Chapter 35: Musculoskeletal Function Flashcards
A nurse on the orthopedic unit is assessing a client’s peroneal nerve. The nurse should perform this assessment by doing what action?
A. Pricking the skin between the great and second toe
B. Stroking the skin on the sole of the client’s foot
C. Pinching the skin between the thumb and index finger
D. Stroking the distal fat pad of the small finger
ANS: A
Rationale: The nurse will evaluate the sensation of the peroneal nerve by pricking the skin centered between the great and second toe. None of the other listed actions elicits the function of one of the peripheral nerves.
A public health nurse is organizing a campaign that will address the leading cause of musculoskeletal-related disability. The nurse should focus on what health problem?
A. Osteoporosis
B. Arthritis
C. Hip fractures
D. Lower back pain
ANS: B
Rationale: The leading cause of musculoskeletal-related disability is arthritis
A nurse is providing care for a client whose pattern of laboratory testing reveals long-standing hypocalcemia. Which other laboratory result is most consistent with this finding?
A. An elevated parathyroid hormone level
B. An increased calcitonin level
C. An elevated potassium level
D. A decreased vitamin D level
ANS: A
Rationale: In the response to low calcium levels in the blood, increased levels of parathyroid hormone prompt the mobilization of calcium and the demineralization of bone. Increased calcitonin levels would exacerbate hypocalcemia. Vitamin D levels do not increase in response to low calcium levels. Potassium levels would likely be unaffected.
A nurse is caring for a client whose cancer metastasis has resulted in bone pain. What should the nurse expect the client to describe?
A. A dull, deep ache that is “boring” in nature
B. Soreness or aching that may include cramping
C. Sharp, piercing pain that is relieved by immobilization
D. Spastic or sharp pain that radiates
ANS: A
Rationale: Bone pain is characteristically described as a dull, deep ache that is “boring” in nature, whereas muscular pain is described as soreness or aching and is referred to as “muscle cramps.” 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.
A nurse is assessing a client who is experiencing peripheral neurovascular dysfunction. Which assessment findings are most consistent with this diagnosis?
A. Hot skin and a capillary refill of 1 to 2 seconds
B. Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin
C. Pain, diaphoresis, and erythema
D. Jaundiced skin, weakness, and capillary refill of 3 seconds
ANS: B
Rationale: 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. Jaundice, diaphoresis, and warmth are inconsistent with peripheral neurovascular dysfunction.
A client has symptoms of osteoporosis and is being assessed during an annual physical examination. The assessment shows that the client will require further testing related to a possible exacerbation of osteoporosis. The nurse should anticipate which diagnostic test?
A. Bone densitometry
B. Hip bone radiography
C. Computed tomography (CT)
D. Magnetic resonance imaging (MRI)
ANS: A
Rationale: Bone densitometry is considered the most accurate test for osteoporosis and for predicting a fracture. As such, it is more likely to be used than CT, MRI, or x-rays.
A client injured in a motor vehicle accident has sustained a fracture to the diaphysis of the right femur. Of which tissue is the diaphysis of the femur mainly constructed?
A. Epiphyses
B. Cartilage
C. Cortical bone
D. Cancellous bone
ANS: C
Rationale: The long bone shaft, which is referred to as the diaphysis, is constructed primarily of cortical bone.
A client has come to the clinic for a regular check-up. The nurse’s initial inspection reveals an increased thoracic curvature of the client’s spine. The nurse should document the presence of which condition?
A. Scoliosis
B. Epiphyses
C. Lordosis
D. Kyphosis
ANS: D
Rationale: Kyphosis is the increase in thoracic curvature of the spine. Scoliosis is a deviation in the lateral curvature of the spine. Epiphyses are the ends of the long bones. Lordosis is the exaggerated curvature of the lumbar spine.
When assessing a client’s peripheral nerve function, the nurse uses an instrument to prick the fat pad at the top of the client’s small finger. This action will assess what nerve?
A. Radial
B. Ulnar
C. Median
D. Tibial
ANS: B
Rationale: The ulnar nerve is assessed for sensation by pricking the fat pad at the top of the small finger. The radial, median, and tibial nerves are not assessed in this manner.
The results of a nurse’s musculoskeletal examination show an increase in the lumbar curvature of the spine. The nurse should recognize the presence of what health problem?
A. Osteoporosis
B. Kyphosis
C. Lordosis
D. Scoliosis
ANS: C
Rationale: The nurse documents the spinal abnormality as lordosis. Lordosis is an increase in lumbar curvature of the spine. Kyphosis is an increase in the convex curvature of the spine. Scoliosis is a lateral curvature of the spine. Osteoporosis is the significant loss of bone mass and strength with an increased risk for fracture.
A client has sustained traumatic injuries that involve several bone fractures. A fracture of what type of bone may interfere with the protection of the client’s vital organs?
A. Long bones
B. Short bones
C. Flat bones
D. Irregular bones
ANS: C
Rationale: Flat bones, such as the sternum, provide vital organ protection. Fractures of the flat bones may lead to puncturing of the vital organs or may interfere with the protection of the vital organs. Long, short, and irregular bones do not usually have this physiologic function.
A client has just had an arthroscopy performed to assess a knee injury. What nursing intervention should the nurse perform following this procedure?
A. Wrap the joint in a compression dressing.
B. Perform passive range of motion exercises.
C. Maintain the knee in flexion for up to 30 minutes.
D. Apply heat to the knee.
ANS: A
Rationale: Interventions to perform following an arthroscopy include wrapping the joint in a compression dressing, extending and elevating the joint, and applying ice or cold packs. Passive ROM exercises, static flexion, and heat are not indicated.
During assessment, a client reports experiencing rhythmic muscle contractions when the nurse performs passive extension of the wrist. The nurse should recognize the presence of which condition?
A. Fasciculations
B. Contractures
C. Effusion
D. Clonus
ANS: D
Rationale: Clonus may occur when the ankle is dorsiflexed or the wrist is extended. It is characterized as rhythmic contractions of the muscle. Fasciculation is involuntary twitching of muscle fiber groups. Contractures are prolonged tightening of muscle groups, and an effusion is the pathologic escape of body fluid.
A nurse is caring for an older adult who has been diagnosed with geriatric failure to thrive. The nurse should perform interventions to prevent what complication?
A. Muscle clonus
B. Muscle atrophy
C. Rheumatoid arthritis
D. Muscle fasciculations
ANS: B
Rationale: If a muscle is in disuse for an extended period of time, it is at risk of developing atrophy, which is the decrease in size. Clonus is a pattern of rhythmic muscle contractions and fasciculation is the involuntary twitch of muscle fibers; neither results from immobility. Lack of exercise is a risk factor for rheumatoid arthritis.
A nurse is caring for a client who has been scheduled for a bone scan. Which statement should the nurse include when educating the client about this diagnostic test?
A. “The test is brief and requires that you drink a calcium solution 2 hours before the test.”
B. “You will not be allowed fluid for 2 hours before and 3 hours after the test.”
C. “You will be encouraged to drink water after the administration of the radioisotope injection.”
D. “This is a common test that can be safely performed on anyone.”
ANS: C
Rationale: It is important to encourage the client to drink plenty of fluids to help distribute and eliminate the isotope after it is injected. There are important contraindications to the procedure, including pregnancy or an allergy to the radioisotope. The test requires the injection of an intravenous radioisotope, and the scan is performed 2 to 3 hours after the isotope is injected. A calcium solution is not used.
A nurse is assessing a child who has a diagnosis of muscular dystrophy. Assessment reveals that the child’s muscles have greater-than-normal tone. The nurse should document the presence of:
A. tonus.
B. flaccidity.
C. atony.
D. spasticity.
ANS: D
Rationale: A muscle with greater-than-normal tone is described as spastic. Soft and flabby muscle tone is defined as atony. A muscle that is limp and without tone is described as being flaccid. The state of readiness known as muscle tone (tonus) is produced by the maintenance of some of the muscle fibers in a contracted state.
The nurse’s comprehensive assessment of an older adult involves the assessment of the client’s gait. How should the nurse best perform this assessment?
A. Instruct the client to walk heel-to-toe for 15 to 20 steps.
B. Instruct the client to walk in a straight line while not looking at the floor.
C. Instruct the client to walk away from the nurse for a short distance and then toward the nurse.
D. Instruct the client to balance on one foot for as long as possible and then walk in a circle around the room.
ANS: C
Rationale: Gait is assessed by having the client walk away from the examiner for a short distance. The examiner observes the client’s gait for smoothness and rhythm. Looking at the floor is not disallowed and gait is not assessed by observing balance on one leg. Heel-to-toe walking ability is not gauged during an assessment of normal gait.
A clinic nurse is caring for a client with a history of osteoporosis. What diagnostic test will best allow the care team to assess the client’s risk of fracture?
A. Arthrography
B. Bone scan
C. Bone densitometry
D. Arthroscopy
ANS: C
Rationale: Bone densitometry is used to detect bone density and can be used to assess the risk of fracture in osteoporosis. Arthrography is used to detect acute or chronic tears of joint capsule or supporting ligaments. Bone scans can be used to detect metastatic and primary bone tumors, osteomyelitis, certain fractures, and aseptic necrosis. Arthroscopy is used to visualize a joint.
A nurse is performing a musculoskeletal assessment of a client with arthritis. During passive range-of-motion exercises, the nurse hears an audible grating sound. The nurse should document the presence of what assessment finding?
A. Fasciculations
B. Clonus
C. Effusion
D. Crepitus
ANS: D
Rationale: Crepitus is a grating, crackling sound or sensation that occurs as the irregular joint surfaces move across one another, as in arthritic conditions. Fasciculations are involuntary twitching of muscle fiber groups. Clonus is the rhythmic contractions of a muscle. Effusion is the collection of excessive fluid within the capsule of a joint.
A client’s fracture is healing and compact bone is replacing spongy bone around the periphery of the fracture. This process characterizes what phase of the bone healing process?
A. Hematoma formation
B. Fibrocartilaginous callus formation
C. Remodeling
D. Bony callus formation
ANS: C
Rationale: Remodeling occurs as necrotic bone is removed by the osteoclasts. In this phase, compact bone replaces spongy bone around the periphery of the fracture. Each of the other listed phases precedes this stage.
A 10-year-old client is growing at a rate appropriate for the client’s age. Which cells are responsible for the secretion of bone matrix, which eventually results in bone growth?
A. Osteoblasts
B. Osteocytes
C. Osteoclasts
D. Lamellae
ANS: A
Rationale: Osteoblasts function in bone formation by secreting bone matrix. Osteocytes are mature bone cells, and osteoclasts are multinuclear cells involved in dissolving and resorbing bone. Lamellae are circles of mineralized bone matrix.
A nurse is caring for a client who has an MRI scheduled. What is the priority safety action prior to this diagnostic procedure?
A. Assessing the client for signs and symptoms of active infection
B. Ensuring that the client can remain immobile for up to 3 hours
C. Assessing the client for a history of nut allergies
D. Ensuring that there are no metal objects on or in the client
ANS: D
Rationale: Absolutely no metal objects can be present during MRI—their presence constitutes a serious safety risk. The procedure takes up to 90 minutes. Nut allergies and infection are not contraindications to MRI.
A nurse is taking a health history on a client with musculoskeletal dysfunction. What should the nurse prioritize during this phase of the assessment?
A. Evaluating the effects of the musculoskeletal disorder on the client’s function
B. Evaluating the client’s adherence to the existing treatment regimen
C. Evaluating the presence of genetic risk factors for further musculoskeletal disorders
D. Evaluating the client’s active and passive range of motion
ANS: A
Rationale: The nursing assessment of the client with musculoskeletal dysfunction includes an evaluation of the effects of the musculoskeletal disorder on the client. This is a vital focus of the health history and supersedes the assessment of genetic risk factors and adherence to treatment, though these are both valid inclusions to the interview. Assessment of ROM occurs during the physical assessment, not the interview.
A client is scheduled for a bone scan to rule out osteosarcoma of the pelvic bones. Which client status would be most important for the nurse to verify before the client’s scan?
A. Completion of the bowel cleansing regimen
B. Empty bladder
C. No allergy to penicillins
D. Fast for at least 8 hours
ANS: B
Rationale: Before the scan, the nurse asks the client to empty the bladder, because a full bladder interferes with accurate scanning of the pelvic bones. Bowel cleansing and fasting are not indicated for a bone scan, and an allergy to penicillins is not a contraindication.
