Chapter 23: Musculoskeletal System
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
1. A patient is being assessed for range-of-joint movement. The nurse asks him to move his arm
in toward the center of his body. What is this movement called?
a.
Flexion
b.
Abduction
c.
Adduction
d.
Extension
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 which movement?
a.
Flexion
b.
Abduction
c.
Adduction
d.
Extension
3. What are the functional units of the musculoskeletal system?
a.
Bones
b.
Joints
c.
Muscles
d.
Tendons
4. When reviewing the musculoskeletal system, the nurse should recall that hematopoiesis takes
place where?
a.
Liver
b.
Spleen
c.
Kidneys
d.
Bone marrow
5. What are the fibrous bands that run directly from one bone to another, strengthen the joint,
and help prevent movement in undesirable directions called?
a.
Bursa
b.
Tendons
c.
Cartilage
d.
Ligaments
6. The nurse notices that a woman in an exercise class is unable to do one-person jump rope.
What does the nurse know that the shoulder must be able to do in order for one to be able to
do one-person jump rope?
a.
Inversion
b.
Supination
c.
Protraction
d.
Circumduction
7. What is the articulation of the mandible and the temporal bone called?
a.
Intervertebral foramen
b.
Condyle of the mandible
c.
Temporomandibular joint
d.
Zygomatic arch of the temporal bone
8. To palpate the temporomandibular joint, where should the nurse place his or her fingers?
a.
The depression inferior to the tragus of the ear
b.
The depression superior to the tragus of the ear
c.
The depression anterior to the tragus of the ear
d.
The depression posterior to the tragus of the ear
9. Of the 33 vertebrae in the spinal column, which is correct?
a.
5 lumbar
b.
5 thoracic
c.
7 sacral
d.
12 cervical
10. If an imaginary line were drawn connecting the highest point on each iliac crest. What
vertebra would that line cross?
a.
First sacral
b.
Fourth lumbar
c.
Seventh cervical
d.
Twelfth thoracic
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. What is the nurse referring to as shock absorbers?
a.
Vertebral column
b.
Nucleus pulposus
c.
Vertebral foramen
d.
Intervertebral disks
12. The nurse is providing patient education for a man who has been diagnosed with a rotator cuff
injury. When explaining the structures involved in his injury, what should the nurse include?
a.
Nucleus pulposus
b.
Medial epicondyle
c.
Glenohumeral joint
d.
Articular processes
13. During an interview the 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.” What should the nurse
tell this patient?
a.
“That is the subacromial bursa.”
b.
“That is the acromion process.”
c.
“That is the glenohumeral joint.”
d.
“That is the greater tubercle of the humerus.”
14. The nurse is checking the range of motion in a patient’s knee and knows that the knee is
capable of which movement(s)?
a.
Circumduction
b.
Flexion and extension
c.
Inversion and eversion
d.
Supination and pronation
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 that he is unable to
remove his wedding ring. What is the name of this patient’s affected joint?
a.
Tibiotalar
b.
Interphalangeal
c.
Tarsometatarsal
d.
Metacarpophalangeal
16. The nurse is assessing a patient’s ischial tuberosity. How should the nurse position the patient
to palpate the ischial tuberosity?
a.
Standing
b.
Flexing the hip
c.
Flexing the knee
d.
Lying in the supine position
17. The nurse is examining the hip area of a patient and palpates a flat depression on the upper,
lateral side of the thigh when the patient is standing. What is the nurse palpating?
a.
Iliac crest
b.
Ischial tuberosity
c.
Greater trochanter
d.
Gluteus maximus muscle
18. What is articulated with the tibia and fibula in the ankle joint?
a.
Talus
b.
Cuboid
c.
Calcaneus
d.
Cuneiform bones
19. A woman who is 8 months pregnant comments that she has noticed a change in her 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. What is the term for this shift in posture?
a.
Lordosis
b.
Scoliosis
c.
Ankylosis
d.
Kyphosis
20. An 85-year-old patient comments during his annual physical examination that he seems to be
getting shorter as he ages. Why does height decrease with aging?
a.
The vertebral column shortens.
b.
Long bones tend to shorten with age.
c.
A significant loss of subcutaneous fat occurs.
d.
A thickening of the intervertebral disks develops.
21. A patient has been diagnosed with osteoporosis and asks the nurse, “What is osteoporosis?”
What is the best explanation by the nurse?
a.
“It is the loss of bone density.”
b.
“It is an increase in bone matrix.”
c.
“It is new bone growth that is weaker.”
d.
“There is a decrease in phagocytic activity.”
22. The nurse is teaching a class on preventing osteoporosis to a group of perimenopausal women.
Which of these actions is the best way to prevent or delay bone loss in this group?
a.
Assessing bone density annually
b.
Taking medications to prevent osteoporosis
c.
Performing physical activity, such as fast walking
d.
Taking 800 mg calcium and 200 IU vitamin D supplements daily
23. A teenage girl has arrived reporting pain in her left wrist. She was playing basketball when
she fell and landed on her left hand. The nurse examines her hand. Which finding would lead
the nurse to expect a fracture?
a.
Dull ache
b.
Deep pain in her wrist
c.
Sharp pain that increases with movement
d.
Dull throbbing pain that increases with rest
24. A patient is reporting pain in his joints that is worse in the morning, better after he moves
around for a while, and then gets worse again if he sits for long periods. The nurse should
assess for other signs of what problem?
a.
Tendinitis
b.
Osteoarthritis
c.
Rheumatoid arthritis
d.
Intermittent claudication
25. A patient states, “I can hear a crunching or grating sound when I kneel.” She also states that
“it is very difficult to get out of bed in the morning because of stiffness and pain in my joints.”
The nurse should assess for signs of what problem?
a.
Bone spur
b.
Tendonitis
c.
Crepitation
d.
Fluid in the knee joint
26. 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. What does the nurse suspect?
a.
Crepitation
b.
Rheumatoid arthritis
c.
Rotator cuff lesions
d.
A dislocated shoulder
27. A professional tennis player comes into the clinic complaining of a sore elbow. Where should
the nurse assess for tenderness?
a.
Olecranon bursa
b.
Annular ligament
c.
Base of the radius
d.
Medial and lateral epicondyle
28. The nurse suspects that a patient has carpal tunnel syndrome and wants to perform the Phalen
test. What instructions should the nurse give the patient to perform this test?
a.
Dorsiflex the foot.
b.
Plantarflex the foot.
c.
Hold both hands back to back while flexing the wrists 90 degrees for 60 seconds.
d.
Hyperextend the wrists with the palmar surface of both hands touching, and wait
for 60 seconds.
29. An 80-year-old woman is visiting the clinic for a checkup. She states, “I can’t walk as much
as I used to.” What should the nurse have the patient do to observe for motor dysfunction in
her hip?
a.
Internally rotate her hip while she is sitting.
b.
Abduct her hip while she is lying on her back.
c.
Adduct her hip while she is lying on her back.
d.
Externally rotate her hip while she is standing.
30. The nurse has completed the musculoskeletal examination of a patient’s knee and has found a
positive bulge sign. How does the nurse interpret this finding?
a.
Irregular bony margins
b.
Soft-tissue swelling in the joint
c.
Swelling from fluid in the epicondyle
d.
Swelling from fluid in the suprapatellar pouch
31. During an examination, the nurse asks a patient to bend forward from the waist and notices
that the patient has lateral tilting. When his leg is raised straight up, the patient states pain
going down his buttock into his leg. What does the nurse suspect?
a.
Scoliosis
b.
Meniscus tear
c.
Herniated nucleus pulposus
d.
Spasm of paravertebral muscles
32. The nurse is examining a 3-month-old infant. While the nurse holds his or her thumbs on the
infant’s inner mid thighs and the fingers on the outside of the infant’s hips, touching the
greater trochanter, the nurse adducts the legs until the his or her thumbs touch and then
abducts the legs until the infant’s knees touch the table. The nurse does not notice any
“clunking” sounds. How should the nurse document this finding?
a.
Positive Allis test
b.
Negative Allis test
c.
Positive Ortolani sign
d.
Negative Ortolani sign
33. During a neonatal examination, the nurse notices that the newborn infant has six toes. How
should the nurse document this finding?
a.
Unidactyly
b.
Syndactyly
c.
Polydactyly
d.
Multidactyly
34. A mother brings her newborn baby boy in for a checkup; she tells the nurse that he does not
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. What finding would
support this suspicion?
a.
Negative Allis test
b.
Positive Ortolani sign
c.
Limited range of motion during Lasègue test
d.
Limited range of motion during the Moro reflex
35. A 40-year-old man has come into the clinic reporting extreme pain in his toes. The nurse
notices that his toes are slightly swollen, reddened, and warm to the touch. What does the
nurse suspect?
a.
Acute gout
b.
Osteoporosis
c.
Ankylosing spondylitis
d.
Degenerative joint disease
36. 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. What does the nurse suspect?
a.
Joint effusion
b.
Tear of rotator cuff
c.
Adhesive capsulitis
d.
Dislocated shoulder
37. A 68-year-old woman has come in for an assessment of her rheumatoid arthritis, and the nurse
notices raised, firm, nontender nodules at the olecranon bursa and along the ulna. What is the
appropriate term for these nodules?
a.
Epicondylitis
b.
Gouty arthritis
c.
Olecranon bursitis
d.
Subcutaneous nodules.
38. A woman who has had rheumatoid arthritis for years is starting to notice that her fingers are
drifting to the side. What is term commonly used for this condition?
a.
Radial drift
b.
Ulnar deviation
c.
Swan-neck deformity
d.
Dupuytren contracture
39. A patient who has had rheumatoid arthritis for years comes to the clinic to ask about changes
in her fingers. The nurse will assess for signs of what problems?
a.
Heberden nodes
b.
Bouchard nodules
c.
Swan-neck deformities
d.
Dupuytren contractures
40. 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. What is this
abnormality called?
a.
Dislocated hip
b.
Structural scoliosis
c.
Functional scoliosis
d.
Herniated nucleus pulposus
41. 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?
a.
“If these symptoms persist, you may need arthroscopic surgery.”
b.
“You are experiencing degeneration of your knee, which may not resolve.”
c.
“Your disease is due to repeated stress on the patellar tendon. It is usually
self-limited, and your symptoms should resolve with rest.”
d.
“Increasing your activity and performing knee-strengthening exercises will help
decrease the inflammation and maintain mobility in the knee.”
42. When assessing muscle strength, the nurse observes that a patient has complete range of
motion against gravity with full resistance. What grade of muscle strength should the nurse
record using a 0- to 5-point scale?
a.
2
b.
3
c.
4
d.
5
43. The nurse is examining a 6-month-old infant and places the infant’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 these statements is true of this finding?
a.
This finding is a positive Allis sign and suggests hip dislocation.
b.
The infant probably has a dislocated patella on the right knee.
c.
This finding is a negative Allis sign and normal for an infant of this age.
d.
The infant should return to the clinic in 2 weeks to see if his condition has
changed.
44. The nurse is assessing a 1-week-old infant and is testing his muscle strength. The nurse lifts
the infant with hands under the axillae and notices that the infant starts to “slip” between the
hands. What does the nurse suspect?
a.
A fractured clavicle
b.
Possible deformity of the spine
c.
Weakness of the shoulder muscles
d.
This is a normal finding for an infant at this age
45. The nurse is examining a 2-month-old infant and notices asymmetry of the infant’s gluteal
folds. The nurse should assess for other signs of what disorder?
a.
Spina bifida
b.
Down syndrome
c.
Hip dislocation
d.
Fractured clavicle
46. The nurse should use which test to check for large amounts of fluid around the patella?
a.
Tinel sign
b.
Phalen test
c.
McMurray test
d.
Ballottement
47. A patient tells the nurse that, “All my life I’ve been called ‘knock knees’.” What is medical
term for this condition?
a.
Genu varum
b.
Pes planus
c.
Genu valgum
d.
Metatarsus adductus
48. A man who has had gout for several years comes to the clinic with a problem with his toe. On
examination, the nurse notices the presence of hard, painless nodules over the great toe; one
has burst open with a chalky discharge. What is this called?
a.
Tophi
b.
Callus
c.
Bunion
d.
Plantar wart
49. When performing a musculoskeletal assessment, what is the correct approach?
a.
Proximal to distal
b.
Distal to proximal
c.
Posterior to anterior
d.
Anterior to posterior
MULTIPLE RESPONSE
1. The nurse is assessing the joints of a woman who has stated, “I have a long family history of
arthritis, and my joints hurt.” The nurse suspects that she has osteoarthritis. Which of these are
symptoms of osteoarthritis? (Select all that apply.)
a.
Symmetric joint involvement
b.
Asymmetric joint involvement
c.
Pain with motion of affected joints
d.
Affected joints may have heat, redness, and swelling
e.
Affected joints are swollen with hard, bony protuberances