Chap. 66 Assessment : Musculoskeletal System

A patient reports shoulder pain when the nurse moves the patient‘s arm behind the back. Which question would the nurse ask?

“Do you have difficulty when you are putting on a shirt?”

A patient with left knee pain is diagnosed with bursitis. Which location would the nurse identify as being the site of inflammation?

A fluid-filled sac found at the joint

The nurse notes that a 59-yr-old female patient has lost 1 inch in height over the past 2 years. Which diagnostic test would the nurse plan to discuss with the patient?

Dual-energy x-ray absorptiometry (DXA)

Which information in a 67-yr-old woman‘s health history would alert the nurse to the need for a focused assessment of the musculoskeletal system?

The patient‘s mother became shorter with aging.

Which information obtained during the nurse‘s assessment may indicate a patient‘s increased risk for musculoskeletal problems?

The patient is 5 ft, 2 in tall and weighs 180 lb.

Which medication information would the nurse identify as a potential risk to a patient‘s musculoskeletal system?

The patient has asthma requiring frequent therapy with oral corticosteroids.

The nurse finds that a patient can flex the arms when no resistance is applied but is unable to flex against light resistance. How would the nurse document the patient‘s muscle strength level?

3

After completing the health history, how would the nurse begin to assess the musculoskeletal system?

Observe the patient‘s body build and muscle configuration.

Which action would the nurse include when performing the straight-leg raising test for an ambulatory patient with back pain?

Lift the patient‘s leg to a 60-degree angle from the bed.

A patient with severe kyphosis is scheduled for dual-energy x-ray absorptiometry (DXA) testing. Which action would the nurse plan to take?

Explain the procedure to the patient.

A patient has a new order for magnetic resonance imaging (MRI) without contrast to evaluate possible left femur osteomyelitis after hip arthroplasty surgery. Which information indicates the nurse would consult with the health care provider before scheduling the MRI?

The patient has a pacemaker.

The nurse notes crackling sounds and a grating sensation with palpation of an older patient‘s elbow. How would this finding be documented?

Crepitation

Which finding for a 77-yr-old patient seen in the outpatient clinic is the highest priority for further nursing assessment and intervention?

History of recent loss of balance and fall

Which finding from analysis of fluid from a patient‘s right knee arthrocentesis would be of concern to the nurse?

Cloudy fluid

Which task can the nurse assign to assistive personnel (AP) who are working in the orthopedic clinic?

Obtain blood sample for uric acid from a patient with gout.

A patient‘s radiology report describes a fracture of the proximal tibial epiphysis. Which location corresponds to the reported fracture?

Just below the knee