Chapter 22 4j5627
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Jarvis: Physical Examination and Health Assessment, 5th edition Chapter 22: Musculoskeletal System Test Bank MULTIPLE CHOICE 1. A patient is being assessed for range of t movement. The nurse asks him to move his arm in toward the center of his body. This movement is called: 1. flexion. 2. abduction. 3. adduction. 4. extension. ANS: 3 Moving a limb toward the midline of the body is called adduction; abduction is moving a limb away from the midline of the body. DIF: Application REF: Page: 599 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. A patient tells the nurse that she is having a hard time bringing her hand to her mouth when she eats or tries to brush her teeth. The nurse knows that for her to move her hand to her mouth, she must perform the following movement: 1. flexion. 2. abduction. 3. adduction. 4. extension. ANS: 1 Flexion, or bending a limb at a t, would be required to move your hand to your mouth. DIF: Application REF: Page: 599 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The functional units of the musculoskeletal system are the: 1. ts. 2. bones. 3. muscles. 4. tendons.
ANS: 1 ts are the functional units of the musculoskeletal system because they permit the mobility needed for activities of daily living.
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DIF:
Knowledge
REF: Page: 598
MSC: NCLEX: General
4. Hematopoiesis takes place in the: 1. liver. 2. spleen. 3. kidneys. 4. bone marrow. ANS: 4 The musculoskeletal system functions to encase and protect inner vital organs, the body, produce red blood cells in the bone marrow, and store minerals. DIF:
Application
REF: Page: 598
MSC: NCLEX: General
5. Fibrous bands running directly from one bone to another that strengthen the t and help prevent movement in undesirable directions are called: 1. bursa. 2. tendons. 3. cartilage. 4. ligaments. ANS: 4 Fibrous bands running directly from one bone to another that strengthen the t and help prevent movement in undesirable directions are called ligaments. DIF:
Knowledge
REF: Page: 598
MSC: NCLEX: General
6. The nurse notices that a woman in an exercise class is unable to jump rope. The nurse knows that to jump rope, one’s shoulder has to be capable of: 1. inversion. 2. supination. 3. protraction. 4. circumduction. ANS: 4 Circumduction is defined as moving the arm in a circle around the shoulder. DIF: Application REF: Page: 599 MSC: NCLEX: Physiological Integrity: Physiological Adaptation
22-3 7. 1. 2. 3. 4.
The articulation of the mandible and the temporal bone is known as the: intervertebral foramen. condyle of the mandible. temporomandibular t. zygomatic arch of the temporal bone.
ANS: 3 The articulation of the mandible and the temporal bone is the temporomandibular t. DIF:
Knowledge
REF: Page: 600
MSC: NCLEX: General
8. To palpate the temporomandibular t, the nurse’s fingers should be placed in the depression: 1. distal to the helix of the ear. 2. proximal to the helix of the ear. 3. anterior to the tragus of the ear. 4. posterior to the tragus of the ear. ANS: 3 The temporomandibular t can be felt in the depression anterior to the tragus of the ear. DIF:
Application
REF: Page: 600
MSC: NCLEX: General
9. Of the 33 vertebrae in the spinal column, there are: 1. 5 lumbar. 2. 5 thoracic. 3. 7 sacral. 4. 12 cervical. ANS: 1 There are 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 3 to 4 coccygeal vertebrae. DIF:
Comprehension
REF: Page: 600
MSC: NCLEX: General
10. An imaginary line connecting the highest point on each iliac crest would cross: 1. the first sacral vertebra. 2. the fourth lumbar vertebra. 3. the seventh cervical vertebra. 4. the twelfth thoracic vertebra. ANS: 2 An imaginary line connecting the highest point on each iliac crest crosses the fourth lumbar vertebra. DIF:
Comprehension
REF: Page: 600
MSC: NCLEX: General
11. The nurse is explaining to a patient that there are “shock absorbers” in his back to cushion the spine and to help it move. The nurse is referring to his: 1. costal facets.
22-4 2. nucleus pulposus. 3. vertebral foramen. 4. intervertebral discs. ANS: 4 Intervertebral discs are elastic fibrocartilaginous plates that cushion the spine like shock absorbers and help it move. DIF: Comprehension REF: Page: 601 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The nurse is providing patient education for a man who has been diagnosed with a rotator cuff injury. The nurse knows that a rotator cuff injury involves: 1. nucleus pulposus. 2. the articular process. 3. the medial epicondyle. 4. the glenohumeral t. ANS: 4 A rotator cuff injury involves the glenohumeral t, which is enclosed by a group of four powerful muscles and tendons that and stabilize it. DIF: Application REF: Page: 602 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. During an interview, a patient states, “I can feel this bump on the top of both of my shoulders—it doesn’t hurt but I am curious about what it might be.” The nurse should tell her: 1. “That is your subacromial bursa.” 2. “That is your acromion process.” 3. “That is your glenohumeral t.” 4. “That is the greater tubercle of your humerus.” ANS: 2 The bump of the scapula’s acromion process is felt at the very top of the shoulder. DIF: Application REF: Page: 602 MSC: NCLEX: Physiological Integrity: Physiological Adaptation
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14. The nurse is checking the range of motion in a patient’s knee and knows that the knee is capable of the following movements: 1. flexion and extension. 2. supination and pronation. 3. circumduction. 4. inversion and eversion. ANS: 1 The knee is a hinge t, permitting flexion and extension of the lower leg on a single plane. DIF: Comprehension MSC: NCLEX: General
REF: Pages: 603, 605
15. A patient is visiting the clinic for an evaluation of a swollen, painful knuckle. The nurse notices that the knuckle above his ring on the left hand is swollen and he is unable to remove his wedding ring. This t is called the: 1. interphalangeal t. 2. tarsometatarsal t. 3. metacarpophalangeal t. 4. talocalcaneonavicular t. ANS: 3 See Figure 22-10 for a diagram of the bones and ts of the hand and fingers. DIF:
Application
REF: Page: 603
MSC: NCLEX: General
16. The nurse is assessing a patient’s ischial tuberosity. To palpate the ischial tuberosity, the nurse knows that it is best to have the patient: 1. stand. 2. flex his hip. 3. flex his knee. 4. in the supine position. ANS: 2 The ischial tuberosity lies under the gluteus maximus muscle and is palpable when the hip is flexed. DIF: Application REF: Page: 604 MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. The knee t is the articulation of the femur, the tibia, and the: 1. fibula. 2. radius. 3. patella. 4. humerus.
22-6 ANS: 3 The knee t is the articulation of three bones, including the femur, the tibia, and the patella (kneecap) in one common articular cavity. DIF:
Knowledge
REF: Page: 605
MSC: NCLEX: General
18. The ankle t is the articulation of the tibia, the fibula, and the: 1. talus. 2. cuboid. 3. calcaneus. 4. talocalcaneonavicular t. ANS: 1 The ankle or tibiotalar t is the articulation of the tibia, fibula, and talus. DIF:
Knowledge
REF: Page: 605
MSC: NCLEX: General
19. The nurse is explaining the mechanism of the growth of long bones to a mother of a toddler. The nurse knows that bones increase in width or diameter by deposition of new bony tissue around the shafts. The nurse also knows that lengthening occurs at the: 1. bursa. 2. calcaneus. 3. epiphyses. 4. tuberosities. ANS: 3 Long bones grow in two dimensions: first in width or diameter by deposition of new bony tissue around the shafts. Lengthening occurs at the epiphyses, or growth plates. DIF: Comprehension REF: Page: 606 MSC: NCLEX: Health Promotion and Maintenance 20. A woman who is 8 months pregnant comments that she has noticed a change in posture and is having lower back pain. The nurse tells her that during pregnancy women have a posture shift to compensate for the enlarging fetus. This shift in posture is known as: 1. lordosis. 2. scoliosis. 3. ankylosis. 4. kyphosis. ANS: 1 Lordosis compensates for the enlarging fetus, which would shift the center of balance forward. This shift in balance in turn creates strain on the low back muscles, felt as low back pain during late pregnancy by some women. DIF: Application REF: Page: 606 MSC: NCLEX: Health Promotion and Maintenance
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21. An 85-year-old patient comments during his annual physical that he seems to be getting shorter as he ages. The nurse should explain that decreased height occurs with aging because: 1. long bones tend to shorten with age. 2. of the shortening of the vertebral column. 3. there is a significant loss of subcutaneous fat. 4. there is a thickening of the intervertebral discs. ANS: 2 Postural changes are evident with aging; decreased height is most noticeable and is due to shortening of the vertebral column. Long bones do not shorten with age. DIF: Application REF: Page: 606 MSC: NCLEX: Health Promotion and Maintenance 22. A patient has been diagnosed with osteoporosis and asks the nurse, “What is osteoporosis?” The nurse knows that osteoporosis can be defined as: 1. loss of bone matrix. 2. loss of bone density. 3. new, weaker bone growth. 4. increased phagocytic activity. ANS: 2 Osteoporosis is the loss of bone density. DIF: Knowledge REF: Page: 606 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. 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: 1. twenty-four vertebrae. 2. a missing peroneus teritus. 3. convex anterior curvature of the femur. 4. a second toe that is longer than the great toe. ANS: 4 Joggers and athletes report increased foot problems when a second toe is longer than the great toe. See Table 22-1. DIF: Application REF: Page: 607 MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
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24. The nurse knows that the incidence of osteoporosis is greatest in which group? 1. Black men 2. Black women 3. White women 4. American Indian men ANS: 3 The incidence of osteoporosis is lowest in black men and highest in white women. See Table 22-1. DIF: Comprehension REF: Page: 606 MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 25. A teenage girl has arrived complaining of pain in her left wrist. She had been playing basketball and fell, landing on her left hand. The nurse examines her hand and would expect a fracture if the girl complains: 1. of a dull ache. 2. that the pain in her wrist is deep. 3. of sharp pain that increases with movement. 4. of dull throbbing pain that increases with rest. ANS: 3 A fracture causes sharp pain that increases with movement. DIF: Analysis REF: Page: 608 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. A patient is complaining of pain in his ts 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: 1. tendinitis. 2. osteoarthritis. 3. rheumatoid arthritis. 4. intermittent claudication. ANS: 3 Rheumatoid arthritis is worse in the morning when arising. Movement increases most t pain, except in rheumatoid arthritis, in which movement decreases pain. DIF: Analysis REF: Page: 608 MSC: NCLEX: Physiological Integrity: Physiological Adaptation
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27. 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 ts.” The nurse suspects that the sound she hears is: 1. crepitation. 2. a bone spur. 3. a loose tendon. 4. fluid in the knee t. ANS: 1 Crepitation is an audible and palpable crunching or grating that accompanies movement and occurs when articular surfaces in the ts are roughened, as with rheumatoid arthritis. DIF: Analysis REF: Page: 612 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. 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: 1. crepitation. 2. rotator cuff lesions. 3. dislocated shoulder. 4. rheumatoid arthritis. ANS: 2 Rotator cuff lesions may cause limited range of motion and pain and muscle spasm during abduction, whereas forward flexion stays fairly normal. DIF: Analysis REF: Page: 615 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. A professional tennis player comes into the clinic complaining of a sore elbow. The nurse suspects that he has tenderness at the: 1. olecranon bursa. 2. annular ligament. 3. base of the radius. 4. medial and lateral epicondyle. ANS: 4 Epicondyle, head of radius, and tendons are common sites of inflammation and local tenderness, or “tennis elbow.” DIF: Analysis REF: Page: 616 MSC: NCLEX: Physiological Integrity: Physiological Adaptation
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30. 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: 1. dorsiflex the foot. 2. plantarflex the foot. 3. hold both hands back to back while flexing the wrists 90 degrees for 60 seconds. 4. hyperextend the wrists with the palmar surface of both hands touching and wait for 60 seconds. ANS: 3 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 DIF: Application REF: Page: 621 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 31. 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: 1. internally rotate her hip while she is sitting. 2. abduct her hip while she is lying on her back. 3. adduct her hip while she is lying on her back. 4. externally rotate her hip while she is standing. ANS: 2 Limitation of abduction of the hip while supine is the most common motion dysfunction found in hip disease. DIF: Analysis REF: Page: 623 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 32. The nurse has completed the musculoskeletal examination of a patient’s knee and has found a positive bulge sign. The nurse suspects: 1. irregular bony margins. 2. soft tissue swelling in the t. 3. swelling from fluid in the epicondyle. 4. swelling from fluid in the suprapatellar pouch. ANS: 4 For swelling in the suprapatellar pouch, the bulge sign confirms the presence of fluid. DIF: Analysis REF: Page: 624 MSC: NCLEX: Physiological Integrity: Physiological Adaptation
22-11 33. 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: 1. scoliosis. 2. meniscus tear. 3. herniated nucleus pulposus. 4. spasm of paravertebral muscles. ANS: 3 Lateral tilting and sciatic pain with straight leg raising are findings that occur with a herniated nucleus pulposus. DIF: Analysis REF: Page: 631 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 34. 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: 1. positive Allis. 2. negative Allis. 3. positive Ortolani. 4. negative Ortolani. ANS: 4 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. DIF: Analysis REF: Page: 633 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 35. During a neonatal examination, the nurse notes that the newborn infant has six toes. This finding is documented as: 1. unidactyly. 2. syndactyly. 3. polydactyly. 4. multidactyly. ANS: 3 Polydactyly is the presence of extra fingers or toes. DIF: Comprehension REF: Page: 634 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 36. 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: 1. a negative Allis sign.
22-12 2. a positive Ortolani sign. 3. limited range of motion during the Moro reflex. 4. limited range of motion during LaSegue’s reflex. ANS: 3 For a fractured clavicle, observe for limited arm range of motion and unilateral response to the Moro reflex. DIF: Analysis REF: Page: 634 MSC: NCLEX: Health Promotion and Maintenance 37. 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: 1. osteoporosis. 2. acute gout. 3. ankylosing spondylitis. 4. degenerative t disease. ANS: 2 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. DIF: Analysis REF: Page: 650 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 38. A young swimmer comes to the sports clinic complaining of a very sore shoulder. He was running at the pool, slipped on some 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: 1. t effusion. 2. tear of rotator cuff. 3. adhesive capsulitis. 4. dislocated shoulder. ANS: 4 Dislocated shoulder occurs with trauma involving abduction, extension, and external rotation (e.g., falling on an outstretched arm or diving into a pool). DIF: Analysis REF: Page: 644 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 39. 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: 1. epicondylitis. 2. gouty arthritis.
22-13 3. olecranon bursitis. 4. subcutaneous nodules. ANS: 3 Subcutaneous nodules that are raised, firm, and nontender occur with rheumatoid arthritis in the olecranon bursa and along the extensor surface of the ulna. DIF: Analysis REF: Page: 645 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 40. 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: 1. radial drift. 2. ulnar deviation. 3. swan neck deformity. 4. Dupuytren’s contracture. ANS: 2 Fingers drift to the ulnar side because of stretching of the articular capsule and muscle imbalance caused by chronic rheumatoid arthritis. DIF: Application REF: Page: 647 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 41. 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: 1. Heberden’s nodes. 2. Bouchard’s nodules. 3. swan-neck deformities. 4. Dupuytren’s contractures. ANS: 3 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. DIF: Application REF: Page: 647 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 42. 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: 1. structural scoliosis. 2. functional scoliosis. 3. herniated nucleus pulposus. 4. dislocated nucleus pulposus. ANS: 2
22-14 Functional scoliosis is flexible; it is apparent with standing and disappears with forward bending. DIF: Analysis REF: Page: 652 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 43. 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? 1. “If these symptoms persist, you may need arthroscopic surgery.” 2. “You are experiencing degeneration of your knee, which may not resolve.” 3. “Your disease is due to repeated stress on the patellar tendon. It is usually selflimited, and your symptoms should resolve with rest.” 4. “Increasing your activity and performing knee-strengthening exercises will help to decrease the inflammation and maintain mobility in the knee.” ANS: 3 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. DIF: Application REF: Page: 649 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 44. 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? 1. 2+ 2. 3+ 3. 4+ 4. 5+ ANS: 4 Complete range of motion against gravity is normal muscle strength and is recorded as 5+ muscle strength. DIF: Application REF: Page: 612 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 45. The nurse is examining a 6-month-old baby and places the baby’s feet flat on the table and flexes his knees up. The nurse notes that the right knee is significantly lower than the left. Which of the following is true of this finding? 1. This is a positive Allis sign and suggests hip dislocation. 2. The infant probably has a dislocated patella on the right. 3. This is a normal finding for the Allis test for an infant of this age. 4. The infant should return to the clinic in 2 weeks to see if this has changed. ANS: 1 Finding one knee significantly lower than the other is a positive Allis sign and suggests hip dislocation.
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DIF: Analysis REF: Page: 634 MSC: NCLEX: Health Promotion and Maintenance 46. The nurse is assessing a 1-week-old infant and testing his muscle strength. The nurse lifts the infant with hands under the axillae and notes that the infant starts to “slip” between the hands. The nurse should: 1. suspect a fractured clavicle. 2. consider that the infant may have a deformity of the spine. 3. suspect that the infant may have weakness of the shoulder muscles. 4. consider this a normal finding because the musculature of an infant this age is undeveloped. ANS: 3 A baby who starts to “slip” between your hands shows weakness of the shoulder muscles. DIF: Analysis REF: Page: 635 MSC: NCLEX: Health Promotion and Maintenance 47. The nurse is planning to measure a patient’s angles of t flexion and will use which instrument? 1. Caliper 2. Protracter 3. Goniometer 4. Measuring tape ANS: 3 A goniometer is used to measure the angles of t flexion accurately. DIF: Comprehension REF: Page: 611 MSC: NCLEX: Safe and Effective Care Environment: Management of Care
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48. The nurse should use which test to check for large amounts of fluid around the patella? 1. Ballottement 2. Tinel’s sign 3. Phalen’s test 4. McMurray’s test ANS: 1 Balottement of the patella is reliable when larger amounts of fluid are present. DIF: Comprehension REF: Page: 625 MSC: NCLEX: Safe and Effective Care Environment: Management of Care 49. The nurse knows that another term for “knock knees” is: 1. genu varum. 2. genu valgum. 3. pes planus. 4. metatarsus adductus. ANS: 2 Genu valgum is also known as “knock knees” and is present when there is more than 2.5 cm between the medial malleoli when the knees are together. DIF: Comprehension REF: Page: 636 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 50. A patient has been diagnosed with a ganglion cyst over the dorsum of his left wrist. He asks the nurse, “What is this thing?” The nurse’s best answer would be: 1. “It is a common benign tumor.” 2. “It is a tumor that will have to be watched because it may turn malignant.” 3. “It is caused by chronic repetitive motion injury.” 4. “It is a skin infection that will need to be drained.” ANS: 1 A ganglionic cyst is a common benign tumor; it does not become malignant. DIF: Analysis REF: Page: 646 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 51. A man who has had gout for several years comes to the clinic with a “problem with my toe.” On examination, the nurse notes the presence of hard, painless nodules over the great toe; one had burst open with a chalky discharge. This finding is known as: 1. a callus. 2. a plantar wart. 3. tenosynovitis. 4. tophi.
22-17 ANS: 4 Tophi are collections of sodium urate crystals resulting from chronic gout in and around the t that cause extreme swelling and t deformity. They appear as hard, painless nodules (tophi) over the metatarsophalangeal t of the first toe and they sometimes burst with a chalky discharge. DIF: Application REF: Page: 650 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 52. When performing a musculoskeletal assessment, the nurse knows that the correct approach for the examination should be: 1. proximal to distal. 2. distal to proximal. 3. posterior to anterior. 4. anterior to posterior. ANS: 1 The musculoskeletal assessment should be done in an orderly approach, head to toe, proximal to distal. DIF: Application REF: Page: 610 MSC: NCLEX: Safe and Effective Care Environment: Management of Care
22-18 MULTIPLE RESPONSE 1. The nurse is assessing the ts of a woman who has stated, “I have a long family history of arthritis, and my ts hurt.” The nurse suspects that she has osteoarthritis. Which of the following are symptoms of osteoarthritis? Select all that apply. 1. Symmetric 2. Asymmetric 3. Pain with motion of affected ts 4. Affected ts swollen with hard, bony protuberances 5. Affected ts may have heat, redness, and swelling. ANS: 2, 3, 4 In osteoarthritis, asymmetric t involvement commonly affects hands, knees, hips, and lumbar and cervical segments of the spine. Affected ts have stiffness, swelling with hard bony protuberances, pain with motion, and limitation of motion. DIF: Comprehension REF: Page: 643 MSC: NCLEX: Physiological Integrity: Physiological Adaptation
ANS: 1 ts are the functional units of the musculoskeletal system because they permit the mobility needed for activities of daily living.
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DIF:
Knowledge
REF: Page: 598
MSC: NCLEX: General
4. Hematopoiesis takes place in the: 1. liver. 2. spleen. 3. kidneys. 4. bone marrow. ANS: 4 The musculoskeletal system functions to encase and protect inner vital organs, the body, produce red blood cells in the bone marrow, and store minerals. DIF:
Application
REF: Page: 598
MSC: NCLEX: General
5. Fibrous bands running directly from one bone to another that strengthen the t and help prevent movement in undesirable directions are called: 1. bursa. 2. tendons. 3. cartilage. 4. ligaments. ANS: 4 Fibrous bands running directly from one bone to another that strengthen the t and help prevent movement in undesirable directions are called ligaments. DIF:
Knowledge
REF: Page: 598
MSC: NCLEX: General
6. The nurse notices that a woman in an exercise class is unable to jump rope. The nurse knows that to jump rope, one’s shoulder has to be capable of: 1. inversion. 2. supination. 3. protraction. 4. circumduction. ANS: 4 Circumduction is defined as moving the arm in a circle around the shoulder. DIF: Application REF: Page: 599 MSC: NCLEX: Physiological Integrity: Physiological Adaptation
22-3 7. 1. 2. 3. 4.
The articulation of the mandible and the temporal bone is known as the: intervertebral foramen. condyle of the mandible. temporomandibular t. zygomatic arch of the temporal bone.
ANS: 3 The articulation of the mandible and the temporal bone is the temporomandibular t. DIF:
Knowledge
REF: Page: 600
MSC: NCLEX: General
8. To palpate the temporomandibular t, the nurse’s fingers should be placed in the depression: 1. distal to the helix of the ear. 2. proximal to the helix of the ear. 3. anterior to the tragus of the ear. 4. posterior to the tragus of the ear. ANS: 3 The temporomandibular t can be felt in the depression anterior to the tragus of the ear. DIF:
Application
REF: Page: 600
MSC: NCLEX: General
9. Of the 33 vertebrae in the spinal column, there are: 1. 5 lumbar. 2. 5 thoracic. 3. 7 sacral. 4. 12 cervical. ANS: 1 There are 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 3 to 4 coccygeal vertebrae. DIF:
Comprehension
REF: Page: 600
MSC: NCLEX: General
10. An imaginary line connecting the highest point on each iliac crest would cross: 1. the first sacral vertebra. 2. the fourth lumbar vertebra. 3. the seventh cervical vertebra. 4. the twelfth thoracic vertebra. ANS: 2 An imaginary line connecting the highest point on each iliac crest crosses the fourth lumbar vertebra. DIF:
Comprehension
REF: Page: 600
MSC: NCLEX: General
11. The nurse is explaining to a patient that there are “shock absorbers” in his back to cushion the spine and to help it move. The nurse is referring to his: 1. costal facets.
22-4 2. nucleus pulposus. 3. vertebral foramen. 4. intervertebral discs. ANS: 4 Intervertebral discs are elastic fibrocartilaginous plates that cushion the spine like shock absorbers and help it move. DIF: Comprehension REF: Page: 601 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The nurse is providing patient education for a man who has been diagnosed with a rotator cuff injury. The nurse knows that a rotator cuff injury involves: 1. nucleus pulposus. 2. the articular process. 3. the medial epicondyle. 4. the glenohumeral t. ANS: 4 A rotator cuff injury involves the glenohumeral t, which is enclosed by a group of four powerful muscles and tendons that and stabilize it. DIF: Application REF: Page: 602 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. During an interview, a patient states, “I can feel this bump on the top of both of my shoulders—it doesn’t hurt but I am curious about what it might be.” The nurse should tell her: 1. “That is your subacromial bursa.” 2. “That is your acromion process.” 3. “That is your glenohumeral t.” 4. “That is the greater tubercle of your humerus.” ANS: 2 The bump of the scapula’s acromion process is felt at the very top of the shoulder. DIF: Application REF: Page: 602 MSC: NCLEX: Physiological Integrity: Physiological Adaptation
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14. The nurse is checking the range of motion in a patient’s knee and knows that the knee is capable of the following movements: 1. flexion and extension. 2. supination and pronation. 3. circumduction. 4. inversion and eversion. ANS: 1 The knee is a hinge t, permitting flexion and extension of the lower leg on a single plane. DIF: Comprehension MSC: NCLEX: General
REF: Pages: 603, 605
15. A patient is visiting the clinic for an evaluation of a swollen, painful knuckle. The nurse notices that the knuckle above his ring on the left hand is swollen and he is unable to remove his wedding ring. This t is called the: 1. interphalangeal t. 2. tarsometatarsal t. 3. metacarpophalangeal t. 4. talocalcaneonavicular t. ANS: 3 See Figure 22-10 for a diagram of the bones and ts of the hand and fingers. DIF:
Application
REF: Page: 603
MSC: NCLEX: General
16. The nurse is assessing a patient’s ischial tuberosity. To palpate the ischial tuberosity, the nurse knows that it is best to have the patient: 1. stand. 2. flex his hip. 3. flex his knee. 4. in the supine position. ANS: 2 The ischial tuberosity lies under the gluteus maximus muscle and is palpable when the hip is flexed. DIF: Application REF: Page: 604 MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. The knee t is the articulation of the femur, the tibia, and the: 1. fibula. 2. radius. 3. patella. 4. humerus.
22-6 ANS: 3 The knee t is the articulation of three bones, including the femur, the tibia, and the patella (kneecap) in one common articular cavity. DIF:
Knowledge
REF: Page: 605
MSC: NCLEX: General
18. The ankle t is the articulation of the tibia, the fibula, and the: 1. talus. 2. cuboid. 3. calcaneus. 4. talocalcaneonavicular t. ANS: 1 The ankle or tibiotalar t is the articulation of the tibia, fibula, and talus. DIF:
Knowledge
REF: Page: 605
MSC: NCLEX: General
19. The nurse is explaining the mechanism of the growth of long bones to a mother of a toddler. The nurse knows that bones increase in width or diameter by deposition of new bony tissue around the shafts. The nurse also knows that lengthening occurs at the: 1. bursa. 2. calcaneus. 3. epiphyses. 4. tuberosities. ANS: 3 Long bones grow in two dimensions: first in width or diameter by deposition of new bony tissue around the shafts. Lengthening occurs at the epiphyses, or growth plates. DIF: Comprehension REF: Page: 606 MSC: NCLEX: Health Promotion and Maintenance 20. A woman who is 8 months pregnant comments that she has noticed a change in posture and is having lower back pain. The nurse tells her that during pregnancy women have a posture shift to compensate for the enlarging fetus. This shift in posture is known as: 1. lordosis. 2. scoliosis. 3. ankylosis. 4. kyphosis. ANS: 1 Lordosis compensates for the enlarging fetus, which would shift the center of balance forward. This shift in balance in turn creates strain on the low back muscles, felt as low back pain during late pregnancy by some women. DIF: Application REF: Page: 606 MSC: NCLEX: Health Promotion and Maintenance
22-7
21. An 85-year-old patient comments during his annual physical that he seems to be getting shorter as he ages. The nurse should explain that decreased height occurs with aging because: 1. long bones tend to shorten with age. 2. of the shortening of the vertebral column. 3. there is a significant loss of subcutaneous fat. 4. there is a thickening of the intervertebral discs. ANS: 2 Postural changes are evident with aging; decreased height is most noticeable and is due to shortening of the vertebral column. Long bones do not shorten with age. DIF: Application REF: Page: 606 MSC: NCLEX: Health Promotion and Maintenance 22. A patient has been diagnosed with osteoporosis and asks the nurse, “What is osteoporosis?” The nurse knows that osteoporosis can be defined as: 1. loss of bone matrix. 2. loss of bone density. 3. new, weaker bone growth. 4. increased phagocytic activity. ANS: 2 Osteoporosis is the loss of bone density. DIF: Knowledge REF: Page: 606 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 23. 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: 1. twenty-four vertebrae. 2. a missing peroneus teritus. 3. convex anterior curvature of the femur. 4. a second toe that is longer than the great toe. ANS: 4 Joggers and athletes report increased foot problems when a second toe is longer than the great toe. See Table 22-1. DIF: Application REF: Page: 607 MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
22-8
24. The nurse knows that the incidence of osteoporosis is greatest in which group? 1. Black men 2. Black women 3. White women 4. American Indian men ANS: 3 The incidence of osteoporosis is lowest in black men and highest in white women. See Table 22-1. DIF: Comprehension REF: Page: 606 MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 25. A teenage girl has arrived complaining of pain in her left wrist. She had been playing basketball and fell, landing on her left hand. The nurse examines her hand and would expect a fracture if the girl complains: 1. of a dull ache. 2. that the pain in her wrist is deep. 3. of sharp pain that increases with movement. 4. of dull throbbing pain that increases with rest. ANS: 3 A fracture causes sharp pain that increases with movement. DIF: Analysis REF: Page: 608 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. A patient is complaining of pain in his ts 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: 1. tendinitis. 2. osteoarthritis. 3. rheumatoid arthritis. 4. intermittent claudication. ANS: 3 Rheumatoid arthritis is worse in the morning when arising. Movement increases most t pain, except in rheumatoid arthritis, in which movement decreases pain. DIF: Analysis REF: Page: 608 MSC: NCLEX: Physiological Integrity: Physiological Adaptation
22-9
27. 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 ts.” The nurse suspects that the sound she hears is: 1. crepitation. 2. a bone spur. 3. a loose tendon. 4. fluid in the knee t. ANS: 1 Crepitation is an audible and palpable crunching or grating that accompanies movement and occurs when articular surfaces in the ts are roughened, as with rheumatoid arthritis. DIF: Analysis REF: Page: 612 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 28. 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: 1. crepitation. 2. rotator cuff lesions. 3. dislocated shoulder. 4. rheumatoid arthritis. ANS: 2 Rotator cuff lesions may cause limited range of motion and pain and muscle spasm during abduction, whereas forward flexion stays fairly normal. DIF: Analysis REF: Page: 615 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. A professional tennis player comes into the clinic complaining of a sore elbow. The nurse suspects that he has tenderness at the: 1. olecranon bursa. 2. annular ligament. 3. base of the radius. 4. medial and lateral epicondyle. ANS: 4 Epicondyle, head of radius, and tendons are common sites of inflammation and local tenderness, or “tennis elbow.” DIF: Analysis REF: Page: 616 MSC: NCLEX: Physiological Integrity: Physiological Adaptation
22-10
30. 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: 1. dorsiflex the foot. 2. plantarflex the foot. 3. hold both hands back to back while flexing the wrists 90 degrees for 60 seconds. 4. hyperextend the wrists with the palmar surface of both hands touching and wait for 60 seconds. ANS: 3 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 DIF: Application REF: Page: 621 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 31. 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: 1. internally rotate her hip while she is sitting. 2. abduct her hip while she is lying on her back. 3. adduct her hip while she is lying on her back. 4. externally rotate her hip while she is standing. ANS: 2 Limitation of abduction of the hip while supine is the most common motion dysfunction found in hip disease. DIF: Analysis REF: Page: 623 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 32. The nurse has completed the musculoskeletal examination of a patient’s knee and has found a positive bulge sign. The nurse suspects: 1. irregular bony margins. 2. soft tissue swelling in the t. 3. swelling from fluid in the epicondyle. 4. swelling from fluid in the suprapatellar pouch. ANS: 4 For swelling in the suprapatellar pouch, the bulge sign confirms the presence of fluid. DIF: Analysis REF: Page: 624 MSC: NCLEX: Physiological Integrity: Physiological Adaptation
22-11 33. 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: 1. scoliosis. 2. meniscus tear. 3. herniated nucleus pulposus. 4. spasm of paravertebral muscles. ANS: 3 Lateral tilting and sciatic pain with straight leg raising are findings that occur with a herniated nucleus pulposus. DIF: Analysis REF: Page: 631 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 34. 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: 1. positive Allis. 2. negative Allis. 3. positive Ortolani. 4. negative Ortolani. ANS: 4 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. DIF: Analysis REF: Page: 633 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 35. During a neonatal examination, the nurse notes that the newborn infant has six toes. This finding is documented as: 1. unidactyly. 2. syndactyly. 3. polydactyly. 4. multidactyly. ANS: 3 Polydactyly is the presence of extra fingers or toes. DIF: Comprehension REF: Page: 634 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 36. 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: 1. a negative Allis sign.
22-12 2. a positive Ortolani sign. 3. limited range of motion during the Moro reflex. 4. limited range of motion during LaSegue’s reflex. ANS: 3 For a fractured clavicle, observe for limited arm range of motion and unilateral response to the Moro reflex. DIF: Analysis REF: Page: 634 MSC: NCLEX: Health Promotion and Maintenance 37. 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: 1. osteoporosis. 2. acute gout. 3. ankylosing spondylitis. 4. degenerative t disease. ANS: 2 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. DIF: Analysis REF: Page: 650 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 38. A young swimmer comes to the sports clinic complaining of a very sore shoulder. He was running at the pool, slipped on some 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: 1. t effusion. 2. tear of rotator cuff. 3. adhesive capsulitis. 4. dislocated shoulder. ANS: 4 Dislocated shoulder occurs with trauma involving abduction, extension, and external rotation (e.g., falling on an outstretched arm or diving into a pool). DIF: Analysis REF: Page: 644 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 39. 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: 1. epicondylitis. 2. gouty arthritis.
22-13 3. olecranon bursitis. 4. subcutaneous nodules. ANS: 3 Subcutaneous nodules that are raised, firm, and nontender occur with rheumatoid arthritis in the olecranon bursa and along the extensor surface of the ulna. DIF: Analysis REF: Page: 645 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 40. 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: 1. radial drift. 2. ulnar deviation. 3. swan neck deformity. 4. Dupuytren’s contracture. ANS: 2 Fingers drift to the ulnar side because of stretching of the articular capsule and muscle imbalance caused by chronic rheumatoid arthritis. DIF: Application REF: Page: 647 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 41. 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: 1. Heberden’s nodes. 2. Bouchard’s nodules. 3. swan-neck deformities. 4. Dupuytren’s contractures. ANS: 3 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. DIF: Application REF: Page: 647 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 42. 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: 1. structural scoliosis. 2. functional scoliosis. 3. herniated nucleus pulposus. 4. dislocated nucleus pulposus. ANS: 2
22-14 Functional scoliosis is flexible; it is apparent with standing and disappears with forward bending. DIF: Analysis REF: Page: 652 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 43. 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? 1. “If these symptoms persist, you may need arthroscopic surgery.” 2. “You are experiencing degeneration of your knee, which may not resolve.” 3. “Your disease is due to repeated stress on the patellar tendon. It is usually selflimited, and your symptoms should resolve with rest.” 4. “Increasing your activity and performing knee-strengthening exercises will help to decrease the inflammation and maintain mobility in the knee.” ANS: 3 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. DIF: Application REF: Page: 649 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 44. 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? 1. 2+ 2. 3+ 3. 4+ 4. 5+ ANS: 4 Complete range of motion against gravity is normal muscle strength and is recorded as 5+ muscle strength. DIF: Application REF: Page: 612 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 45. The nurse is examining a 6-month-old baby and places the baby’s feet flat on the table and flexes his knees up. The nurse notes that the right knee is significantly lower than the left. Which of the following is true of this finding? 1. This is a positive Allis sign and suggests hip dislocation. 2. The infant probably has a dislocated patella on the right. 3. This is a normal finding for the Allis test for an infant of this age. 4. The infant should return to the clinic in 2 weeks to see if this has changed. ANS: 1 Finding one knee significantly lower than the other is a positive Allis sign and suggests hip dislocation.
22-15
DIF: Analysis REF: Page: 634 MSC: NCLEX: Health Promotion and Maintenance 46. The nurse is assessing a 1-week-old infant and testing his muscle strength. The nurse lifts the infant with hands under the axillae and notes that the infant starts to “slip” between the hands. The nurse should: 1. suspect a fractured clavicle. 2. consider that the infant may have a deformity of the spine. 3. suspect that the infant may have weakness of the shoulder muscles. 4. consider this a normal finding because the musculature of an infant this age is undeveloped. ANS: 3 A baby who starts to “slip” between your hands shows weakness of the shoulder muscles. DIF: Analysis REF: Page: 635 MSC: NCLEX: Health Promotion and Maintenance 47. The nurse is planning to measure a patient’s angles of t flexion and will use which instrument? 1. Caliper 2. Protracter 3. Goniometer 4. Measuring tape ANS: 3 A goniometer is used to measure the angles of t flexion accurately. DIF: Comprehension REF: Page: 611 MSC: NCLEX: Safe and Effective Care Environment: Management of Care
22-16
48. The nurse should use which test to check for large amounts of fluid around the patella? 1. Ballottement 2. Tinel’s sign 3. Phalen’s test 4. McMurray’s test ANS: 1 Balottement of the patella is reliable when larger amounts of fluid are present. DIF: Comprehension REF: Page: 625 MSC: NCLEX: Safe and Effective Care Environment: Management of Care 49. The nurse knows that another term for “knock knees” is: 1. genu varum. 2. genu valgum. 3. pes planus. 4. metatarsus adductus. ANS: 2 Genu valgum is also known as “knock knees” and is present when there is more than 2.5 cm between the medial malleoli when the knees are together. DIF: Comprehension REF: Page: 636 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 50. A patient has been diagnosed with a ganglion cyst over the dorsum of his left wrist. He asks the nurse, “What is this thing?” The nurse’s best answer would be: 1. “It is a common benign tumor.” 2. “It is a tumor that will have to be watched because it may turn malignant.” 3. “It is caused by chronic repetitive motion injury.” 4. “It is a skin infection that will need to be drained.” ANS: 1 A ganglionic cyst is a common benign tumor; it does not become malignant. DIF: Analysis REF: Page: 646 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 51. A man who has had gout for several years comes to the clinic with a “problem with my toe.” On examination, the nurse notes the presence of hard, painless nodules over the great toe; one had burst open with a chalky discharge. This finding is known as: 1. a callus. 2. a plantar wart. 3. tenosynovitis. 4. tophi.
22-17 ANS: 4 Tophi are collections of sodium urate crystals resulting from chronic gout in and around the t that cause extreme swelling and t deformity. They appear as hard, painless nodules (tophi) over the metatarsophalangeal t of the first toe and they sometimes burst with a chalky discharge. DIF: Application REF: Page: 650 MSC: NCLEX: Physiological Integrity: Physiological Adaptation 52. When performing a musculoskeletal assessment, the nurse knows that the correct approach for the examination should be: 1. proximal to distal. 2. distal to proximal. 3. posterior to anterior. 4. anterior to posterior. ANS: 1 The musculoskeletal assessment should be done in an orderly approach, head to toe, proximal to distal. DIF: Application REF: Page: 610 MSC: NCLEX: Safe and Effective Care Environment: Management of Care
22-18 MULTIPLE RESPONSE 1. The nurse is assessing the ts of a woman who has stated, “I have a long family history of arthritis, and my ts hurt.” The nurse suspects that she has osteoarthritis. Which of the following are symptoms of osteoarthritis? Select all that apply. 1. Symmetric 2. Asymmetric 3. Pain with motion of affected ts 4. Affected ts swollen with hard, bony protuberances 5. Affected ts may have heat, redness, and swelling. ANS: 2, 3, 4 In osteoarthritis, asymmetric t involvement commonly affects hands, knees, hips, and lumbar and cervical segments of the spine. Affected ts have stiffness, swelling with hard bony protuberances, pain with motion, and limitation of motion. DIF: Comprehension REF: Page: 643 MSC: NCLEX: Physiological Integrity: Physiological Adaptation
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