Based on the nurse’s understanding of the physiology of bone and cartilage, the injury that the nurse would expect to heal most rapidly is a
a. fracture of the midhumerus.
b. torn knee cruciate ligament.
c. fractured nose.
d. severely sprained ankle.
ANS: A Bone is dynamic tissue that is continually growing. Nasal fracture, sprains, and ligament tears injure cartilage, tendons, and ligaments, which are slower to heal.
The nurse is assessing the passive range of motion of a patient’s shoulder. The patient complains of pain during circumduction when the nurse moves the arm behind the patient. Which question should the nurse ask?
a. “Do you ever have trouble making it to the toilet?”
b. “Do you have difficulty in putting on a jacket?”
c. “Are you able to feed yourself without difficulty?”
d. “How well are you able to sleep at night?”
ANS: B The patient’s pain will make it more difficult to accomplish tasks like putting on a shirt or jacket. This pain should not impact the patient’s ability to feed himself or herself or use the toilet because these tasks do not involve moving the arm behind the patient. The arm will not usually be positioned behind the patient during sleeping.
When the health care provider tells a patient that the pain in the patient’s knee is caused by bursitis, the patient asks the nurse to explain just what bursitis is. The nurse’s best response would be to tell the patient bursitis is an inflammation of
a. the fibrocartilage that acts as a shock absorber in the knee joint.
b. a small, fluid-filled sac found at many joints.
c. any connective tissue that is found supporting the joints of the body.
d. the synovial membrane that lines the area between two bones of a joint.
ANS: B Bursae are fluid-filled sacs that cushion joints and bony prominences. Fibrocartilage is a solid tissue that cushions some joints. Bursae are a specific type of connective tissue. The synovial membrane lines many joints but is not a bursa.
During assessment of the musculoskeletal system of a 74-year-old woman, the nurse notes that the patient has lost 1 inch in height since the previous visit two years ago. The nurse will plan to teach the patient about
a. diskography studies.
b. magnetic resonance imaging (MRI).
c. dual-energy x-ray absorptiometry (DEXA).
d. myelographic testing.
ANS: C The decreased height and the patient’s age suggest that the patient may have osteoporosis and that bone density testing is needed. Diskography, MRI, and myelography are typically done for patients with current symptoms caused by musculoskeletal dysfunction and are not the initial diagnostic test for osteoporosis.
When taking a patient history during assessment of the musculoskeletal system, the nurse identifies an increased risk for the patient who reports
a. that a parent became much shorter with aging.
b. a sprained ankle 2 years previously.
c. a family history of tuberculosis.
d. taking over-the-counter (OTC) ibuprofen (Advil) for occasional aches.
ANS: A A family history of height loss with aging may indicate osteoporosis, and the patient may need to consider preventative actions, such as calcium supplements. A sprained ankle 2 years previously will not cause any current or future musculoskeletal problems. A family history of tuberculosis is not a risk factor. Occasional nonsteroidal antiinflammatory drug (NSAID) use does not indicate any increased musculoskeletal risk.
Which information obtained during the nurse’s assessment of the patient’s nutritional-metabolic pattern may indicate the risk for musculoskeletal problems?
a. The patient is 5 ft 2 in and weighs 180 lb.
b. The patient prefers whole milk to nonfat milk.
c. The patient dislikes fruits and vegetables.
d. The patient takes a multivitamin daily.
ANS: A The patient’s height and weight indicate obesity, which places stress on weight-bearing joints. The use of whole milk, avoiding fruits and vegetables, and use of a daily multivitamin are not risk factors for musculoskeletal problems.
When the nurse is assessing a new patient in the clinic, which information about the patient’s medications will be of most concern?
a. The patient takes hormone replacement therapy (HRT) to prevent “hot flashes.”
b. The patient takes a daily multivitamin and calcium supplement.
c. The patient has severe asthma and requires frequent therapy with steroids.
d. The patient has migraine headaches which are treated with NSAIDs.
ANS: C Corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. The use of HRT and calcium supplements will help prevent osteoporosis. NSAID use does not increase the risk for musculoskeletal problems.
While testing the patient’s muscle strength, the nurse finds that the patient can flex the arms when no resistance is applied but is unable to flex when the nurse applies light resistance. The nurse should documents the patient’s muscle strength as level
ANS: C A level 3 indicates that the patient is unable to move against resistance but can move against gravity. Level 1 indicates minimal muscle contraction, level 2 indicates that the arm can move when gravity is eliminated, and level 4 indicates active movement with some resistance.
When assessing the musculoskeletal system, the nurse’s initial action will usually be to
a. have the patient move the extremities against resistance.
b. feel for the presence of crepitus during joint movement.
c. observe the patient’s body build and muscle configuration.
d. check active and passive range of motion for the extremities.
ANS: C the usual technique in the physical assessment is to begin with inspection. Abnormalities in muscle mass or configuration will allow the nurse to perform a more focused assessment of abnormal areas. The other assessments are also included in the assessment but are usually done after inspection
A patient is seen at the urgent care center following a blunt injury to the left knee. The knee is grossly swollen and very painful, but the skin is intact. During an arthrocentesis on the patient’s knee, the nurse would expect the aspirated fluid to appear
b. purulent and thick.
c. straw colored.
d. white, thick, and ropelike.
ANS: A The patient’s clinical manifestations suggest hemarthrosis, and the appearance of blood in the synovial fluid is expected. Purulent fluid occurs when there is a joint infection. Straw-colored fluid is normal and will not be expected when the knee is swollen and painful. Thick fluid suggests infection.
A patient suffers an injury to the shoulder while playing football. To identify abnormalities of cartilage and soft tissue surrounding the joint, the nurse would expect the patient to be evaluated with
a. radioisotope bone scanning.
c. standard x-rays.
d. magnetic resonance imaging (MRI).
ANS: D MRI is most useful in assessing for soft tissue injuries. Bone scanning and standard radiographs are used to assess for injures or lesions of bone. Arthroscopy is used for visualizing the joints.
A patient with kyphosis is scheduled for dual-energy x-ray absorptiometry (DEXA) testing. The nurse will plan to
a. start an intravenous line.
b. screen the patient for shellfish allergies.
c. teach the patient that DEXA is noninvasive.
d. give an oral sedative.
ANS: C DEXA testing is painless and noninvasive. No IV access is necessary. Contrast medium is not used. Because the procedure is painless, no antianxiety medications are required.
A patient has a new order for open magnetic resonance imaging (MRI) to evaluate for right femur osteomyelitis. Which information obtained by the nurse indicates that the nurse should consult with the health care provider before scheduling an MRI?
a. The patient is claustrophobic.
b. The patient wears a hearing aid.
c. The patient is allergic to shellfish.
d. The patient has a pacemaker.
ANS: D Patients with permanent pacemakers cannot have MRI. An open MRI will not cause claustrophobia. The patient will need to be instructed to remove the hearing aid before the MRI, but this does not require consultation with the health care provider. Contrast medium will not be used, so shellfish allergy is not a contraindication to MRI.