CHAPTER 18 The Musculoskeletal System

CHAPTER 18 The Musculoskeletal System

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

18.1•Musculoskeletal changes that occur with the aging process include

1. thickening of the vertebral discs.
2. atrophy of muscles in the extremities, occurring first in the upper extremities.
3. a loss in height.
4. increase in range of motion of joints as a result of loosening of ligaments.

Answer: 3

Rationale: Changes with the aging process in the musculoskeletal system include a loss in height, the result of a shortening of the vertebral column. There is a loss of muscle mass in skeletal muscles with muscle atrophy of the extremities occurring first in the lower extremities. The vertebral discs thin with age, and there is a decrease in the range of motion in joints.

Diagnosis

Physiological Integrity

Analysis

18.2•Osteoarthritis

1. is a metabolic bone disease.
2. is most common in thin, small-built female clients.
3. results from synovial inflammation.
4. involves erosion of joint articular cartilages with new bone formation in the joint space.

Answer: 4

Rationale: Osteoarthritis is characterized by progressive erosion of the cartilage within joints, which is then replaced by new bone in the joint spaces. Osteoarthritis is a noninflammatory joint disease. Metabolic bone diseases include osteoporosis, osteomalacia, and Paget’s disease. Obesity is associated with osteoarthritis. Thin body habitus is associated with osteoporosis. Rheumatoid arthritis is a joint disease that involves synovial inflammation.

Diagnosis

Physiological Integrity

Analysis

18.3•The diagnostic test commonly used to diagnose fracture of the hip is

1. bone mineral density (BMD).
2. x-ray of the hip.
3. magnetic resonance imaging (MRI) of the hip.
4. bone scan.

Answer: 2

Rationale: An x-ray of the hip is used to confirm the diagnosis of the fracture. The test is readily available in hospitals, can be done relatively quickly, and details the type of fracture. The BMD measures the mineral density of the bone, which reflects bone strength and is used as an indicator of osteoporosis. An example of BMD, the dual energy x-ray absorptiometry (DEXA), is done at the site of the proximal femur to predict hip fracture risk. The MRI, which requires special facilities, cannot show calcification or bone mineralization, and images of bone structure are not as useful as those of an x-ray. A bone scan uses injection of a radioactive isotope to determine the amount of bone matrix within a bone. It is used to determine stress fractures and to detect whether bone metastasis has occurred in clients with malignancies.

Diagnosis

Physiological Integrity

Application

18.4•Rheumatoid arthritis

1. is diagnosed by a positive pannus blood test.
2. results from a deficiency of vitamin D.
3. includes systemic manifestations as well as bilateral joint deformities.
4. is characterized by low bone mass and compromised bone strength.

Answer: 3

Rationale: Rheumatoid arthritis is an inflammatory condition that includes systemic manifestations as well as the characteristic rheumatoid joint deformity. Diagnosis is made based on physical findings, including evidence of inflammation as verified by elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Rheumatoid factor (RF) is an antibody found in the blood that is associated with rheumatoid arthritis but may not be positive in the early stages of the disease. Pannus, a proliferation of tissue in the synovial space, can be observed on x-rays after the disease has progressed. Osteomalacia, demineralization of the bone, is caused by a deficiency of vitamin D. Osteoporosis is characterized by a loss in bone mass leading to compromised bone strength.

Diagnosis

Physiological Integrity

Analysis