Thompson Chapt 16 - Assessing musculoskeletal system

The patient reports that he exercises at the local gym 7 days a week for a minimum of 60 minutes each day. He reports that he is able to lift weights up to 100 lb. An elevation of which enzyme may indicate muscle injury secondary to strenuous exercise? 1. Creatinine phosphokinase (CPK) 2. Lactate dehydrogenase (LDH) 3. Serum glutamic oxaloacetic transaminase (SGOT) 4. Serum glutamic-pyruvic transaminase (SGPT)

ANS: 1 Feedback 1. This is correct. Elevation of CPK can indicate muscular injury secondary to strenuous exercise, a disease process, or an injury. 2. This is incorrect. LDH is a nonspecific test that can be used to evaluate a number of diseases and conditions including stroke, certain cancers, heart attack, and liver disease. 3. This is incorrect. SGOT is an enzyme present in heart and liver cells that is released into the bloodstream when those organs are injured or damaged. 4. This is incorrect. SGPT is an enzyme present in heart and liver cells that is released into the bloodstream when those organs are injured or damaged.

The musculoskeletal system is a complex system that provides structure, support, protection, and movement. Which is a true statement about the musculoskeletal system? Select all that apply. 1. The skeletal system provides attachment points for ligaments and tendons. 2. Movement occurs when muscles contract. 3. Muscle movement is generally involuntary. 4. Muscles relax in response to neurological stimulus.

ANS: 1, 2 Feedback 1. This is correct. The skeletal system provides attachment points for ligaments and tendons. 2. This is correct. Movement occurs when muscles contract. 3. This is incorrect. Muscle movement is generally voluntary, not involuntary. 4. This is incorrect. Muscles contract, not relax, in response to neurological stimulus.

Prevention of disease and disability of the musculoskeletal system can be accomplished by working to maintain a level of wellness. This can be accomplished through which of the following? Select all that apply. 1. Eating foods rich in calcium, vitamin D, magnesium, and phosphorus 2. Maintaining an ideal body weight 3. Exercising on a regular basis 4. Performing stretching and flexibility exercises 5. Maintaining good body mechanics

ANS: 1, 2, 3, 4, 5 Feedback 1. This is correct. Eating a diet that includes foods rich in calcium, vitamin D, magnesium, and phosphorus improves the level of wellness of the musculoskeletal system. 2. This is correct. Maintaining an ideal body weight improves the wellness of the musculoskeletal system by decreasing its workload. 3. This is correct. Regular physical exercise helps to keep muscles and bones strong and active. 4. This is correct. Flexing and flexibility exercises help to keep the musculoskeletal system strong and active. 5. This is correct. Good body mechanics help to prevent injuries to the musculoskeletal system.

When inspecting the upper extremities with the patient in a relaxed standing position, the nurse expects to observe which of the following? Select all that apply. 1. Straight upper arms 2. Symmetry between left and right upper extremities 3. Forward rounding of the shoulders 4. Wrists in line with the lower arm, palms facing thighs 5. Hyperextension of the elbows

ANS: 1, 2, 4 Feedback 1. This is correct. Upper arms should be straight when standing. 2. This is correct. There should be symmetry between right and left extremities. 3. This is incorrect. There should be no forward rounding of the shoulders. 4. This is correct. Wrists should be in line with the lower arm with palms facing the thighs. 5. This is incorrect. There should be slight bending at the elbow.

A patient needs an assistive device to ambulate. Which of the following are assistive devices? Select all that apply. 1. Walker 2. Rolling walker 3. Wheelchair 4. Cane 5. Crutches

ANS: 1, 2, 4, 5 Feedback 1. This is correct. A walker is considered an assistive device. 2. This is correct. A rolling walker is considered an assistive device. 3. This is incorrect. A wheelchair is not an assistive device because the patient does not walk with a wheelchair. 4. This is correct. A cane is considered an assistive device. 5. This is correct. Crutches are considered an assistive device.

Joints are areas where two or more bones come together. Which of the following statements are true about joints? Select all that apply. 1. Joints that move allow for functional movement of body parts. 2. Ligaments help to stabilize joints. 3. Fused joints are irregularly shaped and flat and are found in the foot. 4. Synovial fluid serves to lubricate and provide nutrients to the joint. 5. Ball and socket joints allow for greater movement. 6. Hinge joints are found in the elbow and the shoulder.

ANS: 1, 2, 4, 5 Feedback 1. This is correct. Joints allow for functional movement of body parts. 2. This is correct. Ligaments help to stabilize joints. 3. This is incorrect. Fused joints are found primarily in the skull. They are irregular and flat. There are irregular bones in the foot but they are not fused. 4. This is correct. Synovial fluid serves to lubricate and provide nutrients to the joint. 5. This is correct. Ball and socket joints allow for greater movement. 6. This is incorrect. Hinge joints are found in the elbows, knees, fingers, and toes. The shoulder is a ball and socket joint.

You are assessing the range of motion of the ankle. Which of the following movements are appropriate to assess? Select all that apply. 1. Inversion 2. Eversion 3. Flexion 4. Extension 5. Dorsiflexion 6. Plantar flexion

ANS: 1, 2, 5, 6 Feedback 1. This is correct. Inversion is a range of motion movement for the ankle. 2. This is correct. Eversion is a range of motion movement for the ankle. 3. This is incorrect. This is a range of motion movement for the hip and knee. 4. This is incorrect. This is a range of motion movement for the hip and knee. 5. This is correct. Flexion is a range of motion movement for the ankle. 6. This is correct. Extension is a range of motion movement for the ankle.

You are a nursing student and need to recognize the normal findings of a musculoskeletal assessment. Identify below all of the normal findings about the musculoskeletal system. Select all that apply. 1. The range of motion of each joint should be symmetric to the opposite limb. 2. Muscle strength should be at least 8/10 in the lower extremities. 3. Limitations against resistance may indicate a problem in the joint. 4. Stretching exercises such as yoga build muscle strength. 5. Bending, lifting, and performing repetitive motions increase the risk of injury.

ANS: 1, 3, 4, 5 Feedback 1. This is correct. Range of motion should be symmetric bilaterally. 2. This is incorrect. Muscle strength should be at least 4/5 in lower extremities. 3. This is correct. Limitation against resistance indicates there may be a problem in the joint. 4. This is correct. Stretching exercises like yoga build muscle strength. 5. This is correct. Bending, lifting, and repetitive motions increase the risk of injury to the joints.

You are inspecting and palpating the upper extremities. What will you assess for? Select all that apply. 1. Tenderness 2. Position 3. Depressions 4. Bulges 5. Changes in temperature

ANS: 1, 3, 4, 5 Feedback 1. This is correct. You inspect and palpate for tenderness. 2. This is incorrect. You do not inspect and palpate for position but for alignment. 3. This is correct. You inspect and palpate for depressions. 4. This is correct. You inspect and palpate for bulges. 5. This is correct. You inspect and palpate for changes in temperature.

When assessing specific musculoskeletal injuries, use of the five "P"s will increase your knowledge about the injury during your focused assessment. Select the correct five "P"s below. Select all that apply. 1. Pain 2. Position 3. Paralysis 4. Paresthesia 5. Pronation 6. Pallor 7. Pulselessness

ANS: 1, 3, 4, 6, 7 Feedback 1. This is correct. Pain is one of the five "P"s. 2. This is incorrect. Position is not one of the five "P"s 3. This is correct. Paralysis is one of the five "P"s. 4. This is correct. Paresthesia is one of the five "P"s 5. This is incorrect. Pronation is not one of the five "P"s 6. This is correct. Pallor is one of the five "P"s 7. This is correct. Pulselessness is one of the five "P"s

You are assessing the vertebral column. Which assessment techniques will you perform? 1. Inspection only 2. Inspection and palpation 3. Inspection, palpation, and percussion 4. Inspection, palpation, and muscle strength

ANS: 2 Feedback 1. This is incorrect. Inspection is not the only assessment technique; palpation of vertebral column is needed. 2. This is correct. Inspection and palpation assess for abnormalities in the structure of the vertebral column. 3. This is incorrect. Percussion does not assess the vertebral column. 4. This is correct. Muscle strength is not a technique to assess the vertebral column.

The movement of the sole of the foot away from the floor toward the knee demonstrates: 1. Plantar flexion. 2. Dorsiflexion. 3. Eversion 4. Inversion.

ANS: 2 Feedback 1. This is incorrect. Plantar flexion is the movement of the sole of the foot toward the floor. 2. This is correct. Dorsiflexion is the movement of the sole of the foot away from the floor. 3. This is incorrect. Eversion is the movement of the great toe/foot away from the midline of the body. 4. This is incorrect. Inversion is the movement of the great toe/foot toward the midline of the body.

A 28-year-old client fell off his bicycle while mountain biking. He states that his back hurts but is nonspecific about the location. The patient denies hitting his head. What question or statement should the nurse ask next? 1. "Where does your upper back hurt?" 2. "Point to the location where your back hurts." 3. "Does the pain hurt in the lumbar area?" 4. "Does the pain radiate to your legs?"

ANS: 2 Feedback 1. This is incorrect. This question is too generalized. 2. This is correct. Having the patient specifically locate the pain by pointing to the location will help you narrow your assessment to that area. 3. This is incorrect. The specific location of the pain is a priority, then you can ask about radiation. 4. This is incorrect. The best answer is pointing to the location, then you can ask about radiation to the lower legs.

When standing, the patient exhibits forward flexion at the hip joint. What may this indicate? Select all that apply. 1. Normal position for the hip joint 2. Tightness of the muscular structure 3. A problem with the lower back 4. A knee injury

ANS: 2, 3 Feedback 1. This is incorrect. Forward flexion of the hip indicates a problem with the hip joint. 2. This is correct. Forward flexion of the hip when standing may indicate tightness of the muscular structure. 3. This is correct. Forward flexion of the hip when standing may indicate a problem with the lower back. 4. This is incorrect. An increase in flexion of the knee may indicate a knee injury.

A patient reports that she has had bilateral knee pain for the last 10 years. You review her past medical history and note osteoarthritis as a diagnosis. This type of arthritis is caused by: 1. A progressive, inflammatory, autoimmune disorder. 2. A progressive disease whereby the bone matrix is not being replaced. 3. A progressive disease whereby the protective cartilage wears down. 4. A progressive disease that causes enlargement of the ends of the joints.

ANS: 3 Feedback 1. This is incorrect. Rheumatoid arthritis is a progressive, inflammatory, autoimmune disorder. 2. This is incorrect. Osteoporosis is a progressive disease. The bone matrix is not being replaced by new bone. 3. This is correct. Osteoarthritis is a progressive disease. The protective cartilage at the ends of the bones wears down. 4. This is correct. Rheumatoid arthritis causes enlargement of the metacarpophalangeal and interphalangeal joints.

The patient had a total hip replacement several years ago. You are going to assess the range of motion of both hips. The range of motion movements for the hip joint include: 1. Supination, dorsiflexion, adduction, and extension. 2. Flexion, internal rotation, supination, and pronation. 3. Adduction, abduction, flexion, and internal rotation. 4. Extension, abduction, inversion, and eversion

ANS: 3 Feedback 1. This is incorrect. The hip joint is not able to dorsiflex or perform supination. 2. This is incorrect. The hip joint is not able to supinate or pronate. 3. This is correct. The hip joint is able to accomplish all of these range of motion activities. 4. This is incorrect. The hip joint is not able to invert or evert.

Mr. Brown's knee assessment shows 4/5 muscle strength bilaterally with full flexion and extension. The nurse assesses the skin temperature and notes increased warmth of the left knee joint. Which of the following is most concerning? 1. The muscle strength is 4/5. 2. Knee joint movement should include flexion deviation. 3. The warmth that is present in the left knee joint. 4. Muscle strength is symmetrical.

ANS: 3 Feedback 1. This is incorrect. This is not an area of concern because normal muscle strength is 4/5. 2. This is incorrect. This is a normal finding because knee joint movement includes flexion. 3. This is correct. Warmth of skin may indicate signs of inflammation or infection. 4. This is incorrect. Muscle strength should be equal on both sides.

What diagnostic test would you expect the health-care provider to order to assess injuries to a tendon, a ligament, or soft tissue? 1. X-ray 2. Ultrasound 3. Magnetic resonance imaging (MRI) 4. Computed tomography (CT) scan

ANS: 3 Feedback 1. This is incorrect. X-rays are commonly done to assess bones and bony structures, but not tendons and ligaments. 2. This is incorrect. Ultrasound uses sound waves to examine organs, soft tissues, and blood vessels. 3. This is correct. MRI assesses soft tissue to determine the nature and severity of injury to tendons, ligaments, bones, and soft tissue. 4. This is incorrect. CT scan may be done if the patient is unable to undergo an MRI due to a metal implant. It does not give as clear a picture of tendon and ligament injury.

The patient is complaining of acute pain in his shoulder after playing tennis. Assessment of the shoulder includes which of the following four motions? 1. Abduction, adduction, supination, and pronation 2. Lateral bending, extension, dorsiflexion, and plantar flexion 3. Flexion, extension, internal rotation, and external rotation 4. Inversion, eversion, protraction, and retraction

ANS: 3 Feedback 1. This is incorrect. The shoulder is able to abduct and adduct, it is not able to supinate and pronate. 2. This is incorrect. The shoulder is not able to laterally bend, dorsiflex, or plantar flex. 3. This is correct. The shoulder is able to flex/extend and internally/externally rotate. 4. This is incorrect. The shoulder is not able to invert and evert, nor protract or retract.

You are performing a musculoskeletal assessment. Put the steps of the assessment in order (1-4). (Enter the number of each step in the proper sequence. Do not use punctuation or spaces. Example: 1234.) 1. Assessing strength 2. Palpating 3. Inspecting 4. Assessing range of motion

ANS: 3241 Feedback: The musculoskeletal assessment is done in the following order: inspecting, palpating, assessing range of motion, and assessing strength.

Who is at greater risk for osteoporosis? 1. An African American man who is thin 2. A Hispanic woman who is obese 3. A Caucasian man who is underweight 4. A Caucasian woman who is of normal weight

ANS: 4 Feedback 1. This is incorrect. African Americans are not at the highest risk for osteoporosis. 2. This is incorrect. Hispanics are not at the highest risk for osteoporosis. 3. This is incorrect. Caucasian men are not at the highest risk for osteoporosis. 4. This is correct. Caucasian women are more likely to have bone loss.

You are assessing the upper arm muscle strength. What is considered to be a minimal normal muscle strength? 1. 1/5 2. 2/5 3. 3/5 4. 4/5 5. 5/5

ANS: 4 Feedback 1. This is incorrect. This is not normal. This indicates that the muscle is only able to contract slightly. 2. This is incorrect. This is not normal. This indicates that the joint is only able to move in a gravity eliminated position. 3. This is incorrect. This is not normal. This indicates that the joint is only able to move against gravity. 4. This is correct. The patient should demonstrate strength of at least 4/5 in all of the motions in the lower extremities. 5. This is incorrect. The minimal muscle strength is a 4/5, not a 5/5.

You are assessing the range of motion of the knee. Which of the following movements are appropriate to assess? Select all that apply. 1. Internal rotation 2. External rotation 3. Abduction 4. Adduction 5. Flexion 6. Extension

ANS: 5, 6 Feedback 1. This is incorrect. This is a range of motion movement for the hip. 2. This is incorrect. This is a range of motion movement for the hip. 3. This is incorrect. This is a range of motion movement for the hip. 4. This is incorrect. This is a range of motion movement for the hip. 5. This is correct. Flexion is a range of motion movement for the knee. 6. This is correct. Extension is a range of motion movement for the knee.

The patient has degenerative disc disease with a complication of foot drop. This is where the foot is at _________ degrees to the lower leg.

ANS: 90; ninety Feedback: Foot drop is a weakness or paralysis of the muscles of the lower leg or the inability to control plantar flexion of the ankle. It may indicate nerve injury or muscle or neurological disorders. This is where the foot is at 90 degrees to the lower leg, much like the letter L.

____________________ is an unsteady gait, which can be used to compensate for an injury or pain in an extremity. It may also indicate a problem with cerebellar function.

ANS: Ataxia Feedback: Ataxia is a shuffling gait that allows for some mobility when an extremity is compromised by injury or pain. It may also be indicative of a problem in cerebellar function.

Mrs. Green complains of pain in both hands related to osteoarthritis. During the musculoskeletal assessment of her hands, you discover nodes on the distal joints of her fingers. These nodes are commonly identified as ____________________ nodes.

ANS: Heberden's; Herberdens Feedback: Heberden's nodes are bony enlargements on the distal joints and are commonly seen in osteoarthritis.

Identify the test. Ask the patient to flex both wrists and press them together for 1 minute. Ask the patient if there is any numbness and tingling sensations. This test is known as ____________________ test.

ANS: Phalen's; Phalens Feedback: Phalen's test reproduces numbness and burning along the median nerve pathway in a person with carpal tunnel syndrome.

Asking a patient to rub the back of his head with his right hand and then the left hand allows functional assessment of ____________________ rotation of the shoulder joint.

ANS: external Feedback: Placing the palmar surface of the hands up and behind the neck moves the shoulders to a position of external rotation

Assessment of the geriatric patient's posture and gait can be assessed as he or she enters the room. This will help the nurse to identify a patient's ____________________ risk

ANS: fall Feedback: When assessing gait and posture in some patients, you may need to provide them with something to hold on to while they walk. Geriatric patients and some patients with neurological conditions may not have the best balance, placing them at risk for falls.

The patient reports that she is having pain with erythema on the right side of her left great toe. You assess the patient's left foot and note a lateral deviation and enlarged joint of the left great toe. This deviation and enlargement is called ____________________.

ANS: hallux valgus Feedback: Hallux valgus (bunion) is a lateral deviation and an enlarged joint of the great toe.

An exaggerated curvature in the thoracic spine is a common finding in an elderly person due to osteoporosis. This condition of the vertebrae is known as ____________________.

ANS: kyphosis Feedback: Kyphosis is an exaggerated curvature of the spine due to osteoporosis that occurs in the elderly.

The patient reports that he injured his ankle while playing soccer. The health-care provider requested an x-ray of the ankle, which was negative for a fracture. The health-care provider tells the patient his ligament was injured. This injury is called a___________________.

ANS: sprain Feedback: Ligament injuries are called sprains. Tendon injuries are called strains.