Chapter 61 Musculoskeletal Assessment

An electromyogram may need to be rescheduled based on which patient statement upon their arrival for the procedure? a. "I drank apple juice last night" b. "I drank 2 cups of coffee this morning" c. "I have been taking antibiotics for one week" d. "I have had knee pain since early this morning"

b. "I drank 2 cups of coffee this morning" An electromyagram helps record electrical activity of the muscles. The nurse should advise the patient to refrain from taking stimulants such as caffeine for 24 hours before the test. If the patient drinks two cups of coffee on the day of the scheduled test, it may alter the results. The nurse should alert the primary care provider of the finding so the test can be rescheduled for more accurate results.

Which term is used to describe enlargement of a joint due to fluid collection, which usually leads to pain and stiffness? a. myalgia b. swelling c. paresthesia d. subluxation

b. swelling Swelling is the term to describe enlargement, often of a joint due to fluid collection. This usually leads to pain and/or stiffness and is caused by trauma or inflammation. Myalgia is general muscle tenderness and pain. Paresthesia is numbness and tingling, often described as a "pins and needles" sensation. Subluxation is partial dislocation of a joint.

What time will the nurse plan to send a patient for a bone scan if the radioisotope was given at 9:00AM? a. 9:30pm b. 10:00am c. 11:00am d. 1:00pm

c. 11:00AM A technician usually administers a calculated dose of radioisotopes 2 hours before a bone scan. If patient was injected at 9AM then the procedure should be done at 11AM.

Which joint is a gliding joint? a. wrist b. shoulder c. between carpal bones d. carpometacarpal of thumb

c. between the carpal bones The joint between carpal bones is a gliding joint because the bones move over the surface of each other. The wrist joint is a condyloid joint capable of flexion, extension, abduction, adduction, and circumduction. The shoulder joint is a ball-and-socket joint also capable of flexion, extension, adduction, abduction, and circumduction. The carpometacarpal joint of the thumb is a saddle joint which allows thumb-finger opposition along with flexion, extension ,adduction, abduction, and circumduction.

Which information will the nurse include when teaching a patient about a bone scan procedure? a. 2 additional follow-up scans will be required b. there will be only mild pain associated with the procedure c. the procedure takes approximately 15 to 30 min to complete d. it is important to drink increased fluids after the procedure

d. it is important to drink increased fluids after the procedure Patients are asked to drink increased fluids after a bone scan to aid in excretion of the radioisotope, if not contraindicated by another condition. No follow-up scans and no pain are associated with bone scans, which take 1 hour of lying supine.

Which condition may present with increased flexion in the hip and knee to clear the foot from the floor and footdrop? a. pes planus b. spastic gait c. short-leg gait d. steppage gait

d. steppage gait Steppage gait is a neurogenic disorder associated with increased hip and knee flexion to clear the foot from the floor, along with foot drop. The patient's foot may slap down and along the walking surface. Pes Plans, also called flatfoot, is an abnormal flatness of the sole and arch of the foot. It may be hereditary or due to muscle paralysis, early muscular dystrophy, or injury to posterior tibial tendon. Spastic gait is characterized by short steps, along with dragging of the foot and jerky, uncoordinated, cross-knee movement. It generally results from neurogenic disorders. Short-leg gait is characterized by limp leg and leg length discrepancy of more than 1 inch. It is structural in origin and may be caused by arthritis or fracture.

Which term refers to the turning of the sole of the foot outward away from the midline of the body? a. eversion b. extension c. abduction d. dorsiflexion

a. eversion Eversion is the turning of the sole outward away from the midline of the body. Extension is the straightening of the joints that increases the angle between two bones. Abduction is the movement of a part away from the midline of the body. Dorsiflexion is the flexion of the ankle and toes toward the shin.

Which term will the nurse use to describe fixation of the knee joint of a patient with a long-standing history of rheumatoid arthritis? a. atrophy b. ankylosis c. crepitation d. contracture

b. ankylosis Ankylosis is stiffness or fixation of a joint, often caused by chronic joint inflammation, and destruction and may be associated with rheumatoid arthritis. Atrophy is a flabby appearance of muscle leading to decreased function and tone. Crepitation is a grating or crackling sound that accompanies movement. Contracture is resistance of movement of muscles or joints due to fibrosis of supporting tissues.

An electromyogram (EMG) is used to test which musculoskeletal function? a. evaluates potential of muscle contractions b. evaluates electrical potential related to skeletal muscle contraction c. records variations in volume and pressure of blood passing through tissues d. evaluates bone mineral density, elasticity and strength of bone using ultrasound

b. evaluates electrical potential related to skeletal muscle contraction An EMG evaluates electrical potential related to skeletal muscle contraction. To record potential of muscle contractions, a plethysmography is used. A somatosensory evoked potential (SSEP) looks at the ability of muscle contractions A quantitative ultrasound (QUS) evaluaties bone mineral density, elasticity, and strength of bone using ultrasound rather than radiation.

Which illnesses are known to affect the musculoskeletal system? Select all that apply. a. pancreatitis b. poliomyelitis c. diverticulitis d. tuberculosis e. diabetes mellitus

b. poliomyelitis d. tuberculosis e. diabetes mellitus A past medical history of tuberculosis, poliomyelitis, and diabetes mellitus can either directly or indirectly affect a person's musculoskeletal system. Pancreatitis and diverticulitis are not known to have any direct deleterious effect on musculoskeletal system.

Which instruction will the nurse give to the patient to assess inversion movement of the foot? a. flex your ankle and toes toward the shin b. turn the sole inward toward the midline of the body c. turn the sole outward away from the midline of the body d. flex your ankle and toes toward the plantar surface of the foot

b. turn the sole inward toward the midline of the body To perform inversion movements of the foot, the nurse should instruct the patient to turn the sole inward toward the midline of the body. Flexion of the ankle and toes toward the shin is called dorsiflexion. Turning the sole outward away from the midline of the body is called eversion, and flexion of ankle and toes toward the plantar surface of the foot is called plantar flexion.

Which intervention may be included for a patient with musculoskeletal issues who complains of fatigue and difficulty sleeping? a. leave the door open at night b. leave the room light on at night c. keep the patient up during the day d. provide pillows and blankets for comfort

c. keep the patient up during the day The nurse can promote rest by providing pillows and blankets for comfort and closing the doors to reduce noise at night. The nurse should also turn the light off at night. The patient can benefit from a nap during the day to reduce feelings of tiredness.

Which medication therapy may be prescribed for a patient whose synovial fluid aspirated during an arthrocentesis is a whitish-yellow color and who has uric acid crystals? a. antigout medications b. anti-diabetic medications c. Lactated Ringer's solution d. IV calcium supplements

a. antigout medications Presence of whitish-yellow synovial fluid with uric acid crystals in the synovial fluid indicates that the patient has gout; therefore, administering antigout medication will be the most beneficial for the patient. Lactated Ringer's solution helps maintain fluid and electrolyte balance but does not reduce symptoms of gout. IV calcium supplements prevent osteoporosis but do not alleviate symptoms of gout.

Which joints are diarthrodial joints? Select all that apply. a. hinge joint of the knee b. ligaments joining the vertebrae c. fibrous connective tissue of the skull d. ball and socket joint of the shoulder or hip e. cartilaginous connective tissue of the pubis joint

a. hinge joint of the knee b. ball and socket joint of the shoulder or hip The diarthrodial (synovial) joints include the hinge joints of the knee and elbow, the ball and socket joints of the shoulder and hip, the pivot joint of the radioulnar joint, and the condyloid, saddle, and gliding joints of the wrist and hand. The ligaments and cartilaginous connective tissue joining the vertebrae and pubis joint and the fibrous connective tissue of the skull are syathrotic joints.

An arthroscopy may be ordered to identify which condition? a. fracture of the bone b. the risk of osteoporosis c. articular cartilage abnormality d. peripheral vasculature potency

c. articular cartilage abnormality An arthroscopy involves insertion of an arthroscope into a joint to see the interior of the joint cavity. This can be used for surgery, repair of joint structures, and diagnosis of abnormalities of meniscus, articular cartilage, ligaments, or joint capsules. Fractures of the bones can be identified with traditional, non-contrasted x-ray. Risk for osteoporosis is measured vis a bone density test. Peripheral vasculature potency is assessed with a Doppler ultrasound.

Which term described flexion of the ankle and toes toward the shin? a. inversion b. eversion c. dorsiflexion d. plantar flexion

c. dorsiflexion Flexion of the ankle and toes toward the shin is called dorsiflexion. Eversion refers to turning of the sole outward away from the midline of body. Inversion means turning of the sole inward toward the midline of body. Plantar flexion means flexion of the ankle and toes toward the plantar surface of the foot.

What instrument will the nurse use to assess range of motion? a. spirometer b. arthroscope c. goniometer d. funduscope

c. goniometer Range of motion is most accurately assessed with a goniometer, which measures the angle of the joint. An arthroscope is used to visualize joints. A funduscope is used to assess eye disorders. A spirometer is used to perform pulmonary function tests.

Active movement against gravity and some resistance is considered which muscle strength grade? a. 1/5 b. 2/5 c. 3/5 d. 4/5

d. 4/5 A score of 4/5 means active movement against gravity with some resistance. 1/5 - a barely detectable flicker or trace of contraction with observation or palpation 2/5 - active movement of body part with elimination of gravity 3/5 - active movement against gravity and not against resistance 4/5 - active movement against gravity with some resistance 5/5 - active movement against full resistance without evident fatigue

Which questions about elimination patterns are important for the nurse to ask as part of a musculoskeletal system health history assessment? Select all that apply? a. do you experience constipation? b. does you functional ability make it difficult for you to reach the toilet in time? c. do you need any assistive devices or equipment to achieve a bowel movement? d. how many times in a day do you have to have a bowel movement? e. do you find that problems related to moving your bowels occur after eating a particular food?

a, b, c While assessing a patient with musculoskeletal problems, ask whether the patient experiences constipation related to decrease mobility or to drugs taken for musculoskeletal problem. Similarly, knowing if the patient has difficulty reaching the commode in time due to a musculoskeletal ailment suggests severity of the disorder. The nurse should also understand that it is important to know whether the patient requires assistive devices or equipment to achieve a bowel movement because it gives the nurse an ideas about severity of ailment.

Musculoskeletal assessment is an important component of care for patients on which type of long-term therapy? a. corticosteroids b. beta-adrenergic blockers c. anti platelet aggregators d. calcium channel blockers

a. corticosteroids Corticosteroids are associated with avascular necrosis and decreased bone and muscle mass. Beta-adrenergic blockers, calcium channel blockers, and anti platelet aggregators commonly are not associated with damage to the musculoskeletal system.

Which method will the nurse use to measure the left leg of a patient who complains of severe pain in the left lower extremity, who has difficulty ambulating, and whose left leg appears to be slightly shorter than the right? Select all that apply. a. measure the muscle mass circumferentially at the largest area b. measure the muscle mass circumferentially at the smallest area c. measure the length and circumferences at the same points of opposite limb d. measure the length of the extremity from the anterior superior iliac spine to the toe e. measure the length of the extremity from the anterior superior iliac spin to the medial malleolus

a. measure the muscle mass circumferentially at the largest area c. measure the length and circumferences at the same points of opposite limb e. measure the length of the extremity from the anterior superior iliac spin to the medial malleolus When length discrepancies or subjective problems are noted, the limb length and circumferential muscle mass measurements should be obtained. Leg length should be measured when gait disorders are observed. Muscle mass should be measured circumferentially at the largest area of the muscle. The measurements should be compared with the same points of opposite limbs. The affected limb should be measured between the anterosuperior iliac crest and the bottom of the medial malleolus.

Fluid aspirated during arthrocentesis procedure for a patient with gout may have which characteristics? Select all that apply? a. floating fat globules b. whitish-yellow color c. purulent and thick fluid d. elevated protein content e. presence of uric acid crystals

b. whitish-yellow color e. presence of uric acid crystals In the patient with gout, the fluid aspirated from arthrocentesis would be whitish-yellow color. The presence of uric acid crystals also suggests a diagnosis of gout. Floating fat globules are found when there is a bone injury. Purulent and thick fluid indicates infection. Protein content is elevated in septic arthritis.

Which statement by the nurse is an appropriate response to an older adult patient who states, "I'm frustrated by my flabby belly and rigid hips." a. "you should go on a diet and exercise more to feel better about yourself." b. "something must be wrong because you should not have these problems" c. "you have arthritis and need to go on nonsteroidal anti-inflammatory drugs (NSAIDs)." d. "decreased muscle mass and strength and increased hip rigidity are normal changes of aging."

d. "decreased muscle mass and strength and increased hip rigidity are normal changes of aging" The musculoskeletal system's normal changes of aging include: -decreased muscle mass and strength -increased rigidity in the hips, neck, shoulders, back and knees -decreased fine motor dexterity -slowed reaction times Going on a diet and exercising will help but not stop the changes. Telling the patient "something must be wrong with you" will not be helpful to the patient's frustrations. The patient does not have arthritis or need NSAIDs.

Which description of muscle strength will the nurse score as 1/5 on the Muscle Strength Scale? a. no detection of muscular contraction b. active movement of the body part with elimination of gravity c. active movement against gravity and not against resistance d. a barely detectable flicker or trace of contraction with observation or palpation

d. a barely detectable flicker or trace of contraction with observation or palpation On the Muscle Strength Scale 0/5 - no detection of muscular contraction 1/5 - barely detectable flicker or trace of contraction with observation or palpation 2/5 - active movement of body part with elimination of gravity 3/5 - active movement against gravity and not against resistance

Which diagnostic test does the nurse expect will be prescribed for a patient with a history of falls who is suspected of having a fracture in the radius of the right hand? a. x-ray b. diskogram c. CT scan d. MRI

a. x-ray X-ray is the preliminary diagnostic test for diagnosing fractures. Diskogram involves x-ray of cervical or lumbar intervertebral disc after injection of contrast media into nucleus pulposus. It helps visualization of intervertebral disc abnormalities. It does not aid in assessing fracture in the radius of the right hand. CT scan and MRI are advanced tests to analyze the condition of various other organs and body parts.

Which intervention will the nurse include when preparing a patient for a MRI procedure? Select all that apply. a. offer ear plugs or music b. inform the patient to remain still throughout the procedure c. ensure that patient is not wearing metal such as zippers or jewelry d. ensure that the patient is shaved completely, and also catheterize the patient e. explain that the machine will make loud tapping noises intermittently, and there is no cause for alarm

a, b, c, e The nurse should inform the patient that the procedure is painless. Offer ear plugs or music to listen to so that the patient will be relaxed during the procedure. The patient should have no metal on the clothing. Explain to the patient that the machine will make loud tapping noises intermittently, and there is no cause for alarm. Inform patients who are claustrophobic that they may experience symptoms during examination. Administer an antianxiety agent if indicated and ordered. The procedure is noninvasive, so the patient need not be shaved or cathererized.

Which musculoskeletal assessment findings are normal? Select all that apply. a. muscle strength 5/5 b. no spinal curvature c. no muscle atrophy or asymmetry d. no joint swelling, deformity, or crepitation e. full range of motion of all joints without pain or laxity f. no tenderness on palpation of spine, joints, or muscles

a, c, d, e, f (not b) The components of a normal musculoskeletal system include muscle strength 5/5/; no muscle atrophy or asymmetry; no joint swelling, deformity, or crepitation; full range of motion of all joints without pain or laxity; no tenderness on palpation of spine, joints, and muscles; ordinary curvature (not absence of curvature).

Which statements by the student nurse indicate understanding of an arthroscopy study? Select all that apply. a. "The procedure will be performed under anesthesia" b. "Fluid from the joints will be aspirated during this procedure" c. " This procedure allows visualization of the interior portion of the joint capsule" d. "In case of inflammatory joint diseases, intraarticular injections of corticosteroids may be given" e. "A needle is inserted in the joint, it is distended with fluid or air, and the joint cavity is examined"

a. "the procedure will be performed under anesthesia" c. "this procedure allows for visualization of the interior portion of the joint capsule" e. "a needle is inserted in the joint, it is distended with fluid or air, and the joint cavity is examined" Arthroscopy allows for visualization of the interior portion of the joint capsule through a small fiberoptic tube. This procedure is performed under anesthesia. A needle is inserted in the joint, it is distended with fluid or air, and the joint cavity is examined. Fluid from the joints are aspirated by a procedure called arthrocentesis in which a needle is inserted into the joint cavity and the synovial fluid is aspirated; however, the procedure does not allow visualization of the joint cavity. Arthroscopy is not done to give corticosteroid injections; intraarticular injections can be given when arthrocentesis is done.

A patient with a lateral S-shaped curvature of the thoracic and lumbar spine may also have which clinical manifestation? a. asymmetric shoulders b. cross-knee movement c. fingers drift to ulnar side of forearms d. abnormal flatness of the sole of the foot

a. asymmetric shoulders Presence of a lateral S-shaped curvature of the thoracic and lumbar spine indicates that the patient has scoliosis. Due to lateral spine curvature, the patient's shoulders rise asymmetrically; therefore the nurse would find asymmetric shoulders in the patient. A patient with cerebral palsy or hemiplegia would have cross-knee movement due to spastic gait. A patient with tendon contracture would have fingers drifted to the ulnar side of the forearm. A patient with muscle paralysis, mild cerebral palsy, or early muscular dystrophy would have abnormal flatness of the sole of the foot.

A middle-aged patient who complains of a sore shoulder after raking the yard may be suffering from which condition? a. bursitis b. fasciitis c. sprained ligament d. achilles tendonitis

a. bursitis Bursitis is common in adults over age 40 and with repetitive motion, such as raking. Plantar fasciitis frequently occurs as a stabbing pain at the heel caused by straining the ligament that supports the arch. A sprained ligament occurs when a ligament is stretched or town from a direct injury or sudden twisting of the joint, not repetitive motion. Achilles tendonitis is an inflammation of the tendon that attaches the calf muscle to the heel bone, not the shoulder, and it causes pain with walking or running.

Longterm use of which medications increase a patient's risk of developing a musculoskeletal ailment? Select all that apply. a. corticosteroids b. anti seizure medications c. potassium-depleting diuretics d. hormone therapy for postmenopausal women e. statin medications for treatment of hyperlipidemia

a. corticosteroids b. anti seizure medications c. potassium-depleting diuretics d. hormone therapy for postmenopausal women It is important to review the use of drugs that can have detrimental effects on the musculoskeletal system. Corticosteroids can cause avascular necrosis and decreased bone and muscle mass. Antiseizure meds can increase risk of osteomalacia. Potassium-depleting diuretics may cause muscle cramps and weakness. Hormonal therapy may have adverse effects on the musculoskeletal system and associated amenorrhea can contribute to the development of osteoporosis.

The nurse may note which finding when assessing a fracture of a patient's hand as the bone fragments rub against each other? a. crepitation b. resorption c. subluxation d. proliferation

a. crepitation Crepitation is the grating sensation and sound produced when broken bone fragments rub against one another. Resorption is the loss of bone mass due to a loss of calcium resulting in porous, weak bones. Proliferation is reproduction or multiplication of similar forms, usually referring to increases of cells. Subluxation is a partial or incomplete dislocation or displacement of a bone from its normal position.

Which nursing interventions are appropriate for a patient who is scheduled for a technetium [Tc]-99m bone scan? Select all that apply. a. increase fluid intake after examination b. ensure that patient's bladder is emptied before scan c. explain to the patient that blood sample will be obtained in the test d. explain to the patient that raioisotope is given two hours before the procedure e. explain to the patient that it will be painless because general anesthesia will be administered

a. increase fluid intake after examination b. ensure that patient's bladder is emptied before scan d. explain to the patient that raioisotope is given two hours before the procedure A bone scan involves injecting a radioisotope (usually technetium [Tc]-99m) that is absorbed by the bone. A uniform uptake of the isotope is normal. Fluid intake should be increased after the examination to help elimination of the radioisotope through urine. The patient should empty bladder before procedure. The nurse should explain to the patient that radioisotope is given 2 hours before procedure. The patient should be informed that the procedure takes 1 hour while the patient lies supine and that no pain or harm will result from isotopes. No blood sample is needed and anesthesia is not administered during this test.

Which information will the nurse include when teaching a patient who is anxious about undergoing an athrocentesis? Select all that apply. a. local anesthetic and aseptic preparation are used b. this procedure can be performed at the bedside or in an examination room c. this procedure can be performed at the bedside or in an examination room d. this procedure is performed to visualize and examine interior of the joint cavity e. there are serious complications, such as respiratory distress, related to the procedure f. this procedure is performed to obtain samples of synovial fluid or to remove excess fluid from the joint cavity

a. local anesthetic and aseptic preparation are used b. this procedure can be performed at the bedside or in an examination room f. this procedure is performed to obtain samples of synovial fluid or to remove excess fluid from the joint cavity The nurse should explain to the patient that arthrocentesis involves an incision or puncture of the joint capsule to obtain samples of synovial fluid or to remove excess fluid from within the joint cavity. Local anesthesia and aseptic preparation are used before the needle is inserted into the joint and fluid is aspirated. It is useful in the diagnosis of joint inflammation, infection, meniscal tears, and subtle fractures. The procedure is usually done at bedside or in an examination room. Respiratory distress is not a complication of this procedure, because local anesthesia is given. The interior of the joint cavity is visualized and examined during arthroscopy and not during arthrocentesis.

Festinating gait may present with which signs and symptoms while the patient is ambulating? Select all that apply. a. speed may increase as if patient is unable to stop b. patient displays delayed start with short, quick, shuffling steps c. the patient is unable to walk for more than two steps at a time d. the patient is unable to walk in a straight line and walks diagonally e. while walking, the neck, trunk and knees flex while the body is rigid

a. speed may increase as if patient is unable to stop b. patient displays delayed start with short, quick, shuffling steps e. while walking, the neck, trunk and knees flex while the body is rigid Festinating gait is a neurogenic disorder characterized by an increase in speed as if the patient is unable to stop (festination), a delayed start with short, quick, shuffling steps, and flexion of the neck, trunk, and knees during walking while the body is rigid. The patient can walk in a straight line and for more than 2 or 3 steps at a time.

Which statements by the student nurse indicate understanding of a straight-leg-raising test? Select all that apply. a. "patient should lie prone for the test" b. "the nerve root at the level of L4-5 or L5-S1 may be involved" c. "the patient is instructed to actively raise his or her legs to 60 degrees" d. "the test is positive if the patient complains of pain along the distribution of the sciatic nerve" e. "a positive test indicates nerve root irritations from intervertebral disc prolapse and herniation"

b. "the nerve root at the level of L4-5 or L5-S1 may be involved" d. "the test is positive if the patient complains of pain along the distribution of the sciatic nerve" e. "a positive test indicates nerve root irritations from intervertebral disc prolapse and herniation" The straight-leg-raising test is performed on a patient with sciatica or leg pain. The test is positive if the patient complains of pain along the distribution of the sciatic nerve when the leg is raised to 60 degrees or less. A positive test indicates nerve root irritation from intervertebral disc prolapse and herniation; usually, the nerve root at the level of L4-5 or L5-S1 is involved. The test is conducted with the patient in supine position. The nurse passively raises the patient's legs 60 degrees or less.

Which types of movements are possible at the shoulder joint? Select all that apply. a. inversion b. adduction c. abducction d. opposition e. circumduction

b. adduction c. abduction e. circumduction The shoulder is considered a ball and socket, or spheroidal type of synovial joint. Movements of this type of joint include flexion, extension, adduction, abduction, and circumduction. Abduction is the movement of arm away from midline of body. Adduction is movement of arm toward the midline of body. Circumduction is combination of flexion, extension, abduction, adduction resulting in circular motion of the shoulder joint. Inversion is turning of sole inward toward midline of body Opposition refers to moving the first and fifth metacarpals anteriorly from a flattened palm.

Which term will the nurse use to describe fixation of the knee joint of a patient with a long-standing history of rheumatoid arthritis? a. atrophy b. ankylosis c. crepitation d. contracture

b. ankylosis Ankylosis is stiffness or fixation of a joint, often caused by chronic joint inflammation, and destruction and may be associated with rheumatoid arthritis. Atrophy is a flabby appearance of muscle leading to decreased function and tone. Crepitation is grating or crackling sounds that accompanies movement. Contracture is resistance of movement of muscles or joints due to fibrosis of supporting tissues.

Which diagnostic study uses radioisotope to detect increased metastatic activity in a patient with cancer? a. MRI b. bone scan c. ultrasound d. barium swallow

b. bone scan Of the choices listed, only bone scan involves the use of a radioisotope to detect increased metastatic activity. MRI, ultrasound, and barium swallow may be used to detect metastatic activity, but these procedures do not involve the use of radioisotopes.

Which pathological condition may have caused knee pain while a patient is walking and inflammation of the knee joint? a. tetany b. bursitis c. lordosis d. scoliosis

b. bursitits Bursae are small saclike connective tissues that line the synovial membrane and produce synovial fluid. Inflammation of the bursae increases the production of synovial fluid and results in the swelling of the joint. The swelling causes joint stiffness and pain while walking, so based on the patient's symptoms, the nurse would suspect bursitis. Tetany is caused by a calcium deficiency. It is characterized by muscle spasms and cramps. Lordosis is characterized by asymmetric scapulae and exaggerated lumbar curvature. Scoliosis is characterized by the presence of asymmetric elevation of the shoulders, scapulae and iliac crests with lateral spine curvature.

Which condition may present with frequent, audible crackling sounds and grating upon joint movement? a. scoliosis b. crepitation c. contracture d. festinating gait

b. crepitation Crepitation is associated with fracture, dislocation, temporomandibular joint dysfunction (TMJ), and osteoarthritis. It manifests as frequent, audible crackling sounds with palpable grating during movement. Scoliosis is the asymmetrical elevation of shoulders, scapulae, and iliac crests with lateral spinal curvature. It is often a congenital condition or occurs due to fracture or dislocation. Contracture is the resistance to movement of a muscle or a joint as a result of fibrosis of the supporting soft tissue. Festinating gait is a condition where neck, trunk, and knees flex but the body is rigid while walking.

An older person may experience which musculoskeletal system changes? Select all that apply. a. increased bone density b. earlier fatigue with activity c. decreased basal metabolic rate d. increased risk for cartilage erosion e. increased water in discs between vertebrae

b. earlier fatigue with activity c. decreased basal metabolic rate d. increased risk of cartilage erosion Many function problems experienced by older adults are related to changes in the musculoskeletal system. Changes may affect older adults' ability to complete self-care tasks and pursue other usual activities. Musculoskeletal system assessment differences for older adults include: -earlier fatigue with activity -decreased basal metabolic rate -increased risk for cartilage erosion that leads to direct contact between bone ends -overgrowth of bone around joint margins -decreased bone density and strength, which increases their risk for osteopenia and osteoporosis -loss of water from discs between vertebrae

Which instruction will the nurse give the patient to assess abduction of the elbow joint? a. move your elbow toward the midline of your body b. move your elbow away from the midline of your body c. bend your elbow to decrease the angle between two bones d. straighten your elbow to increase the angle between two bones

b. move your elbow away from the midline of your body The nurse should instruct the patient to move the elbow away from the midline of the body. Movement of the elbow toward the midline of the body refers to adduction. Flexion refers tot he bending of the joint as a result of muscle contraction, resulting in a decreased angle between 2 bones. Straightening of the elbow that increases the angle between 2 bones refers to extension.

How are bone cells involved in bone remodeling? a. osteoclasts add canaliculi b. osteoblasts deposit new bone c. osteocytes are mature bone cells d. osteons create a dense bone structure

b. osteoblasts deposit new bone Bone remodeling is achieved when osteoclasts remove old bone and osteoblasts deposit new bone. Canaliculi are small canals that extend from the Haversian canals to the lacunae, where mature bone cells are embedded. Osteocytes are mature bone cells, and osteons or Haversian systems create dense bone structures, but these are not involved with bone remodeling.

Which methods will the nurse include when performing palpation of the knee of a patient suffering from extreme pain and weakness in this joint? Select all that apply. a. palpate only the affected region b. palpate the muscles and joints c. rub hands together before palpating d. palpate from above to below (cephalopedal direction) e. do not palpate the knee region because it will cause discomfort for the patient

b. palpate the muscles and joints c. rub hands together before palpating d. palpate from above to below (cephalopedal direction) When palpating, it is important that the nurse palpates the muscles and the joints to allow for evaluation of skin temperature, local tenderness, swelling, and crepitation. Rubbing the hands together before performing palpation prevents muscle spasm. Spasm can interfere with the identification of essential landmarks or soft tissue structures. It is necessary to palpate from above to below so that no part is missed. When palpating, the nurse should palpate the affected area and the neighboring area. Palpation of the affected joint is important, and therefore, palpating the knee is important.

Which patient has an increased risk for a gait disturbances? a. epilepsy - anticonvulsant b. schizophrenia - phenothiazines c. hypertension - potassium sparing diuretics d. asthma - corticosteriods

b. schizophrenia - phenothiazines Phenothiazines are antipsychotic medications that decrease dopamine levels in the brain and may cause gait disturbance in the patient; therefore, there's a risk of gait disturbance. Anticonvulsant meds like carbamazepine cause demineralization of bones, resulting in osteomalacia. Potassium sparing diuretics like spironolactone decrease elimination of potassium through the urine, resulting in hyperkalemia; therefore patient has a risk for muscle cramps and weakness but not gait disturbances. Corticosteroids decrease bone and muscle mass and increase the risk for avascular necrosis in the patient so patient has a risk for avascular necrosis but not gait disturbance.

Which teaching will the nurse include when preparing a patient for a somatosensory evoked potential (SSEP) test? Select all that apply. a. this test analyzes and determines the strength of the bones b. the procedure is similar to EMG but does not involve needles c. transcutaneous or percutaneous electrodes are applied to the skin d. the test measures nerve conduction along the pathways not accessible by electromyogram (EMG) e. the electrodes are pierced in the superficial layer on the skin under anesthesia, so it is not painful

b. the procedure is similar to EMG but does not involve needles c. transcutaneous or percutaneous electrodes are applied to the skin d. the test measures nerve conduction along the pathways not accessible by electromyogram (EMG) The SSEP test helps evaluate evoked potential of muscle contractions. Transcutaneous or percutaneous electrodes are applied to the skin and help to identify neuropathy and myopathy. It is useful in identifying subtle dysfunction of lower motor neuron and primary muscle disease. It measures nerve conduction along pathways not accessible by EMG. The procedure is similar to EMG but does not involve needles. The test does not determine the strength of bones; strength of bones is determined by bone mass density measurements. In SSEP, the electrodes are not pierced into the skin under anesthesia; the electrodes are placed on the skin.

Which information will the nurse include when teaching a patient about electromyography test? Select all that apply. a. this test can be carried out at the bedside b. there may be some discomfort because of the needles c. small-gauge needles are inserted into certain muscles d. there may be severe bleeding and pain, and local anesthesia may be given e. it is useful in identifying any lower motor neuron dysfunction or primary muscle diseases

b. there may be some discomfort because of the needles c. small-gauge needles are inserted into certain muscles e. it is useful in identifying any lower motor neuron dysfunction or primary muscle diseases Electromyography helps evaluate electrical potential associated with skeletal muscle contraction. Small-gauge needles inserted into certain muscles may cause some discomfort. Needle probes are attached to leads that feed information to an electromyogram (EMG) machine. Recordings of electrical activity of the muscle are traced on audio transmitter and on oscilloscope and recording paper. It is useful in identifying any lower motor neuron dysfunction or primary muscle diseases. This procedure is usually done in an EMG laboratory while the patient lies supine on a special table. It is not performed at bedside and is not performed under anesthesia.

Which question related to the sexuality-reproductive pattern is important to ask a patient suffering from severe knee pain? a. what are your sexual preferences? b. how many sexual partners do you have? c. which method of contraception do you use? d. do you face any sexual concerns regarding your mobility?

d. do you face any sexual concerns regarding your mobility? In a patient suffering from knee pain, few questions related to sexual pattern should be asked. Knowing whether the person experiences any sexual concerns due to knee pain gives and indication of the severity of the complaint. The patient's sexual preferences, number of partners, and method of contraception are important in assessing a patient for sexually transmitted infections but not for musculoskeletal system.

Which questions about dietary behavior are important for the nurse to ask as part of a musculoskeletal system health history assessment? Select all that apply. a. do you like to eat out? b. what is your usual daily intake of food? c. do you have difficulties preparing food? d. do you consume any calcium or vitamin D supplements? e. do you face any digestive problem after the consumption of specific food?

b. what is your usual daily intake of food? c. do you have difficulties preparing food? d. do you consume any calcium or vitamin D supplements? When assessing a patient with musculoskeletal problems, probing about nutrition is important. It is important to know the patient's daily diet, as it helps understand whether the patient is getting enough nutrition. Asking whether or not the patient has difficulty preparing food helps understand severity of pain. Knowing if the patient has been taking dietary supplements also helps to assess the patient. Asking the patient about eating out does not help analyze the cause or effect of severe pain in the right knee or lower right extremity. Allergy or sensitivity to certain foods does not help to assess the musculoskeletal system directly.

Which questions will the nurse include when assessing the health perception-health management pattern of a patient who presents with pain in the wrist joint radiating up the entire arm? Select all that apply. a. do you have problems preparing your food? b. do you wake up at night because of musculoskeletal pain? c. do you have any problems performing your usual daily activities? d. do you need any assistive devices or equipment to manage toiletries? e. do your work or exercise habits require repetitive motion or joint stress?

c. do you have any problems performing your usual daily activities? e. do your work or exercise habits require repetitive motion or joint stress The nurse should ask about issues performing daily activities and about work habits as part of the health perception-health management portion of the musculoskeletal health history. Asking about problems staying asleep is part of the sleep-rest pattern portion of the assessment. Asking about devices needed to help manage toileting is part of the elimination pattern portion of the assessment.

What signs and symptoms are associated with boutonnière deformity? Select all that apply. a. partial dislocation of finger joints b. fingers drift to ulnar side of forearm c. flexion of proximal interphalageal joint d. flexion of metacarpophalangeal joint e. hyperextension of the distal interphalangeal joint

c. flexion of proximal interphalangeal joint d. hyperextension of the distal interphalangeal joint Boutonniere deformity is the deformity of rheumatoid and psoriatic arthritis caused by the rupture of the extensor tendons over the fingers. It is characterized by the flexion of the proximal interphalageal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joints of the fingers. Dislocation of the finger joints does not happen in Boutonniere deformity. Ulnar drift refers to the deformity of rheumatoid arthritis due to tendon contracture. Flexion of the metacarpophalageal joint occurs in swan neck deformity.

Which body parts are made up of smooth muscle? (Select all that apply) a. legs b. heart c. uterus d. arteries e. urinary bladder

c. uterus, d. arteries, e. urinary bladder Smooth muscles are the basic component of the walls of hollow structures such as airways, arteries, gastrointestinal (GI) tract, urinary bladder, and uterus. The heart is composed of cardiac muscles. Skeletal muscles account for about half of a human being's body weight. The lower extremities are made up of skeletal muscles.

Which condition may present with pain in the posterior leg, initially when walking and later at rest? a. atrophy b. ankylosis c. antalgic gait d. achilles tendonitis

d. achilles tendonitis Achilles tendonitis occurs due to cumulative stress on the Achilles tendon resulting in inflammation. Initially, the patient experiences pain in the posterior leg while running or walking, and later it is felt even at rest. Atrophy occurs due to muscle denervation, contracture, and prolonged disuse. It results in a flabby appearance of the muscle with decreased function and tone. Ankylosis occurs due to chronic joint inflammation and destruction. It results from stiffness and fixation of a joint. Antalgic gait occurs due to trauma or other disorders. There is pain in the lower extremity on bearing weight. It results in shortened strides with little weight bearing on the affected side.