PrepU Ch. 39: Assessment of Musculoskeletal Function

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

Acute Pain

Which of the following factors would the nurse need to keep in mind about the focus of the initial history when assessing a new client with a musculoskeletal problem?

Any chronic disorder or recent injury

Which nursing action is most important in caring for the client following an arthrogram?

Apply ice to the joint

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

Kyphosis

Which term refers to mature compact bone structures that form concentric rings of bone matrix?

Lamellae

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?

Prick the distal fat pad on the small finger.

The nurse recognizes that rheumatoid arthritis is characterized by:

Ulnar deviation

Which statement by the client preparing for a bone scan indicates further teaching by the nurse is needed?

"I will need to limit my fluid intake so as not to interfere with the isotope."

The nurse is taking care of a client with lower motor neuron destruction. How would the nurse document on the electronic health record the muscle tone in the client's lower legs?

Atonic

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?

Cool skin

Which description refers to an osteon?

Microscopic functional bone unit

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? (Select all that apply.)

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

The nurse is conducting a musculoskeletal assessment on a client documented to have rheumatoid arthritis. Which would the nurse anticipate finding when inspecting the client's fingers?

Soft, subcutaneous nodules along the tendons

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.

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

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

Arthrography

A nurse understands the influence of hormones on bone maintenance. Therefore, the nurse knows that a patient on long-term cortisol may experience:

Increased bone resorption.

Which of the following deformity causes a exaggerated curvature of the lumbar spine?

Lordosis

Which cells are involved in bone resorption?

Osteoclasts Osteoclasts carry out bone resorption by removing unwanted bone while new bone is forming in other areas. Chondrocytes are responsible for forming new cartilage. Osteoblasts are bone-forming cells that secrete collagen and other substances. Osteocytes, derived from osteoblasts, are the chief cells in bone tissue.

A group of students are reviewing information about bones in preparation for a quiz. Which of the following indicates that the students have understood the material?

Osteoclasts are involved in the destruction and remodeling of bone

Which nursing instruction is most important to stress when teaching on calcium intake?

Provide age-related calcium intake recommendations.

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

Which laboratory study indicates the rate of bone turnover?

Serum osteocalcin

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

The patient has rheumatoid arthritis.

The nurse understands that bone maintenance requires a balance between forming and dissolving bone. What is a correct statement about the function of osteoblasts?

They secrete a matrix that consists of collagen.

A client visits the health care provider for a routine checkup. The history reveals that the client was diagnosed with a spinal curvature. Which region of the spine should the nurse assess for complications?

Thoracic

Which clinical manifestation would the nurse recognize as an indicator of peripheral neurovascular dysfunction? Select all that apply.

Toes mottled and cool Complaints of pins and needles in feet

A nursing student asks the nurse why older adults are at risk for falls. The best response by the nurse is:

"Muscles atrophy with aging."

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?

Apply a cold pack at the insertion site in order to reduce/prevent swelling

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."

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."

A patient tells the nurse, "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 is a circulatory indicator of peripheral neurovascular dysfunction?

Indicators of peripheral neurovascular dysfunction related to circulation include:pale, cyanotic or mottled skin with a cool temperature. The capillary refill is more than 3 seconds

Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes?

The peroneal nerve is assessed by asking the client to dorsiflex the ankle and to extend the toes.

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.

The nurse is teaching a client about osteoporosis. What diagnostic test will the nurse include with the client teaching?

dual-energy x-ray absorptiometry

A client is diagnosed with a fracture of a diarthrosis joint. What is an example of this type of joint?

elbow

There are thousands of components of the musculoskeletal system that facilitate mobility and independent function. The function of skeletal muscle is promoting:

movement of skeletal bones.

The nurse is discussing an older adult's risk for skeletal fractures with a group of students assigned to the clinical area. Which of the following would the nurse most likely explain as the underlying reason for the increased risk?

Bone resorption is more rapid than bone formation.

Which hormone inhibits bone resorption and increases the deposit of calcium in the bone?

Calcitonin

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

Carpal bones in the wrist

Choose the correct statement about the endosteum, a significant component of the skeletal system:

Covers the marrow cavity of long bones

A client has recently undergone an invasive joint examination to enable the identification of bone composition. Which signs and symptoms should the nurse monitor in this client?

swelling and bleeding

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

Which data is most important for the nurse to record while assessing a client with an open wound?

when the client last received a tetanus immunization

A client arrives at the orthopedic physician's office stating knee pain sustained while playing soccer. A history and physical assessment is completed. The knee appears reddened with edema. Which other diagnostic testing would the nurse anticipate?

An arthroscopy

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

The homecare nurse is evaluating the musculoskeletal system of a geriatric client whose previous assessment was within normal limits. The nurse initiates a call to the health care provider and/or emergency services when which change is found?

Decreased right-sided muscle strength

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

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:

30 years.

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

Clonus

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?

Gout

A client is scheduled for a bone scan. A bone scan may be ordered to detect metastatic bone lesions, fractures, and certain types of inflammatory disorders. Which nursing considerations are correct in preparing a client for a bone scan? Select all that apply.

Inform the client that the radiopaque isotope will be administered intravenously. Ensure that the client does not have any allergies to the isotope. Encourage the client to drink fluids to help distribute and eliminate the isotope.

A nurse knows that a person with a 3-week-old femur fracture is at the stage where angiogenesis is occurring. What are the characterisitics of this stage?

New capillaries producing a bridge between the fractured bones.

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

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 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.

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

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

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 client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for?

Serous drainage

A group of students are studying for an examination on joints. The students demonstrate understanding of the material when they identify which of the following as an example of a synarthrodial joint?

Skull at the temporal and occipital bones

Skull sutures are an example of which type of joint?

Synarthrosis Joints- fibrous joints which are immovable because of fibrous tissue banding (skull sutures)

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

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 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 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?

Cancellous

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

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

Lordosis

The nurse is working on an orthopedic floor caring for a client injured in a football game. The nurse is reviewing the client's chart noting that the client has previously had an injured tendon. The nurse anticipates an injury between the periosteum of the bone and which of the following?

Muscle

A client is scheduled to undergo an electromyography. When performed, what will this test evaluate?

Muscle weakness

A client is exhibiting diminished range of motion, loss of flexibility, stiffness, and loss of height. The history and physical findings are associated with age-related changes of which area?

Joints History and physical findings associated with age-related changes of the joints include diminished range of motion, loss of flexibility, stiffness, and loss of height

A client is diagnosed with a bone tumor. What result would the nurse expect the blood tests to reveal?

Decreased serum calcium level

A group of students are reviewing the structure and function of bones. The students demonstrate understanding of the information when they state that cortical bone is found primarily in which of the following?

Diaphyses

A client has an elbow injury that involves the cartilage in that joint. The nurse understands that which type of cartilage has been affected?

Hyaline cartilage

During which stage or phase of bone healing after fracture does callus formation occur?

Reparative

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 endurance joint stiffness decreased range of motion

Which term refers to muscle tension being unchanged with muscle shortening and joint motion?

isotonic contraction