Patho CH 35 Dynamic Study Module Acute Musculoskeletal Disorders
The nurse is caring for a patient with osteomyelitis. Which laboratory value should the nurse expect to be increased? Troponin Platelet count White blood cell count Lipase
White blood cell count The white blood cell count will increase as a result of the acute infection. Lipase will not increase as a result of the infection because it is a pancreatic enzyme that increases with inflammation of the pancreas. Increased troponin is found in myocardial infarction. Platelet count would likely not be increased as a result of infection.
The nurse is teaching a group of student athletes about soft tissue injuries and the difference between a strain and a sprain. Which statement by a student indicates that the teaching was effective? "A strain is an injury to a muscle-tendon, and a sprain is an injury to the ligaments around the joint." "A strain only occurs in the back; and all other soft tissue injuries are sprains." "Bursitis is the most common injury and often results in strain in the joint." "Nerve entrapment is a common injury in athletes, and it causes a sprain in the affected tissue."
"A strain is an injury to a muscle-tendon, and a sprain is an injury to the ligaments around the joint." A strain is an injury to a muscle-tendon unit, and a sprain is an injury to the ligaments that support the joint. A strain may occur in any muscle-tendon unit, not just in the back. Bursitis is caused by overuse and inflammation; it does not generally require surgical intervention unless other treatment fails. Nerve entrapment is not a common type of acute injury experienced by athletes.
A patient being treated for a torn anterior cruciate ligament (ACL) asks what caused the injury. With which statement should the nurse respond to this patient? "The ligament is inflamed." "The patella of the knee dislocated, causing the ligament to stretch." "A tear occurred in the ligament." "Bone spurs are around the ligament."
"A tear occurred in the ligament." The cause of an ACL injury is a tear in the ligament. Inflammation is bursitis in the joint, not the ligament. The ACL is not connected to the patella but directly to the femur. Bone spurs affect the bone, not the ligament.
The nurse is teaching colleagues about benign bone tumors. Which statement by a colleague indicates that the teaching was effective? "Benign bone tumors are most common in children and young adults up to the age of 30." "Benign bone tumors are found in multiple bones." "Benign bone tumors require radiation therapy." "Benign bone tumors can invade cartilage and surrounding tissues."
"Benign bone tumors are most common in children and young adults up to the age of 30." Benign bone tumors are common in children and young adults up to the age of 30. Malignant tumors invade cartilage and surrounding tissues, affect multiple bones, and require radiation therapy.
A patient with a comminuted fracture asks why surgery is required. Which response by the nurse is accurate? "If surgery isn't done, the limb might need to be amputated later." "Surgery is only required when there's a risk for neurologic damage in the affected limb." "Surgery will prevent osteomyelitis, which is an infection of the bone." "Surgery is required to stabilize the area around the fracture."
"Surgery is required to stabilize the area around the fracture." Surgery is a direct method of bone healing and is required for comminuted fractures to facilitate bone healing and restore vascularity. Surgery is not performed to decrease the risk of amputation. Surgical procedures increase, not decrease, the risk of osteomyelitis. Surgery is not performed only when there is a concern of neurologic damage; it is intended to promote bone healing. Illustration of external fixation in lower leg. Pins are placed through the bone above and below the fracture site to immobilize the bone. External fixation rods hold the pins in place. A. Fixation of a short oblique fracture with a plate and screws above and below the fracture. B. Fixation of a long oblique fracture with screws through the fracture site. C. Fixation of a segmental fracture with a medullary nail.
A patient is diagnosed with a comminuted fracture. Which phrase should the nurse use to explain this type of fracture? "The bone is broken into fragments." "The fracture is perpendicular to the bone shaft." "The bone has broken through the skin." "The bones are out of correct alignment."
"The bone is broken into fragments." In a comminuted fracture, the bone is broken into many pieces; these bone fragments may cause further injury or complications. In an open fracture, the bone has broken through the skin. A transverse fracture is perpendicular to the bone shaft. In a displaced fracture, the bones are out of alignment with each other. Fractures in children are common as a result of their decreased bone density and are usually the result of trauma. However, it would be important to consider the type of fracture and reported circumstances because of the possibility of child abuse. In the older adult population, fractures may be a result of a fall or osteoporosis. The bones most often broken in the older adult population are the humerus, wrist, and hip.
The nurse is teaching a patient about the risk of fat embolism after a fracture. Which statement indicates that the teaching has been effective? "The risk of fat embolism is increased only in pediatric patients with fractures." "The risk of fat embolism is increased in patients with diabetes mellitus." "The risk of fat embolism is increased in patients who are morbidly obese." "The risk of fat embolism is increased in fractures of long bones or the pelvis."
"The risk of fat embolism is increased in fractures of long bones or the pelvis." Fat embolism is most commonly found in patients with fractures of the pelvis or long bones. The development of fat embolism is not related to morbid obesity or diabetes mellitus. Fat embolism may occur in patients of any age, not just in pediatric patients.
The nurse reviews anterior cruciate ligament (ACL) injuries with a group of new nurses. Which statement by a new nurse indicates that teaching has been effective? "Women are at greater risk for ACL injury than men." "ACL injuries are a result of a crushing injury of the knee." "ACL injuries only happen in athletes." "ACL injuries are more common in adolescents."
"Women are at greater risk for ACL injury than men." Women are at greater risk than men for ACL injury. ACL injuries may happen in anyone and at any age, and are often the result of activities that include running, twisting, or jumping. ACL injuries are usually not related to crush injuries to the knee. Treatment of an ACL injury includes the following: Ice Elevating the extremity Oral pain medication Non-weight bearing until the swelling subsides Physical therapy to improve joint mobility and muscle tone Surgery (may be required)
The nurse is visiting a school-aged patient at home who had an arm cast applied 24 hours ago. The patient is experiencing limited mobility, severe pain, pallor, numbness, and tingling of the fingertips. Which immediate action should the nurse take for this patient? Administer prescribed opioids to reduce pain. Elevate the arm to increase the circulation to the limb. Reassure that these are normal findings 1 day after cast application. Access immediate emergency care.
Access immediate emergency care. Pallor, numbness, and tingling in the fingertips, severe pain, and loss of movement are signs of compartment syndrome. This must be addressed immediately, or the limb could be lost. This is not a normal finding after application of a cast. This is a medical emergency, not something that can wait to be seen. These are not signs of mild edema, which can be addressed by raising the arm; these are serious symptoms.
During a soccer game, a patient experienced a popping sensation in one knee and then fell to the ground. Which kind of injury should the nurse suspect this patient has experienced? Bursitis Tibial fracture Anterior cruciate ligament (ACL) tear Osteochondral lesion
Anterior cruciate ligament (ACL) tear The popping and instability of the knee are consistent with an ACL tear. Bursitis is an inflammation of the joint but would not cause instability of the joint. An osteochondral lesion would cause locking of the knee joint. A tibial fracture would impair mobility but would not affect the stability of the joint.
The nurse is caring for a patient with a sprained ankle. Which intervention should the nurse include in this patient's plan of care? Apply traction. No treatment is required. Apply heat. Apply ice.
Apply ice. At one point in time, the patient would be encouraged to rest, ice, compress, and elevate (RICE) the affected limb. However, the British Journal of Sports Medicine suggested replacing RICE with with POLICE: protection, optimal loading, ice, compression, and elevation. Heat is contraindicated. Application of traction is used in the treatment of fractures. The patient should have some sort of treatment for the sprain.
A patient with a fractured pelvis and femur is experiencing pain and swelling inconsistent with assessment and x-ray findings. For which medical emergency should the nurse quickly assess the patient? Nerve entrapment Fat embolism syndrome Fracture blistering Compartment syndrome
Compartment syndrome Pain and swelling that are not proportionate to the findings of the x-ray are consistent with compartment syndrome and could indicate a more serious injury such as a crush injury. Blistering of the skin occurs in some cases of fracture. Fat embolism syndrome may be common in pelvic injuries but manifests as respiratory distress and hypoxia. Nerve entrapment is seen mostly in carpal tunnel syndrome, in which nerves are compressed, resulting in numbness and tingling.
Which type of fracture may be treated with closed reduction? Segmental Long oblique Complete Comminuted
Complete A complete fracture may be treated with closed reduction, typically in the form of traction or a cast. A comminuted, segmental, or long oblique fracture often requires open reduction involving pins or nails.
An older patient experiences a broken hip. Which risk factor should the nurse suspect as contributing to fracture? Report of abuse Supplemental intake of vitamin D Diagnosis of osteoporosis Participation in sport activity
Diagnosis of osteoporosis Older adults are at risk for fracture due to disease like osteoporosis. Children are at risk of fracture related to sports and cases of abuse. Vitamin D supplementation helps to prevent the risk of bone fracture.
Which early symptoms should the nurse expect to assess in a patient with a fat embolism? Redness and warmth at the site of injury Blistering of the skin Confusion and stupor Dyspnea and tachypnea
Dyspnea and tachypnea Respiratory symptoms such as dyspnea, tachypnea, and hypoxia are often the first indications of fat embolism. Blistering of the skin occurs with some fractures. Redness and warmth at the site of injury could indicate osteomyelitis. Confusion and stupor are late signs of a fat embolism. Other manifestations of fat embolism include the following: Confusion Restlessness Seizures Coma Petechiae rash over the upper body Sudden loss of vision
A patient with a complete fracture is scheduled for a closed reduction. Which information should the nurse include to explain this treatment approach? Placement of a medullary nail External repositioning of the fracture Placement of pins in the bone Placement of a plate and screws
External repositioning of the fracture Closed reduction is the external alignment of a fractured bone. Pins, medullary nails, and plates and screws are used in open reduction. Traction is the application of a pulling force to maintain bone alignment during fracture healing. Different fractures require different types of traction. This image depicts the types of traction used during closed reduction. A. Skin traction applies force to the soft tissues by means of a pulley system attached to the bed, such as Buck traction, shown here for stabilization of the knee and hip. B. If skeletal traction applies, force is applied directly to the bone
A patient with a fractured pelvis begins experiencing shortness of breath. Which complication should the nurse suspect this patient is experiencing? Osteomyelitis Fat embolism Compartment syndrome Fracture blisters
Fat embolism Respiratory symptoms such as dyspnea, tachypnea, and hypoxia are often the first symptoms of fat embolism. Blisters may be seen on the skin 24-48 hours after a fracture but do not cause shortness of breath. Osteomyelitis is an infection of the bone, which does not cause shortness of breath. Compartment syndrome does not result in shortness of breath.
The nurse is caring for a patient with a fracture. Illustration of type of fracture of the arm in which bone fragments are still paritally joined. Which type of fracture is shown in the above image? Open Greenstick Spiral Comminuted
Greenstick The image shows a greenstick fracture, a fracture in which bone fragments are still partially joined. In a comminuted fracture, there are many bone fragments. In an open fracture, the bone protrudes through the skin. A fracture that appears to twist around the bone is a spiral fracture.
An adolescent woman sustained a comminuted fracture during a sleepover at a friend's house. For which risk factor should the nurse assess the patient's weight and body mass index? Inadequate nutrition Physical ability Weight-bearing exercise Supplementation with calcium and vitamin D
Inadequate nutrition Fracture risk increases as a result of inadequate nutritional intake or bone disease and is common in pediatric and older adult populations. Patients who engage in weight-bearing exercise and take calcium and vitamin D supplements are protecting their bones. Physical ability is not a risk factor for fractures.
Which medication would the nurse expect to be prescribed for a patient with impingement syndrome in the shoulder? Opioid Nonsteroidal anti-inflammatory drug Anticonvulsant Antibiotic
Nonsteroidal anti-inflammatory drug Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically used first to reduce swelling in impingement syndrome. Antibiotics, opioids, and anticonvulsant medication are not used to treat impingement syndrome.
A patient calls the nurse to report severe bruising around the fingers, which were splinted after a fracture 2 days ago. The nurse should explain that this is a result of which stage of indirect bone healing? Reparative Closed reduction Inflammatory Remodeling
Inflammatory The inflammatory stage of indirect bone healing, which typically lasts a few days, is denoted by a hematoma around the damaged tissue. During the reparative stage, a soft callus is formed on the bone and then replaced over a period of 6-8 weeks with a hard callus. During the remodeling stage, the hard callus is replaced with lamellar bone, which is stronger still. Closed reduction is a method of direct, not indirect, bone healing.
A patient is diagnosed with an anterior cruciate ligament (ACL) injury. Which manifestation should the nurse expect to assess in the patient? Absence of sensation below the area of injury Cyanosis of the limb below the area of injury Knee popping at the time of injury Painful fluid-filled cyst behind the knee
Knee popping at the time of injury A popping of the knee is common at the time of ACL injury. Absence of sensation and cyanosis of the limb after an injury most likely indicates compartment syndrome, which causes neurovascular compromise. A cyst behind the knee is a Baker cyst.
The nurse is caring for a patient with carpal tunnel syndrome. Which statement should the nurse use to describe this disorder to the patient? Fracture Nerve entrapment Sprain Inflammation of a joint
Nerve entrapment Carpal tunnel is a nerve entrapment disorder that is a form of neuropathy and causes tingling and numbness in the thumb and index finger. Inflammation in the joint is bursitis. A fracture is a break in the bone. A sprain is a bone-ligament injury.
The nurse is caring for a patient with carpal tunnel syndrome. Which clinical manifestation should the nurse expect to assess? Numbness and tingling Grinding of the joint with range of motion Swelling and ecchymosis Warmness, swelling, and redness
Numbness and tingling Numbness and tingling occur with carpal tunnel syndrome, which is a form of nerve entrapment (neuropathy). Grinding in the joint with range of motion is common with bone spurs and osteoarthritis. Swelling and ecchymosis may occur with a sprain or fracture. Warmness, swelling, and redness are symptoms of bursitis.
The nurse is caring for a patient with a benign bone tumor. Which type of tumor should the nurse expect to be documented in the patient's medical record? Osteosarcoma Osteochondroma Ewing sarcoma Chondrosarcoma
Osteochondroma Osteochondroma is a benign bone tumor. Osteosarcoma, Ewing sarcoma, and chondrosarcoma are all malignant bone tumors.
A patient who experienced an open fracture 10 days ago is reporting bone pain, fever, chills, and generalized malaise. Which disorder should the nurse suspect this patient is experiencing? Osteonecrosis Osteomyelitis Osteochondroma Osteosarcoma
Osteomyelitis The patient's symptoms are consistent with osteomyelitis. Osteosarcoma is a malignant bone tumor that causes pain that is increasingly worse at night and associated with muscle weakness. Osteonecrosis results from decreased blood supply to an area of bone and is typically asymptomatic until deterioration has progressed. Osteochondroma is a benign bone tumor that typically causes a dull ache until a fracture has occurred.
A patient with a fractured tibia is screaming in pain even after pain medication has been administered. Which finding should cause the nurse to suspect that the patient has compartment syndrome? Atrophy of the muscle of the lower leg Blistering of the skin of the lower leg Pain and swelling disproportionate to x-ray finding Shortness of breath and petechiae
Pain and swelling disproportionate to x-ray finding The patient's symptoms are consistent with compartment syndrome, which is most common in the legs. Pain and swelling that are not proportionate to the findings of the x-ray could indicate a more serious injury, such as a crush injury or bruising. Atrophy of the muscle is not consistent with compartment syndrome. Shortness of breath and petechiae may occur with fat embolism. Blistering of the skin occurs in some cases of fracture.
The nurse is caring for a patient who was injured while riding a bike. Which symptom should the nurse expect to assess if the patient has a fracture? Pain at the site of injury Atrophy of the muscle Blisters on the skin Shortness of breath
Pain at the site of injury Immediate pain is one of the most common signs of fracture. Shortness of breath is not expected with a fracture unless a complication such as fat embolism occurs. Blisters on the skin may occur, but not until about 24-48 hours after the fracture. Atrophy of the muscle may occur if a cast is applied.
A patient is diagnosed with carpal tunnel syndrome. Which statement explains the etiology of this disorder? Inflammation of fluid-filled sacs located in the bursa Stretching of ligaments around a joint Results from traumatic injury Repetitive motion injury
Repetitive motion injury
Which type of fracture commonly requires direct healing procedures? Complete Segmental Avulsion Stress
Segmental Segmental fractures, such as comminuted and long oblique fractures, often require direct healing procedures because the bone is broken into segments. Stress fractures, complete fractures, and avulsion fractures are treated with closed reduction. Internal fixation hardware lies entirely within the body and includes: A. Fixation of a short oblique fracture with a plate and screws above and below the fracture. B. Fixation of a long oblique fracture with screws through the fracture site. C. Fixation of a segmental fracture with a medullary nail.
A school-aged child reports falling and feeling pain when the left upper arm was twisted during football practice. Which type of fracture should the nurse suspect this patient experienced? Oblique Spiral Impacted Complete
Spiral A spiral fracture is to be suspected when limb twisting occurs during injury. An oblique fracture is diagonal across the bone and allows the muscles to slide down on each other. In a complete fracture, the break involves the entire width of the bone. In an impacted fracture, the broken ends of the bone are forced into each other. Oblique, complete, and impacted fractures do not typically raise suspicions of abuse.
The nurse is assessing a patient with a fracture. Illustration of fracture of the upper arm that appears to twist around the bone. Which type of fracture is depicted in the above image? Comminuted Spiral Greenstick Open
Spiral The fracture in this image appears to twist around the bone and is considered a spiral fracture. A comminuted fracture involves many bone fragments. In a greenstick fracture, the bone fragments are still partially joined. In an open fracture, the bone protrudes through the skin.
