Chapter 14: Musculoskeletal System

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.

A This procedure tests hyperextension of the hip.

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

A A small-boned, thin white American woman has three risk factors for osteoporosis: female gender, white race, and small body size.

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.

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.

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"

A Muscle pain is often described as "crampy."

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.

A This is the correct maneuver for eversion and inversion of the ankle.

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

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.

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 Correct: Lack of exercise weakens muscles that support joints. Overuse of joints damages cartilage in joints. Being overweight puts stress on joints. Incorrect: Estrogen deficiency, smoking, and age are risk factors for osteoporosis rather than osteoarthritis.

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 Correct: These are all expected motions for the ankle joint.

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 Correct: 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.

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 Correct: These are all expected motions for the hip joint.

a. Sternocleidomastoid b. Trapezius c. Deltoid d. Pectoralis major

B The trapezius muscle is tested by the patient shrugging the shoulders while the nurse attempts to push them down.

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 pea-like 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

B This is a description of gout. The pealike nodules are tophi, collections of uric acid in subcutaneous tissue.

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.

B This is the correct technique for assessing these muscles.

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

B This technique is correct, provides a baseline for future comparisons, and provides measurements for side-to-side comparisons.

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

C Internal rotation and adduction of the shoulder is tested by this maneuver.

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

C Placing the right heel on the left patella externally rotates the right hip.

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

C Sudden onset of pain and erythema in the great toe, ankle, and lower leg suggests gout (also called gouty arthritis).

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

C This is an expected finding.

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 together for 1 minute. d. Hold pressure to the radial and ulnar pulses and watch for blanching.

C This is the correct technique for Phalen sign.

A patient asks, "Why is touching my toes 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 ham strings." c. "This allows me to see how straight your spinal column is." d. "I am assessing the flexion of your spine."

C This is the correct technique for inspecting the spine and for detecting scoliosis.

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

C Ulnar deviation, swan-neck, and boutonnière deformities of interphalangeal joints are manifestations of rheumatoid arthritis.

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

C When a joint seems to have increased or decreased range of motion, use a goniometer to measure the angle.

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

D External rotation and abduction of the shoulder is tested by this maneuver.

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

D Supination and pronation of the elbow is tested by this maneuver.

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

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 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, requiring 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

D The mandible should move smoothly and painlessly. An audible or palpable snapping or clicking in the absence of other symptoms is not unusual.

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

D The patient uses the deltoid muscles to resist the action of the nurse.

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

D This is the technique to test strength of the trapezius muscle that is innervated by the cranial nerve XI.