Ch23 Musculoskeletal System

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  • 1/18 Questions

    The nurse explains to Mrs. Barber that obese clients have an increased risk for arthritis in weight-bearing joints.

    • True
    • False
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  • 2. 

    The nurse is assessing the muscle strength of a client. The client had complete range of motion against gravity with full resistance. What would the nurse record using a 0-5 scale in this situation?

    • 2/5

    • 3/5

    • 4/5

    • 5/5

    Correct Answer
    A. 5/5
    Explanation
    Muscle strength is rated on a 0-5 scale (no muscle contraction-normal muscle strength). A rating of 5/5 is considered normal muscle strength, meaning that the client has full range of motion against gravity with full resistance.

    2/5 muscle strength is full range of motion without gravity (passive motion).

    A rating of 3/5 muscle strength is considered fair and means the client has full range of motion with gravity, but not against resistance.

    4/5 muscle strength is documented if the client has full range of motion against gravity with moderate resistance.

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  • 3. 

    An eight-month-pregnant female client tells the nurse, "I am okay except I have a backache and I never had a backache before." Which of the following can the nurse instruct the client about this health concern?

    • "As your baby has grown, your center of gravity has shifted, putting pressure on the lower spine."

    • "Weakened abdominal muscles have caused your posture to change."

    • "This is a normal occurrence and nothing to worry about."

    • "Back pain is often intensified during pregnancy in women who have a history of previous back pain."

    Correct Answer
    A. "As your baby has grown, your center of gravity has shifted, putting pressure on the lower spine."
    Explanation
    As the pregnancy progresses, lordosis (an inward curvature of the lower spine-sway back) compensates for the enlarging fetus. The center of gravity shifts forward, which strains the lower spine, causing lower back pain.

    Weakened abdominal muscles are not the cause of the lordosis.

    The development of back pain is common; however, the nurse should not dismiss the client's concern by stating that "there is nothing to worry about."

    A previous history of back pain may aggravate the situation; however, this woman does not have a previous history of back pain.

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  • 4. 

    A 47-year-old client tells the nurse, "I don't want to develop osteoarthritis like both of my parents." Which of the following can the nurse instruct this client?

    • "If your parents had the disease, you are at increased risk of developing the disease."

    • "Calcium supplements will prevent the disorder."

    • "Over-the-counter analgesics will help prevent the progression of the disease."

    • "Eating a well-balanced diet and regular exercise are the best defense."

    Correct Answer
    A. "Eating a well-balanced diet and regular exercise are the best defense."
    Explanation
    A normal degenerative change associated with aging, osteoarthritis can contribute to decreased physical activity. A well-balanced diet and regular exercise help to slow the progression of this change.

    The disorder is not related to genetics.

    Calcium supplementation will not prevent the development of the disorder.

    Over-the-counter analgesics will help with the pain associated with the disease, but will not prevent the progression of the disease.

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  • 5. 

    The nurse should encourage Mrs. Barber to spend the next several weeks enjoying a sedentary lifestyle because this lifestyle has been found to help clients with arthritis.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Recommend regular exercise according to age and ability to maintain or improve musculoskeletal function. Sedentary lifestyles increase the risk for musculoskeletal complications.

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  • 6. 

    During the assessment of a two-month-old, the nurse flexes the infant's knees and compares the height of the knees. What does this maneuver assess?

    • Tibial torsion

    • Genu valgum

    • Allis' sign

    • Genu varum

    Correct Answer
    A. Allis' sign
    Explanation
    Allis' sign is used to detect unequal leg length, which could indicate congenital hip dislocation and should be assessed at every office visit until one year of age. The nurse is positioned at the infant's feet. With the infant supine, the nurse flexes the infant's knees, keeping the femurs aligned, and compares the height of the knees. An uneven height indicates unequal leg length.

    Tibial torsion is a curving of the tibias.

    Genu valgum (knock knees) is found typically after the age of four and identified when the child walks.

    Genu varum (bowlegs) is identified in infants before they learn to walk.

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  • 7. 

    When performing an assessment on an elderly client, the nurse notes that the client has kyphosis. Which of the following findings did the nurse observe in this client?

    • A lateral curvature of the spine

    • An exaggerated inward curvature of the lower spine

    • An exaggerated convex curve of the thoracic spine

    • Decreased bone density

    Correct Answer
    A. An exaggerated convex curve of the thoracic spine
    Explanation
    Kyphosis is an exaggeration of the normal convex curve of the thoracic spine. It may result from congenital abnormality, rheumatic conditions, compression fractures, or other disease processes including syphilis, tuberculosis, and rickets.

    Scoliosis is a lateral curvature of the spine.

    Lordosis is an exaggeration of the normal lumbar curve of the spine.

    Osteoporosis occurs because of decreased bone density. The nurse is not able to observe this during an assessment.

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  • 8. 

    A postoperative hip replacement client is prescribed a pillow between the legs. Which position will this pillow serve for the client?

    • Abduction

    • Adduction

    • Pronation

    • Flexion

    Correct Answer
    A. Abduction
    Explanation
    Abduction is movement of a limb away from the midline or median plane of the body, along the frontal plane.

    Adduction is movement of a limb toward the midline. Pronation and supination refer only to the movements of the radius around the ulna.

    In pronation, the palm moves to face downward.

    Flexion is a bending movement that decreases the angle of the joint and brings the articulating bones closer together.

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  • 9. 

    A client tells the nurse about upper thigh and hip pain when standing too long. Which of the following does this information suggest to the nurse?

    • The client is experiencing paraesthesia.

    • The client may have some degenerative disease process within the hip.

    • The client may have referred pain from another body region.

    • The client may have lumbosacral nerve root irritation.

    Correct Answer
    A. The client may have some degenerative disease process within the hip.
    Explanation
    Weight-bearing activities may increase the pain if the client has a degenerative disease of the hip, knees, or vertebrae.

    Sensations of burning, tingling, or prickling (paraesthesia) may accompany compression of nerves and blood vessels in a particular body region.

    Shoulder pain may be the result of referred pain such as a hiatal hernia or cardiac, gallbladder, and pleural conditions.

    Lumbosacral nerve root irritation may cause pain to be felt in the leg.

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  • 10. 

    When performing an assessment on a client, the nurse notes that the client's great toe deviates laterally from the midline, crowding the other toes and causing marked enlargement of the joint. The nurse documents the presence of which of the following?

    • Hallus valgus

    • Hammertoe

    • Pes planus

    • Genu varum

    Correct Answer
    A. Hallus valgus
    Explanation
    Hallux valgus (bunion): The great toe deviates laterally from the midline, crowding the other toes. The metatarsophalangeal joint and bursa become enlarged and inflamed, causing a bunion.

    Hammertoe occurs when there is flexion of the proximal interphalangeal joint of a toe, while the distal metatarsophalangeal joint hyperextends. A callus or corn frequently occurs on the surface of the flexed joint from external pressure.

    Pes planus (flatfoot) occurs when the arch of the foot is flattened.

    Genu varum is the term for bowlegs.

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  • 11. 

    When performing a straight-leg-raise test, the client complains of sharp pain in the lower back with radiation down one leg. What does this finding indicate?

    • The presence of arthritis in the lumbar spine

    • A herniated disk

    • Inflammation of the hip joint

    • The presence of synovitis

    Correct Answer
    A. A herniated disk
    Explanation
    If the client complains of sharp pain that begins in the lower back and radiates down the leg during the straight-leg-raise test, the nurse should record the distribution and severity of the pain and the degree of leg elevation at the time the pain occurs. Pain along the course of the sciatic nerve with the straight-leg-raise test may indicate a herniated disk.

    Arthritis of the lumbar spine would not cause symptoms related to pressure on the sciatic nerve.

    Inflammation of the hip joint, arthritis, causes localized pain at the hip and does not radiate down the leg.

    Synovitis is an effusion within the synovium of the knee resulting in distention of the suprapatellar area and lateral aspects of the knee.

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  • 12. 

    During the focused musculoskeletal interview, the nurse learns that a client developed osteomyelitis after hip replacement surgery. What does this information suggest to the nurse?

    • The client may be more prone to develop osteomalacia.

    • The client is more likely to develop osteoarthritis.

    • The client is at risk for future episodes of bone infections.

    • The client is at risk for the development of fractures.

    Correct Answer
    A. The client is at risk for future episodes of bone infections.
    Explanation
    Osteomyelitis, an infection of the bone, frequently recurs in clients with a history of previous infections.

    Individuals with osteomalacia (adult vitamin D deficiency) are more prone to develop multiple fractures of the bone.

    The development of osteoarthritis is not related to osteomyelitis.

    A previous history of osteomyelitis is not a risk factor for the development of fractures.

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  • 13. 

    The nurse is assessing a client with carpal tunnel syndrome. When the nurse percusses lightly over the median nerve, the client feels numbness, tingling, and pain along the median nerve. The nurse documents which of the following?

    • A positive Phalen's test

    • A positive Tinel's sign

    • A positive Dupuytren's contracture

    • Positive thenar atrophy

    Correct Answer
    A. A positive Tinel's sign
    Explanation
    A positive Tinel's sign is present if there is numbness, tingling, and pain along the median nerve when percussing lightly over the median nerve in each wrist. A positive Tinel's sign is often seen with carpal tunnel syndrome.

    A positive Phalen's test is performed in individuals with carpal tunnel syndrome. The wrists are bent downward, pressing the backs of both hands together causing the flexion of the wrists to 90 degrees. Normally clients experience no symptoms with this maneuver. In individuals with carpal tunnel syndrome, this maneuver produces pain, tingling, and numbness that radiates to the arm, shoulder, or neck.

    Dupuytren's contracture is not associated with carpal tunnel syndrome. With Dupuytren's contracture, the fourth and fifth fingers are flexed. This is a progressive, painless, inherited disorder that causes severe flexion in the affected fingers, is usually bilateral, and is more common in middle-aged and older males.

    Atrophy of the thenar eminence is a common finding with carpal tunnel syndrome; however, it does not cause numbness and tingling.

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  • 14. 

    During the musculoskeletal assessment of a female client, the nurse documents that the client has pain in the muscles and soft tissues around the head, neck, shoulders, and hips. Which of the following disorders do these findings suggest in the client?

    • Osteoarthritis

    • Systemic lupus erythematosus

    • Gout

    • Fibromyalgia

    Correct Answer
    A. Fibromyalgia
    Explanation
    Fibromyalgia, classified as a rheumatic disease, is characterized by pain in the muscles and soft tissues that support and surround joints. Pain is experienced in tender points of the head, neck, shoulders, and hips.

    With osteoarthritis, the joint cartilage erodes, resulting in pain and stiffness primarily in the spine, knees, and hips.

    Systemic lupus erythematosus (SLE) is an autoimmune disease that causes inflammation in joints and other body organs.

    Gout is a type of arthritis caused by uric acid crystal deposits in the joints. The deposits cause inflammation, pain, and swelling in the joints, especially the great toe.

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  • 15. 

    A client is newly diagnosed with osteoarthritis of the spine. The nurse knows that this client has a disease process within the:

    • Fibrous joints

    • Cartilaginous joints

    • Synovial joints

    • Cervical bursae

    Correct Answer
    A. Cartilaginous joints
    Explanation
    With osteoarthritis the joint cartilage erodes and typically affects the spine, hips, and knees. Bones joined by cartilage, such as the vertebrae, are called cartilaginous joints.

    Bones joined by fibrous tissue, such as the sutures joining the bones of the skull, are called fibrous joints.

    Bones separated by a fluid-filled joint cavity are called synovial joints.
    Synovial joints are reinforced and strengthened by ligaments. Ligaments are protected by small, synovial fluid-filled sacs called bursae.

    Cervical bones do not have bursae.

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  • 16. 

    During the assessment of a client's shoulder joints, the client shrugs his shoulders and then complains of pain with abduction. What does this finding suggest to the nurse?

    • Olecranon bursitis

    • Possible rotator cuff tear

    • A dislocated shoulder

    • Osteoarthritis of the joint

    Correct Answer
    A. Possible rotator cuff tear
    Explanation
    In rotator cuff tears, the client is unable to perform abduction without lifting or shrugging the shoulder. This sign is accompanied by pain, tenderness, and muscle atrophy.

    Olecranon bursitis occurs over the olecranon process of the elbow. It s caused by swelling of the bursa and results in swelling of the elbow.

    A dislocation of a joint would result in obvious deformity of the area and an inability to move the joint.

    Osteoarthritis of the joint causes generalized pain and stiffness of the area.

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  • 17. 

    When the nurse assesses Mrs. Barber and finds out that she has had erythematous, hot, swollen, tender fingers and pain with movement, which of the following goals would be the most realistic?

    • The most important goal for Mrs. Barber would be to have an understanding of her disease process and have increased awareness of symptoms associated with arthritis.

    • The most important goal for Mrs. Barber would be to be free of any pain.

    • The most important goal for Mrs. Barber is to be able to participate in a fast-paced aerobic exercise regimen several times a week.

    • The most important goal for Mrs. Barber is that she will not require any further medication for pain or discomfort associated with her symptoms.

    Correct Answer
    A. The most important goal for Mrs. Barber would be to have an understanding of her disease process and have increased awareness of symptoms associated with arthritis.
    Explanation
    Increasing the client’s awareness about her disease process will allow her to be able to cope with her disease with an understanding of of her symptoms.

    This is probably not the most realistic goal for the client, considering how much pain she has been experiencing.

    The nurse should set realistic goals for the client. Because the client has been experiencing a great deal of pain in the past few weeks, the nurse should use goals that are more realistic until she feels better.

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  • 18. 

    The nurse knows that arthritis affects more than 40% of the adult population.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    According to Healthy People 2010, arthritis affects more than 20% of the adult population, instead of more than 40%.

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Quiz Review Timeline (Updated): Apr 17, 2012 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Apr 17, 2012
    Quiz Edited by
    ProProfs Editorial Team
  • Apr 17, 2012
    Quiz Created by
    Shinichiro
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