Chapter 49 - Assessment of the Musculoskeletal System

The client is scheduled to undergo closed magnetic resonance imaging (MRI) without contrast medium. Which information does the nurse give to the client before the test?

"All jewelry and clothing with zippers or metal fasteners must be removed." The client must remove all metal objects on clothing and all jewelry before undergoing MRI.

The nursing student is studying the skeletal system. Which statement indicates to the nursing instructor that the student understands a normal physiologic function of the skeletal system?

"Hematopoiesis occurs in the red marrow, which is where blood cells are produced." Hematopoiesis is the production of blood cells in the red marrow.

The client experiencing kyphosis appears withdrawn and does not initiate any conversation with the nurse when medications are given each day. Which statement by the nurse is most supportive of this client?

"How do you feel about the pain in your spine? I am here if you want to talk." This is an open-ended question that allows the client to discuss her or his feelings and gives support to the client. It also informs the client that the nurse is available to listen.

The client recently has had an amputation of the right hand. Which statement by the client, who was right-handed, indicates that he or she is coping effectively?

"I can learn to write with my left hand." This statement indicates that the client is coping effectively by planning to adapt to the loss of the right hand.

A nursing student studying the musculoskeletal system learns about important related hormones. What information does the student learn? (Select all that apply.)

- A lack of vitamin D can lead to rickets. - Estrogens stimulate osteoblastic activity. - Parathyroid hormone stimulates osteoclastic activity. Vitamin D is needed to absorb calcium and phosphorus. A deficiency of vitamin D can lead to rickets. Estrogen stimulates osteoblastic activity. Parathyroid hormone stimulates osteoclastic activity. Calcitonin decreases serum calcium levels when they get too high. Thyroxine increases the rate of protein synthesis in all tissue types.

The nurse is using Lovett's scale to grade a client's muscle strength. The client is able to complete range of motion (ROM) with gravity eliminated. Which grade will the nurse document in this client's record?

2 Two indicates poor: can complete range of motion with gravity eliminated.

A client is distressed at body changes related to kyphosis. What response by the nurse is best?

Ask the client to explain more about these feelings Assessment is the first step of the nursing process, and the nurse should begin by getting as much information about the client's feelings as possible.

Which diagnostic test requires the nurse to know whether the client is allergic to iodine-based contrast?

Computed tomography (CT) A CT scan creates three-dimensional images and may be done with iodine-based contrast.

The 65-year-old female client has chronic hip pain and muscle atrophy from an arthritic disorder. Which musculoskeletal assessment finding does the nurse expect to see in the client?

Antalgic gait This client would have a combination of antalgic gait and lurch. The client with chronic hip pain and muscle atrophy from arthritic disorders would likely have a lurch in the gait.

A client is undergoing computed tomography (CT) of a joint. What action by the nurse is most important before the test?

Assess for seafood or iodine allergy. Because CT uses iodine-based contrast material, the nurse assesses the client for allergies to iodine or seafood (which often contains iodine).

A client had an arthroscopy 1 hour ago on the left knee. The nurse finds the left lower leg to be pale and cool, with 1+/4+ pedal pulses. What action by the nurse is best?

Assess the neurovascular status of the right leg. The nurse should compare findings of the two legs as these findings may be normal for the client. If a difference is observed, the nurse notifies the provider.

When assessing gait, what features does the nurse inspect? (Select all that apply.)

Balance Ease of stride Length of stride Steadiness

A school nurse is conducting scoliosis screening. In screening the client, what technique is most appropriate?

Bending forward from the hips To assess for scoliosis, a spinal deformity, the student should bend forward at the hips. Standing behind the student, the nurse looks for a lateral curve in the spine.

A student nurse learns about changes that occur to the musculoskeletal system due to aging. Which changes does this include? (Select all that apply.)

Bone changes lead to potential safety risks. Osteoarthritis occurs due to cartilage degeneration. Some muscle tissue atrophy occurs with aging.

The client's chart indicates genu varum. What does the nurse understand this to mean?

Bow-legged Genu varum is a bow-legged deformity. A fluid accumulation is an effusion. Genu valgum is knock-kneed. A spinal curvature could be kyphosis or lordosis.

Which ethnic group of women typically has the least amount of bone density?

Caucasian Rationale: Caucasian women tend to have the least amount of bone density of any group, which makes them more likely to have osteoporosis and fractures.

A client returns to the postanesthesia care unit (PACU) after an arthroscopy for a shoulder rotator cuff tear. What is the nurse's priority when caring for this client?

Check the neurovascular status of the affected arm. The priority for postprocedure care after arthroscopy is to assess the neurovascular status of the patient's affected limb every hour or according to agency or surgeon protocol. Monitor and document distal pulses, warmth, color, capillary refill, pin, movement, and sensation of the affected extremity.

The nurse understands that care of the older adult may be affected by which physiologic change in the musculoskeletal system?

Decreased range of motion (ROM) Decreased ROM occurs in the older adult. The client may need assistance with self-care skills. Cartilage degeneration is an age-related change that occurs in the musculoskeletal system. Decreased bone density occurs with musculoskeletal system aging, and porous bones are more likely to fracture. The older adult experiences kyphotic posture, widened gait, and a shift in the center of gravity.

A client is having a myelography. What action by the nurse is most important?

Ensure that informed consent is on the chart. This diagnostic procedure is invasive and requires informed consent.

The nurse plans to use which tool to measure joint range of motion (ROM)?

Goniometer A goniometer provides an exact measurement of flexion and extension or joint ROM. A Doppler device is used to check and find pulses. A reflex hammer is used to test and elicit reflexes and is used in neurologic examinations. A tonometer is used to measure tension or pressure in the eye.

A nurse is providing community education about preventing traumatic musculoskeletal injuries related to car crashes. Which group does the nurse target as the priority for this education?

High school football team Young men are at highest risk for musculoskeletal injury due to trauma, especially due to motor vehicle crashes. The high school football team, with its roster of young males, is the priority group.

Which statement best validates an older patient's understanding of musculoskeletal health interventions?

I should try to exercise at least five times a week It is important to prevent falls in older adults. Regular exercise is the most important element in healthy musculoskeletal aging. Assistive devices may be needed for ambulation. A nutrient-rich diet is an important part of maintaining musculoskeletal health. Assessment of pain can present many challenges. Pain can be related to bone, muscle, or joint problems and may be described as acute or chronic. Patients should not ignore changes in musculoskeletal pain.

The nurse is conducting a musculoskeletal history in the older adult client who requires a caregiver to perform all activities of daily living. Which level of functioning does the nurse record in the client's history using Gordon's Functional Health Patterns?

Level IV-is dependent and does not participate Level IV indicates that the client is dependent and does not participate in activities of daily living such as dressing himself. Level 0 indicates a client who is able to perform full self-care. Level II indicates a client who requires assistance or supervision of another person without assistive equipment or devices. Level III indicates that the client requires the assistance or supervision of another person, as well as assistive equipment or devices.

A diabetic older adult client who had arthroscopic surgery on the right knee the previous day has a red, swollen, and painful right knee. The nurse anticipates that the physician will request which medication?

Levofloxacin (Levaquin) The client's symptoms indicate a possible right knee infection. The first action will be to start antibiotic therapy, especially because the client is diabetic and is at greater risk for infection.

When assessing a female client, the nurse learns that the client has several risk factors for osteoporosis. Which risk factor will be the priority for client teaching?

Low calcium intake The client's calcium intake is the only risk factor that the client can change. The nurse will discuss the other risk factors as contributing to osteoporosis, but the teaching will focus on ways to increase calcium intake.

The ambulatory surgery postanesthesia care unit (PACU) nurse has just received report about clients who had arthroscopic surgery. Which client will the nurse plan to assess first?

Middle-aged adult client who returned to the PACU 25 minutes ago after left knee arthroscopic surgery under epidural anesthesia. After epidural anesthesia, frequent assessments for the return of sensation and movement of the leg will be important. This client is at greatest risk for complications and should be assessed first.

The client is suspected of having muscular dystrophy (MD). For which laboratory test does the nurse anticipate seeing an abnormal result?

Moderately elevated aspartate aminotransferase (AST) The AST level is moderately elevated (three to five times normal) in certain musculoskeletal diseases, such as MD. The CK level is elevated in musculoskeletal diseases such as MD.

An older client's serum calcium level is 8.7 mg/dL. What possible etiologies does the nurse consider for this result? (Select all that apply.)

Normal age-related decrease in serum calcium Possible occurrence of osteoporosis or osteomalacia

The charge nurse in the hospital-based day surgery center is making client assignments for the staff. Which client is most appropriate to assign to a nurse who has floated from the general surgical unit?

Older adult who has undergone arthroscopic surgery of the shoulder under local anesthesia Arthroscopic surgery and local anesthesia have low complication rates and could be monitored by the float nurse, who would be expected to know how to assess neurovascular status

The nurse is reviewing the medication history for a client scheduled for a left total hip replacement. The nurse plans to contact the physician if the client is taking which medication?

Prednisone (Deltasone) to treat asthma Long-term steroid use is strongly associated with osteoporosis and will increase the risk for poor wound healing and prolonged recovery after the hip replacement.

The nurse knows that hematopoiesis occurs in what part of the musculoskeletal system?

Red marrow Hematopoiesis occurs in the red marrow, which is part of the cancellous tissues containing both types of bone marrow.

The nurse is assessing four clients with musculoskeletal disorders. The nurse should assess the client with which laboratory result first?

Serum phosphorus: 2 mg/dL A normal serum phosphorus level is 3 to 4.5 mg/dL; a level of 2 mg/dL is low, and this client should be assessed first.

A nurse is performing a musculoskeletal assessment on an older adult living independently in a senior housing apartment. What normal physiologic changes of aging does the nurse expect? Select all that apply.

Slowed movements Decreased coordination Normal physiologic changes associated with aging include slowed movement and decreased coordination. Muscle contractures, lordosis, and antalgic gait are abnormalities associated with problems with the musculoskeletal system.

Which client information is most essential for the nurse to report to the physician before a client with knee pain undergoes magnetic resonance imaging (MRI)?

The client has a permanent pacemaker. Having a permanent pacemaker is a contraindication for MRI because metallic implants are present within the client.

A hospitalized client's strength of the upper extremities is rated at 3. What does the nurse understand about this client's ability to perform activities of daily living (ADLs)?

The client is able to perform ADLs but not lift some items. This rating indicates fair muscle strength with full range of motion against gravity but not resistance. The client could complete ADLs independently unless they required lifting objects.

Which aspect of a musculoskeletal assessment will the physical therapist and the nurse plan to collaborate on?

The need for ambulatory devices The nurse and the physical therapist assess and collaborate on the need for ambulatory devices

The nurse is completing an admission assessment on a client scheduled for arthroscopic knee surgery. Which information will be most essential for the nurse to report to the health care provider?

Warm, red, and swollen knee Swelling, heat, and redness may indicate infection in the knee joint, which would indicate a need to cancel the procedure.

A patient is scheduled for an electromyography (EMG) to evaluate diffuse or localized muscle weakness. What question should the nurse ask the patient before the test?

What herbal over-the-counter medicines do you take? EMG helps in the diagnosis of neuromuscular, lower motor neuron, and peripheral nerve disorders. This test is contraindicated for patients undergoing anticoagulant therapy. Many patients do not consider herbal agents medications, but many herbal agents may alter anticoagulation, creating an unanticipated risk of the procedure. Adequate sedation and, at times, management of anxiety are necessary interventions during the procedure.