MSNCB Musculoskeletal Care 2 — Questions and Answers
Question 1: A patient with a long leg cast reports severe pain unrelieved by opioids and paresthesia in the toes. What is the priority nursing action?
- Elevate the extremity higher
- Administer additional analgesic
- Bivalve or remove the cast immediately (Correct answer)
- Apply ice over the cast
Correct answer: Bivalve or remove the cast immediately
Unrelieved pain and paresthesia indicate compartment syndrome, requiring immediate cast removal to relieve pressure.
Question 2: Which lab value is most important to monitor in a patient taking long-term corticosteroids for rheumatoid arthritis who reports back pain?
- Serum potassium
- Bone mineral density (DEXA scan result) (Correct answer)
- Hemoglobin A1c
- Serum creatinine
Correct answer: Bone mineral density (DEXA scan result)
Long-term corticosteroid use causes osteoporosis; bone mineral density monitoring detects vertebral fracture risk from steroid-induced bone loss.
Question 3: A nurse is caring for a patient 6 hours post-total hip arthroplasty (THA). Which position is contraindicated?
- Hip abduction with a pillow between legs
- Supine with head of bed at 30 degrees
- Hip flexion greater than 90 degrees (Correct answer)
- Leg in neutral rotation
Correct answer: Hip flexion greater than 90 degrees
Hip flexion beyond 90 degrees risks prosthetic dislocation in the early postoperative period after posterior-approach THA.
Question 4: A patient with Paget's disease of bone asks why their serum alkaline phosphatase is elevated. The best nursing response is:
- It indicates liver damage from your medications
- It reflects increased osteoblastic activity due to abnormal bone remodeling (Correct answer)
- It shows your kidneys are not filtering waste properly
- It means you are developing bone cancer
Correct answer: It reflects increased osteoblastic activity due to abnormal bone remodeling
In Paget's disease, markedly elevated alkaline phosphatase reflects excessive, disorganized osteoblastic bone remodeling activity.
Question 5: Which finding in a patient with a fractured femur warrants the most immediate nursing intervention?
- Pain rated 7/10
- Blood pressure 88/54 mmHg and heart rate 118 bpm (Correct answer)
- Mild swelling at the fracture site
- Temperature of 37.8°C
Correct answer: Blood pressure 88/54 mmHg and heart rate 118 bpm
Femur fractures can cause 1–2 L of blood loss; hypotension and tachycardia indicate hemorrhagic shock requiring immediate intervention.
Question 6: A patient on skeletal traction asks why weights cannot be removed for comfort. The correct nursing explanation is:
- Weights must remain continuous to maintain bone alignment and prevent muscle spasm (Correct answer)
- Weights can be temporarily removed during meals only
- Removing weights prevents nerve damage
- Weights are removed only during physical therapy
Correct answer: Weights must remain continuous to maintain bone alignment and prevent muscle spasm
Continuous traction is essential; interruption allows bone fragments to override and muscle spasm to recur, negating the therapeutic effect.
Question 7: A patient post-spinal fusion develops urinary retention and bilateral leg weakness on postoperative day 1. The priority action is:
- Perform intermittent catheterization and document
- Notify the surgeon immediately for suspected epidural hematoma (Correct answer)
- Increase IV fluids to improve bladder perfusion
- Apply warm compresses to the lower back
Correct answer: Notify the surgeon immediately for suspected epidural hematoma
New bilateral motor weakness and urinary retention after spinal surgery suggest epidural hematoma, a surgical emergency requiring immediate notification.
MSNCB Musculoskeletal Care 2
A patient with a long leg cast reports severe pain unrelieved by opioids and paresthesia in the toes.
What is the priority nursing action?