450 ch 39 prep u

The nurse is conducting the admission assessment for a client who is to undergo an arthrogram. What is the priority question the nurse should ask?

"Do you have any allergies?" Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood. Asking about eating or urinating is important but not priority. The claustrophobia is not a concern for the arthrogram.

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?

"I should use my heating pad this evening to reduce some of the pain in my knee." The client requires additional teaching if he states that he'll use a heating pad to reduce pain the evening of the procedure. The client shouldn't use heat at the procedure site during the first 24 hours because doing so may increase localized swelling. Ice is indicated during this time. Elevating the extremity helps reduce swelling. The client may experience some discomfort after the procedure for which the physician may order medication. Bruising and swelling are common after an arthroscopy.

A patient tells the nurse, "I was working out and lifting weights and now that I have stopped, I am flabby and my muscles have gone!" What is the best response by the nurse?

"Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued." Muscles need to exercise to maintain function and strength. When a muscle repeatedly develops maximum or close to maximum tension over a long time, as in regular exercise with weights, the cross-sectional area of the muscle increases. This enlargement, known as hypertrophy, results from an increase in the size of individual muscle fibers without an increase in their number. Hypertrophy persists only if the exercise is continued.

Which statement describes paresthesia?

Abnormal sensations Abnormal sensations, such as burning, tingling, and numbness, are referred to as paresthesias. The absence of muscle tone suggesting nerve damage is referred to as paralysis. A fasciculation is the involuntary twitch of muscle fibers. A muscle that holds no tone is referred to as flaccid.

The nurse is providing care to a client following a knee arthroscopy. What would the nurse expect to include in the client's plan of care?

Administering the prescribed analgesic. After an arthroscopy, the client's entire leg is elevated without flexing the knee. A cold pack is placed over the bulky dressing covering the site where the arthroscope was inserted. A prescribed analgesic is administered as necessary. The client is allowed to resume his or her usual diet as tolerated.

A client arrives at the orthopedic physician's office stating knee pain sustained while playing soccer. A history and physical assessment is completed. The knee appears reddened with edema. Which other diagnostic testing would the nurse anticipate?

An arthroscopy -the internal inspection of the joint using an arthroscope. The physician can inspect the joint for injury or deterioration and can also complete therapeutic procedures such as removing bit of torn or floating cartilage.

A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration?

An electromyography tests the electrical potential of muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration. A serum calcium test evaluates the calcium in the blood. An arthroscopy assesses changes in the joint. An MRI identifies abnormalities in the targeted area.

Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist?

Arthrography Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. Meniscography is a distractor for this question. Bone densitometry is used to estimate bone mineral density. An EMG provides information about the electrical potential of the muscles and nerves leading to them.

Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy?

Aspirin has anti-clotting properties, and bone is a very vascular tissue. The client taking aspirin in close proximity to a bone biopsy is at increased risk for excessive bleeding.

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone?

Calcitonin

Which hormone inhibits bone resorption and increases the deposit of calcium in the bone?

Calcitonin secreted by the thyroid gland in response to elevated blood calcium levels, inhibits bone reabsorption and increases the deposit of calcium in the bone.

Which is an indicator of neurovascular compromise?

Capillary refill of more than 3 seconds is an indicator of neurovascular compromise. Other indicators include cool skin temperature, pale or cyanotic color, weakness, paralysis, paresthesia, unrelenting pain, pain upon passive stretch, and absence of feeling. Cool skin temperature is an indicator of neurovascular compromise. Unrelenting pain is an indicator of neurovascular compromise. Pain upon passive stretch is an indicator of neurovascular compromise.

What is the term for a rhythmic contraction of a muscle?

Clonus a rhythmic contraction of the muscle. Atrophy is a shrinkage-like decrease in the size of a muscle. Hypertrophy is an increase in the size of a muscle. Crepitus is a grating or crackling sound or sensation that may occur with movement of ends of a broken bone or irregular joint surface.

The nurse is performing a neurovascular assessment of a client's injured extremity. Which would the nurse report?

Dusky or mottled skin color

A nurse understands the influence of hormones on bone maintenance. Therefore, the nurse knows that a patient on long-term cortisol may experience:

Increased bone resorption. Increased levels of cortisol result in increased bone resorption and decreased bone formation. These patients are at increased risk for steroid-induced osteopenia and fractures.

Which term refers to mature compact bone structures that form concentric rings of bone matrix?

Lamellae are mineralized bone matrices. Endosteum refers to the marrow cavity lining of hollow bone. Trabecula refers to latticelike bone structure. Cancellous bone refers to spongy, latticelike bone structure.

The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding?

Lordosis is an exaggeration of the lumbar spine curve.

The nurse would expect which of the following age-related change of the musculoskeletal system?

Loss of bone mass Age-related changes include gradual, progressive loss of bone mass after age 30 years, decreased elasticity of tendons, thinning of intervertebral discs, and muscle atrophy.

After a person experiences a closure of the epiphyses, which statement is true?

No further increase in bone length occurs.

An osteocalcin (bone GLA protein) level has been ordered. How will the nurse prepare for this order?

Obtain a blood specimen. An osteocalcin level is determined from a blood sample. It is used to assess the rate of bone turnover.

A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells?

Ossification and calcification Ossification and calcifications the body's process to transform osteoblasts into mature bone cells called osteocytes. Osteocytes are involved in maintaining bone tissue. Resorption and remodeling are involved in bone destruction. Epiphyses and diaphyses are bone tissues that provide strength and support to the human skeleton.

An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification?

Osteoblasts Osteoblasts secrete bone matrix (mostly collagen), in which inorganic minerals, such as calcium salts, are deposited. This process of ossification and calcification transforms the blast cells into mature bone cells, called osteocytes, which are involved in maintaining bone tissue. Cortical bone is dense hard bone found in the long shafts; cancellous bone is spongy bone found in the irregular rounded edges of bone.

The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.)

Pale, cyanotic, or mottled color Cool temperature of the extremity More than 3-second capillary refill

The nurse observes a client with a shuffling gait. What disease is commonly associated with a shuffling gait?

Parkinson's disease Client with Parkinson's disease may have a shuffling gait. Clients with a lower motor disease will have steppage gait. Clients with scoliosis may have a limp. Clients with Paget's disease may have bone fractures.

Red bone marrow produces which of the following? Select all that apply.

Platelets White blood cells (WBCs) Red blood cells (RBCs)

The nurse is caring for a client who experienced a crushing injury of the lower extremities. Which of the following symptoms is essential to be reported to the physician?

Pulselessness Neurovascular checks (circulation, sensation, motion) are essential with a crushing injury. The absence of a pulse is a critical assessment finding to report to the physician. The other options are symptoms that need regular assessment.

After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement?

Remodeling the final stage of fracture repair. During inflammation, macrophages invade and debride the fracture area. Revascularization occurs within about 5 days after a fracture. Callus forms during the reparative stage but is disrupted by excessive motion at the fracture site.

A client has just undergone arthrography. What is the most important instruction for the nurse to include in the teaching plan?

Report joint crackling or clicking noises occurring after the second day. After undergoing arthrography, the client must be informed that he or she may hear crackling or clicking noises in the joints for up to 2 days, but if noises occur beyond this time, they should be reported. These noises may indicate the presence of a complication, and therefore should not be ignored or treated by the client. Massage is not indicated. The client need not be asked to avoid sunlight or dairy products.

Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis?

Risk for infection

A client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for?

Serous drainage

Which laboratory study indicates the rate of bone turnover?

Serum osteocalcin Urine calcium concentration increases with bone destruction. Serum calcium concentration is altered in clients with osteomalacia and parathyroid dysfunction. Serum phosphorous concentration is inversely related to calcium concentration and is diminished in osteomalacia associated with malabsorption syndrome.

A client is seen in the emergency room for a knee injury that happened during a basketball game. Diagnostic tests reveal torn cords of fibrous connective tissue that connect muscles to bones. What type of tear has this client sustained?

Tendon Tendons are broad, flat sheets of connective tissue that attach muscles to bones, soft tissue, and other muscles. Ligaments bind bones together. A bursa is a synovial-filled sac, and fascia surround muscle cells.

The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site?

The fracture is on the diaphysis. A fracture that is on the diaphysis is understood to be chiefly found in the long shafts of the arms and legs. The epiphyses are rounded, irregular ends of the bones.

A patient has a fracture of the right femur sustained in an automobile accident. What process of fracture healing does the nurse understand will occur with this patient?

The process of fracture healing occurs over three phases. These include the following: Phase I: Reactive phase; Phase II: Reparative phase; and Phase III: Remodeling phase.

Which term refers to the shaft of the long bone?

diaphysis is primarily cortical bone. An epiphysis is an end of a long bone

bone densitometry

estimates bone density

A patient has had a stroke and is unable to move the right upper and lower extremity. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding?

flaccidity A muscle that is limp and without tone is described as flaccid; a muscle with greater-than-normal tone is described as spastic. Conditions characterized by lower motor neuron destruction (e.g., muscular dystrophy), denervated muscle becomes atonic (soft and flabby) and atrophies.

arthrocentesis

is the aspiration of synovial fluid. An arthrocentesis may be completed during an arthroscopy

The nurse is conducting a medication reconciliation with a client admitted with a fracture. What medication predisposes a client for a risk for fractures?

prednisone Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures. Furosemide, digoxin, and metoprolol do not interfere with bone resorption or predispose clients to fractures.

A nurse practitioner assesses a patient's movement in his left hand after a cast is removed. The nurse asks the patient to turn his wrist so the palm of his hand is facing up. This movement is known as:

supination

bone scan

used to detect metastatic bone lesions, fractures, or inflammatory disorders.

The nurse is admitting an older adult to a skilled nursing facility. What assessment parameters will the nurse expect to find with the musculoskeletal assessment? Select all that apply.

-decreased endurance -joint stiffness -decreased range of motion Significant assessment findings of the musculoskeletal system in the older adult would include joint stiffness and decreased height, range of motion, muscle strength, and endurance. Older adults may have decreased height from osteoporosis and decreased muscle strength from atrophy.

Your patient presents for hip replacement surgery (Arthroplasty). What would warrant a call to the Physician prior to surgery?

I stopped my Eliquis two days ago. eliquis or apixaban is for DVT (blood thinner) puts patients at risk or bleeding

Which cells are involved in bone resorption?

Osteoclasts Osteoclasts carry out bone resorption by removing unwanted bone while new bone is forming in other areas. Chondrocytes are responsible for forming new cartilage. Osteoblasts are bone-forming cells that secrete collagen and other substances. Osteocytes, derived from osteoblasts, are the chief cells in bone tissue.

Which of the following is the most common site of joint effusion?

The most common site for joint effusion is the knee. If inflammation or fluid is suspected in a joint, consultation with a provider is indicated. The elbow, hip, and shoulder are not the most common site of joint effusion.

A client is recovering from a fractured hip. What would the nurse suggest that the client increase intake of to facilitate calcium absorption from food and supplements?

increase the intake of vitamin D vitamin D protects against bone loss and decreases the risk of recurring fracture by facilitating calcium absorption from food and supplements. Amino acids and vitamin B6, though important, do not facilitate the absorption of calcium. Dairy products also do not facilitate the absorption of calcium; however, the exception to this is vitamin D-fortified milk.

A client has recently undergone an invasive joint examination to enable the identification of bone composition. Which signs and symptoms should the nurse monitor in this client?

swelling and bleeding If the client has undergone an invasive joint examination, such as a biopsy, the nurse should inspect the area for swelling and bleeding. A client is unlikely to experience a hypersensitivity or nausea after the procedure is completed. Neurologic symptoms are unlikely.

Which is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes?

Compartment syndrome Compartment syndrome is caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes. Remodeling is a process that ensures bone maintenance through simultaneous bone resorption and formation. Hypertrophy is an increase in muscle size. Fasciculation is the involuntary twitch of muscle fibers.

Which of the following is an example of a hinge joint?

Hinge joints permit bending in one direction only and include the knee and elbow. The hip is a ball-and-socket joint. The joint at the base of the thumb is a saddle joint. Gliding joints allow for limited movement in all directions and are represented by the joints of the carpal bones in the wrist.

An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification?

Osteoblasts secrete bone matrix (mostly collagen), in which inorganic minerals, such as calcium salts, are deposited. This process of ossification and calcification transforms the blast cells into mature bone cells, called osteocytes, which are involved in maintaining bone tissue. Cortical bone is dense hard bone found in the long shafts; cancellous bone is spongy bone found in the irregular rounded edges of bone.

A 10-year-old boy who was brought to the emergency room after a skiing accident is diagnosed with a fracture of the distal end of the femur. Why is this type of fracture significant?

Potential growth problems may result from damage to the epiphyseal plate. The distal and proximal ends of a long bone are called epiphyses, which are composed of cancellous bone. The epiphyseal plate, which separates the epiphyses from the diaphysis, is the center for longitudinal growth in children. Its damage can be a critical indictor of potential growth problems if fractured. All other choices are wrong.

Which diagnostic test would the nurse expect to be ordered for a client with lower extremity muscle weakness?

electromyography The EMG provides information about the electrical potential of the muscles and the nerves leading to them. The test is performed to evaluate muscle weakness, pain, and disability. An arthrocentesis, bone scan, and biopsy does not measure muscle weakness.