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The nurse is caring for a patient who has pain during circumduction of the shoulder when the nurse moves the arm behind the patient. Which of the following questions should the nurse ask?
- A. Do you have difficulty in putting on a jacket?
- B. Are you able to feed yourself without difficulty?
- C. Are you able to sleep through the night without waking?
- D. Do you ever have trouble lowering yourself to the toilet?
Correct Answer: A
Rationale: The patient's pain will make it more difficult to accomplish tasks like putting on a shirt or jacket. This pain should not affect the patient's ability to feed himself or herself 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.
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The nurse is assessing a new patient in the clinic. Which of the following information about the patient's medications should be of most concern?
- A. The patient takes a daily multivitamin and calcium supplement.
- B. The patient has migraine headaches that are treated with nonsteroidal anti-inflammatory drugs (NSAIDs).
- C. The patient has severe asthma and requires frequent therapy with oral steroids.
- D. The patient takes hormone replacement therapy (HRT) to prevent 'hot flashes.'
Correct Answer: C
Rationale: 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.
The nurse is caring for a patient with kyphosis. Which of the following findings should the nurse expect to assess?
- A. Shortened stride
- B. Exaggerated thoracic curvature
- C. Grating sound when performing passive ROM
- D. Uncoordinated, swaying gait
Correct Answer: B
Rationale: Patients with kyphosis (dowager's hump) have a forward bending of thoracic spine, an exaggerated thoracic curvature. A shortened stride is antalgic gait. Crepitation is crackling sound or grating sensation as a result of friction between bones, broken bone, or cartilage bits in joint. An uncoordinated swaying gait is an ataxic gait.
The nurse is assessing an older female patient and notes that the patient has lost 2 cm in height since the previous visit 2 years ago. Which of the following diagnostic tests should the nurse include in the teaching plan?
- A. Discography studies
- B. Myelographic testing
- C. Magnetic resonance imaging (MRI)
- D. Dual-energy x-ray absorptiometry (DEXA)
Correct Answer: D
Rationale: 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.
The nurse is assessing the movement of a patient's elbow and notes crackling sounds and a grating sensation with palpation. Which of the following terms should the nurse use to document these findings?
- A. Torticollis
- B. Crepitation
- C. Subluxation
- D. Epicondylitis
Correct Answer: B
Rationale: Crackling sounds and a grating sensation that accompany movement are described as crepitus or crepitation. Torticollis is a twisting of the neck to one side, subluxation is a partial dislocation of the joint, and epicondylitis is an inflammation of the elbow that causes a dull ache that increases with movement.
Which of the following information in a female, older-adult patient's health history will alert the nurse to the need for a more focused assessment of the musculoskeletal system?
- A. The patient experienced a sprained ankle at age 13.
- B. The patient's mother became much shorter with aging.
- C. The patient's father died of complications of military tuberculosis.
- D. The patient reports taking ibuprofen for occasional headaches.
Correct Answer: B
Rationale: 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 anti-inflammatory drug (NSAID) use does not indicate any increased musculoskeletal risk.