Med Surg. Ch. 36 Management of Patients with Musculoskeletal Disorders

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?

Comminuted

Which type of fracture produces several bone fragments?

Comminuted

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states not being able to move or feel the fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures?

Compartment syndrome

T/F: The nurse should recommend short periods of bed rest, in a prone position, for patients experiencing back pain resulting from a compression fracture.

FALSE

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?

Lower lumbar

abduction

Movement away from the midline of the body

sequestrum

dead bone in abscess cavity

During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?

"After menopause, the body's bone density declines, resulting in a gradual loss of height."

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided?

"I will avoid prolonged sitting or walking."

The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given?

Alendronate

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?

Alkaline phosphatase

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem?

Apply lotions and take warm baths or soaks.

A nurse is reviewing a client's activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation?

Bending down to put on socks

________________ are administered on arising in the morning with a full glass of water on an empty stomach, and the patient must stay upright for 30 to 60 minutes.

Bisphosphonates

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?

Bone fracture

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)?

Calcitonin

While the nurse is performing a physical assessment, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. What should this assessment indicate to the nurse?

Carpal tunnel syndrome

The nurse caring for a client, who has been treated for a hip fracture, instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client?

Do not flex the hip more than 90 degrees.

A nurse is caring for a client after stabilization of a radial fracture. Which actions by the nurse would be appropriate for the client following arm casting? Select all that apply.

Handle the cast with the palms of hands Circulate room air with a portable fan Petal and smooth the edges of the cast

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign?

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication?

Hypovolemic shock

A client is diagnosed with carpal tunnel syndrome. Which assessment findings would the nurse expect?

Inability to flex index and middle fingers

A client is diagnosed with carpal tunnel syndrome. Which of the following assessment findings would the nurse expect?

Inability to flex index and middle fingers

Which aspect should a nurse include in the teaching plan for a client with osteomalacia?

Include calcium, phosphorus, and vitamin D supplements

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely?

Long bone bowing

adduction

Movement toward the midline of the body

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply.

Muscle spasms will be relieved. The bones of the left leg will be aligned. Immobilization of the left leg will be maintained.

The most common causative organism of osteomyelitis is ________________.

Staphylococcus aureus

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing?

Surgical debridement

T/F: Nursing interventions for a patient undergoing foot surgery include a neurovascular assessment every 1 to 2 hours for the first 24 hours.

TRUE

T/F: Symptoms of plantar fasciitis include acute heel pain experienced in the morning upon arising.

TRUE

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action?

Walk or perform weight-bearing exercises outdoors

osteophyte

a bony outgrowth or protuberance; bone spur

contracture

abnormal shortening of muscle fibers, tendons, or connective tissue making it difficult to stretch muscle

subchondral bone

bony plate that supports the articular cartilage

____________ is an inflammation of a fluid-filled sac in the joint.

bursitis

Osteoporosis frequently results in

compression fractures of the spine, fractures of the neck or intertrochanteric region of the femur, and Colles fractures of the wrist.

avascular necrosis

death of tissue due to insufficient blood supply

osteoprosis

degenerative disease of the bone characterized by reduced mass, deterioration of matrix, and diminished architectural strength

radiculopathy

disease of a spinal nerve root, often resulting in pain and extreme sensitivity to touch

bursitis

inflammation of a fluid-filled sac in a joint

tendonitis

inflammation of muscle tendons

sciatica

inflammation of the sciatic nerve, resulting in pain and tenderness along the nerve through the thigh and leg

Musculoskeletal disorders, particularly impairment of the back, joints, and spine, are

leading health problems and causes of disability. The functional and psychological limitations for the patient may be severe.

osteopenia

low bone mineral density

osteolysis

lysis of bone from inflammatory reaction against polyethylene particulate debris

heterotopic ossification

misplaced formation of bone

involucrum

new bone growth around a sequestrum

Risk factors for osteoarthritis and its progression include

older age, female gender, and obesity.

The most prevalent bone disease in the world is __________________.

osteoporosis

risk factors for osteoporosis

over 65, asian heritage, postmenopausal, smoker, alcohol doesn't matter, walking helps

Low back pain that radiates down the leg suggests the presence of nerve root involvement known as _____________.

sciatica

osteotomy

surgical cutting of bone

arthroplasty

surgical repair or replacement of fluid-filled sac in a joint