Musculoskeletal MSIII

At a health fair, a woman, age 43, with a family history of osteoporosis asks the nurse how much calcium she should consume. The nurse tells her that the recommended daily calcium intake for premenopausal women is: 1. 250 to 500 mg. 2. 600 to 800 mg. 3. 1,000 to 1,200 mg. 4. 1,500 to 2,000 mg.

3. Most authorities recommend that premenopausal women consume 1,000 to 1,200 mg of calcium daily.

What are hallmark sign's of Rheumatoid Arthritis? 1. Heberden & Bouchard's sign 2. Kyphosis 3. Swan neck & Boutinere's sign 4. Lardosis

3. Rheumatoid Arthritis is an autoimmune disease that ^ the synnovial fluid of the joints; the smaller joints first and is symmetrical.

What are the interventions for soft tissue injury?

Rest Ice Compression Elevation

External fixation is used for what type of injuries?

open fractures with soft tissue damage

Is bone resorption INCREASED or DECREASED with aging?

increased

The abducens Nerve is what # and does what? How do you test it?

# 6, makes your eyes move side to side, test using cardinal fields of vision

Client is admitted for right total knee arthroplasty. Which of the following indicates understanding of preoperative teaching? 1. I will wear elastic stockings until I am discharged 2. I will ask for pain medicine when the pain gets unbearable 3. I have to use a machine for PROM 24 hrs a day 4. I cannot get out of bed for 2 weeks

1

The nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? 1. Assessing the extremity for neurovascular integrity 2. Keeping the client from sliding to the foot of the bed 3. Keeping the ropes over the center of the pulley 4. Ensuring that the weights hang free at all times

1. Although all measures are correct, assessing neurovascular integrity takes priority.

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative plan of care? 1. Elevating the stump for the first 24 hours 2. Maintaining the client on complete bed rest 3. Applying heat to the stump as the client desires 4. Removing the pressure dressing after the first 8 hours

1. Elevating the stump for the first 24 hours. Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity.

The nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize the risk of injury to the osteoarthritic client, the nurse should instruct the client to: 1. install safety devices in the home. 2. wear shoes that are worn to promote comfort. 3. get help when lifting objects. 4. wear protective devices when exercising.

1. Most accidents occur in the home, and safety devices are the most important element in minimizing the risk of injury.

A 69-year-old client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? 1. OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints. 2. OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints. 3. OA affects joints on both sides of the body. RA is usually unilateral. 4. OA is more common in women. RA is more common in men.

1. OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally.

What are priority actions, IN ORDER, for hypovolemic shock secondary to an open fracture?

1. Stabilize fracture/STOP BLEEDING 2. Initiate IV w/ 18 g needle 3. Pain management OR O2 if critical 4. Call DR for reduction

Sprain is an injury to: 1. Ligament 2. Tendon 3. Cartilage 4. muscle

1. ligament ex: ankle, wrist, knee

Two days after fracturing tibia pt returns to ER with reports from friends saying he is not acting like himself and seems confused. Nurse notes he has a long leg cast on and is disoriented to time and place. Vital signs reveal he is tachypneic and tachycardic. The nurse should assess for other signs of: Hypovolemic Shock Fat Emboli Syndrome Thrombophlebitis Bone Malalignment

2 - fat embolism usually occurs with long bones. Classic presentation is respiratory response with confusion. Rash may follow.

After sustaining injuries in a motor vehicle accident, a client spends 10 days recovering in the intensive care unit. His condition stabilizes and he's transferred to the orthopedic unit. Upon arrival at the unit, his vital signs are stable, his temperature is 100° F (37.8° C), and he has an indwelling urinary catheter in place. He is currently on bed rest and able to consume a regular diet. Which independent nursing action should the nurse include in this client's plan of care? 1. Request an order from the physician to discontinue the indwelling urinary catheter. 2. Encourage the client to increase his intake of fluids. 3. Check the client's medical record to see whether the physician prescribed antibiotics for the client. 4. Encourage the client to ambulate in the hallway twice a day.

2. Encouraging the client to increase his intake of fluids is an independent nursing action that the nurse can take to help reduce the client's fever, which might be caused by infection or dehydration.

A client undergoes cerebral angiography to evaluate for neurologic deficits. Afterward, the nurse checks frequently for signs and symptoms of complications associated with this procedure. Which findings indicate spasm or occlusion of a cerebral vessel by a clot? 1. Nausea, vomiting, and profuse sweating 2. Hemiplegia, seizures, and decreased level of consciousness (LOC) 3. Difficulty breathing or swallowing 4. Tachycardia, tachypnea, and hypotension

2. Spasm or occlusion of a cerebral vessel by a clot causes signs and symptoms similar to those of a stroke — hemiplegia, seizures, decreased LOC, aphasia, hemiparesis, and increased focal symptoms. Nausea, vomiting, and profuse sweating suggest a delayed reaction to the contrast material used in cerebral angiography. Difficulty breathing or swallowing may signal a hematoma in the neck. Tachycardia, tachypnea, and hypotension suggest internal hemorrhage.

A pt is 3 days postop from right total hip arthroplasty. The pt complains of pain. How would you know if the prosthesis has dislocated? 1. There is bulging in the hip area 2. The right leg has shortened 3. Adduction of the left leg 4. External rotation of the right leg

2. shortening of the affected leg and abnormal rotation will cause increased pain.

Which nursing diagnosis takes highest priority for a client with a compound fracture? 1. Imbalanced nutrition: Less than body requirements related to immobility 2. Impaired physical mobility related to trauma 3. Risk for infection related to effects of trauma 4. Activity intolerance related to weight-bearing limitations

3. Risk for infection related to trauma. A compound fracture involves an opening in the skin at the fracture site. Because the skin is the body's first line of defense against infection, any skin opening places the client at risk for infection.

After a motor vehicle accident, a client is admitted to the medical-surgical unit with a cervical collar in place. The cervical spinal X-rays haven't been read, so the nurse doesn't know whether the client has a cervical spinal injury. Until such an injury is ruled out, the nurse should restrict this client to which position? 1. Flat 2. Supine, with the head of the bed elevated 30 degrees 3. Flat, except for logrolling as needed 4. A head elevation of 90 degrees to prevent cerebral swelling

3. When caring for a client with a possible cervical spinal injury who's wearing a cervical collar, the nurse must keep the client flat to decrease mobilization and prevent further injury to the spinal column. The client can be logrolled, if necessary, with the cervical collar on.

Which would be appropriate for a patient having a scheduled arthrography? 1. NPO for 48 hrs 2. Assess patient for claustrophobia pre-procedure 3. Tell patient to rest joint & avoid strenuous activity for 12 hours post procedure 4. Tell patient he will feel immediate relief

3. arthrography is used to identify cause of joint pain and diagnose joint disease.

The nurse is teaching a client with a long leg cast how to use crutches properly while descending a staircase. The nurse should tell the client to: 1. advance both legs first. 2. advance the unaffected leg first. 3. advance the affected leg first. 4. advance both crutches first.

4. To walk down a flight of stairs, body weight is first transferred to the unaffected leg. Both crutches are then advanced to the stair below. Body weight is transferred to the crutches as the affected leg descends. The unaffected leg is then brought down to the next step so that both legs and crutches are all on the same step. The procedure is repeated for each step.

What kind of diet teaching is important for the patient with Gout?

Avoid foods high in purines (shellfish and organ meat) Avoid alcohol/lower consumption

What is the # 1 priority for dislocation/subluxation?

Immobilization/stabilization

____________ Union is when the length of time for healing of bones is taking longer than expected. The time frame for this is ___________ mos.

Mal Union 3 - 6 mos

_____ union is failure of bones to meet. This happens in a time frame of _______ months.

Non union > 9

Hydroxycloroquine is treatment for what disorder? What are 4 top nursing interventions when administering this medication?

Systemic Lupus Erethmytous 1. Contraindicated with liver disease (check liver enzymes) 2. Take with food 3. Get eye exams before administration (causes retinal detachment) 4. Usually administered in conjunction with corticosteroids