EAQ Ch. 61 Musculoskeletal

Active movement against gravity and some resistance is considered which muscle strength grade? 1) 1/5 2) 2/5 3) 3/5 4) 4/5 CORRECT

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

Which condition may present with pain in the posterior leg, initially when walking and later at rest? 1) Atrophy 2) Ankylosis 3) Antalgic gait 4) Achilles tendonitis CORRECT

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 in 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.

An electromyogram (EMG) is used to test which musculoskeletal function? 1) Evaluates potential of muscle contractions 2) Evaluates electrical potential related to skeletal muscle contraction CORRECT 3) Records variations in volume and pressure of blood passing through tissues 4) Evaluates bone mineral density, elasticity, and strength of bone using ultrasound

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) evaluates bone mineral density, elasticity, and strength of bone using ultrasound rather than radiation.

An arthroscopy may be ordered to identify which condition? 1) Fractures of the bone 2) The risk for osteoporosis 3) Articular cartilage abnormality CORRECT 4) Peripheral vasculature patency

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 measure via a bone density test. Peripheral vasculature patency is assessed with Doppler ultrasound.

Which term will the nurse use to describe fixation of the knee joint of a patient with a long-standing history of rheumatoid arthritis? Atrophy Ankylosis CORRECT Crepitation Contracture

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.

How are bone cells involved in bone remodeling? Osteoclasts add canaliculi. Osteoblasts deposit new bone. CORRECT Osteocytes are mature bone cells. Osteons create a dense bone structure

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 a dense bone structure, but these are not involved with bone remodeling.

Which signs and symptoms are associated with boutonnière deformity? Select all that apply. Partial dislocation of finger joints Fingers drift to ulnar side of forearm Flexion of proximal interphalangeal joint CORRECT Flexion of the metacarpophalangeal joint Hyperextension of the distal interphalangeal joint CORRECT

Boutonnière 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 interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joints of the fingers. Dislocation of the finger joints does not happen in Boutonnière deformity. Ulnar drift refers to the deformity of rheumatoid arthritis due to tendon contracture. Flexion of the metacarpophalangeal joint occurs in swan neck deformity.

Musculoskeletal assessment is an important component of care for patients on which type of long-term therapy? 1) Corticosteroids CORRECT 2) β-adrenergic blockers 3) Antiplatelet aggregators 4) Calcium channel blockers

Corticosteroids are associated with avascular necrosis and decreased bone and muscle mass. β-adrenergic blockers, calcium channel blockers, and antiplatelet aggregators commonly are not associated with damage to the musculoskeletal system.

The nurse may note which finding when assessing a fracture of a patient's hand as the bone fragments rub against each other? 1) Crepitation CORRECT 2) Resorption 3) Subluxation 4) Proliferation

Crepitation

Which condition may present with frequent, audible crackling sounds and grating upon joint movement? 1) Scoliosis 2) Crepitation CORRECT 3) Contracture 4) Festinating gait

Crepitation is associated with fracture, dislocation, temporomandibular joint dysfunction, and osteoarthritis. It manifests as frequent, audible crackling sounds with palpable grating during movement. Scoliosis is the asymmetric elevation of shoulders, scapulae, and iliac crests with lateral spine 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 tissues. Festinating gait is a condition where the neck, trunk, and knees flex but the body is rigid while walking.

Which term describes flexion of the ankle and toes toward the shin? 1) Inversion 2) Eversion 3) Dorsiflexion CORRECT 4) Plantar flexion

Dorsiflexion

Which term refers to the turning of the sole of the foot outward away from the midline of the body? 1) Eversion CORRECT 2) Extension 3) Abduction 4) Dorsiflexion

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 question related to the sexuality-reproductive pattern is important to ask a patient suffering from severe knee pain? What are your sexual preferences? How many sexual partners do you have? Which method of contraception do you use? Do you face any sexual concerns related to your mobility? CORRECT

In a patient suffering from knee pain, few questions related to sexual pattern should be asked. Knowing whether the patient experiences any sexual concerns due to knee pain gives an indication of the severity of the complaint. The patient's sexual preferences, number of sexual partners, and method of contraception are important in assessing a patient for sexually transmitted infection (STI) but not for musculoskeletal system

Which questions will the nurse ask when assessing health history of a patient with severe back pain in the lumbar region? Select all that apply. Have you been vaccinated against hepatitis? Does your work involve lifting any heavy objects? CORRECT Have you taken any high-dose antibiotic recently? Has this pain affected your social or professional life? CORRECT Do you consume any dietary supplements like calcium or vitamin D? CORRECT Do you require frequent change of position while you are sleeping because of the pain? CORRECT

Lifting heavy objects can lead to back pain; therefore it is important to know whether the patient's work involves lifting heavy objects. Knowing if the pain has affected the patient's social and professional life helps to determine the severity of the problem. Knowing whether the patient is taking dietary supplements like calcium and vitamin D helps to understand how the patient is treating self and also helps to plan future interventions for the patient. Similarly, knowing whether the patient has frequent changes in position while asleep helps to understand the severity of the complaint. Vaccination against hepatitis is not connected to back pain. Similarly, antibiotic therapy is not relevant in the back pain assessment

An older adult may experience which musculoskeletal system changes? Select all that apply. 1) Increased bone density 2) Earlier fatigue with activity CORRECT 3) Decreased basal metabolic rate CORRECT 4) Increased risk for cartilage erosion CORRECT 5) Increased water in discs between vertebrae

Many functional 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, and increased risk for cartilage erosion that leads to direct contact between bone ends and overgrowth of bone around joint margins. Older adults may experience decreased bone density and strength, which increases their risk for osteopenia and osteoporosis. There is a loss of water from discs between vertebrae.

Which diagnostic study uses radioisotope to detect increased metastatic activity in a patient with cancer? 1) MRI 2) Bone scan CORRECT 3) Ultrasound 4) Barium swallow

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

Which instrument will the nurse use to assess range of motion? 1) Spirometer 2) Arthroscope 3) Goniometer CORRECT 4) Funduscope

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.

Which body parts are made up of smooth muscles? Select all that apply 1) Legs 2) Heart 3) Uterus CORRECT 4) Arteries CORRECT 5) Urinary bladder CORRECT

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 increased flexion in the hip and knee to clear the foot from the floor and footdrop? 1) Pes planus 2) Spastic gait 3) Short-leg gait 4) Steppage gait CORRECT

Steppage gait is a neurogenic disorder associated with increased hip and knee flexion to clear the foot from the floor, along with footdrop. The patient's foot may slap down and along the walking surface. Pes planus, 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 is used to describe enlargement of a joint due to fluid collection, which usually leads to pain and stiffness? 1) Myalgia 2) Swelling CORRECT 3) Paresthesia 4) Subluxation

Swelling is the term used 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.

Which musculoskeletal assessment findings are normal? Select all that apply 1) Muscle strength 5/5 CORRECT 2) No spinal curvature 3) No muscle atrophy or asymmetry CORRECT 4) No joint swelling, deformity, or crepitation CORRECT 5) Full range of motion of all joints without pain or laxity CORRECT 6) No tenderness on palpation of spine, joints, or muscles CORRECT

The components of a normal musculoskeletal system include muscle strength of 5/5; no muscle atrophy or asymmetry; no joint swelling, deformity, or crepitation; a full range of motion of all joints without pain or laxity; and no tenderness on palpation of spine, joints, or muscles. The spine should have ordinary spinal curvatures, not an absence of curvature.

Which joints are diarthrodial joints? Select all that apply. Hinge joint of the knee CORRECT Ligaments joining the vertebrae Fibrous connective tissue of the skull Ball-and-socket joint of the shoulder or hip CORRECT Cartilaginous connective tissue of the pubis joint

The diarthrodial (synovial) joints include the hinge joint of the knee and elbow, the ball-and-socket joint 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 synarthrotic joints.

Which joint is a gliding joint? 1) Wrist 2) Shoulder 3) Between carpal bones CORRECT 4) Carpometacarpal of thumb

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 intervention may be included for a patient with musculoskeletal issues who complains of fatigue and difficulty sleeping? 1) Leave the door open at night. 2) Leave the room light on at night. 3) Keep the patient up during the day. 4) Provide pillows and blankets for comfort. CORRECT

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 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. Do you have problems preparing your food? Do you wake up at night because of musculoskeletal pain? Do you have any problems performing your usual daily activities? CORRECT Do you need any assistive devices or equipment to manage toileting? Do your work or exercise habits require repetitive motion or joint stress? CORRECT

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 preparing food is part of the nutritional-metabolic pattern. Asking about problems staying asleep is part of the sleep-rest pattern portion of the assessment. Asking about devices needed to help to manage toileting is part of the elimination pattern portion of the assessment.

Which instruction will the nurse give the patient to assess abduction of the elbow joint? Move your elbow toward the midline of your body. Move your elbow away from the midline of your body. CORRECT Bend your elbow to decrease the angle between two bones. Straighten your elbow to increase the angle between two bones

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 body refers to adduction. Flexion refers to the bending of the joint as a result of muscle contraction, resulting in a decreased angle between two bones. Straightening of the elbow that increases the angle between two bones refers to extension.

Which instruction will the nurse give to the patient to assess inversion movement of the foot? Flex your ankle and toes toward the shin. Turn the sole inward toward the midline of the body. CORRECT Turn the sole outward away from the midline of the body. Flex your ankle and toes toward the plantar surface of the foot.

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 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? X-ray CORRECT Diskogram CT scan MRI

X Ray