Prep U 21 chapter

Shoulder abduction Raising the arms out to the side tests for should abduction. Moving the arm towards the midline assesses for shoulder adduction. The elbow is assessed for flexion, extension, pronation, and supination. p.626

"raise the arm out to the side"

Straight leg raise test The straight leg raise test involves having the client lie supine with the examiner raising the leg. If the client experiences a sharp pain radiating from the back down the leg in an L5 or S1 distribution, that suggests a herniated disc. Leg strength test, Tinel's test, and Phelan's test do not assess for a herniated disc. p. 622.

A 32-year-old warehouse worker presents for evaluation of low back pain. He notes a sudden onset of pain after lifting a heavier-than-usual set of boxes. He also states that he has numbness and tingling in the left leg. What test should the nurse perform to assess for a herniated disc? Leg length test Phelan's test Straight leg raise test Tinel's test

Calcitonin Although osteoporosis can be treated, no cure has been found. Prevention is very important, especially for women. Current treatment includes bisphosphonates, calcitonin, estrogen and/or HRT, raloxifene, and parathyroid hormone. p. 609.

A 70-year-old woman has come to the clinic to follow up her bone density testing. The results suggest that she has osteoporosis. What is a medication that might be ordered for this patient? Calcitonin Vitamin C supplements Thyroid hormone testosterone

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. p. 619, p. 638.

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? Activity Intolerance Impaired Physical Mobility Risk for Trauma Disturbed Body Image

arthritis. Pain and stiffness in the joints is associated with arthritis. p. 611.

A client visits the clinic and tells the nurse that she has joint pain in her hands, especially in the morning. The nurse should assess the client further for signs and symptoms of osteoporosis. carpal tunnel syndrome. a neurologic disorder. arthritis.

Ask the client to raise the leg to the point of pain and then dorsiflex the foot : To perform the straight leg test, the nurse should ask the client to raise the client's leg to the point of pain and then dorsiflex the foot to check for a herniated nucleus pulposus. Asking the client to bend forward and touch the toes facilitates assessment of range of motion of the lumbar spine. Asking the client to touch the chin to the chest evaluates range of motion of the cervical spine. The spinous processes and the paravertebral muscles on both sides of the spine are palpated for tenderness and pain and are not a part of the straight leg test. p. 622.

A client visits the health care facility with reports of lumbar back pain that radiates down the back. The nurse performs the straight leg test to determine the origin of the pain. Which techniques should the nurse use to perform this test? Instruct the client to bend forward and touch the toes Ask the client to raise the leg to the point of pain and then dorsiflex the foot Palpate the spinous processes and the paravertebral muscles Instruct the client to touch the chin to the chest

Importance of regular exercise Maintaining a body weight appropriate to height and frame Using proper body mechanics with lifting objects Maintaining a safe home environment Health promotion topics to prevent musculoskeletal injuries include engaging in regular exercise, maintaining a body weight appropriate to height and frame, using proper body mechanics with lifting or moving objects, and maintaining a safe home environment. Clients should not be told to limit dairy intake because this is a source of dietary calcium. Having the recommended daily intake of calcium can prevent risk factors for osteoporosis, therefore, musculoskeletal injuries. p. 609.

A community health nurse is providing education to help reduce musculoskeletal injuries in adults. What should the nurse include in these instructions? (Select all that apply.) Importance of regular exercise Limiting intake of dairy products Maintaining a safe home environment Maintaining a body weight appropriate to height and frame Using proper body mechanics with lifting objects

Scaphoid fracture The "anatomical snuffbox" is found between the extensor and abductor tendons at the base of the thumb. Tenderness should make one think of a scaphoid fracture. Not only is this the most common carpal bone injury, but the poor blood supply puts the bone at risk for avascular necrosis when injured. This fracture if commonly missed on X-ray, so this is an important physical finding to support further or repeat studies. p. 604.

A high school football player injured his wrist in a game. He is tender between the two tendons at the base of the thumb. Which of the following should be considered? DeQuervain's tenosynovitis Rheumatoid arthritis Wrist sprain Scaphoid fracture

Low estrogen levels : Modifiable risk factors include low estrogen levels. Small-boned thin frame, personal history of fractures, and age cannot be modified. p608

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? Low estrogen levels Personal history of fractures Small-boned, thin frame Age

Turning the palm of the hand upward Supination involves turning or facing upward, in this case turning the palm upward. Pronation involves turning or facing downward, in this case turning the palm downward. Flexion involves bending the extremity at the joint and decreasing the angle of the joint, in this case moving the tips of the fingers toward the forearm. Extension involves straightening the extremity at the joint and increasing the angle of the joint, in this case moving the tips of the fingers away from the forearm. p.603, p. 628.

A nurse is testing the range of motion of a client's wrist for supination. Which movement will this involve?

Increased bone resorption Decreased calcium absorption Decreased osteoblast production Osteoporosis is more common as a person ages because that is a time when bone resorption increases, calcium absorption decreases, and production of osteoblasts decreases as well. Arthritis is not a risk factor for osteoporosis. It is not established that decreased intake of vitamin K or increased sun exposure are associated with advancing age, and even if it were, these are not risk factors associated with osteoporosis. p. 605, pp. 608-609.

A nurse is working with an older client who has osteoporosis. The nurse understands that osteoporosis is more common in older people for which of the following reasons? Select all that apply. Decreased intake of vitamin K Decreased osteoblast production Increased incidence of arthritis Increased bone resorption Decreased calcium absorption Increased sun exposure

Asked the client to open and close the mouth Asked the client to jut the jaw forward Asked the client to rock the jaw laterally Range of motion of the temporomandibular joint consists of three activities: opening and closing of the mouth, jutting the jaw forward, and rocking the jaw laterally. If the patient is able to perform these activities, then the joint has full range of motion. Range of motion of the jaw is not assessed by swallowing or extending the tongue. pp. 622-623.

After a physical assessment, the nurse determines that a client has full range of motion of the temporomandibular joint. Which of the following assessments did the nurse complete with the client? (Select all that apply.) Asked the client to jut the jaw forward Asked the client to swallow Asked the client to rock the jaw laterally Asked the client to extend the tongue Asked the client to open and close the mouth

Red marrow The red marrow of the bone is responsible for producing red blood cells. Compact bone is hard and dense and makes up the shaft and outer layers. Yellow marrow is mostly fat. Spongy bone contains numerous spaces and makes up the ends and centers of the bone. p. 601.

After teaching a group of students about the bones and their functions, the instructor determines that the teaching was successful when the students state that blood cells are produced in which of the following? spongy marrow Red marrow Compact bone Yellow marrow

gouty arthritis. A diet high in purine (e.g., liver, sardines) can trigger gouty arthritis. p. 644.

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 bone fractures. osteomalacia. gouty arthritis. osteomyelitis.

herniated intervertebral disc. Thirty-three bones: 7 concave-shaped cervical (C); 12 convexshaped thoracic (T); 5 concave-shaped lumbar (L); 5 sacral (S); and 3-4 coccygeal, connected in a vertical column. 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. , p. 648.

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 metastases. rheumatoid arthritis. osteoporosis. herniated intervertebral disc.

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. pg. 622.

As the nurse assesses the temporomandibular joint (TMJ), an audible click is heard and palpated. What is nurse's best action? Ask the client if painful to move jaw side to side. Suggest myofascial release therapy. Teach the client about oral surgery procedures. Advise the client take an anti-inflammatory.

5/5 Scale for grading muscle strength: muscle strength is graded on a 0 to 5 scale: 0: No muscular contraction detected 1: A barely detectable flicker or trace of contraction 2: Active movement of the body part with gravity eliminated 3: Active movement against gravity 4: Active movement against gravity and some resistance 5: Active movement against full resistance without evident fatigue. This is normal muscle strength. p. 616.

How would the nurse document normal muscle strength? 1:1 4+ 5/5 2 & 2

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. p. 603.

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 Pronation Supination Retraction

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. p620

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 size of the client's knee changes throughout the joint's range of motion Whether the client's swollen knee is caused by tissue swelling or by fluid accumulation Whether the client's knee joint is capable of adduction and abduction Whether swelling in the knee joint is a normal age-related change or a pathological finding

False p603

The nurse instructs the patient to raise his arm out to the side and overhead. The nurse is asking the patient to adduct his arm. False True

Tenderness Tenderness implies an inflammatory process along with increased temperature. Nodules and ecchymosis are not typically associated with inflammatory processes. p. 617, p. 625.

The nurse is assessing a client with joint pain and is trying to decide whether it is inflammatory or non-inflammatory. Which of the following symptoms is consistent with an inflammatory process? Tenderness Nodules Ecchymosis Cool temperature

Goniometer If ROM is limited, use a goniometer to measure the angle of the joint at its maximum flexion and extension. p. 617.

The nurse is assessing the range of motion (ROM) of a patient's joints. What would the nurse use to assess flexion and extension of a joint if the patient complains of pain on examination? Goniometer Scoliometer Calibrator Angulator

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. pp. 614-615.

The nurse is performing an assessment of a client's musculoskeletal system. What would the nurse examine first? The client's cervical ROM The client's leg length The client's gait The client's lateral bending ability

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. p. 620.

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 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 Whether the size of the client's knee changes throughout the joint's range of motion

Produces red blood cells Bones contain red marrow that produces blood cells and yellow marrow composed mostly of fat. The periosteum covers the bones and contains osteoblasts and blood vessels that promote nourishment and formation of new bone tissues. Composed of osseous tissue, bones can be divided into two types: compact bone, which is hard and dense and makes up the shaft and outer layers; and spongy bone, which contains numerous spaces and makes up the ends and centers of the bones. p. 601.

The nurse is working with a client who has leukemia, which affects the red marrow of the bones. The nurse understands that which of the following is characteristic of red marrow? Is hard and dense and makes up the shaft and outer layers Is composed mostly of fat Produces red blood cells Covers the bones and contains osteoblasts and blood vessels

shoulder joint. Articulation of the head of the humerus in the glenoid cavity of the scapula. The acromioclavicular joint includes the clavicle and acromion process of the scapula. It contains the subacromial and subscapular bursae. p. 601.

The subacromial bursae are contained in the wrist joint. temporomandibular joint. shoulder joint. elbow joint.

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. p. 619.

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 Reports of tingling, numbness, and pain in the involved wrist Stiffness in the hands and fingers after holding and releasing a tight fist A change in the color of the fingers from red to white (pale)

neurological system The musculoskeletal system is enervated by the neurological system. Examination of the two systems are closely aligned. p. 617.

When providing teaching to clients in the community, a nurse is accurate in stating that the musculoskeletal system is most closely aligned with which other body system? gastrointestinal system neurological system integumentary system renal system

Ask the client to move the part against gravity. If the client cannot move the part against resistance when testing muscle strength, then the nurse should ask the client to move the part against gravity and, if that is not possible, attempt to passively move the part through its full range of motion. Percussion is not indicated. p. 618.

When testing muscle strength, a client has difficulty moving her right arm against resistance. What would the nurse to do next? Inspect by touch for a palpable contraction of the muscle. Ask the client to move the part against gravity. Move the part passively through its range of motion. Percuss the client's shoulder joint

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. pg. 630.

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?

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. p. 612.

Which nutrient deficiency should a nurse recognize as placing a client at risk for osteoporosis? Calcium Vitamin D Protein Vitamin C

average weakness. Muscle strength that is active motion against gravity is rated as a 3 or average weakness. p. 618.

While assessing muscle strength in an older adult client, the nurse determines that the client's knee joint has a rating of 3 and exhibits active motion against gravity. The nurse should document the client's muscle strength as being/having slight weakness. poor range of motion. normal. average weakness.

inability to extend the ring and little finger. Inability to extend the ring and little fingers is seen in Dupuytren's contracture. p. 643.

While reviewing a client's chart before seeing the client for the first time, the nurse notes that the client has a diagnosis of Dupuytren contracture. The nurse anticipates that the client will exhibit inability to turn the wrists. ulnar deviation of the hands. flexion of the distal interphalangeal joints. inability to extend the ring and little finger.