Musculoskeletal

The nurse is caring for a client with Lyme disease. Which symptoms in the client lead the nurse to suspect early localized disease? Select all that apply. 1. Arthralgia 2. Cranial neuritis 3. Bull's-eye rash 4. Lymphadenopathy 5. Subacute encephalopathy

1. Arthralgia 3. Bull's-eye rash 4. Lymphadenopathy

A client is diagnosed with degenerative disc disease. Which form of physical therapy does the nurse anticipate the health-care provider will prescribe to reduce the movement of the spine and enhance the healing process? 1. Braces 2. Massage 3. Electrotherapies 4. Heat and cold packs

1. Braces

The nurse is reviewing the medical records of four clients. Client 1 - Injury to menisci Client 2- slightly abducted leg Client 3- sustained a fall on flexed hand Client 4- sustained a fall on extended hand Which client's medical record indicates the need to perform the McMurray test to assess the condition? 1. Client 1 2. Client 2 3. Client 3 4. Client 4

1. Client 1

After assessing a client with spinal stenosis, the health-care provider orders immediate decompression surgery. Which symptom in the client did the health-care provider likely observe? 1. Diminished bowel and bladder function 2. Severe lower back pain 3. Pain walking up and down stairs 4. Diminished Achilles reflex

1. Diminished bowel and bladder function

A nurse is caring for a client whose lumbar spinal nerve 4 (L4) is affected by degenerative disc disease (DDD). Which assessment finding does the nurse anticipate in the client? 1. Diminished patella reflex 2. Diminished Achilles reflex 3. Difficulty with dorsiflexion of the foot 4. Difficulty with plantarflexion of the foot

1. Diminished patella reflex

What are the modifiable risk factors for vertebral compression fracture? Select all that apply. 1. Estrogen deficiency 2. Presence of dementia 3. Bilateral ovariectomy 4. Susceptibility to falling 5. Presence of osteoporosis

1. Estrogen deficiency 5. Presence of osteoporosis

The radiographic reports of a client reveal inflammation of the metatarsophalangeal joint of the great toe. Which disorder should the nurse suspect in the client? 1. Gout 2. Lyme disease 3. Septic arthritis 4. Polymyalgia rheumatica

1. Gout

The nurse is assisting the health-care provider while performing some specific maneuvers in a client with a knee injury. The health-care provider stabilizes the client's distal femur with one hand, grasps the proximal tibia with the other hand, and then attempts to sublux the tibia anteriorly. Which maneuver is the health-care provider performing? 1. Lachman test 2. McMurray test 3. Valgus stress test 4. Anterior drawer test

1. Lachman test

The nurse is providing care for a client diagnosed with polymyositis and dermatomyositis. The nurse prepares the client for which most definitive diagnostic test? 1. Muscle biopsy 2. Western blot test 3. Immunofluorescent assay 4. Dual energy x-ray absorptiometry (DEXA) scan

1. Muscle biopsy

The nurse observes that an older adult client has a hunched back. Which disorder does the nurse suspect? 1. Osteoporosis 2. Osteomalacia 3. Osteoarthritis 4. Spinal stenosis

1. Osteoporosis

Which are the causes of secondary gout? Select all that apply. 1. Psoriasis 2. Scleroderma 3. Rheumatoid arthritis 4. Neoplastic disease 5. Glycogen storage disease

1. Psoriasis 4. Neoplastic disease 5. Glycogen storage disease

Which statement is true regarding rheumatoid arthritis and osteoarthritis? 1. Rheumatoid arthritis is an autoimmune disease. 2. Osteoarthritis is mainly treated with methotrexate. 3. Osteoarthritis is less common than rheumatoid arthritis. 4. Rheumatoid arthritis affects mainly the proximal and distal interphalangeal joints.

1. Rheumatoid arthritis is an autoimmune disease.

Which disorders result from vitamin D deficiency? Select all that apply. 1. Rickets 2. Osteoporosis 3. Osteoarthritis 4. Osteomalacia 5. Spinal stenosis

1. Rickets 4. Osteomalacia

A client presents with joint pain and limited range of motion (ROM) in the right shoulder. The client has a history of rheumatoid arthritis but states the pain in the shoulder is much worse than usual. Aspiration of synovial fluid indicates the presence of septic arthritis. Which intervention does the nurse include on the client's plan of care? 1. Short-term joint immobilization for pain control 2. Monitoring for the need of additional joint aspiration 3. Implementation and evaluation of active ROM exercises 4. Promotion of physical therapy during the acute stage for maintenance

1. Short-term joint immobilization for pain control

Which are the forms of psoriatic arthritis? Select all that apply. 1. Spondylitis 2. Septic arthritis 3. Dermatomyositis 4. Arthritis mutilans 5. Distal interphalangeal (DIP) predominant

1. Spondylitis 4. Arthritis mutilans 5. Distal interphalangeal (DIP) predominant

Which hormone indirectly helps in the formation of bone by stimulating muscle growth? 1. Testosterone 2. Calcitriol 3. Calcitonin 4. Parathyroid hormone

1. Testosterone

A client reports pain and immobility of the wrist. On assessment, the nurse finds decreased range of motion (ROM), edema, and ecchymosis of the distal radius. The health-care provider recommends a neurovascular examination for confirmation. Which information does the nurse expect to infer from these findings? 1. The client has a Smith fracture. 2. The client has a Colles fracture. 3. The client has a clavicle fracture. 4. The client has a greenstick fracture.

1. The client has a Smith fracture.

The nurse is caring for a client with degenerative disc disease (DDD). Which outcome indicates effective chiropractic therapy? 1. The client's discs are realigned. 2. The client has diminished inflammation. 3. The client has decreased neuropathic pain. 4. The client has receding pain from sciatica.

1. The client's discs are realigned.

Which type of joint is the shoulder joint classified as? Select all that apply. 1. Synovial 2. Vertebral 3. Diarthrosis 4. Synarthrosis 5. Amphiarthrosis

1. synovial 3. Diarthrosis

A nurse is providing care for a client diagnosed with ankylosing spondylitis. For which test does the nurse prepare the client? 1. X-ray 2. Bone biopsy 3. Electromyography 4. Radionuclide bone scan

1.X-ray

A nursing instructor is teaching a group of nursing students the causes of spinal nerve impingement. Which statement made by the student indicates the need for further teaching? 1. "Herniated discs may cause spinal nerve impingement." 2. "Disc thickening may cause spinal nerve impingement." 3. "Osteocyte formation may cause spinal nerve impingement." 4. "Compression of the disc may cause spinal nerve impingement."

2. "Disc thickening may cause spinal nerve impingement."

The nurse is teaching a client nonpharmacological therapy to treat gout. Which statement by the client indicates the need for additional teaching? 1. "I need to have some rapid weight loss." 2. "I should increase the intake of meats." 3. "I need to avoid incidences of binge drinking." 4. "I should drink 2 to 3 liters of fluid per day."

2. "I should increase the intake of meats."

Which statement made by a staff nurse indicates the need for additional information about treatment of various musculoskeletal disorders? 1. "Doxycycline is the first-line treatment for Lyme disease." 2. "Immunosuppressive agents are first-line agents for psoriatic arthritis." 3. "Oral corticosteroids are the first-line treatment for polymyalgia rheumatica." 4. "NSAIDs are the first-line agents for gout."

2. "Immunosuppressive agents are first-line agents for psoriatic arthritis."

The laboratory report of a client with a bone infection shows an abscess below the bone surface. Which stage of bone infection does the nurse recognize in the client? 1. 1 2. 2 3. 3 4. 4

2. 2

Which treatment does the nurse expect to be beneficial for a client diagnosed with Lyme disease? 1. A local corticosteroid injection 2. A 10- to 21-day course of doxycycline 3. A high starting dose of NSAIDs 4. An immediate single dose of doxycycline

2. A 10- to 21-day course of doxycycline

The nurse is providing care for an older adult client with a history of diabetes mellitus. The client presents with chills, fever, and malaise. The nurse notes localized tenderness, erythema, edema, and pain with movement of the lower right extremity. Which additional assessment information is most likely to support the presence of an infection? 1. A recent bout of influenza 2. A knee replacement surgery 3. A decrease in physical activity 4. A move to an extended care facility

2. A knee replacement surgery

Which are the common predisposing factors that cause cervical strain? Select all that apply. 1. Bruxism 2. Abnormal posture 3. Lifting heavy objects 4. Motor vehicle accidents 5. Fall on a supinated forearm

2. Abnormal posture 3. Lifting heavy objects 4. Motor vehicle accidents

For which reason does the nurse instruct the parents of a young girl to reduce the use of sunblock and cover-ups with their child? 1. Overuse of sunblock and cover-ups will inhibit the production of estrogen. 2. Absorption of calcium by the gastrointestinal (GI) tract is inhibited by the overuse of sunblock and cover-ups. 3. The production of osteoblast cells is inhibited by the excessive use of sunblock and cover-ups. 4. The level of parathyroid hormone decreases with the excessive use of sunblock and cover-ups.

2. Absorption of calcium by the gastrointestinal (GI) tract is inhibited by the overuse of sunblock and cover-ups.

The nurse finds that a client with a musculoskeletal disorder has pain in the malleolar zone. The client is also unable to bear weight for more than four steps. Which does the nurse expect the health-care provider to prescribe? 1. Foot x-ray 2. Ankle x-ray 3. Hawkins test 4. Apprehension test

2. Ankle x-ray

After assessing a client with a musculoskeletal disorder, the nurse concludes that the client has skeletal injuries. Which characteristics observed in the client support the nurse's conclusion? Select all that apply. 1. Spasm 2. Crepitus 3. Numbness 4. Clumsiness 5. Tingling sensation

2. Crepitus 3. Numbness 5. Tingling sensation

The nurse is obtaining a health history from a female client who is 70 years of age. The client has experienced two bone fractures over the past 5 years, one from an auto accident and the other from a fall on ice. Which information most strongly supports a concern about osteoporosis? 1. Wears sunscreen and a hat when outdoors 2. Experienced a total hysterectomy at age 35 3. Limited walking because of osteoarthritis 4. Receives protein primarily from chicken and fish

2. Experienced a total hysterectomy at age 35

A client presents with a swollen left thigh and a lower extremity that appears shortened. Which is the client's most likely condition recognized by the nurse? 1. Greenstick femur shaft fracture 2. Impacted femur shaft fracture 3. Incomplete femur shaft fracture 4. Transverse femur shaft fracture

2. Impacted femur shaft fracture

The nurse is caring for a client whose bone mineral density is -2 based on a T-score value, which compares the client's bone mineral density to the mean for young adult women. Which condition does this score indicate? 1. Osteomalacia 2. Osteopenia 3. Osteoporosis 4. Severe osteoporosis

2. Osteopenia

Which condition in a client is a cause of cauda equina syndrome? 1. Celiac disease 2. Paget's disease 3. Cushing's disease 4. End-stage renal disease

2. Paget's disease

Which are signs and symptoms of musculoskeletal trauma? Select all that apply. 1. Edema 2. Paresthesia 3. Joint clicking 4. Joint swelling 5. Gait disturbance

2. Paresthesia 3. Joint clicking 4. Joint swelling

A client exhibits pitting, ridging, and separation of nails from the nail bed. Which musculoskeletal disorder does the nurse suspect in the client? 1. Septic arthritis 2. Psoriatic arthritis 3. Ankylosing spondylitis 4. Polymyalgia rheumatica

2. Psoriatic arthritis

While reviewing an x-ray of the fingers of a client, the nurse observes that the end of the bone is whittled down to a sharp point. Which musculoskeletal disorder does the nurse suspect in the client? 1. Lyme disease 2. Psoriatic arthritis 3. Ankylosing spondylitis 4. Pott's disease

2. Psoriatic arthritis

A client is diagnosed with osteomalacia and undergoes therapy to correct the vitamin D deficiency and normalize phosphate levels. Which outcome indicates the successful completion of therapy? 1. The client does not experience any cervical back pain. 2. The client is able to walk up and down stairs comfortably. 3. The client does not report any numbness in the lower extremities. 4. The client reports normal bowel and bladder function.

2. The client is able to walk up and down stairs comfortably.

Which statement made by a client with musculoskeletal inflammation supports the nurse's suspicion of polymyalgia rheumatica? 1. "I feel pain and stiffness in my back when I am up during the day." 2. "I have noticed my nails are separating from my nail beds." 3. "I thought I had the flu, but the symptoms have lasted too long." 4. "I have pain during the night and have not been sleeping or resting well."

3. "I thought I had the flu, but the symptoms have lasted too long."

The nurse is reviewing synovial fluid with a group of staff nurses. Which statement by an attending nurse indicates the need for further review? 1. "Synovial fluid provides stabilizing effects." 2. "The volume of synovial fluid increases in the presence of a joint disease." 3. "There is a wide exchange between the bloodstream and the synovial joint." 4. "All the essential nutrients are delivered and metabolic by-products are cleared by the bloodstream."

3. "There is a wide exchange between the bloodstream and the synovial joint."

The nurse is caring for a client with a diagnosis of gout. Which medication in the client's prescription does the nurse suspect to decrease uric acid synthesis? 1. Probenecid 2. Colchicine 3. Allopurinol 4. Oral corticosteroids

3. Allopurinol

The nurse is providing care for a client diagnosed with iritis and pulmonary fibrosis. Which condition does the nurse associate with the client's diagnosis? 1. Polymyositis 2. Psoriatic arthritis 3. Ankylosing spondylitis 4. Polymyalgia rheumatica

3. Ankylosing spondylitis

While assessing a client with a musculoskeletal disorder, the nurse abducts the client's arm to 90 degrees and places anteriorly directed force on the posterior humeral head from behind. Which test is the nurse performing? 1. Hawkins test 2. Relocation test 3. Apprehension test 4. Neer impingement test

3. Apprehension test

The nurse is providing care for a client with a lower extremity fracture immobilized by a cast. Which complication does the nurse identify if assessment reveals tissue ischemia, functional impairment, and pain level disproportionate to the injury? 1. Horner syndrome 2. Cauda equina syndrome 3. Compartment syndrome 4. Carpal tunnel syndrome

3. Compartment syndrome

The nurse in a pediatric clinic identifies an infant with rickets. The mother, who is from a Middle Eastern culture, has been exclusively breastfeeding the infant since birth. Which most probable cause does the nurse recognize? 1. Incidence of rickets in breastfed infants is high. 2. The infant lacks sufficient calcium and vitamin D. 3. Cultural practices contribute to the diagnosis. 4. The mother has a history of being lactose intolerant.

3. Cultural practices contribute to the diagnosis.

The nurse is reviewing the medical record of a client. Which physiological disorder does the nurse recognize with a medical diagnosis of adhesive capsulitis? 1. Bursitis 2. Plantar fasciitis 3. Frozen shoulder 4. Carpal tunnel syndrome

3. Frozen shoulder

A client is diagnosed with ankylosing spondylitis. Which complications does the nurse expect to be present in the client? Select all that apply. 1. Neural inflammation 2. Paralysis of facial nerves 3. Inflammation of the eyes 4. Scarring throughout the lungs 5. Inflammation of joints in the extremities

3. Inflammation of the eyes 4. Scarring throughout the lungs 5. Inflammation of joints in the extremities

The nurse is reviewing laboratory results for a client. Which pathogen does the nurse recognize as causing ankylosing spondylitis? 1. Escherichia coli 2. Borrelia burgdorferi 3. Klebsiella pneumoniae 4. Staphylococcus aureus

3. Klebsiella pneumoniae

A client has a skin rash presenting as an oval-shaped and red-colored lesion. On assessment, the nurse finds enlargement of lymph nodes in this client. Which condition does the nurse suspect in the client? 1. Sacroiliitis 2. Dactylitis 3. Lyme disease 4.Psoriatic arthritis

3. Lyme Disease

The nurse is providing care for a client with suspected rickets. For which diagnostic testing does the nurse prepare the client? 1. Electromyography (EMG) 2. Bone mineral density (BMD) examination 3. Multiple-view x-ray studies 4. Dual energy x-ray absorptiometry (DEXA)

3. Multiple-view x-ray studies

Which physiological process takes place more rapidly after an individual is 30 years of age? 1. Bone growth 2. Osteoblastic activity 3. Osteoclastic activity 4. Bone remodeling

3. Osteoclastic activity

The nurse is providing client teaching about treatment needed for a grade 2 ankle sprain. Which type of acute treatment does the nurse teach to the client? 1. Rest, ice, compression, and elevation (RICE) 2. Immobilization 3. Protect, rest, ice, compression, and elevation (PRICE) 4. Physical therapy

3. Protect, rest, ice, compression, and elevation (PRICE)

The nurse is providing care for a client diagnosed with Pott's disease. Which possible complication does the nurse associate with the diagnosis? 1. Spinal rigidity from scarring 2. Development of pulmonary tuberculosis (TB) 3. Spinal deformity with instability 4. Uncorrectable spinal cord compression

3. Spinal deformity with instability

The nurse is discussing the various fluids of the musculoskeletal system with staff nurses. Which statement made by an attending nurse indicates understanding? 1. "Lubricin is a lubricating liquid present in a joint." 2. "Synovial fluid is a protein that acts as a lubricant for the bone surfaces of a joint." 3. "Chondrocytes synthesize proteoglycan fluid in the later stages of osteoarthritis." 4. "Edematous fluid makes the joint capsule less effective as a protector."

4. "Edematous fluid makes the joint capsule less effective as a protector."

The nurse is providing care for an older female client diagnosed with gout. Which statement by the nurse to the client conveys correct information? 1. "Thiazides are used to treat gout." 2. "Primary gout is attributed to obesity." 3. "Pott's disease is associated with gout." 4. "Estrogen protects against hyperuricemia."

4. "Estrogen protects against hyperuricemia."

The nurse is reviewing degenerative disc disease (DDD) with a group of staff nurses. Which statement made by an attending nurse indicates understanding? 1. "DDD occurs only in the cervical region of the vertebral column." 2. "Age-related degenerative changes in the discs are the main causes of lower back pain." 3. "Males are more susceptible than females to lumbar DDD." 4. "Onset of lumbar DDD occurs most often between the ages of 30 and 50."

4. "Onset of lumbar DDD occurs most often between the ages of 30 and 50."

The nurse is preparing to discharge a client to a rehabilitation facility after a total hip replacement because of a hip fracture. Which summary of the client's hospitalization best indicates adequate nursing care? 1. Lack of infection 2. Decreasing levels of pain 3. Obtained mobility with a walker 4. Absence of pulmonary complications

4. Absence of pulmonary complication

When assessing a client with a musculoskeletal disorder, the nurse finds lack of sensation in the dermatome areas of the lower extremity L5. The nurse suspects lumbar sprain/strain. Which does the nurse expect the health-care provider to prescribe in this situation? 1. Anticoagulant therapy 2. IV injection of muscle relaxants 3. X-ray and dual energy x-ray absorptiometry scan of the spine 4. Anteroposterior and lateral x-rays of the lumbar spine

4. Anteroposterior and lateral x-rays of the lumbar spine

The registered nurse is evaluating the performance of a student nurse performing a valgus stress test on a client whose leg is slightly abducted. Which intervention does the registered nurse correct before it can be performed by the student nurse? 1. Placing one hand at the lateral aspect of the knee joint 2. Placing one hand at the medial aspect of the distal tibia 3. Applying valgus stress with the knee at 30 degrees of flexion 4. Applying valgus stress with the knee at 90 degrees of flexion

4. Applying valgus stress with the knee at 90 degrees of flexion

The nurse is performing a physical examination on a client with a suspected musculoskeletal disorder. Which is the first nursing intervention performed during the examination? 1. Testing sensation using perception 2. Measuring muscle girth for symmetry 3. Evaluating peripheral vascular integrity 4. Assessing general appearance, contour, and symmetry

4. Assessing general appearance, contour, and symmetry

A client who is middle-aged comes to a clinic and reports knee pain. The client states, "I don't understand. I walk to and from work every day and climb three flights of steps to my office." Besides age, the nurse's assessment reveals the client is slightly overweight, and the knees are warm to the touch and slightly edematous. Which contributing factor to the client's manifestation does the nurse suspect? 1. Accumulation of edematous fluid in the joint 2. Increased joint stress related to body weight 3. Pain from inflammation of the synovial membrane 4. Cartilage deterioration from excess weight bearing

4. Cartilage deterioration from excess weight bearing

The nurse is caring for four clients diagnosed with different musculoskeletal disorders. Client 1 - Hip fracture Client 2- stress fracture Client 3- femur shaft fracture Client 4- vertebral compression fracture Which client requires treatment with calcitonin, calcium or vitamin D supplements, analgesics, and muscle relaxants? 1. Client 1 2. Client 2 3. Client 3 4. Client 4

4. Client 4

While teaching a group of student nurses about different types of fractures, the nursing instructor says, "This fracture is characterized by the crushing of cancellous bone." Which type of fracture is the nursing instructor describing? 1. Complete 2. Transverse 3. Comminuted 4. Compression

4. Compression

Which diagnostic test does the nurse expect the health-care provider to prescribe to confirm a diagnosis of osteoporosis? 1. Electromyography (EMG) 2. Computerized tomography (CT) scan 3. Magnetic resonance imaging (MRI) scan 4. Dual energy x-ray absorptiometry (DEXA) scan

4. Dual energy x-ray absorptiometry (DEXA) scan

Which condition is related to ankylosing spondylitis? 1. Formation of abscesses in the bone 2. Inflammation at the joint of the great toe 3. Formation of abscesses in the paravertebral muscles 4. Inflammation where tendons and ligaments join the bone around a joint

4. Inflammation where tendons and ligaments join the bone around a joint

For which reason is a dual energy x-ray absorptiometry scan used for a client with a musculoskeletal disorder? 1. It detects soft tissue abnormalities. 2. It identifies stress fractures and bony metastases. 3. It determines mechanical derangement of the knee joint. 4. It visualizes the bone mineral density (BMD) of the hip and vertebrae.

4. It visualizes the bone mineral density (BMD) of the hip and vertebrae.

The nurse is providing care for a client with a bone fracture. Which cells does the nurse identify as being involved in the healing of a bone? 1. Osteoblasts 2. Osteocytes 3. Osteoclasts 4. Osteoprogenitor cells

4. Osteoprogenitor cells

The nurse is providing care for a client with nonunion at the site of a fracture in a lower extremity. After 12 weeks of monitoring, the fracture site shows no signs of healing. Which prescription does the nurse anticipate from the health-care provider? 1. IV antibiotic therapy 2. Physical therapy to maintain function 3. Surgery to debride dead bone tissue 4. Placement of a bone graft at the site

4. Placement of a bone graft at the site

The laboratory report for a client shows elevated levels of interleukin-2 (IL-2) and interleukin-6 (IL-6). Which musculoskeletal disorder does the nurse suspect in the client? 1. Gout 2. Psoriatic arthritis 3. Ankylosing spondylitis 4. Polymyalgia rheumatica

4. Polymyalgia rheumatica

The primary care provider recommends measuring the trabecular bone density in a client's spine. For which diagnostic test does the nurse prepare the client? 1. X-ray 2. Electromyography (EMG) 3. Magnetic resonance imaging (MRI) scan 4. Quantitative computerized tomography (QCT) scan

4. Quantitative computerized tomography (QCT) scan

A client with osteoporosis was prescribed teriparatide therapy. Which outcome indicates the therapeutic effect of the medication has been achieved? 1. Reduced pain 2. Fortification of the bone 3. Reduced inflammation 4. Strengthening of the bone

4. Strengthening of the bone

In order to maintain a high level of understanding about skeletal muscles, the nurse reviews anatomy and physiology concepts. Which recall of information indicates the effectiveness of the nurse's review? 1. The thick filaments of sarcomeres are made up of a protein called actin. 2. The thin filaments of sarcomeres are made up of a protein called myosin. 3. The fascicles contain 10 to 30 muscle fibers encased in connective tissue called epimysium. 4. The individual muscle fibers of skeletal muscle are arranged in bundles called fascicles.

4. The individual muscle fibers of skeletal muscle are arranged in bundles called fascicles.

When assessing a client's muscle strength using the Lovett scale, the nurse finds the client has no joint motion with palpable contraction of the muscle. Which grade does the nurse assign to the client based on this finding? 1. Fair 2. Poor 3. Good 4. Trace

4. Trace