NSG 245 Ch 39- Assessment Musculoskeletal Function

How do you assess peroneal nerve function?

Prick the skin midway between the great and 2nd toe

The nurse assesses soft subcutaneous nodules along the line of the tendon's in a patient's hand and wrist. What does this finding indicate to the nurse?

The patient has rheumatoid arthritis

Which term refers to the shaft of the long bone?

diaphysis The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone.

Fracture healing occurs in four areas, including the

external soft tissue. Fracture healing occurs in four areas, including the bone marrow, bone cortex, periosteum, and the external soft tissue, where a bridging callus (fibrous tissue) stabilizes the fracture. Cartilage is special tissue at the ends of bone. The bursae are fluid-filled sacs found in connective tissue, usually in the area of joints. Fascia is fibrous tissue that covers, supports, and separates muscles.

The leading cause of musculoskeletal related disability in the United States is

Arthritis

A patient injured in a motor vehicle accident has sustained a fracture to the diaphysis of the right femur. Of what is the diaphysis of the femur mainly constructed?

Cortical bone

After a person experiences a closure of the epiphyses, which statement is true?

No further increase in bone length occurs.

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?

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

How do you assess median nerve function?

Prick the top or distal surface of the index finger

A patient tells the nurse, "s 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?

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

Which laboratory study indicates the rate of bone turnover?

Serum osteocalcin Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Urine calcium concentration increases with bone destruction. Serum calcium concentration is altered in clients with osteomalacia and parathyroid dysfunction. Serum phosphorous concentration is inversely related to calcium concentration and is diminished in osteomalacia associated with malabsorption syndrome.

How do you assess tibial nerve function?

Prick the medial and lateral surface of the sole of the foot

Approximately how many milligrams of calcium daily is essential to maintain adult bone mass

1000 to 1200 mg

In the human body there are how many

206

The approximate percentage of total body calcium present in the bones is

98%

A patient is having repeated tears of the joint capsule in the shoulder, and the physician prescribes an arthrogram. What intervention should the nurse provide after the procedure is completed?

Apply a compression bandage to the area Administer a mild analgy sick Inform the patient that a clicking or crackling noise in the joint may persist for a couple of days

A clinic nurse is caring for a patient with a history of osteoporosis. Which of the following diagnostic tests best allows the care team to assess the patients risk of fracture?

Bone densitometry Bone densitometry is used to detect bone density and can be used to assess the risk of fracture in osteoporosis. Arthrography is used to detect acute or chronic tears of joint capsule or supporting ligaments. Bone scans can be used to detect metastatic and primary bone tumors, osteomyelitis, certain fractures, and aseptic necrosis. Arthroscopy is used to visualize a joint.

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone?

Calcitonin Calcitonin, secreted by the thyroid gland in response to elevated blood calcium concentration, inhibits bone reabsorption and increases the deposit of calcium in the 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.

How do you assess ulnar nerve function?

Prick the distal fat pad of the small finger

The nurse is caring for a client who experienced a crushing injury of the lower extremities. Which of the following symptoms is essential to be reported to the physician?

Pulselessness Neurovascular checks (circulation, sensation, motion) are essential with a crushing injury. The absence of a pulse is a critical assessment finding to report to the physician. The other options are symptoms that need regular assessment.

A patient is scheduled for a bone scan to rule out osteosarcoma of the pelvic bones. What would be most important for the nurse to assess before the patients scan?

That the patient emptied the bladder Before the scan, the nurse asks the patient to empty the bladder, because a full bladder interferes with accurate scanning of the pelvic bones. Bowel cleansing and fasting are not indicated for a bone scan and an allergy to penicillins is not a contraindication.

Red bone marrow is located in the shaft of 4 long and flat bones. what are the bones?

The sternum The Ilium Vertebrae Ribs ​

A nurse is caring for a patient who has been scheduled for a bone scan. What should the nurse teach the patient about this diagnostic test?

Youll be encouraged to drink water after the administration of the radioisotope injection. It is important to encourage the patient to drink plenty of fluids to help distribute and eliminate the isotopic after it is injected. There are important contraindications to the procedure, include pregnancy or an allergy to the radioisotope. The test requires the injection of an intravenous radioisotope and the scan is preformed 2 to 3 hours after the isotope is injected. A calcium solution is not utilized.

The nurse is assessing a client with a musculoskeletal system condition. Which statement indicates to the nurse that the client is experiencing bone pain?

"The pain feels deep in my legs and keeps me awake at night." Bone pain is typically described as a dull, deep ache that is "boring" in nature. This pain is not typically related to movement and may interfere with sleep. Muscular pain is described as soreness or aching and is referred to as "muscle cramps." Joint pain is felt around or in the joint and typically worsens with movement. Fracture pain is sharp and piercing and is relieved by immobilization. Sharp pain may also result from bone infection with muscle spasm or pressure on a sensory nerve.

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." Weight-bearing exercises maintain bone mass. Weight-resistance exercises maintain and strengthen muscles. Cardio training is important for heart health and weight maintenance/reduction. Range-of-motion exercises are essential for joint mobility.

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 nurse is caring for a patient with a diagnosis of cancer that has metastasized. What laboratory value would the nurse expect to be elevated in this patient?

Alkaline phosphatase Alkaline phosphatase is elevated during early fracture healing and in diseases with increased osteoblastic activity (e.g., metastatic bone tumors). Elevated bilirubin, potassium, and creatinine would not be expected in a patient with metastatic bone tumors.

A patient is undergoing diagnostic testing for suspected Pagets disease. What assessment finding is most consistent with this diagnosis?

Altered serum calcium levels Serum calcium levels are altered in patients with osteomalacia, parathyroid dysfunction, Pagets disease, metastatic bone tumors, or prolonged immobilization. Pagets disease is not directly associated with altered magnesium, potassium, or sodium levels.

A public health nurse is organizing a campaign that will address the leading cause of musculoskeletalrelated disability in the United States. The nurse should focus on what health problem?

Arthritis

The nurse is assessing a patient for dietary factors that may influence her risk for osteoporosis. The nurse should question the patient about her intake of what nutrients? Select all that apply.

Calcium Vitamin D A patients risk for osteoporosis is strongly influenced by vitamin D and calcium intake. Carbohydrate, protein, and fiber intake do not have direct effect on the development of osteoporosis

A patient tells the healthcare provider about shoulder pain that is present even without any strenuous movement. The healthcare provider identifies a sack filled with synovial fluid. What condition should the nurse educate the patient about?

Chronic bursitis

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?

Clonus

While assessing a patient, the patient tells the nurse that she is experiencing rhythmic muscle contractions when the nurse performs passive extension of her wrist. What is this pattern of muscle contraction referred to as?

Clonus Clonus may occur when the ankle is dorsiflexed or the wrist is extended. It is characterized as rhythmic contractions of the muscle. Fasciculation is involuntary twitching of muscle fiber groups. Contractures are prolonged tightening of muscle groups and an effusion is the pathologic escape of body fluid.

A nurse is caring for a patient who has an MRI scheduled. What is the priority safety action prior to this diagnostic procedure?

Ensuring that there are no metal objects on or in the patient

A nurse is caring for a patient who has just had an arthroscopy as an outpatient and is getting ready to go home. The nurse should teach the patient to monitor closely for what postprocedure complication?

Fever Following arthroscopy, the patient and family are informed of complications to watch for, including fever. Synovial fluid leakage is unlikely and crepitus would not develop as a postprocedure complication. Fasciculations are muscle twitches and do not involve joint integrity or function.

A patient has had a stroke and is unable to move the right upper and lower extremities. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding?

Flaccidity

Diagnostic tests show that a patients bone density has decreased over the past several years. The patient asks the nurse what factors contribute to bone density decreasing. What would be the nurses best response?

For many people, lack of nutrition can cause a loss of bone density. Nutrition has a profound effect on bone density, especially later life. Genetics are also an important factor, but nutrition has a more pronounced effect. The pathophysiology of bone density is well understood and psychosocial stress has a minimal effect.

A patient has been experiencing an unexplained decline in knee function and has consequently been scheduled for arthrography. The nurse should teach the patient about what process?

Injection of a contrast agent into the knee joint prior to ROM exercises During arthrography, a radiopaque contrast agent or air is injected into the joint cavity to visualize the joint structures such as the ligaments, cartilage, tendons, and joint capsule. The joint is put through its range of motion to distribute the contrast agent while a series of x-rays are obtained. Synovial fluid is not aspirated or replaced and corticosteroids are not administered.

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?

Kyphosis

An older adult patient has come to the clinic for a regular check-up. The nurses initial inspection reveals an increased thoracic curvature of the patients spine. The nurse should document the presence of which of the following?

Kyphosis Kyphosis is the increase in thoracic curvature of the spine. Scoliosis is a deviation in the lateral curvature of the spine. Epiphyses are the ends of the long bones. Lordosis is the exaggerated curvature of the lumbar spine.

The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding?

Lordosis

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?

Ossification and calcification 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 child is growing at a rate appropriate for his age. What cells are responsible for the secretion of bone matrix that eventually results in bone growth?

Osteoblasts Osteoblasts function in bone formation by secreting bone matrix. Osteocytes are mature bone cells and osteoclasts are multinuclear cells involved in dissolving and resorbing bone. Lamellae are circles of mineralized bone matrix.

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?

Parasthesia

A patient has a fracture that is being treated with open rigid compression plate fixation devices. How will the progress of bone healing be monitored?

Perform cereal x-rays

Red bone marrow produces which of the following? Select all that apply.

Platelets White blood cells (WBCs) Red blood cells (RBCs) The red bone marrow located within the bone cavities produces RBC, WBCs, and platelets through the process of hematopoiesis.

Which of the following is the final stage of fracture repair?

Remodeling The final stage of fracture repair consists of remodeling the new bone into its former structural arrangement. During cartilage calcification, enzymes within the matrix vesicles prepare the cartilage for calcium release and deposit. Cartilage removal occurs when the calcified cartilage is invaded by blood vessels and becomes reabsorbed by chondroblasts and osteoclasts. Angiogenesis occurs when new capillaries infiltrate the hematoma, and fibroblasts from the periosteum, endosteum, and bone marrow produce a bridge between the fractured bones.

A nurses assessment of a teenage girl reveals that her shoulders are not level and that she has one prominent scapula that is accentuated by bending forward. The nurse should expect to read about what health problem in the patients electronic health record?

Scoliosis Scoliosis is evidenced by an abnormal lateral curve in the spine, shoulders that are not level, an asymmetric waistline, and a prominent scapula, accentuated by bending forward. Lordosis is the curvature in the lower back; kyphosis is an exaggerated curvature of the upper back. This finding is not suggestive of muscular dystrophy.

A patient is receiving ongoing nursing care for the treatment of Parkinsons disease. When assessing this patients gait, what finding is most closely associated with this health problem?

Shuffling gait A variety of neurologic conditions are associated with abnormal gaits, such as a spastic hemiparesis gait (stroke), steppage gait (lower motor neuron disease), and shuffling gait (Parkinsons disease). A rapid gait is not associated with Parkinsons disease.

Skull sutures are an example of which type of joint?

Synarthrosis Skull sutures are considered synarthrosis joints and are immovable. Amphiarthrosis joints allow limited movement, such as a vertebral joint. Diarthrosis joints are freely movable joints such as the hip and shoulder. Aponeuroses are broad, flat sheets of connective tissue.

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.

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. 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.

When assessing a patients peripheral nerve function, the nurse uses an instrument to prick the fat pad at the top of the patients small finger. This action will assess which of the following nerves?

Ulnar The ulnar nerve is assessed for sensation by pricking the fat pad at the top of the small finger

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 major hormonal regulators of calcium homeostasis are

parathyroid hormone Calcitonin

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." Explanation: 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 nurses musculoskeletal assessment of a patient reveals involuntary twitching of muscle groups. How would the nurse document this observation in the patients chart?

Fasciculations Fasciculation is involuntary twitching of muscle fiber groups. Clonus is a series of involuntary, rhythmic, muscular contractions and tetany is involuntary muscle contraction, but neither is characterized as twitching. Atony is a loss of muscle strength.

Which serum level indicates the rate of bone turnover?

Osteocalcin Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Serum myoglobin is assessed to evaluate muscle trauma. Serum enzyme levels of creatinine kinase and aspartate aminotransferase become elevated with muscle damage.

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?

Peroneal Injury to the peroneal nerve as a result of pressure may cause foot drop or the inability to dorsiflex the foot and extend the toes.

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.

How do you assess radial nerve function?

Prick the skin midway between the thumb and 2nd finger

A patient has a fracture of the right femur sustained in a motor vehicle crash. What process of fracture healing does the nurse understand will occur with this patient?

Reactive phase, reparative phase, remodeling phase

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 patient has just had an arthroscopy performed to assess a knee injury. What nursing intervention should the nurse implement following this procedure?

Wrap the joint in a compression dressing. Interventions to perform following an arthroscopy include wrapping the joint in a compression dressing, extending and elevating the joint, and applying ice or cold packs. Passive ROM exercises, static flexion, and heat are not indicated.

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

kyphosis Kyphosis is an exaggerated convex curvature of the thoracic spine. Lordosis is an excessive concave curvature of the lumbar spine. Scoliosis is a lateral curvature of the spine. Diaphyses are the long shafts of bones in the arms and legs.

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

shuffling gait A variety of neurologic conditions are associated with abnormal gaits, such as spastic hemiparesis gait (stroke), steppage gait (lower motor neuron disease), and shuffling gait (Parkinson's disease). Scissors gait is seen in cerebral palsy.

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?

Arthroscopy

The nurse is performing a neurological assessment. What will this assessment include?

Ask the client to plantar flex the toes. A neurological assessment evaluates sensation and motion. Assessing plantar flexion of the toes would be included in a neurological assessment. Capillary refill, palpation of pulses, and inspecting for edema would be included in a vascular assessment.

Which assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy?

Increased diameter of the calf Increasing diameter of the calf can be indicative of bleeding into the muscle.

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.

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

Arthography Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. Meniscography is a distractor for this question. Bone densitometry is used to estimate bone mineral density. An EMG provides information about the electrical potential of the muscles and nerves leading to them.

A patient has been experiencing progressive increases in knee pain and diagnostic imaging reveals a worsening effusion in the synovial capsule. The nurse should anticipate which of the following?

Arthrocentesis Arthrocentesis (joint aspiration) is carried out to obtain synovial fluid for purposes of examination or to relieve pain due to effusion. Arthrography, biopsy, and electromyography would not remove fluid and relieve pressure.

The human body is designed to protect its vital parts. A fracture of what type of bone may interfere with the protection of vital organs?

Flat bones Flat bones, such as the sternum, provide vital organ protection. Fractures of the flat bones may lead to puncturing of the vital organs or may interfere with the protection of the vital organs. Long, short, and irregular bones do not usually have this physiologic function.

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.

A nurse is assessing a child who has a diagnosis of muscular dystrophy. Assessment reveals that the childs muscles have greater-than-normal tone. The nurse should document the presence of which of the following?

Spasticity A muscle with greater-than-normal tone is described as spastic. Soft and flabby muscle tone is defined as atony. A muscle that is limp and without tone is described as being flaccid. The state of readiness known as muscle tone (tonus) is produced by the maintenance of some of the muscle fibers in a contracted state.

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 nurse is caring for a patient whose cancer metastasis has resulted in bone pain. Which of the following are typical characteristics of bone pain?

A dull, deep ache that is boring in nature Bone pain is characteristically described as a dull, deep ache that is boring in nature, whereas muscular pain is described as soreness or aching and is referred to as muscle cramps. Fracture pain is sharp and piercing and is relieved by immobilization. Sharp pain may also result from bone infection with muscle spasm or pressure on a sensory nerve.

Which term refers to moving away from midline?

Abduction Abduction is moving away from the midline. Adduction is moving toward the midline. Inversion is turning inward. Eversion is turning outward.

A nurse is assessing a patient who is experiencing peripheral neurovascular dysfunction. What assessment findings are most consistent with this diagnosis?

Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin Indicators of peripheral neurovascular dysfunction include pale, cyanotic, or mottled skin with a cool temperature; capillary refill greater than 3 seconds; weakness or paralysis with motion; and paresthesia, unrelenting pain, pain on passive stretch, or absence of feeling

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.

A bone biopsy has just been completed on a patient with suspected bone metastases. What assessment should the nurse prioritize in the immediate recovery period?

Assessment for pain Bone biopsy can be painful and the nurse should prioritize relevant assessments. Dehiscence is not a possibility, since the incision is not linear. Signs and symptoms of infection would not be evident in the immediate recovery period and hematoma formation is not a common complication.

An older adult patient has symptoms of osteoporosis and is being assessed during her annual physical examination. The assessment shows that the patient will require further testing related to a possible exacerbation of her osteoporosis. The nurse should anticipate what diagnostic test?

Bone densitometry Bone densitometry is considered the most accurate test for osteoporosis and for predicting a fracture. As such, it is more likely to be used than CT, MRI, or x-rays.

The nurse is performing an assessment of a patients musculoskeletal system and is appraising the patients bone integrity. What action should the nurse perform during this phase of assessment?

Compare parts of the body symmetrically When assessing bone integrity, symmetric parts of the body, such as extremities, are compared. Analgesia should not be necessary and percussion is not a clinically useful assessment technique. Bone integrity is best assessed when the patient is not moving.

A patient has had a cast placed for the treatment of a humeral fracture. The nurses most recent assessment shows signs and symptoms of compartment syndrome. What is the nurses most appropriate action?

Contact the primary care provider immediately. This major neurovascular problem is caused by pressure within a muscle compartment that increases to such an extent that microcirculation diminishes, leading to nerve and muscle anoxia and necrosis. Function can be permanently lost if the anoxic situation continues for longer than 6 hours. Therefore, immediate medical care is a priority over further nursing assessment. Assessment of calcium levels is unnecessary.

The results of a nurses musculoskeletal examination show an increase in the lumbar curvature of the spine. The nurse should recognize the presence of what health problem?

Lordosis The nurse documents the spinal abnormality as lordosis. Lordosis is an increase in lumbar curvature of the spine. Kyphosis is an increase in the convex curvature of the spine. Scoliosis is a lateral curvature of the spine. Osteoporosis is the significant loss of bone mass and strength with an increased risk for fracture.

A nurse on the orthopedic unit is assessing a patients peroneal nerve. The nurse will perform this assessment by doing which of the following actions?

Pricking the skin between the great and second

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 The process of fracture healing occurs over three phases. These include the following: Phase I: Reactive phase; Phase II: Reparative phase; and Phase III: Remodeling phase.

A client has just undergone arthrography. What is the most important instruction for the nurse to include in the teaching plan?

Report joint crackling or clicking noises occurring after the second day. 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 assessing the client for scoliosis. What will the nurse have the client do to perform the assessment?

Stand behind the client and ask the client to bend forward at the waist. Scoliosis is characterized by a lateral curvature of the spine. The nurse stands behind the client and asks the client to bend forward at the waist for the nurse to examine the spine curvature. The nurse cannot see the spine by standing beside the client or in front of the client. The spinal curve cannot be seen by watching the client walk.

After a bone density test, an older adult female patient tells the nurse, I don't understand why I have osteoporosis because I eat well and take my calcium. What is the best response by the nurse?

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

A patients fracture is healing and callus is being deposited in the bone matrix. This process characterizes what phase of the bone healing process?

The reparative phase Callus formation takes place during the reparative phase of bone healing. The reactive phase occurs immediately after injury and the remodeling phase builds on the reparative phase. There is no discrete revascularization phase.

Which is an indicator of neurovascular compromise?

Capillary refill of more than 3 seconds Capillary refill of more than 3 seconds is an indicator of neurovascular compromise. Other indicators include cool skin temperature, pale or cyanotic color, weakness, paralysis, paresthesia, unrelenting pain, pain upon passive stretch, and absence of feeling.

The nurses comprehensive assessment of an older adult involves the assessment of the patients gait. How should the nurse best perform this assessment?

Instruct the patient to walk away from the nurse for a short distance and then toward the nurse Gait is assessed by having the patient walk away from the examiner for a short distance. The examiner observes the patients gait for smoothness and rhythm. Looking at the floor is not disallowed and gait is not assessed by observing balance on one leg. Heel-to-toe walking ability is not gauged during an assessment of normal gait.

The nurse is performing a musculoskeletal assessment for a client whose right leg muscles exhibit no tone and are limp. Which descriptor should the nurse use to document this condition?

Flaccid The term flaccid describes muscles that have no tone or are limp. Spastic describes muscles that have greater-than-normal tone. Atonic describes muscles that are not enervated and become soft and flabby. Atrophic describes muscles deterioration that occurs with lack of use and exercise.

A nurse is explaining a patients decreasing bone density in terms of the balance between bone resorption and formation. What dietary nutrients and hormones play a role in the resorption and formation of adult bones? Select all that apply

Thyroid hormone Growth hormone Estrogen The balance between bone resorption and formation is influenced by the following factors: physical activity; dietary intake of certain nutrients, especially calcium; and several hormones, including calcitriol (i.e., activated vitamin D), parathyroid hormone (PTH), calcitonin, thyroid hormone, cortisol, growth hormone, and the sex hormones estrogen and testosterone. Luteinizing hormone and vitamin B12 do not play a role in bone formation or resorption.

Which statement reflects the progress of bone healing?

Serial x-rays are used to monitor the progress of bone healing. 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 nurse is taking a health history on a new patient who has been experiencing unexplained paresthesia. What question should guide the nurses assessment of the patients altered sensations?

How does the feeling in the affected extremity compare with the feeling in the unaffected extremity? Questions that the nurse should ask regarding altered sensations include How does this feeling compare to sensation in the unaffected extremity? Asking questions about strength and color are not relevant and a family history is unlikely.

A client scheduled to undergo an electromyography asks the nurse what this test will evaluate. What is the correct response from the nurse?

Muscle weakness Electromyography tests the electric potential of the muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration, pain, disability, and to differentiate muscle and nerve problems. A bone biopsy is done to identify bone composition. Bone densitometry is done to evaluate bone density. A bone scan would be appropriate to detect metastatic bone lesions.

A client comes to the emergency department with reports of pain in the left ankle. The client states, "I missed a step coming down the stairs, and landed funny." The ankle is swollen and tender to the touch. What will the nurse do to help control the swelling?

Raise the left leg above the level of the heart. Explanation: To help relieve swelling and promote tissue perfusion, the nurse would have the client elevate the swollen body part above the level of the heart to promote venous circulation. If appropriate, the nurse would consult with the health care provider about applying ice to the area to help relieve edema. Telling the client to flex the foot would have no effect on edema and would most likely increase the pain and possibly the injury. Dangling the leg over the side of the bed would cause venous stasis, possibly increasing the edema due to the effect of gravity.

A nurse is caring for an older adult who has been diagnosed with geriatric failure to thrive. This patients prolonged immobility creates a risk for what complication?

Muscle atrophy If a muscle is in disuse for an extended period of time, it is at risk of developing atrophy, which is the decrease in size. Clonus is a pattern of rhythmic muscle contractions and fasciculation is the involuntary twitch of muscle fibers; neither results from immobility. Lack of exercise is a risk factor for rheumatoid arthritis.

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. Administer a mild analgesic. Inform the client that a clicking or crackling noise in the joint may persist for a couple of days. 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.

After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement?

Remodeling 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 is taking a health history on a patient with musculoskeletal dysfunction. What is the primary focus of this phase of the nurses assessment?

Evaluating the effects of the musculoskeletal disorder on the patients function The nursing assessment of the patient with musculoskeletal dysfunction includes an evaluation of the effects of the musculoskeletal disorder on the patient. This is a vital focus of the health history and supersedes the assessment of genetic risk factors and adherence to treatment, though these are both valid inclusions to the interview. Assessment of ROM occurs during the physical assessment, not the interview.

A nurse is providing care for a patient whose pattern of laboratory testing reveals longstanding hypocalcemia. What other laboratory result is most consistent with this finding?

An elevated parathyroid hormone level In the response to low calcium levels in the blood, increased levels of parathyroid hormone prompt the mobilization of calcium and the demineralization of bone. Increased calcitonin levels would exacerbate hypocalcemia. Vitamin D levels do not increase in response to low calcium levels. Potassium levels would likely be unaffected.

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

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 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.

A nurse is performing a nursing assessment of a patient suspected of having a musculoskeletal disorder. What is the primary focus of the nursing assessment with a patient who has a musculoskeletal disorder?

Activities of daily living The nursing assessment is primarily a functional evaluation, focusing on the patients ability to perform activities of daily living. The nurse also assesses strength, gait, and ROM, but these are assessed to identify their effect on functional status rather than to identify a medical diagnosis.

A client is scheduled to have an x-ray examination of the shoulder in which the synovial fluid will be aspirated and sent to the laboratory for analysis. This will be followed by administration of a contrast medium and x-rays. What procedure will the nurse prepare the client for?

Arthrogram An arthrogram is a radiographic examination of a joint, usually the knee or shoulder. The health care provider first injects a local anesthetic and then inserts a needle into the joint space. Fluoroscopy may be used to verify correct placement of the needle. The synovial fluid in the joint is aspirated and sent to the laboratory for analysis. A contrast medium is then injected, and x-ray films are taken. Arthroscopy is the internal inspection of a joint using an instrument called an arthroscope. Arthrocentesis is the aspiration of synovial fluid. The client receives local anesthesia just before this procedure. The health care provider inserts a large needle into the joint and removes the fluid. This can be done during an arthrogram or arthroscopy. Bone densitometry estimates bone density using radiography or advanced radiographic techniques.

A nurse is performing a musculoskeletal assessment of a patient with arthritis. During passive range-of- motion exercises, the nurse hears an audible grating sound. The nurse should document the presence of which of the following?

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