Chapter 31: The Musculoskeletal System

MULTIPLE CHOICE – Student Review Question Answers:

1. The nurse reminds a patient that, to prevent osteoporosis, the person should:
3. exercise throughout life.

A lifetime of even mild daily exercise will delay or prevent osteoporosis.

2. When the patient asks what is the purpose of goniometry, the nurse replies that goniometry
measures:
4. range of motion.
Goniometry measures joint mobility, described as the number of degrees that the joint can move
from the 0-degree mark.
3. The nurse making the bed of a patient who has a fractured right leg in traction will:
1. begin on the left side of the bed.
Begin on the left side of the bed and work toward the right. Linens should not be pulled from
under patients as this can cause skin damage.
4. The nurse is aware that positioning and range-of-motion (ROM) exercises help the immobilized
patient to prevent:
2. contractures.
Anatomical alignment and ROM exercises help prevent contractures in the immobilized patient.
5. The nurse adds interventions for range-of-motion (ROM) and isometric exercises for the new
patient with a stroke because the nurse is aware that contracture formation begins as early as
_____ day(s) of immobilization.
3. 3
Contracture-related muscle changes occur as early as 3 days of immobilization.
6. The nurse explains that, if muscles are not regularly stretched and contracted, the muscles will
become:
3. shorter and less elastic.
Immobility allows the muscles to adapt by becoming shorter and less elastic. There is no pain
associated with this process until the muscle is stretched after the contracture has occurred.
7. The nurse uses a visual aid to show the pathologic muscle tone changes that result in footdrop.
Those changes are:
2. flexor muscles are stretched.
Calf muscle contract and flexor muscles are stretched, allowing the unbraced foot to drop toward
the surface of the bed.
8. The nurse informs the patient that the frequency of range-of-motion (ROM) exercise should be:
3. 3 to 4 times a day.
For optimum effectiveness, ROM exercises should be performed 3 to four times a day.
9. The nurse uses an example to explain the physiology of isometric exercises, which is:
1. flexing lower arm while trying to straighten it with the other hand.
Isometric exercises are based on the energy of opposing muscles working against each other.
10. When the patient returns to the unit from having had an arthroscopy, the nurse will:
2. apply ice packs to knee.
Ice packs applied to the knee will reduce swelling.
11. The nurse encourages the patient to use the four-point crutch gait technique because this
technique:
2. is the most stable gait.
The four-point crutch gait is the most stable, requires that there be partial weight bearing on both
legs, and does not mimic normal walking pattern.
12. The nurse assessing the cane for appropriate length will assess to affirm that:
1. the hand grip is at the level of the hip.

The hand grip should be at hip level to allow for proper flexion of the arm to bear weight. The
cane tip should be placed 6 inches from the good foot. The elbow angle should be 30 degrees.
13. The nurse instructing the patient for quadriceps and gluteal muscle exercises will tell the patient
to:
1. while lying down, straighten leg and tense leg muscles while raising heel.

The quad setting exercise is to straighten the leg and tense the leg muscles while raising the heel.
14. The anatomical structure that joins the bones of a joint together is the:
1. ligament.

Ligaments hold the bones of a joint together.

15. When the 90-year-old patient says, “My old bones are just about done in,” the nurse reminds him
that his bones are being constantly renewed through the action of the:
1. osteoblasts.

Osteoblasts lay down new bone as the old bone is reabsorbed into the body.
16. The nurse recognizes a need for further instruction relative to the use of the continuous passive
motion (CPM ) machine when the patient says:
3. “I can make my new knee stronger if I reset this thing to go faster and flex my
knee more.”
The CPM is preset as to speed and the degree of flexion.
17. When preparing a patient for electromyography (EMG), the nurse will instruct the patient to:
3. take the prescribed muscle relaxants prior to test.
Prior to the test, smoking and use of caffeine should be ceased for 3 hours. The test usually takes
1 hour.
18. When the 88-year-old patient enters the room for her health assessment, she walks with tiny
steps, her shoulders are rounded and hunched, and her arms are crossed in front of her with her
hands tucked in her armpits. The sensitive nurse would inquire:
1. “Are you cold?”

Because of age-related changes, the older adult feels cold more easily than a younger person.
Older adults walk with shoulders rounded and limbs close to the body.
19. When changing the position of a person with flaccid paralysis, it is important to:
1. change joint position.
 Frequent changes in joint position reduces the incidence of ankylosis.
MULTIPLE RESPONSE
20. The functions of the musculoskeletal system are: (Select all that apply.)
1. motion.
2. blood production.
3. support.
4. protection of organs.
5. body shape.
ANS: 1, 2, 3, 4, 5
All options listed are functions of the musculoskeletal system.
21. The nurse points out the age-related changes that occur in the musculoskeletal system, which are:
1. decrease of bone density.
2. bones are brittle and break easily.
3. bones heal slowly.
4. decrease in muscle mass.
5. tendon sclerosis.
ANS: 1, 2, 3, 4, 5
All options listed are age-related changes in the musculoskeletal system.
22. When the nurse plans for the progressive mobilization of a hemiplegic, the nurse will consider
the patient’s ability to:
1. move limbs.
2. change position in bed independently.
3. transfer self from bed to chair.
4. stand.
5. walk.
ANS: 1, 2, 3, 4, 5
All options listed are abilities that must be assessed before an effective progressive mobilization
plan can be designed.
COMPLETION
23. When a joint is obliterated by bony overgrowth, the joint is said to be ____________________.
ankylosed
Ankylosis occurs when the joint is overgrown with bony overgrowth.
24. The canal system that runs through the bone and contains the blood and lymph vessels is called
the ____________________.
haversian system
The haversian system is the canal system that runs through the bone to carry blood and lymph
vessels.
OTHER
25. Arrange the instructions for a person on crutches to sit down.
1. Transfer both crutches to the side of injury.
2. With weight on good leg, reach back and grasp chair arm.
3. Sit back in chair.
4. Turn slowly and touch backs of legs to seat of chair.
 5. Using crutch and chair arm for support, slowly sit on chair.
ANS:
4, 1, 2, 5, 3
The steps are taught to prevent falls and promote independence.
Chapter 32: Care of Patients with Muculoskeletal and Connective Tissue Disorders

MULTIPLE CHOICE
1. The nurse differentiates a grade 2 sprain from a grade 3 with the assessment of:
4. minor loss of function.
The minor loss of function is the differentiating factor. Pain, swelling, and bleeding into the joint
are true of both grade 2 and grade 3. A grade 3 sprain has loss of function of the joint.
2. The nurse who has accompanied the outing for some older adults from the church treats the
sprained ankle of the 92 year old initially by:
1. elevating the foot to reduce swelling.

Elevation is the initial intervention as it can be done immediately. Applying ice and medicating
for pain will follow quickly.
3. When the clinic nurse starts to take the “air cast” off the grade 2 sprain, the patient asks why it is
being removed as he still has pain. The nurse explains that the cast is removed because:
3. long-term immobilization can cause permanent disability.
Lengthy immobilization can lead to permanent disability. Casts and splints are left on only until
the joint is strengthened.
4. The nurse recognizes a need for further instruction about application of ice to a sprain when the
patient says:
2. “I will keep the ice on this knee for the rest of the day.”
Ice should be applied for 20 minutes of each hour for the first 24 hours.
5. The industrial nurse examines an employee who states his right shoulder hurts when he abducts
it and points with one finger to the spot at the point of his shoulder that is painful. He mentions
that he won a racquetball tournament yesterday. The nurse suspects the employee is suffering
from:
2. bursitis.
Bursitis occurs after overuse, with pain in the joint on activity with no erythema and little, if any,
swelling. Dislocations are very painful and the pain is spread all over the shoulder. The shoulder
also looks misshapen in a dislocation. Rotator cuff tear would prevent the patient from abducting
his shoulder.
6. The patient who is a legal secretary asks the nurse how she can avoid developing carpal tunnel
syndrome. The nurse suggests:
3. acquiring a pad to support wrists while typing.
Elevating the wrist with a firm support eliminates the need to keep the wrists flexed for long
periods of time. This wrist support will help prevent carpal tunnel syndrome.
7. The nurse explains that carpal tunnel syndrome is caused when the carpal tunnel compresses the:
3. median nerve.
When the median nerve is compressed by the carpal tunnel to the point that numbness, pain, and
tingling occur, the result is carpal tunnel syndrome.
 8. The patient with mild discomfort from carpal tunnel syndrome delightedly reports amazing relief
from taking a daily dose of vitamin:
2. B6.
Vitamin B6 has been found helpful in relieving the pain of carpal tunnel syndrome.
9. The assessment made by the nurse caring for a patient just returned from surgery following a
surgical decompression of the carpal tunnel that would require immediate remedy is:
3. capillary refill of 8 seconds.

A capillary refill of over 5 seconds is an indication of diminished perfusion. Pain and swelling
are to be expected.
10. When the 80-year-old choir director falls down behind the organ and suffers a compound fracture
of the femur, a nurse from the congregation comes up to:
3. splint the leg as it is.
Any fracture, even a compound one, should be immobilized in position to avoid further injury to
the soft tissue attached to the bones.
11. The nurse explains that the major advantage of the external fixation device is that the patient:
3. has greater freedom of movement.
The external device for fracture reduction allows greater freedom of movement, decreasing the
problems of immobility. Healing time and pain are the same as with any other fracture reduction
method.
12. The patient in a long arm cast (from below the shoulder to the wrist, with a 90-degree elbow
flexion) complains of a burning sensation over the elbow. The nurse’s initial intervention should
be:
2. check to see if the cast is properly supported.

The initial intervention should be to assess for adequate support to the cast, then elevate the limb
for 30 minutes. If the pain has not diminished, document the intervention and notify the charge
nurse.

13. The nurse will need to reposition the patient who is in bilateral Buck’s traction when the:
3. patient’s feet are against the footboard.
When the patient’s feet are against the footboard, the traction is ineffective. The heels should be
off the surface of the mattress to reduce the threat of pressure ulcer. The weights should be
hanging free.
14. The 30-year-old man who is in Russell’s traction with a Pearson attachment for a fracture of the
tibia complains of intense pain at the fracture site. The nurse assesses a temperature of 102º F
and increased swelling at the fracture site. These assessments suggest:
1. osteomyelitis.

The assessment indicates osteomyelitis, which can be confirmed with x-rays and a complete
blood count to evaluate WBC count.
15. While the nurse is giving morning care to a 35-year-old man who sustained a fractured pelvis
and bilateral fractures of the femur in a motorcycle accident yesterday, the patient complains of
shortness of breath and is audibly wheezing. An assessment of the oxygen saturation reveals
76%. The initial intervention by the nurse should be to:
 4. raise patient to a high-Fowler’s position.
Raising the patient to high-Fowler’s is the best initial intervention as it can be done immediately.
There is no need to notify the code team, and 5 L/min of oxygen is too much. Informing the
charge nurse and giving oxygen at 2 to 3 L/min can be done when the patient has been made
more comfortable.
16. The nurse instructing the patient with rheumatic arthritis about the prescribed exercise program
includes that the exercises should be:
1. done every day 3 to 10 times for every joint.

Exercises are essential to preserve joint function and should be done every day 3 to 10 times per
joint. Exercises should be omitted if there is inflammation present and should not be taken past
the point of pain, or made up the next day.
17. The patient with osteoporosis calls the nurse in the doctor’s office to report she has forgotten to
take her weekly bisphosphonate (alendronate [Fosamax]) for 2 days past the weekly time. The
nurse should advise the patient to:
3. skip this week and pick up the schedule next week.
ANS: 3
If 2 or more days have passed since the regular dose time, this week’s dose should be skipped
and the weekly schedule should be picked up next week.
18. When caring for a patient who has an abductor wedge in place following a total hip replacement,
the nurse should assess for
2. alteration in peripheral circulation.
Pressure from the abductor wedge can interrupt arterial blood supply and compress the peroneal
nerve.
MULTIPLE RESPONSE
19. Prior to confirming by x-ray, the dislocation can be diagnosed by: (Select all that apply.)
1. history of forceful injury.
3. severe pain, aggravated by motion.
4. muscle spasm.
5. abnormal appearance of joint.
ANS: 1, 3, 4, 5
A dislocation will be evidenced by severe pain aggravated by motion, muscle spasm, and an
abnormal-appearing joint after the history of a forceful injury. A hematoma, if it forms, will not
be evident for a few hours.
20. The nurse understands that all soft tissue injuries require the nurse to assist with or instruct
about: (Select all that apply.)
1. exercise.
2. pain control.
3. immobilization.
4. activity restrictions.
5. prevention of recurrence.
ANS: 1, 2, 3, 4, 5
All options listed are part of the care to a patient with a soft tissue injury.
21. The nurse lists the advantages of fiberglass casts, which include that this type of cast: (Select all
that apply.)
1. is lighter.
2. allows weight bearing in 30 minutes.
4. dries quickly.
Fiberglass casts are lighter and dry quickly, allowing weight bearing in as little as 30 minutes.
Fiberglass casts are very expensive and do not lend themselves to molding to body parts. The
surface is very rough and often abrades the skin.
22. The patient is returning to the unit with a wet long leg cast. To prevent damage to the wet cast,
the nurse should: (Select all that apply.)
1. determine the cast material.
3. support cast with palms of hands rather than holding it with fingers.
4. assess heat generated from the drying cast.
Determining the cast material will inform the nurse of how quickly the cast can be expected to
dry. The cast should be supported on palms of hands rather than holding with fingers. The heat of
the drying cast should be evaluated to prevent skin irritation.
23. The nurse instructs a patient going home with a short arm synthetic cast to: (Select all that
apply.)
1. cover cast with plastic bag when taking a shower.
2. blow cool air into cast to relieve itching.
3. observe skin at edge of cast for irritation or injury.
4. check circulation and sensation in fingers frequently.
5. move and flex fingers to stimulate circulation.
ANS: 1, 2, 3, 4, 5
All options listed are important teaching points for cast care.
24. The probability of compartment syndrome in a patient with a side arm cast and traction is
considered when the nurse assesses: (Select all that apply.)
2. complaint of pain in hand and fingers.
3. edema of fingers.
4. weak radial pulse.
5. tingling and numbness.
Warm, rosy fingers would be assessed as a sign of adequate perfusion.
COMPLETION
25. The nurse explains that the “C” in the acronym RICE for sprain treatment stands for
____________________.
compression
RICE stands for Rest, Ice, Compression, and Elevation.
26. The nurse uses a visual aid to show the difference between a complete dislocation and a partial
dislocation, which is also called a____________________.
subluxation
A subluxation is a partial dislocation.
MATCHING
Match the fracture type to the description that characterizes it.
1. Complete fracture
 2. Comminuted fracture
3. Closed fracture
4. Compound fracture
5. Greenstick fracture
27. Bone is partially broken and partially bent
28. Fracture that has not broken through skin
29. Fracture bone end protruding through skin
30. Bone that is in two distinct pieces
31. Bone shattered in more than two pieces
27. ANS: 5
28. ANS: 3
29. ANS: 4
30. ANS: 1
31. ANS: 2

Match the type of fracture stabilization with the characteristics that best describe it.
(The options can be used once, more than once, or not at all.)
1. Closed reduction
2. Open reduction
3. Internal fixation
4. External fixation
32. Reduction of fracture through surgical incision
33. Metal appliances are used to stabilize pieces of fracture
34. Reduction of fracture and fixation to device that maintains alignment
35. Used with infected fractures that do not heal properly
36. Manual reduction and manipulation of bones into alignment
37. Used with older adults when brittle bones do not heal quickly
32. ANS: 2
33. ANS: 3
34. ANS: 4
35. ANS: 4
36. ANS: 1
37. ANS: 3

OTHER
38. Place the steps of the process of fracture healing in proper order.
1. Medullary canal is reconstructed.
2. Mature bone cells form ossification.
3. Callus is formed.
4. Granulation tissue is formed.
5. Hematoma is formed between broken ends of bone.
ANS:
5, 4, 3, 2, 1
The hematoma is formed between broken ends of the bone, followed by the formation of
granulation tissue from which the callus is made. Mature bone cells form ossification and the
medullary canal is reconstructed.