Prepu: Chapter 60: Introduction to the Musculoskeletal System

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." Explanation: 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.

A client who is postmenopausal is taking medication to reverse bone loss. Although loss of bone mass accelerates after menopause, at what age do people begin to lose bone mass?

35 years Explanation: After 35 years, people generally experience loss of bone mass and height and changes in the structure of the spine and joints.

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

Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin Explanation: 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. Jaundice, diaphoresis, and warmth are inconsistent with peripheral neurovascular dysfunction.

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

Alkaline phosphatase Explanation: 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 client with metastatic bone tumors.

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

Altered serum calcium levels Explanation: Serum calcium levels are altered in clients with osteomalacia, parathyroid dysfunction, Paget's disease, metastatic bone tumors, or prolonged immobilization. Paget's disease is not directly associated with altered magnesium, potassium, or sodium levels.

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

Apply ice to the joint. Explanation: 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.

Which of the following diagnostic studies are done to relieve joint pain due to effusion?

Arthrocentesis Explanation: 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.

A client has been experiencing progressive increases in knee pain and diagnostic imaging reveals a worsening effusion in the synovial capsule. The nurse should anticipate what diagnostic procedure?

Arthrocentesis Explanation: 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.

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 Explanation: 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 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 Explanation: Arthroscopy is a procedure that allows direct visualization of a joint through the use of a fiberoptic endoscope. Thus, it is a useful adjunct to diagnosing joint disorders.

A client has symptoms of osteoporosis and is being assessed during an annual physical examination. The assessment shows that the client will require further testing related to a possible exacerbation of osteoporosis. The nurse should anticipate which diagnostic test?

Bone densitometry Explanation: 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.

A clinic nurse is caring for a client with a history of osteoporosis. What diagnostic test will best allow the care team to assess the client's risk of fracture?

Bone densitometry Explanation: 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 Explanation: 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. The other answers do not apply.

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

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

Which is an indicator of neurovascular compromise?

Capillary refill of more than 3 seconds Explanation: 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. Cool skin temperature is an indicator of neurovascular compromise. Unrelenting pain is an indicator of neurovascular compromise. Pain upon passive stretch is an indicator of neurovascular compromise.

During assessment, a client reports experiencing rhythmic muscle contractions when the nurse performs passive extension of the wrist. The nurse should recognize the presence of which condition?

Clonus Explanation: 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.

The nurse is performing an assessment of a client's musculoskeletal system and is appraising the client's bone integrity. Which action should the nurse perform during this phase of assessment?

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

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

Contact the primary provider immediately. Explanation: 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.

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

Crepitus Explanation: 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.

Which term refers to the shaft of the long bone?

Diaphysis Explanation: The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone. Lordosis refers to an increase in lumbar curvature of spine. Scoliosis refers to lateral curving of the spine.

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

Elbow Explanation: A diarthrosis joint, like the elbow, is freely movable. The skull is an example of an immovable joint. The vertebral joints and symphysis pubis are amphiarthrosis joints that have limited motion.

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

Electromyograph (EMG) Explanation: 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.

A client is scheduled for a bone scan to rule out osteosarcoma of the pelvic bones. Which client status would be most important for the nurse to verify before the client's scan?

Empty bladder Explanation: Before the scan, the nurse asks the client 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.

A nurse is caring for a client 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 client Explanation: Absolutely no metal objects can be present during MRI—their presence constitutes a serious safety risk. The procedure takes up to 90 minutes. Nut allergies and infection are not contraindications to MRI.

A client has sustained traumatic injuries that involve several bone fractures. A fracture of what type of bone may interfere with the protection of the client's vital organs?

Flat bones Explanation: 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 nurse is taking a health history on a new client who has been experiencing unexplained paresthesia. What question should guide the nurse's assessment of the client's altered sensations?

How does the feeling in the affected extremity compare with the feeling in the unaffected extremity? Explanation: 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 is not relevant and a family history is unlikely.

The nurse's comprehensive assessment of an older adult involves the assessment of the client's gait. How should the nurse best perform this assessment?

Instruct the client to walk away from the nurse for a short distance and then toward the nurse. Explanation: Gait is assessed by having the client walk away from the examiner for a short distance. The examiner observes the client's 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 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 Explanation: Common deformities of the spine include kyphosis, which is an increased forward curvature of the thoracic spine that causes a bowing or rounding of the back, leading to a hunchback or slouching posture. The second deformity of the spine is referred to as lordosis, or swayback, an exaggerated curvature of the lumbar spine. A third deformity is scoliosis, which is a lateral curving deviation of the spine (Fig. 40-4). Osteoporosis is abnormal excessive bone loss.

A client has come to the clinic for a regular check-up. The nurse's initial inspection reveals an increased thoracic curvature of the client's spine. The nurse should document the presence of which condition?

Kyphosis Explanation: 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.

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

Lordosis Explanation: Lordosis is an exaggerated curvature of the lumbar spine. Scoliosis is a lateral curving deviation of the spine. Kyphosis is an increased forward curvature of the thoracic spine. Steppage gait is not a type of spinal deformity.

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

Lordosis Explanation: Lordosis is an exaggeration of the lumbar spine curve.

A 10-year-old client is growing at a rate appropriate for the client's age. Which cells are responsible for the secretion of bone matrix, which eventually results in bone growth?

Osteoblasts Explanation: 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.

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.)

Pale, cyanotic, or mottled color Cool temperature of the extremity More than 3-second capillary refill Explanation: Indicators of peripheral neurovascular dysfunction include pale, cyanotic, or mottled skin color; cool temperature of the extremities; and a capillary refill of more than 3 seconds.

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 Explanation: 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.

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 Explanation: 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.

What would not be included in client and family teaching after a musculoskeletal injury?

Pursue any physical activities that are comfortable. Explanation: The client may not pursue any activities that are comfortable. It is appropriate for the client to resume work, bathing, and other activities per physician's orders. Excessive pain or throbbing, prolonged or fresh bleeding, swelling, skin color changes, decrease in sensation, or purulent drainage should be reported.

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 Explanation: 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.

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 Explanation: 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's fracture is healing and compact bone is replacing spongy bone around the periphery of the fracture. This process characterizes what phase of the bone healing process?

Remodeling Explanation: Remodeling occurs as necrotic bone is removed by the osteoclasts. In this phase, compact bone replaces spongy bone around the periphery of the fracture. Each of the other listed phases precedes this stage.

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. Explanation: 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 client is receiving ongoing nursing care for the treatment of Parkinson disease. When assessing this client's gait, which finding is most closely associated with this health problem?

Shuffling gait Explanation: 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 (Parkinson disease). A rapid gait is not associated with Parkinson disease.

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 Explanation: The subcutaneous nodules of rheumatoid arthritis are soft and occur within and along tendons that provide extensor function to the joints. The nodules of gout are hard and lie within and immediately adjacent to the joint capsule itself. Osteoarthritic nodules are hard and painless and represent bony overgrowth that results from destruction of the cartilaginous surface of bone within the joint capsule.

Skull sutures are an example of which type of joint?

Synarthrosis Explanation: 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.

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

Wrap the joint in a compression dressing. Explanation: 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.

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. Explanation: 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.

During the physical assessment of a client with a musculoskeletal disorder, which techniques would enable the nurse to determine the client's ability to exhibit fine motor skills?

asking the client to grasp objects Explanation: Asking the client to grasp objects helps the nurse determine the client's ability to exhibit fine motor skills.

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

kyphosis Explanation: 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 human body has 206 bones, which are classified into four categories. Which types of bones are located in the forearm?

long bones Explanation: Long bones are the type of bone that is located in the forearm, specifically, the ulna.

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

long bones Explanation: The femur and ulna are long bones.

The human body has 206 bones, which are classified into four categories. Which types of bones are located in the digits?

short bones Explanation: Short bones are the type that is located in the fingers and toes.

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 Explanation: If the client has undergone an invasive joint examination, such as a biopsy, the nurse should inspect the area for swelling and bleeding. A client is unlikely to experience a hypersensitivity or nausea after the procedure is completed. Neurologic symptoms are unlikely.