Ortho D/O Part1
A client describes a foul odor from his cast. Which of the following responses or interventions would be the most appropriate? A. Assess further because this may be a sign of infection. B. Teach him proper cast care, including hygiene measures. C. This is normal, especially when a cast is in place for a few weeks. D. Assess further because this may be a sign of neurovascular compromise
A A foul odor from a cast may be a sign of infection. The nurse needs to assess for fever, malaise, and possibly, an elevation in white blood cells. Odor from a cast is never normal, and it isn't a sign of neurovascular compromise, which would include decreased pulses, coolness, and paresthesia
A 20-year-old client developed osteomyelitis 2 weeks after a fishhook was removed from his foot. Which of the following rationales best explains the expected long-term antibiotic therapy needed? * A. Bone has poor circulation. B. Tissue trauma requires antibiotics. C. Feet are normally more difficult to treat. D. Fishhook injuries are highly contaminated.
A Bone has very poor blood circulation, making it difficult to treat an infection in the bone. This requires a long-term use of IV antibiotics to make sure the infection is cleared. Tissue trauma doesn't always require antibiotics, at least not long term. Feet aren't more difficult to treat than other parts of the body unless the client has a circulatory problem or diabetes mellitus. Fishhooks may not be any more contaminated than another instrument that caused an injury.
Which patients below are at risk for developing osteoarthritis? Select-all-that-apply:* A. A 65 year old male with a BMI of 35. B. A 59 year old female with a history of taking long term doses of corticosteroids. C. A 55 year old male with a history of repeated right knee injuries. D. A 60 year old female with high uric acid levels.
A and C. The risk factors for developing OA include: older age, being overweight (BMI >25), repeated injuries to the weight bearing joints, genetics. Option B is at risk for osteoporosis, and option D is at risk for gout.
A patient with osteoarthritis is describing their signs and symptoms. Which signs and symptoms below are NOT associated with osteoarthritis? Select-all-that-apply:* A. Morning stiffness greater than 30 minutes B. Experiencing grating during joint movement C. Fever and Anemia D. Symmetrical joint involvement E. Pain and stiffness tends to be worst at the end of the day
A, C, D. These options are signs and symptoms found with rheumatoid arthritis NOT osteoarthritis. In OA: morning stiffness is LESS than 30 minutes, it is NOT systemic as RA (so fever and anemia will not be present), and it is asymmetrical (both joints are not involved). Pain and stiffness will actually be worst at the end of the day compared to the beginning due to overuse of the joints.
A physician suspects a patient may have rheumatoid arthritis due to the patient's presenting symptoms. What diagnostic testing can be ordered to help a physician diagnose rheumatoid arthritis? Select all that apply:* A. Rheumatoid factor B. Uric acid level C. Erythrocyte sedimentation D. Dexa-Scan E. X-ray imaging
A, C, and E. These are diagnostic tests to help diagnose RA. Option B is used in gout, and option D is used with osteoporosis.
For a client diagnosed with Ewing's sarcoma, which test is most useful in determining the extent of metastasis? * A. Bone scan B. Computerized tomography (CT) scan C. Magnetic resonance imaging (MRI) D. Positron emission tomography (PET)
A. A bone scan views the entire skeletal structure, indicating areas of possible metastases. CT scan, MRI, and PET scan visualize only one body area at a time.
A patient with rheumatoid arthritis is experiencing sudden vision changes. Which medication found in the patient's medication list can cause retinal damage?* A. Hydroxychloroquine (Plaquenil) B. Lefluomide (Arava) C. Sulfasalazine (Azulfidine) D. Methylprednisolone (Medrol)
A. This medication is a DMARD and can cause retinal damage. Therefore, the patient should be monitored for vision changes.
Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is classified as: * A. sarcoma. B. lymphoma. C. carcinoma. D. melanoma.
A. Tumors that originate from bone, muscle, and other connective tissue are called sarcomas.
Which of the following nursing interventions is appropriate for a client in traction? * A. Assess the pin sites every shift and as needed. B. Add and remove weights as the client wants. C. Make sure the knots in the rope catch on the pulley. D. Give range of motion to all joints, including those immediately proximal and distal to the fracture, every shift.
A. Nursing care for a client in traction include assessing pin sites every shift and as needed and making sure the knots in the rope don't catch on the pulley. Add and remove weights as the physician orders, and give range of motion to all joints except those immediately proximal and distal to the fracture every shift.
A 63 year old patient has severe osteoarthritis in the right knee. The patient is scheduled for a knee osteotomy. You are providing pre-op teaching about this procedure to the patient. Which statement made by the patient is correct about this procedure?*A. "This procedure will realign the knee and help decrease the amount of weight experienced on my right knee."B. "A knee osteotomy is also called a total knee replacement."C. "A knee osteotomy is commonly performed for patients who have osteoarthritis in both knees."D. "This procedure will realign the unaffected knee and help alleviate the amount of weight experienced on the right knee."
A. A knee osteotomy is NOT known as a total knee replacement. A knee osteotomy can be used as an alternative for a total knee replacement but is not the same thing. In addition, a knee osteotomy is performed when there is OA on only one side of the knee.
Which of the following diagnostic tests confirms Paget's disease? * A.X-ray B.Bone scan C.Bone biopsy D.Serum alkaline phosphate
Answer: A. X-ray X- rays confirm the diagnosis of Paget's disease. Local areas of demineralization and bone overgrowth produce characteristic mosaic patterns and irregularities. Bone scans demonstrate the extent of the disease. Bone biopsy may aid in the differential diagnosis. Elevated serum alkaline phosphatase concentration reflects increased osteoblastic activity.
Which of the following medications used in Paget's disease which facilitates remodeling of abnormal bone? * A.Plicamycin B.Calcitonin C.Dexamethasone D.Atropine sulfate
Answer: B. CalcitoninCalcitonin, a polypeptide hormone, retards bone resorption by decreasing the number and availability of osteoclasts. Calcitonin therapy facilitates remodeling of abnormal bone into normal lamellar bone, relieves bone pain, and helps alleviate neurologic and biochemical signs and symptoms.
The nurse knows that a 60-year-old female client's susceptibility to osteoporosis is most likely related to: * A. Lack of exercise B. Hormonal disturbances C. Lack of calcium D. Genetic predisposition
Answer: B. Hormonal disturbances After menopause, women lack hormones necessary to absorb and utilize calcium. Options A and C: Doing weight-bearing exercises and taking calcium supplements can help to prevent osteoporosis but are not causes. Option D: Body types that frequently experience osteoporosis are thin Caucasian females, but they are not most likely related to osteoporosis.
A client with gout is encouraged to increase fluid intake. Which of the following statements best explains why increased fluids are encouraged for gout? * A.Fluids decrease inflammation. B.Fluids increase calcium absorption. C.Fluids promote the excretion of uric acid. D.Fluids provide a cushion for weakened bones
Answer: C. Fluids promote the excretion of uric acid. With gout, fluids promote the excretion of uric acid. Fluids don't decrease inflammation, increase calcium absorption, or provide a cushion for weakened bones.
Pathophysiologic changes seen with osteoarthritis include: * A. Joint cartilage degeneration. B. The formation of bony spurs at the edges of the joint surfaces. C. Narrowing of the joint space. D. All of the above.
Answer: C. Narrowing of the joint space. Narrowing of the joint space can be seen through x-ray in a patient with osteoarthritis. A: There is joint cartilage degradation in osteoarthritis. B: There is no formation of bony spurs at the edges of the joint surfaces. D: There is only one correct answer, and that is C.
Alendronate (Fosamax) is given to a client with osteoporosis. The nurse advises the client to? * A. Take the medication in the morning with meals. B. Take the medication 2 hours before bedtime. C. Take the medication with a glass of water after rising in the morning. D. Take the medication during lunch.
Answer: C. Take the medication with a glass of water after rising in the morning. Alendronate needs to be taken with a glass of water after rising in the morning in order to prevent gastrointestinal effects.
A client has been prescribed a diet that limits purine-rich foods. Which of the following foods would the nurse teach him to avoid eating? * A.Bananas and dried fruits B.Milk, ice cream, and yogurt C.Wine, cheese, preserved fruits, meats, and vegetables D.Anchovies, sardines, kidneys, sweetbreads, and lentils
Answer: D. Anchovies, sardines, kidneys, sweetbreads, and lentils Anchovies, sardines, kidneys, sweetbreads, and lentils are high in purines. Bananas and dried fruits are high in potassium. Milk, ice cream, and yogurt are rich in calcium. Wine, cheese, preserved fruits, meats, and vegetables contain tyramine.
Which of the following dietary management is recommended to patient with osteomalacia associated with diet? * A.Adequate calcium and low protein intake B.Adequate protein and moderate vitamin intake C.Restrict calcium and vitamin D intake D.Increase calcium and vitamin D intake
Answer: D. Increase calcium and vitamin D intake If osteomalacia is dietary in origin, a diet with adequate protein and increased calcium and vitamin D is provided. The patient is instructed about dietary sources of calcium and vitamin D (fortified milk and cereals, eggs, chicken livers).
Which of the following areas would be included in a neurovascular assessment? * Orientation, movement, pulses, warmth Capillary refill, movement, pulses, warmth Orientation, pupillary response, temperature, pulses Respiratory pattern, orientation, pulses, temperature
B A correct neurovascular assessment should include capillary refill, movement, pulses, and warmth. Neurovascular assessment involves nerve and blood supply to an area. Respiratory pattern, orientation, temperature, and pupillary response aren't part of a neurovascular examination
The most common symptoms of osteomalacia are * A.Bone fractures and kyphosis B.Bone pain and tenderness C.Muscle weakness and spasm D.Softened and compressed vertebrae
B Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. As a result of faulty mineralization, there is softening and weakening of the skeleton, causing pain, tenderness to touch, bowing of the bones, and pathologic fractures.
You receive your patient back from radiology. The patient had an x-ray of the hips and knees for the evaluation of possible osteoarthritis. What findings would appear on the x-ray if osteoarthritis was present? Select-all-that-apply:* A. Increased joint space B. Osteophytes C. Sclerosis of the bone D. Abnormal sites of hyaline cartilage
B and C. The joint space would be DECREASED not increased in OA. In addition, an x-ray cannot show hyaline cartilage...therefore, the cartilage cannot be assessed on an x-ray. The radiologist would be looking for osteophytes (bone spurs), sclerosis of the bone (abnormal hardening of the bones), and decreased joint space.
A patient with osteoarthritis has finished their first physical therapy session. As the nurse you want to evaluate the patient's understanding of the type of exercises they should be performing regularly at home as self-management. Select all the appropriate types of exercise stated by the patient:* A. Jogging B. Water aerobics C. Weight Lifting D. Tennis E. Walking
B, C, E. The patient wants to perform exercises that are low impact like: walking, water aerobics, stationary bike riding along with strengthen training (lifting weights: helps strengthen muscles around the joint), ROM: improves the mobility of the joint and decreases stiffness. It is important patients with OA avoid high impact exercises that will increase stress on weight bearing joints such as running/jogging, jump rope, tennis, or any type of exercise with both feet off the ground.
During a head-to-toe assessment of a patient with osteoarthritis, you note bony outgrowths on the distal interphalangeal joints. You document these findings as:* A. Bouchard's Nodes B. Heberden's Nodes C. Neurofibromatosis D. Dermatofibromas
B. Bony outgrowths found on the DISTAL interphalangeal joint (closest to the fingernail and furthest away from the body) is called Heberden's Node. If the bony outgrowth was found on the PROXIMAL interphalangeal joint (middle joint of the finger...closest to the body) it is called Bouchard's Node.
You're providing care to a patient with severe rheumatoid arthritis. While performing the head-to-toe nursing assessment, you note the patient's overall skin color to be pale and the patient looks exhausted. You ask the patient how she is feeling, and she says "I'm so tired. I can't even get out of this bed without getting short of breath." Which finding on the patient's morning lab work may confirm a complication that can be experienced with rheumatoid arthritis? A. Potassium 3.2 mEq/L B. Hemoglobin 7 g/dL C. Sodium 135 mEq/L D. WBC count 6,500
B. Patients with RA can experience anemia. A hemoglobin level can be helpful in diagnosing anemia (a normal level in females is 12 to 15.5 g/dL). The patient's signs and symptoms above are classic findings in anemia.
Which of the following interventions is appropriate immediately after a patient is suspected with joint dislocation? * A. Provide range of motion exercises immediately. B. Immobilize the joint and maintain in a stable position. C. Place the affected extremity above the level of the heart. D. Prepare the patient for traction as the treatment of choice.
B. The affected joint needs to be immobilized at the scene and during transport to the hospital. The dislocation is promptly reduced and displaced parts are placed back in proper anatomic position. Use of analgesia, muscle relaxants, and possibly anesthesia. The joint is immobilized by splints, casts, or traction and is maintained in a stable position. Neurovascular status is assessed at a minimum of every 15 minutes until stable. After reduction, if the joint is stable, gentle, progressive, active and passive movement is begun
Management for a patient with sprain includes RICE. Which of the following is the correct meaning of RICE? * A. Rise, Ice, Compression, and Elevation B. Rest, Ice, Compression, and Elevation C. Rinse, Immobilize, Cast, and Elevation D. Rest, Immobilize, Compression, and Elevation
B. Treatment of contusions, strains, and sprains consists of resting and elevating the affected part, applying cold, and using a compression bandage. (The acronym RICE—rest, ice, compression, elevation—is helpful for remembering treatment interventions.)
Which of the following serious complications can occur with long bone fractures? * A. Bone emboli B. Fat emboli C. Platelet emboli D. Serous emboli
B. A serious complication of a long bone fractures is the development of fat emboli. Bone or platelet emboli are rare occurrences. There aren't emboli known as serous emboli.
Which of the following symptoms is an early sign of compartment syndrome? * A. Heat B. Paresthesia C. Skin pallor D. Swelling
B. Paresthesia is the earliest sing of compartment syndrome. Pain, heat, and swelling are also signs but occur after paresthesia. Skin pallor isn't a sign of compartment syndrome.
A client with osteoarthritis has a prescription for Celebrex (celecoxib). Which instruction should be included in the discharge teaching? * A. Take the medication with milk. B. Report chest pain. C. Remain upright after taking for 30 minutes. D. Allow 6 weeks for optimal effects.
B. Report chest pain. Cox II inhibitors have been associated with heart attacks and strokes. Any changes in cardiac status or signs of a stroke should be reported immediately, along with any changes in bowel or bladder habits because bleeding has been linked to use of Cox II inhibitors. Options A, C, and D: The client does not have to take the medication with milk, remain upright, or allow 6 weeks for optimal effect.
Which of the following discharge instructions should be given to a client after surgery for repair of a hip fracture? * A. "Don't flex the hip more than 30 degrees, don't cross your legs, get help putting on your shoes." B. "Don't flex the hip more than 60 degrees, don't cross your legs, get help putting on your shoes." C. "Don't flex the hip more than 90 degrees, don't cross your legs, get help putting on your shoes." D. "Don't flex the hip more than 120 degrees, don't cross your legs, get help putting on your shoes."
C Discharge instructions should include not flexing the hip more than 90 degrees, don't cross your legs, get help putting on your shoes. These restrictions prevent dislocation of the new prosthesis.
Treatment of compartment syndrome includes which of the following measures? * A. Amputation B. Casting C. Fasciotomy D. Observation, no treatment is necessary
C Treatment of compartment syndrome includes fasciotomy, which involves cutting the fascia over the affected area to permit muscle expansion. Amputation and casting aren't treatments for compartment syndrome
Which of the following is the primary treatment of septic arthritis? * A. Aspiration of joint fluid B. Arthrotomy C. Antibiotics D. Arthroscopy
C. Broad-spectrum IV antibiotics are started promptly and then changed to organism-specific antibiotics after culture results are available. The IV antibiotics are continued until symptoms resolve. The synovial fluid is aspirated and analyzed periodically for sterility and decrease in WBCs. In addition to prescribing antibiotics, the physician may aspirate the joint with a needle to remove excessive joint fluid, exudate, and debris. This promotes comfort and de- creases joint destruction caused by the action of proteolytic enzymes in the purulent fluid. Occasionally, arthrotomy or arthroscopy is used to drain the joint and remove dead tissues
A client has above-the-knee amputation 4 days after a traumatic injury. Which nursing diagnosis is most appropriate? * A. Risk for impaired skin integrity related to decreased peripheral circulation B. Impaired gas exchange: Fat embolism related to surgical removal of bone and tissue C. Acute pain: Phantom limb pain related to surgical removal of leg after traumatic injury D. Decreased cardiac output: Shock related to decreased fluid volume
C. Phantom limb pain is common after limb amputation and may be more severe with traumatic injury. Because the limb was severed traumatically rather than removed because of poor circulation, peripheral circulation should be adequate. Fat embolism is more typical with long bone fractures. The risk of shock is relatively low on the 4th postoperative day.
A patient newly diagnosed with osteoarthritis asks about the medication treatments for their condition. Which medication is NOT typically prescribed for OA?* A. NSAIDs B. Topical Creams C. Oral corticosteroids D. Acetaminophen (Tylenol)
C. Intra-articular corticosteroids (an injection in the joint) are commonly prescribed rather than oral corticosteroids. Remember OA in within the joint...not systemic so oral corticosteroids are not as effective. All the other medications listed are prescribed in OA. 8. You receive your patient back from radiology. The patient had an x-ray of the hips and knees for the evaluation of possible osteoarthritis. What findings would appear on the x-ray if osteoarthritis was present? Select-all-that-apply:
Vitamin D is important in the healing of fractures for which of the following reasons? * A. It reduces the excretion of calcium and phosphorus. B. It increases the excretion of calcium and phosphorus. C. It reduces the absorption and use of calcium and phosphorus. D. It increases the absorption and use of calcium and phosphorus.
D Vitamin D increases the absorption and use of calcium and phosphorus. It doesn't reduce the absorption or affect the excretion of calcium and phosphorus
A client is put in traction before surgery. Which of the following reasons for the traction is correct? * A. Prevents skin breakdown B. Aids in turning the client C. Helps the client become active D. Prevents trauma and overcomes muscle spasms
D Traction prevents trauma and overcomes muscle spasms. Traction doesn't prevent skin breakdown, help n turning the client, nor help the client become active.
At the scene of an accident, which of the following interventions applies to a client with a suspected fracture? * A. Don't move the client. B. Move the client to safety immediately. C. Sit the client up to facilitate his airway. D. Immobilize the extremity, and move the client to safety.
D. At the scene of an accident, a client with a suspected fracture should have the extremity immobilized and be moved to safety. If the client is in safe place, don't try to move him. Never try to sit the client up, this could make the fracture worst.
Nursing interventions to treat a musculoskeletal injury may include cold or heat therapy. Cold therapy decreases pain by which of the following actions? * A. Promotes analgesia and circulation B. Numbs the nerves and dilates the vessels C. Promotes circulation and reduces muscle spasms D. Causes local vasoconstriction and prevents edema or muscle spasm
D. Cold causes the blood vessels to constrict, which reduces the leakage of fluid into the tissues and prevents swelling and muscle spasms. Cold therapy may reduce pain by numbing the nerves and tissues. Heat therapy promotes circulation, enhances flexibility, reduces muscle spasms, and also provides analgesia.
Which of the following symptoms are considered signs of a fracture? * A. Tingling, coolness, loss of pulses B. Loss of sensation, redness, coolness C. Coolness, redness, new site of pain D. Redness, warmth, pain at the site of injury
D. Signs of fracture may include redness, warmth, numbness or loss of sensation, and new site of pain. Coolness, tingling, and loss of pulses are signs of a vascular problem.
Osteomyelitis most commonly results from which of the following mechanisms? * A. Immune suppression B. IV drug use C. Surgery D. Trauma
D. Trauma is the most common event causing osteomyelitis. Individuals who are immunosuppressed may be at greater risk for osteomyelitis, but immunosuppression isn't a cause of osteomyelitis. IV drug use is more commonly associated with endocarditis. Surgery isn't likely to be a cause.
A client who has an above-the-knee amputation is to use crutches until the prosthesis is properly fitted. When teaching the client about using the crutches, the nurse instructs the client to support her weight primarily on which of the following body areas? * A. Axillae B. Elbows C. Upper arms D. Hands
D. When using crutches, the client is taught to support her weight primarily on the hands. Supporting body weight on the axillae, elbows, or upper arms must be avoided to prevent nerve damage from excessive pressure.
After a hip replacement, which of the following activity level is usually ordered? * A. Bed rest B. No restrictions C. No weight bearing D. Limited weight bearing
D. After a hip replacement, the client's activity is usually ordered as limited weight bearing. The client is allowed to move with restrictions for approximately 2 to 3 months. The hip shouldn't be flexed more than 90 degrees. Abduction past the midline of the body is prohibited. Progressive weight bearing reduces the complications of immobility.
Osteoarthritis develops due to the deterioration of the synovium within the joint that can lead to complete bone fusion.* True False
FALSE: Osteoarthritis is the most common type of arthritis that develops due to the deterioration of the HYALINE CARTILAGE (not synovium) of the bone. This can lead to bone break down, sclerosis of the bone, and osteophytes formation (bone spurs).
To reduce the roughness of a cast, which of the following measures should be used? * Petal the edges. Elevate the limb. Break off the rough area. Distribute pressure evenly.
Petal the edges To reduce the roughness of the cast, petal the edges. Elevating the limb will prevent swelling. Never break a rough area off the cast. Distributing pressure evenly will prevent pressure ulcers.
A patient newly diagnosed with osteoarthritis asks about the medication treatments for their condition. Which medication is NOT typically prescribed for OA?* A. NSAIDs B. Topical Creams C. Oral corticosteroids D. Acetaminophen (Tylenol)
The answer is C. Intra-articular corticosteroids (an injection in the joint) are commonly prescribed rather than oral corticosteroids. Remember OA in within the joint...not systemic so oral corticosteroids are not as effective. All the other medications listed are prescribed in OA.
Which of the following weight is commonly applied to an extremity for Buck's traction in and adult? * 1 to 2 lb 1 to 5 lb 5 to 7 lb 8 to 10 lb
The common weight used for Buck's traction in an adult is 5 to 7 lb.
A client is admitted to the emergency department with a foot fracture. Which of the following reasons explains why the foot is placed in a brace? * To act as a splint To prevent infection To allow for movement To encourage direct contact
The purpose of the brace is to act as a splint, maintain immobility, and prevent direct contact. A brace doesn't prevent infection
