CH 23 - Musculoskeletal System

Cartilage serves which functions in the body? Select all that apply. Cushioning the bones Providing stability Covering the surface of the bone Nourishing the synovial fluid Smoothing the surface of the bone

Cartilage is connective tissue that covers the surface of opposing bones in synovial joints. It cushions the bone, aiding in movement and providing stability to the musculoskeletal structure. Cartilage also smooths the surface of the bone, facilitating movement. Cartilage receives nourishment from the synovial fluid during joint movement and does not provide nourishment for the synovial fluid.

Which assessment indicates genu varum? 2 cm between the medial malleoli when the knees are together 3 cm between the medial malleoli when the knees are together 2 cm between the knees when the medial malleoli are together 3 cm between the knees when the medial malleoli are together

A persistent space of more than 2.5 cm between the knees when the medial malleoli are together indicates genu varum, or bowlegs. Therefore the distance of 3 cm indicates genu varum in the child. A distance of 2 cm between the medial malleoli when the knees are together is a normal finding, and it does not indicate any deformity. The child with genu valgum, or knock-knees, may have a distance of 3 cm between the medial malleoli when the knees are together. A distance of 2 cm between the knees when the medial malleoli are together does not indicate any structural deformity in the child and is a normal finding.

Which condition would the nurse expect in a patient who has been on bed rest for a month? Adhesive capsulitis Tear of rotator cuff Dislocated shoulder Subacromial bursitis

Adhesive capsulitis refers to the formation of fibrous tissues in the joint capsule, resulting in stiffness, progressive limitation of motion, and pain. It is associated with prolonged bed rest resulting in shoulder immobility for longer periods. Tearing of the rotator cuff occurs from a fall on the shoulder, throwing, or heavy lifting, but not caused by prolonged bed rest. Shoulder dislocation may occur with trauma but not because of prolonged bed rest. Subacromial bursitis involves strain in the muscles because of sports and local or systemic inflammatory process, but not as a result of prolonged bed rest.

Which instruction would the nurse give the patient to assess the trigeminal nerve? Close the eyes. Shrug the shoulders. Touch the chest with the chin. Move the jaw forward and laterally.

Cranial nerve V, or the trigeminal nerve, innervates the muscles of the jaw and mediates motor functions such as biting and chewing. Therefore the nurse asks the patient to move the jaw forward and laterally to check the integrity of the trigeminal nerve. Asking the patient to close the eyes helps in assessing the integrity of the oculomotor nerve. Asking the patient to touch the chest with the chin and to shrug the shoulders helps in assessing the integrity of the spinal accessory nerve.

The nurse appreciates a grating sound during joint manipulation of a patient with rheumatoid arthritis. Which term would the nurse use to document this finding? Ankylosis Crepitation Dislocation Subluxation

Crepitation is an audible and palpable crunching or grating sound associated with movement. In diseases such as rheumatoid arthritis, the articular surfaces in the joints become rough and the synovium becomes inflamed, causing crunching or crepitation. Ankylosis is stiffness or fixation of a joint; it does not produce a crunching sound with movement. Dislocation is a complete loss of contact between the two bones of a joint. Dislocation is also not associated with the grating of joints. In the case of subluxation, two bones in a joint stay in contact, but their alignment is disrupted.

The patient has been experiencing axial skeletal pain for 4 months and reports confusion, forgetfulness, insomnia, and fatigue. The nurse suspects which diagnosis? Scoliosis Achilles tenosynovitis Fibromyalgia syndrome Herniated nucleus pulposus

Fibromyalgia syndrome manifests as a widespread pain in the muscles. The patient with fibromyalgia syndrome may also have fatigue and insomnia along with the pain. This condition may cause psychosocial distress in the patient, leading to cognitive problems such as mental confusion and forgetfulness. Lateral curvature of the thoracic and lumbar segments of the spine indicates scoliosis in the patient; this patient will not necessarily have cognitive problems. Inflammation of a tendon sheath near the ankle is a sign of Achilles tenosynovitis. This condition will not manifest as a widespread pain in the axial skeleton. Nucleus pulposus present in the center of the intervertebral disc ruptures into the spinal canal, causing pressure on the spinal nerves. This condition is known as herniated nucleus pulposus. The patient with herniated nucleus pulposus will have severe pain, but not cognitive problems.

Which complication occurs as a result of a decrease in the blood supply to the femoral epiphysis? Spina bifida Talipes equinovarus Congenital dislocated hip Legg-Calve-Perthes syndrome

Inadequate blood supply to the femoral epiphysis may cause necrosis of the femoral head, resulting in Legg-Calve-Perthes syndrome, or coxa plana. Spina bifida occurs because of incomplete closure of the posterior vertebrae. Talipes equinovarus, or clubfoot, occurs because of genetic or environmental factors, such as exposure to cigarette smoke. Congenital hip dislocation refers to the displacement of the femoral head out of the acetabulum. Decreased blood supply to the femoral head will not cause hip dislocation.

Which signs and symptoms are associated with rheumatoid arthritis? Select all that apply. Fatigue Tingling Numbness Weight loss Low-grade fever

Inflammation of the synovial tissues and hyperplasia occur in the patient with rheumatoid arthritis, which is an autoimmune disease. Increased cytokine production in the patient with rheumatoid arthritis may lead to an increase in the basal metabolic rate. This increases caloric needs in the patient. Therefore the patient may have fatigue and weight loss. The patient with rheumatoid arthritis may have increased production of prostaglandins. Prostaglandins reset the thermostat of the brain to a higher level, resulting in low-grade fever. The patient with rheumatoid arthritis will not have tingling and burning sensations at the joints. Tingling and numbness are symptoms of a ganglion cyst.

Which disease is associated with hard, nontender Heberden and Bouchard nodules? Scoliosis Osteoporosis Osteoarthritis Carpal tunnel syndrome

Osteoarthritis is characterized by hard, nontender Heberden and Bouchard nodules. The bony outgrowths of distal interphalangeal joints are called Heberden nodes, and the bony outgrowths of proximal interphalangeal joints are called Bouchard nodes. Scoliosis is characterized by the lateral curvature of the thoracic and lumbar segments of the spine. Osteoporosis is a bone disorder characterized by a decrease in bone mass and density, which increases the risk of fractures. Carpal tunnel syndrome results in pain, burning, and numbness. It occurs because of atrophy of the median nerve of the wrist and hand.

Which joint facilitates pronation and supination movements of the hand and the forearm? Tibiotalar Radioulnar Radiocarpal Glenohumeral

Pronation is turning the forearm so that the palm faces down. Supination is turning the forearm so that the palm faces up. The elbow joint consists of three bones: the humerus, radius, and ulna. The radius and ulna articulate with one another at two radioulnar joints: one at the elbow and the other at the wrist. Both the radius and ulna move together and permit the pronation and supination movements of the hand and the forearm. The tibiotalar joint is present in the ankle and the feet; it permits extension and flexion of the foot in one plane. The radiocarpal joint is present in the wrist; it permits flexion and extension of the wrist. The glenohumeral joint is present in the shoulder; it permits movement of the arm on many axes.

Which characteristic feature indicates a positive Allis sign? Difference in the level of scapulae Burning sensation along the median nerve Presence of one knee lower than the other Presence of numbness while flexing the wrist

The Allis test helps in assessing for hip dislocation. The nurse performs this test by comparing the lengths of the legs; the presence of one knee lower than the other indicates a positive Allis sign. A difference in the levels of the scapulae occurs in the patient with scoliosis. A burning and tingling sensation along the distribution of the median nerve indicates a positive Tinel sign. A positive Tinel sign is indicative of carpal tunnel syndrome. Numbness during the flexion of the wrist indicates a positive Phalen test.

Which test helps in screening a child's fine and gross motor skills? Allis test Ortolani test Tinel sign test Denver II test

The Denver II test helps the nurse in screening a child's fine and gross motor skills. The nurse assesses the overall development of the child. The Allis test helps assess for hip dislocation. The Tinel sign test helps diagnose carpal tunnel syndrome. The Ortolani test helps assess developmental dysplasia of the hip.

Which instruction would the nurse give the patient in whom carpal tunnel syndrome is suspected? "Touch your chin to your chest." "Open your mouth as widely as you can." "Raise each leg with the knee extended." "Place your hands back to back and flex your wrists at a right angle."

The Phalen test reproduces numbness and burning in a person with carpal tunnel syndrome. It is a disorder of the wrist. To perform the Phalen test, the patient is asked to hold the hands back to back while flexing the wrists 90 degrees. Acute flexing of a normal wrist for 60 seconds produces no symptoms in a person not affected by carpal tunnel. Touching chin to chest and lifting the chin toward the ceiling test the function of the cervical spine. Asking the patient to open the mouth maximally assesses the proper functioning of the temporomandibular joint. Raising each leg with the knee extended assesses the functioning of the hip joint.

Which test helps in assessing a flexion deformity of the patient's hip? Allis Phalen Thomas McMurray

The Thomas test is a leg-raising test that involves flexion of the hip joint; therefore it helps determine hip flexion deformity in the patient. The nurse compares leg lengths of the patient while performing the Allis test to assess for hip dislocation. The patient holds the hands back to back while flexing the wrists during the Phalen test; this test helps determine carpal tunnel syndrome. The nurse instructs the patient to flex the knee joint while performing the McMurray test to determine the presence of a torn meniscus.

Which structure connects the knee joint at both sides and prevents its dislocation? Lateral meniscus Prepatellar bursa Cruciate ligaments Collateral ligaments

The knee joint is an articulation of three bones: the femur, the tibia, and the patella. Collateral ligaments connect the knee joint at both sides and prevent dislocation by giving medial and lateral stability. The lateral meniscus is a wedge-shaped cartilage that cushions the tibia and femur and protects them from external pressures. The prepatellar bursa lies between the patella and the skin, prevents friction, and thus helps the muscles and tendons glide smoothly over the bone. Cruciate ligaments provide anterior and posterior stability and help control rotation of the knee.

Which condition would the nurse assess by palpating the anterior thigh 10 cm from the patella and proceeding toward the knee? Crepitation Torn meniscus Subcutaneous nodules Quadriceps muscle atrophy

The quadriceps muscle in the anterior thigh is checked for atrophy of the muscles in the knee. The process involves palpating high, about 10 cm above the patella on the anterior thigh. The thumb and the fingers are used while palpating. The nurse would proceed down the knee, exploring the region of the suprapatellar pouch. Crepitation is detected by an audible crunching or grating of the joint caused by roughening of the articular surface of the joint. Crepitation is detected when the patient is checked for range of motion. The nurse palpates the area of the olecranon bursa to detect subcutaneous nodules. A torn meniscus is evaluated with the McMurray test. Common sites for subcutaneous nodules are in the olecranon bursa and along the extensor surface of the ulna.

Which condition involves the accumulation of sodium urate crystals in the joint space? Talipes equinovarus Achilles tenosynovitis Fibromyalgia syndrome Tophi with chronic gout

Tophi are collections of sodium urate crystals that appear in and around the joint. Tophi may appear in the joints of the patient with chronic gout. Patients with Achilles tenosynovitis, talipes equinovarus, or fibromyalgia syndrome will not have high levels of uric acid in the blood. Therefore they will not have tophi in the joint space. Achilles tenosynovitis refers to inflammation of the tendon sheath near the ankle. Talipes equinovarus refers to congenital and fixed malposition of the foot. Fibromyalgia syndrome manifests as widespread pain in the muscles.