ch 39 musculoskeletal prep u
A client is diagnosed with a fracture of a diarthrosis joint. What is an example of this type of joint?
Elbow
A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively?
Performing hourly neurovascular assessments for the first 24 hours
Which of the following is the final stage of fracture repair?
Remodeling
In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?
Surgical debridement
A client had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated?
The left leg is internally rotated.
Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy?
aspirin
Which is not a risk factor for osteoporosis?
being male
A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period?
osteomyelitis
An example of a flat bone is the
sternum.
The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.)
Pale, cyanotic, or mottled color Cool temperature of the extremity More than 3-second capillary refill
Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis?
Risk for infection
Bursitis is an inflammation of the bursa, a fluid-filled sac that cushions bone ends to enhance a gliding movement. What possible assessment findings would be present in a client with bursitis? Select all that apply.
painful movement of a joint a distinct lump
A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate?
"You may need to be evaluated for an underlying cause, such as renal failure."
The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for?
A fasciotomy
While the nurse is performing a physical assessment, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. What should this assessment indicate to the nurse?
Carpal tunnel syndrome
The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response?
Decrease in estrogen
In which deformity does the great toe deviate laterally?
Hallux valgus
Which type of cast encloses the trunk and a lower extremity?
Hip spica
Which of the following are common primary sites of tumors that metastasize to the bone? Select all that apply.
Kidney Prostate Lung Breast Ovary
The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding?
Lordosis
An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification?
Osteoblasts
A client has Paget's disease. An appropriate nursing diagnosis for this client is:
Risk for falls
What is the term for a lateral curving of the spine?
Scoliosis
Which principle applies to the client in traction?
Skeletal traction is never interrupted.
A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following?
Staphylococcus aureus
Red bone marrow produces which of the following? Select all that apply.
White blood cells (WBCs) Platelets Red blood cells (RBCs)
A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?
"I should use my heating pad this evening to reduce some of the pain in my knee."
A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintaine
Abduction
The nurse is evaluating a client's peripheral neurovascular status. Which would the nurse report to the health care provider as a circulatory indicator of peripheral neurovascular dysfunction?
Cool skin
Which would be consistent as a component of self-care activities for the client with a cast?
Cushion rough edges of the cast with tape
Which evaluation finding requires follow up by the nurse caring for a client with a total knee replacement? Select all that apply.
650 ml bloody drainage in drain wound Knee flexion at 30 degrees
A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy?
Apply a cold pack at the insertion site.
A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan?
Assessing movement and sensation in the fingers of the right hand
What food can the nurse suggest to the client at risk for osteoporosis?
Broccoli
A healthcare provider asks a nurse to test a client for Tinel's sign to diagnose carpal tunnel syndrome. What should the nurse do to perform this assessment?
Have the client hold the palm of the hand up while the nurse percusses over the median nerve.
A client has an elbow injury that involves the cartilage in that joint. The nurse understands that which type of cartilage has been affected?
Hyaline cartilage
The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as?
Kyphosis
A client with a sports injury undergoes a diagnostic arthroscopy of the left knee. What comment by the client following the procedure will the nurse address first?
My toes are numb."
Which term refers to a disease of a nerve root?
Radiculopathy
A client diagnosed with osteoporosis is being discharged home. Which priority education should the nurse should provide?
Remove all small rugs from the home
Which statement is accurate regarding care of a plaster cast?
The cast can be dented while it is damp.
The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed?
The skin may be covered with a yellowish crust that will shed in a few days.
A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?
Better molding to the client
Which of the following describes a muscle that is limp and without tone?
Flaccid
Which laboratory study indicates the rate of bone turnover?
Serum osteocalcin
Which is not a guideline for avoiding hip dislocation after replacement surgery.
The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.
Which clinical manifestation would the nurse recognize as an indicator of peripheral neurovascular dysfunction? Select all that apply.
Toes mottled and cool Complaints of pins and needles in feet
A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure:
the client that he or she won't be cut.
Which of the following is an example of a hinge joint?
Knee
A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks?
L4, L5, and S1
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?
Lower lumbar
Which is an inaccurate principle of traction?
Skeletal traction is interrupted to turn and reposition the client.
A group of students are studying for an examination on joints. The students demonstrate understanding of the material when they identify which of the following as an example of a synarthrodial joint?
Skull at the temporal and occipital bones
On a visit to the family health care provider, a client is diagnosed with a bunion on the lateral side of the great toe at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?
Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."
Which device is designed specifically to support and immobilize a body part in a desired position?
Splint
A nurse practitioner assesses a patient's movement in his left hand after a cast is removed. The nurse asks the patient to turn his wrist so the palm of his hand is facing up. This movement is known as:
Supination.
Skull sutures are an example of which type of joint?
Synarthrosis
A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan?
Teach the client how to prevent problems caused by immobility.
A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period?
Hematoma
The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication?
Hypovolemic shock
Which aspect should a nurse include in the teaching plan for a client with osteomalacia?
Include calcium, phosphorus, and vitamin D supplements
To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan?
Increase fiber intake.
The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding?
Tear in the joint capsule
While reading a client's chart, the nurse notices that the client is documented to have paresthesia. The nurse plans care for a client with
abnormal sensations.
Which would be contraindicated as a component of self-care activities for the client with a cast?
Cover the cast with plastic to insulate it
A nurse knows that a person with a 3-week-old femur fracture is at the stage where angiogenesis is occurring. What are the characteristics of this stage?
New capillaries producing a bridge between the fractured bones.
The nurse is assessing a client's peroneal nerve. What technique will the nurse use?
Prick the skin mid-way between the great and second toe.
Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.)
The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device."
A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse?
"A splint is applied when more swelling is expected at the site of injury."
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?
"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?
"You will receive IV antibiotics for 3 to 6 weeks."
A patient tells the nurse, "I was working out and lifting weights and now that I have stopped, I am flabby and my muscles have gone!" What is the best response by the nurse?
"Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued."
Which statement describes paresthesia?
Abnormal sensations
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?
Alkaline phosphatase
The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery?
Anticoagulation therapy
A patient is scheduled for a procedure that will allow the physician to visualize the knee joint in order to diagnose the patient's pain. What procedure will the nurse prepare the patient for?
Arthroscopy
The nurse is performing a neurological assessment. What will this assessment include?
Ask the client to plantar flex the toes.
A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority?
Assessing the extremity for neurovascular integrity
Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse?
CPM increases range of motion of the joint."
Which hormone inhibits bone resorption and increases the deposit of calcium in the bone?
Calcitonin
Which of the following inhibits bone resorption and promotes bone formation?
Calcitonin
Which cleansing solution is the most effective for use in completing pin site care?
Chlorhexidine
A client was playing softball and dislocated four of his fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as?
Closed reduction
After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do?
Discuss the complications that the client may experience if there is lack of cooperation with the care plan.
The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication?
Dislocation of the hip
A client with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate?
Document the findings.
The nurse teaching the client with a cast about home care includes which instruction?
Dry a wet fiberglass cast thoroughly to avoid skin problems
Which intervention should the nurse implement with the client who has undergone a hip replacement?
Instruct the client to avoid internal rotation of the leg.
The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is:
Risk for ineffective therapeutic regimen management
Morton neuroma is exhibited by which clinical manifestation?
Swelling of the third (lateral) branch of the median plantar nerve
A client diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. What is the best response by the nurse? You Selected
"CTS is a neuropathy that is characterized by compression of the median nerve at the wrist."
The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment by the client should the nurse be most concerned?
"I was worried I would have an incision and scar."
When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide?
"Limit hip flexion to 90 degrees."
The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective?
"Metal pins will go through my skin to the bone."
Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.)
"Place pillows between your legs when you lay on your side." "Avoid bending forward when sitting in a chair." "Use a raised toilet seat and high-seated chair."
Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education?
"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device."
The nurse is preparing the client for computed tomography. Which information should be given by the nurse?
"You must remain very still during the procedure."
A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation?
Abduction
The nurse is providing care to a client following a knee arthroscopy. What would the nurse expect to include in the client's plan of care?
Administering the prescribed analgesic.
Which would be an inappropriate initial pain relief measure for the client with a cast?
Application of a new cast
A patient has a cast removed after bone healing takes place. What should the nurse instruct the patient to do after removal? (Select all that apply.)
Apply an emollient lotion to soften the skin. Control swelling with elastic bandages, as directed. Gradually resume activities and exercise.
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?
Arthroscopy
Which action would be most important postoperatively for a client who has had a knee or hip replacement?
Assisting in early ambulation.
A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?
Better molding to the client
A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction?
Buck's
Which of the following are the major hormonal regulators of calcium homeostasis? Select all that apply.
Calcitonin Parathormone
Which is an indicator of neurovascular compromise?
Capillary refill of more than 3 seconds
A group of students are reviewing the structure and function of bones. The students demonstrate understanding of the information when they state that cortical bone is found primarily in which of the following?
Diaphyses
Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?
Dupuytren's contracture
The nurse is performing a neurovascular assessment of a client's injured extremity. Which would the nurse report?
Dusky or mottled skin color
A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain?
Elevate the affected extremity and use cold applications.
A patient has had a stroke and is unable to move the right upper and lower extremity. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding?
Flaccidity
The nurse is very concerned about the potential debilitating complication of peroneal nerve injury. What symptom does the nurse recognize as a result of that complication?
Foot drop
During a routine physical examination of a client, the nurse observes a flexion deformity of the proximal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding?
Hammer toe
A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign?
Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.
The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided?
I will avoid prolonged sitting or walking."
Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery?
It promotes healing by increasing circulation and movement of the knee joint.
A client is exhibiting diminished range of motion, loss of flexibility, stiffness, and loss of height. The history and physical findings are associated with age-related changes of which area?
Joints
The nurse is caring for a client with a spica cast. What is the nurse's priority intervention?
Keep the cast clean and dry.
A client has undergone an external fixation. Which actions would be the priority for this client?
Maintaining pin care.
The nurse is working on an orthopedic floor caring for a client injured in a football game. The nurse is reviewing the client's chart noting that the client has previously had an injured tendon. The nurse anticipates an injury between the periosteum of the bone and which of the following?
Muscle
A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply.
Muscle spasms will be relieved. The bones of the left leg will be aligned. Immobilization of the left leg will be maintained.
Which cells are involved in bone resorption?
Osteoclasts
The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for?
Pulmonary embolism
The nurse is caring for a client who experienced a crushing injury of the lower extremities. Which of the following symptoms is essential to be reported to the physician?
Pulselessness
The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize?
Quadriceps
A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize?
Right shoulder slopes downward and droops inward.
A client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for?
Serous drainage
A patient arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the patient to describe the pain?
Sharp and piercing
A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied?
Short leg cast
Which statements describe open reduction of a fracture? Select all that apply.
The bone is surgically exposed and realigned. It is performed in the operating room. The client usually receives general or spinal anesthetic.
The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site?
The fracture is on the diaphysis.
The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse?
The patient has rheumatoid arthritis.
Which statement describes external fixation?
The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.
A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include?
Use the large muscles of the leg when lifting items.
The older client asks the nurse how best to maintain strong bones. What is the nurse's best response?
Weight-bearing exercises can strengthen bones."
A client tells the health care provider about shoulder pain that is present even without any strenuous movement. The health care provider identifies a sac filled with synovial fluid. What condition will the nurse educate the client about?
bursitis
A client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications?
common adverse effects
The human body has 206 bones, which are classified into four categories. Which types of bones are the femur and ulna?
long bones
A nurse notices a client lying on the floor at the bottom of the stairs. The client is alert and oriented and denies pain other than in the arm, which is swollen and appears deformed. After calling for help, what should the nurse do?
mmobilize the client's arm.
The nurse is conducting a medication reconciliation with a client admitted with a fracture. What medication predisposes a client for a risk for fractures?
prednisone
A client is reporting jaw pain, and is experiencing muscle spasm and tenderness of the masseter and temporalis muscles. The physician has diagnosed a temporomandibular disorder (TMD). What would the treatment course for this client include? Select all that apply.
referral to a dentist who has experience managing clients with TMD analgesics custom-fitted mouth guard during sleep
Arthrodesis is:
fusion of a joint (most often the wrist or knee) for stabilization and pain relief.
The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician?
Crackles in the lung bases
A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first?
My toes are stiff."
During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?
"After menopause, the body's bone density declines, resulting in a gradual loss of height."
A group of students are reviewing information about bones in preparation for a quiz. Which of the following indicates that the students have understood the material?
Osteoclasts are involved in the destruction and remodeling of bone.
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?
Perform neuromuscular assessment every hour.
A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client?
Changing the client's position within prescribed limits.
What is the best action by the nurse to achieve optimal outcomes when caring for a client with a musculoskeletal disorder who is using a cast?
Educate the client on cast care and complications
The health care provider is preparing to bivalve the client's cast. Which supplies should the nurse assemble?
Elastic compression bandage
A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for?
Left hip arthroplasty
After a person experiences a closure of the epiphyses, which statement is true?
No further increase in bone length occurs.
Which of the following presents with an onset of heel pain with the first steps of the morning?
Plantar fasciitis
A client is scheduled to undergo an electromyography. When performed, what will this test evaluate?
Muscle weakness
A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder?
Chlorpheniramine