Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 787
Chapter 61: Assessment: 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)
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)
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 - Lewis's Medical Surgical Nursing (11th Edition by Harding) 788
a. discography studies.
b. myelographic testing.
c. magnetic resonance imaging (MRI).
d. dual-energy x-ray absorptiometry (DXA).
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)
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)
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 - Lewis's Medical Surgical Nursing (11th Edition by Harding) 789
d. 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)
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)
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)
, Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 790
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)
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)
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.
Chapter 61: Assessment: 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)
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)
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 - Lewis's Medical Surgical Nursing (11th Edition by Harding) 788
a. discography studies.
b. myelographic testing.
c. magnetic resonance imaging (MRI).
d. dual-energy x-ray absorptiometry (DXA).
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)
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)
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 - Lewis's Medical Surgical Nursing (11th Edition by Harding) 789
d. 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)
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)
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)
, Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 790
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)
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)
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.
