(Osborn) Chapter 54 Learning Outcomes (Number and Title)

[Osborn] chapter 54
Learning Outcomes [Number and Title ]

Learning Outcome 1
Identify basic anatomy and physiology of the musculoskeletal
system.
Learning Outcome 2
Analyze the process of obtaining a history on the
musculoskeletal system.
Learning Outcome 3
Identify the general guidelines required for a musculoskeletal
examination.
Learning Outcome 4
Identify the process of assessment of the following structures:
temporomandibular joint, shoulders, elbows, wrists, hands,
fingers, neck, spine, hips, knees, ankles, and feet, as well as
assessment of gait.
Learning Outcome 5
Compare and contrast normal and abnormal findings associated
with the temporomandibular joint, shoulders, elbows, wrists,
hands, fingers, neck, spine, hips, knees, ankles, feet, and gait.
Learning Outcome 6
Compare and contrast the normal and abnormal range of motion
for the temporomandibular joint, shoulders, elbows, wrists,
hands, fingers, neck, spine, hips, knees, ankles, feet, and gait.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. A patient is newly diagnosed with arthritis of the cervical vertebrae. The nurse realizes
this patient has a disease process within the:
1.
2.
3.
4.
Cartilaginous joints.
Fibrous joints.
Synovial joints.
Spheroidal joints.
Correct Answer: Cartilaginous joints.

Rationale: Cartilaginous joints are only slightly moveable and are located between the
vertebrae. Fibrous joints occur where bones are joined together, such as the sutures of the
skull. Synovial joints are between bones that do not come in contact with each other, such
as the knee. Spheroidal joints are located in the hip and shoulder.
Cognitive Level: Analysis
Nursing Process: Assessment
Client Need: Health Promotion and Maintenance
LO: 1
2. A patient tells the nurse that he has damaged cartilage in his knee. Which of the
following is the nurses best response to this patient?
1.
2.
3.
4.
Did the doctor talk with you about having a knee replacement or other surgery?
It will take a few months for the damage to heal.
Exercise will increase the healing time for the cartilage.
That is considered a strain and will heal itself in a few weeks.
Correct Answer: Did the doctor talk with you about having a knee replacement or other
surgery?
Rationale: Cartilage is a connective tissue and serves as a cushioner. Once damaged,
cartilage cannot be repaired. The correct answer would be for the nurse to ask the patient
if the doctor has talked about surgery with the patient. Exercise will not increase the
healing time for the cartilage. A strain occurs with a tendon.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 1
3. A patient recovering from hip replacement surgery is prescribed a pillow between the
legs. The nurse realizes that the pillow will facilitate which of the following positions for
the patient?
1.
2.
3.
4.
Abduction
Adduction
Flexion
Extension
Correct Answer: Abduction

Rationale: Abduction is the movement of an extremity away from the midline of the
body, which is what needs to be done to maintain the integrity of the new hip. Adduction
moves an extremity toward the midline of the body and would put unnecessary strain on
the new hip. Flexion is bending an extremity at a joint. Extension is straightening the
extremity of a joint.
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 1
4. The nurse is preparing to conduct a history on a patient being seen for hip pain and
reduced range of motion. The nurse realizes that the primary purpose of the history is to:
1.
2.
3.
4.
Determine the patients functioning to plan the care.

Allow the patient to talk about the ailment.
Figure out if the patient needs assistive devices.
Evaluate the degree of pain the patient is experiencing.
Correct Answer: Determine the patients functioning to plan the care.

Rationale: A detailed history of the musculoskeletal system determines a patients ability
to function, which plays an important role in developing an effective plan of care. The
nurse should develop a caring relationship with the patient so that the patient will talk
about the ailment; however, that is not the purpose of the history. Figuring out if a patient
needs an assistive device and evaluating the degree of pain the patient has might be
discussed during the history; however, these are not the overall purpose of the history.
Nursing Process: Planning
LO: 2
5. A patient provides the nurse with a list of current medications and adds that he takes
glucosamine every day. This information would be helpful for the nurse to document in
which part of the health history?
1.
2.
3.
4.
Past medical history

Chief complaint
Social history
Biographical data
Correct Answer: Past medical history

Rationale: The past medical history contains the patients current medications, including
herbal remedies. This is where the nurse should document this information. The chief
complaint includes the patients description of the current problem, its duration, and what
has been done to try to alleviate the symptoms. The social history contains lifestyle
aspects such as smoking and alcohol intake. Biographical data includes age, gender,
culture, and educational background.
LO: 2
6. A patient tells the nurse that she is tired of having leg pain because it gets in the
way of enjoying the activities that she wants to do with her family. The nurse should
best respond with which of the following?
1. How does your family react when you are having the pain and cant participate
in activities?
2. At least you are able to do regular activities around the house.
3. But you are still working, so you are productive.
4. Everyone has some degree of pain every day, and Im sure your family
understands.
Correct Answer: How does your family react when you are having the pain and cant
participate in activities?
Rationale: The nurse should ask the patient how she copes with the pain and whether it
affects her personal relationship with her family. The other choices do not assess the
patients ability to cope.
Client Need: Psychosocial Integrity
LO: 2
7. The nurse assesses that a patient is unable to completely straighten his right arm. This
finding could indicate which of the following?
1.
2.
3.
4.
Muscle atrophy
Muscle fasciculation
Gout
The presence of nodules
Correct Answer: Muscle atrophy

Rationale: Muscle atrophy is the shortening of a muscle, which is evidenced by the
patients inability to completely straighten his arm. Muscle fasciculations are abnormal
contractions within a muscle. Gout is an inflammation of a toe, heel, elbow, or ankle.
Nodules are small raised areas that are found upon palpation.
LO: 3
8. The nurse rates a patients biceps muscle strength as a 3. This finding would indicate
which of the following?
1.
2.
3.
4.
Active ROM with gravity and moderate weakness

Complete active ROM with minimal weakness
Passive ROM
Complete ROM with no weakness
Correct Answer: Active ROM with gravity and moderate weakness

Rationale: Muscle strength is graded on a scale from 0 to 5. Grade 3 is active ROM with
gravity and moderate weakness. Grade 4 is complete active ROM with minimal
weakness. Grade 2 is passive ROM. Grade 5 is complete ROM with no weakness.
LO: 3
9. A patient tells the nurse that he has had increasing difficulty bending his knees to pick
objects up from the floor since he got a desk job about 10 months ago. The nurse suspects
that the patients loss of knee and hip range of motion would be due to:
1.
2.
3.
4.
Atrophy.
Pain.
Muscle spasms.
Gout.
Correct Answer: Atrophy.

Rationale: Atrophy occurs when muscles are not used. The patient states that he has had
increased difficulty bending the knees to pick objects up from the floor since obtaining a
desk job. This could mean the muscles are not being used and are becoming atrophied.
There is no evidence to suggest the patient is experiencing pain or muscle spasms. Gout
is an inflammation of the great toe, heel, elbow, or ankles.
LO: 3
10. The nurse asks the patient to shrug the shoulders while the nurse applies pressure to
keep the shoulders from moving. The muscle the nurse is assessing would be:
1.
2.
3.
4.
Trapezius.
Biceps.
Triceps.
Sternoclidomastoid.
Correct Answer: Trapezius.

Rationale: The assessment of the trapezius muscle is done to determine the status of the
patients shoulder functioning. To assess the trapezius muscle, the patient is asked to
shrug the shoulders while the nurse tries to hold the shoulders down. The biceps muscle
is assessed by asking the patient to flex the arm while the nurse tries to extend it. The
triceps muscle is assessed by having the patient extend the arm while the nurse tries to
flex it. The sternoclidomastoid muscle is assessed with the neck; the patient is asked to
turn his head against resistance applied by the nurses hand.
LO: 4
11. The nurse asks the patient to move the thumb of his one hand away from the palm and
then back. This technique is assessing which of the following functions of the thumb?
1.
2.
3.
4.
Adduction
Opposition
Flexion
Extension
Correct Answer: Adduction

Rationale: To test for adduction, the patient should be asked to move the thumb anteriorly
away from the palm and then back. Opposition is assessed by asking the patient to touch
each of the fingertips with the thumb. Flexion is assessed by asking the patient to move
the thumb across the palm and touch the fifth finger. Extension is assessed by asking the
patient to move the thumb across the palm away from the rest of the fingers.
LO: 4
12. While conducting a physical assessment, the patient walks to the door of the
examination room and the nurse is watching the patient switch weight on the feet. The
nurse is assessing ___________ of the patients musculoskeletal status.
1.
2.
3.
4.
Second-phase gait
First-phase gait
Hip flexion
Knee extension
Correct Answer: Second-phase gait

Rationale: The assessment of gait has two phases. The first phase is the stance of gait and
occurs when the foot is on the ground and the patient is bearing weight or walking on the
foot. The second phase is the swing phase and occurs when the patient moves the foot
forward and is not bearing weight. This is the phase the nurse is observing. Hip flexion
and knee extension are not assessed with walking.
LO: 4
13. The nurse assessing a patients musculoskeletal status notes that the left shoulder is
flat. This finding would be most consistent with which of the following?
1.
2.
3.
4.
Dislocation
Scoliosis
Arthritis
Rotator cuff tear
Correct Answer: Dislocation

Rationale: Shoulders that appear flat or asymmetrical may be dislocated. Patients with
scoliosis may have one shoulder higher than the other. Pain is associated with arthritis
and rotator cuff tears.
LO: 5
14. The nurse is assessing a patient who complains of numbness and tingling in the
hands. When the patient bends the wrist downward and presses the backs of the hands
together, there is numbness and tingling in the wrists and fingers. Which of the following
should the nurse suspect the patient is experiencing?
1.
2.
3.
4.
Carpel tunnel syndrome

Arthritis
Dislocation
Fracture
Correct Answer: Carpal tunnel syndrome

Rationale: The nurse has the patient perform the Phalens test that is used to help
diagnose carpal tunnel syndrome. Numbness, tingling, and pain in the wrist and fingers
would suggest the patient is experiencing carpel tunnel syndrome. The maneuver the
nurse had the patient perform is not used to help diagnose arthritis, dislocation, or a
fracture of the wrist.
LO: 5
15. While examining the knee of a patient, the nurse places the patient in the supine
position and uses firm pressure to stroke the medial aspect of the knee upward while
applying pressure to the lateral side and observing the medial side. The nurse is utilizing
the _____________ diagnostic test to assess this patient.
1.
2.
3.
4.
Bulge sign
Balloon sign
Ballottement
Tinels sign
Correct Answer: Bulge sign

Rationale: The bulge sign is used to detect fluid in the knee. After stroking the medial
aspect of the knee upward to displace the fluid, a hand is placed on the lateral side of the
knee while looking for a bulge of fluid in the hollow area medial to the patella. The
balloon sign is done by placing the thumb and index finder of one hand on each side of
the patella while the other hand compresses the suprapatellar pouch against the femur in
efforts to feel for fluid. The ballottement test is used to assess for fluid in the
suprapatellar pouch and is done by pressing against the sides of the patella with the
thumb and index finder of one hand while pushing the patella against the femur with the
opposite hand. While pressing on the sides of the patella, fluid is moved into the
suprapatellar pouch and then while pushing the patella against the femur, the fluid returns
to the pouch and a wave can be felt. Tinels sign is used to help diagnose carpal tunnel
syndrome.
LO: 5
16. A patient is complaining of a fever and a stiff neck. Upon assessment, the patient is
unable to rotate the neck. Which of the following do these assessment findings suggest to
the nurse?
1.
2.
3.
4.
Infectious process
Arthritis
Gout
Cervical vertebrae fracture
Correct Answer: Infectious process

Rationale: Neck pain with decreased range of motion accompanied by a fever may be due
to an infectious process. Arthritis is not typically associated with a fever. Gout is not
known to affect the cervical vertebrae. The patient would have pain, tingling, and
numbness in addition to a change in range of motion if cervical vertebrae were fractured.
LO: 6
17. While assessing a patients left knee for range of motion, the nurse hears clicking and
the patient says that at times his knee locks. Which of the following does this
information suggest to the nurse?
1.
2.
3.
4.
Damage to the meniscus

Fluid in the knee
Dislocation
Rheumatoid arthritis
Correct Answer: Damage to the meniscus

Rationale: Clicking sounds with knee movement in addition to the patient complaining of
the knee locking may indicate damage to the meniscus. These findings are not typically
associated with fluid in the knee, dislocation, or rheumatoid arthritis.
LO: 6
18. While assessing a patients hands, the nurse notes that the patient is unable to fully
extend the ring or fifth finger of both hands. This finding is consistent with which of the
following?
1.
2.
3.
4.
Dupuytrens contracture
Bouchards nodes
Heberdens nodes
Swan neck deformity
Correct Answer: Dupuytrens contracture

Rationale: Difficulty extending or the inability to extend the ring or fifth finger of the
hands is a sign of Dupuytrens contracture, an abnormal finding when conducting range
of motion of the hands and fingers. Bouchards nodes are hard, painless nodules over the
proximal interphalangeal joints of the fingers. Heberdens nodes are hard, painless
nodules over the distal interphalangeal joints of the fingers. A swan neck deformity is
when the proximal interphalangeal joint is hyperextended and the distal joint is fixed in
flexion.
LO: 6

(Osborn) Chapter 54 Learning Outcomes (Number and Title)

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(Osborn) Chapter 54 Learning Outcomes (Number and Title)

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[Osborn] chapter 54

Learning Outcomes [Number and Title ]

Correct Answer: Cartilaginous joints.

Correct Answer: Abduction

Determine the patients functioning to plan the care.

Correct Answer: Determine the patients functioning to plan the care.

Past medical history

Correct Answer: Past medical history

Correct Answer: Muscle atrophy

Active ROM with gravity and moderate weakness

Correct Answer: Active ROM with gravity and moderate weakness

Correct Answer: Atrophy.

Correct Answer: Trapezius.

Correct Answer: Adduction

Correct Answer: Second-phase gait

Correct Answer: Dislocation

Carpel tunnel syndrome

Correct Answer: Carpal tunnel syndrome

Correct Answer: Bulge sign

Correct Answer: Infectious process

Damage to the meniscus

Correct Answer: Damage to the meniscus

Correct Answer: Dupuytrens contracture

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