Chapter 48: Disorders of Musculoskeletal Function: Trauma, Infection, and Neoplasms
The nursing student is studying hip fractures. The faculty member knows that the student understands the topic when she states: "Risk factors for hip fracture include high body mass index (BMI) and tall body structure." "Femoral neck fractures, with marked displacement, are associated with an increased incidence of avascular necrosis." "MRIs are required to diagnose hip fractures." "Subtrochanteric fractures account for the majority of hip fractures."
"Femoral neck fractures, with marked displacement, are associated with an increased incidence of avascular necrosis." Explanation: Femoral neck fractures, particularly those involving marked displacement, often disrupt the blood supply to the femoral head and are therefore associated with an increased incidence of complications (nonunion and avascular necrosis). Risk factors for hip fracture include low body mass index (BMI) and tall body structure. Femoral neck and intertrochanteric fractures account for the majority of hip fractures. Most hip fractures are diagnosed based on clinical findings and standard radiographs. A bone scan for MRI may be done when radiograph is negative but the clinical findings support the diagnosis of hip fracture.
Following a fracture, the nurse is educating the client and his family about bone healing. The nurse begins by stating: "Just like on your hands after hard work, your body will begin the healing process by forming a callus at the fracture site." "Your body will first absorb any excess bone fragments that occurred as a result of the break." "The first thing that will happen is your body will form a soft tissue callus around the fracture site." "In order to initiate the cellular events essential to bone healing, within a day or so, your body will develop a blood clot at the fracture site."
"In order to initiate the cellular events essential to bone healing, within a day or so, your body will develop a blood clot at the fracture site." Explanation: There are essentially four stages involved in bone healing: hematoma formation, fibrocartilaginous callus development, ossification, and remodeling. Hematoma formation is thought to be necessary for the initiation of the cellular events essential to bone healing. As the result of hematoma formation, clotting factors remain in the injured area to initiate the formation of a fibrin meshwork, which serves as a framework for the growth of fibroblasts and new capillary buds.
The client asks, "What is reduction?" How will the nurse respond? "It is what happens when the fracture is immobilized." "It means the fracture is healed." "It means the fracture will be casted." "It refers to realigning the bone."
"It refers to realigning the bone." Explanation: Reduction is the term for when bones are realigned to restore their original structure.
A nurse is teaching the parent of a child with a diagnosis of Legg-Calve¨-Perthes disease about the prescribed treatment. Which statement by the parent indicates adequate understanding? "My child will need to use careful hand washing." "I will administer the antibiotics twice a day until finished." "My child will need to use crutches until the hip heals." "I will allow the kids to wrestle in the house."
"My child will need to use crutches until the hip heals." Explanation: Treatment for early osteonecrosis depends on the cause. Because there is no injury or infection with Legg-Calve¨-Perthes disease, treatment may begin with short-term immobilization, nonsteroidal anti-inflammatory drugs, exercises, and restricted weight-bearing activity.
What would the nurse include in the teaching plan for a client who asks "What is a subluxation?" "It happens when a ligament pulls off a section of bone." "The bone is partially out of the joint when it is subluxated." "It happens with a bone fracture, causing a piece of bone to go under the other." "It involves the displacement of the bone out of a joint."
"The bone is partially out of the joint when it is subluxated." Explanation: A subluxation is a partial dislocation in which the bone ends in the joint are still in partial contact with each other.
A month after surgical repair of a rotator cuff tear of the shoulder, a client tells the nurse, "This is not getting any better. I still have a lot of pain and limited motion." Which response by the nurse is most accurate? "Keep taking your steroid medication and the inflammation will subside." "The shoulder joint is complex and can take up to 6 months to heal depending on the injury." "Add massage therapy to your exercise routine to stretch tissues." "Schedule an appointment with your surgeon for an evaluation."
"The shoulder joint is complex and can take up to 6 months to heal depending on the injury." Explanation: A rotator cuff repair may take several months to fully heal, depending on the sport and injury. After an extended period of joint rest, the client will need a rehabilitation program to regain strength, flexibility, and endurance. If the initial injury was mild, conservative treatment with anti-inflammatory agents, corticosteroid injections, and physical therapy would be implemented before surgical intervention.
What is a priority concern for a client who has a hip dislocation? Tendonitis Pain Edema Blood supply to the femoral head
Blood supply to the femoral head Explanation: 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.
What factor may adversely affect bone healing? Delayed union Tight alignment Weight bearing Immobilization
Delayed union Explanation: Delayed union is the failure of a fracture to unite within the normal period (e.g., 20 weeks for a fracture of the tibia or femur in an adult). Malunion is caused by inadequate reduction or malalignment of the fracture. For healing to occur, the bone needs to be aligned and immobilized to maintain the alignment during bone remodeling. Weight-bearing helps to maintain some muscle tone while the bone is immobilized, avoiding muscle atrophy and loss of range of motion.
A client who is a recent immigrant from a developing country visits the clinic with a low-grade fever, elevated white blood count, and pain in the back and hips. Which test will confirm the diagnosis of spinal tuberculosis (TB)? X-ray Biopsy Complete blood count (CBC) Magnetic resonance imaging (MRI)
Biopsy Explanation: X-rays are inconclusive for spinal TB. MRI will not confirm the type of infection. A computed tomography scan may be used to guide the biopsy, but culture or biopsy of the infected tissue is needed to confirm the diagnosis. A CBC is not specific for TB.
Which interventions for a client with metastatic bone disease can help prevent pathologic fractures? Select all that apply. Radiation therapy Range-of-motion exercises Intramedullary rods Opioid analgesics Bisphosphonates
Bisphosphonates Radiation therapy Explanation: Pathologic fractures develop as a result of the tumors destroying bone tissue. Bisphosphonates have been shown to decrease symptoms of bone metastasis. Radiation therapy can minimize tumor growth to decrease the risk of fracture. Surgery to place intramedullary rods is used to stabilize the bone after a fracture has occurred. Opioid analgesics may be used for pain control but do not prevent pathologic fractures. Range-of-motion exercises will reduce the risk of contractures but does not prevent fractures. Bracing is usually recommended after a pathologic fracture.
What is a priority concern for a client who has a hip dislocation? Edema Pain Tendonitis Blood supply to the femoral head
Blood supply to the femoral head Explanation: 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.
Osteomyelitis is an infection of the bone. Chronic osteomyelitis is complicated by a piece of infected dead bone that has separated from the living bone. How long does the initial intravenous antibiotic therapy last for chronic osteomyelitis? 12 weeks 6 weeks 4 weeks 8 weeks
6 weeks Explanation: Intravenous therapy is usually needed for up to 6 weeks. Initial antibiotic therapy is followed by surgery to remove foreign bodies (e.g., metal plates, screws) or sequestra and by long-term antibiotic therapy.
Which person is at highest risk for hip fractures? 80-year-old White female 26-year-old White female volleyball player 70-year-old Asian male with dementia 80-year-old Black female
80-year-old White female Explanation: Hip fracture is a major public health problem and is accompanied by risk of death and impact on function and quality of life. The incidence of hip fractures increases with age and is higher in White women as compared to non-White women, making the 80-year-old White female at highest risk
Which client presenting to the emergency department would most likely be diagnosed with a pathologic stress fracture? A postmenopausal female who was diagnosed with breast cancer with metastasis to bone A weightlifter who, while bench-pressing 200 kg (440 lb), lost balance and fell to the side, landing on his hip A teenager who fell of a ladder and hit the concrete driveway, landing on his hip A competitive volleyball player diving to retrieve a volley and landing on his hip
A postmenopausal female who was diagnosed with breast cancer with metastasis to bone Explanation: A pathologic stress fracture occurs in bones that already are weakened by disease or tumors. Fractures of this type may occur spontaneously with little or no stress. The underlying disease state can be local (as with infections, cysts, or tumors) or it can be generalized, as in osteoporosis, Paget disease, or disseminated tumors. A fatigue fracture results from repeated excessive wear on a bone. The most common fractures are those resulting from sudden direct impact (such as from a fall or blow) or indirect, such as a massive muscle contraction injury.
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 uniform and well-defined area with well-demarcated edges Abnormal bone merging with surrounding normal bone tissue An area of partially destroyed bone adjacent to completely normal areas A moth-eaten pattern of bone destruction
A uniform and well-defined area with well-demarcated edges Explanation: 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.
A client is experiencing severe pain in his back to the point of being immobile and running a temperature. The client also has swelling in his lower back (vertebrae). Following biopsy, the results show spinal tuberculosis. The nurse will anticipate explaining which priority intervention to this client? Drain the abscess in the lower back Log-roll the client while he is on bed rest Administer the four-drug antimicrobial medications Locate a chiropractor for pain control
Administer the four-drug antimicrobial medications Explanation: Because there are no specific radiographic findings in tubercular osteomyelitis, the diagnosis is usually made by tissue biopsy or culture findings. In spinal tuberculosis, a computed tomography (CT)-guided biopsy is often used. The mainstay of treatment for tubercular osteomyelitis remains the appropriate three- or four-drug antimicrobial therapy based on current guidelines. Conservative treatment is usually as effective as surgery, especially for earlier and milder cases.
The health care provider is caring for a client diagnosed with an osteosarcoma who asks, "What does this mean?" Which response best describes the diagnosis? The least common form of malignant bone tumor Benign bone tumor Aggressive; malignant bone tumor Slow-growing; malignant bone tumor
Aggressive; malignant bone tumor Explanation: Osteosarcoma is an aggressive and highly malignant bone tumor with an unknown cause. It is the most common malignant bone tumor, representing one-fifth of all primary bone tumors.
Which client would be considered high risk for falling and fracturing the hip? An 81-year-old woman taking medication for osteoporosis A 54-year-old man with obesity and short stature A 77-year-old man with hearing impairment and corrective eye lenses A 36-year-old woman whose diet consists of excessive sugar intak
An 81-year-old woman taking medication for osteoporosis Explanation: Risk factors for hip fracture include excessive consumption of alcohol and caffeine (rather than sugar), physical inactivity, low body weight, tall stature, use of certain psychotropic drugs, residence in an institution, visual impairment (rather than hearing), and dementia. Osteoporosis weakens the bone and is an important contributing factor. Most hip fractures result from falls.
The health care provider is evaluating a client who is at risk for the development of osteonecrosis. The client is at risk for: Development of an unspecified mass or growth on the bone An chronic infection of the bone An acute infection of the bone Aseptic necrosis of a bone segment caused by interruption of the blood supply
Aseptic necrosis of a bone segment caused by interruption of the blood supply Explanation: Osteonecrosis, also known as avascular necrosis, is an aseptic destruction of a segment of bone that is due to an interruption in blood flow rather than an infection. It is relatively common and can occur in the medullary cavity of the metaphysis and the subchondral region of the epiphysis, especially in the hips, knees, shoulders, and ankles. Destruction of bone frequently is severe enough to require joint replacement surgery.
What is the term use to describe a tumor that while growing slowly does not destroy the surrounding tissues? Malignant Ewing sarcoma Osteosarcoma Benign
Benign Explanation: A benign tumor grows slowly and does not destroy or invade the surrounding tissues. The other options are malignant tumors that do invade surrounding tissues and structures.
While taking a client history, which finding may lead the nurse to suspect the client is at risk for developing osteonecrosis? Synovial inflammation with painful swelling and warm to touch Previous stress fracture in the hips Bone marrow ischemia due to radiation therapy for cancer Bacterial infection in the knee following total knee replacement
Bone marrow ischemia due to radiation therapy for cancer Explanation: Osteonecrosis refers to necrosis or death of bone and marrow in the absence of infection. Causes include mechanical disruption of blood vessels; thrombosis and embolism; vessel injury from systemic lupus erythematosus (SLE), rheumatoid arthritis, radiation therapy or connective tissue disease; and corticosteroid therapy. All forms of bone necrosis result from ischemia. The site of the lesion is related to ischemia of the vessels involved rather than a bone fracture or joint area inflammation.
Metastatic bone lesions are most closely associated with which types of primary tumors? Breast cancer and prostate cancer Non-Hodgkin lymphoma and bladder cancer Acute myelogenous leukemia (AML) and malignant melanoma Cervical cancer and ovarian cancer
Breast cancer and prostate cancer Explanation: Although any cancer can ultimately involve the skeleton, tumors that frequently spread to the skeletal system are those of the breast, lung, prostate, and colorectal system.
The client had a full cast applied for a left humerus fracture in the emergency department 3 hours ago and now complains of increased pain at the site. The client cannot feel the pressure applied to the nail beds when the nurse tests capillary refill pressure, which is found to be 4.5 seconds. What action should the nurse take? Elevate the client's left arm on three pillows and reassess in 15 minutes. Administer analgesia and perform range-of-motion exercises with the left hand. Complete a neurovascular assessment and notify the physician of the findings. Call for assistance and prepare to split the client's cast immediately.
Call for assistance and prepare to split the client's cast immediately. Explanation: The client is showing signs of impaired circulation and immediate action, such as splitting the cast, should be taken to restore the circulation and prevent permanent damage to the extremity. Taking the time to perform more assessments or to administer analgesia and range-of-motion exercises will put the client at risk for worsening ischemia and possible permanent impairment. While the arm should be elevated above the level of the heart for the first 24 hours to minimize swelling, this will not be an adequate intervention now that the client is showing evidence of ischemia to the casted extremity.
Which client with a fracture has the appropriate immobilization in place? Client with a fractured ankle has a cast to the knee Client with a femoral fracture has the knee immobilized Client with a humeral fracture has the arm splint immobilizing the arm and shoulder Client with a suspected wrist fracture has a splint from fingers to elbow
Client with a humeral fracture has the arm splint immobilizing the arm and shoulder Explanation: When a splint is applied to an extremity, it should extend from the joint above the fracture site to the joint below it.
A client presents to the emergency department following an accident where he fell off a chair. The client reports initial hip numbness followed by increasing pain and muscle cramping. Which type of injury does the triage nurse suspect? Closed hip fracture Dislocated joint Osteosarcoma Osteomyelitis
Closed hip fracture Explanation: Shortly after a fracture has occurred, nerve function at the fracture site may be temporarily lost. The area may become numb, and the surrounding muscles may become flaccid. After this brief period, the pain sensation returns and with it muscle spasms and contractions of the surrounding muscles. There is pain, tenderness at the site of bone disruption, swelling, loss of function, deformity of the affected part, and abnormal mobility.
The nurse is assessing a client who sustained a fractured radius. A cast was applied to the extremity approximately 1 hour ago, and the client is now complaining of increased pain and numbness to the finger tips. The client is most likely experiencing: Thromboemboli Complex regional pain syndrome Compartment syndrome Fracture blisters
Compartment syndrome Explanation: Compartment syndrome occurs as a result of increased pressure within a limited space (e.g., abdominal and limb compartments) that compromises the circulation and function of the tissues within the space. The hallmark symptom of an acute compartment syndrome is severe pain that is out of proportion to the original injury or physical findings. Nerve compression may cause changes in sensation (e.g., paresthesias such as burning or tingling or loss of sensation), diminished reflexes, and eventually the loss of motor function. Fracture blisters are skin bullae and blisters. The complex regional pain syndrome or reflex sympathetic dystrophy is caused by involvement of nerve fibers.
The nurse is caring for a client who states that he is suddenly having severe pain at a leg fracture site. The nurse notes increased swelling in the limb and difficulty palpating a pulse. The nurse suspects that the client may have: Compartment syndrome Fracture blisters Reflex sympathetic dystrophy Hematogenous osteomyelitis
Compartment syndrome Explanation: The hallmark symptom of acute compartment syndrome is severe pain out of proportion to the original injury. One of the most important causes of compartment syndrome is bleeding and edema caused by fractures and bone surgery. Edema or swelling may make it difficult to palpate a pulse. Reflex sympathetic dystrophy, while characterized by pain out of proportion to the injury, does not exhibit decreased pulses. Fracture blisters are areas of epidermal necrosis with separation of epidermis from the underlying dermis by edema fluid. They are a warning sign of compartment syndrome. Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the bloodstream.
What term describes an injury to the soft tissue of the body? Fracture Tendon rupture Ligament tear Contusion
Contusion Explanation: Soft tissue injury from trauma is termed a contusion. A fracture describes bone breakage. Ligaments and tendons are not classified as soft tissue.
A basketball player collided hard with another player and suffered a soft tissue injury to the forearm from the impact. The injury did not break the skin. The nurse should recognize the presence of which type of injury? Contusion Strain Sprain Ecchymosis
Contusion Explanation: A contusion is an injury to soft tissue that results from direct trauma and is usually caused by striking a body part against a hard object. With a contusion, the skin overlying the injury remains intact. Ecchymotic tissue is a "black and blue" bruise. A sprain, which involves the ligamentous structures (strong bands of connective tissue) surrounding the joint, resembles a strain, but the pain and swelling subside more slowly. A strain is a stretching injury to a muscle or a musculotendinous unit caused by mechanical overloading.
What is the most serious complication resulting from a hip fracture experienced by an older adult? Pain Immobility Dependency Death
Death Explanation: The literature varies, but as many as 18% to 33% of older adults who sustain a hip fracture die in the year after a hip fracture—with as many as 50% never regaining their ability to walk independently. Although pain is a factor, it is not as serious as death.
The nurse is caring for a client with several fractures that have been immobilized. Which assessment finding would be most indicative of a potential complication? Pulses palpable with warm skin Pulse 105 bpm, blood pressure 134/86 mm Hg Peripheral capillary refill 2 seconds Deep, severe, unrelenting pain
Deep, severe, unrelenting pain Explanation: Complications of fractures include compartment syndrome, when swelling after the injury impairs blood and nerve function. As the tissue is compressed, the extremity becomes edematous, has reduced capillary refill, is cold, and the pain is described as severe (and out of proportion to the original injury); additionally, the pain is not relieved by medication or positioning. Some elevation of vital signs is not unusual with acute pain and does not automatically indicate a complication.
A client has developed osteomyelitis and asks the health care provider how the problem occurred. Which response is most accurate? Deficiency of calcium Direct contamination of an open wound Rheumatoid disease Excessive vitamin intake
Direct contamination of an open wound Explanation: 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.
The emergency department physician explains to the nurse that the trauma client has a subluxation injury of the shoulder. The nurse understands this injury is a type of: Fracture Dislocation Sprain Strain
Dislocation Explanation: A subluxation is a partial dislocation in which the bone ends in the joint are still in partial contact with each other. Strains and sprains are not associated with subluxations. A fracture is a discontinuity of the bone.
A 13-year-old girl and her father have come to emergency department for assessment of the girl's stiff and warm knee. The father reports that she hurt it sliding into base during a softball game, but later in the interview 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. Which condition might be the cause of the girl's symptoms? Chondroma Osteosarcoma Osteoma Osteochondroma
Explanation: 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 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 tumours, but may or may not occur with benign tumors. Pain that persists at night and is not relieved by rest suggests malignancy.
Which activity is most likely to create a spiral fracture? Slipping on ice and landing on one side Stopping a fall by landing on a straightened arm Running 10 miles per day training for a marathon Falling on a ski hill with bindings that do not release
Falling on a ski hill with bindings that do not release Explanation: Fractures can be classified by type. A spiral fracture results from twisting and covers a large area of the bone. A stress fracture can occur from overuse. An impacted fracture can occur when landing on a joint. The angle of fracture, number of bone pieces, and whether the bone pierces the skin are all additional characteristics used to describe a fracture.
The nurse is caring for a client who sustained a femur fracture 3 days before. The nurse notes that the client, who was previously oriented, now doesn't know where he is. The nurse suspects which condition? Osteomyelitis Compartment syndrome Reflex sympathetic dystrophy Fat embolism syndrome (FES)
Fat embolism syndrome (FES) Explanation: The FES refers to multiple life-threatening manifestations from the presence of fat droplets in the small blood vessels of the lung, kidney, brain, and other organs after a long bone (femur) or pelvic fracture. Initial symptoms of FES begin to develop within a few hours to 3 to 4 days after injury. The first symptoms include subtle changes in behavior and signs of disorientation. Reflex sympathetic dystrophy represents soft tissue complications of musculoskeletal injuries. Compartment syndrome is a condition of increased pressure within a limited space. Osteomyelitis represents an acute or chronic infection of the bone.
A client who was involved in an automobile accident experienced major trauma and sustained a fractured femur. The nurse notices the following changes 4 hours after admission to the critical care unit: Disorientation Dyspnea Tachycardia Low-grade temperature Diaphoresis Substernal chest pain The nurse suspects: Fat embolism syndrome (FES) Autonomic hyperreflexia Parasympathetic nervous system response Sympathetic nervous system response
Fat embolism syndrome (FES) Explanation: The main clinical features of FES are respiratory failure, cerebral dysfunction, and skin and mucosal petechiae. Cerebral manifestations include encephalopathy, seizures, and focal neurologic deficits unrelated to head injury. Initial symptoms begin within a few hours to 3 to 4 days after injury and include a subtle change in behavior and signs of disorientation resulting from emboli in the cerebral circulation combined with respiratory depression. There may be reports of substernal chest pain and dyspnea accompanied by tachycardia and a low-grade fever. Diaphoresis, pallor, and cyanosis become evident as respiratory function deteriorates. The other options would not have these manifestations.
A child has a notable limp and states there is "a lot of leg pain." There was no history of injury. Which assessment data corresponds to a diagnosis of osteomyelitis? Select all that apply. Fracture Periosteal elevation on X-ray Fever Redness Bone shortening
Fever Redness Periosteal elevation on X-ray Explanation: Hematogenous osteomyelitis occurs more often in children when the infecting organism travels through the bloodstream to the bone. Manifestations include chills, fever, and malaise, along with local tenderness and swelling, pain on movement, loss of movement, and x-ray that may be initially normal followed by periosteal elevation and increased osteoclast activity. Open fractures may lead to osteomyelitis, but without history of injury, osteomyelitis did not cause the fracture.
The pathophysiology student is reviewing the stages of the healing process following a bone fracture. The student explains that the process follows which order? Early fibrosis; hematoma; remodeling; formation of cartilage and woven bone near the fracture site Formation of a large clot; new capillary buds; continued formation of the callus; reconstruction of the shaft Formation of fibrin meshwork; death of bone cells; clot becomes organized by invasion of blood vessels; remodeling Inflammatory phase; hematoma formation; reparative phase; remodeling phase
Formation of a large clot; new capillary buds; continued formation of the callus; reconstruction of the shaft Explanation: Four stages of the healing process have been identified. The first stage, hematoma formation, develops from torn blood vessels and forms a large clot. Disruption of blood vessels also leads to death of bone cells at the fracture site. The second or inflammatory phase is characterized by new vascularization. Most of the clot is organized by invasion of blood vessels and early fibrosis. A fibrin meshwork is initiated. Granulation tissue forms and this is referred to as the beginning of the callus. The reparative stage allows continued formation of the callus and woven bone near the fracture site. The final phase is remodeling. The osteoclastic and osteoblastic functions continue at a rapid rate until the fracture site is healed and bone is reconstructed.
A child tripped while running in the yard and reports pain with weight bearing. The next morning, the foot is swollen, discolored, and painful to touch and pressure of walking. About which problem will the health care provider likely be talking to the parents and the child related to this injury? Bone cancer Fractured bone Nerve impingement Strained ligament
Fractured bone Explanation: The signs and symptoms of a fracture include pain, tenderness at the site, swelling, loss of function, deformity of the affected part, and abnormal mobility. If nerve impingement occurs, there will be numbness of the affected area. A sprain is a stretch or tear in a ligament. Ligaments are bands of fibrous tissue that connect bones to bones at joints. A strain is also a stretch or tear, but it happens in a muscle or a tendon. Signs and symptoms of bone cancer include bone pain, swelling and tenderness near the affected area, fatigue and unintended weight loss
A nurse admitting a client to the emergency department with a suspected fracture notes a deep abrasion with bruising. The client reports receiving a hard tackle during a football game. Which grade of tissue damage accompanies this fracture? Grade 1 Grade 2 Grade 3 Grade 0
Grade 2 Explanation: Gradations of tissue injury with closed fractures are classified on the Oestern and Tscherne scale. Grade 0 has minimal soft tissue damage with an indirect injury to the limb and results in a simple fracture. Grade 1 includes superficial abrasion or contusion and a mild fracture pattern. Grade 2 has deep abrasion with skin or muscle contusion, direct limb trauma, and a severe fracture. Grade 3 has extensive skin contusion or a crushing injury with severe damage to underlying muscle, subcutaneous avulsion, and may include compartment syndrome. The fracture pattern with grade 3 is also severe.
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? Chronic Direct penetration Vascular insufficiency Hematogenous
Hematogenous Explanation: 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 is the term used to refer to the failure of bone to heal before the process of bone repair stops? Nonunion Malunion Delayed union Misunion
Nonunion Explanation: Nonunion is the term used to identify the failure of bone to heal before the process of bone repair stops. Delayed union refers to the failure of fracture to heal within predicted time. Malunion occurs when there is a deformity at the fracture site. Misunion is not a term generally used to identify complications of fracture healing.
What formation must occur at the fracture site to initiate the cellular events essential to bone healing? Hematoma Ossification Callus Fibrin meshwork
Hematoma Explanation: There are essentially four stages involved in bone healing: hematoma formation, fibrocartilaginous callus development, ossification, and remodeling. Hematoma formation is thought to be necessary for the initiation of the cellular events essential to bone healing. As the result of hematoma formation, clotting factors remain in the injured area to initiate the formation of a fibrin meshwork, which serves as a framework for the growth of fibroblasts and new capillary buds
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? Closely monitoring the client's serum potassium levels Implementing falls prevention measures Assessing the client's skin integrity twice per shift Monitoring the client's neurologic vital signs
Implementing falls prevention measures Explanation: 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.
The client has a cast applied for a fractured tibia. Which physiologic response to the fracture places this client at risk for compartment syndrome? Extremity elevation on pillows makes it hard for blood to circulate Inflammation causes increase in volume but cast limits compartment size Muscle atrophy from lack of ability to exercise Joint immobility due to the cast placeme
Inflammation causes increase in volume but cast limits compartment size Explanation: One of the most important causes of compartment syndrome is bleeding and edema caused by fractures and bone surgery. Compartment syndrome can result from a decrease in compartment size caused by constrictive dressings and casts; increased content volume caused by inflammation, swelling, bleeding, and venous obstruction; or a combination of the two factors. Muscle atrophy decreases volume of contents; casting (rather than immobility caused by the cast) can compress the compartment. Extremity elevation enhances venous return and decreases edema.
A child is being treated for hematogenous osteomyelitis. Which statement is an accurate description of this type of osteomyelitis? Bacterial proliferation in the absence of the classic signs of infection Introduction of microorganisms from the bloodstream The presence of dead bone tissue Destruction of the vascular network in the endosteum
Introduction of microorganisms from the bloodstream Explanation: Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the bloodstream. Dead bone tissue is indicative of osteonecrosis, not osteomyelitis. Hematogenous osteomyelitis is normally accompanied by the classic signs and symptoms of infection; the destruction of the vascular network in the endosteum is not a hallmark of the hematogenous variant of osteomyelitis.
A client with a compound fracture of the lower leg has a limb-lengthening system attached for stabilization. Which basic care activities can the nurse expect to provide? Select all that apply. Isometric exercises Regular pin site care Weight-bearing gait Neurovascular assessment Bivalving the cast
Isometric exercises Regular pin site care Neurovascular assessment Explanation: A limb-lengthening system is an external fixation device that can be used to stabilize complex fractures, allow for lengthening of shortened limbs, and provide access to care for soft tissue injuries. The device stays in place until the bone is healed. Pin site care to prevent infection is provided because pins inserted into the bone through the skin provide an access path for organisms. The device is not designed for weight-bearing activities, but clients should perform isometric exercises to promote muscle strength. Neurovascular assessment is important to monitor the health of the affected extremity. There is no cast involved in external fixation.
Following a lengthy series of diagnostic tests, a client's chronic hip pain has been attributed to advanced osteonecrosis. What treatment is this client most likely to require? Intravenous antibiotics Joint replacement surgery Injections of corticosteroids into the synovial space Transfusion of packed red blood cells
Joint replacement surgery Explanation: Advanced osteonecrosis often necessitates joint replacement surgery, because necrotic bone cannot be rehabilitated. Osteonecrosis is noninfectious in etiology, so antibiotics are not normally necessary. Steroid injections will not restore the affected bone. Blood transfusions do not address the cause of consequences of the problem.
What would be the best treatment option for a soft tissue contusion on the right ankle? Apply heat compresses for 15 minutes at a time for 24 hours. Administration of pain medications as needed. Keep the ankle elevated for the first 24 hours Surgery will be the expected treatment and we need to have a consent form signed.
Keep the ankle elevated for the first 24 hours Explanation: 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.
The family of an older adult client is concerned about injuries from falls. The nurse providing discharge teaching would best minimize this risk by encouraging the family to perform which intervention? Cover the kitchen's tiled floor with several scatter rugs. Discourage the client from wearing rubber-soled shoes. Keep walkways free of clutter since alteration in vision happens with aging. Place exposed extension cords under decorative carpet runners.
Keep walkways free of clutter since alteration in vision happens with aging. Explanation: Older adults are at risk for falls related to environmental hazards, such as scatter rugs, loose or loosely covered cords, and cluttered walkways. The use of rubber-soled shoes is appropriate. Other fall prevention in older adults focuses on strength/balance exercises and vitamin D supplements to improve bone health.
Athletic injuries fall into two types: acute or overuse injuries. Where do overuse injuries commonly occur? Neck Wrist Knee Fingers
Knee Explanation: Overuse injuries have been described as chronic injuries, including stress fractures that result from constant high levels of physiologic stress without sufficient recovery time. They commonly occur in the elbow ("Little League elbow" or "tennis elbow") and in tissue in which tendons attach to the bone, such as the heel, knee, and shoulder.
Which manifestations are associated with metastatic bone cancer of the spine? Select all that apply. Pain resulting from nerve entrapment Pathologic fractures Swelling at the affected site Vertebrae that are easily crumbled Localized bone pain that is worse at night
Localized bone pain that is worse at night Pain resulting from nerve entrapment Pathologic fractures Vertebrae that are easily crumbled Explanation: The major symptom of bone metastasis is pain in a specific bone area; this is validated with evidence of an impending pathologic fracture. It usually develops gradually, over weeks, and is more severe at night. Pain is caused by stretching of the periosteum of the involved bone or by nerve entrapment. The affected bone of the pathologic fracture appears to be eaten away on x-ray images; in severe cases, it crumbles on impact, much like dried toast. Observable swelling is not associated with bone metastasis.
A client is diagnosed with a bone tumor after a pathologic fracture. What is the most likely cause of the tumor? Primary osteosarcoma Metastatic bone disease Osteochondroma Osteoma
Metastatic bone disease Explanation: Metastatic bone disease is relatively common as cancers spread from the primary tumor site. Primary malignant bone tumors such as osteosarcomas are uncommon and account for less than 0.2% of all cancers. Osteochondromas are benign, usually do not destroy supporting or surrounding tissue, and grow more slowly than malignancies. An osteoma is a small bony tumor on the surface of a long bone, flat bone, or the skull.
The physical therapy student is explaining complications of fracture healing. Which of the following is a contributing factor to failure of a bone to heal before the process of bone repair stops? Large displaced fracture Malalignment of fracture at time of immobilization Mobility at fracture site Large hematoma
Mobility at fracture site Explanation: Failure of bone to heal before the process of bone repair stops is known as nonunion, and a contributing factor is mobility at the fracture site. Large hematomas and large displaced fractures are contributing factors for delayed union. Malalignment of a fracture at the time of immobilization is a contributing factor for malunion.
The client has a bone neoplasm that is growing rapidly and spreading to other parts of the body through the blood stream or lymphatics. The nurse knows this malignant tumor is likely which type of neoplasm? Select all that apply. Osteochondroma Multiple myeloma Giant cell tumor Chondrosarcoma Ewing sarcoma
Multiple myeloma Ewing sarcoma Chondrosarcoma Explanation: Malignant tumors grow rapidly and can spread to other parts of the body through the bloodstream or lymphatics. Multiple myeloma, Ewing sarcoma, and chondrosarcoma are all malignant neoplasms. The other options are benign neoplasms.
A client has a transverse fracture of the left humerus. Which assessment indicates a developing complication? Hematocrit 35% (0.35) New onset of shortness of breath White blood cells 9500 cells/mm³ (9.5 ×109/L) Warm fingers
New onset of shortness of breath Explanation: The laboratory values are within normal limits, but new onset of shortness of breath could indicate development of venous thromboembolic disorders, which include pulmonary embolism and deep vein thrombosis. The fracture of long bones such as the humerus, tibia, or femur could force the fat from within the bone marrow (yellow marrow) into the bloodstream where it could become an embolus.
Osteosarcoma is an aggressive malignancy of the bone. What is the primary clinical feature of osteosarcoma? Pain, worse during the day Soreness in nearest joint Nighttime awakening from pain Erythema in the overlaying skin
Nighttime awakening from pain Explanation: The primary clinical feature of osteosarcoma is deep localized pain with nighttime awakening and swelling in the affected bone. In osteosarcoma, the pain is worse at night. There may be erythema in the overlaying skin, but that is not the primary clinical feature of the disease. Osteosarcoma does not cause soreness in the nearest joint; it may impede range of motion.
Shortly after a closed fracture has occurred, what localized early manifestation occurs? Deformity Necrosis Numbness Tetany
Numbness Explanation: Shortly after a fracture has occurred, nerve function at the fracture site may be temporarily lost. The area may become numb, and the surrounding muscles may become flaccid. After this brief period, the pain sensation returns and, with it, muscle spasms and contractions of the surrounding muscles. There is pain, tenderness at the site of bone disruption, swelling, loss of function, deformity of the affected part, and abnormal mobility.
Which client is most likely to experience complications in bone healing due to avascular necrosis? Middle-aged adult with a stress fracture of the tibia Young adult with compound fracture of the humerus Child with a greenstick fracture of the radius Older adult with an intertrochanteric fracture of the hip
Older adult with an intertrochanteric fracture of the hip Explanation: Subtrochanteric and intertrochanteric fractures that occur distal to these vessels do not usually disturb the blood supply to the femoral head, whereas femoral neck fractures, particularly those involving marked displacement, often disrupt the blood supply to the femoral head and are therefore associated with increased incidence of complications (nonunion and avascular necrosis). Fractures that involve an open wound are most prone to nonunion, infection, or osteomyelitis. Closed fractures generally heal more quickly and with fewer complications.
The client with sickle cell disease is at risk for development of which bone complication? Osteomyelitis Benign neoplasms Complex regional pain syndrome (CRPS) Osteonecrosis
Osteonecrosis Explanation: Osteonecrosis, or death of a segment of bone, is a condition caused by interruption of blood supply to the marrow, medullary bone, or cortex in the absence of infection. It is a common complication of sickle cell disease. Osteomyelitis represents an acute or chronic infection of the bone. Benign neoplasms of the bone and CRPS are not associated with sickle cell disease.
A client presents with sudden onset of deep, localized pain and swelling in the proximal femur while undergoing diagnostic workup for suspected lung cancer. The nurse suspects the client may have developed which type of neoplasm of the skeletal system? Osteochondroma Enchondroma Osteosarcoma Exostosis
Osteosarcoma Explanation: Osteosarcoma is an aggressive and highly malignant bone tumor that normally requires surgery and chemotherapy. Exostosis and osteochondroma are synonymous terms for types of benign neoplasms that often require no treatment. Enchondroma is also benign and may self-resolve.
A client sustains a musculoskeletal injury of the wrist. Which manifestation would the nurse expect to accompany the strain? False motion and discoloration Catching and limited motion Pain and stiffness Joint deformity and swelling
Pain and stiffness Explanation: Manifestations common among musculoskeletal injuries are pain and swelling. Differences arise from the type of injury. Strains occur in muscles from overstretching and usually have no external evidence, but there is pain, stiffness, and swelling. Sprains occur when the ligaments supporting a joint are torn. Mild sprains involve only a few strands of the ligament, while a severe sprain can completely separate the ligament from the bone. Swelling, pain, heat, discoloration, and limited function are common signs of sprain. A fracture involves break in the integrity of a bone. Signs and symptoms of fracture include pain, tenderness at the site, swelling, loss of function, deformity, and abnormal mobility (or false motion). A dislocation occurs when the bone ends of a joint are separated. Symptoms include pain, deformity, and loss of function. A loose body is a small piece of bone or cartilage in the joint. It can cause catching and locking of the joint.
The oncologist is evaluating a medical student's understanding of Ewing sarcoma. Which statement by the student is most accurate? "The most frequent site of Ewing sarcoma is the pelvis." "Pathologic fractures are common." "Manifestations of Ewing tumor include a painless lump over the involved bone." "Females are affected slightly more frequently than males."
Pathologic fractures are common." Explanation: Pathologic fractures are common in Ewing sarcoma because of bone destruction. The most frequent site of Ewing sarcoma is the femur. Manifestations of Ewing tumor include bone pain and tenderness over the involved bone or soft tissue. Males are affected slightly more frequently than females.
A client with a closed reduction of a wrist fracture has a plaster cast applied. Which nursing intervention is the highest priority immediately after the procedure? Performing a peripheral circulation assessment Immobilizing the arm in a sling Handling the cast with the palms of the hands Elevating the extremity on a pillow
Performing a peripheral circulation assessment Explanation: Complications of fractures include compartment syndrome (when swelling after the injury impairs blood and nerve function), delayed healing, infection, and emboli. Of these conditions, compartment syndrome has the earliest onset and is monitored by peripheral circulation assessment. This includes capillary refill, temperature of the distal extremity, and sensation and the ability to move fingertips.
A client with a diagnosis of small cell lung carcinoma has developed bone metastases, a finding that has prompted a series of new interventions. What are the primary goals of the treatment regimen for this client's bone cancer? Prevention of brain metastasis and early identification of osteonecrosis Prevention of pathologic fractures and survival with maximum functioning Promotion of bone remodeling at tumor sites through calcium and vitamin D supplements Pain management and prevention of osteomyelitis
Prevention of pathologic fractures and survival with maximum functioning Explanation: The primary goals in treatment of metastatic bone disease are to prevent pathologic fractures and promote survival with maximum functioning, allowing the person to maintain as much mobility and pain control as possible. Osteonecrosis, osteomyelitis, and brain metastasis are not typical sequelae of bone metastasis. Tumor sites do not normally undergo remodeling. Dietary supplements alone would not foster this process.
A client with a compound fracture of the femur is in balanced skeletal traction. Which assessment data must be reported immediately? Wiggles toes every few minutes Clear drainage around pin insertion sites Uses trapeze to shift position Redness and heat at fracture site
Redness and heat at fracture site Explanation: 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 client with a recent fracture visits the doctor's office to monitor bone healing. X-ray reveals new calcium deposits at the fracture site with the fracture line still evident. At which stage in the healing process is this fracture? Remodeling phase Inflammatory phase Hematoma formation Reparative phase
Reparative phase Explanation: There are four stages of bone healing. Hematoma formation occurs during the first 1-2 days after the injury. The inflammatory phase involves formation of new capillaries and development of granulation tissue into a callus. The reparative phase allows the continued formation of the callus into calcified bony tissue. The final phase is remodeling and removes the excess tissue at the fracture site to a shape similar to its pre-fracture state.
The nurse is assessing a client who arrived to the emergency department reporting pain at 8 of 10 and swelling of the upper arm after a fall. Which intervention will the nurse perform first? Request an X-ray be performed. Prepare the client for the application of a cast. Assess the client's strength and range of motion. Request a surgical consult.
Request an X-ray be performed. Explanation: The client may have a new fracture based on the history of having fallen and having pain and swelling of the upper arm. The nurse should first arrange for an X-ray to confirm the diagnosis and determine what treatment is necessary. The nurse should not test strength or range of motion, because this could aggravate pain and displace the fracture, if present. Whether a cast or surgery will be needed cannot be determined until a diagnosis has been made.
A young adult client who is a competitive skier complains of knee pain when climbing stairs or sitting with the knees bent. What will the nurse teach the client about the diagnosis of chondromalacia? Strengthening exercises and a diet higher in calcium will heal the condition. The knee will require immobilization for about 6 weeks to heal from this injury. Rest and isometric exercises followed by ice are effective treatment measures. This is a lifelong inflammatory condition that should be treated with steroids.
Rest and isometric exercises followed by ice are effective treatment measures. Explanation: Chondromalacia is softening of the articular cartilage, most often on the posterior surface of the patella in active young adults. Treatment includes rest, isometric strengthening exercises, and ice therapy after exercise. Surgery to remove the softened bone would be performed only after conservative therapy has not been successful.
A client is admitted with suspected soft tissue injury during a soccer game. What is the best intervention? Have the client come back based on their symptoms Send the client for an X-ray Send the client for a physical exam. Send the client for an MRI
Send the client for an MRI Explanation: Current practice dictates that clients suspected of soft tissue injury have magnetic resonance imaging (MRI) for best diagnosis.
The client has been diagnosed with chronic osteomyelitis in his leg. The hallmark feature of this disorder is: Abscess formation Sequestrum Ischemic foot ulcers Involucrum
Sequestrum Explanation: The hallmark feature of chronic osteomyelitis is the presence of infected dead bone, a sequestrum, that has separated from the living bone. A sheath of new bone, called the involucrum, forms around the dead bone. Abscess formation is found in tubercular osteomyelitis. In persons with vascular insufficiency, osteomyelitis develops from a skin lesion such as an ischemic foot ulcer.
A client with a fractured hip is in Buck's traction awaiting surgery. Which observation by the nurse requires immediate intervention? Traction weights hanging over the end of the bed Trapeze hanging within the client's reach Sheets hanging over the traction ropes Stuffed bear hanging from the overbed frame
Sheets hanging over the traction ropes Explanation: Traction is a pulling force applied to an extremity or body part while a counterforce pulls in the opposite direction. There must be nothing interfering with the straight line of pull or the effectiveness of traction is reduced. Weights should hang freely, and nothing should interfere with the movement of the ropes in the pulleys.
What is the purpose of the meniscus?
Shock absorption Explanation: The meniscus plays a major role in load bearing and shock absorption for the knee joint. It helps to maintain the femur and tibia in correct position as well.
A client sustains a musculoskeletal injury of the left hip. In addition to pain, which manifestations would the nurse expect to accompany a dislocation? Select all that apply. Limited movement Swelling Shortened left leg Joint locking Heat False motion
Shortened left leg Limited movement Explanation: Manifestations common among musculoskeletal injuries are pain and swelling. Differences arise from the type of injury. A dislocation occurs when the bone ends of a joint are separated. Symptoms include pain, deformity, and limited movement. Strains occur in muscles from overstretching and usually have no external evidence, but there is pain, stiffness, and swelling. Sprains occur when the ligaments supporting a joint are torn. Mild sprains involve only a few strands of the ligament, whereas a severe sprain can completely separate the ligament from the bone. Swelling, pain, heat, discoloration, and limited function are common signs of sprain. A fracture involves break in the integrity of a bone. Signs and symptoms of fracture include pain, tenderness at the site, swelling, loss of function, deformity, and abnormal mobility (or false motion), which occurs when the affected part bends across the break. A loose body is a small piece of bone or cartilage in the joint. It can cause catching and locking of the joint.
A 50-year-old male has been diagnosed with contiguous spread osteomyelitis of the right hip acetabulum. What would be an expected treatment for this condition? Surgical amputation of the affected area Surgical arthroplasty and parenteral antimicrobial agents Short-term administration of antimicrobials and rest for the affected area Elevate legs and treat with opioid analgesics for the discomfort
Surgical arthroplasty and parenteral antimicrobial agents Explanation: Treatment includes antibiotics and selective use of surgical interventions. Usually, antimicrobial agents are used prophylactically in persons undergoing bone surgery. For persons with osteomyelitis, early antimicrobial treatment—before there is extensive destruction of bone—produces the best results. The choice of agents and method of administration depend on the microorganisms causing the infection. Usually antibiotics are first given parenterally and then orally. If it does not respond to antibiotic therapy, surgical decompression is used to release intramedullary pressure and remove drainage from the periosteal area
Which treatment would the nurse caring for a client with chondrosarcoma expect to implement? Radiation protocol Surgical preparation Chemotherapy Interferon treatments
Surgical preparation Explanation: Chondrosarcomas are the second-most common type of bone tumor. They are more common in middle age and develop at the point of muscle attachment to bones. Chondrosarcomas are resistant to chemotherapy and radiation and are best treated by radical surgical excision
What are typical assessment findings the nurse expects to observe in a client with a simple fracture of the leg? Select all that apply. Swelling Absence of feeling Cyanosis Pain Loss of function
Swelling Loss of function Pain
A client presents to the emergency department after suffering an injury while playing sports. The client is diagnosed with a sprain. Select the best explanation of the injury. Tear of a ligamentous structure Excessive stretch of a muscle Hyperextension of a muscle Unusual muscle contraction
Tear of a ligamentous structure Explanation: A sprain, which involves the joint ligaments or capsule surrounding the joint, resembles a strain, but the pain and swelling subside more slowly. It usually is caused by abnormal or excessive movement of a joint. With a sprain, the ligaments may be incompletely torn or, in a severe sprain, completely torn or ruptured. A strain involves hyperextension of a muscle, unusual muscle contraction, and excessive stretch of a muscle.
A client experienced a humeral fracture during an physical assault, and treatment has now begun. During the healing process, which physiologic process(es) will take place? Select all that apply. Granulation tissue replaces the hematoma at the healing site. Spongy bone will eventually replace compact bone at the end of the healing process. The client will develop a hematoma in the first 48 hours after the injury. Remodeling will take place near the beginning of the healing process. The client will develop a callus of cartilage and woven bone near the fracture site.
The client will develop a callus of cartilage and woven bone near the fracture site. The client will develop a hematoma in the first 48 hours after the injury. Granulation tissue replaces the hematoma at the healing site. Explanation: Hematoma formation occurs during the first 1 to 2 days after fracture; granulation tissue replaces the hematoma after a few days. Callus formation is an expected phase of wound healing and consists of cartilage and woven bone near the fracture site. Compact bone eventually replaces spongy bone, which is temporary. Remodeling is the final phase of the healing process.
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? Your age at the time of injury increases your risk for surgical complications. The risk of infection is increased with a hip pinning instead of replacement. The replacement prevents a delay in healing that happens from loss of blood flow to the bone. You will be able to get out of bed sooner with the hip replacement instead of a pin.
The replacement prevents a delay in healing that happens from loss of blood flow to the bone. Explanation: 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.
The nurse assesses the neurovascular status of a client who had surgery to repair a fractured hip. Which assessment data for the affected leg indicates that the client has developed a neurologic complication? Ruddy skin color Tingling sensations Nonpitting edema Cool skin temperature
Tingling sensations Explanation: Complications of fractures include compartment syndrome (when swelling after the injury impairs blood and nerve function), delayed healing, infection, and emboli. Of these conditions, compartment syndrome has the earliest onset. The neurologic assessment includes sensation and the ability to move the toes. Vascular assessment includes capillary refill, edema, and temperature of the distal extremity.
A newly admitted client's health record states that the client's health history includes tubercular osteomyelitis. Where is the most likely anatomical site of this infection? Vertebrae Cranial bone Humerus Femur
Vertebrae Explanation: Any bone, joint, or bursa may be affected, but the spine is the most common site, followed by the knees and hips.
A pathologic stress fracture occurs in bones subjected to which type of stress? Sudden direct force Weakening by disease Massive muscle contraction Repeated excessive use
Weakening by disease Explanation: A pathologic stress fracture occurs in bones that already are weakened by disease or tumors. Fractures of this type may occur spontaneously with little or no stress. The underlying disease state can be local (as with infections, cysts, or tumors) or it can be generalized (as in osteoporosis, Paget disease, or disseminated tumors). A fatigue fracture results from repeated excessive wear on a bone. The most common fractures are those resulting from sudden direct impact (such as from a fall or blow) or indirect, such as a massive muscle contraction injury.
A client returns to the doctor's office for evaluation 6 weeks after a tibial fracture. Which assessment indicates the potential for nonunion? X-ray shows minimal calcification at the fracture. There is ankle joint stiffness. There is tenderness when the fracture site is touched. Skin is dry and peeling under the cast.
X-ray shows minimal calcification at the fracture. Explanation: There are four stages of bone healing. Hematoma formation occurs during the first 1-2 days after the injury. The inflammatory phase involves formation of new capillaries and development of granulation tissue into a callus. The reparative phase allows the continued formation of the callus into calcified bony tissue. The final phase is remodeling and removes the excess tissue at the fracture site to a shape similar to its pre-fracture state. By the sixth week after initial injury, evidence of healing is expected, showing callus formation with granulation and calcification. The client may develop nonunion without such signs of healing. Expected assessment data for a casted limb include peeling skin under a cast, stiffness of immobilized joints, and tenderness at the site.
Which client should be seen first? client whose sprain includes a slight tear of the ligament client whose sprain includes an incomplete tear of the ligament client whose sprain includes a complete tear of the ligament client whose sprain include an avulsion of the medial femoral condyle
client whose sprain include an avulsion of the medial femoral condyle Explanation: Sprains involve the ligamentous structures surrounding the joint. The most severe sprain involves an avulsion fracture (when the ligament pulls off a section of bone). The other sprains described are less severe (grade 1, 2, 3)
A 16-year-old adolescent suffered a fracture of the ulna. The fracture does not protrude through the skin and there are several pieces of broken bone evident on the x-ray. Which term should the nurse use to describe this fracture? transverse fracture open spiral fracture closed comminuted fracture closed greenstick fracture
closed comminuted fracture Explanation: The fracture would be described as closed because it does not break through the skin. It is comminuted because it broke into more than two pieces. A closed greenstick fracture is a fracture that is a partial break in bone continuity, common in young children whose bones are not yet fully ossified. An open spiral fracture is a fracture that breaks through the skin. A transverse fracture is a single break straight across the bone.
A client with a fractured clavicle is told that the bone will heal well if immobilized for the next 6 to 8 weeks, but there will be a large "bump" where the break occurred. This bump will be caused by: localized infection. accumulation of dead white cells. formation of scar tissue. formation of a bony callus.
formation of a bony callus. Explanation: The bony callus is still present due to the misalignment of the ends of the bone (occurs only with clavicle or improperly placed healing). This is not formed by scar tissue and is not the result of scarring or dead white cells.
A client tells the nurse about being very concerned because the health care provider noted that the client's fractured arm is healing with malunion. The nurse recognizes this as: failure of a fracture to unite within the normal period. healing with deformity, angulation, or rotation that is visible on x-ray films. an expected outcome because the client is obese. failure to produce union and cessation of the processes of bone repair.
healing with deformity, angulation, or rotation that is visible on x-ray films. Explanation: Malunion is healing with deformity, angulation, or rotation that is visible on x-ray films. Delayed union is the failure of a fracture to unite within the normal period (e.g., 20 weeks for a fracture of the tibia or femur in an adult). Nonunion is failure to produce union and cessation of the processes of bone repair. Obesity does not influence fracture alignment.
While explaining to a group of nursing students the difference between benign and malignant bone tumors, the instructor will emphasize that a benign tumor: Select all that apply. may be asymptomatic and detected incidentally. is a painful mass that is detected on a long bone and seems to be increasing in size. may cause the client to have a pathological fracture. is associated with constant, deep aching pain that does not go away with rest.
may be asymptomatic and detected incidentally. may cause the client to have a pathological fracture. Explanation: There are three major manifestations of bone tumors: pain, presence of a mass, and impairment of function. Although benign tumors are frequently asymptomatic and are detected as an incidental finding, malignant tumors are associated with constant, deep aching pain that does not go away with rest and is present at night. A mass or hard lump may be the first sign of a bone tumor. A malignant tumor is suspected when a painful mass exists that is enlarging or eroding the cortex of the bone. Benign and malignant tumors may cause the bone to erode to the point where it cannot withstand the strain of ordinary use. A sudden increase in pain followed by trivial trauma that is preceded by a history of mild, dull aching pain is suggestive of a pathologic fracture.
Following a knee replacement surgery, a nurse's next door neighbor asks, "I don't think I am healing right. Can you come look at my knee?" Upon assessment, the nurse notices the client is warm to touch and has a fever; the incision is inflamed and not well approximated with foul-smelling drainage around the incision line. At this point, the nurse tells the client she needs to go see her surgeon because the client may have: an abscess in the pocket of the incision. osteomyelitis. contaminated the wound with MRSA. potential bone cancer.
osteomyelitis. Explanation: Osteomyelitis after trauma or bone surgery usually is associated with persistent or recurrent fever, increased pain at the operative or trauma site, and poor incisional healing, which often is accompanied by continued wound drainage and wound separation. Prosthetic joint infections often present with joint pain, fever, and cutaneous drainage. There is no indication the client has developed a bone cancer.
An 80-year-old client is admitted to the hospital with a displaced intracapsular hip fracture. The physician explains to the client's family that this type of fracture is best treated by: open reduction and internal fixation. external fixation. nonoperative treatment. surgical hip replacement and early mobilization
surgical hip replacement and early mobilization. Explanation: Displaced intracapsular fractures in the elderly are usually best treated by surgical hip replacement and early mobilization. Young, healthy people are treated by reduction of the fracture and internal fixation. Intertrochanteric fractures are usually treated with open reduction and internal fixation. External fixation devices are not used for hip fractures.
An 80-year-old client is admitted to the hospital with a displaced intracapsular hip fracture. The physician explains to the client's family that this type of fracture is best treated by: open reduction and internal fixation. external fixation. surgical hip replacement and early mobilization. nonoperative treatment.
surgical hip replacement and early mobilization. Explanation: Displaced intracapsular fractures in the elderly are usually best treated by surgical hip replacement and early mobilization. Young, healthy people are treated by reduction of the fracture and internal fixation. Intertrochanteric fractures are usually treated with open reduction and internal fixation. External fixation devices are not used for hip fractures.
Which event(s) in a client's history increases risk of developing osteoarthritis? Select all that apply. torn meniscus in left knee at age 19 varicella (chickenpox) at age 14 fractured right radius at age 6 loose body in knee joint at age 40 hip dislocation at age 35
torn meniscus in left knee at age 19 loose body in knee joint at age 40 hip dislocation at age 35 Explanation: Knee injuries in young to middle adulthood and the presence of loose bodies in the knee joint increase the risk of osteoarthritis. Dislocation of a hip is also a risk factor for future osteoarthritis. Obesity increases stress on weight bearing joints and increases risk of osteoarthritis. Fractures in young children and varicella infection are not considered risks for osteoarthritis.
The nurse is educating caregivers of children ranging from infant through adolescent about how to prevent injury. Which leading cause of nonfatal injury in this age group will the nurse emphasize? electrocution unintentional falls poisoning motor vehicle collisions
unintentional falls Explanation: Unintentional falls are the number one cause of nonfatal injuries in children and adolescents between 0 and 14 years of age in the United States. While preventing the other potential causes of injury should also taught, the nurse ensures the caregivers are aware that falls are the most common.
