NUR 635 Musculoskeletal Nursing Test
Bank 2026/2027| Orthopedics Exam Prep
| Verified Answers
EXAM
1. A patient who has developed postmenopausal osteoporosis will begin taking
alendronate [Fosamax]. The nurse will teach this patient to take the drug:
Answer: while sitting upright with plenty of water .
Rationale: Alendronate can cause esophagitis, a risk minimized by taking the drug with
a full glass of water while remaining upright .
2. A patient has severe Paget disease of the bone. The patient asks the nurse what
can be done to alleviate the pain. The nurse will suggest that the patient discuss
the use of which medication with the provider?
Answer: Calcitonin-salmon [Miacalcin] .
Rationale: Calcitonin-salmon is noted as the drug of choice for rapid relief of pain
associated with Paget disease .
3. A patient is taking alendronate [Fosamax] to treat Paget disease. The patient
asks the nurse why calcium supplements are necessary. The nurse will tell the
patient that calcium supplements are necessary to:
Answer: prevent hyperparathyroidism .
Rationale: The rationale is that adequate calcium intake helps prevent secondary
hyperparathyroidism, which can occur during treatment with bisphosphonates like
alendronate .
4. A postmenopausal patient is at high risk for developing osteoporosis. The
patient's prescriber orders raloxifene [Evista], and the nurse provides teaching
about this drug. Which statement by the patient indicates understanding of the
teaching?
Answer: "I should walk as much as possible during long airline flights" .
, Rationale: Raloxifene, a selective estrogen receptor modulator (SERM), increases the
risk of venous thromboembolism. Walking during long flights helps prevent deep vein
thrombosis (DVT) .
5. A patient with chronic gout has an acute gouty episode and is admitted to the
hospital. The patient has been taking nonsteroidal anti-inflammatory drugs for
several months. The prescriber plans to begin therapy with probenecid. What will
the nurse do?
Answer: Suggest delaying the probenecid therapy until the acute episode has
subsided .
Rationale: Probenecid, a uricosuric agent, may exacerbate acute episodes of gout.
Therefore, treatment with this drug should be delayed until the acute attack has passed .
6. A patient is being treated with warfarin [Coumadin] to prevent thrombus. The
patient develops hyperuricemia, and the provider orders allopurinol [Zyloprim].
The nurse will contact the provider to discuss ________ the dose of ________.
Answer: reducing; warfarin .
Rationale: Allopurinol can inhibit hepatic drug-metabolizing enzymes and thus delay
the inactivation of other drugs. This is a particular concern in patients taking warfarin;
therefore, the warfarin dose should be reduced when allopurinol is also used .
Questions 7–20: Osteoporosis & Metabolic Bone Disorders
7. A patient taking denosumab [Prolia] for osteoporosis reports new-onset jaw
pain. What is the nurse’s priority action?
Answer: Assess for signs of osteonecrosis of the jaw (ONJ) and notify the
provider.
Rationale: Denosumab (a RANKL inhibitor) is associated with osteonecrosis of the
jaw, especially after dental procedures or poor oral hygiene. Jaw pain is an early
sign requiring immediate evaluation.
8. A patient with osteoporosis is prescribed teriparatide [Forteo]. What instruction
about administration is most important?
, Answer: Inject subcutaneously into the thigh or abdomen daily and store the pen
in the refrigerator.
Rationale: Teriparatide is a recombinant PTH analog given as a daily
subcutaneous injection. It must be refrigerated, and the patient should be taught
to rotate injection sites.
9. A patient on long-term glucocorticoid therapy asks why they need a
bisphosphonate. What is the nurse’s best response?
Answer: “Glucocorticoids accelerate bone loss; bisphosphonates help prevent
fractures by slowing bone breakdown.”
Rationale: Glucocorticoid-induced osteoporosis is common due to decreased
bone formation and increased resorption. Bisphosphonates are first-line
prevention.
10. A postmenopausal patient with osteoporosis has a T-score of -3.0. She asks
what this means. How should the nurse respond?
Answer: “Your bone density is significantly below average, indicating a high risk
for fractures.”
Rationale: A T-score ≤ -2.5 is diagnostic for osteoporosis. -3.0 indicates severe
osteoporosis with elevated fracture risk.
11. A patient with Paget’s disease is receiving IV zoledronic acid [Reclast]. Which
finding requires immediate nursing intervention?
Answer: Temperature of 101.8°F (38.8°C) with myalgia.
Rationale: Flu-like symptoms (fever, myalgia) are common after bisphosphonate
infusion but should be monitored. Severe fever may indicate an acute-phase
reaction; hydration and antipyretics are indicated, but the reaction is usually self-
limiting.
Bank 2026/2027| Orthopedics Exam Prep
| Verified Answers
EXAM
1. A patient who has developed postmenopausal osteoporosis will begin taking
alendronate [Fosamax]. The nurse will teach this patient to take the drug:
Answer: while sitting upright with plenty of water .
Rationale: Alendronate can cause esophagitis, a risk minimized by taking the drug with
a full glass of water while remaining upright .
2. A patient has severe Paget disease of the bone. The patient asks the nurse what
can be done to alleviate the pain. The nurse will suggest that the patient discuss
the use of which medication with the provider?
Answer: Calcitonin-salmon [Miacalcin] .
Rationale: Calcitonin-salmon is noted as the drug of choice for rapid relief of pain
associated with Paget disease .
3. A patient is taking alendronate [Fosamax] to treat Paget disease. The patient
asks the nurse why calcium supplements are necessary. The nurse will tell the
patient that calcium supplements are necessary to:
Answer: prevent hyperparathyroidism .
Rationale: The rationale is that adequate calcium intake helps prevent secondary
hyperparathyroidism, which can occur during treatment with bisphosphonates like
alendronate .
4. A postmenopausal patient is at high risk for developing osteoporosis. The
patient's prescriber orders raloxifene [Evista], and the nurse provides teaching
about this drug. Which statement by the patient indicates understanding of the
teaching?
Answer: "I should walk as much as possible during long airline flights" .
, Rationale: Raloxifene, a selective estrogen receptor modulator (SERM), increases the
risk of venous thromboembolism. Walking during long flights helps prevent deep vein
thrombosis (DVT) .
5. A patient with chronic gout has an acute gouty episode and is admitted to the
hospital. The patient has been taking nonsteroidal anti-inflammatory drugs for
several months. The prescriber plans to begin therapy with probenecid. What will
the nurse do?
Answer: Suggest delaying the probenecid therapy until the acute episode has
subsided .
Rationale: Probenecid, a uricosuric agent, may exacerbate acute episodes of gout.
Therefore, treatment with this drug should be delayed until the acute attack has passed .
6. A patient is being treated with warfarin [Coumadin] to prevent thrombus. The
patient develops hyperuricemia, and the provider orders allopurinol [Zyloprim].
The nurse will contact the provider to discuss ________ the dose of ________.
Answer: reducing; warfarin .
Rationale: Allopurinol can inhibit hepatic drug-metabolizing enzymes and thus delay
the inactivation of other drugs. This is a particular concern in patients taking warfarin;
therefore, the warfarin dose should be reduced when allopurinol is also used .
Questions 7–20: Osteoporosis & Metabolic Bone Disorders
7. A patient taking denosumab [Prolia] for osteoporosis reports new-onset jaw
pain. What is the nurse’s priority action?
Answer: Assess for signs of osteonecrosis of the jaw (ONJ) and notify the
provider.
Rationale: Denosumab (a RANKL inhibitor) is associated with osteonecrosis of the
jaw, especially after dental procedures or poor oral hygiene. Jaw pain is an early
sign requiring immediate evaluation.
8. A patient with osteoporosis is prescribed teriparatide [Forteo]. What instruction
about administration is most important?
, Answer: Inject subcutaneously into the thigh or abdomen daily and store the pen
in the refrigerator.
Rationale: Teriparatide is a recombinant PTH analog given as a daily
subcutaneous injection. It must be refrigerated, and the patient should be taught
to rotate injection sites.
9. A patient on long-term glucocorticoid therapy asks why they need a
bisphosphonate. What is the nurse’s best response?
Answer: “Glucocorticoids accelerate bone loss; bisphosphonates help prevent
fractures by slowing bone breakdown.”
Rationale: Glucocorticoid-induced osteoporosis is common due to decreased
bone formation and increased resorption. Bisphosphonates are first-line
prevention.
10. A postmenopausal patient with osteoporosis has a T-score of -3.0. She asks
what this means. How should the nurse respond?
Answer: “Your bone density is significantly below average, indicating a high risk
for fractures.”
Rationale: A T-score ≤ -2.5 is diagnostic for osteoporosis. -3.0 indicates severe
osteoporosis with elevated fracture risk.
11. A patient with Paget’s disease is receiving IV zoledronic acid [Reclast]. Which
finding requires immediate nursing intervention?
Answer: Temperature of 101.8°F (38.8°C) with myalgia.
Rationale: Flu-like symptoms (fever, myalgia) are common after bisphosphonate
infusion but should be monitored. Severe fever may indicate an acute-phase
reaction; hydration and antipyretics are indicated, but the reaction is usually self-
limiting.
