Chapter 35 Assessment of Musculoskeletal Function
1. A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes
aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that
which of the following procedures will be involved?
A) Angiography
B) Myelography C) Paracentesis D) Arthocentesis Ans: D
Feedback:
Arthrocentesis involves needle aspiration of synovial fluid. Angiography is an x-ray
study of circulation with a contrast agent injected into a selected artery. Myelography is an x-
ray of the spinal subarachnoid space taken after the injection of a contrast agent into the
spinal subarachnoid space through a lumbar puncture. Paracentesis is removal of fluid
(ascites) from the peritoneal cavity through a small surgical incision or puncture made through
the abdominal wall under sterile conditions.
2. A nurse is providing care for a patient who has just been diagnosed as being in the early stage
of rheumatoid arthritis. The nurse should anticipate the administration of which
of the following?
A) Hydromorphone (Dilaudid) B) Methotrexate (Rheumatrex) C) Allopurinol
(Zyloprim)
D) Prednisone
Ans: B
Feedback:
In the past, a step-wise approach starting with NSAIDs was standard of care. However,
evidence clearly documenting the benefits of early DMARD (methotrexate [Rheumatrex],
antimalarials, leflunomide [Arava], or sulfasalazine [Azulfidine]) treatment has changed
national guidelines for management. Now it is recommended
, that treatment with the non-biologic DMARDs begin within 3 months of disease onset.
Allopurinol is used to treat gout. Opioids are not indicated in early RA. Prednisone is used in
unremitting RA.
3. A nurse is performing the initial assessment of a patient who has a recent diagnosis of
systemic lupus erythematosus (SLE). What skin manifestation would the nurse expect to
observe on inspection?
A) Petechiae
B) Butterfly rash
C) Jaundice
D) Skin sloughing
Ans: B
Feedback:
An acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the
nose and cheeks occurs in SLE. Petechiae are pinpoint skin hemorrhages, which are not a
clinical manifestation of SLE. Patients with SLE do not typically experience jaundice or skin
sloughing.
4. A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology
of gout to the patient, the nurse should describe which of the following?
A) Autoimmune processes in the joints
B) Chronic metabolic acidosis
C) Increased uric acid levels
D) Unstable serum calcium levels
Ans: C
Feedback:
, Gout is caused by hyperuricemia (increased serum uric acid). Gout is not categorized as an
autoimmune disease and it does not result from metabolic acidosis or unstable serum calcium
levels.
5. A nurse is planning the care of a patient who has a long history of chronic pain, which has only
recently been diagnosed as fibromyalgia. What nursing diagnosis is most likely to apply to this
woman's care needs?
A) Ineffective Role Performance Related to Pain
B) Risk for Impaired Skin Integrity Related to Myalgia
C) Risk for Infection Related to Tissue Alterations D) Unilateral Neglect Related to
Neuropathic Pain Ans: A
Feedback:
Typically, patients with fibromyalgia have endured their symptoms for a long period of time.
The neuropathic pain accompanying FM can often impair a patient's ability to perform normal
roles and functions. Skin integrity is unaffected and the disease has no associated infection
risk. Activity limitations may result in neglect, but not of a unilateral nature.
6. A patient's decreased mobility is ultimately the result of an autoimmune reaction originating
in the synovial tissue, which caused the formation of pannus. This patient has been diagnosed
with what health problem?
A) Rheumatoid arthritis (RA)
B) Systemic lupus erythematosus
C) Osteoporosis
D) Polymyositis
Ans: A
Feedback:
In RA, the autoimmune reaction results in phagocytosis, producing enzymes within the
, joint that break down collagen, cause edema and proliferation of the synovial membrane, and
ultimately form pannus. Pannus destroys cartilage and bone. SLE, osteoporosis, and
polymyositis do not involve pannus formation.
7. A nurse is performing the health history and physical assessment of a patient who has a
diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the
clinical presentation of RA?
A) Cool joints with decreased range of motion
B) Signs of systemic infection
C) Joint stiffness, especially in the morning
D) Visible atrophy of the knee and shoulder joints
Ans: C
Feedback:
In addition to joint pain and swelling, another classic sign of RA is joint stiffness, especially in
the morning. Joints are typically swollen, not atrophied, and systemic infection does not
accompany the disease. Joints are often warm rather than cool.
8. A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now
prescribed cyclophosphamide (Cytoxan). The nurse's subsequent assessments should
address what potential adverse effect?
A) Infection
B) Acute confusion
C) Sedation
D) Malignant hyperthermia
Ans: A
Feedback:
When administering immunosuppressives such as Cytoxan, the nurse should be alert to
manifestations of bone marrow suppression and infection. Confusion and sedation are
1. A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes
aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that
which of the following procedures will be involved?
A) Angiography
B) Myelography C) Paracentesis D) Arthocentesis Ans: D
Feedback:
Arthrocentesis involves needle aspiration of synovial fluid. Angiography is an x-ray
study of circulation with a contrast agent injected into a selected artery. Myelography is an x-
ray of the spinal subarachnoid space taken after the injection of a contrast agent into the
spinal subarachnoid space through a lumbar puncture. Paracentesis is removal of fluid
(ascites) from the peritoneal cavity through a small surgical incision or puncture made through
the abdominal wall under sterile conditions.
2. A nurse is providing care for a patient who has just been diagnosed as being in the early stage
of rheumatoid arthritis. The nurse should anticipate the administration of which
of the following?
A) Hydromorphone (Dilaudid) B) Methotrexate (Rheumatrex) C) Allopurinol
(Zyloprim)
D) Prednisone
Ans: B
Feedback:
In the past, a step-wise approach starting with NSAIDs was standard of care. However,
evidence clearly documenting the benefits of early DMARD (methotrexate [Rheumatrex],
antimalarials, leflunomide [Arava], or sulfasalazine [Azulfidine]) treatment has changed
national guidelines for management. Now it is recommended
, that treatment with the non-biologic DMARDs begin within 3 months of disease onset.
Allopurinol is used to treat gout. Opioids are not indicated in early RA. Prednisone is used in
unremitting RA.
3. A nurse is performing the initial assessment of a patient who has a recent diagnosis of
systemic lupus erythematosus (SLE). What skin manifestation would the nurse expect to
observe on inspection?
A) Petechiae
B) Butterfly rash
C) Jaundice
D) Skin sloughing
Ans: B
Feedback:
An acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the
nose and cheeks occurs in SLE. Petechiae are pinpoint skin hemorrhages, which are not a
clinical manifestation of SLE. Patients with SLE do not typically experience jaundice or skin
sloughing.
4. A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology
of gout to the patient, the nurse should describe which of the following?
A) Autoimmune processes in the joints
B) Chronic metabolic acidosis
C) Increased uric acid levels
D) Unstable serum calcium levels
Ans: C
Feedback:
, Gout is caused by hyperuricemia (increased serum uric acid). Gout is not categorized as an
autoimmune disease and it does not result from metabolic acidosis or unstable serum calcium
levels.
5. A nurse is planning the care of a patient who has a long history of chronic pain, which has only
recently been diagnosed as fibromyalgia. What nursing diagnosis is most likely to apply to this
woman's care needs?
A) Ineffective Role Performance Related to Pain
B) Risk for Impaired Skin Integrity Related to Myalgia
C) Risk for Infection Related to Tissue Alterations D) Unilateral Neglect Related to
Neuropathic Pain Ans: A
Feedback:
Typically, patients with fibromyalgia have endured their symptoms for a long period of time.
The neuropathic pain accompanying FM can often impair a patient's ability to perform normal
roles and functions. Skin integrity is unaffected and the disease has no associated infection
risk. Activity limitations may result in neglect, but not of a unilateral nature.
6. A patient's decreased mobility is ultimately the result of an autoimmune reaction originating
in the synovial tissue, which caused the formation of pannus. This patient has been diagnosed
with what health problem?
A) Rheumatoid arthritis (RA)
B) Systemic lupus erythematosus
C) Osteoporosis
D) Polymyositis
Ans: A
Feedback:
In RA, the autoimmune reaction results in phagocytosis, producing enzymes within the
, joint that break down collagen, cause edema and proliferation of the synovial membrane, and
ultimately form pannus. Pannus destroys cartilage and bone. SLE, osteoporosis, and
polymyositis do not involve pannus formation.
7. A nurse is performing the health history and physical assessment of a patient who has a
diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the
clinical presentation of RA?
A) Cool joints with decreased range of motion
B) Signs of systemic infection
C) Joint stiffness, especially in the morning
D) Visible atrophy of the knee and shoulder joints
Ans: C
Feedback:
In addition to joint pain and swelling, another classic sign of RA is joint stiffness, especially in
the morning. Joints are typically swollen, not atrophied, and systemic infection does not
accompany the disease. Joints are often warm rather than cool.
8. A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now
prescribed cyclophosphamide (Cytoxan). The nurse's subsequent assessments should
address what potential adverse effect?
A) Infection
B) Acute confusion
C) Sedation
D) Malignant hyperthermia
Ans: A
Feedback:
When administering immunosuppressives such as Cytoxan, the nurse should be alert to
manifestations of bone marrow suppression and infection. Confusion and sedation are
