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Chapter 62: Musculoskeletal System
Terms in this set (15)
A 42-year-old male patient complains of shoulder pain when the nurse moves his 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?"
The patient's pain will make it more difficult to accomplish tasks like 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. The nurse will explain that bursitis is an inflammation of
a. the synovial membrane that lines the joint.
b. a small, fluid-filled sac found at some joints.
c. the fibrocartilage that acts as a shock absorber in the knee joint.
d. any connective tissue that is found supporting the joints of the body.
Bursae are fluid-filled sacs that cushion joints and bony prominences. Fibrocartilage is a solid tissue that cushions some joints. Bursae are a specific type of connective tissue. The synovial membrane lines many joints but is not a bursa.
The nurse who notes that a 59-year-old female patient has lost 1 inch in height over the past 2 years will plan to teach the patient about
a. discography studies.
b. myelographic testing.
c. magnetic resonance imaging (MRI).
d. dual-energy x-ray absorptiometry (DXA).
The decreased height and the patient's age suggest that the patient may have osteoporosis and that 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-year-old woman's health history will alert the nurse to the need for a more focused assessment of the musculoskeletal system?
a. The patient sprained her ankle at age 13.
b. The patient's mother became shorter with aging.
c. The patient takes ibuprofen (Advil) for occasional headaches.
d. The patient's father died of complications of miliary tuberculosis.
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 of a 30-year-old patient's nutritional-metabolic pattern may indicate the 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 and weighs 180 lb.
d. The patient prefers whole milk to nonfat milk.
The patient's height and weight indicate obesity, which places stress on weight-bearing joints. The use of whole milk, avoiding fruits and vegetables, and use of a daily multivitamin are not risk factors for musculoskeletal problems.
Which medication information will the nurse identify as a concern for a patient's musculoskeletal status?
a. The patient takes a daily multivitamin and calcium supplement.
b. The patient takes hormone therapy (HT) to prevent "hot flashes."
c. The patient has severe asthma and requires frequent therapy with oral corticosteroids.
d. The patient has migraine headaches treated with nonsteroidal antiinflammatory drugs (NSAIDs).
Frequent or chronic corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. The use of HT 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 when the nurse applies light resistance. The nurse should document the patient's muscle strength as level
A level 3 indicates that the patient is unable to move against resistance but can move against gravity. Level 1 indicates minimal muscle contraction, level 2 indicates that the arm can move when gravity is eliminated, and level 4 indicates active movement with some resistance.
After completing the health history, the nurse assessing the musculoskeletal system will begin by
a. having the patient move the extremities against resistance.
b. feeling for the presence of crepitus during joint movement.
c. observing the patient's body build and muscle configuration.
d. checking active and passive range of motion for the extremities.
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 abnormal areas. The other assessments are also included in the assessment but are usually done after inspection.
Which nursing action is correct when performing the straight-leg raising test for an ambulatory patient with back pain?
a. Raise the patient's legs to a 60-degree angle from the bed.
b. Place the patient initially in the prone position on the exam table.
c. Have the patient dangle both legs over the edge of the exam table.
d. Instruct the patient to elevate the legs and tense the abdominal muscles.
When performing the straight leg-raising test, the patient is in the supine position and the nurse passively lifts the patient's legs to a 60-degree angle. The other actions would not be correct for this test.
A 72-year-old patient with kyphosis is scheduled for dual-energy x-ray absorptiometry (DXA) testing. The nurse will plan to
a. explain the procedure.
b. start an IV line for contrast medium injection.
c. give an oral sedative 60 to 90 minutes before the procedure.
d. screen the patient for allergies to shellfish or iodine products.
DXA testing is painless and noninvasive. No IV access is necessary. Contrast medium is not used. Because the procedure is painless, no antianxiety medications are required.
A patient has a new order for magnetic resonance imaging (MRI) to evaluate for left femur osteomyelitis after a hip replacement surgery. Which information indicates that the nurse should consult with the health care provider before scheduling the MRI?
a. The patient has a pacemaker.
b. The patient is claustrophobic.
c. The patient wears a hearing aid.
d. The patient is allergic to shellfish.
Patients with permanent pacemakers cannot have MRI because of the force exerted by the magnetic field on metal objects. An open MRI will not cause claustrophobia. 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 elbow. How will this finding be documented?
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 that causes a dull ache that increases with movement.
Which finding is of highest priority when the nurse is planning care for a 77-year-old patient seen in the outpatient clinic?
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
A history of falls requires further assessment and development of fall prevention strategies. The other changes are more typical of bone and joint changes associated with normal aging.
Which finding from a patient's right knee arthrocentesis will be of concern to the nurse?
a. Cloudy fluid
b. Scant thin fluid
c. Pale yellow fluid
d. Straw-colored fluid
The presence of purulent fluid suggests a possible joint infection. Normal synovial fluid is scant in amount and pale yellow/straw-colored.
Which action can the nurse delegate 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.
Drawing blood specimens is a common skill performed by UAP in clinic settings. The other actions are assessments and require registered nurse (RN)-level judgment and critical thinking.
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