NURS 623 FINAL EXAM - MUSCULOSKELETAL

NURS 623 FINAL EXAM - MUSCULOSKELETAL

SECTION QUESTIONS AND CORRECT

ANSWERS

A 13-year-old obese (BMI greater than 95%) boy reports low-grade left knee pain for the past 2 months. He denies antecedent trauma but admits to frequent horseplay with his friends. The pain has progressively worsened, and he is now unable to bear weight at all on his left leg. His current complaints include left groin, thigh, and medial knee pain and tenderness. His examination demonstrates negative Drawer, Lachman, and McMurray tests; left hip with decreased internal rotation and abduction; and knee flexion causing external hip rotation. Based on the above scenario,

the NP should suspect:

• a left meniscal tear.
• a left ACL tear
• a slipped capital femoral epiphysis
• osgood-schlatter disease. - Correct Answer C.

Colchicine may be used to terminate an acute attack of gouty arthritis as well as prevent recurrent

episodes. The mechanism of action is to:

• interrupt the cycle of urate crystal deposition and inflammatory response.
• increase serum uric acid levels.
• potentiate the excretion of uric acid.
• inhibit the tubular reabsorption of urate, promoting the excretion of uric acid. - Correct Answer A.

Cass, age 67, tells the NP that she has been diagnosed with a condition that causes sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of the diagnosis, but she knows that it is cause by urate crystals that "get stuck in the joint and cause pain".Joan is on HcTz for management of her hypertension. The NP should suspect a diagnosis of:

• septic arthritis
• gout.
• rheumatoid arthritis.
• Charcot neuro-osteoarthropathy - Correct Answer B.

Treatment of choice for polymyalgia rheumatica (PMR) is:

• acetaminophen or NSAIDS
• low dose steroids. 1 / 3

• tricyclic antidepressants.
• antibiotics - Correct Answer B.

Dan, age 49, developed osteomyelitis of the femur after a motorcycle accident. Which of the following statements about the clinical manifestations of osteomyelitis is correct?

• integumentary effects involve swelling, erythema, and warmth at the involved site.
• there is a low grade fever with intermittent chills
• musculoskeletal effects include tenderness of the entire leg.
• cardiovascular effects include bradycardia. - Correct Answer A.

Matthew, age 52, is a chef who just severed two of his fingers with a meat cutter. You would

recommend that he:

• wrap the severed fingers tightly in a dry towel for transport to the emergency department with

him.

• leave the severed fingers at the scene because fingers cannot be reattached.
• immediately freeze the severed fingers for reattachment in the near future.
• pack the fingers in a saline-soaked dressing and seal in a plastic bag. - Correct Answer D.

Bursitis is an inflammatory process that may be caused by infection, trauma, repetitive motion disorders, gout, or neoplastic disease. The most common cause of septic bursitis due to infection is

from which of the following:

• Mycobacterium tuberculosis
• Candida
• Staphylococcus aureus.
• streptococcus - Correct Answer C.

When a provider elicits a painful Finkelstein's sign he or she is testing for:

• carpal tunnel syndrone
• bursitis of the shoulder.
• de Quervain's tenosynovitis
• tennis elbow. - Correct Answer C. 2 / 3

Marsha, age 34, presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia than of chronic fatigue syndrome?

• musculoskeletal pain
• difficulty sleeping
• depression
• fatigue - Correct Answer A.

A coccygeal fracture is treated with:

• traction
• surgical repair
• analgesia and by use of a donut cushion when sitting
• prolonged bedrest for 6 weeks. - Correct Answer C.

The most common cause of cauda equina syndrome is:

• fracture
• hematoma
• lumbar intervertebral disk herniation.
• space occupying lesion. - Correct Answer C.

If any limitation or any increase in range of motion occurs when assessing the musculoskeletal

system, the angles of the bones should be measured using:

• Phalen's test
• skeletometry
• The Thomas test
• a goniometer. - Correct Answer D.

Management of fibromyalgia would include:

• giving psychotropic drugs, such as amitriptyline (Elavil), in a low dose at bedtime.
• instructing clients to keep as busy as possible to keep their minds off the symptoms.
• using high doses of NSAIDS.
• avoiding exercise. - Correct Answer A.
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