Ch. 43 PrepU quiz

Aggressive; malignant bone tumor

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.

Aseptic necrosis of a bone segment caused by interruption of the blood supply

The health care provider is evaluating a client who is at risk for the development of osteonecrosis. The client is at risk for:

A uniform and well-defined area with well-demarcated edges

The health care provider is evaluating a client with a suspected benign bone tumor. The provider confirms the diagnosis after evaluation of the client's x-ray results. Select the best description of the results.

Promoting adequate nutrition for a patient with a recent fracture

A nurse is planning care for patients with musculoskeletal disorders. Which of the following goals is appropriate for the patients?

The woman experiences intermittent, painful locking of her joint.

A 41 year-old woman has been diagnosed as having a loose body of cartilage in her left knee. What data would be most likely to lead clinicians to this conclusion?

"One of the risks that these steroids bring is the possibility that part of a bone might die."

A 51 year-old male with a history of hypertension has received a kidney transplant. The client's physician is explaining some of the consequences of the procedure, including the fact that he will need to be on long term steroid therapy. Which of the following teaching points should the physician emphasize?

Prevention of pathologic fractures.

A 56 year-old female with a diagnosis of breast cancer has developed bone metastases, which her oncologist would like to treat with radiation therapy. What is her physician's most likely primary goal in the treatment plan of the metastases?

Vascular insufficiency has contributed to infection in both soft tissue and now his bone.

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?

Legg-Calve-Perthes disease

A 6-year-old child has developed idiopathic osteonecrotic disease of the proximal (capital) femoral epiphysis. The health care provider would recognize this as:

Healing with deformity, angulation, or rotation that is visible on x-ray films

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:

The client will need early reduction of the dislocation to prevent complications.

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:

formation of a bony callus.

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:

structural scoliosis

A curvature of the spine that does not correct with bending is known as

Assessment of motor and sensory function with the goal of identifying compartment syndrome.

A nurse is providing care for a client who has had a cast applied to her fractured arm 6 hours prior. The client is now complaining of severe pain that she describes as "even worse than when I broke my arm." What would be the nurse's best course of action?

"My child will need to use crutches until the hip heals."

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?

Surgical hip replacement and early mobilization

An 80-year-old client is admitted to the hospital with a displaced intracapsular hip fracture. The physician explains to the client's family that this type of fracture is best treated by which of the following?

Implementing falls prevention measures

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?

• No weight bearing on the femur. • Bedrest. • Traction.

Child/parents are coming into the physician's office to get the results of some diagnostic testing relating to their knee pain and unusual stiffness and fatigue. The physician suspects the child may have slipped capital femoral epiphysis. The nurse should anticipate that the treatment will involve: (Select all that apply).

"You'll need to be very careful to avoid causing fractures to his fragile bones."

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?

Antimicrobial treatment depending on the microbe.

Following prosthetic joint replacement of the knee, the patient continues to complain of pain and discomfort above what would be expected. There is poor incisional healing. The clinic nurse is concerned when she sees that the incision is still draining after three weeks post-op. The nurse suspects a prosthetic joint infection. The nurse should anticipate the physician will prescribe:

Prevent pathologic fractures Promote survival with maximum functioning Maintain mobility and pain control

Metastatic bone diseases are the most common malignancies of osseous tissue. They occur at a time when primary tumors in the lungs, breasts, and prostate seed themselves (metastasize) to the musculoskeletal system. What are the primary goals of treatment for metastatic bone disease? (Select all that apply.)

Thickening of patellar tendon

Osgood-Schlatter disease is a disease that strikes children between the ages of 11 and 15. This disease involves microfractures, where the patellar tendon inserts into the tibial tubercle. What is Osgood-Schlatter disease characterized by?

• Triangular appearance to face • Blue or gray sclera • Scoliosis

Osteogenesis imperfecta is the most common hereditary bone disease. What are the manifestations of osteogenesis imperfecta? (Select all that apply.)

Nighttime awakening

Osteosarcoma is an aggressive malignancy of the bone. What is the primary clinical feature of osteosarcoma?

Because of the deformity it causes

Scoliosis is an abnormal curvature of the spine. Why is it first noticed?

Physical therapy Corticosteroid injections Anti-inflammatory agents

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.)

"It refers to realigning the bone."

The client asks, "What is reduction"? How will the nurse respond?

Knee

The client experiences a meniscus injury. The physical therapist understands this involves which of the following joints?

Osteonecrosis

The client with sickle cell disease is at risk for development of which bone complication?

Compartment syndrome

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?

Fat embolism syndrome (FES)

The nurse is caring for a client who sustained a femur fracture three days before. The nurse notes that the client, who was previously oriented, now doesn't know where he is. The nurse suspects which of the following conditions?

Asymetrical gluteal and thigh folds

The nurse is screening a newborn for developmental dysplasia of the hip. Which of the following assessment findings supports this diagnosis?

82 year old female with macular degeneration and uses a walker to go to the bathroom.

The nurse knows that which of the following patients listed below is at high risk for developing a hip fracture?

• Loss of function • Pain • Swelling

What are typical assessment findings the nurse expects to find in a client with a simple fracture of the leg? Select all that apply

Teach the client about X-ray examination

What intervention will the nurse perform first for the client who has a new fracture of their leg?

Blood supply to the femoral head

What is a priority concern for a client who has a hip dislocation?

Shock absorption

What is the purpose of the meniscus?

Benign

What is the term use to describe a tumor that while growing slowly does not destroy the surrounding tissues?

"You will need to keep your joint immobilized for 4 to 6 weeks."

What should the nurse include in the teaching plan for a client with a grade 4 sprain?

Contusion

What term describes an injury to the soft tissue of the body?

Keep the ankle elevated for the first 24 hours

What would be the best treatment option for a soft tissue contusion on the right ankle?

"The bone is partially out of the joint when it is subluxated."

What would the nurse include in the teaching plan of a client who asks "What is a subluxation?"

Osteosarcoma

A 13-year-old girl and her father have come to emergency department for assessment of the girl's stiff and warm knee. The father reports that she hurt it sliding into base during a softball game, but later in the interview 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 condition might be the cause of the girl's symptoms?

Closed comminuted fracture

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.

"I'm really nervous about having to get surgery and chemo."

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?

When there is a large separation between the knees greater than 15 degrees

A 2-year-old has bowing of the legs. Which of the following is when the health care professional should be concerned?

• Decreased lubrication in the knee joint • Reduced shock absorption capacity • Decreased stability of the knee

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.

Contusion

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?

Cerebral palsy

A child has been diagnosed with myopathic neuromuscular scoliosis. What other concurrent diagnosis may the child have?

Assess the child for pain and prepare for diagnostic studies.

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?

Pain in front of the knee

A child with Osgood-Schlatter disease most often presents with which of the following assessment findings?

Direct contamination of an open wound

A client has developed osteomyelitis and asks the health care provider how the problem occurred. The best response would be:

the quality and quantity of blood flow to the site.

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:

"A strain is a stretching injury. You need to rest your back."

A client is admitted to the emergency department with a muscle strain to the back. What is an appropriate statement for the nurse to make to this client?

Assess the child for pain and prepare for diagnostic studies.

A client sustained a fall that resulted in an injury to the right shoulder, and the emergency doctor suspects a rotator cuff injury. The client would most likely manifest: Select all that apply.

"We'll likely need to start putting the first of a series of casts on her legs quite soon."

A female toddler has been diagnosed with toeing-in (metatarsus adductus). What teaching should the pediatrician provide to the parents of the child about her diagnosis?

"The shoulder joint is complex and can take up to a year to heal completely."

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?

"Musculoskeletal screening is important to identify anything that needs intervention."

A new mother asks, "why are you examining my babies' hips?" Which of the following is the nurse's best response?

Vertebrae

A newly admitted client's health record states that the client's health history includes tubercular osteomyelitis. Where is the most likely anatomical site of this infection?

Grade 2

A nurse admitting a patient to the emergency department with a suspected fracture notes a deep abrasion with bruising. The patient reports receiving a hard tackle during a football game. Which of the following grades of tissue damage accompanies this fracture?

false

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?

• Fever • Redness • Periosteal elevation

A parent brings a child to the clinic because the child has a notable limp and states there is a lot of leg pain. There was no history of injury. Which of the following assessment data corresponds to a diagnosis of osteomyelitis? Select all that apply.

A closed, comminuted fracture

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?

Since the head of the femur has only limited collateral circulation, interruption in the blood flow from the fracture causes necrosis and irreversible damage.

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?

Performing a neurovascular assessment (NVA)

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?

• Take ibuprofen for pain. • Bend knees to pick up objects. • Reduce activity for a few days.

A patient is seen in the emergency department and is diagnosed with a strained back. Which of the following instructions should the nurse provide? Select all that apply.

X-ray shows minimal calcification at the fracture.

A patient returns to the doctor's office for evaluation 6 weeks after a tibial fracture. Which of the following assessments indicates the potential for nonunion?

Applying ice and sitting out the rest of the game

A patient suffers a musculoskeletal injury while participating in a sporting event. Which of the following is the appropriate initial treatment?

Swelling Discoloration Abnormal mobility Loss of function

A patient sustains a musculoskeletal injury of the right foot. In addition to pain, which of the following manifestations would accompany a fracture? Select all that apply.

Pain and stiffness

A patient sustains a musculoskeletal injury of the wrist. Which of the following manifestations would the nurse expect to accompany the strain?

Biopsy

A patient who is a recent immigrant from a developing country visits the clinic with a low-grade fever, elevated white blood count, and pain in the back and hips. Which of the following tests will confirm the diagnosis of spinal tuberculosis (TB)?

Redness and heat at fracture site

A patient with a compound fracture of the femur is in balanced skeletal traction. Which of the following assessment data must be reported immediately?

"The potentially harmful outcomes of screening have been shown to outweigh the benefits."

A public health nurse has learned that a colleague has been screening for scoliosis during visits made to schools even though such screening is not mandated. How should the nurse best respond to the colleague?

"Most hip fractures are actually a break at the very top of the thigh bone."

A public health nurse is conducting a health promotion teaching session at a seniors' drop-in center. Which of the following teaching points about hip fractures in older adults is most justified?

ewing sarcoma

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.

Osgood-Schlatter disease

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:

Deep, throbbing, unrelenting pain

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?

• Endocrine conditions • Malabsorption disorders • Malignancies • Alcoholism • certain medications

The nursing student who is studying about osteoporosis correctly identifies which of the following to be conditions associated with secondary osteoporosis? Check all that apply.

"The child's measurements fit within the acceptable assessment period; treatment is not necessary at this time."

The parents of a 6-year-old child diagnosed with bilateral genu valgum (knock knees) ask the health care provider when treatment will begin to correct the problem. The best response would be:

"This harness allows your baby some mobility as it slowly brings the leg back into abduction."

The parents of a newborn who has been diagnosed with developmental dysplasia of the hip ask the nurse about the reason this harness has to be on their child. The nurse responds:

Cold, pale toes on the side with the cast. Patient complaining of tingling and numbness in the casted leg.

The parents of an active 9-year old is leaving the emergency department (ED) following cast placement for their sons lower extremity as a result of a fall in soccer. The nurse should emphasize that assessment of the cast is important and that they should bring their son back to the ED if they note which of the following signs/symptoms? Select all that apply.

Formation of a large clot; neovascularization; continued formation of the callus; reconstruction

The pathophysiology student is reviewing the stages of the healing process. The student explains that the process follows which order?

Ortolani manoeuvre

The primary care provider has positioned an infant in the supine position with both knees flexed and applied gentle downward pressure to both knees. The knee and thigh have been abducted while an upward and medial pressure was applied to the proximal thigh. What examination technique has been performed on this infant?

Genu varum, which can be treated by bracing

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?

Tend to grow very slowly without destroying the supporting tissue.

When trying to explain to a patient diagnosed with a benign bone tumor, the nurse should emphasize the fact that benign tumors primarily:

The client with an avulsion

Which client should be seen first?

• torn meniscus in left knee at age 19 • obesity following pregnancy at age 24 • hip dislocation at age 35

Which events in a client's history increase risk of developing osteoarthritis? Select all that apply.

Falling on a ski hill with bindings that do not release

Which of the following activities is most likely to create a spiral fracture?

Rotational deformity of the proximal tibia

Which of the following assessment findings leads the nurse to believe a child has Blount's disease?

• Epiphyseal separation • Blood vessel rupture • Nutritional deficiencies • Thyroid hormone deficiency

Which of the following can influence the growth of cells in the epiphyseal growth plate? Select all that apply.

A 79 year-old man who is immunocompromised following a bone marrow transplant.

Which of the following individuals is likely to have the highest risk of developing tuberculosis osteomyelitis?

• "Limit exposure to alcohol." • "Do not take any medication without first talking to your healthcare provider."

Which of the following information would the nurse include when teaching potential parents about prevention of congenital deformities? Select all that apply.

Treatment within 6 months of life

Which of the following interventions is necessary for a child with developmental dysplasia of the hip?

Abnormalities present at birth

Which of the following is the definition of a congenital deformity?

A girl who was born with toeing-in and who was in a breech presentation.

Which of the following newborn infants demonstrates the highest risk of presenting with developmental dysplasia of the hip (DDH)?

10-year-old boy with Legg-Calvè-Perthes disease 57-year-old man with long history of alcohol abuse 79-year-old woman taking alendronate (Fosamax)

Which of the following patients are at increased risk for developing avascular necrosis? Select all that apply.

6-year-old with a compound fracture of the right wrist

Which of the following patients is at greatest risk for developing osteomyelitis?

Young adult with compound fracture of the humerus

Which of the following patients is most likely to experience complications in bone healing?

An 8 year-old boy who fell out of a tree and on to his arm.

Which of the following recent admissions to an emergency department is most likely to be diagnosed with a greenstick fracture?

The health care provider is explaining the course of treatment to the parents of a 2-day-old infant born with clubfeet. The most appropriate information to provide would be:

Which of the following should the nurse teach a patient about syndactyly?

Treatment needs to be individualized.

Which of the following statements is true about treatment of developmental dysplasia of the hip?

"A genetic pattern for this disease has not been established."

Which of the following statements will the nurse teach the parent of a child with Legg-Calvé-Perthes disease?

66-year-old Caucasian female with history of alcoholism

Which person is most at risk for hip fractures?

• Osteoclasts gradually remove dead bone. • Mineralized bone is present along the lines of the injury.

Which statements are true regarding bone remodeling? Select all that apply.

Comminuted fracture

Which type of fracture involves healing of more than two pieces of bone?

Ortolani maneuver

While an infant is in the supine position with both knees flexed, the clinician applies gentle downward pressure to both knees, and the knee and thigh are abducted as an upward and medial pressure is applied to the proximal thigh. This examination technique, used to screen for a reducible dislocation, is called:

"It looks like a mild to moderate sprain and you'll need to keep it immobilized for a few weeks."

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?

Observation and no active treatment.

While measuring the height of a 12 year-old girl during an office visit, the primary care physician noted a deviation of the girl's spine. This was subsequently quantified as being a right curve scoliosis of approximately 10 degrees deviation. Which of the following treatment options is most clearly indicated?

Observation and no active treatment

While measuring the height of a 12-year-old girl, the primary care provider noted a deviation of the girl's spine. This was quantified as being a right curve scoliosis of approximately 10 degrees deviation. Which treatment option is most appropriate?