Nur 314 Musculoskeletal

Assessment of the musculoskeletal system usually proceeds from general to specific and from? A. Head to toe B. Right to left C. Bottom to top D. Anterior to posterior

A. Head to toe As with other systems, assessment of the musculoskeletal system usually proceeds from general to specific and from head to toe. Focused assessments may be more appropriate when the client reports an injury to a specific area or joint.

After a physical assessment, the nurse determines that a client has full range of motion of the temporomandibular joint. Which of the following assessments did the nurse complete with the client? Select all that apply. A. Asked the client to open and close the mouth B. Asked the client to jut the jaw forward C. Asked the client to rock the jaw laterally D. Asked the client to swallow E. Asked the client to extend the tongue

A. Asked the client to open and close the mouth B. Asked the client to jut the jaw forward C. Asked the client to rock the jaw laterally Range of motion of the temporomandibular joint consists of three activities: opening and closing of the mouth, jutting the jaw forward, and rocking the jaw laterally. If the client is able to perform these activities, then the joint has full range of motion. Range of motion of the jaw is not assessed by swallowing or extending the tongue.

A nurse is providing health education about osteoporosis to a community group. What ethnicity is considered to be an independent risk factor for osteoporosis? A. Caucasian B. African American C. South Asian D. Native American

A. Caucasian Caucasian ethnicity is a risk factor for osteoporosis. This is not true of the other listed ethnicities.

A new client is admitted to a long term care facility. The nurse assesses the client with an unsteady gait and incontinence. Which problem should the nurse address when planning care for this client? A. Falls B. Osteoporosis C. Low back pain D. Neck pain

A. Falls Risk factors for falls include impaired mobility and incontinence. Impaired mobility and incontinence are not risk factors for the development of osteoporosis or low back or neck pain.

Which of the following assessments can a registered nurse delegate to an unlicensed care provider? A. Height, weight, and vital signs B. Active and passive ROM C. Palpation and percussion of the knee D. Blood draw for calcium and Vitamin D

A. Height, weight, and vital signs Rationale: Nurses frequently delegate the taking of height, weight, and vital signs to unlicensed care providers. Active and passive ROM, palpation and percussion of the knee, and a blood draw for calcium and vitamin D are parts of assessment that cannot be delegated to unlicensed personnel.

A nurse is working with an older client who has osteoporosis. The nurse understands that osteoporosis is more common in older people for which of the following reasons? Select all that apply. A. Increased bone resorption B. Decreased calcium absorption C. Decreased osteoblast production D. Increased incidence of arthritis E. Decreased intake of vitamin K F. Increased sun exposure

A. Increased bone resorption B. Decreased calcium absorption C. Decreased osteoblast production Osteoporosis is more common as a person ages because that is a time when bone resorption increases, calcium absorption decreases, and production of osteoblasts decreases as well. Arthritis is not a risk factor for osteoporosis. It is not established that decreased intake of vitamin K or increased sun exposure are associated with advancing age, and even if it were, these are not risk factors associated with osteoporosis.

The nurse is assessing an elderly client and finds an exaggerated thoracic curve. This would be documented as what? A. Kyphosis B. Scoliosis C. Ankylosing spondylitis D. Lordosis

A. Kyphosis Kyphosis is an exaggerated thoracic curve and is common with aging. Scoliosis is lateral curvature of the thoracic spine with an increase in the convexity on the curved side. An exaggerated lumbar curve is lordosis. Ankylosing spondylitis is associated with a flattening of the lumbar curvature.

The client is complaining that his lower joints are increasingly painful as the day progresses. The nurse suspects the client is experiencing what musculoskeletal disorder? A. Osteoarthritis B. Rheumatoid arthritis C. Fibromyalgia D. Bone fracture

A. Osteoarthritis Osteoarthritis is characterized by pain with motion that increases throughout the day. Rheumatoid arthritis discomfort decreases with motion. A bone fraction causes a sharp, knife-lie pain. Chronic pain and fatigue is a symptom of fibromyalgia.

Which action by a nurse is a correct method for performing Tinel's test to determine the presence of carpel tunnel syndrome? A. Percuss lightly on the inner aspect of the wrist B. Palpate the hollow area on the back of the wrist C. Ask the client to bend the wrist down and back D. Perform wrist movements against resistance

A. Percuss lightly on the inner aspect of the wrist The nurse should tap at the inner aspect of the wrist to percuss the median nerve because the median nerve is located at the inner aspect of the wrist where it enters the carpal canal. Palpation of the hollow area on the back of the wrist is done to examine the anatomic snuffbox. Asking the client to bend the wrist down and back and performing wrist movements against resistance are done to assess range of motion and muscle strength.

The nurse is testing a client for carpal tunnel syndrome. The client flexes the wrists at an angle of 90° and holds the backs of the hands to each other for 60 seconds. The client tells the nurse that he is experiencing a burning pain as a result. Which test is the nurse performing on this client? A. Phalen's B. Tinel's C. Ballottement D. McMurray's

A. Phalen's Phalen's test evaluates for carpal tunnel syndrome. The client flexes the wrists at an angle of 90° and holds the backs of the hands to each other for 60 seconds. Normal response is denial of any discomfort. Positive signs include numbness, burning, or pain. Tinel's sign is a test to assess for irritated nerves. It is performed by lightly percussing over the nerve to elicit a sensation or tingling in the distribution of the nerve. Ballottement is a test to assess for increased fluid in the knee joint. The McMurray test is used to test individuals for tears in the meniscus of the knee.

When assessing the elbow, a nurse asks a client to hold the arm out and turn the palm down. The nurse is testing which of the following? A. Pronation B. Flexion C. Rotation D. Supination

A. Pronation Turning the palm down tests pronation. Having the client turn the palm up would test supination. Flexion is tested by having the client bend the elbow and bring the hand to the forehead. Rotation is not assessed for the elbow.

In assessing a client's temporomandibular joint (TMJ), the nurse asks the client to move the jaw forward. This movement is known as which of the following? A. Protraction B. Retraction C. Pronation D. Supination

A. Protraction Protraction is moving forward. Retraction is moving backward. Pronation is turning or facing downward. Supination is turning or facing upward. Pronation and supination are not possible at the TMJ.

A client visits the health care facility with reports of lumbar back pain that radiates down the back. The nurse performs Lasègue's test to determine the origin of the pain. Which techniques should the nurse use to perform Lasègue's test? A. Raise the leg to the point of pain and dorsiflex the foot B. Instruct the client to bend forward and touch the toes C. Instruct the client to touch the chin to the chest D. Palpate the spinous processes and the paravertebral muscles

A. Raise the leg to the point of pain and dorsiflex the foot To perform the Lasègue's test, the nurse should raise the client's leg to the point of pain and dorsiflex the foot to check for a herniated nucleus pulposus. Asking the client to bend forward and touch the toes facilitates assessment of range of motion of the lumbar spine. Asking the client to touch the chin to the chest evaluates range of motion of the cervical spine. The spinous processes and the paravertebral muscles on both sides of the spine are palpated for tenderness and pain and are not a part of Lasègue's test.

The nurse is planning the care of a 77-year-old woman who has recently been diagnosed with osteoporosis. What nursing diagnoses should the nurse address in the client's plan of care? Select all that apply. A. Risk for injury related to osteoporosis B. Risk for infection related to osteoporosis C. Activity intolerance related to osteoporosis D. Impaired physical mobility related to osteoporosis E. Disturbed sensory perception related to osteoporosis

A. Risk for injury related to osteoporosis C. Activity intolerance related to osteoporosis D. Impaired physical mobility related to osteoporosis Osteoporosis creates risks for injury, activity intolerance, and impaired mobility as consequences of musculoskeletal changes. The disease does not normally result in infection or impaired sensation.

A client is unable to perform abduction with the right arm and reports pain when attempting to do so. The nurse notices that the muscles surrounding the right shoulder are smaller than those on the left shoulder. The nurse recognizes this finding as the possibility of what condition? A. Rotator cuff tear B. Tendinitis C. Fracture D. Degenerative joint disease

A. Rotator cuff tear Painful and limited abduction accompanied by muscle weakness and atrophy are seen with rotator cuff tears. Rotator cuff tendinitis causes the client to report sharp catches of pain when bringing the hands overhead. A bone fracture presents with acute, severe pain, and often weakness of the entire extremity. Degenerative joint disease may cause limited range of motion for all of the shoulder movements and most likely occurs symmetrically.

The nurse is assessing a client with joint pain and is trying to decide whether it is inflammatory or non-inflammatory. Which of the following symptoms is consistent with an inflammatory process? A. Tenderness B. Cool temperature C. Ecchymosis D. Nodules

A. Tenderness Tenderness implies an inflammatory process along with increased temperature. Nodules and ecchymosis are not typically associated with inflammatory processes.

The nurse is assessing an older adult with new onset dementia. The nurse is using the Morse Fall Scale; the client's score is 63. What does this tell the nurse? A. That the client is at high risk for falling B. That the client is at low risk for falling C. That the client is at moderate risk for falling D. That the client needs to be restrained for his own safety

A. That the client is at high risk for falling A score of 63 on the Morse Fall Scale represents a high risk for falling. Restraints are used only as a last possible resort in cases where the client poses a risk of violent harm to self or others. Restraints usually have serious legal ramifications and would not be appropriate for consideration in this situation.

After assessing the client for posture and body alignment, how would the nurse document head position in relation to the spine if alignment is normal with noticeable defect? A. The head is midline and aligned with the spine B. The head is centered and in line with the backbone C. The head is straight up and down in accordance with the spine D. The head is equally distributed on the neck

A. The head is midline and aligned with the spine The correct documentation would be "the trunk and head are erect with weight distributed equally on both feet. The head is midline and aligned with the spine."

A nurse is testing the range of motion of a client's wrist for supination. Which movement will this involve? A. Turning the palm of the hand upward B. Turning the palm of the hand downward C. Moving the tips of the fingers toward the forearm D. Moving the tips of the fingers away from the forearm

A. Turning the palm of the hand upward Supination involves turning or facing upward, in this case turning the palm upward. Pronation involves turning or facing downward, in this case turning the palm downward. Flexion involves bending the extremity at the joint and decreasing the angle of the joint, in this case moving the tips of the fingers toward the forearm. Extension involves straightening the extremity at the joint and increasing the angle of the joint, in this case moving the tips of the fingers away from the forearm.

A client visits the clinic and tells the nurse that she has joint pain in her hands, especially in the morning. The nurse should assess the client further for signs and symptoms of A. arthritis. B. osteoporosis. C. carpal tunnel syndrome. D. a neurologic disorder.

A. arthritis. Pain and stiffness in the joints is associated with arthritis.

While assessing the elbow of an adult client, the client complains of pain and swelling. The nurse should further assess the client for A. arthritis. B. ganglion cyst. C. carpal tunnel syndrome. D. nerve damage.

A. arthritis. Redness, heat, and swelling may be seen with bursitis of the olecranon process due to trauma or arthritis.

A client has osteoarthritis of the elbow. Which assessment approach should the nurse expect to be impacted by this health problem? A. flexion B. rotation C. abduction D. adduction

A. flexion A hinge joint provides movement in one plane such as flexion and extension. A ball and socket joint provides a wide range of movement including rotation, abduction, and adduction.

An adult client tells the nurse that he eats sardines every day. The nurse should instruct the client that a diet high in purines can contribute to A. gouty arthritis. B. osteomalacia. C. bone fractures. D. osteomyelitis.

A. gouty arthritis. A diet high in purine (e.g., liver, sardines) can trigger gouty arthritis.

A client is unable to externally rotate the left shoulder. What health problem should the nurse suspect is occurring with this client? A. rotator cuff tear B. rotator cuff tendinitis C. carpal tunnel syndrome D. anterior dislocation of the humerus

A. rotator cuff tear In a complete tear of the supraspinatus tendon, or a rotator cuff tear, active abduction and forward flexion at the glenohumeral joint are severely impaired, producing a characteristic shrugging of the shoulder and a positive "drop arm" test. Rotator cuff tendonitis is characterized by acute, recurrent, or chronic pain of the supraspinatus tendon. Carpal tunnel syndrome effects the wrist and not the shoulder. Anterior dislocation of the humerus is characterized by the shoulder seeming to slip out of the joint.

The nurse is going to test range of motion in a client. To test extension of the triceps muscle, the nurse would instruct the client to A. straighten the elbow B. bend the elbow C. turn the palm up D. turn the palm down

A. straighten the elbow The client should have full range of motion.

The nurse suspects carpal tunnel syndrome after examining a client in the clinic. A test result that would suggest this diagnosis would be A. weak opposition of the thumb B. negative Tinel sign C. negative Phelan sign D. increased thumb abduction

A. weak opposition of the thumb If the client cannot raise the thumb up from the plane and stretch the thumb pad to the little finger pad, this indicates thumb weakness in carpal tunnel syndrome.

A client has been admitted to a medical unit. The nurse notes that the client has irregular, uncoordinated movements. How would the nurse document this finding? A. "Patient exhibits spasticity." B. "Patient shows signs of ataxia." C. "Patient is atonic." D. "Patient demonstrates hypotonicity."

B. "Patient shows signs of ataxia." Ataxia (irregular uncoordinated movements) or loss of balance may be due to cerebellar disorders, Parkinson disease, multiple sclerosis, strokes, brain tumors, inner ear problems, or medications.

When assessing muscle tone and strength, the nurse would document expected findings as A. "extremity muscle strength is 5/5 bilaterally" B. "upper and lower extremity muscle strength is 5/5 bilaterally" C. "upper and lower extremity muscle strength is 5/5" D. "upper extremity muscle strength is 5/5 bilaterally"

B. "upper and lower extremity muscle strength is 5/5 bilaterally" 5/5 (100%) normal muscle strength with complete ROM against gravity and full resistance.

The nurse is preparing information about osteoporosis for a community health fair. Which information should the nurse include as a handout for the participants? Select all that apply. A. Avoid all alcohol B. Avoid severe weight loss diets C. Ensure adequate calcium intake D. Engage in weight-bearing activities E. Avoid smoking and second-hand smoke

B. Avoid severe weight loss diets C. Ensure adequate calcium intake D. Engage in weight-bearing activities E. Avoid smoking and second-hand smoke Teaching to avoid the development of osteoporosis should include avoiding severe weight loss diets, ensuring an adequate calcium intake, engaging in weight-bearing activities, and avoiding smoke and second-hand smoke. Heavy drinking should be avoided however all alcohol does not need to be avoided to prevent the development of osteoporosis.

A nurse is working with a client who has cervical disc degenerative disease with resulting impaired range of motion and pain that radiates to the back. The nurse understands that joints between the vertebrae are which type of joint? A. Fibrous B. Cartilaginous C. Synovial D. Compact

B. Cartilaginous Fibrous joints (e.g., sutures between skull bones) are joined by fibrous connective tissue and are immovable. Cartilaginous joints (e.g., joints between vertebrae) are joined by cartilage. Synovial joints (e.g., shoulders, wrists, hips, knees, ankles) contain a space between the bones that is filled with synovial fluid, a lubricant that promotes a sliding movement of the ends of the bones. Compact is a type of bone, not a type of joint.

Mark is a contractor who recently injured his back. He was told he had a "bulging disc" to account for the burning pain down his right leg and slight foot drop. The vertebral bodies of the spine involve which type of joint? A. Synovial B. Cartilaginous C. Fibrous D. Synostosis

B. Cartilaginous The vertebral bodies of the spine are connected by cartilaginous joints involving the discs. The elbow would be an example of a synovial joint and the sutures of the skull are an example of a fibrous joint.

During the nursing history of a newly admitted client, the nurse is reviewing a client's current medication regimen. What medication category creates a risk for decreased bone density? A. Beta-adrenergic blockers B. Corticosteroids C. Nonsteroidal anti-inflammatories (NSAIDs) D. Calcium channel blockers

B. Corticosteroids Steroids can deplete bone mass, thereby contributing to osteoporosis. This is not true of beta blockers, calcium channel blockers, or NSAIDs.

A client presents to the health care clinic with reports of pain in the hands and right wrist. Additional history reveals that the client is a factory worker who spends all day performing the same repetitive task. The nurse performs the Phalen's test and Tinel's tests with positive results. The hand grips are unequal with the right weaker than the left. What nursing diagnosis can the nurse confirm from this data? A. Risk for Trauma B. Impaired Physical Mobility C. Disturbed Body Image D. Activity Intolerance

B. Impaired Physical Mobility This client is likely experiencing carpal tunnel syndrome because of the repetitive hand movements that inflame the median nerve as it passes through the wrist. Impaired Physical Mobility related to decreased muscle strength as evidenced by a weak right hand grip meets the major criteria to confirm this nursing diagnosis. Risk for Trauma cannot be confirmed because the client already has carpal tunnel syndrome so he is not at risk. Disturbed Body Image and Activity Intolerance do not meet any major defining characteristics to confirm these nursing diagnoses.

Your patient was playing softball with their daughters and felt a pop in the left knee. It appears swollen and they have difficulty moving sideways. What is the first assessment you should make? A. Palpate the left and right knee. B. Inspect both knees for swelling and deformity. C. Assess active ROM in the knee. D. Twist both knees to determine the pain difference.

B. Inspect both knees for swelling and deformity. Rationale: The first step is inspection. The first thing to do is to compare one knee with the other for symmetry. Palpating the knees, assessing active ROM, and twisting both knees to determine pain difference are all procedures for assessing joints, which may be indicated but do not represent the first step that the nurse should take.

A client expresses to the nurse that he has a "giving in" or "locking" sensation in the knee. Which test should the nurse perform to elicit related findings of a possible tear in the meniscus of the client's knee? A. Ballottement B. McMurray's C. Bulge D. Phalen's

B. McMurray's The nurse should perform McMurray's test to confirm meniscal tear. Pain or clicking during the test is indicative of a torn meniscus of the knee. The ballottement test and the bulge test are done to detect the presence of fluid in the knee joint. Phalen's test is done to test for carpal tunnel syndrome.

The subacromial bursae are contained in the A. temporomandibular joint. B. shoulder joint. C. elbow joint. D. wrist joint.

B. shoulder joint. Articulation of the head of the humerus in the glenoid cavity of the scapula. The acromioclavicular joint includes the clavicle and acromion process of the scapula. It contains the subacromial and subscapular bursae.

A female client who works as an administrative assistant which involves a lot of typing as part of her daily duties. She presents to the clinic with complaints of burning, pain, and numbness in both hands. What teaching should the nurse prepare to provide for this client? A. GI ulcer prophylaxis while taking anti-inflammatory medications. B. Post-operative healing time after carpal tunnel release. C. How to apply a hand and wrist splint to relieve Dupuytren contractures. D. Wearing arm slings while awake and removing them at bedtime.

B. Post-operative healing time after carpal tunnel release The client's symptoms are consistent with carpal tunnel syndrome, which is often treated surgically. Arthritic conditions, such as acute rheumatoid arthritis is treated with anti-inflammatories more often than carpal tunnel syndrome. The client's symptoms are consistent with carpal tunnel, not contractures. Arm slings are not recommended for carpal tunnel as the condition affects the wrists mainly due to compression of the median nerve.

The nurse is working with a client who has leukemia, which affects the red marrow of the bones. The nurse understands that which of the following is characteristic of red marrow? A. Is composed mostly of fat B. Produces red blood cells C. Covers the bones and contains osteoblasts and blood vessels D. Is hard and dense and makes up the shaft and outer layers

B. Produces red blood cells Bones contain red marrow that produces blood cells and yellow marrow composed mostly of fat. The periosteum covers the bones and contains osteoblasts and blood vessels that promote nourishment and formation of new bone tissues. Composed of osseous tissue, bones can be divided into two types: compact bone, which is hard and dense and makes up the shaft and outer layers; and spongy bone, which contains numerous spaces and makes up the ends and centers of the bones.

After teaching a group of students about the bones and their functions, the instructor determines that the teaching was successful when the students state that blood cells are produced in which of the following? A. Compact bone B. Red marrow C. Yellow marrow D. Spongy bone

B. Red marrow The red marrow of the bone is responsible for producing red blood cells. Compact bone is hard and dense and makes up the shaft and outer layers. Yellow marrow is mostly fat. Spongy bone contains numerous spaces and makes up the ends and centers of the bone.

A high school football player injured his wrist in a game. He is tender between the two tendons at the base of the thumb. Which of the following should be considered? A. De Quervain's tenosynovitis B. Scaphoid fracture C. Wrist sprain D. Rheumatoid arthritis

B. Scaphoid fracture The "anatomical snuffbox" is found between the extensor and abductor tendons at the base of the thumb. Tenderness should make one think of a scaphoid fracture. Not only is this the most common carpal bone injury, but the poor blood supply puts the bone at risk for avascular necrosis when injured. This fracture if commonly missed on X-ray, so this is an important physical finding to support further or repeat studies.

A 32-year-old warehouse worker presents for evaluation of low back pain. He notes a sudden onset of pain after lifting a heavier-than-usual set of boxes. He also states that he has numbness and tingling in the left leg. What test should the nurse perform to assess for a herniated disc? A. Leg length test B. Straight leg raise test C. Tinel's test D. Phelan's test

B. Straight leg raise test The straight leg raise test involves having the client lie supine with the examiner raising the leg. If the client experiences a sharp pain radiating from the back down the leg in an L5 or S1 distribution, that suggests a herniated disc. Leg strength test, Tinel's test, and Phelan's test do not assess for a herniated disc.

Which of the following patients is at the highest risk for osteoporosis? A. African American young male with a stable job preparing for a bodybuilding contest, who is using anabolic steroids. B. White middle-aged female of lower socioeconomic status who is sedentary, a heavy smoker, and drinks alcohol six times a week. C. Hispanic female who works as an executive, drinks vodka three times a week, and is a recreational marathoner. D. Retired Asian American male, nonsmoker, who drinks alcohol socially and goes dancing three times a week.

B. White middle-aged female of lower socioeconomic status who is sedentary, a heavy smoker, and drinks alcohol six times a week. Rationale: This patient has six risk factors present, all of which cause osteoporosis and risk for injury: White, increased age, lower socioeconomic status, sedentary, smoker, and increased alcohol. People who identify as female of lower socioeconomic status are more likely to report limitations in activity and arthritis, obesity, and osteoporosis. Smoking also increases the risk of developing fractures. Alcohol use is associated with increased risk of osteoporosis because it raises parathyroid hormone levels, which causes calcium loss from bones.

Bones in synovial joints are joined together by A. cartilage. B. ligaments. C. tendons. D. periosteal tissue.

B. ligaments. Bones in synovial joints are joined by ligaments, which are strong, dense bands of fibrous connective tissue.

While sitting a client raises both legs while the nurse holds the lower legs below the knee. What does this finding indicate? A. flexion deformity of both legs B. normal quadriceps muscle strength C. distal muscle symmetric weakness D. proximal muscle symmetric weakness

B. normal quadriceps muscle strength An active movement against full resistance without evidence of fatigue is considered normal muscle strength. If the client is unable to keep the opposite leg extended, when one leg is flexed, it suggests a flexion deformity of the opposite leg's hip. Symmetric weakness of the proximal muscles suggests a myopathy or muscle disorder. Symmetric weakness of distal muscles suggests a polyneuropathy, or disorder of peripheral nerves.

To correctly document that ROM in the fingers is full and active, you would write that the patient can A. perform rotation, lateral flexion, and hyperextension. B. perform flexion, extension, abduction, and thumb-to-finger opposition. C. touch finger to own nose and to examiner's finger back and forth. D. perform supination, pronation, and lateral deviation.

B. perform flexion, extension, abduction, and thumb-to-finger opposition. Rotation is a shoulder movement. Finger to nose is coordination. Supination and pronation are tests for the shoulder.

What is an appropriate question by the nurse to ask a client about the presence of temporomandibular joint dysfunction? A. "Do you notice any swelling around the teeth or gums?" B. "Can you fully clench your teeth and feel the muscles in your jaw tense?" C. "Have you noticed a popping or grating sound when you chew?" D. "Please stick out your tongue sand move it from side to side"

C. "Have you noticed a popping or grating sound when you chew?" The temporomandibular joint (TMJ) provides the stability of the jaw to open and close. Often the joint can become swollen, causing pain and decrease in range of motion of the jaw. Decreased muscle strength and range of motion, along with a popping, clicking, or grating sound may be noted with TMJ dysfunction. Swelling around the teeth and gums is seen with gingivitis. Clenching the teeth test the integrity of cranial nerve V (trigeminal nerve). Asking the client to stick out the tongue and move it from side to side tests cranial nerve XII (hypoglossal nerve).

Assessment reveals that a client has slight weakness with active range of motion against some resistance. How would the nurse document this finding? A. 2/5 B. 3/5 C. 4/5 D. 5/5

C. 4/5 Muscle strength is rated on a 5-point scale, with specific defining characteristics for each. Slight weakness with active motion against some resistance is 4 of 5 points. 2 of 5 points would indicate passive and poor range of motion. 3 of 5 points would indicate average weakness with active motion against gravity. 5 of 5 points would indicate normal findings, with active motion against full resistance.

Phil comes to the office with left "shoulder pain" that is markedly worse when his left arm is drawn across his chest (adduction). Which of the following is suspected? A. Rotator cuff tear B. Subacromial bursitis C. Acromioclavicular joint involvement D. Adhesive capsulitis

C. Acromioclavicular joint involvement Adduction of the client's arm across his chest can cause pain if the acromioclavicular joint is involved. In adhesive capsulitis, this maneuver may not be possible because of limited range of motion. Subacromial bursitis would present with tenderness inferior to the acromion. Rotator cuff injury would ordinarily not be associated with pain during this maneuver.

Inspection of a client's knee reveals swelling, and the nurse suspects that there is significant fluid in the knee. What test would the nurse perform to confirm the suspicion? A. Phalen's test B. Tinel's test C. Ballottement test D. Lasegue's test

C. Ballottement test The ballottement test is used to detect large amounts of fluid in the knee. Phalen's test and Tinel's test would be used to assess for carpal tunnel syndrome. Lasegue's test is used to detect low back pain.

To assess abduction of the shoulders and arms, a nurse should ask a client to do which of the following? A. Move the arms forward starting with the arms at the sides B. Move the arms to the sides starting with the hands together overhead C. Bring both hands together overhead starting with the arms at the sides D. Move the arms backward starting with the arms at the sides

C. Bring both hands together overhead starting with the arms at the sides To elicit abduction, the nurse should ask the client to bring both hands together overhead. Asking the client to move the arms forward elicits flexion, and asking the client to move the arms backward elicits extension. Asking the client to move the arms to the sides starting with the arms overhead elicits adduction.

Ms. Sobcyzk is an older adult female who fell and fractured her left ankle. What is the priority nursing assessment of the admitting orthopedic nurse? A. Pulse proximal to the injury of the right ankle B. Capillary refill proximal to the injury of the right ankle C. Capillary refill distal to the injury of the left ankle D. Capillary refill distal to the injury of the right ankle

C. Capillary refill distal to the injury of the left ankle Neurological and circulatory deficits are seen distal to the injury, as the nerves and arteries flow proximal to distal. It is important to compare left and right, but the priority is the injured side.

A client complains of chronic pain and fatigue. The nurse suspects fibromyalgia. What is a diagnosis of this condition based on? A. Lab tests B. X-rays C. Client's symptoms D. Range of motion tests

C. Client's symptoms Fibromyalgia, manifested by chronic pain and fatigue, affects about 5 million Americans. Diagnosis is made based on a person's symptoms as no there are no objective findings on X-rays or lab tests or range of motion tests. Persistent pain and fatigue interferes with the client's activities of daily living.

A nurse notices that a client has decreased range of motion with lateral bending of the cervical spine to the left side. What should the nurse do next in relation to this finding? A. Notify the health care provider for further orders B. Ask the client about previous injuries to the head and neck C. Compare this finding to the range of motion to the right side D. Finish with the assessment of the cervical spine before documenting

C. Compare this finding to the range of motion to the right side It is always important to compare both sides of the body for symmetry before making a judgment that data is abnormal. The nurse should then ask the client about previous injuries to the head and neck. All data must be properly documented in the client's record. If this finding is abnormal, the nurse should alert the health care provider for further orders.

A nurse notices that a client has decreased range of motion with lateral bending of the cervical spine to the left side. What should the nurse do next in relation to this finding? A. Notify the health care provider for further orders B. Ask the client about previous injuries to the head and neck. C. Compare this finding to the range of motion to the right side D. Finish with the assessment of the cervical spine before documenting

C. Compare this finding to the range of motion to the right side It is always important to compare both sides of the body for symmetry before making a judgment that data is abnormal. The nurse should then ask the client about previous injuries to the head and neck. All data must be properly documented in the client's record. If this finding is abnormal, the nurse should alert the health care provider for further orders.

When assessing the gait pattern of a client diagnosed with Alzheimer disease, the nurse should expect to observe which finding? A. Lifting the leg high so that toes clear the ground B. Limping when not wearing adaptive shoes C. Difficulty initiating a slow, shuffling gait D. A waddling gait while ambulating in hallway

C. Difficulty initiating a slow, shuffling gait Apraxic gait occurs when the client has difficulty initiating walking, then exhibits a slow, shuffling gait. It is often seen in clients with Alzheimer disease. Foot drop or steppage, raising the leg high when walking, occurs with nerve injuries or damage to spinal nerve roots. Limping is indicative of short leg gait. A waddling gait is often seen with hip dysplasia or muscular dystrophy.

A nurse is clustering data after performing a comprehensive assessment on an older adult client. The nurse notes the following findings: bilateral joint pain and stiffness that is worse in the morning and after sitting for long periods of time. Pain and stiffness improve with movement. What is the best action of the nurse? A. Document findings as age-related kyphosis. B. Refer the client to a specialist for ankylosing spondylitis. C. Further assess the client for other signs and symptoms of rheumatoid arthritis. D. Inform the client that these are all normal age-related changes associated with osteoarthritis.

C. Further assess the client for other signs and symptoms of rheumatoid arthritis. The client's symptoms are not normal age-related changes. Rheumatoid arthritis is systemic; it affects bilateral joints causing pain and stiffness when at rest, and symptoms improve with movement. The nurse should further assess the client for rheumatoid arthritis. Kyphosis is an abnormal thoracic curvature often seen in older clients as the spine shrinks. Ankylosing spondylitis is a flattening of the lumbar curvature. Rheumatoid arthritis is caused by wear and tear of individual joints; pain decreases with rest and increases with movement of the joint involved.

A clinical nurse is assessing a patient's knowledge and understanding of bone health and maintenance. Which of the following responses by the patient indicates adequate understanding to maintain musculoskeletal health? A. I will take calcium supplementation as prescribed and eat plenty of citrus fruits. B. I will expose myself to sunlight at least 1 hour daily and eat plenty of green, leafy vegetables. C. I will take calcium supplementation and vitamin D as prescribed. D. I will exercise daily and take vitamin E as prescribed.

C. I will take calcium supplementation and vitamin D as prescribed. Rationale: Calcium is essential for bone growth and remodeling. Vitamin D is essential for calcium absorption. Eating plenty of citrus fruits or increasing vitamin C intake will not assist in calcium absorption. Exposing to sunlight for at least an hour daily is not needed and is impractical. Weight-bearing exercises help build stronger bones, but vitamin E will not assist in calcium absorption.

Mary started a job 2 weeks ago that requires carrying heavy buckets. She presents with elbow pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance when her palms face the floor. What condition does she have? A. Medial epicondylitis (golfer's elbow) B. Olecranon bursitis C. Lateral epicondylitis (tennis elbow) D. Supracondylar fracture

C. Lateral epicondylitis (tennis elbow) Mary's injury probably occurred by lifting heavy buckets with her palms down (toward the bucket). This caused her chronic overuse injury at the lateral epicondyle. Medial epicondylitis has reproducible pain when palmar flexion against resistance is performed and also features tenderness over the involved epicondyle. Olecranon bursitis produces erythema and swelling over the olecranon process. A supracondylar fracture of the humerus is a major injury and would present more acutely.

A nurse notices that a client's flexibility of the right elbow is less than the left elbow. What is an appropriate action by the nurse in regard to this finding? A. Notify the health care provider B. Assess the client's hand grips C. Measure movement with a goniometer D. Note that the dominant side is stronger

C. Measure movement with a goniometer If the nurse identifies a limitation in the range of motion for a joint, a goniometer should be used to measure the exact angle of movement present. The goniometer is placed at the joint and then moved to match the angle of the joint being assessed. It is not necessary to notify the health care provider until all information is collected. The hand grips test strength, not range of motion. The dominant side of the body is stronger but does not necessarily have greater range of motion.

An older adult male, an avid crossfit athlete, reports numbness on his right foot, pain on his right thigh, and hip pain. What test would you anticipate performing next? A. McMurray and Lachman tests B. Bulge test and ballottement C. Patrick or FABERE test D. Phalen and Tinel tests

C. Patrick or FABERE test Rationale: The FABERE test is Flexion of the hip and knee, with Abduction, External Rotation, and Extension. The patient lies in the supine position on the examining table, with the hip flexed, abducted, and externally rotated and the foot on the opposite knee. The examiner then presses the flexed hip into the table while stabilizing the opposite hip. Pain in the back on the ipsilateral side as the hip is flexed is a positive test for sacroiliac hip joint pathology. Both Phalen and Tinel signs are specific findings with carpal tunnel syndrome. Bulge and ballottement tests look for effusion in the knee joint. The McMurray test assesses for meniscus tears in the knee.

A client waiting to be seen for a clinic appointment is observed periodically shaking the left wrist. On what should the nurse focus when assessing this client? A. Paralysis B. Fractured wrist C. Dupuytren contracture D. Carpal tunnel syndrome

D. Carpal tunnel syndrome A motion that resembles shaking a thermometer could indicate the presence of carpal tunnel syndrome. The wrist and hand would not be mobile if the limb is paralyzed. Moving the hand and wrist would produce excruciating pain if the wrist is fractured. The inability to extend the ring and little finger is associated with a Dupuytren contracture.

A client presents to the health care clinic with reports of onset of neck pain 3 days ago. The nurse recognizes that the most common cause of neck pain is what condition? A. Cervical disc degenerative disease B. Cervical spinal cord compression C. Compression fractures D. Cervical strain

D. Cervical strain The most common cause of neck pain is cervical strain. This can occur from sleeping in the wrong position, carrying a heavy load, or being in an automobile accident. Cervical disc degenerative disease is associated with impaired range of motion and pain that radiates to the back, shoulders, or arms. Cervical spinal cord compression causes neck pain with loss of sensation in the legs. Compression fractures of the neck may also cause loss of sensation in the legs if the spinal cord becomes compressed.

The nurse is performing an assessment on an adolescent client and notes a 45-degree flexion of the cervical spine. What should the nurse do next? A. Assess the thoracic and lumbar spine. B. Palpate the spinous processes. C. Perform the Lasegue test. D. Continue the exam because this curve is normal.

D. Continue the exam because this curve is normal. Normal flexion of the cervical spine is 45 degrees. Because the finding is normal, assessing the thoracic and lumbar spine, palpating the spinous processes, and performing the Lasegue test would be unnecessary.

When assessing the client's upper extremities, the nurse instructs the client to put the hands behind the neck with the elbows pointed laterally. This positioning facilitates assessment of which of the following functions? A. Elbow flexion B. Internal rotation of the shoulder C. Muscle strength of the deltoids D. External rotation of the shoulder

D. External rotation of the shoulder Pointing the elbows laterally tests the shoulder's ability to rotate externally and abduct.

A client presents to the health care clinic with reports of a swollen, tender, reddened joint in the left big toe. The nurse recognizes this finding as an indication of what inflammatory process? A. Rheumatoid arthritis B. Verruca vulgaris (warts) C. Degenerative joint disease D. Gouty arthritis

D. Gouty arthritis Tender, painful, reddened, hot, and swollen metatarsophalangeal joint in the great (big) toe is seen in gouty arthritis. This is an inflammatory condition caused by an abnormal buildup of uric acid in the body that becomes deposited in the joints. Rheumatoid arthritis can occur in any joint but usually affects the hands first. Verruca vulgaris (warts) is a painful wart that occurs under a callus. Degenerative joint disease does not typically cause the joints to be reddened and hot because it is not an inflammatory process.

The school nurse notes that the client carries her left shoulder higher than her right shoulder. You should recognize the likely presence of what health problem? A. Torn rotator cuff B. Dislocated shoulder C. Broken clavicle D. Scoliosis

D. Scoliosis Scoliosis may cause elevation of one shoulder.

The school nurse notes that the client carries her left shoulder higher than her right shoulder. You should recognize the likely presence of what health problem? A. Torn rotator cuff B. Dislocated shoulder C. Broken clavicle D. Scoliosis

D. Scoliosis Scoliosis may cause elevation of one shoulder. S-shaped

The nurse is conducting a musculoskeletal assessment of an older adult client. What aspect of the client's medical history requires the nurse to alter the usual sequence or content of this assessment? A. The client takes medications to treat hypertension. B. The client suffered a fractured humerus 1 year earlier. C. The client has a diagnosis of type 1 diabetes. D. The client had a total hip replacement 2 years ago.

D. The client had a total hip replacement 2 years ago. If the client has had a total hip replacement, do not test ROM unless the physician gives permission to do so, due to the risk of dislocating the hip prosthesis. A 1-year-old arm fracture is likely to have healed fully and would not normally affect the content of the assessment. Diabetes can affect various aspects of the musculoskeletal system, but it does not likely require the nurse to modify the assessment. Antihypertensives are unlikely to affect assessment.

A young male active-duty member reports right knee pain (6/10) and swelling for more than 4 weeks. Which of the following test or tool might be ineffective for diagnosing tibial stress fractures? A. Tuning fork test B. CT scan C. MRI D. X-ray

D. X-ray Rationale: X-ray visualization shows bone fractures but not soft-tissue injury. CT and MRI can reveal soft-tissue damage, including ligament and tendon injuries, although MRI is the most sensitive and specific imaging test for diagnosing stress fractures of the lower extremity.

You note that an adolescent has uneven shoulder height. To differentiate functional from structural scoliosis, you ask the patient to A. stand up straight while you check the height of the iliac crest. B. flex the elbow and pull against your resistance. C. shrug both shoulders while you provide resistance. D. bend forward at the waist while you palpate the spine.

D. bend forward at the waist while you palpate the spine. Rationale: Checking the height of the iliac crest will provide information about scoliosis but will not differentiate functional from structural. With functional scoliosis, the spine straightens with bending. This problem usually is associated with uneven leg length. Standing up straight while you check the height of the iliac crest is another finding, but bending reveals a more subtle deformity. Flexing the elbow or shrugging both shoulders will not change the angle of the back.

Joints may be classified as cartilaginous, synovial, or A. articulate. B. flexible. C. immobile. D. fibrous.

D. fibrous. The joint (or articulation) is the place where two or more bones meet. Joints provide a variety of ranges of motion (ROM) for the body parts and may be classified as fibrous, cartilaginous, or synovial.

A client visits the clinic and tells the nurse that after playing softball yesterday, he thinks his knee is "locking up." The nurse should perform the McMurray test by asking the client to A. move from a standing to a squatting position. B. raise his leg while in a supine position. C. bend forward while trying to touch the toes. D. flex the knee and hip while in a supine position.

D. flex the knee and hip while in a supine position. If the client complains of a "giving in" or "locking" of the knee, perform McMurray's test. With the client in the supine position, ask the client to flex one knee and hip. Then place your thumb and index finger of one hand on either side of the knee. Use your other hand to hold the heel of the foot up. Rotate the lower leg and foot laterally. Slowly extend the knee, noting pain or clicking. Repeat, rotating lower leg and foot medially. Again, note pain or clicking.

Articulation between the head of the femur and the acetabulum is in the A. knee joint. B. tibial joint. C. ankle joint. D. hip joint.

D. hip joint. Articulation between the head of the femur and the acetabulum occurs in the hip joint.

While reviewing a client's chart before seeing the client for the first time, the nurse notes that the client has a diagnosis of Dupuytren contracture. The nurse anticipates that the client will exhibit A. inability to turn the wrists. B. ulnar deviation of the hands. C. flexion of the distal interphalangeal joints. D. inability to extend the ring and little finger.

D. inability to extend the ring and little finger. ability to extend the ring and little fingers is seen in Dupuytren's contracture.

The nurse is performing an assessment of a client's musculoskeletal system. What would the nurse examine first? A. the client's leg length B. the client's lateral bending ability C. the client's cervical range of motion D. the client's gait

D. the client's gait Gait inspection provides a valuable overview of musculoskeletal function. For this reason, gait inspection is usually performed at the beginning of the objective exam and prior to more detailed assessments, such as leg length, lateral bending ability, and cervical range of motion.

A teenager was playing soccer and suddenly heard a pop in their right knee. Upon assessment by the school nurse, the teenager was able to walk forward without any pain but unable to move sideways. A meniscus cartilage injury is suspected. What is the most appropriate test for this condition? A. Lachman test B. Lasegue test c. McMurray test D. Hawkins impingement test

c. McMurray test Rationale: The McMurray test checks for meniscus cartilage injury. Have the patient lie supine and flex the hip and knee. Support the knee with one hand and hold the foot with the other, rotating the foot laterally. Slowly extend the patient's knee while assessing for the positive findings of pain or clicking. Repeat the procedure, rotating the lower leg medially. Lachman test is used to evaluate patients with a suspected anterior cruciate ligament (ACL) injury. Lasegue sign or straight leg raising test is a neurodynamic exam to assess nerve root irritation in the lumbosacral area. Hawkins impingement tests for subacromial impingement in the shoulder.