MUSCULOSKELETAL

When grading muscle strength, the nurse records a score of 3/5, which indicates a. no detection of muscular contraction. b. a barely detectable flicker of contraction. c. active movement against full resistance without fatigue. d. active movement against gravity but not against resistance.

d. active movement against gravity but not against resistance.

A patient is scheduled for total ankle replacement. The nurse should tell the patient that after surgery he should avoid a. lifting heavy objects. b. sleeping on the back. c. abduction exercises of the affected ankle. d. bearing weight on the affected leg for 6 weeks.

d. bearing weight on the affected leg for 6 weeks.

The bone cells that function in the formation of new bone tissue are called a. osteoids. b. osteocytes. c. osteoclasts. d. osteoblasts.

d. osteoblasts.

A patient with a stable, closed humeral fracture has a temporary splint with bulky padding applied with an elastic bandage. The nurse notifies the provider of possible early compartment syndrome when the patient has a. increasing edema of the limb. b. muscle spasms of the lower arm. c. bounding pulse at the fracture site. d. pain when passively extending the fingers.

d. pain when passively extending the fingers.

A patient with suspected disc herniation has acute pain and muscle spasms. The nurse's responsibility is to a. encourage total bed rest for several days. b. teach principles of back strengthening exercises. c. stress the importance of straight-leg raises to decrease pain. d. promote use of cold and hot compresses and pain medication.

d. promote use of cold and hot compresses and pain medication.

In teaching a patient with systemic lupus erythematosus about the disorder, the nurse knows the pathophysiology includes a. circulating immune complexes formed from IgG autoantibodies reacting with IgG. b. an autoimmune T-cell reaction that results in destruction of the deep dermal skin layer. c. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles. d. the production of a variety of autoantibodies directed against components of the cell nucleus.

d. the production of a variety of autoantibodies directed against components of the cell nucleus.

The nurse suspects an ankle sprain when a patient at the urgent care center describes a. being hit by another soccer player during a game. b. having ankle pain after sprinting around the track. c. dropping a 10-lb weight on his lower leg at the health club. d. twisting his ankle while running bases during a baseball game.

d. twisting his ankle while running bases during a baseball game.

Which persons are at high risk for chronic low back pain? (select all that apply) a. A 63-yr-old man who is a long-distance truck driver b. A 30-yr-old nurse who works on an orthopedic unit and smokes c. A 55-yr-old construction worker who is 6 ft, 2 in and weighs 250 lb d. A 44-yr-old female chef with prior compression fracture of the spine e. A 28-yr-old female yoga instructor who is 5 ft, 6 in and weighs 130 lb

a. A 63-yr-old man who is a long-distance truck driver b. A 30-yr-old nurse who works on an orthopedic unit and smokes c. A 55-yr-old construction worker who is 6 ft, 2 in and weighs 250 lb d. A 44-yr-old female chef with prior compression fracture of the spine

The nurse is obtaining a health history of a patient with a fracture. Which condition poses the most concern related to the musculoskeletal system? a. Diabetes b. Hypertension c. Chronic bronchitis d. Nephrotic syndrome

a. Diabetes

Teach the patient with fibromyalgia the importance of limiting intake of which foods? (select all that apply) a. Sugar b. Alcohol c. Caffeine d. Red meat e. Root vegetables

a. Sugar b. Alcohol c. Caffeine

The increased risk for falls in the older adult is likely due to (select all that apply) a. changes in balance. b. decrease in bone mass. c. loss of ligament elasticity. d. erosion of articular cartilage. e. decrease in muscle mass and strength.

a. changes in balance. b. decrease in bone mass. c. loss of ligament elasticity. e. decrease in muscle mass and strength.

A patient with a pelvic fracture should be monitored for a. changes in urine output. b. petechiae on the abdomen. c. a palpable lump in the buttock. d. sudden increase in blood pressure.

a. changes in urine output.

A patient with a torn ligament in the knee asks what the ligament does. The nurse's response is based on the knowledge that ligaments a. connect bone to bone. b. provide strength to muscle. c. lubricate joints with synovial fluid. d. relieve friction between moving parts.

a. connect bone to bone.

While performing passive range of motion for a patient, the nurse puts the elbow joint through the movements of (select all that apply) a. flexion and extension. b. inversion and eversion. c. pronation and supination. d. flexion, extension, abduction, and adduction. e. pronation, supination, rotation, and circumduction.

a. flexion and extension. c. pronation and supination.

A patient with a humeral fracture is returning for a 4-week checkup. The nurse explains that initial evidence of healing on x-ray is indicated by a. formation of callus. b. complete bony union. c. hematoma at the fracture site. d. presence of granulation tissue.

a. formation of callus.

The nurse teaches the patient with an above-the-knee amputation that the residual limb should not be routinely elevated because this position promotes a. hip flexion contracture. b. clot formation at the incision. c. skin irritation and breakdown. d. increased risk for wound dehiscence.

a. hip flexion contracture.

A patient who has had surgical correction of bilateral hallux valgus is being discharged from the same-day surgery unit. The nurse will teach the patient to a. rest frequently with the feet elevated. b. wear shoes continually except when bathing. c. soak the feet in warm water several times a day. d. expect the feet to be numb for the next few days.

a. rest frequently with the feet elevated.

A patient with osteomyelitis undergoes surgical debridement with implantation of antibiotic beads. When the patient asks why the beads are used, the nurse answers (select all that apply) a. "Oral or IV antibiotics are not effective in most cases of bone infection." b. "The beads are an adjunct to debridement and antibiotics for deep infections." c. "The beads are used to deliver antibiotics directly to the site of the infection." d. "This is the safest method to deliver long-term antibiotic therapy for bone infection." e. "Ischemia and bone death related to osteomyelitis are impenetrable to IV antibiotics."

b. "The beads are an adjunct to debridement and antibiotics for deep infections." c. "The beads are used to deliver antibiotics directly to the site of the infection."

A patient with osteosarcoma of the humerus shows understanding of his treatment options when he states a. "I accept that I have to lose my arm with surgery." b. "The chemotherapy before surgery will shrink the tumor." c. "This tumor is related to the melanoma I had 3 years ago." d. "I'm glad they can take out the cancer with such a small scar."

b. "The chemotherapy before surgery will shrink the tumor."

When administering medications to the patient with chronic gout, the nurse recognizes which drug is used as a treatment for this disease? a. Colchicine b. Allopurinol c. Sulfasalazine d. Cyclosporine

b. Allopurinol

What is most important to include in the teaching plan for a patient with osteopenia? a. Lose weight. b. Stop smoking. c. Eat a high-protein diet. d. Start swimming for exercise.

b. Stop smoking.

In caring for a patient after a spinal fusion, the nurse would report which finding to the health care provider? a. The patient has a single episode of emesis. b. The patient is unable to move the lower extremities. c. The patient is nauseated and has not voided in 4 hours. d. The patient reports of pain at the bone graft donor site.

b. The patient is unable to move the lower extremities.

In assessing the joints of a patient with osteoarthritis, the nurse understands that Bouchard's nodes a. are often red, swollen, and tender. b. indicate osteophyte formation at the PIP joints. c. are the result of pannus formation at the DIP joints. d. occur from deterioration of cartilage by proteolytic enzymes.

b. indicate osteophyte formation at the PIP joints.

A patient with rheumatoid arthritis has articular involvement. The nurse recognizes these characteristic changes include (select all that apply) a. bamboo-shaped fingers. b. metatarsal head dislocation in feet. c. noninflammatory pain in large joints. d. asymmetric involvement of small joints. e. morning stiffness lasting 60 minutes or more.

b. metatarsal head dislocation in feet. e. morning stiffness lasting 60 minutes or more.

The nurse should teach the patient with ankylosing spondylitis the importance of a. avoiding extremes in environmental temperatures b. regularly exercising and maintaining proper posture. c. maintaining patient's usual physical activity during flares. d. applying hot and cool compresses for relief of local symptoms.

b. regularly exercising and maintaining proper posture.

A patient with osteoarthritis is scheduled for total hip arthroplasty. The nurse explains the purpose of this procedure is to (select all that apply) a. fuse the joint. b. replace the joint. c. prevent further damage. d. improve or maintain ROM. e. decrease the amount of destruction in the joint.

b. replace the joint. d. improve or maintain ROM.

An abnormal assessment finding of the musculoskeletal system is a. equal leg length bilaterally. b. ulnar deviation and subluxation. c. full range of motion in all joints. d. muscle strength of 5/5 in all muscles.

b. ulnar deviation and subluxation.

In teaching a patient with Sjögren's syndrome about drug therapy for this disorder, the nurse includes instruction about the use of which drug? a. Pregabalin (Lyrica) b. Etanercept (Enbrel) c. Cyclosporine (Restasis) d. Cyclobenzaprine (Flexeril)

c. Cyclosporine (Restasis)

A patient is scheduled for a bone scan. The nurse explains that this diagnostic test involves a. incision or puncture of the joint capsule. b. insertion of small needles into certain muscles. c. administration of a radioisotope before the procedure. d. placement of skin electrodes to record muscle activity.

c. administration of a radioisotope before the procedure.

The nurse suspects a neurovascular problem based on assessment of a. exaggerated strength with movement. b. increased redness and heat below the injury. c. decreased sensation distal to the fracture site. d. purulent drainage at the site of an open fracture.

c. decreased sensation distal to the fracture site.

A patient with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when a. the patient is unable to tolerate prolonged immobilization. b. the patient cannot tolerate the surgery for a closed reduction. c. other nonsurgical methods cannot achieve adequate alignment. d. a temporary cast would be too unstable to provide normal mobility.

c. other nonsurgical methods cannot achieve adequate alignment.