MSNCB Musculoskeletal Care 2

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?

Accepted Answer

Bivalve or remove the cast immediately

Answer

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?

Accepted Answer

Bone mineral density (DEXA scan result)

Answer

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?

Accepted Answer

Hip flexion greater than 90 degrees

Answer

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:

Accepted Answer

It reflects increased osteoblastic activity due to abnormal bone remodeling

Answer

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?

Accepted Answer

Blood pressure 88/54 mmHg and heart rate 118 bpm

Answer

Femur fractures can cause 1–2 L of blood loss; hypotension and tachycardia indicate hemorrhagic shock requiring immediate intervention.

(MSNCB) Medical-Surgical Nursing Certification Board Practice Test