NUR 603 Final Exam Study Guide
You have detected the presence of crepitus on examination of a patient with a
musculoskeletal complaint. Additionally, there is limited range of motion (ROM with both
active and passive movement. These findings suggest that the origin of the
musculoskeletal complaint is: - answer Articular
Which of the following signs or symptoms indicate an inflammatory etiology to
musculoskeletal pain? - answer Morning stiffness
Which of the following statements concerning the musculoskeletal examination is true? -
answer The uninvolved side should be examined initially and then compared to the
involved side.
Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited
movement in her right shoulder. She denies any history of trauma. Her examination
reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs.
Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her
medical history is significant for type 1 diabetes mellitus and hypertension. Her social
history reveals that she is a secretary and that she is right-handed. Based on her
examination and medical history, you suspect adhesive capsulitis, or "frozen shoulder."
Which clue in Mrs. Gray history supports this diagnosis? - answerHer history of diabetes
mellitus
Jennifer is an 18-year-old woman who comes to the emergency room after a fall during
a soccer game. Jennifer explains that she fell on her left side and kept her arm straight
to break her fall. She has been experiencing severe pain and limited ROM in her left
shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the
following statements are true concerning shoulder dislocation? - answerThere is a risk
of neurovascular and neurosensory trauma, so the clinician should check for distal
pulses.
Fred has been diagnosed with a trigger finger of the ring finger. Which of the following
management strategies is appropriate? - answerLocal anesthetic injection into the
tendon sheath
Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal
tunnel syndrome. She has two young children and asks the clinician what the chances
are that they also will develop carpal tunnel syndrome. Which of the following responses
would be correct regarding the risk of developing carpal tunnel syndrome? -
answerPeople with occupations that require repeated flexion extension of the wrist, use
of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk
for developing carpal tunnel.
,Which of the following statements is true regarding the treatment of carpal tunnel
syndrome? - answerAll of the above: goal of tx is to prevent flexion and extension
movements of wrist, splints are used because they allow for free movement of the
fingers and thumb while maintaining the wrist in neutral position, and corticosteroid
injections are discouraged in the treatment because the risks for median nerve damage,
scarring, and infection
Sam is a 25-year-old who has been diagnosed with low back strain based on his history
of localized low back pain and muscle spasm along with a normal neurological
examination. As the clinician, you explain to Sam that low back pain is a diagnosis of
exclusion. Which of the following symptoms would alert the clinician to the more serious
finding of a herniated nucleus pulposus or ruptured disc? - answerUnilateral radicular
pain symptoms that extend below the knee and are equal to or greater than the back
pain
The clinician has instructed Sirius, a 23-year-old patient with low back strain, to us
NSAIDs to manage his symptoms of pain and discomfort. Which of the following
statements would be most appropriate when teaching Sam about the use of NSAIDs? -
answer"You should start with the lowest dose that is effective in managing your pain,
because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as
ulcers and hemorrhage.
Which of the following statements is true concerning the management of the client with
a herniated disc? - answerIntolerable pain for more than a 3mo period is an indication
for surgical intervention.
John is a 16-year-old boy who presents to the emergency room after hurting his knee in
a football game. He described twisting his knee and then being unable to extend it
completely. John tells the clinician that he heard a pop when the injury occurred and
has been experiencing localized pain. The clinician suspects a meniscal tear. Which
test would be most appropriate to assess for the presence of a meniscal tear? -
answerMcMurray circumduction test
The clinician is caring for Diane, a 22-year-old woman who presents with an injured
ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane
that an x-ray is not always necessary for an injured ankle and that the decision to obtain
radiographs is dependent on the examination and Diane's description of her injury.
Which of the following clues in Diane's examination or history would alert the clinician to
the need for obtaining radiographs? - answerAll of the above: Inability to bear weight
immediately after the injury, development of marked ankle swelling and discoloration
after the injury, and crepitation with palpation or movement of the ankle
Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthritis. The clinician
has explained to Mr. Jackson that the goals for managing osteoarthritis include
controlling pain, maximizing functional independence and mobility, minimizing disability,
, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice
would be to use complementary therapies to control his condition and asks what
therapies are most effecting in treating osteoarthritis. What would be the most
appropriate response from the clinician? - answer"I would be happy to discuss all the
treatment options available to you. Complementary therapies, such as acupuncture,
acupressure, and tai-chi, are being studied for use in the treatment of osteoarthritis and
have shown promise when used with standard medical therapy."
Chris is a 28-year-old male who complains of lower back pain that began 3 days ago.
The pain is worse when he stands or bends, and it is somewhat relieved when he sits.
The clinician performs the straight leg raise test and it is negative. Plain film x-ray is
positive. Which diagnosis is most likely? - answerMuscle strain
A clinician has performed a synovial fluid analysis and the results are as follows: visual
analysis: turbid and yellow, viscosity: decreased, 52,000 white blood cells (WBCs) per
mm3, polymorphonuclear leukocytes (PMNs): 75%, protein: 5g/dL. Which of the
following conditions could this result be attributed to? - answerSeptic arthritis
What is the recommended daily calcium intake for men 70 years and younger? -
answer1000 mg/day
Which of the following medications is appropriate to treat Paget's disease? -
answerReclast
One of the most frequent presenting signs/symptoms of osteoporosis is: - answerBony
fracture
Mrs. Tomas was seen in the office complaining of pain and point tenderness in the area
of her elbow. The pain has increased following a day of gardening 1 week ago. A
physical finding that differentiates the diagnosis and is most consistent with lateral
epicondylitis (tennis elbow) is: - answerPain at the elbow with resisted movements at
the wrist and forearm
Which of the following would lead the clinician to suspect a tumor when paired with low
back pain? - answerUnintended weight loss >10% of body weight in 6 months
The clinician is assessing Sally's diffuse hip pain. How should the clinician begin the
examination? - answerPhysical examination of the hip must first assess its position at
rest
Felice is a 66-year-old female who complains that walking and prolonged standing
causes pain and weakness in her legs and buttocks. She expresses that she has short-
term relief when she leans on the shopping cart. When she sleeps on her back, she
sometimes wakes up in the night in pain. Which of the following diagnoses is most
likely? - answerLumbar spinal stenosis
You have detected the presence of crepitus on examination of a patient with a
musculoskeletal complaint. Additionally, there is limited range of motion (ROM with both
active and passive movement. These findings suggest that the origin of the
musculoskeletal complaint is: - answer Articular
Which of the following signs or symptoms indicate an inflammatory etiology to
musculoskeletal pain? - answer Morning stiffness
Which of the following statements concerning the musculoskeletal examination is true? -
answer The uninvolved side should be examined initially and then compared to the
involved side.
Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited
movement in her right shoulder. She denies any history of trauma. Her examination
reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs.
Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her
medical history is significant for type 1 diabetes mellitus and hypertension. Her social
history reveals that she is a secretary and that she is right-handed. Based on her
examination and medical history, you suspect adhesive capsulitis, or "frozen shoulder."
Which clue in Mrs. Gray history supports this diagnosis? - answerHer history of diabetes
mellitus
Jennifer is an 18-year-old woman who comes to the emergency room after a fall during
a soccer game. Jennifer explains that she fell on her left side and kept her arm straight
to break her fall. She has been experiencing severe pain and limited ROM in her left
shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the
following statements are true concerning shoulder dislocation? - answerThere is a risk
of neurovascular and neurosensory trauma, so the clinician should check for distal
pulses.
Fred has been diagnosed with a trigger finger of the ring finger. Which of the following
management strategies is appropriate? - answerLocal anesthetic injection into the
tendon sheath
Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal
tunnel syndrome. She has two young children and asks the clinician what the chances
are that they also will develop carpal tunnel syndrome. Which of the following responses
would be correct regarding the risk of developing carpal tunnel syndrome? -
answerPeople with occupations that require repeated flexion extension of the wrist, use
of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk
for developing carpal tunnel.
,Which of the following statements is true regarding the treatment of carpal tunnel
syndrome? - answerAll of the above: goal of tx is to prevent flexion and extension
movements of wrist, splints are used because they allow for free movement of the
fingers and thumb while maintaining the wrist in neutral position, and corticosteroid
injections are discouraged in the treatment because the risks for median nerve damage,
scarring, and infection
Sam is a 25-year-old who has been diagnosed with low back strain based on his history
of localized low back pain and muscle spasm along with a normal neurological
examination. As the clinician, you explain to Sam that low back pain is a diagnosis of
exclusion. Which of the following symptoms would alert the clinician to the more serious
finding of a herniated nucleus pulposus or ruptured disc? - answerUnilateral radicular
pain symptoms that extend below the knee and are equal to or greater than the back
pain
The clinician has instructed Sirius, a 23-year-old patient with low back strain, to us
NSAIDs to manage his symptoms of pain and discomfort. Which of the following
statements would be most appropriate when teaching Sam about the use of NSAIDs? -
answer"You should start with the lowest dose that is effective in managing your pain,
because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as
ulcers and hemorrhage.
Which of the following statements is true concerning the management of the client with
a herniated disc? - answerIntolerable pain for more than a 3mo period is an indication
for surgical intervention.
John is a 16-year-old boy who presents to the emergency room after hurting his knee in
a football game. He described twisting his knee and then being unable to extend it
completely. John tells the clinician that he heard a pop when the injury occurred and
has been experiencing localized pain. The clinician suspects a meniscal tear. Which
test would be most appropriate to assess for the presence of a meniscal tear? -
answerMcMurray circumduction test
The clinician is caring for Diane, a 22-year-old woman who presents with an injured
ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane
that an x-ray is not always necessary for an injured ankle and that the decision to obtain
radiographs is dependent on the examination and Diane's description of her injury.
Which of the following clues in Diane's examination or history would alert the clinician to
the need for obtaining radiographs? - answerAll of the above: Inability to bear weight
immediately after the injury, development of marked ankle swelling and discoloration
after the injury, and crepitation with palpation or movement of the ankle
Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthritis. The clinician
has explained to Mr. Jackson that the goals for managing osteoarthritis include
controlling pain, maximizing functional independence and mobility, minimizing disability,
, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice
would be to use complementary therapies to control his condition and asks what
therapies are most effecting in treating osteoarthritis. What would be the most
appropriate response from the clinician? - answer"I would be happy to discuss all the
treatment options available to you. Complementary therapies, such as acupuncture,
acupressure, and tai-chi, are being studied for use in the treatment of osteoarthritis and
have shown promise when used with standard medical therapy."
Chris is a 28-year-old male who complains of lower back pain that began 3 days ago.
The pain is worse when he stands or bends, and it is somewhat relieved when he sits.
The clinician performs the straight leg raise test and it is negative. Plain film x-ray is
positive. Which diagnosis is most likely? - answerMuscle strain
A clinician has performed a synovial fluid analysis and the results are as follows: visual
analysis: turbid and yellow, viscosity: decreased, 52,000 white blood cells (WBCs) per
mm3, polymorphonuclear leukocytes (PMNs): 75%, protein: 5g/dL. Which of the
following conditions could this result be attributed to? - answerSeptic arthritis
What is the recommended daily calcium intake for men 70 years and younger? -
answer1000 mg/day
Which of the following medications is appropriate to treat Paget's disease? -
answerReclast
One of the most frequent presenting signs/symptoms of osteoporosis is: - answerBony
fracture
Mrs. Tomas was seen in the office complaining of pain and point tenderness in the area
of her elbow. The pain has increased following a day of gardening 1 week ago. A
physical finding that differentiates the diagnosis and is most consistent with lateral
epicondylitis (tennis elbow) is: - answerPain at the elbow with resisted movements at
the wrist and forearm
Which of the following would lead the clinician to suspect a tumor when paired with low
back pain? - answerUnintended weight loss >10% of body weight in 6 months
The clinician is assessing Sally's diffuse hip pain. How should the clinician begin the
examination? - answerPhysical examination of the hip must first assess its position at
rest
Felice is a 66-year-old female who complains that walking and prolonged standing
causes pain and weakness in her legs and buttocks. She expresses that she has short-
term relief when she leans on the shopping cart. When she sleeps on her back, she
sometimes wakes up in the night in pain. Which of the following diagnoses is most
likely? - answerLumbar spinal stenosis
