Question 1

Which description of pain from the patient makes a nurse suspect the patient's pain is originating from a muscle?

Accepted Answer

Muscle pain is often described as "crampy." Bone pain typically is described as "deep" and "dull." Bone pain typically is described as "boring" and "intense." Muscle pain usually remains crampy on movement.

Question 2

The nurse asks the patient to hold the arms straight out, perpendicular to the floor, and the nurse tries to push the patient's arms down. This procedure tests the strength of which muscles?

Accepted Answer

The patient uses the deltoid muscles to resist the action of the nurse. The nurse would test the triceps muscle strength by having the patient extend the arm and resist while the nurse tries to push the arm to a flexed position. The nurse would test the muscle strength of the biceps by having the patient flex the forearm while the nurse applies resistance. The nurse would test the trapezius by having the patient shrug the shoulders against resistance.

Question 3

A nurse palpates the patient's jaw movement by placing two fingers in front of each ear and asking the patient to slowly open and close the mouth. What movement does the nurse ask the patient to do next?

Accepted Answer

Moving the jaw side to side assesses the range of motion of the jaw; asking the patient to protrude and retract the jaw also assesses range of motion. Swallowing assesses cranial nerve IX (glossopharyngeal) and X (vagus). Smiling assesses cranial nerve VII (facial). Clenching the teeth together assesses cranial nerve VII (facial).

Question 4

A nurse asks a patient to describe his new onset of leg pain. He slept well through the night, but this morning he suddenly developed pain in his left lower leg that is red and too painful to touch. Nothing relieves the pain. Based on these data, the nurse suspects which disorder is causing this pain?

Accepted Answer

Sudden onset of pain and erythema in the great toe, ankle, and lower leg suggests gout (also called gouty arthritis). Patients with rheumatoid arthritis often have morning stiffness lasting 1 to 2 hours. Patients with osteoarthritis experience pain when bearing weight that is relieved by rest. Tendonitis may awaken the patient, especially when the patient is lying on the affected limb.

Question 5

With the patient in a supine position, how does a nurse test the external rotation of the patient's right hip?

Accepted Answer

Placing the right heel on the left patella externally rotates the right hip. Moving the right leg laterally with the right knee straight assesses abduction of the right hip. Flexing the right knee and turning medially toward the left side (inward) internally rotates the right hip. Raising the right leg straight up and perpendicular to the body flexes the right hip.

Question 6

What movement from the patient does a nurse request to assess for hyperextension of the hip?

Accepted Answer

Procedure A tests hyperextension of the hip. Procedure B tests hip flexion. Procedure C tests hip abduction. Procedure D tests hip adduction.

Question 7

A patient reports joint pain interfering with sleep and morning joint stiffness for the first hour after getting out of bed. Considering this report, what abnormal findings does the nurse anticipate during the examination?

Accepted Answer

The history and these examination findings are consistent with rheumatoid arthritis. Joints are involved bilaterally in rheumatoid arthritis because it is a systemic autoimmune disorder. The examination finding in option A is more consistent with bursitis. The examination finding in option B is more consistent with osteoarthritis. The examination finding in option C is more consistent with gout.

Question 8

The nurse notes that there is an audible clicking sound when the patient opens and closes the mouth. What is the appropriate response of the nurse at this time?

Accepted Answer

The mandible should move smoothly and painlessly. An audible or palpable snapping or clicking in the absence of other symptoms is not unusual. Option A would be an incorrect action because clicking of the mandible with no other associated signs or symptoms is a normal finding. Option B is not a correct assessment technique to use. Option C is not a correct assessment technique to use.

Question 9

When a nurse asks a patient to place the right arm behind the head, the nurse is testing for which range of motion?

Accepted Answer

External rotation and abduction of the shoulder is tested by this maneuver. Flexion of the elbow requires the patient to flex the elbow, but the elbow flexion is usually tested by asking the patient to bend the elbow so that the fingers are touching the shoulder. Hyperextension of the shoulder is tested by moving the arm straight backward. Internal rotation and adduction of the shoulder is tested by asking the patient to place the hand behind the back.

Question 10

A patient reports a history of compression of the left cranial nerve XI (spinal accessory nerve) from an old sports injury. Based on this information, what technique does the nurse include in the focused assessment?

Accepted Answer

Option D is the technique to test strength of the trapezius muscle that is innervated by the cranial nerve XI. Option A is the technique to test the sternocleidomastoid muscle. Option B is the technique to test the sternocleidomastoid muscle. Option C is the technique to test the sternocleidomastoid muscle.

Question 11

With the patient lying supine, a nurse raises the patient's leg to flex the hip. The patient complains of pain when the leg is raised to 40 degrees. The nurse correlates this finding with which disorder?

Accepted Answer

To evaluate for nerve root irritation or lumbar disk herniation, perform straight leg raises. Pain in the back of the leg with 30 to 60 degrees of elevation indicates pressure on a lumbar peripheral nerve by an intervertebral disk. Straight leg raises evaluate for herniated disks, but not in the cervical disks in the neck. Osteoarthritis is a degenerative disease of articular cartilage that affects weight-bearing joints such as vertebrae, hips, knees, and ankles. Straight leg raises is not a technique to assess for osteoarthritis. Bursa become inflamed by constant friction around joints and may be precipitated by arthritis or injury. The hip is a common site, but not vertebrae. Manifestations include painful range of motion, point tenderness, and erythema of the affected joint.

Question 12

To assess the triceps and biceps muscle strength, the nurse applies resistance to the patient's arm. What should be done to ensure the appropriate muscle is being assessed?

Accepted Answer

Option B is the correct technique for assessing these muscles. Abducting and adducting test range of motion rather than muscle strength. Option C is a reversal of the correct technique. Abducting and adducting test range of motion rather than muscle strength.

Question 13

When assessing the neck of a healthy adult, a nurse expects which findings?

Accepted Answer

Option C is an expected finding. The posterior cervical spine should be concave. The patient should be able to laterally bend the head 40 degrees from midline in each direction. The patient should be able to hyperextend the head 55 degrees from midline.

Question 14

On inspection of a patient's hands, the nurse notices ulnar deviation and swan-neck deformities bilaterally and correlates this finding with which disorder?

Accepted Answer

Ulnar deviation, swan-neck, and boutonnière deformities of interphalangeal joints are manifestations of rheumatoid arthritis. The findings are consistent with rheumatoid arthritis.

Question 15

A patient asks, "Why is touching my toes necessary? This is a sports physical examination, not exercise class." What is the most appropriate response by the nurse?

Accepted Answer

Option C is the correct technique for inspecting the spine and for detecting scoliosis. Option A is an incorrect technique for assessing arm symmetry. The hamstrings are not normally assessed. Option D is not a correct statement.

Question 16

During a history, the patient reports having gout. Based on this information, what findings does the nurse anticipate during a focused assessment?

Accepted Answer

Option B is a description of gout. The pealike nodules are tophi, collections of uric acid in subcutaneous tissue. Option A is a description of findings of a patient who has rheumatoid arthritis. Bilateral joint involvement is common. Option C is a description of findings of a patient who has osteoarthritis. Enlarged and tender PIP joints refer to Heberden nodes and DIP joints refer to Bouchard nodes. Option D is a description of epicondylitis (tennis elbow).

Question 17

In assessing a patient with a history of poliomyelitis, the nurse suspects the right leg muscles are smaller than the left leg. What is the best approach for the nurse to confirm or reject this suspicion?

Accepted Answer

Technique B is correct, provides a baseline for future comparisons, and provides measurements for side-to-side comparisons. Option A describes an appropriate procedure to determine tenderness of muscles, but not muscle size. The goniometer is used to measure the degree of joint flexion and extension rather than muscle size. The Lovett scale is used to grade and record muscle strength, rather than muscle size.

Question 18

The nurse asks the patient to rest the left arm on a table and to move the lower arm so that the palm of the hand is up and then down. What motion is the nurse testing?

Accepted Answer

Supination and pronation of the elbow is tested by this maneuver. The movements of the wrist are flexion, extension, and ulnar and radial deviation. Option C is not a movement of the elbow. The elbow moves in flexion, extension, pronation, and supination.

Question 19

When a nurse asks a patient to place the right arm behind the back, so that the back of the hand is touching the lower spine, the nurse is testing for which range of motion?

Accepted Answer

Internal rotation and adduction of the shoulder is tested by this maneuver. Pronation of the elbow is tested by pronating the palm on a flat surface. Hyperextension of the elbow is not a motion of the elbow. External rotation and abduction of the shoulder is tested by asking the patient to place the hand behind the head.

Question 20

In assessing the joint range of motion of a patient's knees, the nurse notices the flexion is less than expected in both knees. What is the next appropriate action for the nurse?

Accepted Answer

When a joint seems to have increased or decreased range of motion, use a goniometer to measure the angle. Option A is not an expected finding. Even when the finding is bilateral, when it is abnormal, additional examination is needed. Option B is the procedure for palpating the knees, in which data are collected, but it may not have a direct bearing on the lack of flexion of the knees. Option D is the procedure for testing leg muscles for strength, in which data are collected, but it may not have a direct bearing on the lack of flexion of the knees.

Quiz 14: Musculoskeletal System