100% Verified Lewis’s Medical-Surgical
Nursing, 13th Edition – 50-Question Mastery
Test Bank
Musculoskeletal & Integumentary
1. A patient with osteoarthritis of the knee is most likely to
report which symptom? [Ch. 65: Osteoarthritis]
A. Morning stiffness lasting more than 1 hour
B. Joint pain that improves with exercise
C. Joint pain that increases with activity and brief morning
stiffness (Correct)
D. Joint pain accompanied by fever and fatigue
Rationale: Osteoarthritis causes pain that worsens with use and
short-lived morning stiffness. In contrast, RA produces
prolonged morning stiffness (>1 hr) and systemic symptoms (A,
D), and pain in OA does not improve with exercise (B).
Difficulty: Moderate.
2. A patient is newly diagnosed with rheumatoid arthritis.
Which laboratory finding is most specific for RA? [Ch. 65:
Rheumatoid Arthritis]
A. Antinuclear antibody (ANA) positivity
B. Rheumatoid factor (RF) positivity
,C. Anti–cyclic citrullinated peptide (anti-CCP) antibody
(Correct)
D. HLA-B27 positivity
Rationale: Anti-CCP antibodies are highly specific (~94–99%)
for RA. Rheumatoid factor (RF) can be positive in other
diseases, and ANA is associated with lupus. HLA-B27 is linked
to ankylosing spondylitis, not RA. Difficulty: Moderate.
3. A patient with a new below-knee cast complains of severe
pain unrelieved by medication and forefoot numbness.
Which action is most appropriate? [Ch. 66: Fractures and
Casts]
A. Elevate the extremity and apply ice
B. Encourage toe movement exercises
C. Perform frequent neurovascular checks and notify the
provider (Correct)
D. Apply heat packs to the cast
Rationale: Severe pain and numbness after cast placement
suggests compartment syndrome. Immediate neurovascular
assessment and provider notification are required. Elevation and
movement (A, B) can be done later, but identifying
compartment syndrome is highest priority. Heat (D) is not
indicated. Difficulty: Moderate.
4. Which statement by a patient taking alendronate
(Fosamax) indicates correct teaching? [Ch. 66: Osteoporosis]
A. “I will take it at bedtime with a snack.”
B. “I will take it with a full glass of water and remain
upright for 30 minutes.” (Correct)
,C. “I can skip the dose on days I exercise.”
D. “I will take it with my coffee in the morning.”
Rationale: Bisphosphonates like alendronate must be taken with
a full glass of water and the patient must remain upright for at
least 30 minutes to prevent esophageal irritation. Taking it at
night or with coffee or without regard to posture can cause
esophageal injury. Difficulty: Easy.
5. A patient with a history of gout should limit intake of
which foods? [Ch. 65: Gout]
A. Leafy green vegetables
B. Red meat and shellfish (Correct)
C. Low-fat dairy products
D. Whole grains
Rationale: Gout is precipitated by high-purine foods; patients
should limit red meat, shellfish, and organ meats to reduce uric
acid buildup. Dairy and whole grains are safe and can even
lower uric acid, and vegetables (unless organ meats) are
generally low-purine. Difficulty: Easy.
6. To prevent pressure ulcers in an immobile patient, the
nurse should reposition the patient at least: [Ch. 66: Pressure
Ulcer Prevention]
A. Every 30 minutes
B. Every 2 hours (Correct)
C. Once per shift
D. Only when the patient complains of pain
Rationale: Patients unable to reposition themselves should be
turned at least every 2 hours to relieve pressure points. More
, frequent (A) is unnecessary; once per shift (C) or waiting for
discomfort (D) is inadequate to prevent ulcers. Difficulty: Easy.
7. Which finding is most consistent with a deep (second-
degree) partial-thickness burn? [Ch. 66: Burns]
A. Blisters, red skin, and severe pain
B. White or pale, moist skin with patchy red areas and
moderate pain (Correct)
C. Dry, leathery skin with no pain
D. Sunburn-like erythema only
Rationale: Deep partial-thickness burns often appear mottled red
and white, are moist, and are painful (though sometimes less so
than superficial burns). Blisters and bright red skin (A) describe
superficial partial-thickness burns. Dry, leathery, anesthetic
tissue (C) indicates full-thickness burns. Sunburn (D) is
superficial. Difficulty: Moderate.
8. Which description indicates a Stage III pressure ulcer?
[Ch. 66: Pressure Ulcers]
A. Nonblanchable erythema of intact skin (Stage I)
B. Partial-thickness skin loss with exposed dermis (Stage II)
C. Full-thickness skin loss with visible subcutaneous fat but
no bone/tendon (Correct)
D. Full-thickness tissue loss exposing muscle or bone (Stage IV)
Rationale: Stage III pressure injuries involve full-thickness skin
loss with subcutaneous fat visible but no exposed bone/tendon.
Stage I (A) has intact skin; Stage II (B) is partial thickness;
Stage IV (D) involves exposed bone/muscle. Difficulty:
Moderate.
Nursing, 13th Edition – 50-Question Mastery
Test Bank
Musculoskeletal & Integumentary
1. A patient with osteoarthritis of the knee is most likely to
report which symptom? [Ch. 65: Osteoarthritis]
A. Morning stiffness lasting more than 1 hour
B. Joint pain that improves with exercise
C. Joint pain that increases with activity and brief morning
stiffness (Correct)
D. Joint pain accompanied by fever and fatigue
Rationale: Osteoarthritis causes pain that worsens with use and
short-lived morning stiffness. In contrast, RA produces
prolonged morning stiffness (>1 hr) and systemic symptoms (A,
D), and pain in OA does not improve with exercise (B).
Difficulty: Moderate.
2. A patient is newly diagnosed with rheumatoid arthritis.
Which laboratory finding is most specific for RA? [Ch. 65:
Rheumatoid Arthritis]
A. Antinuclear antibody (ANA) positivity
B. Rheumatoid factor (RF) positivity
,C. Anti–cyclic citrullinated peptide (anti-CCP) antibody
(Correct)
D. HLA-B27 positivity
Rationale: Anti-CCP antibodies are highly specific (~94–99%)
for RA. Rheumatoid factor (RF) can be positive in other
diseases, and ANA is associated with lupus. HLA-B27 is linked
to ankylosing spondylitis, not RA. Difficulty: Moderate.
3. A patient with a new below-knee cast complains of severe
pain unrelieved by medication and forefoot numbness.
Which action is most appropriate? [Ch. 66: Fractures and
Casts]
A. Elevate the extremity and apply ice
B. Encourage toe movement exercises
C. Perform frequent neurovascular checks and notify the
provider (Correct)
D. Apply heat packs to the cast
Rationale: Severe pain and numbness after cast placement
suggests compartment syndrome. Immediate neurovascular
assessment and provider notification are required. Elevation and
movement (A, B) can be done later, but identifying
compartment syndrome is highest priority. Heat (D) is not
indicated. Difficulty: Moderate.
4. Which statement by a patient taking alendronate
(Fosamax) indicates correct teaching? [Ch. 66: Osteoporosis]
A. “I will take it at bedtime with a snack.”
B. “I will take it with a full glass of water and remain
upright for 30 minutes.” (Correct)
,C. “I can skip the dose on days I exercise.”
D. “I will take it with my coffee in the morning.”
Rationale: Bisphosphonates like alendronate must be taken with
a full glass of water and the patient must remain upright for at
least 30 minutes to prevent esophageal irritation. Taking it at
night or with coffee or without regard to posture can cause
esophageal injury. Difficulty: Easy.
5. A patient with a history of gout should limit intake of
which foods? [Ch. 65: Gout]
A. Leafy green vegetables
B. Red meat and shellfish (Correct)
C. Low-fat dairy products
D. Whole grains
Rationale: Gout is precipitated by high-purine foods; patients
should limit red meat, shellfish, and organ meats to reduce uric
acid buildup. Dairy and whole grains are safe and can even
lower uric acid, and vegetables (unless organ meats) are
generally low-purine. Difficulty: Easy.
6. To prevent pressure ulcers in an immobile patient, the
nurse should reposition the patient at least: [Ch. 66: Pressure
Ulcer Prevention]
A. Every 30 minutes
B. Every 2 hours (Correct)
C. Once per shift
D. Only when the patient complains of pain
Rationale: Patients unable to reposition themselves should be
turned at least every 2 hours to relieve pressure points. More
, frequent (A) is unnecessary; once per shift (C) or waiting for
discomfort (D) is inadequate to prevent ulcers. Difficulty: Easy.
7. Which finding is most consistent with a deep (second-
degree) partial-thickness burn? [Ch. 66: Burns]
A. Blisters, red skin, and severe pain
B. White or pale, moist skin with patchy red areas and
moderate pain (Correct)
C. Dry, leathery skin with no pain
D. Sunburn-like erythema only
Rationale: Deep partial-thickness burns often appear mottled red
and white, are moist, and are painful (though sometimes less so
than superficial burns). Blisters and bright red skin (A) describe
superficial partial-thickness burns. Dry, leathery, anesthetic
tissue (C) indicates full-thickness burns. Sunburn (D) is
superficial. Difficulty: Moderate.
8. Which description indicates a Stage III pressure ulcer?
[Ch. 66: Pressure Ulcers]
A. Nonblanchable erythema of intact skin (Stage I)
B. Partial-thickness skin loss with exposed dermis (Stage II)
C. Full-thickness skin loss with visible subcutaneous fat but
no bone/tendon (Correct)
D. Full-thickness tissue loss exposing muscle or bone (Stage IV)
Rationale: Stage III pressure injuries involve full-thickness skin
loss with subcutaneous fat visible but no exposed bone/tendon.
Stage I (A) has intact skin; Stage II (B) is partial thickness;
Stage IV (D) involves exposed bone/muscle. Difficulty:
Moderate.
