Patho Exam 2 Musculoskeletal System

A nurse is caring for a client with ankylosing spondylitis. For which associated symptom does the nurse assess?

Kyphosis Explanation: Loss of motion in the spinal column is characteristic of the disease. Loss of lumbar lordosis occurs as the disease progresses, followed by kyphosis of the thoracic spine and extension of the neck.

A nurse is caring for a client with a fractured elbow. Which instruction is important to give the client to prevent cartilage degeneration while the elbow is immobilized?

"To prevent cartilage atrophy, slowly and gradually resume exercising." Explanation: Cartilage atrophy is rapidly reversible with activity after a period of immobilization; impact exercise during the period of remobilization can prevent reversal of the atrophy. Slow and gradual remobilization may be important in preventing cartilage injury.

A physician is providing care for several clients on a hospital-based medical ward. Which client is most likely to experience chronic fatigue?

51-year-old woman admitted for exacerbation of her multiple sclerosis. Explanation: Neurologic conditions such as multiple sclerosis are particularly associated with chronic fatigue. Infections, wounds, and fistulae will undoubtedly cause fatigue but are less likely to contribute to the long-term presentation associated with chronic fatigue.

We have both red and yellow bone marrow in our bodies. What is yellow bone marrow largely composed of?

Adipose cells Explanation: Yellow bone marrow is composed largely of adipose cells. Hematopoietic cells are in red bone marrow. Cancellous cells are in spongy bone. Osteogenic cells line the latticelike pattern that forms bone marrow.

The health care provider is caring for a client diagnosed with an osteosarcoma who asks, "What does this mean?" Which response best describes the diagnosis?

Aggressive; malignant bone tumor Explanation: Osteosarcoma is an aggressive and highly malignant bone tumor with an unknown cause. It is the most common malignant bone tumor, representing one-fifth of all primary bone tumors.

A nurse is caring for a client who has systemic lupus erythematosus (SLE). Which of the following causes the disease?

Autoimmune process Explanation: The cause of SLE is unknown. It is characterized by the formation of autoantibodies and immune complexes.

When explaining to the client diagnosed with gout how the xanthine oxidase inhibitors work, the health care provider would include which statement?

Blocks the production of uric acid by the body Explanation: Xanthine oxidase inhibitors block the synthesis of uric acid. In this classification, the most commonly prescribed to lower urate levels is allopurinol. The uricosuric agents prevent the tubular reabsorption of urate and increase its excretion in the urine. Uricase agents convert insoluble uric acid to a soluble product than can be excreted easily. Pegloticase is an infusible uricase agent that works rapidly to reduce serum uric acid.

A gymnastics student hurts the ankle and is diagnosed with a torn cartilage. The health care worker states it may take months for this injury to heal. What is the basic physiologic reason behind the prolonged recovery of cartilage?

Cartilage lacks blood vessels. Explanation: Cartilage is avascular tissue, a fact that stands in contrast to bone tissue. Both bone and cartilage contain cells that secrete an extracellular matrix, which forms the structure of the tissue. Cartilage is more flexible than bone, but it also exhibits considerable tensile strength. Cartilage repair is a particularly slow process and may in fact not occur in some cases. In contrast to cartilage, the extracellular matrix of bone is mineralized, producing a hard tissue capable of providing support for the body and protection for its vital structures.

The nurse is caring for a client who states that he is suddenly having severe pain at a leg fracture site. The nurse notes increased swelling in the limb and difficulty palpating a pulse. The nurse suspects that the client may have:

Compartment syndrome Explanation: The hallmark symptom of acute compartment syndrome is severe pain out of proportion to the original injury. One of the most important causes of compartment syndrome is bleeding and edema caused by fractures and bone surgery. Edema or swelling may make it difficult to palpate a pulse. Reflex sympathetic dystrophy, while characterized by pain out of proportion to the injury, does not exhibit decreased pulses. Fracture blisters are areas of epidermal necrosis with separation of epidermis from the underlying dermis by edema fluid. They are a warning sign of compartment syndrome. Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the bloodstream.

The nurse is caring for a client with several fractures that have been immobilized. Which assessment finding would be most indicative of a potential complication?

Deep, severe, unrelenting pain Explanation: Complications of fractures include compartment syndrome, when swelling after the injury impairs blood and nerve function. As the tissue is compressed, the extremity becomes edematous, has reduced capillary refill, is cold, and the pain is described as severe (and out of proportion to the original injury); additionally, the pain is not relieved by medication or positioning. Some elevation of vital signs is not unusual with acute pain and does not automatically indicate a complication.

A client has developed osteomyelitis and asks the health care provider how the problem occurred. Which response is most accurate?

Direct contamination of an open wound Explanation: Osteomyelitis represents an acute or chronic infection of the bone and marrow. All types of organisms—including parasites, viruses, bacteria, and fungi—can cause osteomyelitis, but certain pyogenic bacteria and mycobacteria are the most common. Organisms may reach the bone by seeding through the bloodstream (hematogenous spread), direct penetration or contamination of an open fracture or wound (exogenous origin), or extension from a contiguous site. Vitamin intake or deficiency will not cause infection.

Osteoporosis is a disease caused by demineralization of bone. What is the clinical method of choice for diagnosing osteoporosis?

Dual-energy x-ray absorptiometry (DXA) of the spine and hip Explanation: The clinical method of choice for bone mineral density (BMD) studies is dual-energy x-ray absorptiometry (DXA) of the spine and hip. The other answers will not diagnose osteoporosis.

The pediatric nurse is providing teaching to a parent of a child with toeing-out (slew foot). Which statement should the nurse include in the teaching?

It will most likely self-correct as the child becomes proficient in walking. Explanation: Toeing-out (slew foot) is a common problem in children that usually corrects itself as the child becomes proficient in walking. Occasionally a night splint is utilized. Sleeping in the supine position does not impact toeing-out.

An older adult client is admitted for the treatment of pneumonia. The nurse notes the home medications include nasal calcitonin, vitamin D, and calcium chloride. Which disease process is this client likely treating with these medications?

Osteoporosis Explanation: Common pharmacologic treatments for osteoporosis include nasal calcitonin, vitamin D supplements, and calcium supplements. This combination of drugs does not address the etiology or manifestations of scleroderma, osteoarthritis, or rheumatoid arthritis.

A client sustained a fall that resulted in an injury to the right shoulder, and the emergency doctor suspects a rotator cuff injury. The client would most likely manifest: Select all that apply.

Pain Muscle atrophy Difficulty abducting the affected arm Explanation: The major clinical features of rotator cuff disorders are pain (especially at night), tenderness, and occasionally muscle atrophy. Pain and impingement may be noted when motions of the arm squeeze and pinch cuff tendons between the humerus and the overlying arch. With rotator cuff tears, there may be difficulty abducting and rotating the arm.

A nurse assesses a client for fatigue. Which manifestations are characteristic of acute fatigue? Select all that apply.

Rapid onset Relieved by rest Explanation: Acute physical fatigue usually occurs with increased muscle activity and develops rapidly. It may be present with acute viral or bacterial infections and occurs more rapidly with people who are physically deconditioned, such as those on bedrest. There is usually a clear cause of the fatigue and it improves with rest.

The joint capsule consists of an outer fibrous layer and an inner synovium. What does the inner synovium do to facilitate movement?

Secretes synovial fluid Explanation: The synovium secretes a slippery fluid with the consistency of egg white called synovial fluid. This fluid acts as a lubricant and facilitates the movement of the articulating surfaces of the joint. The synovium surrounds, rather than connects, the tendons that pass through the joints. The synovium forms folds that surround the margins of articulations but do not cover the weight-bearing articular cartilage. The tendons and ligaments of the joint capsule, rather than the synovium layer, are sensitive to position and movement, particularly stretching and twisting.

The nurse is providing client education related to intra-articular corticosteroid injections. Which instruction should the nurse include?

The injections will be given only 3 to 4 times per year because they can increase joint destruction. Explanation: The client needs to be educated regarding the limited use of the injections and the risk of these injections causing additional joint destruction. The client should not be encouraged to run, but can participate in muscle-strengthening exercises. The statements regarding discomfort and daily administration are not correct.

The nurse is caring for clients with autoimmune conditions. Which client will the nurse assess first?

client with systemic lupus erythematosus reporting chest pain Explanation: The client with systemic lupus erythematosus (SLE) and chest pain is the priority client to assess. Pericarditis and other cardiac problems are possible. Articular symptoms of rheumatoid arthritis (RA) are pain and stiffness; this is not a priority from the clients presented. The client with SLE reporting a facial rash is not presenting with any other symptoms and is not a priority. The client with RA and vasculitis can experience neuropathy which can result in numbness and tingling. If this were a new symptom, this client would be the second one the nurse would assess.

The nurse is assessing an infant with a possible head injury. When palpating the skull, the nurse feels for the joints that exist between the bones of the skull. How will the nurse document the name for these joints?

sutures Explanation: Synarthroses are joints that lack a joint cavity and move little or not at all and are either fibrous or cartilaginous joints. The fibrous joints are divided into sutures, gomphoses, and syndesmoses. Sutures are only found in the skull. Gomphoses connect teeth to the jaw. Synchondroses are joints that have a layer of cartilage separating two ossification centers such as in a growth plate. Symphyses are joints in which two separate bones are connected by cartilage such as the pubic symphysis.