NUR 216F 52

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TomWruble
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248825
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NUR 216F 52
Updated:
2013-12-03 19:36:38
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assessment musculoskeletal system
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Assessment of the Musculoskeletal System
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  1. The AAA bone is the least common type and develops within a tendon; the BBB is a typical example.
    • A) sesamoid
    • B) patella
  2. Bones provide for storage of ...
    mineral salts (e.g., calcium and phosphorus)
  3. Bone can be classified in two ways-by shape
    • Longbones, such as the femur
    • Shortbones, such as the phalanges
    • Flatbones such as the scapula
    • Irregular bones, such as carpal bones
    • Sesamoid bones, such as patella
  4. AAA, or completely immovable, joints (e.g., in the cranium)
    Synarthrodial
  5. AAA, or slightly movable, joints (e.g., in the pelvis)
    Amphiarthrodial
  6. AAA or freely movable, joints (e.g., the elbow and knee)
    Diarthrodial (synovial)
  7. The knee is often classified as a hinge joint, but it rotates slightly, as well as flexes and extends. It is best described as a AAA type of synovial joint.
    condylar
  8. AAA joints permit rotation only, as in the BBB area.
    • A) Pivot
    • B) radioulnar
  9. AAA and BBB, for instance, often occur in several generations of a family. Also, CCC.
    • A) Osteoporosis (age-related bone loss)
    • B) gout
    • C) Osteogenic sarcoma, a type of bone cancer, may be genetically influenced by TP53 gene mutation.
  10. An abnormality in the stance phase of gait is called an ...
    antalgic gait

    When part of one leg is painful, the patient shortens the stance phase on the affected side.
  11. An abnormality in the stance phase of gait is called an AAA gait. When part of one leg is painful, the patient shortens the stance phase on the affected side.
    A) antalgic
  12. An abnormality in the swing phase is called a AAA.
    A) lurch

    This abnormal gait occurs when the muscles in the buttocks and/or legs are too weak to allow the person to change weight from one foot to the other.
  13. The priority for post procedure arthroscopy care is to
    evaluate the neurovascular status of the patient's affected limb every hour or according to agency or surgeon protocol. Monitor and document distal pulses, warmth, color, capillary refill, pain, movement, and sensation of the affected extremity.
  14. When arthroscopic surgery is performed, the health care provider usually prescribes ...
    an opioid-analgesic combination, such as oxycodone and acetaminophen (Percocet, Tylox).
  15. Thrombophlebitis Signs and symptoms
    • pain in the part of the body affected
    • skin redness or inflammation (not always present)
    • swelling (edema) of the extremities (ankle and foot)
    • palpable cord-like veins
  16. Which statement best validates an older patient’s understanding of musculoskeletal health interventions?

    A. “I should try to exercise at least five times a week.”
    B. “I should drink orange juice daily.”
    C. “I should ignore my pain and adapt to moving more slowly.”
    D. “I should use a cane when I walk.”
    A. “I should try to exercise at least five times a week.”

    Regular exercise is the most important element in healthy musculoskeletal aging.
    (this multiple choice question has been scrambled)
  17. A patient is scheduled for an electromyography (EMG) to evaluate diffuse or localized muscle weakness. What question should the nurse ask the patient before the test?

    A. “Did you take your cyclobenzaprine (Flexeril) this morning?”
    B. “Do you take any antianxiety medications?”
    C. “When did you last eat or drink?”
    D. “What herbal over-the-counter medicines do you take?”
    D. “What herbal over-the-counter medicines do you take?”

    EMG helps in the diagnosis of neuromuscular, lower motor neuron, and peripheral nerve disorders.

    This test is contraindicated for patients undergoing anticoagulant therapy. Many patients do not consider herbal agents medications, but many herbal agents may alter anticoagulation, creating an unanticipated risk of the procedure.

    Adequate sedation and, at times, management of anxiety are necessary interventions during the procedure.

    The patient does not need to be NPO for this examination, but it is important to know when he or she last ate or drank before all studies.

    Skeletal muscle relaxants are frequently discontinued for several days before the procedure to prevent medication from affecting the test results.
    (this multiple choice question has been scrambled)
  18. A client is admitted to the PACU after an arthroscopic procedure to repair a torn knee ligament. Which of these nursing activities can be delegated to the nursing assistant?

    A. Explaining the client’s status to his life partner
    B. Taking the client’s temperature, pulse, and respiratory rate
    C. Teaching the client how to perform his postoperative leg exercises
    D. Observing the surgical dressing for bloody drainage
    B. Taking the client’s temperature, pulse, and respiratory rate

    This task can be delegated to the nursing assistant with the understanding that any abnormal findings must be reported to the nurse immediately.

    A is incorrect. The registered nurse or the physical therapist would be responsible for teaching postoperative exercises and evaluating the patient’s return demonstration or ability to comply with the exercise plan. If the patient is not able to comply with the exercise plan, contact with the physician may be necessary for further evaluation.

    B is incorrect. Although the nursing assistant can be instructed to report any evidence of bleeding to the nurse, it is the nurse’s responsibility to monitor the dressing for signs of bleeding and to intervene accordingly. A pressure dressing, ice, or contact to the physician may be necessary, depending on the evaluation and amount of bleeding noted. The dressing should be reinforced to prevent wound contamination and possible infection.

    D is incorrect. The physician or nurse would be responsible for explaining the patient’s status and answering appropriate questions. Information shared with anyone other than the patient regarding care must be done with the patient’s permission or only to legally designated individuals in order to comply with HIPAA regulations.
    (this multiple choice question has been scrambled)
  19. The physician orders an arthroscopy for surgical repair. Explain the procedure in terms that the patient will understand.
    You will be given anesthesia. A large tourniquet may be placed around your thigh to minimize bleeding during the procedure; also you may receive a drug that helps to control bleeding. The knee is flexed to at least 40 degrees, and the knee is irrigated. The arthroscope is inserted through a very small incision. Multiple incisions may be required to allow inspection at a variety of angles. After the procedure, a dressing may be applied.
  20. The skeletal system consists of AAA bones and multiple joints.
    206
  21. Synovial joint cartilage can become less elastic and compressible as a person ages leading to ...
    osteoarthritis
  22. musculoskeletal assessment: Ask about allergies, particularly allergy to AAA, and previous and current use of medications.
    A) dairy products
  23. Proximal muscle weakness may indicate ...
    myopathy

    • This meaning implies that the primary defect is within the muscle, as opposed to the nerves
    • "neuropathies"
  24. AAA [distal/proximal] weakness may indicate neuropathy (a problem in nerve tissue).
    Distal
  25. Most joints are studied by ...
    magnetic resonance imaging
  26. Which of the following is not an important function of the skeletal system?

    A. Provides a framework for the body
    B. Assists in movement
    C. Protects vital organs
    D. Manufactures blood cells
    D. Manufactures blood cells
    (this multiple choice question has been scrambled)
  27. The RN working in the ambulatory surgery postanesthesia care unit (PACU) has just received report about all of these patients who had arthroscopic surgery. Which patient will the RN need to assess first?

    A. A 44-year-old who has multiple right knee incisions for a repair of torn cartilage and arrived in the PACU an hour ago
    B. A 22-year-old who has been in the PACU for 30 minutes after left knee arthroscopy under local anesthesia
    C. A 30-year-old who had a synovial biopsy of the right knee under local anesthesia and has been in the PACU for 20 minutes
    D. A 46-year-old who returned to the PACU 25 minutes ago after left knee arthroscopic surgery under epidural anesthesia
    D. A 46-year-old who returned to the PACU 25 minutes ago after left knee arthroscopic surgery under epidural anesthesia

    After epidural anesthesia, frequent assessments for the return of sensation and movement of the leg will be important. Neurovascular assessment of all of these patients will be essential, but the patient who received epidural anesthesia is most at risk for complications and should be assessed first.
    (this multiple choice question has been scrambled)
  28. All these data are obtained by the nurse when admitting a patient before arthroscopic knee surgery. Which information is most important to report to the physician?

    A. Warm, red, and swollen knee
    B. Previous surgery on the other knee
    C. Knee pain at a level 9 (0-to-10 scale)
    D. Allergy to shellfish and iodine
    A. Warm, red, and swollen knee

    Swelling, heat, and redness may indicate infection in the knee joint, which would indicate a need to cancel the procedure.

    The other data will be reported but will not impact on whether the patient has surgery.
    (this multiple choice question has been scrambled)
  29. The nurse who is admitting a patient for a left total hip replacement obtains this assessment information. Which information is most important to report to the surgeon?

    A. The patient has had chronic left hip pain.
    B. The patient takes prednisone (Deltasone) to treat asthma.
    C. The patient is of African-American origin.
    D. The patient uses acetaminophen (Tylenol) for pain relief.
    B. The patient takes prednisone (Deltasone) to treat asthma.

    Chronic steroid use is strongly associated with osteoporosis and will increase the risk for poor wound healing and a prolonged recovery after the hip replacement.

    The other information will also be reported to the surgeon but will not impact on the potential success of the surgery.
    (this multiple choice question has been scrambled)
  30. A diabetic long-term care resident who had arthroscopic surgery to the right knee the previous day has a red, swollen, and painful right knee. Which of these prescriptions obtained from the physician will the nurse implement first?

    A. Acetaminophen (Tylenol) 650 mg every 6 hours
    B. Ibuprofen (Motrin) 400 mg orally three times daily
    C. Levofloxacin (Levaquin) 500 mg IV daily
    D. Oxycodone (Roxicodone) 15 mg every 4 hours
    C. Levofloxacin (Levaquin) 500 mg IV daily

    The patient's symptoms indicate a possible right knee infection. The first action will be to start antibiotic therapy. The other medications will help decrease the patient's pain, but the highest priority is to treat the infection
    (this multiple choice question has been scrambled)
  31. When assessing a female patient, the nurse learns that the patient has these risk factors for osteoporosis. Which one should be the priority for patient teaching?

    A. Low calcium intake
    B. Postmenopausal status
    C. Positive family history
    D. Previous use of steroids
    A. Low calcium intake

    The patient's calcium intake is the only risk factor that the patient can change.

    The nurse will discuss the other risk factors as contributing to the osteoporosis, but the teaching will focus on ways to increase calcium intake.
    (this multiple choice question has been scrambled)
  32. Which diagnostic test requires the nurse to know if the client is allergic to iodine-based contrast?

    A. Electromyography (EMG)
    B. Computed tomography (CT)
    C. Tomography
    D. Arthroscopy
    B. Computed tomography (CT)

    iodine-based contrast?

    Correct: A CT scan creates three-dimensional images and may be done with iodine-based contrast.

    Incorrect: EMG evaluates diffuse or localized muscle weakness by testing nerve conduction studies. It does not use iodine-based contrast.

    Incorrect: Arthroscopy involves inserting a fiberoptic tube into a joint for direct visualization of ligaments, menisci, and articular surfaces of the joint. It does not require iodine-based contrast.
    (this multiple choice question has been scrambled)
  33. Hypercalcemia (increased calcium): seen in
    Norm: 9.0-10.5 mg/dL

    • Metastatic cancers of the bone
    • Paget's disease - chronic disorder that can result in enlarged and misshapen bones. Paget's is caused by the excessive breakdown and formation of bone.
    • Bone fractures in healing stage
  34. Hypocalcemia (decreased calcium): seen in
    Norm: 9.0-10.5 mg/dL

    Osteoporosis - reduced bone density

    Osteomalacia - softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium
  35. Hyperphosphatemia (increased phosphorus): seen in
    • Bone fractures in healing stage
    • Bone tumors
    • Acromegaly
  36. Hypophosphatemia (decreased phosphorus): seen in
    Osteomalacia
  37. Elevations of Alkaline phosphatase (ALP): seen in
    • Metastatic cancers of the bone
    • Paget's disease
    • Osteomalacia
  38. Elevations of Serum muscle enzymes
    Creatine kinase (CK): seen in
    • Muscle trauma
    • Progressive muscular dystrophy
    • Effects of electromyography
  39. Elevations of Lactate dehydrogenase (LDH): seen in
    • Skeletal muscle necrosis
    • Extensive cancer
    • Progressive muscular dystrophy
  40. Elevations of Aspartate aminotransferase(AST): seen in
    • Skeletal muscle trauma
    • Progressive muscular dystrophy
  41. Elevations of Aldolase (ALD): seen in
    • Polymyositis and dermatomyositis
    • Muscular dystrophy

    Polymyositis - chronic inflammation of the muscles.

    dermatomyositis - connective-tissue disease related to polymyositis (PM) that is characterized by inflammation of the muscles and the skin. While DM most frequently affects the skin and muscles, it is a systemic disorder that may also affect the joints, the esophagus, the lungs, and, less commonly, the heart.
  42. Acromegaly: lab values Dx of
    Hyperphosphatemia (increased phosphorus)
  43. Bone fractures in healing stage: lab values Dx of
    • Hypercalcemia (increased calcium)
    • Hyperphosphatemia (increased phosphorus)
  44. Bone tumors: lab values Dx of
    Hyperphosphatemia (increased phosphorus)
  45. Effects of electromyography: lab values Dx of
    Elevations of Serum muscle enzymes Creatine kinase (CK)
  46. Extensive cancer: lab values Dx of
    Elevations of Lactate dehydrogenase (LDH)
  47. Metastatic cancers of the bone: lab values Dx of
    • Hypercalcemia (increased calcium)
    • Elevations of Alkaline phosphatase (ALP)
  48. Muscular dystrophy: lab values Dx of
    Elevations of Aldolase (ALD)
  49. Osteomalacia: lab values Dx of
    • Hyperphosphatemia (increased phosphorus)
    • Hypercalcemia (increased calcium)
    • Elevations of Alkaline phosphatase (ALP)
  50. Osteoporosis: lab values Dx of
    Hypocalcemia (decreased calcium)
  51. Paget's disease: lab values Dx of
    • Hypercalcemia (increased calcium)
    • Elevations of Alkaline phosphatase (ALP)
  52. Polymyositis and dermatomyositis: lab values Dx of
    Elevations in Aldolase (ALD)
  53. Progressive muscular dystrophy: lab values Dx of
    • Elevations of Serum muscle enzymes Creatine kinase (CK)
    • Elevations in Lactate dehydrogenase (LDH)
  54. Extensive cancer: lab values Dx of
    Elevations in Lactate dehydrogenase (LDH)
  55. Skeletal muscle necrosis: lab values Dx of
    Elevations in Lactate dehydrogenase (LDH)
  56. Muscle trauma: lab values Dx of
    • Elevations in Aspartate aminotransferase (AST)
    • Elevations of Serum muscle enzymes Creatine kinase (CK)
  57. The client is suspected of having muscular dystrophy (MD). For which laboratory test does the nurse anticipate seeing an abnormal result?

    A. Decreased CK-MM level
    B. Moderately elevated aspartate aminotransferase (AST)
    C. Decreased serum creatine kinase (CK) level
    D. Decreased alkaline phosphatase (ALP)
    B. Moderately elevated aspartate
    (this multiple choice question has been scrambled)
  58. The client experiencing kyphosis appears withdrawn and does not initiate any conversation with the nurse when medications are given each day. Which statement by the nurse is the most supportive to this client?

    A. ''You could exercise more to build up your strength and endurance.''
    B. ''It is normal to feel depressed at times about your condition. You have my support.''
    C. ''How do you feel about the pain in your spine? I am here if you want to talk.''
    D. ''What does your family say to you? Try talking to them.''
    C. ''How do you feel about the pain in your spine? I am here if you want to talk.''

    Incorrect: This is a leading statement and is not supportive. The client may not be depressed.

    When in doubt ask Pt HOW they feel about it A ND be available to LISTEN.
    (this multiple choice question has been scrambled)
  59. Which physiologic change of the musculoskeletal system occurs with aging, affecting the care of older adults?

    A. Regeneration of cartilage
    B. Increased bone density
    C. Decreased range of motion (ROM)
    D. Narrower gait
    C. Decreased range of motion (ROM)

    Incorrect: Cartilage degeneration is an age-related change that occurs in the musculoskeletal system.
    (this multiple choice question has been scrambled)
  60. The nurse is conducting a musculoskeletal history in the older adult client who requires his spouse to perform all activities of daily living. Which level of functioning does the nurse record in the client's history using Gordon's Functional Health Patterns?

    A. Level I - Requires use of equipment or device
    B. Level II-Requires assistance or supervision of another person
    C. Level IV-is dependent and does not participate
    D. Level 0 - full self-care
    E. Level III-Requires assistance of or supervision by another person and equipment or device
    C. Level IV-is dependent and does not participate
    (this multiple choice question has been scrambled)

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