Lewis Chapter 64: Musculoskeletal System TEST BANK Flashcards
The nurse is caring for a patient who has pain during circumduction of the shoulder when the
nurse moves the arm behind the patient. Which of the following questions should the nurse
ask?
a. “Do you have difficulty in putting on a jacket?”
b. “Are you able to feed yourself without difficulty?”
c. “Are you able to sleep through the night without waking?”
d. “Do you ever have trouble lowering yourself to the toilet?”
ANS: A
The patient’s pain will make it more difficult to accomplish tasks like putting on a shirt or
jacket. This pain should not affect the patient’s ability to feed himself or herself or use the
toilet because these tasks do not involve moving the arm behind the patient. The arm will not
usually be positioned behind the patient during sleeping.
The nurse is caring for a patient with knee pain who is diagnosed with bursitis and asks the
nurse to explain just what bursitis is. The nurse will respond that bursitis is an inflammation of
which of the following structures?
a. A small, fluid-filled sac found at many joints
b. The synovial membrane that lines the joint area
c. The fibrocartilage that acts as a shock absorber in the knee joint
d. Any connective tissue that is found supporting the joints of the body
ANS: A
Bursae are fluid-filled sacs that cushion joints and bony prominences. Fibrocartilage is a solid
tissue that cushions some joints. Bursae are a specific type of connective tissue. The synovial
membrane lines many joints but is not a bursa.
The nurse is assessing an older female patient and notes that the patient has lost 2.5 cm in
height since the previous visit 2 years ago. Which of the following diagnostic tests should the nurse include in the teaching plan?
a. Discography studies
b. Myelographic testing
c. Magnetic resonance imaging (MRI)
d. Dual-energy x-ray absorptiometry (DEXA)
ANS: D
The decreased height and the patient’s age suggest that the patient may have osteoporosis and that bone density testing is needed. Discography, MRI, and myelography are typically done for patients with current symptoms caused by musculoskeletal dysfunction and are not the
initial diagnostic tests for osteoporosis.
Which of the following information in a female, older-adult patient’s health history will alert
the nurse to the need for a more focused assessment of the musculoskeletal system?
a. The patient experienced a sprained ankle at age 13.
b. The patient’s mother became much shorter with aging.
c. The patient’s father died of complications of miliary tuberculosis.
d. The patient reports taking ibuprofen for occasional headaches
ANS: B
A family history of height loss with aging may indicate osteoporosis, and the nurse should
perform a more thorough assessment of the patient’s current height and other risk factors for
osteoporosis. A sprained ankle during adolescence does not place the patient at increased current risk for musculoskeletal problems. A family history of tuberculosis is not a risk factor. Occasional nonsteroidal anti-inflammatory drug (NSAID) use does not indicate any increased musculoskeletal risk
Which of the following information obtained during the nurse’s assessment of the patient’s
nutritional-metabolic pattern may indicate the risk for musculoskeletal condition?
a. The patient takes a multivitamin daily.
b. The patient dislikes fruits and vegetables.
c. The patient is 158 cm and weighs 81.6 kg.
d. The patient prefers whole milk to nonfat milk.
ANS: C
The patient’s height and weight indicate obesity, which places stress on weight-bearing joints.
The use of whole milk, avoiding fruits and vegetables, and use of a daily multivitamin are not risk factors for musculoskeletal condition.
The nurse is assessing a new patient in the clinic. Which of the following information about
the patient’s medications should be of most concern?
a. The patient takes a daily multivitamin and calcium supplement.
b. The patient has migraine headaches that are treated with nonsteroidal antiinflammatory drugs (NSAIDs).
c. The patient has severe asthma and requires frequent therapy with oral steroids.
d. The patient takes hormone replacement therapy (HRT) to prevent “hot flashes.”
ANS: C
Corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis.
The use of HRT and calcium supplements will help prevent osteoporosis. NSAID use does not
increase the risk for musculoskeletal problems.
While testing the patient’s muscle strength, the nurse finds that the patient can flex the arms
when no resistance is applied but is unable to flex when the nurse applies light resistance. The
nurse should document the patient’s muscle strength as level
a. 1.
b. 2.
c. 3.
d. 4.
ANS: C
A level 3 indicates that the patient is unable to move against resistance but can move against
gravity. Level 1 indicates minimal muscle contraction, level 2 indicates that the arm can move when gravity is eliminated, and level 4 indicates active movement with some resistance.
The nurse is preparing to assess a patient’s musculoskeletal system. Which of the following
actions should the nurse do first?
a. Feel for the presence of crepitus during joint movement.
b. Have the patient move the extremities against resistance.
c. Observe the patient’s body build and muscle configuration.
d. Check active and passive range of motion for the extremities
ANS: C
The usual technique in the physical assessment is to begin with inspection. Abnormalities in
muscle mass or configuration will allow the nurse to perform a more focused assessment of
abnormal areas. The other assessments also are included in the assessment but are usually
done after inspection.
Which of the following assessments of synovial fluid indicates that the findings are normal?
a. Transparent and colourless
b. Reddish pink fluid
c. Grey, thin fluid
d. Whitish yellow fluid
ANS: A
Normal synovial fluid is transparent and colourless or straw-coloured. It should be scant in amount and of low viscosity. Fluid from an infected joint may be purulent and thick or grey
and thin. In gout, the fluid may be whitish yellow. Blood may be aspirated.
The nurse is caring for a patient with kyphosis who is scheduled for dual-energy x-ray
absorptiometry (DEXA) testing. Which of the following actions should the nurse plan to
implement?
a. Give an oral sedative.
b. Start an intravenous line.
c. Teach the patient about DEXA.
d. Screen the patient for shellfish allergies.
ANS: C
DEXA testing is painless and noninvasive. No IV access is necessary. Contrast medium is not
used. Because the procedure is painless, no antianxiety medications are required.
The nurse is caring for a patient who has a new prescription for magnetic resonance imaging
(MRI) to evaluate for right femur osteomyelitis. Which of the following patient information
indicates that the nurse should consult with the health care provider before scheduling the
MRI?
a. The patient has a pacemaker.
b. The patient is claustrophobic.
c. The patient wears a hearing aid.
d. The patient is allergic to shellfish
ANS: A
Patients with permanent pacemakers cannot have MRI because of the force exerted by the
magnetic field on metal objects. An open MRI will not cause claustrophobia. The patient will
need to be instructed to remove the hearing aid before the MRI, but this does not require
consultation with the health care provider. Since contrast medium will not be used, shellfish
allergy is not a contraindication to MRI.
The nurse is assessing the movement of a patient’s elbow and notes crackling sounds and a grating sensation with palpation. Which of the following terms should the nurse use to
document these findings?
a. Torticollis
b. Crepitation
c. Subluxation
d. Epicondylitis
ANS: B
Crackling sounds and a grating sensation that accompany movement are described as crepitus
or crepitation. Torticollis is a twisting of the neck to one side, subluxation is a partial
dislocation of the joint, and epicondylitis is an inflammation of the elbow that causes a dull
ache that increases with movement.
The nurse obtains this information when assessing an older-adult patient in the outpatient clinic. Which of the following findings is of highest priority when the nurse is planning care for the patient?
a. Symmetrical joint swelling of fingers
b. Decreased right knee range of motion
c. History of recent loss of balance and fall
d. Complaint of left hip aching when jogging
ANS: C
A history of falls requires further assessment and development of fall prevention strategies.
The other changes are more typical of bone and joint changes associated with normal aging
The nurse is assessing a patient in the clinic who has knee pain following an arthroscopic
procedure 7 days previously and has just had an arthrocentesis. Which of the following
findings should be of most concern to the nurse?
a. Scant thin fluid
b. Sanguineous fluid
c. Straw-coloured fluid
d. Purulent appearing fluid
ANS: D
The presence of purulent fluid suggests a possible joint infection. Bloody fluid might be
expected after an arthroscopic procedure. Normal synovial fluid is scant in amount and straw-coloured.
The nurse is caring for a patient with kyphosis. Which of the following findings should the
nurse expect to assess?
a. Shortened stride
b. Exaggerated thoracic curvature
c. Grating sound when preforming passive ROM
d. Uncoordinated, swaying gait
ANS: B
Patients with kyphosis (dowager’s hump) have a forward bending of thoracic spine, an
exaggerated thoracic curvature. A shortened stride is antalgic gait. Crepitation is crackling
sound or grating sensation as a result of friction between bones, broken bone, or cartilage bits
in joint. An uncoordinated swaying gait is an ataxic gait.
