NU 325 - Musculoskeletal/ Ortho Exam

Total hip arthroplasty is scheduled for a client with DJD of the left femoral head. Following surgery, it is most important for the nurse to place the client's left leg in which position?

Abducted with toes pointing upward

______ is moving away from the body

Abduction

A client has undergone a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity?

Advise the client to use a trochanter roll. Advise the client to adduct the stump so it presses against the other leg when the client is lying on the stomach.

_______ is an enzyme produced by an osteoblast, needed for mineralization of the bone. If it is elevated, healing fractures, bone cancers, osteoporosis, vitamin D deficiencies may be the cause.

Alkaline Phosphatase

A client has suffered a muscle strain and is reporting pain at 6 on a 10-point scale. The nurse should recommend what action?

Applying a cold pack to the injured site

_________ is carried out to obtain synovial fluid for purposes of examination or to relieve pain due to effusion. Helpful in the diagnosis of septic arthritis and other inflammatory arthropathies. Normally, synovial fluid is clear, pale, straw-colored and scanty in volume

Arthrocentesis

____ is performed when patient has joint pain; checks progression of diseases; contrast involved

Arthrogram

The nurse makes a home health care visit to a client with a fractured right femur. The nurse assesses the client's ability to safely use crutches. The nurse intervenes if which observation is made?

Before the client sits in a chair, the client stands on the unaffected leg and transfers both crutches to the hand on the affected side of the body

_________-evaluates bone mineral density; by x-ray or ultrasounds; DEXA scan

Bone densitometry

______ is a grating or crackling sound or sensation

Crepitus

A nurse is caring for a client who is being assessed following reports of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain?

CT, Magnetic resonance imaging, Ultrasound, X-ray

_______ is the same as a myelogram but allows you to see the intervertebral discs of the spinal cord; usually done in OR after someone has an epidural

Discogram

_______ is a fracture in which One side is broken, the other is just bent; occurs in young children with soft bones

Greenstick

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?

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

______ is done after a fracture is reduced to maintain proper position and alignment until union occurs

Immobilization

_____ is a fracture across long axis of the bone

Longitudinal

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?

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

________ permits visualization of the segments of the spinal cord; used when MRIs are not clear or patient cannot tolerate laying flat or has claustrophobia; bed rest for 2 hours afterwards, hydrate heavily afterwards to remove dye

Myelogram

Which types of bone cells function to build bone?

Osteoblasts

A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications?

Pneumonia, skin breakdown, sepsis, delirium

A client experiences an acute bout of gouty arthritis. The nurse expects the client's affected foot to have which appearance?

Red

_____ is the restoring of a bone to proper anatomical alignment

Reduction

The nurse provides care for a client in balanced suspension traction. The client reports pain in the affected extremity, and the nurse administers medication. One hour later the client states, "I don't know why, but the pain isn't getting any better." Which action does the nurse take first?

perform a neuromuscular assessment

What are the functions of the musculoskeletal system?

protection of vital organs, mobility and movement, facilitation of return of blood to the heart, production of blood cells, reservoir for immature blood cells, and reservoir for vital minerals

Muscles are attaches to bones and other structures by ______.

tendons

The nurse provides care for an older adult client eight days after an open reduction and internal fixation of the right hip. The nurse intervenes if which observation is made?

the client is not wearing elastic stockings

The nurse prepares a client for a total hip replacement. What information will likely postpone the surgery?

the client reports burning on urination

Where do immature blood cells live?

the musculoskeletal system (bones)

The nurse is providing instructions to the client following application of a fiberglass cast. Which statement by the client indicates further education is needed?

"Under no circumstances should I get my cast wet."

The nurse provides care for a client with DJD (osteoarthritis). The client receives a new prescription for celecoxib. The nurse is most concerned if the client makes which statement?

"I am allergic to aspirin"

A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse?

"I cannot seem to catch my breath." "I have a pins-and-needles sensation in my toes." Dorsoplantar weak and unequal bilaterally T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90%

Aspirin is prescribed for a client. The nurse administers this medication with which liquid?

A glass of milk

_________ allows direct visualization of a joint through the use of a fiberoptic endoscope; useful to adjunct diagnosing of joint disorders. Biopsy and treatment of tears, defects, and disease processes may be performed through this procedure.

Arthroscopy

A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications?

Assess the fingers for color and temp, assess for a pressure sore, determine the exact site of the pain

Three hours after arriving in the orthopedic unit, a client reports a hot feeling under the cast. Which action does the nurse take first?

Assesses the circulation in the casted extremity and changes the client's position

Which nursing intervention is most appropriate for a client diagnosed with RA and reporting generalized pain?

Assist the client with heat application and ROM exercises

______ is the shrinkage-like decrease in the size of the muscle

Atrophy

A client is scheduled for a total hip replacement and the surgeon has explained the risks of blood loss associated with orthopedic surgery. The risk of blood loss is the indication for which of the following actions?

Autologous blood donation

A provider asks the nurse to teach a client with low back pain how to sit in order to minimize pressure on the spine. Which teaching points would the nurse include?

Avoid hip extension. Place feet flat on the floor. Sit with the buttocks "tucked under." Sit in a straight-backed chair with arm rests

______ is rotating a joint all the way around, 360 degrees

Circumduction

_____ is the rhythmic contraction of muscle

Clonus

Which assessment findings would the nurse expect to find in the client with osteomyelitis?

Column B

_____ is a fracture broken into multiple small pieces, may happen in jam or crush injury

Comminuted

_____ is a Fracture that is completely in two different pieces, completely separated

Complete

______ or an EMG; pins and needles inserted into your muscles and nerves to check electrical potential to rule out muscle damage

Electromyography

The nurse provides care for a client with a newly applied plaster cast to the lower extremity. The nurse takes which action?

Elevates the leg on pillows and leaves the cast open to air

An older adult client has an open reduction and internal fixation of the left femoral head after a fracture. Which action by the nurse is best?

Encourage the client to cough and deep breathe every 2 hours

_____ is turning out, like ballerina feet

Eversion

The nurse is providing care for a client who has had a below-the-knee amputation. The nurse enters the client's room and finds the client resting in bed with the residual limb supported on a pillow. What is the nurse's most appropriate action?

Explain the risks of flexion contracture to the client

_____ is stretching something out, like straightening a joint

Extension

A client has just begun been receiving skeletal traction and the nurse is aware that muscles in the client's affected limb are spastic. How does this change in muscle tone affect the client's traction prescription?

Extra weight is needed initially to keep the limb in proper alignment.

What is the fibrous tissue that encases muscles called?

Fascia

_____ is a fracture in which fragments are driven into each other; legs on dash when in car wreck, or fall and land on legs

Impacted

______ is a fracture in which a Fragment remains attached, and only a portion of the bone is broken

Incomplete

The nurse witnesses a car hit a pedestrian in the parking lot. As the nurse approaches the pedestrian, the pedestrian cries out, "I think my leg is broken!" Which action does the nurse take first?

Inspects the affected leg for evidence of bleeding

_____ is a fracture in which the line extends through the articular surface of the bone

Intra-articular

_____ is turning in of a body part, like inverting something

Inversion

Which statements describe open reduction of a fracture?

It is performed in the operating room. The bone is surgically exposed and realigned. The client usually receives general or spinal anesthetic.

Which baseline labs should be gathered before Heparin administration?

PTT, CBC w/ diff, Hgb/Hct, RBC

The nurse provides care for an older adult client reporting a new onset of bone pain, rapidly increasing in intensity, as well as fatigue and difficulty walking. The client reports a decrease in height and the labs show a high alkaline phosphatase level. The nurse prepares to teach the client about which disease process?

Paget disease

The nurse assesses a client diagnosed with osteoarthritis. The nurse expects to observe which signs/ symptoms?

Pain usually provoked by activity, and stiffness of the joints after periods of rest

______ is a fracture that is Spontaneous at site of bone disease (tumor or osteomyelitis)

Pathologic

A client with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care?

Prepare to remove the cast. Provide support to the injured extremity.

A client has had a brace prescribed to facilitate recovery from a knee injury. What are the potential therapeutic benefits of a brace?

Preventing additional injury Providing support Controlling movement

_____ is the opposite of supination, like palms facing down

Pronation

A client diagnosed with osteoporosis is being discharged home. Which priority education should the nurse should provide?

Remove all small rugs from the home

____ is pulling back

Retraction

_____ is rotating a joint, like your head

Rotation

_______ is the contractile unit of skeletal muscle that contains actin and myosin

Sarcomere

What assessment findings of the leg are consistent with a fracture of the femoral neck?

Shortened, adducted, and externally rotated

The nurse provides care for an older adult client after a total hip replacement due to degenerative joint disease. The nurse intervenes if which observation is made?

The client is sitting on a chair with no arms

The nurse provides care for a client immediately following a right BKA. The nurse is most concerned if which observation is made?

The client reports persistent pain at the operative site

The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client?

The client will experience a tolerable level of pain. The client will demonstrate wound care. The client will maintain adequate nutritional intake.

______ is the application of a pulling force to an injured or diseased body part

Traction

_____ is a fracture that is Crossways at right angles to long axis of bone, straight across

Transverse

Which of the following are associated with compartment syndrome?

Trauma from accidents Surgery Casts Tight bandages Crushing injuries

What is the reversal agent for Warfarin?

Vitamin K

What does a CBC include?

WBC, RBC, Hgb, Hct, Platelet count

What oral medication will your patient likely be on when Heparin therapy is stopped?

Warfarin

What is the production of blood cells called?

hematopoiesis

The clinic nurse counsels a client reporting low back pain. Which client statement requires a follow-up by the nurse?

"I work full-time as a package handler at Amazon"

The home care nurse makes a home visit to a client diagnosed with osteoarthritis. The nurse asks the client's spouse if the client is having any problems. The nurse further assesses if the spouse makes which statement?

"My spouse has not been participating in regular activities."

A client asks the nurse, "What is the difference between RA and osteoarthritis?" Which response by the nurse is best?

"Rheumatoid arthritis is a systemic disease and osteoarthritis is not."

A client diagnosed with Type 1 Diabetes is scheduled for a right BKA due to a gangrenous toe. The client asks the nurse why the amputation is so extensive. The nurse's response is based on which understanding?

A below the skeeter's amputation results in better circulation and healing

____ is bringing closer to the body

Adduction

The nurse provides care for a client in Buck traction. Which is the most important nursing action to maintain effective traction?

Allow weights to hang freely at all times

A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until the femur can be rodded in surgery. For what early complication(s) should the nurse monitor this client?

Deep vein thrombosis Compartment syndrome Fat embolism

The nurse is in the outpatient clinic instructs a client receiving probenecid. It is most important for the nurse to make which statement?

Drink 6-8 glasses of water a day

______ is a study in which they watch red blood cells fall and count the rate in which they become sediment. If elevated, RA, osteomyelitis, inflammation may be present.

ESR/ Sed Rate

_____ is the bending of a joint, like flexing a muscle

Flexion

A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. The nurse identifies this as which type of cast?`

Gauntlet cast

____ is a fracture that remains in good anatomical position

Non-displaced

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment?

Nonunion

____ is the process of formation of the bone matrix and deposition of minerals

Ossification

Which type of bone cells, that are located in Howship's lacunae are multinuclear cells that function in destroying, resorbing, and remodeling bone?

Osteoclasts

Which type of bone cells, that are located in the lacunae, are mature cells that function in bone maintenance?

Osteocytes

____ is pushing forward, like bench press

Protraction

The nurse provides care for a client after an amputation with an immediate prosthetic fitting. The nurse includes which activity in the client's plan of care?

Provide cast care on the affected extremity

The nurse provides care for a client with RA. Which finding assumes the highest priority for the nurse when assessing and planning the client's care?

Slight contracture of the right wrist

______ is a fracture that is Twisted around the shaft of the bone (usually child abuse injuries will be this type)

Spiral

______ is an injury to a muscle due to overuse, over stretching, or excessive stress; painful with no swelling

Strain

_____ is a fracture that occurs as a result of repeated stress to the bones; overtraining in runner or severe bone disease

Stress

_____ is turning upward, like lying supine, or palms facing upward

Supination

Prednisone 2 mg daily is prescribed for a client with RA. Which important point does the nurse include when teaching the client about this medication?

The dosage of prednisone must be increased and decreased gradually

The nurse evaluates care given to a client after a left BKA. The nurse intervenes if which observation is made?

The dressing to the surgical site is dated two days prior

A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip?

The left leg is shorter than the right. Limited range of motion of the left hip. The skin of the lower left leg is pale.

Which is one of the most common causes of death in clients diagnosed with fat emboli syndrome?

acute respiratory distress syndrome

When should intermittent heat be used for care of a soft tissue injury?

after the acute inflammatory phase

A physician writes a prescription to discontinue skeletal traction on an orthopedic client. The nurse should anticipate what subsequent intervention?

application of a cast

An older adult client has fallen in the home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the client's presurgical care, the nurse should be aware of the client's heightened risk of what complication?

avascular necrosis

A client has low back pain and the healthcare provider needs to rule out the presence of a tumor. Which diagnostic procedure would the nurse anticipate to be ordered for the client?

bone scan

The nurse teaches a client with a BKA to care for the residual limb at home. The nurse advises the client to take which action?

expose the residual limb to air

The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication?

fat embolism syndrome

What are the 5 P's?

pain, pallor, paresthesias, paralysis, pulselessness

What would be given if the patient started bleeding uncontrollably?

protamine sulfate

A client who was injured while playing basketball reports an extremely painful elbow, which is very edematous. What type of injury has the client experienced?

sprain

An older adult client is diagnosed with a fractured femur. The nurse recognizes which observation is an early sign of fat embolism?

Altered mental status

A client who has fractured the radial head asks the nurse about factors that will promote bone healing. Which statement should the nurse include when responding to the client?

"Immobilization of the fracture will promote healing by maximizing contact of bone fragments." "Fractured bones require a good blood supply and adequate nutrition for healing." "Weight bearing stimulates healing of the long bones of the leg, if the fracture is stabilized."

A client comes to the clinic 2 days after sustaining a sprain to the left ankle. What intervention can the nurse encourage the client to perform that will help improve circulation?

applying heat

What areas of the body may be examined when bone densitometry is done?

hip, spine, wrist

_____ is a fracture Resulting from strong pulling effect of tendon or ligaments at the bone attachment

Avulsion

_____ is a fracture in which bones are broken and no longer in anatomical position; something will have to be manipulated before casting for it to grow back correctly

Displaced

____ is an injury of the ligaments around a joint caused by twisting or wrenching a motion beyond its ROM. Blood vessels are torn which causes swelling and pain

Sprain

The nurse teaches a client diagnosed with a fractured left demur that is in a cast. The client asks how to keep the muscles if the legs strong during the time the cast os on the left leg. Which response by the nurse is best?

"I'll teach you how to do isometric exercises with your left leg"

The client is admitted to the hospital with a diagnosis of left femoral neck fracture. Which treatment modality would the nurse expect the health care provider to order?

Buck's traction

____ is a fluid-filled sac found in connective tissue

Bursa

_____ is a fracture that is a slanting break

Oblique

A nurse is caring for an older adult client who is preparing for discharge following recovery from a total hip replacement. What outcome must be met prior to discharge?

client is able to perform transfers safely

A client with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate?

document the findings

The health care provider is preparing to bivalve the client's cast. Which supplies should the nurse assemble?

elastic compression bandages

Which intervention would the nurse implement with the client in skeletal traction?

ensure the pins or wires are covered with caps, position trapeze within the client's reach, instruct the client on isometric exercises for immobilized extremity

Lifestyle risk factors for osteoporosis include

lack of exposure to sunshine

Emergency medical technicians transport a client to the emergency department and inform the nurse that the client fell from a two-story building. The comatose client has a large contusion on the left side of the chest, a hematoma in the left parietal area, and a compound fracture of the left femur. The client was intubated and is maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority?

assessing the left leg