chapter 35 assessment of musculoskeletal function
The nurse is performing a musculoskeletal assessment of a client in a nursing home who had a stroke 2 years ago and who has right sided hemiplegia. The nurse notes that the girth of the client's right calf is 2 inches less in diameter than the right calf. The nurse attributes the decreased girth to
atrophy of right calf muscle
Which hormone inhibits bone resorption and increases the deposit of calcium in the bone?
calcitonin
The nurse is assessing a client for dietary factors that may influence her risk for osteoporosis. The nurse should question the client about her intake of what nutrients?
calcium vitamin D
The orthopedic nurse is caring for a client diagnosed with a fracture of the radius. In which type of bone tissue does the nurse anticipate the fracture being?
cancellous
What is the term for a rhythmic contraction of a muscle?
clonus
The nurse is admitting an older adult to a skill nursing facility. What assessment parameters will the nurse expect to find with the musculoskeletal assessment?
decreased endurance joint stiffness decreased range of motion
The nurse is performing a neurovascular assessment of a client's injured extremity. Which would the nurse report?
dusky or mottled skin color
A client is diagnosed with a fracture of a diarthrosis joint. What is an example of this type of joint?
elbow
A client is diagnosed with a fracture of diarthrosis joint. What is an example of this type of joint?
elbow
Which diagnostic test would the nurse expect to be ordered for a client with lower extremity muscle weakness?
electromyograph (emg)
Which of the following describes a muscle that is limp and without tone?
flaccid
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
What areas of the body may be examined when bone densitometry is done?
hip spine wrist
A client with a sports injury undergoes a diagnostic arthroscopy of the left knee. What comment by the client following the procedure will the nurse address first?
my toes are numb
After a person experiences a closure of the epipyses, which statement is true?
no further increase in bone length occurs
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 nurse practitioner assesses a patient's movement in his left hand after a cast is removed. The nurse asks the patient to turn his wrist so the palm of his hand is facing up. The movement is known as:
supination
A client is seen in the emergency room for a knee injury that happened during a basketball game. Diagnostic tests reveal cords of fibrous connective tissue that connect muscles to bones. What type of tear has this client sustained?
tendon
The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site?
the fracture is on the diaphysis
The nurse is assessing a client with a musculoskeletal system condition. Which statement indicates to the nurse that the clietn is experiencing bone pain?
the pain feels deep in my legs and keeps me awake at night
Patient education for musculoskeletal conditions for the aging is based on the understanding that there is a gradual loss of bone after a peak of bone mass at age:
30 years
The nurse is performing a neurological assessment. What will this assessment include?
Ask the client to plantar flex the toes
A client is diagnosed with a bone tumor. What result would the nurse expect the blood tests to reveal?
Decreased serum calcium level
A nurse understands the influence of hormones on bone maintenance. Therefore, the nurse knows that a patient on long-term cortisol may experience:
Increased bone resorption.
Which term refers to moving away from midline?
abduction
While reading a client's chart, the nurse notices that the client is documented to have paresthesia. The nurse plans care for a client with
abnormal sensations
A client tells the health care provider about shoulder pain that is present even without any strenuous movement. The health care provider identifies a sac filled with synovial fluid. What condition will the nurse educate the client about?
bursitis
Which hormone inhibits bone reabsorption and increases calcium deposit in the bone?
calcitonin
The home care nurse is evaluating the musculoskeletal system of a geriatric client whose previous assessment was within normal limits. The nurse initates a call to the health care provider and / or emergency services when which change is found?
decreased right sided muscle strength
The nurse working in the emergency department receives a call from the x ray department communicating that the client the nurse is caring for has a fracture in the shaft of the tibia. The nurse tells the physician that the client's fracture is in the
diaphysis
Which term refers to the shaft of the long bone?
diaphysis
A client has an exaggerated convex curvature of the thoracic spine. What is this condition called?
kyphosis
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
The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding?
lordosis
The nurse is employed at a long term care facility caring for geriatric clients. Which assessment finding is characteristic of an age related change?
loss of height
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
After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement?
remodeling
The nurse is assessing a young client during an annual sports physical at school. The assessment reveals that the client has lateral curving of the spine. THe nurse reports to the health care professional that the assessment revealed
scoliosis
An example of a flat bone is the
sternum
The nurse is teaching a client about a vitamin that supports calcium's absorption. What vitamin is the nurse teaching the client about?
vitamin D
The older client asks the nurse how best to maintain strong bones. What is the nurse's best response?
weight bearing exercises can strengthen bones
Which assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy?
increased diameter of the calf
A nurse performs a neurovascular assessment on a client 2 weeks after a wrist cast had been removed. The nurse documents in the client's chart that there is normal sensation in the ulnar nerve. What finger assessment test will the nurse perform on this client?
prick the distal fat pad on the small finger
The nurse is caring for a client who experienced a crushing injury of the lower extremities. Which of the following symptoms is essential to be reported to the physician?
pulselessness
The nurse is conducting the admission assessment for a client who is to undergo an arthrogram. What is the priority question the nurse should ask?
"Do you have any allergies?"
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
Which is an indicator of neurovascular compromise?
Capillary refill of more than 3 seconds
Which of the following biologically active vitamin functions to increase the amount of calcium in the blood?
D
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
Which cells are involved in bone resorption?
Osteoclasts
The nurse is reviewing the client's admission assessment and notes that crepitus of the right knee joint was documented. What assessment will the nurse find as described by crepitus?
a grating sound when a joint is put through range of motion
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. Muscluar dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration?
an electromyography
The nurse is preparing the client with a right neck mass for magnetic resonance imaging (MRI). Which question should the nurse ask?
are you wearing any jewelry have you removed your hearing aid do you have a pacemaker
Which of the following diagnostic studies are done to relieve joint pain due to effusion?
arthrocentesis
Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist?
arthrography
A patient is scheduled for a procedure that will allow the physician to visualize the knee joint in order to diagnose the patient's pain. What procedure will the nurse prepare the patient for?
arthroscopy
Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy?
aspirin
Which is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes?
compartment syndrome
The nurse is evaluating a client's peripheral neurovascular status. Which would the nurse report to the health care provider as a circulatory indicator of peripheral neurovascular dysfunction?
cool skin
A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?
i should use my heating pad this evening to reduce some of the pain in my knee
Which of the following is an example of a hinge joint?
knee
Which of the following is the most common site of joint effusion?
knee
The nurse is empolyed at a long term care faciliity caring for geriatric clients. Which assessment finding is characteristic of an age related change?
loss of height
The nurse is caring for a client who has a definicency in the formation of cartilage in joints. Which essential substance is absent?
matrix
The nurse is preparing to assess the spine of an older adult. Which actions will the nurse take during this assessment?
measure height ask the client to bend backward ask the client to bend forward
There are thousands of components of the musculoskeletal system that facilitate mobility and independent function. The function of skeletal muscle is promoting
movement of skeletal bones
A nurse knows that a person with a 3 week old femur fracture is at the stage where angiogenesis is occurring. What are the characteristics of this stage?
new capillaries producing a bridge between the fractured bones
An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification?
osteoblasts
Which serum level indicates the rate of bone turnover?
osteocalcin
Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes?
peroneal
Red bone marrow produces which of the following?
platelets WBC RBC
A patient has a fracture of the right femur sustained in an automobile accident. What process of fracture healing does the nurse understand will occur with this patient?
reactive, reparative, remodeling
Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis?
risk for infection
A client has a fracture that is being treated with open rigid compression plate fixation devices. What teaching will the nurse reinforce to the client about how the progress of bone healing will be monitored?
serial x ray will be taken
A client has a fracture that is being with open rigid compression plate fixation devices. What teaching will the nurse reinforce to the client about how the progress of bone healing will be monitored?
serial x rays will be taken
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
The nurse is assigned to a client admitted with advanced parkinson's disease. What type of gait correlates with parkinson's disease?
shuffling
The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse?
the patient has rheumatoid arthritis
A client is recovering from a fractured hip. What would the nurse suggest that the client increase intake of to facilitate calcium absorption from food and supplements?
vitamin D
The older client asks the nurse how best to maintain strong muscles What is the nurse's best response?
weight resistance exercises can strengthen muscles
A client's blood test results reveal an elevated alkaline phosphatase. What might this indicate?
a bone tumor
