Module 16: Alterations of Musculoskeletal Function

a dual energy x-ray absorptiometry (DEXA) scan.

A common screening test for osteoporosis is:

decreased estrogen levels. Feedback: The hormone estrogen helps maintain bone strength and integrity in women. In menopause, decreased estrogen production increases a woman's risk of developing osteoporosis.

A factor that contributes to the development of osteoporosis in older women (post-menopausal) is:

Chondrosarcoma

A middle-aged patient has a tumor that infiltrates trabeculae in spongy bone. Which diagnosis will the nurse observe documented on the chart?

thin build.

A nurse is discussing the risk factors for osteoporosis. Which information is correct? A known cause of osteoporosis includes:

Transchondral Feedback: Transchondral fractures (chondral = cartilage) involve the separation of the articular cartilage from the bone and typically occur in adolescents.

An adolescent patient has sustained a fracture that involves fragmentation of the articular cartilage. Which type of fracture did the adolescent sustain?

trauma Feedback: Episodes of gout can be triggered by excessive alcohol intake, use of certain drugs, and trauma.

Episodes of gout are often triggered by:

Rickets Feedback: Rickets is a form of osteomalacia caused by a vitamin D deficiency that results in soft, deformable bones in children.

If osteomalacia occurs in the growing bones of a child, which of the following diseases will the nurse use to describe this condition?

pathologic bone fractures. Feedback: Osteoporosis weakens the bone structure and increases the risk of fracture.

Patients with osteoporosis should be assessed by the nurse for the risk of:

Fever

Which assessment finding is typical in a patient with rheumatoid arthritis?

Malunion Feedback: Malunion is a complication that occurs when the bone fails to align correctly during the healing process.

Which complication should the nurse assess for in a patient who had improper immobilization of a fracture?

Pain and swelling in the thigh Feedback: Because of inflammation, a fracture generally manifests with pain and swelling at the site of injury.

Which of the following assessment symptoms are typical in a patient who has just sustained a femoral fracture?

Gout and pain at night

Which of the two concepts are most closely associated?

an increase in the number of osteoclasts at the fracture site. Feedback: Osteoblasts migrate to the site of injury to repair the fractured bone tissue.

Which statement indicates that a nurse needs more teaching about bone healing? An event that occurs following a bone fracture is:

Joint pain Feedback: Joint degeneration in osteoarthritis almost always causes pain in affected joints.

While performing the assessment on a patient with osteoarthritis, which finding is typical?

external fixation.

A patient has a set of pins connected to stabilizing bars on the outside of the patient. The nursing is providing care to a patient who has undergone:

Strain

A patient has a tear in the tendon. Which diagnosis will the nurse observe documented on the chart?

Osteosarcoma Feedback: Though considered a bone-forming tumor (osteogenic cells), the radiologic appearance of sarcoma is quite variable and often shows a moth-eaten (lytic) pattern of destruction with the tumor extending into the adjacent soft tissue.

A patient has a tumor that causes a moth-eaten appearance in the bone. A nurse suspects that the patient has which of the following musculoskeletal tumors?

subluxation. Feedback: Subluxation results in joint deformity, immobility, and pain.

A patient has displacement of two bones in which the articular surfaces partially lose contact with each other. The nurse is providing care to a patient with a:

Second-degree sprain

A patient has a partial/incomplete tear of a ligament. Which term will the nurse use to describe this condition?

blood-borne bacteria. Feedback: Endogenous osteomyelitis is caused by blood-borne infections. The specific causative organisms differ among age and population groups.

A nurse is asked what causes endogenous osteomyelitis. What is the nurse's best response? The cause of most cases of endogenous osteomyelitis is (are):

vertebral joint fusion. Feedback: Ankylosing spondylitis results in joint fibrosis, ossification, and fusion. Joints most commonly affected include the intervertebral and sacroiliac joints.

A nurse is describing the pathophysiology of ankylosing spondylitis. Which information should the nurse include? Ankylosing spondylitis results in:

alcohol and nicotine.

A nurse is describing the pathophysiology of bone healing. Which information should the nurse include? Factor(s) that can prevent proper bone healing include:

being an athlete. Feedback: OA usually occurs in those persons who put exceptional stress on joints (e.g., obese persons, gymnasts, long-distance runners or marathoners); persons participating in such sports as basketball, soccer, or football have been shown to develop osteoarthritis at earlier ages than usual.

A nurse is asked about the risk factors for osteoarthritis (OA). How should the nurse reply? A risk factor for osteoarthritis includes:

proteoglycans. Feedback: Enzymatic processes assist in breaking the macromolecules of proteoglycans, glycosaminoglycans, and collagen in osteoarthritis.

A nurse is describing the pathophysiology of osteoarthritis. Which information should the nurse include? The activation of enzymes breaks down:

low calcium levels and secretion of parathyroid hormone (PTH).

A nurse is describing the pathophysiology of osteomalacia. Which information should the nurse include? The pathophysiology of osteomalacia involves:

Deterioration/impaired trabecular bone Feedback: Patients with osteoporosis are prone to fractures. Bone tissue can be normally mineralized in osteoporosis but the mass (density) of bone is decreased and the structural integrity of trabecular bone is impaired.

A nurse is describing the pathophysiology of osteoporosis. Which information will the nurse include?

neutrophils and inflammatory cytokines causing damage to articular cartilage. FEedback: In rheumatoid arthritis, neutrophils and inflammatory cytokines (IL-1 and TNF-alpha) cause damage to articular cartilage and the nearby synovium.

A nurse is describing the pathophysiology of rheumatoid arthritis. Which information is correct? Synovial joint problems in rheumatoid arthritis are due to:

autoimmune injury. Feedback: Rheumatoid arthritis is caused by autoimmune injury to synovial joints.

A nurse is describing the pathophysiology of rheumatoid arthritis. Which information should the nurse include? Rheumatoid arthritis results from joint inflammation caused by:

invasion of osteoblasts. Feedback: Bone healing occurs in the following manner: A, Bleeding at broken ends of the bone with subsequent hematoma formation. B, Organization of hematoma into a fibrous network. C, Invasion of osteoblasts, lengthening of collagen strands, and deposition of calcium. D, Callus formation; new bone is built while osteoclasts destroy dead bone. E, Remodeling is accomplished while excess callus is reabsorbed and trabecular bone is deposited.

A nurse is describing the process of bone healing. Which information should the nurse include? After the organization of the hematoma into a fibrous network, the next step is:

Osteomalacia Feedback: Osteomalacia is a rare metabolic disease characterized by inadequate mineralization of bone tissue in compact and spongy bone. The most common cause of osteomalacia is vitamin D deficiency.

A nurse is discussing a disorder that presents with significant bone demineralization from a vitamin D deficiency and usually results in skeletal pain. Which disorder is the nurse describing?

Avulsion Feedback: A complete separation of a tendon or ligament from its bony attachment site is known as an avulsion.

A nurse is providing care to a patient that has a tendon torn from the bone. Which term will the nurse use to describe this condition?

Elevated serum creatine kinase

A nurse is reviewing a patient's laboratory results. Which result will the nurse observe on the report for a patient who has rhabdomyolysis?

Energy metabolism Feedback: Glycogen storage diseases such as McArdle disease, acid maltase deficiency, lipid deficiency, and myoadenylate deaminase deficiency (MDD) are examples of energy metabolism disorders/diseases.

A nurse is teaching about McArdle disease, acid maltase deficiency, lipid deficiency, and myoadenylate deaminase deficiency (MDD). Which type of disorders/diseases is the nurse describing?

Fibrous tissues and collagenic Feedback: Neoplasms of the bone can arise from bone cells themselves (osteogenic or bone forming) or from supportive tissues such as cartilage (chondrogenic) and fibrous tissues (collagenic) or from bone marrow (myelogenic).

A nurse is teaching about the various types of tumors in the musculoskeletal system. Which terms should the nurse use together?

tophaceous gout. Feedback: The third and chronic stage of gout is called tophaceous gout. Progressive hyperuricemia leads to urate crystal deposits called tophi in cartilage, synovial membranes, tendons, and soft tissues.

A nurse recalls that the final, chronic stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called:

loss of articular cartilage. Feedback: The hallmark of degenerative joint disease is degeneration of articular cartilage in synovial joints.

A nurse recalls the chief pathologic feature of degenerative joint disease is:

Pathological fracture Feedback: A pathologic fracture occurs in a place where there was pre-existing disease that weakened the area.

A patient fractures a bone in a place where there was a pre-existing disease. Which type of fracture is being described?

Nonunion Feedback: Nonunion is failure of the bone ends to grow together. The gap between the broken ends of the bone fills with dense fibrous and fibrocartilaginous tissue instead of new bone.

A patient had a fracture that developed fibrous and fibrocartilaginous tissue instead of new bone. Which complications did the patient experience?

2 to 6 weeks Feedback: Treatment consists of reduction and immobilization for 2 to 6 weeks and exercises to maintain normal range of motion in the joint.

A patient has a dislocated shoulder. When the patient asks how long the shoulder will be immobilized, how should the nurse reply?

Paget disease Feedback: Paget disease (osteitis deformans) is characterized by excessive bone resorption and formation, resulting in chronic enlargement and softening of certain bones.

A patient has a disorder that is characterized by enlargement and softening of the bones. Which disease does the patient have?

Insufficiency fracture Feedback: Insufficiency fractures, also known as fragility fractures, are breaks that occur in bones lacking the normal ability to deform and recover; these fractures can occur with normal weight bearing or activity.

A patient has a fracture in a bone that does not have the ability to recover. The nurse will be caring for which type of fracture?

Oblique fracture

A patient has a fracture line at an angle to the long axis of the bone. Which type of fracture did the patient sustain?

Comminuted Feedback: A fracture in which the bone breaks into two or more fragments is called a comminuted fracture.

A patient has a fracture that broke into several fragments. Which type of fracture did the patient sustain?

Renal stones Feedback: Individuals with gout are 1000 times more likely to develop renal stones. An excessive uric acid level in the blood in gout promotes the development of uric acid calculi (stones) in the kidneys.

A patient has gout. Which complication is most commonly associated with gout?

Administering vitamin D supplements Feedback: Treatment for osteomalacia may include treating the underlying disease (for example, disorders of the small bowel, liver disease, and renal failure), rebalancing serum calcium and phosphate levels, and vitamin D supplementation.

A patient has osteomalacia. Which intervention is the priority?

Bacteria

A patient has osteomyelitis. When the nurse is reviewing the laboratory results, which type of organism will the nurse most likely observe on the report?

Staphylococcus aureus

A patient has osteomyelitis. Which of the following organisms will the nurse most likely observe on the report as the cause of the infection?

Dark brown urine Feedback: A classic triad of muscle pain, weakness, and dark urine is considered typical of rhabdomyolysis.

A patient has severe muscle trauma related to crushing injuries sustained from a motorcycle accident. Which finding will alert the nurse to the development of rhabdomyolysis?

Rhabdomyolysis Feedback: Severe trauma can result in the release of myoglobin from skeletal muscle cells, causing a life-threatening condition called rhabdomyolysis.

A patient has sustained severe muscle trauma from crush injuries. Which complication should the nurse monitor for in this patient?

Muscle spasms and unnatural alignment Feedback: The signs and symptoms of a fracture include unnatural alignment (deformity), swelling, muscle spasm, tenderness, pain and impaired sensation, and decreased mobility.

A patient presents to the emergency department with a fractured leg. Which findings are typical?

To slow the progression of RA Feedback: Early treatment of RA begins with disease-modifying antirheumatic drugs (DMARDs), which slow the progression of RA.

A patient with rheumatoid arthritis (RA) is prescribed disease-modifying antirheumatic drugs (DMARDs). What is the rationale for the nurse administering these drugs?

incomplete fracture. Feedback: A torus fracture is a type of incomplete fracture that occurs when the cortex of the bone buckles but does not break.

A torus fracture is a type of:

uric acid

Which information indicates that the nurse has a good understanding of gout? Pain and inflammation associated with gout are caused by crystallization of _____ in the tissues.

Trigger/tender point pain

Which of the following is a characteristic assessment finding in a patient with fibromyalgia?

Kidneys Feedback: Maintaining adequate urinary flow and prevention of kidney failure are goals of treatment. Myoglobinuria can result in renal failure caused by accumulation of myoglobin in the renal tubules.

With a patient who has myoglobinuria (rhabdomyolysis), which organ is the priority assessment?