Musculoskeletal Flashcards
1
Q
How many bones are in the human body?
A
206 bones
2
Q
What types of bone are there?
A
Compact and Spongey
3
Q
What do osteoblasts do?
A
Build bone
4
Q
What do osteoclasts do?
A
Break down bone
5
Q
The axial skeleton include what parts of the body?
A
Head and trunk
6
Q
The appendicular skeleton include what parts of the body?
A
Extremities, shoulders & hips
7
Q
What are the three types of skeletal muscle?
A
Voluntary skeletal muscle, smooth skeletal muscle, and cardiac skeletal muscle
8
Q
What is a fibrous joint and where is it found?
A
A fibrous joint connects bones with dense connective tissue.
Sutures between skull bone.
9
Q
What is a cartilaginous joint and where is it found?
A
A cartilaginous joint connects bones with cartilage, found in spinal vertebrae.
10
Q
What is a synovial joint and where is it found?
A
A synovial joint allows movement, found in knees, hip, and shoulder.
11
Q
What are Bursae?
A
Small sacs filled with synovial fluid that serve to cushion the joint.
12
Q
What is the normal ROM for hip flexion with the knee straight vs knee bent?
A
90 degrees of hip flexion with the knee straight and 120 degrees with the knee bent.
13
Q
Hallux valgus
A
The great toe is deviated laterally and may overlap the second toe. An enlarged, painful, inflamed bursa (bunion) may form on the medial side.
14
Q
What is Acute Gouty Arthritis and what are the symptoms?
A
The metatarsophalangeal joint of the great toe is tender, painful, reddened, hot, and swollen.
15
Q
What are corns?
A
Painful thickenings of the skin that occur over bony prominences and at pressure points.
16
Q
Plantar warts
A
Painful warts that occur under a callus, appearing as tiny dark spots.
17
Q
What is a Hammer Toe?
A
Hyperextension at the metatarsophalangeal joint with flexion at the proximal interphalangeal joint
18
Q
Osteoporosis risk is low in which group vs high in which other group?
A
Osteoporosis is lowest in males of African descent and highest
in females of European descent
19
Q
Modifiable Risk Factors of Osteoporosis
A
Alcohol intake
Smoking tobacco
Low BMI
Poor nutrition (SDOH?)
Vitamin D deficiency
Eating disorders
Low dietary calcium intake Insufficient exercise (sedentary lifestyle)
Frequent falls
20
Q
Non-modifiable risk factors of Osteoporosis
A
Age
Gender
Family history
Previous fracture
Ethnicity
SDOH
Menopause/hysterectomy
Long-term glucocorticoid therapy
Rheumatoid arthritis
Primary/secondary hypogonadism in those assigned as male at birth
21
Q
What test is performed when assessing the gait of an older adult or handicap adult at risk for falling backwards?
A
“Nudge Test”
Stand behind the client and put your arms around the client while you gently nudge the sternum.
22
Q
How can TMJ affect ROM?
A
Decreased ROM, and a clicking, popping, or grating sound may be noted with TMJ dysfunction
23
Q
What cranial nerve is also assessed during the assessment of TMJ?
A
It tests the integrity of cranial nerve V (trigeminal nerve).
24
Q
What are we assessing for in the Sternoclavicular Joint?
A
Inspect for location, color, swelling, and masses. Then palpate for tenderness or pain.
25
A flattened lumbar curvature may be seen with...
A herniated lumbar disk or ankylosing spondylitis
26
Lateral curvature of the thoracic spine with an increase in the convexity is known as...
Scoliosis
27
An exaggerated lumbar curve is known as ____ and often seen with ____.
(Lordosis) is often seen in pregnancy or obesity
28
The normal ROM for the cervical spine includes flexion and extension of how many degrees?
45 degrees
29
What are some causes of strains in the cervical spine?
Sleeping in the wrong position, carrying a heavy suitcase, or being in an automobile crash.
30
Impaired ROM and neck pain associated with fever, chills, and headache could be indicative of...
A serious infection such as meningitis
31
What is the normal range of motion for lateral bending?
40 degrees to the right and left.
32
Limited ROM in lateral bending of the cervical spine can indicate what kind of injuries?
Limited ROM is seen with neck injuries, osteoarthritis, spondylosis, or disk degeneration.
33
What is the normal range of motion for cervical spine rotation?
70 degrees of rotation
34
Limited ROM in cervical spine rotation can indicate what kind of injuries?
Limited ROM is seen with neck injuries, osteoarthritis, spondylosis, or disk degeneration.
35
What is the normal range of flexion for the lumbar spine?
Flexion of 75–90 degrees, smooth movement, lumbar concavity flattens out, and the spinal processes are in alignment.
36
If the client has low back pain that radiates down the back, what test do we perform?
Perform the straight leg test to check for a herniated nucleus pulposus.
37
During inspection of the shoulder, what are we assessing?
Shoulders are symmetrically round; no redness, swelling, deformity, or heat. Muscles are fully developed. Clavicles and scapulae are even and symmetric. The client reports no tenderness.
38
What is the normal range of motion for the shoulder?
Extent of forward flexion should be 180 degrees; hyperextension, 50 degrees; adduction, 50 degrees; and abduction 180 degrees.
39
What is a ganglion?
A nontender, round, enlarged, swollen, fluid-filled cyst
40
How do you perform the squeeze test of the hand and why do you perform it?
Perform the squeeze test by squeezing the client’s hand across the knuckle joints. Extreme pain may indicate rheumatoid arthritis and psoriatic arthritis of the hand.
41
What is the anatomical snuffbox?
The hollow area on the back of the wrist at the base of the fully extended thumb
42
If a patient experiences tenderness when you palpate the snuffbox, what can that indicate?
Snuffbox tenderness may indicate a scaphoid fracture, which is often the result of falling on an outstretched hand.
43
Ulnar deviation of the wrist and fingers with limited ROM is often seen in...
Rheumatoid arthritis
44
What is the test for Tinel sign?
You percuss over the median nerve of the wrist. Median nerve entrapped in the carpal tunnel results in pain, numbness, and impaired function of the hand and finger.
45
If the client has had a total hip replacement, why do we NOT test for ROM unless the physician gives permission?
Test ROM can lead to the risk of dislocating the hip prosthesis.
46
Inability to abduct the hip is a common sign of _____?
Hip disease
47
Explain the Lasegue Test or Straight leg Raising
Client lying supine, legs flat and extended, support and raise one leg, keeping it straight. Continue to raise that leg just short of pain and then dorsiflex the foot. This maneuver stretches the nerve over a protruded disk.
48
If a patient experiences pain with the Lasegue Test or Straight leg Raising, what can that indicate?
If pain client had is reproduced or worsens, the test is positive, which is seen with a herniated disc.
49
What is the bulge test?
If you notice swelling in the knee, perform the bulge test to determine if the swelling is due to accumulation of fluid or soft-tissue swelling.
50
How do you perform the bulge test?
With the client in a supine position, use the ball of your hand to firmly stroke the medial side of the knee upward, to displace any accumulated fluid. Then press on the lateral side of the knee and look for a bulge on the medial side of the knee.
51
What is the ballottement test?
Detects large amounts of fluid in the knee
52
How do you perform the ballottement test?
In the supine position, place your nondominant thumb and index finger firmly on each side of the patella to displace fluid from the suprapatellar bursa, which lies between the femur and patella. Next, use your dominant fingers to press the patella downward onto the femur. Feel for a fluid wave or a click.
53
Abnormal findings for the McMurray test for the knee may indicate..
Pain or clicking is indicative of a torn meniscus of the knee.
54
How do you perform the McMurray test?
Flex the knee and hip, and drive the knee up 90 degrees. Rotate laterally, then slowly extend the knee, checking for pain or clicking. Repeat by rotating the lower leg and foot medially, again noting any pain or clicking.
55
During palpation, you feel nodules in the posterior ankle. What can this indicate?
Rheumatoid arthritis
56
If you perform a squeeze test of the ankle, extreme pain may indicate...
Extreme pain may indicate rheumatoid arthritis and psoriatic arthritis of the foot
57
Flattening of the lumbar curvature may be seen with...
A herniated lumbar disc or ankylosing spondylitis.
58
Lumber hyperlordosis
Extreme swayback. Note the use of the hands for stability.
59
Boutonnière deformity
Flexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint
60
Swan-neck deformity
Hyperextension of the proximal interphalangeal joint with flexion of the distal interphalangeal joint
61
Swan-neck deformity and Boutonnière deformity are common in what condition?
Chronic rheumatoid arthritis
62
The nurse notes limitation in active range of motion of a client's right shoulder. What would the nurse do next?
The nurse should measure range of motion with a goniometer to provide information about the joint motion in degrees.
63
While assessing the knee joint of a client, a nurse also explains about the typical motions associated with that joint. What would the nurse include?
Flexion and Extension
64
Assessment reveals that a client has slight weakness with active range of motion against some resistance. How would the nurse document this finding?
4/5
65
During the nursing history of a newly admitted client, the nurse is reviewing a client's current medication regimen. What medication category creates a risk for decreased bone density?
Corticosteroids
66
What would the nurse interpret as a positive response to the Phalen test for a client suspected of having carpal tunnel syndrome?
Complaints of numbness, tingling, and pain indicate a positive response, suggesting carpal tunnel syndrome.
67
Disease in which bones demineralize and become porous and fragile, making them susceptible to fractures, silent and progressive
Osteoporosis
68
Describe the effect of weight gain on the MSK system.
Weight gain can increase physical stress and strain on the MSK system
69
What is the character and quality of bone pain (what does it feel like)?
Bone pain is dull, deep and throbbing
70
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
71
What is the character and quality of muscle pain (what does it feel like)?
Muscle pain is aching but either mechanical or inflammatory
72
Sharp knife-like pain occurs with what type of bone injury?
Fractures
73
A patient presents with joint pain that initially affects one set of joints on one side of the body. They describe a deep, aching pain that improves with rest, worsens in rainy weather, and includes a sensation of bones grating together. The patient also reports morning stiffness. Based on these symptoms, which condition is this?
Joint pain with Osteoarthritis
74
A patient presents with burning, throbbing joint pain accompanied by heat and soreness. They also report muscle weakness, fatigue, depression, weight loss, decreased appetite, an increased temperature, and morning stiffness lasting over an hour. Based on these symptoms, which condition is this?
Rheumatoid arthritis
75
Explain how menopause is related to the MSK system and related conditions
Decreased estrogen levels lead to a greater risk for the development of osteoporosis because decreased estrogen levels tend to decrease the density of bone mass
76
A nurse is assessing a patient’s dietary habits as part of their musculoskeletal (MSK) health evaluation. Which of the following statements by the patient may indicate a risk for gouty arthritis?
A) "I drink a glass of milk daily and take calcium supplements."
B) "I eat plenty of protein to maintain muscle tone."
C) "I consume liver and red meat regularly and enjoy alcohol on weekends."
D) "I take vitamin C to help with tissue and bone healing."
Answer: C) "I consume liver and red meat regularly and enjoy alcohol on weekends."
Rationale: A diet high in purines, found in red meat, liver, sardines, and alcohol, increases uric acid levels, which can trigger gouty arthritis. Proper diet modifications, including reducing purine intake and staying hydrated, can help prevent flare-ups.
77
The nurse notes that a client’s abdominal skin is pale and taut. What should the nurse suspect is causing this finding?
Pale taut skin may be seen with ascites which is significant abdominal swelling that indicates fluid accumulation in the abdominal cavity.
78
How does smoking, caffeine, and alcohol affect the risk of osteoporosis?
Tobacco, alcohol and caffeinated beverages increases risk of osteoporosis
79
Factors that increase the risk of osteoporosis
Diet (low calcium and vitamin intake)
Estrogen (estrogen levels tend to decrease the density of bone mass
Sedentary lifestyle increases the risk as prolonged immobility leads to muscular atrophy
80
If you identify a limitation in ROM, you measure the ROM with what device?
GONIOMETER
81
Inspection of a client's foot reveals an enlarged, painful, inflamed bursa on the medial side of the foot. The nurse should make a referral for what health problem?
Hallux valgus
82
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 health care provider for possible
Painful and limited abduction accompanied by muscle weakness and atrophy are seen with a rotator cuff tear.
83
What nutritional value promotes muscle tone and bone growth
Adequate protein in the diet
84
What nutritional value promotes healing of tissues and bones?
Vitamin C
85
What sign indicates a large effusion in the knee joint when fluid is palpable medial to the patella when the suprapatellar pouch is depressed?
Balloon sign
86
This movement describes a decrease in the angle of the joint (bend elbow).
Flexion
87
This movement describes an increase in the angle of the joint (straight elbow)
Extension
88
This movement describes an excessive increase in the angle of the joint (bending head backward).
Hyperextension
89
This movement describes moving bone away from the body.
Abduction
90
This movement describes moving bone toward the body.
Adduction
91
This movement describes moving the bone around the central axis.
Rotation
92
A nurse is preparing a program on osteoporosis for a local women's group. What would the nurse cite as a risk factor?
Multiple Pregnancies
Obesity
Smoking
Oral Contraceptives
Smoking is a risk factor for osteoporosis
93
Most of our joints are what kind of joints?
Synovial joints
94
How can the use of diuretics affect the musculoskeletal system?
Diuretics alter electrolyte levels, causing muscle weakness
95
How can the use of steroids affect the musculoskeletal system?
Steroids deplete muscle mass. Bone loss occurs most rapidly in the first 6 months after starting oral steroids
96
How can the use of statins affect the musculoskeletal system?
Reactions to statins can lead to myopathy (muscle pain, soreness, tiredness and weakness)
97
What nutritional value promotes the absorption of calcium?
Vitamin D is needed to absorb calcium
98
Diet high in purine (meat, liver and sardines) and alcohol can trigger what medical condition?
Gouty arthritis
99
If a nurse is assessing muscle strength in a patient who exhibits no muscular contraction, what would the nurse document?
Strength rating of 0, Paralysis
100
If a nurse is assessing muscle strength in a patient who exhibits a slight flicker of contraction, what would the nurse document?
Strength rating of 1, Severe weakness
101
A nurse is assessing muscle strength in a patient who can perform passive ROM (gravity removed and assisted by the examiner), what would the nurse document?
Strength rating of 2, Poor ROM
102
A nurse is assessing muscle strength in a patient who exhibits active motion against gravity, what would the nurse document?
Strength rating of 3, Average weakness
103
A nurse is assessing muscle strength in a patient who exhibits active motion against some resistance, what would the nurse document?
Strength rating of 4, Slight weakness
104
If a nurse is assessing the muscle strength of a patient who exhibits active motion against full resistance, what would the nurse document?
Strength rating of 5, normal finding
105
Falling backward easily is seen with ____ and ____.
Cervical spondylosis and Parkinson's disease.
106
Decreased ROM, and a clicking, popping, or grating sound may be noted with ______ condition.
TMJ dysfunction
107
What is crepitus
A clicking, popping, or grinding sound that occurs when opening or closing the mouth
108
The nurse is beginning a focused assessment of a new admission to inspect and palpate the cervical, thoracic, and lumbar spine. What are the steps and observations the nurse will take?
Have the patient standing erect with an adequate view of the spine. Observe for symmetry, noting differences in the height of the shoulders, iliac crests, and buttock creases.
109
Describe a normal finding when assessing the spine (cervical, lumbar, thoracic)
The cervical and lumbar spines are concave. The thoracic spine is convex. The spine is straight (when observed from behind).
110
A flattened lumbar curvature can be observed with which of the following conditions (select all that apply)?
Scoliosis
Herniated disc
Kyphosis
Compression fracture
Ankylosing spondylitis
COPD
Herniated disc & ankylosing spondylitis
111
An exaggerated lumbar curve (lordosis) can be observed with which of the following conditions (select all that apply).
Pregnancy
Anorexia
Obesity
Collapsed vertebrae
Hypothermia
Pregnancy & Obesity
112
_______ and ______ strains can cause pain and tenderness of the Spinal processes and Paravertebral muscles.
Compression fractures and Lumbosacral muscle
113
What is the Lasegue test? What does it check for?
Straight leg test; When a patient reports of low back pain that radiates down. Check for a herniated nucleus pulposus.
114
How do you perform the straight leg test?
Ask the client to lie flat and raise each leg independently until pain is experienced. At the point of pain, dorsiflex the client’s foot.
115
Painful and limited abduction accompanied by muscle weakness and atrophy are seen with a _____.
Rotator cuff tear
116
Flat, hollow, or less-rounded shoulders are seen with ______.
Dislocation
117
A patient comes into the ED reporting tenderness, swelling, and heat throughout the MSK system. What are some possible diagnoses?
Shoulder strains, sprains, arthritis, bursitis, and degenerative joint disease (DJD)
118
What is bursitis?
Redness, heat, and swelling are seen because of an inflamed bursa (a fluid-filled sac that cushions bones, tendons, and muscles near joints)
119
Which nerve is entrapped in CTS?
The median nerve
120
The median nerve of a 13-year-old patient is entrapped in the carpal tunnel. What are some symptoms they could experience?
Pain, numbness, and impaired function of the hand and fingers
121
Findings seen in acute rheumatoid arthritis
Swollen, stiff, tender, finger joints
122
Findings seen the hands of a person with osteoarthritis
Hard, painless nodules over distal interphalangeal joints (Heberden nodes) and over the proximal interphalangeal joints (Bouchard nodes)
123
Hard and painless nodules over distal interphalangeal joints are known as...
Heberden nodes
124
Hard and painless nodules over proximal interphalangeal joints are known as...
Bouchard nodes
125
Instability, inability to stand, and/or a deformed hip area may indicate what kind of MSK injury?
Hip fracture
126
Tenderness, edema, decreased ROM, and crepitus in the hip may indicate what kind of MSK injury?
Hip inflammation and DJD (Degenerative joint disease).
127
What is a hallmark sign of hip disease?
Inability to abduct hip.
128
Pain and decrease in internal hip rotation could be a sign of _____ or ______.
Sign of osteoarthritis or femoral neck stress fracture.
129
Pain as client moves from standing to lying down could be a sign of _____.
Bursitis of the hip.
130
When you are inspecting the knee, how should the patient be positioned?
With patient supine, then sitting with knees dangling
131
What can explain why some older clients have a bow-legged appearance?
Because of decreased muscle control.
132
Genu valgum
Knock-kneed (inward)
133
Genu varum
Bow legged (outward)
134
What may explain swelling about or next to patella?
Fluid in the knee joint or thickening of synovial membrane
135
Tenderness and warmth with boggy consistency in the knee can be linked to _____.
Symptoms of synovitis
136
Asymmetric muscle development in quadriceps is due to ___
atrophy
137
Hallmark characteristics of Osteoarthritis
Decreased ROM with synovial thickening and crepitation
138
What are the symptoms of a torn meniscus? How can you test for this?
Pain or clicking when knee slowly extends and when lower leg and foot rotate medially (McMurray Test).
139
Normal ranges for knee ROM
120-130 degrees of flexion.
0 degrees of extension to 15 degrees of hyperextension.
Patient should have full ROM against resistance.
140
Pes varus
Toes pointing inward instead of forward
141
Pes valgus
Toes pointing outward instead of forward
142
What is the most common site of sprains
Ankles are the most common site
143
What is a bunion?
A hallux vagus, enlarged, painful, inflamed bursa on the medial side (inner side) of the foot.
144
The nurse is working with a client who has leukemia, which affects the red marrow of the bones. The nurse understands that a characteristic of red marrow is...
Produces RBCs
145
The external covering of the bone that contains osteoblasts and blood vessels is termed the
Periosteum
146
A client has osteoarthritis of the elbow. Which assessment approach should the nurse expect to be impacted by this health problem?
Flexion
Extension
Rotation
Abduction
Adduction
Hyperextension
Flexion & Extension.
The elbow is a hinge joint that 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.
147
Which of the following are types of connective tissue? Select all that apply.
Bone
Ligaments
Skeletal muscle
Articulations
Tendons
Bone
Ligaments
Tendons
148
Which of these medications should a nurse ask a client if they are taking when assessing the risk for osteoporosis? Select all that apply.
Corticosteroids
Antihypertensives
Estrogen replacement therapy
Thyroid replacement drugs
Rescue inhaler for asthma
Medications that may increase a client's risk for osteoporosis include corticosteroids, thyroid replacement drugs, seizure medications, and some drugs for gastrointestinal disorders.
149
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
150
A client has a disorder of the hypothalamus. The nurse recognizes that this structure is found in which area of the brain?
Diencephalon
151
The nurse suspects the client has increased intracranial pressure due to meningitis. What should the nurse assess?
Neck mobility
152
When documenting assessment of the nervous system, a nurse should keep in mind what important principle?
Describe the response
