A hospitalized older adult with osteoporosis is alert, walks with some unsteadiness and needs help to the bathroom. Which nursing intervention addresses this patient's greatest safety risk?
Implementing fall-risk precautions
✓
Keeping the patient on strict bed rest
Restricting calcium-rich foods
Limiting fluids for the whole day
Correct Answer
Implementing fall-risk precautions
Fragile bones mean a fall can easily cause a hip, spine or wrist fracture, so fall-risk precautions are the key safety measure for a patient with osteoporosis. Keeping the patient on strict bed rest is wrong because immobility speeds bone loss and weakens muscles. Restricting calcium-rich foods works against bone health, since calcium intake is encouraged. Limiting fluids for the whole day does not prevent falls and risks dehydration.
Category: Osteoporosis
Question 2
Why does the nurse measure and record height at each visit for an older adult with osteoporosis?
Height is used to set a daily fluid limit
Gradual height loss can signal vertebral compression
✓
A gain in height shows the bones are healing
Height loss confirms rheumatoid arthritis
Correct Answer
Gradual height loss can signal vertebral compression
Weakened vertebrae can compress and collapse, producing gradual height loss and a forward-curved, hunched posture, so accurate baseline and follow-up measurements reveal progression. Height is used to set a daily fluid limit is wrong because fluid limits are not based on height in osteoporosis. A gain in height shows the bones are healing is wrong because adults do not regain lost height as bone density improves. Height loss confirms rheumatoid arthritis is wrong because height loss points to spinal bone loss, not an autoimmune joint disease.
Category: Osteoporosis
Question 3
A provider plans to aspirate fluid from a patient's swollen knee during a workup for arthritis. What is the purpose of this procedure?
To measure the bone mineral density
To record the muscle's electrical activity
To test the joint fluid for infection or crystals
✓
To replace the worn joint surface
Correct Answer
To test the joint fluid for infection or crystals
Arthrocentesis removes synovial fluid so it can be examined for infection or crystals, which helps rule out conditions such as gout or a septic joint when osteoarthritis is suspected. To measure the bone mineral density describes a DXA scan. To record the muscle's electrical activity describes electromyography. To replace the worn joint surface describes joint replacement surgery.
Category: Osteoarthritis
Question 4
A patient with knee osteoarthritis and obesity asks which lifestyle change would ease the joint pain. What should the nurse recommend?
Avoiding all exercise until the pain is gone
Keeping the knee fully straight at all times
Switching to high-impact running for fitness
Losing weight to reduce the load on the knees
✓
Correct Answer
Losing weight to reduce the load on the knees
Extra body weight increases the force on weight-bearing joints, so weight loss is a core nondrug treatment for osteoarthritis of the knee. Avoiding all exercise until the pain is gone leads to stiffness and weaker supporting muscles; regular activity is recommended. Keeping the knee fully straight at all times reduces range of motion. Switching to high-impact running for fitness adds stress to damaged joints; low-impact activity is preferred.
Category: Osteoarthritis
Question 5
A patient with osteoarthritis of the hands has trouble buttoning clothes and gripping utensils. Which referral helps the patient keep doing these tasks independently?
Occupational therapy
✓
Respiratory therapy
Speech-language therapy
Dietitian services
Correct Answer
Occupational therapy
Occupational therapists assess activities of daily living and provide adaptive devices, such as button hooks and built-up utensil handles, that help patients with joint limits stay independent. Respiratory therapy manages breathing treatments and pulmonary equipment. Speech-language therapy addresses communication and swallowing. Dietitian services address nutrition, not hand function.
Category: Osteoarthritis
Question 6
A patient arrives with a tibia fracture in which a bone end has broken through the skin. Compared with a closed fracture, which complication is this patient at greater risk for?
Bone density loss
Infection
✓
Gout flare
Kidney stones
Correct Answer
Infection
An open, or compound, fracture exposes bone and deep tissue to the outside, so bacteria can enter and cause wound or bone infection. Bone density loss is a feature of osteoporosis, not a direct result of the skin being broken. Gout flare is caused by uric acid crystals in a joint. Kidney stones are unrelated to whether a fracture is open or closed.
Category: Fracture Complications
Question 7
The day after a femur fracture, a patient becomes newly confused and short of breath. Which complication should the nurse suspect?
Compartment syndrome
Osteomyelitis
Fat embolism
✓
Avascular necrosis
Correct Answer
Fat embolism
Fat from the marrow of a long bone can enter the circulation and lodge in the lungs or brain, typically within the first few days after injury, causing shortness of breath and neurological changes such as confusion. Compartment syndrome causes pain, swelling and poor circulation in the injured limb, not confusion. Osteomyelitis is a bone infection that develops more slowly with pain and fever. Avascular necrosis is bone death from lost blood supply that develops over a much longer period.
Category: Fracture Complications
Question 8
A patient with a casted forearm fracture is being monitored for compartment syndrome. Which finding is a late sign?
Pain unrelieved by the prescribed opioid
Pain when the fingers are passively stretched
Numbness and tingling in the fingers
Absent radial pulse
✓
Correct Answer
Absent radial pulse
Pressure in a muscle compartment usually blocks capillary and tissue blood flow well before it can stop flow in a major artery, so loss of the distal pulse appears late, when tissue damage may already be severe. Pain unrelieved by the prescribed opioid is an early warning sign. Pain when the fingers are passively stretched is also an early sign of ischemic muscle. Numbness and tingling in the fingers reflect nerve compression and often appear before the pulse is lost.
Category: Fracture Complications
Question 9
A patient in a long-leg cast reports severe, worsening leg pain that the prescribed opioid does not relieve, and the toes are swollen and tight. What should the nurse do first?
Notify the provider immediately
✓
Apply ice packs over the cast
Elevate the leg well above heart level
Recheck the leg at the next scheduled assessment
Correct Answer
Notify the provider immediately
These findings suggest compartment syndrome, a limb-threatening emergency that may need a fasciotomy, so the provider must be told right away. Apply ice packs over the cast is wrong because cold constricts vessels and can further reduce blood flow. Elevate the leg well above heart level is wrong because raising the limb high lowers arterial pressure to the compartment; it is kept at heart level. Recheck the leg at the next scheduled assessment delays care while muscle and nerve tissue die.
Category: Fracture Complications
Question 10
During a neurovascular check of a casted arm, the patient reports numbness and a pins-and-needles feeling in the fingers. Which neurovascular finding does this represent?
Pallor
Paresthesia
✓
Paralysis
Pulselessness
Correct Answer
Paresthesia
Paresthesia is an abnormal sensation such as numbness or tingling, and in a casted limb it suggests nerve compression or damage. Pallor is pale skin from poor blood flow. Paralysis is the inability to move the extremity. Pulselessness is an absent pulse below the injury.
Category: Fracture Care
Question 11
A patient going home with an external fixator has been taught to clean the pin sites with soap and water. How should the patient dry the skin around the pins?
Rub the skin firmly with a towel
Leave the soap on to dry
Pat the skin dry gently
✓
Blow-dry it on a hot setting
Correct Answer
Pat the skin dry gently
Gently patting the skin dry avoids friction, which can break down the skin around the pins and open a path for infection. Rub the skin firmly with a towel creates that friction. Leave the soap on to dry irritates the skin; sites are cleaned and then dried. Blow-dry it on a hot setting risks burning skin that may have reduced sensation.
Category: Fracture Care
Question 12
A patient going home with a plaster cast that is not water-safe asks about showering. What should the nurse teach?
Let the cast get wet and air-dry afterward
Take the cast off before showering
Soak the cast to keep the plaster soft
Wrap the cast in plastic to keep it dry
✓
Correct Answer
Wrap the cast in plastic to keep it dry
A plaster cast that gets wet can soften and lose its shape, so it is covered with plastic before showering. Let the cast get wet and air-dry afterward risks remolding the plaster and trapping moisture against the skin. Take the cast off before showering is wrong because only the provider removes a cast. Soak the cast to keep the plaster soft defeats its purpose of holding the bone in place.
Category: Fracture Care
Question 13
Why does Duchenne muscular dystrophy mainly affect males?
It is inherited in an X-linked recessive pattern
✓
It is caused by a viral infection in early childhood
Testosterone directly damages the muscle fibers
It is inherited in an autosomal dominant pattern
Correct Answer
It is inherited in an X-linked recessive pattern
The gene for dystrophin is on the X chromosome, so a male with one altered copy has the disease, while a female usually has a second, working copy. It is caused by a viral infection in early childhood is wrong because muscular dystrophy is genetic. Testosterone directly damages the muscle fibers is wrong because hormones do not cause the disease. It is inherited in an autosomal dominant pattern would affect males and females about equally.
Category: Muscular Dystrophy
Question 14
In advanced muscular dystrophy, weakness of which muscle reduces lung function and may eventually require ventilator support?
Biceps
Diaphragm
✓
Quadriceps
Masseter
Correct Answer
Diaphragm
The diaphragm is the main muscle of breathing, and as it weakens, pulmonary function tests show reduced lung function and the patient may need ventilator support. Biceps weakness limits arm flexion, not breathing. Quadriceps weakness affects standing and walking. Masseter weakness affects chewing.
Category: Muscular Dystrophy
Question 15
Which type of muscular dystrophy is marked by muscles that cannot relax after contracting?
Duchenne muscular dystrophy
Becker muscular dystrophy
Myotonic dystrophy
✓
Facioscapulohumeral dystrophy
Correct Answer
Myotonic dystrophy
Myotonic dystrophy prevents muscles from relaxing after a contraction, a feature called myotonia, and it can also affect heart rhythm. Duchenne muscular dystrophy appears in early childhood, often when walking begins. Becker muscular dystrophy is a milder form that usually begins in later childhood or adolescence. Facioscapulohumeral dystrophy weakens the face, shoulders and upper arms.
Category: Muscular Dystrophy
Question 16
A patient with systemic lupus erythematosus develops new high blood pressure, swelling and a rising serum creatinine. Which complication should the nurse suspect?
Pericarditis
Pleuritis
Raynaud phenomenon
Lupus nephritis
✓
Correct Answer
Lupus nephritis
Immune complexes can inflame the kidneys in SLE, and kidney involvement shows up as hypertension, fluid retention and rising creatinine and BUN. Pericarditis causes substernal chest pain. Pleuritis causes chest pain with breathing. Raynaud phenomenon causes the fingers to turn pale with cold or stress.
Category: Connective Tissue Disease
Question 17
A patient with rheumatoid arthritis has joint stiffness that is worst on waking. Which morning routine should the nurse suggest to ease it?
Taking a warm shower before starting activity
✓
Staying in bed until the stiffness passes
Holding the joints still in tight splints all morning
Doing vigorous exercise as soon as waking
Correct Answer
Taking a warm shower before starting activity
Heat relaxes muscles and eases joint stiffness, so a warm shower or bath before activity helps loosen joints that stiffen during rest. Staying in bed until the stiffness passes prolongs immobility, which worsens stiffness. Holding the joints still in tight splints all morning prevents the gentle movement that relieves stiffness; splints are used to rest inflamed joints. Doing vigorous exercise as soon as waking stresses stiff, inflamed joints; activity is increased gradually and balanced with rest.
Category: Connective Tissue Disease
Question 18
A soccer player twisted an ankle and overstretched the ligament that holds the joint together. Which injury is this?
Strain
Sprain
✓
Contusion
Bursitis
Correct Answer
Sprain
A sprain is an overstretching or tearing of a ligament, the tissue that connects bone to bone, and it often affects the ankle, knee or wrist. Strain is an injury to a muscle or tendon. Contusion is a bruise from a direct blow. Bursitis is inflammation of a fluid-filled sac near a joint.
Category: Soft Tissue Injuries
Question 19
A patient with an injured ankle ligament is being discharged with a stabilizing brace. Which nursing action confirms the patient is ready to manage it at home?
Handing the patient written instructions only
Telling the patient a relative must apply it
Watching the patient apply the brace without help
✓
Applying it tight enough to stop all movement
Correct Answer
Watching the patient apply the brace without help
The nurse helps apply the brace the first time and then confirms the patient can put it on correctly alone before discharge. Handing the patient written instructions only does not show the patient can perform the skill. Telling the patient a relative must apply it limits independence and is not required. Applying it tight enough to stop all movement could impair circulation and is not the goal of bracing.
Category: Soft Tissue Injuries
Question 20
A provider realigns a displaced forearm fracture by manipulating the bone from outside the body, without an incision, before a cast is applied. What is this procedure called?
Internal fixation
External fixation
Arthroplasty
Closed reduction
✓
Correct Answer
Closed reduction
Closed reduction realigns the bone fragments by hand from outside the body, usually with sedation or local anesthesia, followed by a cast or splint. Internal fixation places plates, screws or rods surgically inside the bone. External fixation drills pins into the bone and connects them to a frame outside the body. Arthroplasty replaces a damaged joint with an artificial one.
Category: Fracture Care