Prep-U Ch. 60 - Intro to the Musculoskeletal System

A child is growing at a rate appropriate for his age. What cells are responsible for the secretion of bone matrix that eventually results in bone growth? A. Osteoblasts B. Osteocytes C. Osteoclasts D. Lamellae

A. Osteoblasts - Osteoblasts function in bone formation by secreting bone matrix. Osteocytes are mature bone cells and osteoclasts are multinuclear cells involved in dissolving and resorbing bone. Lamellae are circles of mineralized bone matrix.

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 A. absence of muscle movement suggesting nerve damage. B. involuntary twitch of muscle fibers. C. abnormal sensations. D. absence of muscle tone.

C. abnormal sensations. - 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.

A nurse is assessing a child who has a diagnosis of muscular dystrophy. Assessment reveals that the child's muscles have greater-than-normal tone. The nurse should document the presence of which of A. tonus. B. flaccidity. C. atony. D. spasticity.

D. spasticity. - A muscle with greater-than-normal tone is described as spastic. Soft and flabby muscle tone is defined as atony. A muscle that is limp and without tone is described as being flaccid. The state of readiness known as muscle tone (tonus) is produced by the maintenance of some of the muscle fibers in a contracted state.

A client who is postmenopausal is taking medication to reverse bone loss. Although loss of bone mass accelerates after menopause, at what age do people begin to lose bone mass? A. 35 years B. 45 years C. 40 years D. 50 years

A. 35 years - After 35 years, people generally experience loss of bone mass and height and changes in the structure of the spine and joints.

Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes? A. Radial B. Peroneal C. Median D. Ulnar

B. Peroneal - 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.

A client's fracture is healing and compact bone is replacing spongy bone around the periphery of the fracture. This process characterizes what phase of the bone healing process? A. Hematoma formation B. Fibrocartilaginous callus formation C. Remodeling D. Bony callus formation

C. Remodeling - Remodeling occurs as necrotic bone is removed by the osteoclasts. In this phase, compact bone replaces spongy bone around the periphery of the fracture. Each of the other listed phases precedes this stage.

Which term refers to moving away from midline? A. Adduction B. Inversion C. Eversion D. Abduction

D. Abduction - Abduction is moving away from the midline. Adduction is moving toward the midline. Inversion is turning inward. Eversion is turning outward.

Which hormone inhibits bone resorption and increases the deposit of calcium in the bone? A. Growth hormone B. Vitamin D C. Sex hormones D. Calcitonin

D. Calcitonin - Calcitonin, secreted by the thyroid gland in response to elevated blood calcium levels, inhibits bone reabsorption and increases the deposit of calcium in the bone.

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? A. All options are correct. B. between the ribs C. covering elbow joints D. between the vertebrae

A. All options are correct. - Types of cartilage include costal cartilage, which connects the ribs and sternum; semilunar cartilage, which is one of the cartilages of the knee joint; fibrous cartilage, found between the vertebrae (intervertebral disks); and elastic cartilage, found in the larynx, epiglottis, and outer ear.

The human body has 206 bones, which are classified into four categories. Which types of bones are located in the digits? A. short bones B. long bones C. flat bones D. irregular bones

A. short bones - Short bones are the type that is located in the fingers and toes.

A nurse is performing a musculoskeletal assessment of a client with arthritis. During passive range-of-motion exercises, the nurse hears an audible grating sound. The nurse should document the presence of what assessment finding? A. Fasciculations B. Clonus C. Effusion D. Crepitus

D. Crepitus - Crepitus is a grating, crackling sound or sensation that occurs as the irregular joint surfaces move across one another, as in arthritic conditions. Fasciculations are involuntary twitching of muscle fiber groups. Clonus is the rhythmic contractions of a muscle. Effusion is the collection of excessive fluid within the capsule of a joint.

A client has just had an arthroscopy performed to assess a knee injury. What nursing intervention should the nurse perform following this procedure? A. Wrap the joint in a compression dressing. B. Perform passive range of motion exercises. C. Maintain the knee in flexion for up to 30 minutes. D. Apply heat to the knee.

A. Wrap the joint in a compression dressing. - Interventions to perform following an arthroscopy include wrapping the joint in a compression dressing, extending and elevating the joint, and applying ice or cold packs. Passive ROM exercises, static flexion, and heat are not indicated.

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? A. Tear in the joint capsule B. Fracture of the clavicle C. Decreased bone density D. Injury to the radial nerve

A. Tear in the joint capsule - 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 scheduled for a bone scan to rule out osteosarcoma of the pelvic bones. What would be most important for the nurse to assess before the client's scan? A. That the client completed the bowel cleansing regimen B. That the client emptied the bladder C. That the client is not allergic to penicillins D. That the client has fasted for at least 8 hours

B. That the client emptied the bladder - Before the scan, the nurse asks the client to empty the bladder, because a full bladder interferes with accurate scanning of the pelvic bones. Bowel cleansing and fasting are not indicated for a bone scan and an allergy to penicillins is not a contraindication.

When assessing a client's peripheral nerve function, the nurse uses an instrument to prick the fat pad at the top of the client's small finger. This action will assess what nerve? A. Radial B. Ulnar C. Median D. Tibial

B. Ulnar - The ulnar nerve is assessed for sensation by pricking the fat pad at the top of the small finger. The radial, median, and tibial nerves are not assessed in this manner.

A nurse is caring for a client with a diagnosis of cancer that has metastasized. What laboratory value would the nurse expect to be elevated in this client? A. Bilirubin B. Potassium C. Alkaline phosphatase D. Creatinine

C. Alkaline phosphatase - Alkaline phosphatase is elevated during early fracture healing and in diseases with increased osteoblastic activity (e.g., metastatic bone tumors). Elevated bilirubin, potassium, and creatinine would not be expected in a client with metastatic bone tumors.

After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement? A. Inflammation B. Revascularization C. Reparative D. Remodeling

D. Remodeling - 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.

Which of the following diagnostic studies are done to relieve joint pain due to effusion? A. Arthrocentesis B. Electromyography (EMG) C. Bone scan D. Biopsy

A. Arthrocentesis - Arthrocentesis (joint aspiration) is carried out to obtain synovial fluid for purpose of examination or to relieve pain due to effusion. EMG provides information about the electrical potential of the muscles and the nerves leading to them. A bone scan is performed to detect metastatic and primary bone tumors, osteomyelitis, certain fractures, and aseptic necrosis. A biopsy may be performed to determine the structure and composition of bone marrow, bone, muscle, or synovium to help diagnose specific diseases.

Skull sutures are an example of which type of joint? A. Synarthrosis B. Amphiarthrosis C. Diarthrosis D. Aponeuroses

A. 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.

A client injured in a motor vehicle accident has sustained a fracture to the diaphysis of the right femur. Of what is the diaphysis of the femur mainly constructed? A. Epiphyses B. Cartilage C. Cortical bone D. Cancellous bone

C. Cortical bone - The long bone shaft, which is referred to as the diaphysis, is constructed primarily of cortical bone.

A client is diagnosed with a fracture of a diarthrosis joint. What is an example of this type of joint? A. Symphysis pubis B. Skull C. Elbow D. Fifth thoracic vertebrae

C. Elbow - 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.

A client has sustained traumatic injuries that involve several bone fractures. A fracture of what type of bone may interfere with the protection of the client's vital organs? A. Long bones B. Short bones C. Flat bones D. Irregular bones

C. Flat bones - Flat bones, such as the sternum, provide vital organ protection. Fractures of the flat bones may lead to puncturing of the vital organs or may interfere with the protection of the vital organs. Long, short, and irregular bones do not usually have this physiologic function.

A nurse is taking a health history on a new client who has been experiencing unexplained paresthesia. What question should guide the nurse's assessment of the client's altered sensations? A. How does the strength in the affected extremity compare to the strength in the unaffected extremity? B. Does the color in the affected extremity match the color in the unaffected extremity? C. How does the feeling in the affected extremity compare with the feeling in the unaffected extremity? D. Does the client have a family history of paresthesia or other forms of altered sensation?

C. How does the feeling in the affected extremity compare with the feeling in the unaffected extremity? - Questions that the nurse should ask regarding altered sensations include "How does this feeling compare to sensation in the unaffected extremity?" Asking questions about strength and color is not relevant and a family history is unlikely.

The nurse's comprehensive assessment of an older adult involves the assessment of the client's gait. How should the nurse best perform this assessment? A. Instruct the client to walk heel-to-toe for 15 to 20 steps. B. Instruct the client to walk in a straight line while not looking at the floor. C. Instruct the client to walk away from the nurse for a short distance and then toward the nurse. D. Instruct the client to balance on one foot for as long as possible and then walk in a circle around the room.

C. Instruct the client to walk away from the nurse for a short distance and then toward the nurse. - Gait is assessed by having the client walk away from the examiner for a short distance. The examiner observes the client's gait for smoothness and rhythm. Looking at the floor is not disallowed and gait is not assessed by observing balance on one leg. Heel-to-toe walking ability is not gauged during an assessment of normal gait.

While assessing a client, the client tells the nurse that she is experiencing rhythmic muscle contractions when the nurse performs passive extension of her wrist. The nurse should recognize the presence of: A. fasciculations. B. contractures. C. effusion. D. clonus.

D. clonus. - Clonus may occur when the ankle is dorsiflexed or the wrist is extended. It is characterized as rhythmic contractions of the muscle. Fasciculation is involuntary twitching of muscle fiber groups. Contractures are prolonged tightening of muscle groups and an effusion is the pathologic escape of body fluid.