PrepU Chapter 35: Assessment of Musculoskeletal Function

Patient education for musculoskeletal conditions for the aging is based on the understanding that there is a gradual loss of bone after a peak of bone mass at age: 20 years. 30 years. 40 years. 50 years.

Correct response: 30 years. Explanation: Bone mass peaks by about age 30, after which there is a universal and gradual loss of bone.

Which term refers to moving away from midline? Adduction Inversion Eversion Abduction

Correct response: Abduction Explanation: Abduction is moving away from the midline. Adduction is moving toward the midline. Inversion is turning inward. Eversion is turning outward.

The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding? Lordosis Scoliosis Kyphosis Dowager's hump

Correct response: Lordosis Explanation: Lordosis is an exaggeration of the lumbar spine curve.

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: Eversion. Extension. Supination. Pronation.

Correct response: Supination. Explanation: Refer to Figure 40-3 in the text for an illustration of body movements produced by muscle contraction.

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." "My knee aches." "My feet are cold." "My foot is swollen."

Correct response: "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. Cold or swollen feet are not priority assessments.

The orthopedic nurse is caring for a client diagnosed with a fracture of the radius. In which type of bone tissue does the nurse anticipate the fracture being? Collagen Cortical Cancellous Cartilage

Correct response: Cancellous Explanation: Cancellous bone or spongy bone is light and contains many spaces making it a less solid bone than the cortical or compact bone. Collagen and cartilage are not types of bone.

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 Decreased flexibility Decreased agility Increased joint stiffness

Correct response: Decreased right-sided muscle strength Explanation: Although symmetrical decreases in muscle strength can be a part of the aging process, asymmetrical decreases are not. The nurse should contact the health care provider when decreased right-sided muscle strength is found, as this could indicate a stroke or transient ischemic attack. Decreased flexibility, decreased agility, and increased joint stiffness are all part of the aging process and therefore do not require the nurse to contact the health care provider.

The nurse is performing a neurovascular assessment of a client's injured extremity. Which would the nurse report? Positive distal pulses Capillary refill of 3 seconds Dusky or mottled skin color Skin warm to touch

Correct response: 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. Presence of pulses, capillary refill of 3 seconds, and warm skin are normal findings.

A patient has had a stroke and is unable to move the right upper and lower extremity. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding? Rigidity Flaccidity Atonic Tetanic

Correct response: Flaccidity Explanation: A muscle that is limp and without tone is described as flaccid; a muscle with greater-than-normal tone is described as spastic. Conditions characterized by lower motor neuron destruction (e.g., muscular dystrophy), denervated muscle becomes atonic (soft and flabby) and atrophies.

The nurse is reporting on the results of client blood work to the oncoming nurse. Upon reviewing the data, it is noted that the client has an elevated uric acid level. Which inflammatory process would the nurse screen for on shift rounds? Rheumatoid arthritis Lupus erythematosus Osteoporosis Gout

Correct response: Gout Explanation: Gout is a medical condition with symptoms of acute inflammatory arthritis that is caused by high levels of uric acid in the blood. The client has uric acid crystal deposits in the joint. The nurse would assess joint areas for pain, redness, and swelling. Rheumatoid arthritis is a chronic disease of joint inflammation and pain. Lupus erythematous is a chronic tissue disorder of the connective tissue and is known to have an elevated antinuclear antibody level. Osteoporosis has a deficiency in the serum calcium level.

The nurse is assessing the muscle tone of a client with cerebral palsy. Which description does the nurse determine to be an expected assessment of this client's muscle tone? Atonic Hypertonic Atrophied Flaccid

Correct response: Hypertonic Explanation: In clients with conditions characterized by upper motor neuron destruction, as in cerebral palsy, the muscles are often hypertonic. However, in conditions with lower motor neuron destruction, the muscles become atonic, atrophied, and/or flaccid.

Which of the following is the final stage of fracture repair? Cartilage removal Angiogenesis Remodeling Cartilage calcification

Correct response: Remodeling Explanation: The final stage of fracture repair consists of remodeling the new bone into its former structural arrangement. During cartilage calcification, enzymes within the matrix vesicles prepare the cartilage for calcium release and deposit. Cartilage removal occurs when the calcified cartilage is invaded by blood vessels and becomes reabsorbed by chondroblasts and osteoclasts. Angiogenesis occurs when new capillaries infiltrate the hematoma, and fibroblasts from the periosteum, endosteum, and bone marrow produce a bridge between the fractured bones.

A client experiences a musculoskeletal injury that involves the structure that connects a muscle to the bone. The nurse understands that this injury involves which structure? Cartilage Joint Ligament Tendon

Correct response: Tendon Explanation: Tendons are cordlike structures that attach muscles to the periosteum of the bone. Ligaments consisting of fibrous tissue connect two adjacent, freely movable bones. Cartilage is a firm dense type of connective tissue that reduces friction between articular surfaces, absorbs shock, and reduces the stress on joint surfaces. A joint is the junction between 2 or more bones.

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 osteoarthritis. The patient has neurofibromatosis. The patient has rheumatoid arthritis. The patient has lupus erythematosus.

Correct response: The patient has rheumatoid arthritis. Explanation: The subcutaneous nodules of rheumatoid arthritis are soft and occur within and along tendons that provide extensor function to the joints. Osteoarthritic nodules are hard and painless and represent bony overgrowth that has resulted from destruction of the cartilaginous surface of bone within the joint capsule. Lupus and neurofibromatosis are not associated with the production of nodules.

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? excessive fluid within the capsule of a joint a grating sound when a joint is put through range of motion characterized by limited range of motion of a joint characterized by involuntary muscle twitching of the knee

Correct response: a grating sound when a joint is put through range of motion Explanation: Crepitus is a grating sound or sensation when a joint is put through range of motion. Limited range of motion can be a contracture and is not part of crepitus. Excessive fluid is an effusion. An involuntary muscle twitching is clonus.

The nurse working in the emergency department receives a call from the x-ray department communicating that the client the nurse is caring for has a fracture in the shaft of the tibia. The nurse tells the physician that the client's fracture is in the epiphysis. lordosis. scoliosis. diaphysis.

Correct response: diaphysis. Explanation: The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone. Lordosis refers to an increase in lumbar curvature of spine. Scoliosis refers to lateral curving of the spine.

Which term refers to moving away from midline? Adduction Inversion Eversion Abduction

Correct response: Abduction Explanation: Abduction is moving away from the midline. Adduction is moving toward the midline. Inversion is turning inward. Eversion is turning outward.

A client has an exaggerated convex curvature of the thoracic spine. What is this condition called? scoliosis kyphosis lordosis diaphysis

Correct response: kyphosis Explanation: Kyphosis is an exaggerated convex curvature of the thoracic spine. Lordosis is an excessive concave curvature of the lumbar spine. Scoliosis is a lateral curvature of the spine. Diaphyses are the long shafts of bones in the arms and legs.

Which of the following is an example of a hinge joint? Knee Hip Joint at base of thumb Carpal bones in the wrist

Correct response: 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.

Red bone marrow produces which of the following? Select all that apply. Platelets White blood cells (WBCs) Red blood cells (RBCs) Estrogen Corticosteroids

Correct response: Platelets White blood cells (WBCs) Red blood cells (RBCs) Explanation: The red bone marrow located within the bone cavities produces RBC, WBCs, and platelets through the process of hematopoiesis. The red bone marrow does not produce estrogen or corticosteroids.

A client tells the health care provider about shoulder pain that is present even without any strenuous movement. The health care provider identifies a sac filled with synovial fluid. What condition will the nurse educate the client about? a fracture of the clavicle osteoarthritis of the shoulder bursitis ankylosing spondylitis

Correct response: bursitis Explanation: A bursa is a small sac filled with synovial fluid. Bursae reduce friction between areas, such as tendon and bone and tendon and ligament. Inflammation of these sacs is called bursitis. A fracture of the clavicle is a bone break. Osteoarthritis is an inflammatory disease. Ankylosing spondylitis is a form of arthritis affecting the spine.

The older client asks the nurse how best to maintain strong bones. What is the nurse's best response? "Range-of-motion exercises build bone mass." "Cardio training is the best way to build bones." "Weight-resistance exercises can strengthen bones." "Weight-bearing exercises can strengthen bones."

Correct response: "Weight-bearing exercises can strengthen bones." Explanation: Weight-bearing exercises maintain bone mass. Weight-resistance exercises maintain and strengthen muscles. Cardio training is important for heart health and weight maintenance/reduction. Range-of-motion exercises are essential for joint mobility.

The nurse is preparing the client for computed tomography. Which information should be given by the nurse? "You must remain very still during the procedure." "A small bit of tissue will be removed and sent to the lab." "Fluid will be removed from you affected joint." "A radioisotope will be given through an IV."

Correct response: "You must remain very still during the procedure." Explanation: In computed tomography, a series of detailed x-rays are taken. The client must lie very still during the procedure. A contrast agent, not a radioisotope, may or may not be injected. Arthrocentesis involves the removal of fluid from a joint. A small bit of tissue is removed with a biopsy.

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? Keeping the affected knee flexed. Applying warm packs to the insertion site. Maintaining the client's NPO status. Administering the prescribed analgesic.

Correct response: Administering the prescribed analgesic. Explanation: After an arthroscopy, the client's entire leg is elevated without flexing the knee. A cold pack is placed over the bulky dressing covering the site where the arthroscope was inserted. A prescribed analgesic is administered as necessary. The client is allowed to resume his or her usual diet as tolerated.

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? Arthrocentesis Bone scan Electromyography Arthroscopy

Correct response: 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.

The nurse is performing a neurological assessment. What will this assessment include? Ask the client to plantar flex the toes. Observe for capillary refill of the great toe. Palpate the dorsalis pedis pulse. Inspect the foot for edema.

Correct response: Ask the client to plantar flex the toes. Explanation: A neurological assessment evaluates sensation and motion. Assessing plantar flexion of the toes would be included in a neurological assessment. Capillary refill, palpation of pulses, and inspecting for edema would be included in a vascular assessment.

Which body movement involves moving toward the midline? Pronation Adduction Abduction Eversion

Correct response: Adduction Explanation: Adduction is moving toward the midline. Pronation is turning inward. Abduction is moving away from the midline. Eversion is turning outward.

After a person experiences a closure of the epiphyses, which statement is true? The bone grows in length but not thickness. The bone increases in thickness and is remodeled. Both bone length and thickness continue to increase. No further increase in bone length occurs.

Correct response: No further increase in bone length occurs. Explanation: After closure of the epiphyses, no further increase in bone length can occur. The other options are inappropriate and not related to closure of the epiphyses.

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 absence of muscle movement suggesting nerve damage. involuntary twitch of muscle fibers. abnormal sensations. absence of muscle tone.

Correct response: 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.

The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site? The fracture is on the diaphysis. The fracture is ventrally located. The fracture is on the epiphyses. The fracture is on the tuberosity.

Correct response: The fracture is on the diaphysis. Explanation: A fracture that is on the diaphysis is understood to be chiefly found in the long shafts of the arms and legs. The epiphyses are rounded, irregular ends of the bones. Saying a fracture is ventrally located does not assist in providing adequate details of the location of the fracture. A tuberosity is a projection from the bone or a protuberance.

A client is recovering from a fractured hip. What would the nurse suggest that the client increase intake of to facilitate calcium absorption from food and supplements? Amino acids Vitamin B6 Vitamin D Dairy products

Correct response: Vitamin D Explanation: The nurse must advise a client recovering from a fractured hip to increase the intake of vitamin D, because vitamin D protects against bone loss and decreases the risk of recurring fracture by facilitating calcium absorption from food and supplements. Amino acids and vitamin B6, though important, do not facilitate the absorption of calcium. Dairy products also do not facilitate the absorption of calcium; however, the exception to this is vitamin D-fortified milk.

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 An arthroscopy A magnetic resonance imaging (MRI) A serum calcium test

Correct response: 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.

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 Osteoporosis Scoliosis Lordosis

Correct response: 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). Osteoporosis is abnormal excessive bone loss.

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 Cortical bone Osteoclasts Cancellous bone

Correct response: 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 conducting a musculoskeletal assessment on a client documented to have rheumatoid arthritis. Which would the nurse anticipate finding when inspecting the client's fingers? Soft, subcutaneous nodules along the tendons Hard nodules adjacent to the joints Hard nodules of bony overgrowth Soft nodules along the palmar surface

Correct response: Soft, subcutaneous nodules along the tendons Explanation: The subcutaneous nodules of rheumatoid arthritis are soft and occur within and along tendons that provide extensor function to the joints. The nodules of gout are hard and lie within and immediately adjacent to the joint capsule itself. Osteoarthritic nodules are hard and painless and represent bony overgrowth that results from destruction of the cartilaginous surface of bone within the joint capsule.

A nurse provides nutritional health teaching to an adult client who had two fractures in 1 year. Besides recommending supplemental calcium, the nurse suggests a high-calcium diet. What would the nurse recommend that the client increase intake of? Canned mixed fruit. Salmon and sardines. Yogurt and cheese. Almonds and peanuts.

Correct response: Yogurt and cheese. Explanation: Yogurt and cheese are excellent sources of calcium. The other choices are low-calcium foods.

The nurse is preparing an education program on risk factors for musculoskeletal disorders. Which risk factors are appropriate for the nurse to include in the teaching program? Select all that apply. age menopause bed rest calcium-rich diet current cigarette smoking

Correct response: age menopause bed rest current cigarette smoking Explanation: Increasing age, menopause, immobility (such as bed rest), and current cigarette smoking increase the risk for musculoskeletal disorders. A diet rich in calcium is beneficial in maintaining bone and muscle.

The nurse is teaching a client about osteoporosis. What diagnostic test will the nurse include with the client teaching? dual-energy x-ray absorptiometry bone biopsy arthrocentesis arthroscopy

Correct response: 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 client's blood test results reveal an elevated alkaline phosphatase. What might this indicate? a bone tumor Paget's disease osteomalacia systemic lupus erythematosus

Correct response: a bone tumor Explanation: An elevated alkaline phosphatase level may indicate bone tumors and healing fractures. An elevated acid phosphatase level is seen with Paget's disease and metastatic cancer. A decreased serum calcium level is seen with osteomalacia, osteoporosis, and bone tumors. An elevated antinuclear antibody level may indicate systemic lupus erythematosus.

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. "When is the last time you had food or drink?" "Are you wearing any jewelry?" "Have you removed your hearing aid?" "Do you have a pacemaker?" "Did you take your medications this morning?"

Correct response: Are you wearing any jewelry?" "Have you removed your hearing aid?" "Do you have a pacemaker?" Explanation: Magnetic resonance imaging (MRI) is a noninvasive imaging technique that uses magnetic fields, radio waves, and computers to demonstrate abnormalities of soft tissue. Individuals with any metal implants, clips, or pacemakers are not candidates for MRI. Individuals do not need to be NPO and can take usual medications.