Question 1

A 14-year-old boy who has been diagnosed with Osgood-Schlatter disease reports painful swelling just below the knee for the past 5 months.Which response by the nurse is appropriate?

Accepted Answer

Osgood-Schlatter disease is painful swelling of the tibial tubercle just below the knee.It is most likely due to repeated stress on the patellar tendon.It is usually self-limited,occurring during rapid growth and most often in males.The symptoms resolve with rest.

Question 2

The nurse knows that the incidence of osteoporosis is greatest in which group?

Accepted Answer

The incidence of osteoporosis is lowest in black men and highest in white women.See Table 22-1.

Question 3

A patient is complaining of pain in his joints that is worse in the morning,is better after he has moved around for awhile,and then gets worse again if he sits for long periods of time.The nurse suspects that he may have:

Accepted Answer

Rheumatoid arthritis is worse in the morning when arising.Movement increases most joint pain,except in rheumatoid arthritis,in which movement decreases pain.

Question 4

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

Accepted Answer

Polydactyly is the presence of extra fingers or toes.

Question 5

When assessing muscle strength,the nurse observes that a patient has complete range of motion against gravity with full resistance.What should the nurse record using a 0 to 5+ scale?

Accepted Answer

Complete range of motion against gravity is normal muscle strength and is recorded as 5+ muscle strength.

Question 6

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

Accepted Answer

Subcutaneous nodules that are raised,firm,and nontender occur with rheumatoid arthritis in the olecranon bursa and along the extensor surface of the ulna.

Question 7

The nurse has completed the musculoskeletal examination of a patient's knee and has found a positive bulge sign.The nurse suspects:

Accepted Answer

For swelling in the suprapatellar pouch,the bulge sign confirms the presence of fluid.

Question 8

A 28-year-old jogger comes to the sports clinic complaining of increased foot problems while running.The nurse knows that a possible cause of this could be:

Accepted Answer

Joggers and athletes report increased foot problems when a second toe is longer than the great toe.See Table 22-1.

Question 9

A patient's annual physical examination reveals a lateral curvature of the thoracic and lumbar segments of his spine;however,this curvature disappears with forward bending.The nurse knows that this abnormality of the spine would be called:

Accepted Answer

Functional scoliosis is flexible;it is apparent with standing and disappears with forward bending.

Question 10

A professional tennis player comes into the clinic complaining of a sore elbow.The nurse suspects that he has tenderness at the:

Accepted Answer

Epicondyle,head of radius,and tendons are common sites of inflammation and local tenderness,or "tennis elbow."

Question 11

A 40-year-old man has come into the clinic with complaints of "extreme tenderness in my toes." The nurse notes that his toes are slightly swollen,reddened,and warm to the touch.His complaints would suggest:

Accepted Answer

Acute gout occurs primarily in men over 40 years of age.Clinical findings consist of redness,swelling,heat,and extreme tenderness.Gout is a metabolic disorder of disturbed purine metabolism,associated with elevated serum uric acid.

Question 12

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

Accepted Answer

For the Phalen's test,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's test reproduces numbness and burning in a person with carpal tunnel syndrome

Question 13

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

Accepted Answer

Fingers drift to the ulnar side because of stretching of the articular capsule and muscle imbalance caused by chronic rheumatoid arthritis.

Question 14

A patient states,"I can hear a crunching or grating sound when I kneel." She also states "it is very difficult to get out of bed in the morning because of stiffness and pain in my joints." The nurse suspects that the sound she hears is:

Accepted Answer

Crepitation is an audible and palpable crunching or grating that accompanies movement and occurs when articular surfaces in the joints are roughened,as with rheumatoid arthritis.

Question 15

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 suspects:

Accepted Answer

Rotator cuff lesions may cause limited range of motion and pain and muscle spasm during abduction,whereas forward flexion stays fairly normal.

Question 16

A patient who has had rheumatoid arthritis for years comes to the clinic to ask about changes in her hands.The nurse knows that changes associated with rheumatoid arthritis include:

Accepted Answer

Changes in the hands caused by chronic rheumatoid arthritis include swan-neck and boutonniere deformities.Heberden's nodes and Bouchard's nodules are associated with osteoarthritis.

Question 17

The nurse is examining a 3-month-old infant.While holding the thumbs on the infant's inner mid thighs and the fingers outside on the hips,touching the greater trochanter,the nurse adducts the legs until the nurse's thumbs touch and then abducts the legs until the infant's knees touch the table.The nurse does not note any "clunking" sounds and is confident to record a:

Accepted Answer

Normally this maneuver feels smooth and has no sound.With a positive Ortolani sign,you will feel and hear a "clunk" as the head of the femur pops back into place.

Question 18

During an examination,the nurse asks a patient to bend forward from the waist and notes that the patient has lateral tilting.When his leg is raised straight up,he complains of a pain going down his buttock into his leg.The nurse suspects:

Accepted Answer

Lateral tilting and sciatic pain with straight leg raising are findings that occur with a herniated nucleus pulposus.

Question 19

An 80-year-old woman is visiting the clinic for a checkup.The nurse is observing for motor dysfunction in her hip and would have her:

Accepted Answer

Limitation of abduction of the hip while supine is the most common motion dysfunction found in hip disease.

Question 20

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

Accepted Answer

For a fractured clavicle,observe for limited arm range of motion and unilateral response to the Moro reflex.

Quiz 22: Musculoskeletal System