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This pain should not affect the patient’s ability to feed imself 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) 1494 TOP: Nursing Process: Assessment MSC: NCI_EX: 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. . any onnective 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) REF: 1493 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 a. iscography studies. b. myelographic testing. . magnetic resonance imaging (MRI). d. dual-energy x-ray absorptiometry (DXA). ANS: D The decreased height and the patient’s 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. DIE: Cognitive Level: Apply (application) REFI 1494 | 1501 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance USTESTBANK.
COM 4. Which information in a 67-year-old woman’s health history will alert the urse to the need for a more focused assessment of the musculoskeletal system? a. The patient sprained her ankle at age 13. b. The patient’s 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 patient’s 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. 1496 5. Which information obtained during the nurse’s assessment of a 30-yearold patient’s 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 ft2 in and weighs 180 lb. 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. 6. Which medication information will the nurse identify as a concern for a musculoskeletal status? a. The patient takes a daily multivitamin and calcium supplement. b. The patient takes hormone therapy (H T) 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 (NSAlDs). Frequent or chronic corticosteroid use may lead to skeletal problems such as vascular 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) 1495 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 patient’s muscle strength as level 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 indicates that the arm can move when gravity is eliminated, and level 4 indicates active movement with some resistance. DIF: Cognitive Level: understand (comprehension) REF: 1498 8. After completing the health history, the nurse assessing the musculoskeletal system will begin by b. d. having the patient move the extremities against resistance. eeling for the presence of crepitus during joint movement. observing the patient’s body build and muscle configuration. checking active and passive range Of motion for the extremities. 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. DIE: Cognitive Level: Understand (comprehension) RER 1497 9.
Which nursing action is correct when performing the straight-leg raising test for an ambulatory patient with back pain? a. Raise the patient’s 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 levate 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 patient’s legs to a 60-degree angle.
The other actions would not be correct for this test. 1498 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. ANS: A DXA testing is painless and noninvasive. No IV access is necessary. Contrast medium is not used. Because the procedure is painless, no antianxiety medications are required.
DIF: Cognitive Level: Apply (application) RER 1501 1 1 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. ANS: A Patients with permanent pacemakers cannot have MRI because of the force exerted by the magnetic field on metal objects. An open MRI will not cause claustrophobia.
The patient will need to be instructed to remove the hearing aid before the MRI, but this does not require consultation with the health care provider. Because contrast medium will not be used, shellfish allergy is not a contraindication to MRI. DIR Cognitive Level: Apply (application) REF: 12. The nurse notes crackling sounds and a grating sensation with palpation of an older patient’s elbow. How will this finding be documented? a. Torticollis b. Crepitation c. Subluxation d. Epicondylitis ANS: B Crackling sounds and a grating sensation that accompany movement are described as crepitus or crepitation.