Ch. 23: Musculoskeletal System

Question 1

A woman who is 8 months pregnant comments that she has noticed a change in posture and is having lower back pain. The nurse tells her that during pregnancy women have a posture shift to compensate for the enlarging fetus. This shift in posture is known as:

A) lordosis
B) scoliosis
C) ankylosis
D) kyphosis

Answer 1

A) lordosis

Question 2

A patient is being assessed for range of joint movement. The nurse asks him to move his arm in toward the center of his body. This movement is called:

A) flexion
B) abduction
C) adduction
D) extension

Answer 2

C) adduction

Question 3

A patient tells the nurse that she is having a hard time bringing her hand to her mouth when she eats or tries to brush her teeth. The nurse knows that for her to move her hand to her mouth, she must perform which movement?

A) flexion
B) abduction
C) adduction
D) extension

Answer 3

A) flexion

Question 4

The functional units of the musculoskeletal system are the:

A) joints
B) bones
C) muscles
D) tendons

Answer 4

A) joints

Question 5

When reviewing the musculoskeletal system, the nurse recalls that hematopoiesis takes place in the:

A) liver
B) spleen
C) kidneys
D) bone marrow

Answer 5

D) bone marrow

Question 6

Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions are called:

A) bursa
B) tendons
C) cartilage
D) ligaments

Answer 6

D) ligaments

Question 7

The nurse notices that a woman in an exercise class is unable to jump rope. The nurse knows that to jump rope, one’s shoulder has to be capable of:

A) inversion
B) supination
C) protraction
D) circumduction

Answer 7

D) circumduction

Question 8

The articulation of the mandible and the temporal bone is known as the:

A) intervertebral foramen
B) condyle of the mandible
C) temporomandibular joint
D) zygomatic arch of the temporal bone

Answer 8

C) temporomandibular joint

Question 9

To palpate the temporomandibular joint, the nurse’s fingers should be placed in the depression _____ of the ear.

A) distal to the helix
B) proximal to the helix
C) anterior to the tragus
D) posterior to the tragus

Answer 9

C) anterior to the tragus

Question 10

Of the 33 vertebrae in the spinal column, there are:

A) 5 lumbar
B) 5 thoracic
C) 7 sacral
D) 12 cervical

Answer 10

A) 5 lumbar

Question 11

An imaginary line connecting the highest point on each iliac crest would cross the _____ vertebra.

A) first sacral
B) fourth lumbar
C) seventh cervical
D) twelfth thoracic

Answer 11

B) fourth lumbar

Question 12

The nurse is explaining to a patient that there are “shock absorbers” in his back to cushion the spine and to help it move. The nurse is referring to his:

A) vertebral column
B) nucleus pulposus
C) vertebral foramen
D) intervertebral disks

Answer 12

D) intervertebral disks

Question 13

The nurse is providing patient education for a man who has been diagnosed with a rotator cuff injury. The nurse knows that a rotator cuff injury involves the:

A) nucleus pulposus
B) articular process
C) medial epicondyle
D) glenohumeral joint

Answer 13

D) glenohumeral joint

Question 14

During an interview the patient states, “I can feel this bump on the top of both of my shoulders—it doesn’t hurt but I am curious about what it might be.” The nurse should tell the patient, “That is:

A) your subacromial bursa.”
B) your acromion process.”
C) your glenohumeral joint.”
D) the greater tubercle of your humerus.”

Answer 14

B) your acromion process.”

Question 15

The nurse is checking the range of motion in a patient’s knee and knows that the knee is capable of which movement(s)?

A) flexion and extension
B) supination and pronation
C) circumduction
D) inversion and eversion

Answer 15

A) flexion and extension

Question 16

A patient is visiting the clinic for an evaluation of a swollen, painful knuckle. The nurse notices that the knuckle above his ring on the left hand is swollen and that he is unable to remove his wedding ring. This joint is called the _____ joint.

A) interphalangeal
B) tarsometatarsal
C) metacarpophalangeal
D) tibiotalar

Answer 16

C) metacarpophalangeal

Question 17

The nurse is examining the hip area of a patient and palpates a flat depression on the upper, lateral side of the thigh when the patient is standing. The nurse interprets this finding as the:

A) ischial tuberosity
B) greater trochanter
C) iliac crest
D) gluteus maximus muscle

Answer 17

B) greater trochanter

Question 18

The ankle joint is the articulation of the tibia, the fibula, and the:

A) talus
B) cuboid
C) calcaneus
D) cuneiform bones

Answer 18

A) talus

Question 19

The nurse is explaining the mechanism of the growth of long bones to a mother of a toddler. Where does lengthening of the bones occur?

A) bursa
B) calcaneus
C) epiphyses
D) tuberosities

Answer 19

C) epiphyses

Question 20

The nurse is teaching a class on osteoporosis prevention to a group of postmenopausal woman. A participant shows that she needs more instruction when she states, “I will:

A) start swimming to increase my weight-bearing exercise.”
B) try to stop smoking as soon as possible.”
C) check with my doctor about taking calcium supplements.”
D) get a bone-density test soon.”

Answer 20

A) start swimming to increase my weight-bearing exercise.”

Question 21

A teenage girl has arrived complaining of pain in her left wrist. She was playing basketball when she fell and landed on her left hand. The nurse examines her hand and would expect a fracture if the girl complains:

A) of a dull ache
B) that the pain in her wrist is deep
C) of sharp pain that increases with movement
D) of dull throbbing pain that increases with rest

Answer 21

C) of sharp pain that increases with movement

Question 22

A patient is complaining of pain in his joints that is worse in the morning, is better after he has moved around for awhile, and then gets worse again if he sits for long periods of time. The nurse should assess for other signs of what problem?

A) tendinitis
B) osteoarthritis
C) rheumatoid arthritis
D) intermittent claudication

Answer 22

C) rheumatoid arthritis

Question 23

A patient states, “I can hear a crunching or grating sound when I kneel.” She also states that “it is very difficult to get out of bed in the morning because of stiffness and pain in my joints.” The nurse should assess for signs of what problem?

A) crepitation
B) a bone spur
C) a loose tendon
D) fluid in the knee joint

Answer 23

A) crepitation

Question 24

A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasms; the nurse should suspect:

A) crepitation
B) rotator cuff lesions
C) dislocated shoulder
D) rheumatoid arthritis

Answer 24

B) rotator cuff lesions

Question 25

A professional tennis player comes into the clinic complaining of a sore elbow. The nurse will assess for tenderness at the:

A) olecranon bursa
B) annular ligament
C) base of the radius
D) medial and lateral epicondyle

Answer 25

D) medial and lateral epicondyle

Question 26

The nurse suspects that a patient has carpal tunnel syndrome and wants to perform the Phalen’s test. To perform this test, the nurse should instruct the patient to:

A) dorsiflex the foot
B) plantarflex the foot
C) hold both hands back to back while flexing the wrists 90 degrees for 60 seconds
D) hyperextend the wrists with the palmar surface of both hands touching and wait for 60 seconds

Answer 26

C) hold both hands back to back while flexing the wrists 90 degrees for 60 seconds

Question 27

An 80-year-old woman is visiting the clinic for a checkup. She states, “I can’t walk as much as I used to.” The nurse is observing for motor dysfunction in her hip and should have her:

A) internally rotate her hip while she is sitting
B) abduct her hip while she is lying on her back
C) adduct her hip while she is lying on her back
D) externally rotate her hip while she is standing

Answer 27

B) abduct her hip while she is lying on her back

Question 28

The nurse has completed the musculoskeletal examination of a patient’s knee and has found a positive bulge sign. The nurse interprets this finding to indicate:

A) irregular bony margins
B) soft tissue swelling in the joint
C) swelling from fluid in the epicondyle
D) swelling from fluid in the suprapatellar pouch

Answer 28

D) swelling from fluid in the suprapatellar pouch

Question 29

During an examination, the nurse asks a patient to bend forward from the waist and notices that the patient has lateral tilting. When his leg is raised straight up, he complains of a pain going down his buttock into his leg. The nurse suspects:

A) scoliosis
B) meniscus tear
C) herniated nucleus pulposus
D) spasm of paravertebral muscles

Answer 29

C) herniated nucleus pulposus

Question 30

The nurse is examining a 3-month-old infant. While holding the thumbs on the infant’s inner mid thighs and the fingers outside on the hips, touching the greater trochanter, the nurse adducts the legs until the nurse’s thumbs touch and then abducts the legs until the infant’s knees touch the table. The nurse does not notice any “clunking” sounds and is confident to record a:

A) positive Allis test
B) negative Allis test
C) positive Ortolani’s sign
D) negative Ortolani’s sign

Answer 30

D) negative Ortolani’s sign

Question 31

During a neonatal examination, the nurse notices that the newborn infant has six toes. This finding is documented as:

A) unidactyly
B) syndactyly
C) polydactyly
D) multidactyly

Answer 31

C) polydactyly

Question 32

A mother brings her newborn baby boy in for a checkup; she tells the nurse that he doesn’t seem to be moving his right arm as much as his left and that he seems to have pain when she lifts him up under the arms. The nurse suspects a fractured clavicle and would observe for:

A) a negative Allis test
B) a positive Ortolani’s sign
C) limited range of motion during the Moro’s reflex
D) limited range of motion during Lasègue’s test

Answer 32

C) limited range of motion during the Moro’s reflex

Question 33

A 40-year-old man has come into the clinic with complaints of “extreme tenderness in my toes.” The nurse notices that his toes are slightly swollen, reddened, and warm to the touch. His complaints would suggest:

A) osteoporosis
B) acute gout
C) ankylosing spondylitis
D) degenerative joint disease

Answer 33

B) acute gout

Question 34

A young swimmer comes to the sports clinic complaining of a very sore shoulder. He was running at the pool, slipped on some wet concrete, and tried to catch himself with his outstretched hand. He landed on his outstretched hand and has not been able to move his shoulder since then. The nurse suspects:

A) joint effusion
B) tear of rotator cuff
C) adhesive capsulitis
D) dislocated shoulder

Answer 34

D) dislocated shoulder

Question 35

A 68-year-old woman has come in for an assessment of her rheumatoid arthritis, and the nurse notices raised, firm, nontender nodules at the olecranon bursa and along the ulna. These nodules are most commonly diagnosed as:

A) epicondylitis
B) gouty arthritis
C) olecranon bursitis
D) subcutaneous nodules

Answer 35

C) olecranon bursitis

Question 36

A woman who has had rheumatoid arthritis for years is starting to notice that her fingers are drifting to the side. The nurse knows that this condition is commonly referred to as:

A) radial drift
B) ulnar deviation
C) swan neck deformity
D) Dupuytren’s contracture

Answer 36

B) ulnar deviation

Question 37

A patient who has had rheumatoid arthritis for years comes to the clinic to ask about changes in her fingers. The nurse will assess for signs of what problems?

A) Heberden’s nodes
B) Bouchard’s nodules
C) Swan neck deformities
D) Dupuytren’s contractures

Answer 37

C) Swan neck deformities

Question 38

A patient’s annual physical examination reveals a lateral curvature of the thoracic and lumbar segments of his spine; however, this curvature disappears with forward bending. The nurse knows that this abnormality of the spine is called:

A) structural scoliosis
B) functional scoliosis
C) herniated nucleus pulposus
D) dislocated hip

Answer 38

B) functional scoliosis

Question 39

A 14-year-old boy who has been diagnosed with Osgood-Schlatter disease reports painful swelling just below the knee for the past 5 months. Which response by the nurse is appropriate?

A) “If these symptoms persist, you may need arthroscopic surgery.”
B) “You are experiencing degeneration of your knee, which may not resolve.”
C) “Your disease is due to stress on the patellar tendon. It is usually self-limited, and your symptoms should resolve with rest.”
D) “Increasing your activity and performing knee-strengthening exercises will help to decrease the inflammation and maintain mobility in the knee.”

Answer 39

C) “Your disease is due to repeated stress on the patellar tendon. It is usually self-limited, and your symptoms should resolve with rest.”

Question 40

When assessing muscle strength, the nurse observes that a patient has complete range of motion against gravity with full resistance. What Grade should the nurse record using a 0 to 5 point scale?

A) 2
B) 3
C) 4
D) 5

Answer 40

D) 5

Question 41

The nurse is examining a 6-month-old infant and places the infant’s feet flat on the table and flexes his knees up. The nurse notes that the right knee is significantly lower than the left. Which of these statements is true of this finding?

A) this is a positive Allis sign and suggests hip dislocation
B) the infant probably has a dislocated patella on the right
C) this is a normal finding for the Allis test for an infant of this age
D) the infant should return to the clinic in 2 weeks to see if this has changed

Answer 41

A) this is a positive Allis sign and suggests hip dislocation

Question 42

The nurse is assessing a 1-week-old infant and is testing his muscle strength. The nurse lifts the infant with hands under the axillae and notices that the infant starts to “slip” between the hands. The nurse should:

A) suspect a fractured clavicle
B) suspect that the infant may have a deformity of the spine
C) suspect that the infant may have weakness of the shoulder muscles
D) consider this a normal finding because the musculature of an infant this age is undeveloped

Answer 42

C) suspect that the infant may have weakness of the shoulder muscles

Question 43

The nurse is examining a 2-month-old infant and notices asymmetry of the infant’s gluteal folds. The nurse should assess for other signs of what disorder?

A) Fractured clavicle
B) Down syndrome
C) Spina bifida
D) Hip dislocation

Answer 43

D) Hip dislocation

Question 44

The nurse should use which test to check for large amounts of fluid around the patella?

A) Ballottement
B) Tinel sign
C) Phalen’s test
D) McMurray’s test

Answer 44

A) Ballottement

Question 45

A patient tells the nurse that “all my life I’ve been called ‘knock knees.’” The nurse knows that another term for “knock knees” is:

A) genu varum
B) genu valgum
C) pes planus
D) metatarsus adductus

Answer 45

B) genu valgum

Question 46

A patient has been diagnosed with a ganglion cyst over the dorsum of his left wrist. He asks the nurse, “What is this thing?” The nurse’s best answer would be, “It is:

A) a common benign tumor.”
B) a tumor that will have to be watched because it may turn malignant.”
C) caused by chronic repetitive motion injury.”
D) a skin infection that will need to be drained.”

Answer 46

A) a common benign tumor.”

Question 47

A man who has had gout for several years comes to the clinic with a problem with his toe. On examination, the nurse notices the presence of hard, painless nodules over the great toe; one has burst open with a chalky discharge. This finding is known as:

A) a callus
B) a plantar wart
C) a bunion
D) tophi

Answer 47

D) tophi

Question 48

When performing a musculoskeletal assessment, the nurse knows that the correct approach for the examination should be:

A) proximal to distal
B) distal to proximal
C) posterior to anterior
D) anterior to posterior

Answer 48

A) proximal to distal

Question 49

The nurse is assessing the joints of a woman who has stated, “I have a long family history of arthritis, and my joints hurt.” The nurse suspects that she has osteoarthritis. Which of these are symptoms of osteoarthritis? Select all that apply.

A. symmetric joint involvement
B. asymmetric joint involvement
C. pain with motion of affected joints
D. affected joints are swollen with hard, bony protuberances
E. affected joint may have heat, redness, and swelling

Answer 49

B. asymmetric joint involvement
C. pain with motion of affected joints
D. affected joints are swollen with hard, bony protuberances

Question 50

The nurse is assessing a patient’s ischial tuberosity. To palpate the ischial tuberosity, the nurse knows that it is best to have the patient:

A. standing
B. flexing the hip
C. flexing the knee
D. Lying in the supine position

Answer 50

B. flexing the hip

Question 51

An 85-year-old patient comments during his annual physical that he seems to be getting shorter as he ages. The nurse should explain that decreased height occurs with aging because:

A. long bones tend to shorten with age
B. the vertebral column
C. significant loss of subcutaneous fat occurs
D. a thickening of the intervertebral disks develops

Answer 51

B. the vertebral column

Question 52

A patient has been diagnosed with osteoporosis and asks the nurse, “What is osteoporosis?” The nurse explains to the patient that osteoporosis is defined as:

A. increased bone matrix
B. loss of bone density
C. new, weaker bone growth
D. increased phagocytic

Answer 52

B. loss of bone density