Musculo-skeletal

A patient states, "Whenever I open my mouth real wide, I feel this popping sensation in front of my ears." To further examine this, the nurse would:

A) place the stethoscope over the temporomandibular joint and listen for bruits.

B) place the hands over his ears and ask him to open his mouth "really wide."

C) place one hand on his forehead and the other on his jaw and ask him to try to open his mouth.

D) place a finger on his temporomandibular joint and ask him to open and close his mouth.

ANS: D) place a finger on his temporomandibular joint and ask him to open and close his mouth.

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A patient is being assessed for range-of-joint movement. The nurse asks him to move his arm in toward the centre of his body. This movement is called:

a. Flexion

b. Abduction

c. Adduction

d. Extension

ANS: C

Moving an extremity toward the midline of the body is called adduction; moving an extremity away from the midline of the body is called abduction. Flexion is bending an extremity at a joint; and extension is straightening an extremity at a joint

A patient tells the nurse that she is having a hard time bringing her hand to her mouth when she eats or tries to brush her teeth. The nurse knows that for her to move her hand to her mouth, she must perform which movement?

a. Flexion

b. Abduction

c. Adduction

d. Extension

ANS: A

Flexion, or bending an extremity at a joint, is required to move the hand to the mouth.

Extension is straightening an extremity at a joint. Moving an extremity toward the midline of the body is called adduction; abduction is moving an extremity away from the midline of the body.

The nurse is assessing a patient who reports having functional difficulty and pain bending her knees when climbing stairs. The nurse will assess the functional unit of the musculoskeletal system involved, which is the:

a. Joint

b. Bone

c. Muscle

d. Tendon

ANS: A

Joints are the functional units of the musculoskeletal system because they permit the mobility needed to perform the activities of daily living (ADLs). The skeleton (bones) is the framework of the body. The other options are not correct.

The nurse is assessing a patient who sprained his ankle playing soccer. The nurse explains that the fibrous bands which usually connect the medial and lateral malleolus and strengthen that joint have been stretched beyond their limits. The nurse identifies these bands as:

a. Bursa

b. Tendons

c. Cartilage

d. Ligaments

ANS: D

Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions are called ligaments. The other options are not correct.

The nurse notices that a woman in an exercise class is unable to jump rope. The nurse is aware that to jump rope, one’s shoulder has to be capable of:

a. Inversion

b. Supination

c. Protraction

d. Circumduction

ANS: D

Circumduction is defined as moving the arm in a circle around the shoulder. The other options are not correct.

After an impact injury to the jaw, the nurse palpates the area in front of both ears to assess the function of the patient’s:

a. Intervertebral foramen

b. Condyle of the mandible

c. Temporomandibular joint

d. Zygomatic arch of the temporal bone

ANS: C

The articulation of the mandible and the temporal bone is the temporomandibular joint (TMJ).

The TMJ enables jaw function for speaking and chewing. To assess the joint, place the tips of your first two fingers in front of each ear, and ask the patient to open and close the mouth.

Drop your fingers into the depressed area over the joint, and note smooth motion of the mandible. The other responses are not correct

To palpate the TMJ, the nurse’s fingers should be placed in the depression __________ of the ear.

a. Distal to the helix

b. Proximal to the helix

c. Anterior to the tragus

d. Posterior to the tragus

ANS: C

The TMJ can be felt in the depression anterior to the tragus of the ear. The other locations are not correct.

When assessing the patient’s spine, the nurse differentiates between the cervical and thoracic vertebrae at the base of the neck by using the:

a. Spinous processes

b. Thoracic vertebrae T7 and T8

c. Iliac crests

d. 12 cervical vertebrae

ANS: A

There are 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 3 to 4 coccygeal vertebrae in the spinal column. The following surface landmarks will orient you to their levels:

• The spinous processes of C7 and T1 are prominent at the base of the neck.

• The inferior angle of the scapula normally is at the level of the interspace between T7 and T8.

• An imaginary line connecting the highest point on each iliac crest crosses L4.

• An imaginary line joining the two symmetrical dimples that overlie the posterior superior iliac spines crosses the sacrum.

The nurse is explaining to a patient that there are shock absorbers in his back to cushion the spine and to help it move. The nurse is referring to his:

a. Vertebral column

b. Nucleus pulposus

c. Vertebral foramen

d. Intervertebral discs

ANS: D

Intervertebral discs are elastic fibrocartilaginous plates that cushion the spine similar to shock absorbers and help it move. The vertebral column is the spinal column itself. The nucleus pulposus is located in the centre of each disc. The vertebral foramen is the channel, or opening, for the spinal cord in the vertebrae

The nurse is providing patient education to a man who has been diagnosed with a rotator cuff injury. The nurse knows that a rotator cuff injury involves the:

a. Nucleus pulposus

b. Articular processes

c. Medial epicondyle

d. Glenohumeral joint

ANS: D

A rotator cuff injury involves the glenohumeral joint, which is enclosed by a group of four powerful muscles and tendons that support and stabilize it. The nucleus pulposus is located in the centre of each intervertebral disc. The articular processes are projections in each vertebral disc that lock onto the next vertebra, thereby stabilizing the spinal column. The medial epicondyle is located at the elbow.

During an interview the patient states, “I can feel this bump on the top of both of my shoulders—it doesn’t hurt but I am curious about what it might be.” The nurse should tell the patient that it is his:

a. Subacromial bursa

b. Acromion process

c. Glenohumeral joint

d. Greater tubercle of the humerus

ANS: B

The bump of the scapula’s acromion process is felt at the very top of the shoulder. The other options are not correct

The nurse is checking the ROM in a patient’s knee and knows that the knee is capable of which movement(s)?

a. Flexion and extension

b. Supination and pronation

c. Circumduction

d. Inversion and eversion

ANS: A

The knee is a hinge joint, permitting flexion and extension of the lower leg on a single plane.

The knee is not capable of the other movements listed.

The nurse is assessing a patient’s ischial tuberosity. To palpate the ischial tuberosity, the nurse asks the patient to bend his knee toward his chest to:

a. Flex the ankle

b. Flex the hip

c. Extend the knee

d. Extend the spine

ANS: B

The ischial tuberosity lies under the gluteus maximus muscle and is palpable when the hip is flexed by bending the knee toward the chest. The other options are not correct.

The nurse is examining the hip area of a patient and palpates a flat depression on the upper, lateral side of the thigh when the patient is standing. The nurse interprets this finding as the:

a. Ischial tuberosity

b. Greater trochanter

c. Iliac crest

d. Gluteus maximus muscle

ANS: B

The greater trochanter of the femur is palpated when the person is standing, and it appears as a flat depression on the upper lateral side of the thigh. The iliac crest is the upper part of the hip bone; the ischial tuberosity lies under the gluteus maximus muscle and is palpable when the hip is flexed; and the gluteus muscle is part of the buttocks.

During assessment of the ankle joint, the nurse asks the patient to flex and extend the articulation of the tibia, fibula, and:

a. Talus

b. Cuboid bones

c. Calcaneus

d. Cuneiform bones

ANS: A

The ankle or tibiotalar joint is the articulation of the tibia, fibula, and talus. It is a hinge joint, limited to flexion (dorsiflexion) and extension (plantar flexion) in one plane. The other bones listed are foot bones and not part of the ankle joint.

The nurse is explaining the mechanism of the growth of long bones to a mother of a toddler.

Where does lengthening of the bones occur?

a. Bursa

b. Calcaneus

c. Epiphyses

d. Tuberosities

ANS: C

Lengthening occurs at the epiphyses, or growth plates. The other options are not correct.

An 85-year-old patient comments during his annual physical examination that he seems to be getting shorter as he ages. The nurse should explain that decreased height occurs with aging because:

a. Long bones tend to shorten with age.

b. The vertebral column shortens.

c. A significant loss of subcutaneous fat occurs.

d. A thickening of the intervertebral discs develops.

ANS: B

Postural changes are evident with aging; decreased height is most noticeable and is caused by shortening of the vertebral column. Long bones do not shorten with age. Intervertebral discs actually get thinner with age. Subcutaneous fat is not lost but is redistributed to the abdomen and hips.

During assessment of a 75-year-old female admitted with a hip fracture after falling, the patient states a history of osteoporosis. The nurse recognizes that the patient is more susceptible to bone fractures because of:

a. Increased bone matrix

b. Loss of bone density

c. New, weaker bone growth

d. Increased phagocytic activity

ANS: B

After age 40 years, loss of bone matrix (resorption) occurs more rapidly than new bone formation. The net effect is a gradual loss of bone density, or osteoporosis. The other options are not correct

The nurse is teaching a class on preventing osteoporosis with a group of perimenopausal women. The nurse recommends:

a. Increasing intake of coffee

b. Eating less dairy products

c. Brisk walking outside in good weather

d. Reducing activity to rest the body

ANS: C

Bones and muscles must work against gravity to have a bone-building effect. A regular program of weight-bearing exercise for at least 30 minutes three times a week is recommended as the minimum. The patient should try walking, low-impact aerobics, dancing, or stationary cycling. Resistance training with light weights or resistance bands is also recommended, and exercises that focus on posture and balance, such as tai chi, can help reduce the risk for falls. Sunshine also helps the body produce vitamin D. About 15 minutes of exposure to sunshine a day is all that is needed to maintain a good vitamin D supply.

A patient is complaining of pain in his joints that is worse in the morning, better after he moves around for a while, and then gets worse again if he sits for long periods. The nurse should assess for other signs of what problem?

a. Tendinitis

b. Osteoarthritis

c. Rheumatoid arthritis

d. Intermittent claudication

ANS: C

Rheumatoid arthritis is worse in the morning when a person arises. Movement increases most joint pain, except the pain with rheumatoid arthritis, which decreases with movement. The other options are not correct

A patient states, “I can hear a crunching or grating sound when I kneel.” She also states that “it is very difficult to get out of bed in the morning because of stiffness and pain in my joints.” The nurse should assess for signs of what problem?

a. Crepitation

b. Bone spur

c. Loose tendon

d. Fluid in the knee joint

ANS: A

Crepitation is an audible and palpable crunching or grating that accompanies movement and occurs when articular surfaces in the joints become roughened, as with rheumatoid arthritis. The other options are not correct

A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasms. The nurse should suspect:

a. Crepitation

b. Rotator cuff lesions

c. Dislocated shoulder

d. Rheumatoid arthritis

ANS: B

Rotator cuff lesions may limit ROM and cause pain and muscle spasms during abduction, whereas forward flexion remains fairly normal. The other options are not correct.

An 80-year-old woman is visiting the clinic for a checkup. She states, “I can’t walk as much as I used to.” The nurse is observing for motor dysfunction in her hip and should ask her to:

a. Internally rotate her hip while she is sitting

b. Abduct her hip while she is lying on her back

c. Adduct her hip while she is lying on her back

d. Externally rotate her hip while she is standing

ANS: B

Limited abduction of the hip while supine is the most common motion dysfunction found in hip disease. The other options are not correct

A young swimmer comes to the sports clinic complaining of a very sore shoulder. He was running at the pool, slipped on wet concrete, and tried to catch himself with his outstretched hand. He landed on his outstretched hand and has not been able to move his shoulder since. The nurse suspects:

a. Joint effusion

b. Tear of rotator cuff

c. Adhesive capsulitis

d. Dislocated shoulder

ANS: D

A dislocated shoulder occurs with trauma involving abduction, extension, and external rotation (e.g., falling on an outstretched arm or diving into a pool). (See Table 24-3 for descriptions of the other conditions.)

A patient’s annual physical examination reveals a lateral curvature of the thoracic and lumbar segments of his spine; however, this curvature disappears with forward bending. The nurse recognizes these findings to likely be:

a. Structural scoliosis

b. Functional scoliosis

c. Herniated nucleus pulposus

d. Dislocated hip

ANS: B

Functional scoliosis is flexible and apparent with standing but disappears with forward bending. Structural scoliosis is fixed; the curvature shows both when standing and when bending forward. (See Table 24-8 for description of herniated nucleus pulposus.) These findings are not indicative of a dislocated hip

When assessing muscle strength, the nurse observes that a patient has complete ROM against gravity with full resistance. What grade of muscle strength should the nurse record using a 0-to-5-point scale?

a. 2

b. 3

c. 4

d. 5

ANS: D

Complete ROM against gravity is normal muscle strength and is recorded as grade 5 muscle strength. The other options are not correct

The nurse is assessing a 1-week-old infant and is testing his muscle strength. The nurse lifts the infant with hands under the axillae and notices that the infant starts to slide down between the hands. The nurse should:

a. Suspect a fractured clavicle

b. Suspect that the infant may have a deformity of the spine

c. Suspect that the infant may have weakness of the shoulder muscles

d. Conclude that this is a normal finding because the musculature of an infant at this age is not fully developed

ANS: C

An infant who starts to “slip” between the nurse’s hands shows weakness of the shoulder muscles. An infant with normal muscle strength wedges securely between the nurse’s hands.

The other responses are not correct

When performing a musculoskeletal assessment, the nurse knows that the correct approach for the examination should be:

a. Proximal to distal

b. Distal to proximal

c. Posterior to anterior

d. Anterior to posterior

ANS: A

The musculoskeletal assessment should be performed in an orderly approach, head to toe, proximal to distal, from the midline outward. The other options are not correct

The nurse is assessing the joints of a woman who has stated, “I have a long family history of arthritis, and my joints hurt.” The nurse suspects that she has osteoarthritis. Which of these are symptoms of osteoarthritis? **(Select all that apply.)**

a. Symmetrical joint involvement

b. Asymmetrical joint involvement

c. Pain with motion of affected joints

d. Affected joints are swollen with hard, bony protuberances

e. Affected joints may have heat, redness, and swelling

ANS: B, C, D

In osteoarthritis, asymmetrical joint involvement commonly affects the hands, knees, hips, and lumbar and cervical segments of the spine. Affected joints have stiffness, swelling with hard bony protuberances, pain with motion, and limitation of ROM. The other options reflect the signs of rheumatoid arthritis