Chapter 39: Assessment of Musculoskeletal Function

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?"

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."

The nurse is conducting a community education program on hip fracture risk. The nurse evaluates that the participants understand the program when the participants determine that client at highest risk for a hip fracture is a(n)

80-year-old man recently widowed.

Which term refers to moving away from midline?

Abduction

Which statement describes paresthesia?

Abnormal sensations

Which body movement involves moving toward the midline?

Adduction

The nurse is providing care to a client following a knee arthroscopy. What would the nurse expect to include in the client's plan of care?

Administering the prescribed analgesic.

A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy?

Apply a cold pack at the insertion site.

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone?

Calcitonin

Which of the following is an example of a gliding joint?

Carpal bones in the wrist

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

Which is a circulatory indicator of peripheral neurovascular dysfunction?

Cool skin

Choose the correct statement about the endosteum, a significant component of the skeletal system:

Covers the marrow cavity of long bones

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

Which term refers to the shaft of the long bone?

Diaphysis

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 assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy?

Increased diameter of the calf

After a person experiences a closure of the epiphyses, which statement is true?

No further increase in bone length occurs.

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

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 of the following is the final stage of fracture repair?

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-rays will be taken.

Skull sutures are an example of which type of joint?

Synarthrosis

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.

Which clinical manifestation would the nurse recognize as an indicator of peripheral neurovascular dysfunction? Select all that apply.

Toes mottled and cool Complaints of pins and needles in feet

Red bone marrow produces which of the following? Select all that apply.

White blood cells (WBCs) Red blood cells (RBCs) Platelets

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.

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

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 left calf. The nurse attributes the decreased girth to

atrophy of right calf muscle.

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

Parkinson's disease

The nurse is preparing the client with a right neck mass for magnetic resonance imaging (MRI). Which question should the nurse ask? Select all that apply.

"Have you removed your hearing aid?" "Are you wearing any jewelry?" "Do you have a pacemaker?"

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."

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."

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

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

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 fracture of a 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)

The nurse is reporting on the results of client blood work to the oncoming nurse. Upon reviewing the data, it is noted that the client has an elevated uric acid level. Which inflammatory process would the nurse screen for on shift rounds?

Gout

The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding?

Lordosis

Which description refers to an osteon?

Microscopic functional bone unit

The nurse is working on an orthopedic floor caring for a client injured in a football game. The nurse is reviewing the client's chart noting that the client has previously had an injured tendon. The nurse anticipates an injury between the periosteum of the bone and which of the following?

Muscle

Which cells are involved in bone resorption?

Osteoclasts

The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.)

Pale, cyanotic, or mottled color Cool temperature of the extremity More than 3-second capillary refill

Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes?

Peroneal

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

A patient is scheduled for a bone marrow biopsy. The nurse explains to the family that the bone marrow is located mainly in four areas. She tells the family that the site to be used would be the:

Sternum.

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. This 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 torn cords of fibrous connective tissue that connect muscles to bones. What type of tear has this client sustained?

Tendon

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

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.

Fracture healing occurs in four areas, including the

external soft tissue.

A client has an exaggerated convex curvature of the thoracic spine. What is this condition called?

kyphosis

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 assessing the client for scoliosis. What will the nurse have the client do to perform the assessment?

Stand behind the client and ask the client to bend forward at the waist.

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.

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.

The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding?

Tear in the joint capsule

Which term refers to mature compact bone structures that form concentric rings of bone matrix?

Lamellae

A client is scheduled to undergo an electromyography. When performed, what will this test evaluate?

Muscle weakness

A client comes to the emergency department with reports of pain in the left ankle. The client states, "I missed a step coming down the stairs, and landed funny." The ankle is swollen and tender to the touch. What will the nurse do to help control the swelling?

Raise the left leg above the level of the heart.