NCLEX : Causes and Treatments of Musculoskeletal Conditions

Study concepts, example questions & explanations for NCLEX

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Example Questions

Example Question #1 : Causes And Treatments Of Musculoskeletal Conditions

What syndrome presents with pain or stiffness, usually in the neck, shoulders, and hips, which may be caused by an inflammatory condition of blood vessels such as temporal arteritis? 

Possible Answers:

Amyotrophic lateral sclerosis (ALS)

Polymyalgia rheumatica

Myositis

Guillain–Barré syndrome

Correct answer:

Polymyalgia rheumatica

Explanation:

Polymyalgia rheumatica is an inflammatory musculoskeletal condition that presents with pain or stiffness, usually in the neck, shoulders, and hips. Amyotrophic lateral sclerosis (ALS) is a genetic disorder of muscle wasting and neuronal death. Symptoms include progressive muscular weakness, leading to paralysis and death. Guillain–Barré syndrome is a rapid-onset condition of reversible muscle paralysis and weakness following infection, most commonly Campylobacter jejuni. Myositis is a general term for inflammation of the muscles, and can be due to various causes.

Example Question #2 : Causes And Treatments Of Musculoskeletal Conditions

Duchenne's muscular dystrophy is caused by dysfunctional production of what protein?

Possible Answers:

Actin

Dystroglycan

Dystrophin

Troponin

Correct answer:

Dystrophin

Explanation:

Duchenne's muscular dystrophy (DMD) is caused by dysfunctional production of dystrophin, a protein that is part of a complex of proteins that anchor the cytoskeleton of a muscle cell to the extracellular matrix, also known as the dystrophin-associated protein complex. Its absence disrupts multiple intracellular signaling pathways, leading to muscle necrosis. Dystroglycan is another protein in this complex, but it is unaffected in DMD. Actin and troponin are also unaffected in DMD.

Example Question #3 : Causes And Treatments Of Musculoskeletal Conditions

Duchenne's muscular dystrophy has what inheritance type?

Possible Answers:

X-linked dominant

Autosomal dominant

Autosomal recessive

X-linked recessive

Correct answer:

X-linked recessive

Explanation:

Duchenne's muscular dystrophy is an X-linked recessive disease. Because of this, it is almost exclusively seen in males and rarely presents in females (girls would have to receive a recessive gene on both the X-chromosome from their mother and their father; historically, boys with a defective gene on their X-chromosome rarely lived past their teens, decreasing the likelihood of reproduction). 

Example Question #4 : Causes And Treatments Of Musculoskeletal Conditions

What antibodies are present in 90% of patients presenting with myasthenia gravis?

Possible Answers:

Antibodies to acetylcholine receptors

Antibodies to acetylcholinesterase receptor

Anti-dsDNA (double-stranded DNA) antibodies

Anti-ro antibodies

Correct answer:

Antibodies to acetylcholine receptors

Explanation:

Myasthenia gravis is a condition in which the immune system makes antibodies to aceytlcholine receptors, thus blocking receptors and preventing the stimulating effect of acetylcholine at the neuromuscular junction. This results in muscle weakness that progresses during activity and improves with rest. Anti-ro antibodies are commonly seen in Sjögren’s syndrome and systemic lupus erythematosus (SLE), and anti-dsDNA antibodies are highly specific for SLE.

Example Question #5 : Causes And Treatments Of Musculoskeletal Conditions

What condition is characterized by a deficiency of normal type-1 collagen, resulting in the formation of brittle, fragile bones? 

Possible Answers:

Osteogenesis imperfecta 

Legg-Calvé-Perthes syndrome

Marfan syndrome

Ehlers–Danlos syndrome

Correct answer:

Osteogenesis imperfecta 

Explanation:

Osteogenesis imperfecta is a genetic condition characterized by a deficiency of normal type-1 collagen, resulting in the formation of brittle, fragile bones. Bones fracture easily, often with no obvious trauma. Osteogenesis imperfecta has many sub categories that range in severity, several of which are not compatible with life.

Ehlers–Danlos syndrome is a collagen abnormality that primarily affects the skin, joints, and vasculature, causing lax joints and general instability. Marfan syndrome is also a condition of connective tissue abnormality, which largely effects the structure and function of smooth muscle in the cardiovascular system. Legg-Calvé-Perthes syndrome is a condition of necrosis in the femoral head, not related to any alterations in collagen formation. 

Example Question #6 : Causes And Treatments Of Musculoskeletal Conditions

The rehab nurse provides care to an immobilized patient. He bears weight down on the patient’s leg while the patient attempts to lift that leg. What type of exercise is this?

Possible Answers:

Isometric

Active assistive range of motion

Active range of motion

Passive range of motion

Active resistive range of motion

Correct answer:

Active resistive range of motion

Explanation:

Active resistive range of motion is performed by the client against resistance (manual or mechanical). This exercise builds muscle strength. Isometric exercises are performed by the client without motion; rather, the client contracts and relaxes the muscle without moving the joint. This maintains strength in the muscle while the joint is immobilized. Passive range of motion is performed by the nurse without assistance from the client, which retains circulation and range of motion in the joint, Active range of motion is performed by the client without assistance of the nurse and maintains joint mobility and muscle strength. Active assistive range of motion is performed by the client with help of the nurse to increase motion in the joint.

Example Question #7 : Causes And Treatments Of Musculoskeletal Conditions

In the emergency department, the nurse evaluates a patient with severe pain in the left calf after falling during a soccer game. Which of the following is the most appropriate action by the nurse?

Possible Answers:

Notify the physician

X-ray the calf

Apply heat to the calf

Bandage the calf

Give morphine

Correct answer:

X-ray the calf

Explanation:

The nurse should begin assessment to determine the cause of the complaint. Obtaining an x-ray for the leg is the best assessment; you need to rule out possible fracture before giving pain medication or bandaging the leg. Heat is inappropriate for this injury because ice is best for sports injuries such as sprains and breaks. Notifying the physician may be done after all assessments are completed.

Example Question #8 : Causes And Treatments Of Musculoskeletal Conditions

The nurse evaluates a patient status-post right hip replacement and observes a moderate amount of serosanguinous drainage on the dressing 1 day after the surgery. Which of the following is the best action?

Possible Answers:

Change the dressing and clean the site with normal saline.

Notify the doctor about possible infection.

Leave the dressing alone to let the wound heal.

Replace the dressing and document.

Remove the dressing and leave the wound open to air.

Correct answer:

Replace the dressing and document.

Explanation:

24 hours after surgery, surgical wounds are expected to drain small to moderate amounts of serous or serosanguinous drainage. The physician does not need to be notified because this observation is expected and not emergent; however, the doctor would be notified if drainage exceeds these expectations. The soiled dressing should be removed and replaced with a new dressing, and the wound site would not be irrigated unless infected; there are no signs of infection noted. The wound should not be open to air due to the risk of infection. The nurse should always document wound appearance and dressing changes.

Example Question #9 : Causes And Treatments Of Musculoskeletal Conditions

The nurse prepares discharge information for a 70-year-old woman recently diagnosed with osteoporosis. Which of the following information is most essential for the nurse to share with the patient?

Possible Answers:

A recommendation for a doctor that specializes in bone pain.

An information sheet for acetaminophen use.

A brochure about opioid medication use.

A flyer for an soccer program.

A pamphlet about physical activity and daily exercise for people with osteoporosis.

Correct answer:

A pamphlet about physical activity and daily exercise for people with osteoporosis.

Explanation:

Osteoporosis is common among elderly women. Patients require important education on how to live with the disease. Lifestyle changes such as diet and exercise should be promoted by the patient during discharge, and should be specific to the patient’s condition. Of the available options, the most accurate and essential information for the nurse to share should concern physical activity and exercise, as osteoporosis affects bone density and body strength. A recommendation for a doctor that specializes in bone pain may be beneficial, but is not a responsibility of the nurse (education is the priority). Patients with osteoporosis that are being discharged usually take ibuprofen to manage pain (not opioids or acetaminophen). A soccer program may not be appropriate for a 70-year-old woman with osteoporosis; a flyer for an adult walking group might be better.

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