Med-Surg II Exam II Part I
A technician usually administers a calculated dose of a radioisotope how many hours before a bone scan?
2 hours
How many IU of vitamin D do young adults need daily?
600 IU,
How many IU of Vitamin D do adults 50 years and older require?
800 to 1000 IU
What is a bursa?
A bursa is a closed, fluid-filled sac that works as a cushion and gliding surface to reduce friction between tissues of the body.
Movement away from the midline.
Abduction
Movement toward the midline.
Adduction.
The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given?
Alendronate
The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given?
Alendronate (Fosamax)
What is a hematoma?
An accumulation of blood outside of the blood vessels is generally formed by a rupture in the blood vessel wall.
Calcitonin and PTH are referred to as ________hormones because of their opposing actions.
Antagonistic
What is an example of a pivot joint?
Articulation between the radius and the ulna.
The junction of two or more bones is identified as?
Articulation, also known as joint.
The nurse is caring for a client with osteoporosis. Which information will the nurse include when teaching actions to manage the condition?
Avoid excessive alcohol intake Stop smoking Engage in regular weight-bearing exercise
The hip and shoulder are examples of what type of joint?
Ball-and-socket joints
Which type of joint permits full freedom of movement.?
Ball-and-socket joints
What is an example of a saddle joint (biaxial joint)?
Base of the thumb
Why do people with Paget's disease often develop kidney stones and/or calcium deposits in blood vessels and heart valves?
Because of the increased calcium in the body from the accelerated breakdown of bone tissue.
During bone healing, where are new osteons formed?
Bone cortex
Where does fracture healing occur?
Bone marrow
What is the outcome of vitamin D deficiency?
Bone mineralization deficit, deformity, and fractures.
Functional changes for which tissue? Bones fragile and prone to fracture—vertebrae, hip, wrist
Bones
Physical Finding for which tissue? Loss of height, Postural changes, Kyphosis, Loss of flexibility, Flexion of hips and knees, Back pain, Osteoporosis, Fracture
Bones
Structural changes for which tissues? Gradual, progressive loss of bone mass after 30 y of age, vertebral collapse
Bones
Which bones are likely to consist of cortisol bones and why?
Bones that are designed for weight-bearing and movement such as long bones
What hormone does the thyroid gland produce and release to help regulate calcium levels in the blood?
Calcitonin
Which medication can prevent hypercalcemia?
Calcitonin
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)?
Calcitonin
How does calcitonin react to the elevation of blood calcium levels?
Calcitonin, secreted by the thyroid gland in response to elevated blood calcium levels, inhibits bone resorption and increases the deposit of calcium in bone.
Which electrolyte triggers a contraction within the muscle cell?
Calcium
What part of the body consists of short bones?
Carpal and tarsal
What are amphiarthrosis?
Cartilaginous joints with limited motion
A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder?
Chlorpheniramine
Why are fractures common among seniors?
Collagen structures are less able to absorb energy. Increased inactivity, diminished neuron stimulation, musculoskeletal disorders, and nutritional deficiencies contribute to the loss of muscle strength.
What are indicators of peripheral circulation dysfunction?
Color: Pale, cyanotic, or mottled Temperature: Cool Capillary refill: More than 3 s
A nurse is assessing a patient with a hip and femur fracture and notes pallor and paresthesia, and the patient reports increasing pain despite pain medications or elevation. The nurse is concerned about which possible complication?
Compartment syndrome
How many mg daily of calcium is essential to maintain adult bone mass?
Daily intake of approximately 1000 to 1200 mg of calcium
What are some dietary sources of vitamin D?
Dietary sources of vitamin D include vitamin D-fortified milk and cereals, egg yolks, saltwater fish, and liver.
During an outpatient visit a nurse is assessing a patient's understanding about the signs and symptoms associated with osteoporosis.
Dowager's Hump Some patients are asymptomatic Fractures most commonly in the hips, wrist, and spine
How is walking an example of both isometric and isotonic muscle contractions?
During walking, isotonic contraction results in the shortening of the leg, and isometric contraction causes the stiff leg to push against the floor.
List examples of hinge joints.
Elbows and knees
You're developing a nursing care plan for a patient with gout present on the right foot. What specific nursing interventions will you include in this patient's plan of care?
Encourage fluid intake of 2-3 liters per day. Use a footboard while the patient is in bed. Apply alternating cold and warm compresses to foot as tolerated by the patient daily.
Where is cancellous bone located within the body?
Ends of long bones, pelvic bones, ribs, skull, and the vertebrae in the spinal column
Longitudinal growth is nurtured and facilitated by which section of the long bone?
Epiphyseal plate
What layer of cartilage separates the epiphysis and diaphysis?
Epiphyseal plate, also known as the growth plate
What section of the long bone consists of spongy cancellous bone?
Epiphysis
What role does estrogen play in bone formation?
Estrogen stimulates osteoblasts and inhibits osteoclasts; therefore, bone formation is enhanced and resorption is inhibited.
Turning outward
Eversion
How often does complete bone turnover occur?
Every 10 years
Straightening at a joint.
Extension
Bending at a joint.
Flexion
When has fracture strength been achieved?
Fracture strength is obtained when the new osteons have become established
What are diarthrosis joints?, also referred to as synovial joints, are freely movable joints (
Free-moving synovial joints.
Which joint allows for limited movement in all directions ?
Gliding joint
Which joint is represented by the joints of the carpal bones in the wrist?
Gliding joint
Which joint permits bending in only flexion or extension?
Hinge joints
A patient is taking Calcitonin for osteoporosis. The patient should be monitored for?
Hypocalcemia
What is the role of insulin-like growth factor 1 (IGF-1)?
IGF-I stimulates bone formation and resorption. The result is an increase in the overall rate of bone remodeling, with a net effect of bone accumulation.
How does vitamin D deficiency affect the bones of children?
In children, it can cause rickets. Rickets is a rare disease that causes the bones to become soft and bend
How does PTH react to low calcium levels in the blood?
In response to low calcium levels in the blood, increased levels of PTH prompt the mobilization of calcium, the demineralization of bone, and the formation of bone cysts.
How does calcitonin reduce calcium?
Increase diuresis and decrease reabsorption of calcium
Turning inward
Inversion
During a biceps curl, holding the dumbbell in a constant/static position rather than actively raising or lowering it is an example of what type of muscle contraction?
Isometric
Pushing against an immovable object is an example of what type of muscle contraction?
Isometric
Which muscle contraction involves increasing tension in the muscle, but the muscle does not change length, nor does the angle of the joint change?
Isometric muscle contraction
. How does testosterone affect bone growth and formation?
It directly causes skeletal growth in adolescence and has continued effects on skeletal muscle growth throughout the lifespan.
How might growth hormone and IGF-I affect the aging process?
It is believed that the low levels of both growth hormone and IGF-I that occur with aging may be partly responsible for decreased bone formation and resultant osteopenia.
How does growth hormone effect skeletal growth and remodeling?
It stimulates the liver to produce insulin-like growth factor 1 (IGF-I), which accelerates bone modeling in children and adolescents.
What type of fibrous sheath surrounds the articulating bone?
Joint capsule
Functional changes for which tissues? Stiffness, reduced flexibility, and pain interfere with activities of daily living
Joints
Physical changes for which tissue? Diminished range of motion, Stiffness, Loss of height
Joints
Structural changes for which tissue? Cartilage—progressive deterioration Thinning of intervertebral discs
Joints
Where is the bursa located within the body?
Joints of the elbow, shoulder, hip, and knee.
Functional changes for which tissue? Lax ligaments (less-than-normal strength; weakness)
Ligaments
Physical findings for which tissue? Joint pain on motion; resolves with rest, Crepitus, Joint swelling/enlargement, Osteoarthritis (degenerative joiJoint swelling/enlargement, Osteoarthritis (degenerative joint disease)nt disease))
Ligaments
Structural Findings for which tissue? Lax ligaments (less-than-normal strength; weakness)
Ligaments
What bundles of collagen connect the articulating bones together?
Ligaments
What vessels supply blood to cancellous tissue?
Metaphyseal and epiphyseal vessels
How do muscles react to low levels of calcium?
Muscle cramps
Functional changes for which tissues?
Muscles
Physical changes for which tissue? Loss of strength, Diminished agility, Decreased endurance, Prolonged response time (diminished reaction time) Diminished tone, Broad base of support, History of falls
Muscles
Structural changes for which tissue? Increase in collagen and resultant, fibrosis, Muscles atrophy (diminish in size); wasting, Tendons less elastic
Muscles
A patient is prescribed Alendronate (Fosamax) at 0800 for the treatment of osteoporosis. As the nurse you know you must administer this medication:
On an empty stomach with a full glass of water and keep the patient upright for 30 minutes.
During bone healing, endothelial cells are transformed into what type of cells within the bone marrow?
Osteoblasts
What bone cells form new bones and grow and heal existing bones?
Osteoblasts are the cells that form new bones and grow and heal existing bones.
Which bone cells are responsible for bone maintenance and regulation of osteoblasts and osteoclasts?
Osteocytes
How does osteogenesis differ from ossification?
Osteogenesis refers to the broader picture of bone formation. Ossification refers to the formation and hardening process of the bone matrix through the crystallization of calcium and phosphorus and the bounding of collagen fibers.
Which of the following is the most common and most fatal primary malignant bone tumor?
Osteogenic sarcoma (osteosarcoma)
What is the microscopic functioning unit of mature cortical bones?
Osteon
What are the major hormonal regulators of calcium homeostasis?
PTH and calcitonin are the major hormonal regulators of calcium homeostasis.
How does PTH regulate the concentration of calcium in the blood?
PTH regulates the concentration of calcium in the blood, in part by promoting the movement of calcium from the bone
What hormones are vital in ensuring that calcium is available for bone mineralization and matrix formation?
PTH, calcitonin, calcitriol
What hormones are vital in ensuring that calcium is properly absorbed?
PTH, calcitonin, calcitriol
Which substance stimulates osteoclast activity?
Parathyroid hormone
What are indicators of peripheral sensation dysfunction?
Paresthesia, Unrelenting pain, Pain on passive stretch, Absence of feeling
How does long-term use of corticosteroids affect bones?
Patients receiving long-term synthetic cortisol or corticosteroids (e.g., prednisone) are at increased risk for steroid-induced osteopenia and fractures.
What vessel supplies blood to compact bone?
Periosteal vessel
During bone healing, where is a hard callus formed?
Periosteum
Which membranous structure consist of nerves, blood vessels, and lymphatics?
Periosteum
Which membranous structure of the bone provides nourishment and facilitates grow?
Periosteum
Which type of joint allows one bone to move around a central azis without displacement?
Pivot joint
Turning downward with palm facing the floor.
Pronation
Mandible facing forward.
Protraction.
What are some quality sources of calcium?
Quality sources of calcium include low-fat milk, yogurt, and cheese. Foods with added calcium such as orange juice, cereals, and bread are also beneficial.
Red bone marrow is responsible for producing what blood products?
RBC, WBC, platelets
How is the bone structure and function maintained?
Resorption and osteogenesis
Mandible facing upward and head pulling backwards.
Retraction
Which joint allows movement in two planes at right angles to each other?
Saddle joint
What are the contractile units of skeletal muscle?
Sarcomeres
What is osteoblasts function in bone formation?
Secrete bone matrix
What type of x-rays are used to monitor the progress of bone healing?
Serial x-rays
What is an example of a synarthrosis joint?
Skull
A muscle with greater-than-normal tone is described as ______.
Spastic
Bleeding into the injured tissue and local vasoconstriction occur, and a hematoma forms at the site of the fracture. Which stage?
Stage I
Cytokines are released, initiating the fracture healing processes by causing replicating cells known as fibroblasts to proliferate, which in turn causes angiogenesis to occur. WHich stage?
Stage I
Degranulated platelets and inflammatory cells release growth factor, which stimulates the generation of osteoclasts and osteoblasts. Which stage?
Stage I
Granulation tissue begins to form within the clot and becomes dense. Which stage?
Stage I
Fibroblasts and osteoblasts migrate into the fractured site and begin the reconstruction of bone.
Stage II
Fibroblasts and osteoblasts migrate into the fractured site and begin the reconstruction of bone. Which stage?
Stage II
Inflammatory phase occurs with the formation of granulation tissue. Which stage?
Stage II
Maximum girth by the end of the second or third week occurs. However, in iit is still not strong enough for weight bearing. Which stage?
Stage II
The fibroblasts produce a fibrocartilaginous soft callus bridge that connects the bone fragments. Which stage?
Stage II
he fibroblasts produce a fibrocartilaginous soft callus bridge that connects the bone fragments. Which stage?
Stage II
At this time, it is usually safe to remove a cast, if one is present. Which stage?
Stage III
During this stage, mature bone gradually replaces the fibrocartilaginous callus and the excess callus is gradually reabsorbed by the osteoclasts. Which stage?
Stage III
During this stage, the fracture site feels immovable and appears aligned on x-ray. At this time, it is usually safe to remove a cast, if one is present. Which stage?
Stage III
Reparative phase usually begins during the third or fourth week of fracture healing and continues until a firm bony union is formed. Which stage?
Stage III
Compact bone replaces spongy bone around the periphery of the fracture. Which stage?
Stage IV
Remodeling occurs as necrotic bone is removed by the osteoclasts. Which stage?
Stage IV
What part of the body consists of flat bones?
Sternum, ribs, skull, scapula,
Turning upward, with palm facing the ceiling.
Suprination
Immovable joints are known as?
Synarthrosis joint
Joints with fibrous tissue banding are known as _____?
Synarthrosis joints
The joint capsule is lined with what type of membrane?
Synovium
What membrane secretes synovial fluid into the joint capsule?
Synovium
What membrane secretes synovial fluid?
Synovium
How does testosterone help preserve men's bones?
Testosterone converts to estrogen in adipose tissue, providing an additional source of bone-preserving estrogen for aging men.
During bone healing, when does hematoma formation occur?
The first 1 to 2 days of the fracture.
In order for an immobile patient to regain pre-injured strength and functional ability, they need what type of exercising?
The healed muscle needs progressive exercising to resume its pre-injury strength and functional ability.
What is the bone matrix?
The intercellular substance of the bone that forms most of the mass of the bone.
What is the bone matrix made of?
The matrix consists of collagen and ground substances (glycoproteins and proteoglycans) that provide a framework for the deposits of inorganic mineral salt deposits like calcium, phosphorus, and hydroxyapatite.
A decrease in the size of a muscle is caused by what?
The replacement of inactive contractile muscle tissue with fibrotic tissue.
What muscle contraction describes isotonic contraction?
The shortening of the muscle without an increase in tension within the muscle.
What is rickets?
The softening and weakening of bones in children.
What factors influence the rate of fracture healing?
The type of bone fractured, the adequacy of blood supply, the condition of the fracture fragments, the immobility of the fracture site, and the age and general health of the person
How does a lack of physical activity affect the bone formation of people on bed rest or who have physical disabilities?
Those on prolonged bed rest or those with some physical disabilities have increased bone resorption from calcium loss, and their bones become osteopenic (reduced in terms of mass) and weak. Their weakened bones may fracture easily.
Adequate immobilization is essential until there is x-ray evidence of bone formation with ossification True or False
True
Despite a multitude of age-related musculoskeletal changes, the many effects of aging can be slowed if the body is kept healthy and active through positive lifestyle behaviors. True or False
True
Remodeling may take months to years, depending on the extent of bone modification needed, the function of the bone, and the functional stresses on the bone. True or false
True
How does vitamin D deficiency affect adult bones?
Vitamin D deficiency can lead to a loss of bone density, osteoporosis, and fractures.
What are indicators of peripheral motion dysfunction?
Weakness, Paralysis
What physical activities support osteogenesis?
Weight-bearing activity acts to stimulate bone formation and remodeling
What type of bone develops during the healing process?
cortical bone remodeling Immature bone develops from the endosteum. intensive regeneration of new osteons
A client with a musculoskeletal injury is instructed to make dietary alterations to facilitate calcium absorption. Which food item(s) should the nurse encourage the client to include in the diet?
fatty fish vitamin D-fortified milk eggs
A muscle that is limp and without tone is described as _____.
flaccid
Which bones are important sites of hematopoiesis and frequently protect vital organs?
flat bones,
Red bone marrow, located mainly in the sternum, ilium, vertebrae, and ribs in adults, is responsible for producing red blood cells, white blood cells, and platelets through a process called
hematopoiesis.
What type of bones contain red bone marrow?
ilium, sternum, scapula, vertebrae, and ribs,, clavicle, skull, and spine.
How can an immobile patient decrease the effects of immobility?
isometric exercise of the muscles of the immobilized part.
What muscle contraction involves no change in muscle tension, but the muscle length and joint angle both change?
isotonic contraction
Which layer of the bone provides for attachment of the tendons and ligaments?
periosteum
What factors help to balance resorption and osteogenesis?
physical activity, dietary intake of certain nutrients, especially calcium; and several hormones, including calcitriol (i.e., activated vitamin D), parathyroid hormone (PTH), calcitonin, thyroid hormone, cortisol, growth hormone, and the sex hormones estrogen and testosterone
What are examples of amphiarthrosis?
the vertebral joints and the symphysis pubis
Gout is a type of arthritis that occurs due to the accumulation of ____________ in the blood that causes needle-like crystals to form around the joints.
uric acid