Chapter 61 Assessment of Musculoskeletal System PDF

Preview

Summary

Download Chapter 61 Assessment of Musculoskeletal System PDF

Description

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

797

Chapter61:AssessmentofMusculoskeletalSystem TestBank MULTIPLECHOICE 1.A42-year-oldmalepatientcomplainsofshoulderpainwhenthenursemoveshisarmbehindtheback. Whichquestionshouldthenurseask? a.

Areyouabletofeedyourselfwithoutdifficulty?

b.

Doyouhavedifficultywhenyouareputtingonashirt?

c.

Areyouabletosleepthroughthenightwithoutwaking?

d.

Doyoueverhavetroubleloweringyourselftothetoilet?

ANS:B Thepatientspainwillmakeitmoredifficulttoaccomplishtaskslikeputtingonashirtorjacket.Thispain shouldnotaffectthepatientsabilitytofeedhimselforusethetoiletbecausethesetasksdonotinvolvemoving thearmbehindthepatient.Thearmwillnotusuallybepositionedbehindthepatientduringsleeping. DIF:CognitiveLevel:Apply(application)REF:1451 TOP:NursingProcess:AssessmentMSC:NCLEX:HealthPromotionandMaintenance 2.Apatientwithleftkneepainisdiagnosedwithbursitis.Thenursewillexplainthatbursitisisan inflammationof a.

thesynovialmembranethatlinesthejoint.

b.

asmall,fluid-filledsacfoundatsomejoints.

c.

thefibrocartilagethatactsasashockabsorberinthekneejoint.

d.

anyconnectivetissuethatisfoundsupportingthejointsofthebody.

ANS:B Bursaearefluid-filledsacsthatcushionjointsandbonyprominences.Fibrocartilageisasolidtissuethat cushionssomejoints.Bursaeareaspecifictypeofconnectivetissue.Thesynovialmembranelinesmanyjoints butisnotabursa. DIF:CognitiveLevel:Understand(comprehension)REF:1450 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 3.Thenursewhonotesthata59-year-oldfemalepatienthaslost1inchinheightoverthepast2yearswill plantoteachthepatientabout

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

a.

discographystudies.

b.

myelographictesting.

c.

magneticresonanceimaging(MRI).

d.

dual-energyx-rayabsorptiometry(DXA).

798

ANS:D Thedecreasedheightandthepatientsagesuggestthatthepatientmayhaveosteoporosisandthatbonedensity testingisneeded.Discography,MRI,andmyelographyaretypicallydoneforpatientswithcurrentsymptoms causedbymusculoskeletaldysfunctionandarenottheinitialdiagnostictestsforosteoporosis. DIF:CognitiveLevel:Apply(application)REF:1451 TOP:NursingProcess:PlanningMSC:NCLEX:HealthPromotionandMaintenance 4.Whichinformationina67-year-oldwomanshealthhistorywillalertthenursetotheneedforamore focusedassessmentofthemusculoskeletalsystem? a.

Thepatientsprainedherankleatage13.

b.

Thepatientsmotherbecameshorterwithaging.

c.

Thepatienttakesibuprofen(Advil)foroccasionalheadaches.

d.

Thepatientsfatherdiedofcomplicationsofmiliarytuberculosis.

ANS:B Afamilyhistoryofheightlosswithagingmayindicateosteoporosis,andthenurseshouldperformamore thoroughassessmentofthepatientscurrentheightandotherriskfactorsforosteoporosis.Asprainedankle duringadolescencedoesnotplacethepatientatincreasedcurrentriskformusculoskeletalproblems.Afamily historyoftuberculosisisnotariskfactor.Occasionalnonsteroidalantiinflammatorydrug(NSAID)usedoes notindicateanyincreasedmusculoskeletalrisk. DIF:CognitiveLevel:Apply(application)REF:1453 TOP:NursingProcess:AssessmentMSC:NCLEX:HealthPromotionandMaintenance 5.Whichinformationobtainedduringthenursesassessmentofa30-year-oldpatientsnutritional-metabolic patternmayindicatetheriskformusculoskeletalproblems? a.

Thepatienttakesamultivitamindaily.

b.

Thepatientdislikesfruitsandvegetables.

c.

Thepatientis5ft2inandweighs180lb.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

d.

799

Thepatientpreferswholemilktononfatmilk.

ANS:C Thepatientsheightandweightindicateobesity,whichplacesstressonweight-bearingjoints.Theuseofwhole milk,avoidingfruitsandvegetables,anduseofadailymultivitaminarenotriskfactorsformusculoskeletal problems. DIF:CognitiveLevel:Apply(application)REF:1453 TOP:NursingProcess:AssessmentMSC:NCLEX:HealthPromotionandMaintenance 6.Whichmedicationinformationwillthenurseidentifyasaconcernforapatientsmusculoskeletalstatus? a.

Thepatienttakesadailymultivitaminandcalciumsupplement.

b.

Thepatienttakeshormonetherapy(HT)topreventhotflashes.

c.

Thepatienthassevereasthmaandrequiresfrequenttherapywithoralcorticosteroids.

d.

Thepatienthasmigraineheadachestreatedwithnonsteroidalantiinflammatorydrugs(NSAIDs).

ANS:C Frequentorchroniccorticosteroidusemayleadtoskeletalproblemssuchasavascularnecrosisand osteoporosis.TheuseofHTandcalciumsupplementswillhelppreventosteoporosis.NSAIDusedoesnot increasetheriskformusculoskeletalproblems. DIF:CognitiveLevel:Apply(application)REF:1452 TOP:NursingProcess:AssessmentMSC:NCLEX:HealthPromotionandMaintenance 7.Thenursefindsthatapatientcanflexthearmswhennoresistanceisappliedbutisunabletoflexwhenthe nurseapplieslightresistance.Thenurseshoulddocumentthepatientsmusclestrengthaslevel a.

0.

b.

1.

c.

2.

d.

3.

ANS:D Alevel3indicatesthatthepatientisunabletomoveagainstresistancebutcanmoveagainstgravity.Level1 indicatesminimalmusclecontraction,level2indicatesthatthearmcanmovewhengravityiseliminated,and level4indicatesactivemovementwithsomeresistance. DIF:CognitiveLevel:Understand(comprehension)REF:1455

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

800

TOP:NursingProcess:AssessmentMSC:NCLEX:HealthPromotionandMaintenance 8.Aftercompletingthehealthhistory,thenurseassessingthemusculoskeletalsystemwillbeginby a.

havingthepatientmovetheextremitiesagainstresistance.

b.

feelingforthepresenceofcrepitusduringjointmovement.

c.

observingthepatientsbodybuildandmuscleconfiguration.

d.

checkingactiveandpassiverangeofmotionfortheextremities.

ANS:C Theusualtechniqueinthephysicalassessmentistobeginwithinspection.Abnormalitiesinmusclemassor configurationwillallowthenursetoperformamorefocusedassessmentofabnormalareas.Theother assessmentsarealsoincludedintheassessmentbutareusuallydoneafterinspection. DIF:CognitiveLevel:Understand(comprehension)REF:1454 TOP:NursingProcess:AssessmentMSC:NCLEX:HealthPromotionandMaintenance 9.Whichnursingactioniscorrectwhenperformingthestraight-legraisingtestforanambulatorypatientwith backpain? a.

Raisethepatientslegstoa60-degreeanglefromthebed.

b.

Placethepatientinitiallyinthepronepositionontheexamtable.

c.

Havethepatientdanglebothlegsovertheedgeoftheexamtable.

d.

Instructthepatienttoelevatethelegsandtensetheabdominalmuscles.

ANS:A Whenperformingthestraightleg-raisingtest,thepatientisinthesupinepositionandthenursepassivelylifts thepatientslegstoa60-degreeangle.Theotheractionswouldnotbecorrectforthistest. DIF:CognitiveLevel:Understand(comprehension)REF:1455 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 10.A72-year-oldpatientwithkyphosisisscheduledfordual-energyx-rayabsorptiometry(DXA)testing.The nursewillplanto a.

explaintheprocedure.

b.

startanIVlineforcontrastmediuminjection.

c.

giveanoralsedative60to90minutesbeforetheprocedure.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

d.

801

screenthepatientforallergiestoshellfishoriodineproducts.

ANS:A DXAtestingispainlessandnoninvasive.NoIVaccessisnecessary.Contrastmediumisnotused.Becausethe procedureispainless,noantianxietymedicationsarerequired. DIF:CognitiveLevel:Apply(application)REF:1458 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 11.Apatienthasaneworderformagneticresonanceimaging(MRI)toevaluateforleftfemurosteomyelitis afterahipreplacementsurgery.Whichinformationindicatesthatthenurseshouldconsultwiththehealthcare providerbeforeschedulingtheMRI? a.

Thepatienthasapacemaker.

b.

Thepatientisclaustrophobic.

c.

Thepatientwearsahearingaid.

d.

Thepatientisallergictoshellfish.

ANS:A PatientswithpermanentpacemakerscannothaveMRIbecauseoftheforceexertedbythemagneticfieldon metalobjects.AnopenMRIwillnotcauseclaustrophobia.Thepatientwillneedtobeinstructedtoremovethe hearingaidbeforetheMRI,butthisdoesnotrequireconsultationwiththehealthcareprovider.Because contrastmediumwillnotbeused,shellfishallergyisnotacontraindicationtoMRI. DIF:CognitiveLevel:Apply(application)REF:1458 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 12.Thenursenotescracklingsoundsandagratingsensationwithpalpationofanolderpatientselbow.How willthisfindingbedocumented? a.

Torticollis

b.

Crepitation

c.

Subluxation

d.

Epicondylitis

ANS:B Cracklingsoundsandagratingsensationthataccompanymovementaredescribedascrepitusorcrepitation. Torticollisisatwistingofthenecktooneside,subluxationisapartialdislocationofthejoint,and epicondylitisisaninflammationoftheelbowthatcausesadullachethatincreaseswithmovement.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

802

DIF:CognitiveLevel:Understand(comprehension)REF:1457 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 13.Whichfindingisofhighestprioritywhenthenurseisplanningcarefora77-year-oldpatientseeninthe outpatientclinic? a.

Symmetricjointswellingoffingers

b.

Decreasedrightkneerangeofmotion

c.

Reportoflefthipachingwhenjogging

d.

Historyofrecentlossofbalanceandfall

ANS:D Ahistoryoffallsrequiresfurtherassessmentanddevelopmentoffallpreventionstrategies.Theotherchanges aremoretypicalofboneandjointchangesassociatedwithnormalaging. DIF:CognitiveLevel:Apply(application)REF:1451 OBJ:SpecialQuestions:PrioritizationTOP:NursingProcess:Assessment MSC:NCLEX:PhysiologicalIntegrity 14.Whichfindingfromapatientsrightkneearthrocentesiswillbeofconcerntothenurse? a.

Cloudyfluid

b.

Scantthinfluid

c.

Paleyellowfluid

d.

Straw-coloredfluid

ANS:A Thepresenceofpurulentfluidsuggestsapossiblejointinfection.Normalsynovialfluidisscantinamountand paleyellow/straw-colored. DIF:CognitiveLevel:Apply(application)REF:1456 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 15.Whichactioncanthenursedelegatetounlicensedassistivepersonnel(UAP)whoareworkinginthe orthopedicclinic? a.

Gradelegmusclestrengthforapatientwithbackpain.

b.

Obtainbloodsampleforuricacidfromapatientwithgout.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

c.

Performstraight-leg-raisetestingforapatientwithsciatica.

d.

Checkforkneejointcrepitationbeforearthroscopicsurgery.

ANS:B DrawingbloodspecimensisacommonskillperformedbyUAPinclinicsettings.Theotheractionsare assessmentsandrequireregisterednurse(RN)leveljudgmentandcriticalthinking. DIF:CognitiveLevel:Apply(application)REF:15 OBJ:SpecialQuestions:Delegation;MultiplePatientsTOP:NursingProcess:Planning MSC:NCLEX:SafeandEffectiveCareEnvironment OTHER 1.Whichpartofthemusculoskeletalassessmentisthenursedoinginthevideo? Clickheretoviewthevideoclip a.Passivehiprangeofmotion b.Inspectionofthelegsandfeet c.Internalandexternalhiprotation d.Adductionandabductionofthehip ANS: D Hipabductionandadductionisassessedbyhavingthepatientmovethehipjointlaterallyandmedially. DIF:CognitiveLevel:Understand(comprehension)REF:1449 TOP:NursingProcess:AssessmentMSC:NCLEX:HealthPromotionandMaintenance

803...