Chapter 40: Assessment of Musculoskeletal Function

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply. a) Muscle spasms will be relieved. b) Immobilization of the left leg will be maintained. c) The bones of the left leg will be aligned. d) Surgery will not be required. e) Less pain medication will be required.

a) Muscle spasms will be relieved. b) Immobilization of the left leg will be maintained. c) The bones of the left leg will be aligned. Traction is used to relieve muscle spasm, align bones, and maintain immobilization when used properly. It will not replace surgery to correct the fracture. The client will still require pain medication prior to surgical correction.

Red bone marrow produces which of the following? Select all that apply. a) White blood cells (WBCs) b) Red blood cells (RBCs) c) Corticosteroids d) Estrogen e) Platelets

a) White blood cells (WBCs) b) Red blood cells (RBCs) e) Platelets 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.

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? a) Pain b) Pulselessness c) Ischemia d) Coolness

b) 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.

Which of the following would be most important for the nurse to include in the teaching plan for a client who has undergone arthrography? a) Gently massage joints with any crackling or clicking joint noises. b) Report joint crackling or clicking noises occurring after the second day. c) Avoid intake of dairy products. d) Avoid sunlight or harsh, dry climate.

b) 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.

Which of the following would be a circulatory indicator of peripheral neurovascular dysfunction? a) Paralysis b) Paresthesia c) Cool skin d) Weakness

c) Cool skin 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. Weakness and paralysis is related to motion. Paresthesia is related to sensation.

A client has undergone an external fixation. Which actions would be the priority for this client? a) Monitoring the client's blood pressure. b) Monitoring the client's urine output. c) Planning the client's diet. d) Maintaining pin care.

d) Maintaining pin care. Pin care is a priority for a client with external fixation, because pin sites are entry points for infection. The nurse should also monitor redness, drainage, and tenderness at the site. Planning the client's diet and monitoring the client's urine output and blood pressure, although necessary, are not as important as maintaining pin care.

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? a) The patient has rheumatoid arthritis. b) The patient has lupus erythematosus. c) The patient has neurofibromatosis. d) The patient has osteoarthritis.

a) The patient has rheumatoid arthritis. The subcutaneous nodules of rheumatoid arthritis are soft and occur within and along tendons that provide extensor function to the joints. Osteoarthritic nodules are hard and painless and represent bony overgrowth that has resulted from destruction of the cartilaginous surface of bone within the joint capsule. Lupus and neurofibromatosis are not associated with the production of nodules.

Which of the following is an indicator of neurovascular compromise? a) Warm skin temperature b) Capillary refill of more than 3 seconds c) Diminished pain d) Pain on active stretch

b) 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 on passive stretch, and absence of feeling. Cool skin temperature is an indicator of neurovascular compromise. Unrelenting pain is an indicator of neurovascular compromise. Pain on passive stretch is an indicator of neurovascular compromise.

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? a) Apply warm compresses to the insertion site. b) Provide a gentle massage. c) Apply a cold pack at the insertion site. d) Assist with performing ROM exercises.

c) Apply a cold pack at the insertion site. After covering the arthroscope insertion site with a bulky dressing and elevating the client's entire leg, the nurse needs to apply a cold pack at the site to minimize any chances of swelling.

Which of the following terms refers to muscle tension being unchanged with muscle shortening and joint motion? a) Fasciculation b) Contracture c) Isotonic contraction d) Isometric contraction

c) Isotonic contraction Exercises such as swimming and bicycling are isotonic. Isometric contraction is characterized by increased muscle tension, unchanged muscle length, and no joint motion. Contracture refers to abnormal shortening of muscle, joint, or both. Fasciculation refers to the involuntary twitch of muscle fibers.

A client who is undergoing skeletal traction complains of pressure on bony areas. Which action would be most appropriate to provide comfort for the client? a) Assisting with range-of-motion and isometric exercises. b) Changing the client's position within prescribed limits. c) Administering prescribed analgesics. d) Applying warm compresses.

b) Changing the client's position within prescribed limits. Changing the position of a client within prescribed limits helps relieve pressure on bony areas and promotes comfort. Analgesics help to relive pain but may not help relieve pressure on bony areas. Warm compresses aid blood circulation. The client should not exercise while on traction unless prescribed to regain strength in the affected limb.

Which of the following statements is accurate regarding care of a plaster cast? a) The cast will dry in about 12 hours. b) The cast must be covered with a blanket to keep it moist during the first 24 hours. c) The cast can be dented while it is damp. d) A dry plaster cast is dull and gray.

c) The cast can be dented while it is damp. The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding.

Which of the following describes a muscle that is limp and without tone? a) Paralysis b) Spastic c) Flaccid d) Atonic

c) 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.

Foot drop occurs when there is injury to which of the following areas? a) Sciatic b) Achilles c) Peroneal d) Femoral

c) Peroneal Injury to the peroneal nerve as a result of pressure is a cause of foot drop.

A patient with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which of the following is the priority action by the nurse? a) Reposition the patient for comfort. b) Assess for previous opioid drug use. c) Assess for complications. d) Teach relaxation techniques.

c) Assess for complications. Unrelieved pain can be an indicator of a complication, such as, compartment syndrome. Previous opioid drug use should not influence a complete and thorough assessment. Repositioning the patient for comfort may be appropriate once all indications of a complication are ruled out. It is appropriate to teach relaxation techniques to help ease the pain, but assessing for a complication remains the highest priority.