letting pain be your guide. Exercise should begin as soon as possible after the
acute injury and be directed at building endurance and stamina, with consideration given to one’s pain tolerance.
Option 4:
A Boston brace may be used in the treatment of scoliosis.
Matthew, age 52, is a chef who just severed 2 of his fingers with a meat cutter. You would recommend that he:
1. Wrap the severed fingers tightly in a dry towel for transport to the emergency department with him.
2. Leave the severed fingers at the scene because fingers cannot be reattached.
3. Immediately freeze the severed fingers for reattachment in the near future.
4. Wrap the fingers in a clean, damp cloth; seal them in a plastic bag; and place the bag in an ice water bath.
Rationales
Option 1:
Sean, a factory line worker, has osteoarthritis (OA) of the right hand. According to the American College of
Rheumatology (ACR), the guidelines for pharmacologic treatment include:
1. Acetaminophen, tramadol, and intra-articular corticosteroid injections.
2. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and articular corticosteroid injections.
3. Acetaminophen, topical capsaicin, and topical nonsteroidal anti-inflammatory drugs (NSAIDs).
4. Topical capsaicin, topical nonsteroidal anti-inflammatory drugs (NSAIDs), and oral NSAIDs.
Rationales
Option 1:
Acetaminophen, oral nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and intra-articular corticosteroid
injections are recommended for initial management of hip OA.
Option 2:
Acetaminophen, oral NSAIDs, tramadol, and intra-articular corticosteroid injections are recommended for initial
management of hip OA.
Option 3:
The ACR conditionally recommends acetaminophen, oral NSAIDs, topical NSAIDs, tramadol, and intra-articular
corticosteroid injections for OA of the knee.
Option 4:
Topical capsaicin, topical NSAIDs, oral NSAIDs, and tramadol are recommended by the ACR for the treatment of OA
of the hand.
Margaret, age 55, presents to you for evaluation of left hand and wrist pain and swelling after a slip and fall on
the ice yesterday. On examination, you note tenderness at her “anatomical snuffbox.” You know this probably
indicates a(n):
1. Ulnar styloid fracture.
2. Scaphoid fracture.
3. Hamate fracture.
4. Radial head fracture.
Rationales
Option 1:
An ulnar styloid fracture would produce tenderness at the distal ulna.
Option 2:
There is tenderness over the “anatomical snuffbox” in a scaphoid (aka navicular) fracture, the most common injury
of the carpal bones. Poor blood supply puts the scaphoid bone at risk of avascular necrosis; therefore, wrist pain
and tenderness in the anatomical snuffbox, even without history of antecedent trauma, warrant a wrist x-ray.
, Option 3:
A fracture of the hook of the hamate is an uncommon injury seen in golfers and players of racket sports that
involves pain and tenderness on the ulnar side of the palm.
Option 4:
A radial head fracture would result in pain at the elbow joint where the radial head lies proximal to the distal
humerus. Be sure not to confuse the radial head (proximal end of the radius) with the radial styloid (distal end of
the radius at the wrist).
Jim, age 22, a stock boy, has an acute episode of low back pain. The nurse practitioner orders a nonsteroidal
anti-inflammatory drug (NSAID) and should educate him in which of the following?
1. Maintaining moderate bed rest for 3 to 4 days.
2. Calling the office for narcotic medication if there is no relief with the NSAID after 24 to 48 hours.
3. Beginning lower back strengthening exercises depending on pain tolerance.
4. Wearing a Boston brace at night.
Rationales
Option 1:
Years ago, muscle relaxants and bed rest were the treatments of choice for low back pain. Studies have now shown
that resuming normal activity within the limits imposed by the pain has an effect as good as, if not better than, 2
days of bed rest.
Option 2:
NSAIDs, not narcotics, are generally the first-line medication treatment of low back pain and have no risk of opioid
dependency.
Option 3:
Years ago, muscle relaxants and bed rest were the treatments of choice for low back pain. Studies have now shown
that resuming normal activity within the limits imposed by the pain has an effect as good as, if not better than, 2
days of bed rest. The key here is letting pain be your guide. Exercise should begin as soon as possible after the
acute injury and be directed at building endurance and stamina, with consideration given to one’s pain tolerance.
Option 4:
A Boston brace may be used in the treatment of scoliosis.
Matthew, age 52, is a chef who just severed 2 of his fingers with a meat cutter. You would recommend that he:
1. Wrap the severed fingers tightly in a dry towel for transport to the emergency department with him.
2. Leave the severed fingers at the scene because fingers cannot be reattached.
3. Immediately freeze the severed fingers for reattachment in the near future.
4. Wrap the fingers in a clean, damp cloth; seal them in a plastic bag; and place the bag in an ice water bath.
Rationales
Option 1:
