Chapter 36: Structure and Function of the Musculoskeletal System My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 36: Structure and Function of the Musculoskeletal System

Test Bank

MULTIPLE CHOICE

1. A clinician is preparing to teach about bone matrix. Which information should be included? The component of the bone matrix that gives bone tensile strength is:

a.

Calcium

b.

Phosphate

c.

Collagen

d.

Magnesium

ANS: C

Collagen is the component of bone matrix that gives bone tensile strength.

Calcium plays a role on bone formation, but collagen is the component of bone matrix that gives bone tensile strength.

Phosphate plays a role in bone formation, but collagen is the component of bone matrix that gives bone tensile strength.

Magnesium plays a role in bone formation, but collagen is the component of bone matrix that gives bone tensile strength.

REF: p. 954

2. Which information indicates the nurse has a good understanding of osteoblasts? Once their initial function is complete, osteoblasts become:

a.

Osteoclasts

b.

Osteocytes

c.

Chondroblasts

d.

Osteoids

ANS: B

Osteoblasts are the bone-forming cells. Their primary function is to lay down new bone. Once this function is complete, osteoblasts become osteocytes.

Osteoclasts reabsorb bone.

Chondroblasts are a part of mature bone.

Osteoids are part of non-mineralized bone matrix that the osteoblasts work on.

REF: p. 955

3. Which information indicates the nurse understands osteocalcin? Osteocalcin is a:

a.

Glycoprotein

b.

Hormone

c.

Mineral

d.

Vitamin

ANS: A

Osteocalcin is a glycoprotein.

Osteocalcin is a glycoprotein, not a hormone.

Osteocalcin is a glycoprotein, not a mineral.

Osteocalcin is a glycoprotein, not a vitamin.

REF: p. 958

4. A clinician is preparing to discuss hydroxyapatite. Which information should be included? Hydroxyapatite in the bone matrix contains which of the following molecules in its crystalline structure?

a.

Calcium and magnesium

b.

Calcium and phosphate

c.

Phosphate and magnesium

d.

Magnesium and hydrogen

ANS: B

Calcium and phosphate form amorphous (fluid) calcium phosphate compounds that are converted, in stages, to solid hexagonal crystals of hydroxyapatite.

Hydroxyapatite contains calcium and phosphate, not calcium and magnesium.

Hydroxyapatite contains calcium and phosphate, not phosphate and magnesium.

Hydroxyapatite contains calcium and phosphate, not magnesium and hydrogen.

REF: p. 958

5. Which information indicates the nursing student has a good understanding between compact bone and spongy bone? The major difference between compact bone and spongy bone is the:

a.

Organization of the structural elements

b.

Location within the body

c.

Activating chemicals in each

d.

Types of minerals in the bone matrix

ANS: A

The major difference between the two types of tissue is the organization of the elements.

The major difference between the two types of tissue is the organization of the elements, not the location in the body.

The major difference between the two types of tissue is the organization of the elements, not the activating chemicals in each.

The major difference between the two types of tissue is the organization of the elements, not the type of minerals.

REF: p. 960

6. A staff member asks a nurse how blood gets to the bone. How should the nurse reply? Blood vessels penetrate to the inner structures of the bone via:

a.

Volkmann canals

b.

Canaliculi

c.

Sharpey fibers

d.

Lamellae

ANS: A

The outer layer of the periosteum contains blood vessels and nerves, some of which penetrate to the inner structures of the bone through channels called Volkmann canals.

Canaliculi are small channels or canals.

Sharpey fibers also help hold or attach tendons and ligaments to the periosteum of bones.

Concentric layers of bone matrix are called lamellae.

REF: p. 960

7. A nurse is preparing to teach the staff about bones. Which information should the nurse include? After puberty, the epiphyseal plate calcifies, and the epiphysis and _____ merge.

a.

Epiphyseal line

b.

Diaphyseal plate

c.

Metaphysis

d.

Articular cartilage

ANS: C

After puberty, the epiphyseal plate calcifies, and the epiphysis and metaphysis merge.

After puberty, the epiphyseal plate calcifies, and the epiphysis and metaphysis, not the epiphyseal line, merge.

After puberty, the epiphyseal plate calcifies, and the epiphysis and metaphysis, not the diaphyseal plate, merge.

After puberty, the epiphyseal plate calcifies, and the epiphysis and metaphysic, not the articular cartilage, merge.

REF: p. 960

8. When a staff member asks how remodeling of bone occurs, what is the nurses best response? Remodeling is done by clusters of bone cells called:

a.

Precursor stimulating cells

b.

Osteoclastic cutting cones

c.

Basic multicellular units

d.

Haversian system cells

ANS: C

Remodeling is carried out by clusters of bone cells termed basic multicellular units.

Precursor cells differentiate into osteoclasts and osteoblasts.

The osteoclasts form a cutting cone, which gradually resorbs bone, not remodels it.

Haversian canals are part of compact bone.

REF: p. 961

9. A nurse is discussing the different phases of bone remodeling. Which information should be included? Phase 2 of the bone remodeling cycle involves bone:

a.

Formation

b.

Activation

c.

Resorption

d.

Fracturing

ANS: C

Phase 2 is resorption.

Phase 2 is resorption, not formation.

Phase 2 is resorption, not activation.

Phase 2 is resorption, not fracturing.

REF: p. 962

10. When the physical therapist is describing a freely movable joint, which term should be used?

a.

Synarthrosis

b.

Amphiarthrosis

c.

Fibrous

d.

Diarthrosis

ANS: D

A diarthrotic joint is freely moveable.

A synarthrotic joint is immovable.

An amphiarthrotic joint is slightly movable.

A fibrous joint has little, if any, movement.

REF: p. 963

11. A nurse recalls fibrous joints generally are:

a.

Rotating

b.

Slightly movable

c.

Freely movable

d.

Calcified

ANS: B

A fibrous joint has little, if any, movement.

A fibrous joint has little, if any, movement; it is not rotating.

A fibrous joint has little, if any, movement; it is not freely moveable.

A fibrous joint has little, if any, movement; it is not calcified.

REF: p. 963

12. Which of the following should the nurse include when discussing the different types of cartilaginous joints?

a.

Sutures and gomphosis

b.

Syndesmosis and gomphosis

c.

Symphysis and synchondrosis

d.

Gomphosis and synchondrosis

ANS: C

There are two types of cartilaginous joints: symphyses and synchondroses.

There are two types of cartilaginous joints: symphyses and synchondroses. It is not sutures and gomphosis.

There are two types of cartilaginous joints: symphyses and synchondroses. It is not syndesmosis and gomphosis.

There are two types of cartilaginous joints: symphyses and synchondroses. It is not gomphosis and synchondrosis.

REF: p. 964

13. Which statement indicates the nurse has a good understanding of joints? The joints between the teeth and the maxilla or mandible are examples of a:

a.

Symphysis

b.

Diarthrosis

c.

Gomphosis

d.

Syndesmosis

ANS: C

The teeth held in the maxilla or mandible are gomphosis joints.

The teeth held in the maxilla or mandible are gomphosis joints, not symphysis.

The teeth held in the maxilla or mandible are gomphosis joints, not diarthrosis.

The teeth held in the maxilla or mandible are gomphosis joints, not syndesmosis.

REF: p. 964

14. A nurse recalls the elbow joint is an example of a(n):

a.

Amphiarthrosis

b.

Diarthrosis

c.

Synarthrosis

d.

Symphysis

ANS: B

The elbow joint is an example of a diarthrosis joint.

The elbow joint is freely moveable and is an example of a diarthrosis joint; amphiarthrosis joints are only slightly moveable.

The elbow joint is freely moveable and is an example of a diarthrosis joint; synarthrosis joints are immoveable.

The elbow joint is freely moveable and is an example of a diarthrosis joint; a symphysis is a cartilaginous joint in which bones are united by a pad or disk of fibrocartilage.

REF: p. 965

15. When a staff member asks where costal cartilage is located, how should the nurse respond? Between the:

a.

Vertebrae

b.

Ribs and sternum

c.

Sutures of the skull

d.

Facial bones

ANS: B

Costal cartilage is located between the ribs and the sternum.

Costal cartilage is not found between the vertebrae.

Costal cartilage is not found between the sutures of the skull.

Costal cartilage is not found between the facial bones.

REF: p. 964

16. The epimysium, perimysium, and endomysium are made of:

a.

Bone

b.

Epithelium

c.

Fascia

d.

Cartilage

ANS: C

Each skeletal muscle is a separate organ, encased in a three-part connective tissue framework called fascia.

Each skeletal muscle is a separate organ, encased in a three-part connective tissue framework called fascia. It is not bone.

Each skeletal muscle is a separate organ, encased in a three-part connective tissue framework called fascia. It is not epithelium.

Each skeletal muscle is a separate organ, encased in a three-part connective tissue framework called fascia. It is not cartilage.

REF: p. 965

17. Which layer forms the fascicles in skeletal muscle?

a.

Tendon sheath

b.

Endomysium

c.

Epimysium

d.

Perimysium

ANS: D

The perimysium further subdivides the muscle fibers into bundles of connective tissue called fascicles.

The perimysium further subdivides the muscle fibers into bundles of connective tissue called fascicles. It is not the tendon sheath.

The endomysium is the smallest unit of muscle.

The outermost layer, the epimysium, is located on the surface of the muscle and tapers at each end to form the tendon.

REF: p. 967

18. When a staff member asks the nurse about the contractile unit of a muscle, how should the nurse reply? The contractile unit of a muscle cell is called the:

a.

Motor unit

b.

Basement membrane

c.

Myofibril

d.

Ribosome

ANS: C

The muscle fiber contains bundles of myofibrils, the fibers functional subunits.

The muscle fiber contains bundles of myofibrils, not the motor unit; it is the fibers functional subunits.

The muscle fiber contains bundles of myofibrils, the fibers functional subunits. It is not the basement membrane.

The muscle fiber contains bundles of myofibrils, the fibers functional subunits. It is not the ribosome.

REF: p. 968

19. An isolated muscle is believed to be a type 1 fiber. Which of the following should be observed by the nurse when the muscle is stimulated?

a.

The muscle resists fatigue.

b.

The muscle tires easily.

c.

The muscle will not contract.

d.

The muscle has no fascia.

ANS: A

Type I fibers can resist fatigue for longer periods because of their capacity for oxidative metabolism.

Type I fibers resist fatigue; it would not tire easily.

Type I fibers resist fatigue; not contracting does not describe a type I fiber.

Type I fibers resist fatigue; it would not be that the muscle has no fascia.

REF: p. 968

20. An isolated muscle is believed to be a type II fiber. Which of the following should be observed by the nurse when the muscle is stimulated?

a.

The muscle has slow contraction speed.

b.

The muscle is fatigued easily.

c.

The muscle has a profuse capillary supply.

d.

The muscle has no fascia.

ANS: B

Type II fibers rely on anaerobic glycolytic metabolism and fatigue readily.

Type II fibers rely on anaerobic glycolytic metabolism and fatigue readily. They may not have slow contraction speed.

Type II fibers rely on anaerobic glycolytic metabolism and fatigue readily. The do not have additional capillary supply.

Type II fibers rely on anaerobic glycolytic metabolism and fatigue readily. They do have fascia around the muscle.

REF: p. 969 | p. 972

21. When the nurse is using the term sarcopenia, what is the nurse describing? It is the:

a.

Absence of muscle cells

b.

Fatigue of muscle cells

c.

Age-related loss in skeletal muscle

d.

Muscles that are unable to contract

ANS: C

Age-related loss in skeletal muscle is referred to as sarcopenia and is a direct cause of the age-related decrease in muscle strength.

Age-related loss in skeletal muscle is referred to as sarcopenia and is a direct cause of the age-related decrease in muscle strength. It is not the absence of muscle cells.

Age-related loss in skeletal muscle is referred to as sarcopenia and is a direct cause of the age-related decrease in muscle strength. It is not muscle fatigue.

Age-related loss in skeletal muscle is referred to as sarcopenia and is a direct cause of the age-related decrease in muscle strength. It is not muscles that cannot contract.

REF: p. 974

22. A nurse is preparing to teach about myofibrils. Which information should the nurse include? The structure of the contractile subunit of the myofibril is called the:

a.

Sarcoplasmic reticulum

b.

Actin

c.

Motor endplate

d.

Sarcomere

ANS: D

The sarcomere is the contractile portion of the myofibril.

The sarcoplasmic reticulum is made like the endoplasmic reticulum in other cells.

Actin is a protein of the sarcomere.

It is at the motor nerve endplate where the nerve impulse is transmitted.

REF: p. 968

23. While planning care for a patient with muscle problems, which information should the nurse remember? _____ ions directly control the contraction of muscles.

a.

Sodium

b.

Potassium

c.

Calcium

d.

Magnesium

ANS: C

Contraction begins as the calcium ions combine with troponin, a reaction that overcomes the inhibitory function of the troponin-tropomyosin system.

Calcium, not sodium, controls the contraction of muscles.

Calcium, not potassium, controls the contraction of muscles.

Calcium, not magnesium, controls the contraction of muscles.

REF: p. 972

24. A patient has researched muscles on the internet. Which information indicates the patient has a good understanding? The molecule that prevents a muscle contraction from occurring when the muscle is at rest is:

a.

Calcium

b.

Troponin-tropomyosin

c.

Actin

d.

Myosin

ANS: B

Contraction begins as the calcium ions combine with troponin, a reaction that overcomes the inhibitory function of the troponin-tropomyosin system.

Calcium does not prevent contraction; it could facilitate it.

Actin does not prevent contraction; it facilitates it.

Myosin facilitates contraction.

REF: p. 972

25. A nursing student wants to know during which stage actin binds to myosin. What is the nurses best response? During:

a.

Coupling

b.

Relaxation

c.

Discharging

d.

Excitation

ANS: A

During coupling, depolarization of the transverse tubules occurs. This triggers the release of calcium ions from the sarcoplasmic reticulum, exposing binding sites on the actin molecule.

Relaxation is the last step. It begins as calcium ions are actively transported back into the sarcoplasmic reticulum, removing ions from interaction with troponin.

Discharging is not a step in the process.

Excitation is the first step of muscle contraction and it begins with the spread of an action potential from the nerve terminal to the neuromuscular junction.

REF: p. 972

26. When a patient asks what the fuel for skeletal muscle contraction is, how should the nurse respond? The main energy source or fuel for skeletal muscle contraction is:

a.

Calcium

b.

Lactic acid

c.

Adenosine triphosphate (ATP)

d.

Actin

ANS: C

The main energy source for muscle contraction is ATP.

The main energy source for muscle contraction is ATP, not calcium.

The main energy source for muscle contraction is ATP, not lactic acid.

The main energy source for muscle contraction is ATP, not actin.

REF: p. 972

27. The nurse observed the patients muscle contracted, but the limb did not move. How should the nurse chart this muscle contraction?

a.

Isotonic contraction

b.

Isometric contraction

c.

Eccentric contraction

d.

Concentric contraction

ANS: B

During isometric contraction, the muscle contracts, but the limb does not move.

During isotonic contraction, the muscle maintains a constant tension as it moves.

Eccentric contraction is a form of isotonic contraction.

Concentric contraction is a form of isotonic contraction.

REF: p. 973

28. A nurse recalls that when a muscle acts as the prime mover, it is called the:

a.

Flexor

b.

Recruiter

c.

Antagonist

d.

Agonist

ANS: D

When a muscle contracts and acts as a prime mover, it is called an agonist.

When a muscle contracts and acts as a prime mover, it is called an agonist, not a flexor.

When a muscle contracts and acts as a prime mover, it is called an agonist, not a recruiter.

When a muscle contracts and acts as a prime mover, it is called an agonist; its reciprocal muscle, or antagonist, relaxes.

REF: p. 973

MULTIPLE RESPONSE

1. The nurse has a good understanding of bone matrix when he comments that the following molecules are part of the bone matrix? (Select all that apply.)

a.

Collagen fibers

b.

Elastin fibers

c.

Proteoglycans

d.

Glycoproteins

e.

Epithelial cells

ANS: A, B, D

Bone matrix is composed of collagen fibers, proteoglycans, and glycoproteins.

REF: p. 955

2. The nursing student has a good understanding of glycoproteins when he states that the following glycoproteins are present in the bone? (Select all that apply.)

a.

Osteocalcin

b.

Sialoprotein

c.

Bone albumin

d.

Alpha-glycoprotein

e.

Collagen

ANS: A, B, C, D

Four glycoproteins are present in bone: sialoprotein, which binds easily with calcium; osteocalcin, which binds preferentially to crystallized calcium; bone albumin, which is identical to serum albumin and possibly transports essential nutrients to and from bone cells and maintains the osmotic pressure of bone fluid; and alpha-glycoprotein (-glycoprotein). Collagen is not a glycoprotein.

REF: p. 958

3. A patient has researched compact bones on the Internet. Which information indicates the patient has a good understanding of compact bone? The structures present in compact bone include the (select all that apply):

a.

Haversian canals

b.

Trabeculae

c.

Canaliculi

d.

Lamellae

e.

Lacunae

ANS: A, C, D, E

Compact bone is highly organized, solid, and extremely strong. The basic structural unit in compact bone is the haversian system. Each haversian system is made up of haversian canals, lamellae, and canaliculi. Trabeculae are found in spongy bone.

REF: p. 960

4. Which information indicates the staff member has a good understanding of bone classifications? The shapes that represent bone classifications include (select all that apply):

a.

Long

b.

Flat

c.

Short

d.

Irregular

e.

Round

ANS: A, B, C, D

Bones can be classified by shape as long, flat, short (cuboidal), or irregular.

REF: p. 960

5. Which information indicates the nurse has a good understanding of synovial joints? The synovial joints in the body include the (select all that apply):

a.

Syndesmosis type that connects two vertebrae

b.

Spheroid type found in the shoulder

c.

Hinge type found in the elbow

d.

Gliding type found in the hand

e.

Gomphosis joint in the mandible

ANS: B, C, D

A syndesmosis joint does not have a joint space.

REF: p. 964

6. A nurse is preparing to teach about skeletal muscles. Which information should the nurse include? The terms used to describe skeletal muscle are (select all that apply):

a.

Voluntary

b.

Striated

c.

Extrafusal

d.

Fibrotic

e.

Epithelial

ANS: A, B, C

Skeletal muscle has been termed voluntary, striated, or extrafusal.

REF: p. 967

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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