Musculoskeletal System Chapter 18
On inspection of the spine of a 79-year-old man, the nurse might expect to find a(n) -decreased cervical curve -increased thoracic curve -increased cervical curve -decreased lumbar curve
increased thoracic curve An exaggerated thoracic curve (kyphosis) is common with aging.
Bones in synovial joints are joined together by: -cartilage. -periosteal tissue. -tendons. -ligaments.
ligaments. Bones in synovial joints are joined by ligaments, which are strong, dense bands of fibrous connective tissue.
While sitting a client raises both legs while the nurse holds the lower legs below the knee. What does this finding indicate? -flexion deformity of both legs -normal quadriceps muscle strength -distal muscle symmetric weakness -proximal muscle symmetric weakness
normal quadriceps muscle strength -An active movement against full resistance without evidence of fatigue is considered normal muscle strength. -If the client is unable to keep the opposite leg extended, when one leg is flexed, it suggests a flexion deformity of the opposite leg's hip. -Symmetric weakness of the proximal muscles suggests a myopathy or muscle disorder. -Symmetric weakness of distal muscles suggests a polyneuropathy, or disorder of peripheral nerves.
A client with insulin-dependent diabetes visits the clinic and complains of painful hip joints. The nurse should assess the client carefully for signs and symptoms of -osteomyelitis. -arthritis. -scoliosis. -gait difficulties.
osteomyelitis. Having diabetes mellitus, sickle cell anemia, or SLE places the client at risk for development of musculoskeletal problems such as osteoporosis and osteomyelitis.
A female client visits the clinic and tells the nurse that she began menarche at the age of 16 years. The nurse should instruct the client that she is at a higher risk for -osteoporosis. -osteomyelitis. -rheumatoid arthritis. -lordosis.
osteoporosis. -Women who begin menarche late or begin menopause early are at greater risk for development of osteoporosis because of decreased estrogen levels, which tend to decrease the density of bone mass.
A client is unable to externally rotate the left shoulder. What health problem should the nurse suspect is occurring with this client? -rotator cuff tear -rotator cuff tendinitis -carpal tunnel syndrome -anterior dislocation of the humerus
rotator cuff tear -In a complete tear of the supraspinatus tendon, or a rotator cuff tear, active abduction and forward flexion at the glenohumeral joint are severely impaired, producing a characteristic shrugging of the shoulder and a positive "drop arm" test. -Rotator cuff tendonitis is characterized by acute, recurrent, or chronic pain of the supraspinatus tendon. -Carpal tunnel syndrome effects the wrist and not the shoulder. -Anterior dislocation of the humerus is characterized by the shoulder seeming to slip out of the joint.
While assessing the range of motion in an adult client's shoulders, the client expresses pain and exhibits limited abduction and muscle weakness. The nurse plans to refer the client to a physician for possible: -rotator cuff tear. -nerve damage. -cervical disc degeneration. -tendonitis.
rotator cuff tear. Painful and limited abduction accompanied by muscle weakness and atrophy are seen with a rotator cuff tear.
The nurse is assessing the spine of an adult client and detects lateral curvature of the thoracic spine with an increase in convexity on the left curved side. The nurse suspects that the client is experiencing -lordosis. -arthritis. -kyphosis. -scoliosis.
scoliosis. A lateral curvature of the spine with an increase in convexity on the side that is curved is seen in scoliosis.
The nurse is going to test range of motion in a client. To test extension of the triceps muscle, the nurse would instruct the client to: -straighten the elbow -bend the elbow -turn the palm up -turn the palm down
straighten the elbow The client should have full range of motion.
Skeletal muscles are attached to bones by: -tendons. -cartilage. -fibrous connective tissue. -ligaments.
tendons. Skeletal muscles attach to bones by way of strong, fibrous cords called tendons.
What is an appropriate question by the nurse to ask a client about the presence of temporomandibular joint dysfunction? -"Do you notice any swelling around the teeth or gums?" -"Can you fully clench your teeth and feel the muscles in your jaw tense?" -"Have you noticed a popping or grating sound when you chew?" -"Please stick out your tongue sand move it from side to side"
"Have you noticed a popping or grating sound when you chew?" -The temporomandibular joint (TMJ) provides the stability of the jaw to open and close. -Often the joint can become swollen, causing pain and decrease in range of motion of the jaw. -Decreased muscle strength and range of motion, along with a popping, clicking, or grating sound may be noted with TMJ dysfunction. -Swelling around the teeth and gums is seen with gingivitis. -Clenching the teeth test the integrity of cranial nerve V (trigeminal nerve). -Asking the client to stick out the tongue and move it from side to side tests cranial nerve XII (hypoglossal nerve).
When assessing muscle tone and strength, the nurse would document expected findings as -"extremity muscle strength is 5/5 bilaterally" -"upper and lower extremity muscle strength is 5/5 bilaterally" -"upper and lower extremity muscle strength is 5/5" -"upper extremity muscle strength is 5/5 bilaterally"
"upper and lower extremity muscle strength is 5/5 bilaterally" 5/5 (100%) normal muscle strength with complete ROM against gravity and full resistance.
The nurse is planning the care of a 77-year-old woman who has recently been diagnosed with osteoporosis. What nursing diagnoses should the nurse address in the client's plan of care? Select all that apply. -Risk for injury related to osteoporosis -Risk for infection related to osteoporosis -Activity intolerance related to osteoporosis -Impaired physical mobility related to osteoporosis -Disturbed sensory perception related to osteoporosis
--Activity intolerance related to osteoporosis --Risk for injury related to osteoporosis --Impaired physical mobility related to osteoporosis -Osteoporosis creates risks for injury, activity intolerance, and impaired mobility as consequences of musculoskeletal changes. -The disease does not normally result in infection or impaired sensation.
A client is being discharged home from the hospital. This client has a history of falling at home. A caregiver is not able to stay with the client all the time. What can be done to decrease the risk for falling at the client's home? Select all that apply. -Correct environmental hazards in the home -Install grab bars in the bathroom -Make sure house hallways are well lit -Have the client go to a physical therapy three times a week -Place colorful throw rugs near the exits
-Install grab bars in the bathroom -Make sure house hallways are well lit -Correct environmental hazards in the home -Clients should correct environmental hazards such as slippery surfaces, uneven floors, poor lighting on stairs, loose rugs, unstable furniture, and objects on floors. -The nurse can recommend installation of grab bars in restrooms for clients with poor balance. -Participation in physical therapy might help clients with gait and balance problems, but the nurse cannot implement this intervention independently.
The nurse is assessing the client to assist in diagnosing which musculoskeletal condition a client is suffering from. Which signs and symptoms are most suggestive of osteoarthritis? (Select all that apply.) -Onset at age 57 -Tender joints in lower extremities -Upper extremity pain -Significant stiffness in the mornings -Significant pain in the great toes
-Onset at age 57 -Tender joints in lower extremities -Signs and symptoms of osteoarthritis include: pain in the lower extremities, onset of age in the 50s-60s, and pain that's worse later in the day and after inactivity. -Upper extremity pain and morning stiffness are signs of rheumatoid arthritis. -Significant pain in the great toes is indicative of gouty arthritis.
Assessment reveals that a client has slight weakness with active range of motion against some resistance. The nurse would document this as which of the following? -3/5 -2/5 -4/5 -5/5
4/5 -Muscle strength is rated on a 5-point scale with specific defining characteristics for each. -2/5 points would indicate passive and poor range of motion. -3/5 points would indicate average weakness with active motion against gravity. -Slight weakness with active motion against some resistance is 4/5 points. -5/5 points would indicate normal findings with active motion against full resistance.
A client is brought to the health care facility with a sudden loss of movement on the right side of the body. Upon assessment, the nurse finds that the client has a slight flicker of contraction in the muscles on the right side. What should the nurse document as the muscle strength rating? -2 -4 -3 -1
1 -The nurse should rate the muscle strength as 1. -If the client is able to perform passive ROM, the muscle strength is rated as 2. -When the client is able to perform active movements against gravity, the muscle strength is graded as 3. -Muscle rating 4 is given when the client is able to perform active motion against some resistance.
Put the following scale in order from 0 to 6 for grading muscle strength. 1 active movement against gravity and some resistance 2 active movement against gravity with full resistance and no evident fatigue 3 no muscular contraction detected 4 active movement against gravity 5 barely detectable flicker or trace of contraction 6 active movement of body part with gravity eliminated
3 --> 0 no muscular contraction detected 5 --> 1 barely detectable flicker or trace of contraction 6 --> 2 active movement of body part with gravity eliminated 4 --> 3 active movement against gravity 1 --> 4 active movement against gravity and some resistance 2 --> 5 active movement against gravity with full resistance and no evident fatigue
How many vertebrae make up the spinal column? -31 -32 -33 -37
33 The spine is a column of 33 vertebrae: -7 cervical -12 thoracic -5 lumbar -5 sacral -3 to 4 coccygeal.
During range of motion assessment, the nurse moves the limbs away from the median plan of the body. This is known as what? -Circumduction -Inversion -Abduction -Adduction
Abduction -Abduction is movement away from the midline. -Adduction is movement toward the midline. -Circular motion is circumduction. -Inversion is moving inward.
Which joint movement is a nurse testing when asking a client to move an extremity towards the body? -Flexion -Extension -Adduction -Abduction
Adduction -Adduction is the movement towards the midline of the body. -Flexion is bending the extremity at the joint and decreasing the angle of the joint. -Extension is straightening the extremity at the joint and increasing the angle of the joint. -Abduction is moving away from the midline of the body.
A client diagnosed with rheumatoid arthritis exhibits edema, redness, and tenderness of the fingers. What is the nurse's priority action? -Administer prescribed anti-inflammatory. -Teach finger stretching exercises. -Notify the healthcare provider. -Apply ice and immobilize the fingers.
Administer prescribed anti-inflammatory. -Rheumatoid arthritis (RA) may cause edema, redness, and tenderness of the finger and wrist joints. -Arthritis is inflammation of the joints, and anti-inflammatories are commonly prescribed for relief. -Applying ice, immobilizing fingers, and stretching exercise are not common treatments for RA. -Notifying the healthcare provider is not the priority action because these findings are expected for RA.
As the nurse assesses the temporomandibular joint (TMJ), an audible click is heard and palpated. What is nurse's best action? -Teach the client about oral surgery procedures. -Ask the client if painful to move jaw side to side. -Advise the client take an anti-inflammatory. -Suggest myofascial release therapy.
Ask the client if painful to move jaw side to side. -The TMJ normally has an audible and palpable click when opened. -The jaw should move with ease and should be assessed. -If the client had signs of TMJ abnormalities, myofascial massage, medications, or surgical correction may be recommended.
The nurse is preparing to palpate the anatomic snuffbox. At which location would the nurse palpate? -At the anterior area of the sternoclavicular joint -At the posterior temporomandibular joint -At the olecranon process of the elbow -At the back of the wrist and extended thumb
At the back of the wrist and extended thumb -The anatomic snuffbox is located at the hollow area on the back of the wrist at the base of the fully extended thumb. -It is not located at the sternoclavicular, temporomandibular, or elbow joints.
A nurse is caring for a client who is recovering from a stroke. The nurse assesses the muscle strength of the client's arm and finds that the joint exhibits active motion against gravity. Which of the following should the nurse document to classify muscle strength based on this finding? -Severe weakness -Slight weakness -Average weakness -Poor range of motion
Average weakness -The nurse should document the finding as average weakness of the arm muscles. -In passive range of motion (ROM), gravity is removed and the client performs ROM with assistance; in this case, the strength is classified as poor ROM. -When the client is able to perform the active motion against some resistance, it is classified as slight weakness. -If the client has only a slight flicker of contraction, muscle strength is classified as severe weakness.
Deep, aching back pain has prompted a 31-year-old woman to visit her primary care provider. The client claims that spinal movements do not exacerbate her pain and assessment reveals no deficits in range of motion. Which of the following etiologies would the clinician first suspect? -Radicular low back pain -Back pain that is referred from the abdomen or pelvis -Chronic persistent low back stiffness -Lumbar spinal stenosis
Back pain that is referred from the abdomen or pelvis -Back pain referred from the abdomen or pelvis does NOT typically restrict range of motion and is NOT exacerbated by spinal movements. ---> It often has a deep, aching quality. -Radicular low back pain, chronic persistent low back stiffness, and lumbar spinal stenosis all manifest in decreased range of motion and varying degrees of spinal stiffness.
For a nursing exam, students must label a diagram using the correct medical terminology. Where would the students label the metacarpophalangeal joint? -In the foot -Between the hand and the finger -In the finger -In the hand
Between the hand and the finger -The metacarpophalangeal and interphalangeal joints permit finger movement. -The other options do not accurately describe the appropriate location.
Birthmarks, port-wine stains, hairy patches, and lipomas often overlie what? -Muscular defects -Missing bursa -Bony defects -Malformed ligaments
Bony defects Birthmarks, port-wine stains, hairy patches, and lipomas often overlie bony defects such as spina bifida.
To assess abduction of the shoulders and arms, a nurse should ask a client to do which of the following? -Move the arms forward starting with the arms at the sides -Bring both hands together overhead starting with the arms at the sides -Move the arms backward starting with the arms at the sides -Move the arms to the sides starting with the hands together overhead
Bring both hands together overhead starting with the arms at the sides -To elicit abduction, the nurse should ask the client to bring both hands together overhead. -Asking the client to move the arms forward elicits flexion, and asking the client to move the arms backward elicits extension. -Asking the client to move the arms to the sides starting with the arms overhead elicits adduction.
Which nutrient deficiency should a nurse recognize as placing a client at risk for osteoporosis? -Protein -Vitamin C -Vitamin D -Calcium
Calcium -A calcium deficiency increases the risk osteoporosis. ---> This causes the bones to become softer in nature because the rate at which bone is destroyed is occurring at a faster rate than new bone is made. -Protein functions in muscle tone and growth. -Vitamin C promotes healing of tissues and bones. -Vitamin D deficiency causes osteomalacia, softening of the bones due to defective bone mineralization. -->Osteomalacia in children is known as rickets.
A client waiting to be seen for a clinic appointment is observed periodically shaking the left wrist. On what should the nurse focus when assessing this client? -Paralysis -Fractured wrist -Dupuytren contracture -Carpal tunnel syndrome
Carpal tunnel syndrome -A motion that resembles shaking a thermometer could indicate the presence of carpal tunnel syndrome. -The wrist and hand would not be mobile if the limb is paralyzed. -Moving the hand and wrist would produce excruciating pain if the wrist is fractured. -The inability to extend the ring and little finger is associated with a Dupuytren contracture.
A nurse is working with a client who has cervical disc degenerative disease with resulting impaired range of motion and pain that radiates to the back. The nurse understands that joints between the vertebrae are which type of joint? -Synovial -Compact -Cartilaginous -Fibrous
Cartilaginous -Fibrous joints (e.g., sutures between skull bones) are joined by fibrous connective tissue and are immovable. -Cartilaginous joints (e.g., joints between vertebrae) are joined by cartilage. -Synovial joints (e.g., shoulders, wrists, hips, knees, ankles) contain a space between the bones that is filled with synovial fluid, a lubricant that promotes a sliding movement of the ends of the bones. -Compact is a type of bone, not a type of joint.
Mark is a contractor who recently injured his back. He was told he had a "bulging disc" to account for the burning pain down his right leg and slight foot drop. The vertebral bodies of the spine involve which type of joint? -Synovial -Synostosis -Cartilaginous -Fibrous
Cartilaginous -The vertebral bodies of the spine are connected by cartilaginous joints involving the discs. -The elbow would be an example of a synovial joint and the sutures of the skull are an example of a fibrous joint.
A 50-year-old realtor comes to the office for evaluation of neck pain. She was in a motor vehicle collision 2 days ago and was assessed by the emergency medical technicians on site, but she didn't think that she needed to go to the emergency room at that time. Now, she has severe pain and stiffness in her neck. On physical examination, the nurse notes pain and spasm over the paraspinous muscles on the left side of the neck, and pain when the client does active range of motion of the cervical spine. What is the most likely cause of this neck pain? -Cervical herniated disc -Cervical sprain -Simple stiff neck -Aching neck
Cervical sprain -The client most likely has an acute whiplash injury secondary to the collision. -The features of the physical examination, local tenderness and pain on movement, are consistent with cervical sprain.
A client presents to the health care clinic with reports of onset of neck pain three (3) days ago. The nurse recognizes that the most common cause of neck pain is what condition? -Cervical disc degenerative disease -Cervical spinal cord compression -Compression fractures -Cervical strain
Cervical strain -The most common cause of neck pain is cervical strain. -->This can occur from sleeping in the wrong position, carrying a heavy load, or being in an automobile accident. -Cervical disc degenerative disease is associated with impaired range of motion and pain that radiates to the back, shoulders, or arms. -Cervical spinal cord compression causes neck pain with loss of sensation in the legs. -Compression fractures of the neck may also cause loss of sensation in the legs if the spinal cord becomes compressed.
A nurse notices that a client has decreased range of motion with lateral bending of the cervical spine to the left side. What should the nurse do next in relation to this finding? -Notify the health care provider for further orders -Ask the client about previous injuries to the head and neck -Compare this finding to the range of motion to the right side -Finish with the assessment of the cervical spine before documenting
Compare this finding to the range of motion to the right side -It is always important to compare both sides of the body for symmetry before making a judgment that data is abnormal. -The nurse should then ask the client about previous injuries to the head and neck. -All data must be properly documented in the client's record. -If this finding is abnormal, the nurse should alert the health care provider for further orders.
When determining a client's strength, it is necessary to implement what assessment? -Comparing one side to the other -Assessing the extremities at the same time -Comparing upper and lower extremities -Assessing upper and lower extremities at the same time
Comparing one side to the other -When assessing muscle tone and strength, it is necessary to compare one side to the other. -It is not necessary to compare the upper extremities to the lower extremities or to assess them at the same time since doing so has no relevance to the strength of similar muscles.
A client comes to the clinic and reports a sore knee. The nurse notes popping and cracking noises when the client attempts to bend the knee. The client exhibits signs of pain by facial expression. The nurse knows that the popping and cracking noises should be charted as what? -Popping and cracking noises -Crepitus -Tactile emphysema -Grating noise
Crepitus -Crepitus may be heard as a popping sound and may be felt as grating in the joint as it moves. -The other options are incorrect since they are not considered medical terms that describe the assessment findings.
The client is the pitcher of the high school baseball team. He is brought to the clinic by his mother with a complaint of pain in his right elbow. Where would the nurse expect to locate his tenderness? -Distal to the right lateral epicondyle -Distal to the right medial epicondyle -Over the right olecranon process -Proximal to the right olecranon bursa
Distal to the right medial epicondyle Tenderness is distal to the epicondyle in lateral epicondylitis (tennis elbow) and less commonly in medial epicondylitis (pitcher's or golfer's elbow)
During palpation of the client's knee, the nurse compresses the suprapatellar pouch against the client's femur with one hand while feeling on each side of the patella with the opposite hand. For which of the following problems is the nurse assessing? -Crepitus uteri flexion -Osteoarthritis -Effusion in the knee joint -Ligament trauma
Effusion in the knee joint -The balloon sign is indicative of a large effusion in the knee joint when fluid is palpable medial to the patella when the suprapatellar pouch is depressed. -The presence of crepitus, osteoarthritis, or ligament damage is not directly suggested by a positive balloon sign.
The nurse performs the maneuver shown with the client. What is the nurse assessing? -Elbow flexion -Shoulder adduction -Shoulder abduction -Elbow extension -Carpal tunnel syndrome
Elbow extension -Elbow extension is assessed by having the client push against the nurse's hand. -Elbow flexion is assessed by having the client pull against the nurse's hand. -This maneuver does not assess shoulder function or integrity of the median nerve in the hand.
Assessment of the musculoskeletal system usually proceeds from general to specific and from? -Head to toe -Right to left -Bottom to top -Anterior to posterior
Head to toe -As with other systems, assessment of the musculoskeletal system usually proceeds from general to specific and from head to toe. -Focused assessments may be more appropriate when the client reports an injury to a specific area or joint.
A nurse asks a client to bring his hands together behind his head with his elbows flexed. What is the nurse testing? -Abduction -Adduction -External rotation -Internal rotation
External rotation -When the client brings the hands together behind the head with the elbows flexed, the nurse is testing external rotation. -Abduction is tested by having the client bring both hands together overhead with the elbows straight. -Adduction is tested by having the client bring both hands together in front of the body, past the midline, with the elbows straight. -Internal rotation is tested by having the client bring the hands together behind the back with the elbows flexed.
When assessing the client's upper extremities, the nurse instructs the client to put the hands behind the neck with the elbows pointed laterally. This positioning facilitates assessment of which of the following functions? -External rotation of the shoulder -Internal rotation of the shoulder -Elbow flexion -Muscle strength of the deltoids
External rotation of the shoulder Pointing the elbows laterally tests the shoulder's ability to rotate externally and abduct.
A 28-year-old graduate student comes to the clinic for evaluation of pain "all over." With further questioning, she can relate that the pain is worse in the neck, shoulders, hands, low back, and knees. She denies swelling in her joints; she states that the pain is worse in the morning; there is no limitation in her range of motion. On physical examination, she has several points on the muscles of the neck, shoulders, and back that are tender to palpation; muscle strength and range of motion are normal. Which of the following is likely the cause of her pain? -Rheumatoid arthritis -Osteoarthritis -Polymyalgia rheumatica -Fibromyalgia
Fibromyalgia -The client has pain in specific trigger point areas on the muscles with normal strength and range of motion. --->This is an indication for fibromyalgia.
The nurse asks the client to perform the action shown. What is the nurse assessing? -Lateral flexion -Extension -Flexion -Rotation
Flexion -Bending forward to touch the toes assesses for spinal flexion. -Twisting the spine from side to side assesses for spinal rotation. -Bending the back as far as possible assesses spinal extension. -Bending to the side from the waist assesses for lateral flexion.
Which movement should the nurse instruct the client to perform to assess range of motion for the knee? -Flexion -Circumduction -Rotation -Abduction
Flexion -The nurse should instruct the client to perform flexion to assess the range of motion for the client's knee. -Circumduction, rotation, and abduction movements are not possible in the knees. -Circumduction is the circular motion of the joint. -Rotation involves turning the head to the right shoulder then back to midline and then turning the head to the left shoulder then back to midline. -Abduction refers to moving away from the midline of the body. ***The knees are capable of performing only flexion and extension.
An 85-year-old retired housewife comes with her daughter to establish care. Her daughter is concerned because the client has experienced frequent falls in recent months. As part of the physical examination, the nurse asks the client to walk across the examination room. Which of the following is not part of the stance phase of gait? -Heel strike -Push-off -Foot arched -Mid-stance
Foot arched -The foot when it is flat is part of the stance phase of gait, not the foot when it is arched. -The heel-strike, mid-stance and push-off are components of the stance phase of the client's gait.
An adult client has been diagnosed with carpal tunnel syndrome. What type of working conditions may have contributed to this diagnosis? -Heavy lifting -Frequent repetitive movements -Substantial physical activity -Prolonged sitting
Frequent repetitive movements -Some working conditions present potential risks to the musculoskeletal system. -Workers required to lift heavy objects may strain and injure their backs. -Jobs requiring substantial physical activity, such as construction work and fire fighting, increase the likelihood of sprains, strains, and fractures. -Frequent repetitive movements may lead to misuse disorders such as carpal tunnel syndrome, pitcher's elbow, or vertebral degeneration. -Musculoskeletal injuries may also occur when people sit for long periods at desks with poor ergonomic design.
A nurse inspects a child's legs while standing and notices that the knees turn inward. How should this finding be documented in the medical record? -Genu valgum -Genu varum -Bowed legs -Ballottement
Genu valgum -The inward turning of the knees is called knock knees or genu valgum. -Genu varum is the outward turning or the knees or bowed legs. -Ballottement is a knee test used to assess for the presence of large amounts of fluid in the knee.
Which of the following tools would a nurse practitioner be more likely than a registered nurse to use during the performance of a musculoskeletal assessment on a client to measure maximum flexion of a joint? -Flashlight -Gradiometer -Scale -Goniometer
Goniometer -A goniometer measures the angle at which a joint can flex or extend. -Nurses do not use flashlights or gradiometers during musculoskeletal assessments. -The registered nurse would be more likely than the advanced practice nurse to use a scale to weigh a client.
Upon examination of an elderly client, the nurse finds hard, painless nodules over the distal interphalangeal joints. What is the appropriate term the nurse should use to document this finding in the client's medical records? -Painful corns -Bouchard's nodes -Heberden's nodes -Inflamed bursa
Heberden's nodes -The nurse should document the hard, painless nodules over the distal interphalangeal joints as Heberden's nodes. -Inflamed bursa is an inappropriate term because bursa are not found in interphalangeal joints. -Bouchard's nodes are seen over the proximal interphalangeal joints. -Painful corns are thickenings of the skin that occur over bony prominences and at pressure points.
When the client performs straight leg flexion, the client complains of pain that radiates down his leg. The nurse understands that this may indicate what? -Degenerative joint disease -Arthritis -Hip fracture -Herniated disc
Herniated disc -Straight leg flexion that produces back and leg pain radiating down the leg may indicate a herniated disc. -One leg longer than the other may indicate a hip fracture. -Arthritis is accompanied by pain and stiffness. -Asymmetry, discomfort when touched, or crepitus during movement may occur with degenerative joint disease.
A client presents to the health care clinic with reports of pain in the hands and right wrist. Additional history reveals that the client is a factory worker who spends all day performing the same repetitive task. The nurse performs Phalen's test and Tinel's test with positive results. The hand grips are unequal, with the right weaker than the left. What nursing diagnosis can the nurse confirm from this data? -Risk for Trauma -Impaired Physical Mobility -Disturbed Body Image -Activity Intolerance
Impaired Physical Mobility -This client is likely experiencing carpal tunnel syndrome because of the repetitive hand movements that inflame the median nerve as it passes through the wrist. -Impaired Physical Mobility related to decreased muscle strength as evidenced by a weak right hand grip meets the major criteria to confirm this nursing diagnosis. -Risk for Trauma cannot be confirmed because the client already has carpal tunnel syndrome so he is not at risk. -Disturbed Body Image and Activity Intolerance do not meet any major defining characteristics to confirm these nursing diagnoses.
A client has rheumatoid arthritis most prominent in the hands, where the client has decreased range of motion (ROM), pain, and tenderness. What is an appropriate nursing diagnosis for this client? -Impaired physical mobility related to reduced strength and ROM -Risk for depression related to immobility -Risk for falls related to degenerative joint disease -Risk for infection related to pain and inflammation
Impaired physical mobility related to reduced strength and ROM -Decreased ROM, pain, and tenderness are most likely to impair the client's physical mobility. -The client is not totally immobile, and nothing in the scenario indicates that the client is depressed. -The client is not at risk for falls from the problems in the hands and is not showing signs of infection.
A school age client has been diagnosed with genu valgum. What is the other name for this disease? -Clubfoot -Flatfeet -Bowlegs -Knock kneed
Knock kneed -Many children have a temporary period of genu valgum, but persistent knock knee may be genetic or the result of metabolic bone disease. -The client may need to swing each leg outward while walking to prevent striking the planted limb with the moving limb. -The strain on the knee frequently causes anterior and medial knee pain. -Physical therapy and surgical intervention may be required. -Bowlegs, also known as genu varum, the knees do not touch when the child stands with the feet together. Bowlegs is consider normal up to the age of 2 to 3 years, but may persist until age 6. -Clubfoot, also known as congenital talipes equinovarus (CTEV), is a congenital deformity that rotates the foot internally at the ankle. -Flatfeet, a deformity of the foot where the arch collapses or never properly forms
The nurse is assessing an elderly client and finds an exaggerated thoracic curve. This would be documented as what? -Kyphosis -Scoliosis -Ankylosing spondylitis -Lordosis
Kyphosis -Kyphosis is an exaggerated thoracic curve and is common with aging. -Scoliosis is lateral curvature of the thoracic spine with an increase in the convexity on the curved side. -An exaggerated lumbar curve is lordosis. -Ankylosing spondylitis is associated with a flattening of the lumbar curvature.
A nurse is preparing a program on osteoporosis for a local women's group. Which of the following would the nurse include as a modifiable risk factor? -Small-boned, thin frame -Personal history of fractures -Low estrogen levels -Age
Low estrogen levels -Modifiable risk factors: include low estrogen levels. -Small-boned thin frame, personal history of fractures, and age cannot be modified.
A client expresses to the nurse that he has a "giving in" or "locking" sensation in the knee. Which test should the nurse perform to elicit related findings of a possible tear in the meniscus of the client's knee? -Phalen's -Bulge -McMurray's -Ballottement
McMurray's -The nurse should perform McMurray's test to confirm meniscal tear. --->Pain or clicking during the test is indicative of a torn meniscus of the knee. -The ballottement test and the bulge test are done to detect the presence of fluid in the knee joint. -Phalen's test is done to test for carpal tunnel syndrome.
A nurse notices that a client's flexibility of the right elbow is less than the left elbow. What is an appropriate action by the nurse in regard to this finding? -Notify the health care provider -Assess the client' hand grips -Measure movement with a goniometer -Note that the dominant side is stronger
Measure movement with a goniometer -If the nurse identifies a limitation in the range of motion for a joint, a goniometer should be used to measure the exact angle of movement present. --> The goniometer is placed at the joint and then moved to match the angle of the joint being assessed. -It is not necessary to notify the health care provider until all information is collected. -The hand grips test strength not range of motion. -The dominant side of the body is stronger but does not necessarily have greater range of motion.
The nurse notes limitation in active range of motion of a client's right shoulder. What would the nurse to do next? -Measure range of motion with a goniometer. -Ask the client which is the dominant side. -Perform passive range of motion test. -Test muscle strength.
Measure range of motion with a goniometer. -When limited range of motion is noted, the nurse should measure range of motion with a goniometer to provide information about the joint motion in degrees. -Testing muscle strength may be done later once the measurement is obtained. -Asking the client about his or her dominant side would be important to know when testing muscle strength, not joint motion. -If the client cannot move the part against resistance when testing muscle strength, then the nurse would ask the client to move the part against gravity, and if not possible, attempt to passively move the part through its full range of motion.
A 33-year-old construction worker comes for evaluation and treatment of acute onset of low back pain. He notes that the pain is aching, located in the lumbosacral area. It has been present intermittently for several years; there is no known trauma or injury. He points to the left lower back. The pain does not radiate and there is no numbness or tingling in the legs, or incontinence. He was moving furniture for a friend over the weekend. On physical examination, the nurse notes muscle spasm, with normal deep tendon reflexes and muscle strength. What is the most likely cause of this client's low back pain? -Ankylosing spondylitis -Herniated disc -Mechanical low back pain -Compression fracture
Mechanical low back pain -The case is an example of mechanical low back pain; in a large percentage of cases there is no known underlying cause. -The pain is often precipitated by moving, lifting, or twisting motions and relieved by rest.
The nurse is testing the client for extension of the wrist and notes weakness on the right side. This assessment finding is consistent with what disease of the nervous system? -Lyme disease -Fibromyalgia -Multiple sclerosis -Guillian-Barré
Multiple sclerosis Weakness of extension is seen in peripheral nerve disease such as radial nerve damage and in central nervous system disease producing hemiplegia, as in stroke or multiple sclerosis.
Louise is a 60-year-old woman who complains of left knee pain associated with tenderness throughout, redness, and warmth over the joint. Which of the following is least helpful in determining if a joint problem is inflammatory? -Pain -Redness -Warmth -Tenderness
Pain -Pain is present in both inflammatory and non-inflammatory conditions. -Warmth, redness, and tenderness to palpation should lead one to consider an inflammatory etiology for the pain.
The client presents at the clinic with a history of cerebral palsy. When examining the client the nurse notes increased resistance that is rate dependent and increases with rapid movement. What would the nurse chart about this client? -Patient has muscular atrophy -Patient demonstrates spasticity -Patient demonstrates muscular atony -Patient has rigidity
Patient demonstrates spasticity -Spasticity is increased resistance that worsens at the extremes of range. -Spasticity, seen in central corticospinal tract diseases, is rate dependent, increasing with rapid movement.
Which action by a nurse is a correct method for performing Tinel's test to determine the presence of carpel tunnel syndrome? -Perform wrist movements against resistance -Palpate the hollow area on the back of the wrist -Percuss lightly on the inner aspect of the wrist -Ask the client to bend the wrist down and back
Percuss lightly on the inner aspect of the wrist -The nurse should tap at the inner aspect of the wrist to percuss the median nerve because the median nerve is located at the inner aspect of the wrist where it enters the carpal canal. -Palpation of the hollow area on the back of the wrist is done to examine the anatomic snuffbox. --Asking the client to bend the wrist down and back and performing wrist movements against resistance are done to assess range of motion and muscle strength.
A client receives physical therapy for carpal tunnel syndrome. Which action by the nurse is appropriate to assess the efficacy of the treatment? -Place the backs of both hands against each other -Bend the wrists down and back -Flex the wrists 90 degrees upward -Maintain flexed wrists for 90 seconds
Place the backs of both hands against each other -The nurse should ask the client to place the backs of both hands against each other while flexing the wrist 90 degrees downwards for 60 seconds for the Phalen's test. --->If therapy for carpal tunnel syndrome has not been successful, the client may report tingling, numbness, and pain after holding the position for 60 seconds. -The client need not flex the wrists 90 degrees upward for 90 seconds. -The nurse asks the client to bend the wrists down and back to test the client's range of motion for the wrist.
Articulation between the head of the femur and the acetabulum is in the -knee joint. -tibial joint. -ankle joint. -hip joint.
hip joint. Articulation between the head of the femur and the acetabulum occurs in the hip joint.
A 55-year-old woman with a history of type 2 diabetes went through menarche at age 19 and menopause 2 years ago. Which of the preceding is a risk factor for osteoporosis? -Diabetes -Postmenopausal status -Late menopause -Late menarche
Postmenopausal status -Diabetes, late menopause, and late menarche are not associated with osteoporosis. -Postmenopausal status is the only choice that is a known risk factor for osteoporosis.
In assessing a client's temporomandibular joint (TMJ), the nurse asks the client to move the jaw forward. This movement is known as which of the following? -Protraction -Retraction -Pronation -Supination
Protraction -Protraction is moving forward. -Retraction is moving backward. -Pronation is turning or facing downward. -Supination is turning or facing upward. ***Pronation and supination are not possible at the TMJ.
What finding should a nurse expect when performing Phalen's test on a client with suspected carpal tunnel syndrome? -Inability to perform active range of motion with the involved wrist -Stiffness in the hands and fingers after holding and releasing a tight fist -Reports of tingling, numbness, and pain in the involved wrist -A change in the color of the fingers from red to white (pale)
Reports of tingling, numbness, and pain in the involved wrist -Phalen's test is performed by asking the client to place the backs of both hands against each other while flexing the wrists 90 degrees downward. ---The client holds this position for 60 seconds. -A positive test would be the report of tingling, numbness, and pain in the involved wrist by the client. -Inability to perform active range of motion with the involved wrist and stiffness in the hands and fingers after holding and releasing a tight fist may be seen in clients with arthritis in the joints. -A change in color of the fingers from red to white (pale) is seen in clients with Raynaud's disease.
A 38-year-old woman presents with multiple small joints that are symmetrically involved with pain, swelling, and stiffness. Which of the following is the most likely explanation? -Rheumatoid arthritis -Septic arthritis -Gout -Trauma
Rheumatoid arthritis -Rheumatoid arthritis is a systemic disease and accounts for multiple symmetrically involved joints. -Septic arthritis is usually monoarticular, as are gout and trauma related joint pain.
The client tells the nurse that he has joint stiffness that is worse in the morning but improves as the day progresses. The nurse should assess the client for what musculoskeletal disorder? -Osteoporosis -Gouty arthritis -Osteoarthritis -Rheumatoid arthritis
Rheumatoid arthritis -Stiffness and pain related to rheumatoid arthritis is worse in the morning and after activities and usually occurs in the upper extremities. -Osteoarthritis pain is worse later in the day. -Gouty arthritis pain is at the base of the big toe. -Osteoporosis is weakening of the bones and there is an increased for fractures.
A 50-year-old man has sought care because of the intense shoulder pain that resulted when he threw a baseball to home plate from the outfield the previous evening. The client states that he has never had problems with his shoulder previously. The nurse has asked to client to slowly abduct his affected arm to shoulder level and maintain the position. Which of the following shoulder problems does the nurse suspect? -Rotator cuff tear -Adhesive capsulitis -Bicipital tendinitis -Calcific tendinitis
Rotator cuff tear -A rotator cuff tear is often the result of a strong, single throwing motion and is assessed for using the drop arm test. -Calcific tendinitis, adhesive capsulitis, and bicipital tendinitis are degenerative diseases that typically have a more gradual onset.
A client is unable to perform abduction with the right arm and reports pain when attempting to do so. The nurse notices that the muscles surrounding the right shoulder are smaller than those on the left shoulder. The nurse recognizes this finding as the possibility of what condition? -Degenerative joint disease -Fracture -Rotator cuff tear -Tendinitis
Rotator cuff tear -Painful and limited abduction accompanied by muscle weakness and atrophy are seen with rotator cuff tears. -Rotator cuff tendinitis causes the client to report sharp catches of pain when bringing the hands overhead. -A bone fracture presents with acute, severe pain, and often weakness of the entire extremity. -Degenerative joint disease may cause limited range of motion for all of the shoulder movements and most likely occurs symmetrically.
A 68-year-old retired banker comes to your clinic for evaluation of left shoulder pain. He swims for 30 minutes daily each morning. He notes a sharp, catching pain and a sensation of something grating when he tries overhead movements of his arm. On physical examination, you note tenderness just below the tip of the acromion in the area of the tendon insertions. The drop arm test is negative, and there is no limitation with shoulder shrug. The client is not holding his arm close to his side, and there is no tenderness to palpation in the bicipital groove when the arm is at the client's side, flexed to 90 degrees, and then supinated against resistance. Based on this description, what is the most likely cause of his shoulder pain? -Bicipital tendinitis -Rotator cuff tear -Rotator cuff tendinitis -Calcific tendinitis
Rotator cuff tendinitis -Rotator cuff tendinitis is typically precipitated by repetitive motions, such as occurs with throwing or swimming. -Crepitus/grating is noted in the shoulder with range of motion.
The school nurse notes that the client carries her left shoulder higher than her right shoulder. You should recognize the likely presence of what health problem? -Torn rotator cuff -Dislocated shoulder -Broken clavicle -Scoliosis
Scoliosis Scoliosis may cause elevation of one shoulder.
Which of the following risk factors for osteoporosis is the best predictor of low bone density? -Smoking -Estrogen deficiency -Prior vertebral fracture -Low body weight
Smoking -Tobacco use is associated with low bone density. --->Low weight, estrogen deficiency, and prior vertebral fractures are NOT noted to predict low bone density.
The client is facing the nurse with his forearm turned so that his palm is up. What movement is the client exhibiting? -Supination -Pronation -Inversion -Eversion
Supination -Supination occurs when the forearm is turned so that the palm is up. -Pronation is turning the forearm so the palm is down. -Inversion is turning the sole of the foot inward. -Turning the sole of the foot outward is eversion.
The nurse assesses a client's musculoskeletal system as shown. What is the nurse assessing? -Supraspinatus strength -Hand grasp strength -Carpal tunnel syndrome -Tennis elbow
Supraspinatus strength -This is a maneuver to test supraspinatus strength (sometimes called the "empty can test"). --->It is conducted by elevating the arms to 90 degrees and internally rotating the arms with the thumbs pointing down. -The client is asked to resist as pressure is placed downward on the arms. --->This is not a test for tennis elbow, hand grasp strength, or carpal tunnel syndrome.
A high school soccer player "blew out his knee" when the opposing goalie's head and shoulder struck his flexed knee while the goalie was diving for the ball. All of the following structures were involved in some way in his injury, but which of the following is a nonarticular structure? -Tendons -Joint capsule -Synovium -Juxta-articular bone
Tendons -Nonarticular structures include the periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve and overlying skin. -The articular structures include the joint capsule and articular cartilage, the synovium and synovial fluid, intra-articular ligaments, and juxta-articular bone.
The nurse is performing an assessment of a client's musculoskeletal system. What would the nurse examine first? -The client's leg length -The client's lateral bending ability -The client's cervical ROM -The client's gait
The client's gait -Gait inspection provides a valuable overview of musculoskeletal function. -->For this reason, it is usually performed at the beginning of the objective exam and prior to more detailed assessments.
After assessing the client for posture and body alignment, how would the nurse document head position in relation to the spine if alignment is normal with noticeable defect? -The head is midline and aligned with the spine -The head is centered and in line with the backbone -The head is straight up and down in accordance with the spine -The head is equally distributed on the neck
The head is midline and aligned with the spine The correct documentation would be "the trunk and head are erect with weight distributed equally on both feet. The head is midline and aligned with the spine."
A group of students is reviewing information related to the major bones of the skeleton. The students demonstrate understanding of the material when they identify which of the following as part of the axial skeleton? -Humerus -Femur -Vertebral column -Carpals
Vertebral column -The axial skeleton consists of the head and the trunk and includes the cranium, facial bones, mandible, ribs, sternum, and vertebral column. -The appendicular skeleton consists of the bones of the extremities, shoulders, and hips.
The nurse is performing the bulge test during the assessment of a client's knee. This test will allow the nurse to make what determination? -Whether the client's swollen knee is caused by tissue swelling or by fluid accumulation -Whether the size of the client's knee changes throughout the joint's range of motion -Whether swelling in the knee joint is a normal age-related change or a pathological finding -Whether the client's knee joint is capable of adduction and abduction
Whether the client's swollen knee is caused by tissue swelling or by fluid accumulation -The bulge test is used to determine if knee swelling is due to accumulation of fluid or soft tissue swelling. -It does not address range or motion. -Knee swelling is never considered to be an age-related change.
While assessing the elbow of an adult client, the client complains of pain and swelling. The nurse should further assess the client for -arthritis. -ganglion cyst. -carpal tunnel syndrome. -nerve damage.
arthritis. Redness, heat, and swelling may be seen with bursitis of the olecranon process due to trauma or arthritis.
Joints may be classified as cartilaginous, synovial, or -articulate. -flexible. -immobile. -fibrous.
fibrous. -The joint (or articulation) is the place where two or more bones meet. -Joints provide a variety of ranges of motion (ROM) for the body parts and may be classified as fibrous, cartilaginous, or synovial.
An adult client tells the nurse that he eats sardines every day. The nurse should instruct the client that a diet high in purines can contribute to -gouty arthritis. -osteomalacia. -bone fractures. -osteomyelitis.
gouty arthritis. A diet high in purine (e.g., liver, sardines) can trigger gouty arthritis.
An older adult client visits the clinic and tells the nurse that she has had shooting pain in both of her legs. The nurse should assess the client for signs and symptoms of -herniated intervertebral disc. -rheumatoid arthritis. -osteoporosis. -metastases.
herniated intervertebral disc. 33 bones connected in a vertical column: -7 concave-shaped cervical (C) -12 convex shaped thoracic (T) -5 concave-shaped lumbar (L) -5 sacral (S) -3-4 coccygeal -Bones are cushioned by elastic fibrocartilaginous plates (intervertebral discs) that provide flexibility and posture to the spine. -Paravertebral muscles are positioned on both sides of vertebrae.
The nurse suspects carpal tunnel syndrome after examining a client in the clinic. A test result that would suggest this diagnosis would be -increased thumb abduction -negative Phelan sign -weak opposition of the thumb -negative Tinel sign
weak opposition of the thumb If the client cannot raise the thumb up from the plane and stretch the thumb pad to the little finger pad, this indicates thumb weakness in carpal tunnel syndrome.