Chapter 39: Assessment of Musculoskeletal Function

After a bone density test, an older adult female client tells the nurse, "I don't understand why I have osteoporosis because I eat well and take my calcium." What does the nurse explain as the reason that the client may have osteoporosis? Everyone gets osteoporosis and there is nothing you can do to prevent it. Men lose more bone mass than women but women still lose some. In order to prevent bone loss, women have to take hormones. The loss is from withdrawal of estrogen and a decrease in activity levels.

The loss is from withdrawal of estrogen and a decrease in activity levels.

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

The patient has rheumatoid arthritis.

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?"

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

A nursing student asks the nurse why older adults are at risk for falls. The best response by the nurse is: "Muscles atrophy with aging." "Bones become more fragile." "Cartilage deteriorates with age." "Ligaments become lax with age."

"Muscles atrophy with aging."

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."

"My toes are numb."

The older client asks the nurse how best to maintain strong bones. What is the nurse's best response? "Weight-bearing exercises can strengthen bones." "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."

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."

"You must remain very still during the procedure."

A patient tells the nurse, "I was working out and lifting weights and now that I have stopped, I am flabby and my muscles have gone!" What is the best response by the nurse? "While you are lifting weights, endorphins are released, creating increase in muscle mass, but if the muscles are not used they will atrophy." "The muscle mass has decreased from the lack of calcium in the cells." "Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued." "Once you stop exercising, the contraction of the muscle does not regain its strength."

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

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

Abduction

A client arrives at the orthopedic physician's office stating knee pain sustained while playing soccer. A history and physical assessment is completed. The knee appears reddened with edema. Which other diagnostic testing would the nurse anticipate? A bone densitometry A bone scan An arthrocentesis An arthroscopy

An arthroscopy

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

An electromyography

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? Client's age Client's lifestyle Any chronic disorder or recent injury Duration and location of discomfort or pain

Any chronic disorder or recent injury

A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy? Apply a cold pack at the insertion site. Apply warm compresses to the insertion site. Provide a gentle massage. Assist with performing ROM exercises.

Apply a cold pack at the insertion site.

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

Apply ice to the joint.

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

Arthrography

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

Arthroscopy

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

Calcitonin

Which is an indicator of neurovascular compromise? Warm skin temperature Diminished pain Pain upon active stretch Capillary refill of more than 3 seconds

Capillary refill of more than 3 seconds

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

Carpal bones in the wrist

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

Clonus

What is the term for a rhythmic contraction of a muscle? Atrophy Clonus Hypertrophy Crepitus

Clonus

Which is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes? Remodeling Hypertrophy Fasciculation Compartment syndrome

Compartment syndrome

Which is a circulatory indicator of peripheral neurovascular dysfunction? Weakness Paresthesia Cool skin Paralysis

Cool skin

Choose the correct statement about the endosteum, a significant component of the skeletal system: Covers the marrow cavity of long bones Supports the attachment of tendons to bones Contains blood vessels and lymphatics Facilitates bone growth

Covers the marrow cavity of long bones

A group of students are reviewing the structure and function of bones. The students demonstrate understanding of the information when they state that cortical bone is found primarily in which of the following? Rounded irregular ends Epiphyses Diaphyses Osteoblasts

Diaphyses

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

Elbow

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

Flaccidity

A client has an elbow injury that involves the cartilage in that joint. The nurse understands that which type of cartilage has been affected? Costal cartilage Semilunar cartilage Fibrous cartilage Hyaline cartilage

Hyaline cartilage

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? Flaccid Atonic Atrophied Hypertonic

Hypertonic

A nurse understands the influence of hormones on bone maintenance. Therefore, the nurse knows that a patient on long-term cortisol may experience: Increased deposits of calcium in the bone. Increased bone resorption. Accelerated bone modeling. Inhibition of osteoclasts.

Increased bone resorption.

A nurse provides health teaching to the family of an older adult client who has trouble walking independently. The nurse reviews age-related changes to the musculoskeletal system with the family. Which of the following statements would the nurse include in the teaching? Select all that apply. Tendons become more elastic. Intervertebral discs become thin. Muscles atrophy. Muscle fibrosis increases. Collagen increases

Intervertebral discs become thin. Muscles atrophy. Muscle fibrosis increases. Collagen increases

Which term refers to muscle tension being unchanged with muscle shortening and joint motion? Isotonic contraction Isometric contraction Contracture Fasciculation

Isotonic

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

Knee

Which of the following is the most common site of joint effusion? Knee Elbow Hip Shoulder

Knee

Which term refers to mature compact bone structures that form concentric rings of bone matrix? Endosteum Lamellae Trabecula Cancellous bone

Lamellae

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

Lordosis

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? Joint Muscle Ligament Cartilage

Muscle

A client is scheduled to undergo an electromyography. When performed, what will this test evaluate? Muscle weakness Muscle composition Bone density Metastatic bone lesions

Muscle weakness

A nurse knows that a person with a 3-week-old femur fracture is at the stage where angiogenesis is occurring. What are the characteristics of this stage? The formation of a hematoma and fibrin. Inflammation and the stimulation of osteoblasts and osteoclasts. Cartilage cells forming matrix villa that regulate calcification of the cartilage. New capillaries producing a bridge between the fractured bones.

New capillaries producing a bridge between the fractured bones.

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.

No further increase in bone length occurs.

An osteocalcin (bone GLA protein) level has been ordered. How will the nurse prepare for this order? Obtain a blood specimen. Obtain a clean-catch urine. Assist the health care provider in obtaining a synovial fluid specimen. Assist the health care provider in obtaining a bone marrow specimen.

Obtain a blood specimen.

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? Remodeling Resorption Ossification and calcification Epiphyses and diaphysis formation

Ossification and calcification

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

Osteoblasts

Which cells are involved in bone resorption? Chondrocytes Osteoblasts Osteoclasts Osteocytes

Osteoclasts

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

Osteoclasts are involved in the destruction and remodeling of bone.

The nurse is conducting a musculoskeletal assessment of a client in a nursing home. The client is unable to dorsiflex the right foot or extend the toes. The nurse evaluates this finding as an injury to which nerve? Sciatic Peroneal Femoral Achilles

Peroneal

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

Peroneal

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

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

A 10-year-old boy who was brought to the emergency room after a skiing accident is diagnosed with a fracture of the distal end of the femur. Why is this type of fracture significant? Osteoblast formation will stop during the time needed for fracture healing. Red blood cell production will be temporarily reduced because of the damage to the medullar cavity. Potential growth problems may result from damage to the epiphyseal plate. Periosteal blood vessels will be damaged, thus compromising blood flow to the compact bone.

Potential growth problems may result from damage to the epiphyseal plate.

A nurse performs a neurovascular assessment on a client 2 weeks after a wrist cast had been removed. The nurse documents in the client's chart that there is normal sensation in the ulnar nerve. What finger assessment test will the nurse perform on this client? Prick the skin midway between the thumb and second finger. Prick the distal fat pad on the small finger. Prick the top or distal surface of the index finger. Prick the top of the middle finger.

Prick the distal fat pad on the small finger.

Which nursing instruction is most important to stress when teaching on calcium intake? Eat green, leafy vegetables. Drink calcium- and vitamin D-fortified orange juice. Provide age-related calcium intake recommendations. Maintain diary sources of calcium intake.

Provide age-related calcium intake recommendations.

A patient has a fracture of the right femur sustained in an automobile accident. What process of fracture healing does the nurse understand will occur with this patient? Reactive phase, reparative phase, remodeling phase Primary phase, secondary phase, third phase First intention, secondary intention, third intention Active phase, dormant phase, restructure phase

Reactive phase, reparative phase, remodeling phase

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

Remodeling

Which statement reflects the progress of bone healing? All fracture healing takes place at the same rate no matter the type of bone fractured. Serial x-rays are used to monitor the progress of bone healing. The age of the client influences the rate of fracture healing. Adequate immobilization is essential until ultrasound shows evidence of bone formation with ossification.

Serial x-rays are used to monitor the progress of bone healing.

A client has a fracture that is being treated with open rigid compression plate fixation devices. What teaching will the nurse reinforce to the client about how the progress of bone healing will be monitored? The plate will be removed to determine if the bone is growing back. Serial x-rays will be taken. An arthroscopy will be performed. The bone will heal on its own without intervention.

Serial x-rays will be taken.

A client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for? Lack of sleep and appetite Serous drainage Signs of depression Signs of shock

Serous drainage

Which laboratory study indicates the rate of bone turnover? Urine calcium Serum calcium Serum phosphorous Serum osteocalcin

Serum osteocalcin

A group of students are studying for an examination on joints. The students demonstrate understanding of the material when they identify which of the following as an example of a synarthrodial joint? Between the vertebrae In the fingers At the hip Skull at the temporal and occipital bones

Skull at the temporal and occipital bones

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: Extension. Pronation. Eversion. Supination.

Supination.

Skull sutures are an example of which type of joint? Synarthrosis Amphiarthrosis Diarthrosis Aponeuroses

Synarthrosis

The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding? Tear in the joint capsule Fracture of the clavicle Decreased bone density Injury to the radial nerve

Tear in the joint capsule

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? Ligament Tendon Cartilage Joint

Tendon

A client is seen in the emergency room for a knee injury that happened during a basketball game. Diagnostic tests reveal torn cords of fibrous connective tissue that connect muscles to bones. What type of tear has this client sustained? Fascia Ligament Bursa Tendon

Tendon

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.

The fracture is on the diaphysis.

The nurse understands that bone maintenance requires a balance between forming and dissolving bone. What is a correct statement about the function of osteoblasts? They are multinuclear cells involved in resorbing bone. They secrete a matrix that consists of collagen. They are located in shallow lacunae (small pits in bones). They are nourished by capillaries that are part of the Haversian system.

They secrete a matrix that consists of collagen.

A client visits the health care provider for a routine checkup. The history reveals that the client was diagnosed with a spinal curvature. Which region of the spine should the nurse assess for complications? Cervical Thoracic Lumbar Sacral

Thoracic

The nurse recognizes that rheumatoid arthritis is characterized by: Ulnar deviation Ballottement sign Clonus Fasciculations

Ulnar deviation

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? Amino acids Vitamin B6 Vitamin D Dairy products

Vitamin D

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.

Yogurt and cheese.

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.

abnormal sensations.

Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy? aspirin furosemide digoxin NPH insulin

aspirin

The nurse is admitting an older adult to a skilled nursing facility. What assessment parameters will the nurse expect to find with the musculoskeletal assessment? Select all that apply. decreased endurance increase in height joint stiffness increased muscle strength decreased range of motion

decreased endurance joint stiffness decreased range of motion

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.

diaphysis.

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

kyphosis

There are thousands of components of the musculoskeletal system that facilitate mobility and independent function. The function of skeletal muscle is promoting: movement of skeletal bones. organ function. involuntary function. All options are correct.

movement of skeletal bones.

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

shuffling

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.

Administering the prescribed analgesic.

The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.) Pale, cyanotic, or mottled color Cool temperature of the extremity More than 3-second capillary refill Tenting skin turgor Limited range of motion

Pale, cyanotic, or mottled color Cool temperature of the extremity More than 3-second capillary refill

The nurse observes a client with a shuffling gait. What disease is commonly associated with a shuffling gait? Parkinson's disease lower motor neuron disease scoliosis Paget's disease

Parkinson's disease

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

dual-energy x-ray absorptiometry

A client reports being consistently tired, with no energy. The client's CBC indicates low hemoglobin. Where is hemoglobin manufactured? ribs ulna femur eyes

ribs