Question 1

A patient tells the nurse that she is "tired of having leg pain" because it "gets in the way" of enjoying the activities that she wants to do with her family. What is the nurse's best response?

Accepted Answer

The nurse's best response is to show empathy and understand the impact the leg pain is having on the patient's life. By asking about the family's reaction, the nurse can better assess the patient's emotional and social support system and provide appropriate interventions. Options B, C, and D minimize the patient's concerns and do not address the underlying issue.

Question 2

A patient is newly diagnosed with arthritis of the cervical vertebrae. The nurse plans to assess which type of joint?

Accepted Answer

D

Question 3

The nurse assessing a patient's musculoskeletal status notes that the left shoulder does not have its normal curvature and fullness. The nurse would conduct additional assessment for which disorder?

Accepted Answer

A dislocation can cause a change in the normal contour and fullness of a joint, such as the shoulder, due to the displacement of bones from their normal position.

Question 4

The nurse has just begun testing range of motion in a patient's right knee when the patient says, "That really hurts." Which interventions should be implemented?. Select all that apply.

Accepted Answer

If a patient reports significant pain during range of motion testing, it is important to stop that particular test on the joint and move on to another joint. Testing ROM in the opposite, unaffected joint can still provide valuable information for comparison. Massaging the knee for 20 minutes is not a necessary intervention for pain during ROM testing, and continuing to try to achieve normal ROM could cause further pain and damage. The nurse could also consider informing the healthcare provider if the pain is severe or if the patient has a history of joint problems.

Question 5

A patient tells the nurse that he has damaged cartilage in his knee. How should the nurse respond to this information?

Accepted Answer

The best response is to inquire if the patient has discussed treatment options with their doctor. Knee cartilage damage can be a serious issue and treatment options can vary depending on the severity of the damage. It is important for the nurse to encourage the patient to schedule an appointment with their doctor to discuss treatment options.

Question 6

During assessment of a patient's knee, the nurse tests for the bulge sign. Which technique is the nurse using?

Accepted Answer

The bulge sign is a test for minor effusions in the knee. It involves stroking the medial aspect of the knee to displace any fluid and then tapping the lateral side to observe if a bulge of fluid occurs on the medial side, indicating the presence of excess fluid in the knee joint.

Question 7

A patient is complaining of a fever and a "stiff neck." Upon assessment, the patient is unable to rotate the neck. The nurse would conduct additional assessment for which condition?

Accepted Answer

A fever and stiff neck are classic signs of meningitis, an infectious process. The inability to rotate the neck further suggests an infectious cause rather than a mechanical injury or chronic condition like arthritis.

Question 8

A patient recovering from hip replacement surgery is prescribed a pillow between the legs. The nurse explains that the pillow will facilitate which positioning?

Accepted Answer

Placing a pillow between the legs after hip replacement surgery facilitates abduction, which will help prevent dislocation of the hip joint.

Question 9

During a physical assessment, the patient walks to the door of the examination room as the nurse watches the patient switch the weight on the feet. The nurse would document assessment of which part of the musculoskeletal status?

Accepted Answer

Observing a patient switch weight on their feet during walking primarily assesses the second-phase gait, which involves the stance and swing phases of walking. This observation helps evaluate how the patient distributes weight and maintains balance, crucial aspects of gait assessment.

Question 10

The nurse is preparing to conduct a history on a patient being seen for hip pain and reduced range of motion. For which purpose does the nurse conduct this history?

Accepted Answer

Conducting a patient history helps the nurse determine the patient's level of function, which will inform the care plan. This includes assessing the patient's mobility, activities of daily living, and any assistive devices the patient may need. While evaluating pain and allowing the patient to talk about symptoms is important, it is not the primary purpose of conducting a history in this case.

Question 11

The nurse asks the patient to shrug the shoulders while the nurse applies pressure to keep the shoulders from moving. The nurse would document the results of this test as indicating strength of which muscle?

Accepted Answer

This test is known as the shoulder shrug test, and it assesses the strength of the trapezius muscle. The trapezius is responsible for elevating and retracting the shoulders, which is what the patient is attempting to do while the nurse applies pressure to prevent movement.

Question 12

The nurse rates a patient's biceps muscle strength at 3. Another nurse reading this rating would expect the patient's best movement of the muscle to be at which functional level?

Accepted Answer

A muscle strength rating of 3 indicates that the patient is able to perform active ROM against gravity but with moderate weakness. This means that the patient is not able to perform complete active ROM without any weakness, nor are they limited to just passive ROM. Therefore, the best choice based on the given information would be B.

Question 13

While assessing a patient's hands, the nurse notes that the patient is unable to fully extend the ring or fifth finger. The nurse would suspect which condition?

Accepted Answer

Dupuytren's contracture causes a flexion deformity of the ring and/or little finger, making it difficult or impossible to fully extend them.

Question 14

The nurse assesses that a patient is unable to completely straighten the right arm. The nurse conducts additional assessment for which condition?

Accepted Answer

Muscle atrophy is a condition in which the muscles waste away and become smaller. This can be caused by a number of factors, including nerve damage, disuse, and malnutrition. In the case of the patient in the question, the nurse is assessing for muscle atrophy because the patient is unable to completely straighten the right arm. This could be a sign that the muscles in the arm are wasting away.

Question 15

A patient provides the nurse with a list of current medications and adds that she takes glucosamine every day. The nurse would document this information in which part of the health history?

Accepted Answer

Glucosamine is a medication typically used for joint pain and can have interactions with other medications, so it would be documented in the past medical history section of the health history.

Question 16

While assessing a patient's left knee for range of motion, the nurse hears clicking. The patient says that at times the knee "locks." The nurse would conduct additional assessment for which condition?

Accepted Answer

Clicking and locking of the knee is a common symptom of damage to the meniscus, which is a piece of cartilage in the knee joint. Rheumatoid arthritis and fluid in the knee may cause pain and stiffness but do not typically cause clicking or locking. Dislocation may also cause pain and swelling but would be accompanied by visible deformity of the joint.

Question 17

The nurse is assessing an older adult's musculoskeletal system. The nurse would evaluate that which findings represent normal age-related changes?. Select all that apply.

Accepted Answer

Slightly reduced range of motion (ROM) in the shoulder is a normal age-related change as the joint cartilage becomes less elastic. Slower gait is also a normal age-related change due to decreased strength and flexibility in the lower extremities. Redness and crepitus in the knee joint, inability to abduct the thumb, and asymmetry of the pelvis are not normal age-related changes and require further evaluation by the healthcare provider.

Question 18

The nurse wishes to test opposition ability in the patient's thumb. How would the nurse instruct the patient?

Accepted Answer

Opposition is the ability to touch the thumb to the tips of the other fingers.

Question 19

A patient tells the nurse that he has had increasing difficulty bending his knees to pick objects up from the floor since he got a desk job about 10 months ago. The nurse suspects that the patient's loss of knee and hip range of motion would be due to which condition?

Accepted Answer

Atrophy is a decrease in muscle mass, which can occur as a result of decreased physical activity or disuse, such as with a desk job. This can lead to weakness and loss of range of motion in the affected muscles and joints. Gout, muscle spasms, and pain may also contribute or result from the patient's symptoms but are less likely to be the primary cause of the loss of range of motion.

Question 20

The nurse is assessing a patient who complains of numbness and tingling in the hands. When the patient bends the wrist downward and presses the backs of the hands together, there is numbness and tingling in the wrists and fingers. The nurse would conduct additional assessment for which condition?

Accepted Answer

The symptoms described are classic signs of carpel tunnel syndrome, which occurs due to the compression of the median nerve at the wrist. Arthritis, dislocation, or fracture would not necessarily cause numbness and tingling in specific locations as seen in this case.

Quiz 48: Nursing Management of the Patient With Musculoskeletal Disorders