HESI Case Study: Musculoskeletal System – Flashcards

The Registered nurse (RN) notes the client's history of osteoporosis and her report of low back pain. As Ms. Lieu walks to the exam room, the RN prepares to complete a history and physical assessment, focusing on the musculoskeletal system. 1. The RN begins the assessment as the client ambulates in the hallway. What observations should the RN make while client is walking to the exam room? (Select all that apply). -Fine Motor function -Gait -Balance -Posture -Bone density

2. Once the client is settled int he exam room, which action by the RN has the highest priority? -Review the client's medical record for any history of bone or spinal fractures. -Obtain more in-depth information about the client's osteoporosis management -Compare bilateral muscle strength and tone in the client's lower extremities. -Gather data about the nature, location and duration of the client's back pain

Ms. Lieu places her hand over her lubar area to show the RN the location of her pain and rates it at a 7 on a scale of 1-10. The RN consults the electronic medication administration record and notes a prescription for an anti-inflammatory medication. 3. Indomethacin 50mg capsules by mouth every 6 hours as needed for back pain is prescribed. Indomethacin 25mg capsules are available. The how many capsules should the RN administer?

The RN returns 30 minutes after administering the medication, and Ms. Lieu states her back pain is now a 1 on a scale of 1-10. Ms. Lieu stats that she is able to proceed with the rest of the musculoskeletal assessment. 4. Because of Ms. Lieu's history of knee pain and current report of low back pain, which nursing action is most useful in developing an initial plan of care for the client? -Observe for callus formation -Obtain a family medical history -Ask about any recent weight gain -Complete a functional assessment

Ms. Lieu shares with the RN that she often experiences knee pain. The RN asks Ms. Lieu about other common joint symptoms. On which symptoms should the RN focus? (select all that apply) -Swelling -Warmth -Numbness -Cramping -Stiffness

6. Which information in Ms. Lieu's history reflects a high risk for low back pain? -Volunteers on the weekend as a tour guide at a historical city mansion -often rides a bicycle to her job as a history professor at a local college -Frequently travels with her husband to Korea by air to visit relatives -Spends her evening working in her large vegetable and flower garden

After completing the history, the RN beings the physical assessment of the client's musculoskeletal system. The RN begins the physical assessment and prepares to assess the curvatures of the client's spine. 7. To Check for scoliosis, the RN provides the client which instruction? -Stand with arms straight at your sides and your feet together -Twist from one side to the other with your hands on your hips -Place hands on hips and lean to one side and then the other -Place feet apart and slowly raise both arms about your head.

8. When observing the client from the side, the RN observes a slightly convex thoracic curve and a slightly concave lumbar curve. What action should the nurse take in response to these findings? -Not the client's poor posture as a possible cause of her back pain. -Ask the client how long she has had a "Dowager's Hump" -Document the normal spinal curvature on the assessment form -record these symptoms of osteoporosis in the client's chart

9. While assessing the spine, the RN assesses Ms. Lieu's low back pain further. Which action will help determine the cause of her pain? -Instruct the client to balance on one foot with her arms at her sides -Watch the client while she stands upright and slowly squats down -Help the client to a prone position, rotating both legs inward -Ask the client to lie supine and raise on leg, keeping it straight

10. Ms. Leiu follows the RN's instructions to swing her arms forward and up in a wide arc, then back. The action allows the RN to observe what shoulder range of motion? -Internal and external rotation -Abduction and adduction -Forward and reverse motion -Flexion and hyperextension

11. While assessing shoulder rang of motion, the RN notes the absence of crepitation with movement. What action should the RN take in response to this finding? -Record the degree of range of motion limitation -Ask the client about her intake of dietary calcium -Review the client's record for history of arthritis -Document this normal finding in the assessment

Ms. Lieu does not exhibit any sciatic pain. After completing the spinal assessment, the RN assists MS. Lieu back to a sitting position, which her legs dangling over the edge of the exam table. The RN beings the assessment of MS. Lieu's upper extremities. 12. The RN next assesses the client's elbows. When comparing these joints bilaterally, for what should the RN observe? (select all that apply) -Resonance -Contour -Size -Skin color -Tympany

13. The RN observes Ms. Lieu as she rests her lower arms on a table with her hands at a 90degree angle to the table and the thumbs up. Ms. Lieu turns her hands upward with the back of the hand flat on the table and then downward with the palm flat on the table. What action is the RN observing? -Flexion and extension of the wrist -Elbow supination and pronation -Lower arm adduction and abduction -Hand and finger hyperextension

14. The RN prepares to palpate the joints in MS. Lieu's Wrist and hands. First, the RN supports the client's hands. What action should the RN take next? -Instruct the client to make a fist with both hands -Ask the client to spread her fingers apart -Use both thumbs to apply gentle pressure -Use the index fingers to lightly compress the pulses

15. While palpating the client's hands, the RN asks Ms. Lieu if she has any tenderness in her fingers. Ms. Lieu reports that sometimes her finger get stiff after several hours of computer work, but states that she is not currently experiencing any tenderness. When using the SOAP format of charting, how should the RN document this finding -O: Client reports fingers are stiff -O: Denies finer tenderness at pressent -S: History of finger discomfort -S: Fingers get stiff after computer work

16. Ms. Lieu is able to move her upper extremities through complete range of motion. In documenting full range of motion of the upper extremities, the RN is able to note the absence of which abnormality? -Kyphosis -Flaccidity -Contracture -Arthritis

While the RN documents the findings related to the upper extremity assessment, the RN and Ms. Lieu continue the conversation about the stiffness in Ms. Lieu's fingers after using the computer. Ms. Lieu laughs quietly and states, "Getting older is not much fun. I often wonder how much longer I can keep working before my body gives out on me." 17. In responding to Ms. Lieu, the RN recognizes that the client is dealing with issues related to which of Erikson's developmental stages? -Integrity vs despair -Generativity vs stagnation -Identity vs inferiority -initiative vs guilt

18. Ms. Lieu continues the conversation, stating "I guess I may have to change the way I do certain things in order to continue to do the things I love." How should the RN respond to this statement? (Select all that apply) -Recognized that the client has repressed to an earlier developmental stage because of her worry about her current physical problems. -Explore with the client what strategies she has used in the past to successfully adjust to change in her life. -Offer encouragement to the client as she struggles to find meaning in her life despite her current physical problems. -Document on the assessment form that the client seems to be overly fixated on her currently physical problems. -support the client as she considered strategies to adapt to the physiologic changes contributing to her current physical problems. After further conversation, the RN continues the physical assessment by next examining the client's lower extremities

19. Ms. Lieu lies down on the exam table in a supine position. The RN assesses adduction and abduction of the hip by instructing the client to take what action? -bend the knee so the foot is flat on the table and allow the knee to drop inward and outward -Lift each leg straight about the body to a 90degree angle -Turn both legs so the toes are pointed inward and then outward -swing the entire leg laterally and then medically, keeping the knee straight while moving.

Ms. Lieu demonstrates FROM of her hips 20. While Ms. Lieu moves her legs through the various forms of ROM, the RN grades her muscle strength. To indicate 100% muscle strength, the RN assess for movement against which? (Select all that apply) -Rest -Gravity -Resistance -Light touch -Pain

21. To assess muscle strength in the foot, the RN next asks the client to dorsiflex her foot. The client points her toes downward. What action should the RN take next? -Place on hand on the bottom of the client's foot -Ask the client to flex her foot upward -Help the client evert and then invert her foot -Apply gentle pressure over the client's toes.

22. Ms. Lieu states that she is uncomfortable lying on the exam table, so the RN assists her to a sitting position before completing the assessment of her knees. The RN begins by observing the anterior thighs and knees. How should the RN assess for the presence of muscle atrophy? -Gently apply pressure around the patella -Observe the size of the muscle -Palpate the tissues for edema -Measure the muscle with a goniometer

23. Earlier, Ms. Lieu reported that she often experiences unilateral knee pain. The RN palpates Ms. Lieu's Left knee and notes the presence of a small amount of swelling. Which sign should the RN attempt to elicit? -Allis sign -Battle sign -Tinel's sign -Bulge sign

Following the completion of the assessment, Ms. Lieu stands up next to the exam table. She grabs hold of the table and lurches forward, indicating that her knee suddenly "gave way". The RN assists her back to a sitting position on the exam table. 24. Upon further questioning by the RN, Ms. Lieu reports that this buckling of her knee has occurred several times previously. What additional information is most important for the RN to obtain? -The date Ms. Lieu last had her bone density measured -How frequently Ms. Lieu performs weight-bearing exercises -Any recent history of trauma or injury to the affected knee -Whether MS. Lieu takes any pain medication for her knee pain

The RN performs McMurray's test and hears an audible click while maneuvering Ms. Lieu's left leg. In response to this finding, what action should the RN implement? -Explain to the client that her knee dislocation has resolved -Observe the client's gait as she walks across the room -Report the assessment to the clinic healthcare provider (HCP) -Plan to instruct the client ab out knee strengthening exercises.