Assessing the Musculoskeletal System

The nurse is preparing to assess a​ patient's musculoskeletal status. In which order should the nurse perform the techniques of this​ examination?

1 Assess gait and posture. 2 Inspect and palpate the bones for any obvious deformity or changes in size, shape, or a painful response. 3 Measure the extremities for length and circumference, and compare limbs bilaterally. 4 Assess joints for swelling, pain, redness, warmth, crepitus, and range of motion (ROM). ​Rationale: When performing an assessment of the musculoskeletal​ system, first review the​ patient's gait and posture. Inspection is the next technique. Inspect and palpate the bones for any obvious deformity or changes in size or shape. Palpation also will elicit tenderness or pain. Inspect the extremities for​ symmetry, having equal length and muscle mass. If a difference is​ noted, measure extremity length and​ circumference, comparing limbs bilaterally. Inspect and palpate joints for​ swelling, pain,​ redness, or warmth.

In which order should the nurse assess a patient complaining of pain in both​ knees? Place in order of priority.

1 inspection 2 palpation 3 measurement of muscle mass 4 range of motion ​Rationale: The techniques used to assess the musculoskeletal system are​ inspection, palpation, and measurement of muscle mass and range of motion​ (ROM). The patient may​ stand, sit, or lie​ down, and the sequence of the exam should be such that the patient does not have frequent position changes.

The nurse is reviewing data collected during the assessment of an older female. What should the nurse identify as being a normal​ age-related change?

1 cm nodule palpated in right foot lateral curvature of the spine decreased range of motion in right and left hips This is the correct answer. height decreased 0.5 inch in 2 years This is the correct answer. complains of frequent cramping of lower extremities correct ​Rationale: The height decrease is a geriatric consideration due to the shortening of the spinal column and the decrease in bone mass. Muscle cramping can occur as the muscle fibers atrophy and the fibrous tissue replaces muscle tissue. A nodule that is palpated in the foot is not a change that is common in the geriatric population and should be examined further. Decrease in range of motion is a common finding. Lateral curvature of the spine or scoliosis is not a common geriatric finding and may have several causes.

The nurse completes a physical assessment on a patient recovering from a stroke. The patient has no muscle function of the left leg and passive range of motion of the left arm. The right leg and arm have full range of motion against full resistance. How should the nurse document the muscle grading of these assessment​ findings?

5 right arm This is the correct answer. 2 left arm This is the correct answer. 0 left leg This is the correct answer. 5 right leg This is the correct answer. 3 left arm ​Rationale: A grading of 0 means no muscle function. A grading of 2 means function with passive range of motion. A grading of 5 means full range of motion against full resistance. A grading of 3 means full range of motion against gravity.

A patient is seen in the clinic for chronic low blood calcium. What effect will this have on bone​ health?

Bones will pull the needed calcium from other body structures. Bone production will occur in order to help increase the blood calcium. Bone resorption will be triggered in order to increase serum calcium levels. This is the correct answer. Bones will not be affected because the calcium is low in the blood. ​Rationale: When blood levels of calcium​ decrease, parathyroid hormone​ (PTH) is released. PTH then stimulates osteoclast activity and bone resorption so that calcium is released from the bone matrix. As a​ result, blood levels of calcium​ rise, and the stimulus for PTH release ends. Bone production does not occur to increase low blood calcium levels. Bones will be affected to address the​ body's need for calcium. There are no other body structures that have adequate amounts of calcium to increase serum levels.

While conducting range of motion with an older​ patient, the patient begins to cry and​ states, "My knee hurts when you do​ that!" Which interventions should be implemented at this​ time?

Continue with the assessment. Call the physician. This is the correct answer. Stop ROM immediately in that extremity. This is the correct answer. Have the patient complete the assessment alone. Massage the knee for 20 minutes. ​Rationale: ROM should be performed without causing the patient discomfort. Knee pain may be referred pain from a hip fracture or other hip injury as well as alteration in the structure of the knee. The action should be stopped. The physician may order diagnostic tests in order to evaluate the source of the pain. Massaging the knee may cause further pain and discomfort to the patient and has no therapeutic benefit at this time. Do not cause further injury by continuing with the assessment.

A patient is scheduled for an electromyelogram​ (EMG). What should the nurse instruct the patient about this diagnostic​ test?

Do not take any medication prior to this test without physician approval. This is the correct answer. The test measures nerve conduction along pathways. The test measures electrical activity of skeletal muscles at rest. This is the correct answer. Fluids containing caffeine are permitted prior to the test. Do not smoke for 3 hours before the test. This is the correct answer. correct ​Rationale: The electromyelogram​ (EMG) measures the electrical activity of skeletal muscles at rest. When preparing the patient for the​ testing, instruct the patient to avoid behaviors that may influence the test. This includes no smoking for 3 hours before the test and avoiding fluids containing caffeine. The physician must have the final determination regarding which medications can be allowed prior to the testing.

A patient needs an​ x-ray of the arm. What should the nurse do to prepare the patient for this diagnostic​ test?

Find out the​ patient's allergies. Initiate a peripheral IV in the opposite arm. Do no special preparation. This is the correct answer. Cleanse the arm with antibacterial cleanser. ​Rationale: No special preparation is needed for standard​ x-rays. Routine​ x-rays do not require the patient to have an IV inserted. Allergies will not impact routine​ x-ray studies. Cleaning the extremity is not necessary for the​ x-ray.

A patient complains of pain in the​ jaw, swelling, and the inability to open the mouth without pain. Where should the nurse palpate when assessing this​ patient?

Option A This is the correct answer. Option C Option D Option B Rationale​: The nurse will palpate the temporomandibular​ joints, in front of the​ ears, just below the​ "sideburns."

The nurse determines that a​ patient's gait is normal. What did the nurse assess to make this clinical​ decision?

The gait is slow and deliberate as if the patient is gingerly pulling one side up to meet the other. The patient does not​ stumble, run into​ objects, or fall. The gait is jerky and​ quick, which indicates the patient has excellent motor control. The gait is smooth and steady without limping. This is the correct answer. The posture is upright and straight. correct ​Rationale: Alterations in gait can be difficult to assess. The nurse should watch the patient walk from the front and from behind and look closely to see that gait is smooth and steady and that posture is upright and straight.​ Slow, jerky, or stumbling movements are abnormalities that warrant further evaluation.​ Slow, deliberate movements can indicate pain or another health problem.

The patient is about to have a magnetic resonance imaging​ (MRI) to diagnose a soft tissue abnormality of the lower leg. About which finding should the nurse immediately notify the​ physician?

The patient has a concern about what will be found on the MRI. The patient has a history of hypertension. The patient did not eat breakfast due to earlier nausea. The patient has a pacemaker. correct ​Rationale: The patient will be prohibited from having an MRI due to the pacemaker. Metallic implants prevent the test because radio waves and magnetic fields are used. All tests have the capacity to promote patient concern and anxiety. This is a normal behavior and does not require physician notification. The presence of hypertension and reduced dietary intake will not have an adverse impact on the MRI results.

A patient comes to the emergency department complaining of right knee pain after being knocked down while playing basketball. The exam reveals the patient experiences difficulty when stepping down on the right leg due to acute pain around the knee and slight swelling of the right knee. What should the nurse expect to be prescribed for this​ patient?

The patient will be sent home with instructions to use ice for one week. The patient will be admitted to the hospital and scheduled for exploratory surgery. The patient will be scheduled to see an orthopedic physician and a tentative appointment for a magnetic resonance imaging​ (MRI) scan. This is the correct answer. The patient will be admitted to the hospital and seen by an orthopedic specialist. ​Rationale: This injury would not be considered an emergency if alterations in​ sensation, perfusion, and movement of the leg are present. Since these changes are not noted on​ assessment, hospitalization or surgery would not be indicated. The possible injury to the knee​ (likely cartilage​ injury) will be evaluated by a specialist and a decision will be made regarding the need for the MRI. An MRI would evaluate tears of a ligament or cartilage.

The nurse is planning to determine whether a patient has fluid in the knee. What should the nurse use to make this​ assessment?

Thomas test bulge sign This is the correct answer. ballottement This is the correct answer. ​Phalen's test McMurray test ​Rationale: To assess for larger amounts of fluid in the​ knee, the nurse should conduct the ballottement​ test, which is done by applying downward pressure on the knee with one hand while pushing the patella backward against the femur with the other hand. There should be no movement of the patella. The patella should rest firmly over the femur. Increased fluid will cause a tapping sound as the patella displaces the fluid and hits the femur. Bulge sign indicates increased fluid in the knee joint and is indicated to assess for smaller amounts of fluid on the knee.​ Phalen's test is an assessment tool that may be indicative of carpal tunnel syndrome. The Thomas test may indicate hip contracture. The McMurray test is used to indicate an injury to a​ meniscus, a disk of cartilaginous tissue in the knee.

A patient is scheduled for a bone scan. For which health problem should the nurse suspect this test is being used to​ diagnose?

a muscle mass near the bone bone cancer This is the correct answer. normal calcium level new onset pain in the area of the bone ​Rationale: Bone scans show increased uptake of the radioisotope in bone cancer. The bone scan would do little to provide a definite analysis of a muscle mass. New onset bone pain would require other initial evaluation studies. A bone scan is not indicated to diagnose a normal calcium level.

The nurse would document​ "unable to​ assess" for which patient in relation to performing​ Phalen's test?

a patient with a long leg cast a patient with osteoarthritis of the hips a patient wearing compression stockings a patient with an​ above-the-elbow amputation correct ​Rationale: ​Phalen's test involves holding the wrists in acute flexion against one another for 60​ seconds, which​ isn't possible following upper extremity amputation. Numbness and burning in the fingers could indicate carpal tunnel syndrome. The presence of a leg​ cast, compression​ stocking, or hip pain would not deter the nurse from completing the exam.

The nurse is reviewing assigned patients who are scheduled for an MRI. Which patient should the nurse identify as being able to safely undergo an MRI diagnostic​ test?

a patient with external hardware following a fracture repair a patient with an open abdominal wound This is the correct answer. a patient with a pacemaker for three years a patient with shrapnel from a military assault ​Rationale: Magnetic resonance imaging​ (MRI) uses radio waves and magnetic fields to detect musculoskeletal disorders. The nurse must screen patients prior to the exam for metallic implants such as​ pacemakers, shrapnel, or joint replacements. The presence of an open abdominal wound​ (presumably packed and​ bandaged) would not cause concern for injury.

The nurse is teaching a patient about an endoscopic examination of the interior surfaces of a joint during which surgery and diagnosis can also be accomplished. About which technique is the nurse instructing the​ patient?

arthrocentesis arthroscopy This is the correct answer. atherogenesis arthrodesis ​Rationale: Arthroscopy is endoscopic examination of the interior surfaces of a joint during which surgery and diagnosis can also be accomplished. Arthrocentesis is the clinical procedure of using a syringe to collect synovial fluid from a joint​ capsule; it is used in the diagnosis of​ gout, arthritis, and synovial infections. Atherogenesis the formation of subintimal plaques in the lining of arteries. Arthodesis is the artificial induction of joint ossification between two bones.

The patient is ordered to be on bed rest for two months. The nurse realizes that the​ patient's bones will

be affected positively by the rest and be stronger as a result. increase their osteoblastic activity to promote ossification. undergo increased osteoclast activity and bone resorption. This is the correct answer. not be affected by the bed rest. ​Rationale: Bones that are not in use for a prolonged time promote bone resorption or bone loss. Bones that are inactive undergo increased osteoclast activity and bone resorption. Bones that are in use and subjected to stress will increase their osteoblastic activity and develop bone ossification.

The nurse is assessing a patient with carpal tunnel syndrome. What assessment techniques should the nurse use to determine this​ patient's finger​ function?

bending the hand forward and backward making a fist This is the correct answer. spreading the fingers This is the correct answer. shaking hands This is the correct answer. straightening the arm ​Rationale: To assess the function of the​ fingers, the nurse should ask the patient to shake​ hands, make a​ fist, and spread the fingers. Straightening the arm assesses the triceps muscle. Bending the hand forward and backward assesses the wrist muscles.

The patient complains of pain and clicking in the right knee. The nurse will use what test to assess the​ patient? Mark an​ "X" on the correct figure.

caregiver bended pt knee Rationale​: The nurse will perform​ McMurray's test.​ Pain, locking, or a popping sound may indicate an injury to the​ meniscus, a disk of cartilaginous tissue in the knee. The second option is the Thomas test for hip flexion contracture. The third option shows manual traction.

The nurse is caring for an older patient. What should the nurse realize is an expected​ age-related change in this​ patient's musculoskeletal​ system?

decreased bone mass and calcium​ absorption, which increase risk for fractures This is the correct answer. difficulty with dexterity after age 50 vertebrae lengthening and​ thinning, which leads to increased bone production pain when ambulating due to increased bone mass and minerals ​Rationale: Normal aging is associated with a reduction in bone mass and calcium absorption. Bone production does not increase with aging. Pain with ambulation is not associated with increased bone mass. Difficulty with dexterity is not necessarily a usual occurrence after age 50.

The nurse is assessing an older​ patient's musculoskeletal status. What should the nurse consider as normal findings for this​ patient?

decreased bone mass and minerals This is the correct answer. elongated vertebrae decreased range of motion This is the correct answer. increased calcium reabsorption atrophied muscle fibers correct ​Rationale: With​ aging, decreased bone​ mass, minerals, and calcium absorption contribute to bones that are thinner and weaker. Muscle fibers​ atrophy, leading to loss of muscle​ mass, strength, and agility. The vertebrae shorten and height decreases. Range of motion declines as cartilage on bone surfaces in joints​ deteriorates, making movement more painful.

A patient recovering from a total hip replacement develops a fever and redness at the surgical site. What should the nurse consider first when assessing this​ patient?

development of osteomyelitis This is the correct answer. subacute osteoporosis undiagnosed osteitis deformans pathological fracture ​Rationale: Osteomyelitis is an infection of a bone. Since the patient had a total hip​ replacement, the joint or bone may be infected. Subacute osteoporosis is not a clinical disorder. This patient is not demonstrating signs of a pathological fracture. Osteitis deformans is a chronic disorder that causes irregular bone breakdown and bone weakness.

The nurse is completing a health history with a patient. When assessing for a family or genetic history of musculoskeletal​ disorders, what should the nurse​ include?

fibromyalgia osteoarthritis This is the correct answer. lupus erythematosis This is the correct answer. ankylosing spondylitis This is the correct answer. gout correct ​Rationale: Musculoskeletal diseases believed to have a genetic component include​ osteoarthritis, gout, muscular​ dystrophy, ankylosing​ spondylitis, and lupus erythematosus. Fibromyalgia is not believed to have a genetic component.

A patient is having a creatine kinase​ (CK) level drawn. For which health problem would the nurse expect this level to be​ elevated?

gout muscle disease This is the correct answer. bone tumors juvenile rheumatoid arthritis ​Rationale: CK​ (the isoenzyme​ CK-MM) is elevated in muscle trauma and muscle disease. Juvenile rheumatoid arthritis is a systemic disease process that affects the​ body's joints and other​ systems; CK levels will not assist in its diagnosis. Uric acid levels are used to diagnose gout. The presence of bone tumors would be identified by radiological testing.

The nurse is preparing to assess a patient with myotonic dystrophy. For what health problems should the nurse assess this​ patient?

hair loss This is the correct answer. significant muscle wasting This is the correct answer. cataracts This is the correct answer. long extremities spinal deformities ​Rationale: Myotonic dystrophy is an inherited disorder in which the muscles become​ weak, have a decreased ability to​ relax, and eventually waste away. Other manifestations include hair​ loss, and cataracts. Long extremities and spinal deformities are characteristics of Marfan syndrome.

The nurse notes that a patient is prescribed to have a human leukocyte antigen​ (HLA) test drawn. For which health problems should the nurse potentially plan care for this​ patient?

osteoporosis ankylosing spondylitis This is the correct answer. Paget disease rheumatoid arthritis juvenile rheumatoid arthritis correct ​Rationale: The human leukocyte antigen​ (HLA) test is used to diagnose diseases such as juvenile RA or ankylosing spondylitis. Alkaline phosphatase is used to diagnose bone diseases such as​ osteoporosis, Paget​ disease, and rheumatoid arthritis.

A patient is seen in the​ physician's office following several tests. The test results include elevated blood​ calcium, elevated alkaline​ phosphatase, elevated​ phosphorus, normal creatine​ kinase, and increased uptake of the radioisotope on bone scan. The nurse realizes that the patient most likely is experiencing which health​ problem?

osteoporosis rheumatoid arthritis bone cancer This is the correct answer. bone spurs ​Rationale: The test results are a likely combination in a patient with bone cancer. The blood values described would be anticipated because the bone levels would be reduced in the presence of a malignancy. Osteoporosis would not produce the same blood value alterations. Areas of disease will demonstrate an increase in uptake of radioisotopes on the scans.​ X-rays would be useful in diagnosis of bone spurs. Rheumatoid factor is used to diagnose rheumatoid arthritis.

A patient is seen in the clinic complaining of pain in the left wrist. There is no deformity of the​ wrist, the left radial pulse is​ strong, and there is no history of a fall or injury. What does the nurse expect to see​ ordered?

rest and comfort measures for several days unless pain worsens This is the correct answer. an​ x-ray of both arms to ensure there is no injury present a computerized tomography​ (CT) scan of the wrist to check for soft tissue injury lab work to assess calcium and phosphorus levels ​Rationale: Based on the history and objective​ findings, there is not a present need to order​ x-rays or lab work. A CT scan of a wrist is not expected.​ Initially, rest and comfort measures are best to see if the pain resolves. If the pain persists over several days or if other signs and symptoms​ emerge, a more aggressive approach would be expected.

A patient is recovering from orthopedic surgery on a fractured arm. The nurse realizes that for musculoskeletal​ function, what type of muscle is​ needed?

smooth skeletal This is the correct answer. cardiac a combination of skeletal and smooth ​Rationale: Skeletal muscle is the only muscle in the body that allows musculoskeletal function. Cardiac muscle is exclusive to the heart and smooth muscle is found in organs and is not under voluntary control. Smooth muscle is not needed for musculoskeletal function.

A​ health-conscious young adult female asks the nurse what diagnostic test might help predict the likelihood for developing osteoporosis. With which diagnostic test should​ respond?

somatosensory evoked potential​ (SSEP) arthroscopy an electromyogram​ (EMG) dual energy​ x-ray absorptiometry​ (DEXA) correct ​Rationale: The DEXA can calculate the size and thickness of bone. Arthroscopy is an endoscopic examination of a joint. The electromyogram measures electrical activity of skeletal muscles at rest and during​ contraction, while the SSEP measures nerve conduction.

A patient is diagnosed with a disease that affects fibrous tissue. In which musculoskeletal areas should the nurse expect the patient to experience health​ problems?

teeth This is the correct answer. shoulders hips skull bones This is the correct answer. distal tibia and fibula correct ​Rationale: Fibrous tissue connects bones through collagen fibers. The areas of the​ patient's body that would be affected include the skull​ sutures, the ligament connecting the distal tibia and​ fibula, and the connections between the​ patient's teeth and sockets. Synovial tissue is located in the hip and shoulder joints.

A​ 62-year-old female patient is scheduled to have a DEXA exam. What should the nurse consider as most likely the reason the test has been ordered for this​ patient?

to check for fractures to screen for osteomyelitis to check the degree of osteoporosis This is the correct answer. to evaluate bone cancer ​Rationale: The bone density exam​ (DEXA) evaluates bone mineral density and the degree of osteoporosis.​ X-rays would be used to assess for the presence of fractures. Bone scans would be used in the evaluation of osteomyelitis and potential bone cancer.

The nurse is caring for a patient with a musculoskeletal disorder. For which reason does the nurse suspect the​ patient's alkaline phosphatase​ (ALP) is being​ assessed?

to diagnose muscle trauma to evaluate the presence of bone diseases This is the correct answer. to determine phosphorus levels to establish true calcium levels ​Rationale: Alkaline phosphatase​ (ALP) levels are assessed in patients who are experiencing musculoskeletal disorders in order to evaluate the presence of bone diseases. Blood tests other than ALP establish calcium and phosphorus​ levels, and diagnose muscle trauma.

The nurse is instructing a patient about preparations needed for an electromyogram. Which patient statement indicates that further teaching is​ required?

​"It will be all right to have a glass of water before the​ test." ​"I will not smoke any cigarettes up to three hours before the​ test." ​"I can take my lisinopril the night before my test for my blood​ pressure." ​"I can take my Flexaril before having my test so that my back​ won't hurt." correct ​Rationale: The patient should not take medications such as muscle​ relaxants, anticholinergics, or cholinergics prior to testing since the purpose of the test is to measure the electrical activity of skeletal muscles at rest and during contraction. The muscle relaxant Flexaril will alter the results of the function of the skeletal muscles. The patient is showing his understanding of the instructions for the test when he states that he will not smoke before the test. It is acceptable to have water before the test as long as there is no intake of fluid with caffeine prior to testing. The patient may take his lisinopril for his blood pressure the night before the test.

The​ patient's right femur was fractured and repaired at the diaphysis. When discussing the​ repair, the patient asks the nurse to explain the diaphysis. How should the nurse​ respond?

​"Long bones like the femur have a​ mid-portion or shaft that is called the​ diaphysis." This is the correct answer. ​"Short bones like the femur are​ cuboid, spongy bone that in medical terms are called the​ diaphysis." ​"Irregular bones like the femur are plates of compact bone that are also called the​ diaphysis." ​"Flat bones like the femur are​ disc-shaped and, in medical​ terms, are called the​ diaphysis." ​Rationale: The femur is the long bone in the upper leg that consists of the​ mid-portion (diaphysis) and two broad ends. The femur is not a​ short, irregular, or flat bone.

The height of a female patient has decreased 1 inch over the last year. The patient is concerned and asks the​ nurse, "What is happening to​ me?" How should the nurse respond to the​ patient?

​"There is no need to​ worry; you only lost 1 inch since last year. You probably​ won't lose much more than​ that." ​"Everybody gets shorter as they get​ older." ​"There could be something​ wrong, so you should discuss it with your​ physician." ​"There can be several causes for the loss of​ height, but as we​ age, bone mass decreases and the spinal column​ shortens." correct ​Rationale: With​ aging, the spinal column shortens and height decreases. Telling the patient that everyone gets shorter as they get older is a nontherapeutic answer to the concern that the patient has and does not address the concern. The second answer dismisses the​ patient's concern and predicts a height loss that may not be accurate. The fourth answer also dismisses the​ patient's concern and does not give the nurse the opportunity to educate the patient.

A patient is experiencing numbness and tingling of the left foot. When assessing this​ patient's limb, which movements should the nurse use to determine motor function of the​ patient's left​ ankle?

​120-degree flexion ​20-degree dorsiflexion This is the correct answer. ​45-degree plantar flexion This is the correct answer. ​30-degree hyperextension ​50-degree adduction ​Rationale: Dorsiflexion is performed by bending the ankle to bring the top of the foot towards the shin. Plantar flexion is the straightening of the ankle to point the toes down. Flexion of 120 degrees is used to assess the function of the knee joint. Adduction of 50 degrees is used to assess function of the shoulder joint. Hyperextension of 30 degrees is used to assess function of the hip joint.

The nurse wants to determine if a patient is experiencing carpel tunnel syndrome. Which test should the nurse use to make this​ assessment?

​Phalen's test This is the correct answer. bulge sign Thomas test ballottement ​Rationale: To perform​ Phalen's test, ask the patient to hold the wrist in acute flexion for 60 seconds. There should be no​ tingling, numbness, or pain. Numbness and burning in the fingers during​ Phalen's test may indicate carpal tunnel syndrome. Bulge sign indicates small amounts of fluid on the knee. Ballottement indicates larger amounts of fluid on the knee. The Thomas test is used to assess hip contracture.

The nurse assessing a​ 68-year-old female patient notes an exaggerated curvature of the thoracic spine when the patient bends at the waist. With which alteration does the nurse recognize this finding to be​ consistent?

​scoliosis, which is a normal curvature in the elderly ​kyphosis, which the patient will have to have surgically corrected ​kyphosis, which is a common curvature in older patients This is the correct answer. ​lordosis, which is common in elderly patients ​Rationale: Kyphosis is common in older adult patients. Surgical correction of kyphosis is not a treatment method. Scoliosis is not a normal curvature in the elderly population. Lordosis is an increased lumbar curve and not a normal curvature in the elderly population.