Exam 3 - Musculoskeletal

The nurse is assessing a client for neurologic impairment after a total knee replacement. Which finding indicates impaired nerve function in the affected extremity? a. Coolness to the touch b. Diminished capillary refill c. Decreased distal pulse d. Inability to move

d

The progressive deterioration and loss of articular (joint) cartilage and bone in one or more joints. Which of these terms is this describing? a. osteoarthritis b. rheumatoid arthritis c. osteoporosis d. SLE

a

Which actions would the nurse recommend to a 72 year old client with osteoporosis to help reduce the rate of osteoporosis and prevent harm? Select all that apply a. Walking 1 mile every 5-7 days b. Eating a diet high in fruits and veggies c. Swimming for 30 minutes 3-5 times per week d. Preforming isometric and isotonic exercises daily e. Taking a daily calcium and vitamin D supplement f. Performing ROM exercises for the arm while sitting

a,d,e

Which assessment findings would the nurse expect in an older female with a history of osteoporosis? Select all that apply a. Gait changes b. Inability to bear weight c. Muscle atrophy d. History of fractures e. Swelling in her finger joints f. Spinal curvature with postural changes

a,d,f

The nurse is caring for an adult with a grade III compound fracture of the right femur; the client has been placed in skeletal traction. What is the intended outcome of the traction? a. Prevent skin breakdown b. Prevent movement in bed c. Preserve normal length of the leg d. Reduce and immobilize the fracture

d

The single most effective exercise for osteoporosis prevention is which of the following? a. Aerobic water exercises 2-3 times per week b. Bed rest everyday c. Nutritional supplementation through protein shakes d. Walking for 30 min 3-5 times per week

d

Which of these medications should a patient with a recent fracture should receive if put in Buck's tractions? a. phenobarbital b. lorazepam c. propranolol d. enoxaparin

d

The causes of osteomyelitis are many including bone surgery or a trauma to the bone. Which assessment finding(s)/manifestation(s) would you not expect to observe in a patient who has osteomyelitis? a. Bone pain that is worse with movement b. Fever c. Poor distal circulation d. Warm extremities e. Tenderness, swelling, redness, and warmth around infected bone area f. Increased WBC count g. Increased wound healing

d,g

Fat embolism is a complication that can occur with fractures, but hip fractures are at highest risk especially 24-72 hours after injury or surgery. True or false Fat embolism's are the presence of fat globules in the circulatory system causing a disruption of the blood vessels.

true

T/F Osteoarthritis is a unilateral disease process, whereas Rheumatoid arthritis is a bilateral disease process.

true

True or False Systemic Lupus Erythematosus (SLE) is a connective tissue disorder that can have periods of remission and exacerbation.

true

True or false A fasciotomy may be performed emergently to treat compartment syndrome

true

Which of these are expected outcomes for patients diagnosed with osteoporosis? Select all that apply a. Cluttering up the home b. Avoiding fractures by preventing falls c. Managing risk factors d. Taking as many medications as possible e. Adhering to preventive or treatment measures for bone loss.

b,c,e

What is type 3 hypersensitivity (an abnormal immune response is mediated by the formation of antigen-antibody aggregates called "immune complexes." They can precipitate in various tissues such as skin, joints)

Circulating autoantibodies attack tissues, causing this type of hypersensitivity reaction with formation of immune complexes.

True or false Patient's with chronic osteomyelitis are usually prescribed 4 to 6 weeks of antimicrobial therapy (sometimes more than one antimicrobial agent may be needed to combat multiple types of organisms.

False

Which body minerals are stored almost exclusively in the bones and contribute to bone density? Select all that apply a. Chloride b. Calcium c. Magnesium d. Phosphorus e. Sodium f. Potassium

b,d

True or false A rheumatologist is often most responsible for the day-to-day management of SLE.

True

What will you instruct a femur fracture to do to prevent future fractures, and what nonpharmacologic interventions will you teach them to prevent further bone loss? Select all that apply a. Decrease magnesium intake b. Increase calcium intake c. Increase iron intake d. Take Vitamin D to help with calcium absorption e. Decrease fluid intake f. Increase weight bearing exercise

b,d,f

A patient is recently diagnosed with osteomalacia. Which of these is the best description of the diagnosis? a. Softening of bone in adults due to inadequate vitamin D. b. Stiffening of the cartilage due to low calcium levels. c. The bone begins to break down itself to increase calcium levels. d. None of the above

a

Which actions will the nurse recommend to the client who has SLE for relief of general joint and muscle pain? a. Warm moist heat b. Medical marijuana c. Avoidance of all exercise d. Application of ice packs

a

Which client with persistent joint pain and stiffness will that nurse suspect has rheumatoid arthritis rather than another type of arthritis? a. 36 y/o white woman with bilateral wrist swelling b. 40 y/o black woman whose mother has osteoarthritis c. 45 y/o white woman with kidney stones d. 50 y/o black man who played professional football

a

Which of these is the primary drug of choice for pain because osteoarthritis is not a primary inflammatory disorder? a. acetaminophen b. oxycodone c. Percocet d. aspirin

a

______________________ is a procedure that uses a fiberoptic tube directly inserted in the joint to provide direct visualization. It is used for diagnostic purposes or during surgical repair/replacement of a joint. a. Arthoscopy b. MRI c. CT d. X Ray

a

i. Nonsteroidal antiinflammatory drug (NSAID) ii. Ibuprofen 200 mg 4x/day iii. Diclofenac gel iv. COX-2 inhibitor celecoxib (Celebrex) These drugs are examples of which category of pain relievers for osteoarthritis? a. moderate to severe b. mild to moderate

a

Which medications are used to help decrease the permanent effectors of RA? These drugs may show disease progression and decrease the risk of joint erosion and deformity. Select all that apply a. Methotrexate b. Sulfasalazine (Azulfidine) c. Hydroxychloroquine (Plaquenil) d. COX-2 Inhibitor

a,b,c

Which of these are potential complications from a fracture? a. Acute compartment syndrome b. Hypovolemic shock c. Fat embolism d. Venous thromboembolism e. Infection f. Paralytic Ileus

a,b,c,d,e

What are the five Ps that should guide the assessment of a femur fracture patient before and after surgery? a. Pain b. Pallor c. Paresthesia d. Parallel e. Pressure f. Paralysis

a,b,c,e,f

Which actions will the nurse take for a client after a total knee arthroplasty (TKA) to prevent venous thromboembolism? Select all that apply a. Encourage early ambulation b. Instructing client to keep legs straight at all times c. Administering the prescribed anticoagulant therapy medications d. Removing antiembolic socks for 1 hour every 4 hours e. Ensuring SCD placement and function f. Helping client to perform dorsiflexion and plantar flexion every hour

a,b,c,e,f

What interventions can be done by the nurse to prevent contractures? Select all that apply a. Wrap the residual limb (figure 8) b. Assist patient to prone position Q3-4 hrs for 20-30 mins c. Encourage laying on the affected side d. ROM exercises e. Decreasing pain medication administration

a,b,d

Which of these are characteristics of Buck's traction? Select all that apply. a. Circulation, movement, and sensation is an important assessment for Buck's traction. b. Weights need to be freely hanging at all times. c. Pin site care is an essential part of nursing management for Buck's traction. - needed for skeletal traction not skin traction d. A Velcro boot is used to immobilize the affected leg and connect to the weights. e. The weights can be lifted manually as needed for comfort.

a,b,d

Which of these are the non-pharma logical interventions for osteoarthritis? Select all that apply a. Rest balanced with exercise b. Joint positioning c. Walking up hills d. Heat or cold applications e. Weight control f. Exercising through the pain to build muscle g. Take adequate work breaks to rest joints in jobs where repetitive motion or joint stress is common.

a,b,d,e,g

A femur fracture patient recovers and is transferred to the rehabilitation unit and is prescribed alendronate (Fosamax) 70mg/week. Which instructions are appropriate as you provide patient teaching about this drug? Select all that apply. a. "You need to sit or stand upright for at least 30 minutes after taking the medication." b. "Take the medication with 8 ounces of water immediately on arising." c. "You can eat your breakfast along with this medication." d. "You can take this medication with your morning coffee or orange juice." e. "If you experience any severe abdominal pain, vomiting, or jaw pain, notify your doctor immediately."

a,b,e

Which of these are signs/symptoms of Systemic Lupus Erythematosus? Select all that apply a. Red, macular, facial rash over the cheeks and nose in the shape of a butterfly b. Bone pain that is constant, localized, and pulsating and worsens with movement. c. Coin-shaped lesions on the face, scalp, and sun-exposed areas d. Sensitivity to sunlight e. Decreased wound healing f. Presence of antinuclear antibodies (ANA).

a,c,d,f

Which information should be included in the teaching plan for a client with osteoporosis? Select all that apply. a. Avoid clutter and throw rugs to prevent falls b. Limit smoking to 1/2 pack or less per day. c. Maintain a diet with adequate amounts of Vitamin D, as in milk and cereals. d. Try swimming as a good exercise to maintain bone mass. e. Choose good calcium sources such as figs, broccoli, and almonds.

a,c,e

Which of these are the most common symptoms of osteoporosis? Select all that apply a. Back pain b. Leg pain c. Spontaneous fractures d. Internal bleeding e. Gradual loss of height f. Kyphosis

a,c,e,f

A client with a right knee injury is scheduled for an MRI. The nurse is preparing the client for the imaging test. Which question would be a priority to ask the client? a. Do you have trouble laying still? b. Do you have any type of metal in or on your body? c. Have you ever had an MRI before? d. What medications do you take on a regular basis?

b

Osteoarthritis is a slow progressive, __________________, disorder of the diarthrodial joints. a. inflammatory b. non inflammatory

b

Osteoporosis is a chronic, progressive __________________ bone disease, marked by low bone mass and structural deterioration of bone tissue, leading to increased bone fragility. a. catabolic b. metabolic c. chronic d. acute

b

Which assessment finding indicates to the nurse a possibility of systemic lupus erythematosus (SLE)? a. Use of penicillin prophylactically before dental examinations and procedures b. Intermittent fever and fatigue with no other symptoms of infection c. Joint and muscle pain without swelling after exercise d. Oily skin and increased facial acne

b

Which assessment finding on a client who has a closed fracture of the lower femur with extensive swelling and bruising indicates to the nurse that perfusion in the affected limb is adequate? a. Pulse ox in the affected leg is 98% b. Pedal pulse of the affected limb is easily palpated and strong c. Femoral pulse of the affected limb is easily palpated and strong d. Cap refill on the great toe of the affected limb is about 4 seconds

b

Which condition should the nurse assess when completing the history and physical examination of a client diagnosed with osteoarthritis? a. Osteoporosis b. Local joint pain c. Anemia d. Weight loss

b

Which of these cells are bone forming? a. osteoclasts b. osteoblasts c. osteocytes d. osteogenesis cells

b

Which of these statements is not true as to the purpose of traction for bone fractures? a. Immobilize a joint or part of the body b. Prevent new formation of bone c. Reduce a fracture or dislocation d. Prevent or reduce muscle spasm

b

Which test is used to detect osteoporosis? a. Arthroscopy b. Bone mineral density c. Serum calcium level d. Lumbar puncture

b

________________________________ is a chronic, progressive, systemic inflammatory autoimmune disease process that affects primarily the synovial joints. a. osteoarthritis b. rheumatoid arthritis c. osteoporosis d. SLE

b

Disorders of the bone and parathyroid gland are often reflected in an alteration of which two serum blood levels? a. Magnesium b. Calcium c. Phosphorus d. Iron e. Potassium

b,c

Which two things should patients who are diagnosed with osteoporosis avoid because they compromise bone health? a. tobacco b. alcohol c. caffeine d. carbohydrates

b,c

What are some treatments that may be prescribed for a diagnosis of osteomyelitis? Select all that apply a. Buck's traction b. Hyperbaric O2 therapy c. Antibiotics (4-6 weeks) d. Surgical management (amputation, debridement, sequestrectomy)

b,c,d

Which assessment findings in a client with a complete and displaced fracture of the femur indicates to the nurse possible fat embolism syndrome? Select all that apply a. Increased swelling over fracture site b. Pa02 = 72 mmHg c. Sudden onset of confusion d. Decreased platelet count e. Petechiae of chest and neck f. Dry mucous membranes

b,c,d,e

You are performing an assessment on a patient who has fractured a hip. What assessment findings would you anticipate to observe? a. Decreased pain b. Change in bone alignment c. Alteration in length of extremity d. Change in shape of bone e. Decreased ROM f. Crepitus g. Ecchymotic skin h. Swelling at the fracture site

b,c,d,e,f,g,h

Which statement by a client with osteoarthritis indicates to the nurse the need for more education about health promotion to prevent harm? Select all that apply a. My children gave me a gift certificate for paraffin dips for my feet b. When my joints are stiff I stay in bed for the rest of the day c. I find my knees hurt less when I wear shoes with firm soles rather than slippers d. Keeping my knees bent on a large pillow when sleeping at night helps to reduce my pain e. Even on days when I have more severe symptoms I try to walk short distances outside f. I read that avoiding tomatoes, potatoes, and eggplant can help reduce arthritic pain

b,d,f

A client is admitted to the surgical floor with an open tibial fracture. The nurse is aware of what possible complication of this type of fracture ? a. Generalized edema b. Surgery c. Osteomyelitis d. Inability for the bone to heal

c

An ___________________________ is an invasive diagnostic procedure that may be used for patients with joint swelling caused by excess synovial fluid (effusion) that will help relieve pressure. a. arthroscopy b. synovial fluid puncture c. arthrocentesis d. paracentesis

c

Clinical manifestations such as deformities (swan neck or ulnar deviation) and moderate-to severe pain and morning stiffness are indicative of which of the following? a. early stage osteoarthritis b. mid stage osteoporosis c. late stage rheumatoid arthritis d. late stage SLE

c

There is no characteristic pattern that occurs in the progressive involvement of SLE. Any organ can be affected. Generalized complaints, such as fever, weight loss, _________________ and excessive fatigue may precede an exacerbation of disease activity. a. kyphosis b. lordosis c. butterfly rash d. ecchymosis

c

This is often referred to as a silent disease or silent thief because the first sign in most people follows some kind of fracture. a. osteoarthritis b. rheumatoid arthritis c. osteoporosis d. SLE

c

What is the nurses best response when a client who has been treated for 4weeks for osteomyelitis asks why the disease is so difficult to cure? a. Bones have a poor blood supply and are located deep in the body that is hard for antibiotics to reach them b. There are no early symptoms of osteomyelitis, so by the time its detected the infection is wide spread. c. After a bone abscess forms, it gets covered with a new bone layer that is difficult for drugs to penetrate. d. The most common organisms that cause osteomyelitis are usually drug resistant.

c

What is the typical age onset of osteoarthritis? a. 30 years b. 45 years c. 60 years d. 75 years

c

When performing a musculoskeletal assessment on a patient, it is important to obtain a patient history and a __nutritional_________ history. a. exercise b. genetic c. nutritional d. none of the above

c

Which assessment finding on an older client who fell while getting out of bed indicates to the nurse possible fracture? a. The client is extremely confused and trying to get up b. The skin on both legs is darker and cooler than lower extremities c. One leg is shorter than the other and has a protruding bump on the side d. The client cries out when the nurse examines him

c

Which client statement indicates to the nurse that more teaching about systemic lupus erythematosus is needed? a. During flares, I may need higher doses of my corticosteroids b. I will take walks and stretch my muscles daily even when it doesn't hurt c. If I do not have a flare in over a year I can stop my corticosteroids d. If my urine becomes bloody or foamy I will call my rheumatology provider immediately

c

Which of these complications does not typically occur after an amputation? a. hypovolemic shock b. infection c. fat embolism d. phantom limb pain e. neuroma f. flexion contractures

c

Which of these is the newest laboratory test that is very specific and sensitive in detecting RA? a. Anti-Xa factor b. Synovial fluid analysis c. Anticyclic citrullinated peptide (anti-CCP) d. Rheumatoid factor

c

__________________________ is a chronic disease of cellular regulation in which bone loss causes significant decreased density and possible fracture. a. osteoarthritis b. rheumatoid arthritis c. osteoporosis d. SLE

c

Which client statement indicates to the nurse possibility of osteoarthritis? a. When I stand to long in one place my back hurts although walking doesn't bother it b. I noticed that my third finger joint seems to be tilting inwards towards my other fingers c. My knees hurt so much I end up taking a lot of acetaminophen or aspirin d. There is a lot of osteoarthritis in my family how can I prevent it?

c - persistent specific joint pain

Which of these is a characteristic of compartment syndrome? Select all that apply a. Warmth of the extremity b. Pain distal to the injury that is not relieved by opioid analgesics c. Numbness and tingling of the extremity d. Pallor of the extremity e. Petechiae over the extremity

c,d

Which of these are signs/symptoms of acute osteomyelitis? Select all that apply a. Necrosis b. Decreased circulation to area c. Fever (above 38.3 C) d. Swelling around the affected area e. Erythema and heat in the affected area f. Tenderness g. Bone pain that is constant, localized, and pulsating and worsens with movement.

c,d,e,f,g

A patient has just returned to the unit following elective amputation of their right foot. Which assessment findings should the nurse report to the doctor as concerning? Select all that apply a. Wound is approximated b. CMS intact c. Skin is purplish/blue color d. Pain is 4/10 e. Minimal swelling at the ankle f. Skin is cool to touch

c,f

Rheumatoid arthritis is a chronic, systemic autoimmune disease. It causes inflammation of the _________________ tissue in the _diathrodial_________ or synovial joints.

connective

Normal bone building is disrupted, and calcification does not occur to harden the bone due to a ____________________ deficiency. a. Vitamin B d. Vitamin E c. Vitamin C d. Vitamin D

d

Patients with OA are encouraged to exercise and lose weight if appropriate. What type of exercise would you recommend them? a. anaerobic b. strenuous c. light d. aerobic

d

Which of these is not a musculoskeletal changes associated with aging? a. Decreased coordination b. Loss of muscle strength c. Gait changes d. Risk for injury d/t falls e. Increased calcium retention

e

___________________________________ is less invasive, the patient will wear a boot around the skin and lay in a special orthopedic that has pulleys to attach to the boot. a. skin traction b. buck's traction c. skeletal traction d. none of the above e. a and b f. b and c g. a and c

e

Which of these lab studies are not performed to help in diagnosing RA? a. Rheumatoid factor (RF) b. ESR and C-reactive protein (CRP) c. Antinuclear antibody (ANA) d. Antibodies to citrullinated peptide (anti-CCP) e. Synovial fluid analysis f. Lumbar puncture

f

True or false Buck's traction is skeletal traction

false

True or false Patients who have traction as part of their treatment should decrease their fluid intake.

false

________________________________ is adipose from the yellow bone marrow within the bone breaks off from inside the bone during a fracture and can lodge into blood vessels in the body. Some signs/symptoms that may be seen are hypoxia, anxiety, restlessness, feeling of doom, petechiae rash.

fat embolism

_____________________ is the most common symptom of osteoarthritis.

joint pain

Which of these is NOT a risk factor for developing osteoporosis? a. Advancing age (>65 yr) b. Female gender c. Low body weight d. White or Asian e. Current cigarette smoking f. Prior fracture g. Sedentary lifestyle h. Estrogen deficiency i. Family history j. Diet low in calcium/vitamin D deficiency k. Excessive use of alcohol (>2 drinks/day) l. Specific diseases m. Certain drugs(corticosteroids) n. Testosterone deficiency

n

True or false An important teaching point for someone at risk for osteomyelitis is oral hygiene.

true

True or false Osteoarthritis is a degenerative disease with secondary inflammation.

true

True or false Osteoarthritis may be unilateral, single joint, affects weight-bearing joints and hands, spine and is non-systemic.

true