Honan-Chapter 40: Nursing Assessment: Musculoskeletal Function

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. "When is the last time you had food or drink?" B. "Are you wearing any jewelry?" C. "Have you removed your hearing aid?" D. "Do you have a pacemaker?" E. "Did you take your medications this morning?"

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

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? A. Prick the skin midway between the thumb and second finger. B. Prick the distal fat pad on the small finger. C. Prick the top or distal surface of the index finger. D. Prick the top of the middle finger

B. Prick the distal fat pad on the small finger. RATIONALE See Table 40-2 in the text. The ulnar nerve runs near the ulnar bone and enters the palm of the hand. It branches to the fifth finger (small finger) and the ulnar side of the fourth finger.

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

B. Serial x-rays are used to monitor the progress of bone healing. RATIONALE 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 client influence the rate of fracture healing. Adequate immobilization is essential until x-ray shows evidence of bone formation with ossification.

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? A. Ligament B. Tendon C. Cartilage D. Joint

B. Tendon RATIONALE 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 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. Rheumatoid arthritis B. Lupus erythematosus C. Osteoporosis D. Gout

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

A. Apply ice to the joint. RATIONALE 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.

An MRI has been ordered for a patient with low back pain. What should be included in the teaching plan for this patient? A. The patient will need to lie still for 3 to 4 hours. B. A rhythmic rocking sound will be heard during the procedure. C. There is no risk of claustrophobia. D. It is an invasive technique.

B. A rhythmic rocking sound will be heard during the procedure. RATIONALE During the MRI, that patient needs to lie still for 30 to 60 minutes and hears a rhythmic knocking sound. Patients who experience claustrophobia may be able to tolerate the confinement of closed MRI equipment with sedation. The MRI is a noninvasive imaging technique that uses magnetic fields, radiowaves, and computers to demonstrate abnormalities.

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

B. Clonus RATIONALE Clonus is a rhythmic contraction of the muscle. Atrophy is a shrinkagelike 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.

Which of the following techniques will the nurse implement to assess a patient's gait? A. Instruct the patient to walk heal to toe for 15 to 20 steps. B. Instruct the patient to lightly run in place for 15 to 20 seconds. C. Instruct the patient to walk away from the nurse for a short distance. D. Instruct the patient to balance on one foot for as long as possible.

C. Instruct the patient to walk away from the nurse for a short distance. RATIONALE Gait is assessed by having the patient walk away from the examiner for a short distance. The examiner observes the patient's gait for smoothness and rhythm.

The nurse is performing a musculoskeletal assessment on a patient with arthritis. During passive range-of-motion exercises, the nurse hears grating and cracking sounds. This assessment finding is referred to as what? A. Fasciculations B. Clonus C. Effusion D. Crepitus

D. Crepitus RATIONALE Crepitus is a grating, cracking sound or sensation that occurs as the irregular joint surfaces move across one another, as in arthritic conditions. Effusion is the collection of excessive fluid within the capsule of a joint. Clonus is the rhythmic contractions of a muscle. Fasciculations are involuntary twitching of muscle fiber groups. Reference:

A 12-year-old girl complained to the school nurse about back pain. The nurse's assessment revealed a deviation of the vertebrae to the right, with a raised shoulder and hip. What is the terminology for this finding? A. Kyphosis B. Lordosis C. Osteoporosis D. Scoliosis

D. Scoliosis RATIONALE Scoliosis is an abnormal lateral curvature of the spine.

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.

D. Supination. RATIONALE Refer to Figure 40-3 in the text for an illustration of body movements produced by muscle contraction.

A cast was applied to a patient's fractured leg 4 hours ago. Which finding is associated with neurovascular compromise? A. Capillary refill of 5 seconds B. Ability to move the toes without limitation C. Full sensation D. Toes warm to touch

A. Capillary refill of 5 seconds RATIONALE Capillary refill should be less than 2 seconds; a delay in capillary refill indicates impaired arterial perfusion.

A 78-year-old woman is complaining of neck and upper back pain. The nurse's assessment reveals an abnormal convex curvature of the cervical and thoracic area. What is the terminology for this finding? A. Kyphosis B. Lordosis C. Kyphoscoliosis D. Scoliosis

A. Kyphosis RATIONALE Kyphosis is an abnormal convex curvature (causes the back to bow) of the thoracic spine. It may also be noted in the thoracolumbar or sacral level.

A nurse is taking a newly admitted patient's health history, and the patient states that she has had ongoing problems with a "pinched nerve." In addition to the potential for pain, the nurse should consider the fact that physical pressure that is placed on nerves can often lead to what? A. Crepitus B. Paresthesias C. Muscle hypertrophy D. Osteoporosis

B. Paresthesias RATIONALE The patient may describe paresthesias, which are burning, tingling sensations, or numbness. These sensations may be caused by pressure on nerves or by circulatory impairment. Crepitus and osteoporosis are not manifestations of neurological dysfunction. Nerve pressure would not lead to muscle hypertrophy. Reference:

What food would the nurse recommend for bone health? A. Herbal tea B. Yogurt C. Liver D. Eggs

B. Yogurt RATIONALE Sources of calcium include milk, cheese, yogurt, calcium fortified foods, sardines, oysters, clams, canned salmon with bones and dark leafy vegetables. To reduce the risk of osteoporosis, calcium intake should be the highest during adolescence and after 50 years of age.

Which of the following diagnostic studies are done to relieve joint pain due to effusion? A. Arthrocentesis B. Electromyography (EMG) C. Bone scan D. Biopsy

A. 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 assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy? A. Increased diameter of the calf B. Capillary refill < 3 seconds C. Toes move freely without pain D. Bounding dorsalis pedis pulses

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

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? A. Tear in the joint capsule B. Fracture of the clavicle C. Decreased bone density D. Injury to the radial nerve

A. Tear in the joint capsule RATIONALE 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. Reference: