CH 24: Assessing Musculoskeletal System

For a nursing exam, students must label a diagram using the correct medical terminology. Where would the students label the metacarpophalangeal joint?

Between the hand and the finger The metacarpophalangeal and intraphalangeal joints permit finger movement.

The nurse is caring for an adult client who is in a cast because of a fractured arm. To promote healing of the bone and tissue, the nurse should instruct the client to eat a diet that is high in

vitamin C. Adequate protein in the diet promotes muscle tone and bone growth; vitamin C promotes healing of tissues and bones.

When the client performs straight leg flexion, the client complains of pain that radiates down his leg. The nurse understands that this may indicate what?

Herniated disc Straight leg flexion that produces back and leg pain radiating down the leg may indicate a herniated disc

Joints may be classified as cartilaginous, synovial, or

fibrous

The subacromial bursae are contained in the

shoulder joint.

A nurse has just finished assessing a client's spine and neck muscles. How would the nurse document normal findings?

C7 and T1 spinous processes prominent. Paravertebral, sternocleidomastoid, and trapezius muscles fully developed, symmetrical, and nontender

Which nutrient deficiency should a nurse recognize as placing a client at risk for osteoporosis?

Calcium A calcium deficiency increases the risk osteoporosis. This causes the bones to become softer in nature because the rate at which bone is destroyed is occurring at a faster rate than new bone is made. Protein functions in muscle tone and growth. Vitamin C promotes healing of tissues and bones. Vitamin D deficiency causes osteomalacia, softening of the bones due to defective bone mineralization. Osteomalacia in children is known as rickets.

A client presents to the health care clinic with reports of onset of neck pain 3 days ago. The nurse recognizes that the most common cause of neck pain is what condition?

Cervical strain The most common cause of neck pain is cervical strain. This can occur from sleeping in the wrong position, carrying a heavy load, or being in an automobile accident. Cervical disc degenerative disease is associated with impaired range of motion and pain that radiates to the back, shoulders, or arms. Cervical spinal cord compression causes neck pain with loss of sensation in the legs. Compression fractures of the neck may also cause loss of sensation in the legs if the spinal cord becomes compressed.

A client presents to the emergency department after falling off a ladder while doing some outside painting at home. The client's ankle appears swollen, out of alignment, and is painful to touch. What is the nurse's first action?

Check for a pulse, color, temperature, and capillary refill. The first nursing actions include taking vital signs, monitoring pulses, and assessing color, temperature, and capillary refill distal to the injury to evaluate tissue perfusion.

A nurse notices that a client has decreased range of motion with lateral bending of the cervical spine to the left side. What should the nurse do next in relation to this finding?

Compare this finding to the range of motion to the right side It is always important to compare both sides of the body for symmetry before making a judgment that data is abnormal

A college age athlete presents to the clinic with pain in the tibiotalar joint. It is a hinge joint limited to flexion and extension. The terms used to describe these movements are what?

Dorsiflexion and plantar flexion

During palpation of the client's knee, the nurse compresses the suprapatellar pouch against the client's femur with one hand while feeling on each side of the patella with the opposite hand. For which of the following problems is the nurse assessing?

Effusion in the knee joint The balloon sign is indicative of a large effusion in the knee joint when fluid is palpable medial to the patella when the suprapatellar pouch is depressed.

When examining a patient's musculoskeletal system, the nurse finds acute involvement of only one joint. What would this suggest to you? (Select all that apply.)

Gout Septic arthritis Trauma

A client presents to the health care clinic with reports of a swollen, tender, reddened joint in the left big toe. The nurse recognizes this finding as an indication of what inflammatory process?

Gouty arthritis Tender, painful, reddened, hot, and swollen metatarsophalangeal joint in the great (big) toe is seen in gouty arthritis. This is an inflammatory condition caused by an abnormal buildup of uric acid in the body that becomes deposited in the joints. Rheumatoid arthritis can occur in any joint but usually affects the hands first. Verruca vulgaris (warts) is a painful wart that occurs under a callus. Degenerative joint disease does not typically cause the joints to be reddened and hot because it is not an inflammatory process.

Upon examination of an elderly client, the nurse finds hard, painless nodules over the distal interphalangeal joints. What is the appropriate term the nurse should use to document this finding in the client's medical records?

Heberden's nodes The nurse should document the hard, painless nodules over the distal interphalangeal joints as Heberden's nodes. Inflamed bursa is an inappropriate term because bursae are not found in interphalangeal joints. Bouchard's nodes are seen over the proximal interphalangeal joints. Painful corns are thickenings of the skin that occur over bony prominences and at pressure points.

The nurse is developing a plan of care for a client found to have a strength problem. What would be an appropriate nursing diagnosis for this client?

Impaired physical mobility The most appropriate diagnosis would be impaired physical mobility related to reduced strength and ROM

A nurse notices that a client's flexibility of the right elbow is less than the left elbow. What is an appropriate action by the nurse in regard to this finding?

Measure movement with a goniometer If the nurse identifies a limitation in the range of motion for a joint, a goniometer should be used to measure the exact angle of movement present. The goniometer is placed at the joint and then moved to match the angle of the joint being assessed

The nurse is testing a client for carpal tunnel syndrome. The client flexes the wrists at an angle of 90° and holds the backs of the hands to each other for 60 seconds. The client tells the nurse that he is experiencing a burning pain as a result. Which test is the nurse performing on this patient?

Phalen's Phalen's test evaluates for carpal tunnel syndrome. The client flexes the wrists at an angle of 90° and holds the backs of the hands to each other for 60 seconds. Normal response is denial of any discomfort. Positive signs include numbness, burning, or pain. Tinel's sign is a test to assess for irritated nerves. It is performed by lightly percussing over the nerve to elicit a sensation or tingling in the distribution of the nerve. Ballottement is a test to assess for increased fluid in the knee joint. The McMurray test is used to test individuals for tears in the meniscus of the knee.

A 50-year-old man has sought care because of the intense shoulder pain that resulted when he threw a baseball to home plate from the outfield the previous evening. The client states that he has never had problems with his shoulder previously. The nurse has asked to client to slowly abduct his affected arm to shoulder level and maintain the position. Which of the following shoulder problems does the nurse suspect?

Rotator cuff tear A rotator cuff tear is often the result of a strong, single throwing motion and is assessed for using the drop arm test

The school nurse notes that the client carries her left shoulder higher than her right shoulder. You should recognize the likely presence of what health problem?

Scoliosis Scoliosis may cause elevation of one shoulder.

A 32-year-old warehouse worker presents for evaluation of low back pain. He notes a sudden onset of pain after lifting a heavier-than-usual set of boxes. He also states that he has numbness and tingling in the left leg. What test should the nurse perform to assess for a herniated disc?

Straight leg raise test The straight leg raise test involves having the client lie supine with the examiner raising the leg. If the client experiences a sharp pain radiating from the back down the leg in an L5 or S1 distribution, that suggests a herniated disc.

A nurse is inspecting a client's gait. Which of the following would indicate an abnormal finding?

Toes point out Abnormal findings in gait include the following: uneven weight bearing is evident; client cannot stand on heels or toes; toes point in or out; client limps, shuffles, propels forward, or has wide-based gait.

Bones contain yellow marrow that is composed mainly of

fat. Bones contain red marrow that produces blood cells and yellow marrow composed mostly of fat.

A client visits the clinic and tells the nurse that after playing softball yesterday, he thinks his knee is "locking up." The nurse should perform the McMurray test by asking the client to

flex the knee and hip while in a supine position. If the client complains of a "giving in" or "locking" of the knee, perform McMurray's test. With the client in the supine position, ask the client to flex one knee and hip. Then place your thumb and index finger of one hand on either side of the knee. Use your other hand to hold the heel of the foot up. Rotate the lower leg and foot laterally. Slowly extend the knee, noting pain or clicking. Repeat, rotating lower leg and foot medially. Again, note pain or clicking.

An adult client tells the nurse that he eats sardines every day. The nurse should instruct the client that a diet high in purines can contribute to

gouty arthritis. A diet high in purine (e.g., liver, sardines) can trigger gouty arthritis.

An older adult client visits the clinic and tells the nurse that she has had shooting pain in both of her legs. The nurse should assess the client for signs and symptoms of

herniated intervertebral disc. Thirty-three bones: 7 concave-shaped cervical (C); 12 convexshaped thoracic (T); 5 concave-shaped lumbar (L); 5 sacral (S); and 3-4 coccygeal, connected in a vertical column. Bones are cushioned by elastic fibrocartilaginous plates (intervertebral discs) that provide flexibility and posture to the spine. Paravertebral muscles are positioned on both sides of vertebrae.

On inspection of the spine of a 79-year-old man, the nurse might expect to find a(n)

increased thoracic curve An exaggerated thoracic curve (kyphosis) is common with aging.

A female client visits the clinic and tells the nurse that she began menarche at the age of 16 years. The nurse should instruct the client that she is at a higher risk for

osteoporosis Women who begin menarche late or begin menopause early are at greater risk for development of osteoporosis because of decreased estrogen levels, which tend to decrease the density of bone mass.

The external covering of the bone that contains osteoblasts and blood vessels is termed the

periosteum. The periosteum covers the bones; it contains osteoblasts and blood vessels that promote nourishment and formation of new bone tissues.

One of the functions of a bone is to

produce blood cells. Bones provide structure, give protection, serve as levers, store calcium, and produce blood cells.

A client is unable to externally rotate the left shoulder. What health problem should the nurse suspect is occurring with this client?

rotator cuff tear In a complete tear of the supraspinatus tendon, or a rotator cuff tear, active abduction and forward flexion at the glenohumeral joint are severely impaired, producing a characteristic shrugging of the shoulder and a positive "drop arm" test.

While assessing the range of motion in an adult client's shoulders, the client expresses pain and exhibits limited abduction and muscle weakness. The nurse plans to refer the client to a physician for possible

rotator cuff tear. Painful and limited abduction accompanied by muscle weakness and atrophy are seen with a rotator cuff tear.

Skeletal muscles are attached to bones by

tendons