Adult Health II Musculoskeletal Assessment Chapter 35 PREP U

A client has just undergone arthrography. What is the most important instruction for the nurse to include in the teaching plan? Avoid sunlight or harsh, dry climate. Avoid intake of dairy products. Report joint crackling or clicking noises occurring after the second day. Gently massage joints with any crackling or clicking joint noises.

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 is an appropriate priority nursing diagnosis for the client following an arthrocentesis? Risk for infection Chronic pain Deficient knowledge: procedure Activity intolerance

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 client has a fracture that is being treated with open rigid compression plate fixation devices. What teaching will the nurse reinforce to the client about how the progress of bone healing will be monitored? The plate will be removed to determine if the bone is growing back. Serial x-rays will be taken. An arthroscopy will be performed. The bone will heal on its own without intervention.

Serial x-rays will be taken. Serial x-rays are used to monitor the progress of bone healing. The plate need not be disturbed. An arthroscopy is used to visualize joints. While the bone will heal without interference, monitoring of bone healing is needed to ensure further adjustments are not necessary.

A nurse practitioner assesses a patient's movement in his left hand after a cast is removed. The nurse asks the patient to turn his wrist so the palm of his hand is facing up. This movement is known as: Extension. Pronation. Eversion. Supination.

Supination.

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? Ligament Tendon Cartilage Joint

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 understands that bone maintenance requires a balance between forming and dissolving bone. What is a correct statement about the function of osteoblasts? They are multinuclear cells involved in resorbing bone. They secrete a matrix that consists of collagen. They are located in shallow lacunae (small pits in bones). They are nourished by capillaries that are part of the Haversian system.

They secrete a matrix that consists of collagen. Osteoblasts function in bone formation by secreting bone matrix, which consists of collagen and ground substances that provide a framework for inorganic mineral salts to be deposited. The other choices are characteristic of osteoclasts.

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 furosemide digoxin NPH insulin

aspirin Aspirin has anti-clotting properties, and bone is a very vascular tissue. The client taking aspirin in close proximity to a bone biopsy is at increased risk for excessive bleeding.

The nurse is admitting an older adult to a skilled nursing facility. What assessment parameters will the nurse expect to find with the musculoskeletal assessment? Select all that apply. decreased endurance increase in height joint stiffness increased muscle strength decreased range of motion

decreased endurance joint stiffness decreased range of motion

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. "When is the last time you had food or drink?" "Are you wearing any jewelry?" "Have you removed your hearing aid?" "Do you have a pacemaker?" "Did you take your medications this morning?"

"Are you wearing any jewelry?" "Have you removed your hearing aid?" "Do you have a pacemaker?"

A client is having repeated tears of the joint capsule in the shoulder, and the health care provider 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. Apply heat to the area for 48 hours. Administer a mild analgesic. Inform the client that a clicking or crackling noise in the joint may persist for a couple of days. Actively exercise the area immediately after the procedure.

Apply a compression bandage to the area. Administer a mild analgesic. Inform the client that a clicking or crackling noise in the joint may persist for a couple of days.

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

Arthrography Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. Meniscography is a distractor for this question. Bone densitometry is used to estimate bone mineral density. An EMG provides information about the electrical potential of the muscles and nerves leading to them.

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone? Growth hormone Vitamin D Sex hormones Calcitonin

Calcitonin Calcitonin, secreted by the thyroid gland in response to elevated blood calcium concentration, inhibits bone reabsorption and increases the deposit of calcium in the bone. The other answers do not apply.

The orthopedic nurse is caring for a client diagnosed with a fracture of the radius. In which type of bone tissue does the nurse anticipate the fracture being? Collagen Cortical Cancellous Cartilage

Cancellous Cancellous bone or spongy bone is light and contains many spaces making it a less solid bone than the cortical or compact bone. Collagen and cartilage are not types of bone.

What is the term for a rhythmic contraction of a muscle? Atrophy Clonus Hypertrophy Crepitus

Clonus Clonus is a rhythmic contraction of the muscle. Atrophy is a shrinkage-like 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.

The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding? Lordosis Scoliosis Kyphosis Dowager's hump

Lordosis Lordosis is an exaggeration of the lumbar spine curve.

The nurse is working on an orthopedic floor caring for a client injured in a football game. The nurse is reviewing the client's chart noting that the client has previously had an injured tendon. The nurse anticipates an injury between the periosteum of the bone and which of the following? Joint Muscle Ligament Cartilage

Muscle Tendons attach muscles to the periosteum of bone. Joints are a junction between two or more bones. Ligaments connect two freely movable bones. Cartilage is a dense connective tissue used to reduce friction between two structures.

A client scheduled to undergo an electromyography asks the nurse what this test will evaluate. What is the correct response from the nurse? Muscle weakness Muscle composition Bone density Metastatic bone lesions

Muscle weakness Electromyography tests the electric potential of the muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration, pain, disability, and to differentiate muscle and nerve problems. A bone biopsy is done to identify bone composition. Bone densitometry is done to evaluate bone density. A bone scan would be appropriate to detect metastatic bone lesions.

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 Flaccidity Atonia Effusion

Paresthesia

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

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.

The nurse is assessing a client's ulnar nerve. What technique will the nurse use? Prick the distal fat pad of the small finger. Ask the client to stretch the thumb, then the wrist, then the fingers. Prick the skin mid-way between the thumb and second finger. Ask the client to flex the wrist.

Prick the distal fat pad of the small finger. To assess the ulnar nerve, the nurse would prick the distal fat pad of the small finger.

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching? "Elevating my leg will reduce swelling after the procedure." "My physician may prescribe pain pills after the procedure." "I should use my heating pad this evening to reduce some of the pain in my knee." "I may notice some bruising or swelling in my knee."

"I should use my heating pad this evening to reduce some of the pain in my knee." The client requires additional teaching if he states that he'll use a heating pad to reduce pain the evening of the procedure. The client shouldn't use heat at the procedure site during the first 24 hours because doing so may increase localized swelling. Ice is indicated during this time. Elevating the extremity helps reduce swelling. The client may experience some discomfort after the procedure for which the physician may order medication. Bruising and swelling are common after an arthroscopy.

The nurse is assessing a client with a musculoskeletal system condition. Which statement indicates to the nurse that the client is experiencing bone pain? "I have soreness and aching like cramps in both of my arms." "The pain feels deep in my legs and keeps me awake at night." "The pain feels tender, hurts, and is worse when I move." "The pain is sharp in my arms but is relieved by not moving."

"The pain feels deep in my legs and keeps me awake at night." Bone pain is typically described as a dull, deep ache that is "boring" in nature. This pain is not typically related to movement and may interfere with sleep. Muscular pain is described as soreness or aching and is referred to as "muscle cramps." Joint pain is felt around or in the joint and typically worsens with movement. Fracture pain is sharp and piercing and is relieved by immobilization. Sharp pain may also result from bone infection with muscle spasm or pressure on a sensory nerve.

The older client asks the nurse how best to maintain strong bones. What is the nurse's best response? "Weight-bearing exercises can strengthen bones." "Range-of-motion exercises build bone mass." "Cardio training is the best way to build bones." "Weight-resistance exercises can strengthen bones."

"Weight-bearing exercises can strengthen bones." Weight-bearing exercises maintain bone mass. Weight-resistance exercises maintain and strengthen muscles. Cardio training is important for heart health and weight maintenance/reduction. Range-of-motion exercises are essential for joint mobility

Which assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy? A. Increased diameter of the calf B. Capillary refill < 3 seconds C. Toes move freely without pain D. Bounding dorsalis pedis pulses

A. 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.

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

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 diagnostic studies are done to relieve joint pain due to effusion? Arthrocentesis Electromyography (EMG) Bone scan Biopsy

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.

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

Covers the marrow cavity of long bones The endosteum is a thin vascular membrane that covers the marrow cavity of long bones and the spaces in cancellous bone. Osteoclasts are located near the endosteum.

Which is an indicator of neurovascular compromise? A. Warm skin temperature B. Diminished pain C. Pain upon active stretch D. Capillary refill of more than 3 seconds

D. 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.

The nurse is educating a group of students about peroneal nerve damage. The nurse knows that which assessment will show this type of nerve damage? Dorsiflexion of the foot and extension of the toes Skin prick along the client's skin with the index finger Stretching of the client's thumb above the wrist Pricking of the skin along the medial side of the foot

Dorsiflexion of the foot and extension of the toes Assessment of peripheral nerve function has two key elements: evaluation of sensation and evaluation of motion. To assess motion of the peroneal nerve, the client should be asked to dorsiflex the foot and extend the toes.

A client is diagnosed with a fracture of a diarthrosis joint. What is an example of this type of joint? Symphysis pubis Skull Elbow Fifth thoracic vertebrae

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

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? Lordosis Scoliosis Osteoporosis Kyphosis

Kyphosis Common deformities of the spine include kyphosis, which is an increased forward curvature of the thoracic spine that causes a bowing or rounding of the back, leading to a hunchback or slouching posture. The second deformity of the spine is referred to as lordosis, or swayback, an exaggerated curvature of the lumbar spine. A third deformity is scoliosis, which is a lateral curving deviation of the spine (Fig. 40-4). Osteoporosis is abnormal excessive bone loss.

Which serum level indicates the rate of bone turnover? Osteocalcin Myoglobin Creatinine kinase Aspartate aminotransferase

Osteocalcin Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Serum myoglobin is assessed to evaluate muscle trauma. Serum enzyme levels of creatinine kinase and aspartate aminotransferase become elevated with muscle damage.

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? The yellow marrow is responsible for manufacturing red blood cells. Long bones typically contain more red bone marrow than yellow. Osteoclasts are involved in the destruction and remodeling of bone. Osteocytes are transformed into osteoblasts or mature bone cells.

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 Tenting skin turgor Limited range of motion

Pale, cyanotic, or mottled color Cool temperature of the extremity More than 3-second capillary refill

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? Coolness Pain Pulselessness Ischemia

Puselessness 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 client comes to the emergency department with reports of pain in the left ankle. The client states, "I missed a step coming down the stairs, and landed funny." The ankle is swollen and tender to the touch. What will the nurse do to help control the swelling? Apply heat to the ankle. Tell the client to flex the left foot frequently. Have the client dangle the left leg over the side of the bed. Raise the left leg above the level of the heart.

Raise the left leg above the level of the heart. To help relieve swelling and promote tissue perfusion, the nurse would have the client elevate the swollen body part above the level of the heart to promote venous circulation.

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 Primary phase, secondary phase, third phase First intention, secondary intention, third intention Active phase, dormant phase, restructure phase

Reactive phase, reparative phase, remodeling phase The process of fracture healing occurs over three phases. These include the following: Phase I: Reactive phase; Phase II: Reparative phase; and Phase III: Remodeling phase.

Which laboratory study indicates the rate of bone turnover? Urine calcium Serum calcium Serum phosphorous Serum osteocalcin

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.

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? Between the vertebrae In the fingers At the hip Skull at the temporal and occipital bones

Skull at the temporal and occipital bones A synarthrodial joint is immovable and can be found at the suture line of the skull between the temporal and occipital bones. Amphiarthrodial joints are slightly moveable and are found between the vertebrae. The finger and hip joints are examples of diarthrodial joints that are freely moveable.

The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site? The fracture is on the diaphysis. The fracture is ventrally located. The fracture is on the epiphyses. The fracture is on the tuberosity.

The fracture is on the diaphysis. A fracture that is on the diaphysis is understood to be chiefly found in the long shafts of the arms and legs. The epiphyses are rounded, irregular ends of the bones. Saying a fracture is ventrally located does not assist in providing adequate details of the location of the fracture. A tuberosity is a projection from the bone or a protuberance. Reference:

After a bone density test, an older adult female client tells the nurse, "I don't understand why I have osteoporosis because I eat well and take my calcium." What does the nurse explain as the reason that the client may have osteoporosis? Everyone gets osteoporosis and there is nothing you can do to prevent it. Men lose more bone mass than women but women still lose some. In order to prevent bone loss, women have to take hormones. The loss is from withdrawal of estrogen and a decrease in activity levels.

The loss is from withdrawal of estrogen and a decrease in activity levels. Numerous metabolic changes, including menopausal withdrawal of estrogen and decreased activity, contribute to osteoporosis. Everyone does not get osteoporosis. Gender differences are not exclusive for osteoporosis. Women do not have to take hormones, especially if women have other risk factors for hormone therapy.

While reading a client's chart, the nurse notices that the client is documented to have paresthesia. The nurse plans care for a client with absence of muscle movement suggesting nerve damage. involuntary twitch of muscle fibers. abnormal sensations. absence of muscle tone.

abnormal sensations 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.

The nurse is preparing an education program on risk factors for musculoskeletal disorders. Which risk factors are appropriate for the nurse to include in the teaching program? Select all that apply. age menopause bed rest calcium-rich diet current cigarette smoking

age menopause bed rest current cigarette smoking

Which is a circulatory indicator of peripheral neurovascular dysfunction? Weakness Paresthesia Cool skin Paralysis

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 are related to motion. Paresthesia is related to sensation.

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 epiphysis. lordosis. scoliosis. diaphysis.

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

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

movement of the skeletal bones The skeletal muscles promote movement of the bones of the skeleton. Reference:

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? Sciatic Peroneal Femoral Achilles

peroneal

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

serous drainage When the client undergoes an invasive knee joint examination, the nurse should inspect the knee area for swelling, bleeding, and serous drainage. An invasive joint examination does not cause lack of sleep or appetite, depression, or shock. The client may be in shock due to the injury itself.

A client has recently undergone an invasive joint examination to enable the identification of bone composition. Which signs and symptoms should the nurse monitor in this client? swelling and bleeding hypersensitivity reaction tingling sensation or numbness nausea and vomiting

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

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 A. edema in left lower extremity. B. increased use of left calf muscle. C. atrophy of right calf muscle. D. bruising in right lower extremity.

C. atrophy of the right calf muscle

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? Arthrocentesis Bone scan Electromyography Arthroscopy

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

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

A nurse knows that a person with a 3-week-old femur fracture is at the stage where angiogenesis is occurring. What are the characteristics of this stage? The formation of a hematoma and fibrin. Inflammation and the stimulation of osteoblasts and osteoclasts. Cartilage cells forming matrix villa that regulate calcification of the cartilage. New capillaries producing a bridge between the fractured bones.

New capillaries producing a bridge between the fractured bones Angiogenesis and cartilage formation begin when fibroblasts from the periosteum produce a bridge between the fractured bones. This is known as a callus.

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? Cervical Thoracic Lumbar Sacral

Thoracic The nurse should assess the thoracic region of the spine because a progressive curvature of more than 65 degrees in this region may lead to cardiopulmonary failure as well as less serious signs and symptoms, such as fatigue, back pain, decreased height, and cosmetic deformity. Although a curvature may affect any part of the spine, life-threatening complications aren't associated with curvature of the cervical, lumbar, or sacral regions.

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? A. Osteoblasts B. Cortical bone C. Osteoclasts D. Cancellous bone

A. 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 term refers to moving away from midline? Adduction Inversion Eversion Abduction

Abduction Abduction is moving away from the midline. Adduction is moving toward the midline. Inversion is turning inward. Eversion is turning outward.