Prep U: Chapter 24: Assessing Musculoskeletal System
The school nurse notes that the client carries her left shoulder higher than her right shoulder. You should recognize the likely presence of what health problem?
Scoliosis Explanation: Scoliosis may cause elevation of one shoulder.
A nurse conducts a physical examination of the musculoskeletal system of a client who reports upper arm pain. Which instruction should the nurse provide the client when assessing flexion of the elbow?
"Bend your elbow." Explanation: Asking the client to bend the elbow assesses for flexion. Asking the client to straighten the elbow assesses for extension. Asking the client turn the palms down assesses for pronation. Asking the client to turn the palms down and point fingers to the floor assesses flexion of the elbow.
What is an appropriate question by the nurse to ask a client about the presence of temporomandibular joint dysfunction?
"Have you noticed a popping or grating sound when you chew?" Explanation: The temporomandibular joint (TMJ) provides the stability of the jaw to open and close. Often the joint can become swollen, causing pain and decrease in range of motion of the jaw. Decreased muscle strength and range of motion, along with a popping, clicking, or grating sound may be noted with TMJ dysfunction. Swelling around the teeth and gums is seen with gingivitis. Clenching the teeth test the integrity of cranial nerve V (trigeminal nerve). Asking the client to stick out the tongue and move it from side to side tests cranial nerve XII (hypoglossal nerve).
When assessing muscle tone and strength, the nurse would document expected findings as
"upper and lower extremity muscle strength is 5/5 bilaterally" Explanation: 5/5 (100%) normal muscle strength with complete ROM against gravity and full resistance.
Which joint movement is a nurse testing when asking a client to move an extremity towards the body?
Adduction Explanation: Adduction is the movement towards the midline of the body. Flexion is bending the extremity at the joint and decreasing the angle of the joint. Extension is straightening the extremity at the joint and increasing the angle of the joint. Abduction is moving away from the midline of the body.
A client 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?
Ask the client to raise the leg to the point of pain and then dorsiflex the foot Explanation: 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.
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 open and close the mouth Asked the client to jut the jaw forward Asked the client to rock the jaw laterally Explanation: 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.
To assess abduction of the shoulders and arms, a nurse should ask a client to do which of the following?
Bring both hands together overhead starting with the arms at the sides
A nurse has just finished assessing a client's spine and neck muscles. How would the nurse document normal findings?
C7 and T1 spinous processes prominent. Paravertebral, sternocleidomastoid, and trapezius muscles fully developed, symmetrical, and nontender Explanation: Normal findings are that the C7 and T1 spinous processes are prominent. The paravertebral, sternocleidomastoid, and trapezius muscles are fully developed, symmetrical, and nontender. Therefore, other options are incorrect.
Which nutrient deficiency should a nurse recognize as placing a client at risk for osteoporosis?
Calcium Explanation: A calcium deficiency increases the risk osteoporosis. This causes the bones to become softer in nature because the rate at which bone is destroyed is occurring at a faster rate than new bone is made. Protein functions in muscle tone and growth. Vitamin C promotes healing of tissues and bones. Vitamin D deficiency causes osteomalacia, softening of the bones due to defective bone mineralization. Osteomalacia in children is known as rickets.
A client waiting to be seen for a clinic appointment is observed periodically shaking the left wrist. On what should the nurse focus when assessing this client?
Carpal tunnel syndrome Explanation: A motion that resembles shaking a thermometer could indicate the presence of carpal tunnel syndrome. The wrist and hand would not be mobile if the limb is paralyzed. Moving the hand and wrist would produce excruciating pain if the wrist is fractured. The inability to extend the ring and little finger is associated with a Dupuytren contracture.
The nurse asks the client to perform the action shown. What is the nurse assessing?
Carpal tunnel syndrome Explanation: This maneuver is the Phalen test which assesses for carpal tunnel syndrome. The client flexes the wrists 90 degrees and holds the backs of the hands together for 60 seconds. Positive signs include numbness, burning, or pain. This maneuver is not done to test for shoulder or hand grasp strength or to assess for elbow range of motion
When assessing a client's strength, it is necessary to
Compare one side to the other Explanation: When assessing muscle tone and strength, it is necessary to compare one side to the other. It is not necessary to compare the upper extremities to the lower extremities or to assess the upper and lower extremities.
A nurse notices that a client has decreased range of motion with lateral bending of the cervical spine to the left side. What should the nurse do next in relation to this finding?
Compare this finding to the range of motion to the right side Explanation: It is always important to compare both sides of the body for symmetry before making a judgment that data is abnormal. The nurse should then ask the client about previous injuries to the head and neck. All data must be properly documented in the client's record. If this finding is abnormal, the nurse should alert the health care provider for further orders.
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
Which movement shoud lthe nurse instruct the client to perform oto assesss range of motion for the knee.
Flexion
What range of motion is the nurse testing by asking a client to stoop to pick an object off the floor?
Flexion Explanation: Stooping is another term for bending. The client must be able to flex the thoracic and lumbar spines and flex the knees. Extension is straightening the extremity at the joint and increasing the angle of the joint. Abduction is moving away from the midline of the body. Rotation is turning the head to the right and then the left.
A client presents to the health care clinic with reports of a swollen, tender, reddened joint in the left big toe. The nurse recognizes this finding as an indication of what inflammatory process?
Gouty arthritis Explanation: Tender, painful, reddened, hot, and swollen metatarsophalangeal joint in the great (big) toe is seen in gouty arthritis. This is an inflammatory condition caused by an abnormal buildup of uric acid in the body that becomes deposited in the joints. Rheumatoid arthritis can occur in any joint but usually affects the hands first. Verruca vulgaris (warts) is a painful wart that occurs under a callus. Degenerative joint disease does not typically cause the joints to be reddened and hot because it is not an inflammatory process.
What is an approximate quest by the nurse to ask a client about the presence of temporomandibular joint dysfunction?
Have you noticed a popping or grating sound when you chew?
The nurse performs the technique shown when assessing a client. What is the nurse assessing?
Hip flexion Explanation: Applying pressure above the knee and asking the client to keep the leg elevated and extended assesses hip flexion. This technique does not assess for knee strength, fluid in the knee, or spinal nerve status.
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?
Impaired Physical Mobility Explanation: This client is likely experiencing carpal tunnel syndrome because of the repetitive hand movements that inflame the median nerve as it passes through the wrist. Impaired Physical Mobility related to decreased muscle strength as evidenced by a weak right hand grip meets the major criteria to confirm this nursing diagnosis. Risk for Trauma cannot be confirmed because the client already has carpal tunnel syndrome so he is not at risk. Disturbed Body Image and Activity Intolerance do not meet any major defining characteristics to confirm these nursing diagnoses.
A 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.
Increased bone resorption Decreased calcium absorption Decreased osteoblast production Explanation: 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.
A school age client has been diagnosed with genu valgum. What is the other name for this disease?
Knock kneed Explanation: Many children have a temporary period of genu valgum, but persistent knock knee may be genetic or the result of metabolic bone disease. The client may need to swing each leg outward while walking to prevent striking the planted limb with the moving limb. The strain on the knee frequently causes anterior and medial knee pain. Physical therapy and surgical intervention may be required. Bowlegs, also known as genu varum, the knees do not touch when the child stands with the feet together. Bowlegs is consider normal up to the age of 2 to 3 years, but may persist until age 6. Clubfoot, also known as congenital talipes equinovarus (CTEV), is a congenital deformity that rotates the foot internally at the ankle. Flatfeet, a deformity of the foot where the arch collapses or never properly forms.
The nurse is assessing an elderly client and finds an exaggerated thoracic curve. This would be documented as what?
Kyphosis Explanation: Kyphosis is an exaggerated thoracic curve and is common with aging. Scoliosis is lateral curvature of the thoracic spine with an increase in the convexity on the curved side. An exaggerated lumbar curve is lordosis. Ankylosing spondylitis is associated with a flattening of the lumbar curvature.
Increased lumbar curvature, which compensates for the enlarging uterus in pregnant women, is called what?
Lordosis Explanation: Lordosis, increased lumbar curvature, compensates for the enlarging uterus. Kyphosis, overcurvature of the spine in the thoracic and sacral spine, can result from arthritis, osteoporosis, or trauma. Scoliosis is a side to side curvature of the spine. Keracytosis is a skin disorder and a distracter for this question.
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 characteristics of red marrow?
Produces red blood cells
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?
Produces red blood cells Explanation: 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.
What finding should a nurse expect when performing phalen's test on a client with suspected carpal tunnel syndrome?
Reports of tingling, numbness, and pain in the involved wrist
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?
Straight leg raise test Explanation: 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.
The client is facing the nurse with his forearm turned so that his palm is up. What movement is the client exhibiting?
Supination Explanation: Supination occurs when the forearm is turned so that the palm is up. Pronation is turning the forearm so the palm is down. Inversion sis turning the sole of the foot inward. Turning the sole of the foot outward is eversion.
Mrs. Fletcher presents to the office with chronic unilateral pain when chewing. She does not have facial or scalp tenderness. Which of the following is the most likely cause of her pain?
Temporomandibular joint syndrome Explanation: Temporomandibular joint syndrome is a very common cause of pain with chewing. Ischemic pain with chewing, or jaw claudication, can occur with temporal arteritis, but the lack of tenderness of the scalp overlying the artery makes this less likely. Trigeminal neuralgia can be associated with extreme tenderness over the branches of the trigeminal nerve. While a tumour of the mandible is possible, it is much less likely than the other choices.
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 Explanation: Tenderness implies an inflammatory process along with increased temperature. Nodules and ecchymosis are not typically associated with inflammatory processes.
While assessing the elbow of an adult client, the client complains of pain and swelling. The nurse should further assess the client for
arthritis. Explanation: Redness, heat, and swelling may be seen with bursitis of the olecranon process due to trauma or arthritis.
Bones contain yellow marrow that is composed mainly of
fat. Explanation: Bones contain red marrow that produces blood cells and yellow marrow composed mostly of fat.
A client visits the clinic and tells the nurse that after playing softball yesterday, he thinks his knee is "locking up." The nurse should perform the McMurray test by asking the client to
flex the knee and hip while in a supine position. Explanation: If the client complains of a "giving in" or "locking" of the knee, perform McMurray's test. With the client in the supine position, ask the client to flex one knee and hip. Then place your thumb and index finger of one hand on either side of the knee. Use your other hand to hold the heel of the foot up. Rotate the lower leg and foot laterally. Slowly extend the knee, noting pain or clicking. Repeat, rotating lower leg and foot medially. Again, note pain or clicking.
A client has osteoarthritis of the elbow. Which assessment approach should the nurse expect to be impacted by this health problem?
flexion Explanation: A hinge joint provides movement in one plane such as flexion and extension. A ball and socket joint provides a wide range of movement including rotation, abduction, and adduction.
An adult client tells the nurse that he eats sardines every day. The nurse should instruct the client that a diet high in purines can contribute to
gouty arthritis. Explanation: A diet high in purine (e.g., liver, sardines) can trigger gouty arthritis.
Bones in synovial joints are joined together by
ligaments. Explanation: Bones in synovial joints are joined by ligaments, which are strong, dense bands of fibrous connective tissue.
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?
neurological system Explanation: The musculoskeletal system is enervated by the neurological system. Examination of the two systems are closely aligned.
A female client visits the clinic and tells the nurse that she began menarche at the age of 16 years. The nurse should instruct the client that she is at a higher risk for
osteoporosis. Explanation: Women who begin menarche late or begin menopause early are at greater risk for development of osteoporosis because of decreased estrogen levels, which tend to decrease the density of bone mass.
The external covering of the bone that contains osteoblasts and blood vessels is termed the
periosteum. Explanation: The periosteum covers the bones; it contains osteoblasts and blood vessels that promote nourishment and formation of new bone tissues.
A client is unable to externally rotate the left shoulder. What health problem should the nurse suspect is occurring with this client?
rotator cuff tear Explanation: In a complete tear of the supraspinatus tendon, or a rotator cuff tear, active abduction and forward flexion at the glenohumeral joint are severely impaired, producing a characteristic shrugging of the shoulder and a positive "drop arm" test. Rotator cuff tendonitis is characterized by acute, recurrent, or chronic pain of the supraspinatus tendon. Carpal tunnel syndrome effects the wrist and not the shoulder. Anterior dislocation of the humerus is characterized by the shoulder seeming to slip out of the joint.
While assessing the range of motion in an adult client's shoulders, the client expresses pain and exhibits limited abduction and muscle weakness. The nurse plans to refer the client to a physician for possible
rotator cuff tear. Explanation: Painful and limited abduction accompanied by muscle weakness and atrophy are seen with a rotator cuff tear.
A client has uneven height of the shoulders and hips. What should the nurse suspect this client is demonstrating?
scoliosis Explanation: In scoliosis the shoulders and hips will have unequal height. There is an increase in the lumbar curvature in lordosis. There is an increase in the thoracic curvature in kyphosis. Sacroiliitis is associated with tenderness over the sacroiliac joint.
Skeletal muscles are attached to bones by
tendons. Explanation: Skeletal muscles attach to bones by way of strong, fibrous cords called tendons.