Chapter 58Assessment of Musculoskeletal Function My Nursing Test Banks

Chapter 58Assessment of Musculoskeletal Function

MULTIPLE CHOICE

1.A client is being treated for a fractured scapula. The nurse realizes that the scapula is what kind of bone type?

1.

Flat

2.

Irregular

3.

Long

4.

Short

ANS: 1

The scapula, iliac crest, and sternum are flat bone types. Metacarpals are an example of the short type. The femur is a long type bone, and the vertebra is an irregular type.

PTS: 1 DIF: Analyze REF: Table 58-1 Types of Bone

2.A school age child has sustained a fractured femur. When assessing the location of the break, the area that could cause the most concern would be the:

1.

diaphysis.

2.

epiphyseal plate.

3.

medullary cavity.

4.

metaphysis.

ANS: 2

The epiphyseal plate, or growth plate, is where active longitudinal growth occurs. If a fracture occurs in or through the epiphyseal plate, growth in that extremity may be delayed or stopped. The diaphysis is the shaft of the long bone. The medullary cavity is the bone marrow. The metaphysis is the area of transition between the diaphysis and the epiphysis.

PTS: 1 DIF: Analyze REF: Macroscopic Structure of Bone

3.A client is experiencing an increase in resorption of bone. The nurse realizes that which of the following bone cells is responsible for this function?

1.

Osteoblasts

2.

Osteoclasts

3.

Osteocytes

4.

Osteomasts

ANS: 2

Osteoclasts are responsible for resorption in the bone and work chemically through enzymatic and phagocytic action. Osteoblasts build bone. Osteocytes are mature bone cells, and osteomasts demineralize bone.

PTS: 1 DIF: Analyze REF: Microscopic Structure of Bone: Cell Types

4.A client, recovering from an extended illness, is having difficulty coordinating his movements to walk. The nurse should remind the client that skeletal muscle has which of the following normal properties?

1.

It is automatic.

2.

It is convulsive.

3.

It is involuntary.

4.

It is voluntary.

ANS: 4

Skeletal muscle is voluntary. Cardiac and smooth muscles are involuntary. Skeletal muscle is not normally convulsive in nature.

PTS: 1 DIF: Apply REF: Anatomy and Physiology of Skeletal Muscles

5.A client is experiencing unstable hip joints with ambulation. The nurse suspects that a disorder is occurring within the strong bands of connective tissue that attach bone to bone or the:

1.

bursae.

2.

cartilage.

3.

ligaments.

4.

tendons.

ANS: 3

Ligaments are strong bands of connective tissue that attach bone to bone or bone to cartilage. Ligaments help to give joints stability, guide the joint movement, and prevent excess motion within the joint. Tendons connect muscle to bone. Bursae are synovial fluid-filled sacs near joints. Cartilage covers the ends of bone to reduce friction.

PTS: 1 DIF: Analyze REF: Tendons, Ligaments, and Bursae

6.The nurse is moving a clients leg toward the body during range-of-motion exercises. The nurse is doing which of the following with the clients extremity?

1.

Abduction

2.

Adduction

3.

Extension

4.

Flexion

ANS: 2

Abduction is movement away from the body, and adduction is movement toward the body. Extension is a movement that increases the angle between two joints, and flexion is a movement that decreases the angle between two joints.

PTS:1DIF:ApplyREF:Range of Motion

7.A client has an elevated C-reactive protein level. Which of the following should the nurse assess in this client?

1.

Alcohol intake

2.

Cigarette use

3.

Recent weight loss

4.

Pregnancy status

ANS: 2

Cigarettes can elevate levels of C-reactive protein. The nurse should assess the client for smoking. Alcohol and weight loss can falsely lower C-reactive protein levels. Pregnancy status does not affect the C-reactive protein level.

PTS:1DIF:Apply

REF: Table 58-5 Laboratory Tests (Serum) Related to Musculoskeletal Disorders

8.During the assessment of a clients muscle status, the nurse notes the client is able to complete range of motion against gravity with some resistance. The nurse would document this assessment finding as being:

1.

2.

2.

3.

3.

4.

4.

5.

ANS: 3

Complete range of motion against gravity with some resistance is graded as being 4 or good. Complete range of motion without gravity is graded as being 2 or poor. Complete range of motion against gravity without added resistance is graded as being 3 or fair. Complete range of motion against gravity with full resistance is graded as being 5 or normal.

PTS: 1 DIF: Apply REF: Table 58-3 Graded Muscle Strength

9.A client is seeking medical attention for pain in the knee that occurred during a recent sports activity. The nurse realizes that the client will most likely have which of the following diagnostic tests?

1.

Arthrography

2.

MRI

3.

Angiogram

4.

Bone scan

ANS: 2

Magnetic resonance imaging (MRI) is now the diagnostic intervention of choice due to its noninvasive nature. Arthrography is seldom used today. Angiogram is used to confirm a diagnosis of deep vein thrombosis or pulmonary embolism. Bone scan is used to detect early bone disease.

PTS:1DIF:AnalyzeREF:Radiographic Studies

10.A middle-aged female client tells the nurse that her mother and aunts all have been diagnosed with osteoporosis. The nurse realizes that this client might benefit from having which of the following diagnostic tests?

1.

Dual energy s-ray absorptiometry (DEXA) scan

2.

MRI

3.

CT scan

4.

Myelogram

ANS: 1

DEXA scans measure bone density and are used in the early diagnosis of osteoporosis. MRIs, CT scans, and myelograms are not used to help diagnose osteoporosis.

PTS:1DIF:AnalyzeREF:Radiographic Studies

11.A client is recovering from surgery to repair a torn anterior cruciate ligament of the knee. The nurse should prepare the client to have which of the following diagnostic tests after the procedure?

1.

Bone scan

2.

Arthrometry

3.

Arthroscopy

4.

Bone marrow biopsy

ANS: 2

Arthrometry is used after surgery to repair a torn anterior cruciate ligament injury to confirm stability. Bone scans are used to identify bone disease. Arthroscopy is used to diagnose and repair specific disorders of the knee. A bone marrow biopsy is used to examine the bone marrow for abnormal tissue growth.

PTS: 1 DIF: Apply REF: Arthrometry

12.Which of the following should the nurse instruct a client who is scheduled for electromyography studies?

1.

Eat nothing after midnight.

2.

Avoid taking prescribed pain medication prior to the test.

3.

Have an alternative form of transportation to get home after the test.

4.

Refrain from nicotine and caffeine for 2 to 3 hours before the test.

ANS: 4

Clients are required to refrain from nicotine and caffeine 2 to 3 hours before an electromyography. The client does not need to eat nothing after midnight. The client can take prescribed pain medication prior to the test. The client will have no restrictions after the test and will be able to drive.

PTS: 1 DIF: Apply REF: Nerve Conduction Studies

13.A client, recovering from a fractured arm, is scheduled for an x-ray 3 weeks after the injury. The nurse explains to the client that the purpose of this x-ray is to:

1.

evaluate the ossification stage of bone healing.

2.

determine the presence of a callus.

3.

assess if fibroblasts have invaded the fracture site.

4.

determine if a hematoma has formed at the fracture site.

ANS: 2

A hematoma will form at the fracture site within 24 hours after the injury. Fibroblasts invade the fracture site within 48 hours after the injury. The callus will reach maximum size in 2 to 3 weeks after the injury. This is the purpose of the clients x-ray 3 weeks after the injury. Ossification of bone healing will not occur until 3 to 4 months after the injury.

PTS: 1 DIF: Apply REF: Bone Repair/Fracture Healing

14.An elderly client tells the nurse that he has been having increasing difficulty walking and he has reduced range of motion in both hips. The nurse suspects that which of the following is occurring with this client?

1.

Loss of elasticity of the ligaments and tendons

2.

Reduction in blood supply to the hips

3.

Interruption in nerve supply to the hips

4.

Hairline fractures of both hips

ANS: 1

Age-related changes to the muscular system include the loss of elasticity of the ligaments and tendons. The ligaments and tendons shorten, and the client experiences stiffness, loss of flexibility, and loss of range of motion. The client most likely does not have a reduction in blood and nerve supply to the hips. The client would not be able to bear weight on the legs if hairline fractures were present in the hips.

PTS: 1 DIF: Analyze REF: Aging and the Muscular System

MULTIPLE RESPONSE

1.The nurse is assessing a clients gait. Which of the following is a part of this assessment? (Select all that apply.)

1.

The foot location during midstance

2.

The way the client pushes off from the ball of the foot

3.

The rate and rhythm of acceleration

4.

Alignment of the head

5.

Gap between the legs

6.

Breathing pattern

ANS: 1, 2, 3, 4, 5

The gait has two phases: stance and swing. The nurse should assess the clients foot location during midstance, the way the client pushes off from the ball of the foot, and the rate and rhythm of acceleration. The nurse should also assess the clients head alignment during walking and the gap between the legs. The clients breathing pattern is not assessed during the assessment of gait.

PTS:1DIF:ApplyREF:Analysis of Gait

2.A client is scheduled for a myelogram. Which of the following should the nurse instruct the client regarding pre-procedure activities? (Select all that apply.)

1.

Drink extra fluids the evening before the procedure.

2.

Take nothing by mouth 4 to 8 hours before the procedure.

3.

Empty the bladder before the procedure.

4.

Sleep with head elevated at a 30 degree angle.

5.

Stay in bed for 16 hours.

6.

Take pain medication as prescribed .

ANS: 1, 2, 3

Pre-procedure activities for a myelogram include drinking extra fluids the evening before the procedure; taking nothing by mouth for 4 to 8 hours before the procedure; and empty the bladder before the procedure. Sleeping with the head of the bed elevated, staying in bed for 16 hours, and taking pain medication are all post-procedure activities.

PTS: 1 DIF: Apply REF: Myelogram

3.A client, scheduled to have joint fluid aspirated from the knee, asks the nurse why the procedure is being done. Which of the following should the nurse explain to this client? (Select all that apply.)

1.

It is done to examine the synovial fluid in the joint cavity.

2.

It is done to realign the knee joint.

3.

It is done to relieve pain.

4.

It is done to visualize the bone structure.

5.

It is done to relieve edema and effusion.

6.

It is done to evaluate the status of ligaments.

ANS: 1, 3, 5

Joint aspiration is performed to examine the synovial fluid in the joint cavity. It is also used to relieve pain in the joint resulting from edema and effusion. Joint aspiration is not done to realign the joint, visualize the bone structure, or evaluate the status of ligaments.

PTS:1DIF:ApplyREF:Joint Aspiration

4.A client is scheduled for somatosensory evoked potentials. The nurse realizes this test is used to help diagnose which of the following disorders? (Select all that apply.)

1.

Multiple sclerosis

2.

Radiculopathies

3.

Myasthenia gravis

4.

Peripheral nerve function

5.

Charcot-Marie-Tooth disease

6.

Huntingtons chorea

ANS: 2, 4, 5

Somatosensory evoked potentials are used to measure time in meters per second from the stimulation of a peripheral nerve through the response. It is useful in the evaluation of radiculopathies and peripheral nerve function and the diagnosis of Charcot-Marie-Tooth disease. This diagnostic test is not used for multiple sclerosis, myasthenia gravis, or Huntingtons chorea.

PTS:1DIF:Analyze

REF: Somatosensory Evoked Potentials (Evoked Potentials)

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