Chapter 21: Musculoskeletal System Test Bank—Nursing

The Thomas test is used to detect: a. hip dislocation. b. unstable sacroiliac joints. c. knee instability. d. flexion contractures of the hip.

NS: D The Thomas test requires the patient to lie supine, with one leg stretched out flat and the other raised and bent in toward the chest. If the patient is unable to keep the extended leg flat on the table, this is an indicator of a hip flexion contracture.

Test performed to assess shoulder rotator cuff impingement or tear

Neer test Harkins test

The ________ and _________ are used to identify instability of the lateral and medial collateral ligaments.

Varus (abduction) and valgus (adduction) stress test.

The anterior and posterior ______ is used to identify instability of the anterior and posterior cruciate ligament.

drawer test Have the patient lie supine and flex the knee 45 to 90° placing the foot flat on the table. Place both hands on the lower leg with the thumb on the ridge of the anterior tibia just distal to the tibial to diversity. Draw the tibia forward, forcing the tibia to the side forward of the femur. Then push the tibia backwards. Anterior posterior movement of the knee greater than 5 mm in either direction is an unexpected finding.

the _________ or hip extension test is used to detect inflammation of the nerve root at the L1, L2, L3, and sometimes L4 level.

femoral stretch test Have the patient lie prone and extend the hip. No pain is expected. The presence of pain on extension is a positive sign of nerve root irritation.

Anterior cruciate ligament integrity is assessed via the _________ test.

ANS: Lachman The Lachman test evaluates anterior cruciate ligament integrity.

A tingling sensation radiating from the wrist to the hand on striking the median nerve is a positive _____ sign

ANS: Tinel The Tinel sign is a test for carpal tunnel syndrome. A positive result is elicited when the median nerve is struck, producing a tingling sensation from the wrist toward the fingers.

The most mobile vertebrae are the _______________ vertebrae.

ANS: cervical The cervical vertebrae are the most mobile because flexion and extension occur between the skull and C1

The elbow joint that allows for flexion and extension in one plane represents a type of _____ joint.

ANS: hinge A hinge joint allows for flexion and extension in one plane.

During a football game, a player was struck on the lateral side of the left leg while his feet were firmly planted. He is complaining of left knee pain. To examine the left knee, you should initially perform the __________ test.

ANS: valgus stress The injury described will most likely result in a medial meniscus or medial collateral ligament damage. Your initial assessment would be to apply the valgus stress test to assess the medial meniscus.

What temporary disorder may be experienced by pregnant women during the third trimester because of fluid retention? a. Carpal tunnel syndrome b. Osteitis deformans c. Radial head subluxation d. Talipes equinovarus

ANS: A Carpal tunnel syndrome may be experienced by pregnant women during their last trimester because of fluid retention. Fluid retention at the tunnel causes pressure and inflammation at the medial nerve. This results in the symptoms.

When palpating joints, crepitus may occur when: a. irregular bony surfaces rub together. b. supporting muscles are excessively spastic. c. joints are excessively lax. d. there is excess fluid within the synovial membrane.

ANS: A Crepitus is felt or heard when irregular bony surfaces rub together, when two rough edges of a broken bone rub together, or with the movement of tendon inside the tendon sheath when tenosynovitis is present

Ulnar deviation and swan neck deformities are characteristic of: a. rheumatoid arthritis. b. osteoarthritis. c. osteoporosis. d. congenital defects.

ANS: A Deviation of the fingers toward the ulnar side and swan neck deformities are classic symptoms of rheumatoid arthritis. Osteoarthritis, congenital defects, and osteoporosis do not present with these symptoms.

Long bones in children have growth plates known as: a. epiphyses. b. epicondyles. c. synovium. d. fossae.

ANS: A Epiphyses are the growth plates found in long bones in children.

When a patient abducts an arm and the ipsilateral scapula becomes more prominent (winged), this usually means that: a. there has been an injury to the nerve of the anterior serratus muscle. b. one of the clavicles has been fractured. c. there is a unilateral trapezius muscle separation. d. one shoulder is dislocated.

ANS: A If the long thoracic nerve is damaged or bruised, it can cause paralysis of the serratus anterior muscle and winging of the scapula, or shoulder blade. This is not a symptom of a fractured clavicle or trapezius muscle separation. A dislocated shoulder would result in a hollowing effect.

A dowager hump is: a. the hallmark of osteoporosis. b. pathognomic of scoliosis. c. indicative of tendonitis. d. characteristic of rickets.

ANS: A Osteoporosis leads to vertebral compression and kyphotic bowing of the spine, known as dowager hump.

Bones are attached to muscles by: a. tendons. b. ligaments. c. muscles. d. cartilage.

ANS: A Tendons attach muscle to bone. Ligaments attach bone to bone. Muscles are not bound together by other muscles. Cartilage helps in the production of new bone and acts as an insulator for bones in joints.

The physical assessment technique most frequently used to assess joint symmetry is: a. inspection. b. palpation. c. percussion. d. the use of joint calipers.

ANS: A The assessment technique most commonly used to assess joint symmetry is inspection.

The type of joint that has the widest range of motion in all planes is the: a. ball-and-socket. b. condyloid. c. gliding. d. saddle.

ANS: A The ball-and-socket joint is the joint that has the widest range of motion (e.g., the hip joint). A condyloid joint may only move in two planes. A gliding joint is only able to glide. A saddle joint has no axial rotation.

The cruciate ligaments of the knee provide for: a. anterior and posterior stability. b. medial and lateral stability. c. movement on one plane. d. pivoting and rotation.

ANS: A The cruciate ligaments of the knee are positioned as to provide anterior and posterior stability. The collateral ligaments maintain medial and lateral stability. The knee joint is a hinge joint that allows movement in one plane.

The articulation of the radius and carpal bones is the: a. wrist. b. elbow. c. shoulder. d. clavicle.

ANS: A The joint comprising the radius and carpal bones is called the wrist.

When performing the McMurray test, the examiner should place the patient in a supine position with a hand on the patient's completely flexed knee and the foot flat on the table at the buttocks, and then: a. grasp and evert the foot and extend the knee. b. grasp and invert the foot and rotate the knee. c. apply valgus stress with the foot planted. d. apply varus stress with the foot planted.

ANS: A The next step is to turn the ankle outward while applying a valgus stress and then extend the knee.

A 3-year-old is brought to the clinic complaining of a painful right elbow. He is holding his right arm slightly flexed and pronated and refuses to move it. The mother states that symptoms started right after his older brother had been swinging him around by his arms. This presentation supports a diagnosis of: a. radial head subluxation. b. femoral anteversion. c. carpal tunnel syndrome. d. osteomyelitis.

ANS: A The symptoms this child is experiencing are indicative of a radial head subluxation, or nursemaid's elbow.

The tibia, fibula, and talus articulate to form the: a. ankle. b. knee. c. hip. d. pelvis.

ANS: A The tibia, fibula, and talus (or heel) join to form the ankle.

The musculoskeletal examination should begin when: a. the patient enters the examination room. b. during the collection of subjective data. c. when height is measured. d. when joint mobility is assessed.

ANS: A When the patient first walks in the room, the examiner should be observing his or her gait and posture as part of the musculoskeletal examination

Cardinal signs for rheumatoid disorders include which of the following? (Select all that apply.) a. Gradual onset b. Weakness that is usually localized and not severe c. Coarse crepitus on motion d. Joint tenderness e. Sleep disturbance

ANS: A, D, E Hallmark signs of rheumatoid arthritis are gradual onset of stiffness for 1 hour after rising, sleep disturbance, joint tenderness, and medium to fine crepitus.

You note that a child has a positive Gower sign. You know that this indicates generalized: a. arthropathy. b. muscle weakness. c. bursitis. d. muscle hypertrophy.

ANS: B A positive Gower sign indicates generalized muscle weakness and is characterized by a child trying to stand up by flexing at the knee and pushing down on the thighs while trying to pull the trunk up.

Fluid that lubricates articular cavities is called: a. blood. b. synovial fluid. c. mucus. d. cerumen.

ANS: B Articular cavities are lined with synovial membrane, which secretes synovial fluid that provides lubrication for the joint to move. Blood does not act as a lubricant. Mucus should not be found in articular cavities. Cerumen is ear wax.

Which technique is performed at every infant's examination during the first year of life to detect hip dislocation? a. Ballottement maneuver b. Barlow-Ortolani maneuver c. Range of motion d. Thomas McMurray assessment

ANS: B At every examination during an infant's first year of life, the Barlow-Ortolani maneuver is performed. This test involves stabilizing the pelvis and flexing one hip and knee to 90 degrees. It detects hip dislocation, which is signified by a clicking noise with the maneuver.

Joints are held together by: a. tendons. b. ligaments. c. muscles. d. cartilage.

ANS: B Bones are held together within a joint by ligaments. Tendons attach muscle to bone, bones are not held together by muscles, and cartilage forms most of the joints in the adult skeleton and merely acts as a shock absorber.

A common finding in markedly obese patients and pregnant women is: a. kyphosis. b. lordosis. c. paraphimosis. d. scoliosis.

ANS: B Bowing of the back, or lordosis, is more commonly found in pregnant women or obese patients because of an altered center of gravity. Kyphosis is more commonly seen in older adults. Paraphimosis is a penile condition. Scoliosis is more commonly seen in teenagers.

Fasciculation occurs after injury to a muscle's: a. venous return. b. motor neuron. c. strength. d. tendon.

ANS: B Fasciculations can often be visualized as muscle twitching or dimpling under the skin, but they usually do not generate sufficient force to move a limb. They may represent a benign condition or occur as a manifestation of motor neuron disease or peripheral nervous system diseases.

The strength of the trapezius muscle is evaluated by having the patient: a. clench her or his teeth during muscle palpation. b. push her or his head against the examiner's hand. c. straighten her or his leg with examiner opposition. d. uncross her or his legs with examiner resistance.

ANS: B Having the patient apply opposite force with differing head motions, against the examiner's hand, assesses the sternocleidomastoid and trapezius muscles.

The temporalis and masseter muscles are evaluated by: a. having the patient shrug their shoulders. b. having the patient clench their teeth. c. asking the patient to fully extend their neck. d. passively opening the patient's jaw.

ANS: B Having the patient to bite down and clench their teeth is the method for evaluating the strength of the temporalis and masseter muscles. Cranial nerve V is tested with this same maneuver.

The elasticity of pelvic ligaments and softening of cartilage in a pregnant woman are the result of: a. decreased mineral deposition. b. increased hormone secretion. c. uterine enlargement. d. gait changes.

ANS: B Increased hormone secretion during pregnancy is responsible for the elasticity of pelvic ligaments and softening of the cartilage. These changes help accommodate the growing fetus.

An adult with bowed tibias and a shortened thorax may have: a. ankylosing spondylitis. b. Paget disease. c. rheumatoid arthritis. d. Sprengel deformity.

ANS: B Paget disease is characterized by bowed tibias, an asymmetric skull, a shortened chest, and susceptibility to fractures.

Your examination of an infant reveals a positive Allis sign. To confirm this finding, you would perform (or elicit) a: a. startle reflex. b. Barlow-Ortolani maneuver. c. Trendelenburg test. d. tibial torsion test.

ANS: B The Allis sign will show unequal upper leg lengths, suggestive of a hip dislocation. The Barlow-Ortolani maneuver can confirm the results for a hip dislocation.

Which one of the following techniques is used to detect a torn meniscus? a. Drawer test b. McMurray test c. Thomas test d. Trendelenburg test

ANS: B The McMurray test detects a meniscus tear. The drawer test detects an anterior cruciate ligament tear. The Thomas test detects hip contraction. The Trendelenburg test detects weak hip abductor muscles.

The joint where the humerus, radius, and ulna articulate is the: a. wrist. b. elbow. c. shoulder. d. clavicle.

ANS: B The elbow is the site where the humerus, radius, and ulna meet. The wrist is made up of the radius and the carpal bones of the hand. The shoulder is made up of the humerus and scapula. The clavicle connects to the scapula but not to the humerus.

The glenohumeral joint is the other name for the: a. elbow. b. shoulder. c. wrist. d. scapula.

ANS: B The shoulder joint, also called the glenohumeral joint, consists of the union between the humerus and scapula.

Arm length is measured from the acromion process through the: a. olecranon joint to the carpal thumb hinge. b. olecranon process to the distal ulnar prominence. c. proximal radial prominence to the distal joint. d. proximal ulnar joint to the middle fingertip.

ANS: B Total arm length is assessed by the standard measurement of the length from the shoulder (acromion process) through the elbow joint (olecranon process) to the wrist (distal ulnar prominence)

Skeletal changes in older adults are the result of: a. increased bone deposition. b. increased bone resorption. c. decreased bone deposition. d. decreased bone resorption.

ANS: B With age, the skeletal system changes. One of the dramatic changes in skeletal equilibrium is that bone resorption dominates bone deposition.

The family history for a patient with joint pain should include information about siblings with: a. trauma to the skeletal system. b. chronic atopic dermatitis. c. genetic disorders. d. obesity

ANS: C An important history to obtain for a patient with joint pain would be family history of genetic disorders, such as osteogenesis imperfecta, dwarfing syndrome, rickets, hypophosphatemia, and hypercalciuria.

An increase in muscle tone is known as: a. crepitus. b. effusion. c. spasticity. d. atrophy.

ANS: C An increase in muscle tone is referred to as spasticity.

When the shoulder contour is asymmetric and one shoulder has hollows in the rounding contour, you would suspect: a. kyphosis. b. fractured scapula. c. a dislocated shoulder. d. muscle wasting.

ANS: C Asymmetric contours to the shoulder with a hollowing in the socket are symptoms of a shoulder dislocation. Kyphosis is a condition of the back; muscle wasting and a scapular fracture do not present with these symptoms.

A 7-year-old child who begins to limp and complains of persistent hip pain may have: a. congenital hip dislocation. b. Dupuytren contracture. c. Legg-Calvé-Perthes disease. d. osteoarthritis.

ANS: C Constant hip pain with a limp in a young child is indicative of Legg-Calvé-Perthes disease. This condition results in avascular necrosis of the femoral head caused by an inadequate blood supply.

Spinal vertebrae are separated from each other by: a. bursae. b. tendons. c. disks. d. ligaments.

ANS: C Except for sacral vertebrae, the spinal vertebrae are separated from one another by disks. Spinal movement is achieved by paraspinous muscles, tendons, and ligaments. Bursae are located in the knee, elbow, shoulder, and hip.

A red, hot, swollen joint in a 40-year-old man should lead you to suspect: a. trauma. b. bursitis. c. gout. d. cellulitis.

ANS: C Gout is characterized as red, hot, swollen joints, especially in the great toe. Gout is commonly found in men older than 40 years.

Inquiry about nocturnal muscle spasms would be most significant when taking the musculoskeletal history of: a. adolescents. b. infants. c. older adults. d. middle-age adults.

ANS: C History taking of older adults should consist of symptoms of nocturnal muscle spasms. Pregnant women and older adults commonly experience nocturnal leg cramps resulting from imbalances of fluids, hormones, minerals, or electrolytes or dehydration. A particular concern with the older adults is that this may be a sign of intermittent claudication

A positive straight leg raise test usually indicates: a. leg length discrepancy. b. improperly conditioned muscles. c. lumbar nerve root irritation. d. hip bursitis.

ANS: C Lumbar nerve root irritation at the L4, L5, and S1 levels can be assessed by asking the patient to lie supine with their neck flexed and to raise one leg. If pain is felt, this is a positive straight leg raise.

Carpal tunnel syndrome would result in: a. a negative Tinel sign. b. a negative Phalen test. c. reduced abduction of the thumb. d. palm tingling.

ANS: C Median nerve compression, as in carpal tunnel syndrome, results in a positive Tinel sign, positive Phalen test, reduced abduction of the thumb, and sparing of palm tingling.

When the patient flexes forward at the waist, which spinal observation would lead you to suspect scoliosis? a. Prominent lumbar hump b. Prominent cervical concave curve c. Lateral curvature of the spine d. Restricted ability to flex at the hips

ANS: C Scoliosis is suspected when there is a noticeable lateral curvature of the spine, or rib hump, as the patient bends forward at the waist.

A goniometer is used to assess: a. bone maturity. b. joint proportions. c. range of motion. d. muscle strength.

ANS: C The angle of a joint can be accurately measured by using a goniometer. A goniometer is used when the joint range of motion is beyond normal limits.

The suprapatellar bursa separates the patella, quadriceps tendon, and muscle from the: a. tibia. b. fibula. c. femur. d. pelvis.

ANS: C The suprapatellar bursa separates the knee, quadriceps, and muscle from the femur.

The temporomandibular joint is palpated: a. under the mandible, anterior to the sternocleidomastoid muscle. b. above the mandible at midline. c. anterior to the tragus. d. at the mastoid process.

ANS: C The temporomandibular joint is palpated just anterior to the tragus of the ear; the fingertips are placed inside the joint space as the patient opens and closes the mouth.

The wrist moves in: (Select all that apply.) a. eversion and inversion. b. proximal radius and ulna articulation. c. flexion and extension d. adduction and abduction.

ANS: C, D The wrist movement is in two planes, flexion and extension or radial and ulnar rotation. Adduction and abduction are for shoulder and hip joints, and eversion and inversion are for ankle movement.

Dupuytren contracture affects the: a. hip flexor muscle. b. rotator cuff. c. carpal tunnel. d. palmar fascia.

ANS: D A contracture of the palmar fascia of one or multiple fingers is called a Dupuytren contracture.

Term infants normally resist: a. ankle dorsiflexion. b. McMurray test. c. forefoot adduction. d. knee extension.

ANS: D Along with elbows and hips, newborns tend to resist extension of the knee; however, their movements should be symmetric

Risk factors for sports-related injuries include: a. competing in colder climates. b. previous fracture. c. history of recent weight loss. d. failure to warm up before activity.

ANS: D Failure to warm-up before exercise is one risk factor for sports-related injuries. Climate, previous fractures, and weight loss are not as strong risk factors for sports-related injuries. Also included are poor physical conditioning, intensity of competition, collision and contact sports participation, rapid growth, and overuse of joints.

Excessive hyperextension of the knee with weight bearing may indicate: a. advanced joint degeneration. b. gout. c. rotation of the Achilles tendon. d. weakness of the quadriceps muscle.

ANS: D Genu recurvatum, which is hyperextension of the knee, is a result of quadriceps muscle weakness.

A finding that is indicative of osteoarthritis is (are): a. swan neck deformities. b. Bouchard nodes. c. ganglions. d. Heberden nodes.

ANS: D Heberden nodes are bony overgrowths of the distal end of the fingers and are associated with osteoarthritis. When the overgrowths are concentrated in the proximal interphalangeal joint, they are known as Bouchard nodes and are associated with rheumatoid arthritis, as are swan neck deformities; ganglions are present in nerve conditions.

Pain, disease of the muscle, or damage to the motor neuron may all cause: a. bony hypertrophy. b. muscle crepitus. c. muscle hypertrophy. d. muscle wasting.

ANS: D Muscle wasting is a consequence of pain from injury, pathology of the muscle, or injury to the motor neuron.

In contrast to the patient with rheumatoid arthritis (RA), the osteoarthritis patient typically exhibits: a. pain most pronounced after periods of rest. b. depression. c. sudden onset. d. less weakness and fatigue.

ANS: D One of the key differences between the symptoms of osteoarthritis and RA is that fatigue is uncommon in osteoarthritis patients.

Light skin and thin body habitus are risk factors for: a. rheumatoid arthritis. b. osteoarthritis. c. congenital bony defects. d. osteoporosis.

ANS: D People with light skin and a thin body frame are at greater risk for developing osteoporosis. Rheumatoid arthritis, osteoarthritis, and bony defects are not found to have a correlation with light skin and small frame.

Expected normal findings during the inspection of spinal alignment include: a. asymmetric skin folds at the neck. b. slight right-sided scapular elevation. c. concave lumbar curve. d. the head positioned superiorly to the gluteal cleft.

ANS: D Spinal alignment is considered within normal limits when the patient's head is positioned directly over the gluteal cleft. The skin folds should be symmetric, the scapulae are at even heights, and both the cervical and lumbar curves are convex.

Which joints are frequently moving articulations that are enclosed by a capsule of fibrous articular cartilage? a. Synarthroses b. Synchondroses c. Amphiarthroses d. Synovial

ANS: D Synovial articulations are freely moving joints that are enclosed by a compartment made up of cartilage and ligaments. Synarthroses are immovable joints. Synchondroses are immovable joints. Amphiarthroses are slightly movable.

Medial and lateral surfaces of the tibiotalar joint are protected by: a. bursae. b. tendons. c. muscles. d. ligaments.

ANS: D The ankle joint, or tibiotalar joint, is protected by ligaments on the medial and lateral sides.

A wheelchair-dependent older woman would most likely develop skin breakdown at: a. C7. b. the iliac crests. c. L4. d. the gibbus.

ANS: D This older woman, most likely kyphotic from osteoporosis, would have the greatest friction point at the gibbus. The gibbus results from collapsed vertebrae, resulting in a sharp, pointy deformity of the back. C7 and L4 remain as concave curves, with less friction. The iliac crests would not protrude as far as the gibbus.

__________ is used to determine the presence of excess fluid or an effusion in the knee

Ballottement With the knee extended, apply downward pressure on the suprapatellar pouch with the web or the thumb and forefinger of one hand, and then push the patella sharply downward against the femur with a finger of your other hand. If in a effusion is present a tapping or clicking will be sensed when the patella is pushed against the femur. Release the pressure against the patella but keep your finger lightly touching it. If an effusion is present the patella will float out as it for a fluid wave were pushing it.

The ___________ test is a maneuver to detect weak hip abductor muscles

Trendelenburg Ask the patient to stand and balance first on one foot and then on the other. Observe from behind, note any asymmetry or change in the level of the iliac crests. When the iliac crest drops on the side of the lifted leg, the hip abductor muscles on the weight baring side are weak