prepu exam 2

What would be the best treatment option for a soft tissue contusion on the right ankle? a. Administration of pain medications as needed. b. Keep the ankle elevated for the first 24 hours c. Surgery will be the expected treatment and we need to have a consent form signed. d. Apply heat compresses for 15 minutes at a time for 24 hours.

b. (For a soft tissue contusion, the treatment would consist of elevating the affected areas and applying ice—not heat—for the first 24 hours. Pain medications may be helpful, but the nonpharmacologic treatments would best treat the condition. Surgery is not required.)

A 13-year-old girl and her father come in to the local health clinic hoping to see an orthopedic doctor about the girl's stiff and warm knee. The father reports that she hurt it sliding into base during a softball game, and the daughter concurs, but with further discussion it becomes clear that the slide made an existing pain worse. Her knee had been stiff, warm, and shiny, and had been keeping her awake at night for a week or so before the game. What might be the cause of the girl's symptoms? a. Chondroma b. Osteosarcoma c. Osteoma d. Osteochondroma

b. (Osteosarcoma is the most common bone tumor in children and the third most common cancer in children and adolescents; they most commonly arise in the vicinity of the knee. The primary clinical feature of osteosarcoma is deep, localized pain with nighttime awakening and swelling in the affected bone. Because the pain is often of sudden onset, clients and their families often associate the symptoms with recent trauma. The skin overlying the tumor may be warm, shiny, and stretched, with prominent superficial veins. The range of motion of the adjacent joint may be restricted. The four most common types of benign bone tumors are osteoma, chondroma, osteochondroma, and giant cell tumor; pain is a feature common to almost all malignant tumors, but may or may not occur with benign tumors; pain that persists at night and is not relieved by rest suggests malignancy.)

A client with a femoral neck fracture is scheduled for a hip replacement and asks the nurse why the hip needs to be replaced instead of stabilized with a pin. Which response should the nurse give? a. You will be able to get out of bed sooner with the hip replacement instead of a pin. b. The replacement prevents a delay in healing that happens from loss of blood flow to the bone. c. Your age at the time of injury increases your risk for surgical complications. d. The risk of infection is increased with a hip pinning instead of replacement.

b. (The blood flow to the femoral head may be disrupted at the time of injury due to fracture at the femoral neck. The osteonecrosis that results would cause pain and delayed healing. Surgical replacement of the femoral head with a prosthesis allows for early mobilization of the client's knee. The risk for infection is present with both surgeries.)

A 6-year-old child has developed idiopathic osteonecrotic disease of the proximal (capital) femoral epiphysis. The health care provider would document this finding as which diagnosis? a. Blount disease b. Legg-Calvé-Perthes disease c. Osgood-Schlatter disease d. Sever disease

b. (Legg-Calvé-Perthes disease is an idiopathic osteonecrotic disease of the proximal (capital) femoral epiphysis with later reabsorption. Juvenile osteochondroses are caused by abnormalities in ossification of cartilaginous tissue resulting from a genetically determined normal variation, or from trauma (including Osgood-Schlatter disease, Blount disease, and Sever disease)

Which recent admission to an emergency department is most likely to be diagnosed with a greenstick fracture? a. An 8-year-old boy who fell out of a tree and onto his arm. b. A 32-year-old woman who fell awkwardly on her arm while skiing. c. A 20-year-old football player who had an opposing player fall laterally on his leg. d. An 81-year-old woman with a history of osteoporosis who stumbled and fell on her hip.

a. (A greenstick fracture is seen almost exclusively in children under age 10.)

A child presents to the emergency room with suspected trauma to the growth plate in the ankle during a soccer game. Which step is the best intervention? a. Assess the child for pain and prepare for diagnostic studies. b. Tell the parents to make an appointment with a specialist. c. Tell the parents to take the child to their family physician. d. Take the child to an orthopedist.

a. (Due to the suspected nature of the injury, the child should remain in the emergency department for evaluation of the injury. The nurse should proceed with assessment and treatment while awaiting further intervention.)

The client develops osteomyelitis that has originated from infectious organisms that reach the bone through the bloodstream. This is known as which type of osteomyelitis? a. Hematogenous b. Vascular insufficiency c. Chronic d. Direct penetration

a. (Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the bloodstream. The other types are not caused by infectious organisms in the bloodstream.)

What are typical assessment findings the nurse expects to observe in a client with a simple fracture of the leg? Select all that apply. a. Loss of function b. Swelling c. Cyanosis d. Pain e. Absence of feeling

a., b., d. (The client with a fractured leg can have swelling, loss of function, pain, deformity and abnormal mobility. Cyanosis and absence of feeling are not typical findings with a simple fractured leg.)

The health care provider is evaluating a client with a suspected benign bone tumor. Which description on the radiology results correlates with this finding? a. Abnormal bone merging with surrounding normal bone tissue b. An area of partially destroyed bone adjacent to completely normal areas c. A uniform and well-defined area with well-demarcated edges d. A moth-eaten pattern of bone destruction

c. (Benign bone tumors usually are limited to the confines of the bone, have well-demarcated edges, and are surrounded by a thin rim of sclerotic bone. The most common benign tumors are of either fibrous or cartilaginous tissue origin. Benign fibrous tumors of the bone are common in growing bones. They are usually asymptomatic, resolve in 2 to 3 years, and do not require treatment. The other options identify malignant tumors.)

What is the definition of a congenital deformity? a. Abnormalities occurring after birth b. Deformities occurring at inception c. Abnormalities present at birth d. Deformities occurring from the birthing process

c. (Congenital deformities are abnormalities that are present at birth. They range in severity from mild limb deformities, which are relatively common, to major limb malformations, which are relatively rare.)

While being tackled, a 20 year-old football player put out his hand to break his fall to the ground. Because the intense pain in his wrist did not subside by the end of the game, he was brought to an emergency department, where diagnostic imaging indicated an incomplete tear of the ligament surrounding his wrist joint. At the time of admission, his wrist was swollen with a severely restricted range of motion. What will his care team most likely tell the player about his diagnosis and treatment? a. "You've suffered a severe sprain and you might need a cast." b. "This strain will likely resolve itself with sufficient rest." c. "It looks like a mild to moderate sprain and you'll need to keep it immobilized for a few weeks." d. "Your wrist contusion will have to be observed for bleeding under the skin surface."

c. (Damage to the ligament structures is associated with sprains, and an incomplete tear would be indicative of a mild to moderate (grade 1 or 2) sprain. A strain is associated most commonly with overuse. A severe sprain would involve total disruption of the ligament.)

The client asks, "What is reduction?" How will the nurse respond? a. "It means the fracture is healed." b. "It is what happens when the fracture is immobilized." c. "It refers to realigning the bone." d. "It means the fracture will be casted."

c. (Reduction is the term for when bones are realigned to restore their original structure.)

An older adult client has been diagnosed with metastatic bone disease. Which aspect of the client's care plan most directly addresses a common complication of this disease? a. Closely monitoring the client's serum potassium levels b. Assessing the client's skin integrity twice per shift c. Implementing falls prevention measures d. Monitoring the client's neurologic vital signs

c. (The primary goals in treatment of metastatic bone disease are to prevent pathologic fractures and promote survival with maximum functioning. Preventing falls is imperative due to the sharp decline in bone strength that accompanies the disease. Potassium levels are not likely to be highly unstable and neurologic status is not normally affected. Skin integrity must be monitored, but not to a larger extent than in clients with other diagnoses.)

A client reporting bone pain has sought care. Diagnostic testing reveals that the client has developed osteonecrosis. When addressing the most likely cause of this complication, the nurse should focus on: a. the client's recent use of nonsteroidal anti-inflammatory drugs (NSAIDs). b. the client's red cell, hemoglobin, and hematocrit levels. c. the quality and quantity of blood flow to the site. d. any weight bearing that the client has performed in recent days.

c. (Ischemia is the essential cause of osteonecrosis. Anemia is not a noted cause and NSAIDs are not linked to the disease. Weight bearing does not cause osteonecrosis, even when heavy or repeated.)

While an infant is in the supine position with both knees flexed, the clinician applies gentle downward pressure to both knees, and the knee and thigh are abducted as an upward and medial pressure is applied to the proximal thigh. This examination technique, used to screen for a reducible dislocation, is called: a. Galeazzi test b. Clubfoot test c. Ortolani maneuver d. Trendelenburg test

c. (The Ortolani maneuver tests for a reducible dislocation. The Galeazzi test is a measurement of the length of femurs that is done by comparing the height at the knees while they are flexed at 90 degrees. Trendelenburg's test is used for an older child.)

A client with a compound fracture of the femur is in balanced skeletal traction. Which assessment data must be reported immediately? a. Uses trapeze to shift position b. Clear drainage around pin insertion sites c. Wiggles toes every few minutes d. Redness and heat at fracture site

d. (Osteomyelitis is an infection in the bone. With a compound fracture, infecting organisms can easily enter the bone through open tissue. Manifestations include chills, fever, malaise, pain of the affected extremity, local tenderness, redness, and swelling. Clear drainage at pin sites is common and does not indicate infection without other indicators.)

A child with Osgood-Schlatter disease most often presents with which assessment finding? a. Pain in the hip b. Inability to walk c. No symptoms d. Pain in front of the knee

d. (The child with Osgood-Schlatter disease most often presents with pain in front of the knee. The other symptoms are not common with this disease.)

What is a priority concern for a client who has a hip dislocation? a. Pain b. Tendonitis c. Edema d. Blood supply to the femoral head

d. (The major cause for concern for a client with a hip dislocation is that the dislocated position puts tension on the blood supply to the femoral head and avascular necrosis may result. Restoring or preserving circulation is the priority. Tendonitis and edema are not usually a concern. Pain is a secondary concern.)

A nurse is teaching the parent of a child with a diagnosis of Legg-Calvè-Perthes disease about the prescribed treatment. Which statement by the parent indicates adequate understanding? a. "I will administer the antibiotics twice a day until finished." b. "I will allow the kids to wrestle in the house." c. "My child will need to use careful hand washing." d. "My child will need to use crutches until the hip heals."

d. (Treatment for early osteonecrosis depends on the cause. Because there is no injury or infection with Legg-Calvè-Perthes disease, treatment may begin with short-term immobilization, nonsteroidal anti-inflammatory drugs, exercises, and restricted weight-bearing activity.)

A client has developed osteomyelitis and asks the health care provider how the problem occurred. Which response is most accurate? a. Deficiency of calcium b. Rheumatoid disease c. Excessive vitamin intake d. Direct contamination of an open wound

d. (Osteomyelitis represents an acute or chronic infection of the bone and marrow. All types of organisms—including parasites, viruses, bacteria, and fungi—can cause osteomyelitis, but certain pyogenic bacteria and mycobacteria are the most common. Organisms may reach the bone by seeding through the bloodstream (hematogenous spread), direct penetration or contamination of an open fracture or wound (exogenous origin), or extension from a contiguous site. Vitamin intake or deficiency will not cause infection.)