musculoskeletal chapter 39

A middle-aged patient has a tumor that infiltrates trabeculae in spongy bone. Which diagnosis will the nurse observe documented on the chart? A) Chondrosarcoma B) Leukemia C) Lymphoma D) Osteosarcoma

A. Chondrosarcoma Chondrosarcoma is a tumor of middle-aged and older adults that infiltrates trabeculae in spongy bone.

A patient has a fracture that broke into several fragments. Which type of fracture did the patient sustain? A) Comminuted fracture B) Open fracture C) Greenstick fracture D) Occult fracture

A. Comminuted fracture A fracture in which the bone breaks into two or more fragments is called a comminuted fracture.

A nurse is providing care to a patient that has a tendon torn from the bone. Which term will the nurse use to describe this condition? A) Avulsion B) Arthritis C) Delta lesions D) Bursitis

A. Avulsion A complete separation of a tendon or ligament from its bony attachment site is known as an avulsion.

A nurse is discussing a disorder that presents with significant bone demineralization from a vitamin D deficiency and usually results in skeletal pain. Which disorder is the nurse describing? A) Osteomalacia B) Osteopenia C) Osteomyelitis D) Osteoporosis

A. Osteomalacia Osteomalacia is a rare metabolic disease characterized by inadequate mineralization of bone tissue in compact and spongy bone. The most common cause of osteomalacia is vitamin D deficiency.

If osteomalacia occurs in the growing bones of a child, which of the following diseases will the nurse use to describe this condition? A) Rickets B) Osteosarcoma C) Paget disease D) Rhabdomyoma

A. Rickets Rickets is a form of osteomalacia caused by a vitamin D deficiency which results in soft, deformable bones in children.

Which of the following is a characteristic assessment finding in a patient with fibromyalgia? A) Trigger/tender point pain B) Leg cramps C) Permanent shortening of muscles D) Muscle atrophy

A. Trigger/tender point pain Fibromyalgia specifically manifests with trigger/tender point pain.

A nurse is asked about the risk factors for osteoarthritis (OA). How should the nurse reply? A risk factor for osteoarthritis includes: A) athletes. B) younger aged people. C) a thin build. D) a low calcium intake.

A. athletes. OA usually occurs in those persons who put exceptional stress on joints (e.g., obese persons, gymnasts, long-distance runners or marathoners); persons participating in such sports as basketball, soccer, or football have been shown to develop osteoarthritis at earlier ages than usual.

A patient has researched menopause and osteoporosis on the internet. Which information indicates the patient has a good understanding? Factors contributing to the development of osteoporosis in older women (menopausal) include: A) decreased estrogen levels. B) increased androgen levels. C) excessive dietary calcium. D) strenuous exercise.

A. decreased estrogen levels. The hormone estrogen helps maintain bone strength and integrity in women. In menopause, decreased estrogen production increases a woman's risk of developing osteoporosis.

A patient has displacement of two bones in which the articular surfaces partially lose contact with each other. The nurse is providing care to a patient with a: A) subluxation. B) subjugation. C) sublimation. D) dislocation.

A. subluxation. The displacement of two bones in which the articular surfaces partially lose contact with each other is called subluxation. Subluxation results in joint deformity, immobility, and pain.

A nurse recalls the final, chronic stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called: A) tophaceous gout. B) monarticular arthritis. C) complicated gout. D) asymptomatic hyperuricemia.

A. tophaceous gout. The third and chronic stage of gout is called tophaceous gout. Progressive hyperuricemia leads to urate crystal deposits called tophi in cartilage, synovial membranes, tendons, and soft tissues.

A nurse is describing the pathophysiology of ankylosing spondylitis. Which information should the nurse include? Ankylosing spondylitis results in: A) vertebral joint fusion. B) instability of synovial joints. C) costal cartilage degeneration. D) temporomandibular joint degeneration.

A. vertebral joint fusion. Ankylosing spondylitis results in joint fibrosis, ossification, and fusion. Joints most commonly affected include the intervertebral and sacroiliac joints.

While performing the assessment on a patient with osteoarthritis, which finding is typical? A) Joint fusion B) Joint pain C) Fever D) Contractures

B. Joint pain Joint degeneration in osteoarthritis almost always causes pain in affected joints.

A patient breaks a bone in a place where there was a pre-existing disease. Which type of fracture is being described? A) Transchondral B) Pathological C) Stress D) Fatigue

B. Pathological A pathologic fracture occurs in a place where there was pre-existing disease that weakened the area.

A patient has sustained severe muscle trauma from crush injuries. Which complication should the nurse monitor for in this patient? A) Myotonia B) Rhabdomyolysis C) Myocarditis D) Fibromyalgia

B. Rhabdomyolysis Severe trauma can result in the release of myoglobin from skeletal muscle cells, causing a life-threatening condition called rhabdomyolysis.

A patient has a partial/incomplete tear of a ligament. Which term will the nurse use to describe this condition? A) First-degree sprain B) Second-degree sprain C) First-degree strain D) Second-degree strain

B. Second-degree sprain A second-degree sprain involves partial tearing of a ligament.

A nurse is describing the pathophysiology of bone healing. Which information should the nurse include? Factor(s) that can prevent proper bone healing include: A) vitamins C and E. B) alcohol and nicotine. C) high-protein diet. D) dehydration.

B. alcohol and nicotine. Alcohol and nicotine can delay proper bone healing.

A nurse is describing the pathophysiology of a torus fracture. Which information should the nurse include? A torus fracture is a type of: A) complete fracture. B) incomplete fracture. C) fracture that breaks through the entire bone. D) fracture that occur straight across the bone.

B. incomplete fracture. A torus fracture is a type of incomplete fracture that occurs when the cortex of the bone buckles, but does not break.

A nurse is discussing the risk factors for osteoporosis. Which information is correct? A known cause of osteoporosis includes: A) late menopause. B) thin build. C) not smoking. D) hypophosphatemia.

B. thin build. Thin build is a risk factor for osteoporosis.

Which information indicates the nurse has a good understanding of gout? Pain and inflammation associated with gout are caused by crystallization of _____ in the tissues. A) amino acid B) uric acid C) ketones D) hyaluronic acid

B. uric acid Pain and inflammation associated with gout are caused by crystallization of uric acid in the tissues.

A nurse is teaching about McArdle disease, acid maltase deficiency, lipid deficiency, and myoadenylate deaminase deficiceny (MDD). Which type of disorders/diseases is the nurse describing? A) Idiopathic inflammatory myopathies B) Endocrine based C) Energy metabolism D) Inclusion-body myositis

C. Energy metabolism Glycogen storage diseases such as McArdle disease, acid maltase deficiency, lipid deficiency, and myoadenylate deaminase deficiency (MDD) are examples of energy metabolism disorders/diseases.

With a patient who has myoglobinuria (rhabdomyolysis), which organ is the priority assessment? A) Liver B) Lungs C) Kidneys D) Pancreas

C. Kidneys Maintaining adequate urinary flow and prevention of kidney failure are goals of treatment. Myoglobinuria can result in renal failure caused by accumulation of myoglobin in the renal tubules.

Which complication should the nurse assess for in a patient who had improper immobilization of a fracture? A) Disunion B) Aunion C) Malunion D) Imunion

C. Malunion Malunion is a complication that occurs when the bone fails to align correctly during the healing process.

A patient has a tumor that causes a moth eaten appearance in the bone. A nurse suspects the patient has which of the following musculoskeletal tumors? A) Rhabdosarcoma B) Liposarcoma C) Osteosarcoma D) Chondrosarcoma

C. Osteosarcoma Though considered a bone-forming tumor (osteogenic cells), the radiologic appearance of sarcoma is quite variable and often shows a moth-eaten (lytic) pattern of destruction with the tumor extending into the adjacent soft tissue.

A patient has a disorder that is characterized by enlargement and softening of the bones. Which disease does the patient have? A) Osteomyelitis B) Osteoporosis C) Paget disease D) Rickets

C. Paget disease Paget disease (osteitis deformans) is characterized by excessive bone resorption and formation, resulting in chronic enlargement and softening of certain bones.

Which of the following assessment symptoms are typical in a patient who has just sustained a femoral fracture? A) Chest pain and shortness of breath B) Low blood glucose and seizures C) Pain and swelling in the thigh D) Limb paralysis and referred pain

C. Pain and swelling in the thigh Because of inflammation, a fracture generally manifests with pain and swelling at the site of injury.

A patient has a tear in the tendon. Which diagnosis will the nurse observe documented on the chart? A) Fracture B) Sprain C) Strain D) Subluxation

C. Strain A strain is a tear in a tendon.

An adolescent patient has sustained a fracture that involves fragmentation of the articular cartilage. Which type of fracture did the adolescent sustain? A) Greenstick B) Stress C) Transchondral D) Insufficiency

C. Transchondral Transchondral fractures (chondral = cartilage) involve the separation of the articular cartilage from the bone and typically occur in adolescents.

A nurse is asked what is a common diagnostic test for osteoporosis. How should the nurse respond? A common screening test for osteoporosis is: A) an x-ray. B) a bone biopsy. C) a dual energy x-ray absorptiometry (DEXA) scan. D) a thorough physical exam.

C. a dual energy x-ray absorptiometry (DEXA) scan. A DEXA scan is the most useful test for evaluating bone density if osteoporosis is suspected.

A nurse is describing the pathophysiology of rheumatoid arthritis. Which information should the nurse include? Rheumatoid arthritis results from joint inflammation caused by: A) bacterial infection. B) trauma. C) autoimmune injury. D) congenital hypermobility.

C. autoimmune injury. Rheumatoid arthritis is caused by autoimmune injury to synovial joints.

A patient has a set of pins connected to stabilizing bars on the outside of the patient. The nursing is providing care to a patient who has undergone: A) open reduction. B) closed manipulation. C) external fixation. D) skin traction.

C. external fixation. A set of pins connected to stabilizing bars on the outside of the patient is a type of treatment for fractures called external fixation.

A nurse recalls the chief pathologic feature of degenerative joint disease is: A) stress fractures of the epiphysis. B) loss of synovial fluid. C) loss of articular cartilage. D) enlargement of the joint capsule.

C. loss of articular cartilage. The hallmark of degenerative joint disease is degeneration of articular cartilage in synovial joints.

A nurse is describing the pathophysiology of rheumatoid arthritis. Which information is correct? Synovial joint problems in rheumatoid arthritis are due to: A) articular cartilage being lost through trauma. B) free radicals attaching to the synovial membrane and articular cartilage. C) neutrophils and inflammatory cytokines causing damage to articular cartilage. D) cysts developing in the subchondral bone and creating fissures in the articular cartilage.

C. neutrophils and inflammatory cytokines causing damage to articular cartilage. In rheumatoid arthritis, neutrophils and inflammatory cytokines (IL-1 and TNF-alpha) cause damage to articular cartilage and the nearby synovium.

A nurse is teaching a group of people about triggers of gout. Which statement indicates the teaching was successful? Episodes of gout are often triggered by: A) high fat diet. B) pannus. C) trauma. D) caffeine intake.

C. trauma. Episodes of gout can be triggered by excessive alcohol intake, use of certain drugs, and trauma.

Which statement indicates a nurse needs more teaching about bone healing? An event that occurs following a bone fracture is: A) development of a blood clot in the medullary canal. B) leukocyte infiltration into bone tissue. C) blood vessel growth at the fracture site. D) an increase in the number of osteoclasts at the fracture site.

D. an increase in the number of osteoclasts at the fracture site. Osteoblasts migrate to the site of injury to repair the fractured bone tissue.

A nurse is asked what causes endogenous osteomyelitis. What is the nurses best response? The cause of most cases of endogenous osteomyelitis is (are): A) fungal skin infection. B) viral pneumonia. C) parasitic infection from a dog bite. D) blood-borne bacteria.

D. blood-borne bacteria. Endogenous osteomyelitis is caused by blood-borne infections. The specific causative organisms differ among age and population groups.

A patient has osteomyelitis. When the nurse is reviewing the lab results, which organism will the nurse most likely observe on the report? A) Fungus B) Parasite C) Virus D) Bacteria

D. Bacteria Osteomyelitis is a bone infection most often caused by bacteria.

Which assessment finding is typical in a patient with rheumatoid arthritis? A) Subluxation B) Fractures C) Infection D) Fever

D. Fever Fever can manifest with rheumatoid arthritis.

A patient has gout. Which complication should the nurse most monitor for in this patient? A) Coronary artery disease B) Osteoarthritis C) Contractures D) Renal stones

D. Renal stones Individuals with gout are 1000 times more likely to develop renal stones. An excessive uric acid level in the blood in gout promotes the development of uric acid calculi (stones) in the kidneys.

A nurse is describing the pathophysiology of osteomalacia. Which information should the nurse include? The pathophysiology of osteomalacia involves: A) increased concentration of phosphate serum levels. B) collagen breakdown in the bone matrix. C) osteoclast activity that is increased. D) low calcium levels and secretion of parathyroid hormone (PTH).

D. low calcium levels and secretion of parathyroid hormone (PTH). Low plasma calcium levels stimulate increased synthesis and secretion of PTH.

Patients with osteoporosis should be assessed by the nurse for the risk of: A) rhabdomyolysis. B) osteomyelitis. C) osteomalacia. D) pathologic bone fractures.

D. pathologic bone fractures. Osteoporosis weakens the bone structure and increases the risk of fracture.