Chapter 24: Assessing Musculoskeletal System

A nurse conducts a physical examination of the musculoskeletal system of a client who reports upper arm pain. Which instruction should the nurse provide the client when assessing flexion of the elbow? a. "Bend your elbow." b. "Straighten your elbow." c. "Turn your palms down." d. "With palms down, point your fingers toward the floor."

a. "bend your elbow." Asking the client to bend the elbow assesses for flexion. Asking the client to straighten the elbow assesses for extension. Asking the client turn the palms down assesses for pronation. Asking the client to turn the palms down and point fingers to the floor assesses flexion of the elbow.

When the client performs straight leg flexion, the client complains of pain that radiates down his leg. The nurse understands that this may indicate what? a. Herniated disc b. Hip fracture c. Degenerative joint disease d. Arthritis

a. Herniated disc Straight leg flexion that produces back and leg pain radiating down the leg may indicate a herniated disc. One leg longer than the other may indicate a hip fracture. Arthritis is accompanied by pain and stiffness. Asymmetry, discomfort when touched, or crepitus during movement may occur with degenerative joint disease.

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 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.

A 38-year-old woman presents with multiple small joints that are symmetrically involved with pain, swelling, and stiffness. Which of the following is the most likely explanation? a. Rheumatoid arthritis b. Septic arthritis c. Gout d. Trauma

a. Rheumatoid arthritis Rheumatoid arthritis is a systemic disease and accounts for multiple symmetrically involved joints. Septic arthritis is usually monoarticular, as are gout and trauma related joint pain.

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.

Which of the following are types of connective tissue? Select all that apply. a. Bone b. Ligaments c. Tendons d. Skeletal muscle e. Articulations

a. bone b. ligaments c. tendons The musculoskeletal system is composed of skeletal muscle and five types of connective tissue: bone, cartilage, ligaments, tendons, and fascia. Articulations are not connective tissue. Skeletal muscle is not connective tissue.

Which of these medications should a nurse ask a client if they are taking when assessing the risk for osteoporosis? Select all that apply. a. Corticosteroids b. Antihypertensives c. Estrogen replacement therapy d. Thyroid replacement drugs e. Rescue inhaler for asthma

a. corticosteroids d. thyroid replacement therapy Medications that may increase a client's risk for osteoporosis include corticosteroids, thyroid replacement drugs, seizure medications, and some drugs for gastrointestinal disorders. Antihypertensives & rescue inhalers for asthma do not cause bone loss. Estrogen replacement therapy is often indicated for females at risk for osteoarthritis when approaching menopause.

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.

An older adult client visits the clinic and tells the nurse that she has had shooting pain in both of her legs. The nurse should assess the client for signs and symptoms of a. herniated intervertebral disc. b. rheumatoid arthritis. c. osteoporosis. d. metastases.

a. herniated intervertebral disc Thirty-three bones: 7 concave-shaped cervical (C); 12 convex shaped thoracic (T); 5 concave-shaped lumbar (L); 5 sacral (S); and 3-4 coccygeal, connected in a vertical column. Bones are cushioned by elastic fibrocartilaginous plates (intervertebral discs) that provide flexibility and posture to the spine. Paravertebral muscles are positioned on both sides of vertebrae.

When providing teaching to clients in the community, a nurse is accurate in stating that the musculoskeletal system is most closely aligned with which other body system? a. neurological system b. gastrointestinal system c. renal system d. integumentary system

a. neurological system The musculoskeletal system is enervated by the neurological system. Examination of the two systems are closely aligned.

While assessing the range of motion in an adult client's shoulders, the client expresses pain and exhibits limited abduction and muscle weakness. The nurse plans to refer the client to a physician for possible a. rotator cuff tear. b. nerve damage. c. cervical disc degeneration. d. tendonitis.

a. rotator cuff tear Painful and limited abduction accompanied by muscle weakness and atrophy are seen with a rotator cuff tear.

A nurse is conducting a physical examination of the musculoskeletal system of a client who reports having joint pain. Which signs indicate there is inflammation in the joints? Select all that apply. a. swelling b. warmth c. redness d. tenderness e. subcutaneous nodules

a. swelling b. warmth c. redness d. tenderness Swelling is palpable and involves the synovial membrane of the joints. The nurse should assess to note if the area surrounding the joints feels boggy and doughy. Nearby tissues of joints may feel warm to touch; heat is always generated as a result of the inflammation process. Redness is less common, but if present it is also a sign of inflammation around a joint. Due to pressure from swelling of the tissues surrounding affected joints, inflammation causes tenderness and is painful to touch. Subcutaneous nodules are extra-articular lesions associated with rheumatoid arthritis and is not one of the four signs of inflammation commonly seen in the tissues surrounding joints.

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.

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 using a goniometer while conducting the physical examination of a client's musculoskeletal status. What will the nurse use this device to measure? a. Length of extremities b. Degree of joint motion c. Ease of ambulation d. Amount of subcutaneous tissue

b. Degree of joint motion The goniometer is used to measure the degrees of joint motion. A tape measure is used to measure extremity length. No device is used to measure the ease of ambulation. Skinfold caliper is used to measure the amount of subcutaneous tissue.

A college age athlete presents to the clinic with pain in the tibiotalar joint. It is a hinge joint limited to flexion and extension. The terms used to describe these movements are what? a. Adducting and abducting b. Dorsiflexion and plantar flexion c. Supination and pronation d. Rotation and supination

b. Dorsiflexion and plantar flexion The terms used to describe the movements of the tibiotalar joint are dorsiflexion and plantar flexion. Adducting means to move a part of the body toward the midline. Abducting is moving a part of the body away from the midline. Supination is a motion where the foot or palm of the hand is moved to a surface up position. Pronation is a motion where the foot or palm of the hand is moved to a surface down position. Rotation is simply the movement of the joint. Rotation could be either internal or external in nature.

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 a 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 nurse suspects that a client has carpal tunnel syndrome of the right wrist. What did the nurse assess to make this clinical determination? a. strong hand grasp b. numb index finger c. weak extension of the wrist d. wrists held in flexion for 90 seconds

b. numb index finger The median nerve innervates the thumb, index finger, middle finger, and part of the ring finger of the volar surface. A numb index finger would indicate carpal tunnel syndrome. A strong hand grasp indicates adequate innervation of the hand. Weak extension of the wrist is seen in peripheral nerve disease such as radial nerve damage and in central nervous system disease producing hemiplegia, as in stroke or multiple sclerosis. The ability to hold the wrists in flexion for 90 seconds indicates the absence of 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.

Mrs. Fletcher presents to the office with chronic unilateral pain when chewing. She does not have facial or scalp tenderness. Which of the following is the most likely cause of her pain? a. Trigeminal neuralgia b. Temporomandibular joint syndrome c. Temporal arteritis d. Tumor of the mandible

b. temporomandibular joint syndrome Temporomandibular joint syndrome is a very common cause of pain with chewing. Ischemic pain with chewing, or jaw claudication, can occur with temporal arteritis, but the lack of tenderness of the scalp overlying the artery makes this less likely. Trigeminal neuralgia can be associated with extreme tenderness over the branches of the trigeminal nerve. While a tumor of the mandible is possible, it is much less likely than the other choices.

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).

A client is able to actively move the right arm against gravity. How should the nurse document this finding using the muscle strength grading scale? a. 1 b. 2 c. 3 d. 4

c. 3 Using the muscle strength grading scale, active movement against gravity is graded as a 3. A grade 1 is a barely detectable flicker or trace of contraction. A grade 2 is active movement of the body part with no gravity. A grade 4 is active movement against gravity and some resistance.

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.

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.

The nurse is planning a presentation on osteoporosis to a group of high school students. Which of the following should the nurse plan to include in the presentation? a. Bone density rises to a peak at age 50 for both sexes. b. Bone density in the Asian population is higher than in the white population. c. Moderate strenuous exercise tends to increase bone density. d. Approximately 5 million fractures in the United States are due to osteoporosis.

c. Moderate strenuous exercise tends to increase bone density. Regular exercise promotes flexibility, bone density, and muscle tone and strength. It can also help to slow the usual musculoskeletal changes (progressive loss of total bone mass and degeneration of skeletal muscle fibers) that occur with aging.

A community health nurse is providing education to help reduce musculoskeletal injuries in adults. What should the nurse include in these instructions? (Select all that apply.) a. Importance of regular exercise b. Maintaining a body weight appropriate to height and frame c. Using proper body mechanics with lifting objects d. Maintaining a safe home environment e. Limiting intake of dairy products

c. Using proper body mechanics with lifting objects b. Maintaining a body weight appropriate to height and frame a. Importance of regular exercise d. Maintaining a safe home environment Health promotion topics to prevent musculoskeletal injuries include engaging in regular exercise, maintaining a body weight appropriate to height and frame, using proper body mechanics with lifting or moving objects, and maintaining a safe home environment. Clients should not be told to limit dairy intake because this is a source of dietary calcium. Having the recommended daily intake of calcium can prevent risk factors for osteoporosis, therefore, musculoskeletal injuries.

Which joint movement is a nurse testing when asking a client to move an extremity towards the body? a. Flexion b. Extension c. Adduction d. Abduction

c. adduction Adduction is the movement towards the midline of the body. Flexion is bending the extremity at the joint and decreasing the angle of the joint. Extension is straightening the extremity at the joint and increasing the angle of the joint. Abduction is moving away from the midline of the body.

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.

During palpation of the client's knee, the nurse compresses the suprapatellar pouch against the client's femur with one hand while feeling on each side of the patella with the opposite hand. For which of the following problems is the nurse assessing? a. Crepitus uteri flexion b. Osteoarthritis c. Effusion in the knee joint d. Ligament trauma

c. effusion in the knee joint The balloon sign is indicative of a large effusion in the knee joint when fluid is palpable medial to the patella when the suprapatellar pouch is depressed. The presence of crepitus, osteoarthritis, or ligament damage is not directly suggested by a positive balloon sign.

What range of motion is the nurse testing by asking a client to stoop to pick an object off the floor? a. Extension b. Abduction c. Flexion d. Rotation

c. flexion Stooping is another term for bending. The client must be able to flex the thoracic and lumbar spines and flex the knees. Extension is straightening the extremity at the joint and increasing the angle of the joint. Abduction is moving away from the midline of the body. Rotation is turning the head to the right and then the left.

One of the functions of a bone is to a. store fat. b. produce secretions. c. produce blood cells. d. store protein.

c. produce blood cells Bones provide structure, give protection, serve as levers, store calcium, and produce blood cells.

A nurse has just finished assessing a client's spine and neck muscles. How would the nurse document normal findings? a. C8 and T1 spinous processes prominent. Paravertebral, sternocleidomastoid, and trapezius muscles fully developed, symmetrical, and nontender b. All findings within normal limits c. Neck assessment WNL d. C7 and T1 spinous processes prominent. Paravertebral, sternocleidomastoid, and trapezius muscles fully developed, symmetrical, and nontender

d. C7 and T1 spinous processes prominent. Paravertebral, sternocleidomastoid, and trapezius muscles fully developed, symmetrical, and nontender Normal findings are that the C7 and T1 spinous processes are prominent. The paravertebral, sternocleidomastoid, and trapezius muscles are fully developed, symmetrical, and nontender. Therefore, other options are incorrect.

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.

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.

A school age client has been diagnosed with genu valgum. What is the other name for this disease? a. Clubfoot b. Flatfeet c. Bowlegs d. Knock kneed

d. knock kneed Many children have a temporary period of genu valgum, but persistent knock knee may be genetic or the result of metabolic bone disease. The client may need to swing each leg outward while walking to prevent striking the planted limb with the moving limb. The strain on the knee frequently causes anterior and medial knee pain. Physical therapy and surgical intervention may be required. Bowlegs, also known as genu varum, the knees do not touch when the child stands with the feet together. Bowlegs is consider normal up to the age of 2 to 3 years, but may persist until age 6. Clubfoot, also known as congenital talipes equinovarus (CTEV), is a congenital deformity that rotates the foot internally at the ankle. Flatfeet, a deformity of the foot where the arch collapses or never properly forms.

The external covering of the bone that contains osteoblasts and blood vessels is termed the a. cartilage. b. synovial membrane. c. connective tissue. d. periosteum.

d. periosteum The periosteum covers the bones; it contains osteoblasts and blood vessels that promote nourishment and formation of new bone tissues.

The nurse is assessing the spine of an adult client and detects lateral curvature of the thoracic spine with an increase in convexity on the left curved side. The nurse suspects that the client is experiencing a. lordosis. b. arthritis. c. kyphosis. d. scoliosis.

d. scoliosis A lateral curvature of the spine with an increase in convexity on the side that is curved is seen in scoliosis.

A high school soccer player "blew out his knee" when the opposing goalie's head and shoulder struck his flexed knee while the goalie was diving for the ball. All of the following structures were involved in some way in his injury, but which of the following is a nonarticular structure? a. Synovium b. Joint capsule c. Juxta-articular bone d. Tendons

d. tendons Nonarticular structures include the periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve and overlying skin. The articular structures include the joint capsule and articular cartilage, the synovium and synovial fluid, intra-articular ligaments, and juxta-articular bone.

The nurse instructs the client to raise his arm out to the side and overhead. The nurse is asking the client to adduct his arm. true false

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