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Musculoskeletal System

1. Mrs. Gauthier, 72, arrives complaining of chronic knee pain that has slowly worsened over the past several years. She reports stiffness in both knees each morning, but says it improves within 15–20 minutes once she starts moving. She states the pain becomes worse at the end of the day after walking around her apartment building. During assessment, the LPN notes crepitus when flexing and extending her knee. Which clinical manifestation is most associated with osteoarthritis? *
2. Ms. Côté, 55, presents with progressive fatigue and joint pain in both hands. She reports stiffness in the morning lasting nearly two hours before she can make a full fist. On assessment, the joints of her fingers appear swollen and slightly warm to the touch. Which manifestation is most characteristic of rheumatoid arthritis? *
3. Mr. Palen, 63, arrives at the clinic with sudden intense pain in his right big toe. He describes the pain as “burning fire,” beginning overnight without injury. The joint is red, swollen, shiny, and extremely tender even to light touch. He admits to having eaten seafood and drinking alcohol at a wedding the day before. Which clinical manifestation supports the suspected diagnosis? *
4. Ms. Nguyen, 46, works as an administrative assistant and reports numbness and tingling in her thumb, index, and middle fingers during typing. Symptoms worsen at night, occasionally waking her. The LPN performs a Phalen test, which reproduces the tingling sensation. Which manifestation is characteristic of carpal tunnel syndrome? *
5. Mr. Sanou, 44, presents with low back pain radiating down his left leg. He reports tingling and occasional numbness along the lateral thigh and calf. Pain increases when sitting and improves when lying flat. Straight-leg raise test triggers sharp shooting pain down the leg. Which manifestation corresponds to a lumbar disc herniation? *
6. Mr. Lefebvre, an 81-year-old retired teacher, is recovering on the orthopedic floor after surgical repair of a left hip fracture caused by a fall at home. His medical history includes hypertension and mild chronic obstructive pulmonary disease (COPD). Twelve hours after surgery, the LPN is called to his bedside due to sudden shortness of breath.

On assessment, Mr. Lefebvre is restless, confused, and breathing rapidly. His oxygen saturation has dropped to 88% on room air. His respiratory rate is 30 breaths/min, and he has a fine rash resembling petechiae on his upper chest. Lung auscultation reveals crackles bilaterally. The physician suspects fat embolism syndrome (FES), a known complication of long-bone fractures.

Which clinical manifestation is MOST characteristic of this condition? *
7. Mrs. Morin, 79, arrives after noticing she has become shorter over the past year. She reports back pain that worsens when standing for long periods. Her history includes long-term corticosteroid use for COPD. The LPN notes a gradual kyphotic curvature of her spine. Which manifestation relates most to osteoporosis? *
8. Mrs. Renée Gagnon, a 77-year-old woman living alone in Shawinigan, arrives at the outpatient clinic after noticing progressive upper-back discomfort over the past 6 months. She describes a “heavy tired feeling” between her shoulder blades that worsens after standing for long periods. She denies any recent falls but admits that she has lost about 4 cm (1.5 inches) in height compared to last year.

She has a history of postmenopausal osteoporosis, diagnosed 4 years ago, and has been inconsistent with her alendronate therapy because “it upsets my stomach.” Her diet is low in calcium, and she rarely goes outside during winter, limiting her vitamin D exposure.

During assessment, the nurse notices that Mrs. Gagnon walks with her head slightly forward, shoulders rounded, and her thoracic spine appearing more curved than before. She sighs, stating, “I don’t know why my back looks like this… maybe it's just aging.” She denies acute neurological symptoms.

Her vitals:
BP: 128/72
HR: 82
RR: 18
SpO₂: 98%
Pain: 4/10 dull upper-back ache

Her last bone density scan (10 months ago) showed markedly low T-scores in the lumbar and hip regions.

Based on Mrs. Gagnon’s presentation, which clinical manifestation is the nurse MOST likely observing? *
9. Mrs. Jeanne Lemieux, 82, is brought to the ED after a fall at home. She has osteoporosis, hypertension, and mild cognitive impairment. She complains of severe left hip pain and cannot bear weight. On exam the left leg is shortened and externally rotated. X-ray confirms a displaced left femoral neck fracture. She is awaiting transfer to orthopedics for hemiarthroplasty; analgesics and DVT prophylaxis are ordered. Six hours after admission, while still in the ED, the nurse notes sudden restlessness and confusion. Her respiratory rate increases to 34/min, SpO₂ falls to 85% on room air, and she becomes tachycardic at 128 bpm. Small petechial rash is visible over her chest and conjunctivae. ABG shows PaO₂ 56 mmHg on 2 L O₂. Which complication should the nurse suspect? *
11. Mr. Olivier Martel, 34, sustained a closed tibial shaft fracture after a motorcycle accident. He is conscious, on opioids for pain, with an above-knee splint applied in the ED. Initial neurovascular check is intact. Overnight, the patient reports increasing, severe pain out of proportion to the injury and is restless despite analgesia. The nurse notes progressive swelling and tense tightness of the lower leg, pain on passive dorsiflexion of the toes, decreased sensation between the first and second toes, and weak dorsalis pedis pulse compared to the contralateral side. Capillary refill is delayed. Which complication is the nurse most concerned about? *
12. Mrs. Monique Gauthier, 71, underwent an elective left total knee arthroplasty yesterday for severe osteoarthritis. Her history includes obesity and controlled hypertension. She is ambulating with assistance but reports increased calf tightness today and mild swelling. She is on routine pharmacologic DVT prophylaxis and pneumatic compression. This afternoon she suddenly becomes breathless, clutching her chest with pleuritic pain. Her SpO₂ falls to 86% on room air, HR 140 bpm, BP 88/52 mmHg, and she becomes diaphoretic and anxious. Ongoing assessment reveals a swollen, tender left calf with increased circumference compared to the right. Which complication should the nurse suspect? *
13. Mr. Karim Boulos, 45, sustained an open distal tibia fracture two months ago after a workplace accident; it was irrigated and externally fixed. He received IV antibiotics in hospital and was discharged on oral antibiotics. Over the last three weeks he reports intermittent low-grade fevers, persistent localized pain, and a purulent draining sinus over the fracture site. WBC is mildly elevated at 12.1 ×10⁹/L, CRP remains elevated, and X-ray now shows periosteal reaction and localized bone lucency. Wound culture grows Staphylococcus aureus. He notes increasing difficulty bearing weight. Which complication is most consistent with this presentation? *
14. Mrs. Hélène Carrière, 68, has polymyalgia rheumatica treated for years with prednisone 10–15 mg daily. She complains of sudden severe midline thoracic back pain after a minor trip at home and cannot stand upright due to pain. She reports new numbness and weakness in both lower extremities and difficulty with gait since the event. On exam she has tenderness over the T8 vertebra, decreased lower-extremity strength (3/5), hyperreflexia, and urinary hesitancy. Spine X-ray demonstrates a burst compression fracture at T8 with retropulsion of bony fragments. Which complication should the nurse suspect? *
15. Mr. Daniel Ng, 52, with recurrent gout poorly controlled on intermittent NSAIDs and high-purine diet, presents today with sudden severe right flank pain radiating to the groin, nausea, and vomiting. He reports cloudy, foul-smelling urine and a history of prior kidney stones. Vitals: HR 110 bpm, BP 148/86 mmHg, RR 18/min. Urinalysis shows hematuria and crystals; serum uric acid is 520 µmol/L. Noncontrast CT abdomen confirms a 6 mm obstructing calculus in the right proximal ureter. Which complication of chronic hyperuricemia is the nurse managing? *
16. A 36-year-old patient who loves running shows up at the hospital. A week ago, a weight of 100 lbs fell on him. He now has shooting back pain and can only take small steps without moving his body. In the questionnaire, the LPN notes that the patient is sweating and has trembling hands. He complains of numbness in the legs and a neck pain rated at 8/10. He says that the painkillers he’s currently taking bring very little relief and that he consumes a lot of energy drinks. The medical record mentions that the patient has already received a consultation for tendonitis in the buttocks. An MRI is then requested by the physician, as he fears a lumbar discal hernia. Which of the following clinical manifestations relates to the patient’s condition? *
17. A 73-year-old beneficiary living in a CHSLD suffers from osteoporosis. She explains to the LPN that when bending to tie her shoes, she felt a sharp pain in her lower back. She also suffers from a deformed spine and has a stooped posture. The beneficiary mentions that she plays cards despite a hand deformation that makes her “all thumbs.” She remains active by participating in an exercise session every week. Which of the following clinical manifestations relate to the patient’s condition? *
18. A woman who lives in a private residence is brought to the emergency room for a deterioration of her general condition. The LPN receiving her fills out the admission questionnaire and writes that the patient is oriented in the three spheres and has eaten little for two weeks. The patient complains of joint pain and has swollen red fingers. She must be assisted in her ADLs (activities of daily living) because she can no longer use her hands as well as before. Her weakness leads her to not want to move. She gets angry, uses profanity, and tries to hit the LPN when she tries to place her in her chair for meals. The doctor diagnoses an arthritis attack. A prescription for anti-inflammatory drugs and a blood test will soon follow. Which of the following clinical manifestations relates to the patient’s condition? *
19. A sixteen-year-old patient is hospitalized because she has had two epileptic seizures in 48 hours. During her meal, she ecomes disorganized, and her gait is unstable. Her speech in inadequate and sometimes incomprehensible. Her face is pale, and her gaze is fixed and empty. The patient begins to have tonic movements followed by successive and irregular periods of muscle relaxation. The LPN places her on the floor with a pillow under her head and asked for help. Which of the following clinical manifestations relates to the patient’s condition? *