Quiz 7: Musculoskeletal Assessment and Nursing Interventions

When assessing muscle strength, the nurse observes that a patient has complete range of motion against gravity with full resistance. What grade of muscle strength should the nurse record using a 0- to 5-point scale?

5

Complete range of motion against gravity is normal muscle strength and is recorded as grade 5 muscle strength. The other options are not correct. A grade 4 indicates full ROM against gravity and some resistance. A grade 3 indicates full ROM with gravity. A grade 2 indicates full ROM with gravity eliminated (passive motion). A grade 1 indicates slight contraction and a grade 0 indicates no contraction.

A patient's annual physical examination reveals a lateral curvature of the thoracic and lumbar segments of the spine; however, this curvature disappears with forward bending. What is this abnormality called?

Functional scoliosis

Functional scoliosis is flexible and apparent with standing but disappears with forward bending. Structural scoliosis is fixed; the curvature shows both when standing and when bending forward. These findings are not indicative of a herniated nucleus pulposus or dislocated hip.

The nurse is teaching a class on preventing osteoporosis to a group of perimenopausal women. Which action is the best way to prevent or delay bone loss in this group?

Performing physical activity, such as fast walking

To reduce the risk of osteoporosis, all adults should engage in regular physical activity, including strength training, balance training, and fast walking. The other options are not correct. Annually assessing bone density does not prevent or delay bone loss, it just monitors it. There are no medications to prevent osteoporosis, but to treat it. Taking 800 mg calcium and 200 IU vitamin D supplements daily is not enough to meet the recommended daily doses for a perimenopausal woman. The best way to prevent or delay bone loss is exercise.

What are the fibrous bands that run directly from one bone to another, strengthen the joint, and help prevent movement in undesirable directions called?

ligaments

Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions are called ligaments. A bursa is an enclosed sac filled with viscous synovial fluid, much like a joint. A tendon is a strong fibrous cord that attaches skeletal muscle to bone. Cartilage is a very stable connective tissue that has a tough, firm consistency yet is flexible.

The nurse has completed the musculoskeletal examination of a patient's knee and has found a positive bulge sign. How does the nurse interpret this finding?

Swelling from fluid in the suprapatellar pouch

A positive bulge sign confirms the presence of swelling caused by fluid in the suprapatellar pouch. The other options are not correct.

The nurse is assessing the joints of a patient who has stated, “I have a long family history of arthritis, and my joints hurt.” The nurse suspects that the patient has osteoarthritis. Which of these are symptoms of osteoarthritis? (Select all that apply.)

- Asymmetric joint involvement

- Affected joints are swollen with hard, bony protuberances

- Pain with motion of affected joints

In osteoarthritis, asymmetric joint involvement commonly affects hands, knees, hips, and lumbar and cervical segments of the spine. Affected joints have stiffness, swelling with hard bony protuberances, pain with motion, and limitation of motion. The other options reflect the signs of rheumatoid arthritis.

The nurse notices that someone in an exercise class is unable to do one-person jump rope. What does the nurse know that the shoulder must be able to do in order for someone to be able to do one-person jump rope?

Circumduction

Circumduction is defined as moving the arm in a circle around the shoulder. This movement is necessary to perform one-person jump rope. Inversion is the moving of the sole of the foot inward at the ankle. Supination is turning the forearm so the palm is down. Protraction is moving a body part forward and parallel to the ground.

A woman who is 8 months pregnant comments that she has noticed a change in her posture and is having lower back pain. The nurse tells her that during pregnancy, women have a posture shift to compensate for the enlarging fetus. What is the term for this shift in posture?

Lordosis

Lordosis is a shifting of weight farther back on the lower extremities which occurs in pregnant women to. This shift in balance compensates for the enlarging fetus, which would otherwise shift the center of balance forward. This shift in balance, in turn creates strain on the low back muscles, which in some women is felt as low back pain during late pregnancy Scoliosis is lateral curvature of portions of the spine; ankylosis is extreme flexion of the wrist, as observed with severe rheumatoid arthritis; and kyphosis is an enhanced thoracic curvature of the spine. The symptoms this patient is experiencing are lordosis.

A patient has been diagnosed with osteoporosis and asks the nurse, "What is osteoporosis?" What is the best explanation by the nurse?

"It is the loss of bone density."

Osteoporosis is a disease involving the loss of mineralized bone mass, which leads to porous bone and thus the risk of fractures. Although aging women have a greater amount of bone loss compared with aging men, decreased levels of estrogen in both sexes are partly responsible because osteoblasts that form new bone have estrogen receptors. The other options are not correct. There is a decrease, not increase, in bone matrix with aging; new bone growth is slower than the loss of bone matrix (not weaker bone growth); and phagocytic activity has nothing to do with bones.

A patient tells the nurse they are having a hard time bringing their hand to their mouth when they eat or try to brush their teeth. The nurse knows that for the patient to move their hand to their mouth, they must perform which movement?

Flexion

Flexion is bending a limb at a joint. To move the hand to the mouth flexion of the elbow is required. Extension is straightening a limb at a joint. Moving a limb toward the midline of the body is called adduction; abduction is moving a limb away from the midline of the body.

A patient states, "I can hear a crunching or grating sound when I kneel." The patient also states that "it is very difficult to get out of bed in the morning because of stiffness and pain in my joints." The nurse would assess for signs of what problem?

Crepitation

Crepitation is an audible and palpable crunching or grating that accompanies movement and occurs when articular surfaces in the joints are roughened, as with rheumatoid arthritis. A bone spur is a bony projection (osteophyte) that develops along a bone edge, usually where bones meet at a joint. They often do not cause pain, but when they do, it is usually pain with movement in the specific joint with the bone spur. Tendonitis is an inflammation of a tendon and produces a swelling and tenderness to that one spot in the joint and affects only certain planes of ROM, especially during active ROM. Excess fluid in the knee can cause swelling and difficulty moving the knee, but usually does not cause pain, although the disease process causing the fluid (e.g. rheumatoid arthritis, osteoarthritis) may cause pain. The symptoms this patient is experiencing (audible and palpable crunching when kneeling indicates crepitation.

The nurse is checking the range of motion in a patient's knee and knows that the knee is capable of which movement(s)?

Flexion and extension

The knee is a hinge joint, permitting flexion and extension of the lower leg on a single plane. The knee is not capable of circumduction, inversion, eversion, supination, or pronation.

A patient has come into the clinic reporting extreme pain in their toes. The nurse notices that their toes are slightly swollen, reddened, and warm to the touch. What does the nurse suspect?

Acute gout

Clinical findings for acute gout consist of redness, swelling, heat, and extreme pain such as a continuous throbbing. Gout is a metabolic disorder of disturbed purine metabolism, associated with elevated serum uric acid. Osteoporosis is a decrease in skeletal bone mass leading to low bone mineral density and impaired bone density which increases the risk for fractures. It occurs primarily in postmenopausal white women. Ankylosing spondylitis is chronic inflamed vertebrae and is characterized by inflammatory back pain that is dull and deep in lower back or buttocks. Degenerative joint disease (osteoarthritis) is a localized, progressive disorder involving deterioration of articular cartilages and subchondral bone remodeling, synovial inflammation, and formation of new bone at joint surfaces. Asymmetric joint involvement commonly affects hands, knees, hips, and lumbar and cervical segments of the spine. This patient's symptoms are consistent with acute gout.

To palpate the temporomandibular joint, where would the nurse place his or her fingers?

The depression anterior to the tragus of the ear

The temporomandibular joint can be felt in the depression anterior to the tragus of the ear. The other locations are not correct.

What are the functional units of the musculoskeletal system?

Joints

Joints are the functional units of the musculoskeletal system because they permit the mobility needed to perform the activities of daily living. The skeleton (bones) is the framework of the body. There are three types of muscles: skeletal, smooth, and cardiac and they produce movement when they contract. Tendons are strong fibrous cords that attach skeletal muscles to the bones. The joints, not bones, muscles, or tendons are the functional units of the musculoskeletal system.

When reviewing the musculoskeletal system, the nurse would recall that hematopoiesis takes place where?

Bone marrow

One of the many functions of the musculoskeletal system is to produce the red blood cells, white blood cells, and platelets in the bone marrow (hematopoiesis). The musculoskeletal system also functions to encase and protect the inner vital organs, to support the body, and to store minerals. The other options are not correct. The liver has many functions such as detoxifying the blood, production of bile, and synthesis of proteins needed for blood to clot, but hematopoiesis is not one of its functions. The spleen has many functions such as filtering the blood as part of the immune system, recycling old red blood cells, and storing platelets and white bloods cells but it is not the location of hematopoiesis. The kidney also has many functions such as maintaining fluid balance, filtering minerals, and production of hormones that help stimulate red blood cells production; however, it is not the location of hematopoiesis.

The nurse is explaining to a patient that there are shock absorbers in his back to cushion the spine and to help it move. What is the nurse referring to as shock absorbers?

Intervertebral disks

Intervertebral disks are elastic fibrocartilaginous plates that cushion the spine similar to shock absorbers and help it move. The vertebral column is the spinal column itself. The nucleus pulposus is located in the center of each disk. The vertebral foramen is the channel, or opening, for the spinal cord in the vertebrae.

A patient is able to flex their right arm forward without difficulty or pain but is unable to abduct the arm because of pain and muscle spasms. What does the nurse suspect?

Rotator cuff lesions

Rotator cuff lesions may limit range of motion and cause pain and muscle spasms during abduction, whereas forward flexion remains fairly normal. Crepitation is an audible and palpable crunching or grating that accompanies movement and occurs when articular surfaces in the joints are roughened, as with rheumatoid arthritis. Rheumatoid arthritis is a chronic inflammatory condition in the joints. Joint involvement is symmetric and bilateral (not just one side as in this patient), with heat, redness, swelling, and painful motion of affected joints. A dislocated shoulder shows an obvious deformity and severe pain with movement (not just with certain movements as with this patient). The symptoms this patient is experiencing are that of rotator cuff lesions.

A patient is being assessed for joint range-of-motion. The nurse asks him to move his arm in toward the center of his body. What is this movement called?

Adduction

Moving a limb toward the midline of the body is called adduction; moving a limb away from the midline of the body is called abduction. Flexion is bending a limb at a joint; and extension is straightening a limb at a joint.

A patient is reporting pain in the joints that is worse in the morning, better after they move around for a while, and then gets worse again if they sit for long periods. The nurse would assess for other signs of what problem?

Rheumatoid arthritis

Rheumatoid arthritis pain is worse in the morning when a person arises and then improves with movement. Movement increases most other types of joint pain.