Musculosketal Structure
The nurse is screening children for scoliosis. What nursing assessment finding is indicative of scoliosis?
A. lateral curvature of the spine
B. loss of 1 inch (2.5 cm) in height
C. contracture of the wrists
D. crepitus of the knee joint
Answer: lateral curvature of the spine
Rationale: Scoliosis is characterized by a lateral curvature of the spine. Loss of inches in height is seen with osteoporosis. Contracture of the wrists is a connective tissue problem. Crepitus of the knee joint is seen with joint movements.
The nurse would expect which of the following age-related change of the musculoskeletal system?
A. Loss of bone mass
B. Increased elasticity of tendons
C. Thickening of intervertebral discs
D. Muscle hypertrophy
Answer: Loss of bone mass
Rationale: Age-related changes include gradual, progressive loss of bone mass after age 30 years, decreased elasticity of tendons, thinning of intervertebral discs, and muscle atrophy.
A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit?
A. Making sure the client is receiving a daily bath
B. Ensuring that the client is eating enough
C. Observing for safety hazards that could be a fall risk
D. Making sure the client has adequate financial resources
Answer: Observing for safety hazards that could be a fall risk
Rationale: Clients with osteomalacia exhibit a waddling type of gait, putting them at risk for falls and fractures. Safety would be the priority in this circumstance such as scatter rugs, loose boards, and stairs. Older adult clients do not require a daily bath, and it may dry the skin. Nutrition is a necessity to question but the priority would be safety. Whether the client has adequate financial resources would be referred to social service.
A nurse is performing discharge teaching for an older adult client diagnosed with osteoporosis. Which statement about home safety should the nurse include?
A. "Most falls among older adults occur outside the home. Clients should confine themselves to their homes as much as practical."
B. "Most accidental injuries among older adults are automobile-related. Older adult clients should have vision testing every 6 months while they're still driving."
C. "Because of the increase in home burglaries involving older adults, these clients should have burglar bars on every window in the home."
D. "Most falls among older adults occur in the home. These clients should remove throw rugs and install bathroom grab bars."
Answer:
D. "Most falls among older adults occur in the home. These clients should remove throw rugs and install bathroom grab bars."
Rationale:
Falls in the home cause most injuries among older adults. Older adult clients should take measures to decrease the clutter that can contribute to falls, such as removing objects such as throw rugs from the floor. Older adult clients should also install grab bars in the shower and next to the toilet. The threat of fire makes burglar bars on every window impractical.
Using proper body mechanics to lift objects is essential to prevent exacerbations of low back pain. Which of the following is the most important teaching point?
A. Avoid lifting above waist level
B. Limit time lifting up to reach something
C. Contract trunk muscles to stabilize the spine
D. Lift with the large leg muscles (quadriceps), not the back muscles.
Answer: Lift with the large leg muscles (quadriceps), not the back muscles.
Rationale: All teaching points are important but the most important involves limiting back strain by maximizing the use of the quadriceps muscle.
The nurse is caring for a teenage client with an acute musculoskeletal concern. The nurse is explaining skeletal muscles to the client. Which statement would the nurse use to correctly explain the skeletal muscles?
A. "Skeletal muscles are voluntary muscles that promote movement of the bones of the skeleton."
B. "Skeletal muscles are voluntary muscles that are found mainly in the walls of certain organs or cavities of the body."
C. "Skeletal muscles are involuntary muscles controlled by neurotransmitters released by the autonomic nervous system."
D. "Skeletal muscles are involuntary muscles that are controlled by the central nervous system."
Answer: "Skeletal muscles are voluntary muscles that promote movement of the bones of the skeleton."
Rationale: The skeletal muscles are voluntary muscles that promote movement of the skeleton's bones. They are controlled by impulses from the central nervous system. Smooth and cardiac muscles are involuntary, controlled by mechanisms in their tissue of origin and neurotransmitters of the autonomic nervous system. Smooth muscles are found mainly in the walls of certain organs such as the stomach, intestine, blood vessels, and ureters. Cardiac muscle is found only in the heart.
During a general musculoskeletal assessment, what would help the nurse determine the client's muscle strength?
A. Palpating each of the client's muscles and joints.
B. Asking the client to lift specified amounts of weights.
C. Examining extremities for symmetry, size, and contour.
D. Applying force to the client's extremity as the client pushes against that force.
Answer: Applying force to the client's extremity as the client pushes against that force.
To correctly test the client's muscle strength, the nurse should apply force to the client's extremity while the client pushes against that force. Palpating the muscles and joints helps identify swelling, degree of firmness, local warm areas, and any involuntary movements. Examining the client for symmetry, size, and contour of extremities will not help determine the client's muscle strength. It is not advisable to ask the client to lift weights with an affected limb during a musculoskeletal assessment.
A nurse is teaching a client with osteomalacia about the role of diet. What would be the best choice for breakfast for a client with osteomalacia?
A. Cereal with milk, a scrambled egg, and grapefruit
B. Poached eggs with sausage and toast
C. Waffles with fresh strawberries and powdered sugar
D. A bagel topped with butter and jam with a side dish of grapes
Answer: Cereal with milk, a scrambled egg, and grapefruit
Rationale: The best meal option is the one that contains the highest dietary sources of calcium and vitamin D. The best selection among those listed is cereal with milk, and eggs, as these foods contain calcium and vitamin D in a higher quantity over the other menu options.
A nurse is teaching a client with osteoporosis about dietary selections. What client statement indicates the teaching was effective?
A. "I will decrease my intake of red meat."
B. "I will decrease my intake of popcorn, nuts, and seeds."
C. "I will eat more fruits to increase my potassium intake."
D. "I will eat more dairy products to increase my calcium intake."
Answer:
"I will eat more dairy products to increase my calcium intake."
Rationale: Osteoporosis causes a severe, general reduction in skeletal bone mass. To offset this reduction, the nurse should advise the client to increase calcium intake by consuming more dairy products for improved calcium intake. Decreasing red meat will help with increased cholesterol and triglycerides. Clients with osteoporosis do not need to decrease popcorn, nuts or seeds. The client will osteoporosis does not need more potassium.
The nurse is educating a client with low back pain on proper lifting techniques. The nurse recognizes that the education was effective when the client
A. reaches over the head with the arms fully extended.
B. places the load close to the body.
C. uses a narrow base of support.
D. bends at the hips and tightens the abdominal muscles.
Answer: places the load close to the body.
Rationale: Instructions for the client with low back pain should include that, when lifting, the client should avoid overreaching. The client should also keep the load close to the body, bend the knees, and tighten the abdominal muscles; use a wide base of support; and use a back brace to protect the back. Bending at the hips increases the strain on the back muscles when lifting.
A client with a sports injury undergoes a diagnostic arthroscopy of the left knee. What comment by the client following the procedure will the nurse address first?
A. "My toes are numb."
B. "My knee aches."
C. "My feet are cold."
D. "My foot is swollen."
Answer: "My toes are numb."
Rationale: Numbness would indicate neurological compromise of the extremity and requires immediate intervention to prevent permanent damage. An aching knee is expected after the procedure. Cold or swollen feet are not priority assessments.
The nurse is admitting an older adult to a skilled nursing facility. What assessment parameters will the nurse expect to find with the musculoskeletal assessment? (Select all that apply)
A. decreased endurance
B. increase in height
C. joint stiffness
D. increased muscle strength
E. decreased range of motion
Answer:
decreased endurance
joint stiffness
decreased range of motion
Rationale: Significant assessment findings of the musculoskeletal system in the older adult would include joint stiffness and decreased height, range of motion, muscle strength, and endurance. Older adults may have decreased height from osteoporosis and decreased muscle strength from atrophy.
A nurse is planning the care of an older adult client with osteomalacia. What action should the nurse recommend in order to promote vitamin D synthesis?
A. Ensuring adequate exposure to sunlight
B. Eating a low-salt diet
C. Performing cardiovascular exercise while avoiding weight-bearing exercises
D. Taking thyroid supplements as prescribed
Answer: Ensuring adequate exposure to sunlight
Rationale: Because sunlight is necessary for synthesizing vitamin D, clients should be encouraged to spend some time in the sun. A low-salt diet is not a relevant action, and thyroid supplements do not directly affect bone function. Action must be taken to prevent fractures, but weight-bearing exercise within safe parameters is not necessarily contraindicated.
The nurse is planning an education program for clients of childbearing years. What does the nurse recognize as the primary prevention of osteoporosis?
A. Engaging in non-weight-bearing exercises daily
B. Undergoing assessment of serum calcium levels every year
C. Having a dexa scans beginning at age 35 years
D. Ensuring adequate calcium and vitamin D intake
Answer: Ensuring adequate calcium and vitamin D intake
Rationale: Nutritional intake of calcium and vitamin D are essential for the prevention of osteoporosis.
The nurse is educating the client with low back pain about the proper way to lift objects. What muscle should the nurse encourage the client to maximize?
A. Gastrocnemius
B. Latissimus dorsi
C. Quadriceps
D. Rectus abdominis
Answer: Quadriceps
Rationale:The nurse instructs the client in the safe and correct way to lift objects using the strong quadriceps muscles of the thighs, with minimal use of weak back muscles
The nurse is assessing the client for scoliosis. What will the nurse have the client do to perform the assessment?
A. Stand behind the client and ask the client to bend forward at the waist.
B. Stand to the side of the client and observe the client's spinal curvatures.
C. Stand behind the client and ask the client to walk a short distance away.
D. Stand in front of the client and ask the client to bend forward at the waist.
Answer: Stand behind the client and ask the client to bend forward at the waist.
Rationale: Scoliosis is characterized by a lateral curvature of the spine. The nurse stands behind the client and asks the client to bend forward at the waist for the nurse to examine the spine curvature. The nurse cannot see the spine by standing beside the client or in front of the client. The spinal curve cannot be seen by watching the client walk.
Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy?
A. aspirin
B. furosemide
C. digoxin
D. NPH insulin
Answer: aspirin
Rationale: Aspirin has anti-clotting properties, and bone is a very vascular tissue. The client taking aspirin in close proximity to a bone biopsy is at increased risk for excessive bleeding.
The nurse's comprehensive assessment of an older adult with osteomalacia and involves the assessment of the client's gait. How should the nurse best perform this assessment?
A. Instruct the client to walk heel-to-toe for 15 to 20 steps.
B. Instruct the client to walk in a straight line while not looking at the floor.
C. Instruct the client to walk away from the nurse for a short distance and then toward the nurse.
D. Instruct the client to balance on one foot for as long as possible and then walk in a circle around the room.
Answer: Instruct the client to walk away from the nurse for a short distance and then toward the nurse.
Rationale: Gait is assessed by having the client walk away from the examiner for a short distance. The examiner observes the client's gait for smoothness and rhythm. Looking at the floor is not disallowed and gait is not assessed by observing balance on one leg. Heel-to-toe walking ability is not gauged during an assessment of normal gait.
An older adult client has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density?
A. Diabetes
B. Hypertension
C. Compression fractures
D. Cardiac disease
Answer: Compression fractures
Rationale: In osteoporosis, loss of bone substance exceeds bone formation. The total bone mass and density is reduced, resulting in bones that become progressively porous, brittle, and fragile. Compression fractures of the vertebrae are common. Diabetes, hypertension, and cardiac disease may occur in response to the aging process but are not the result of osteoporosis.
A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The nurse knows that the origin of the pain is between which intervertebral disks?
A. C3, C4, and L1
B. L1, L2, and L4
C. L2, L3, and L5
D. L4, L5, and S1
Answer: L4, L5, and S1
Rationale: The lower lumbar disks, L4–L5 and L5–S1, are subject to the greatest mechanical stress and the greatest degenerative changes. Disk protrusion (herniated nucleus pulposus) or facet joint changes can cause pressure on nerve roots as they leave the spinal canal, which results in pain that radiates along the nerve.
A nurse is caring for a client who has had a total hip replacement. The nurse is reviewing health education prior to discharge. Which of the client's statements would indicate to the nurse that the client requires further teaching?
A. "I'll need to keep several pillows between my legs at night."
B. "I need to remember not to cross my legs. It's such a habit."
C. "The occupational therapist is showing me how to use a 'sock puller' to help me get dressed."
D. "I will need my spouse to assist me in getting off the low toilet seat at home."
Answer: "I will need my spouse to assist me in getting off the low toilet seat at home."
Rationale: To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. Assistive devices, such as a raised toilet seat, should be used to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Likewise, teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees.
The nurse is conducting a medication reconciliation with a client admitted with a fracture. What medication predisposes a client for a risk for fractures?
A. prednisone
B. furosemide
C. digoxin
D. metoprolol
Answer: prednisone
Rationale: Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures. Furosemide, digoxin, and metoprolol do not interfere with bone resorption or predispose clients to fractures.
The nurse is performing a neurological assessment for a patient with osteomalacia. What will this assessment include?
A. Ask the client to plantar flex the toes.
B. Observe for capillary refill of the great toe
C. Palpate the dorsalis pedis pulse
D. Inspect the foot for edema.
Answer: Ask the client to plantar flex the toes.
Rationale: A neurological assessment evaluates sensation and motion. Assessing plantar flexion of the toes would be included in a neurological assessment. Capillary refill, palpation of pulses, and inspecting for edema would be included in a vascular assessment.
The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response?
A. Decrease in estrogen
B. Increase in calcitonin
C. Decrease in parathyroid hormone
D. Increase of vitamin D
Answer: Decrease in estrogen
Rationale: Age related processes that contribute to loss of bone mass and osteoporosis are decreases in estrogen, calcitonin, and vitamin D and an increase in parathyroid hormone.
The nurse has educated a client with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the client shows understanding of the education the nurse provided?
A. “I will lie prone with my legs slightly elevated.”
B. “I will bend at the waist when I am lifting objects from the floor.”
C. “I will avoid prolonged sitting or walking.”
D. “Instead of turning around to grasp an object, I will twist at the waist.”
Answer: “I will avoid prolonged sitting or walking.”
Rationale: The nurse encourages the client to alternate lying, sitting, and walking activities frequently, and advises the client to avoid sitting, standing, or walking for long periods.