Question 1

The patient with an old knee injury says, "I think I have water on my knee again." The nurse would prepare to conduct which tests to assess for that finding?. Select all that apply.

Accepted Answer

Ballottement and Bulge sign are specific tests used to assess for fluid accumulation in the knee joint, which is commonly referred to as "water on the knee." Phalen's test is used for carpal tunnel syndrome, Thomas test is used to assess hip flexure issues, and Heberden's sign is associated with osteoarthritis of the fingers.

Question 2

The nurse plans to use a goniometer during assessment of a patient's musculoskeletal system. Which technique should the nurse use?. Select all that apply.

Accepted Answer

When using a goniometer, the nurse should document the angle of the joint in range of degrees, place the fulcrum of the goniometer on the joint, and place the stationary arm of the goniometer on the part of the limb that will not move. Moving the patient's arm through the normal full range of motion is not necessary when using a goniometer. Placing the movable arm of the goniometer on the stationary part of the joint could cause inaccurate measurements. Therefore, options C and E are not correct.

Question 3

During an assessment of the feet, the nurse asks the patient to sit, feet dangling, and point the toes toward the nose. The nurse is assessing which movement?

Accepted Answer

Dorsiflexion is the movement of the foot towards the shin, resulting in the top of the foot moving upward. This is what the nurse is assessing when asking the patient to point their toes toward their nose.

Question 4

When assessing a 68 year-old female patient, the nurse notes an exaggerated curvature of the thoracic spine when the patient bends at the waist. How would the nurse evaluate this finding?

Accepted Answer

An exaggerated curvature of the thoracic spine is commonly seen in older patients as a result of age-related changes in the spine. This curvature is called kyphosis, and while it can cause discomfort or affect mobility, it does not typically require emergency surgery. Scoliosis refers to a lateral curvature of the spine, which is not what the nurse is observing in this scenario. The fact that the patient is a woman does not necessarily have any bearing on this finding.

Question 5

The nurse is assessing a patient's ability to internally rotate the shoulders. Which direction would the nurse provide?

Accepted Answer

Placing the hands behind the lower back allows for internal rotation of the shoulders.

Question 6

The nurse is assessing a patient's gait. Which findings would the nurse consider normal?. Select all that apply.

Accepted Answer

The answer of The nurse is assessing a patient's gait....

Question 7

A 70-year-old woman is diagnosed with a pathologic fracture of the fibula. The nurse would assess for which most common condition?

Accepted Answer

Osteoporosis is the most common condition associated with pathologic fractures in older adults, as it can cause weakening of the bones without any obvious trauma or injury. Elder abuse, unreported falls or injuries, and cancer of the bone are all potential causes of fractures but are less common in this age group.

Question 8

The nurse determines that a patient's shoulder muscle strength is normal when it is graded as _______ or better.

Accepted Answer

The answer of The nurse determines that a patient's shoulder...

Question 9

The nurse determines that a patient has pain when turning the hand palm down and then palm up. Which documentation is appropriate?. Select all that apply.

Accepted Answer

Pain on forearm supination (palm up) and pain on pronation of the hand (palm down) indicate a potential issue with the radial and ulnar collateral ligaments, so options A and D would be appropriate documentation. The other options do not specifically address the movement of turning the hand from palm up to palm down and vice versa.

Question 10

The nurse wishes to assess the anatomic snuffbox of a patient's wrist. Which instruction should the nurse provide?

Accepted Answer

The anatomic snuffbox is located on the lateral aspect of the wrist and can be assessed by having the patient extend their thumb fully to the side. Option A is incorrect as it would not allow access to the snuffbox. Option B is incorrect as making a tight fist would not allow the thumb to be fully extended. Option D is incorrect as flexing the wrist would not provide access to the snuffbox.

Quiz 48: Nursing Management of the Patient With Musculoskeletal Disorders