Question 1

During a neonatal examination, the nurse notices that the newborn infant has six toes.This finding is documented as:

Accepted Answer

Polydactyly is the presence of extra fingers or toes.Syndactyly is webbing between adjacent fingers or toes.The other terms are not correct.

Question 2

A 68-year-old woman has come in for an assessment of her rheumatoid arthritis, and the nurse notices raised, firm, nontender nodules at the olecranon bursa and along the ulna.These nodules are most commonly diagnosed as:

Accepted Answer

The presence of raised, firm nodules along the ulna and olecranon bursa are most likely subcutaneous nodules, a common manifestation of rheumatoid arthritis. Epicondylitis refers to an inflammation of the elbow tendons, while gouty arthritis would present with sudden onset of intense pain, redness, and swelling in the joints. Olecranon bursitis would present with a painful, swollen, and fluid-filled sac at the tip of the elbow.

Question 3

A patient who has had rheumatoid arthritis for years comes to the clinic to ask about changes in her fingers.The nurse will assess for signs of what problems?

Accepted Answer

Changes in the fingers caused by chronic rheumatoid arthritis include swan neck and boutonniere deformities.Heberden's nodes and Bouchard's nodules are associated with osteoarthritis.Dupuytren's contractures occur because of chronic hyperplasia of the palmar fascia and causes contractures of the digits (see Table 22-4).

Question 4

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:

Accepted Answer

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.

Question 5

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:

Accepted Answer

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.

Question 6

A 40-year-old man has come into the clinic with extreme pain in his toes.The nurse notices that his toes are slightly swollen, reddened, and warm to the touch and recognizes that he has findings of:

Accepted Answer

The patient's symptoms of extreme pain, swelling, redness, and warmth in his toes are classic signs of acute gout. Osteoporosis is a condition characterized by weakened bone density, not joint pain or inflammation. Ankylosing spondylitis is a type of inflammatory arthritis that affects the spine and pelvic joints, and degenerative joint disease (also known as osteoarthritis) is a condition that results from wear and tear on the joints over time.

Question 7

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?

Accepted Answer

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.

Question 8

The nurse is assessing a 22-year-old patient, a dedicated violin player, who complains of elbow pain and aching forearm muscles.During examination, the nurse elicits pain by touching the outside area of the elbow and when having the patient resist extension of the hand.The nurse recognizes this as:

Accepted Answer

Chronic, disabling pain at lateral epicondyle of humerus, radiates down extensor surface of forearm.Pain can be located by touching with one finger (as shown in the illustration).Resisting extension of the hand will increase pain.Pain occurs with activities that combine excessive pronation and supination of the forearm with an extended wrist (e.g., playing racket sports, using a screwdriver, or repeated bending of the elbow).(See Tables 24-3 and 24-5.)

Question 9

The nurse is examining a 3-month-old infant and performs the Ortolani manoeuvre.The nurse notes that the movements feel smooth and no sounds are produced.The nurse will document the findings as a:

Accepted Answer

Normally, this manoeuvre feels smooth and has no sound.With a positive Ortolani sign, however, the nurse will feel and hear a "clunk," as the head of the femur pops back into place.A positive Ortolani sign also reflects hip instability and warrants referral

Question 10

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

Accepted Answer

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.

Question 11

A woman who has had rheumatoid arthritis for years is noticing that her fingers are starting to drift to the side.The nurse knows that this condition is commonly referred to as:

Accepted Answer

Ulnar deviation is the term used to describe the fingers drifting towards the ulnar side (away from the thumb) in rheumatoid arthritis. Radial drift, on the other hand, refers to the opposite direction (towards the thumb). Swan-neck deformity and Dupuytren's contracture are also common deformities associated with rheumatoid arthritis, but they do not involve finger drifting to the side. Swan-neck deformity is characterized by hyperextension of the proximal interphalangeal joint and flexion of the distal interphalangeal joint, while Dupuytren's contracture involves the thickening and shortening of the palmar fascia leading to finger flexion contractures.

Question 12

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?

Accepted Answer

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.

Question 13

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:

Accepted Answer

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

Question 14

The nurse has completed the musculoskeletal examination of a patient's knee and has found a positive bulge sign.The nurse interprets this finding to indicate:

Accepted Answer

A positive bulge sign confirms the presence of swelling caused by fluid in the suprapatellar pouch.The other options are not correct.

Question 15

The nurse suspects that a patient has carpal tunnel syndrome and wants to perform the Phalen test.To perform this test, the nurse should instruct the patient to:

Accepted Answer

For the Phalen test, the nurse should ask the person to hold both hands back to back while flexing the wrists 90 degrees.Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand.The Phalen test reproduces numbness and burning in a person with carpal tunnel syndrome.The other actions are not correct when testing for carpal tunnel syndrome.

Question 16

During an examination, the nurse asks a patient to bend forward from the waist and notices that the patient has lateral tilting.When asked to perform the LaSègue test, the patient complains of a pain going down his buttock into his leg.The nurse suspects:

Accepted Answer

Lateral tilting and sciatic pain with the LaSègue test (straight leg raising) are findings that occur with a herniated nucleus pulposus.A positive LaSègue test result is obtained when sciatic pain reproduced by lifting of the affected leg, confirming the presence of a herniated nucleus pulposus.The other options are not correct.

Question 17

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:

Accepted Answer

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.

Question 18

A mother brings her newborn baby boy in for a checkup; she tells the nurse that he does not seem to be moving his right arm as much as his left arm and that he seems to have pain when she lifts him up by holding him under the arms.The nurse suspects a fractured clavicle and would observe for:

Accepted Answer

For a fractured clavicle, the nurse should observe for limited arm range of motion and unilateral response to the Moro reflex.The other tests are not appropriate for this type of fracture.

Question 19

A professional tennis player comes into the clinic complaining of a sore elbow.The nurse will assess for tenderness at the:

Accepted Answer

The epicondyles, the head of the radius, and the tendons are common sites of inflammation and local tenderness, commonly referred to as tennis elbow.The other locations are not affected.

Question 20

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:

Accepted Answer

The young swimmer's inability to move his shoulder after falling on an outstretched hand strongly suggests a dislocated shoulder. A dislocated shoulder occurs when the head of the humerus bone pops out of its socket in the shoulder blade, causing intense pain and an inability to move the arm. Joint effusion, tear of rotator cuff, and adhesive capsulitis can also be causes of shoulder pain, but the mechanism of injury described by the young swimmer is most consistent with a dislocated shoulder.

Quiz 24: Musculoskeletal System