61 MS assessment

9. The nurse performing range of motion (ROM) with a patient puts each joint through its full movement. Which joints are capable of abduction and adduction (select all that apply)? a. Hip b. Knee c. Wrist d. Elbow e. Thumb f. Shoulder

a, c, e, f. Abduction is moving the part away from the midline of the body, and adduction is moving the part toward the midline of the body. These movements can be done with the hip, wrist, thumb, and shoulder. The knee and elbow move with flexion and extension.

8. What is the function of a tendon? a. Attaches muscle to bone b. Connects bone to bone at the joint c. Connects cartilage to muscle in joints d. Attaches synovium to the joint capsule

a. The function of the tendon is to attach muscle to bone. The ligament attaches bone to bone at the joint. Fascia encloses individual muscles but does not connect cartilage to muscle in joints. The bursae are lined with synovial membrane; they are located in joints to relieve pressure and decrease friction between moving parts.

14. During muscle strength testing, the patient has active movement against gravity and some resistance to pressure. What score should the nurse give this finding? _______________________________________

4 strength is graded on a scale of 0 to 5, with 0 = no detection of muscle contraction and 5 = active movement against full resistance without evident fatigue (normal). Active movement against gravity and some resistance = 4. (See Table 61.4.)

12. When obtaining information about the patient's use of medications, the nurse is concerned that both bone and muscle function may be impaired when the patient reports taking what type of drug? a. Corticosteroids b. Oral hypoglycemic agents c. Potassium-depleting diuretics d. Nonsteroidal antiinflammatory drugs (NSAIDs)

a. Corticosteroids affect both bone and muscle function by causing avascular necrosis with tiny breaks in bone tissue; protein catabolism with skeletal muscle wasting; and increased osteoclast activity with loss of bone mass, which can have a marked detrimental effect on mobility and activity. Potassium-depleting diuretics may cause hypokalemia, which is associated with muscle weakness and cramps. Oral hypoglycemic drugs and nonsteroidal antiinflammatory drugs (NSAIDs) are not known to affect the musculoskeletal system.

5. The patient is told by the health care provider (HCP) that the size of the patient's muscle has decreased. How should the nurse document this occurrence? a. Hyaline b. Atrophy c. Isometric d. Hypertrophy

b. Atrophy describes a decrease in muscle size. Hyaline is the most common type of cartilage tissue. Isometric describes a muscle contraction that produces hypertrophy. Hypertrophy refers to the increase in the size of cells, causing an increase in the organ.

15. On observation of the patient, the nurse notes the presence of a limping gait. How should the nurse further evaluate the patient? a. Palpate the hips for crepitation. b. Measure the length of the limbs. c. Evaluate the degree of leg movement. d. Compare the muscle mass of 1 leg with the other.

b. Because a short-leg gait is noticed, the length of both legs should be measured between the anterosuperior iliac crest and the bottom of the medial malleolus; both sides should be compared. Palpating for crepitus will identify friction between bones, usually at joints. Joint movement and muscle mass size may affect gait in various ways, but differences in limb length will always affect gait.

17. An adolescent patient referred to the office by the school nurse is found to have a lateral curvature of the spine. The nurse would document this condition as a. lordosis. b. scoliosis. c. ankylosis. d. kyphosis.

b. Scoliosis is a lateral "S" curve of the thoracic and lumbar spine. Lordosis is an exaggerated lumbar curvature or swayback. Ankylosis refers to fixation of a joint. Kyphosis is an exaggerated forward thoracic curvature.

18. In report, the nurse is told that the patient has a contracture of the right arm. What would the nurse expect to find when assessing the patient? a. A fluid-filled cyst b. Generalized muscle pain c. Shortening of a muscle or ligament d. Grating sensation between bones with movement

c. A contracture is shortening of a muscle or ligament that causes resistance of movement. A fluid-filled cyst is a ganglion cyst. Generalized muscle pain is myalgia. Crepitation is a grating sensation between bones with movement.

24. Which serologic studies would be done to evaluate rheumatoid arthritis (select all that apply)? a. Uric acid b. Anti-DNA antibody c. Rheumatoid factor (RF) d. Antinuclear antibody (ANA) e. Erythrocyte sedimentation rate (ESR) f. Anticyclic citrullinated peptide (anti-CCP)

c, d, e, f. Increases in rheumatoid factor (RF), antinuclear antibody (ANA), and anticyclic citrullinated peptide (anti-CCP) may occur in rheumatoid arthritis. Increased erythrocyte sedimentation rate (ESR) and presence of human leukocyte antigen (HLA)-B27 may be found. Uric acid may be elevated in gout. Anti-DNA antibody is the most specific test for systemic lupus erythematosus.

16. A patient with severe joint immobility is receiving physical and exercise therapy. To evaluate the effect of the treatment, the nurse may assess joint range of motion using what equipment? a. Ergometer b. Myometer c. Goniometer d. Peak flow meter

c. A goniometer is a protractor device that measures the angle of joints and can be used to determine specific degrees of joint range of motion (ROM). It is used when a specific musculoskeletal problem that affects ROM has been identified. An ergometer measures the amount of work done by a muscle. A myometer measures the extent of muscle contraction. A peak flow meter measures peak expiratory flow for asthma patients.

22. What is the most common diagnostic test used to assess musculoskeletal disorders? a. Myelogram b. Arthroscopy c. Standard x-ray d. MRI

c. A standard x-ray evaluates structural or functional changes of bones and joints and can help in determination of bone density. Myelogram is a sensitive test for nerve impingement and can detect very subtle lesions and injuries. Arthroscopy involves visualizing the inside of joint; it is used to diagnose, or repair joint problems. MRI is used to view soft tissue.

4. Which type of cell is responsible for the formation of bone? a. Osteocyte b. Osteoclast c. Osteoblast d. Sarcomere

c. Osteoblasts form bone. Osteocytes are mature bone cells. Osteoclasts are responsible for the resorption of bone. A sarcomere is the contractile unit of myofibrils.

20. The patient describes having burning, sharp pain on the sole of the foot, especially in the morning. This description describes what common musculoskeletal problem? a. Pes planus b. Tenosynovitis c. Plantar fasciitis d. Muscle atrophy

c. Plantar fasciitis presents as burning sharp pain at the sole of the foot that is worse in the morning. Pes planus is abnormal flatness of the sole and arch of the foot. Tenosynovitis involves inflammation and swelling of a tendon, with pain along a tendon sheath. Muscle atrophy presents as flabby-appearing muscle with decreased function and tone.

6. An older patient is describing increased stiffness in the shoulders, back, and hips. The loss of elasticity in what tissue contributes to this? a. Actin b. Fascia c. Myosin d. Ligament

d. A loss of elasticity in ligaments and tendons increases stiffness in the neck, shoulders, back, hips, and knees of older patients. Actin (thin) filaments and myosin (thick) filaments make up the contractile unit of the myofibrils, which decrease in strength with lack of use. Fascia is connective tissue that can withstand limited stretching.

23. What test provides fast, precise measurement of the bone mass of the spine, femur, forearm, and total body to evaluate osteoporosis? a. Bone scan b. Diskogram c. Quantitative ultrasound (QUS) d. Dual-energy x-ray absorptiometry (DEXA)

d. Dual energy x-ray absorptiometry (DEXA) measures bone mass of spine, femur, forearm, and total body. It is used to diagnose osteoporosis and monitor changes in bone density with treatment. Bone scan is done with the injection of a radioisotope that is taken up by the bone to identify osteomyelitis and primary and metastatic malignant lesions. A diskogram is an x-ray with contrast media to evaluate intervertebral disc abnormalities. Quantitative ultrasound (QUS) evaluates density, elasticity, and strength of bone, and is commonly performed at the calcaneus (heel).

11. A 78-year-old woman has physiologic changes in her joints related to aging. What is an appropriate nursing intervention related to common changes of aging in the musculoskeletal system? a. Encourage adequate rest to eliminate fatigue. b. Provide all care for the patient to ensure that care is completed. c. Encourage eating enough calories to avoid the risk for impaired skin integrity. d. Have the patient exercise to maintain muscle strength and avoid the risk for falls.

d. Exercise will decrease the older adult's risk of falls. Loss of muscle mass and strength, decreased motor neurons, limited movement because of joint changes, cartilage deterioration, and less flexible tendons and ligaments are changes that contribute to this risk. Although rest and nutrients are important, fatigue and a high risk for impaired skin integrity are not directly related to changes associated with aging in the musculoskeletal system. Being overweight will increase stress on joints. Providing all care only contributes to weakening of muscles and decreased independence.

10. While having his height measured during a routine health examination, a 79-year-old man asks the nurse why he is "shrinking." How should the nurse explain the decreased height that occurs with aging? a. Decreased muscle mass results in a stooped posture. b. Loss of cartilage in the knees and hip joints causes a loss of height. c. Long bones become less dense and shorten as bone tissue compacts. d. Vertebrae become more compressed with thinning of intervertebral discs.

d. Loss of water from discs between vertebrae, vertebral disc compression, and narrowing of intervertebral spaces all contribute to a loss of height in the older adult. Although bone density decreases and cartilage is lost from joints, these do not affect the long bones or the height of the person.

7. What is the best description of the periosteum? a. Lining of a joint capsule b. A characteristic of skeletal muscle c. Most common type of cartilage tissue d. Fibrous connective tissue covering bone

d. Periosteum is the fibrous connective tissue covering bone. Synovium is the lining of a joint capsule. Striated refers to a characteristic of skeletal muscle. Hyaline is the most common type of cartilage.

21. When assessing the patient, the nurse notices that the patient has foot drop and the foot slaps down on the floor as the patient walks. How should the nurse document this gait? a. Ataxic gait b. Spastic gait c. Antalgic gait d. Steppage gait

d. Steppage gait uses increased hip and knee flexion to clear the foot from the floor, and then the foot slaps down on the walking surface. Ataxic gait is a staggering, uncoordinated gait, often with a sway. Spastic gait has short steps with dragging of the foot in a jerky cross-knee movement. Antalgic gait has a shortened stride with as little weight bearing as possible on the painful side.

19. The patient is diagnosed with torticollis. What should the nurse be prepared to provide for the patient? a. An immobilizer to hold the bones in place b. Exercises to increase the strength of the muscles c. A pillow to use to support the knees while sleeping d. Enough pillows to support the patient's head comfortably

d. With torticollis, the neck twisted in an unusual position to 1 side; the nurse should provide enough pillows to support the patient's head comfortably. An immobilizer to hold bones in place may be used with dislocation or for a joint with subluxation. Exercises to increase or maintain muscle strength and maintain ROM are appropriate for most patients. Pillows to support the knees while sleeping may be done for valgum or varum deformities or for any patient's comfort.