NR 283: Pathophysiology Core Assessment Final Exam Comprehensive The Definitive Study and Exam Prep Guide: Comprehensive Topic Review, Realistic Practice Questions, Complete Test Bank Mastery, and Advanced Preparation Manual

A patient recovering from a lower-extremity injury asks which type of muscle tissue is primarily responsible for moving the bones of the skeleton. Which response by the nurse is most accurate? A. Smooth, involuntary muscle B. Cardiac, involuntary muscle C. Striated, voluntary muscle D. Non-striated, voluntary muscle Correct Answer: C. Striated, voluntary muscle Rationale: Skeletal muscles are striated because their contractile proteins form visible bands, and they are generally under voluntary control. They attach to bones and produce movement across joints. Smooth muscle is non-striated and controls internal organs. Cardiac muscle is striated but involuntary and is found only in the heart. Non-striated voluntary muscle is not a recognized category. Question 2 During an assessment of an older adult with osteoarthritis, the nurse observes firm, painless enlargements at the distal interphalangeal joints. How should these findings be documented? A. Bouchard nodes B. Heberden nodes C. Rheumatoid nodules D. Gouty tophi Correct Answer: B. Heberden nodes Rationale: Heberden nodes are bony enlargements of the distal interphalangeal joints associated with osteoarthritis. Bouchard nodes affect the proximal interphalangeal joints. Rheumatoid nodules are associated with rheumatoid arthritis and commonly occur over pressure points. Gouty tophi consist of urate crystal deposits and may develop around joints after prolonged hyperuricaemia. Question 3 A postmenopausal patient sustains a vertebral compression fracture after bending to lift a light object. Which underlying pathological change most likely contributed to the fracture? A. Excessive mineralisation of osteoid tissue B. Loss of bone mass with increased porosity and brittleness C. Deposition of uric acid crystals within the vertebrae D. Autoimmune destruction of the articular cartilage Correct Answer: B. Loss of bone mass with increased porosity and brittleness Rationale: Osteoporosis causes reduced bone mass and deterioration of bone architecture, making bones porous, brittle, and vulnerable to low-trauma fractures. Excessive mineralisation does not describe osteoporosis. Uric acid deposition causes gout, while autoimmune joint destruction is characteristic of rheumatoid arthritis and primarily affects synovial joints. Question 4 Which patient has the greatest overall risk for developing osteoporosis? A. A physically active premenopausal woman with adequate calcium intake B. A large-framed woman with no family history of bone disease C. A thin woman with early menopause and inadequate vitamin D intake D. A young adult who performs weight-bearing exercise regularly Correct Answer: C. A thin woman with early menopause and inadequate vitamin D intake Rationale: Early menopause reduces lifetime oestrogen exposure and can accelerate bone loss. Low body mass and inadequate vitamin D further increase the risk of reduced bone strength. Weight-bearing exercise and adequate calcium intake help protect bone health, while a larger body frame is generally associated with greater bone mass. Question 5 A patient with osteomalacia asks why the bones have become painful and weak. Which explanation is most accurate? A. Mature bone is being replaced by malignant cartilage cells. B. Osteoid tissue is being produced but is inadequately mineralised. C. Excess uric acid is eroding the bone surface. D. Antibodies are destroying the synovial membranes. Correct Answer: B. Osteoid tissue is being produced but is inadequately mineralised. Rationale: Osteomalacia results from defective mineralisation of newly formed osteoid, commonly associated with vitamin D deficiency or impaired vitamin D metabolism. The bone matrix therefore remains soft and weak. Malignant cartilage cells describe chondrosarcoma, uric acid deposition causes gout, and autoimmune synovial inflammation is associated with rheumatoid arthritis. Question 6 A patient with chronic bone pain has excessive bone resorption followed by disorganised formation of enlarged, structurally weak bone. Which disorder should the nurse suspect? A. Paget disease B. Osteomalacia C. Osteomyelitis D. Osteoarthritis Correct Answer: A. Paget disease Rationale: Paget disease involves accelerated bone resorption followed by excessive and disorganised bone formation. The resulting bone may become enlarged, deformed, and mechanically weak. Osteomalacia involves defective mineralisation, osteomyelitis is an infection of bone and marrow, and osteoarthritis primarily involves degeneration of articular cartilage and subchondral bone. Question 7 A patient with an infected tibia develops an area of dead bone surrounded by newly formed bone. Which complication of osteomyelitis does this finding represent? A. Tophus formation B. Sequestrum with involucrum formation C. Pannus development D. Osteoid mineralisation Correct Answer: B. Sequestrum with involucrum formation Rationale: In osteomyelitis, impaired blood supply may cause bone necrosis. The dead bone fragment is called a sequestrum, while the new bone that forms around the infected area is called an involucrum. A tophus contains urate crystals, and pannus is inflammatory tissue associated with rheumatoid arthritis. Osteoid mineralisation is a normal bone-forming process. Question 8 A patient in a newly applied lower-leg cast reports severe pain that is not relieved by opioids. The toes are pale, and passive movement causes marked pain. What is the nurse’s priority concern? A. Osteomyelitis B. Compartment syndrome C. Fat embolism syndrome D. Expected postoperative swelling Correct Answer: B. Compartment syndrome Rationale: Severe pain that is disproportionate to the injury, pain with passive movement, pallor, and impaired circulation strongly suggest compartment syndrome. Increased pressure within the compartment can compromise circulation and nerve function and requires emergency intervention. Osteomyelitis develops as an infection, while fat embolism syndrome commonly produces respiratory and neurological manifestations. Question 9 A child presents with a spiral fracture, and the caregiver’s explanation is inconsistent with the injury pattern. What is the nurse’s most appropriate action? A. Assume that all spiral fractures indicate abuse. B. Document the findings objectively and follow safeguarding procedures. C. Ask the caregiver to provide a different explanation. D. Delay reporting until radiographs prove intentional injury. Correct Answer: B. Document the findings objectively and follow safeguarding procedures. Rationale: Spiral fractures can occur accidentally, but an inconsistent history may raise concern for non-accidental trauma. The nurse should objectively document the findings, preserve relevant evidence, and follow institutional safeguarding and reporting procedures. The nurse should not automatically label the injury as abuse, pressure the caregiver to change the history, or delay required reporting while attempting to independently establish intent. Question 10 A football player twists his knee and tears the structure connecting one bone to another. Which injury has occurred? A. Tendon strain B. Ligament sprain C. Muscle contusion D. Cartilage dislocation Correct Answer: B. Ligament sprain Rationale: A sprain involves stretching or tearing of a ligament, which connects bone to bone and helps stabilize joints. A strain affects a muscle or tendon, while tendons connect muscle to bone. A contusion is a bruise caused by blunt trauma, and dislocation refers to displacement of bones at a joint.