Bone PrepU

epiphyseal fracture

epiphysis separates from the diaphysis along the epiphyseal plate

pathologic fracture

occurs when a weakened bone breaks under normal strain

compression fracture

occurs when the bone is pressed together (compressed) on itself

Which client would the nurse identify as having the greatest risk for osteoporosis? A 40-year-old overweight African American woman A 16-year-old male with a history of asthma A small-framed, thin 45-year-old white woman A 20-year-old male athlete with repeated injuries

A small-framed, thin 45-year-old white woman Explanation: Small-framed, thin white women are at greatest risk for osteoporosis. African American women have a greater bone density and thus are less susceptible to osteoporosis. Men have an increased bone mass and do not have hormonal changes, and do not acquire osteoporosis as frequently and get it at a later age. Asthma does not increase the risk for osteoporosis.

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 High-impact aerobic exercise for 1 hour three times per week Lawn bowling for 1 hour per week Running 1 mile per day with good athletic shoes

Correct response: Brisk walking three times per week on a flat surface Explanation: 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.

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing: Complex regional pain syndrome Delayed union Compartment syndrome Fat embolism syndrome

Fat embolism syndrome The typical first manifestations are pulmonary and include hypoxia, tachypnea, and dyspnea accompanied by tachycardia, substernal chest pain, low-grade fever, crackles, and additional manifestations of respiratory failure. Chest x-ray may show evidence of acute respiratory distress syndrome (ARDS) or it may be normal. Petechial rash may develop 2 to 3 days after the onset of symptoms. This rash is secondary to dysfunction in the microcirculation and/or thrombocytopenia and is typically located in nondependent regions (e.g., chest, mucous membranes) of the body.

Which group is at the greatest risk for osteoporosis? Men Caucasian women Asian women African American women

Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Asian women of slight build are at risk for low peak bone mineral density. African American women, who have a greater bone mass than Caucasian women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.

A nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan? Examine the surgical dressing every hour. Administer pain medication per client request. Monitor vital signs every 4 hours. Perform neuromuscular assessment every hour.

The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is important to prevent complications from the surgery. The surgical dressing does not need to be examined hourly. Administering pain medication is important, but assessing the foot color and temperature are most important. Vital sign monitoring is important, but not a priority after foot surgery.

transverse fracture

a direction of the fracture line that is straight across

spiral fracture

a fracture in which the bone has been twisted apart

stress fracture

a slight bone break caused by repetitive low-impact forces, such as running, rather than single forceful impact

simple fracture

bone is broken cleanly; the ends do not penetrate the skin

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? Bone fracture Loss of estrogen Negative calcium balance Dowager's hump

Correct response: Bone fracture Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

oblique fracture

fracture at an angle to the bone

greenstick fracture

one in which the bone is bent and only partially broken

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care? "Cover the cast with a blanket until the cast dries." "Keep your right leg elevated above heart level." "Use a knitting needle to scratch itches inside the cast." "A foul smell from the cast is normal."

Correct response: "Keep your right leg elevated above heart level." Explanation: The nurse should instruct the client to elevate the leg to promote venous return and prevent edema. The cast shouldn't be covered while drying. Covering the cast will cause heat buildup and prevent air circulation. The client should be instructed not to insert foreign objects into the cast because of the risk of cutting the skin and causing an infection. A foul smell from a cast is never normal and may indicate an infection.

Which of the following inhibits bone resorption and promotes bone formation? Calcitonin Estrogen Parathyroid hormone Corticosteroids

Correct response: Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis.

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? Ability to stretch arm over the head Difficulty lying on affected side Pain worse in the morning Minimal pain with movement

Correct response: Difficulty lying on affected side Explanation: Clients with a rotator cuff tear experience pain with movement and limited mobility of the shoulder and arm. They especially have difficulty with activities that involve stretching their arm above their head. Many clients find that the pain is worse at night and that they are unable to sleep on the affected side.

Which is not a risk factor for osteoporosis? being male small-framed, thin White or Asian women being postmenopausal family history

Correct response: being male Explanation: Being male is not considered a risk factor. Some of the risk factors for osteoporosis are being a small-framed, thin White or Asian woman; being postmenopausal; family history; inactivity; chronic low calcium intake; and excessive caffeine or tobacco us

A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose? contusion sprain strain subluxation

Correct response: contusion Explanation: A contusion is a soft tissue injury resulting from a blow or blunt trauma. Sprains are injuries to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A subluxation is a partial dislocation.

Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? Deficient knowledge about osteoporosis and the treatment regimen Acute pain related to fracture and muscle spasm Risk for constipation related to immobility Risk for injury related to fractures due to osteoporosis

The most important concern for an elderly patient with osteoporosis is prevention of falls and fractures. Pain and constipation can be managed, and knowledge can be reinforced, but fractures can cause significant morbidity and mortality.

A client with a musculoskeletal injury is instructed to increase dietary calcium. Which statement by the nurse is appropriate? "You need to increase the amount of red meat in your diet." "You need to increase the amount of non-citrus fruits in your diet." "You need to increase the amount of vitamin D in your diet." "You need to increase the amount of phosphorus in your diet."

Vitamin D is needed for the absorption of calcium. Although fruits containing vitamin C assist in the absorption of calcium, non-citrus fruits are of little benefit for calcium absorption. Increasing phosphorus in the diet can cause calcium to be lost from the bone, decreasing bone density. Red meat does not facilitate calcium absorption.

An older adult client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate? Maintaining protein levels Maintaining vitamin levels Promoting weight-bearing exercises Promoting range-of-motion (ROM) exercises

When the mechanical stressors of weight bearing are absent, disuse osteoporosis can occur. Therefore, if the client does weight-bearing exercises, disuse complications can be prevented. Maintaining protein and vitamins levels is important, but neither will prevent osteoporosis. ROM exercises will help prevent muscle atrophy and contractures.

comminuted fracture

bone is splintered or crushed into many pieces

impacted fracture

broken bone ends are forced into each other

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? Elevating the stump for the first 24 hours Maintaining the client on complete bed rest Applying heat to the stump as the client desires Removing the pressure dressing after the first 8 hours

Correct response: Elevating the stump for the first 24 hours Explanation: Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery.

A client with a right below-the-knee amputation is being transferred from the postanesthesia care unit to a medical-surgical unit. What is the highest priority nursing intervention by the receiving nurse? Ensure that a large tourniquet is in the room. Document the receiving report from the transferring nurse. Delegate the gathering of enough pillows for proper positioning and comfort. Review the physician's orders for type and frequency of pain medication.

Correct response: Ensure that a large tourniquet is in the room. Explanation: The client with an amputation is at risk for hemorrhage. A tourniquet should be placed in plain sight for use if the client hemorrhages. Documenting the receiving report is important but is not the highest priority. The nurse may delegate to unlicensed assistive personnel (UAP) the job of gathering more pillows for positioning, but this is not the highest priority. The nurse will need to review the physician's orders for pain medication, but again, this is not the highest priority, because any hemorrhaging by the client needs to be addressed first.

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply. skin breakdown wound infection pneumonia diarrhea

Correct response: skin breakdown wound infection pneumonia Explanation: After surgery, the nurse implements measures to prevent skin breakdown, wound infection, pneumonia, constipation, urinary retention, muscle atrophy, and contractures.

A client who was injured while playing basketball reports an extremely painful elbow, which is very edematous. What type of injury has the client experienced? sprain strain contusion All options are correct.

Correct response: sprain Explanation: Sprains are injuries to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A contusion is a soft tissue injury resulting from a blow or blunt trauma. Sprains are injuries to the ligaments surrounding a joint.

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis? Compartment syndrome Fat embolism Infection Volkmann's ischemic contracture

Correct response: Fat embolism Explanation: Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury. It occurs when fat droplets released at the fracture site enter the circulation, become lodged in pulmonary capillaries, and break down into fatty acids. Because these acids are toxic to the lung parenchyma, capillary endothelium, and surfactant, the client may develop pulmonary hypertension. Signs and symptoms of fat embolism include an altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae. Compartment syndrome and infection may complicate any fracture and aren't specific to a pelvis fracture. Volkmann's ischemic contracture is a potential complication of a hand or forearm fracture.

A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? Performing passive range-of-motion (ROM) exercises on the client's legs once each shift Keeping a pillow between the client's legs at all times Turning the client from side to side every 2 hours Maintaining the client in semi-Fowler's position

Correct response: Keeping a pillow between the client's legs at all times Explanation: After open reduction with internal fixation, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period, because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After open reduction with internal fixation, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.

A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall? Impacted fracture Transverse fracture Compound fracture Pathologic fracture

Correct response: Pathologic fracture Explanation: A pathologic fracture is a fracture that occurs through an area of diseased bone and can occur without trauma or a fall. An impacted fracture is a fracture in which a bone fragment is driven into another bone fragment. A transverse fracture is a fracture straight across the bone. A compound fracture is a fracture in which damage also involves the skin or mucous membranes

Elderly clients who fall are most at risk for which injuries? Wrist fractures Humerus fractures Pelvic fractures Cervical spine fractures

Correct response: Pelvic fractures Explanation: Elderly clients who fall are most at risk for pelvic and lower extremity fractures. These injuries are devastating because they can seriously alter an elderly client's lifestyle and reduce functional independence. Wrist fractures usually occur with falls on an outstretched hand or from a direct blow. Such fractures are commonly found in young men. Humerus fractures and cervical spine fractures aren't age-specific

Which may occur if a client experiences compartment syndrome in an upper extremity? Whiplash injury Volkmann's contracture Callus Subluxation

Correct response: Volkmann's contracture Explanation: If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a claw-like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation.

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? Increase fiber in the diet Walk or perform weight-bearing exercises outdoors Reduce stress Decrease the intake of vitamin A and D

Correct response: Walk or perform weight-bearing exercises outdoors Explanation: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine in moderation.

avulsion fracture

broken bone in which the site of muscle, tendon, or ligament insertion is detached by a forceful pull

depressed fracture

broken bone portion is pressed inward, typical of skull fracture

open fracture

compound fracture; broken bone with an open wound

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? "Apply ice packs for the first 12 to 18 hours." "Apply heat packs for the first 24 to 48 hours." "Apply ice packs for the first 24 to 48 hours, then apply heat packs." "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours."

Correct response: "Apply ice packs for the first 24 to 48 hours, then apply heat packs." Explanation: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? Compound Greenstick Oblique Spiral

Correct response: Compound Explanation: A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

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: limitations on weight-bearing exercise. bone density testing on a scheduled basis. assessment for the presence of genu varum or genu valgum. orthopedic surgery.

Correct response: bone density testing on a scheduled basis. Explanation: 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.