PrepU Chapter 21 Questions

During the health history of the musculoskeletal system, the client reports having low back pain that radiates into the leg with numbness and tingling. The nurse should further assess for spinal stenosis when the client makes which of the following statements? a) "The pain improves when I am leaning over a shopping cart" b) "The pain is relieved when I am sitting to have a bowel movement" c) " The pain is relieved when I cough or sneeze" d) "The pain improves when I exercise"

"The pain improves when I am leaning over a shopping cart" Explanation: Radiating leg pain with numbness and tingling are common low back pain symptoms. Pain due to spinal stenosis is relieved when the client is in a flexed position, such as when leaning over a shopping cart. Leg pain that resolves with forward flexion suggests spinal stenosis. Because pain from spinal stenosis is due to spinal compression, exercise may actually exacerbate pain caused by this condition. Coughing, sneezing and bearing down, such as when the client is sitting to have a bowel movement would also serve to increase pain associated with spinal stenosis.

A client is brought to the health care facility with a sudden loss of movement on the right side of the body. Upon assessment, the nurse finds that the client has a slight flicker of contraction in the muscles on the right side. What should the nurse document as the muscle strength rating? a) 2 b) 4 c) 3 d) 1

1 Explanation: The nurse should rate the muscle strength as 1. Muscle rating 4 is given when the client is able to perform active motion against some resistance. When the client is able to perform active movements against gravity, the muscle strength is graded as 3. If the client is able to perform passive ROM, the muscle strength is rated as 2.

How many vertebrae make up the spinal column? a) 31 b) 32 c) 33 d) 37

33 Explanation: The spine is a column of 33 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 3 to 4 coccygeal.

Assessment reveals that a client has slight weakness with active range of motion against some resistance. The nurse would document this as which of the following? a) 2/5 b) 4/5 c) 3/5 d) 5/5

4/5 Explanation: Muscle strength is rated on a 5-point scale with specific defining characteristics for each. Slight weakness with active motion against some resistance is 4 of 5 points. 2 of 5 points would indicate passive and poor range of motion. 3 of 5 points would indicate average weakness with active motion against gravity. 5 of 5 points would indicate normal findings with active motion against full resistance

To test flexion and extension of the biceps and triceps muscle at the elbow, the nurse tells the patient to a) put the arm behind the back b) pull and push against the examiner's hand c) hold the arm over the head d) bend at the elbow

pull and push against the examiner's hand

Skeletal muscles are attached to bones by a) ligaments. b) fibrous connective tissue. c) tendons. d) cartilage.

tendons. Explanation: Skeletal muscles attach to bones by way of strong, fibrous cords called tendons.

What is an appropriate question by the nurse to ask a client about the presence of temporomandibular joint dysfunction? a) "Have you noticed a popping or grating sound when you chew?" b) "Please stick out your tongue sand move it from side to side" c) "Do you notice any swelling around the teeth or gums?" d) "Can you fully clench your teeth and feel the muscles in your jaw tense?"

"Have you noticed a popping or grating sound when you chew?" Explanation: 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 patient has been admitted to a medical unit. The nurse notes that the patient has irregular, uncoordinated movements. How would the nurse document this finding? a) "Patient shows signs of ataxia." b) "Patient is atonic." c) "Patient demonstrates hypotonicity." d) "Patient exhibits spasticity."

"Patient shows signs of ataxia." Explanation: Ataxia (irregular uncoordinated movements) or loss of balance may be due to cerebellar disorders, Parkinson disease, multiple sclerosis, strokes, brain tumors, inner ear problems, or medications

A previously healthy 64-year-old man has been recently diagnosed with osteoarthritis. The client is motivated to maintain his quality of life and slow the progression of his new health problem. What advice can the nurse provide for the client in his efforts to minimize the effects and progression of osteoarthritis? a) "It's important for you to maintain a healthy body weight." b) "Because this is generally an unavoidable aspect of the aging process, there is little you can do to affect how quickly or slowly it progresses." c) "Increasing the amount of calcium that you get in your diet has been shown to have a real effect." d) "It is helpful for you to make sure that you get enough vitamin D in your diet or to take supplements."

"It's important for you to maintain a healthy body weight." Explanation: Maintaining a healthy body weight can slow the progression of OA. The disease is not significantly affected by calcium and vitamin D intake. While it is a common accompaniment to aging, there are still tangible actions that clients can take to slow the progression.

When assessing a patient's foot, how would the nurse document an exaggerated arch height? a) "Patient has pes varus." b) "Patient has pes planus." c) "Patient has pes cavus." d) "Patient has pes valgus."

"Patient has pes cavus." Explanation: Pes cavus is an exaggerated arch height.

Moving a part of the body away from the midline is called? a) Abduction b) Rotation c) Extension d) Adduction

Abduction Explanation: Movement of a part away from the center of the body is called abduction. Adduction is movement of a part of the body toward the midline. Rotation can be either internal or external, referring to rotation of a joint toward or away from the body. Extension is a straightening movement that increases the angle between body parts.

A nurse performs a nudge test to assess the gait of a client with Parkinson's disease. Which action by the nurse demonstrates the correct technique for performing this test? The nurse should stand: a) At the back of the client and nudge the back b) In front of the client and nudge the back c) At the back of the client and nudge the sternum d) In front of the client and nudge the sternum

At the back of the client and nudge the sternum Explanation: To perform the nudge test, the nurse should stand at the back of the client and nudge his sternum. The nurse should put arms around the client to prevent a fall. Falling backward easily is seen with cervical spondylosis and Parkinson's disease. Standing in front of the client and nudging his sternum, standing at the back of the client and nudging his back, and standing in front of the client and nudging his back are inaccurate methods for performing the nudge test.

A nurse is caring for a client who is recovering from a stroke. The nurse assesses the muscle strength of the client's arm and finds that the joint exhibits active motion against gravity. Which of the following should the nurse document to classify muscle strength based on this finding? a) Poor range of motion b) Average weakness c) Slight weakness d) Severe weakness

Average weakness Explanation: The nurse should document the finding as average weakness of the arm muscles. In passive range of motion (ROM), gravity is removed and the client performs ROM with assistance; in this case, the strength is classified as poor ROM. When the client is able to perform the active motion against some resistance, it is classified as slight weakness. If the client has only a slight flicker of contraction, muscle strength is classified as severe weakness.

Inspection of a client's knee reveals swelling, and the nurse suspects that there is significant fluid in the knee. Which of the following would the nurse use to confirm the suspicion? a) Tinel's test b) Ballottement test c) Phalen's test d) Lasegue's test

Ballottement test Explanation: The ballottement test is used to detect large amounts of fluid in the knee. Phalen's test and Tinel's test would be used to assess for carpal tunnel syndrome. Lasegue's test is used to detect low back pain

To assess abduction of the shoulders and arms, a nurse should ask a client to do which of the following? a) Move the arms backward starting with the arms at the sides b) Bring both hands together overhead starting with the arms at the sides c) Move the arms forward starting with the arms at the sides d) Move the arms to the sides starting with the hands together overhead

Bring both hands together overhead starting with the arms at the sides Explanation: 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 70-year-old woman has come to the clinic to follow up her bone density testing. The results suggest that she has osteoporosis. What is a medication that might be ordered for this patient? a) Thyroid hormone b) Testosterone c) Vitamin C supplements d) Calcitonin

Calcitonin Explanation: Although osteoporosis can be treated, no cure has been found. Prevention is very important, especially for women. Current treatment includes bisphosphonates, calcitonin, estrogen and/or HRT, raloxifene, and parathyroid hormone

A nurse is working with a client who has cervical disc degenerative disease with resulting impaired range of motion and pain that radiates to the back. The nurse understands that joints between the vertebrae are which type of joint? a) Cartilaginous b) Compact c) Synovial d) Fibrous

Cartilaginous Explanation: Fibrous joints (e.g., sutures between skull bones) are joined by fibrous connective tissue and are immovable. Cartilaginous joints (e.g., joints between vertebrae) are joined by cartilage. Synovial joints (e.g., shoulders, wrists, hips, knees, ankles) contain a space between the bones that is filled with synovial fluid, a lubricant that promotes a sliding movement of the ends of the bones. Compact is a type of bone, not a type of joint.

Mark is a contractor who recently injured his back. He was told he had a "bulging disc" to account for the burning pain down his right leg and slight foot drop. The vertebral bodies of the spine involve which type of joint? a) Synovial b) Cartilaginous c) Synostosis d) Fibrous

Cartilaginous Explanation: The vertebral bodies of the spine are connected by cartilaginous joints involving the discs. The elbow would be an example of a synovial joint and the sutures of the skull are an example of a fibrous joint.

A nurse is providing health education about osteoporosis to a community group. What ethnicity is considered to be an independent risk factor for osteoporosis? a) South Asian b) African American c) Native American d) Caucasian

Caucasian Explanation: Caucasian ethnicity is a risk factor for osteoporosis. This is not true of the other listed ethnicities.

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) Range of motion tests c) X-rays d) Client's symptoms

Client's symptoms Explanation: 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.

The nurse is assessing an adolescent client and notes 45-degree flexion of the cervical spine. What is the nurse's most appropriate action? a) Perform the Lasègue test. b) Facilitate a referral for medical follow up. c) Continue the exam because this curve is normal. d) Palpate the spinous processes.

Continue the exam because this curve is normal. Explanation: Normal flexion of the cervical spine is 45 degrees. Since the finding is normal, further assessment or referral would be unnecessary.

When assessing the client's upper extremities, the nurse instructs the client to put the hands behind the neck with the elbows pointed laterally. This positioning facilitates assessment of which of the following functions? a) Internal rotation of the shoulder b) Muscle strength of the deltoids c) Elbow flexion d) External rotation of the shoulder

External rotation of the shoulder Explanation: Pointing the elbows laterally tests the shoulder's ability to rotate externally and abduct.

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) Ease of ambulation b) Length of extremities c) Amount of subcutaneous tissue d) Degree of joint motion

Degree of joint motion Explanation: 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 client complains of temporomandibular joint (TMJ) pain. Which of the following would the nurse most likely assess? a) History of fracture b) Knife-like pain c) Recent weight gain d) Difficulty chewing

Difficulty chewing Explanation: A client with temporomandibular joint problems may describe the jaw "getting locked" or difficulty chewing. Jaw tenderness, pain, or clicking sound may be present with range of motion. Knife-like pain, history of fracture, and recent weight gain are not associated with TMJ pain

The client is the pitcher of the high school baseball team. He is brought to the clinic by his mother with a complaint of pain in his right elbow. Where would the nurse expect to locate his tenderness? a) Over the right olecranon process b) Proximal to the right olecranon bursa c) Distal to the right lateral epicondyle d) Distal to the right medial epicondyle

Distal to the right medial epicondyle Explanation: Tenderness is distal to the epicondyle in lateral epicondylitis (tennis elbow) and less commonly in medial epicondylitis (pitcher's or golfer's elbow)

The nurse is examining an older adult client. During the physical assessment, the client appears to be getting fatigued. What can the nurse do to help the client finish the assessment? a) Omit tests b) Divide the assessment into portions c) Halt the assessment, and finish when the client has enough strength d) Rush through each activity to finish more quickly

Divide the assessment into portions Explanation: Examiners should allow extra time for older adults to complete each activity. They may divide the assessment into portions if an older client appears fatigued. Rushing through the assessment or omitting tests would not provide a through assessment.

A nurse asks a client to bring the hands together behind the head with the elbows flexed. The nurse is testing which of the following? a) Internal rotation b) External rotation c) Abduction d) Adduction

External rotation Explanation: When the client brings the hands together behind the head with the elbows flexed, the nurse is testing external rotation. Abduction is tested by having the client bring both hands together overhead with the elbows straight; adduction is tested by having the client bring both hands together in front of the body past the midline with the elbows straight. Internal rotation is tested by having the client bring the hands together behind the back with the elbows flexed

When assessing the client's upper extremities, the nurse instructs the client to put the hands behind the neck with the elbows pointed laterally. This positioning facilitates assessment of which of the following functions? a) Elbow flexion b) Internal rotation of the shoulder c) External rotation of the shoulder d) Muscle strength of the deltoids

External rotation of the shoulder Explanation: Pointing the elbows laterally tests the shoulder's ability to rotate externally and abduct.

A 55-year-old woman with a history of type 2 diabetes went through menarche at age 19 and menopause 2 years ago. Which of the preceding is a risk factor for osteoporosis? a) Diabetes b) Late menarche c) Postmenopausal status d) Late menopause

Postmenopausal status Explanation: Diabetes, late menopause, and late menarche are not associated with osteoporosis. Postmenopausal status is the only choice that is a known risk factor for osteoporosis.

A 28-year-old graduate student comes to the clinic for evaluation of pain "all over." With further questioning, she can relate that the pain is worse in the neck, shoulders, hands, low back, and knees. She denies swelling in her joints; she states that the pain is worse in the morning; there is no limitation in her range of motion. On physical examination, she has several points on the muscles of the neck, shoulders, and back that are tender to palpation; muscle strength and range of motion are normal. Which of the following is likely the cause of her pain? a) Rheumatoid arthritis b) Polymyalgia rheumatica c) Osteoarthritis d) Fibromyalgia

Fibromyalgia Explanation: The client has pain in specific trigger point areas on the muscles with normal strength and range of motion. This is an indication for fibromyalgia

Which of the following would the nurse expect to find when examining a client with a herniated lumbar disc? a) Rounded thoracic convexity b) Lateral curvature of the spine c) Lumbar lordosis d) Flattened lumbar curve

Flattened lumbar curve Explanation: In a client with a herniated lumbar disc, flattening of the lumbar curve may be seen. A rounded thoracic convexity or kyphosis is commonly seen in older adults. Lumbar lordosis or an exaggerated lumbar curve is often seen in pregnancy and obesity. Lateral curvature of the spine is seen with scoliosis

An adult client has been diagnosed with carpal tunnel syndrome. What type of working conditions may have contributed to this diagnosis? a) Heavy lifting b) Prolonged sitting c) Substantial physical activity d) Frequent repetitive movements

Frequent repetitive movements Explanation: Some working conditions present potential risks to the musculoskeletal system. Workers required to lift heavy objects may strain and injure their backs. Jobs requiring substantial physical activity, such as construction work and fire fighting, increase the likelihood of sprains, strains, and fractures. Frequent repetitive movements may lead to misuse disorders such as carpal tunnel syndrome, pitcher's elbow, or vertebral degeneration. Musculoskeletal injuries may also occur when people sit for long periods at desks with poor ergonomic design.

A nurse inspects a child's legs while standing and notices that the knees turn inward. How should this finding be documented in the medical record? a) Genu varum b) Ballotment c) Genu vulgum d) Bowed legs

Genu vulgum Explanation: The inward turning of the knees is called knock knees or genu valgum. Genu varum is the outward turning or the knees or bowed legs. Ballotment is a knee test used to assess for the presence of large amounts of fluid in the knee

Which of these medications should a nurse ask whether a client is taking when assessing the risk for osteoporosis? a) Estrogen replacement therapy b) Antihypertensives c) Rescue inhaler for asthma d) Glucocorticoids

Glucocorticoids Explanation: Medications that may increase a client's risk for osteoporosis include glucocorticoids. Antihypertensives and rescue inhalers for asthma do not cause bone loss. Estrogen replacement therapy is often indicated for females at risk for osteoarthritis when approaching menopause

The nurse is assessing the range of motion (ROM) of a patient's joints. What would the nurse use to assess flexion and extension of a joint if the patient complains of pain on examination? a) Goniometer b) Angulator c) Calibrator d) Scoliometer

Goniometer Explanation: If ROM is limited, use a goniometer to measure the angle of the joint at its maximum flexion and extension

A patient presents at the clinic with an enlarged, swollen, hot, and red metatarsophalangeal joint and bursa of the great toe. What medical diagnosis would the nurse suspect? a) Hammer toe b) Pes planus c) Gouty arthritis d) Hallux valgus

Gouty arthritis Explanation: An enlarged, swollen, hot, reddened metatarsophalangeal joint and bursa of the great toe indicates gouty arthritis

Upon examination of an elderly client, the nurse finds hard, painless nodules over the distal interphalangeal joints. What is the appropriate term the nurse should use to document this finding in the client's medical records? a) Inflamed bursa b) Bouchard's nodes c) Painful corns d) Heberden's nodes

Heberden's nodes Explanation: The nurse should document the hard, painless nodules over the distal interphalangeal joints as Heberden's nodes. Inflamed bursa is an inappropriate term because bursae are not found in interphalangeal joints. Bouchard's nodes are seen over the proximal interphalangeal joints. Painful corns are thickenings of the skin that occur over bony prominences and at pressure points

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) Hip fracture b) Degenerative joint disease c) Herniated disc d) Arthritis

Herniated disc Explanation: 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

A client presents to the health care clinic with reports of pain in the hands and right wrist. Additional history reveals that the client is a factory worker who spends all day performing the same repetitive task. The nurse performs the Phalen's test and Tinel's tests with positive results. The hand grips are unequal with the right weaker than the left. What nursing diagnosis can the nurse confirm from this data? a) Activity Intolerance b) Risk for Trauma c) Impaired Physical Mobility d) Disturbed Body Image

Impaired Physical Mobility Explanation: This client is likely experiencing carpal tunnel syndrome because of the repetitive hand movements that inflame the median nerve as it passes through the wrist. Impaired Physical Mobility related to decreased muscle strength as evidenced by a weak right hand grip meets the major criteria to confirm this nursing diagnosis. Risk for Trauma cannot be confirmed because the client already has carpal tunnel syndrome so he is not at risk. Disturbed Body Image and Activity Intolerance do not meet any major defining characteristics to confirm these nursing diagnoses.

Which finding in an elderly client requires additional assessment by a nurse when inspecting the musculoskeletal system? a) Slow and steady gait with a wide base of support b) An exaggerated thoracic curve (kyphosis) c) Inability to button the jacket due to swollen finger joints d) Symmetrical atrophy of the biceps muscles

Inability to button the jacket due to swollen finger joints Explanation: With aging, the joints and muscles lose their flexibility and bones loose their density. Therefore, the elderly client is at risk for joint stiffening, muscle atrophy, and fractures. Swelling of the joints may indicate an inflammatory process is occurring and this needs to be further assessed by the nurse. When muscle loss is symmetrical it is generally due to the normal aging process. A slow and steady gait assists the elderly client to maintain balance. Kyphosis is a normal finding in the elderly client.

Mary started a job 2 weeks ago that requires carrying heavy buckets. She presents with elbow pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance when her palms face the floor. What condition does she have? a) Supracondylar fracture b) Lateral epicondylitis (tennis elbow) c) Olecrenon bursitis d) Medial epicondylitis (golfer's elbow)

Lateral epicondylitis (tennis elbow) Explanation: Mary's injury probably occurred by lifting heavy buckets with her palms down (toward the bucket). This caused her chronic overuse injury at the lateral epicondyle. Medial epicondylitis has reproducible pain when palmar flexion against resistance is performed and also features tenderness over the involved epicondyle. Olecranon bursitis produces erythema and swelling over the olecranon process. A supracondylar fracture of the humerus is a major injury and would present more acutely.

When examining a client with a rotator cuff tear, which of the following would the nurse expect to find? a) Sharp catches of pain with movement b) Chronic pain c) Limited abduction d) Limitation of all shoulder motion

Limited abduction Explanation: Painful and limited abduction accompanied by muscle weakness and atrophy are seen with a rotator cuff tear. Chronic pain and limitation of all shoulder motion is seen with calcified tendonitis. Sharp catches of pain are associated with rotator cuff tendonitis.

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) Bulge c) Phalen's d) McMurray's

McMurray's Explanation: The nurse should perform McMurray's test to confirm 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 carpal tunnel syndrome.

A nurse obtains an order to measure a client's leg length. How should a nurse correctly implement this order? a) Assess from the umbilicus to the knee then from the knee to the heel b) Place the tape on the iliac crest and measure down to the heel c) Ask the client to stand up straight and measure from the iliac crest to the floor d) Measure from the anterior superior iliac spine to the medial malleolus

Measure from the anterior superior iliac spine to the medial malleolus Explanation: To correctly measure leg length, ask the client to lie with legs extended. With a tape, measure the distance between the anterior superior iliac spine and the medial malleolus, crossing the tape on the medial side of the knee

A nurse notices that a client's flexibility of the right elbow is less than the left elbow. What is an appropriate action by the nurse in regard to this finding? a) Assess the client' hand grips b) Notify the health care provider c) Note that the dominant side is stronger d) Measure movement with a goniometer

Measure movement with a goniometer Explanation: If the nurse identifies a limitation in the range of motion for a joint, a goniometer should be used to measure the exact angle of movement present. The goniometer is placed at the joint and then moved to match the angle of the joint being assessed. It is not necessary to notify the health care provider until all information is collected. The hand grips test strength not range of motion. The dominant side of the body is stronger but does not necessarily have greater range of motion.

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) Approximately 5 million fractures in the United States are due to osteoporosis. b) Bone density in the Asian population is higher than in the white population. c) Bone density rises to a peak at age 50 for both sexes. d) Moderate strenuous exercise tends to increase bone density.

Moderate strenuous exercise tends to increase bone density. Explanation: 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 nurse has just performed the test for Allis' sign on a newborn; the result is positive. What did the nurse observe while performing this test? a) Knees are at equal height b) One knee is lower than the other c) No clicking sound is heard d) A clicking sound is heard

One knee is lower than the other Explanation: The examiner tests for Allis' sign by placing the infant supine with flexed hips and knees and both feet flat on the table. A negative Allis' sign is when the knees are at equal heights. A positive Allis' sign is when one knee is lower than the other, indicating hip dysplasia. In the Barlow-Ortolani maneuver, the infant is supine with flexed knees and hips so that the heels touch the buttocks. The examiner places his or her fingers on the baby's greater trochanter of the humerus and adducts the legs, moving the knees down and laterally. This maneuver is negative when the movement is smooth, with no clicking sound. If a clicking sound is audible, the maneuver is considered a positive indication of hip dislocation

The client is complaining that his lower joints are increasingly painful as the day progresses. The nurse suspects the client is experiencing what musculoskeletal disorder? a) Osteoarthritis b) Rheumatoid arthritis c) Bone fracture d) Fibromyalgia

Osteoarthritis Explanation: Osteoarthritis is characterized by pain with motion that increases throughout the day. Rheumatoid arthritis discomfort decreases with motion. A bone fraction causes a sharp, knife-lie pain. Chronic pain and fatigue is a symptom of fibromyalgia.

The client presents at the clinic with a history of cerebral palsy. When examining the patient the nurse notes increased resistance that is rate dependent and increases with rapid movement. What would the nurse chart about this patient? a) Patient demonstrates muscular atony b) Patient demonstrates spasticity c) Patient has rigidity d) Patient has muscular atrophy

Patient demonstrates spasticity Explanation: Spasticity is increased resistance that worsens at the extremes of range. Spasticity, seen in central corticospinal tract diseases, is rate dependent, increasing with rapid movement.

Which action by a nurse is a correct method for performing Tinel's test to determine the presence of carpel tunnel syndrome? a) Palpate the hollow area on the back of the wrist b) Perform wrist movements against resistance c) Percuss lightly on the inner aspect of the wrist d) Ask the client to bend the wrist down and back

Percuss lightly on the inner aspect of the wrist Explanation: The nurse should tap at the inner aspect of the wrist to percuss the median nerve because the median nerve is located at the inner aspect of the wrist where it enters the carpal canal. Palpation of the hollow area on the back of the wrist is done to examine the anatomic snuffbox. Asking the client to bend the wrist down and back and performing wrist movements against resistance are done to assess range of motion and muscle strength.

Which action by a nurse is a correct method for performing the Tinel's test to determine the presence of carpel tunnel syndrome? a) Percuss lightly on the inner aspect of the wrist. b) Ask the client to bend the wrist down and back. c) Perform wrist movements against resistance. d) Palpate the hollow area on the back of the wrist.

Percuss lightly on the inner aspect of the wrist. Explanation: The nurse should tap at the inner aspect of the wrist to percuss the median nerve because the median nerve is located at the inner aspect of the wrist where it enters the carpal canal. Palpation of the hollow area on the back of the wrist is done to examine the anatomic snuffbox. Asking the client to bend the wrist down and back and performing wrist movements against resistance are done to assess range of motion and muscle strength.

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 patient? a) Phalen's b) Ballottement c) McMurray's d) Tinel's

Phalen's Explanation: 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 client receives physical therapy for carpal tunnel syndrome. Which action by the nurse is appropriate to assess the efficacy of the treatment? a) Flex the wrists 90 degrees upward b) Bend the wrists down and back c) Place the backs of both hands against each other d) Maintain flexed wrists for 90 seconds

Place the backs of both hands against each other Explanation: The nurse should ask the client to place the backs of both hands against each other while flexing the wrist 90 degrees downwards for 60 seconds for the Phalen's test. If therapy for carpal tunnel syndrome has not been successful, the client may report tingling, numbness, and pain after holding the position for 60 seconds. The client need not flex the wrists 90 degrees upward for 90 seconds. The nurse asks the client to bend the wrists down and back to test the client's range of motion for the wrist.

When assessing the elbow, a nurse asks a client to hold the arm out and turn the palm down. The nurse is testing which of the following? a) Rotation b) Flexion c) Supination d) Pronation

Pronation Explanation: Turning the palm down tests pronation. Having the client turn the palm up would test supination. Flexion is tested by having the client bend the elbow and bring the hand to the forehead. Rotation is not assessed for the elbow.

In assessing a client's temporomandibular joint (TMJ), the nurse asks the client to move the jaw forward. This movement is known as which of the following? a) Protraction b) Pronation c) Supination d) Retraction

Protraction Explanation: Protraction is moving forward. Retraction is moving backward. Pronation is turning or facing downward. Supination is turning or facing upward. Pronation and supination are not possible at the TMJ

A client visits the health care facility with reports of lumbar back pain that radiates down the back. The nurse performs Lasègue's test to determine the origin of the pain. Which techniques should the nurse use to perform Lasègue's test? a) Raise the leg to the point of pain and dorsiflex the foot b) Instruct the client to touch the chin to the chest c) Palpate the spinous processes and the paravertebral muscles d) Instruct the client to bend forward and touch the toes

Raise the leg to the point of pain and dorsiflex the foot Explanation: To perform the Lasègue's test, the nurse should raise the client's leg to the point of pain and dorsiflex the foot to check for a herniated nucleus pulposus. Asking the client to bend forward and touch the toes facilitates assessment of range of motion of the lumbar spine. Asking the client to touch the chin to the chest evaluates range of motion of the cervical spine. The spinous processes and the paravertebral muscles on both sides of the spine are palpated for tenderness and pain and are not a part of Lasègue's test.

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) Trauma b) Gout c) Rheumatoid arthritis d) Septic arthritis

Rheumatoid arthritis Explanation: 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 client tells the nurse that he has joint stiffness that is worse in the morning but improves as the day progresses. The nurse should assess the client for what musculoskeletal disorder? a) Osteoarthritis b) Rheumatoid arthritis c) Osteoporosis d) Gouty arthritis

Rheumatoid arthritis Stiffness and pain related to rheumatoid arthritis is worse in the morning and after activities and usually occurs in the upper extremities. Osteoarthritis pain is in lower extremities and is worse later in the day. Gouty arthritis pain is at the base of the big toe. Osteoporosis is weakening of the bones and there is an increased for fractures.

The school nurse notes that the client carries her left shoulder higher than her right shoulder. You should recognize the likely presence of what health problem? a) Torn rotator cuff b) Broken clavicle c) Scoliosis d) Dislocated shoulder

Scoliosis Explanation: Scoliosis may cause elevation of one shoulder.

The subacromial bursae are contained in the a) shoulder joint. b) wrist joint. c) elbow joint. d) temporomandibular joint.

Shoulder joint. Explanation: 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

Into which of the following positions should the client be placed for the nurse to effectively examine the tibiofemoral joint of the knee? a) Prone with soles of feet facing up b) Supine with feet flat on the surface c) Standing with knees bent d) Sitting with knees in flexion

Sitting with knees in flexion Explanation: To examine the tibiofemoral joint of the knee, the nurse should ask the client to sit on the edge of the examining table with the knees flexed. The supine position is used to assess muscle strength. The prone position with soles facing up is not the correct position for assessing this joint. The standing position is used to assess knee alignment and contours but should be used with the client standing up straight.

Assessment of a client's ankle joint includes palpation along the Achilles tendon to look for which of the following? a) Tenderness and nodules b) Atrophy and flexibility c) Bogginess and calluses d) Tension and strength

Tenderness and nodules Explanation: Palpation of the Achilles tendon involves assessing for tenderness or nodules. Strength and flexibility are not assessed during palpation, and calluses and bogginess are not typically associated with the Achilles tendon.

A nurse is inspecting a client's gait. Which of the following would indicate an abnormal finding? a) Posture is erect b) Arms swing in opposition c) Weight is evenly distributed d) Toes point out

Toes point out Explanation: Abnormal findings in gait include the following: uneven weight bearing is evident; client cannot stand on heels or toes; toes point in or out; client limps, shuffles, propels forward, or has wide-based gait. Posture being erect, arms swinging in opposition, and weight being evenly distributed are all normal findings

Sarah presents with left lateral knee pain and has some locking in full extension. There is tenderness over the medial joint line. When the knee is extended with the foot externally rotated and some valgus stress is applied, a click is noted. What is the most likely diagnosis? a) Torn lateral meniscus b) Torn posterior cruciate ligament c) Torn anterior cruciate ligament d) Torn medial meniscus

Torn medial meniscus Explanation: This maneuvre is called McMurray's test. Along with the medial joint line tenderness, the nurse should suspect a medial meniscus injury. Cruciate ligament tears should cause an anterior or posterior "drawer sign." Although we can't rule out a lateral meniscus tear, the tenderness along the medial joint line makes this the more likely site of injury

The nurse is caring for a patient with a diagnosis of degenerative disease of the cervical spine. What might the nurse find on inspection of this patient? a) Atrophy b) Hypotonicity c) Torticollis d) Hypertonicity

Torticollis Explanation: Degenerative joint disease of the cervical vertebrae may cause lateral tilting of the head and neck. Lateral deviation of the neck (i.e., torticollis) may be due to acute muscle spasms, congenital difficulties, or abnormal head posture to correct vision problems.

The nurse is performing the bulge test during the assessment of a client's knee. This test will allow the nurse to make what determination? a) Whether swelling in the knee joint is a normal age-related change or a pathological finding b) Whether the size of the client's knee changes throughout the joint's range of motion c) Whether the client's knee joint is capable of adduction and abduction d) Whether the client's swollen knee is caused by tissue swelling or by fluid accumulation

Whether the client's swollen knee is caused by tissue swelling or by fluid accumulation Explanation: The bulge test is used to determine if knee swelling is due to accumulation of fluid or soft tissue swelling. It does not address range or motion. Knee swelling is never considered to be an age-related change

A client visits the clinic and tells the nurse that she has joint pain in her hands, especially in the morning. The nurse should assess the client further for signs and symptoms of a) carpal tunnel syndrome. b) arthritis. c) a neurologic disorder. d) osteoporosis.

arthritis. Explanation: Pain and stiffness in the joints is associated with arthritis.

While assessing muscle strength in an older adult client, the nurse determines that the client's knee joint has a rating of 3 and exhibits active motion against gravity. The nurse should document the client's muscle strength as being/having a) poor range of motion. b) normal. c) average weakness. d) slight weakness.

average weakness. Explanation: Muscle strength that is active motion against gravity is rated as a 3 or average weakness.

Joints may be classified as cartilaginous, synovial, or a) articulate. b) immobile. c) flexible. d) fibrous.

fibrous. Explanation: The joint (or articulation) is the place where two or more bones meet. Joints provide a variety of ranges of motion (ROM) for the body parts and may be classified as fibrous, cartilaginous, or synovial

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) flex the knee and hip while in a supine position. c) raise his leg while in a supine position.

flex the knee and hip while in a supine position. Explanation: 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.

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) raise his leg while in a supine position. b) bend forward while trying to touch the toes. c) flex the knee and hip while in a supine position. d) move from a standing to a squatting position.

flex the knee and hip while in a supine position. Explanation: 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.

A client has osteoarthritis of the elbow. Which assessment approach should the nurse expect to be impacted by this health problem? a) rotation b) flexion c) adduction d) abduction

flexion Explanation: A hinge joint provides movement in one plane such as flexion and extension. A ball and socket joint provides a wide range of movement including rotation, abduction, and adduction.

While examining the spine of an adult client, the nurse notes that the client has a flattened lumbar curvature. The nurse should refer the client to a physician for possible a) cervical disc degeneration. b) scoliosis. c) herniated disc. d) kyphosis.

herniated disc. Explanation: Flattening of the lumbar curvature may be seen with a herniated lumbar disc or ankylosing spondylitis.

Articulation between the head of the femur and the acetabulum is in the a) hip joint. b) knee joint. c) tibial joint. d) ankle joint.

hip joint. Explanation: Articulation between the head of the femur and the acetabulum occurs in the hip joint.

While reviewing a client's chart before seeing the client for the first time, the nurse notes that the client has a diagnosis of Dupuytren contracture. The nurse anticipates that the client will exhibit a) flexion of the distal interphalangeal joints. b) inability to extend the ring and little finger. c) ulnar deviation of the hands. d) inability to turn the wrists.

inability to extend the ring and little finger. Explanation: Inability to extend the ring and little fingers is seen in Dupuytren's contracture.

A client visits the clinic and tells the nurse that he has had lower back pain for the past several days. To perform Lasègue test, the nurse should ask the client to a) lean forward and touch his toes. b) bend backward toward the nurse. c) lie flat and raise his leg to the point of pain. d) twist the shoulders in both directions.

lie flat and raise his leg to the point of pain. Explanation: Lasègue's test (straight leg test).

While sitting a client raises both legs while the nurse holds the lower legs below the knee. What does this finding indicate? a) flexion deformity of both legs b) distal muscle symmetric weakness c) normal quadriceps muscle strength d) proximal muscle symmetric weakness

normal quadriceps muscle strength Explanation: An active movement against full resistance without evidence of fatigue is considered normal muscle strength. If the client is unable to keep the opposite leg extended, when one leg is flexed, it suggests a flexion deformity of the opposite leg's hip. Symmetric weakness of the proximal muscles suggests a myopathy or muscle disorder. Symmetric weakness of distal muscles suggests a polyneuropathy, or disorder of peripheral nerves.

While sitting a client raises both legs while the nurse holds the lower legs below the knee. What does this finding indicate? a) flexion deformity of both legs b) normal quadriceps muscle strength c) proximal muscle symmetric weakness d) distal muscle symmetric weakness

normal quadriceps muscle strength Explanation: An active movement against full resistance without evidence of fatigue is considered normal muscle strength. If the client is unable to keep the opposite leg extended, when one leg is flexed, it suggests a flexion deformity of the opposite leg's hip. Symmetric weakness of the proximal muscles suggests a myopathy or muscle disorder. Symmetric weakness of distal muscles suggests a polyneuropathy, or disorder of peripheral nerves.

While assessing the musculoskeletal system of an adult client, the nurse observes hard painless nodules over the distal interphalangeal joints. The nurse should document the presence of a) bursitis. b) tendonitis. c) rheumatoid arthritis. d) osteoarthritis.

osteoarthritis. Explanation: Osteoarthritis (degenerative joint disease) nodules on the dorsolateral aspects of the distal interphalangeal joints (Heberden's nodes) are due to the bony overgrowth of osteoarthritis.

A female client visits the clinic and tells the nurse that she began menarche at the age of 16 years. The nurse should instruct the client that she is at a higher risk for a) osteomyelitis. b) rheumatoid arthritis. c) lordosis. d) osteoporosis.

osteoporosis. Explanation: Women who begin menarche late or begin menopause early are at greater risk for development of osteoporosis because of decreased estrogen levels, which tend to decrease the density of bone mass.

A client is unable to externally rotate the left shoulder. What health problem should the nurse suspect is occurring with this client? a) rotator cuff tear b) rotator cuff tendinitis c) carpal tunnel syndrome d) anterior dislocation of the humerus

rotator cuff tear Explanation: In a complete tear of the supraspinatus tendon, or a rotator cuff tear, active abduction and forward flexion at the glenohumeral joint are severely impaired, producing a characteristic shrugging of the shoulder and a positive "drop arm" test. Rotator cuff tendonitis is characterized by acute, recurrent, or chronic pain of the supraspinatus tendon. Carpal tunnel syndrome effects the wrist and not the shoulder. Anterior dislocation of the humerus is characterized by the shoulder seeming to slip out of the joint.

The nurse is going to test range of motion in a patient. To test extension of the triceps muscle, the nurse would instruct the patient to a) turn the palm down b) turn the palm up c) straighten the elbow d) bend the elbow

straighten the elbow Explanation: The client should have full range of motion.

When the nurse moves a client's leg upward, the nurse is performing a) external rotation. b) supination. c) eversion. d) internal rotation.

supination. Explanation: Supination is turning or facing upward.

The nurse suspects carpal tunnel syndrome after examining a patient in the clinic. A test result that would suggest this diagnosis would be a) negative Phelan sign b) negative Tinel sign c) weak opposition of the thumb d) increased thumb abduction

weak opposition of the thumb Explanation: If the client cannot raise the thumb up from the plane and stretch the thumb pad to the little finger pad, this indicates thumb weakness in carpal tunnel syndrome.

The nurse notes that the client has decreased muscle tone. The nurse knows that this can be caused by what? (Select all that apply.) a) Brain stem injury b) Disease of the peripheral nervous system c) Acute stages of spinal cord injury d) Cerebral disease e) Cerebellar disease

• Acute stages of spinal cord injury • Cerebellar disease • Disease of the peripheral nervous system Explanation: Decreased resistance suggests disease of the peripheral nervous system, cerebellar disease, or the acute stages of spinal cord injury.

After completing the musculoskeletal health history, the nurse determines that a client is at risk for osteoporosis. Which of the following risk factors were most likely identified in this client?(Select all that apply.) a) Age 65 b) Weight 180 pounds c) Sedentary lifestyle d) Current smoker e) Alcohol intake four drinks per day

• Age 65 • Current smoker • Sedentary lifestyle • Alcohol intake four drinks per day Explanation: Risk factors for the development of osteoporosis include age over 50 years, current smoker, sedentary lifestyle, and higher than the daily recommended allowance of alcohol intake. Body weight less than 70 kg or 154 pounds increases the client's risk for osteoporosis.

The nurse is providing community education osteoporosis. What risk factors for osteoporosis need to be included in the teaching? Select all that apply. a) Low salt intake b) Alcohol consumption c) Smoking d) Hormones e) Weight-bearing activities

• Alcohol consumption • Smoking • Hormones Explanation: Risk factors for osteoporosis include alcohol consumption, smoking, hormones and high salt intake. Weight bearing exercises are recommended to prevent osteoporosis.

A client is being discharged home from the hospital. This client has a history of falling at home. A caregiver is not able to stay with the client all the time. What can be done to decrease the risk for falling at the client's home? Select all that apply. a) Have the client go to a physical therapy three times a week b) Correct environmental hazards in the home c) Make sure house hallways are well lit d) Install grab bars in the bathroom e) Place colorful throw rugs near the exits

• Correct environmental hazards in the home • Install grab bars in the bathroom • Make sure house hallways are well lit Explanation: Clients should correct environmental hazards such as slippery surfaces, uneven floors, poor lighting on stairs, loose rugs, unstable furniture, and objects on floors. The nurse can recommend installation of grab bars in restrooms for clients with poor balance. Participation in physical therapy might help clients with gait and balance problems, but the nurse cannot implement this intervention independently

A nurse tells a client that the next step in the musculoskeletal assessment is to perform range of motion of the thoracic and lumbar spine. The nurse should demonstrate which movements for the client to facilitate the examination? Select all that apply. a) Lateral bending b) Flexion c) Extension d) Rotation e) Circumduction

• Flexion • Lateral bending • Rotation Explanation: To assess the range of motion of the thoracic and lumbar spine, the client should be shown the muscle movements of flexion, lateral bending (right and left), rotation (twisting the shoulders one way then the other), and bending backwards (hyperextension). Circumduction is moving is a circular motion.

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) Limiting intake of dairy products c) Maintaining a body weight appropriate to height and frame d) Maintaining a safe home environment e) Using proper body mechanics with lifting objects

• Importance of regular exercise • Maintaining a body weight appropriate to height and frame • Maintaining a safe home environment • Using proper body mechanics with lifting objects Explanation: 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

A nurse is teaching a group of children about how to grow healthy bones and to prevent osteoporosis later in life. Which of the following should the nurse mention? Select all that apply. a) Playing outside in the sun for at least 20 minutes a day b) Wearing sunscreen when outdoors c) Drinking plenty of vitamin D-fortified milk d) Drinking 8 cups of water per day e) Eating a low-fat diet

• Playing outside in the sun for at least 20 minutes a day • Drinking plenty of vitamin D-fortified milk Explanation: Exposure to sunlight, which is necessary for the manufacture of vitamin D in the body, is recommended to prevent deficiency in this nutrient and to thus help prevent osteoporosis. Likewise, intake of calcium and vitamin D by drinking fortified milk is also recommended. Wearing sunscreen when outdoors will help prevent sunburn but will not help prevent osteoporosis. Drinking plenty of water and eating a low-fat diet, while healthy, will also not help prevent osteoporosis.

The nurse is planning the care of a 77-year-old woman who has recently been diagnosed with osteoporosis. What nursing diagnoses should the nurse address in the client's plan of care? Select all that apply. a) Disturbed sensory perception related to osteoporosis b) Risk for infection related to osteoporosis c) Risk for injury related to osteoporosis d) Activity intolerance related to osteoporosis e) Impaired physical mobility related to osteoporosis

• Risk for injury related to osteoporosis • Activity intolerance related to osteoporosis • Impaired physical mobility related to osteoporosis Explanation: Osteoporosis creates risks for injury, activity intolerance, and impaired mobility as consequences of musculoskeletal changes. The disease does not normally result in infection or impaired sensation.