Lewis's Medical Surgical Nursing Test Bank 11th Edition [Harding]
Chapter 61 - Assessment: Musculoskeletal System
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?
Answer: B
Explanation: Pain with internal rotation and extension of the shoulder (as when moving the
arm behind the back) commonly affects activities like putting on a shirt or jacket. Feeding,
sleeping, and toileting are less likely to be impacted by this specific movement.
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.
Answer: B
Explanation: Bursae are small, fluid-filled sacs that cushion bones, tendons, and muscles near
joints. Bursitis is the inflammation of these sacs. The synovial membrane lines joint cavities,
fibrocartilage acts as a shock absorber, and connective tissue is a broader category.
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
A. discography studies.
B. myelographic testing.
C. magnetic resonance imaging (MRI).
D. dual-energy x-ray absorptiometry (DXA).
Answer: D
Explanation: Loss of height can indicate osteoporosis. DXA is a standard test for measuring
bone mineral density. Discography, myelography, and MRI are used for evaluating disc or
nerve issues, not primarily for osteoporosis screening.
,4. Which information in a 67-year-old woman's 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 military tuberculosis.
Answer: B
Explanation: A family history of height loss may suggest osteoporosis, warranting further
musculoskeletal assessment. A past ankle sprain, occasional NSAID use, or family history of
tuberculosis are not specific risk factors for musculoskeletal issues.
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.
D. The patient prefers whole milk to nonfat milk.
Answer: C
Explanation: Obesity (as indicated by the patient's height and weight) increases stress on
weight-bearing joints, raising the risk for musculoskeletal problems. Multivitamin use,
dietary preferences, or milk type are not direct risk factors.
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).
Answer: C
Explanation: Frequent corticosteroid use can lead to osteoporosis, avascular necrosis, and
other skeletal issues. Calcium, vitamin D, hormone therapy, and NSAIDs do not pose similar
risks.
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.
Answer: D
Explanation: Muscle strength grading: Level 3 indicates ability to move against gravity but
not against resistance. Level 0: no contraction; Level 1: trace contraction; Level 2: movement
with gravity eliminated.
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 creptius during joint movement.
C. observing the patients body build and muscle configuration.
D. checking active and passive range of motion for the extremities.
Answer: C
Explanation: Inspection is the first step in physical assessment. Observing body build,
posture, and muscle symmetry helps identify abnormalities before proceeding to palpation or
range-of-motion testing.
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.
Answer: A
Explanation: The straight-leg raising test is performed with the patient supine; the nurse
passively lifts each leg to about 60 degrees. Pain may indicate sciatic nerve irritation. Prone
positioning or active patient movement is not part of this test.
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.
D. screen the patient for allergies to shellfish or iodine products.
, Answer: A
Explanation: DXA is a noninvasive, painless scan that measures bone density. No IV access,
sedation, or contrast is used, so allergy screening is unnecessary. Patient education is key.
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.
Answer: A
Explanation: Pacemakers are a contraindication for MRI due to strong magnetic fields.
Claustrophobia can be managed; hearing aids are removed; shellfish allergy is only relevant
if contrast is used (uncommon for bone MRI).
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
Answer: B
Explanation: Crepitation (or crepitus) refers to a grating sound or sensation caused by friction
between bones or roughened cartilage. Torticollis is neck twisting, subluxation is partial
dislocation, and epicondylitis is elbow inflammation.
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
Answer: D
Explanation: A history of falls requires immediate attention due to the risk of injury. Other
findings may reflect chronic or age-related changes but are less urgent.
Chapter 61 - Assessment: Musculoskeletal System
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?
Answer: B
Explanation: Pain with internal rotation and extension of the shoulder (as when moving the
arm behind the back) commonly affects activities like putting on a shirt or jacket. Feeding,
sleeping, and toileting are less likely to be impacted by this specific movement.
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.
Answer: B
Explanation: Bursae are small, fluid-filled sacs that cushion bones, tendons, and muscles near
joints. Bursitis is the inflammation of these sacs. The synovial membrane lines joint cavities,
fibrocartilage acts as a shock absorber, and connective tissue is a broader category.
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
A. discography studies.
B. myelographic testing.
C. magnetic resonance imaging (MRI).
D. dual-energy x-ray absorptiometry (DXA).
Answer: D
Explanation: Loss of height can indicate osteoporosis. DXA is a standard test for measuring
bone mineral density. Discography, myelography, and MRI are used for evaluating disc or
nerve issues, not primarily for osteoporosis screening.
,4. Which information in a 67-year-old woman's 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 military tuberculosis.
Answer: B
Explanation: A family history of height loss may suggest osteoporosis, warranting further
musculoskeletal assessment. A past ankle sprain, occasional NSAID use, or family history of
tuberculosis are not specific risk factors for musculoskeletal issues.
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.
D. The patient prefers whole milk to nonfat milk.
Answer: C
Explanation: Obesity (as indicated by the patient's height and weight) increases stress on
weight-bearing joints, raising the risk for musculoskeletal problems. Multivitamin use,
dietary preferences, or milk type are not direct risk factors.
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).
Answer: C
Explanation: Frequent corticosteroid use can lead to osteoporosis, avascular necrosis, and
other skeletal issues. Calcium, vitamin D, hormone therapy, and NSAIDs do not pose similar
risks.
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.
Answer: D
Explanation: Muscle strength grading: Level 3 indicates ability to move against gravity but
not against resistance. Level 0: no contraction; Level 1: trace contraction; Level 2: movement
with gravity eliminated.
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 creptius during joint movement.
C. observing the patients body build and muscle configuration.
D. checking active and passive range of motion for the extremities.
Answer: C
Explanation: Inspection is the first step in physical assessment. Observing body build,
posture, and muscle symmetry helps identify abnormalities before proceeding to palpation or
range-of-motion testing.
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.
Answer: A
Explanation: The straight-leg raising test is performed with the patient supine; the nurse
passively lifts each leg to about 60 degrees. Pain may indicate sciatic nerve irritation. Prone
positioning or active patient movement is not part of this test.
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.
D. screen the patient for allergies to shellfish or iodine products.
, Answer: A
Explanation: DXA is a noninvasive, painless scan that measures bone density. No IV access,
sedation, or contrast is used, so allergy screening is unnecessary. Patient education is key.
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.
Answer: A
Explanation: Pacemakers are a contraindication for MRI due to strong magnetic fields.
Claustrophobia can be managed; hearing aids are removed; shellfish allergy is only relevant
if contrast is used (uncommon for bone MRI).
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
Answer: B
Explanation: Crepitation (or crepitus) refers to a grating sound or sensation caused by friction
between bones or roughened cartilage. Torticollis is neck twisting, subluxation is partial
dislocation, and epicondylitis is elbow inflammation.
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
Answer: D
Explanation: A history of falls requires immediate attention due to the risk of injury. Other
findings may reflect chronic or age-related changes but are less urgent.
