Pathophysiology musculoskeletal
A client presents to the emergency department after suffering an injury while playing sports. The client is diagnosed with a sprain. Select the best explanation of the injury.
Tear of a ligamentous structure Explanation: A sprain, which involves the joint ligaments or capsule surrounding the joint, resembles a strain, but the pain and swelling subside more slowly. It usually is caused by abnormal or excessive movement of a joint. With a sprain, the ligaments may be incompletely torn or, in a severe sprain, completely torn or ruptured .A strain involves hyperextension of a muscle, unusual muscle contraction, and excessive stretch of a muscle. Page 1079
A client was involved in an auto accident and is brought to the hospital by ambulance. The admitting diagnosis is right hip dislocation. Select the most appropriate intervention for this client:
The client will need early reduction of the dislocation to prevent complications. Explanation: Hip dislocation is an emergency. The disorder is typically accompanied by severe pain and inability to move the lower extremity. In the dislocated position, great tension is placed on the blood supply to the femoral head and avascular necrosis may result. To prevent this complication, early reduction is indicated. Weight bearing is usually limited after reduction to prevent the dislocation from reoccurring and allow healing to occur. Page 1083
Which client should be seen first?
The client with an avulsion Explanation: Sprains involve the ligamentous structures surrounding the joint. Grade 4 is the most severe, and involves an avulsion, which is when the ligament pulls off a section of bone. The other sprains are less severe (grade 1, 2, 3). Page 1080
Which of the following is the first thing a nurse should say to a parent who asks, "What is femoral anteversion? I was told my daughter has this."
"How old is your daughter?" The nurse should first ascertain the age of the child, as it is commonly seen in young girls. It does not matter who told the parent that their daughter has this. The nurse should never say "don't worry." It is not a bone displacement.
A 17 year-old male has been diagnosed with osteosarcoma of the upper tibia following several months of leg pain. Which of the following statements by the client demonstrates that he has an accurate understanding of his diagnosis?
"I'm really nervous about having to get surgery and chemo." Explanation: Osteosarcomas are malignant bone tumors that are treatable by surgery and chemotherapy. Survival is in the range to 55-70%, so death is not uncommon. Amputation is sometimes necessary, but is certainly not an inevitability. Page 1096
While being tackled, a 20 year-old football player put out his hand to break his fall to the ground. Because the intense pain in his wrist did not subside by the end of the game, he was brought to an emergency department where diagnostic imaging indicated an incomplete tear of the ligament surrounding his wrist joint. At the time of admission, his wrist was swollen with a severely restricted range of motion. What will his care team most likely tell the player about his diagnosis and treatment?
"It looks like a mild to moderate sprain and you'll need to keep it immobilized for a few weeks." Explanation: Damage to the ligament structures is associated with sprains, and an incomplete tear would be indicative of a mild to moderate (grade one or two) sprain. A strain is associated most commonly with overuse and severe sprain would involve total disruption of the ligament. Page 1079
The client asks, "What is reduction"? How will the nurse respond?
"It refers to realigning the bone." Explanation: Reduction is the term for when bones are realigned to restore their original structure. Page 1085
A new mother asks, "why are you examining my babies' hips?" Which of the following is the nurse's best response?
"Musculoskeletal screening is important to identify anything that needs intervention." Explanation: Musculoskeletal screening is important to identify things that need intervention early on. The hips are not most often damaged in birthing and abnormalities here are not linked with other abnormalities. Early ambulation is not a concern at birth. Page 1102
A nurse is teaching the parent of a child with a diagnosis of Legg-Calvè-Perthes disease about the prescribed treatment. Which of the following statements by the parent indicates adequate understanding?
"My child will need to use crutches until the hip heals." Explanation: Treatment for early osteonecrosis depends on the cause. Because there is no injury or infection with Legg-Calvè-Perthes disease, treatment may begin with short-term immobilization, nonsteroidal anti-inflammatory drugs, exercises, and restricted weight-bearing activity. Page 1104
A month after surgical repair of a rotator cuff tear of the shoulder, a patient tells the nurse, "This is not getting any better. I still have a lot of pain and limited motion." Which of the following is the nurse's best response?
"The shoulder joint is complex and can take up to a year to heal completely." Explanation: A rotator cuff repair may take from 6 to 12 months to fully heal. After an extended period of joint rest, the patient will need a rehabilitation program to regain strength, flexibility, and endurance. If the initial injury was mild, conservative treatment with anti-inflammatory agents, corticosteroid injections and physical therapy would be implemented before surgical intervention. Page 1081
Which of the following should the nurse teach a patient about syndactyly?
"This is a simple webbing of the fingers or toes." Explanation: The nurse should tell the patient that syndactyly is a simple webbing of the fingers or toes that occurs at birth. It is not a rare abnormality. It is unknown if it can be prevented. Surgery can remove the webbing. Page 1101
Which of the following is appropriate for the nurse to tell the parent of a child born with polydactyly?
"This is the most common congenital abnormality." Explanation: The nurse can inform the parent that this is the most common congenital abnormality. It is not correct to say it is rare. The nurse should never tell a parent or any patient "not to worry." Because the nurse does not know what caused the congenital abnormality, the nurse does not know if it could or could not have been prevented. Page 1101
What should the nurse include in the teaching plan for a client with a grade 4 sprain?
"You will need to keep your joint immobilized for 4 to 6 weeks." Explanation: The treatment for an avulsion fracture and severe sprain is usually immobilization for 4 to 6 weeks. The client may need surgery, but they will not be able to walk without pain and further injury to the joint. Page 1080
Following genetic testing and a thorough history from the child's mother and father, a 5 month-old boy has been diagnosed with osteogenesis imperfecta. What teaching point should the care team provide to the mother and father?
"You'll need to be very careful to avoid causing fractures to his fragile bones." Explanation: There is no definitive treatment for correction of the defective collagen synthesis that is characteristic of osteogenesis imperfecta, and prevention and treatment of fractures is important. Hip dislocation is not a common manifestation and neither hormone therapy nor calcium supplements are useful in treatment. Page 1102
Which of the following information would the nurse include when teaching potential parents about prevention of congenital deformities? Select all that apply.
-"Do not take any medication without first talking to your healthcare provider." -"Limit exposure to alcohol." Explanation: The nurse should teach women intending to get pregnant to stay away from alcohol and medication. Staying out in the sun and avoiding exercise does not influence congenital defects. Page 1101
Shoulder and rotator cuff injuries usually occur from trauma or overuse. What orders would be given for conservative treatment of an injured shoulder? (Select all that apply.)
-Physical therapy -Corticosteroid injections -Anti-inflammatory agents Explanation: Conservative treatment with anti-inflammatory agents, corticosteroid injections, and physical therapy often is undertaken. A period of rest is followed by a customized exercise and rehabilitation program to improve strength, flexibility, and endurance. Pain medicine and anesthetic injections are not usually prescribed for conservative treatment of a shoulder or rotator cuff injury. Page 1081
A parent brings his child to the emergency department after the child sustains a fall from a tree. The child has severe right arm pain. A radiograph shows a complete break in the humerus with multiple pieces of bone at the fracture line and the skin is not broken. This type of fracture is classified as which of the following?
A closed, comminuted fracture Explanation: The type of fracture is determined by its communication with the external environment, the degree of break in continuity of the bone, and the character of the fracture pieces. A fracture can be classified as open or closed. When bone fragments have broken through the skin, the fracture is called an open or compound fracture. The character of a fracture is determined by its pieces. A comminuted fracture has more than two pieces. A fracture is called impacted when the fracture fragments are wedged together. A greenstick fracture is a type of partial break in the continuity of the bone. Page 1085
The health care provider is caring for a client who has just been diagnosed with an osteosarcoma. Select the response that 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. Page 1096
Which of the following recent admissions to an emergency department is most likely to be diagnosed with a greenstick fracture?
An 8 year-old boy who fell out of a tree and on to his arm. Explanation: A greenstick fracture is seen almost exclusively in children under age 10. Page 1085
The health care provider is evaluating a client who is at risk for the development of osteonecrosis. The client is at risk for:
Aseptic necrosis of a bone segment caused by interruption of the blood supply Explanation: Osteonecrosis, also known as avascular necrosis, is an aseptic destruction of a segment of bone that is due to an interruption in blood flow rather than an infection. It is relatively common and can occur in the medullary cavity of the metaphysis and the subchondral region of the epiphysis, especially in the hips, knees, shoulders, and ankles. Destruction of bone frequently is severe enough to require joint replacement surgery. Page 1091
A child presents to the emergency room with suspected trauma to the growth plate in the ankle during a soccer game. Which of the following steps is the best intervention?
Assess the child for pain and prepare for diagnostic studies. Explanation: Due to the suspected nature of the injury, the child should remain in the emergency department for evaluation of the injury. The nurse should proceed with assessment and treatment while awaiting further intervention. Page 1079
Which of the following should the nurse include in the initial care plan for a child who is "toeing out"?
Assess the child periodically. Explanation: The nurse should instruct the parent to have the child periodically assessed for the resolution of this problem, as toeing out usually corrects itself as the child becomes proficient in walking. Strict exercises are not necessary, and neither is surgery. The child should not limit weight bearing, as walking helps to correct the problem. Page 1098
The nurse is screening a newborn for developmental dysplasia of the hip. Which of the following assessment findings supports this diagnosis?
Asymetrical gluteal and thigh folds Explanation: Asymmetrical gluteal and thigh folds is a common indication that the child should be assessed for dysplasia of the hip. The other assessment findings do not indicate developmental dysplasia of the hip. Page 1103
What is the term use to describe a tumor that while growing slowly does not destroy the surrounding tissues?
Benign Explanation: A benign tumor grows slowly and does not destroy or invade the surrounding tissues. The other options are malignant tumors that do invade surrounding tissues and structures. Page 1095
What is a priority concern for a client who has a hip dislocation?
Blood supply to the femoral head Explanation: The major cause for concern for a client with a hip dislocation is that the dislocated position puts tension on the blood supply to the femoral head and avascular necrosis may result. Restoring or preserving circulation is the priority. Tendonitis and edema is not usually a concern. Pain is a secondary concern. Page 1084
A child has been diagnosed with myopathic neuromuscular scoliosis. What other concurrent diagnosis may the child have?
Cerebral palsy Explanation: Neuromuscular scoliosis develops from neuropathic or myopathic disease. It is seen with cerebral palsy, myelodysplasia, and poliomyelitis. It is not linked to Huntington disease, epilepsy, or Down syndrome. Page 1106
A 16-year-old male football player suffered a fracture of his radius and ulna. Assessment of the fracture includes the following data: the fracture does not protrude through the skin, and both bones broke completely through into two pieces. Select the best description of the injury.
Closed comminuted fracture Explanation: Closed comminuted fracture is a closed fracture because it does not break through the skin. It is comminuted because it broke cleanly into two pieces. A closed greenstick fracture is a fracture that is a partial break in bone continuity, common in young children whose bones are not yet fully ossified. An open spiral fracture is a fracture that breaks through the skin. Thromboemboli is a clot not a fracture. Page 1085
Which of the following statements is true about congenital club foot?
Club foot may be associated with congenital syndromes. Explanation: Club foot may be associated with congenital syndromes; however, it does not only occur with other genetic defects. It is treatable and affects boys more often than girls. Page 1104
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 which of the following?
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 blood stream. Page 1089
A basketball player collided hard with another player and suffered a soft tissue injury to the forearm from the impact though it did not break the skin. The nurse should recognize the presence of which type of injury?
Contusion Explanation: A contusion is an injury to soft tissue that results from direct trauma and is usually caused by striking a body part against a hard object. With a contusion, the skin overlying the injury remains intact. Ecchymotic tissue is a "black and blue" bruise. A sprain, which involves the ligamentous structures (strong bands of connective tissue) surrounding the joint, resembles a strain, but the pain and swelling subside more slowly. A strain is a stretching injury to a muscle or a musculotendinous unit caused by mechanical overloading. Page 1079
What term describes an injury to the soft tissue of the body?
Contusion Explanation: Soft tissue injury from trauma is termed a "contusion". A fracture describes bone breakage, and ligaments and tendons are not classified as soft tissue. Page 1079
The nurse is caring for a client several fractures that have been immobilized. Which of the following assessment data would be most indicative of a potential complication?
Deep, throbbing, 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 throbbing, which 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. Page 1089
A client has developed osteomyelitis and asks the health care provider how the problem occurred. The best response would be:
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. Page 1092
A young adult has been diagnosed with a tumor of the femur, and the health care provider suspects a malignancy. Upon further assessment, the client states that he experiences bone pain, limitation of movement, and tenderness over the involved bone area. Select the most likely diagnosis.
Ewing sarcoma Explanation: Manifestations of Ewing sarcoma include bone pain, limitation of movement, and tenderness over the involved bone or soft tissue. It often is accompanied by systemic manifestations such as fever or weight loss, which may serve to confuse the diagnosis. The primary clinical feature of osteosarcoma is deep, localized pain with nighttime awakening and swelling in the affected bone. Chondrosarcomas are slow growing, metastasize late, and often are painless. Osteonecrosis is an aseptic destruction of a segment of bone. Page 1097
When a 4 year-old boy stands erect with his medial malleoli touching, the distance between his knees is two inches. What is the child's most likely diagnosis and treatment?
Genu varum which can be treated by bracing. Explanation: Genu varum, or bowlegs, can be treated by bracing. The child's stance is not indicative of flatfoot, genu valgum or femoral torsion. Page 1100
A client tells the nurse she is very concerned because the health care provider informed her that her fractured arm is healing with malunion. The nurse recognizes this as:
Healing with deformity, angulation, or rotation that is visible on x-ray films Explanation: Malunion is healing with deformity, angulation, or rotation that is visible on x-ray films. Delayed union is the failure of a fracture to unite within the normal period (e.g., 20 weeks for a fracture of the tibia or femur in an adult). Nonunion is failure to produce union and cessation of the processes of bone repair. Obesity does not influence fracture alignment. Page 1088
The client develops osteomyelitis that has originated from infectious organisms that reach the bone through the bloodstream. This is known as which type of osteomyelitis?
Hematogenous Explanation: Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the bloodstream. The other types are not caused by infectious organisms in the bloodstream. Page 1091
An older adult client has been diagnosed with metastatic bone disease. Which aspect of the client's care plan most directly addresses a common complication of this disease?
Implementing falls prevention measures Explanation: The primary goals in treatment of metastatic bone disease are to prevent pathologic fractures and promote survival with maximum functioning. Preventing falls is imperative due to the sharp decline in bone strength that accompanies the disease. Potassium levels are not likely to be highly unstable and neurologic status is not normally affected. Skin integrity must be monitored, but not to a larger extent than in client's with other diagnoses. Page 1097
What would be the best treatment option for a soft tissue contusion on the right ankle?
Keep the ankle elevated for the first 24 hours Explanation: For a soft tissue contusion the treatment would consist of elevating the affected areas and applying ice not heat for the first 24 hours. Pain medications may be helpful, but the nonpharmacologic treatments would best treat the condition. Surgery is not required. Page 1079
Athletic injuries fall into two types, acute or overuse injuries. Where do overuse injuries commonly occur?
Knee Explanation: Overuse injuries have been described as chronic injuries, including stress fractures that result from constant high levels of physiologic stress without sufficient recovery time. They commonly occur in the elbow ("Little League elbow" or "tennis elbow") and in tissue in which tendons attach to the bone, such as the heel, knee, and shoulder. The other answers are incorrect. Page 1079
The health care provider reviews the following assessment data of a client: • Pain in the front of the knee that is associated with inflammation and thickening of the patellar tendon • Pain during specific activities such as kneeling, running, bicycle riding, or stair climbing • Swelling, tenderness, and increased prominence of the tibial tubercle Based on these findings, the provider determines that the most likely diagnosis would be:
Osgood-Schlatter disease Explanation: Osgood-Schlatter is characterized by pain in the front of the knee that is associated with inflammation and thickening of the patellar tendon. The pain usually is associated with specific activities such as kneeling, running, bicycle riding, or stair climbing. There is swelling, tenderness, and increased prominence of the tibial tubercle. The symptoms usually are self-limiting. They may recur during growth periods but usually resolve after closure of the tibial growth plate. The other options do not apply. Page 1105
The client with sickle cell disease is at risk for development of which bone complication?
Osteonecrosis Explanation: Osteonecrosis, or death of a segment of bone, is a condition caused by interuption of blood supply to the marrow, medullary bone, or cortex in the absence of infection. It is a common complication of sickle cell disease. Osteomyelitis represents an acute or chronic infection of the bone. Benign neoplasms of the bone and CRPS are not associated with sickle cell disease. Page 1093
A 13-year-old girl and her father come in to the local health clinic hoping to see an orthopedic doctor about the girl's stiff and warm knee. The father reports that she hurt it sliding into base during a softball game, and the daughter concurs, but with further discussion it becomes clear that the slide made an existing pain worse. Her knee had been stiff, warm, and shiny, and had been keeping her awake at night for a week or so before the game. Which of the following might be the cause of the girl's symptoms?
Osteosarcoma Explanation: Osteosarcoma is the most common bone tumor in children and the third most common cancer in children and adolescents; they most commonly arise in the vicinity of knee. The primary clinical feature of osteosarcoma is deep localized pain with nighttime awakening and swelling in the affected bone. Because the pain is often of sudden onset, patients and their families often associate the symptoms with recent trauma. The skin overlying the tumor may be warm, shiny, and stretched, with prominent superficial veins. The range of motion of the adjacent joint may be restricted. The four most common types of benign bone tumors are osteoma, chondroma, osteochondroma, and giant cell tumor; pain is a feature common to almost all malignant tumors, but may or may not occur with benign tumors; pain that persists at night and is not relieved by rest suggests malignancy. Page 1096
A patient had a closed reduction of a wrist fracture and had a plaster cast applied. Which of the following nursing actions is the highest priority immediately after the procedure?
Performing a neurovascular assessment (NVA) Explanation: Complications of fractures include compartment syndrome when swelling after the injury impairs blood and nerve function, delayed healing, infection, and emboli. Of these conditions, compartment syndrome has the earliest onset and is monitored by NVA. NVA includes capillary refill, temperature of the distal extremity, and sensation and the ability to move fingertips. Page 1089
A patient with a compound fracture of the femur is in balanced skeletal traction. Which of the following assessment data must be reported immediately?
Redness and heat at fracture site Explanation: Osteomyelitis is an infection in the bone. With a compound fracture, infecting organisms can easily enter the bone through open tissue. Manifestations include chills, fever, malaise, pain of the affected extremity, local tenderness, redness, and swelling. Clear drainage at pin sites is common and does not indicate infection without other indicators. Page 1091
Which of the following assessment findings leads the nurse to believe a child has Blount's disease?
Rotational deformity of the proximal tibia Explanation: Blount's disease is a rotational deformity of the proximal tibia, especially when unilateral involvement suggests tibia vara (Blount's disease). Page 1101
A patient asks the nurse why their hip fracture (head of the femur) bone has died (osteonecrosis). The nurse responds based on which of the following pathophysiological principles?
Since the head of the femur has only limited collateral circulation, interruption in the blood flow from the fracture causes necrosis and irreversible damage. Explanation: Bone has a rich blood supply that varies from site to site. The flow in the medullary portion of bone originates in nutrient vessels from an interconnecting plexus that supplies the marrow, trabecular bone, and endosteal half of the cortex. Some bony sites, such as the head of the femur, have only limited collateral circulation, so that interruption of the flow, such as with a hip fracture, can cause necrosis of a substantial portion of medullary and cortical bone and irreversible damage. Not all fractures interrupt blood supply to the bone. It is not common for the entire head of the femur to break off leaving the area with no blood supply. Page 1093
Tuberculosis can spread from the lungs into the musculoskeletal system. What is the most common site in the skeletal system for tuberculosis to be found?
Spine Explanation: Any bone, joint, or bursa may be affected, but the spine is the most common site, followed by the knees and hips. The ankles and shoulders are not common sites for tuberculosis to be found. Page 1092
What intervention will the nurse perform first for the client who has a new fracture of their leg?
Teach the client about X-ray examination Explanation: The client who has a new fracture will need an X-ray exam to confirm the diagnosis and determine what treatment is necessary. This needs to be done before any other treatment. Page 1085
When trying to explain to a patient diagnosed with a benign bone tumor, the nurse should emphasize the fact that benign tumors primarily:
Tend to grow very slowly without destroying the supporting tissue. Explanation: Benign tumors, such as osteochondromas, tend to grow rather slowly and usually do not destroy the supporting or surrounding tissue or spread to other parts of the body (metastasize). Malignant tumors ten to grow rapidly, destroy supporting or surrounding tissue, or spread to other parts of the body through the bloodstream or lymphatics. Page 1095
Which client admitted to the emergency department should the nurse prioritize to see first?
The client with a puncture wound of the chest. Explanation: Puncture wounds into the chest have the potential to have caused significant damage to internal organs and should be seen first. The other clients have lower priority. Page 1079
Which of the following statements is true about treatment of developmental dysplasia of the hip?
Treatment needs to be individualized. Explanation: Treatment for developmental dysplasia of the hip needs to be individualized. Subluxation often resolves on it's own. Treatment should be completed within 6 months after birth. Not all infants will need surgery. Page 1103
A 56 year-old male is obese and has poorly-controlled type 2 diabetes mellitus. The home care nurse who changes the dressing on his chronic foot ulcer three times weekly has noted that the client's bone is now visible in the wound bed. The client has a fever and has not complained of any notable increase in pain to his foot. Which of the following statements best captures what is likely occurring?
Vascular insufficiency has contributed to infection in both soft tissue and now his bone. Explanation: Diabetes is strongly associated with vascular insufficiency; this process is more likely than infection from the bloodstream, and his situation is not indicative of direct penetration osteomyelitis. Decreased immune status is not directly responsible for his problem. Page 1092
A client with a fractured clavicle is told that the bone will heal well if immobilized for the next 6 to 8 weeks, but there will be a large "bump" where the break occurred. This bump will be caused by:
formation of a bony callus. Explanation: The bony callus is still present due to the misalignment of the ends of the bone (occurs only with clavicle or improperly placed healing). This is not formed by scar tissue and is not the result of scarring or dead white cells. Page 1087
A client has sought care, reporting bone pain. Diagnostic testing reveals that the client has developed osteonecrosis. When addressing the most likely cause of this complication, the nurse should focus on:
the quality and quantity of blood flow to the site. Explanation: Ischemia is the essential cause of osteonecrosis. Anemia is not a noted cause and NSAIDs are not linked to the disease. Weight bearing does not cause osteonecrosis, even when heavy or repeated. Page 1093
Which of the following should the nurse teach the parent whose child was diagnosed with osteogenesis imperfecta? Select all that apply.
-"This is a hereditary disease." -"This is a disease characterized by defective collagen." -"Your child will need to be protected from trauma." -"Hearing loss is very common." Explanation: The nurse should teach the parent that this disease is hereditary and caused by defective collagen. Protection from trauma is important, and hearing loss is common. The child will not grow out of the disease. Page 1101
A 22 year-old woman has sustained a lateral blow to her right knee during a game, and subsequent imaging has confirmed a severe meniscus injury. Which of the following consequences should the woman expect over the course of recovery? Select all that apply.
-Decreased stability of the knee -Decreased lubrication in the knee joint -Reduced shock absorption capacity Explanation: Meniscal injuries have consequences for the lubricating and shock absorption capacities of the meniscus, and would involve decreased range of motion. An infectious process is unlikely due to the internal nature of meniscal injuries, and healing is typically very slow. Page 1082
Which statements are true regarding bone remodeling? Select all that apply.
-Osteoclasts gradually remove dead bone. -Mineralized bone is present along the lines of the injury. Explanation: During remodeling dead portions of the bone are gradually removed by osteoclasts. Compact bone replaces spongy bone around the periphery of the fracture, and there is reorganization of mineralized bone along the lines of mechanical stress. The final structure of the remodeled area resembles that of the original unbroken bone; however, a thickened area on the surface of the bone may remain as evidence of a healed fracture Page 1087
Which of the following events in a patient's history increase the risk of developing osteoarthritis? Select all that apply.
-Torn meniscus in left knee at age 19 -Obesity following pregnancy at age 24 -Hip dislocation at age 35 Explanation: Knee injuries in young to middle adulthood increase the risk of osteoarthritis, as do hip injuries in middle age. Obesity increases stress on weight-bearing joints and increases risk of osteoarthritis. Fractures in young children and chicken pox are not considered risks for osteoarthritis. Page 1082
Osteomyelitis is an infection of the bone. Chronic osteomyelitis is complicated by a piece of infected dead bone that has separated from the living bone. How long does the initial intravenous antibiotic therapy last for chronic osteomyelitis?
6 weeks Explanation: Intravenous therapy is usually needed for up to 6 weeks. Initial antibiotic therapy is followed by surgery to remove foreign bodies (e.g., metal plates, screws) or sequestra and by long-term antibiotic therapy. The other answers are incorrect. Page 1092
The nurse knows that which of the following patients listed below is at high risk for developing a hip fracture?
82 year old female with macular degeneration and uses a walker to go to the bathroom. Explanation: Hip fracture is a major public health problem in the Western world. The incidence of hip fractures increases with age. The incidence is also higher in white women compared with nonwhite women. Risk factors for hip fracture include low BMI, tall body structure, use of benzodiazepines, lack of exercise, previous injury to lower body extremity, vision problems, and confusion. Page 1083
Which of the following individuals is likely to have the highest risk of developing tuberculosis osteomyelitis?
A 79 year-old man who is immunocompromised following a bone marrow transplant. Explanation: Older age and immunocompromised status are noted risk factors for the development of tuberculosis osteomyelitis. Post-surgical status and diabetes are not noted to be strongly associated with the pathology. Page 1092
Which of the following newborn infants demonstrates the highest risk of presenting with developmental dysplasia of the hip (DDH)?
A girl who was born with toeing-in and who was in a breech presentation. Explanation: Female sex, a history of breech presentation and congenital skeletal abnormalities are all correlated with DDH. Respiratory emergencies, delivery by caesarian section, advanced age of the mother, Down syndrome and drug exposure are not noted risk factors for DDH. Page 1102
A nursing student who is studying about disorders of the skeletal system is heard making the following statement, "Many skeletal disorders of early infancy are caused by intrauterine positions and need to be surgically fixed." Is this statement true or false?
False Explanation: Although it is true that many disorders of early infancy are caused by intrauterine positions, they are mostly resolved as the child grows. Page 1098
A client who was involved in an automobile accident experienced major trauma and sustained a fractured femur. The nurse notices the following changes 4 hours after admission to the critical care unit: • Disorientation • Dyspnea • Tachycardia • Low-grade temperature • Diaphoresis • Substernal chest pain The nurse suspects:
Fat embolism syndrome (FES) Explanation: The main clinical features of FES are respiratory failure, cerebral dysfunction, and skin and mucosal petechiae. Cerebral manifestations include encephalopathy, seizures, and focal neurologic deficits unrelated to head injury. Initial symptoms begin within a few hours to 3 to 4 days after injury and include a subtle change in behavior and signs of disorientation resulting from emboli in the cerebral circulation combined with respiratory depression. There may be complaints of substernal chest pain and dyspnea accompanied by tachycardia and a low-grade fever. Diaphoresis, pallor, and cyanosis become evident as respiratory function deteriorates. The other options would not have these manifestations. Page 1090
A patient sustains a musculoskeletal injury of the wrist. Which of the following manifestations would the nurse expect to accompany the strain?
Pain and stiffness Explanation: Manifestations common among musculoskeletal injuries are pain and swelling. Differences arise from the type of injury. Strains occur in muscles from overstretching and usually have no external evidence, but there is pain, stiffness, and swelling. Sprains occur when the ligaments supporting a joint are torn. Mild sprains involve only a few strands of the ligament, while a severe sprain can completely separate the ligament from the bone. Swelling, pain, heat, discoloration, and limited function are common signs of sprain. A fracture involves break in the integrity of a bone. Signs and symptoms of fracture include pain, tenderness at the site, swelling, loss of function, deformity, and abnormal mobility, or false motion. A dislocation occurs when the bone ends of a joint are separated. Symptoms include pain, deformity, and loss of function. A loose body is a small piece of bone or cartilage in the joint. It can cause catching and locking of the joint. Page 1079
The nurse assesses the neurovascular status of a patient who had surgery to repair a fractured hip. Which of the following assessment data for the affected leg indicates that the patient has developed a neurological complication?
Tingling sensations Explanation: Complications of fractures include compartment syndrome when swelling after the injury impairs blood and nerve function, delayed healing, infection, and emboli. Of these conditions, compartment syndrome has the earliest onset. The neurologic assessment includes sensation and the ability to move the toes. Vascular assessment includes capillary refill, edema, and temperature of the distal extremity. Page 1089
A 2-year-old has bowing of the legs. Which of the following is when the health care professional should be concerned?
When there is a large separation between the knees greater than 15 degrees Explanation: If a child older than 2 years of age has a separation between the knees greater than 15 degrees, the child may require bracing. The health care professional would be most concerned about this. A separation less than 10 degrees is not concerning. The child being overweight does not cause the bowing. The child can sit in the tailor position; this is not a concern. Page 1100
