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.

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.

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).

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.

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.

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.

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 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.