Chapter 39: Assessment of Musculoskeletal Function

The nurse is teaching a client about a vitamin that supports calcium's absorption. What vitamin is the nurse teaching the client about?

Vitamin D To support the absorption of calcium from the gastrointestinal tract and increase the amount of calcium in the blood, there needs to be sufficient active vitamin D. Vitamin A is for eye health. Vitamin B12 is for anemia prevention. Vitamin C is used for skin and immune health. Reference:

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?

"I should use my heating pad this evening to reduce some of the pain in my knee." 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.

The nurse is planning care for a client with a musculoskeletal injury. Which nursing diagnosis would be the highest priority?

Acute pain 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.

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?

Administering the prescribed analgesic. 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 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?

Brutus 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.

What is the term for a rhythmic contraction of a muscle?

Clonus 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. Reference:

The nurse is conducting the admission assessment for a client who is to undergo an arthrogram. What is the priority question the nurse should ask?

Do you have any allergies?" 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. Asking about eating or urinating is important but not priority. The claustrophobia is not a concern for the arthrogram.

The nurse is performing a neurovascular assessment of a client's injured extremity. Which would the nurse report?

Dusky or mottled skin color 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.

Which of the following is an example of a hinge joint?

Knee 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 human body has 206 bones, which are classified into four categories. Which types of bones are the femur and ulna?

Long bones The femur and ulna are long bones.The femur and ulna are long bones.

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?

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

Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis?

Risk for infection. 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.

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?

Serial x-rays Will be taken Serial x-rays are used to monitor the progress of bone healing. The plate need not be disturbed. An arthroscopy is used to visualize joints. While the bone will heal without interference, monitoring of bone healing is needed to ensure further adjustments are not necessary.

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 Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. X-rays are used to diagnose bone fractures. Bone densitometry is used to estimate bone mineral density. An electromyogram (EMG) provides information about the electrical potential of the muscles and nerves leading to them.

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?

Tendon 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.

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?

Tendon 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.

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." Numbness would indicate neurological compromise of the extremity and requires immediate intervention to prevent permanent damage. An aching knee is expected after the procedure. Cold or swollen feet are not priority assessments.

The nurse is preparing the client for computed tomography. Which information should be given by the nurse?

"You must remain very still during the procedure." 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 client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration?

An electromyography An 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 diagnostic test would the nurse expect to be ordered for a client with lower extremity muscle weakness?

Electromyograph (EMG) 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.

Which of the following is the most common site of joint effusion?

Knee 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.

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 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.

A patient comes to the clinic and informs the nurse of numbness, tingling, and a burning sensation in the arm from the elbow down to the fingers. What type of symptom would this be documented as?

Paresthesia Sensory disturbances are frequently associated with musculoskeletal problems. The patient may describe paresthesias, which are sensations of burning, tingling, or numbness. These sensations may be caused by pressure on nerves or by circulatory impairment.

A patient is scheduled for a bone marrow biopsy. The nurse explains to the family that the bone marrow is located mainly in four areas. She tells the family that the site to be used would be the:

Sternum The sternum, along with the ilium, vertebrae, and ribs are responsible for producing red blood cells and are used for bone marrow aspiration sites.

The orthopedic nurse is caring for a client diagnosed with a fracture of the radius. When the nurse is considering all of the various types of bone fractures, which bone type is most anticipated?

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

The nurse is conducting a medication reconciliation with a client admitted with a fracture. What medication predisposes a client for a risk for fractures?

Prednisone Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures. Furosemide, digoxin, and metoprolol do not interfere with bone resorption or predispose clients to fractures.

Which of the following describes a muscle that is limp and without tone?

A muscle that is limp and without tone is described as flaccid. 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 nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes?

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

An example of a flat bone is the

sternum 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.

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

abnormal sensations. Abnormal sensations, such as burning, tingling, and numbness, are referred to as paresthesias. The absence of muscle tone suggesting nerve damage is referred to as paralysis. A fasciculation is the involuntary twitch of muscle fibers. A muscle that holds no tone is referred to as flaccid

The 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 range of motion joint stiffness decreased endurance Significant assessment findings of the musculoskeletal system in the older adult would include joint stiffness and decreased height, range of motion, muscle strength, and endurance. Older adults may have decreased height from osteoporosis and decreased muscle strength from atrophy.

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?

Yogurt and cheese. Yogurt and cheese are excellent sources of calcium. The other choices are low-calcium foods.

Which statement describes paresthesia?

Abnormal sensations Abnormal sensations, such as burning, tingling, and numbness, are referred to as paresthesias. The absence of muscle tone suggesting nerve damage is referred to as paralysis. A fasciculation is the involuntary twitch of muscle fibers. A muscle that holds no tone is referred to as flaccid.