Lewis: Chapter 61: Assessment: Musculoskeletal System Flashcards
A patient reports shoulder pain when the nurse moves the patient’s arm behind the back. Which question should the nurse ask?
a. “Are you able to feed yourself without difficulty?”
b. “Do you have difficulty when you are putting on a shirt?”
c. “Are you able to sleep through the night without waking?”
d. “Do you ever have trouble lowering yourself to the toilet?
b. “Do you have difficulty when you are putting on a shirt?”
The patient’s pain will make it more difficult to accomplish tasks such as putting on a shirt or jacket. This pain should not affect the patient’s ability to feed himself or use the toilet because these tasks do not involve moving the arm behind the patient. The arm will not usually be positioned behind the patient during sleeping.
A patient with left knee pain is diagnosed with bursitis. What area should the nurse explain is the site of inflammation in bursitis?
a. A fluid-filled sac found at some joints.
b. A synovial membrane that lines some joints.
c. The connective tissue joining bones within a joint.
d. The fibrocartilage that acts as a shock absorber in the knee.
a. A fluid-filled sac found at some joints.
Bursae are fluid-filled sacs that cushion joints and bony prominences. Fibrocartilage is a solid tissue that cushions some joints. Ligaments are connective tissue joining bones within a joint. The synovial membrane lines many joints but is not affected in bursitis.
The nurse notes that a 59-yr-old female patient has lost 1 inch in height over the past 2 years. What diagnostic test should the nurse plan to discuss with the patient?
a. Discography studies
b. Myelographic testing
c. Magnetic resonance imaging (MRI)
d. Dual-energy x-ray absorptiometry (DXA)
d. Dual-energy x-ray absorptiometry (DXA)
The decreased height and the patient’s age suggest that the patient may have osteoporosis, and bone density testing is needed. Discography, MRI, and myelography are typically done for patients with current symptoms caused by musculoskeletal dysfunction and are not the initial diagnostic tests for osteoporosis.
Which information in a 67-yr-old woman’s health history should alert the nurse to the need for a focused assessment of the musculoskeletal system?
a. The patient sprained her ankle at age 13.
b. The patient’s father died of tuberculosis.
c. The patient’s mother became shorter with aging.
d. The patient takes ibuprofen for occasional headaches.
c. The patient’s mother became shorter with aging.
A family history of height loss with aging may indicate osteoporosis, and the nurse should perform a more thorough assessment of the patient’s current height and other risk factors for osteoporosis. A sprained ankle during adolescence does not place the patient at increased current risk for musculoskeletal problems. A family history of tuberculosis is not a risk factor. Occasional nonsteroidal antiinflammatory drug (NSAID) use does not indicate any increased musculoskeletal risk.
Which information obtained during the nurse’s assessment may indicate a patient’s increased risk for musculoskeletal problems?
a. The patient takes a multivitamin daily.
b. The patient dislikes fruits and vegetables.
c. The patient is 5 ft, 2 in tall and weighs 180 lb.
d. The patient prefers whole milk to nonfat milk.
c. The patient is 5 ft, 2 in tall and weighs 180 lb.
The patient’s height and weight indicate obesity, which places stress on weight-bearing joints and predisposes the patient to osteoarthritis. The use of whole milk, avoidance of fruits and vegetables, and use of a daily multivitamin are not risk factors for musculoskeletal problems.
Which medication information should the nurse identify as a potential risk to a patient’s musculoskeletal system?
a. The patient takes a daily multivitamin and calcium supplement.
b. The patient has asthma requiring frequent therapy with oral corticosteroids.
c. The patient takes hormone replacement therapy (HRT) to prevent “hot flashes.”
d. The patient has headaches treated with nonsteroidal antiinflammatory drugs
(NSAIDs).
b. The patient has asthma requiring frequent therapy with oral corticosteroids.
Frequent or chronic corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. The use of HRT and calcium supplements will help prevent osteoporosis. NSAID use does not increase the risk for musculoskeletal problems.
The nurse finds that a patient can flex the arms when no resistance is applied but is unable to flex against light resistance. How should the nurse document the patient’s muscle strength level?
a. 0
b. 1
c. 2
d. 3
d. 3
Muscle strength of 3 indicates the patient is unable to move against resistance but can move against gravity. Level 1 indicates minimal muscle contraction, level 2 indicates the arm can move when gravity is eliminated, and level 4 indicates active movement with some resistance.
After completing the health history, how should the nurse begin to assess the musculoskeletal system?
a. Feel for the presence of crepitus during joint movement.
b. Have the patient move the extremities against resistance.
c. Observe the patient’s body build and muscle configuration.
d. Check active and passive range of motion for the extremities.
c. Observe the patient’s body build and muscle configuration.
The usual technique in the physical assessment is to begin with inspection. Abnormalities in muscle mass or configuration will allow the nurse to perform a more focused assessment of affected areas. The other assessments are included but are usually done after inspection.
Which action should the nurse include when performing the straight-leg raising test for an ambulatory patient with back pain?
a. Lift the patient’s leg to a 60-degree angle from the bed.
b. Place the patient in the prone position on the exam table.
c. Ask the patient to dangle both legs over the edge of the exam table.
d. Instruct the patient to elevate the legs and tense the abdominal muscles.
a. Lift the patient’s leg to a 60-degree angle from the bed.
When performing the straight leg-raising test, nurse passively lifts the patient’s legs to a 60-degree angle while the patient is in the supine position. The other actions would not be correct for this test.
A patient with severe kyphosis is scheduled for dual-energy x-ray absorptiometry (DXA) testing. Which action should the nurse plan to take?
a. Explain the procedure to the patient.
b. Start an IV line for contrast injection.
c. Give an oral sedative 60 to 90 minutes before the procedure.
d. Screen the patient for allergies to shellfish or iodine products.
a. Explain the procedure to the patient.
DXA testing is painless and noninvasive. No IV access is necessary. Contrast medium is not used. Shellfish or iodine allergies are not a concern with DXA testing. Because the procedure is painless, antianxiety medications are not typically required.
A patient has a new order for magnetic resonance imaging (MRI) to evaluate possible left femur osteomyelitis after hip arthroplasty surgery. Which information indicates the nurse should consult with the health care provider before scheduling the MRI?
a. The patient has a pacemaker.
b. The patient wears a hearing aid.
c. The patient is allergic to shellfish.
d. The patient uses supplemental oxygen.
a. The patient has a pacemaker.
Patients with most permanent pacemakers cannot have an MRI because of the force exerted by the magnetic field on metal objects. Supplemental oxygen can be delivered during the MRI. The patient will need to be instructed to remove the hearing aid before the MRI, but this does not require consultation with the health care provider. Because contrast medium will not be used, shellfish allergy is not a contraindication to MRI.
The nurse notes crackling sounds and a grating sensation with palpation of an older patient’s lbow. How should this finding be documented?
a. Torticollis
b. Crepitation
c. Subluxation
d. Epicondylitis
b. Crepitation
Crackling sounds and a grating sensation that accompany movement are described as crepitus or crepitation. Torticollis is a twisting of the neck to one side, subluxation is a partial dislocation of the joint, and epicondylitis is an inflammation of the elbow causing a dull ache that increases with movement.
Which finding for a 77-yr-old patient seen in the outpatient clinic is the highest priority for further nursing assessment and intervention?
a. Symmetric joint swelling of fingers
b. Decreased right knee range of motion
c. Report of left hip aching when jogging
d. History of recent loss of balance and fall
d. History of recent loss of balance and fall
A history of falls is a safety issue that requires further assessment and development of fall prevention strategies. The other changes may require additional attention but are less urgent.
Which finding from analysis of fluid from a patient’s right knee arthrocentesis should be of concern to the nurse?
a. Cloudy fluid
b. Scant thin fluid
c. Pale yellow fluid
d. Straw-colored fluid
a. Cloudy fluid
The presence of purulent (cloudy) fluid suggests a possible joint infection. Normal synovial fluid is scant in amount and pale yellow/straw-colored.
Which task can the nurse assign to unlicensed assistive personnel (UAP) who are working in the orthopedic clinic?
a. Grade leg muscle strength for a patient with back pain.
b. Obtain blood sample for uric acid from a patient with gout.
c. Perform straight-leg-raise testing for a patient with sciatica.
d. Check for knee joint crepitation before arthroscopic surgery.
b. Obtain blood sample for uric acid from a patient with gout.
In clinic setting, drawing blood specimens is a common skill performed by UAP who are trained. The other actions are assessments and require registered nurse (RN)–level judgment and critical thinking.
