MSNCB Musculoskeletal Care 5 — Questions and Answers
Question 1: A patient with systemic lupus erythematosus (SLE) develops new avascular necrosis of the femoral head. The most likely contributing factor is:
- Long-term NSAID use
- Long-term high-dose corticosteroid therapy (Correct answer)
- Elevated anti-dsDNA antibodies
- Vitamin C deficiency
Correct answer: Long-term high-dose corticosteroid therapy
Long-term corticosteroid use is the most common cause of avascular necrosis (osteonecrosis) by impairing blood supply to bone.
Question 2: A patient with a cervical spine injury is placed in halo traction. Which nursing action is the priority?
- Ensure a wrench is taped to the halo vest at all times for emergency vest removal (Correct answer)
- Pad the halo ring for patient comfort
- Encourage the patient to rotate their neck slowly for range of motion
- Remove the vest daily for skin inspection
Correct answer: Ensure a wrench is taped to the halo vest at all times for emergency vest removal
A wrench must be immediately accessible to remove the halo vest during cardiopulmonary resuscitation.
Question 3: A nurse is caring for a patient in Buck's traction. Which action is correct?
- Allow weights to rest on the floor during repositioning
- Ensure the rope moves freely in the pulley with weights hanging freely (Correct answer)
- Remove traction for two hours every shift
- Position the head of bed at 90 degrees
Correct answer: Ensure the rope moves freely in the pulley with weights hanging freely
Effective skin traction requires that weights hang freely without touching the floor and that the rope moves unobstructed through the pulley.
Question 4: A patient is diagnosed with carpal tunnel syndrome. Which conservative treatment should the nurse reinforce first?
- Surgical decompression
- Wrist splinting in neutral position, especially at night (Correct answer)
- Hot compresses applied continuously
- Strengthening exercises for the wrist flexors
Correct answer: Wrist splinting in neutral position, especially at night
Wrist splinting in neutral position reduces median nerve compression and is first-line conservative management for carpal tunnel syndrome.
Question 5: When caring for a patient with a dislocated hip prosthesis, the nurse should position the affected limb:
- In internal rotation with the hip flexed
- In slight abduction and extension pending surgical reduction (Correct answer)
- In adduction across the midline
- Crossed over the unaffected leg for comfort
Correct answer: In slight abduction and extension pending surgical reduction
A dislocated hip prosthesis is immobilized in slight abduction and extension to reduce further tissue injury until closed or open reduction.
Question 6: A patient with multiple myeloma is at highest risk for which musculoskeletal complication?
- Gout from uric acid overproduction
- Pathologic fractures due to osteolytic lesions (Correct answer)
- Septic arthritis from immunosuppression
- Avascular necrosis of the femoral head
Correct answer: Pathologic fractures due to osteolytic lesions
Multiple myeloma causes osteolytic bone lesions that weaken bone structure, placing patients at high risk for pathologic fractures.
Question 7: A nurse is assessing a patient who sustained a crush injury to the leg 8 hours ago. Creatine kinase (CK) is 28,000 U/L and urine is dark brown. The priority nursing concern is:
- Hypothermia
- Acute kidney injury from myoglobinuria (Correct answer)
- Compartment syndrome in the contralateral leg
- Hypernatremia from IV fluid administration
Correct answer: Acute kidney injury from myoglobinuria
Markedly elevated CK and dark urine indicate rhabdomyolysis; myoglobin precipitates in renal tubules, causing acute kidney injury requiring aggressive IV hydration.
MSNCB Musculoskeletal Care 5
A patient with systemic lupus erythematosus (SLE) develops new avascular necrosis of the femoral head.
The most likely contributing factor is: