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Chapter 61: Assessment: Musculoskeletal System Harding: Lewis’s Medical-Surgical Nursing, 11th Edition

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Chapter 61: Assessment: Musculoskeletal System Harding: Lewis’s Medical-Surgical Nursing, 11th Edition 1. A patient reports shoulder pain when the nurse moves the patient’s arm behind the back... . Which question should the nurse ask? 2. A patient with left knee pain is diagnosed with bursitis. What area should the nurse explain is the site of inflammation in bursitis? 3. The nurse notes that a 59-yr-old female patient has lost 1 inch in height over the past 2 years. What diagnostic test should the nurse plan to discuss with the patient? 4. Which information in a 67-yr-old woman’s health history should alert the nurse to the need for a focused assessment of the musculoskeletal system? 5. Which information obtained during the nurse’s assessment may indicate a patient’s increased risk for musculoskeletal problems? 6. Which medication information should the nurse identify as a potential risk to a patient’s musculoskeletal system? 7. The nurse finds that a patient can flex the arms when no resistance is applied but is unable to flex against light resistance. How should the nurse document the patient’s muscle strength level? 8. After completing the health history, how should the nurse begin to assess the musculoskeletal system? 9. Which action should the nurse include when performing the straight-leg raising test for an ambulatory patient with back pain? 10. A patient with severe kyphosis is scheduled for dual-energy x-ray absorptiometry (DXA) testing. Which action should the nurse plan to take? ANS: A DXA testing is painless and noninvasive. No IV access is necessary. Contrast medium is not used. Shellfish or iodine allergies are not a concern with DXA testing. Because the procedure is painless, antianxiety medications are not typically required. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 11. A patient has a new order for magnetic resonance imaging (MRI) to evaluate possible left femur osteomyelitis after hip arthroplasty surgery. Which information indicates the nurse should consult with the health care provider before scheduling the MRI? a. The patient has a pacemaker. b. The patient wears a hearing aid. c. The patient is allergic to shellfish. d. The patient uses supplemental oxygen. ANS: A Patients with most permanent pacemakers cannot have an MRI because of the force exerted by the magnetic field on metal objects. Supplemental oxygen can be delivered during the MRI. 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. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 12. The nurse notes crackling souNndsRanId a GgratBin.g CsensMation with palpation of an older patient’s elbow. How should 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. 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 causing a dull ache that increases with movement. DIF: Cognitive Level: Understand (comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 13. Which finding for a 77-yr-old patient seen in the outpatient clinic is the highest priority for further nursing assessment and intervention? a. Symmetric joint swelling of fingers b. Decreased right knee range of motion c. Report of left hip aching when jogging d. History of recent loss of balance and fall ANS: D A history of falls is a safety issue that requires further assessment and development of fall prevention strategies. The other changes may require additional attention but are less urgent. DIF: Cognitive Level: Analyze (analysis) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 14. Which finding from analysis of fluid from a patient’s right knee arthrocentesis should be of concern to the nurse? a. Cloudy fluid b. Scant thin fluid c. Pale yellow fluid d. Straw-colored fluid ANS: A The presence of purulent (cloudy) fluid suggests a possible joint infection. Normal synovial fluid is scant in amount and pale yellow/straw-colored. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 15. Which task can the nurse assign to unlicensed assistive personnel (UAP) who are working in the orthopedic clinic? a. Grade leg muscle strength for a patient with back pain. b. Obtain blood sample for uric acid from a patient with gout. c. Perform straight-leg-raise testing for a patient with sciatica. d. Check for knee joint crepitation before arthroscopic surgery. ANS: B NURSINGTB.COM In clinic setting, drawing blood specimens is a common skill performed by UAP who are trained. The other actions are assessments and require registered nurse (RN)–level judgment and critical thinking. DIF: Cognitive Level: Apply (application) OBJ: Special Questions: Delegation |Special Questions: Multiple Patients TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment [Show More]

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