Lewis's Med Surg Chapter 66&67;
Assessment: Musculoskeletal System,
Trauma And Orthopedic Surgery
1. A Patient Reports Shoulder Pain When The Nurse Moves The Patient's Arm Behind The
Back. Which Question Would 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
2. The Patient’s Pain Will Make It More Difficult To Accomplish Tasks Such As Putting On A
Shirt Or Jacket. This Pain Should Not Affect The Patient’s 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.
A Patient With Left Knee Pain Is Diagnosed With Bursitis. Which Location Would The Nurse
Identify As Being The Site Of Inflammation?
A. A Fluid-Filled Sac Found At The Joint
B. A Synovial Membrane That Lines The Joint
C. The Connective Tissue Fastening Bones Within A Joint D. The Fibrocartilage That Acts As A
Shock Absorber In The Joint
Ans: A
Bursae Are Fluid-Filled Sacs That Cushion Joints And Bony Prominences. Fibrocartilage Is A Solid
Tissue That Cushions Some Joints. Ligaments Are Connective Tissue Joining Bones Within A
Joint. The Synovial Membrane Lines Many Joints But Is Not Affected In Bursitis
, 3. The Nurse Notes That A 59-Yr-Old Female Patient Has Lost 1 Inch In Height Over The Past
2 Years. Which Diagnostic Test Would The Nurse Plan To Discuss With The Patient?
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 Patient‘sAge Suggest That The Patient May Have Osteoporosis,
And 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.
4. Which Information In A 67-Yr-Old Woman's Health History Would Alert The Nurse To The
Need For A Focused Assessment Of The Musculoskeletal System?
A. The Patient Sprained An Ankle At Age 13.
B. The Patient's Father Died Of Tuberculosis.
C. The Patient's Mother Became Shorter With Aging.
D. The Patient Takes Ibuprofen For Occasional Headaches.
Ans: C
,A Family History Of Height Loss With Aging May Indicate Osteoporosis, And The Nurse Should
Perform A More Thorough Assessment Of The Patient‘sCurrent 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 Anti-inflammatory Drug (NSAID) Use Does Not Indicate Any Increased
Musculoskeletal Risk.
5. Which Information Obtained During The Nurse's Assessment May Indicate A Patient's
Increased 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 Tall And Weighs 180 Lb.
D. The Patient Prefers Whole Milk To Nonfat Milk.
Ans: C
The Patient‘sHeight And Weight Indicate Obesity, Which Places Stress On Weight-Bearing Joints
And Predisposes The Patient To Osteoarthritis. The Use Of Whole Milk, Avoidance Of Fruits And
Vegetables, And Use Of A Daily Multivitamin Are Not Risk Factors For Musculoskeletal Problems.
6. Which Medication Information Would The Nurse Identify As A Potential Risk To A
Patient's Musculoskeletal System?
A. The Patient Takes A Daily Multivitamin And Calcium Supplement.
B. The Patient Has Asthma Requiring Frequent Therapy With Oral Corticosteroids.
C. The Patient Takes Hormone Replacement Therapy (Hrt) To Prevent "Hot Flashes."
D. The Patient Has Headaches Treated With Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
, Ans: B
Frequent Or Chronic Corticosteroid Use May Lead To Skeletal Problems Such As Avascular
Necrosis And Osteoporosis. The Use Of Hrt And Calcium Supplements Will Help Prevent
Osteoporosis. NSAID Use Does Not Increase The Risk For Musculoskeletal Problems.
7. The Nurse Finds That A Patient Can Flex The Arms When No Resistance Is Applied But Is
Unable To Flex Against Light Resistance. How Would The Nurse Document The Patient's
Muscle Strength Level?
A. 0
B. 1
C. 2
D. 3
Ans: D
Muscle Strength Of 3 Indicates The Patient Is Unable To Move Against Resistance But Can Move
Against Gravity. Level 1 Indicates Minimal Muscle Contraction, Level 2 Indicates The Arm Can
Move When Gravity Is Eliminated, And Level 4 Indicates Active Movement With Some
Resistance.
8. After Completing The Health History, How Would The Nurse Begin To Assess The
Musculoskeletal System?
A. Feel For The Presence Of Crepitus During Joint Movement.
B. Have The Patient Move The Extremities Against Resistance. C. Observe The Patient's Body
Build And Muscle Configuration.
Assessment: Musculoskeletal System,
Trauma And Orthopedic Surgery
1. A Patient Reports Shoulder Pain When The Nurse Moves The Patient's Arm Behind The
Back. Which Question Would 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
2. The Patient’s Pain Will Make It More Difficult To Accomplish Tasks Such As Putting On A
Shirt Or Jacket. This Pain Should Not Affect The Patient’s 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.
A Patient With Left Knee Pain Is Diagnosed With Bursitis. Which Location Would The Nurse
Identify As Being The Site Of Inflammation?
A. A Fluid-Filled Sac Found At The Joint
B. A Synovial Membrane That Lines The Joint
C. The Connective Tissue Fastening Bones Within A Joint D. The Fibrocartilage That Acts As A
Shock Absorber In The Joint
Ans: A
Bursae Are Fluid-Filled Sacs That Cushion Joints And Bony Prominences. Fibrocartilage Is A Solid
Tissue That Cushions Some Joints. Ligaments Are Connective Tissue Joining Bones Within A
Joint. The Synovial Membrane Lines Many Joints But Is Not Affected In Bursitis
, 3. The Nurse Notes That A 59-Yr-Old Female Patient Has Lost 1 Inch In Height Over The Past
2 Years. Which Diagnostic Test Would The Nurse Plan To Discuss With The Patient?
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 Patient‘sAge Suggest That The Patient May Have Osteoporosis,
And 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.
4. Which Information In A 67-Yr-Old Woman's Health History Would Alert The Nurse To The
Need For A Focused Assessment Of The Musculoskeletal System?
A. The Patient Sprained An Ankle At Age 13.
B. The Patient's Father Died Of Tuberculosis.
C. The Patient's Mother Became Shorter With Aging.
D. The Patient Takes Ibuprofen For Occasional Headaches.
Ans: C
,A Family History Of Height Loss With Aging May Indicate Osteoporosis, And The Nurse Should
Perform A More Thorough Assessment Of The Patient‘sCurrent 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 Anti-inflammatory Drug (NSAID) Use Does Not Indicate Any Increased
Musculoskeletal Risk.
5. Which Information Obtained During The Nurse's Assessment May Indicate A Patient's
Increased 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 Tall And Weighs 180 Lb.
D. The Patient Prefers Whole Milk To Nonfat Milk.
Ans: C
The Patient‘sHeight And Weight Indicate Obesity, Which Places Stress On Weight-Bearing Joints
And Predisposes The Patient To Osteoarthritis. The Use Of Whole Milk, Avoidance Of Fruits And
Vegetables, And Use Of A Daily Multivitamin Are Not Risk Factors For Musculoskeletal Problems.
6. Which Medication Information Would The Nurse Identify As A Potential Risk To A
Patient's Musculoskeletal System?
A. The Patient Takes A Daily Multivitamin And Calcium Supplement.
B. The Patient Has Asthma Requiring Frequent Therapy With Oral Corticosteroids.
C. The Patient Takes Hormone Replacement Therapy (Hrt) To Prevent "Hot Flashes."
D. The Patient Has Headaches Treated With Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
, Ans: B
Frequent Or Chronic Corticosteroid Use May Lead To Skeletal Problems Such As Avascular
Necrosis And Osteoporosis. The Use Of Hrt And Calcium Supplements Will Help Prevent
Osteoporosis. NSAID Use Does Not Increase The Risk For Musculoskeletal Problems.
7. The Nurse Finds That A Patient Can Flex The Arms When No Resistance Is Applied But Is
Unable To Flex Against Light Resistance. How Would The Nurse Document The Patient's
Muscle Strength Level?
A. 0
B. 1
C. 2
D. 3
Ans: D
Muscle Strength Of 3 Indicates The Patient Is Unable To Move Against Resistance But Can Move
Against Gravity. Level 1 Indicates Minimal Muscle Contraction, Level 2 Indicates The Arm Can
Move When Gravity Is Eliminated, And Level 4 Indicates Active Movement With Some
Resistance.
8. After Completing The Health History, How Would The Nurse Begin To Assess The
Musculoskeletal System?
A. Feel For The Presence Of Crepitus During Joint Movement.
B. Have The Patient Move The Extremities Against Resistance. C. Observe The Patient's Body
Build And Muscle Configuration.
