Prep U Chapter 60: Introduction to the Musculoskeletal System

Which of the following is an example of a hinge joint? a) Joint at base of thumb b) Carpal bones in the wrist c) Knee d) Hip

C) Knee

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. The best response by the nurse is: a) "CPM increases range of motion of the joint." b) "CPM delivers analgesic agents directly into the joint." c) "CPM strengthens the muscles of the leg." d) "CPM prevents injury by limiting flexion of the knee."

a) "CPM increases range of motion of the joint."

The nurse is performing an assessment of a patient's musculoskeletal system and is appraising the patient's bone integrity. What action should the nurse perform during this phase of assessment? a) Compare parts of the body symmetrically. b) Administer analgesia 30 to 60 minutes before assessment. c) Assess extremities when in motion rather than at rest. d) Percuss as many joints as are accessible.

a) Compare parts of the body symmetrically.

The human body has 206 bones, which are classified into four categories. Which types of bones are located in the digits? a) Short bones b) Long bones c) Irregular bones d) Flat bones

a) short bones

Patient education for musculoskeletal conditions for the aging is based on the understanding that there is a gradual loss of bone after a peak of bone mass at age: a) 50 years. b) 30 years. c) 20 years. d) 40 years.

b) 30 years

The client presents with an exaggeration of the lumbar spine curve. The nurse interprets these findings as indicative of: a) Dowager's hump b) Lordosis c) Scoliosis d) Kyphosis

b) Lordosis

A nurse is performing a musculoskeletal assessment of a patient with arthritis. During passive range-of-motion exercises, the nurse hears an audible grating sound. The nurse should document the presence of which of the following? a) Effusion b) Crepitus c) Fasciculations d) Clonus

b) creptius

A patient is undergoing diagnostic testing for suspected Paget's disease. What assessment finding is most consistent with this diagnosis? a) Altered serum sodium levels b) Altered serum potassium levels c) Altered serum calcium levels d) Altered serum magnesium levels

c) Altered serum calcium levels

The results of a nurse's musculoskeletal examination show an increase in the lumbar curvature of the spine. The nurse should recognize the presence of what health problem? a) Scoliosis b) Kyphosis c) Lordosis d) Osteoporosis

c) Lordosis

A 19-year-old client presents at the emergency department with a compound fracture of the right femur. Skeletal traction is applied to align the bones. What type of traction would you expect to be used? a) Thomas splint b) Buck's traction c) Steinmann traction d) Russell traction

c) Steinmann traction Skeletal traction is applied directly to a bone by using a wire (Kirschner), pin (Steinmann), or cranial tongs (Crutchfield). General or local anesthesia may be used when inserting these devices.

The nurse reading a patient's chart notices that the patient is documented to have paresthesia. The nurse plans care for a patient with which of the following? a) Involuntary twitch of muscle fibers b) Absence of muscle tone c) Absence of muscle movement suggesting nerve damage d) Abnormal sensations

d) Abnormal sensations Abnormal sensations, such as burning, tingling, and numbness, are referred to as paresthesias. The absence of muscle tone suggesting nerve damage is referred to as paralysis. A fasciculation is the involuntary twitch of muscle fibers. A muscle that holds no tone is termed flaccid.

The nurse would expect which of the following diagnostic tests to be ordered for a patient with lower extremity muscle weakness? a) Bone scan b) Biopsy c) Arthrocentesis d) Electromyograph (EMG)

d) Electromyograph

What is the term for a lateral curving of the spine? a) Epiphysis b) Lordosis c) Diaphysis d) Scoliosis

d) Scoliosis

The nurse is conducting a musculoskeletal assessment on a patient documented to have rheumatoid arthritis. Which of the following would the nurse anticipate finding when inspecting the patient's fingers? a) Hard nodules of bony overgrowth b) Hard nodules adjacent to the joints c) Soft, nodules along the palmar surface d) Soft, subcutaneous nodules along the tendons

d) Soft, subcutaneous nodules along the tendons

Eric Darwin, a 19-year-old college athlete, presents at the ED where you practice nursing with a compound fracture of his right femur. Due to the nature of the fracture, open reduction will be used to align the femur. What other rationale requires the use of open reduction? a) Wound débridement is necessary b) Fracture causes wide bone separation c) Fracture involves several, small pieces of bone d) All options are correct

d) all options are correct

The human body is designed to protect its vital parts. A fracture of what type of bone may interfere with the protection of vital organs? a) Flat bones b) Long bones c) Short bones d) Irregular bones

a) Flat bones Flat bones, such as the sternum, provide vital organ protection. Fractures of the flat bones may lead to puncturing of the vital organs or may interfere with the protection of the vital organs. Long, short, and irregular bones do not usually have this physiologic function.

A patient is receiving ongoing nursing care for the treatment of Parkinson's disease. When assessing this patient's gait, what finding is most closely associated with this health problem? a) Shuffling gait b) Spastic hemiparesis gait c) Rapid gait d) Steppage gait

a) shuffling gait

The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which of the following findings? a) Tear in the joint capsule b) Injury to the radial nerve c) Decreased bone density d) Fracture of the clavicle

a) tear in the joint capsule

A patient is scheduled for a procedure that will allow the physician to visualize the knee joint in order to diagnose the patient's pain. What procedure will the nurse prepare the patient for? a) Electromyography b) Arthroscopy c) Arthrocentesis d) Bone scan

b) Arthroscopy

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone? a) Vitamin D b) Calcitonin c) Sex hormones d) Growth hormone

b) Calcitonin

Which of the following is an indicator of neurovascular compromise? a) Warm skin temperature b) Pain on active stretch c) Capillary refill of more than 3 seconds d) Diminished pain

c) Capillary refill of more than 3 seconds

Which of the following is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? a) It provides active range of motion. b) It prevents infection and controls edema and bleeding. c) It promotes healing by increasing circulation and movement of the knee joint. d) It promotes healing by immobilizing the knee joint.

c) It promotes healing by increasing circulation and movement of the knee joint.

An older adult patient has symptoms of osteoporosis and is being assessed during her annual physical examination. The assessment shows that the patient will require further testing related to a possible exacerbation of her osteoporosis. The nurse should anticipate what diagnostic test? a) Hip bone radiography b) Computed tomography (CT) c) Bone densitometry d) Magnetic resonance imaging (MRI)

c) bone densitometry

A nurse practitioner assesses a patient's movement in his left hand after a cast is removed. The nurse asks the patient to turn his wrist so the palm of his hand is facing up. This movement is known as: a) Supination. b) Eversion. c) Pronation. d) Extension.

a) supination

A 16-year-old patient is seen in the emergency room for a knee injury that happened during a basketball game. Diagnostic tests reveal torn cords of fibrous connective tissue that connect muscles to bones. The nurse knows that the patient had sustained a tear of the: a) Tendon. b) Fascia. c) Ligament. d) Bursa.

a) tendon

The nurse is caring for a patient who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? a) Keep the affected leg in a position of adduction. b) Keep the hip flexed by placing pillows under the patient's knee. c) Protect the affected leg from internal rotation. d) Have the patient reposition himself independently.

c) Protect the affected leg from internal rotation.

The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as? a) Kyphosis b) Scoliosis c) Osteoporosis d) Lordosis

a) Kyphosis

Choice Multiple question - Select all answer choices that apply. The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.) a) More than 3-second capillary refill b) Cool temperature of the extremity c) Limited range of motion d) Tenting skin turgor e) Pale, cyanotic, or mottled color

a) More than 3-second capillary refill b) Cool temperature of the extremity e) Pale, cyanotic, or mottled color

After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement? a) Remodeling b) Reparative c) Revascularization d) Inflammation

a) Remodeling

A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy? a) Apply warm compresses to the insertion site. b) Apply a cold pack at the insertion site. c) Assist with performing ROM exercises. d) Provide a gentle massage.

b) Apply a cold pack at the insertion site.

While assessing a patient who has had knee replacement surgery, the nurse notes that the patient has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this patient? a) Risk for Infection b) Unilateral Neglect c) Risk for Peripheral Neurovascular Dysfunction d) Disturbed Kinesthetic Sensory Perception

c) Risk for Peripheral Neurovascular Dysfunction The hematoma may cause an interruption of tissue perfusion, so the most appropriate nursing diagnosis is Risk of Peripheral Neurovascular Dysfunction. There is also an associated risk for infection because of the hematoma, but impaired neurovascular function is a more acute threat. Unilateral neglect and impaired sensation are lower priorities than neurovascular status

A patient has a fracture that is being treated with open rigid compression plate fixation devices. How will the progress of bone healing be monitored? a) Serial x-rays b) Remove the plate and determine if the bone is growing back. c) The bone will heal on its own without intervention. d) Arthroscopy

a) Serial x-rays

Which of the following are true statements about smooth muscles? Choose all that are correct. a) They are found mainly in the walls of certain organs or cavities of the body. b) They are involuntary muscles; their activity is controlled by mechanisms in their tissue of origin and by neurotransmitters released from the autonomic nervous system. c) They promote movement of the bones of the skeleton. d) Their function is controlled by impulses that travel from efferent nerves of the brain and spinal cord.

a) They are found mainly in the walls of certain organs or cavities of the body. b) They are involuntary muscles; their activity is controlled by mechanisms in their tissue of origin and by neurotransmitters released from the autonomic nervous system.

The orthopedic surgeon has prescribed balanced skeletal traction for a patient. What advantage is conferred by balanced traction? a) Balanced traction can be applied at night and removed during the day. b) Balanced traction allows for greater patient movement and independence than other forms of traction. c) Balanced traction facilitates bone remodeling in as little as 4 days. d) Balanced traction is portable and may accompany the patient's movements.

b) Balanced traction allows for greater patient movement and independence than other forms of traction.

Each bone is comprised of cells, protein matrix, and mineral deposits. Which type of bone cell is not only a mature bone cell; it is involved in maintaining bone tissue. a) Osteoblasts b) Osteomytes c) Osteocytes d) Osteoclasts

c) Osteocytes Mature bone cells, called osteocytes, are involved in maintaining bone tissue.

A patient has a fracture of the right femur sustained in an automobile accident. What process of fracture healing does the nurse understand will occur with this patient? a) First intention, secondary intention, third intention b) Active phase, dormant phase, restructure phase c) Reactive phase, reparative phase, remodeling phase d) Primary phase, secondary phase, third phase

c) Reactive phase, reparative phase, remodeling phase

A patient has had a cast placed for the treatment of a humeral fracture. The nurse's most recent assessment shows signs and symptoms of compartment syndrome. What is the nurse's most appropriate action? a) Assess the patient's joint function symmetrically. b) Arrange for a STAT assessment of the patient's serum calcium levels. c) Perform active range of motion exercises. d) Contact the primary care provider immediately.

d) Contact the primary care provider immediately. This major neurovascular problem is caused by pressure within a muscle compartment that increases to such an extent that microcirculation diminishes, leading to nerve and muscle anoxia and necrosis. Function can be permanently lost if the anoxic situation continues for longer than 6 hours. Therefore, immediate medical care is a priority over further nursing assessment. Assessment of calcium levels is unnecessary.

A nurse is caring for a patient with a diagnosis of cancer that has metastasized. What laboratory value would the nurse expect to be elevated in this patient? a) Potassium b) Creatinine c) Bilirubin d) Alkaline phosphatase

d) alkaline phosphatase

Tendons are cordlike structures that attach muscles to the periosteum of the bone. Which of the following is not true about tendons? a) Tendons attach muscle to a bone in just one location. b) Tendons attach muscle to bone with two or more attachments. c) One of the attachments is called the origin and is more fixed. d) A second attachment is called the insertion and is more movable.

a) Tendons attach muscle to a bone in just one location.

Which of the following biologically active vitamin functions to increase the amount of calcium in the blood? a) C b) D c) A d) E

b) D Biologically active vitamin D (Calcitrol) functions to increase the amount of calcium in the blood by promoting absorption of calcium from the gastrointestinal tract.

Ms. Cramer is in your clinic and the physician has scheduled a bone scan for her. A bone scan may be ordered to detect metastatic bone lesions, fractures, and certain types of inflammatory disorders. Select all of the following nursing considerations that are correct in preparing a client for a bone scan. a) Ensuring the client is NPO for 12 hours before the test b) Encouraging the client to drink fluids to help distribute and eliminate the isotope c) Informing the client that the radiopaque isotope will be administered intravenously d) Ensuring that the client does not have any allergies to the isotope

b) Encouraging the client to drink fluids to help distribute and eliminate the isotope c) Informing the client that the radiopaque isotope will be administered intravenously d) Ensuring that the client does not have any allergies to the isotope

A nurse is caring for a patient who is postoperative day 1 right hip replacement. How should the nurse position the patient? a) Seat the patient in a low chair as soon as possible. b) Keep hips flexed at no less than 90 degrees. c) Elevate the head of the bed to high Fowler's. d) Keep the patient's hips in abduction at all times.

d) Keep the patient's hips in abduction at all times. The hips should be kept in abduction by an abductor pillow. Hips should not be flexed more than 90 degrees, and the head of bed should not be elevated more than 60 degrees. The patient's hips should be higher than the knees; as such, high seat chairs should be used.

Skull sutures are an example of which type of joint? a) Diarthrosis b) Amphiarthrosis c) Aponeuroses d) Synarthrosis

d) Synarthrosis Skull sutures are considered synarthrosis joints and are immovable. Amphiarthrosis joints allow limited movement, such as a vertebral joint. Diarthrosis joints are freely movable joints such as the hip and shoulder. Aponeuroses are broad, flat sheets of connective tissue.