Musculo
A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following? a) Proteus vulgaris b) Escherichia coli c) Psuedomonas aeruginosa d) Staphylococcus aureus
Staphylococcus aureus Explanation: S. aureus causes over 50% of bone infections. Other organisms include P. vulgaris and P. aeruginosa, as well as E. coli.
In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations? a) Wound irrigation b) Wound packing c) Surgical debridement d) Vitamin supplements
Surgical debridement Explanation: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.
Morton's neuroma is exhibited by which of the following clinical manifestations? a) Inflammation of the foot-supporting fascia b) High arm and a fixed equinus deformity c) Longitudinal arch of the foot is diminished d) Swelling of the third (lateral) branch of the median plantar nerve
Swelling of the third (lateral) branch of the median plantar nerve Explanation: Morton's neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.
A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct? a) The recommended daily allowance of calcium may be found in a wide variety of foods. b) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. c) To prevent fractures, the client should avoid strenuous exercise. d) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss.
The recommended daily allowance of calcium may be found in a wide variety of foods. Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.
A male patient with a musculoskeletal injury is instructed to alter his diet. The objective of this diet alteration is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which of the following food items should the nurse encourage the patient to include in the diet? a) Green vegetables b) Red meat c) Bananas d) Vitamin D-fortified milk
Vitamin D-fortified milk Explanation: The nurse should advise the patient to include dietary sources of vitamin D, such as fatty fish, vitamin D-fortified milk, and cereals. These foods protect against bone loss and decrease the risk of fracture by facilitating the absorption of calcium from food and supplements. Red meat, bananas, and green vegetables do not facilitate calcium absorption from food and supplements.
The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? a) Decrease the intake of vitamin A and D b) Walk or perform weight-bearing exercises outdoors c) Increase fiber in the diet d) Reduce stress
Walk or perform weight-bearing exercises outdoors Explanation: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation.
Which of the following diagnostics confirms Paget's disease? a) Blood calcium level b) X-ray c) Bone scan d) Bone biopsy
X-ray Explanation: X-rays confirm the diagnosis of Paget's disease. Local areas of demineralization and bone overgrowth produce characteristic mosaic patterns and irregularities. Bone scans demonstrate the extent of the disease. A bone biopsy may aid in the differential diagnosis.
Choice Multiple question - Select all answer choices that apply. Which of the following are clinical manifestations of impingement syndrome? Select all that apply. a) Pain b) Limited movement c) Shoulder tenderness d) Muscle spasms e) Atrophy
• Pain • Shoulder tenderness • Limited movement • Muscle spasms • Atrophy Explanation: The patient experiences pain, shoulder tenderness, limited movement, muscle spasms, and atrophy. The process may progress to a rotator cuff tear
During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? a) "After menopause, the body's bone density declines, resulting in a gradual loss of height." b) "There may be some slight discrepancy between the measuring tools used." c) "The posture begins to stoop after middle age." d) "After age 40, height may show a gradual decrease as a result of spinal compression"
"After menopause, the body's bone density declines, resulting in a gradual loss of height." Explanation: The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question.
On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session? a) "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth." b) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." c) "Bunions are congenital and can't be prevented." d) "Bunions are caused by a metabolic condition called gout."
"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." Explanation: Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion.
The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a) "You need to perform weight-bearing exercises twice a week." b) "You will receive IV antibiotics for 3 to 6 weeks." c) "You need to limit the amount of protein and calcium in your diet." d) "Use your continuous passive motion machine (CPM) 2 hours each day."
"You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks.
Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client? ml
0.5 Explanation: 100 units x 1 ml/200 units = 0.5 ml.
23. According to the U.S. Department of Labor, occupation-related musculoskeletal disorders are illnesses or injuries of what? (Mark all that apply.) A) Nerves B) Cartilage C) Tendons D) Arteries E) Veins
Ans: A, B, C Feedback: According to the U.S. Department of Labor, occupation-related musculoskeletal disorders are injuries or illnesses of the muscles, nerves, tendons, joints, cartilage, and bones that occur because of exposure to work-related risks. Veins and arteries are not included in musculoskeletal disorders.
Instructions for the patient with low back pain include that when lifting the patient should a) place the load away from the body. b) bend the knees and loosen the abdominal muscles. c) avoid overreaching. d) use a narrow base of support.
Avoid overreaching. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. When lifting, the patient with low back pain should keep the load close to the body. When lifting, the patient with low back pain should bend the knees and tighten the abdominal muscles.
The nurse recognizes that the client with osteomyelitis is at risk for: a) Bone abscess formation b) Impingement syndrome c) Metastatic bone disease d) Pathological fractures
Bone abscess formation Explanation: Bone abscess formation is a potential complication of osteomyelitis.
The nurse recognizes that the client with osteomyelitis is at risk for: a) Metastatic bone disease b) Bone abscess formation c) Impingement syndrome d) Pathological fractures
Bone abscess formation Explanation: Bone abscess formation is a potential complication of osteomyelitis.
Which of the following clinical manifestations would the nurse expect to find in a client who has Paget's disease? a) Dowager's hump b) Flexion deformity of the toe c) Bowing of the legs d) High arch of the foot
Bowing of the legs Explanation: Paget's disease is characterized by pain and bowing of the legs.
Which of the following inhibits bone resorption and promotes bone formation? a) Parathyroid hormone b) Corticosteroids c) Estrogen d) Calcitonin
Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis.
When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with: a) Impingement syndrome b) Carpal tunnel syndrome c) Dupuytren's contracture d) Morton's neuroma
Carpal tunnel syndrome Explanation: Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome.
Which group is at the greatest risk for osteoporosis? a) African American women b) Men c) Caucasian women d) Asian women
Caucasian women Explanation: Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Asian women of slight build are at risk for low peak BMD. African American women, who have a greater bone mass that Caucasian women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.
Which of the following clinical manifestations would the nurse expect to find in a client who has had osteoporosis for several years? a) Increased heel pain b) Bone spurs c) Diarrhea d) Decreased height
Decreased height Explanation: Clients with osteoporosis become shorter over time.
Which of the following was formerly called a bunion? a) Hallux valgus b) Plantar fasciitis c) Morton's neuroma d) Ganglion
Hallux valgus Explanation: Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.
During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following? a) Hallux valgus b) Bunion c) Hammer toe d) Mallet toe
Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? a) Initiating weight-bearing exercise routines b) Stopping estrogen therapy c) Taking a 300-mg calcium supplement to meet dietary guidelines d) Living a sedentary lifestyle to reduce the incidence of injury
Initiating weight-bearing exercise routines Explanation: Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which of the following bone disorders? a) Osteoporosis b) Osteomalacia c) Osteitis deformans d) Osteomyelitis
Osteitis deformans Explanation: Osteitis deformans (Paget's disease) results in bone that is highly vascularized and structurally weak, predisposing to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from the extension of a soft tissue infection, direct bone contamination, or hematogenous spread.
Which of the following is a metabolic bone disease that is characterized by inadequate mineralization of bone? a) Osteomalacia b) Osteomyelitis c) Osteoarthritis d) Osteoporosis
Osteomalacia Explanation: Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from extension of soft tissue infection, direct bone contamination, or hematogenous spread. Osteoarthritis (OA), also known as degenerative joint disease, is the most common and frequently disabling of the joint disorders. OA affects the articular cartilage, subchondral bone, and synovium.
The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? a) Fat embolism b) Avascular necrosis c) Osteomyelitis d) Compartment syndrome
Osteomyelitis Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection.
The nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan? a) Monitor vital signs every 4 hours. b) Administer pain medication per client request. c) Examine surgical dressing every hour. d) Perform neuromuscular assessment every hour.
Perform neuromuscular assessment every hour. Explanation: The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is critical.
The nurse recognizes that goal of treatment for metastatic bone cancer is to: a) Diagnose the extent of bone damage b) Promote pain relief and quality of life c) Cure the diseased bone and cartilage d) Reconstruct the bone with a prosthesis
Promote pain relief and quality of life Explanation: Treatment of metastatic bone cancer is palliative.
A 70-year-old client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate? a) Promoting range-of-motion (ROM) exercises b) Promoting weight-bearing exercises c) Maintaining protein levels d) Maintaining vitamin levels
Promoting weight-bearing exercises Explanation: When the mechanical stressors of weight bearing are absent, disuse osteoporosis can occur. Therefore, if the client does weight-bearing exercises, disuse complications can be prevented. Maintaining protein and vitamins levels is important, but neither will prevent osteoporosis. ROM exercises will help prevent muscle atrophy and contractures.
Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women? a) Raloxifene b) Fosamax c) Denosumab d) Forteo
Raloxifene Explanation: Raloxifene is the only selective estrogen receptor modulator (SERM) approved for osteoporosis in post menopausal women as it does not increase the risk of breast or uterine cancer, but it does come with an increased risk of thromboembolism. Fosamax is a bisphosphonate. Forteo is a subcutaneously administered medication that is given one daily for the treatment of osteoporosis. Denosumab has recently been approved for treatment of postmenopausal women with osteoporosis who are at risk for fractures.
The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis? a) plicamycin (Mithracin) b) methotrexate (Rheumatrex) c) penicillamine (Cuprimine) d) raloxifene (Evista)
Raloxifene (Evista) Explanation: Raloxifene (Evista) is used for the prevention and treatment of osteoporosis.
38. As an amputee a patient is being assessed prior to being discharged home. What is an expected patient outcome the nurse would assess for? A) Patient exhibits healed, nontender, nonadherent scar B) Patient can stand for at least 2 hours C) Patient eats three nutritious meals daily D) Patient exercises 30 minutes weekly
Ans: A Feedback: Expected patient outcomes may include the following: achieves wound healing; controls residual limb edema; exhibits healed, nontender, nonadherent scar; demonstrates residual limb care.
2. A patient has sustained a long bone fracture. The nurse is preparing a care plan for this patient. Which intervention should the nurse include in the care plan to enhance fracture healing? A) Limit weight-bearing and exercising B) Monitor color, temperature, and pulses of the affected extremity C) Avoid immobilization of the fracture fragments D) Administration of high doses of corticosteroids
Ans: B Feedback: The nurse should include monitoring for sufficient blood supply by assessing the color, temperature, and pulses of the affected extremity as adequate blood supply enhances the healing of a fracture. Factors that inhibit fracture healing include inadequate or lack of immobilization of the fracture fragments and administration of corticosteroids. Weight-bearing exercises are encouraged for patients with long bone fractures.
14. The nurse at the pediatrian's office is assessing a 17-year-old soccer player who presented to the clinic stating that he sustained an injury that resulted in the knee being struck medially while his foot is firmly planted on the ground. The nurse knows that the patient likely has experienced what? A) Lateral collateral ligament injury B) Medial collateral ligament injury C) Anterior cruciate ligament injury D) Posterior cruciate ligament injury
Ans: A Feedback: When the knee is struck medially, damage may occur to the lateral collateral ligament. If the knee is struck laterally, damage may occur to the medial collateral ligament.
16. Radiographs were ordered for a 10-year-old boy who had his right upper arm injured. The radiographs show that the humerus appears to be fractured on one side and slightly bent on the other. What type of fracture is this an example of? A) Impacted B) Compound C) Compression D) Greenstick
Ans: D Feedback: Greenstick fractures are a result of the bone being broken on one side, while the other side is bent. Therefore options A, B, and C are incorrect.
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? a) Bone fracture b) Loss of estrogen c) Negative calcium balance d) Dowager's hump
Bone fracture Correct Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.
Which of the following positions should be avoided in severe back pain? a) Prone b) Supine c) Head and thorax elevated 30 degrees d) Lateral recumbent
Prone Explanation: A prone position should be avoided because it accentuates lordosis (inward curvature of the spine). Lumbar flexion is increased by elevating the head and thorax 30 degrees using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head.
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? a) "Using arm splints will prevent hyperflexion of the wrist." b) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." c) "Surgery is the only sure way to manage this condition." d) "This condition is associated with various sports."
"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Explanation: Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints.
40. The patient was placed in a long arm cast after fracturing her humerus. Twelve hours after the application of the cast, the patient tells the nurse that her arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action? A) Preparing the patient for cast removal or bivalving of the cast B) Obtaining an order for a different pain medication C) Encouraging the patient to wiggle and move the fingers D) Petaling the edges of his cast
Ans: A Feedback: Acute compartment syndrome involves a sudden and severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur. The patient complains of deep, throbbing, unrelenting pain, which continues to increase despite the administration of opioids and seems out of proportion to the injury. Removing or bivalving the cast relieves pressure. Ordering different analgesics doesn't address the underlying problem. Encouraging the patient to move the fingers or perform range-of-motion exercises won't treat or prevent compartment syndrome. Petaling the edges of a cast with tape prevents abrasions and skin breakdown, not compartment syndrome.
34. A rehabilitation nurse is working with a patient who is an amputee. The nurse knows that it is important for a patient who is an amputee to be an active participant is self-care. What do the nurse and patient need to maintain during the learning process? A) Positive attitudes B) Balanced nutrition C) Optimal mobility D) Family support
Ans: A Feedback: Amputation of an extremity affects the patient's ability to provide adequate self-care. The patient is encouraged to be an active participant in self-care. The patient needs time to accomplish these tasks and must not be rushed. Practicing an activity with consistent, supportive supervision in a relaxed environment enables the patient to learn self-care skills. The patient and the nurse need to maintain positive attitudes and to minimize fatigue and frustration during the learning process. Balanced nutrition, optimal mobility, and family support are important in the rehabilitation process but they do not have a higher priority in the delivery of care to amputees than the maintaining of positive attitudes.
27. A 25-year-old male is involved in a motorcycle accident and injures his arm. The physician diagnoses the man with an intra-articular fracture and splints the injury. When the man comes back for his 6-week checkup the nurse implements the teaching plan she has developed for this patient. What sequelae of intra-articular fractures would the nurse be sure to inform the patient about? A) Post-traumatic arthritis B) Post-traumatic nerve damage C) Post-traumatic stress syndrome D) Post-traumatic compartment syndrome
Ans: A Feedback: Intra-articular fractures often lead to post-traumatic arthritis. Research does not indicate a correlation between intra-articular fractures and nerve damage, PTSD, or compartment syndrome.
30. The patient is 6 weeks post-ORIF of his ankle when he comes to the orthopedic clinic for a follow-up appointment. The physician informs the patient that the bones in his ankle have not grown back together. What type of complication is this considered? A) Late complication B) Early complication C) Minor complication D) Major complication
Ans: A Feedback: Late complications include delayed union, malunion, and nonunion; therefore options B, C, and D are incorrect.
8. The patient scheduled for a Syme amputation in the morning is concerned about the ability to stand on the amputated extremity. The patient asks the nurse about his ability to stand after surgery. What is the nurse's best response to this question? A) "You will be able to withstand full weight-bearing on this durable extremity after the amputation." B) "You will have minimal weight-bearing on this extremity and will require the use of an assistive device." C) "You will not be able to use this extremity and will receive teaching on use of a wheelchair." D) "You will be fitted for a prosthesis and your commitment to rehabilitation will determine your functional abilities."
Ans: A Feedback: Syme amputation (modified ankle disarticulation amputation) is performed most frequently for extensive foot trauma and produces a painless, durable extremity end that can withstand full weight-bearing. Therefore options B, C, and D are incorrect.
24. A hockey player is brought to the emergency department after a game because of an injury. He is complaining of not being able to move his left arm, and his left arm appears longer than his right arm. The triage nurse suspects the hockey player has what? A) Dislocated left shoulder B) Fractured left clavicle C) Dislocated left elbow D) Fractured left humerus
Ans: A Feedback: Symptoms of a dislocated shoulder: pain. lack of motion, may feel empty shoulder socket, uneven posture in comparison to other shoulder, affected arm appears longer, abduction limited.
11. The nurse is caring for a patient who had a right extremity below the knee amputation (BKA). The nurse recognizes the importance of implementing measures that focus on preventing flexion contracture of the hip and maintaining proper positioning. Which of the following measures will achieve these goals? A) Encouraging the patient to turn from side to side and to assume a prone position B) Initiating ROM exercises of the hip and knee 3 months after the amputation C) Minimizing movement of the flexor muscles of the hip D) Encouraging the patient to sit in the chair for at least 8 hours of the day
Ans: A Feedback: The nurse encourages the patient to turn from side to side and to assume a prone position, if possible, to stretch the flexor muscles and to prevent flexion contracture of the hip. Postoperative ROM exercises are started early, because contracture deformities develop rapidly. ROM exercises include hip and knee exericises for patients with BKAs. The nurse also discourages sitting for prolonged periods of time.
5. The nurse is writing a care plan for a patient admitted to the Emergency Department (ED) with an open fracture. The nurse will assign priority to what nursing diagnosis for a patient with an open fracture of the radius? A) Risk for infection B) Risk for activity intolerance C) Risk for imbalanced nutrition: less than body requirements D) Risk for powerlessness
Ans: A Feedback: While all nursing diagnoses may be pertinent to the care of a patient with an open fracture of the radius, the nursing diagnosis that will receive the highest priority is "Risk for infection" related to the risks of osteomyelitis and tetanus. The objectives of management are to prevent infection of the wound, soft tissue, and bone and to promote healing. Another priority diagnosis for a patient with an open fracture would be "Risk for peripheral neurovascular dysfunction".
36. Your patient is returned from the PACU after an AKA of the right leg. You know to monitor for postoperative bleeding. Put your actions in the correct order that you would perform them if postoperative bleeding occurs after an amputation. A. Apply tourniquet that is kept at the bedside to affected limb. B. Monitor vital signs. C. Apply a pressure dressing. D. Call the surgeon.
Ans: A, D, B, C Feedback: Immediate postoperative bleeding may develop slowly or may take the form of massive hemorrhage resulting from a loosened suture. A large tourniquet should be in plain sight at the patient's bedside, so that if severe bleeding occurs, it can be applied to the residual limb to control the hemorrhage. The nurse immediately notifies the surgeon in the event of excessive bleeding. A pressure dressing is only applied at the doctor's order.
13. The orthopedic nurse is precepting a graduate nurse. They are caring for four fracture patients. The orthopedic nurse asks the graduate nurse which of their patients is at an increased risk for Volkmann's contracture. What should the graduate nurse respond? A) Femur B) Humerus C) Radial head D) Clavicle
Ans: B Feedback: The most serious complication of a supracondular fracture of the humerus is Volkmann's ischemic contracture, which results from antecubital swelling or damage to the brachial artery.
1. A patient is arriving to the orthopedic floor from the emergency room. While giving report to the floor nurse, the emergency room nurse states that the patient has a fracture of the nose that has resulted in a skin tear and involvement of the mucous membranes of the nasal passages. The orthopedic nurse is aware that this description likely indicates which type of fracture? A) Compression B) Compound C) Impacted D) Transverse
Ans: B Feedback: A compound fracture involves damage to the skin or mucous membranes and is also called an open fracture. A compression fracture involves compression of bone and is seen in vertebral fractures. An impacted fracture occurs when a bone fragment is driven into another bone fragment. A transverse fracture occurs straight across the bone shaft.
3. The nurse is assessing a patient's right knee. The assessment shows edema, tenderness, muscle spasms, and ecchymosis. The patient states that 2 days ago he ran 10 miles and now it hurts to stand up. Based upon these symptoms, the nurse bases her teaching upon the fact that she anticipates the patient has experienced what? A) A first-degree strain B) A second-degree strain C) A first-degree sprain D) A second-degree sprain
Ans: B Feedback: A second-degree strain involves tearing of muscle fibers and is manifested by notable loss of load-bearing strength with accompanying edema, tenderness, muscle spasm, and ecchymosis. A first-degree strain reflects tearing of a few muscle fibers and is accompanied by minor edema, tenderness, and mild muscle spasm, without noticeable loss of function. A first-degree sprain is caused by tearing of a few ligamentous fibers and is manifested by mild edema, local tenderness, and pain that is elicited when the joint is moved, but there is no joint instability. A second-degree sprain involves tearing of nerve fibers and results in increased edema, tenderness, pain with motion, joint instability, and partial loss of normal joint function.
7. A clinic nurse is caring for a patient who has a tibial fracture. The patient has just had a long-leg walking cast removed and a short leg cast applied. The nurse explains to the patient that the short leg cast will allow for what? A) Ankle motion B) Knee motion C) Hip motion D) Toe motion
Ans: B Feedback: A short leg cast or brace is placed 3 to 4 weeks after the fracture and will allow for knee motion that is not allowed by the long leg walking cast.
31. A 77-year-old female has fallen in her home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the neck of the left femur. What complication is common in fractures of the neck of the femur? A) Osteoporosis B) Avascular necrosis C) Nonadherance of bones D) Septicemia
Ans: B Feedback: Fractures of the neck of the femur may damage the vascular system that supplies blood to the head and the neck of the femur, and the bone may become ischemic. For this reason, AVN is common in patients with femoral neck fractures. Osteoporosis is not a complication of a fractured femur neck. Options C and D are also not complications of a fractured femur neck.
19. iWhich of the following is the most appropriate nursing intervention for the nursing diagnosis of Impaired physical mobility related to fractured hip? A) Administer analgesics as required. B) Place pillow between legs when turning. C) Monitor vital signs. D) Assess wound appearance.
Ans: B Feedback: Placing a pillow between the patient's legs when turning prevents adduction and supports the patient's legs. Administering analgesics is appropriate for the nursing diagnosis of pain. Monitoring vital signs is appropriate for the nursing diagnoses related to hyperthermia, ineffective breathing pattern or impaired cardiac output. Assessing wound appearance would be appropriate for a nursing diagnosis of Impaired skin integrity.
9. A patient with a simple fracture is involved in discharge teaching with their nurse. What would the nurse instruct the patient to do? A) Elevate the affected extremity to shoulder level. B) Engage in exercises that strengthen the unaffected muscles. C) Take corticosteroids as prescribed. D) Expect to regain full strength and mobility in 2 to 4 weeks.
Ans: B Feedback: The nurse will encourage the patient to engage in exercises that strengthen the unaffected muscles. Corticosteroids should be avoided, as this classification of drug will inhibit the healing of the fracture. The nurse should inform the patient that fracture healing and restoration of full strength may take months. Comfort measures may include analgesics and elevation of the affected extremity to the heart level.
35. You are caring for a patient who has had an amputation. What nursing action would you be least likely to perform with this type of patient? A) Teaching the patient self-care activities B) Placing the residual limb on a pillow C) Promoting mobility D) Teaching the patient how to wrap the stump
Ans: B Feedback: The residual limb should not be placed on a pillow, because a flexion contracture of the hip may result. This would be the least likely nursing action you would perform.
39. An elderly woman with a fractured hip is being cared for on your unit. What are contributory factors in the incidence of falls and fractured hips? (Mark all that apply.) A) Living alone B) TIAs C) Emboli D) Decreased hearing E) General frailty
Ans: B, C, E Feedback: Elderly people (particularly women) who have low bone density from osteoporosis and who tend to fall frequently have a high incidence of hip fracture. Weak quadriceps muscles, general frailty due to age, and conditions that produce decreased cerebral arterial perfusion (transient ischemic attacks, anemia, emboli, cardiovascular disease, effects of medications) contribute to the incidence of falls. Decreased hearing and living alone do not contribute to the incidence of falls.
15. A 16-year-old girl is taken to the emergency department after being kicked in the lower leg during a volleyball match. The leg area has become swollen and discolored. The triage nurse recognizes that the patient has likely sustained what? A) Sprain B) Strain C) Contusion D) Dislocation
Ans: C Feedback: A contusion is a soft-tissue injury that results in bleeding into soft tissues, creating a hematoma and ecchymosis. A sprain is an injury to ligaments caused by wrenching or twisting. A strain is a "muscle-pull" from overuse, overstretching, or excessive stress. A dislocation is a condition in which the articular surfaces of the bones forming a joint are no longer in anatomic contact.
25. A patient has presented to the emergency department with an injury to the wrist. The patient is diagnosed with a third-degree strain. Why would the physician order an x-ray of the wrist? A) Nerve damage is associated with third-degree strains. B) Compartment syndrome is associated with third-degree strains. C) Avulsion fractures are associated with third-degree strains. D) Greenstick fractures are associated with third-degree strains.
Ans: C Feedback: An x-ray should be obtained to rule out bone injury, because an avulsion fracture (in which a bone fragment is pulled away from the bone by a tendon) may be associated with a third-degree strain. Nerve damage, compartment syndrome, and greenstick fractures are not associated with third-degree strains.
6. While caring for a patient with a hip fracture, the nurse will instruct the patient to do what to prevent the most common complication associated with a hip fracture? A) Take the prescribed stool softener daily. B) Use the prescribed oxygen with ambulation. C) Increase fluid intake. D) Avoid movement of the feet and ankles.
Ans: C Feedback: Deep vein thrombosis (DVT) is the most common complication related to a hip fracture. To prevent DVT, the nurse encourages intake of fluids and ankle and foot exercises. While respiratory complications commonly include atelectasis and pneumonia, the use of deep-breathing exercises, changes in position at least every 2 hours, and the use of incentive spirometry help prevent the respiratory complications. Constipation may also occur after a hip fracture, but is not the most common complication.
17. The nurse is performing a shift assessment on an elderly patient who is recovering after surgery for a hip fracture. The nurse notes that the patient is complaining of chest pain, has an increased heart rate and respiratory rate. The nurse further notes that the patient is febrile and hypoxic, coughing and producing large amounts of thick white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, as she recognizes that this patient is likely demonstrating symptoms related to what? A) Avascular necrosis of bone B) Compartment syndrome C) Fat embolism syndrome D) Complex regional pain syndrome
Ans: C Feedback: Fat embolism syndrome occurs most frequently in young adults and elderly patients who experience fractures of the proximal femur (ie, hip fracture). Presenting features of fat embolism syndrome include hypoxia, tachypnea, tachycardia, and pyrexia. The respiratory distress response includes tachypnea, dyspnea, wheezes, precordial chest pain, cough, large amounts of thick white sputum, and tachycardia. Avascular necrosis (AVN) occurs when the bone loses its blood supply and dies it does not include coughing and neither does complex regional pain syndrome.
10. Six weeks after an above the knee (AKA) amputation, a patient returns to the outpatient office for a routine postoperative check up. During the nurse's assessment, the patient reports symptoms of phantom pain. What would the nurse correctly tell the patient to do to reduce the discomfort of the phantom pain? A) Apply hot compresses to the area of the amputation. B) Avoid rehabilitation exercises until the pain subsides. C) Comfortably increase their level of activity. D) Assess for a pulse in the extremity of the amputation every 4 to 6 hours.
Ans: C Feedback: Keeping the patient active helps decrease the occurrence of phantom pain. Early intensive rehabilitation and stump desensitization with kneading massage brings relief. Hot compresses should be avoided, as the extreme heat can compromise the tissue integrity of the area of healing. It is not necessary for the patient to assess a pulse in the affected extremity every 4 to 6 hours if experiencing phantom pain, as the cause of the pain is unknown.
18. A 28-year-old man with a fractured humerus calls the nurse into his room. Upon assessment, the nurse finds the patient to be tachycardic, pale, and confused. The nurse suspects the patient may be experiencing which of the following complications? A) Disseminated intravascular coagulopathy B) Compartment syndrome C) Fat emboli D) Deep vein thrombosis
Ans: C Feedback: Long-bone fractures may develop fat emboli syndrome, which presents with features including hypoxia, tachypnea, tachycardia, pyrexia, and mental status changes.
26. A 12-year-old boy is brought in by ambulance to the emergency department after being involved in an accident while participating in a BMX race. The boy has an open fracture of his tibia. The wound is highly contaminated and there is extensive soft tissue damage. What grade fracture would this be considered? A) Grade I B) Grade II C) Grade III D) Grade IV
Ans: C Feedback: Open fractures are graded according to the following criteria. Grade I is a clean wound less than 1 cm long. Grade II is a larger wound without extensive soft tissue damage. Grade III is highly contaminated, has extensive soft tissue damage, and is the most severe. There is no grade IV fracture.
28. A 65-year-old female patient has fallen and injured her ankle. Radiographs show that the woman has a trimalleolar fracture. The physician informs the woman that she needs surgery to repair her ankle. What type of internal fixation device would be used to hold the malleolus of the tibia in place? A) Plate B) Wire C) Screw D) Rod
Ans: C Feedback: Through a surgical approach, the fracture fragments are anatomically aligned. Internal fixation devices (metallic pins, wires, screws, plates, nails, or rods) may be used to hold the bone fragments in position until solid bone healing occurs. Screws are used to hold the small malleolus in anatomical place after it has broken off the tibia.
32. A 74-year-old male has fallen and broken his hip. What must the nurse be sure to assess the patient for so that complications can be prevented? A) Family history B) AVN C) Chronic conditions D) Fat embolism
Ans: C Feedback: To prevent complications, the nurse must assess the elderly patient for chronic conditions that require close monitoring. Family history is assessed but it does not prevent complications. A fat embolism is an early complication; assessing for it does not prevent complications. An AVN is the result of certain types of hip fractures; assessing for it does not aid in preventing fractures.
29. A 29-year-old male is admitted to the orthopedic unit with a fractured femur after running his motorcycle into a bridge abutment. The patient has been placed in traction until his femur can be rodded in surgery. What early complications would the nurse have to monitor this patient for? (Mark all that apply.) A) Alteration in elimination B) Alteration in personality C) Deep vein thrombosis D) Compartment syndrome E) Fat embolism
Ans: C, D, E Feedback: Early complications include shock, fat embolism, compartment syndrome, and venous thromboemboli (deep vein thrombosis [DVT], pulmonary embolism [PE]). Alteration in elimination and Alteration in personality are nursing diagnosis, not complications.
12. You are caring for a patient wearing a sling to support her arm after a clavicle fracture. What would the nurse instructs the patient to do? A) Elevate the arm above the shoulder 3 or 4 times daily. B) Avoid moving the elbow, wrist, and fingers for about 2 months. C) Engage in active range of motion using the affected bone. D) Use the arm for light activities within the range of motion.
Ans: D Feedback: A patient with a clavicle fracture may use a sling to support the arm and relieve the pain. The patient may be permitted to use the arm for light activities within the range of comfort. The patient should not elevate the arm above the shoulder level until the ends of the bones have united at about 6 weeks, but the nurse should encourage the patient to exercise the elbow, wrist, and fingers. Vigorous activity is limited for 3 months.
20. A patient with a fractured left femur is being cared for by an orthopedic nurse. The nurse would know that what signs indicate potential fat emboli? A) Increased partial pressure of arterial oxygen (PaÓ), reduced sensation in left leg or foot B) Left leg pain, dyspnea C) Bradycardia, skin bruises D) Cyanosis, decreased PaÓ
Ans: D Feedback: Fat emboli may occur with fractures of the long bones and pelvis and may be fatal. Clinical manifestations include cyanosis, dyspnea, tachycardia, chest pain, tachypnea, apprehension, restlessness, confusion, petechiae, and decreased PaÓ. Increased PaÓ reduced sensation in left leg or foot, pain in the affected extremity, skin bruises, and bradycardia aren't associated with fat emboli.
22. The nursing instructor is discussing dislocations and subluxations with the beginning nursing students. Why would the instructor tell the students that dislocation and subluxations are medical emergencies and need to be reduced immediately? A) The longer the joint is misplaced, the harder it is to get it back in place B) Because the pain is so bad C) The longer the joint is misplaced, the more difficult it is to apply splints to immobilize the extremity D) Avascular necrosis may develop
Ans: D Feedback: If a dislocation or subluxation is not reduced immediately, avascular necrosis (AVN) may develop.
21. A 55-year-old male is brought to the emergency department by ambulance after stepping in a hole and falling. While assessing him the nurse notes that his right leg is shorter than his left leg; his right hip is deformed and he is in acute pain. What would the nurse suspect has happened to this patient? A) Subluxated right hip B) Fractured right hip C) Right pelvic fracture D) Traumatic dislocation of right hip
Ans: D Feedback: Signs and symptoms of a traumatic dislocation include acute pain, change in positioning of the joint, shortening of the extremity, deformity, and decreased mobility. A subluxation is a partial dislocation and does not cause as much deformity as a complete dislocation. A fracture does not necessarily cause a deformity. A pelvic fracture would not cause a deformity of the right hip.
33. Patients who have had amputations are cared for by a multidisciplinary rehabilitation team. What does the multidisciplinary team do for patients who are amputees? A) Ensure top quality health care B) Provide holistic health care C) Assist in preventing complications D) Help achieve the highest possible level of function
Ans: D Feedback: The multidisciplinary rehabilitation team (patient, nurse, physician, social worker, physical therapist, occupational therapist, psychologist, prosthetist, vocational rehabilitation worker) helps the patient achieve the highest possible level of function and participation in life activities. Prosthetic clinics and amputee support groups facilitate this rehabilitation process.
37. A patient is a BKA amputee who is to be discharged in 48 hours. You are going over discharge teaching with this patient. You review what factors with this patient? A) Exercise B) Nutrition C) Support groups D) Mobility aids
Ans: D Feedback: The patient receives ongoing instructions and practice sessions to learn to transfer and to use mobility aids and other assistive devices safely.
4. The nurse is preparing the patient for discharge from the emergency room to home after incurring a sprain to the left ankle. While providing discharge teaching, the nurse is correct when they instruct the patient to what? A) Apply heat for the first 24 to 48 hours after injury B) Maintain the ankle in a dependent position C) Exercise hourly by performing rotation exercises of the ankle D) Apply an elastic compression bandage to the ankle
Ans: D Feedback: Treatment of a sprain consists of resting and elevating the affected part, applying cold, and using a compression bandage. After the acute inflammatory stage (usually 24 to 48 hours after injury), heat may be applied intermittently.
When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location? a) Wrist-hand junction b) Proximal humerus c) Femur-hip area d) Distal femur around the knee
Distal femur around the knee Explanation: Malignant bone tumors usually are located around the knee in the distal femur or proximal fibula; a few are found in the proximal humerus. The wrist-hand junction and femur-hip area are not common sites.
The nurse is planning an education program for women of childbearing years. The nurse recognizes that primary prevention of osteoporosis includes: a) Having a DXA beginning at age 35 years b) Engaging in non-weight-bearing exercises daily c) Undergoing assessment of serum calcium levels every year d) Ensuring adequate calcium and vitamin D intake
Ensuring adequate calcium and vitamin D intake Explanation: Nutritional intake of calcium and vitamin D are essential for the prevention of osteoporosis.
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? a) Thoracic b) Lower lumbar c) Upper lumbar d) Cervical
Lower lumbar Explanation: The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes.
A male client is to have an amputation. He is acutely ill and diagnosed with a gangrenous limb and related fever, disorientation, and electrolyte imbalances. Which of the following would be most important for the nurse to monitor in this client? a) Reduced urine output b) Signs of nausea and vomiting c) Occurrence of allergic reactions d) Signs of sepsis
Signs of sepsis Explanation: If the client is acutely ill with a gangrenous limb, related fever, disorientation, and electrolyte imbalances, the nurse should monitor for signs of sepsis and circulation in the limb for any changes such as severe pain, color changes, and lack of peripheral pulses. It is crucial for the nurse to inform the physician about the problems as they occur or else the surgery may become an emergency. Monitoring for signs of nausea and vomiting, occurrence of allergic reactions, and reduced urine output, although necessary, is not as crucial for the client.
