Chapter 14: Musculoskeletal System

Which description of pain from the patient makes a nurse suspect the patient's pain is originating from a muscle? a. "Crampy" b. "Dull and deep" c. "Boring and intense" d. "Sharp upon movement"

ANS: A Muscle pain is often described as "crampy." Bone pain typically is described as "deep" and "dull." Bone pain typically is described as "boring" and "intense." Muscle pain usually remains crampy on movement. REF: p. 279

What movement from the patient does a nurse request to assess for hyperextension of the hip? a. Raise one leg at a time while lying prone. b. Raise one leg at a time while lying supine. c. Move one leg at a time laterally, away from midline, while lying prone. d. Move one leg at a time medially, toward midline, while lying supine.

ANS: A Procedure A tests hyperextension of the hip. Procedure B tests hip flexion. Procedure C tests hip abduction. Procedure D tests hip adduction. REF: p. 298

During a history, the patient reports having gout. Based on this information, what findings does the nurse anticipate during a focused assessment? a. Warm, tender, and deformed wrists and peripheral interphalangeal (PIP) joints bilaterally b. Edema, warmth, and redness of one great toe and pealike nodules in the ear lobes c. Enlarged and tender PIP or distal interphalangeal (DIP) joints on one or several fingers d. Tenderness with pronation and supination of the elbow and point tenderness on the lateral epicondyle

ANS: B Option B is a description of gout. The pealike nodules are tophi, collections of uric acid in subcutaneous tissue. Option A is a description of findings of a patient who has rheumatoid arthritis. Bilateral joint involvement is common. Option C is a description of findings of a patient who has osteoarthritis. Enlarged and tender PIP joints refer to Heberden nodes and DIP joints refer to Bouchard nodes. Option D is a description of epicondylitis (tennis elbow). REF: p. 279 | p. 304

A patient asks, "Why is touching my toes is necessary? This is a sports physical examination, not exercise class." What is the most appropriate response by the nurse? a. "This is the best way to check for symmetry of your arms." b. "I am looking at the stretch of your hamstrings." c. "This allows me to see how straight your spinal column is." d. "I am assessing the flexion of your spine."

ANS: C Option C is the correct technique for inspecting the spine and for detecting scoliosis. Option A is an incorrect technique for assessing arm symmetry. The hamstrings are not normally assessed. Option D is not a correct statement. REF: p. 289

In teaching the group of patients about osteoporosis, the nurse identifies which one of these participants as having the highest risk for this disease? a. A small-boned, thin white American woman b. An American Indian man who smokes c. A Hispanic woman who has completed menopause d. An African-American man with a family history of osteoporosis

ANS: A A small-boned, thin white American woman has three risk factors for osteoporosis: female gender, white race, and small body size. Patient B has one risk factor: smoking. Patient C has two risk factors: female gender and menopause. Patient D has one risk factor: family history. REF: p. 278

A nurse palpates the patient's jaw movement by placing two fingers in front of each ear and asking the patient to slowly open and close the mouth. What movement does the nurse ask the patient to do next? a. Move the jaw side to side. b. Swallow. c. Smile. d. Clench the teeth together.

ANS: A Moving the jaw side to side assesses the range of motion of the jaw; asking the patient to protrude and retract the jaw also assesses range of motion. Swallowing assesses cranial nerve IX (glossopharyngeal) and X (vagus). Smiling assesses cranial nerve VII (facial). Clenching the teeth together assesses cranial nerve VII (facial). REF: p. 286

How does a nurse assess the eversion and inversion of a patient's ankle? a. For eversion, ask the patient to turn the sole of the foot away from the body and for inversion turn the sole of the foot toward the midline. b. For eversion, ask the patient to turn the sole of the inward toward the midline and for inversion turn the sole of the foot away from the body. c. For eversion, ask the patient to walk on his toes and, for inversion, to walk on his heels. d. For eversion, ask the patient to point the toes forward and, for inversion, to point the toes backward.

ANS: A Option A is the correct maneuver for eversion and inversion of the ankle. The movement mentioned in option B is the opposite of the correct movement. Option C is the test for muscle strength of the ankles and feet. Option D is the maneuver for dorsiflexion and plantar flexion of the ankle. REF: p. 300

With the patient lying supine, a nurse raises the patient's leg to flex the hip. The patient complains of pain when the leg is raised to 40 degrees. The nurse correlates this finding with which disorder? a. Lumbar nerve compression b. Cervical disk herniation c. Osteoarthritis d. Bursitis

ANS: A To evaluate for nerve root irritation or lumbar disk herniation, perform straight leg raises. Pain in the back of the leg with 30 to 60 degrees of elevation indicates pressure on a lumbar peripheral nerve by an intervertebral disk. Straight leg raises evaluate for herniated disks, but not in the cervical disks in the neck. Osteoarthritis is a degenerative disease of articular cartilage that affects weight-bearing joints such as vertebrae, hips, knees, and ankles. Straight leg raises is not a technique to assess for osteoarthritis. Bursa become inflamed by constant friction around joints and may be precipitated by arthritis or injury. The hip is a common site, but not vertebrae. Manifestations include painful range of motion, point tenderness, and erythema of the affected joint. REF: p. 297

Which movements does a nurse expect to find when assessing the ankle range of motion of a healthy person? (Select all that apply.) a. Inversion and eversion b. Plantar flexion and dorsiflexion c. Pronation and supination d. Adduction and abduction e. Rotation

ANS: A, B, D, E Options A, B, D, and E are all expected motions for the ankle joint. Pronation and supination are not expected motions for the ankle joint. REF: p. 283 | p. 300

Which findings are expected from a musculoskeletal assessment of a left-handed healthy adult? (Select all that apply.) a. Cervical concave, thoracic convex, and lumbar concave contours of the spine b. Muscle strength of 3/5 bilaterally c. Circumference of left upper arm larger than right upper arm d. Lumbar and thoracic spine flexion of 75 degrees e. External rotation and abduction of left arm of 90 degrees f. Flexion of right and left knees of 90 degrees

ANS: A, C, D, E Cervical concave, thoracic convex, and lumbar concave contours of the spine are expected findings of the spine. The circumference of the left upper arm larger than the right upper arm is considered an expected finding because this patient is left-handed, which may account for the increase in circumference. Lumbar and thoracic spine flexion of 75 degrees is an expected finding of the spine. Ninety-degree external rotation and abduction of the left arm is an expected finding of the spine. The expected muscle strength is 5/5. The expected flexion is 120 degrees. REF: p. 281 | p. 282 | p. 289 | p. 292

To assess the triceps and biceps muscle strength, the nurse applies resistance to the patient's arm. What should be done to ensure the appropriate muscle is being assessed? a. The patient pushes up against the nurse's hand to abduct the triceps muscle and pushes down against the nurse's hand to adduct the biceps muscle. b. The patient pushes forward against the nurse's hand to extend the triceps muscle and pulls backward against the nurse's hand to flex the biceps muscle. c. The patient pulls backward against the nurse's hand to flex the triceps muscle and pushes forward against the nurse's hand to extend the biceps muscle. d. The patient pushes up against the nurse's hand to abduct the biceps muscle and pushes down against the nurse's hand to adduct the triceps muscle.

ANS: B Option B is the correct technique for assessing these muscles. Abducting and adducting test range of motion rather than muscle strength. Option C is a reversal of the correct technique. Abducting and adducting test range of motion rather than muscle strength. REF: p. 285 | p. 292

In assessing a patient with a history of poliomyelitis, the nurse suspects the right leg muscles are smaller than the left leg. What is the best approach for the nurse to confirm or reject this suspicion? a. Palpating both legs using the pads of the thumb and index fingers and comparing one side with another b. Using a tape to measure each leg's circumference at the same location, above or below the nearest joint c. Using a goniometer to measure the upper and lower legs with the patient in supine and standing positions d. Palpating the legs using the tips of the thumb and index fingers, and comparing the findings with the Lovett scale

ANS: B Technique B is correct, provides a baseline for future comparisons, and provides measurements for side-to-side comparisons. Option A describes an appropriate procedure to determine tenderness of muscles, but not muscle size. The goniometer is used to measure the degree of joint flexion and extension rather than muscle size. The Lovett scale is used to grade and record muscle strength, rather than muscle size. REF: p. 282

Which movements does a nurse expect to find when assessing the hip range of motion of a healthy person? (Select all that apply.) a. Pronation and supination b. Flexion and extension c. Internal and external rotation d. Adduction and abduction e. Hyperextension

ANS: B, C, D, E Options B, C, D, and E are all expected motions for the hip joint. Pronation and supination are not expected motions for the hip joint. REF: p. 283

Nurses inquire about lifestyle behaviors of patients with risk factors for osteoarthritis. Which risk factors for osteoarthritis does the nurse ask about? (Select all that apply.) a. Estrogen deficiency b. Physical inactivity c. Overuse of joints d. Smoking e. Obesity f. Age

ANS: B, C, E Lack of exercise weakens muscles that support joints. Overuse of joints damages cartilage in joints. Being overweight puts stress on joints. Estrogen deficiency, smoking, and age are risk factors for osteoporosis rather than osteoarthritis. REF: p. 279

When a nurse asks a patient to place the right arm behind the back, so that the back of the hand is touching the lower spine, the nurse is testing for which range of motion? a. Pronation of the elbow b. Hyperextension of the elbow c. Internal rotation and adduction of the shoulder d, External rotation and abduction of the shoulder

ANS: C Internal rotation and adduction of the shoulder is tested by this maneuver. Pronation of the elbow is tested by pronating the palm on a flat surface. Hyperextension of the elbow is not a motion of the elbow. External rotation and abduction of the shoulder is tested by asking the patient to place the hand behind the head. REF: p. 283

When assessing the neck of a healthy adult, a nurse expects which findings? a. A convex contour of the posterior cervical spine b. Bending of the head to the right and left (ear to shoulder) 15 degrees c. Turning the chin to the right shoulder and then the left shoulder d. Hyperextension of the head 30 degrees from midline

ANS: C Option C is an expected finding. The posterior cervical spine should be concave. The patient should be able to laterally bend the head 40 degrees from midline in each direction. The patient should be able to hyperextend the head 55 degrees from midline. REF: p. 287

While giving a history, the patient reports having carpal tunnel syndrome. Based on this information, what technique does the nurse include in a focused assessment? a. Ask the patient to press the pads of the right and left fingers against each other and hold for 1 minute. b. Ask the patient to push the hand against the nurse's forearm while attempting to flex the wrist. c. Ask the patient to flex both wrists and press the dorsal aspects of the hands d. together for 1 minute. Hold pressure to the radial and ulnar pulses and watch for blanching.

ANS: C Option C is the correct technique for Phalen sign. Options A and B are not the correct techniques for Phalen sign. Option D is the technique for Allen's test, which is used to detect arterial circulation of the hand, rather than Phalen sign, which is used to test for carpel tunnel syndrome. REF: p. 296

With the patient in a supine position, how does a nurse test the external rotation of the patient's right hip? a. Asking the patient to move the right leg laterally with the right knee straight b. Asking the patient to flex the right knee and turn medially toward the left side (inward) c. Asking the patient to place the right heel on the left patella d. Asking the patient to raise the right leg straight up and perpendicular to the body

ANS: C Placing the right heel on the left patella externally rotates the right hip. Moving the right leg laterally with the right knee straight assesses abduction of the right hip. Flexing the right knee and turning medially toward the left side (inward) internally rotates the right hip. Raising the right leg straight up and perpendicular to the body flexes the right hip. REF: p. 297 | p. 298

A nurse asks a patient to describe his new onset of leg pain. He slept well through the night, but this morning he suddenly developed pain in his left lower leg that is red and too painful to touch. Nothing relieves the pain. Based on these data, the nurse suspects which disorder is causing this pain? a. Rheumatoid arthritis b. Osteoarthritis c. Gout d. Tendonitis

ANS: C Sudden onset of pain and erythema in the great toe, ankle, and lower leg suggests gout (also called gouty arthritis). Patients with rheumatoid arthritis often have morning stiffness lasting 1 to 2 hours. Patients with osteoarthritis experience pain when bearing weight that is relieved by rest. Tendonitis may awaken the patient, especially when the patient is lying on the affected limb. REF: p. 279

On inspection of a patient's hands, the nurse notices ulnar deviation and swan-neck deformities bilaterally and correlates this finding with which disorder? a. Osteoarthritis b. Osteoporosis c. Rheumatoid arthritis d. Gout

ANS: C Ulnar deviation, swan-neck, and boutonnière deformities of interphalangeal joints are manifestations of rheumatoid arthritis. The findings are consistent with rheumatoid arthritis. REF: p. 303

In assessing the joint range of motion of a patient's knees, the nurse notices the flexion is less than expected in both knees. What is the next appropriate action for the nurse? a. Documenting this finding as expected for this patient because it occurs in both knees b. Palpating the suprapatellar pouch on each side of the quadriceps for contour, tenderness, and edema c. Using a goniometer to measure the flexion in both knees and comparing the results with expected flexion d. Applying opposing force to the lower leg while the patient tries to maintain flexion and extension

ANS: C When a joint seems to have increased or decreased range of motion, use a goniometer to measure the angle. Option A is not an expected finding. Even when the finding is bilateral, when it is abnormal, additional examination is needed. Option B is the procedure for palpating the knees, in which data are collected, but it may not have a direct bearing on the lack of lexion of the knees. Option D is the procedure for testing leg muscles for strength, in which data are collected, but it may not have a direct bearing on the lack of flexion of the knees. REF: p. 284

When a nurse asks a patient to place the right arm behind the head, the nurse is testing for which range of motion? a. Flexion of the elbow b. Hyperextension of the shoulder c. Internal rotation and adduction of the shoulder d. External rotation and abduction of the shoulder

ANS: D External rotation and abduction of the shoulder is tested by this maneuver. Flexion of the elbow requires the patient to flex the elbow, but the elbow flexion is usually tested by asking the patient to bend the elbow so that the fingers are touching the shoulder. Hyperextension of the shoulder is tested by moving the arm straight backward. Internal rotation and adduction of the shoulder is tested by asking the patient to place the hand behind the back. REF: p. 283 | p. 292

A patient reports a history of compression of the left cranial nerve XI (spinal accessory nerve) from an old sports injury. Based on this information, what technique does the nurse include in the focused assessment? a. Asking the patient to rotate the head against resistance of the nurse's hand on the patient's chin b. Asking the patient to flex the chin to the chest against resistance of the nurse's hand on the patient's forehead c. Asking the patient to extend the head back against resistance of the nurse's hand on the back of the patient head d. Asking the patient to shrug the shoulders while the nurse attempts to push them down

ANS: D Option D is the technique to test strength of the trapezius muscle that is innervated by the cranial nerve XI. Option A is the technique to test the sternocleidomastoid muscle. Option B is the technique to test the sternocleidomastoid muscle. Option C is the technique to test the sternocleidomastoid muscle. REF: p. 291

The nurse asks the patient to rest the left arm on a table and to move the lower arm so that the palm of the hand is up and then down. What motion is the nurse testing? a. Adduction and abduction of the wrist b. Supination and pronation of the wrist c. Adduction and abduction of the elbow d. Supination and pronation of the elbow

ANS: D Supination and pronation of the elbow is tested by this maneuver. The movements of the wrist are flexion, extension, and ulnar and radial deviation. Option C is not a movement of the elbow. The elbow moves in flexion, extension, pronation, and supination. REF: p. 293

A patient reports joint pain interfering with sleep and morning joint stiffness for the first hour after getting out of bed. Considering this report, what abnormal findings does the nurse anticipate during the examination? a. Abrupt onset of local tenderness, edema, and decreased range of motion of the shoulder and hip bilaterally b. Decreased range of motion of one hip and knee with pain on flexion and crepitus during movement of these joints c. Erythema in one great toe, ankle, and lower leg that is painful to the touch d. Hot, painful, deformed, and edematous wrists and peripheral interphalangeal joints bilaterally

ANS: D The history and these examination findings are consistent with rheumatoid arthritis. Joints are involved bilaterally in rheumatoid arthritis because it is a systemic autoimmune disorder. The examination finding in option A is more consistent with bursitis. The examination finding in option B is more consistent with osteoarthritis. The examination finding in option C is more consistent with gout. REF: p. 293 | p. 295

The nurse notes that there is an audible clicking sound when the patient opens and closes the mouth. What is the appropriate response of the nurse at this time? a. Recording this as an abnormal finding, requiriing additional assessment b. Measuring the distance between each side of the mandible and the eyes c. Applying resistance to the maxilla and asking the patient to repeat the motion d. Documenting this finding as expected if no other signs or symptoms are found

ANS: D The mandible should move smoothly and painlessly. An audible or palpable snapping or clicking in the absence of other symptoms is not unusual. Option A would be an incorrect action because clicking of the mandible with no other associated signs or symptoms is a normal finding. Option B is not a correct assessment technique to use. Option C is not a correct assessment technique to use. REF: p. 286

The nurse asks the patient to hold the arms straight out, perpendicular to the floor, and the nurse tries to push the patient's arms down. This procedure tests the strength of which muscles? a. Triceps b. Biceps c. Trapezius d. Deltoid

ANS: D The patient uses the deltoid muscles to resist the action of the nurse. The nurse would test the triceps muscle strength by having the patient extend the arm and resist while the nurse tries to push the arm to a flexed position. The nurse would test the muscle strength of the biceps by having the patient flex the forearm while the nurse applies resistance. The nurse would test the trapezius by having the patient shrug the shoulders against resistance. REF: p. 285