Musculoskeletal
What information does the nurse teach a women's group about osteoporosis?
"For 5 years after menopause you lose 2% of bone mass yearly"
A client has been prescribed denosumab (Prolia). What instruction about this drug is most appropriate?
"Make appointments to come get your shot"
A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What explanation by the nurse is best?
"Your feet have less blood flow, so healing is slower"
A client with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this client and family? (Select all that apply)
*Adherence to the antibiotic regimen *Eating high protein and high carbohydrate foods *Proper use of the intravenous equipment
A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply)
*Alcohol *Caffeine *Carbonated beverages *Vitamin D
A client with Paget's disease is hospitalized for an unrelated issue. The client reports pain and it is not yet time for more medication. What comfort measures can the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply)
*Applying a heating pad *Providing a massage
A client is admitted with a bone tumor. The nurse finds the client weak and lethargic with decreased deep tendon reflexes. What actions by the nurse are best? (Select all that apply)
*Assess the daily serum calcium level *Consult the provider about a loop diuretic *Instruct the client to call for help out of bed
The nurse studying osteoporosis learns that which drugs can cause this disorder? (Select all that apply)
*Barbiturates *Corticosteroids *Loop Diuretics
The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease? (Select all that apply)
*Draining sinus tracts *Presence of foot ulcers
A client is suspected to have muscular dystrophy. About what diagnostic testing does the nurse educate the client? (Select all that apply)
*Electromyography *Muscle Biopsy *Serum aldolase *Serum creatinine kinase
Earliest manifestations of fat embolism syndrome ?
*Hypoxemia *Dyspnea *Tachypnea
What are the 5 P's of acute compartment syndrome?
*Pain *Paralysis *Paresthesia *Pallor *Pulselessness
Who is at risk for ischemic necrosis in patients with musculoskeletal trauma? (Select all that apply)
*Patients on long term corticosteroid therapy *Patients undergoing surgical repair of fractures
A nurse is providing education to a community women's group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply)
*Strengthening exercises are important *Take recommenced calcium and vitamin D *Walk 30 minutes at least 3 times a week
What would you assess for in the residual limb after an amputation? (Select all that apply)
*circulation *healing *flexion contracture *infection
What can suggest the indication of infection in older adults?
Acute onset of confusion
A client with osteoporosis is going home, where the client lives alone. What action by the nurse is best?
Arrange a home safety evaluation
A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client admits to not doing the prescribed exercises. What action by the nurse is best?
Ask the client about fear of falling
A client is in the internal medicine clinic reporting bone pain. The client's alkaline phosphatase level is 180 units/L. What action by the nurse is most appropriate?
Assess the client for leg bowing
A client has scoliosis with a 65-degree curve to the spine. What action by the nurse takes priority?
Assess the client's cardiac and respiratory systems
A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the client's psychosocial needs?
Assess the client's coping skills and support systems
What is a complication of musculoskeletal trauma?
Avascular necrosis
What can increase the risk for a fracture in older adults?
Bone diseases
A patient arrives in the ED with a hip dislocation. What traction device will the nurse expect the patient to have?
Buck's traction
A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first?
Client taking raloxifene (Evista) who reports unilateral calf swelling
The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option?
Client with a spinal cord injury who cannot tolerate sitting up
A nurse is assessing an older client and discovers back pain with tenderness along T2 and T3. What action by the nurse is best?
Consult with the provider about an x-ray.
What would be a priority intervention for a patient with an open fracture?
Covering the fracture with sterile gauze
What is a fracture that has not healed within 6 months of injury?
Delayed union
A client in a nursing home refuses to take medications. She is at high risk for osteomalacia. What action by the nurse is best?
Ensure the client gets 15 minutes of sun exposure daily
A client is scheduled for a bone biopsy. What action by the nurse takes priority?
Ensuring that informed consent is on the chart
How do you wrap an amputation?
Figure 8 wrapping - wrap in a distal to proximal direction
What complication is seen in patients with amputation of the lower extremity?
Flexion contracture of the hip or knee
A client has a metastatic bone tumor. What action by the nurse takes priority?
Handle the affected extremity with caution
A hospitalized client is being treated for Ewing's sarcoma. What action by the nurse is most important?
Handling and disposing of chemotherapeutic agents per policy
Which medication can reduce phantom limb pain?
IV calcitonin
Medications used in the treatment of pain for amputations?
IV calcitonin, propranolol, pregabalin, gabapentin, baclofen
Which medication should NEVER be used in older adults due to it having toxic metabolites that can cause seizures and other complications?
Meperidine
A patient has been admitted to the ED with a complete fracture. What medication would you expect the physician to prescribe?
Morphine IV
The nurse enters a patient's room and the patient has a traction device applied. The nurse notices the weights resting on the floor. What is the first intervention the nurse will do?
Notify the Physician
A nurse notices purulent drainage and inflammation of a fracture site. What is the immediate action of the nurse?
Notify the provider
A client is admitted with a large draining wound on the leg. What action does the nurse take first?
Obtain cultures of the leg wound
What is a disadvantage of external fixation?
Pain site infection
What type of fracture occurs after minimal trauma to a bone that has been weakened by a disease?
Pathologic
An older client with diabetes is admitted with a heavily draining leg wound. The client's white blood cell count is 38,000/mm3 but the client is afebrile. What action does the nurse first take?
Place the client on contact isolation
A client has a bone density score of -2.8. What action by the nurse is best?
Planning to teach about bisphosphonates
A nurse is caring for four clients. After the hand-off report, which client does the nurse see first?
Post-microvascular bone transfer client whose distal leg is cool and pale
What is the primary nursing concern in every patient with any type of fracture?
Prevention of neuromuscular dysfunction
What is the nurses initial action when a patient is reporting phantom limb pain?
Recognize that the pain is real and should be managed promptly and completely
Acute compartment syndrome (ACS)
Serious condition in which increased pressure within one or more compartments reduces circulation to the area
What is lontophoresis?
Skin absorbs dexamethasone near the painful area to decrease inflammation and edema and a small device delivers an amount of electricity through electrodes placed on the skin
A patient has been given a wet plaster cast. When moving the patient, the nurse would expect to do what?
Use the palms of the hands
A client has an ingrown toenail. About what self-management measure does the nurse teach the client?
Warm, moist soaks
Why is bleeding a risk with bone injury?
bone is very vascular; total blood flow between 200-400mL/min
Realignment of the bone ends for proper healing is called?
bone reduction
What is the most common treatment for a distal radius fracture?
closed reduction
The lower leg and forearm are the most common areas for patients with ?
compartment syndrome
What type of fracture is produced by a loading force applied to the long axis of cancellous bone?
compression
What type of fracture results from excessive strain and stress on the bone?
fatigue
You would assess vital signs, skin color, and LOC in a patient with a suspected pelvic fracture to indicate possible..?
hypovolemic shock
Warm spots on casts can indicate which condition?
infection
What position would you place the patient with a fracture in to prevent shock?
supination and keeping them warm
What is the primary cause of a fracture?
trauma from a motor vehicle collision or fall
