Chapter 35: Assessment of Musculoskeletal Function

A client is diagnosed with a fracture of a diarthrosis joint. What is an example of this type of joint?

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.

Which of the following describes a muscle that is limp and without tone?

Flaccid

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?

Gout - Gout: a medical condition with symptoms of acute inflammatory arthritis that is caused by high levels of uric acid in the blood. The client has uric acid crystal deposits in the joint. The nurse would assess joint areas for pain, redness, and swelling. - Rheumatoid arthritis; a chronic disease of joint inflammation and pain. - Lupus erythematous: a chronic tissue disorder of the connective tissue & is known to have an elevated antinuclear antibody level. - Osteoporosis: a deficiency in the serum calcium level.

Which of the following is an example of a hinge joint?

Knee - Hinge joints bend in one direction only & include the knee & elbow. - Ball-and-socket: hip. - Saddle Joint: @ the base of the thumb. - Gliding joints: allow for limited movement in all directions (carpal bones in the wrist).

Stages of Fracture Repair (4)

1. Angiogenesis: hematoma. . Cartilage Calcification . Cartilage Removal 4. Remodeling

A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate MUSCLE WEAKNESS or deterioration?

An ELECTROMYOGRAPHY EMG An electromyography tests the electrical potential of muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration. - A serum calcium test evaluates the calcium in the blood. - An arthroscopy assesses changes in the joint. - An MRI identifies abnormalities in the targeted area.

The nurse is 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

atrophy of right calf muscle. Girth of an extremity may increase as a result of exercise, edema, or bleeding into the muscle. However, A CLIENT W R-SIDED HEMIPLEGIA IS UNABLE TO USE THE R-LOWER EXTREMITY. & may experience atrophy of the muscles from lack of use, which results in a subsequent decrease in the girth of the calf muscle.

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

diaphysis. - The DIAPHYSIS is primarily CORTICAL bone; MID bone. - An epiphysis: end of a long bone. - Lordosis: increase in lumbar curve of spine. - Scoliosis: lateral curving of the spine.

Electromyography (EMG)

evaluates MUSCLE WEAKNESS from testing potential of muscles & nerves.

Angiogenesis

formation of new blood vessels

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

kyphosis - Kyphosis is an exaggerated convex curvature of the thoracic spine. - Lordosis is an excessive concave curvature of the lumbar spine. - Scoliosis is a lateral curvature of the spine. - Diaphyses are the long shafts of bones in the arms and legs.

osteoblasts

secrete collagen containing matrix

An example of a flat bone is the

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

Which hormone inhibits bone resorption and increases the deposit of calcium in the bone?

Calcitonin Calcitonin, secreted by the thyroid gland in response to elevated blood calcium levels, inhibits bone reabsorption and increases the deposit of calcium in the bone.

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?

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.

The nurse is evaluating a client's peripheral neurovascular status. Which would the nurse report to the health care provider as a circulatory indicator of peripheral neurovascular dysfunction?

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.

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?

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.

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?

"Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued." Muscles need to exercise to maintain function and strength. When a muscle repeatedly develops maximum or close to maximum tension over a long time, as in regular exercise with weights, the cross-sectional area of the muscle increases. This enlargement, known as hypertrophy, results from an increase in the size of individual muscle fibers without an increase in their number. Hypertrophy persists only if the exercise is continued.

The nurse is conducting a community education program on hip fracture risk. The nurse evaluates that the participants understand the program when the participants determine that client at highest risk for a hip fracture is a(n)

80-year-old man recently widowed. Hip fracture occurs with greater incidence in elderly people and is often a life-altering event that has a negative impact on the client's mobility and quality of life.

Which is useful in IDENTIFYING acute or chronic TEARS OF the JOINT CAPSULE or supporting LIGAMENTS of the knee, shoulder, ankle, hip, or wrist?

Arthrography - Arthrography: identifies acute/chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. - Meniscography: distractor for this question. - Bone densitometry: estimates bone mineral density. - EMG: gives info about the electrical potential of the muscles & nerves leading to them.

Which of the following biologically active vitamin functions to INCREASE THE AMOUNT OF CALCIUM IN THE BLOOD?

D Biologically active vitamin D (Calcitrol) functions to increase the amount of calcium in the blood by promoting absorption of calcium from the gastrointestinal tract.

Which diagnostic test would the nurse expect to be ordered for a client with lower extremity MUSCLE WEAKNESS?

ElectroMYOgraph (EMG) The EMG provides information about the electrical potential of the muscles and the nerves leading to them. The test is performed to evaluate muscle weakness, pain, and disability. An arthrocentesis, bone scan, and biopsy does not measure muscle weakness.

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 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.

The nurse observes a client with a SHUFFLING gait. What disease is commonly associated with a SHUFFLING gait?

Parkinson's Disease Parkinson's disease - shuffling gait. Lower motor disease - steppage gait. Scoliosis - limp. Paget's disease - bone fractures.

Which nerve is being assessed when the nurses asks the client to DORSIFLEX the ANKLE and EXTEND THE TOES?

Peroneal The motor function of the peroneal nerve is assessed by: dorsiflexing the ankle and to extend the toes, while pricking the skin between the great toe and center toe assesses sensory function. - The radial nerve: stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints. - The median nerve: touch the thumb to the little finger. - Spreading all fingers: to assess motor function affected by ulnar innervation.

The nurse is conducting a musculoskeletal assessment of a client in a nursing home. The client is unable to dorsiflex the right foot or extend the toes. The nurse evaluates this finding as an injury to which nerve?

Peroneal Injury to the peroneal neterm-43rve as a result of pressure may cause foot drop or the inability to dorsiflex the foot and extend the toes.

Red bone marrow produces which of the following? Select all that apply.

Platelets RBC WBC

The nurse is caring for a client who experienced a crushing injury of the lower extremities. Which of the following symptoms is essential to be reported to the physician?

Pulselessness Neurovascular checks (circulation, sensation, motion) are essential with a crushing injury. The absence of a pulse is a critical assessment finding to report to the physician. The other options are symptoms that need regular assessment.

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 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 joint stiffness decreased ROM Significant assessment findings of the musculoskeletal system in the older adult would include joint stiffness and decreased height, range of motion, muscle strength, and endurance. Older adults may have decreased height from osteoporosis and decreased muscle strength from atrophy.

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 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.

arthography

tear in the joint capsule

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

"Do you have any allergies?" Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood. - Asking about eating or urinating is important but not priority. - The claustrophobia is not a concern for the arthrogram.

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

"I didn't remove my Transderm-Nitro patch." All metal-containing objects must be removed before the procedure, including transdermal patches containing an aluminized backing. The nurse must contact the health care provider before removing transdermal patches. Screening prior to the MRI are done for metal like joint replacements and pacemakers so clients may not be able to have an MRI. Hearing aides may also be made of metal so they may be prohibited with the diagnostic study.

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?

"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.

A client with a sports injury undergoes a diagnostic arthroscopy of the left knee. What comment by the client following the procedure will the nurse address first?

"My toes are numb." Numbness would indicate neurological compromise of the extremity and requires immediate intervention to prevent permanent damage. An aching knee is expected after the procedure. Cold or swollen feet are not priority assessments.

The nurse is assessing a client with a musculoskeletal system condition. Which statement indicates to the nurse that the client is experiencing bone pain?

"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 & piercing & 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." - Weight-bearing exercises maintain bone mass. - Weight-resistance exercises maintain and strengthen muscles. - Cardio training is important for heart health and weight maintenance/reduction. - ROM exercises are essential for joint mobility.

The older client asks the nurse how best to maintain strong muscles. What is the nurse's best response?

"Weight-resistance exercises can strengthen muscles." -Weight-resistance exercises maintain and strengthen muscles. - Cardio-training is important for heart health and weight maintenance/reduction. - Rest is good if you get exercise but doesn't build muscle on its own. - ROM exercises are essential for joint mobility.

The nurse is preparing the client for computed TOMOGRAPHY. Which information should be given by the nurse?

"You must remain very STILL during the procedure." - Tomography: a series of detailed x-rays are taken. The client must lie very still. -Contrast Agent, may or may not be injected (not a radioisotope). - Arthrocentesis: removing fluid from a joint. - Biopsy: a bit of tissue is removed.

Which statement describes paresthesia?

Abnormal sensations - Paresthesias: abnormal sensations, such as burning, tingling, and numbness. - Paralysis: absence of muscle tone suggesting nerve damage. - Fasciculation: the involuntary twitch of muscle fibers. - Flaccid: muscle that holds no tone.

Which assessment findings indicate to the nurse that a client may have peripheral neurovascular dysfunction? Select all that apply.

Absence of feeling Capillary refill of 4 to 5 seconds Cool skin Pain Weakness in motion Indicators of peripheral neurovascular dysfunction include pale, cyanotic or mottled skin with a cool temperature, capillary refill greater than 3 seconds, weakness or paralysis with motion, and paresthesia, unrelenting pain, pain on passive stretch, or absence of feeling.

The nurse is planning care for a client with a musculoskeletal injury. Which nursing diagnosis would be the highest priority?

Acute Pain The highest priority at this time is Acute Pain and nursing interventions related to decreasing pain. If the client is in pain, instruction to improve health maintenance or surgical recovery is less effective. A "Risk for" diagnosis is a potential problem not an actual problem at this time.

Which body movement involves moving toward the midline?

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

The nurse is providing care to a client following a knee arthroscopy. What would the nurse expect to include in the client's plan of care?

Administering the prescribed analgesic. After an arthroscopy, the client's entire leg is elevated without flexing the knee. A cold pack is placed over the bulky dressing covering the site where the arthroscope was inserted. A prescribed analgesic is administered as necessary. The client is allowed to resume his or her usual diet as tolerated.

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?

An arthroscopy An arthroscopy is the internal inspection of the joint using an arthroscope. The physician can inspect the joint for injury or deterioration and can also complete therapeutic procedures such as removing bit of torn or floating cartilage. - A bone densitometry estimates bone density. - A bone scan is used to detect metastatic bone lesions, fractures, or inflammatory disorders. - An arthrocentesis is the aspiration of synovial fluid. An arthrocentesis may be completed during an arthroscopy.

The nurse is taking an initial history of a new client with a musculoskeletal problem. Which factor is most important for the nurse to keep in mind for this assessment?

Any chronic disorder or recent injury The focus of the initial history depends on the nature of the musculoskeletal problem, whether the client has a chronic disorder or a recent injury. If the disorder is long-standing, the nurse obtains a thorough medical, drug, and allergy history. If the client is injured, the nurse finds out when and how the trauma occurred. The client's age, lifestyle, or duration and location of discomfort or pain, although important, have little influence on the focus of the initial history and assessment of the client.

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. 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.

The nurse is performing a neurological assessment. What will this assessment include?

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.

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

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.

Which is an indicator of neurovascular compromise?

Capillary refill of more than 3 seconds Capillary refill of more than 3 seconds is an indicator of neurovascular compromise. Other indicators include cool skin temperature, pale or cyanotic color, weakness, paralysis, paresthesia, unrelenting pain, pain upon passive stretch, and absence of feeling. Cool skin temperature is an indicator of neurovascular compromise. Unrelenting pain is an indicator of neurovascular compromise. Pain upon passive stretch is an indicator of neurovascular compromise.

Which of the following is an example of a gliding joint?

Carpal bones in the wrist Gliding joints allow for limited movement in all directions and are represented by the joints of the carpal bones in the wrist. - Hinge joints permit bending in one direction only and include the knee and elbow. - The hip is a ball-and-socket joint. - The joint at the base of the thumb is a saddle joint.

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

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 nurse is caring for a pregnant patient with pregnancy-induced hypertension. When assessing the reflexes in the ankle, the nurse observes rhythmic contractions of the muscle when dorsiflexing the foot. What would the nurse document this finding as?

Clonus The nurse may elicit muscle clonus (rhythmic contractions of a muscle) in the ankle or wrist by sudden, forceful, sustained dorsiflexion of the foot or extension of the wrist.

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

Compartment syndrome -Compartment syndrome: caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes. - Remodeling: a process that ensures bone maintenance through simultaneous bone resorption & formation. - Hypertrophy: an increase in muscle size. - Fasciculation: involuntary twitch of muscle fibers.

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

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.

The homecare nurse is evaluating the musculoskeletal system of a geriatric client whose previous assessment was within normal limits. The nurse initiates a call to the health care provider and/or emergency services when which change is found?

Decreased right-sided muscle strength Although symmetrical decreases in muscle strength can be a part of the aging process, asymmetrical decreases are not. The nurse should contact the health care provider when decreased right-sided muscle strength is found, as this could indicate a stroke or transient ischemic attack. Decreased flexibility, decreased agility, and increased joint stiffness are all part of the aging process and therefore do not require the nurse to contact the health care provider.

A client is diagnosed with a bone TUMOR. What result would the nurse expect the blood tests to reveal?

Decreased serum calcium level - Decreased serum calcium level may indicate osteoMALACIA, osteoPOROSIS, and bone TUMORS. - With bone tumors, the Alkaline Phosphatase & Serum Phosphorus levels would be INCREASED. - Decreased red blood cell count may reflect anemia.

A group of students are reviewing the structure and function of bones. The students demonstrate understanding of the information when they state that cortical bone is found primarily in which of the following?

Diaphyses - Cortical bony tissue @ the long shafts, or diaphyses, of bones in the arms and legs. - Cancellous @ the rounded, irregular ends, or epiphyses, of long bones. - Osteoblasts are cells that build bones

After bone fracture, fibrocartilaginous callus formation normally occurs at the same time as which process?

Fibroblast migration 1- Inflammation and hematoma formation occur in the days immediately after the fracture, as macrophages invade and debride the fracture area. 2- Fibrocartilaginous callus formation occurs as fibroblasts and osteoblasts migrate into the fracture site, where they begin to reconstruct the bone; the bone is not yet able to bear weight at the end of this phase. 3- Next, mature bone replaces the fibrocartilaginous callus. Together these processes are sometimes referred to as the reparative stage. 4- Remodeling is the final stage of fracture repair, during which the new bone is reorganized into the bone's former structural arrangement.

The nurse is performing a musculoskeletal assessment for a client whose right leg MUSCLES exhibit no tone & are LIMP. Which descriptor should the nurse use to document this condition?

Flaccid - Flaccid: muscles that have no tone or are limp. - Spastic: muscles that have greater-than-normal tone. - Atonic: muscles that are not enervated & become soft & flabby. - Atrophic describes muscles deterioration that occurs with lack of use & exercise.

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

Flaccidity - Flaccid: a muscle that's limp & without tone. - Spastic: a muscle with greater-than-normal tone. Conditions characterized by lower motor neuron destruction (e.g., muscular dystrophy), denervated muscle becomes atonic (soft and flabby) and atrophies.

The nurse is preparing to perform a musculoskeletal assessment for a client with chronic muscle pain. Which assessment technique would be an appropriate tool to evaluate this type of pain?

Flex the bicep against resistance. Evaluating muscle strength is a part of the musculoskeletal system. Strength of the bicep muscles can be tested by having the client flex the bicep against resistance. - Palpating for the balloon sign assesses for fluid around the knee joint. - Measuring the girth of the thigh evaluates for muscle size. - Cracking with movement may indicate a ligament slipping over a bony prominence.

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

Hyaline cartilage Hyaline/articular cartilage: surface of MOVABLE joints, such as the elbow, and protects the surface of these joints. - costal cartilage: connects the ribs and sternum - semilunar cartilage, a cartilage of the knee joint - fibrous cartilage: between the vertebrae (intervertebral discs) - elastic cartilage: @ larynx, epiglottis, & outer ear.

A client is exhibiting diminished range of motion, loss of flexibility, stiffness, and loss of height. The history and physical findings are associated with age-related changes of which area?

Joints - History and physical findings associated with AGE-RELATED changes of the JOINTS include diminished ROM, loss of flexibility, stiffness, and loss of height. - History and physical findings associated with AGE-RELATED changes of BONES include loss of height, posture changes, kyphosis, flexion of hips and knees, back pain, osteoporosis, and fracture. - History and physical findings associated with AGE-RELATED changes of MUSCLES include loss of strength, diminished agility, decreased endurance, prolonged response time (diminished reaction time), diminished tone, a broad base of support, and a history of falls. - History and physical findings associated with AGE-RELATED changes of LIGAMENTS include joint pain on motion that resolves with rest, crepitus, joint swelling/enlargement, and degenerative joint disease (osteoarthritis).

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

Knee The most common site for joint effusion is the knee. If inflammation or fluid is suspected in a joint, consultation with a provider is indicated. - The elbow, hip, and shoulder are not the most common site of joint effusion.

The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as?

Kyphosis 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. - 2nd deformity of the spine is referred to as LORDOSIS, or swayback, an exaggerated curvature of the lumbar spine. - 3rd deformity is SCOLIOSIS, which is a lateral curving deviation of the spine (Fig. 40-4). - Osteoporosis is abnormal excessive bone loss.

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

Lamellae Lamellae are mineralized bone matrices. - Endosteum refers to the marrow cavity lining of hollow bone. - Trabecula refers to latticelike bone structure. - Cancellous bone refers to spongy, latticelike bone structure.

The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding?

Lordosis Lordosis is an exaggeration of the lumbar spine curve.

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?

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

An osteocalcin (bone GLA protein) level has been ordered. How will the nurse prepare for this order?

Obtain a blood specimen. An osteocalcin level is determined from a blood sample. It is used to assess the rate of bone turnover.

Place an "X" on the figure where the nurse would assess for kyphosis.

On the thoracic vertebrae: spinous process, body of vertebra Kyphosis is an increased convexity of roundness of the thoracic curve of the spine.

A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells?

Ossification & calcification Ossification and calcifications: the body's process to transform OSTEOBLASTS INTO mature bone cells called OSTEOCYTES. - Osteocytes are involved in maintaining bone tissue. - Resorption and remodeling are involved in bone destruction. - Epiphyses and diaphyses are bone tissues that provide strength and support to the human skeleton.

An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of OSSIFICATION?

OsteoBLASTS Osteoblasts secrete bone matrix (mostly collagen), in which inorganic minerals, such as calcium salts, are deposited. This process of ossification and calcification transforms the blast cells into mature bone cells, called osteocytes, which are involved in maintaining bone tissue. - Cortical bone is dense hard bone found in the long shafts aka DIAPHYSIS - Cancellous bone is spongy bone found in the irregular rounded edges of bone.

Which serum level indicates the rate of bone turnover?

Osteocalcin / Serum Osteocalcin (GLA) 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?

Osteoclasts are involved in the destruction and remodeling of bone. Osteoclasts are the cells involved in the destruction, resorption, and remodeling of bone. - Red bone marrow is responsible for manufacturing red blood cells. - Long bones contain yellow bone marrow; the sternum, ileum, vertebrae, and ribs contain red bone marrow. - Osteoblasts are transformed into osteocytes, mature bone cells.

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 Indicators of peripheral neurovascular dysfunction include pale, cyanotic, or mottled skin color; cool temperature of the extremities; and a capillary refill of more than 3 seconds.

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?

Potential growth problems may result from damage to the epiphyseal plate. The distal and proximal ends of a long bone are called epiphyses, which are composed of cancellous bone. The epiphyseal plate, which separates the epiphyses from the diaphysis, is the center for longitudinal growth in children. Its damage can be a critical indictor of potential growth problems if fractured. All other choices are wrong.

Which nursing instruction is most important to stress when teaching on calcium intake?

Provide age-related calcium intake recommendations. Providing accurate and specific age-related daily calcium intake guidelines empowers clients to meet those recommendations in a manner that fits their lifestyle. It is also important to realize that calcium intake guidelines increase to 1200 mg/day for those older than age 50 years. Eating green, leafy vegetables is an important source of calcium as well as drinking fortified orange juice. Dairy sources also provide calcium intake in varying degrees.

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 The process of fracture healing occurs over 3 phases: Phase I: Reactive phase Phase II: Reparative phase Phase III: Remodeling phase.

Which of the following is the final stage of fracture repair?

Remodeling - Angiogenesis occurs when new capillaries infiltrate the hematoma, and fibroblasts from the periosteum, endosteum, and bone marrow produce a bridge between the fractured bones. - During cartilage calcification, enzymes within the matrix vesicles prepare the cartilage for calcium release and deposit. - Cartilage removal occurs when the calcified cartilage is invaded by blood vessels and becomes reabsorbed by chondroblasts and osteoclasts. - The final stage of fracture repair consists of remodeling the new bone into its former structural arrangement.

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

Remodeling Remodeling is the final stage of fracture repair. - During inflammation, macrophages invade and debride the fracture area. - Revascularization occurs within about 5 days after a fracture. - Callus forms during the reparative stage but is disrupted by excessive motion at the fracture site.

A client has just undergone arthrography. What is the most important instruction for the nurse to include in the teaching plan?

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 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.

Which statement reflects the progress of bone healing?

Serial x-rays are used to monitor the progress of bone healing. Serial x-rays are used to monitor the progress of bone healing. The type of bone fractured, the adequacy of blood supply, the surface contact of the fragments, and the general health of the client influence the rate of fracture healing. Adequate immobilization is essential until x-ray shows evidence of bone formation with ossification.

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?

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.

Which laboratory study indicates the rate of bone turnover?

Serum osteocalcin Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Urine calcium concentration increases with bone destruction. Serum calcium concentration is altered in clients with osteomalacia and parathyroid dysfunction. Serum phosphorous concentration is inversely related to calcium concentration and is diminished in osteomalacia associated with malabsorption syndrome.

A group of students are studying for an examination on joints. The students demonstrate understanding of the material when they identify which of the following as an example of a synarthrodial joint?

Skull at the temporal and occipital bones - synarthrodial joint: immovable: @ the suture line of the skull between the temporal & occipital bones. - Amphiarthrodial joints: slightly moveable: between the vertebrae. - diarthrodial: freely movable: finger & hip joints

The nurse is conducting a musculoskeletal assessment on a client documented to have rheumatoid arthritis. Which would the nurse anticipate finding when inspecting the client's fingers?

Soft, subcutaneous nodules along the tendons The subcutaneous nodules of rheumatoid arthritis are soft and occur within and along tendons that provide extensor function to the joints. The nodules of gout are hard and lie within and immediately adjacent to the joint capsule itself. Osteoarthritic nodules are hard and painless and represent bony overgrowth that results from destruction of the cartilaginous surface of bone within the joint capsule.

The nurse is assessing the client for scoliosis. What will the nurse have the client do to perform the assessment?

Stand behind the client and ask the client to bend forward at the waist. Scoliosis is characterized by a lateral curvature of the spine. The nurse stands BEHIND the client and asks the client to bend forward at the waist for the nurse to examine the spine curvature. The nurse CANNOT see the spine by standing beside the client or in front of the client. The spinal curve cannot be seen by watching the client walk.

A patient is scheduled for a bone marrow biopsy. The nurse explains to the family that the bone marrow is located mainly in four areas. The nurse tells the family that the site to be used would be the:

Sternum. The sternum, along with the ilium, vertebrae, and ribs are responsible for producing red blood cells and are used for bone marrow aspiration sites.

Skull sutures are an example of which type of joint?

Synarthrosis Skull sutures are considered SYNARTHROSIS joints and are IMMOVABLE. - Amphiarthrosis joints allow limited movement, such as a vertebral joint. - Diarthrosis joints are freely movable joints such as the hip and shoulder. - Aponeuroses are broad, flat sheets of connective tissue.

The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding?

Tear in the joint capsule Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. - X-rays are used to diagnose bone fractures. - Bone densitometry is used to estimate bone mineral density. - An electromyogram (EMG) provides information about the electrical potential of the muscles and nerves leading to them.

A client experiences a musculoskeletal injury that involves the structure that connects a MUSCLE to the BONE. The nurse understands that this injury involves which structure?

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 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. -A fracture that is on the diaphysis is understood to be chiefly found in the long shafts of the arms and legs. - Epiphyses: 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.

The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse?

The patient has rheumatoid arthritis. - RH: Soft subcutaneous nodules, @ tendons that provide extensor function. - Osteoarthritis: nodules are hard & painless, represent bony overgrowth that has resulted from destruction of the cartilaginous surface of bone within the joint capsule. - Lupus & neurofibromatosis are not associated with the production of nodules.

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 secrete a matrix that consists of collagen. COLLAGEN CONSISTING MATRIX 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.

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?

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

The nurse is teaching a client about a vitamin that supports calcium's absorption. What vitamin is the nurse teaching the client about?

Vit D To support the absorption of calcium from the gastrointestinal tract and increase the amount of calcium in the blood, there needs to be sufficient active vitamin D. Vitamin A is for eye health. Vitamin B12 is for anemia prevention. Vitamin C is used for skin and immune health.

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

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.