Unit 9

The skin assessment of an African American patient reveals the presence of white areas on the skin that are flat, nonpalpable, less than 1cm in diameter, and have a circumscribed border. The nurse documents the presence of which of the following?

Macule A macule is a flat, nonpalable skin color change that is brown, white, tan, purple, or red and less than 1cm with a circumscribed border.

A patient asks the nurse what caused the callus on his foot. Which of the following is the nurse's best response?

"It is a hyperkeratotic plaque of skin due to chronic friction." A callus is caused by a hyperkeratotic plaque of skin due to chronic friction or rubbing on a single area. It is not caused by infection or lesions.

The nurse is giving a talk to a woman's group on osteoporosis. Which of the following should she tell this group happens in osteoporosis?

"Osteoporosis involves a decreased loss of bone mass." Osteoporosis is a metabolic bone disease characterized by a loss of mineralized bone mass causing increased porosity of the skeleton and susceptibility to fractures. The condition is most often related to the aging process and decreased estrogen levels in postmenopausal women

A patient states he has "pruritus." Which of the following questions should the nurse ask?

"Where do you feel itching?" The first thing the nurse should ask is where the itching is occurring. The nurse could then inspect the area. Itching is not necessarily caused by being hit or having a lesion. Asking if the client is on new medications is not particularly helpful, as itching can have many causes. The nurse should first assess the area.

The nurse is reviewing the health histories of four clients. Select the client most at risk for developing secondary osteoporosis.

60-year-old female taking prednisone for asthma Corticosteroid (e.g., prednisone) use is the most common cause of drug-related osteoporosis, and long-term corticosteroid use in the treatment of disorders such as rheumatoid arthritis and chronic obstructive lung disease is associated with a high rate of fractures. The prolonged use of aluminum-containing antacids, which increase calcium excretion, and anticonvulsants, which impair vitamin D production, may also contribute to bone loss. Persons with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) who are being treated with antiretroviral therapy are also at risk. The other options would not cause osteoporosis.

Which person is most at risk for hip fractures?

66-year-old Caucasian female with history of alcoholism Risk factors for hip fracture include physical inactivity, excessive consumption of alcohol, use of certain psychotropic drugs, residence in an institution, visual impairment, and dementia.13 Osteoporosis is an important contributing factor

Which person is most at risk for hip fractures?

66-year-old Caucasian female with history of alcoholism Risk factors for hip fracture include physical inactivity, excessive consumption of alcohol, use of certain psychotropic drugs, residence in an institution, visual impairment, and dementia.13 Osteoporosis is an important contributing factor.

Most of the body's hair follicles are paired with which of the following?

A sebaceous gland Most hair follicles are associated with sebaceous glands, and these structures combine to form the pilosebaceous unit. Langerhans cells are not paired with hair follicles, and apocrine, not eccrine glands, are often associated with a hair follicle. Nerve endings are widely distributed throughout the skin, but these are not paired with hair follicles.

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

Abnormalities present at birth Congenital deformities are abnormalities that are present at birth. They range in severity from mild limb deformities, which are relatively common, to major limb malformations, which are relatively rare.

One of the best products for extremely dry skin on the elbows would be to apply which type of dressing?

An occlusive with petroleum material mixed in the cream Occlusives are thick creams that contain petroleum or some other moisture-proof material. They prevent water loss from the skin. They are the most effective agents for relieving skin dryness. Humectants are the additives in lotions, such as α-hydroxy acids and urea, that draw out water from the deeper skin layers and hold it on the skin surface. However, the water that is drawn to the skin is transepidermal water, not atmospheric water; thus, continued evaporation from the skin can actually exacerbate dryness. α-Hydroxy acids are derived from fruits, hence the abundance of fruit additives in over-the-counter shampoos and lotions. Lotion or cream additives include corticosteroids or mild anesthetics, such as camphor, menthol, lidocaine, or benzocaine. These agents work by suppressing itching while moisturizing the skin.

Which of the following persons should the nurse assess to determine if they have premature osteoporosis?

Anyone with an eating disorder. Having an eating disorder places patients at increased risk due to malabsorption of medications.

During an examination, a nurse notices a semisolid mass in the subcutaneous tissue on the neck of a patient. When documenting this finding, the nurse would identify this condition using which of the following terms?

Cyst A cyst is an encapsulated fluid-filled or semisolid mass in the subcutaneous tissue or dermis

In science class, a group of sixth graders are "freaked out" when they learn that nails grow continuously and are the end product of which of the following components?

Dead cells pushed outward from the nail matrix Like hair, nails are the end product of dead matrix cells that are pushed outward from the nail matrix. Unlike hair, nails grow continuously rather than cyclically. The arrector pili muscle, located under the sebaceous gland, provides a thermoregulatory function by contracting to cause goose bumps. Anagen hair has long inner roots and outer root sheaths, is deeply rooted in the dermis, is difficult to detach, and does not come out with regular brushing. Telogen hair has short, white, club-shaped roots. With formation of new anagen hair below the root, the developing follicle will eventually replace the telogen hair, leading to the shedding of approximately 50 to 100 hairs a day.

Skin disorders are easily identified, as they look exactly alike regardless of the native skin color of the individual.

False No two skin disorders look exactly alike, and they are not necessarily caused by the same agents. The appearance of many skin disorders may be further influenced by excessive itching, infection, or the effects of self-treatment. Skin color also may influence the appearance.

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

Formation of a large clot; new capillary buds; continued formation of the callus; reconstruction of the shaft Four stages of the healing process have been identified. The first stage, hematoma formation, develops from torn blood vessels and forms a large clot. Disruption of blood vessels also leads to death of bone cells at the fracture site. The second or inflammatory phase is characterized by new vascularization. Most of the clot is organized by invasion of blood vessels and early fibrosis. A fibrin meshwork is initiated. Granulation tissue forms and this is referred to as the beginning of the callus. The reparative stage allows continued formation of the callus and woven bone near the fracture site. The final phase is remodeling. The osteoclastic and osteoblastic functions continue at a rapid rate until the fracture site is healed and bone is reconstructed

Using Oestern and Tscherne's Classification, how would a closed fracture that presented superficial abrasions and a mild fracture pattern be graded?

Grade 1 Superficial abrasions and a mild fracture pattern would be graded as Grade 1. This is the only option that accurately grades the described wound.

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 Gradations of tissues injury with closed fractures are classified on the Oestern and Tscherne scale. Grade 0 has minimal soft tissue damage with an indirect injury to the limb and results in a simple fracture. Grade 1 includes superficial abrasion or contusion and a mild fracture pattern. Grade 2 has deep abrasion with skin or muscle contusion, direct limb trauma and a severe fracture. Grade 3 has extensive skin contusion or a crushing injury with severe damage to underlying muscle, subcutaneous avulsion and may include compartment syndrome. The fracture pattern with grade 3 is also severe.

Which symptoms commonly occur with Osgood-Schlatter disease? Select all that apply.

Knee pain Edema of the knee Tenderness in the knee and tibia Most commonly, children with Osgood-Schlatter disease have knee pain, edema, and tenderness of the knee. Femoral and foot pain are not commonly symptoms of this disease.

What is a physiologic basis for albinism?

Lack of tyrosinase Although there are more than 10 different types of albinism, the most common type is recessively inherited oculocutaneous albinism, in which there is a normal number of melanocytes but they lack tyrosinase, the enzyme needed for synthesis of melanin.

A 42-year-old client is admitted to the hospital with severe back pain, intermittent tinnitus, constant headache, and vertigo. He states that the back pain has been a problem for a number of years, but the other symptoms are quite new. Upon further examination, it is noted that he has unexplained hearing loss, and his femur and tibia have begun to bow. What condition does this client most likely have?

Paget Disease The clinical manifestations of Paget disease that involve the skull results in headaches, intermittent tinnitus, vertigo, and eventual hearing loss. In the spine, collapse of the anterior vertebrae causes kyphosis of the thoracic spine. The femur and tibia also become bowed.

The nurse is assessing a patient who has a small pinpoint rash. Which of the following is the best cause of this rash?

Pinpoint petechiae Small pinpoint spots are usually petechiae. Lesions are traumatic or pathologic loss of normal tissue structure and would not be appropriate to document as a rash.

A client was diagnosed with Salmonella 1 week ago and is now experiencing joints that are warm, swollen, and tender. The client also reports experiencing fever and weight loss. The health care provider would interpret these manifestations as:

Reactive arthritis Reactive arthritis is an inflammatory joint disorder that arises after certain inciting gastrointestinal or genitourinary tract infections. It can result from gastrointestinal infection or sexually transmitted disease. Reactive arthritis is most commonly asymmetric and frequently involves the lower extremities. Symptoms typically start within 1 to 4 weeks of the initial infection. Hip disease is uncommon, and involvement of the upper extremities is rare. The joints are typically warm, swollen, and tender. Systemic manifestations including fever and weight loss are common at the onset. The other options do not result from a gastrointestinal disease.

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 Any bone, joint, or bursa may be affected, but the spine is the most common site, followed by the knees and hips. The ankles and shoulders are not common sites for tuberculosis to be found.

The nurse notices that a child appears to have flatfoot and determines that additional assessment is needed. Which assessment finding would meet criteria for flatfoot?

Talus points medially Criteria for flatfoot include that the talus points medially and downward, so that the heel is everted and the forefoot is inverted.

Among the skin's protective functions is the fact that it serves as an immunologic barrier. What cells detect foreign antigens?

The Langerhans cells The skin also serves as an immunologic barrier. The Langerhans cells detect foreign antigens, playing an important part in allergic skin conditions and skin graft rejections. The other cell types are not part of the immunologic barrier.

Lichenified skin is defined as being which one of the following?

Thickened skin with exaggerated markings Lichenified skin is thickening and roughening of the skin or accentuated skin markings that may be secondary to repeated rubbing, irritation, or scratching

A patient with albinism has a genetic lack of which of the following enzymes?

Tyrosinase Tyrosinase converts the amino acid tyrosine to a precursor of melanin. A genetic lack of this enzyme results in a clinical condition called albinism. People with this disorder lack pigmentation in the skin, hair, and iris of the eye. Lack of the other enzymes do not cause albinism.

Which of the following skin disorders is likely to result from the localized lack of melanin production by melanocytes?

Vitiligo In cases of vitiligo, depigmented areas may contain no melanocytes, greatly altered or decreased amounts of melanocytes, or, in some cases, melanocytes that no longer produce melanin. Melasma results from increased pigmentation, and neither bullae nor rashes are consequences of alteration in melanocyte function.

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 If a child older than 2 years of age has a separation between the knees greater than 15 degrees, the child may require bracing. The health care professional would be most concerned about this. A separation less than 10 degrees is not concerning. The child being overweight does not cause the bowing. The child can sit in the tailor position; this is not a concern.

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. There are four stages of bone healing. Hematoma formation occurs during the first 1-2 days after the injury. The inflammatory phase involves formation of new capillaries and development of granulation tissue into a callus. The reparative phase allows the continued formation of the callus into calcified bony tissue. The final phase is remodeling and removes the excess tissue at the fracture site to a shape similar to its prefracture state. By the sixth week after initial injury, evidence of healing is expected, showing callus formation with granulation and calcification. The patient may develop nonunion without such signs of healing. Expected assessment data for a casted limb include peeling skin under a cast, stiffness of immobilized joints, and tenderness at the site.

During a physical assessment, a nurse determines that a patient has excessively dry skin. Which of the following terms would the nurse use to document this condition?

Xerosis Dry skin, also called xerosis, may be a natural occurrence, as in the drying of skin associated with aging, or it may be symptomatic of an underlying systemic disease or skin disorder such as contact dermatitis or diabetes mellitus.

A client with a fractured clavicle is told that the bone will heal well if immobilized for the next 6 to 8 weeks, but there will be a large "bump" where the break occurred. This bump will be caused by:

formation of a bony callus. The bony callus is still present due to the misalignment of the ends of the bone (occurs only with clavicle or improperly placed healing). This is not formed by scar tissue and is not the result of scarring or dead white cells.

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

knee The menisci are C-shaped plates of fibrocartilage that are superimposed between the condyles of the femur and tibia. There are two menisci in each knee.

The skin is richly supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. This particular vascular structure allows a client to:

regulate body temperature. Anastomoses are important for temperature regulation. They can open up, letting blood flow through the skin vessels when there is a need to dissipate body heat, or close off, conserving body heat if the environmental temperature is cold. Although goose bumps are a reaction to cold, they are actually caused by the contraction of the erector pili muscles. They are not involved specifically in oxygenation.

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." The nurse can teach parents that a genetic pattern for this disease has not been established. It occurs in 1 in 1200 live births and affects more males than females. The most common age of diagnosis is 7 years.

Which of the following information is important for the nurse to teach the female patient about the development of osteoporosis?

"Estrogen deficiency contributes to the development of osteoporosis." Estrogen deficiency contributes to the development of osteoporosis. The other statements are not true.

It is suspected that a patient has osteomalacia. Which of the following should the nurse teach the patient about potential causes of this condition?

"Insufficient calcium absorption and phosphate deficiency is the cause." Osteomalacia is a generalized bone condition in which there is inadequate mineralization of bone caused by insufficient calcium absorption from the intestine, because of lack of dietary calcium or deficiency of or resistance to the action of vitamin D. Phosphate deficiency is also cited as a cause.

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

"It refers to realigning the bone." Reduction is the term for when bones are realigned to restore their original structure.

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." Treatment for early osteonecrosis depends on the cause. Because there is no injury or infection with Legg-Calvè-Perthes disease, treatment may begin with short-term immobilization, nonsteroidal anti-inflammatory drugs, exercises, and restricted weight-bearing activity.

A client with osteomalacia asks, "how can I be deficient in vitamin D?" Which of the following is the nurse's best response?

"Tell me about your typical daily food intake." The nurse needs to assess the patient's dietary intake in order to answer. The nurse cannot make any assumptions until an assessment is completed.

Which term is correctly linked with its definition?

A corn is a keratinous thickening of skin. A corn is a keratinous thickening of the skin that usually appears on the toes. A blister is a vesicle and a callous is a hyperkeratotic plaque. Pruritis refers to the sensation of itching.

Eczema is defined as which of the following?

Acute, red, itchy, vesicular-crusted lesion Eczema manifests as inflammation and the residue left after vesicle rupture due to the dried residue of serum pus on the skin surface.

Which disorder places a client at increased risk for secondary osteoporosis? Select all that apply.

Celiac disease Hyperparathyroidism Multiple myeloma Long-term corticosteroid use The patient with malabsorption disorders such as celiac disease, multiple myeloma, hyperparathyroidism, and long-term steroid use places a patient at increased risk of secondary osteoporosis. Constipation would not place a patient at higher risk for osteoporosis.

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 The hallmark symptom of acute compartment syndrome is severe pain out of proportion to the original injury. One of the most important causes of compartment syndrome is bleeding and edema caused by fractures and bone surgery. Edema or swelling may make it difficult to palpate a pulse. Reflex sympathetic dystrophy, while characterized by pain out of proportion to the injury, does not exhibit decreased pulses. Fracture blisters are areas of epidermal necrosis with separation of epidermis from the underlying dermis by edema fluid. They are a warning sign of compartment syndrome. Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the blood stream.

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

Contusion Soft tissue injury from trauma is termed a "contusion". A fracture describes bone breakage, and ligaments and tendons are not classified as soft tissue.

The nurse is caring for a patient with pruritis. The nurse anticipates orders for which of the following interventions?

Corticosteroids Corticosteroids can help to suppress itching. Glycerin soaps are drying and can exacerbate the symptoms, as can heat. Over time scratching the skin can lead to lichenification.

Osteoporosis is a disease caused by demineralization of bone. What is the clinical method of choice for diagnosing osteoporosis?

Dual-energy x-ray absorptiometry (DXA or DEXA) of the spine and hip The clinical method of choice for bone mineral density (BMD) studies is dual-energy x-ray absorptiometry (DXA or DEXA) of the spine and hip. The other answers will not diagnose osteoporosis.

Which definition of a plaque is most accurate?

Elevated, coalesced papules greater than 0.5 cm Plaque may be coalesced papules greater than 0.5 cm. Small, flat discolored lesion is a macule patch, Encapsulated, fluid-filled mass is a cyst, and Flat, flaky, whitish, detachable fragment of epidermis is related to dandruff, psoriasis, or dry skin.

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

Falling on a ski hill with bindings that do not release Fractures can be classified by type. A spiral fracture results from twisting and covers a large area of the bone. A stress fracture can occur from overuse. An impacted fracture can occur when landing on a joint. The angle of fracture, number of bone pieces, and whether the bone pierces the skin are all additional characteristics used to describe a fracture.

The nurse notes a blister on a patient's skin. Which of the following best defines this area?

Fluid-filled papule A blister is a vesicle or fluid-filled papule. The other statements are not appropriate descriptions.

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 For a soft tissue contusion the treatment would consist of elevating the affected areas and applying ice not heat for the first 24 hours. Pain medications may be helpful, but the nonpharmacologic treatments would best treat the condition. Surgery is not required.

Which of the following are pigment-synthesizing cells?

Melanocytes Melanocytes produce pigments that contribute to skin color. Keratinocytes are keratin-filled squamous epithelia of the skin. Merkel cells are sensory cells, and Langerhans cells participate in the immune system.

The nurse is providing teaching for parents of a 2-week-old infant just diagnosed with clubfoot. The nurse includes that the first treatment option is which of the following?

Serial manipulations and casting Serial manipulations and casting will be the first treatment. Each of the other options are more involved and would be attempted after manipulation and casting.

A nurse explaining a macule to a patient defines it as being which one of the following?

Small, flat, nonpalpable, discolored lesion A macule is a flat, nonpalpable skin color change (color may be brown, white, tan, purple, red)and is less than 1 cm, with a circumscribed border.

What is the source of nutrition for the epidermis?

The dermis The dermis is the connective tissue layer that separates the epidermis from the subcutaneous fat layer. It supports the epidermis and serves as its primary source of nutrition.

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

Treatment needs to be individualized. Treatment for developmental dysplasia of the hip needs to be individualized. Subluxation often resolves on it's own. Treatment should be completed within 6 months after birth. Not all infants will need surgery.

A client has sought care, reporting bone pain. Diagnostic testing reveals that the client has developed osteonecrosis. When addressing the most likely cause of this complication, the nurse should focus on:

the quality and quantity of blood flow to the site. Ischemia is the essential cause of osteonecrosis. Anemia is not a noted cause and NSAIDs are not linked to the disease. Weight bearing does not cause osteonecrosis, even when heavy or repeated.

The nurse has just finished teaching a client newly diagnosed with rheumatoid arthritis about the disease. The nurse determines that teaching is effective when the client states:

"Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular." Joint involvement with rheumatoid arthritis usually is symmetric and polyarticular. Any diarthrodial joint can be involved. The disease is characterized by exacerbations and remissions, may involve only a few joints for brief durations, or may become relentlessly progressive and debilitating.

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

"This is a simple webbing of the fingers or toes." The nurse should tell the patient that syndactyly is a simple webbing of the fingers or toes that occurs at birth. It is not a rare abnormality. It is unknown if it can be prevented. Surgery can remove the webbing.

A patient shows the nurse an area on his arm where he has repeatedly been giving insulin injections to himself. The nurse feels the area and the skin appears to be thin. The nurse feels a "valley" or indentation in the area. Which of the following would the nurse tell the patient?

"This is an area of atrophy." The area of skin that feels like an indentation is most likely lipoatrophy or atrophied skin due to repeated insulin injections. A hypertrophied area would feel like a "lump." A scar is an actual mark left from a healing wound.

Which of the following patients is most at risk for premature osteoporosis?

A 16-year-old female athlete who has not had her period The 16-year-old female who has not had her period is most at risk for premature osteoporosis. Children who do not drink milk or eat cheese or who are even lactose intolerant can absorb calcium by taking supplements or eating alternative foods.

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 The type of fracture is determined by its communication with the external environment, the degree of break in continuity of the bone, and the character of the fracture pieces. A fracture can be classified as open or closed. When bone fragments have broken through the skin, the fracture is called an open or compound fracture. The character of a fracture is determined by its pieces. A comminuted fracture has more than two pieces. A fracture is called impacted when the fracture fragments are wedged together. A greenstick fracture is a type of partial break in the continuity of the bone.

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 A pathologic stress fracture occurs in bones that already are weakened by disease or tumors. Fractures of this type may occur spontaneously with little or no stress. The underlying disease state can be local, as with infections, cysts, or tumors, or it can be generalized, as in osteoporosis, Paget disease, or disseminated tumors. A fatigue fracture results from repeated excessive wear on a bone. The most common fractures are those resulting from sudden direct impact, such as from a fall or blow, or indirect, such as a massive muscle contraction injury.

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 Benign bone tumors usually are limited to the confines of the bone, have well-demarcated edges, and are surrounded by a thin rim of sclerotic bone. The most common benign tumors are of either fibrous or cartilaginous tissue origin. Benign fibrous tumors of the bone are common in growing bones. They are usually asymptomatic, resolve in 2 to 3 years, and do not require treatment. The other options identify malignant tumors.

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 Because there are no specific radiographic findings in tubercular osteomyelitis, the diagnosis is usually made by tissue biopsy or culture findings. In spinal tuberculosis, a computed tomography (CT)-guided biopsy is often used. The mainstay of treatment for tubercular osteomyelitis remains the appropriate three- or four-drug antimicrobial therapy based on current guidelines. Conservative treatment is usually as effective as surgery, especially for earlier and milder cases

A nurse is assessing a patient with an irregularly shaped, elevated, firm growth on her right lower ear lobe that developed following an ear piercing. In which of the following races does this excessive formation of collagen occur with greater incidence?

African American A keloid is a hypertrophied scar tissue secondary to excessive collagen formation during healing and are elevated, irregular, and red. There is a greater incidence of this among African Americans.

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 Osteosarcoma is an aggressive and highly malignant bone tumor with an unknown cause. It is the most common malignant bone tumor, representing one fifth of all primary bone tumors.

Which of the following clients would be considered high risk for falling and fracturing a hip?

An 81-year-old female taking medication for chronic osteoporosis Risk factors for hip fracture include excessive consumption of alcohol and caffeine (rather than sugar), physical inactivity, low body weight, tall stature, use of certain psychotropic drugs, residence in an institution, visual impairment (rather than hearing), and dementia. Osteoporosis weakens the bone and is an important contributing factor. Most hip fractures result from falls.

Which best describes metatarsus adductus?

An adducted forefoot which gives the foot a kidney-shaped appearance Metatarsus adductus, or intoeing, is a common congenital deformity characterized by forefoot adduction with a normal hindfoot, giving the foot a kidney-shaped appearance. It can be caused by torsion in the foot, lower leg, or entire leg.

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 acronym RICE is a method to recall the initial treatment of a musculoskeletal injury: rest, ice, compression, and elevation. These activities reduce pain, swelling, and further injury. Any immobilization device should be applied in a functional position. If there is a deformity, there should be no attempt to straighten the limb.

Which statement concerning blood flow to the skin is true?

Arteriovenous anastomoses in the skin regulate temperature. The skin is supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. These anastomoses are important for temperature regulation.

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. Due to the suspected nature of the injury, the child should remain in the emergency department for evaluation of the injury. The nurse should proceed with assessment and treatment while awaiting further intervention.

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

Benign A benign tumor grows slowly and does not destroy or invade the surrounding tissues. The other options are malignant tumors that do invade surrounding tissues and structures.

A client with confirmed low bone density asks the nurse if there is anything she can to decrease the risk of trauma. The best response would be:

Brisk walking three times per week on a flat surface Weight-bearing exercises such as walking, jogging, rowing, and weight lifting are important in the maintenance of bone mass. The other options place the person at risk for injury if the bones are weakened.

While breaking in a new pair of shoes, a client develops a large (1.0 cm) blister filled with clear fluid. The dermatologist diagnoses this as:

Bulla Bullae are large (1.0 cm or larger in diameter) fluid-filled blisters, whereas vesicles are small (<1.0 cm in diameter). Nodules are solid marble-like lesions (>0.5 cm) that are deeper and firmer than a papule. A wheal is a somewhat irregular, relatively transient area of localized skin edema, such as a mosquito bite.

A female athlete has been diagnosed with amenorrhea due to intense training for a spot on the Olympic swimming team. As a health care provider, which of the following should be implemented to prevent premature osteoporosis?

Calcium/vitamin D supplements to support BMD. The female athlete triad, a pattern of disordered eating that leads to amenorrhea and eventually premature osteoporosis, is being seen increasingly in female athletes because of an increased prevalence of eating disorders. Poor nutrition, combined with intense exercise training, can lead to decrease in the critical body fat-to-muscle ratio needed for normal menses and estrogen production by the ovary. The lack of estrogen combined with the lack of calcium and vitamin D from dietary deficiencies results in a loss of bone density and increased risk of fractures. Older athletes are at high risk for osteoarthritis, a degenerative joint disorder that is unrelated loss of bone density.

The nurse has completed an assessment of a client and noted a hyperkeratotic plaque of skin that resulted from chronic pressure or friction. The nurse would document this as:

Callus A callus is a plaque of skin caused by chronic pressure or friction. Blisters are circumscribed elevations of the skin caused by fluid under or within the epidermis. Corns (helomas) are small, well-circumscribed, conical, keratinous thickenings of the skin and usually appear on the toes from rubbing or using ill-fitting shoes. Rashes are temporary eruptions of the skin, such as those associated with childhood diseases, heat, diaper irritation, or drug-induced reactions.

An industrial labourer uses his hands every day when he lifts and transfers heavy materials. Which integumentary adaptation to his work is normal?

Calluses A callus is a hyperkeratotic plaque of skin due to chronic pressure or friction. It represents hyperplasia of the dead, keratinized cells that make up the cornified or horny layer of the skin. Corns are small, well-circumscribed, conical, keratinous thickenings of the skin. They usually appear on the toes from rubbing or ill-fitting shoes. Pruritus is itching, which is not an expected adaptation. Similarly, a rash would not be considered an adaptation.

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

Cerebral palsy Neuromuscular scoliosis develops from neuropathic or myopathic disease. It is seen with cerebral palsy, myelodysplasia, and poliomyelitis. It is not linked to Huntington disease, epilepsy, or Down syndrome.

An elderly client asks the nurse why her skin is so dry. Which response is best for the nurse to give to this client? Select all that apply.

Changes occur in the sebaceous gland. A decrease in skin capillaries occurs. Flattening of the dermal rete ridges occurs. The effects of aging on skin dryness include a change in the composition of sebaceous gland secretions and a decrease in the secretion of moisture from the sweat glands. Aging is also accompanied by a decrease in skin capillaries as well as a flattening of the dermal rete ridges, resulting in less surface area for exchange of fluids between the dermis, epidermis, and skin surface

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 Closed comminuted fracture is a closed fracture because it does not break through the skin. It is comminuted because it broke cleanly into two pieces. A closed greenstick fracture is a fracture that is a partial break in bone continuity, common in young children whose bones are not yet fully ossified. An open spiral fracture is a fracture that breaks through the skin. Thromboemboli is a clot not a fracture.

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

Club foot may be associated with congenital syndromes. Club foot may be associated with congenital syndromes; however, it does not only occur with other genetic defects. It is treatable and affects boys more often than girls

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 Compartment syndrome occurs as a result of increased pressure within a limited space (e.g., abdominal and limb compartments) that compromises the circulation and function of the tissues within the space. The hallmark symptom of an acute compartment syndrome is severe pain that is out of proportion to the original injury or physical findings. Nerve compression may cause changes in sensation (e.g., paresthesias such as burning or tingling or loss of sensation), diminished reflexes, and eventually the loss of motor function. Fracture blisters are skin bullae and blisters. The complex regional pain syndrome or reflex sympathetic dystrophy is caused by involvement of nerve fibers.

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 Although it is true that many disorders of early infancy are caused by intrauterine positions, they are mostly resolved as the child grows.

When assessing a patient diagnosed with Paget disease focused in the skull, the nurse should anticipate which findings?

Headaches Intermitent tinnitus Vertigo Hearing loss Involvement of the skull can cause headaches, intermittent tinnitus, vertigo, and eventual hearing loss. Visual impairment is not associated with Paget disease of the skull.

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 Malunion is healing with deformity, angulation, or rotation that is visible on x-ray films. Delayed union is the failure of a fracture to unite within the normal period (e.g., 20 weeks for a fracture of the tibia or femur in an adult). Nonunion is failure to produce union and cessation of the processes of bone repair. Obesity does not influence fracture alignment.

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 Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the bloodstream. The other types are not caused by infectious organisms in the bloodstream.

The nurse assessing a child with osteogenesis imperfecta notes that the child has blue sclera, hearing problems, and dental problems. The nurse recognizes the child most likely has which type of osteogenesis imperfecta?

I Type I osteogenesis imperfecta is an autosomal dominant disease whose maifestations include multiple fractures, blue sclera, hearing problems, and possible dental problems.

An older adult client has been diagnosed with metastatic bone disease. Which aspect of the client's care plan most directly addresses a common complication of this disease?

Implementing falls prevention measures The primary goals in treatment of metastatic bone disease are to prevent pathologic fractures and promote survival with maximum functioning. Preventing falls is imperative due to the sharp decline in bone strength that accompanies the disease. Potassium levels are not likely to be highly unstable and neurologic status is not normally affected. Skin integrity must be monitored, but not to a larger extent than in client's with other diagnoses.

A patient presents with pruritus of the lower extremities. Which of the following is the priority nursing assessment?

Inspection for presence of dry skin People with dry skin often experience severe pruritus and discomfort, most commonly of the extremities. Other commonly involved areas include the back, abdomen, and waist. Dry skin appears rough and scaly and there may be increased wrinkles or lines. Skin drying also predisposes the skin to scratching, resulting in cracking.

A daughter is concerned because her elderly parent has been diagnosed with osteomalacia. The daughter asks the nurse why this happened. The best response would be that:

Intestinal absorption slows as a natural aging process The incidence of osteomalacia is high among the elderly because of diets deficient in calcium and vitamin D, a problem often compounded by the intestinal malabsorption that accompanies with aging. Melanin is extremely efficient in absorbing UVB radiation; thus, decreased skin pigmentation markedly reduces vitamin D synthesis, as does the use of sunscreens. Osteomalacia also may occur in persons on long-term treatment with medications such as anticonvulsants (e.g., phenytoin, carbamazepine, valproate) that decrease the activation of vitamin D in the liver.

A child has been hospitalized for the treatment of hematogenous osteomyelitis. The defining characteristic of this type of osteomyelitis is:

Introduction of microorganisms from the bloodstream Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the bloodstream. Dead bone tissue is indicative of osteonecrosis, not osteomyelitis. Hematogenous osteomyelitis is normally accompanied by the classic signs and symptoms of infection; the destruction of the vascular network in the endosteum is not a hallmark of the hematogenous variant of osteomyelitis.

The pediatric nurse is providing teaching to a parent of a child with toeing-out (slew foot). Which of the following should the nurse include in the teaching?

It will most likely self correct as the child becomes proficient in walking. Toeing-out (slew foot) is a common problem in children that usually corrects itself as the child becomes proficient in walking. Occasionally a night splint is utilized. Sleeping in the supine position does not impact toeing-out.

A patient's nursing assessment documents that the patient has pruritus. The nurse plans care for a patient with which of the following symptoms?

Itching sensation Pruritus is the medical terminology for an itching sensation and is a symptom common to many skin disorders. Nociceptors (i.e., pain receptors) are free nerve endings in the papillary layer of the dermis. Scratching is a neurologic reflex and a well-known response to itch (pruritus) that can lead to lichenification. Rashes are temporary eruptions of the skin that may cause pruritus.

Following a lengthy series of diagnostic tests, a client's chronic hip pain has been attributed to advanced osteonecrosis. What treatment is this client most likely to require?

Joint replacement surgery Advanced osteonecrosis often necessitates joint replacement surgery, since necrotic bone cannot be rehabilitated. Osteonecrosis is noninfectious in etiology, so antibiotics are not normally necessary. Steroid injections will not restore the affected bone, and blood transfusions do not address the cause of consequences of the problem.

A client with chronic renal disease has severe pruritus. Which interventions should the nurse include in the teaching plan for the client? Select all that apply.

Keep fingernails trimmed Moisturize the skin frequently Take a cool shower before bed Most treatment measures for pruritus are nonspecific. Measures such as using the entire hand to rub over large areas and keeping the fingernails trimmed often can relieve itch and prevent skin damage. Self-limited or seasonal cases of pruritus may respond to treatment measures such as moisturizing lotions, bath oils, and the use of humidifiers. Because vasodilation tends to increase itching, cold applications may provide relief. Cool showers before bed, light sleepwear, and cool home temperatures also may be helpful. Topical corticosteroids may be helpful in some cases, such as itch related to allergy-mediated urticaria.

A nursing instructor is teaching students about skin structure. The instructor evaluates student knowledge of the Langerhans cells based on which of the following statements?

Langerhans cells are the immunologic cells responsible for recognizing foreign antigens harmful to the body. Langerhans cells are scattered in the suprabasal layers of the epidermis among the keratinocytes. Langerhans cells are the immunologic cells responsible for recognizing foreign antigens harmful to the body. Langerhans cells play an important role in defending the body against foreign antigens

In third-world countries, many children experience uncontrolled itching and scratching, which may develop into:

Lichenification Repeated rubbing and scratching can lead to lichenification (thickened and roughened skin characterized by prominent skin markings caused by repeated scratching or rubbing) or excoriation (lesion caused by breakage of the epidermis, producing a raw linear area). Blisters are circumscribed elevations of the skin caused by fluid under or within the epidermis. Pustules are circumscribed pus-filled elevations of the skin. Vesicles are small (<1.0 cm in diameter). An ulcer is a skin defect in which there has been loss of the epidermis and papillary layer of the dermis.

A patient comes to the clinic with a "terrible itch" on the abdomen and waist that has lasted for several months and has been scratched continuously. Inspection reveals an area of thickened rough skin. The nurse documents this condition using which of the following terms?

Lichenification Repeated rubbing and scratching can lead to lichenification (thickened, leathery, and roughened skin characterized by prominent markings).

With eyes closed, an object is placed in a student's hand. The instructor asks the student to identify the object. When he does so correctly, this is primarily the responsibility of

Meissner corpuscles Meissner corpuscles are encapsulated mechanoreceptors specialized for tactile discrimination. They are concentrated on the fingertips and palms of the hands, where they account for about half of the tactile receptors. The skin is also supplied by Krause end bulbs, nerve endings contained in a cylindrical or oval capsule. They are found most frequently in the oral cavity, conjunctiva, and genitalia. Although their function is uncertain, they are thought to act as mechanoreceptors and heat detectors. The stratum spinosum is two to four layers thick, consisting of cells commonly referred to as prickle cells because they develop a spiny appearance as their cell borders interact. The papillary dermis lies adjacent to the epidermis and is densely covered with conical projections called dermal papillae.

A patient expresses concern to the nurse about and an area of skin on the chest that has recently turned white and was diagnosed as vitiligo. The nurse tells the patient that vitiligo is caused by which of the following?

Melanocytes are destroyed, leading to a complete absence of melanin pigment Vitiligo is the complete absence of melanin pigment in patchy areas of white or light skin on the face, neck, hands, feet, body folds, and around orifices—otherwise the depigmented skin is normal.

A client has sought care for a serious sunburn that resulted from falling asleep at the beach. What physiologic process was involved in the client's overexposure to ultraviolet radiation?

Melanocytes were unable to sufficiently protect that client Melanocytes produce a pigment called melanin which is responsible for skin color, tanning, and protecting against ultraviolet radiation. Keratinocytes in the epidermis provide external strength and protection. Merkel cells provide sensory information and Langerhans cells link the epidermis to the immune system.

Which are the sparsest cells in the epidermis?

Merkel cells Merkel cells are clear cells found in the stratum basale of the epidermis. They are the sparsest cells in the epidermis. The other cells appear in higher numbers throughout the body.

Select the cells of the epidermis that are responsible for providing sensory information.

Merkel cells The Merkel cells provide sensory information. Langerhans cells link the epidermis to the immune system, melanocytes provide pigmentation to the skin, and keratinocytes provide a protective function to the skin.

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 this malignant tumor is likely which type of neoplasm? Select all that apply.

Multiple myeloma Ewing sarcoma Chondrosarcoma Malignant tumors grow rapidly and can spread to other parts of the body through the bloodstream or lymphatics. Multiple myeloma, Ewing sarcoma, and chondrosarcoma are all malignant neoplasms. The other options are benign neoplasms.

A child with a diagnosis of Legg-Calvé-Perthes disease will exhibit which of the following?

Necrosis of the proximal femoral head Legg-Calvé-Perthes disease is an idiopathic osteonecrotic disease of the proximal (capital) femoral epiphysis. DDH involves congenital dislocation of the acetabulofemoral joint, whereas defective synthesis of type I collagen accounts for the pathologic effects of osteogenesis imperfecta. Intoeing is neither a cause nor a consequence of Legg-Calvé-Perthes disease.

A nurse assesses a patient with a 3-cm lipoma in the subcutaneous tissue. Which of the following terms would best describe this lesion?

Nodule A nodule is an elevated, palpable, solid mass with a circumscribed border.

A client comes to the clinic with multiple bug bites to the legs bilaterally and severe pruritus. The nurse prepares to education the client about which medication commonly prescribed for pruritis?

Nonsedating antihistamines Systemic antihistamines and corticosteroids may be indicated for people with severe pruritus. Mild cutaneous disorders, such as bug bites, are mediated by histamine. Therefore, nonsedating antihistamines tend to be the treatment of choice.

A patient is being evaluated in the clinic for a raised red rash on both hands. Which of the following factors is the most significant in the evaluation?

Occupation/hobbies The location of the rash suggests contact dermatitis. This condition is most often caused by contact with irritating substances such as might be found in industrial settings or associated with specific hobbies.

The nurse is caring for a child who presented to the emergency department with multiple fractures in various stages of healing all over the body. The nurse collaborates with the physician on care for a patient with which of the following potential conditions?

Osteogenesis imperfecta Osteogenesis imperfecta needs to be considered after ruling out abuse related to the various stages of healing fractures. The condition can be inherited as a recessive trait, but infants are usually still born related to injury. The other options are not associated with the symptoms described.

Which of the following statements correctly describe osteogenesis imperfecta, or brittle bone disease

Osteogenesis imperfecta is caused by deficiencies in the synthesis of type I collagen. Osteogenesis imperfecta is one of the most common hereditary bone diseases, with an estimated 20,00 to 50,000 people with OI in the United States. OI is usually transmitted as an autosomal dominant trait, and it results in extreme skeletal fragility.

A 75-year-old Caucasian female has been admitted to the hospital with a hip fracture. She states, "All I did was fall into my chair, not even very hard." Upon diagnostic testing, the client's bones shows loss of trabeculae from cancellous bone and thinning of the cortex. Which diagnosis is most likely

Osteoporosis Osteoporotic changes occur in the diaphysis and metaphysis where a loss of trabeculae from cancellous bone and thinning of the cortex is to such an extent that minimal stress causes fractures. Osteonecrosis is due to ischemia, osteomyelitis is an infection, and osteomalacia is a metabolic disorder caused by phosphate deficiency.

A client presents to a health care clinic reporting sudden onset of deep, localized pain and swelling in her proximal femur. The client is currently undergoing diagnostic workup for suspected lung cancer. The nurse suspects the client may have developed which of the following neoplasms of the skeletal system?

Osteosarcoma Osteosarcoma is an aggressive and highly malignant bone tumor that normally requires surgery and chemotherapy. Exostosis and osteochondroma are synonymous terms for types of benign neoplasms that often require no treatment. Endochondroma is also benign and may self-resolve.

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 Manifestations common among musculoskeletal injuries are pain and swelling. Differences arise from the type of injury. Strains occur in muscles from overstretching and usually have no external evidence, but there is pain, stiffness, and swelling. Sprains occur when the ligaments supporting a joint are torn. Mild sprains involve only a few strands of the ligament, while a severe sprain can completely separate the ligament from the bone. Swelling, pain, heat, discoloration, and limited function are common signs of sprain. A fracture involves break in the integrity of a bone. Signs and symptoms of fracture include pain, tenderness at the site, swelling, loss of function, deformity, and abnormal mobility, or false motion. A dislocation occurs when the bone ends of a joint are separated. Symptoms include pain, deformity, and loss of function. A loose body is a small piece of bone or cartilage in the joint. It can cause catching and locking of the joint.

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

Pain in front of the knee The child with Osgood-Schlatter disease most often presents with pain in front of the knee. The other symptoms are not common with this disease.

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) Complications of fractures include compartment syndrome when swelling after the injury impairs blood and nerve function, delayed healing, infection, and emboli. Of these conditions, compartment syndrome has the earliest onset and is monitored by NVA. NVA includes capillary refill, temperature of the distal extremity, and sensation and the ability to move fingertips.

A nurse is teaching a patient about psoriasis and the nurse knows that teaching is effective when the client correctly identifies which of the following lesions as being associated with psoriasis? Select all that apply.

Plaques Scales A plaque is an elevated, palpable, solid mass with a circumscribed border. Flakes secondary to desquamated, dead epithelium that may adhere to kin surface; color varies (silvery, white); texture varies (thick, fine). Both types of skin lesions can be found with psoriasis.

In examining an adolescent who is noted to have a lateral curvature in the spine in the upright position, but that corrects with bending, the clinician is aware that this would be identified as which of the following?

Postural scoliosis Scoliosis is a lateral curvature of the spine in the upright position. Scoliosis is classified as postural or structural. With postural scoliosis, there is a small curve that corrects with bending. It can be corrected with passive and active exercises. Structural scoliosis does not correct with bending

Which statement concerning hair follicles is true?

Red hair has spherical melanosomes. The only true statement is that red hair has spherical melanosomes. The other statements are not true.

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 Osteomyelitis is an infection in the bone. With a compound fracture, infecting organisms can easily enter the bone through open tissue. Manifestations include chills, fever, malaise, pain of the affected extremity, local tenderness, redness, and swelling. Clear drainage at pin sites is common and does not indicate infection without other indicators.

The nurse caring for a child with a deficiency of vitamin D knows that the deficiency places the child at risk for which of the following

Rickets Rickets is associated with a Vitamin D deficiency while scurvy is associated with a Vitamin C deficiency. Hip dysplasia is not associated with a Vitamin D deficiency. Paget disease is not associated with children.

When comparing a child's clinical manifestations with that of oligoarthritis versus systemic onset, the health care provider diagnoses this in your 4-year-old child with oligoarthritis based on which of the following clinical findings?

Right knee is warm and painful when putting it through normal range of motion. Oligoarthritis, which is the most common type of JIA, predominantly affects joints of the lower extremities, usually the knees or ankle. Involvement of upper extremity large joints and the hip is rarely a presenting sign. Often a single joint is affected at onset. Children with this form of JIA are usually younger (1 to 5 years at onset) and are often rheumatoid factor (RF) positive. The symptoms of systemic JIA include a daily intermittent high fever, which usually is accompanied by a characteristic faint, erythematous, macular rash. The rash is not pruritic.

When asked to name the parts of the pilosebaceous unit of the skin, which student has the correct answer?

Sebaceous glands Most hair follicles are associated with sebaceous glands, and these structures combine to form the pilosebaceous unit. The nails are hardened keratinized plates. Eccrine sweat glands transport sweat to the outer skin surface to regulate body temperature. The subcutaneous tissue layer consists primarily of fat and connective tissues that lend support to the vascular and neural structures supplying the outer layers of the skin.

A 14-year-old presents to the dermatologist clinic with a severe case of acne. The nurse explains that this acne is a result of inflamed

Sebaceous glands The sebaceous glands are the structures that become inflamed in acne. Growth of the hair is centered in the bulb (i.e., the base) of the hair follicle, which is just one part of the hair structure. Apocrine sweat glands are located deep in the dermal layer and open through a hair follicle. Dermal papillae minimize separation of the dermis and the epidermis and contain capillary venules that nourish the epidermal layers of the skin.

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 Treatment of clubfoot is begun as soon as the diagnosis is made. When treatment is initiated during the first few weeks of life, a nonoperative procedure may be effective. Serial manipulations and casting are used gently to correct each component of the deformity. Surgery may be required for severe deformities or when nonoperative treatment methods are unsuccessful. It is performed most commonly between 6 and 12 months of age. Chemotherapy is not a treatment of choice.

Select the statement that best describes skin disorders.

Skin color may influence the appearance of the skin disorder. No two skin disorders look exactly alike, nor are they necessarily caused by the same agents. The appearance of many skin disorders may be further influenced by excessive itching, infection, or the effects of self-treatment. Skin color also may influence the appearance.

In explaining a papule to a patient, a nurse defines it as being which of the following?

Small, raised solid mass with a circumscribed border A papule is an elevated, palpable, solid mass with a circumscribed border less than 0.5 cm.

A clinic nurse plans care for a newly diagnosed osteoarthritis client. Which items should this client be provided with educational materials? Select all that apply.

Splints to protect and rest the involved joint Use of heat and cold when appropriate for muscle spasms and pain How to use a cane or walker if hip/knees joints are involved Physical measures are aimed at improving the supporting structures of the joint and strengthening opposing muscle groups involved in cushioning weight-bearing forces. This includes a balance of rest and exercise, use of splints to protect and rest the joint, use of heat and cold to relieve pain and muscle spasm, and adjusting the activities of daily living. The involved joint should not be further abused, and steps should be taken to protect and rest it. These include weight reduction (when weight-bearing surfaces are involved) and the use of a cane or walker if the hips and knees are involved.

A nurse educator is teaching students about the layers of the skin. Which of the following layers are commonly referred to as prickle cells?

Stratum spinosum The stratum spinosum is formed as the progeny of the basal cell layer move outward toward the skin surface. The stratum spinosum is two to four layers thick, and its cells become differentiated as they migrate outward. Because they develop a spiny appearance where their cell borders interconnect, the cells of this layer are commonly referred to as prickle cells.

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 Displaced intracapsular fractures in the elderly are usually best treated by surgical hip replacement and early mobilization. Young, healthy people are treated by reduction of the fracture and internal fixation. Intertrochanteric fractures are usually treated with open reduction and internal fixation. External fixation devices are not used for hip fractures.

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

Swelling Discoloration Limited movement Heat Manifestations common among musculoskeletal injuries are pain and swelling. Differences arise from the type of injury. Sprains occur when the ligaments supporting a joint are torn. Mild sprains involve only a few strands of the ligament, whereas a severe sprain can completely separate the ligament from the bone. Swelling, pain, heat, discoloration, and limited function are common signs of sprain. A dislocation occurs when the bone ends of a joint are separated. Symptoms include pain, deformity, and limited movement. Strains occur in muscles from over stretching and usually have no external evidence, but there is pain, stiffness, and swelling. A fracture involves break in the integrity of a bone. Signs and symptoms of fracture include pain, tenderness at the site, swelling, loss of function, deformity, and abnormal mobility, or false motion, which occurs when the affected part bends across the break. A loose body is a small piece of bone or cartilage in the joint. It can cause catching and locking of the joint.

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

Swelling Loss of function Pain The client with a fractured leg can have swelling, loss of function, pain, deformity and abnormal mobility. Cyanosis and absence of feeling are not typical findings with a simple fractured leg.

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

The client with a puncture wound of the chest. Puncture wounds into the chest have the potential to have caused significant damage to internal organs and should be seen first. The other clients have lower priority.

A child's history and physical documents that the child has a grade I metatarsus adductus deformity. When assessing the child, the nurse anticipates finding which result?

The foot can be manipulated into a straight position Metatarsus adductus is graded based on the foot's flexibility when applying pressure to the medial foot. Grade I is a supple deformity that can be passively manipulated into a straight position. Grade II deformity corrects only to a straight lateral border and a grade III deformity is rigid and typically requires further treatment.

A college baseball player has seen his season cut short by a rotator cuff injury. Rotator cuff injuries are frequent because of:

The inherent instability of the shoulder The complexity and flexibility of the shoulder also mean that it is one of the more unstable joints. This makes it extremely vulnerable to injuries, including sprains, dislocations, and degenerative processes such as rotator cuff disorders. The glenohumeral joint contains ligaments, although menisci do not exist in the shoulder. The anatomy of the humerus does not account for the weakness of the joint.

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." The treatment for an avulsion fracture and severe sprain is usually immobilization for 4 to 6 weeks. The client may need surgery, but they will not be able to walk without pain and further injury to the joint.

The nurse is providing care for an adult client whose current medication regimen includes calcitonin and a bisphosphonate. The nurse should recognize the likely need for:

bone density testing on a scheduled basis. Calcitonin and bisphosphonates are commonly used in the treatment of osteoporosis, in order to slow bone resorption; individuals with osteoporosis are encouraged to undergo regular bone density testing. Weight-bearing exercise is beneficial, provided it is performed within safe limits. Surgery is not normally indicated. Genu varum and genu valgum are congenital misalignments of the knee joint that do not affect bone resorption.

Unlike hair, nails grow:

continuously. Like hair, nails are the end product of dead matrix cells that are pushed outward from the nail matrix. Unlike hair, nails grow continuously rather than cyclically. The epidermis, the outermost layer of the skin, contains five layers, or strata.