Pathophysiology Chapter 39: Alterations of Musculoskeletal Function

A nurse is caring for a client with a greenstick fracture. The nurse is most likely caring for which client? a. a boy, age 8. b. a man, age 34. c. a young woman, age 19. d. a young woman, age 23.

a. a boy, age 8 -greenstick fractures occur primarily in children and older (elderly) adults. Young or middle-aged adults, male or female, are not at a high risk for greenstick fracture.

Which assessment finding may the nurse observe in a client with malignant hyperthermia? a. high fever b. hypometabolism c. sinus bradycardia d. volkmann contracture

a. high fever -malignant hyperthermia can cause hypermetabolism with extremely high body temperature, muscle rigidity, rhabdomyolysis, and death if not treated quickly with dantrolene infusion. Sinus tachycardia, not bradycardia, is common. A condition known as Volkmann ischemic contracture can develop when the muscles of the forearm are affected by increased pressure within the forearm muscle compartments (compartment syndrome ), not from malignant hyperthermia.

A nurse is teaching a class about risk factors for osteoarthritis in women. The nurse should include which major risk factor for developing osteoarthritis of the knee? a. obesity b. steroid use c. athletics d. skeletal deformity

a. obesity -although all of the choices are risk factors for developing osteoarthritis, research has found that obesity is the major risk factor for women developing osteoarthritis of the knee.

A nurse is taking care of clients with fractures and monitors the "6 P's" of compartment syndrome. Which areas did the nurse assess? Select all that apply. a. pain b. pallor c. paresis d. pannus e. paresthesia f. pulselessness

a. pain, b. pallor, c. paresis, e. paresthesia, f. pulselessness -the "6 P's" of compartment syndrome are pain (out of proportion to expected injury), pressure (swelling, tenseness of the affected area, pallor, paresthesia, paresis (of the involved extremity), and pulselessness. Pannus is involved in pathophysiology of rheumatoid arthritis.

A client has a comminuted fracture. What does this mean? a. the bone breaks into two or more fragments b. a bone that is slanted in relation to the shaft of the bone c. a fracture that encircles the bone d. an incomplete fracture that causes a break in one cortex of the bone with splintering of inner bone surface

a. the bone breaks into two or more fragments -a comminuted fracture is one in which the bone breaks into two or more fragments. An oblique fracture is one that is slanted in relation to the shaft of the bone. A spiral is a fracture line that encircles the bone, as in a spiral staircase. A greenstick is an incomplete fracture that causes a break in one cortex of bone with splintering of inner bone surface.

Upon assessment, a nurse finds that a client with osteoarthritis has Bouchard nodes. How do these appear? a. these appear on the middle joints of fingers b. these appear as enlargement and bulging of joint contours, especially on the upper joints of the fingers c. these appear below the finger joints d. these appear in the bones of the hand

a. these appear on the middle joints of fingers -bouchard nodes can occur with osteoarthritis, and these appear on the middle joints of the fingers. Heberden nodes are enlargement and bulging of joint contours, especially on the upper joints of the fingers in osteoarthritis. Nodes located below the finger joints occur with rheumatoid arthritis and are called subcutaneous nodes. When the hand shifts toward the ulnar bone it is called ulnar drift, which also occurs with rheumatoid arthritis.

A nurse is teaching a women's group about the risk factors for osteoporosis. Which information about risk factors from the women indicates teaching was successful? a. thin build b. dark skinned c. large stature d. increased calcium intake

a. thin build -risk factors for osteoporosis include: thin build, fair or pale skinned (not dark), small stature (not large), and decreased calcium intake, not increased.

What statement by the client regarding the modifiable risk factors for osteoporosis requires follow-up by the nurse? a. "I need to stop smoking now." b. "I don't exercise because I will break a bone." c. "I need to decrease my alcohol consumption." d. "I need to take calcium with vitamin D supplements."

b. "I don't exercise because I will break a bone." -a risk factor for osteoporosis is a sedentary life style, so weight bearing exercise is recommended. Smoking and excessive alcohol consumption are risk factors for osteoporosis. To maintain bone health, clients should take calcium with vitamin D supplements.

Which information indicates the nurse has a correct understanding about the difference between a sprain and a strain? a. a sprain is a tear in a tendon, whereas a strain is a tear in a ligament. b. a strain is a tear in a tendon, whereas a sprain is a tear in a ligament c. a sprain is a partial dislocation of a joint, whereas a strain is a complete joint dislocation d. a strain is a partial dislocation of a joint, whereas a sprain is a complete joint dislocation

b. a strain is a tear in a tendon, whereas a sprain is a tear in a ligament.

A 40-year-old woman has diffuse pain, fatigue, and increased sensitivity to touch without signs of inflammation. Which condition will the nurse observe written on the chart? a. contracture b. fibromyalgia c. disuse atrophy d. stress-induced muscle tension

b. fibromyalgia -fibromyalgia is a chronic musculoskeletal syndrome characterized by diffuse pain, fatigue, increased sensitivity to touch (i.e., tender points), the absence of systemic or localized inflammation, and the presence of fatigue and nonrestorative sleep; anxiety and depression are also frequently present. Of affected individuals, 80% to 90% are women, and the peak age is 30 to 50 years. Contracture is a contraction of muscle fibers caused by phenomena secondary to the muscle ( spasms or weakness) and sometimes without a muscle action potential. Disuse atrophy is a pathologic reduction in normal size of muscle fibers after prolonged inactivity or local nerve damage. Stress-induced muscle tension is caused by chronic anxiety and includes neck stiffness, back pain, and headache.

Which assessment finding will the nurse observe in a client who fractured a femur? a. chest pain and bradycardia b. pain and swelling in the thigh c. low blood glucose and seizures d. limb paralysis and referred pain

b. pain and swelling in the thigh -the signs and symptoms of a fracture include unnatural alignment (deformity), swelling, muscle spasm, tenderness, pain, impaired sensation, and decreased mobility. Chest pain, bradycardia, low blood glucose, and seizures are not characteristic of a fracture. A fracture does not necessarily cause limb paralysis and referred pain.

A client has ankylosing spondylitis. Which area should the nurse assess first? a. hips b. spine c. knees d. fingers

b. spine -ankylosing spondylitis is a disease characterized by stiffening and fusion of the spine and sacroiliac joints. Osteoarthritis affects the hips. Rheumatoid arthritis affects the knees and fingers.

A client is brought to the hospital after twisting an ankle while running the bases in a baseball game. On examination, the ligaments have sustained tears. Which is the best term to describe this injury? a. strain b. sprain c. avulsion d. reduction

b. sprain -sprains involve tears of the ligaments; strains are tears in tendons or muscles. An avulsion is a complete separation of a tendon from its bony attachment site. Treatment of a displaced fracture involved realigning the bone fragments (reduction) close to their normal or anatomic position and holding the fragments in place.

A client has displacement of two bones in which the articular surfaces partially lose contact with each other. Which term should the nurse use in report to describe this finding? a. sublimation b. subluxation c. subjugation d. strain

b. subluxation -subluxation is partial dislocation of a joint. Tearing or stretching of a muscle or tendon is commonly known as a strain. Sublimation and subjugation are not terms used for partial dislocation of a joint.

A nurse is asked how uric acid is eliminated from the body. How should the nurse respond? a. through sweat b. through the kidneys c. through crystals of tophi d. through metabolism of protein

b. through the kidneys -most uric acid is eliminated from the body through the kidneys. Uric acid is a breakdown produce of purine nucleotides; it is not eliminated in this method. When uric acid reaches a certain concentration in fluids, it crystallizes, forming insoluble precipitates that are deposited in connective tissues throughout the body, forming tophi.

"Tell me the name of that chemical that makes crystals when my gout flares up," says a client. "I was hurting too much to remember it last time someone told me." What is the nurse's best response? a. urea b. uric acid c. calcium phosphate d. beta-hydroxybutyric acid

b. uric acid -gout occurs when uric acid crystals form in joints; this formation is caused by incomplete purine metabolism. Calcium phosphate can cause urinary calculi such as bladder stones.

Which age group should the nurse monitor that has the highest risk for bone tumors? a. infants b. children c. adolescents d. adults between the ages 30 and 35 years

c. adolescents -adolescents have the highest incidence for bone tumors. Children younger than 15 years have few bone tumors. Adults between the ages of 30 and 35 have the lowest incidence. After age 35, incidence increase slowly until age 60, when it is equal to that of adolescents.

A client has osteoporosis. Which treatment will the nurse prepare to administer? a. chelation b. antibiotics c. bisphosphonates d. hyperbaric oxygen therapy

c. bisphosphonates -bisphosphonates are first-line medications for treating osteoporosis; they primarily work by inhibiting hydroxyapatite breakdown, reducing bone resorption. Chelation of bone aluminum can be used in osteomalacia, but not in osteoporosis. Antibiotics and hyperbaric oxygen therapy are given for osteomyelitis, not osteoporosis.

A client has suspected osteoporosis. What diagnostic test is the gold standard used to diagnose osteoporosis? a. radiologic studies (x-ray) b. computed tomography (CT) c. dual x-ray absorptiometry (DXA) d. magnetic resonance imaging (MRI)

c. dual x-ray absorptiometry -DXA is the gold standard for detecting osteoporosis. While CT and MRI have shown osteoporotic changes, as well as x-rays showing bone fractures, DXA is still the diagnostic option of choice.

A nurse is teaching about a fracture that is generally observed in children and the elderly. Which fracture is the nurse describing? a. pelvis b. stress c. greenstick d. transchondral

c. greenstick -greenstick fractures occur most often in the growing bones of children and in the elderly. Pelvis fractures occur most often in older adults. Stress fractures can occur at any age. Transchondral fractures are most prevalent in adolescents.

Which of these assessment data place the client at risk for developing gout? a. premenopausal b. under the age of 30 c. high intake of red meat d. occasional alcohol intake

c. high intake of red meat -male gender, increasing age, and high (not occasional) intake of alcohol, red meat and fructose are all risk factors for gout. Men, especially those over 30, are at higher risk of developing gout. Gout is rare in children and premenopausal women.

A client has osteomalacia. Which information indicated the nurse has a correct understanding of the pathophysiology of osteomalacia? a. increased osteoclast activity b. crowding of cells in the osteoid c. collagen breakdown in the bone breakdown d. inadequate mineralization in the osteoid

d. inadequate mineralization in the osteoid -osteomalacia is characterized by inadequate or delayed mineralization in the osteoid in mature compact and spongy bone.

A nurse is assessing a client for suspected diagnosis of fibromyalgia. Which clinical manifestation will help establish a diagnosis for fibromyalgia? a. tenderness in the groin area b. pain located above the waist c. tenderness in 5 of the 18 "trigger" point d. pain that has lasted for 3 months or more

d. pain that has lasted for 3 months or more -an individual must report pain that has been present for 3 months or more. Tenderness in 11 of the 18 "trigger" or "tender" points occurs when pressure is applied to those areas. Tender points include areas on both sides of the spine and both above and below the waist. There are no tender spots located in the groin area.

A client has fibromyalgia. Which assessment finding is a unique characteristic feature of fibrimyalgia? a. headaches b. contractures c. muscle atrophy d. tender point pain

d. tender point pain -tender point pain is a unique characteristic feature of fibromyalgia.