MED SURG I - CH 39

CT scan (computed tomography)

More detailed cross sectional image of body. Soft tissue or fractures that are difficult to evaluate on x-ray. Performed with or without contrast

After a person experiences a closure of the epiphyses, which statement is true?

No further increase in bone length occurs. EXPLANATION: After closure of the epiphyses, no further increase in bone length can occur.

What is the term for a rhythmic contraction of a muscle?

clonus

Flaccidity

decreased muscle tone; synonym for hypotonicity

epiphyses

ends of long bone

The nurse is reporting on the results of client blood work to the oncoming nurse. Upon reviewing the data, it is noted that the client has an elevated uric acid level. Which inflammatory process would the nurse screen for on shift rounds?

gout

kyphosis

increased forward curvature of the thoracic spine that causes a bowing or rounding of the back, leading to a hunchback or slouching posture aka hunchback

Osteomyelitis

infection of the bone

bursitis

inflammation of fluid filled sac in joint

Atonia

lack of muscle tone

Atonic:

lacking normal muscle tone or strength

Scoliosis

lateral curvature of the lumbar spine

Weight-resistance exercises

maintain and strengthen muscles

Weight-bearing exercises

maintain bone mass

Diaphysis

shaft of a long bone

connective tissue that connect muscles to bones

tendons

electromyography

tests the electrical potential of muscles and nerves leading to the muscles

osteopenia

thinner than average bone density

Which nerve is assessed when the nurse asks the client to spread all fingers?

ulnar

rheumatoid arthritis is characterized by:

ulnar deviation

MRI (magnetic resonance imaging)

High resolution of bones and soft tissues. Performed with or without contrast. *make sure pt is not allergic to iodine or shellfish

The nurse is assessing the muscle tone of a client with cerebral palsy. Which description does the nurse determine to be an expected assessment of this client's muscle tone?

Hypertonic EXPLANATION: In clients with conditions characterized by upper motor neuron destruction, as in cerebral palsy, the muscles are often hypertonic. However, in conditions with lower motor neuron destruction, the muscles become atonic, atrophied, and/or flaccid.

Which of the following is the most common site of joint effusion?

Knee

Paresthesia

abnormal sensation of numbness and tingling without objective cause

Lordosis

an exaggeration of the lumbar spine curve

Skull sutures are an example of which type of joint?

Synarthrosis

When monitoring for potential complications after surgery, what finding would cause the nurse to suspect that the patient is experiencing postoperative bleeding? -Increase in hematocrit -Increase in white blood cell (WBC) count -Decrease in hemoglobin -Decrease in creatinine

-Decrease in hemoglobin Rationale: The decrease in hemoglobin would suggest bleeding. Hematocrit would also decrease. An increase in WBC count indicates infection. Bleeding and decrease in intravascular fluid volume would cause an increase in creatinine from decreased blood volume to the kidneys.

Which of the following can reduce the incidence of fat embolism and shock as complications from a bone fracture? -Early surgical fixation -Oxygen therapy -Ice packs to extremity -Adequate nutrition

-Early surgical fixation Rationale: Stabilization of the fracture with surgical fixation reduces the incidence of bleeding and fat emboli. Application of ice packs assists in the reduction of edema. Proper nutrition enhances fracture healing. Oxygen therapy is an intervention used when respiratory compromise occurs with the complications.

Which of the following are appropriate initial nursing interventions to control discomfort in a fractured extremity stabilized with a splint or cast? (Select all that apply.) -Warm compresses -Elevation of extremity -Intermittent cold packs -Analgesic medication -Lowering of extremity

-Elevation of extremity -Intermittent cold packs -Analgesic medication Rationale: The symptoms of infection include tenderness, pain, redness, swelling, local warmth, elevated temperature, increased white blood cell (WBC) count, and purulent drainage. Decreased hemoglobin is a sign of bleeding.

The nurse is aware that if conservative measures do not relieve pain and restore tissue perfusion, the patient will need which of the following emergency treatments to correct compartment syndrome? -Myotomy -Fasciotomy -Debridement -Incision and drainage

-Fasciotomy Rationale: If the initial steps of loosening the cast or splint and elevation of the limb to the level of the heart do not relieve the pressure and pain and restore circulation, then a fasciotomy may be necessary to relieve the pressure within the muscle compartment and prevent neurovascular damage.

What neurovascular assessment finding would cause the nurse to suspect compartment syndrome? -Bounding pedal pulse on affected side -Localized, reddened area on calf -Heightened sensation at the fracture site -Numbness and/or tingling of affected extremity

-Numbness and/or tingling of affected extremity Rationale: With continued nerve ischemia and edema, the patient experiences sensations of hypoesthesia (diminished sensation followed by complete numbness).

When monitoring for potential complications in the patient with a cast, splint, or brace, the nurse recognizes which of the following is an early hallmark sign of compartment syndrome? -Intermittent pain in the extremity -Sharp knifelike pain -Pain that intensifies with passive range of motion -Absence of pain

-Pain that intensifies with passive range of motion Rationale: A hallmark sign of compartment syndrome is pain that occurs or intensifies with passive range of motion due to accumulation of fluid within the compartmental space.

The nurse understands that assessing neurovascular function in a patient with a brace, splint, or cast is vitally important. Neurovascular assessment findings that indicate neurovascular compromise include which of the following? (Select all that apply.) -Paralysis -Pallor -Paresthesia -Pronation -Proprioception

-Paralysis -Pallor -Paresthesia Rationale: The "5 Ps" indicative of symptoms of neurovascular compromise are pain, pallor, pulselessness, paresthesia, and paralysis.

The nurse is aware that compartment syndrome can occur when which of the following happens? -Perfusion pressure rises above tissue pressure proximal to the injury -Blood flow distal to the injury suddenly increases -Blood flow surrounding the area of injury gradually decreases -Perfusion pressure falls below tissue pressure distal to an injury

-Perfusion pressure falls below tissue pressure distal to an injury Rationale: Compartment syndrome occurs when increased pressure within a confined space compromises blood flow and low tissue perfusion occurs. Ischemia and potentially irreversible neuromuscular damage can occur if action is not taken.

After assessing the patient, the nurse recognizes that the cause of compartment syndrome in Ms. Hughes' case is most likely related to which of the following? -An internal hemorrhage -The nature and location of the fracture -Lack of mobility and range of motion -The restrictive splint dressing

-The restrictive splint dressing Rationale: Compartment syndrome occurs when increased pressure within a confined space compromises blood flow and low tissue perfusion occurs. Tight casts or constrictive splints are often the cause of this complication. In Ms. Hughes' case, when the splint is loosened, perfusion to the extremity is assessed as improved.

paresthesias

Abnormal sensations, such as burning, tingling, and numbness

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

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone?

Calcitonin

A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells?

Ossification and calcification EXPLANATION: Ossification and calcifications the body's process to transform osteoblasts into mature bone cells called osteocytes.

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

Which serum level indicates the rate of bone turnover?

Osteocalcin

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. EXPLANATION: Osteoclasts are the cells involved in the destruction, resorption, and remodeling of bone.

Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes?

Peroneal

Which of the following is the final stage of fracture repair? -Angiogenesis -Cartilage calcification -Cartilage removal -Remodeling

Remodeling

arthroscopy

a procedure that allows direct visualization of a joint through the use of a fiberoptic endoscope. Thus, it is a useful adjunct to diagnosing joint disorders.

hemiplegia

paralysis of one side of the body