Running head: MUSCULOSKELETAL EXAM QUESTIONS 1

Musculoskeletal Exam Questions

Kristen Eden

Bethel College
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Musculoskeletal Exam Questions

Evaluating student learning may be accomplished by writing high quality exam

questions. The questions must be written clearly, at an appropriate level for the students’

understanding, and should reflect the content that has been previously taught during lecture.

Requesting one’s nurse educator colleagues to review the questions for clarity, accuracy, and

appropriate level of difficulty will provide the writer with a variety of perspectives and

suggestions for improvement (McDonald, 2018).

The five exam questions I have written to include during my teaching presentation on the

musculoskeletal system will incorporate diagnostic tests, pathophysiology, and evidence-based

nursing interventions. The content covered in this presentation and set of exam questions

includes assessments and diagnostic testing, fractures, osteomyelitis, osteoporosis, and systemic

lupus erythematosus. The goal will be to assess student learning throughout the presentation and

provide a means for active learning.

Question 1

What type of diagnostic test is most often used to diagnose bone fractures?

A. MRI

B. Arthroscopy

C. Xray

D. Nuclear bone scan

Answer C is the correct answer (Ignatavicius & Workman, 2016, p. 1025). Answer A is

incorrect because MRIs provide more detailed imaging than is needed for a simple fracture

(Ignatavicius & Workman, 2016, p. 1025). Answer B is incorrect because arthroscopy is used to

diagnose damage within joints (Ignatavicius & Workman, 2016, p. 1026). Answer D is incorrect
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because it is used primarily to detect tumors, arthritis, and unexplained bone pain. It is more

detailed imaging than is needed to diagnose a fracture but may be used to diagnose hairline

fractures that are difficult to see on an xray (Ignatavicius & Workman, 2016, p. 1025). This exam

question is written at the knowledge level. The student must simply remember what diagnostic

test is most often used to diagnose bone fractures. This question reflects outcome two because it

is asking the student how to assess for fractures.

Question 2

You are a nurse working on an orthopedic inpatient unit. You are assigned four patients and must

decide who to assess first. Which patient should you recognize as needing immediate attention?

A. The patient with an external fixator complaining of aching pain of 6/10

B. The patient in a leg cast with cold, cyanotic toes

C. The patient with a hip fracture complaining of shortness of breath

D. The patient with a fasciotomy requesting to have his wound dressing changed

The correct answer to this question is C because breathing is always prioritized over

circulation, pain, and discomfort (Ignatavicius & Workman, 2016). Answer A is incorrect but

plausible as a pain rating of 6/10 could indicate issues such as acute compartment syndrome

(Ignatavicius & Workman, p. 1063). Answer B is incorrect but plausible these symptoms

indicate decreased perfusion and risk for tissue death (Ignatavicius & Workman, 2016, p. 1057).

Answer D is incorrect but plausible because protecting the open tissues after a fasciotomy is

important (Ignatavicius & Workman, 2016, p. 1064). This question is written at the application

level. It requires the student to be familiar with abnormal assessment findings and prioritize

which finding is of greatest importance. This exam question reflects outcomes two and three
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because it relates to assessing abnormal findings of fractures and other complications of

treatments of musculoskeletal disorders.

Question 3

The nurse is assessing her patient’s understanding of her teaching on prevention of osteoporosis.

Which statement by the patient indicates a need for further teaching?

A. “I will need to increase my dietary intake of calcium and vitamin D.”

B. “I will walk for 30 minutes each day to maintain my strength.”

C. “I can continue to drink my favorite soda at every meal because it contains

phosphorus.”

D. “I need to make sure my home is clutter free and well lit.”

Answer C is the correct answer. The patient needs further teaching because she thinks

large amounts of soda will not affect her osteoporosis. However, this is untrue as large amounts

of phosphorus decrease calcium levels and further the disease (Ignatavicius & Workman, 2016,

p. 1031). Answer A is incorrect. If the patient makes this statement they understand the need for

dietary intake of calcium and vitamin D maintain healthy bones (Ignatavicius & Workman, 2016,

p. 1031). Answer B is incorrect because physical exercise is important to maintaining bone

strength (Ignatavicius & Workman, 2016, p. 1033). Answer D is incorrect because it is important

to prevent falls from occurring when one has osteoporosis. Osteoporosis increases the risk for

bone fractures due to falls. (Ignatavicius & Workman, 2016, p. 1032). This question is written at

the application level. It requires the student to have an understanding of ways to prevent

osteoporosis and decide which teaching statements are appropriate. This exam question reflects

outcome four because it relates to the care of patients to prevent osteoporosis.

Question 4

Which statements should the nurse include when educating her patient on their new diagnosis of

lupus? Select all that apply.

A. Lupus is an autoimmune disease that causes inflammation and damage to connective

tissues.

B. Sun exposure can minimize the negative effects of lupus on the skin.

C. You should avoid large crowds while taking steroids and immunosuppressants.

D. Spiking a fever is the classic sign of an exacerbation of lupus.

E. Lupus will not affect your ability to maintain a healthy pregnancy.

Answers A, C, and D are correct. Lupus is an autoimmune disease that causes damage to

connective tissues as well as any other body system by forming immune complexes that cause

inflammation, decreased circulation, and damage. Avoiding large crowds is important while

taking immunosuppressants because of the high risk for infection and decreased immunity of the

patient. Spiking a fever is a classic sign of an exacerbation of lupus (Ignatavicius & Workman,

2016, pp. 313-316). Answer B is incorrect because sun exposure triggers exacerbation of lupus

(Ignatavicius & Workman, 2016, p. 316). Answer E is incorrect because lupus can negatively

impact one’s pregnancy (Ignatavicius & Workman, 2016, p. 316). This question is written at the

application level. It requires the student to have an understanding of lupus and the ways to

prevent exacerbations in order to provide adequate teaching to her patient. This exam question

reflects outcome five because it requires the student to evaluate the clinical manifestations of

lupus.
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Question 5

You are evaluating the laboratory values of your patient with systemic lupus erythematosus.

What values indicate organ damage due to her disease?

A. Potassium of 4.0 mmol/L

B. Hemoglobin of 14g/dL

C. Creatinine of 3.6 mg/dL

D. White blood cell count of 7x10^9/L

Answer C is the correct answer. The elevated creatinine value indicates kidney damage

due to the systemic effects of lupus (Ignatavicius & Workman, 2016, p. 315). Answers A, B, and

D are all values within normal range and do not indicate organ damage (Ignatavicius &

Workman, 2016, p. 315). This question is written at the application level because it requires the

student to assess the laboratory values and determine which is abnormal and related to lupus. The

question reflects outcome five because it requires the student to evaluate the patient for clinical

manifestations of lupus.

Evaluating student understanding can be accomplished objectively with the use of

examination questions. Recall of information and critical thinking can be assessed easily by

providing students with high-quality questions that reflect the content taught. Providing answer

rationales and references encourages further learning and assists the student to thoroughly

understand the material.

References

Ignatavicius, D. & Workman, M. (2016). Medical-surgical nursing: Patient-centered

collaborative care (8th ed.). St. Louis, MO: Elsevier.

McDonald, M. (2018). The nurse educator’s guide to assessing learning outcomes (4th ed.).

Burlington, MA: Jones & Bartlett Learning.