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chap 23 Musculoskeletal System EAQs

Terms in this set (18)

Which information about synovial joints is correct?
Freely movable and lined with synovial membranes
Which condition is suspected in a patient with swan-neck deformity and ulnar deviation of the fingers?
Chronic rheumatoid arthritis

Rheumatoid arthritis may lead to swan-neck deformity and ulnar deviation of the fingers. Swan-neck deformity refers to the flexion contracture of the metacarpophalangeal joint. Stretching of the articular capsule and muscle imbalance in the patient with rheumatoid arthritis may result in ulnar deviation of the fingers. Osteoporosis is a bone disorder characterized by a decrease in bone mass and density, which increases the risk of fractures. Olecranon bursitis is swelling of the elbow, which is associated with the presence of a large, soft knob and redness resulting from inflammation of the olecranon bursa. Achilles tenosynovitis is an inflammation of the tendon sheaths near the ankle; any movement results in pain.
Which test would the nurse perform by firmly stroking the medial aspect of the knee three times and tapping the lateral aspect of the knee?
bulge sign

To assess swelling in the suprapatellar pouch, the nurse will check for the bulge sign, which confirms the presence of small amounts of fluid as the nurse tries to move the fluid from one side of the joint to the other. To detect large amounts of fluid in the patellar region, ballottement of the patella is a reliable test. The left hand helps compress the suprapatellar pouch to move any fluid into the knee joint. The right hand helps push the patella sharply against the femur. The Phalen test reproduces numbness and burning in a person with carpal tunnel syndrome and is a disorder of the wrist. The patient needs to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of a normal wrist for 60 seconds produces no symptoms in a normal hand. In carpal tunnel syndrome, percussion of the median nerve produces burning and tingling along its distribution, which is a positive Tinel sign.
Which change in the spine is frequently observed in obese patients?
lordosis

A pronounced lumbar curve, or lordosis, is a prominent finding in an obese patient because of the extra body weight.
Cartilage serves which functions in the body? Select all that apply.
Cushioning the bones
Providing stability
Covering the surface of the bone
Smoothing the surface of the bone

Cartilage is connective tissue that covers the surface of opposing bones in synovial joints. It cushions the bone, aiding in movement and providing stability to the musculoskeletal structure. Cartilage also smooths the surface of the bone, facilitating movement. Cartilage receives nourishment from the synovial fluid during joint movement and does not provide nourishment for the synovial fluid.
Which characteristic feature would the nurse observe in a child with "pigeon toes"?
Walking on the lateral side of the foot

The child with "pigeon toes" tends to walk on the lateral side of the foot, and the longitudinal arch appears higher than normal. The child with genu varum tends to walk with a waddling gait. The child with "flat feet" takes a broad-based stance. The child with genu valgum tends to stand with ankles apart and the knees touching.
Which signs and symptoms are associated with rheumatoid arthritis? Select all that apply.
fatigue
weight loss
low-grade fever

Inflammation of the synovial tissues and hyperplasia occur in the patient with rheumatoid arthritis, which is an autoimmune disease. Increased cytokine production in the patient with rheumatoid arthritis may lead to an increase in the basal metabolic rate. This increases caloric needs in the patient. Therefore the patient may have fatigue and weight loss. The patient with rheumatoid arthritis may have increased production of prostaglandins. Prostaglandins reset the thermostat of the brain to a higher level, resulting in low-grade fever. The patient with rheumatoid arthritis will not have tingling and burning sensations at the joints. Tingling and numbness are symptoms of a ganglion cyst.
Which finding would the nurse expect in a patient who has tophi as a result of chronic gout?
Swollen toe joints with white chalky discharge

Chronic gouty tophi are characterized by the presence of hard, painless nodules over the metatarsophalangeal joint of the first toe. Tophi are collections of sodium urate crystals around the joint. The accumulation of sodium urate crystals may cause swelling, and sometimes tophi burst with white chalky discharge.
Which joint facilitates pronation and supination movements of the hand and the forearm?
radioulnar

Pronation is turning the forearm so that the palm faces down. Supination is turning the forearm so that the palm faces up. The elbow joint consists of three bones: the humerus, radius, and ulna. The radius and ulna articulate with one another at two radioulnar joints: one at the elbow and the other at the wrist. Both the radius and ulna move together and permit the pronation and supination movements of the hand and the forearm. The tibiotalar joint is present in the ankle and the feet; it permits extension and flexion of the foot in one plane. The radiocarpal joint is present in the wrist; it permits flexion and extension of the wrist. The glenohumeral joint is present in the shoulder; it permits movement of the arm on many axes
Which test helps in assessing a flexion deformity of the patient's hip?
thomas test
The Thomas test is a leg-raising test that involves flexion of the hip joint; therefore it helps determine hip flexion deformity in the patient. The nurse compares leg lengths of the patient while performing the Allis test to assess for hip dislocation. The patient holds the hands back to back while flexing the wrists during the Phalen test; this test helps determine carpal tunnel syndrome. The nurse instructs the patient to flex the knee joint while performing the McMurray test to determine the presence of a torn meniscus.
Which structure connects the knee joint at both sides and prevents its dislocation?
Collateral ligaments

Collateral ligaments connect the knee joint at both sides and prevent dislocation by giving medial and lateral stability. The lateral meniscus is a wedge-shaped cartilage that cushions the tibia and femur and protects them from external pressures. The prepatellar bursa lies between the patella and the skin, prevents friction, and thus helps the muscles and tendons glide smoothly over the bone. Cruciate ligaments provide anterior and posterior stability and help control rotation of the knee
Which angular motion involves moving the arm away from midline of the body?
abduction
Which complication occurs as a result of a decrease in the blood supply to the femoral epiphysis?
Legg-Calve-Perthes syndrome

Inadequate blood supply to the femoral epiphysis may cause necrosis of the femoral head, resulting in Legg-Calve-Perthes syndrome, or coxa plana.
Which finding is consistent with Down syndrome?
Simian crease

The simian crease is a palmar crease that extends across the palm and is a characteristic finding in Down syndrome. Syndactyly, or webbed fingers, may also occur in the child with Down syndrome. Polydactyly refers to the presence of extra fingers or toes. This may not occur in the child with Down syndrome. Hip dysplasia refers to an abnormal formation of the hip joint. The child with Down syndrome may not have joint deformities. Dermoid sinus is a neural tube defect. The presence of a dimple in the midline of the spine indicates dermoid sinus.
Which conditions result in the decrease in height experienced by aging individuals? Select all that apply.
Loss of bone matrix
Thinning of intervertebral discs
Decrease in the height of individual vertebrae

A decrease in an individual's height occurs with aging. Osteoporosis results because of the loss of bone matrix, which decreases the height of the vertebrae, and which ultimately decreases the height in older people. Thinning of the intervertebral discs occurs because of the loss of mineral content that comes with aging; this also results in shortening of the vertebral column. There is a decrease in the height of individual vertebrae due to osteoporosis. Epiphysis refers to the end of a long bone and allows longitudinal growth of the long bones. However, closure of the epiphysis occurs by the age of 20 years; therefore this does not result in decrease in height in older people

***Evidence suggests that long bones do not shorten with age**
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