Chapter 40: PrepU - Nursing Assessment: Musculoskeletal Function

A client is scheduled to undergo an electromyography. When performed, what will this test evaluate? 1- Muscle weakness 2- Muscle composition 3- Bone density 4- Metastatic bone lesions

1

Skull sutures are an example of which type of joint? 1- Synarthrosis 2- Amphiarthrosis 3- Diarthrosis 4- Aponeuroses

1

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.) 1- Pale, cyanotic, or mottled color 2- Cool temperature of the extremity 3- More than 3-second capillary refill 4- Tenting skin turgor 5- Limited range of motion

1,2,3

The nurse is reading the admission note for a client with a bone fracture that requires surgery. The note indicates the presence of crepitus. The nurse interprets this as being 1- bleeding. 2- a crackling sound. 3- ecchymosis. 4- a closed fracture.

2

What is the term for a rhythmic contraction of a muscle? 1- Atrophy 2- Clonus 3- Hypertrophy 4- Crepitus

2

Which body movement involves moving toward the midline? 1- Pronation 2- Adduction 3- Abduction 4- Eversion

2

The nurse is performing a neurovascular assessment of a client's injured extremity. Which would the nurse report? 1- Positive distal pulses 2- Capillary refill of 3 seconds 3- Dusky or mottled skin color 4- Skin warm to touch

3

Which of the following is an example of a gliding joint? 1- Carpal bones in the wrist 2- Knee 3- Hip 4- Joint at base of thumb

1

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? 1- Osteoblasts 2- Cortical bone 3- Osteoclasts 4- Cancellous bone

1

The nurse is preparing the client for computed tomography. Which information should be given by the nurse? 1- "You must remain very still during the procedure." 2- "A small bit of tissue will be removed and sent to the lab." 3- "Fluid will be removed from you affected joint." 4- "A radioisotope will be given through an IV."

1

Which nerve is assessed when the nurse asks the client to spread all fingers? 1- Ulnar 2- Peroneal 3- Radial 4- Median

1

Which of the following is the final stage of fracture repair? 1- Remodeling 2- Cartilage calcification 3- Cartilage removal 4- Angiogenesis

1

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? 1- Sciatic 2- Peroneal 3- Femoral 4- Achilles

2

Which term refers to mature compact bone structures that form concentric rings of bone matrix? 1- Endosteum 2- Lamellae 3- Trabecula 4- Cancellous bone

2

Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist? 1- Meniscography 2- Bone densitometry 3- Arthrography 4- EMG

3

Which cells are involved in bone resorption? 1- Chondrocytes 2- Osteoblasts 3- Osteoclasts 4- Osteocytes

3

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? 1- "While you are lifting weights, endorphins are released, creating increase in muscle mass, but if the muscles are not used they will atrophy." 2- "The muscle mass has decreased from the lack of calcium in the cells." 3- "Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued." 4- "Once you stop exercising, the contraction of the muscle does not regain its strength."

3

Parathormone regulates the concentration of calcium in the blood by: 1- Stimulating osteoblastic activity. 2- Stimulating the liver to produce an insulin-like growth factor. 3- Promoting the movement of calcium from the bone. 4- Increasing the release of thyroid hormones.

3

The human body is designed to protect its vital parts. The nurse is aware that a fracture of what type of bone may interfere with the protection of vital organs? 1- Long bones 2- Short bones 3- Flat bones 4- Irregular bones

3

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? 1- The patient has osteoarthritis. 2- The patient has lupus erythematosus. 3- The patient has rheumatoid arthritis. 4- The patient has neurofibromatosis.

3

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? 1- Paresthesia 2- Flaccidity 3- Atonia 4- Effusion

1

A patient has just had an arthroscopy. What is a nursing intervention that is necessary for the nurse to implement following an arthroscopy? 1- Wrap the joint in compression dressing. 2- Flex and lower the joint. 3- Extend and lower the joint. 4- Apply heat.

1

Choose the correct statement about the endosteum, a significant component of the skeletal system: 1- Covers the marrow cavity of long bones 2- Supports the attachment of tendons to bones 3- Contains blood vessels and lymphatics 4- Facilitates bone growth

1

The nurse recognizes that rheumatoid arthritis is characterized by: 1- Ulnar deviation 2- Ballottement sign 3- Clonus 4- Fasciculations

1

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? 1- aspirin 2- furosemide 3- digoxin 4- NPH insulin

1

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? 1- Fascia 2- Ligament 3- Bursa 4- Tendon

4

Which is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes? 1- Remodeling 2- Hypertrophy 3- Fasciculation 4- Compartment syndrome

4

After a person experiences a closure of the epiphyses, which statement is true? 1- The bone grows in length but not thickness. 2- The bone increases in thickness and is remodeled. 3- Both bone length and thickness continue to increase. 4- No further increase in bone length occurs.

4

Which term refers to the shaft of the long bone? 1- Epiphysis 2- Lordosis 3- Scoliosis 4- Diaphysis

4

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 1- epiphysis. 2- lordosis. 3- scoliosis. 4- diaphysis.

4

The nurse is performing a musculoskeletal assessment of a client in a nursing home who had a stroke 2 years ago and who has right-sided hemiplegia. The nurse notes that the girth of the client's right calf is 2 inches less in diameter than the left calf. The nurse attributes the decreased girth to 1- edema in left lower extremity. 2- increased use of left calf muscle. 3- atrophy of right calf muscle. 4- bruising in right lower extremity.

3

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? 1- Between the vertebrae 2- In the fingers 3- At the hip 4- Skull at the temporal and occipital bones

4

There are thousands of components of the musculoskeletal system that facilitate mobility and independent function. The function of skeletal muscle is promoting: 1- movement of skeletal bones. 2- organ function. 3- involuntary function. 4- All options are correct.

1

Which laboratory study indicates the rate of bone turnover? 1- Urine calcium 2- Serum calcium 3- Serum phosphorous 4- Serum osteocalcin

4

Which nursing action is most important in caring for the client following an arthrogram? 1- Apply ice to the joint. 2- Keep the joint below the level of the heart. 3- Administer morphine sulfate. 4- Assist the client with passive range of motion.

1

Which of the following is the priority nursing diagnosis for the client preparing for a bone marrow biopsy? 1- Deficient knowledge: procedure 2- Acute pain 3- Risk for infection 4- Risk for ineffective peripheral tissue perfusion

1

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? 1- Rigidity 2- Flaccidity 3- Atonic 4- Tetanic

2

A medical nurse has provided care for many patients who have bone disorders, and the nurse integrates health education around the maintenance of bone health into care. What should the nurse recommend to patients in an effort to promote bone health? 1- Moderate activity restriction for older adults 2- Daily use of low-dose ASA 3- A low-fat, low-carbohydrate diet 4- Adequate dietary intake of calcium

4

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? 1- Rheumatoid arthritis 2- Lupus erythematosus 3- Osteoporosis 4- Gout

4

A 22-year-old college basketball player is undergoing diagnostic testing following a knee injury, and his primary care provider has ordered arthrography. What teaching should the nurse provide in preparation for this procedure? 1- "A computer will create a three-dimensional image of your knee based on magnetic readings." 2- "You'll be given some anesthetic and then several tissue samples will be taken from your knee joint." 3- "You'll be given a small dose of radioactive solution, and the doctor will observe its distribution in your knee." 4- "The doctor will inject some contrast solution into your joint and take a series of X-rays."

4

A nurse is conducting an assessment of a patient's musculoskeletal system and assessing for joint function. How should the nurse best perform this assessment? 1- Ask the patient to clearly describe any recent changes in mobility or flexibility. 2- Assess the patient's expectations around function and mobility. 3- Palpate and percuss each of the patient's joints bilaterally. 4- Assess the range of motion (ROM) of each of the patient's joints.

4

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? 1- The formation of a hematoma and fibrin. 2- Inflammation and the stimulation of osteoblasts and osteoclasts. 3- Cartilage cells forming matrix villa that regulate calcification of the cartilage. 4- New capillaries producing a bridge between the fractured bones.

4

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? 1- Lordosis 2- Scoliosis 3- Osteoporosis 4- Kyphosis

4

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? 1- Cervical 2- Thoracic 3- Lumbar 4- Sacral

2

A nurse is taking a newly admitted patient's health history, and the patient states that she has had ongoing problems with a "pinched nerve." In addition to the potential for pain, the nurse should consider the fact that physical pressure that is placed on nerves can often lead to what? 1- Crepitus 2- Paresthesias 3- Muscle hypertrophy 4- Osteoporosis

2

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? 1- Decreased right-sided muscle strength 2- Decreased flexibility 3- Decreased agility 4- Increased joint stiffness

1

The nurse is performing a neurological assessment. What will this assessment include? 1- Ask the client to plantar flex the toes. 2- Observe for capillary refill of the great toe. 3- Palpate the dorsalis pedis pulse. 4- Inspect the foot for edema.

1

An emergency department nurse is assessing an 80-year-old patient who has presented with a complaint of abdominal pain. The nurse performs a rapid inspection of the patient and notes multiple significant findings, including kyphosis. The nurse should understand that this assessment finding is suggestive of what musculoskeletal disease? 1- Malignant bone neoplasm 2- Paget's disease 3- Muscular dystrophy 4- Osteoporosis

4

The nurse is providing care for a male patient who has undergone knee arthroplasty. As part of the nurse's morning assessment, the nurse is assessing for peripheral neurovascular dysfunction distal to the surgical site. When performing this assessment, what parameters should the nurse assess and document? Select all that apply. 1- The color of the patient's lower leg and foot 2- The patient's ability to move his foot 3- The patient's sensation in his foot and lower leg 4- The temperature of the patient's foot and lower leg 5- The presence or absence of hair on the patient's foot and lower leg

1,2,3,4

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? 1- Ligament 2- Tendon 3- Cartilage 4- Joint

2

A client is diagnosed with a bone tumor. What result would the nurse expect the blood tests to reveal? 1- Decreased alkaline phosphatase 2- Decreased serum calcium level 3- Decreased serum phosphorus 4- Decreased red blood cell count

2

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? 1- A serum calcium test 2- An electromyography 3- An arthroscopy 4- A magnetic resonance imaging (MRI)

2

A client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for? 1- Lack of sleep and appetite 2- Serous drainage 3- Signs of depression 4- Signs of shock

2

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? 1- Osteoblast formation will stop during the time needed for fracture healing. 2- Red blood cell production will be temporarily reduced because of the damage to the medullar cavity. 3- Potential growth problems may result from damage to the epiphyseal plate. 4- Periosteal blood vessels will be damaged, thus compromising blood flow to the compact bone.

3

A client is recovering from a fractured hip. What would the nurse suggest that the client increase intake of to facilitate calcium absorption from food and supplements? 1- Amino acids 2- Vitamin B6 3- Vitamin D 4- Dairy products

3

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? 1- Remodeling 2- Resorption 3- Ossification and calcification 4- Epiphyses and diaphysis formation

3

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? 1- A bone densitometry 2- A bone scan 3- An arthrocentesis 4- An arthroscopy

4

Which of the following is the most common site of joint effusion? 1- Knee 2- Elbow 3- Hip 4- Shoulder

1

The nurse is performing a musculoskeletal assessment on a patient with arthritis. During passive range-of-motion exercises, the nurse hears grating and cracking sounds. This assessment finding is referred to as what? 1- Fasciculations 2- Clonus 3- Effusion 4- Crepitus

4

A nurse who provides care in an extended-care setting works primarily with adults aged 75 and older. When planning care and implementing safety measures for this population, the nurse should be cognizant of which of the following normal, age-related changes to the musculoskeletal system? 1- Decreased bone mass 2- Presence of osteochondromas 3- Decreased collagen in muscles 4- Increased elasticity of tendons

1

While doing an initial assessment on a patient, the patient tells the nurse that she has bone pain. The nurse asks the patient to describe the characteristics of the pain. Which of the following are typical characteristics of bone pain? 1- Dull, deep ache 2- Soreness or aching that may include cramping 3- Sharp and piercing pain that is relieved by immobilization 4- Spastic or sharp pain that radiates

1

Red bone marrow produces which of the following? Select all that apply. 1- Platelets 2- White blood cells (WBCs) 3- Red blood cells (RBCs) 4- Estrogen 5- Corticosteroids

1,2,3

An older adult patient has been admitted to a subacute geriatric medicine unit with a diagnosis of failure to thrive. The nurse is conducting a comprehensive assessment that focuses on the patient's musculoskeletal system. During this assessment, what will be the nurse's primary focus? 1- Risk factors for common diseases of the musculoskeletal system 2- The presence or absence of musculoskeletal diagnoses 3- The patient's level of function and activities of daily living 4- The integrity of the patient's integumentary system

3

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? 1- Client's age 2- Client's lifestyle 3- Any chronic disorder or recent injury 4- Duration and location of discomfort or pain

3

An elderly patient has come to the clinic for a regular check-up. While reviewing a patient's history, the nurse notes that the patient has an increased thoracic curvature of the spine. What term describes this assessment finding? 1- Scoliosis 2- Epiphyses 3- Lordosis 4- Kyphosis

4

Which hormone inhibits bone resorption and increases the deposit of calcium in the bone? 1- Growth hormone 2- Vitamin D 3- Sex hormones 4- Calcitonin

4