MedSurg PrepU Ch 35 Assessment of Musculoskeletal Function

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.

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

The nurse is preparing the client for magnetic resonance imaging after reports of low back pain. What statement by the client requires action by the nurse?

"I didn't remove my Transderm-Nitro patch."

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." Explanation: Numbness would indicate neurological compromise of the extremity and requires immediate intervention to prevent permanent damage. An aching knee is expected after the procedure

The nurse is assessing a client with a musculoskeletal system condition. Which statement indicates to the nurse that the client is experiencing bone pain?

"The pain feels deep in my legs and keeps me awake at night." Explanation: Bone pain is typically described as a dull, deep ache that is "boring" in nature. This pain is not typically related to movement and may interfere with sleep. -Muscular pain is described as soreness or aching and is referred to as "muscle cramps." Joint pain is felt around or in the joint and typically worsens with movement. -Fracture pain is sharp and piercing and is relieved by immobilization. -Sharp pain may also result from bone infection with muscle spasm or pressure on a sensory nerve.

A patient tells the nurse, "I was working out and lifting weights and now that I have stopped, I am flabby and my muscles have gone!" What is the best response by the nurse?

"Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued."

The primary functions of cartilage are to reduce friction between articular surfaces, absorb shocks, and reduce stress on joint surfaces. Where in the human body is cartilage found?

All option are correct. between the ribs covering elbow joints between the vertebrae

The nurse is taking an initial history of a new client with a musculoskeletal problem. Which factor is most important for the nurse to keep in mind for this assessment?

Any chronic disorder or recent injury

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 Explanation: Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. -Meniscography is a distractor for this question. -Bone densitometry is used to estimate bone mineral density. -An EMG provides information about the electrical potential of the muscles and nerves leading to them.

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 Explanation: Arthroscopy is a procedure that allows direct visualization of a joint through the use of a fiberoptic endoscope. Thus, it is a useful adjunct to diagnosing joint disorders.

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

Calcitonin Explanation: Calcitonin, secreted by the thyroid gland in response to elevated blood calcium concentration, inhibits bone reabsorption and increases the deposit of calcium in the bone.

Which is an indicator of neurovascular compromise?

Capillary refill of more than 3 seconds Explanation: Capillary refill of more than 3 seconds is an indicator of neurovascular compromise. Other indicators include cool skin temperature, pale or cyanotic color, weakness, paralysis, paresthesia, unrelenting pain, pain upon passive stretch, and absence of feeling. Cool skin temperature is an indicator of neurovascular compromise. Unrelenting pain is an indicator of neurovascular compromise. Pain upon passive stretch is an indicator of neurovascular compromise

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

Carpal bones in the wrist

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

A client is diagnosed with a bone tumor. What result would the nurse expect the blood tests to reveal?

Decreased serum calcium level Explanation: Decreased serum calcium level may indicate osteomalacia, osteoporosis, and bone tumors. With bone tumors, the alkaline phosphatase and serum phosphorus levels would be increased.

Which term refers to the shaft of the long bone?

Diaphysis Explanation: The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone

The nurse is educating a group of students about peroneal nerve damage. The nurse knows that which assessment will show this type of nerve damage?

Dorsiflexion of the foot and extension of the toes Explanation: Assessment of peripheral nerve function has two key elements: evaluation of sensation and evaluation of motion. To assess motion of the peroneal nerve, the client should be asked to dorsiflex the foot and extend the toes. Pricking the skin along the top of the index finger assesses sensation of the median nerve. Having the client stretch the thumb away from the wrist assesses motion of the radial nerve. Pricking the skin between the medial and lateral surface of the sole will assess tibial nerve sensation

The nurse is performing a neurovascular assessment of a client's injured extremity. Which would the nurse report?

Dusky or mottled skin color Explanation: Normally, skin color would be similar to the color in other body areas. Pale or dusky skin color indicates an abnormality that needs to be reported.

A client is diagnosed with a fracture of a diarthrosis joint. What is an example of this type of joint?

Elbow Explanation: A diarthrosis joint, like the elbow, is freely movable. -The skull is an example of an immovable joint. -The vertebral joints and symphysis pubis are amphiarthrosis joints that have limited motion.

The nurse is performing a musculoskeletal assessment for a client whose right leg muscles exhibit no tone and are limp. Which descriptor should the nurse use to document this condition?

Flaccid Explanation: The term flaccid describes muscles that have no tone or are limp. -Spastic describes muscles that have greater-than-normal tone. -Atonic describes muscles that are not enervated and become soft and flabby. -Atrophic describes muscles deterioration that occurs with lack of use and exercise.

The nurse is preparing to perform a musculoskeletal assessment for a client with chronic muscle pain. Which assessment technique would be an appropriate tool to evaluate this type of pain?

Flex the bicep against resistance

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

Increased diameter of the calf Explanation: Increasing diameter of the calf can be indicative of bleeding into the muscle.

Which term refers to muscle tension being unchanged with muscle shortening and joint motion?

Isotonic contraction Explanation: Exercises such as swimming and cycling are isotonic. -Isotonic contraction is when a muscle is shortened without a change in its tension. -Isometric contraction is characterized by increased muscle tension, unchanged muscle length, and no joint motion. -Contracture refers to abnormal shortening of the muscle, joint, or both. -Fasciculation refers to the involuntary twitch of muscle fibers.

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

Knee Explanation: Hinge joints permit bending in one direction only and include the knee and elbow. The hip is a ball-and-socket joint. -The joint at the base of the thumb is a saddle joint. -Gliding joints allow for limited movement in all directions and are represented by the joints of the carpal bones in the wrist.

A client scheduled to undergo an electromyography asks the nurse what this test will evaluate. What is the correct response from the nurse?

Muscle weakness

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. Explanation: Angiogenesis and cartilage formation begin when fibroblasts from the periosteum produce a bridge between the fractured bones. This is known as a callus.

Which cells are involved in bone resorption?

Osteoclasts Osteoclasts carry out bone resorption by removing unwanted bone while new bone is forming in other areas. -Chondrocytes are responsible for forming new cartilage. -Osteoblasts are bone-forming cells that secrete collagen and other substances. -Osteocytes, derived from osteoblasts, are the chief cells in bone tissue.

A group of students are reviewing information about bones in preparation for a quiz. Which of the following indicates that the students have understood the material?

Osteoclasts are involved in the destruction and remodeling of bone. Explanation: Osteoclasts are the cells involved in the destruction, resorption, and remodeling of bone. -Red bone marrow is responsible for manufacturing red blood cells. Long bones contain yellow bone marrow; the sternum, ileum, vertebrae, and ribs contain red bone marrow. -Osteoblasts are transformed into osteocytes, mature bone cells.

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

Peroneal Explanation: The motor function of the peroneal nerve is assessed by asking the client to dorsiflex the ankle and to extend the toes, while pricking the skin between the great toe and center toe assesses sensory function. The radial nerve is assessed by asking the client to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints. The median nerve is assessed by asking the client to touch the thumb to the little finger. Asking the client to spread all fingers allows the nurse to assess motor function affected by ulnar innervation.

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

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

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 phase, reparative phase, remodeling phase

What is the term for a lateral curving of the spine?

Scoliosis Explanation: Scoliosis is a lateral curving of the spine. -Lordosis is an increase in the lumbar curvature of the spine.

Skull sutures are an example of which type of joint?

Synarthrosis. Skull sutures are considered synarthrosis joints and are immovable. -Amphiarthrosis joints allow limited movement, such as a vertebral joint. -Diarthrosis joints are freely movable joints such as the hip and shoulder. -Aponeuroses are broad, flat sheets of connective tissue.

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 Explanation: Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. X-rays are used to diagnose bone fractures. -Bone densitometry is used to estimate bone mineral density. -An electromyogram (EMG) provides information about the electrical potential of the muscles and nerves leading to them

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 Explanation: Tendons are broad, flat sheets of connective tissue that attach muscles to bones, soft tissue, and other muscles. -Ligaments bind bones together. -A bursa is a synovial-filled sac, and fascia surround muscle cells.

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 of the following diagnostic studies are done to relieve joint pain due to effusion?

arthrocentesis

The nurse is caring for a pregnant patient with pregnancy-induced hypertension. When assessing the reflexes in the ankle, the nurse observes rhythmic contractions of the muscle when dorsiflexing the foot. What would the nurse document this finding as?

clonus

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

The nurse is admitting an older adult to a skilled nursing facility. What assessment parameters will the nurse expect to find with the musculoskeletal assessment? Select all that apply.

decreased endurance joint stiffness decreased range of motion

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

lamellae

A nursing student asks the nurse why older adults are at risk for falls. The best response by the nurse is:

muscle athropy with aging

Each bone is composed of cells, protein matrix, and mineral deposits. Which type of bone cell works to repair a bone fracture?

osteocyte

The nurse is assigned to a client admitted with advanced Parkinson's disease. What type of gait correlates with Parkinson's disease?

shuffling Explanation: A variety of neurologic conditions are associated with abnormal gaits, such as spastic hemiparesis gait (stroke), steppage gait (lower motor neuron disease), and shuffling gait (Parkinson's disease). Scissors gait is seen in cerebral palsy.

The nurse is assessing a client's gait. What assessments indicate the client has a normal gait? Select all that apply.

smoothness knee flexion

Which nerve is assessed when the nurse asks the client to spread all fingers?

ulnar

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 diagnostic test would the nurse expect to be ordered for a client with lower extremity muscle weakness?

Electromyograph (EMG) Explanation: The EMG provides information about the electrical potential of the muscles and the nerves leading to them. The test is performed to evaluate muscle weakness, pain, and disability

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 Explanation: Common deformities of the spine include kyphosis, which is an increased forward curvature of the thoracic spine that causes a bowing or rounding of the back, leading to a hunchback or slouching posture. -The second deformity of the spine is referred to as lordosis, or swayback, an exaggerated curvature of the lumbar spine. -A third deformity is scoliosis, which is a lateral curving deviation of the spine (Fig. 40-4).

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 Explanation: Osteoblasts secrete bone matrix (mostly collagen), in which inorganic minerals, such as calcium salts, are deposited. This process of ossification and calcification transforms the blast cells into mature bone cells, called osteocytes, which are involved in maintaining bone tissue. -Cortical bone is dense hard bone found in the long shafts; cancellous bone is spongy bone found in the irregular rounded edges of bone.

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

A patient comes to the clinic and informs the nurse of numbness, tingling, and a burning sensation in the arm from the elbow down to the fingers. What type of symptom would this be documented as?

Paresthesia Explanation: Sensory disturbances are frequently associated with musculoskeletal problems. The patient may describe paresthesias, which are sensations of burning, tingling, or numbness. These sensations may be caused by pressure on nerves or by circulatory impairment

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

The nurse is teaching a client about osteoporosis. What diagnostic test will the nurse include with the client teaching?

dual-energy x-ray absorptiometry Explanation: Osteoporosis is characterized by decreased bone density. Dual-energy x-ray absorptiometry can determine the extent of bone loss. -A bone biopsy is used to detect abnormal cells such as a malignancy. -An arthrocentesis is used for joint swelling or arthritis. -An arthroscopy is used to detect joint problems

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

Place an "X" on the figure where the nurse would assess for kyphosis.

Kyphosis is an increased convexity of roundness of the thoracic curve of the spine.

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 Explanation: Remodeling is the final stage of fracture repair. During inflammation, macrophages invade and debride the fracture area. Revascularization occurs within about 5 days after a fracture. Callus forms during the reparative stage but is disrupted by excessive motion at the fracture site.

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. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration?

An electromyography Explanation: An electromyography tests the electrical potential of muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration. -A serum calcium test evaluates the calcium in the blood. -An arthroscopy assesses changes in the joint. -An MRI identifies abnormalities in the targeted area

Which laboratory study indicates the rate of bone turnover?

Serum osteocalcin Explanation: Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. -Urine calcium concentration increases with bone destruction. -Serum calcium concentration is altered in clients with osteomalacia and parathyroid dysfunction. -Serum phosphorous concentration is inversely related to calcium concentration and is diminished in osteomalacia associated with malabsorption syndrome.

What is the term for a rhythmic contraction of a muscle?

Clonus Explanation: Clonus is a rhythmic contraction of the muscle. Atrophy is a shrinkage-like decrease in the size of a muscle. -Hypertrophy is an increase in the size of a muscle. -Crepitus is a grating or crackling sound or sensation that may occur with movement of ends of a broken bone or irregular joint surface.

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. Explanation: Abnormal sensations, such as burning, tingling, and numbness, are referred to as paresthesias. -The absence of muscle tone suggesting nerve damage is referred to as paralysis. -A fasciculation is the involuntary twitch of muscle fibers. -A muscle that holds no tone is referred to as flaccid