Chapter 32: The Musculoskeletal System My Nursing Test Banks

Chapter 32: The Musculoskeletal System

MULTIPLE CHOICE

1. The nurse is discussing actions that can be taken to best prevent osteoporosis with a patient. The nurses teaching should include:

a.

taking an extra calcium supplement.

b.

eating a balanced diet.

c.

exercising throughout life.

d.

eating daily amounts of milk products.

ANS: C

A lifetime of even mild daily exercise will delay or prevent osteoporosis.

DIF: Cognitive Level: Comprehension REF: 718-719 OBJ: 4 (theory)

TOP: Osteoporosis: Supplement KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

2. When the patient asks what the purpose of goniometry is, the nurse replies that goniometry measures:

a.

bone strength.

b.

muscle density.

c.

muscle strength.

d.

range of motion.

ANS: D

Goniometry measures joint mobility, described as the number of degrees that the joint can move from the 0-degree mark.

DIF: Cognitive Level: Comprehension REF: 719 OBJ: 2 (clinical)

TOP: Goniometry: Joint Mobility KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

3. The nurse is aware that positioning and range-of-motion (ROM) exercises most help the immobilized patient to prevent:

a.

increased pain.

b.

contractures.

c.

pressure ulcers.

d.

compromised circulation.

ANS: B

Although positioning may help decrease pain and increase circulation, anatomical alignment and ROM exercises are most helpful in preventing contractures in the immobilized patient. Pressure ulcers are prevented by frequent position changes.

DIF: Cognitive Level: Analysis REF: 719 OBJ: 2 (clinical)

TOP: Contractures: Prevention KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

4. The nurse adds interventions for range-of-motion (ROM) and isometric exercises for the new patient with a stroke because the nurse is aware that contracture formation begins as early as _____ day(s) of immobilization.

a.

1

b.

2

c.

3

d.

10

ANS: C

Contracture-related muscle changes occur as early as 3 days of immobilization.

DIF: Cognitive Level: Comprehension REF: 727 OBJ: 2 (clinical)

TOP: Process of Contracture Formation: Time Frame

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

5. The nurse explains that, if muscles are not regularly stretched and contracted, the muscles will become:

a.

longer and flexed.

b.

fibrosed and spastic.

c.

shorter and less elastic.

d.

shorter and painful.

ANS: C

The formation of contractures (shortening of skeletal muscle tissue causing deformity), loss of muscle tone, and fixation of joints can be prevented in most cases by consistent nursing intervention. The major components of the intervention are gradual mobilization, an exercise program, proper positioning, and instruction of the patient and family. Within a matter of a few days, the structures of immobilized muscles and joints begin to undergo changes. If no effort is made to prevent these changes, the patient will become permanently disabled.

DIF: Cognitive Level: Comprehension REF: 727 OBJ: 2 (clinical)

TOP: Immobility: Effect on Muscles KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

6. The nurse uses a visual aid to show the pathologic muscle tone changes that result in footdrop. Those changes are:

a.

calf muscles are stretched.

b.

flexor muscles are stretched.

c.

toes curl downward.

d.

thigh muscles contract.

ANS: B

The most frequent contractures occurring in patients immobilized for long periods are footdrop, knee and hip flexion contractures, wrist drop, and contractures of the fingers and arms. Calf muscles contract and flexor muscles are stretched, allowing the unbraced foot to drop toward the surface of the bed.

DIF: Cognitive Level: Comprehension REF: 728 OBJ: 2 (clinical)

TOP: Contractures: Pathophysiology KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

7. The nurse informs the patient that the frequency of range-of-motion (ROM) exercises should be:

a.

once a day.

b.

once in the morning and once in the afternoon.

c.

3 to 4 times a day.

d.

4 to 6 times a day.

ANS: C

ROM exercises, both passive and active, are planned and carried out as soon as feasible after immobilization occurs as a result of disease, injury, or surgery. The exercises are done to maintain functional connective tissue within the joint and thereby ensure that every joint retains its function and mobility. ROM exercises should be done three to four times a day.

DIF: Cognitive Level: Comprehension REF: 728 OBJ: 2 (clinical)

TOP: ROM Exercises: Frequency KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

8. The physician has prescribed isometric exercises for a patient. The patient asks the nurse how these exercises work. The nurse uses an example to explain the physiology of isometric exercises, which is:

a.

flexing the lower arm while trying to straighten it with the other hand.

b.

pulling the knees up to chest with the arms.

c.

forcefully flexing the neck to make the chin touch the chest.

d.

flexing the toes up toward the head while lying flat.

ANS: A

Isometric exercises are based on the energy of opposing muscles working against each other.

DIF: Cognitive Level: Analysis REF: 728-729 OBJ: 2 (clinical)

TOP: Isometric Exercises: Concept KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

9. When the patient returns to the unit from having had an arthrogram, which intervention will the nurse perform first?

a.

Ambulate the patient in the room.

b.

Apply ice packs to the knee.

c.

Perform passive range-of-motion exercises.

d.

Wrap the knee in an elastic bandage.

ANS: B

Ice packs applied to the knee will reduce swelling. The patient will ambulate at some point but not before the application of ice. There is not going to be a significant loss of mobility for the patient so range-of-motion exercises will not likely be included in the plan of care. There is no indication that an elastic bandage is needed.

DIF: Cognitive Level: Application REF: 721 OBJ: 4 (clinical)

TOP: Arthroscopy: Aftercare KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

10. The nurse encourages the patient to use the four-point crutch gait technique. This technique is most likely indicated because it:

a.

allows nonweight bearing on one leg.

b.

is the most stable gait.

c.

mimics normal walking pattern.

d.

allows the most rapid pace.

ANS: B

The four-point crutch gait is the most stable, requires that there be partial weight bearing on both legs, and does not mimic normal walking pattern.

DIF: Cognitive Level: Application REF: 730 OBJ: 5 (clinical)

TOP: Four-Point Crutch Gait: Characteristics

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

11. The nurse is assessing the patients cane for appropriate length. The nurse affirms that the appropriate cane has been selected when the:

a.

hand grip is at the level of the hip.

b.

elbow is flexed at 45 degrees when weight is placed on the cane.

c.

cane tip is placed touching outside the good foot.

d.

rubber tip has been removed when measuring cane length.

ANS: A

The hand grip should be at hip level to allow for proper flexion of the arm to bear weight. The cane tip should be placed 6 inches from the good foot. The elbow angle should be 30 degrees.

DIF: Cognitive Level: Application REF: 731 OBJ: 5 (clinical)

TOP: Cane: Measurement KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

12. The nurse is instructing the patient on quadriceps and gluteal muscle exercises. The instructions will include:

a.

while lying down, straightening the leg and tensing leg muscles while raising heel.

b.

flexing the leg and holding it with the hands while pulling the leg back toward the hip.

c.

straightening the legs and raising the head.

d.

flexing both legs and doing an abdominal crunch up toward the knees.

ANS: A

The quad setting exercise is to straighten the leg and tense the leg muscles while raising the heel.

DIF: Cognitive Level: Application REF: 729 OBJ: 2 (clinical)

TOP: Quadriceps and Gluteal Muscle Exercises

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

13. The anatomical structure that joins the bones of a joint together is referred to as:

a.

a ligament.

b.

a tendon.

c.

a muscle.

d.

cartilage.

ANS: A

Ligaments hold the bones of a joint together. Tendons are connective tissues that provide joint movement. Cartilage is a type of connective tissue in which fibers and cells are embedded in a semisolid gel material.

DIF: Cognitive Level: Knowledge REF: 716 OBJ: 1 (theory)

TOP: Ligament: Function KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

14. When a 90-year-old patient says, My old bones are just about done in, the nurse reminds him that his bones are being constantly renewed through the action of:

a.

osteoblasts.

b.

stem cells.

c.

free circulating calcium ions.

d.

combination of phosphorus and vitamin D.

ANS: A

Osteoblasts build bone as the old bone is reabsorbed into the body.

DIF: Cognitive Level: Comprehension REF: 717 OBJ: 1 (theory)

TOP: Bone Regeneration KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

15. The patients plan of care includes using the continuous passive motion (CPM) machine. Which statement by the patient indicates the need for further teaching?

a.

I marched in the Marines for 20 years, and now Im marching flat on my back!

b.

My new knee will be glad to rest at night.

c.

I can make my new knee stronger if I reset this thing to go faster and flex my knee more.

d.

I almost wish this CPM ran at night. The motor noise is soothing.

ANS: C

The continuous passive motion machine is used to provide movement to a joint in recovery. The apparatus is driven by a motor and requires no effort on the part of the patient or nurse to move the limb. It usually is left on all day and is discontinued at night while the patient sleeps. CPM is preset as to speed and the degree of flexion that is determined by the physician and should not be adjusted by the patient.

DIF: Cognitive Level: Application REF: 729 OBJ: 3 (clinical)

TOP: CPM Machine KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

16. When preparing a patient for electromyography (EMG), the nurse will instruct the patient to:

a.

cease smoking for 12 hours before the test.

b.

refrain from caffeine drinks for 3 hours before the test.

c.

take muscle relaxants before the test.

d.

prepare for a lengthy testing time (usually about 2 hours).

ANS: B

Electromyography (EMG) is used to detect abnormal nerve transmission to the muscle and abnormal muscle function, and to assess the rehabilitation progress. Before the test, smoking and use of caffeine should be ceased for 3 hours. The test usually takes 1 hour.

DIF: Cognitive Level: Application REF: 723 OBJ: 5 (theory)

TOP: EMG: Preprocedure Instructions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

17. When an 88-year-old patient enters the room for her health assessment, she walks with tiny steps, her shoulders are rounded and hunched, and her arms are crossed in front of her with her hands tucked in her armpits. Which response by the nurse is most appropriate?

a.

Are you cold?

b.

Does your stomach hurt?

c.

Are your shoes too small?

d.

Do you always walk like that?

ANS: A

The patient in the scenario appears to be feeling chilled. Age-related changes may cause the older adult to feel cold more easily than a younger person. Older adults often walk with shoulders rounded and limbs close to the body.

DIF: Cognitive Level: Application REF: 724 OBJ: 4 (theory)

TOP: Older Adult: Sense of Cold KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

18. The nurse is changing the position of a person with flaccid paralysis. The priority action will be:

a.

to change joint position.

b.

not to use a footboard.

c.

to move only from side to side, not supine.

d.

to refrain from using pillows to keep the patient in place.

ANS: A

Frequent changes in joint position reduces the incidence of ankylosis.

DIF: Cognitive Level: Comprehension REF: 729 OBJ: 2 (clinical)

TOP: Positioning: Flaccid Paralysis KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

19. The nurse is caring for a patient who has had an arthrocentesis. The nurse has completed discharge instructions. Which statement by the patient indicates the need for further instruction?

a.

I will need to avoid moving my knee for at least 1 to 2 weeks.

b.

The steroids prescribed by my physician will reduce the inflammation in my knee.

c.

Some pain is anticipated.

d.

My elastic bandage will be worn for 2 to 3 days.

ANS: A

The patient with the arthrocentesis will be instructed to avoid overuse of the joint; however, it may be moved in moderation. Steroids will be prescribed to limit inflammation. Pain is anticipated and analgesics will likely be prescribed. Elastic bandages are frequently worn for 2 to 3 days.

DIF: Cognitive Level: Application REF: 722 OBJ: 5 (theory)

TOP: Diagnostic Tests for the Musculoskeletal System

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

20. A patient is learning to use crutches on the stairs. When evaluating this patient, which action indicates that the patient needs further instruction?

a.

The patient places the good leg on the step to be climbed first.

b.

The patient places the affected leg on the step to be climbed first.

c.

The patient places the crutches on the floor and uses a swing-through method to get to the next step.

d.

The patient places the crutch on the affected side on the next step first.

ANS: A

When climbing stairs with crutches, the patient should first stand at the foot of the stairs with weight on the good leg and crutches, put weight on the crutch handles, and then lift the good leg up onto the first step of the stairs. Weight should be placed on the good leg to lift the injured leg and crutches up to that step.

DIF: Cognitive Level: Application REF: 731 OBJ: 5 (clinical)

TOP: Patient Teaching: Special Maneuvers on Crutches

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

21. The nurse is assessing the patients crutches. The nurse recognizes that correctly sized crutches are:

a.

the same height as the patients shoulders.

b.

approximately 12 inches shorter than the patients shoulders.

c.

approximately 16 inches shorter than the patients height.

d.

tall enough to allow the patients arms to be fully extended when walking.

ANS: C

Crutches should be about 16 inches (40 cm) shorter than the patients height. When in the standing position with axillary crutches, the axillary bar should be two finger breadths below the axilla. The elbow should be flexed at a 30-degree angle when the palms of the hands rest on the hand grip. It is important that the patient not rest the body at the axilla on the top of the crutch; body weight should be borne by the arms on the hand rests of the crutches. If crutches are too long, pressure on the axilla will occur and can cause nerve and circulatory impairment.

DIF: Cognitive Level: Application REF: 731 OBJ: 5 (clinical)

TOP: Patient Teaching: Special Maneuvers on Crutches

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

22. A patient at risk for the development of osteoporosis has reported plans to increase calcium intake. When making menu choices, which selection demonstrates an understanding of calcium-rich foods?

a.

Grilled salmon, green beans, and milk

b.

Hamburger patty on a wheat bun, baked chips, and milk

c.

Grilled chicken breast, tossed salad, and fruit punch

d.

Bacon, lettuce, and tomato sandwich on whole grain bread, orange slices, and milk

ANS: A

In addition to dairy products, sources of calcium include canned sardines or salmon, tofu, figs, and green vegetables.

DIF: Cognitive Level: Application REF: 719 OBJ: 4 (theory)

TOP: Nutrition for Bone Growth and Density

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

23. The functions of the musculoskeletal system are: (Select all that apply.)

a.

motion.

b.

fighting of infections.

c.

support.

d.

protection of organs.

e.

body shape.

ANS: A, C, D, E

All options listed except for the fighting of infections are functions of the musculoskeletal system.

DIF: Cognitive Level: Knowledge REF: 718 OBJ: 1 (theory)

TOP: Bone Function KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

24. The nurse points out the age-related changes that occur in the musculoskeletal system, which are: (Select all that apply.)

a.

increase of bone density.

b.

bones are brittle and break easily.

c.

bones heal slowly.

d.

decrease in muscle mass.

e.

tendon sclerosis.

ANS: B, C, D, E

All options listed are age-related changes in the musculoskeletal system except increase in bone density. Bone density is usually decreased with aging.

DIF: Cognitive Level: Comprehension REF: 718 OBJ: 1 (theory)

TOP: Age-Related Changes in Musculoskeletal System

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

25. When the nurse plans for the progressive mobilization of a hemiplegic, the nurse will consider the patients ability to: (Select all that apply.)

a.

move limbs.

b.

change position in bed independently.

c.

transfer self from bed to chair.

d.

perform all activities of daily living independently.

e.

walk.

ANS: A, B, C, E

All options listed are abilities that must be assessed before an effective progressive mobilization plan can be designed.

DIF: Cognitive Level: Comprehension REF: 727-728 OBJ: 2 (clinical)

TOP: Planning Progressive Mobilization: Considerations

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

COMPLETION

26. When a joint is obliterated by bony overgrowth, the joint is said to be _________.

ANS:

ankylosed

Ankylosis occurs when the joint is overgrown with bony overgrowth.

DIF: Cognitive Level: Knowledge REF: 728 OBJ: 4 (theory)

TOP: Ankylosis: Process KEY: Nursing Process Step: NA

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

27. The canal system that runs through the bone and contains the blood and lymph vessels is called the ____________.

ANS:

haversian system

The haversian system is the canal system that runs through the bone to carry blood and lymph vessels.

DIF: Cognitive Level: Knowledge REF: 716 OBJ: 1 (theory)

TOP: Haversian System KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

MATCHING

Arrange the instructions for a person on crutches to sit down.

a.

Transfer both crutches to the side of injury.

b.

With weight on good leg, reach back and grasp chair arm.

c.

Sit back in chair.

d.

Turn slowly and touch backs of legs to seat of chair.

e.

Using crutch and chair arm for support, slowly sit on chair.

28. Step 1

29. Step 2

30. Step 3

31. Step 4

32. Step 5

28. ANS: D DIF: Cognitive Level: Application REF: 731

OBJ: 5 (clinical) TOP: Crutch Walker: Instructions to Sit in Chair

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

29. ANS: A DIF: Cognitive Level: Application REF: 731

OBJ: 5 (clinical) TOP: Crutch Walker: Instructions to Sit in Chair

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

30. ANS: B DIF: Cognitive Level: Application REF: 731

OBJ: 5 (clinical) TOP: Crutch Walker: Instructions to Sit in Chair

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

31. ANS: E DIF: Cognitive Level: Application REF: 731

OBJ: 5 (clinical) TOP: Crutch Walker: Instructions to Sit in Chair

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

32. ANS: C DIF: Cognitive Level: Application REF: 731

OBJ: 5 (clinical) TOP: Crutch Walker: Instructions to Sit in Chair

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

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