CH 40

The nurse is providing care to a client following a knee arthroscopy. Which of the following would the nurse expect to include in the client's plan of care? a) Keeping the affected knee flexed. b) Administering the prescribed analgesic. c) Applying warm packs to the insertion site. d) Maintaining the client's NPO status.

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 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? a) A serum calcium test b) A magnetic resonance imaging (MRI) c) An electromyography d) An arthroscopy

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 of the following factors would the nurse need to keep in mind about the focus of the initial history when assessing a new client with a musculoskeletal problem? a) Client's life-style b) Client's age c) Any chronic disorder or recent injury d) Duration and location of discomfort or pain

Any chronic disorder or recent injury Explanation: The focus of the initial history depends on the nature of the musculoskeletal problem, whether the client has a chronic disorder or a recent injury. If the disorder is long-standing, the nurse obtains a thorough medical, drug, and allergy history. If the client is injured, the nurse finds out when and how the trauma occurred. The client's age, life-style, or duration and location of discomfort or pain, while important, have little influence on the focus of the initial history and assessment of the client.

Which of the following is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip or wrist? a) Arthrography b) EMG c) Bone densitometry d) Meniscography

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. 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. Meniscography is a distractor for this question.

The nurse would include which of the following in a neurological assessment? a) Inspect the foot for edema. b) Capillary refill of the great toe. c) Ask the client to plantar flex the toes. d) Palpate the dorsalis pedis pulse.

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.

The nurse is performing a musculoskeletal assessment of a patient in a nursing home who had a stroke 2 years ago and who has right-sided hemiplegia. The nurse notes that the girth of the patient's right calf is 2 inches less in diameter than the left calf. The nurse attributes the decreased girth to which of the following? a) Atrophy of right calf muscle b) Edema in left lower extremity c) Bruising in right lower extremity d) Increased use of left calf muscle

Atrophy of right calf muscle Explanation: Girth of an extremity may increase due to exercise, edema, or bleeding into the muscle. However, a patient with right-sided hemiplegia is unable to use the right lower extremity. This patient may experience atrophy of the muscles from lack of use, which will result in a subsequent decrease in the girth of the calf muscle.

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

Click on the thoracic part of the spine. Explanation: Kyphosis is an increased convexity of roundness of the thoracic curve of the spine.

The nurse is caring for patient scheduled to have magnetic resonance imaging (MRI). The nurse contacts the health care provider to cancel the MRI when the nurse reads which of the following in the patient's medical history? a) Colostomy b) Tumor removal c) Cochlear implant d) Skin graft

Cochlear implant Explanation: Nonremovable cochlear devices can become inoperable when exposed to MRI. Therefore, it is contraindicated for a patient with a cochlear implant to have an MRI. Also, transdermal patches (e.g., nicotine patch [NicoDerm], nitroglycerin transdermal [Transderm-Nitro], scopolamine transdermal [Transderm Scop], clonidine transdermal [Catapres-TTS]) that have a thin layer of aluminized backing must be removed before MRI because they can cause burns. The primary provider should be notified before the patches are removed. Additionally, the patient should remove all jewelry, hair clips, hearing aids, credit cards with magnetic strips, and other metal-containing objects; otherwise, these objects can become dangerous projectiles or cause burns.

Which of the following is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes? a) Compartment syndrome b) Remodeling c) Hypertrophy d) Fasciculation

Compartment syndrome Explanation: Compartment syndrome is caused by pressure within a muscle area that increase to such an extent that microcirculation diminishes. Remodeling is a process that ensures bone maintenance through simultaneous bone resorption and formation. Hypertrophy is an increase in muscle size. Fasciculation is the involuntary twitch of muscle fibers.

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? a) Osteocytes are transformed into osteoblasts or mature bone cells. b) The yellow marrow is responsible for manufacturing red blood cells. c) Osteoclasts are involved in the destruction and remodeling of bone. d) Long bones typically contain more red bone marrow than yellow.

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.

Skull sutures are an example of which type of joint? a) Amphiarthrosis b) Aponeuroses c) Diarthrosis d) Synarthrosis

Synarthrosis Explanation: 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 is scheduled to have an x-ray examination of his shoulder in which the synovial fluid will be aspirated and sent to the laboratory for analysis. This will be followed by administration of a contrast medium and x-rays. The nurse understands that the client will be undergoing which of the following? a) Arthroscopy b) Arthrogram c) Bone densitometry d) Arthrocentesis

Arthrogram Explanation: An arthrogram is a radiographic examination of a joint, usually the knee or shoulder. The physician first injects a local anesthetic and then inserts a needle into the joint space. Fluoroscopy may be used to verify correct placement of the needle. The synovial fluid in the joint is aspirated and sent to the laboratory for analysis. A contrast medium is then injected, and x-ray films are taken. Arthroscopy is the internal inspection of a joint using an instrument called an arthroscope. Arthrocentesis is the aspiration of synovial fluid. The client receives local anesthesia just before this procedure. The physician inserts a large needle into the joint and removes the fluid. This can be done during an arthrogram or arthroscopy. Bone densitometry estimates bone density using radiography or advanced radiographic techniques.

A client is scheduled to undergo an electromyography. The nurse understands that this test is performed to evaluate which of the following? a) Muscle composition b) Muscle weakness c) Metastatic bone lesions d) Bone density

Muscle weakness Explanation: Electromyography tests the electric potential of the muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration, pain, disability, and to differentiate muscle and nerve problems. A bone biopsy is done to identify bone composition. Bone densitometry is done to evaluate bone density. A bone scan would be appropriate to detect metastatic bone lesions.

Which body movement involves moving toward the midline? a) Pronation b) Eversion c) Abduction d) Adduction

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

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? a) The fracture is on the diaphysis. b) The fracture is on the tuberosity. c) The fracture is ventrally located. d) The fracture is on the epiphyses.

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.

Which of the following diagnostic studies are done to relieve joint pain due to effusion? a) Electromyography (EMG) b) Arthrocentesis c) Biopsy d) Bone scan

Arthrocentesis Explanation: 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.

Which of the following would be a circulatory indicator of peripheral neurovascular dysfunction? a) Cool skin b) Paralysis c) Weakness d) Paresthesia

Cool skin Explanation: Indicators of peripheral neurovascular dysfunction related to circulation include pale, cyanotic or mottled skin with a cool temperature. The capillary refill is more than 3 seconds. Weakness and paralysis is related to motion. Paresthesia is related to sensation.

The nurse is planning care for a client with a musculoskeletal injury. Which nursing diagnosis would be the highest priority? a) Ineffective Health Maintenance b) Acute Pain c) Delayed Surgical Recovery d) Risk for Impaired Tissue Perfusion

Acute Pain Explanation: The highest priority at this time is Acute Pain and nursing interventions related to decreasing pain. If the client is in pain, instruction to improve health maintenance or surgical recovery is less effective. A "Risk for" diagnosis is a potential problem not an actual problem at this time.

Mr. Roland is in your clinic undergoing an orthopedic assessment. It is noted that he has an exaggerated convex curvature of the thoracic spine. What is this condition called? a) Kyphosis b) Scoliosis c) Lordosis d) Diaphysis

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 terms refers to mature compact bone structures that form concentric rings of bone matrix? a) Trabecula b) Endosteum c) Lamellae d) Cancellous bone

Lamellae Explanation: Lamellae are mineralized bone matrices. Endosteum refers to the marrow cavity lining of hollow bone. Trabecula refers to latticelike bone structure. Cancellous bone refers to spongy, latticelike bone structure.

The nurse is reading the admission note of a patient with a bone fracture that requires surgery. The note indicates the presence of crepitus. The nurse interprets this as being which of the following? a) Closed fracture b) Bleeding c) Crackling sound d) Ecchymosis

Crackling sound Explanation: Crepitus is a sound or sensation elicited by the rubbing together of fragments of bone, as in a fracture, or in irregular joint surfaces. The sound/sensation can be described as "grating" or "crackling."

Which of the following nursing actions is most important in caring for the client following an arthrogram? a) Assist the client with passive range of motion. b) Apply ice to the joint. c) Keep the joint below the level of the heart. d) Administer morphine sulfate.

Apply ice to the joint. Explanation: Ice is applied to minimize edema and provide analgesia to the joint. The joint is elevated to minimize edema. Mild analgesics are sufficient to control pain. The joint is usually rested for 12 hours post-procedure.

Which of the following is an indicator of neurovascular compromise? a) Capillary refill of more than 3 seconds b) Pain on active stretch c) Warm skin temperature d) Diminished pain

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 on passive stretch, and absence of feeling. Cool skin temperature is an indicator of neurovascular compromise. Unrelenting pain is an indicator of neurovascular compromise. Pain on passive stretch is an indicator of neurovascular compromise.

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

Click on the lumbar part of the spine. Explanation: Lordosis, also known as swayback, is an exaggeration of the lumbar curve of the spine.

Which serum level indicates the rate of bone turnover? a) Aspartate aminotransferase b) Myoglobin c) Osteocalcin d) Creatinine kinase

Osteocalcin Explanation: Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Serum myoglobin is assessed to evaluate muscle trauma. Serum enzyme levels of creatinine kinase and aspartate aminotransferase become elevated with muscle damage.

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching? a) "I should use my heating pad this evening to reduce some of the pain in my knee." b) "Elevating my leg will reduce swelling after the procedure." c) "I may notice some bruising or swelling in my knee." d) "My physician may prescribe pain pills after the procedure."

"I should use my heating pad this evening to reduce some of the pain in my knee." Explanation: The client requires additional teaching if he states that he'll use a heating pad to reduce pain the evening of the procedure. The client shouldn't use heat at the procedure site during the first 24 hours because doing so may increase localized swelling. Ice is indicated during this time. Elevating the extremity helps reduce swelling. The client may experience some discomfort after the procedure for which the physician may order medication. Bruising and swelling are common after an arthroscopy.

Which cells are involved in bone resorption? a) Osteocytes b) Osteoblasts c) Osteoclasts d) Chondrocytes

Osteoclasts Explanation: 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.

The nurse reading a patient's chart notices that the patient is documented to have paresthesia. The nurse plans care for a patient with which of the following? a) Involuntary twitch of muscle fibers b) Absence of muscle tone c) Abnormal sensations d) Absence of muscle movement suggesting nerve damage

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 termed flaccid.

The homecare nurse is evaluating the musculoskeletal system of a geriatric patient whose previous assessment was within normal limits. The nurse initiates a call to the health care provider and/or emergency services when which of the following changes are found? a) Decreased agility b) Increased joint stiffness c) Decreased flexibility d) Decreased right-sided muscle strength

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 working in the ER receives a call from the x-ray department communicating that the patient the nurse is caring for has a fracture in the shaft of the tibia. The nurse tells the physician that the patient's fracture is which of the following? a) Epiphysis b) Lordosis c) Scoliosis d) Diaphysis

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 of the following terms refers to the shaft of the long bone? a) Scoliosis b) Lordosis c) Diaphysis d) Epiphysis

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 diagnostic test does the nurse expect the client with osteoporosis to undergo? a) Arthrocentesis b) Arthroscopy c) Dual-energy x-ray absorptiometry d) Bone biopsy

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.

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

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.

The nurse would expect which of the following diagnostic tests to be ordered for a patient with lower extremity muscle weakness? a) Biopsy b) Electromyograph (EMG) c) Arthrocentesis d) Bone scan

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. An arthrocentesis, bone scan, and biopsy does not measure muscle weakness.

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? a) Osteoporosis b) Lupus erythematosus c) Gout d) Rheumatoid arthritis

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.

Which of the following is the most common site of joint effusion? a) Elbow b) Shoulder c) Hip d) Knee

Knee Explanation: The most common site for joint effusion is the knee. If inflammation or fluid is suspected in a joint, consultation with a provider is indicated. The elbow, hip, and shoulder are not the most common site of joint effusion.

The nurse is employed at a long-term care facility caring for geriatric clients. Which assessment finding is characteristic of an age-related change? a) Cognitive decline b) Increased muscle mass c) Loss of height d) Depressive symptoms

Loss of height Explanation: A common age-related change is the loss of height due to the loss of bone mass and vertebral collapse. Cognitive decline is not an age-related change. Depression occurs in all age groups. Geriatric clients have a decrease in muscle mass.

The nurse is conducting an admission history of a client admitted with a fracture. The nurse recognizes that which of the client's medications placed the client at risk for fractures? a) prednisone (Deltasone) b) digoxin (Lanoxin) c) metoprolol (Lopressor) d) furosemide (Lasix)

prednisone (Deltasone) Explanation: Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures.

An example of a flat bone is the a) vertebra. b) sternum. c) metacarpals. d) femur.

sternum. Explanation: An example of a flat bone is the sternum. A short bone is a metacarpal. The femur is a long bone. The vertebra is an irregular bone.

A client, age 50, visits the physician for a routine checkup. The history reveals that the client was diagnosed with a spinal curvature at age 45. The nurse knows that life-threatening complications can occur if the progressive spinal curvature exceeds 65 degrees. Which region of the spine should the nurse assess for complications? a) Thoracic b) Cervical c) Lumbar d) Sacral

Thoracic Explanation: The nurse should assess the thoracic region of the spine because a progressive curvature of more than 65 degrees in this region may lead to cardiopulmonary failure as well as less serious signs and symptoms, such as fatigue, back pain, decreased height, and cosmetic deformity. Although a curvature may affect any part of the spine, life-threatening complications aren't associated with curvature of the cervical, lumbar, or sacral regions.

Which assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy? a) Toes move freely without pain b) Bounding dorsalis pedis pulses c) Capillary refill < 3 seconds d) Increased diameter of the calf

Increased diameter of the calf Explanation: Increasing diameter of the calf can be indicative of bleeding into the muscle. The other findings are within normal limits.

The nurse is conducting the admission assessment for the client who is to undergo an arthrogram. What is the priority question the nurse should ask? a) "When did you last urinate?" b) "Are you claustrophobic?" c) "Do you have any allergies?" d) "When did you last eat?"

"Do you have any allergies?" Explanation: Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood.

A client with a sports injury undergoes a diagnostic arthroscopy of the left knee. Which of the following comments by the client following the procedure should the nurse address first? a) "My feet are cold." b) "My foot is swollen." c) "My toes are numb." d) "My knee aches."

"My toes are numb." Explanation: Numbness would indicate neurological compromise of the extremity and requires immediate intervention to prevent permanent damage.

The older client asks the nurse how best to maintain strong bones. The best response by the nurse is: a) "Weight-bearing exercises can strengthen bones." b) "Weight-resistance exercises can strengthen bones." c) "Cardio-training is the best way to build bones." d) "Range of motion exercises build bone mass."

"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? a) "Fluid will be removed from you affected joint." b) "You must remain very still during the procedure." c) "A small bit of tissue will be removed and sent to the lab." d) "A radioisotope will be given through an IV."

"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.

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone? a) Calcitonin b) Sex hormones c) Growth hormone d) Vitamin D

Calcitonin Explanation: 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 other answers do not apply.

The nurse is reviewing the client's admission assessment and notes that crepitus of the right knee joint was documented. The nurse recognizes that crepitus is: a) Characterized by limited range of motion of a joint b) Characterized by involuntary muscle twitching of the knee c) Excessive fluid within the capsule of a joint d) A grating sound when a joint is put through range of motion

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.

Which of the following describes an osteon? a) A bone resorption cell b) A bone-forming cell c) A mature bone cell d) A microscopic functional bone unit

A microscopic functional bone unit Explanation: The center of an osteon contains a capillary, a microscopic functional bone unit. An osteoblast is a bone-forming cell. An osteoclast is a bone resorption cell. An osteocyte is a mature bone cell.

Which of the following terms refers to moving away from midline? a) Adduction b) Abduction c) Inversion d) Eversion

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

Which of the following statements describes paresthesia? a) Absence of muscle tone b) Absence of muscle movement suggesting nerve damage c) Abnormal sensations d) Involuntary twitch of muscle fibers

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 which holds no tone is termed flaccid.

The nurse is preparing an education program on risk factors for musculoskeletal disorders. Which of the following would be inappropriate risk factor for the nurse to include in the teaching program? a) Age b) Menopause c) Bedrest d) Calcium-rich diet

Calcium-rich diet Explanation: A diet rich in calcium is beneficial in maintaining bone and muscle. Increasing age, menopause, and immobility (such as bedrest) increase the risk for musculoskeletal disorders.

Which of the following is an example of a gliding joint? a) Knee b) Carpal bones in the wrist c) Joint at base of thumb d) Hip

Carpal bones in the wrist Explanation: Gliding joints allow for limited movement in all directions and are represented by the joints of the carpal bones in the wrist. 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.

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

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.

The client presents with an exaggeration of the lumbar spine curve. The nurse interprets these findings as indicative of: a) Scoliosis b) Lordosis c) Dowager's hump d) Kyphosis

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

Which of the following deformity causes a exaggerated curvature of the lumbar spine? a) Steppage gait b) Lordosis c) Scoliosis d) Kyphosis

Lordosis Explanation: Lordosis is an exaggerated curvature of the lumbar spine. Scoliosis is a lateral curving deviation of the spine. Kyphosis is an increased forward curvature of the thoracic spine. Steppage gait is not a type of spinal deformity.

Which of the following is an age-related change to the musculoskeletal system? a) Increased elasticity of tendons b) Thickening of the vertebral discs c) Loss of bone mass d) Decrease in collagen

Loss of bone mass Explanation: Age-related changes include loss of bone mass, an increase in collagen and resultant fibrosis, thinning of the vertebral discs, and decreased elasticity of tendons.

The nurse is caring for a client who has a deficiency in the formation of cartilage in joints. Which essential substance is absent? a) Myofibrils b) Matrix c) Osteoblasts d) Sarcomeres

Matrix Explanation: Cartilage is a firm, dense type of connective tissue that consists of cells embedded in a substance called matrix. The matrix is firm and compact. Cartilage is essential in reducing friction between articular surfaces and absorbs shock. Osteoblasts build bone. Sarcomeres assist in contracting muscle. Skeletal muscles are composed of myofibrils.

The nurse is working on an orthopedic floor caring for a client injured in a football game. The nurse is reviewing the client's chart noting that the client has previously had an injured tendon. The nurse anticipates an injury between the periosteum of the bone and which of the following? a) Joint b) Muscle c) Cartilage d) Ligament

Muscle Explanation: Tendons attach muscles to the periosteum of bone. Joints are a junction between two or more bones. Ligaments connect two freely movable bones. Cartilage is a dense connective tissue used to reduce friction between two structures.

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

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.

The nurse observes the client and notes a shuffling gait. The nurse recognizes this finding is consistent with: a) Parkinson's disease b) Paget's disease c) Lower motor neuron disease d) Scoliosis

Parkinson's disease Explanation: Parkinson's disease is characterized by a shuffling gait.

Which nerve is being assessed when the nurses asks the patient to dorsiflex his ankle and extend his toes? a) Ulnar b) Radial c) Median d) Peroneal

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

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 of the following? a) Joint b) Cartilage c) Tendon d) Ligament

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 recognizes that rheumatoid arthritis is characterized by: a) Clonus b) Ballottement sign c) Ulnar deviation d) Fasciculations

Ulnar deviation Explanation: Rheumatoid arthritis is characterized by ulnar deviation of the fingers. The ballottement sign is used to detect fluid in the knee. Clonus is the rhythmic contractions of a muscle. Involuntary twitching of muscle fiber groups is called fasciculation.

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

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.

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? a) furosemide b) aspirin c) digoxin d) NPH insulin

aspirin Explanation: Aspirin has anti-clotting properties, and bone is a very vascular tissue. The client taking aspirin in close proximity to a bone biopsy is at increased risk for excessive bleeding.

Which of the following describes a muscle that is limp and without tone? a) Atonic b) Flaccid c) Spastic d) Paralysis

Flaccid Explanation: A muscle that is limp and without tone is described as flaccid. A muscle with greater-than-normal tone is described as spastic. In conditions characterized by lower neuron destruction, denervated muscle becomes atonic (soft and flabby) and atrophies. A person with muscle paralysis has a loss of movement and possibly nerve damage.

Which of the following is a fibrous sheath that surrounds the articulating bones? a) Joint capsule b) Ligament c) Bursa d) Synovium

Joint capsule Explanation: A tough, fibrous sheath called the joint capsule surrounds the articulating bones. Synovium secretes the lubricating and shock-absorbing synovial fluid into the joint capsule. Ligaments bind the articulating bones together. A bursa is a sac filled with synovial fluid that cushions the movements of tendons, ligaments, and bones at a point of friction.

Which serum level indicates the rate of bone turnover? a) Myoglobin b) Creatinine kinase c) Aspartate aminotransferase d) Osteocalcin

Osteocalcin Explanation: Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Serum myoglobin is assessed to evaluate muscle trauma. Serum enzyme levels of creatinine kinase and aspartate aminotransferase become elevated with muscle damage.

Which type of gait correlates with Parkinson's disease? a) Steppage b) Scissors c) Spastic hemiparesis d) Shuffling

Shuffling Correct 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 conducting a community education program on hip fracture risk. The nurse evaluates that the participants understand the program when the program determines that the person at highest risk for a hip fracture is which of the following? a) High school football player b) 30-year-old pregnant woman c) Toddler just starting to walk d) 80-year-old widow

80-year-old widow Explanation: Hip fracture occurs with greater incidence in elderly people and is often a life-altering event that has a negative impact on the person's mobility and quality of life.

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? a) Apply a cold pack at the insertion site. b) Provide a gentle massage. c) Assist with performing ROM exercises. d) Apply warm compresses to the insertion site.

Apply a cold pack at the insertion site. Explanation: After covering the arthroscope insertion site with a bulky dressing and elevating the client's entire leg, the nurse needs to apply a cold pack at the site to minimize any chances of swelling.

The nurse is assessing the client who states a decline in muscle strength. Which is the primary source essential to allow muscle contraction? a) Sarcomeres b) Acetylcholine c) Myofibrils d) Actin and myosin

Myofibrils Explanation: Skeletal muscles are made up of muscle cells or fibers called myofibrils. Without muscle fibers, there can be no muscle contraction. Sliding filaments called sarcomeres make up the myofibrils. Acetylcholine stimulates the motor neuron, which innervated the muscle. Actin and myosin in the sarcomere slide together, resulting in muscle contraction.

A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells? a) Remodeling b) Resorption c) Epiphyses and diaphysis formation d) Ossification and calcification

Ossification and calcification Explanation: Ossification and calcifications the body's process to transform osteoblasts into mature bone cells called osteocytes. Osteocytes are involved in maintaining bone tissue. Resorption and remodeling are involved in bone destruction. Epiphyses and diaphysesare bone tissues that provide strength and support to the human skeleton.

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? a) Cortical bone b) Cancellous bone c) Osteoblasts d) Osteoclasts

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.

Which of the following is a characteristic of fracture pain? a) Sore b) Deep c) Dull d) Piercing

Piercing Explanation: Fracture pain is sharp and piercing and is relieved by immobilization. Bone pain is characteristically described as a dull, deep ache that is "boring" in nature, whereas muscular pain is described as soreness or aching and is referred to as "muscle cramps."

There are thousands of components of the musculoskeletal system that facilitate mobility and independent function. What is the function of skeletal muscle? a) Promoting movement of skeletal bones b) Promoting involuntary function c) Promoting organ function d) All options are correct.

Promoting movement of skeletal bones Explanation: The skeletal muscles promote movement of the bones of the skeleton.

The nurse is caring for a client who experienced a crushing injury of the lower extremities. Which of the following symptoms is essential to be reported to the physician? a) Coolness b) Pulselessness c) Ischemia d) Pain

Pulselessness Explanation: Neurovascular checks (circulation, sensation, motion) are essential with a crushing injury. The absence of a pulse is a critical assessment finding to report to the physician. The other options are symptoms that need regular assessment.

Which of the following is the final stage of fracture repair? a) Remodeling b) Angiogenesis c) Cartilage calcification d) Cartilage removal

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.

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) Remodeling c) Reparative d) Revascularization

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 the fracture. Callus formation occurs during the reparative stage but is disrupted by excessive motion at the fracture site.

Which of the following would be most important for the nurse to include in the teaching plan for a client who has undergone arthrography? a) Avoid sunlight or harsh, dry climate. b) Gently massage joints with any crackling or clicking joint noises. c) Avoid intake of dairy products. d) Report joint crackling or clicking noises occurring after the second day.

Report joint crackling or clicking noises occurring after the second day. Explanation: After undergoing arthrography, the client must be informed that he or she may hear crackling or clicking noises in the joints for up to 2 days, but if noises occur beyond this time, they should be reported. These noises may indicate the presence of a complication, and therefore should not be ignored or treated by the client. Massage is not indicated. The client need not be asked to avoid sunlight or dairy products.

Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis? a) Activity intolerance b) Chronic pain c) Risk for infection d) Deficient knowledge: procedure

Risk for infection Explanation: The priority nursing diagnosis following an arthrocentesis is risk for infection. The client may experience acute pain. The client needs adequate information before experiencing the procedure. Activity intolerance would not be an expected nursing diagnosis.

What is the term for a lateral curving of the spine? a) Lordosis b) Scoliosis c) Epiphysis d) Diaphysis

Scoliosis Explanation: Scoliosis is a lateral curving of the spine. Lordosis is an increase in the lumbar curvature of the spine. Diaphysis is the shaft of a long bone. Epiphysis is the end of a long bone.

Which of the following statements reflect the progress of bone healing? a) All fracture healing takes place at the same rate no matter the type of bone fractured. b) The age of the patient influences the rate of fracture healing. c) Adequate immobilization is essential until there is ultrasound evidence of bone formation with ossification. d) Serial x-rays are used to monitor the progress of bone healing.

Serial x-rays are used to monitor the progress of bone healing. Explanation: Serial x-rays are used to monitor the progress of bone healing. The type of bone fractured, the adequacy of blood supply, the surface contact of the fragments, and the general health of the person influence the rate of fracture healing. Adequate immobilization is essential until there is x-ray evidence of bone formation with ossification.

A client undergoes an invasive joint examination of the knee. The nurse would closely monitor the client for which of the following? a) Lack of sleep and appetite b) Signs of depression c) Signs of shock d) Serous drainage

Serous drainage Explanation: When the client undergoes an invasive knee joint examination, the nurse should inspect the knee area for swelling, bleeding, and serous drainage. An invasive joint examination does not cause lack of sleep or appetite, depression, or shock. The client may be in shock due to the injury itself.

The human body has 206 bones, which are classified into four categories. Which types of bones are located in the digits? a) Irregular bones b) Flat bones c) Long bones d) Short bones

Short bones Explanation: Short bones are the type that is located in the fingers and toes.

When assessing the client for scoliosis, the nurse: a) Stands behind the client and asks the client to bend forward at the waist b) Stands in front of the client and asks the client to bend forward at the waist c) Asks the client to walk away from the nurse for a short distance d) Stands to the side of the client and observes the client's spinal curvatures

Stands behind the client and asks the client to bend forward at the waist Explanation: Scoliosis is characterized by a lateral curvature of the spine. The nurse stands behind the client and asks the client to bend forward at the waist.

Which of the following data is most important for the nurse to record while assessing a client with an open wound? a) Time and place of the injury b) Time when the client last received a tetanus immunization c) Vital signs of the client d) Degree of movement and range of motion

Time when the client last received a tetanus immunization Explanation: If the client has an open wound, the nurse ascertains when the client last received a tetanus immunization. This vital information helps in assessing the risk of infection in a client with an open wound.

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

• "Are you wearing any jewelry?" • "Do you have a pacemaker?" • "Have you removed your hearing aid?" Explanation: Magnetic resonance imaging (MRI) is a noninvasive imaging technique that uses magnetic fields, radiowaves, 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.

Which clinical manifestation would the nurse recognize as an indicator of peripheral neurovascular dysfunction? Select all that apply. a) Dorsiplantar flexion strong b) Capillary refill less than 3 seconds c) Complaints of pins and needles in feet d) Toes mottled and cool e) Absence of pain

• Toes mottled and cool • Complaints of pins and needles in feet Explanation: Clinical manifestations of peripheral neurovascular dysfunction include coolness, mottling, weakness, complaints of paresthesia or a pins and needles sensation, and unrelenting pain. Capillary refill of less than 3 seconds is a normal finding.

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

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