Chapter 21: Musculoskeletal System Test Bank—Nursing

ANS: D Synovial articulations are freely moving joints that are enclosed by a compartment made up of cartilage and ligaments. Synarthroses are immovable joints. Synchondroses are immovable joints. Amphiarthroses are slightly movable.

ANS: B Articular cavities are lined with synovial membrane, which secretes synovial fluid that provides lubrication for the joint to move. Blood does not act as a lubricant. Mucus should not be found in articular cavities. Cerumen is ear wax.

ANS: B Bones are held together within a joint by ligaments. Tendons attach muscle to bone, bones are not held together by muscles, and cartilage forms most of the joints in the adult skeleton and merely acts as a shock absorber.

ANS: A Tendons attach muscle to bone. Ligaments attach bone to bone. Muscles are not bound together by other muscles. Cartilage helps in the production of new bone and acts as an insulator for bones in joints.

ANS: C An increase in muscle tone is referred to as spasticity.

ANS: A The ball-and-socket joint is the joint that has the widest range of motion (e.g., the hip joint). A condyloid joint may only move in two planes. A gliding joint is only able to glide. A saddle joint has no axial rotation.

ANS: C Except for sacral vertebrae, the spinal vertebrae are separated from one another by disks. Spinal movement is achieved by paraspinous muscles, tendons, and ligaments. Bursae are located in the knee, elbow, shoulder, and hip.

ANS: B The shoulder joint, also called the glenohumeral joint, consists of the union between the humerus and scapula.

ANS: B The elbow is the site where the humerus, radius, and ulna meet. The wrist is made up of the radius and the carpal bones of the hand. The shoulder is made up of the humerus and scapula. The clavicle connects to the scapula but not to the humerus.

ANS: A The joint comprising the radius and carpal bones is called the wrist.

ANS: A The cruciate ligaments of the knee are positioned as to provide anterior and posterior stability. The collateral ligaments maintain medial and lateral stability. The knee joint is a hinge joint that allows movement in one plane.

ANS: D The ankle joint, or tibiotalar joint, is protected by ligaments on the medial and lateral sides.

ANS: C The suprapatellar bursa separates the knee, quadriceps, and muscle from the femur.

ANS: A The tibia, fibula, and talus (or heel) join to form the ankle.

ANS: A Epiphyses are the growth plates found in long bones in children.

ANS: B Increased hormone secretion during pregnancy is responsible for the elasticity of pelvic ligaments and softening of the cartilage. These changes help accommodate the growing fetus.

ANS: B With age, the skeletal system changes. One of the dramatic changes in skeletal equilibrium is that bone resorption dominates bone deposition.

ANS: C An important history to obtain for a patient with joint pain would be family history of genetic disorders, such as osteogenesis imperfecta, dwarfing syndrome, rickets, hypophosphatemia, and hypercalciuria.

ANS: D Failure to warm-up before exercise is one risk factor for sports-related injuries. Climate, previous fractures, and weight loss are not as strong risk factors for sports-related injuries. Also included are poor physical conditioning, intensity of competition, collision and contact sports participation, rapid growth, and overuse of joints.

ANS: D People with light skin and a thin body frame are at greater risk for developing osteoporosis. Rheumatoid arthritis, osteoarthritis, and bony defects are not found to have a correlation with light skin and small frame.

ANS: C History taking of older adults should consist of symptoms of nocturnal muscle spasms. Pregnant women and older adults commonly experience nocturnal leg cramps resulting from imbalances of fluids, hormones, minerals, or electrolytes or dehydration. A particular concern with the older adults is that this may be a sign of intermittent claudication

ANS: A When the patient first walks in the room, the examiner should be observing his or her gait and posture as part of the musculoskeletal examination

ANS: D Muscle wasting is a consequence of pain from injury, pathology of the muscle, or injury to the motor neuron.

ANS: B Fasciculations can often be visualized as muscle twitching or dimpling under the skin, but they usually do not generate sufficient force to move a limb. They may represent a benign condition or occur as a manifestation of motor neuron disease or peripheral nervous system diseases.

ANS: A The assessment technique most commonly used to assess joint symmetry is inspection.

ANS: C The angle of a joint can be accurately measured by using a goniometer. A goniometer is used when the joint range of motion is beyond normal limits.

ANS: A Crepitus is felt or heard when irregular bony surfaces rub together, when two rough edges of a broken bone rub together, or with the movement of tendon inside the tendon sheath when tenosynovitis is present

ANS: C The temporomandibular joint is palpated just anterior to the tragus of the ear; the fingertips are placed inside the joint space as the patient opens and closes the mouth.

ANS: B Having the patient to bite down and clench their teeth is the method for evaluating the strength of the temporalis and masseter muscles. Cranial nerve V is tested with this same maneuver.

ANS: B Having the patient apply opposite force with differing head motions, against the examiner's hand, assesses the sternocleidomastoid and trapezius muscles.

ANS: D Spinal alignment is considered within normal limits when the patient's head is positioned directly over the gluteal cleft. The skin folds should be symmetric, the scapulae are at even heights, and both the cervical and lumbar curves are convex.

ANS: B Bowing of the back, or lordosis, is more commonly found in pregnant women or obese patients because of an altered center of gravity. Kyphosis is more commonly seen in older adults. Paraphimosis is a penile condition. Scoliosis is more commonly seen in teenagers.

ANS: D This older woman, most likely kyphotic from osteoporosis, would have the greatest friction point at the gibbus. The gibbus results from collapsed vertebrae, resulting in a sharp, pointy deformity of the back. C7 and L4 remain as concave curves, with less friction. The iliac crests would not protrude as far as the gibbus.

ANS: C Scoliosis is suspected when there is a noticeable lateral curvature of the spine, or rib hump, as the patient bends forward at the waist.

ANS: A If the long thoracic nerve is damaged or bruised, it can cause paralysis of the serratus anterior muscle and winging of the scapula, or shoulder blade. This is not a symptom of a fractured clavicle or trapezius muscle separation. A dislocated shoulder would result in a hollowing effect.

ANS: C Asymmetric contours to the shoulder with a hollowing in the socket are symptoms of a shoulder dislocation. Kyphosis is a condition of the back; muscle wasting and a scapular fracture do not present with these symptoms.

ANS: A Deviation of the fingers toward the ulnar side and swan neck deformities are classic symptoms of rheumatoid arthritis. Osteoarthritis, congenital defects, and osteoporosis do not present with these symptoms.

ANS: D Heberden nodes are bony overgrowths of the distal end of the fingers and are associated with osteoarthritis. When the overgrowths are concentrated in the proximal interphalangeal joint, they are known as Bouchard nodes and are associated with rheumatoid arthritis, as are swan neck deformities; ganglions are present in nerve conditions.

ANS: C Median nerve compression, as in carpal tunnel syndrome, results in a positive Tinel sign, positive Phalen test, reduced abduction of the thumb, and sparing of palm tingling.

ANS: D Genu recurvatum, which is hyperextension of the knee, is a result of quadriceps muscle weakness.

ANS: B Total arm length is assessed by the standard measurement of the length from the shoulder (acromion process) through the elbow joint (olecranon process) to the wrist (distal ulnar prominence)

ANS: C Lumbar nerve root irritation at the L4, L5, and S1 levels can be assessed by asking the patient to lie supine with their neck flexed and to raise one leg. If pain is felt, this is a positive straight leg raise.

NS: D The Thomas test requires the patient to lie supine, with one leg stretched out flat and the other raised and bent in toward the chest. If the patient is unable to keep the extended leg flat on the table, this is an indicator of a hip flexion contracture.

ANS: B The McMurray test detects a meniscus tear. The drawer test detects an anterior cruciate ligament tear. The Thomas test detects hip contraction. The Trendelenburg test detects weak hip abductor muscles.

ANS: A The next step is to turn the ankle outward while applying a valgus stress and then extend the knee.

ANS: B At every examination during an infant's first year of life, the Barlow-Ortolani maneuver is performed. This test involves stabilizing the pelvis and flexing one hip and knee to 90 degrees. It detects hip dislocation, which is signified by a clicking noise with the maneuver.

ANS: B A positive Gower sign indicates generalized muscle weakness and is characterized by a child trying to stand up by flexing at the knee and pushing down on the thighs while trying to pull the trunk up.

ANS: A The symptoms this child is experiencing are indicative of a radial head subluxation, or nursemaid's elbow.

ANS: A Carpal tunnel syndrome may be experienced by pregnant women during their last trimester because of fluid retention. Fluid retention at the tunnel causes pressure and inflammation at the medial nerve. This results in the symptoms.

ANS: C Gout is characterized as red, hot, swollen joints, especially in the great toe. Gout is commonly found in men older than 40 years.

ANS: B Paget disease is characterized by bowed tibias, an asymmetric skull, a shortened chest, and susceptibility to fractures.

ANS: D One of the key differences between the symptoms of osteoarthritis and RA is that fatigue is uncommon in osteoarthritis patients.

ANS: B The Allis sign will show unequal upper leg lengths, suggestive of a hip dislocation. The Barlow-Ortolani maneuver can confirm the results for a hip dislocation.

ANS: D Along with elbows and hips, newborns tend to resist extension of the knee; however, their movements should be symmetric

ANS: C Constant hip pain with a limp in a young child is indicative of Legg-Calvé-Perthes disease. This condition results in avascular necrosis of the femoral head caused by an inadequate blood supply.

ANS: D A contracture of the palmar fascia of one or multiple fingers is called a Dupuytren contracture.

ANS: A Osteoporosis leads to vertebral compression and kyphotic bowing of the spine, known as dowager hump.

ANS: Tinel The Tinel sign is a test for carpal tunnel syndrome. A positive result is elicited when the median nerve is struck, producing a tingling sensation from the wrist toward the fingers.

ANS: Lachman The Lachman test evaluates anterior cruciate ligament integrity.

ANS: valgus stress The injury described will most likely result in a medial meniscus or medial collateral ligament damage. Your initial assessment would be to apply the valgus stress test to assess the medial meniscus.

ANS: hinge A hinge joint allows for flexion and extension in one plane.

ANS: cervical The cervical vertebrae are the most mobile because flexion and extension occur between the skull and C1

ANS: A, D, E Hallmark signs of rheumatoid arthritis are gradual onset of stiffness for 1 hour after rising, sleep disturbance, joint tenderness, and medium to fine crepitus.

ANS: C, D The wrist movement is in two planes, flexion and extension or radial and ulnar rotation. Adduction and abduction are for shoulder and hip joints, and eversion and inversion are for ankle movement.

Varus (abduction) and valgus (adduction) stress test.

Trendelenburg Ask the patient to stand and balance first on one foot and then on the other. Observe from behind, note any asymmetry or change in the level of the iliac crests. When the iliac crest drops on the side of the lifted leg, the hip abductor muscles on the weight baring side are weak

femoral stretch test Have the patient lie prone and extend the hip. No pain is expected. The presence of pain on extension is a positive sign of nerve root irritation.

Ballottement With the knee extended, apply downward pressure on the suprapatellar pouch with the web or the thumb and forefinger of one hand, and then push the patella sharply downward against the femur with a finger of your other hand. If in a effusion is present a tapping or clicking will be sensed when the patella is pushed against the femur. Release the pressure against the patella but keep your finger lightly touching it. If an effusion is present the patella will float out as it for a fluid wave were pushing it.

drawer test Have the patient lie supine and flex the knee 45 to 90° placing the foot flat on the table. Place both hands on the lower leg with the thumb on the ridge of the anterior tibia just distal to the tibial to diversity. Draw the tibia forward, forcing the tibia to the side forward of the femur. Then push the tibia backwards. Anterior posterior movement of the knee greater than 5 mm in either direction is an unexpected finding.

Neer test Harkins test