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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter39:AssessmentofMusculoskeletalFunction  1.

Anurseontheorthopedicunitisassessingapatientsperonealnerve.Thenursewillperformthis assessmentbydoingwhichofthefollowingactions?

A)

Prickingtheskinbetweenthegreatandsecondtoe

B)

Strokingtheskinonthesoleofthepatientsfoot

C)

Pinchingtheskinbetweenthethumbandindexfinger

D)

Strokingthedistalfatpadofthesmallfinger

Ans:

A Feedback: Thenursewillevaluatethesensationoftheperonealnervebyprickingtheskincenteredbetweenthe greatandsecondtoe.Noneoftheotherlistedactionselicitsthefunctionofoneoftheperipheralnerves.

2.

ApublichealthnurseisorganizingacampaignthatwilladdresstheleadingcauseofmusculoskeletalrelateddisabilityintheUnitedStates.Thenurseshouldfocusonwhathealthproblem?

A)

Osteoporosis

B)

Arthritis

C)

Hipfractures

D)

Lowerbackpain

Ans:

B Feedback: Theleadingcauseofmusculoskeletal-relateddisabilityintheUnitedStatesisarthritis.

3.

A)

Anurseisprovidingcareforapatientwhosepatternoflaboratorytestingrevealslongstanding hypocalcemia.Whatotherlaboratoryresultismostconsistentwiththisfinding? Anelevatedparathyroidhormonelevel

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Anincreasedcalcitoninlevel

C)

Anelevatedpotassiumlevel

D)

AdecreasedvitaminDlevel

Ans:

A

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Feedback: Intheresponsetolowcalciumlevelsintheblood,increasedlevelsofparathyroidhormonepromptthe mobilizationofcalciumandthedemineralizationofbone.Increasedcalcitoninlevelswouldexacerbate hypocalcemia.VitaminDlevelsdonotincreaseinresponsetolowcalciumlevels.Potassiumlevels wouldlikelybeunaffected. 4.

Anurseiscaringforapatientwhosecancermetastasishasresultedinbonepain.Whichofthefollowing aretypicalcharacteristicsofbonepain?

A)

Adull,deepachethatisboringinnature

B)

Sorenessorachingthatmayincludecramping

C)

Sharp,piercingpainthatisrelievedbyimmobilization

D)

Spasticorsharppainthatradiates

Ans:

A Feedback: Bonepainischaracteristicallydescribedasadull,deepachethatisboringinnature,whereasmuscular painisdescribedassorenessorachingandisreferredtoasmusclecramps.Fracturepainissharpand piercingandisrelievedbyimmobilization.Sharppainmayalsoresultfromboneinfectionwithmuscle spasmorpressureonasensorynerve.

5.

Anurseisassessingapatientwhoisexperiencingperipheralneurovasculardysfunction.What assessmentfindingsaremostconsistentwiththisdiagnosis?

A)

Hotskinwithacapillaryrefillof1to2seconds

B)

Absenceoffeeling,capillaryrefillof4to5seconds,andcoolskin

C)

Pain,diaphoresis,anderythema

D)

Jaundicedskin,weakness,andcapillaryrefillof3seconds

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

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B Feedback: Indicatorsofperipheralneurovasculardysfunctionincludepale,cyanotic,ormottledskinwithacool temperature;capillaryrefillgreaterthan3seconds;weaknessorparalysiswithmotion;andparesthesia, unrelentingpain,painonpassivestretch,orabsenceoffeeling.Jaundice,diaphoresis,andwarmthare inconsistentwithperipheralneurovasculardysfunction.

6.

Anolderadultpatienthassymptomsofosteoporosisandisbeingassessedduringherannualphysical examination.Theassessmentshowsthatthepatientwillrequirefurthertestingrelatedtoapossible exacerbationofherosteoporosis.Thenurseshouldanticipatewhatdiagnostictest?

A)

Bonedensitometry

B)

Hipboneradiography

C)

Computedtomography(CT)

D)

Magneticresonanceimaging(MRI)

Ans:

A Feedback: Bonedensitometryisconsideredthemostaccuratetestforosteoporosisandforpredictingafracture.As such,itismorelikelytobeusedthanCT,MRI,orx-rays.

7.

Apatientinjuredinamotorvehicleaccidenthassustainedafracturetothediaphysisoftherightfemur. Ofwhatisthediaphysisofthefemurmainlyconstructed?

A)

Epiphyses

B)

Cartilage

C)

Corticalbone

D)

Cancellousbone

Ans:

C Feedback: Thelongboneshaft,whichisreferredtoasthediaphysis,isconstructedprimarilyofcorticalbone.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

8.

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Anolderadultpatienthascometotheclinicforaregularcheck-up.Thenursesinitialinspectionreveals anincreasedthoraciccurvatureofthepatientsspine.Thenurseshoulddocumentthepresenceofwhich ofthefollowing?

A)

Scoliosis

B)

Epiphyses

C)

Lordosis

D)

Kyphosis

Ans:

D Feedback: Kyphosisistheincreaseinthoraciccurvatureofthespine.Scoliosisisadeviationinthelateral curvatureofthespine.Epiphysesaretheendsofthelongbones.Lordosisistheexaggeratedcurvatureof thelumbarspine.

9.

Whenassessingapatientsperipheralnervefunction,thenurseusesaninstrumenttoprickthefatpadat thetopofthepatientssmallfinger.Thisactionwillassesswhichofthefollowingnerves?

A)

Radial

B)

Ulnar

C)

Median

D)

Tibial

Ans:

B Feedback: Theulnarnerveisassessedforsensationbyprickingthefatpadatthetopofthesmallfinger.Theradial, median,andtibialnervesarenotassessedinthismanner.

Theresultsofanursesmusculoskeletalexaminationshowanincreaseinthelumbarcurvatureofthe 10. spine.Thenurseshouldrecognizethepresenceofwhathealthproblem? A)

Osteoporosis

B)

Kyphosis

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Lordosis

D)

Scoliosis

Ans:

C

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Feedback: Thenursedocumentsthespinalabnormalityaslordosis.Lordosisisanincreaseinlumbarcurvatureof thespine.Kyphosisisanincreaseintheconvexcurvatureofthespine.Scoliosisisalateralcurvatureof thespine.Osteoporosisisthesignificantlossofbonemassandstrengthwithanincreasedriskfor fracture. 11. Thehumanbodyisdesignedtoprotectitsvitalparts.Afractureofwhattypeofbonemayinterferewith theprotectionofvitalorgans? A)

Longbones

B)

Shortbones

C)

Flatbones

D)

Irregularbones

Ans:

C Feedback: Flatbones,suchasthesternum,providevitalorganprotection.Fracturesoftheflatbonesmayleadto puncturingofthevitalorgansormayinterferewiththeprotectionofthevitalorgans.Long,short,and irregularbonesdonotusuallyhavethisphysiologicfunction.

12. Apatienthasjusthadanarthroscopyperformedtoassessakneeinjury.Whatnursingintervention shouldthenurseimplementfollowingthisprocedure? A)

Wrapthejointinacompressiondressing.

B)

Performpassiverangeofmotionexercises.

C)

Maintainthekneeinflexionforupto30minutes.

D)

Applyheattotheknee.

Ans:

A

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Feedback: Interventionstoperformfollowinganarthroscopyincludewrappingthejointinacompressiondressing, extendingandelevatingthejoint,andapplyingiceorcoldpacks.PassiveROMexercises,staticflexion, andheatarenotindicated. 13. Whileassessingapatient,thepatienttellsthenursethatsheisexperiencingrhythmicmuscle contractionswhenthenurseperformspassiveextensionofherwrist.Whatisthispatternofmuscle contractionreferredtoas? A)

Fasciculations

B)

Contractures

C)

Effusion

D)

Clonus

Ans:

D Feedback:

Clonusmayoccurwhentheankleisdorsiflexedorthewristisextended.Itischaracterizedasrhythmic contractionsofthemuscle.Fasciculationisinvoluntarytwitchingofmusclefibergroups.Contractures areprolongedtighteningofmusclegroupsandaneffusionisthepathologicescapeofbodyfluid. Anurseiscaringforanolderadultwhohasbeendiagnosedwithgeriatricfailuretothrive.Thispatients 14. prolongedimmobilitycreatesariskforwhatcomplication? A)

Muscleclonus

B)

Muscleatrophy

C)

Rheumatoidarthritis

D)

Musclefasciculations

Ans:

B Feedback: Ifamuscleisindisuseforanextendedperiodoftime,itisatriskofdevelopingatrophy,whichisthe decreaseinsize.Clonusisapatternofrhythmicmusclecontractionsandfasciculationistheinvoluntary twitchofmusclefibers;neitherresultsfromimmobility.Lackofexerciseisariskfactorforrheumatoid arthritis.

15. Anurseiscaringforapatientwhohasbeenscheduledforabonescan.Whatshouldthenurseteachthe patientaboutthisdiagnostictest?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Thetestisbriefandrequiresthatyoudrinkacalciumsolution2hoursbeforethetest.

B)

Youwillnotbeallowedfluidfor2hoursbeforeand3hoursafterthetest.

C)

Youllbeencouragedtodrinkwateraftertheadministrationoftheradioisotopeinjection.

D)

Thisisacommontestthatcanbesafelyperformedonanyone.

Ans:

C

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Feedback: Itisimportanttoencouragethepatienttodrinkplentyoffluidstohelpdistributeandeliminatethe isotopicafteritisinjected.Thereareimportantcontraindicationstotheprocedure,includepregnancyor anallergytotheradioisotope.Thetestrequirestheinjectionofanintravenousradioisotopeandthescan ispreformed2to3hoursaftertheisotopeisinjected.Acalciumsolutionisnotutilized. 16. Anurseisassessingachildwhohasadiagnosisofmusculardystrophy.Assessmentrevealsthatthe childsmuscleshavegreater-than-normaltone.Thenurseshoulddocumentthepresenceofwhichofthe following? A)

Tonus

B)

Flaccidity

C)

Atony

D)

Spasticity

Ans:

D Feedback: Amusclewithgreater-than-normaltoneisdescribedasspastic.Softandflabbymuscletoneisdefinedas atony.Amusclethatislimpandwithouttoneisdescribedasbeingflaccid.Thestateofreadinessknown asmuscletone(tonus)isproducedbythemaintenanceofsomeofthemusclefibersinacontractedstate.

17. Thenursescomprehensiveassessmentofanolderadultinvolvestheassessmentofthepatientsgait. Howshouldthenursebestperformthisassessment? A)

Instructthepatienttowalkheel-to-toefor15to20steps.

B)

Instructthepatienttowalkinastraightlinewhilenotlookingatthefloor.

C)

Instructthepatienttowalkawayfromthenurseforashortdistanceandthentowardthenurse.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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D)

Instructthepatienttobalanceononefootforaslongaspossibleandthenwalkinacirclearound theroom.

Ans:

C Feedback: Gaitisassessedbyhavingthepatientwalkawayfromtheexaminerforashortdistance.Theexaminer observesthepatientsgaitforsmoothnessandrhythm.Lookingatthefloorisnotdisallowedandgaitis notassessedbyobservingbalanceononeleg.Heel-to-toewalkingabilityisnotgaugedduringan assessmentofnormalgait.

18. Aclinicnurseiscaringforapatientwithahistoryofosteoporosis.Whichofthefollowingdiagnostic testsbestallowsthecareteamtoassessthepatientsriskoffracture? A)

Arthrography

B)

Bonescan

C)

Bonedensitometry

D)

Arthroscopy

Ans:

C Feedback: Bonedensitometryisusedtodetectbonedensityandcanbeusedtoassesstheriskoffracturein osteoporosis.Arthrographyisusedtodetectacuteorchronictearsofjointcapsuleorsupporting ligaments.Bonescanscanbeusedtodetectmetastaticandprimarybonetumors,osteomyelitis,certain fractures,andasepticnecrosis.Arthroscopyisusedtovisualizeajoint.

19. Anurseisperformingamusculoskeletalassessmentofapatientwitharthritis.Duringpassiverange-ofmotionexercises,thenursehearsanaudiblegratingsound.Thenurseshoulddocumentthepresenceof whichofthefollowing? A)

Fasciculations

B)

Clonus

C)

Effusion

D)

Crepitus

Ans:

D

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Feedback: Crepitusisagrating,cracklingsoundorsensationthatoccursastheirregularjointsurfacesmoveacross oneanother,asinarthriticconditions.Fasciculationsareinvoluntarytwitchingofmusclefibergroups. Clonusistherhythmiccontractionsofamuscle.Effusionisthecollectionofexcessivefluidwithinthe capsuleofajoint. 20. Apatientsfractureishealingandcallusisbeingdepositedinthebonematrix.Thisprocesscharacterizes whatphaseofthebonehealingprocess? A)

Thereparativephase

B)

Thereactivephase

C)

Theremodelingphase

D)

Therevascularizationphase

Ans:

A Feedback: Callusformationtakesplaceduringthereparativephaseofbonehealing.Thereactivephaseoccurs immediatelyafterinjuryandtheremodelingphasebuildsonthereparativephase.Thereisnodiscrete revascularizationphase.

21. Achildisgrowingatarateappropriateforhisage.Whatcellsareresponsibleforthesecretionofbone matrixthateventuallyresultsinbonegrowth? A)

Osteoblasts

B)

Osteocytes

C)

Osteoclasts

D)

Lamellae

Ans:

A Feedback: Osteoblastsfunctioninboneformationbysecretingbonematrix.Osteocytesarematurebonecellsand osteoclastsaremultinuclearcellsinvolvedindissolvingandresorbingbone.Lamellaearecirclesof mineralizedbonematrix.

22. AnurseiscaringforapatientwhohasanMRIscheduled.Whatistheprioritysafetyactionpriortothis

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diagnosticprocedure? A) B) C) D) Ans:

Assessingthepatientforsignsandsymptomsofactiveinfection Ensuringthatthepatientcanremainimmobileforupto3hours

Assessingthepatientforahistoryofnutallergies Ensuringthattherearenometalobjectsonorinthepatient

D Feedback: AbsolutelynometalobjectscanbepresentduringMRItheirpresenceconstitutesaserioussafetyrisk. Theproceduretakesupto90minutes.NutallergiesandinfectionarenotcontraindicationstoMRI.

23. Anurseistakingahealthhistoryonapatientwithmusculoskeletaldysfunction.Whatistheprimary focusofthisphaseofthenursesassessment? A)

Evaluatingtheeffectsofthemusculoskeletaldisorderonthepatientsfunction

B)

Evaluatingthepatientsadherencetotheexistingtreatmentregimen

C)

Evaluatingthepresenceofgeneticriskfactorsforfurthermusculoskeletaldisorders

D)

Evaluatingthepatientsactiveandpassiverangeofmotion

Ans:

A Feedback: Thenursingassessmentofthepatientwithmusculoskeletaldysfunctionincludesanevaluationofthe effectsofthemusculoskeletaldisorderonthepatient.Thisisavitalfocusofthehealthhistoryand supersedestheassessmentofgeneticriskfactorsandadherencetotreatment,thoughthesearebothvalid inclusionstotheinterview.AssessmentofROMoccursduringthephysicalassessment,notthe interview.

24. Apatientisscheduledforabonescantoruleoutosteosarcomaofthepelvicbones.Whatwouldbemost importantforthenursetoassessbeforethepatientsscan? A)

Thatthepatientcompletedthebowelcleansingregimen

B)

Thatthepatientemptiedthebladder

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Thatthepatientisnotallergictopenicillins

D)

Thatthepatienthasfastedforatleast8hours

Ans:

B

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Feedback: Beforethescan,thenurseasksthepatienttoemptythebladder,becauseafullbladderinterfereswith accuratescanningofthepelvicbones.Bowelcleansingandfastingarenotindicatedforabonescanand anallergytopenicillinsisnotacontraindication. 25. Anurseisexplainingapatientsdecreasingbonedensityintermsofthebalancebetweenboneresorption andformation.Whatdietarynutrientsandhormonesplayaroleintheresorptionandformationofadult bones?Selectallthatapply. A)

Thyroidhormone

B)

Growthhormone

C)

Estrogen

D)

VitaminB12

E)

Luteinizinghormone

Ans:

A,B,C Feedback: Thebalancebetweenboneresorptionandformationisinfluencedbythefollowingfactors:physical activity;dietaryintakeofcertainnutrients,especiallycalcium;andseveralhormones,includingcalcitriol (i.e.,activatedvitaminD),parathyroidhormone(PTH),calcitonin,thyroidhormone,cortisol,growth hormone,andthesexhormonesestrogenandtestosterone.LuteinizinghormoneandvitaminB12donot playaroleinboneformationorresorption.

26. Diagnostictestsshowthatapatientsbonedensityhasdecreasedoverthepastseveralyears.Thepatient asksthenursewhatfactorscontributetobonedensitydecreasing.Whatwouldbethenursesbest response? A)

Formanypeople,lackof...