Chapter 39-Assessment of Musculoskeletal Function

The nurse is conducting the admission assessment for the client who is to undergo an arthrogram. What is the priority question the nurse should ask?

"Do you have any allergies?"

The nurse is preparing the client for magnetic resonance imaging for complaints of low back pain. Which statement by the client requires action by the nurse?

"I didn't remove my Transderm-Nitro patch."

A client with a sports injury undergoes a diagnostic arthroscopy of the left knee. Which of the following comments by the client following the procedure should the nurse address first?

"My toes are numb." Numbness would indicate neurological compromise of the extremity and requires immediate intervention to prevent permanent damage.

What instructions should the nurse include in the discharge teaching for the client following an arthroscopy?

"The pain should be well-controlled with Tylenol."

The older client asks the nurse how best to maintain strong bones. The best response by the nurse is:

"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."

Which statement describes paresthesia?

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.

A patient is having repeated tears of the joint capsule in the shoulder, and the physician 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 patient that a clicking or crackling noise in the joint may persist for a couple of days.

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

Apply ice to the joint.

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?" "Have you removed your hearing aid?" "Do you have a pacemaker?"

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

Arthrocentesis Arthrocentesis (joint aspiration) is carried out to obtain synovial fluid for purpose of examination or to relieve pain due to effusion. EMG provides information about the electrical potential of the muscles and the nerves leading to them. A bone scan is performed to detect metastatic and primary bone tumors, osteomyelitis, certain fractures, and aseptic necrosis. A biopsy may be performed to determine the structure and composition of bone marrow, bone, muscle, or synovium to help diagnose specific diseases.

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

Arthrocentesis Arthrocentesis (joint aspiration) is carried out to obtain synovial fluid for purpose of examination or to relieve pain due to effusion. EMG provides information about the electrical potential of the muscles and the nerves leading to them. A bone scan is performed to detect metastatic and primary bone tumors, osteomyelitis, certain fractures, and aseptic necrosis. A biopsy may be performed to determine the structure and composition of bone marrow, bone, muscle, or synovium to help diagnose specific diseases.

Which 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 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

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 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.

The nurse would include which of the following in a neurological assessment?

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.

The nurse who is taking care of a patient with lower motor neuron destruction documents in the electronic health record that the muscle tone in the lower legs is:

Atonic. A denervated muscle becomes soft and flabby (atonic) and atrophies. A flaccid muscle is limp and without tone; a muscle with greater than normal tone is considered spastic.

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

Bursitis A bursa is a small sac filled with synovial fluid. Bursae reduce friction between areas, such as tendon and bone and tendon and ligament. Inflammation of these sacs is called bursitis.

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

Calcitonin

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. 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.

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

Clonus Clonus is a rhythmic contraction of the muscle. Atrophy is a shrinkagelike decrease in the size of a muscle. Hypertrophy is an increase in the size of a muscle. Crepitus is a grating or crackling sound or sensation that may occur with movement of ends of a broken bone or irregular joint surface.

Which is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes?

Compartment syndrome

Which is a circulatory indicator of peripheral neurovascular dysfunction?

Cool skin

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

Covers the marrow cavity of long bones

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 a neurovascular assessment of a client's injured extremity. Which of the following would the nurse report?

Dusky or mottled skin color Normally, skin color would be similar to the color in other body areas. Pale or dusky skin color indicates an abnormality that needs to be reported. Presence of pulses, capillary refill of 3 seconds, and warm skin are normal findings.

A patient is diagnosed with a fracture of a diarthrosis joint. The nurse knows that an example of this type of joint is the:

Elbow.

The nurse would expect which of the following diagnostic tests to be ordered for a patient with lower extremity muscle weakness?

Electromyograph (EMG)

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

Flaccidity A muscle that is limp and without tone is described as flaccid; a muscle with greater-than-normal tone is described as spastic. Conditions characterized by lower motor neuron destruction (e.g., muscular dystrophy), denervated muscle becomes atonic (soft and flabby) and atrophies.

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

Hyaline or articular cartilage covers the surface of movable joints, such as the elbow, and protects the surface of these joints. Other types of cartilage include costal cartilage, which connects the ribs and sternum; semilunar cartilage, which is one of the cartilages of the knee joint; fibrous cartilage, found between the vertebrae (intervertebral discs); and elastic cartilage, found in the larynx, epiglottis, and outer ear.

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 other findings are within normal limits.

Which of the following is the most common site of joint effusion?

Knee

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

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

Lamellae

A client is scheduled to undergo an electromyography. The nurse understands that this test is performed to evaluate which of the following?

Muscle weakness

The nurse is assessing the client who states a decline in muscle strength. Which is the primary source essential to allow muscle contraction?

Myofibrils Skeletal muscles are made up of muscle cells or fibers called myofibrils. Without muscle fibers, there can be no muscle contraction. Sliding filaments called sarcomeres make up the myofibrils. Acetylcholine stimulates the motor neuron, which innervated the muscle. Actin and myosin in the sarcomere slide together, resulting in muscle contraction.

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

No further increase in bone length occurs.

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 diaphysesare bone tissues that provide strength and support to the human skeleton.

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 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.

Which serum level indicates the rate of bone turnover?

Osteocalcin

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.

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

Parathyroid Hormone

Parathyroid hormone (PTH), also called parathormone or parathyrin, is a hormone secreted by the parathyroid glands that is important in bone remodeling, which is an ongoing process in which bone tissue is alternately resorbed and rebuilt over time. PTH is secreted in response to low blood serum calcium (Ca2+) levels.

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.

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

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. The red bone marrow does not produce estrogen or corticosteroids.

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. The nurse understands that this type of fracture is significant because:

Potential growth problems may result from damage to the epiphyseal plate.

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 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

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 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.

Which of the following would be most important for the nurse to include in the teaching plan for a client who has undergone arthrography?

Report joint crackling or clicking noises occurring after the second day. Look at shoulder, knee or hip. X-rays are used to take a series of pictures. Sometime air is used a s a contrast substance.

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.

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?

Serial x-rays

A client undergoes an invasive joint examination of the knee. The nurse would closely monitor the client for which of the following?

Serous drainage

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.

Which type of gait correlates with Parkinson's disease?

Shuffling

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 (immovable joints are synarthrodial joints)

When assessing the client for scoliosis, the nurse:

Stands behind the client and asks the client to bend forward at the waist

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.

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

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 client experiences a musculoskeletal injury that involves the structure that connects a muscle to the bone. The nurse understands that this injury involves which of the following?

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.

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.

Which nerve is assessed when the nurse asks the client to spread all fingers?

Ulnar Asking the client to spread all fingers allows the nurse to assess motor function affected by ulnar innervation, while pricking the fat pad at the top of the small finger allows assessment of the sensory function affected by the ulnar nerve. The peroneal nerve is assessed by asking the client to dorsiflex the ankle and to extend the toes. The radial nerve is assessed by asking the client to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints. The median nerve is assessed by asking the client to touch the thumb to the little finger.

The nurse recognizes that rheumatoid arthritis is characterized by

Ulnar deviation Rheumatoid arthritis is characterized by ulnar deviation of the fingers. The ballottement sign is used to detect fluid in the knee. Clonus is the rhythmic contractions of a muscle. Involuntary twitching of muscle fiber groups is called fasciculation.

The nurse recognizes that rheumatoid arthritis is characterized by:

Ulnar deviation Rheumatoid arthritis is characterized by ulnar deviation of the fingers. The ballottement sign is used to detect fluid in the knee. Clonus is the rhythmic contractions of a muscle. Involuntary twitching of muscle fiber groups is called fasciculation.

A client is recovering from a fractured hip. The nurse would suggest that the client increase intake of which of the following to facilitate calcium absorption from food and supplements?

Vitamin D The nurse must advise a client recovering from a fractured hip to increase the intake of vitamin D, because vitamin D protects against bone loss and decreases the risk of recurring fracture by facilitating calcium absorption from food and supplements. Amino acids and vitamin B6, though important, do not facilitate the absorption of calcium. Dairy products also do not facilitate the absorption of calcium; however, the exception to this is vitamin D-fortified milk.

Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy?

aspirin

The nurse working in the emergency department receives a call from the x-ray department communicating that the client the nurse is caring for has a fracture in the shaft of the tibia. The nurse tells the physician that the client's fracture is in the

diaphysis.

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

kyphosis

The nurse is conducting an admission history of a client admitted with a fracture. The nurse recognizes that which of the client's medications placed the client at risk for fractures?

prednisone (Deltasone) Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures.

An example of a flat bone is the

sternum. An example of a flat bone is the sternum. A short bone is a metacarpal. The femur is a long bone. The vertebra is an irregular bone.

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.

The nurse is conducting an admission history of a client admitted with a fracture. The nurse recognizes that which of the client's medications placed the client at risk for fractures?

Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures.