Ch. 39 Assessment of Musculoskeletal Function

Which assessment findings indicate to the nurse that a client may have peripheral neurovascular dysfunction? Select all that apply.

- Absence of feeling - Capillary refill of 4 to 5 seconds - Cool skin - Pain - Weakness in motion

Gait

- Clients with a lower motor disease will have steppage gait. - Clients with scoliosis may have a limp. - Clients with Paget's disease may have bone fractures.

A client arrives at the orthopedic physician's office stating knee pain sustained while playing soccer. A history and physical assessment is completed. The knee appears reddened with edema. Which other diagnostic testing would the nurse anticipate?

An arthroscopy; It is the internal inspection of the joint using an arthroscope.

What is the term for a rhythmic contraction of a muscle?

Clonus

Which of the following is the most common site of joint effusion?

Knee; If inflammation or fluid is suspected in a joint, consultation with a provider is indicated.

An osteocalcin (bone GLA protein) level has been ordered. How will the nurse prepare for this order?

Obtain a blood specimen.

The nurse is conducting a medication reconciliation with a client admitted with a fracture. What medication predisposes a client for a risk for fractures?

Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures.

Which of the following is the final stage of fracture repair?

Remodeling

A client has just undergone arthrography. What is the most important instruction for the nurse to include in the teaching plan?

Report joint crackling or clicking noises occurring after the second day.

A client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for?

Serous drainage

Which laboratory study indicates the rate of bone turnover?

Serum osteocalcin

Skull sutures are an example of which type of joint?

Synarthrosis

An arthrocentesis

The aspiration of synovial fluid.

Bone scan

Used to detect metastatic bone lesions, fractures, or inflammatory disorders.

The nurse is preparing the client for computed tomography. Which information should be given by the nurse?

You must remain very still during the procedure; In computed tomography, a series of detailed x-rays are taken. The client must lie very still during the procedure.

Joints

- Synarthrosis joints are immovable such as skull sutures. - Amphiarthrosis joints allow limited movement, such as a vertebral joint. - Diarthrosis joints are freely movable joints such as the hip and shoulder.

The nurse observes a client with a shuffling gait. What disease is commonly associated with a shuffling gait?

Parkinson's disease

Which nursing instruction is most important to stress when teaching on calcium intake?

Provide age-related calcium intake recommendations.

Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis?

Risk for infection

What is the term for a lateral curving of the spine?

Scoliosis

Common deformities of the spine

- Kyphosis is an increased forward curvature of the thoracic spine that causes a bowing or rounding of the back, leading to a hunchback or slouching posture. - Lordosis, or swayback, is an exaggerated curvature of the lumbar spine. - Scoliosis is a lateral curving deviation of the spine.

An example of a flat bone is the:

Sternum

A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration?

An electromyography (EMG); It tests the electrical potential of muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration.

The homecare nurse is evaluating the musculoskeletal system of a geriatric client whose previous assessment was within normal limits. The nurse initiates a call to the health care provider and/or emergency services when which change is found?

Decreased right-sided muscle strength; although symmetrical decreases in muscle strength can be a part of the aging process, asymmetrical decreases are not. The nurse should contact the health care provider when decreased right-sided muscle strength is found, as this could indicate a stroke or transient ischemic attack.

A patient has had a stroke and is unable to move the right upper and lower extremity. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding?

Flaccidity; A muscle that is limp and without tone is described as flaccid; a muscle with greater-than-normal tone is described as spastic. Conditions characterized by lower motor neuron destruction (e.g., muscular dystrophy), denervated muscle becomes atonic (soft and flabby) and atrophies.

The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as?

Kyphosis

A deoxypyridinoline (DPD) level has been ordered. How will the nurse prepare for this measurement?

Obtain a clean-catch urine.

A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells?

Ossification and calcification; Ossification and calcifications the body's process to transform osteoblasts into mature bone cells called osteocytes.