ADULT HEALTH. MUSCULOSKELETAL EXAM 2023
The health care provider suspects a rotator cuff injury in a client who is an avid
tennis player. The nurse would most likely assess which of the following?
1) complete stiffness of the shoulder joint
2) paresthesia over the first 3 1/2 fingers
3) shoulder pain with arm abduction
4) tenderness over the lateral epicondyle - ANSWER 3)
The rotator cuff is a group of 4 shoulder muscles and tendons that attach to the
humeral head. It allows for rotation of the arm. A partial or full thickness rotator
cuff tear can occur gradually over time as a result of aging, repetitive use, or an
injury to the shoulder. It can also occur as a result of a sports injury involving
repetitive overhead arm motion (eg, swimming, tennis, baseball, weight lifting).
Characteristic symptoms of rotator cuff injury usually include shoulder pain and
weakness. Severe pain when the arm is abducted between 60 and 120 degrees
(painful arc) is characteristic (Option 3).
(Option 1) Restriction of active and passive ranges of motion of the shoulder
(complete stiffness) is seen with frozen shoulder.
(Option 2) Pain and paresthesia over the first 3½ fingers suggest carpal tunnel
syndrome.
(Option 4) Tenderness over the lateral epicondyle is seen with tennis elbow.
Educational objective:
Rotator cuff injury involves a group of muscles and tendons in the shoulder.
Characteristic symptoms of rotator cuff injury usually include shoulder pain and
weakness. Severe pain when the arm is abducted between 60 and 120 degrees
(painful arc) is characteristic.
,The nurse is caring for a client who is 12 hours postoperative total hip
replacement. Which nursing intervention is appropriate to help prevent
dislocation of the hip prosthesis?
1) instructing the pt to cross the legs only at ankles
2) maintaining the HOB at over or equal to 60-90 degrees
3) Placing an abductor pillow between the legs when turning the client
4) turning the client to the affected side to alleviate lateral muscle pulling -
ANSWER 3)
Maintaining the affected extremity in alignment and avoiding adduction and hip
flexion are crucial in the initial postoperative period following a total hip
replacement to prevent the prosthesis from becoming displaced or dislocated.
Placing an abductor wedge pillow between the legs or placing 2-3 pillows between
the knees when turning the client from side to side prevents adduction of the
operative extremity and reduces the potential for hip prosthesis dislocation.
(Option 1) The client is instructed not to cross the legs at the ankles or knees to
avoid adduction across the midline.
(Option 2) The head of the bed should be maintained at ≤60 degrees to prevent
excessive hip flexion (>90 degrees).
(Option 4) The client should not sleep or be turned or positioned on the operative
side unless directed by the health care provider. When turning is necessary, the
operative hip must be kept in abduction; pillows or a trochanter roll should
support the entire length of the leg.
Educational objective:
Interventions to help prevent dislocation of a hip prosthesis following total hip
replacement surgery include positioning the client supine with the head of the
bed elevated ≤60 degrees, with the affected extremity in a neutral position; placing
an abductor pillow wedge between the legs when turning the client to the
unaffected side; and instructing the client to avoid crossing the legs.
A client newly diagnosed with osteomalacia is reviewing home care instructions
with the nurse. Which statements indicate the need for further instruction? Select
all that apply.
,1) I will avoid foods high in calcium and phosphorus
2) I will avoid going outside on sunny days
3) I will decrease activity to prevent bone injury
4) I will eat foods that are fortified with vitamin D
5) I will use a cane to help me to get around better - ANSWER 1, 2, 3
Osteomalacia is a reversible bone disorder caused by vitamin D deficiency and is
characterized by weak, soft, and painful bones that can easily fracture or become
deformed. In vitamin D deficiency, calcium and phosphorus cannot be absorbed
from the gastrointestinal tract and are unavailable for calcification of bone tissue.
Vitamin D deficiency is also associated with increased risk of falls, especially in
elderly clients, due to muscle weakness.
Nursing management focuses on:
Implementing safety measures such as canes or walkers to prevent falls and injury
(Option 5)
Encouraging light to moderate activity, which can help promote bone strength and
health (Option 3)
Increasing dietary intake of:
Calcium (eg, leafy green vegetables, dairy) (Option 1)
Phosphorus (eg, milk, organ meats, nuts, fish, poultry, whole grains)
Vitamin D (eg, vitamin D-fortified milk and cereal, egg yolks, saltwater fish, liver);
exposure to sunlight is also recommended as it synthesizes vitamin D (Options 2
and 4)
Taking over-the-counter or prescription supplemental vitamin D
Educational objective:
Osteomalacia occurs when the body is unable to use calcium and phosphorus for
bone calcification due to a vitamin D deficiency. Nursing management focuses on
implementing safety measures, encouraging activity, and increasing intake of
vitamin D, calcium, and phosphorus.
The client has just returned from having a cast placed on the right forearm and is
found putting a lead pencil in the cast to "reach the itch." What is the nurse's
, priority action?
1) offer the client a straw to reach the itch instead of a lead pencil
2) perform a peripheral neurovascular check of the casted extremity
3) Pour a generous amount of baby powder or corn starch in the cast to reach the
itch
4) Review appropriate itch relief technique using the cool setting of a hair dryer -
ANSWER 4)
To relieve itching underneath a casted area, clients should use the cool setting of a
hair dryer to direct air under the cast. Clients should never place any object,
lotions, or powders in or around the casted area as skin irritation, injury, or
infection may occur. Signs and symptoms of infection (eg, sores, purulent
drainage, foul odors) and persistent itching should be reported to the health care
provider.
(Options 1 and 3) Nothing should be placed inside a cast due to the risk for injury
and infection.
(Option 2) The skin of the casted extremity should be assessed as the client could
have damaged it by inserting a pointed object. Regular neurovascular checks
should be performed on a client with a new cast as the client is at risk for
compartment syndrome. However, there is no indication of peripheral vascular
impairment (eg, changes in extremity color, temperature, or pulse) or peripheral
neurologic impairment (eg, loss of sensory or motor function) of the casted
extremity; therefore, this is not the priority at this time.
Educational objective:
The client should be taught that nothing should be placed in a cast. Attempting to
reach an itch with any instrument (eg, pencil, coat hanger) or applying powder or
lotion may cause skin breakdown and infection. Cool air from a hair dryer may
alleviate the itch.
The nurse is reviewing new prescriptions from the health care provider. Which
prescription would require further clarification?
1) atorvastatin for hyperlipidemia in a client with angina pectoris
The health care provider suspects a rotator cuff injury in a client who is an avid
tennis player. The nurse would most likely assess which of the following?
1) complete stiffness of the shoulder joint
2) paresthesia over the first 3 1/2 fingers
3) shoulder pain with arm abduction
4) tenderness over the lateral epicondyle - ANSWER 3)
The rotator cuff is a group of 4 shoulder muscles and tendons that attach to the
humeral head. It allows for rotation of the arm. A partial or full thickness rotator
cuff tear can occur gradually over time as a result of aging, repetitive use, or an
injury to the shoulder. It can also occur as a result of a sports injury involving
repetitive overhead arm motion (eg, swimming, tennis, baseball, weight lifting).
Characteristic symptoms of rotator cuff injury usually include shoulder pain and
weakness. Severe pain when the arm is abducted between 60 and 120 degrees
(painful arc) is characteristic (Option 3).
(Option 1) Restriction of active and passive ranges of motion of the shoulder
(complete stiffness) is seen with frozen shoulder.
(Option 2) Pain and paresthesia over the first 3½ fingers suggest carpal tunnel
syndrome.
(Option 4) Tenderness over the lateral epicondyle is seen with tennis elbow.
Educational objective:
Rotator cuff injury involves a group of muscles and tendons in the shoulder.
Characteristic symptoms of rotator cuff injury usually include shoulder pain and
weakness. Severe pain when the arm is abducted between 60 and 120 degrees
(painful arc) is characteristic.
,The nurse is caring for a client who is 12 hours postoperative total hip
replacement. Which nursing intervention is appropriate to help prevent
dislocation of the hip prosthesis?
1) instructing the pt to cross the legs only at ankles
2) maintaining the HOB at over or equal to 60-90 degrees
3) Placing an abductor pillow between the legs when turning the client
4) turning the client to the affected side to alleviate lateral muscle pulling -
ANSWER 3)
Maintaining the affected extremity in alignment and avoiding adduction and hip
flexion are crucial in the initial postoperative period following a total hip
replacement to prevent the prosthesis from becoming displaced or dislocated.
Placing an abductor wedge pillow between the legs or placing 2-3 pillows between
the knees when turning the client from side to side prevents adduction of the
operative extremity and reduces the potential for hip prosthesis dislocation.
(Option 1) The client is instructed not to cross the legs at the ankles or knees to
avoid adduction across the midline.
(Option 2) The head of the bed should be maintained at ≤60 degrees to prevent
excessive hip flexion (>90 degrees).
(Option 4) The client should not sleep or be turned or positioned on the operative
side unless directed by the health care provider. When turning is necessary, the
operative hip must be kept in abduction; pillows or a trochanter roll should
support the entire length of the leg.
Educational objective:
Interventions to help prevent dislocation of a hip prosthesis following total hip
replacement surgery include positioning the client supine with the head of the
bed elevated ≤60 degrees, with the affected extremity in a neutral position; placing
an abductor pillow wedge between the legs when turning the client to the
unaffected side; and instructing the client to avoid crossing the legs.
A client newly diagnosed with osteomalacia is reviewing home care instructions
with the nurse. Which statements indicate the need for further instruction? Select
all that apply.
,1) I will avoid foods high in calcium and phosphorus
2) I will avoid going outside on sunny days
3) I will decrease activity to prevent bone injury
4) I will eat foods that are fortified with vitamin D
5) I will use a cane to help me to get around better - ANSWER 1, 2, 3
Osteomalacia is a reversible bone disorder caused by vitamin D deficiency and is
characterized by weak, soft, and painful bones that can easily fracture or become
deformed. In vitamin D deficiency, calcium and phosphorus cannot be absorbed
from the gastrointestinal tract and are unavailable for calcification of bone tissue.
Vitamin D deficiency is also associated with increased risk of falls, especially in
elderly clients, due to muscle weakness.
Nursing management focuses on:
Implementing safety measures such as canes or walkers to prevent falls and injury
(Option 5)
Encouraging light to moderate activity, which can help promote bone strength and
health (Option 3)
Increasing dietary intake of:
Calcium (eg, leafy green vegetables, dairy) (Option 1)
Phosphorus (eg, milk, organ meats, nuts, fish, poultry, whole grains)
Vitamin D (eg, vitamin D-fortified milk and cereal, egg yolks, saltwater fish, liver);
exposure to sunlight is also recommended as it synthesizes vitamin D (Options 2
and 4)
Taking over-the-counter or prescription supplemental vitamin D
Educational objective:
Osteomalacia occurs when the body is unable to use calcium and phosphorus for
bone calcification due to a vitamin D deficiency. Nursing management focuses on
implementing safety measures, encouraging activity, and increasing intake of
vitamin D, calcium, and phosphorus.
The client has just returned from having a cast placed on the right forearm and is
found putting a lead pencil in the cast to "reach the itch." What is the nurse's
, priority action?
1) offer the client a straw to reach the itch instead of a lead pencil
2) perform a peripheral neurovascular check of the casted extremity
3) Pour a generous amount of baby powder or corn starch in the cast to reach the
itch
4) Review appropriate itch relief technique using the cool setting of a hair dryer -
ANSWER 4)
To relieve itching underneath a casted area, clients should use the cool setting of a
hair dryer to direct air under the cast. Clients should never place any object,
lotions, or powders in or around the casted area as skin irritation, injury, or
infection may occur. Signs and symptoms of infection (eg, sores, purulent
drainage, foul odors) and persistent itching should be reported to the health care
provider.
(Options 1 and 3) Nothing should be placed inside a cast due to the risk for injury
and infection.
(Option 2) The skin of the casted extremity should be assessed as the client could
have damaged it by inserting a pointed object. Regular neurovascular checks
should be performed on a client with a new cast as the client is at risk for
compartment syndrome. However, there is no indication of peripheral vascular
impairment (eg, changes in extremity color, temperature, or pulse) or peripheral
neurologic impairment (eg, loss of sensory or motor function) of the casted
extremity; therefore, this is not the priority at this time.
Educational objective:
The client should be taught that nothing should be placed in a cast. Attempting to
reach an itch with any instrument (eg, pencil, coat hanger) or applying powder or
lotion may cause skin breakdown and infection. Cool air from a hair dryer may
alleviate the itch.
The nurse is reviewing new prescriptions from the health care provider. Which
prescription would require further clarification?
1) atorvastatin for hyperlipidemia in a client with angina pectoris
