MSNCB Musculoskeletal Care 3 — Questions and Answers
Question 1: When assessing capillary refill in a casted extremity, which finding requires the nurse to contact the provider?
- Refill in less than 2 seconds
- Refill in 4 seconds with pallor (Correct answer)
- Slight pink color return in 2 seconds
- Warmth of the fingers
Correct answer: Refill in 4 seconds with pallor
Capillary refill greater than 3 seconds with pallor indicates compromised arterial circulation and possible neurovascular compromise.
Question 2: A patient with osteoporosis is prescribed alendronate (Fosamax). Which teaching point is essential?
- Take the medication at bedtime with a full glass of milk
- Remain upright for at least 30 minutes after taking the medication (Correct answer)
- Take the medication with food to avoid GI upset
- Crush the tablet and mix with juice for better absorption
Correct answer: Remain upright for at least 30 minutes after taking the medication
Bisphosphonates must be taken with plain water on an empty stomach, and the patient must remain upright for 30 minutes to prevent esophageal erosion.
Question 3: Which clinical manifestation differentiates osteomyelitis from a simple soft tissue infection?
- Localized redness and warmth
- Persistent bone pain with point tenderness and elevated ESR/CRP (Correct answer)
- Low-grade fever
- Mild leukocytosis
Correct answer: Persistent bone pain with point tenderness and elevated ESR/CRP
Osteomyelitis typically presents with bone point tenderness, marked elevation of inflammatory markers (ESR, CRP), and often a positive bone scan.
Question 4: A patient with rheumatoid arthritis (RA) is started on methotrexate. Which laboratory monitoring is required?
- Serum calcium and vitamin D levels monthly
- Liver function tests and complete blood count regularly (Correct answer)
- 24-hour urine creatinine clearance weekly
- Serum uric acid levels every 3 months
Correct answer: Liver function tests and complete blood count regularly
Methotrexate is hepatotoxic and myelosuppressive; LFTs and CBC must be monitored regularly to detect toxicity.
Question 5: A patient returns from the OR after open reduction internal fixation (ORIF) of the radius. What is the priority neurovascular assessment?
- Assess the patient's ability to move the shoulder
- Check pulses, sensation, and movement of the fingers distal to the injury (Correct answer)
- Monitor blood glucose every 4 hours
- Assess respiratory rate and oxygen saturation
Correct answer: Check pulses, sensation, and movement of the fingers distal to the injury
Neurovascular assessment distal to a fracture or surgical site detects early compartment syndrome or vascular injury.
Question 6: The nurse notes fat globules in the urine of a patient with a long bone fracture. This finding is associated with:
- Rhabdomyolysis
- Fat embolism syndrome (Correct answer)
- Pulmonary edema
- Deep vein thrombosis
Correct answer: Fat embolism syndrome
Lipuria (fat in urine) along with petechiae and neurological changes are classic signs of fat embolism syndrome after long bone fractures.
Question 7: A nurse is educating a patient on crutch walking using the three-point gait. Which statement by the patient indicates correct understanding?
- I will move both crutches and my injured leg together, then step through with my good leg (Correct answer)
- I will advance each crutch and leg alternately in a walking pattern
- I will keep full weight on my injured leg while the crutches support balance
- I will move my good leg first, then swing the crutches through
Correct answer: I will move both crutches and my injured leg together, then step through with my good leg
In the three-point gait, both crutches and the non-weight-bearing limb advance together, then the good leg follows.
MSNCB Musculoskeletal Care 3
When assessing capillary refill in a casted extremity, which finding requires the nurse to contact the provider?