Nokea
The nurse is preparing to assess a patient's musculoskeletal system. Which of the following actions should the nurse do first?
- A. Feel for the presence of crepitus during joint movement.
- B. Have the patient move the extremities against resistance.
- C. Observe the patient's body build and muscle configuration.
- D. Check active and passive range of motion for the extremities.
Correct Answer: C
Rationale: 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 also are included in the assessment but are usually done after inspection.
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The nurse is assessing the movement of a patient's elbow and notes crackling sounds and a grating sensation with palpation. Which of the following terms should the nurse use to document these findings?
- A. Torticollis
- B. Crepitation
- C. Subluxation
- D. Epicondylitis
Correct Answer: B
Rationale: 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.
The nurse obtains this information when assessing an older-adult patient in the outpatient clinic. Which of the following findings is of highest priority when the nurse is planning care for the patient?
- A. Symmetrical joint swelling of fingers
- B. Decreased right knee range of motion
- C. History of recent loss of balance and fall
- D. Complaint of left hip aching when jogging
Correct Answer: C
Rationale: 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.
The nurse is assessing a patient in the clinic who has knee pain following an arthroscopic procedure 7 days previously and has just had an arthrocentesis. Which of the following findings should be of most concern to the nurse?
- A. Scant thin fluid
- B. Sanguinous fluid
- C. Straw-coloured fluid
- D. Purulent appearing fluid
Correct Answer: D
Rationale: The presence of purulent fluid suggests a possible joint infection. Bloody fluid might be expected after an arthroscopic procedure. Normal synovial fluid is scant in amount and straw-coloured.
The nurse is assessing a new patient in the clinic. Which of the following information about the patient's medications should be of most concern?
- A. The patient takes a daily multivitamin and calcium supplement.
- B. The patient has migraine headaches that are treated with nonsteroidal anti-inflammatory drugs (NSAIDs).
- C. The patient has severe asthma and requires frequent therapy with oral steroids.
- D. The patient takes hormone replacement therapy (HRT) to prevent 'hot flashes.'
Correct Answer: C
Rationale: Corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. The use of HRT and calcium supplements will help prevent osteoporosis. NSAID use does not increase the risk for musculoskeletal problems.
The nurse is caring for a patient who has a new prescription for magnetic resonance imaging (MRI) to evaluate for right femur osteomyelitis. Which of the following patient 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.
Correct Answer: A
Rationale: 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. Since contrast medium will not be used, shellfish allergy is not a contraindication to MRI.