PrepU Muscoloskeletal

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

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

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?

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

The nursing student is studying hip fractures. The faculty member knows that the student understands the topic when she states which of the following?

"Femoral neck fractures, with marked displacement, are associated with an increased incidence of avascular necrosis."

The nurse is providing discharge instructions to a client who experienced a ligamentous sprain. The nurse determines that teaching was effective when the client states:

"I should rest, apply ice, compression, and elevation to the extremity.""

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."

Following a fracture, the nurse is educating the client and his family about bone healing. The nurse begins by stating:

"In order to initiate the cellular events essential to bone healing, within a day or so, your body will develop a blood clot at the fracture site."

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."

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

"It refers to realigning the bone."

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."

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."

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?

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

The oncologist is evaluating a medical student's understanding of Ewing sarcoma. Which of the following statements, by the student, is most accurate?

"Pathologic fractures are common."

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:

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

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."

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

"This is a simple webbing of the fingers or toes."

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."

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

Abnormalities present at birth

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?

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

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."

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."

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

Which person is most at risk for hip fractures?

66-year-old Caucasian female with history of alcoholism

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.

Which of the following patients' fracture will need the shortest healing time?

9-year-old client a simple wrist fracture

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.

Which of the following children requires further assessment of potential abnormalities?

A child who is walking who has external rotations of the feet

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

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.

Which of the following clients presenting to the emergency department would most likely be diagnosed with a pathologic stress fracture?

A postmenopausal female who was diagnosed with breast cancer with metastasis to bone

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.

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

A client is experiencing severe pain in his back to the point of being immobile and running a temperature. The client also has swelling in his lower back (vertebrae). Following biopsy, the results show spinal tuberculosis. The nurse will anticipate explaining which priority intervention to this client?

Administer the four-drug antimicrobial medications

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

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.

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

Comminuted fracture

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:

Antimicrobial treatment depending on the microbe.

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

Applying ice and sitting out the rest of the game

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

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.

Which of the following should the nurse include in the initial care plan for a child who is "toeing out"?

Assess the child periodically.

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?

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

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

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

Because of the deformity it causes

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

Benign

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

Blood supply to the femoral head

While explaining to the parents of a child diagnosed with postural scoliosis, the nurse will emphasize which of the following concepts? This form of scoliosis:

Can be corrected with bending and active/passive exercises

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

A client presents to the emergency department following an accident where he fell off a chair. He reports hip numbness, increasing pain, and muscle cramping. The triage nurse suspects:

Closed hip fracture

Which of the following statements is true about congenital club foot?

Club foot may be associated with congenital syndromes.

The nurse is assessing a client who sustained a fractured radius. A cast was applied to the extremity approximately 1 hour ago, and the client is now complaining of increased pain and numbness to the finger tips. The client is most likely experiencing:

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?

Compartment syndrome

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

Contusion

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

What factor may adversely affect bone healing?

Delayed union

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

Fat emboli syndrome can occur after a fracture of a long bone. What are the clinical features of this syndrome?

Encephalopathy

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

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

Falling on a ski hill with bindings that do not release

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

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)

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?

Fat embolism syndrome (FES)

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

Knee

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

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

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?

Grade 2

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

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

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

Athletic injuries fall into two types, acute or overuse injuries. Where do overuse injuries commonly occur?

Knee

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

Legg-Calve-Perthes disease

A patient is diagnosed with a bone tumor after a pathologic fracture. Which of the following is the most likely cause of the tumor?

Metastatic bone disease

The physical therapy student is explaining complication of fracture healing. Which of the following is a contributing factor to failure of a bone to heal before the process of bone repair stops?

Mobility at fracture site

What is the term used to refer to the failure of bone to heal before the process of bone repair stops?

Nonunion

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 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:

Ortolani maneuver

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

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

Osteonecrosis

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

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

Pain in front of the knee

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)

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?

Prevention of pathologic fractures.

Osteonecrosis is a condition in which part of a bone dies because of the interruption of its blood supply. What is the most common cause of osteonecrosis other than fracture?

Prior steroid therapy

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

Promoting adequate nutrition for a patient with a recent fracture

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

An infant is born with a clubfoot. The nurse should anticipate which of the following treatment measures may be instituted?

Serial manipulations and casting

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:

Serial manipulations and casting of the affected extremity

What is the purpose of the meniscus?

Shock absorption

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.

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

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?

Surgical hip replacement and early mobilization

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

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

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.

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 emergency intervention to reduce the fracture and prevent complications.

Which client admitted to the emergency department should the nurse prioritize to see first?

The client with a puncture wound of the chest.

Which client should be seen first?

The client with an avulsion

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?

Thickening of patellar tendon

The osteoporosis patient asks the nurse to explain what a bisphosphonate medication does. The nurse will respond:

This medication helps prevent bone resorption which will help prevent fractures.

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

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

Treatment needs to be individualized.

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

Treatment within 6 months of life

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

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?

X-ray shows minimal calcification at the fracture.

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

structural scoliosis

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

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

Which of the following interventions for a patient with metastatic bone disease can help prevent pathologic fractures? Select all that apply.

• Bisphosphonates • Radiation therapy

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

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.

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

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

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

A child in gymnastics class has fallen off the balance beam and hurt her ankle. X-rays are negative for fracture, so the health care provider has diagnosed a severe sprain. Which of the following treatment measures should be taught to the family and child? Select all that apply.

• Immobilization for several weeks • Elevate the ankle on pillows • Apply ice packs to the ankle

Which of the following are associated with metastatic bone cancer of the spine? Select all that apply.

• Localized bone pain that is worse at night • Pain resulting from nerve entrapment • Pathological fractures • Vertebrae that are easily crumbled

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

• Loss of function • Pain • Swelling

While explaining to a group of nursing students the difference between benign and malignant bone tumors, the instructor will emphasize that a benign tumor: Select all that apply.

• May be asymptomatic and detected incidentally • May cause the client to have a pathological fracture

The client has a bone neoplasm that is growing rapidly and spreading to other parts of the body through the blood stream or lymphatics. The nurse knows that it could be which of the following neoplasms? Select all that apply.

• Multiple myeloma • Ewing sarcoma • Chondrosarcoma

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).

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

Several factors can influence the growth of cells in the epiphyseal growth plate. Factors that may affect this bone growth include: Select all that apply.

• Normal levels of thyroid and growth hormone • Epiphyseal separation as a result of trauma to the site • Vitamin C deficiency • Vitamin D deficiency

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.

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

• Swelling • Discoloration • Limited movement • Heat

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.

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

Which events in a client's history increase 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