Chapter 62: Nursing Assessment: Musculoskeletal System Test Bank B ank
MULTIL! C"#IC!
1. A 42-year-old male patient complains of shoulder pain when the nurse moves his arm behind
the back. Which question should the nurse ask? a. Are you able to feed yourself without difficulty?! b. "o you have difficulty d ifficulty when you are puttin# on a shirt?! c. Are you able to sleep throu#h the ni#ht without wakin#?! d. "o you ever have trouble lowerin# yourself to the toilet?! A$%& '
(he patient)s pain will make it more difficult to accomplish tasks like puttin# on a shirt or *acket. (his pain should not affect the patient)s patient)s ability to feed himself or use the toilet because these tasks do not involve movin# the arm behind the patient. (he arm will not usually be positioned behind the patient durin# sleepin#. "+,& o#nitive evel& Apply /application0 ,& 1434 (5& 5& $ursin rsin# # 5ro 5roce cesss& Asses ssessm smen entt 6%& 6%& $ $7 7& 8ea 8eallth 5romo romoti tion on and and 6a 6aint intenan enance ce 2. A patient with left knee pain is dia#nosed with bursitis. (he nurse will e9plain that bursitis is
an inflammation of a. the synovial membrane that lines the *oint. b. a small: fluid-filled sac found at some *oints. c. the fibrocartila#e that acts as a shock absorber in the knee *oint. d. any connective tissue that is found supportin# sup portin# the *oints of the body. A$%& '
'ursae are fluid-filled sacs that cushion *oints and bony prominences. ,ibrocartila#e is a solid tissue that cushions some *oints. 'ursae are a specific type of connective tissue. (he synovial membrane lines many *oints but is not a bursa. "+,& o#nitive evel& ;nderstand /comprehension0 ,& 143< (5& (5& $urs $ursin in# # 5ro 5roce cess ss&& +mp +mple leme ment ntat atio ion n 6%& 6%& $ $7& 7& 5hys 5hysio iolo lo#i #ica call +nte +nte#r #rit ity y <. (he nurse who notes that a =3-year-old female patient has lost 1 inch in hei#ht ov er the past 2
years will plan to teach the patient pa tient about a. disco#raphy studies. b. myelo#raphic testin#. c. ma#netic resonance ima#in# /6+0. d. dual-ener#y 9-ray absorptiometry /"7A0. A$%& "
(he decreased hei#ht and the patient)s a#e su##est that the patient may have osteoporosis and that bone density testin# is needed. "isco#raphy: 6+: and myelo#raphy are typically done for patients with current symptoms caused by musculoskeletal dysfunction and are not the initial dia#nostic tests for osteoporosis.
"+,& o#nitive evel& Apply /application0 ,& 1434 > 1=1 (5& $ursin# 5rocess& 5lannin# 6%& $7& 8ealth 5romotion and 6aintenance 4. Which information in a @-year-old woman)s health history will alert the nurse to the need for
a more focused assessment of the musculoskeletal system? a. (he patient sprained her ankle at a#e 1<. b. (he patient)s mother became shorter with a#in#. c. (he patient takes ibuprofen /Advil0 for occasional heada ches. d. (he patient)s father died of complications of miliary tuberculosis. A$%& '
A family history of hei#ht loss with a#in# may indicate osteoporosis: and the nurse should perform a more thorou#h assessment of the patient)s current hei#ht and other risk factors for osteoporosis. A sprained ankle durin# adolescence does not place the patient at increased current risk for musculoskeletal problems. A family history of tuberculosis is not a risk factor. ccasional nonsteroidal antiinflammatory dru# /$%A+"0 use does not indicate any increased musculoskeletal risk. "+,& o#nitive evel& Apply /application0 ,& 143@ (5& $ursin# 5rocess& Assessment 6%& $7& 8ealth 5romotion and 6aintenance =. Which information obtained durin# the nurse)s assessment of a <-year-old patient)s
nutritional-metabolic pattern may indicate the risk for musculoskeletal problems? a. (he patient takes a multivitamin daily. b. (he patient dislikes fruits and ve#etables. c. (he patient is = ft 2 in and wei#hs 1B lb. d. (he patient prefers whole milk to nonfat milk. A$%&
(he patient)s hei#ht and wei#ht indicate obesity: which places stress on wei#ht-bearin# *oints. (he use of whole milk: avoidin# fruits and ve#etables: and use of a daily multivitamin are not risk factors for musculoskeletal problems. "+,& o#nitive evel& Apply /application0 ,& 143@ (5& $ursin# 5rocess& Assessment 6%& $7& 8ealth 5romotion and 6aintenance @. Which medication information will the nurse identify as a concern for a patient)s
musculoskeletal status? a. (he patient takes a daily multivitamin and calcium supplement. b. (he patient takes hormone therapy /8(0 to prevent hot flashes.! c. (he patient has severe asthma and requires frequent therapy with oral corticosteroids. d. (he patient has mi#raine headaches treated with nonsteroidal antiinflammatory dru#s /$%A+"s0. A$%&
,requent or chronic corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. (he use of 8( and calcium supplements will help prevent osteoporosis. $%A+" use does not increase the risk for musculoskeletal problems. "+,& o#nitive evel& Apply /application0 ,& 143= (5& $ursin# 5rocess& Assessment 6%& $7& 8ealth 5romotion and 6aintenance . (he nurse finds that a patient can fle9 the arms when no resistance is applied but is unable to
fle9 when the nurse applies li#ht resistance. (he nurse should do cument the patient)s muscle stren#th as level a. . b. 1. c. 2. d. <. A$%& "
A level < indicates that the patient is unable to move a# ainst resistance but can move a#ainst #ravity. evel 1 indicates minimal muscle contraction: level 2 indicates that the arm can move when #ravity is eliminated: and level 4 indicates active movement with some resistance. "+,& o#nitive evel& ;nderstand /comprehension0 ,& 143B (5& $ursin# 5rocess& Assessment 6%& $7& 8ealth 5romotion and 6aintenance B. After completin# the health history: the nurse assessin# the musculoskeletal system will be#in
by a. b. c. d.
havin# the patient move the e9tremities a#ainst resistance. feelin# for the presence of crepitus durin# *oint movement. observin# the patient)s body build and muscle confi#uration. checkin# active and passive ran#e of motion for the e9tremities.
A$%&
(he usual technique in the physical assessment is to be#in with inspection. Abnormalities in muscle mass or confi#uration will allow the nurse to perform a more focused assessment of abnormal areas. (he other assessments are also included in the a ssessment but are usually done after inspection. "+,& o#nitive evel& ;nderstand /comprehension0 ,& 143 (5& $ursin# 5rocess& Assessment 6%& $7& 8ealth 5romotion and 6aintenance 3. Which nursin# action is correct when performin# the strai#ht-le# raisin# test for an
ambulatory patient with back pain? a. aise the patient)s le#s to a @-de#ree an#le from the bed. b. 5lace the patient initially in the prone position on the e9am table. c. 8ave the patient dan#le both le#s over the ed#e of the e9am table. d. +nstruct the patient to elevate the le#s and tense the abdominal muscles. A$%& A
When performin# the strai#ht le#-raisin# test: the patient is in the supine position and the nurse passively lifts the patient)s le#s to a @-de#ree an#le. (he other actions would not be correct for this test. "+,& o#nitive evel& ;nderstand /comprehension0 ,& 143B (5& $ursin# 5rocess& Assessment 6%& $7& 5hysiolo#ical +nte#rity 1. A 2-year-old patient with kyphosis is scheduled for dual-ener#y 9-ray absorptiometry /"7A0
testin#. (he nurse will plan to a. e9plain the procedure. b. start an +C line for contrast medium in*ection. c. #ive an oral sedative @ to 3 minutes before the procedure. d. screen the patient for aller#ies to shellfish or iodine products. A$%& A
"7A testin# is painless and noninvasive. $o +C access is necessary. ontrast medium is not used. 'ecause the procedure is painless: no antian9iety medications are required. "+,& o#nitive evel& Apply /application0 ,& 1=1 (5& $ursin# 5rocess& +mplementation 6%& $7& 5hysiolo#ical +nte#rity 11. A patient has a new order for ma#netic resonance ima#in# /6+0 to evaluate for left femur
osteomyelitis after a hip replacement sur#ery. Which information indicates that the nurse should consult with the health care provider before schedulin# the 6+? a. (he patient has a pacemaker. b. (he patient is claustrophobic. c. (he patient wears a hearin# aid. d. (he patient is aller#ic to shellfish. A$%& A
5atients with permanent pacemakers cannot have 6+ because of the force e9erted by the ma#netic field on metal ob*ects. An open 6+ will not cause claustrophobia. (he patient will need to be instructed to remove the hearin# aid before the 6+: but this does not require consultation with the health care provider. 'ecause contrast medium will not be used: shellfish aller#y is not a contraindication to 6+. "+,& o#nitive evel& Apply /application0 ,& 1=1 (5& $ursin# 5rocess& Assessment 6%& $7& 5hysiolo#ical +nte#rity 12. (he nurse notes cracklin# sounds and a #ratin# sensation with palpation of an older patient)s
elbow. 8ow will this findin# be documented? a. (orticollis b. repitation c. %ublu9ation d. picondylitis A$%& '
racklin# sounds and a #ratin# sensation that accompany movement are described as crepitus or crepitation. (orticollis is a twistin# of the neck to one side: sublu9ation is a partial dislocation of the *oint: and epicondylitis is an inflammation of the elbow that causes a dull ache that increases with movement. "+,& o#nitive evel& ;nderstand /comprehension0 ,& 1= (5& $ursin# 5rocess& Assessment 6%& $7& 5hysiolo#ical +nte#rity 1<. Which findin# is of highest priority when the nurse is plannin# care for a -year-old patient
seen in the outpatient clinic? a. %ymmetric *oint swellin# of fin#ers b. "ecreased ri#ht knee ran#e of motion c. eport of left hip achin# when *o##in# d. 8istory of recent loss of balance and fall A$%& "
A history of falls requires further assessment and development of fall prevention strate#ies. (he other chan#es are more typical of bone and *oint chan#es associated with normal a#in#. "+,& o#nitive evel& Apply /application0 ,& 1434 'D& %pecial Euestions& 5rioritiFation (5& $ursin# 5rocess& Assessment 6%& $7& 5hysiolo#ical +nte#rity 14. Which findin# from a patient)s ri#ht knee arthrocentesis will be of concern to the nurse? a. loudy fluid b. %cant thin fluid c. 5ale yellow fluid d. %traw-colored fluid A$%& A
(he presence of purulent fluid su##ests a possible *oint infection. $ormal synovial fluid is scant in amount and pale yellowGstraw-colored. "+,& o#nitive evel& Apply /application0 ,& 1433 > 1=< (5& $ursin# 5rocess& Assessment 6%& $7& 5hysiolo#ical +nte#rity 1=. Which action can the nurse dele#ate to unlicensed assistive personnel /;A50 who are workin#
in the orthopedic clinic? a. Hrade le# muscle stren#th for a patient with back pain. b. btain blood sample for uric acid from a patient with #out. c. 5erform strai#ht-le#-raise testin# for a patient with sciatica. d. heck for knee *oint crepitation before arthroscopic sur#ery. A$%& '
"rawin# blood specimens is a common skill performed by ;A5 in clinic settin#s. (he other actions are assessments and require re#istered nurse /$0Ilevel *ud#ment and critical thinkin#. "+,& o#nitive evel& Apply /application0 ,& 'D& %pecial Euestions& "ele#ationJ 6ultiple 5atients
1=-1@ (5& $ursin# 5rocess& 5lannin#
6%& $7& %afe and ffective are nvironment
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1. Which part of the musculoskeletal assessment is the nurse doin# in the video?
lick here to view the video clip a. 5assive hip ran#e of motion b. +nspection of the le#s and feet c. +nternal and e9ternal hip rotation d. Adduction and abduction of the hip A$%&
" 8ip abduction and adduction is assessed by havin# the patient move the hip *oint laterally and medially. "+,& o#nitive evel& ;nderstand /comprehension0 ,& 1432 > 143B (5& $ursin# 5rocess& Assessment 6%& $7& 8ealth 5romotion and 6aintenance
