Chapter 39: Assessment of musculoskeletal function

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? A.) Arthrocentesis B.) Bone scan C.) Electromyography D.) Arthroscopy

Answer: D.) Arthroscopy

Which of the following is an example of a gliding joint? A.) Carpal bones in the wrist B.) Knee C.) Hip D.) Joint at base of thumb

Answer: A.) Carpal bones in the wrist Rationale: 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.

The nurse is assessing the client for scoliosis. What will the nurse have the client do to perform the assessment? A.) Stand behind the client and ask the client to bend forward at the waist. B.) Stand to the side of the client and observe the client's spinal curvatures. C.) Stand behind the client and ask the client to walk a short distance away. D.) Stand in front of the client and ask the client to bend forward at the waist.

Answer: A.) Stand behind the client and ask the client to bend forward at the waist.

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

Answer: A.) Synarthrosis

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: A.) 20 years. B.) 30 years. C.) 40 years. D.) 50 years.

Answer: B.) 30 years. Rationale: Bone mass peaks by about age 30, after which there is a universal and gradual loss of bone.

Which of the following is an example of a hinge joint? A.) Hip B.) Knee C.) Joint at base of thumb D.) Carpal bones in the wrist

Answer: B.) Knee

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? A.) Amino acids B.) Vitamin B6 C.) Vitamin D D.) Dairy products

Answer: C.) Vitamin D

The nurse is teaching a client about a vitamin that supports calcium's absorption. What vitamin is the nurse teaching the client about? A.) Vitamin A B.) Vitamin B12 C.) Vitamin C D.) Vitamin D

Answer: D.) Vitamin D

Which of the following is the most common site of joint effusion? A.) Elbow B.) Hip C.) Knee D.) Shoulder

Answer: C.) Knee

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

Answer: D.) Calcitonin Rationale: 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 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? A.) Lordosis B.) Scoliosis C.) Osteoporosis D.) Kyphosis

Answer: D.) Kyphosis Rationale: 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.

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

Answer: D.) Remodeling Rationale: Remodeling is the final stage of fracture repair. During inflammation, macrophages invade and debride the fracture area. Revascularization occurs within about 5 days after a fracture. Callus forms during the reparative stage but is disrupted by excessive motion at the fracture site.

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: A.) Extension. B.) Pronation. C.) Eversion. D.) Supination.

Answer: D.) Supination.

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

Answer: D.) Abduction Rationale: Abduction is moving away from the midline. Adduction is moving toward the midline. Inversion is turning inward. Eversion is turning outward.

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.) Osteoblasts B.) Cortical bone C.) Osteoclasts D.) Cancellous bone

Answer: A.) Osteoblasts

Which statement describes paresthesia? A.) Absence of muscle movement suggesting nerve damage B.) Involuntary twitch of muscle fibers C.) Abnormal sensations D.) Absence of muscle tone

Answer: C.) Abnormal sensations

An example of a flat bone is the A.) femur. B.) sternum. C.) vertebra. D.) metacarpals.

Answer: B.) sternum. Rationale: 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 has just undergone arthrography. What is the most important instruction for the nurse to include in the teaching plan? A.) Avoid sunlight or harsh, dry climate. B.) Avoid intake of dairy products. C.) Report joint crackling or clicking noises occurring after the second day. D.) Gently massage joints with any crackling or clicking joint noises.

Answer: C.) Report joint crackling or clicking noises occurring after the second day. Rationale: 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.

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

ANswer: A.) "You must remain very still during the procedure." Rationale: 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.

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.) Ossification and calcification D.) Epiphyses and diaphysis formation

Answer: C.) Ossification and calcification Rationale: 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 diaphyses are bone tissues that provide strength and support to the human skeleton.

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? A.) Osteoblast formation will stop during the time needed for fracture healing. B.) Red blood cell production will be temporarily reduced because of the damage to the medullar cavity. C.) Potential growth problems may result from damage to the epiphyseal plate. D.) Periosteal blood vessels will be damaged, thus compromising blood flow to the compact bone.

ANswer: C.) Potential growth problems may result from damage to the epiphyseal plate. Rationale: The distal and proximal ends of a long bone are called epiphyses, which are composed of cancellous bone. The epiphyseal plate, which separates the epiphyses from the diaphysis, is the center for longitudinal growth in children. Its damage can be a critical indictor of potential growth problems if fractured. All other choices are wrong.

A client is having repeated tears of the joint capsule in the shoulder, and the health care provider orders an arthrogram. What intervention should the nurse provide after the procedure is completed? Select all that apply. - Apply a compression bandage to the area. - Apply heat to the area for 48 hours. - Administer a mild analgesic. - Inform the client that a clicking or crackling noise in the joint may persist for a couple of days. - Actively exercise the area immediately after the procedure.

Answer: - Apply a compression bandage to the area. - Administer a mild analgesic. - Inform the client that a clicking or crackling noise in the joint may persist for a couple of days. Rationale: The client having an arthrogram may feel some discomfort or tingling during the procedure. After the arthrogram, a compression elastic bandage may be applied if prescribed, and the joint is usually rested for 12 hours. Strenuous activity should be avoided until approved by the primary provider. The nurse provides additional comfort measures (e.g., mild analgesia, ice) as appropriate and explains to the client that it is normal to experience clicking or crackling in the joint for 24 to 48 hours after the procedure until the contrast agent or air is absorbed.

Which statement by the client preparing for a bone scan indicates further teaching by the nurse is needed? A.) "I will need to limit my fluid intake so as not to interfere with the isotope." B.) "The scan is done a couple of hours after the isotope is injected." C.) "The radioisotope will be injected through my IV." D.) "I will need to empty my bladder before I go for the scan."

Answer: A.) "I will need to limit my fluid intake so as not to interfere with the isotope." Rationale: The client needs to increase fluid intake to help distribute the isotope and to promote its excretion.

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.) Apply warm compresses to the insertion site. C.) Provide a gentle massage. D.) Assist with performing ROM exercises.

Answer: A.) Apply a cold pack at the insertion site. Rationale: 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.

Which diagnostic test would the nurse expect to be ordered for a client with lower extremity muscle weakness? A.) Electromyograph (EMG) B.) Arthrocentesis C.) Bone scan D.) Biopsy

Answer: A.) Electromyograph (EMG) Rationale: 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 client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding? A.) Lordosis B.) Scoliosis C.) Kyphosis D.) Dowager's hump

Answer: A.) Lordosis

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 ventrally located. C.) The fracture is on the epiphyses. D.) The fracture is on the tuberosity.

Answer: A.) The fracture is on the diaphysis. Rationale: 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.

What is the term for a rhythmic contraction of a muscle? A.) Atrophy B.) Clonus C.) Hypertrophy D.) Crepitus

Answer: B.) Clonus Rationale: Clonus is a rhythmic contraction of the muscle. Atrophy is a shrinkage-like decrease in the size of a muscle. Hypertrophy is an increase in the size of a muscle. Crepitus is a grating or crackling sound or sensation that may occur with movement of ends of a broken bone or irregular joint surface.

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.) Loss of height C.) Depressive symptoms D.) Increased muscle mass

Answer: B.) Loss of height

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

Answer: B.) kyphosis

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.) a fracture of the clavicle B.) osteoarthritis of the shoulder C.) bursitis D.) ankylosing spondylitis

Answer: C.) bursitis Rationale: 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 nurse is conducting a community education program on hip fracture risk. The nurse evaluates that the participants understand the program when the participants determine that client at highest risk for a hip fracture is a(n) A.) high school athlete. B.) 30-year-old pregnant woman. C.) toddler just starting to walk. D.) 80-year-old man recently widowed.

Answer: D.) 80-year-old man recently widowed.

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

Answer: D.) Compartment syndrome Rationale: Compartment syndrome is caused by pressure within a muscle area that increases 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.

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.

Answer: D.) No further increase in bone length occurs. Rationale: 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.

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? A.) Fascia B.) Ligament C.) Bursa D.) Tendon

Answer: D.) Tendon Rationale: Tendons are broad, flat sheets of connective tissue that attach muscles to bones, soft tissue, and other muscles. Ligaments bind bones together. A bursa is a synovial-filled sac, and fascia surround muscle cells.

The nurse is evaluating a client's peripheral neurovascular status. Which would the nurse report to the health care provider as a circulatory indicator of peripheral neurovascular dysfunction? A.) Weakness B.) Paresthesia C.) Cool skin D.) Paralysis

Answer: C.) Cool skin

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

Answer: B.) Obtain a blood specimen.

Which term refers to the shaft of the long bone? A.) Epiphysis B.) Lordosis C.) Scoliosis D.) Diaphysis

Answer: D.) Diaphysis

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

Answer: B.) "Weight-bearing exercises can strengthen bones."

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.) An electromyography C.) An arthroscopy D.) A magnetic resonance imaging (MRI)

Answer: B.) An electromyography Rationale: 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 diagnostic studies are done to relieve joint pain due to effusion? A.) Biopsy B.) Arthrocentesis C.) Electromyography (EMG) D.) Bone scan

Answer: B.) Arthrocentesis Rationale: 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 is an appropriate priority nursing diagnosis for the client following an arthrocentesis? A.) Risk for infection B.) Chronic pain C.) Deficient knowledge: procedure D.) Activity intolerance

Answer: A.) Risk for infection Rationale: 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.