MuscoSkel Pt 1

Which client will the nurse assess most closely for indications of osteoporosis based on race or ethnicity? A. 40-year-old Chinese-American female B. 50-year-old Irish-American female C. 60-year-old African-American female D. 66-year-old African-American male

A Chinese Americans of either gender are most at risk for osteoporosis because of racial differences in bone size and density. Bones are smaller and less dense. The density difference increases the risk for osteoporosis. African Americans have greater bone density than most other races. Although Irish Americans have less bone density than do African Americans, they are taller than and have greater bone density than Chinese Americans.

Which bone problem will the nurse expect in a client who has a tumor that secretes excessive amounts of parathyroid hormone (PTH)? A. Increased osteoclastic activity with osteoporosis B. Increased osteoblastic activity and foot enlargement C. Decreased growth hormone levels and thinning of facial bones D. Decreased bone phosphorus levels resulting in bone spur formation

A PTH is a hormone normally secreted by the parathyroid glands to prevent serum calcium levels from becoming too low. One of its actions is moving calcium out of the bones (calcium resorption) and into the blood by increasing osteoclastic activity. When osteoclastic activity is prolonged and not balanced by osteoblastic activity, bone density is lost and osteoporosis occurs.

How will the nurse interpret the physical therapist's report that a client has 70 degrees of flexion based on goniometry measurement on the left knee? A. Flexion is reduced B. Flexion is increased C. Extension is unaffected D. Range of motion is normal

A The minimum normal knee joint flexion is 90 degrees. Therefore, this client's range of motion in the left knee is reduced. There is not enough information in the question to draw a conclusion about the extension of the left knee.

What is the nurse's best response when a client who is scheduled for an ultrasound to identify whether osteomyelitis is present states that she is afraid of the pain the procedure will cause? A. "This procedure does not involve needles or incisions and is usually painless." B. "There would only be pain with this procedure if you don't remain perfectly still." C. "A small amount of numbing medicine will be applies to the skin before the procedure." D. "The same medication your dentist uses will be injected 10 minutes before the needle is inserted."

A Ultrasonography is noninvasive and involves rolling a probe on the skin over the area to be imaged. Ultrasound jelly is applied to the skin over the site to be examined to reduce the friction of the probe and make movement smoother. Although clients report a cold sensation, pain is not expected, and no special preparation necessary.

Which laboratory changes will the nurse expect to find with a client who suffered extensive soft-tissue damage from a crush injury of the thighs? Select all that apply. A. Serum potassium 5.2 mEq/L B. Creatine kinase 280 units/L C. Serum calcium 11.5 mg/dL D. Alkaline phosphatase 90 units/L E. Aspartate aminotransferase 50 units/L F. White blood cell (WBC) count 11,000/mm3

A, B, D, E All the laboratory values are elevated. The only ones that are associated with probable skeletal muscle trauma are an elevated serum potassium level (because cells have high levels of potassium, which is released when cells are damaged or destroyed), and other substances that are present in higher concentrations in skeletal muscle than in the blood, creatine kinase, alkaline phosphatase, and aspartate aminotransferase. Skeletal muscle damage does not directly increase the serum calcium concentration or the white blood cell count.

Which hormones are important to promoting bone mass and density in an adult client? Select all that apply. A. Calcitonin B. Estrogen C. Glucocorticoids D. Growth hormone E. Insulin F. Parathyroid hormone G. Testosterone H. Thyroxine

A, B, D, E, G, H Except for glucocorticoids and parathyroid hormone, all of the listed hormones play important roles in maintaining bone density and balancing osteoblastic activity with osteoclastic activity for bone health. Glucocorticoids and parathyroid hormone promote hone density loss and do not help maintain healthy bone matrix.

Which aspects will the nurse include when assessing the neurovascular status of a client's right limb after diagnostic arthroscopy 1 hour ago? Select all that apply. A. Presence of pain B. Gait and balance C. Distal pulses D. Capillary refill E. Sensation F. Skin temperature

A, C, D, E, F After arthroscopy for either diagnostic or surgical intervention purposes, the nurse assesses the neurovascular status on a regular basis to prevent harm from poor circulation in the extremity or any possible nerve damage. Assessment includes monitoring distal pulses, warmth, color, capillary refill, pain, movement, and sensation of the affected extremity. Neurovascular assessment does not include gait and balance.

Which body minerals are stored almost exclusively in bones and contribute to bone density? Select all that apply. A. Calcium B. Chloride C. Magnesium D. Phosphorus E. Potassium F. Sodium

A, D Bones is the only significant storage site for calcium and phosphorus, although there is some phosphorus in some other body cells for metabolism and energy production. These two minerals are responsible for maintenance of bone density. All other cells store potassium. The major storage site of sodium and chloride is the kidney. Magnesium is present in higher concentrations in muscle cells.

Which actions will the nurse suggest to a 72-year-old female client to prevent harm by reducing the rate of osteoporosis? Select all that apply. A. Walking one mile 5 to 7 days per week B. Eating a diet high in fruits and vegetables C. Swimming for 30 minutes three times weekly D. Performing isometric and isotonic exercises daily E. Taking a calcium supplement that contains vitamin D F. Performing range-of-motion exercise for the arm while sitting

A, D, E Performing weight-bearing exercises, such as walking, and muscle-strengthening exercises can reduce bone density loss and slow osteoporosis. Ensuring adequate intake of calcium and vitamin D is critical to bone density maintenance. Swimming, although an aerobic activity, is not weight-bearing exercise. Fruits and vegetables are not major sources of either calcium or vitamin D. Arm range-of-motion exercises can maintain arm muscle function and shoulder joint flexibility, but do not prevent bone density loss.

Which assessment findings will the nurse expect in an older female client who has osteoporosis? Select all that apply. A. Gait changes B. Inability to bear weight C. Muscle atrophy D. History of fractures E. Swelling in the finger joints F. Spinal curvature with postural changes

A, D, F Osteoporosis occurs with severe osteopenia in which there is great loss of bone density. Less dense bones, especially in the spine, result in kyphosis with postural changes, and gait changes. The loss of bone density increases the risk for fragile fractures even with minimal trauma. Clients usually can still weight bear. Osteoporosis is not directly responsible for muscle atrophy and does not cause joint swelling.

Which is the priority action for the nurse to perform when caring for a patient who just has a needle bone biopsy under local anesthesia? A. Administering pain medication B. Assessing for bleeding C. Checking the gag reflex D. Assessing the distal pulse

B Bone is very vascular and can bleed excessively after a biopsy. Although pain management is also important, the medication can be administered after first assessing whether excessive bleeding is present. The gag reflex is not affected by local anesthesia. Pulses distal the the biopsy are are not likely to be affected by the procedure. They should be assessed but not as the first or priority action.

Which activity does the nurse ask a client to perform when assessing range of motion (ROM) in the hand? A. Gripping the nurse's hand as hard as possible B. Rapidly rotating the hand from palm up to palm down C. Apposing each finger to thumb and then making a fist D. Waving the hand from side to side as though waving goodbye

C A quick way to assess range of motion in the hand is by asking the client to perform two separate maneuvers. One is making a fist. The other is bringing each fingertip separately to appose the thumb. Gripping is a way to assess strength but not ROM. Waving and rotating the hand palm up and palm down assesses some ROM of the wrist but not of the fingers.

Which client will the nurse recognize as having the greatest risk for developing chronic osteomyelitis? A. 25-year-old who performs heavy manual labor B. 35-year-old who stepped on a rusty nail 10 years ago C. 45-year-old with diabetes who has a recurrent foot ulcer D. 55-yera-old with osteoporosis who has sprained the same wrist twice

C Clients who have diabetes have poor wound healing and a high risk for infection in any open wound. An injury to the foot is difficult to heal and can progress inward through the soft tissue to the bone. Infection can spread to the bone this way, resulting in chronic osteomyelitis.

Which assessment information obtained from a 60-year-old male client with severe osteoarthritis of the right knee will the nurse consider the greatest contributing factor? A. Is 10 lb (4.5 kg) overweight B. Has ridden a motorcycle for 35 years C. Has worked laying carpet for the past 20 years D. Has a 25 pack-year history of cigarette smoking

C Laying carpet requires extensive time in the kneeling position and carpet layers also use their dominant knee to push a device that stretches the carpet and places it under the baseboard. Both actions are repetitive and cause force injuries to the involved joints that can reduce articulating cartilage. Being 10 lb (4.5 kg) overweight is not usually sufficient in a male to cause osteoarthritis of the knee. A smoking history increases the risk for osteopenia but not arthritis. Riding a motorcycle may cause some musculoskeletal problems, but not osteoarthritis of the knees.

Which nutrient will the nurse suspect is deficient in a client who has bowing of the bones in both lower limbs? A. Iron B. Protein C. Vitamin C D. Vitamin D

D A deficiency of vitamin D can result in osteomalacia, which is softening of the bones. When osteomalacia occurs in weight-bearing bones, such as those in the lower legs, the bones can ben or bow.

Which additional electrolyte change will the nurse expect to find in a client who has hypercalcemia? A. Hyponatremia B. Hyperkalemia C. Hypochloremia D. Hypophosphatemia

D Blood calcium and phosphorus levels exist in a balanced reciprocal relationship that causes one level to rise as the other one decreases. Elevations of serum calcium levels about normal cause a corresponding decrease in serum phosphorus levels. High levels of serum calcium do not change the serum levels of sodium, potassium, or chloride.

How will the nurse document the assessment observation in which the client's spinal thoracic vertebrae curve sideways to the right and then return to midline? A. Dextrosis B. Lordosis C. Kyphosis D. Scoliosis`

D Scoliosis is an abnormal lateral curvature of the spine. In lordosis, the abnormal spinal curvature is inward and occurs in the lumbar spinal area. Kyphosis is an outward curvature of the thoracic spine casing a "humped back" appearance. Dextrosis is not a spinal curvature.

Which action will the nurse perform next when an obese client's popliteal pulse on one side cannot be palpated? A. Palpating the popliteal pulse on the opposite side B. Attempting to assess the pedal pulse on the same side C. Notifying the primary health care provider immediately D. Using a Doppler to assess blood flow in that popliteal space

D The popliteal pulse may be difficult to palpate in an obese client. The next best action is to assess this pulse using a Doppler device. Although other assessment findings on that limb, such as checking for a pedal pulse, can help determine whether general blood flow is adequate, it does not establish whether or not there is a problem in that specific artery.