Muscular skeletal

Compound fracture -

A compound fracture is one in which damage also involves the skin or mucous membranes

An involuntary twitch of muscle fibers is referred to as -

A fasciculation

Absence of muscle tone -

A muscle which holds no tone is termed flaccid

Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure? A. Fasciotomy B. Osteotomy C. Arthroplasty D. Arthrodesis

A. Fasciotomy A Fasciotomy is a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure

Which of the following terms refers to muscle tension being unchanged with muscle shortening and joint motion? A. Isotonic contraction B. Isometric contraction C. Contracture D. Fasciculation

A. Isotonic contraction Exercises such as swimming and bicycling are isotonic. Isometric contraction is characterized by increased muscle tension, unchanged muscle length, and no joint motion. Contracture refers to abnormal shortening of muscle, joint, or both. Fasciculation refers to the involuntary twitch of muscle fibers

A patient is exhibiting diminished range of motion, loss of flexibility, stiffness, and loss of height. The history and physical findings are associated with age-related changes of which area? A. Joints B. Bones C. Muscles D. Ligaments

A. Joints History and physical findings associated with age-related changes of the joints include diminished range of motion, loss of flexibility, stiffness, and loss of height

Which of the following terms refers to disease of a nerve root? A. Radiculopathy B. Involucrum C. Sequestrum D. Contracture

A. Radiculopathy - When the patient reports radiating pain down the leg, he or she is describing radiculopathy

Skull sutures are an example of which type of joint? A. Synarthrosis B. Amphiarthrosis C. Diarthrosis D. Aponeuroses

A. Synarthrosis Skull sutures are considered synarthrosis joints and are immovable

Most common cause of death in patients diagnosed with fat emboli syndrome?

Acute pulmonary edema and ARDS are the most common

Appropriate nursing intervention required in caring for a patient who has undergone arthroscopy?

After covering the arthroscope insertion site with a bulky dressing and elevating the patient's entire leg, the nurse needs to apply cold pack at the site to minimize swelling. It is NOT advisable to provide a warm compress, massage, or suggest ROM exercises immediately after arthroscopy

removal of a body part -

Amputation

Which of the following is the most effective cleansing solution to complete pin site care? A. Betadine B. Chlorhexidine C. Hydrogen peroxide D. Alcohol

B. Chlorhexidine Chlorhexidine solution is recommended as the most effective cleansing solution; however, water and saline are alternate choices. Hydrogen peroxide and Betadine solutions have been used, but they are believed to be cytotoxic to osteoblasts and may actually damage healthy tissue.

Which of the following is an inappropriate use of traction? A. Immobilization of a fracture B. Decrease space between opposing structures C. Reduction of deformity D. Minimization of muscle spasms

B. Decrease space between opposing structures Traction is done to increase the space between opposing surfaces. Traction is used to minimize muscle spasms, to reduce align, and immobilize fractures, and to reduce deformity

Fracture healing occurs in four areas, including the A. cartilage B external soft tissue C. bursae D. fascia

B. external soft tissue- fracture healing occurs in four areas, including the bone marrow, bone cortex, periosteum, and the external soft tissue, where a bridging callus (fibrous tissue) stabilizes the fracture

Which of the following statements describes paresthesia ? A. Absence of muscle movement suggesting nerve damage B. Involuntary twitch of muscle fibers C. Abnormal sensations D. Absence of muscle tone

C. Abnormal sensations Abnormal sensations, such as burning, tingling, and numbness are referred to as paresthesias

Which of the following is a metabolic bone disease that is characterized by inadequate mineralization of bone? A. Osteoporosis B. Osteomyelitis C. Osteomalacia D. Osteoarthritis

C. Osteomalacia Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone

Which of the following data is most important for the nurse to record while assessing a patient with an open wound? A. Time and place of the injury B. Degree of movement and range of motion C. Time when the patient last received a tetanus immunization D. Vital signs of the patient

C. Time when the patient last received a tetanus immunization If the patient has an open wound, the nurse ascertains when the patient last received a tetanus immunization

The patient who has had an arm amputated is assigned to nursing care. What potential complications should the nurse closely monitor for in the late postoperative period for the patient?

Chronic osteomyelitis and causalgia

Which type of compartment syndrome occurs when massive external compression of a compartment occurs?

Crush compartment syndrome

Which of the following terms refers to the shaft of the long bone? A. Epiphysis B. Lordosis C. Scoliosis D. Diaphysis

D. Diaphysis The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone. Lordosis refers to an increase in lumbar curvature of spine. Scoliosis refers to lateral curving of the spine

After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement? A. Inflammation B. Revascularization C. Reparative D. Remodeling

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

Colles' fracture occurs in which of the following areas? A. Elbow B. Humeral shaft C. Clavicle D. Distal radius

D. distal radius A Colles' fracture is a fracture of the distal radius ( wrist). It is usually the result of a fall on an open, dorsiflexed hand

Delayed complications of fracture healing include:

Delayed union, nonunion, and avascular necrosis

Flexion deformity caused by a slowly progressive contracture of the palmar fascia?

Dupuytren's contracture

Reloxifene ( Evista) -

Evista reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus

Teriparatide ( Forteo ) -

Forteo has been recently approved by the FDA for the treatment of osteoporosis

Indicators of peripheral neurovascular dysfunction?

Indicators of peripheral neurovascular dysfunction related to circulation include: pale, cyanotic or mottled skin with a cool temperature. The capillary refill is more than 3 seconds

Swelling of the third lateral branch of the median planter nerve

Morton's neuroma

High arch and a fixed equinus deformity

Pes cavus

Serum calcium -

Serum calcium levels are altered in patients with Osteomalacia and parathyroid dysfunction

Which laboratory study indicates the rate of bone turnover?

Serum osteocalcin - (bone GLA protein)

Urine Calcium -

Urine calcium levels increase with bone destruction

A impacted fracture is one in which -

a bone fragment is driven into another bone fragment

if pressure is not relieved by removing the bandage or cast and circulation is not restored, :

a fasciotomy may be necessary to relieve the pressure within the muscle compartment

Hammertoe is

a flexion deformity of the interphangeal joint, which may involve several toes

Pes cavus refers to

a foot with an abnormally high arch and a fixed equines deformity of the forefoot

strain refers to

a muscle pull or tear A strain and sprain are treated by RICE

A sprain is caused by

a wrenching or twisting motion treated with RICE

patients who have open fractures should have systemic antibiotics ordered and administered within which timeframe from time of injury

all open fractures are considered contaminated and carry risks for osteomyelitis , tetanus, and gas gangrene. for this readon, systemic antibiotics are generally ordered and administered ideally within 3 hours of injury

Amphiarthrosis joints -

allow limited movement, such as a vertebral joint

Planter fasciitis is

an inflammation of the food- supporting fascia

A CPM device is -

an instrument that moves a body part to promote healing and circulation.

A short-leg cast extends from

below the knee to the base of the toes

when an infection is blood borne the manifestations include

chills, high fever, rapid pulse, and generalized malaise

Sequestrum refers to

dead bone in an abscess cavity

Hallux valgus is

deformity in which the great toe deviates laterally

corticosteroids place patients at risk for

developing osteoporosis

Bone densitometry is used to -

estimate bone mineral density

Early complications of fracture healing include:

fat embolism syndrome, shock, compartment syndrome, and thromboembolic complications such as DVT and PE

tendon transfer is used to

improving motion

parathyroid hormone PTH

increases with aging, increasing bone turnover and resorption. the consequence of these changes is net loss of bone mass over time

ORIF open reduction with internal fixation

is done to reduce a fracture

a bone graft may be used for

joint stabilization, defect filling, or stimulation of bone healing

a bone scan

may disclose information about infections, tumors, and bone marrow abnormalities

Calcitonin is administered by

nasal spray, subcutaneous or intramuscular injections

Involucrum refers to

new bone growth around the Sequestrum

An Arthroplasty is

or replacement is the replacement of joint surfaces with metal or synthetic materials total joint Arthroplasty is the replacement of both the articular surfaces within a joint with metal or synthetic materials

A hallmark sign of compartment syndrome is -

pain that occurs or intensifies with passive ROM

Chronic compartment syndrome is characterized by

pain, aching, and tightness in a muscle or muscle group that has been subjected to inordinate stress or exercise

Osteoporosis is characterized by

reduction of total bone mass and a change in bone structure that increases susceptibility to fracture

ORIF - open reduction with internal fixation -

refers to surgery to repair ad stabilize a fracture

Calcitonin -

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

Clinical manifestations of reflex sympathetic dystrophy syndrome include :

severe, burning pain, local edema, hyperesthesia, muscle spasms, and vasomotor skin changes

In the immediate postoperative period of an amputation the nurse should closely monitor for what adverse reactions

sleeplessness, nausea, and vomiting

Cartilage is -

special tissue at the ends of bone

Cancellous bone refers to -

spongy, lattice like bone structure

An osteotomy is

surgical cutting of bone

Which of the following is a surgical fusion of a joint? A. Arthrodesis B. Open reduction with internal fixation (ORIF) C. Heterotrophic ossification D. Arthroplasty

A. Arthrodesis Arthrodesis of a joint is created surgically to treat chronic pain

Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing BMD? A. Calcitonin ( Miacalcin) B. Reloxifene ( Evista) C. Teriparatide (Forteo) D. Vitamin D

A. Calcitonin ( Miacalcin) Miacalcin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD.

An x-ray demonstrates a fracture in which the fragments of bone are driven inward. This type of fracture would be which of the following? A. Depressed B. Compound C. Comminuted D. Impacted

A. Depressed Depressed skull fractures occur as a result of blunt trauma

Which of the following nursing interventions would protect bony areas from pressure in a patient who is at risk of being immobilized from a cast application? A. Massaging the bony areas and skin surfaces B. Administering antibiotics C. Applying a cold pack D. Using waterproof tape to petal cast edges

A. Massaging the bony areas and skin surfaces The nurse should massage the bony areas and skin surfaces subjected to pressure unless they remain red when pressure is relieved. These measures prevent further injury and potential infection and promote circulation to the area. Administering antibiotics or applying cold pack helps relieve pain and inflammation, not pressure. Using waterproof tape to petal cast edges protects skin from abrasion

Which nerve is assessed when the nurse asks the patient to spread all fingers? A. Ulnar B. Peroneal C. Radial D. Median

A. Ulnar Asking the patient to spread all fingers allows the nurse to assess motor function affected by ulnar innervation, while pricking the fat pad at the top of the small finger allows assessment of the sensory function affected by the ulnar nerve

Meniscectomy refers to the - A. replacement of one of the articular surfaces of a joint. B. incision and diversion of the muscle fascia C. excision of damaged joint fibrocartilage D. removal of a body part

A. replacement of one of the articular surfaces of a joint The most common site for meniscectomy is the knee

During which stage or phase of bone healing after fracture does callus formation occur? A. Remodeling B. Inflammation C. Reparative D. Revascularization

A.Reparative Callus formation occurs during the reparative stage but is disrupted by excessive motion at the fracture site. Remodeling is the final stage of fracture repair during which the nebne is reorganized into the bone's former structural arrangement. During inflammation, macrophages invade and debride the racture area. Revascularization occurs withn about 5 days after the fracture.

Osteoarthritis (OA) -

AKA degenerative joint disease, is the most common and frequently disabling of the joint disorders. OA affects the articular cartilage, subchondral bone, and synovium.

Which of the following is an inaccurate principle of traction? A. The weights are not removed unless intermittent treatment is prescribed. B. The weights must hang freely C. The patient must be in good alignment in the center of the bed D. Skeletal traction is interrupted to turn and reposition the patient

D. skeletal traction is interrupted to turn and reposition the patient. Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely with the patient in good alignment in the center of the bed

Incision and diversion of the muscle fascia -

Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction.

formerly called a bunion

Hallux valgus

In the immediate postoperative period of an amputation the nurse should closely monitor for what potential complications

Hematoma, hemorrhage, and infection

Which type of cast encloses the trunk and a lower extremity?

Hip spica cast - A hip spica cast encloses the trunk and a lower extremity

when evaluating for hypovolemic shock, the nurse should be aware of what clinical manifestations?

Hypotension weak pulse (thread), decreased blood pressure, decreased urine output, rapid, shallow respirations, and elevated heart rate

Teaching a pt. with a cast should include:

Instruct the pt. to keep the cast dry and to dry a wet fiberglass cast thoroughly using a hair dryer on a cool setting to avoid skin problems, and do not cover with plastic or rubber. A cast should be kept dry but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. A cast extremity should be elevated frequently to heart level to prevent swelling. A broken cast should be reported to the physician and the pt. should not attempt to fix it.

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

Lamellae - are mineralized bone matrices

Individual risk factors for osteoporosis?

Low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D

What would be the teaching plan for a patient diagnosed with planter fasciitis?

Management of planter fasciitis includes stretching exercises. Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices ( eg, heel cups, arch supports), and the use of nonsteroidal anti-inflammatory drugs (NSAIDS).

presents with an onset of heel pain with the first steps of the morning

Plantar fasciitis

inflammation of the foot-supporting fascia

Planter fasciitis

which of the following position should be avoided in severe back pain?

Prone

Risk lowering strategies for osteoporosis?

Rick- lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity.

Serum phosphorous -

Serum phosphorous levels are inversely related to calcium levels and are diminished in Osteomalacia associated with malabsorption syndrome

Principles of patient in traction -

Skeletal traction is applied directly to the bone and is never interrupted. In order to be effective, the weights must hang freely and not rest on the bed or floor. Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Traction must be continuous to be effective in reducing and immobilizing fractures

Teaching plan for patients with Osteomalacia

The nurse should encourage the patients with Osteomalacia to include the supplements of calcium, phosphorus, and vitamin D; adequate nutrition; exposure to sunlight; and progressive exercise and ambulation.

Contracture refers to

abnormal shortening of muscle or fibrosis of joint structures

s/s of planter fasciitis -

an inflammation of the foot supporting fascia, presents as an acute onset of heel pain experienced with taking the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon.

A trapeze is -

an overhead device to promote patient mobility in bed

In chronic osteomyelitis

antibiotics are adjunctive therapy to surgical debridgement

Aponeuroses -

are broad, flat sheets of connective tissue

Diarthrosis joints

are freely moveable joints such as the hip and shoulder

The peroneal nerve is assessed by

asking the patient to dorsiflex the ankle and to extend the toes

The radial nerve is assessed by

asking the patient to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints.

The median nerve is assessed by

asking the patient to touch the thumb to the little finger

Individual risk factors for osteoporosis include:

estrogen deficiency or menopause , female gender, white-non Hispanic or Asian race, increased age, low weight and body mass index, family history of osteoporosis, low initial bone mass, and contributing coexisting medical conditions and medications

Nonunion -

failure of fragments of a fractured bone to heal together- the pt. complains of persistent discomfort and movement at the fracture site

Unresolved planter fasciitis may progress to -

fascial tears at the heel and eventual development of heel spurs

fascia is

fibrous tissue that covers, supports, and separates muscles

longitundinal arch of the footdiminished

flatfoot

Dupuytren's contracture causes -

flexion of the fourth and fifth fingers, and frequently the middle finger

bursae is

fluid-filled sc found in connective tissue, usually in the area of joints

A long-leg cast extends

from the junction of the upper and middle third of the thigh to the base of the toes

Denosumab

has recently been approved for the treatment of postmenopausal women with osteoporosis who are at risk for fractures

Osteomyelitis is an -

infection of bone that comes from extension of soft tissue infection, direct bone contamination, or hematogenous spread.

An EMG provides -

information about the electrical potential of the muscles and nerves leading to them

Forteo

is a subcutaneously administered medication that is given one daily for the treatment of osteoporosis

A brace -

is an externally applied to support a body part, control movement, and prevent injury

Raloxifene

is the only selective estrogen receptor modulator (SERM) approved for osteoporosis in post menopausal women as it does not increase risk of breast or uterine cancer, but it does come with an increased risk of thromboembolism

Hemiarthroplasty

is the replacement of the femoral head with a prosthesis

Arthrography -

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

Describe treatment for joint effusions and hemarthrosis -

joint aspiration and wrapping with compression elastic dressing

History and physical finding associated with age related to ligaments include:

joint pain on motion that resolves with rest, crepitus, joint swelling/enlargement , and degenerative joint disease (osteoarthritis)

the most common primary sites of tumors that metastasize to bone are the

kidney, prostate, lung, breast, ovary, and thyroid

Pulselessness is a very late sign of compartment syndrome and may signify -

lack of distal tissue perfusion

Lifestyle risk factors for osteoporosis include:

lack of exposure to sunshine, low calcium and vitamin D diet, cigarette smoking, use of alcohol and/or caffeine, and lack of weight-bearing exercise.

Trabecula refers to -

lattice like bone structure

History and physical findings associated with age-related changes of bones include -

loss of height, posture changes, kyphosis, flexion of hips and knees, back pain, osteoporosis, and fracture

History and physical finding associated with age related to muscles include:

loss of strength, diminished agility, decreased endurance, prolonged response time ( diminished reaction time), diminished tone, a broad base of support, and a history of falls.

A splint -

may be applied to a fractured extremity initially until swelling subsides. Designed specifically to support and immobilize a body part in a desired position.

clinical manifestations of impingement syndrome?

pain, shoulder tenderness, limited movement, muscle spasms, and atrophy. the process may progress to a rotator cuff tear

the treatment of metastatic bone cancer is

palliative the therepeutic goal is to relieve the patient's pain and discomfort while promoting quality of life

The absence of muscle tone suggesting nerve damage is referred to as -

paralysis

Subluxation refers to

partial separation or dislocation of joint surfaces

A CPM device applied after knee surgery

promotes healing by increasing circulation and movement of the knee joint

Heterotrophic ossification -

refers to formation of bone in the periprosthetic space

malunion

refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union

S/S of Fat embolism syndrome -

subtle personality changes, restlessness, irritability, and confusion Cerebral disturbances in the patient with fat embolism syndrome include subtle personality changes, restlessness, irritability and confusion.

Acute compartment syndrome involves

sudden and severe decease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur

Arthrodesis is

surgical immobilizing fusion of a joint

Arthroplasty refers to -

surgical repair of a joint or joint replacement

A comminuted fracture is one in which -

the bone has splintered into several pieces

Endosteum refers to -

the marrow cavity lining of hallow bone

S/S of compartment syndrome -

the patient complains of deep, throbbing, unrelenting pain

Instructions for the patient with low back pain should include that when lifting ,

the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back.

S/S of hypovolemic shock -

the patient would have a decreased blood pressure and increased pulse rate

Foot drop occurs when there is injury to

the peroneal nerve as a result of pressure is a cause of foot drop

Hemiarthroplasty refers to -

the replacement of one of the articular surfaces of a joint

Dislocation refers to

the separation of joint surfaces

A body cast encloses

the trunk

risk factors for compartment syndrome

trauma from accidents, surgery, casts, tight bandages, and crushing injuries.

Electromyogram

used to evaluate spinal root disorders ( radiculopathies)

which diagnostics confirms Paget's disease

x ray