Chapter 25: Assessment of the Musculoskeletal System Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 25: Assessment of the Musculoskeletal System

MULTIPLE CHOICE

1. The client who has osteoarthritis describes a grating sound in the hip. The nurse explains that this bothersome manifestation is related to

a.

bursa enlargement.

b.

joint irregularities.

c.

normal findings with age.

d.

the presence of fluid.

ANS: B

Crepitus (sound of bone ends rubbing together), heard on range of motion, indicates joint irregularities.

DIF: Comprehension/Understanding REF: p. 461 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

2. The nurse is performing a musculoskeletal assessment on a client who is right-hand dominant. The variation in muscle mass the nurse expects to find is

a.

atrophy.

b.

fasciculations.

c.

hypertrophy.

d.

tremors.

ANS: C

Muscles should feel firm and smooth. A slight increase in mass, or hypertrophy, on the dominant side is normal.

DIF: Application/Applying REF: pp. 466-467 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation

3. To evaluate a clients swollen right knee further, the nurse should first

a.

compare the right knee to the left knee.

b.

palpate for crepitus.

c.

put the knee through range of motion.

d.

test muscle strength.

ANS: A

The initial approach to assessing the joints is to inspect them and compare findings bilaterally.

DIF: Application/Applying REF: p. 467 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

4. A client with a new cast for his fractured ulna tells the nurse that he cannot feel his fingers. The nurse should initially

a.

check for capillary refill in the clients fingers.

b.

notify the physician immediately.

c.

reassure the client that this is normal.

d.

remove the padding around the fingers to increase space.

ANS: A

When casts prevent full neurovascular assessment, the nurse should observe for edema, capillary refill, and joint movement.

DIF: Application/Applying REF: p. 467 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

5. A client describes ripping sounds in his knee during a fall while skiing. The nurse explains to the client that the diagnostic test that will provide the best data is a(n)

a.

arthrogram.

b.

bone scan.

c.

myelogram.

d.

x-ray film.

ANS: A

An arthrogram is a radiographic examination of soft tissue joint structures. It is used to diagnose trauma to joint capsules or supporting ligaments, especially involving the shoulder, wrist, hip, ankle, or knee.

DIF: Comprehension/Understanding REF: p. 468 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

6. The nurse assisting with an arthrocentesis provides which intervention after the procedure is over? The nurse

a.

applies a compression dressing.

b.

gives the client a tetanus shot.

c.

teaches the client crutch-walking.

d.

wraps a heating pad around the knee.

ANS: A

During an arthrocentesis, fluid is aspirated from the joint space for analysis. Generally, a compressive dressing is applied afterwards. None of the other options apply.

DIF: Application/Applying REF: p. 468 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

7. The nurse preparing a client for a dual-energy x-ray absorptiometry (DEXA) test explains that the purpose of this test is to measure

a.

amount of joint deformity.

b.

degree of bone loss.

c.

degree of fracture healing.

d.

presence of bone infection.

ANS: B

A DEXA scan is considered the gold standard test for osteoporosis and measures bone loss.

DIF: Comprehension/Understanding REF: p. 468 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

8. A client complains of deep aching in his lower leg. The nurse completes an assessment focusing on other indicators of

a.

bone cancer.

b.

infection.

c.

muscle strain.

d.

neuromuscular impairment.

ANS: C

Aches generally indicate a muscle strain, sharp pain may indicate a fracture or infection, and throbbing pain is often bone-related.

DIF: Application/Applying REF: p. 461 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

9. A client has had a cast for a week and returns to the orthopedic clinic complaining of an increased level of pain. The most appropriate action by the nurse is to

a.

administer a stronger analgesic.

b.

notify the physician immediately.

c.

remove the cast and inspect the skin.

d.

send the client for an x-ray.

ANS: C

If there is any question about the cause of pain under a cast, the cast should be removed and the underlying skin inspected. If the nurse is not capable of or allowed to remove the cast, the best action would be to inform the physician.

DIF: Application/Applying REF: p. 462 OBJ: Assessment

MSC: Safe, Effective Care Environment Safety and Infection Control-Client Safety

MULTIPLE RESPONSE

1. The nurse assesses the client for common musculoskeletal clinical manifestations, which include (Select all that apply)

a.

infection.

b.

limited range of motion.

c.

pain.

d.

stiffness.

e.

swelling.

ANS: A, B, C, D, E

Other common manifestations include deformity and sensory changes.

DIF: Application/Applying REF: p. 460 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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