Med/Surg - Musculoskeletal

A client is being discharged home after application of a plaster leg cast. The nurse determines that the understands proper care of the cast if the client makes which statement?

"I need to avoid getting the cast wet."

Which patient statement indicates the need for additional teaching for a patient with Rheumatoid Arthritis who is taking meloxicam (Mobic - an NSAID)?

"I take aspirin before I go to bed".

Alendronate (Fosomax) is prescribed for a client with osteoporosis and the nurse is providing instructions on administration of the medication. Which instruction should the nurse reinforce?

"Take the medication with a full glass of water after rising in the morning."

The patient has been diagnosed as having gouty arthritis. The patient asks the nurse to explain the cause of inflammation of the great toe. What is the most appropriate nursing response?

"The inflammation is from small accumulations of uric acid crystals, which are called tophi".

A client with acute muscle spasms has been taking baclofen. The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client?

"Weakness and fatigue commonly occur and will diminish with continued medication use."

The 14-year-old boy who is scheduled for left leg amputation says to the nurse, "What in the world am I going to do with only one leg?" What is the nurse's most therapeutic response?

"What are you thinking about right now?"

The order is Vitamin B12 0.75mg IM stat. The stock supply is 1,000 mcg/ml. How many ml will you give?

0.75ml.

The nurse takes into consideration that a healing fracture progresses through several healing stages. Place the stages in order of healing.

1. Clot formation. 2. Formation of hematoma. 3. Development of fibrin meshwork. 4. Osteoblasts home fracture site form. 5. Vascularization. 6. Collagen fibers collect calcium. 7. Callus.

The nurse is preparing a list of fast care instructions for a client who just had a plaster cast applied to his right forearm. Which instructions should the nurse include on the list?

1. Keep the cast and extremity elevated. 2. The cast needs to be kept clean and dry. 3. Allow the wet cast 24-72 hours to dry.

What are the 5 basic functions of the skeletal system?

1. Support. 2. Protection. 3. Movement. 4. Mineral Storage. 5. Hematopoiesis (blood cell formation).

In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings should the nurse interpret as acceptable responses?

1. Symptom control during periods of emotional stress. 2. Normal white blood cell, platelet, and neutrophil counts. 3. Radiological findings that show nonprogression of joint degeneration. 4. An increased range of motion in the affected joints 3 months into therapy.

What are the 2 divisions of the skeletal system?

1. The Axial Skeleton (skull, hyiod bone, vertebral column, and thorax). 2. The Appendicular Skeleton (upper extremities, lower extremities, shoulder, girdle, and pelvic girdle - excluding the sacrum).

The nurse administering the drug colchicine for gout will give 0.5mg hourly for ______ hours.

12.

How many bones are in the human body?

206.

Order is Potassium Chloride 30mEq PO BID, the supply package contains 15ml of potassium chloride oral solution 10% that is 20mEq/15mL. How many ml will you give?

22.5ml.

Which patient is most likely to develop osteoporosis?

57-year-old white / Asian woman.

The nurse is planning to reinforce instructions to the client about how to stand on crutches. In the instructions the nurse should plan to tell the client to place the crutches in which position?

8 inches to the front and side of the client's toes.

Callus

A bony deposit formed between and around the broken ends of a fractured bone during healing. Forms when the osteoblasts continue to lay the network for bone buildup and osteoclasts destroy dead bone.

Ankylosing Spondylitis or AKS

A chronic, progressive disorder that primarily impacts the spine and may also spread to include the sacroiliac and hip joints, and the adjacent soft tissues. Cause is unknown.

Bone Scan

A diagnostic exam especially valuable in detecting metastatic and inflammatory bone disease?

Computed Tomography or CT Scan

A diagnostic exam that produces a 3D picture of the structure being studied through narrow x-ray beam and is useful in locating injuries to the ligaments or tendons, tumors of the soft tissue and fractures in areas difficult to define by other means.

MRI

A diagnostic exam used in diagnosing abnormalities of bones and joints and surrounding soft tissue structures including cartilage , synovium, ligaments, and tendons.

Myelogram

A diagnostic exam used to detect structural disorders such as a herniated disk, tumors, or the presence of infection.

Arthritis

A disease involving inflammation of the joints.

Osteoporosis

A disorder that results in bone density loss from an unknown cause.

Fibromyalgia

A fairly common condition that results in chronic pain, primarily in joints, muscles, and tendons.

Sequestrum

A fragment of necrosed bone that has become separated from surrounding tissue.

Crepitus

A grating or grinding sensation caused by fractured bone ends or joints rubbing together.

Gout or Gouty Arthritis

A metabolic disease resulting from an accumulation of uric acid in the blood. It is an acute inflammatory condition associated with ineffective metabolism of purines.

Osteoarthritis or Degenerative Joint Diseae (DJD)

A nonsystemic, noninflammatory disorder that progressively causes bones and joints to degenerate.

When a patient is recovering from a fractured tibia asks what callus formation is, the nurse tells her it is:

A part of the bone healing process after a fracture when new bone is being formed over the fracture site.

Compartment Syndrome

A pathologic condition caused by the progressive development of arterial vessel compression and reduced blood supply to one of the body's compartments, typically in an extremity.

Volkmann's Contracture

A permanent contracture with clawhand, flexion of wrist and fingers, and atrophy of the forearm that can occur as a result of compartment syndrome.

Open Reduction with Internal Fixation (ORIF)

A surgical procedure allowing fracture alignment under direct visualization while using various internal fixation devices applied to the bone.

Bipolar Hip Replacement (Hemiarthroplasty)

A surgical procedure that replaces one half of the hip joint with a prosthetic, while leaving the other half intact.

Which of the following are the main purposes of traction?

A. Align and stabilize a fracture. B. Prevent deformities. C Relieve muscle spasms.

Which instructions should the nurse include in a teaching plan for a person with gouty arthritis?

A. Avoid excessive alcohol. B. Maintain rest and immobility while symptomatic C. Check urine for possible kidney stones. E. Use bed cradle to support linens.

A client has been prescribed crutches for an injury, which of the following nursing actions are appropriate for safe crutch use?

A. Distance between the axilla and the arm pieces should be 2-3 finger widths in the axillar space. B. Elbows should slightly flex 20-30 degrees while client is walking c. When ambulating with the client, stand on the affected side. D. Instruct client to never rest the axilla on the axillary bars.

The nurse understands that the goals for a client with a total knee replacement includes:

A. Monitor incision for drainage and infection. B. Perform continuous passive motion for 24-48 hrs. C. The patient should avoid bearing weight on affected leg. D. Prevent leg from dangling over the edge of the bed.

A client incurred an intertrochanteric fracture as a result of a fall, in planning ways to increase her safety the nurse realizes it is most important to determine:

A. Pre-existing health conditions.

A patient is scheduled for an endoscopic spinal surgery to prevent a herniated disk. Which of the following statements is most accurate?

A. Special scopes are placed through small incisions causing minimal damage to surrounding tissue.

The characteristics of osteoarthritis that should be included in a teaching plan would include that osteoarthritis:

A. Will cause the formation of Heberden nodes. C. Results from wear and tear. D. May affect only one side of the body.

The patient that has a bipolar hip replacement following an intracapsular fracture has an order to be turned every 2 hours. The nurse understands that the correct nursing intervention is to keep the legs;

Abducted so the prosthesis does not become dislocated.

What is the movement of an extremity away from the midline of the body called?

Abduction.

Ankylosis

Abnormal stiffening and immobility of a joint due to fusion of the bones.

What is the first priority nursing intervention for an impending fat embolism?

Administer oxygen in a respiratory emergency.

A patient has undergone a bipolar hip repair (hemiarthroplasty). Which is the most appropriate instruction?

Avoid crossing legs.

When caring for a client experiencing an acute gout attack the nurse anticipates administering which medication?

B. Colchicine

A client with a possible fracture has never had a chest x-ray before, the nurse will plan to tell the client which of the following about the procedure?

B. It is necessary to remove all jewelry and metal objects.

What are the three vital functions muscles perform when they contract?

B. Maintenance of poster. C. Motion. E. Production of heat.

In order for a patient to flex the lower leg, which muscle must be contracted.

Biceps Femoris.

A 56-year-old female patient is being seen for osteoarthritis of the knee in the clinic. What should the nurse recommend when discussing strengthening exercises?

Bicycling.

Certain foods may increase the pain associated with gout. Which foods have the highest concentration of purines?

Brain, liver, and kidney.

A patient, age 68, has suffered an intertrochanteric fracture of the right hip. Before surgery, to provide support and comfort, an immobilizing device of a ____________ is applied.

Buck Traction.

Choose the medication that is an analgesic, anti-inflammatory, and a cox2-inhibitor.

C. Celecoxib / Celebrex.

Musculoskeletal chronic pain of unknown etiology that causes pain in muscle, bones, and joints is called:

C. Fibromyalgia.

In caring for a patient with Rheumatoid Arthritis, the nurse remembers that:

C. Rest and exercise are both important part of therapy.

Which are clinical signs of gouty arthritis?

C. Tophi (calculi-containing sodium urate deposits).

Tophi

Calculi containing sodium urate deposits that develop in periarticular fibrous tissue, typically in patients with gout.

The nurse is caring for the client who has had skeletal traction applied to the left leg. The client is complaining of severe left leg pain. Which action should the nurse take first?

Check the client's alignment in bed.

Blanching Test

Circulation status. Capillary Refill.

The Diagnostic procedure that provides an endoscopic exam of various parts is:

D. Arthroscopy

Your client has a history of gout ,when teaching the patient which foods to avoid you should include:

D. Liver, kidney, anchovies, and scallops.

What are common uses for arthrocentesis?

Diagnosing trauma, systemic lupus erythematosus, gout, osteoarthritis, and rheumatoid arthritis.

A patient had an open reduction with internal fixation (ORIF) for a compound fracture of the left tibia and has been placed in a long leg cast, The assessments by the nurse are: left foot warm/pink, pedal pulse weaker than right, capillary refill 3 seconds, and small 1 cm area of blood on cast. What should the nurse do?

Document that all assessments are within normal limits.

The nurse is monitoring a client receiving baclofen for side effects related to the mediation. Which should indicate that the client is experiencing a side effect?

Drowsiness.

The nurse is assigned to care for a client with multiple traumas who is admitted to the hospital. The client has a leg fracture , and a plaster cast has been applied. In positioning the casted leg, the nurse should perform which intervention?

Elevate the leg on pillows continuously for 24-48 hours.

A patient has been casted to stabilize a fracture of the right radius and ulna. The nurse assesses a capillary refill of 5 seconds and cold fingers of the right had. Which initial intervention should the nurse deploy?

Elevate the right hand to heart level to maintain arterial pressure.

The nurse is caring for a client with fresh application of a plaster leg cast. The nurse should plan to prevent the development of compartment syndrome by which action?

Elevating the limb and applying ice to the affected leg.

The patient, age 58, is diagnosed with osteoporosis after densitometry testing. She has been menopausal for 5 years and has been concerned about her risk because her mother has osteoporosis. In teaching her about her osteoporosis, which information does the nurse include?

Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.

48 hours after a patient sustained a fractured femur in a car accident, the nurse assessed a pulse of 110, respirations at 25, and labored crackles in both lung fields. The nurse immediately reports to the charge nurse the probability of a:

Fat Embolism.

What should the nurse instruct the patient before the initiation of the antimalarial drug hydroxychloroquine (Plaquenil)?

Get an eye examination.

The nurse explains that the use of the ________ brace allows a person with a cervical fracture to be mobile.

Halo.

The nurse witnesses a client sustain a fall and suspects that the client''s leg may be fractured. Which action is the priority?

Immobilize the leg before moving the client.

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that this pain may be caused by which condition?

Impaired tissue perfusion.

The nurse clarifies to a patient who is being evaluated for possible rheumatoid arthritis that the elevated erythrocyte sedimentation rate indicates the presence of:

Increased inflammatory reaction in the body.

What should the nurse do when a patient with osteomyelitis is admitted with an open wound that is draining?

Initiate drainage and secretion precautions.

A patient who has had a right below the knee amputation continues to complain of unpleasant sensation in the right foot. What can the nurse explain about this "phantom pain"?

It is related to the severed nerves that are still sending messages to the brain.

When the patient with rheumatoid arthritis complains about the daily exercise, the nurse encouragingly reminds the patient that exercises:

Keeps the joints from "freezing".

Which foods should the home health nurse suggest for the patient with osteoporosis to help slow the disease?

Leafy green vegetables.

The nurse is reviewing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which tests would identify and adverse effect associated with the administration of this medication?

Liver function test. *Dose-related liver damage is the most serious adverse effect of dantrolene.

The office nurse has noted the presence of an increase in lumbar curvature in a 20-year-old female patient. What is this condition known as?

Lordosis

The nurse is evaluating the client's use of a cane for left-sided weakness. The nurse should intervene and correct the client if the nurse observed that the client performed which action?

Moves the cane when the right leg is moved.

A 16-year-old male patient presents in the emergency room with a pathologic fracture of the left femur and complains of pain on weight bearing. These are cardinal indicators of:

Osteogenic Sarcoma.

Subluxations

Partial or incomplete dislocations.

What dose prolonged bed rest put the older adult at risk for?

Pathologic Fractures.

Which findings would delay a CT scan?

Patient's allergy to shellfish.

What is the large fan-shaped muscle that covers the anterior chest from the sternum to the proximal end of the humerus and acts on the joint of the shoulder to flex, adduct, and rotate?

Pectoralis Major

The nurse has provided instructions regarding specific leg exercises for the client immobilized in right skeletal lower leg traction. The nurse determines the need for further teaching if the nurse observes the client doing which activity?

Performing active ROM to the right ankle and knee.

A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse should plan for which intervention?

Petaling the cast edges with adhesive tape.

What should the nurse include in the plan of care for a patient following a myelogram?

Position in a semi-Fowler position for 8 hours to reduce potential of headache.

The nurse is checking the casted extremity of a client. The nurse should check for which sign indicative of infection?

Presence of a "hot spot" on the cast.

The nurse explains to a patient who has had a knee replacement that warfarin (Coumadin) is ordered to:

Prevent formation of emboli.

A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension traction has which primary function?

Provides comfort by reducing muscle spasms and provides fracture immobilization.

What should the nurse stress to a patient who has had a a hip replacement and is beginning strengthening exercises for the unaffected leg?

Push foot down against the foot board for a count of 5.

What should the nurse stress to a post-hip replacement patient in quadriceps setting exercises?

Push knee down to mattress and raise heel off the bed.

Arthroplasty

Repair or refashioning of one or both sides, parts, or specific tissue within a joint. Often required on the elbow, hip, knee, or shoulder to restore or increase mobility.

What should the home health nurse include assessment for in the plan of care for an 82-yera-old female with severe kyphosis from ankylosis?

Respiratory Effort.

How is rheumatoid arthritis distinguished from osteoarthritis?

Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints.

Paresthesia

Sensation of numbness or tingling.

The nurse is evaluating the pin sites of a client win skeletal traction. The nurse would be LEAST concerned with which finding?

Serious drainage.

Calcium is a mineral found in many foods that can slow bone loss during the aging process. Which food is high in calcium?

Spinach.

The nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up, and the leg appears fractured. The nurse should plan to perform which action?

Stay with the person and encourage them to remain still.

Arthrodesis

Surgical fusion of a joint. Can be performed when severe joint destruction has occurred.

What should the nurse include in the teaching plan for a patient who is taking alendronate (Foxamax)?

Take the drug first thing in the morning.

Colles' Fracture

The break of the distal end of the radius at the epiphysis often occurs when the pt has attempted to break his/her fall.

X-Ray

The diagnostic study most often used for determining musculoskeletal system integrity.

Rheumatoid Arthritis

The most serious form of arthritis that leads to severe crippling. It is more common in women and is a systemic.

The nurse instructs the patient who is to have a unicompartmental knee replacement that a major advantage of this partial nee replacement is that;

The patient will be up and walking 2-3 hours after the operation.

Arthrocentesis

The puncture of a joint with a needle and the withdrawal of synovial fluid for diagnostic purposes.

The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept, it is most important for the nurse to collect which data?

The white blood cell counts and platelet counts.

A patients patellar-femoral cartilage has deteriorated due to arthritis. The medial and lateral cartilage is undamaged. This patient is likely to undergo _____________ knee replacement surgery.

Unicompartmental (partial).