LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)

Chapter 38 Assessing the Musculoskeletal System

1) A patient recovering from a total hip replacement develops a fever and redness at the surgical site. What should the nurse consider first when assessing this patient?

1. Development of osteomyelitis

2. Subacute osteoporosis

3. Pathological fracture

4. Undiagnosed osteitis deformans

Page Ref: 1401

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 3. Interpret abnormal findings of the musculoskeletal system collected during assessment.

2) The nurse is reviewing assigned patients who are scheduled for an MRI. Which patient should the nurse identify as being able to safely undergo an MRI diagnostic test?

1. Patient with a pacemaker for three years

2. Patient with shrapnel from a military assault

3. Patient with an open abdominal wound

4. Patient with external hardware following a fracture repair

Page Ref: 1406

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

3) The nurse is assessing an older patient's musculoskeletal status. What should the nurse consider as a normal finding for this patient? Select all that apply.

1. Decreased bone mass and minerals

2. Increased calcium reabsorption

3. Atrophied muscle fibers

4. Elongated vertebrae

5. Decreased range of motion

Page Ref: 1407

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: Aging Process

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.3 Differentiate considerations for assessing the musculoskeletal systems of older adults and veterans.

MNL Learning Outcome: 2. Recognize normal findings of the musculoskeletal system collected during assessment and health promotion activities to support the health of this body system.

4) A health-conscious young adult female asks the nurse what diagnostic test might help predict the likelihood for developing osteoporosis. Which diagnostic test should the nurse explain?

1. Arthroscopy

2. Electromyogram (EMG)

3. Somatosensory evoked potential (SSEP)

4. Dual energy x-ray absorptiometry (DEXA)

Page Ref: 1405

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

5) The nurse is documenting data collected during assessments. For which patient should the nurse include "unable to assess" for the Phalen's test?

1. Patient with a long leg cast

2. Patient with an above-the-elbow amputation

3. Patient wearing compression stockings

4. Patient with osteoarthritis of the hips

Page Ref: 1403

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment/Communication and Documentation

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 3. Interpret abnormal findings of the musculoskeletal system collected during assessment.

6) The nurse is instructing a patient about preparations needed for an electromyogram. Which patient statement indicates that further teaching is required?

1. "I will not smoke any cigarettes up to three hours before the test."

2. "It will be all right to have a glass of water before the test."

3. "I can take my Flexaril before having my test so that my back won't hurt."

4. "I can take my lisinopril the night before my test for my blood pressure."

Page Ref: 1406

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

7) In which order should the nurse assess a patient complaining of pain in both knees? Place the four techniques in order of priority.

Choice 1. Measurement of muscle mass

Choice 2. Range of motion

Choice 3. Inspection

Choice 4. Palpation

Page Ref: 1399-1400

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the musculoskeletal system.

8) An older patient asks why body height has decreased an inch over the last year. How should the nurse respond to the patient?

1. "Everybody gets shorter as they get older."

2. "There is no need to worry; you only lost 1 inch since last year. You probably won't lose much more than that."

3. "There can be several causes for the loss of height, but as we age, bone mass decreases and the spinal column shortens."

4. "There could be something wrong, so you should discuss it with your physician."

Page Ref: 1407

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Aging Process

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation

Learning Outcome: 38.3 Differentiate considerations for assessing the musculoskeletal systems of older adults and veterans.

MNL Learning Outcome: 2. Recognize normal findings of the musculoskeletal system collected during assessment and health promotion activities to support the health of this body system.

9) An older female patient has an exaggerated curvature of the thoracic spine when bending at the waist. With which alteration does the nurse recognize this finding to be consistent?

1. Kyphosis, which is a common curvature in older patients

2. Kyphosis, which the patient will have to have surgically corrected

3. Scoliosis, which is a normal curvature in the elderly

4. Lordosis, which is common in elderly patients

Page Ref: 1407

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: Aging Process

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.3 Differentiate considerations for assessing the musculoskeletal systems of older adults and veterans.

MNL Learning Outcome: 2. Recognize normal findings of the musculoskeletal system collected during assessment and health promotion activities to support the health of this body system.

10) The nurse is reviewing data collected during the assessment of an older female. What should the nurse identify as being a normal age-related change? Select all that apply.

1. Height decreased 0.5 inch in 2 years

2. Complains of frequent cramping of lower extremities

3. 1 cm nodule palpated in right foot

4. Decreased range of motion in right and left hips

5. Lateral curvature of the spine

Page Ref: 1407

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: Aging Process

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.3 Differentiate considerations for assessing the musculoskeletal systems of older adults and veterans.

MNL Learning Outcome: 2. Recognize normal findings of the musculoskeletal system collected during assessment and health promotion activities to support the health of this body system.

11) While conducting range of motion with an older patient, the patient begins to cry and states, "My knee hurts when you do that!" Which intervention should be implemented at this time? Select all that apply.

1. Continue with the assessment.

2. Stop ROM immediately in that extremity.

3. Massage the knee for 20 minutes.

4. Call the healthcare provider.

5. Have the patient complete the assessment alone.

Page Ref: 1403, 1407

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 38.3 Differentiate considerations for assessing the musculoskeletal systems of older adults and veterans.

MNL Learning Outcome: 3. Interpret abnormal findings of the musculoskeletal system collected during assessment.

12) The nurse is planning to determine whether a patient has fluid in the knee. What should the nurse use to make this assessment? Select all that apply.

1. Ballottement

2. Bulge sign

3. Phalen's test

4. Thomas test

5. McMurray test

Page Ref: 1403, 1404

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the musculoskeletal system.

13) A patient's recovering from surgery to repair a fractured right femur asks what the diaphysis is. How should the nurse respond?

1. "Short bones like the femur are cuboid, spongy bone that in medical terms are called the diaphysis."

2. "Irregular bones like the femur are plates of compact bone that are also called the diaphysis."

3. "Flat bones like the femur are disc-shaped and, in medical terms, are called the diaphysis."

4. "Long bones like the femur have a mid-portion or shaft that is called the diaphysis."

Page Ref: 1395

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation

Learning Outcome: 38.1 Describe the anatomy, physiology, and functions of the musculoskeletal system, and identify abnormal findings that may indicate impairments of the musculoskeletal system.

MNL Learning Outcome: 8.1.1. Explain the pathophysiology of traumatic musculoskeletal injuries.

14) A patient is prescribed bed rest for two months. What impact should the nurse expect on the patient's skeletal bones?

1. Not be affected by the bed rest

2. Undergo increased osteoclast activity and bone resorption

3. Increase their osteoblastic activity to promote ossification

4. Be affected positively by the rest and be stronger as a result

Page Ref: 1397

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 38.1 Describe the anatomy, physiology, and functions of the musculoskeletal system, and identify abnormal findings that may indicate impairments of the musculoskeletal system.

MNL Learning Outcome: 3. Interpret abnormal findings of the musculoskeletal system collected during assessment.

15) A patient is seen in the clinic for chronic low blood calcium. What effect will this have on bone health?

1. Bone resorption will be triggered in order to increase serum calcium levels.

2. Bone production will occur in order to help increase the blood calcium.

3. Bones will not be affected because the calcium is low in the blood.

4. Bones will pull the needed calcium from other body structures.

Page Ref: 1397

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.1 Describe the anatomy, physiology, and functions of the musculoskeletal system, and identify abnormal findings that may indicate impairments of the musculoskeletal system.

MNL Learning Outcome: 3. Interpret abnormal findings of the musculoskeletal system collected during assessment.

16) A patient is recovering from surgery to repair a fractured arm. Which type of muscle is needed for this extremity to regain function?

1. Cardiac

2. Smooth

3. Skeletal

4. A combination of skeletal and smooth

Page Ref: 1397

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 38.1 Describe the anatomy, physiology, and functions of the musculoskeletal system, and identify abnormal findings that may indicate impairments of the musculoskeletal system.

MNL Learning Outcome: 3. Interpret abnormal findings of the musculoskeletal system collected during assessment.

17) A patient is scheduled for an electromyelogram (EMG). What should the nurse instruct the patient about this diagnostic test? Select all that apply.

1. Do not smoke for 3 hours before the test.

2. Do not take any medication prior to this test without physician approval.

3. The test measures nerve conduction along pathways.

4. The test measures electrical activity of skeletal muscles at rest.

5. Fluids containing caffeine are permitted prior to the test.

Page Ref: 1406

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

18) The nurse is preparing to assess a patient's musculoskeletal status. In which order should the nurse perform the techniques of this examination? Place the four techniques in the correct order.

Choice 1. Assess joints for swelling, pain, redness, warmth, crepitus, and range of motion (ROM).

Choice 2. Inspect and palpate the bones for any obvious deformity or changes in size, shape, or a painful response.

Choice 3. Measure the extremities for length and circumference, and compare limbs bilaterally.

Choice 4. Assess gait and posture.

Page Ref: 1400

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the musculoskeletal system.

19) The nurse is teaching a patient about an endoscopic examination of the interior surfaces of a joint during which surgery and diagnosis can also be accomplished. About which technique is the nurse instructing the patient?

1. Arthrocentesis

2. Arthroscopy

3. Atherogenesis

4. Arthrodesis

Page Ref: 1405

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

20) The patient is about to have a magnetic resonance imaging (MRI) to diagnose a soft tissue abnormality of the lower leg. About which finding should the nurse immediately notify the healthcare provider?

1. The patient has a concern about what will be found on the MRI.

2. The patient has a pacemaker.

3. The patient has a history of hypertension.

4. The patient did not eat breakfast due to earlier nausea.

Page Ref: 1406

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

21) A patient needs an x-ray of the arm. What should the nurse do to prepare the patient for this diagnostic test?

1. Initiate a peripheral IV in the opposite arm.

2. Find out the patient's allergies.

3. Do no special preparation.

4. Cleanse the arm with antibacterial cleanser.

Page Ref: 1406

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

22) A patient is scheduled for a bone scan. For which health problem should the nurse suspect this test is being used to diagnose?

1. Bone cancer

2. A muscle mass near the bone

3. New onset pain in the area of the bone

4. Normal calcium level

Page Ref: 1406

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

23) An older female patient is scheduled to have a DEXA examination. What should the nurse consider as most likely the reason the test has been prescribed for this patient?

1. Check for fractures.

2. Check the degree of osteoporosis.

3. Screen for osteomyelitis.

4. Evaluate bone cancer.

Page Ref: 1406

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.4 Summarize topics that nurses teach to promote a healthy musculoskeletal system across the lifespan.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

24) The nurse is caring for an older patient. What should the nurse realize is an expected age-related change in this patient's musculoskeletal system?

1. Difficulty with dexterity after age 50

2. Vertebrae lengthening and thinning, which leads to increased bone production

3. Decreased bone mass and calcium absorption, which increase risk for fractures

4. Pain when ambulating due to increased bone mass and minerals

Page Ref: 1407

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: Aging Process

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.3 Differentiate considerations for assessing the musculoskeletal systems of older adults and veterans.

MNL Learning Outcome: 2. Recognize normal findings of the musculoskeletal system collected during assessment and health promotion activities to support the health of this body system.

25) The nurse is caring for a patient with a musculoskeletal disorder. For which reason does the nurse suspect the patient's alkaline phosphatase (ALP) is being assessed?

1. Establish true calcium levels

2. Evaluate the presence of bone diseases

3. Determine phosphorus levels

4. Diagnose muscle trauma

Page Ref: 1405

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

26) A patient is having a creatine kinase (CK) level drawn. For which health problem would the nurse expect this level to be elevated?

1. Juvenile rheumatoid arthritis

2. Gout

3. Muscle disease

4. Bone tumors

Page Ref: 1405

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

27) A patient has an elevated blood calcium, elevated alkaline phosphatase, elevated phosphorus, normal creatine kinase, and increased uptake of the radioisotope on bone scan. Which health problem should the nurse suspect is occurring with this patient?

1. Bone spurs

2. Rheumatoid arthritis

3. Osteoporosis

4. Bone cancer

Page Ref: 1405, 1406

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

28) A patient seeks medical attention because of right knee pain and swelling that occurred while playing basketball. What should the nurse expect to be prescribed for this patient?

1. The patient will be sent home with instructions to use ice for one week.

2. The patient will be admitted to the hospital and seen by an orthopedic specialist.

3. The patient will be scheduled to see an orthopedic physician and a tentative appointment for a magnetic resonance imaging (MRI) scan.

4. The patient will be admitted to the hospital and scheduled for exploratory surgery.

Page Ref: 1406

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

29) The nurse determines that a patient's gait is normal. What did the nurse assess to make this clinical decision? Select all that apply.

1. The patient does not stumble, run into objects, or fall.

2. The gait is smooth and steady without limping.

3. The gait is slow and deliberate as if the patient is gingerly pulling one side up to meet the other.

4. The gait is jerky and quick, which indicates the patient has excellent motor control.

5. The posture is upright and straight.

Page Ref: 1401

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the musculoskeletal system.

30) A patient is diagnosed with a disease that affects fibrous tissue. In which musculoskeletal area should the nurse expect the patient to experience health problems? Select all that apply.

1. Hips

2. Teeth

3. Shoulders

4. Skull bones

5. Distal tibia and fibula

Page Ref: 1398

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.1 Describe the anatomy, physiology, and functions of the musculoskeletal system, and identify abnormal findings that may indicate impairments of the musculoskeletal system.

MNL Learning Outcome: 3. Interpret abnormal findings of the musculoskeletal system collected during assessment.

31) The nurse is preparing to assess a patient with myotonic dystrophy. For what health problem should the nurse assess this patient? Select all that apply.

1. Hair loss

2. Cataracts

3. Long extremities

4. Spinal deformities

5. Significant muscle wasting

Page Ref: 1404

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 3. Interpret abnormal findings of the musculoskeletal system collected during assessment.

32) The nurse is completing a health history with a patient. When assessing for a family or genetic history of musculoskeletal disorders, what should the nurse include? Select all that apply.

1. Gout

2. Fibromyalgia

3. Osteoarthritis

4. Lupus erythematosus

5. Ankylosing spondylitis

Page Ref: 1404

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the musculoskeletal system.

33) A patient is experiencing numbness and tingling of the left foot. When assessing this patient's limb, which movements should the nurse use to determine motor function of the patient's left ankle? Select all that apply.

1. 120-degree flexion

2. 50-degree adduction

3. 20-degree dorsiflexion

4. 45-degree plantar flexion

5. 30-degree hyperextension

Page Ref: 1403

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the musculoskeletal system.

34) The nurse notes that a patient is prescribed to have a human leukocyte antigen (HLA) test completed. For which health problem should the nurse potentially plan care for this patient? Select all that apply.

1. Osteoporosis

2. Paget disease

3. Rheumatoid arthritis

4. Ankylosing spondylitis

5. Juvenile rheumatoid arthritis

Page Ref: 1405

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the musculoskeletal system.

35) The nurse is assessing a patient with carpal tunnel syndrome. What assessment technique should the nurse use to determine this patient's finger function? Select all that apply.

1. Making a fist

2. Shaking hands

3. Spreading the fingers

4. Straightening the arm

5. Bending the hand forward and backward

Page Ref: 1402

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the musculoskeletal system.

36) The nurse completes a physical assessment on a patient recovering from a stroke. The patient has no muscle function of the left leg and passive range of motion of the left arm. The right leg and arm have full range of motion against full resistance. How should the nurse document the muscle grading of these assessment findings? Select all that apply.

1. 0 left leg

2. 2 left arm

3. 3 left arm

4. 5 right leg

5. 5 right arm

Page Ref: 1400

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment/Communication and Documentation

Learning Outcome: 38.2 Outline the components of the assessment of the musculoskeletal system, including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.

MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the musculoskeletal system.

37) The nurse is preparing teaching material for a community fair. What should the nurse include to ensure good bone health? Select all that apply.

1. Avoid obesity

2. Reduce smoking

3. Limit alcohol intake

4. Adequate intake of calcium

5. Engage in weight-bearing exercise

Page Ref: 1407

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Planning/Teaching/Learning

Learning Outcome: 38.4 Summarize topics that nurses teach to promote a healthy musculoskeletal system across the lifespan.

MNL Learning Outcome: 2. Recognize normal findings of the musculoskeletal system collected during assessment and health promotion activities to support the health of this body system.