Chapter 23, Musculoskeletal System: Assessing the Musculoskeletal System—Sherpath

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Question 1 of 21

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When inspecting the musculoskeletal system, which elements of the patient’s posture would the nurse assess?

    • BuildAssessing the patient’s build is not a part of the posture inspection.
    • HeightAssessing the patient’s height is not a part of the posture inspection.
  • Correct
    • ErectnessThe nurse should assess the patient’s erectness when inspecting the patient’s posture.
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    • SymmetryThe nurse should assess the patient’s symmetry when inspecting the patient’s posture.
  • Correct
    • AlignmentThe nurse should assess the patient’s alignment when inspecting the patient’s posture.

Question 2 of 21

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When palpating a patient’s bones, joints, and surrounding muscles, which characteristics would the nurse assess?

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    • ToneThe nurse would assess the tone of a patient’s muscles on palpation.
  • Correct
    • CrepitusThe nurse would assess the patient for crepitus, a gentle bubbly feeling, which can be palpated as well as heard.
    • SymmetryThe nurse would inspect, not palpate, for symmetry.
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    • TemperatureThe nurse would assess the temperature of a patient’s muscles on palpation.
  • Correct
    • Resistance to pressureThe nurse would assess a patient’s muscles for resistance to pressure on palpation.

Question 3 of 21

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Which muscle characteristics should the nurse inspect as part of a thorough musculoskeletal examination?

    • ToneThe nurse would assess muscle tone on palpation, not inspection.
  • Correct
    • AtrophyThe nurse should inspect for muscle atrophy as part of a thorough musculoskeletal examination because it may indicate injury or disease of the muscle or damage to the motor neuron.
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    • SymmetryThe nurse should inspect muscles for bilateral symmetry as part of a thorough musculoskeletal examination.
  • Correct
    • HypertrophyThe nurse should inspect the muscles for hypertrophy as part of a thorough musculoskeletal examination.
  • Correct
    • FasciculationsThe nurse should inspect the muscles for fasciculations as part of a thorough musculoskeletal examination because they may indicate injury to a muscle’s motor neuron.

Question 4 of 21

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When testing muscle strength, the nurse should compare the bilateral muscles using which elements?

    • TendernessThe nurse may palpate the muscles for tenderness, but this assessment would not be included in the comparison of bilateral muscles.
    • ToneThe nurse may palpate the muscles for tone, but this assessment would not be included in the comparison of bilateral muscles.
  • Correct
    • ResistanceThe nurse should compare the bilateral muscle resistance when testing muscle strength.
    • TemperatureThe nurse may palpate the muscles for heat, but this assessment would not be included in the comparison of bilateral muscles.
  • Correct
    • SymmetryThe nurse should compare the bilateral muscle symmetry when testing muscle strength.

Question 5 of 21

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During assessment of range of motion, which parts of the musculoskeletal system should be assessed?

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    • BicepsThe nurse should assess the range of motion for all major joints and evaluate associated muscle groups, including the biceps. Pain, limitation of motion, spastic movement, joint instability, deformity, and contracture suggest a problem with the joint, related muscle group, or nerve supply.
  • Correct
    • Cervical spineThe nurse should assess the range of motion for the cervical spine. Pain, limitation of motion, spastic movement, joint instability, deformity, and contracture suggest a problem with the joint, related muscle group, or nerve supply.
    • Abdominal musclesBecause abdominal muscles are not part of a joint, they would not be assessed for range of motion.
  • Correct
    • Temporomandibular jointThe nurse should assess the range of motion for the temporomandibular joint. Pain, limitation of motion, spastic movement, joint instability, deformity, and contracture suggest a problem with the joint, related muscle group, or nerve supply.
  • Correct
    • Metacarpophalangeal jointThe nurse should assess the range of motion for the metacarpophalangeal joint. Pain, limitation of motion, spastic movement, joint instability, deformity, and contracture suggest a problem with the joint, related muscle group, or nerve supply.

Question 6 of 21

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Which maneuvers are necessary to assess range of motion?

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    • Active movement of a joint by the patientRange of motion can be assessed through active movement of a joint by the patient.
  • Correct
    • Passive movement of a joint by the nurseRange of motion can be assessed through passive movement of a joint by the nurse.
    • Passive movement of a joint by the patientPassive movement is performed by someone other than the patient moving the muscle.
    • Active movement of a joint by the nurseActive movement is performed by the patient independently, not by someone else moving the joint.
    • Pushing of the patient’s hand against the nurse’s handMuscle strength, not range of motion, can be assessed by having the patient push a hand against the nurse’s hand.

Question 7 of 21

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Which type of movement defines a grade 2 range of motion?

    • Trace of movementTrace of movement defines grade 1 range of motion.
    • No evidence of movementNo evidence of movement defines a grade 0 range of motion.
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    • Full passive range of motionFull passive range of motion defines a grade 2 range of motion.
    • Full range of motion against gravity with full resistanceFull range of motion against gravity with full resistance defines a grade 5 range of motion.

Question 8 of 21

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Which type of movement defines a grade 3 range of motion?

    • Trace of movementTrace of movement defines grade 1 range of motion.
  • Correct
    • Full range of motion against gravity, but not resistanceFull range of motion against gravity, but not resistance defines a grade 3 range of motion.
    • Full passive range of motionFull passive range of motion defines grade 2 range of motion.
    • Full range of motion against gravity with full resistanceFull range of motion against gravity with full resistance defines a grade 5 range of motion.

Question 9 of 21

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A grade __ of movement is represented by a complete lack of motion.

    • Your answer: 0Correct answer: 0A complete lack of motion is represented by a grade of 0.

Question 10 of 21

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The nurse should assess range of motion in the hand and wrist by asking the patient to perform which movements?

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    • Touch thumb to each fingertipTo assess range of motion in the hand, the nurse should ask the patient to touch the thumb to each fingertip.
    • Tightly grip two of the nurse’s fingersThe nurse would assess hand strength, not range of motion, by having the patient tightly grip two of the nurse’s fingers.
    • Lift the arms laterally up over the headThe nurse would assess range of motion of the shoulders, not the hands and wrist, by asking the patient to lift the arms laterally up over the head.
  • Correct
    • Bend the hand up and down at the wristThe nurse should ask the patient to bend the hand up and down at the wrist to assess range of motion of the hand.
  • Correct
    • Spread fingers apart, then touch them togetherThe nurse should ask the patient to spread the fingers apart, and then touch them together to assess range of motion of the hand.

Question 11 of 21

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The nurse can examine the elbow’s range of motion by asking the patient to perform which movements?

    • Turn each hand to the right and leftThe nurse can evaluate wrist, not elbow, range of motion by asking the patient to turn each hand to the right and left.
  • Correct
    • Bend and straighten the elbowThe nurse can assess the elbow’s range of motion by asking the patient to bend and straighten elbow.
    • Bend each hand at the wrist up and downThe nurse can evaluate wrist, not elbow, range of motion by asking the patient to bend each hand at the wrist up and down.
  • Correct
    • Turn the hand from palm side down to palm side upThe nurse can assess the elbow’s range of motion by asking the patient to turn the hand from palm side down to palm side up.
    • Lift both arms laterally over the headThe nurse can evaluate shoulder, not elbow, range of motion by asking the patient to lift both arms laterally over the head.

Question 12 of 21

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On assessment of range of motion of the shoulder, the expected degree of hyperextension is __ degrees.

    • Your answer: 50Correct answer: 50When the patient extends and stretches both arms behind the back, expect hyperextension of 50 degrees.

Question 13 of 21

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In which ways can the nurse evaluate hip muscle strength?

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    • Apply resistance during abduction and adductionThe nurse can evaluate hip muscle strength by applying resistance during abduction and adduction.
  • Correct
    • Apply resistance as the patient uncrosses the legs while seatedThe nurse can evaluate hip muscle strength by applying resistance as the patient uncrosses the legs while seated.
    • Ask the patient to swing the straightened leg behind the bodyThe nurse can assess the range of motion, not the strength of the hip, by asking the patient to swing the straightened leg behind the body.
    • Ask the patient to lie supine and swing the leg laterally and medially with the knee straightThe nurse can assess the range of motion, not the strength of the hip, by asking the patient to swing the leg laterally and medially with knee straight.
  • Correct
    • Apply resistance while patient maintains flexion of the hip with knee flexed, then extendedThe nurse can evaluate hip muscle strength by applying resistance while the patient maintains flexion of the hip with knee flexed, then extended.

Question 14 of 21

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How should the patient be positioned while the nurse inspects the feet and ankles?

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    • StandingThe nurse can inspect the feet and ankles while the patient is bearing weight, as when standing.
  • Correct
    • SittingThe nurse can inspect the feet and ankles while the patient is sitting.
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    • WalkingThe nurse can inspect the feet and ankles while the patient is bearing weight, as when walking.
    • With legs crossedThe nurse should not inspect the feet and ankles while the patient has the legs crossed, because they would not be easily visible.
    • With legs raisedThe nurse would not inspect the feet and ankles while the patient has the legs raised, because they would not be easily accessible.

Question 15 of 21

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Match the musculoskeletal assessment technique with the lower extremity joint it evaluates.

  • Ankle range of motion
  • Knee range of motion
  • Hip strength
  • Foot strength

Question 16 of 21

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The nurse should assess which aspect of an infant’s musculoskeletal system during every examination for the first year of life?

    • Genu varumGenu varum, or bowleg, should be assessed in children and not during every examination the first year of an infant’s life.
    • Tibial torsionTibial torsion should be assessed in children and not during every examination for the first year of an infant’s life.
    • Arch of the footThe arch of the foot should be assessed in children and not during every examination for the first year of an infant’s life.
  • Correct
    • Hip dislocation or subluxationThe nurse should use the Barlow-Ortolani maneuvers to assess hip dislocation or subluxation during every examination for the first year of an infant’s life.

Question 17 of 21

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The nurse holds an infant in vertical suspension with hands under the axillae to assess which element of the musculoskeletal system?

    • Range of motionHolding an infant in vertical suspension does not assess range of motion.
    • Muscle painHolding an infant in vertical suspension does not assess muscle pain.
    • Hip dislocationHolding an infant in vertical suspension does not assess hip dislocation.
  • Correct
    • General muscle strengthThe nurse holds an infant in a vertical suspension to assess general muscle strength.

Question 18 of 21

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Which elements of an infant’s feet should be assessed as part of the musculoskeletal examination?

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    • FlexibilityThe flexibility of an infant’s feet should be assessed as part of the musculoskeletal examination.
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    • Number of toesThe number of toes should be assessed as part of the musculoskeletal examination.
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    • Midline of the footThe midline of the foot should be assessed as part of the musculoskeletal examination, and it may bisect the third and fourth toes, rather than the second and third toes.
    • Long bones for fracturesAssessment of the long bones is not part of the infant foot evaluation.
    • Palmar and phalangeal creasesThe palmar and phalangeal creases are elements of an infant’s hands, not feet, and should be assessed as part of the musculoskeletal examination.

Question 19 of 21

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Which types of play and recreation activities are evaluated as part of a child’s musculoskeletal system assessment?

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    • Ability to pick up toysThe child’s ability to pick up toys is evaluated as part of a musculoskeletal system assessment.
    • Ability to sit stillThe child’s ability to sit still is not evaluated as part of a musculoskeletal system assessment.
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    • Movement around the roomThe child’s movement around the room is evaluated as part of a musculoskeletal system assessment.
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    • Ability to sit and creepThe child’s ability to sit and creep is evaluated as part of a musculoskeletal system assessment.
    • Ability to lift heavy objectsThe child’s ability to lift heavy objects is not evaluated as part of a musculoskeletal system assessment.

Question 20 of 21

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How does the musculoskeletal examination of an adolescent differ from that of an adult?

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    • It does not differ.Older children and adolescents should be assessed with the same procedures used for adults.
    • A parent must be present.Presence of a parent is not required for the adolescent musculoskeletal examination.
    • The adolescent should be sitting for the examination.The adolescent does not need to be sitting for the musculoskeletal examination.
    • The nurse should assess passive movement, but not active.Both passive and active movement should be assessed as part of the adolescent musculoskeletal examination.

Question 21 of 21

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For which common lower leg deformities should the nurse assess during the musculoskeletal assessment of a child?

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    • Genu varumBowleg, or genu varum, is a common lower leg deformity seen in children.
    • Fractured clavicleA fractured clavicle may occur in a newborn, but is not a leg deformity.
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    • Genu valgumKnock knee, or genu valgum, is a common lower leg deformity seen in children.
    • Tailor sitting positionThe tailor sitting position is a sitting position common in children, not a leg deformity.
    • Popliteal creasesPopliteal creases are creases found at the back of the knee joint and are not a leg deformity.