NSG 1600 EAQ Unit 2 Musculoskeletal system

Which type of cast or splint will the nurse expect to see on a child with a fractured femur? 1 Cylinder 2 Hip spica 3 Prefabricated knee 4 Robert Jones

2 A hip spica cast is now mainly used for femur fractures in children. A cylinder cast is used for knee fractures because it extends from the groin to the malleoli of the ankle. A prefabricated knee splint is a commonly used cast for lower extremity injuries. A Robert Jones dressing is composed of bulky padding materials, splints, and elastic wrap or stockinette used for lower extremity injuries.

A 90-year-old resident fell and fractured the proximal end of the right femur. The surgeon plans to reduce the fracture with an internal fixation device. Which general fact about the older adult would the nurse consider when caring for this client? 1 Aging causes a lower pain threshold. 2 Aging reduces the physiological coping defenses. 3 Most confused states result from dementia. 4 Older adults psychologically tolerate changes well.

Aging causes a lowering of the physiological coping reserve of various systems of the body. The pain threshold increases with aging. There are many etiologies for confusion (e.g., medication intolerance, altered metabolic state, unfamiliar surroundings). As individuals age they become more entrenched in ideas, environment, and objects that are familiar, and thus do not tolerate change well.

Which condition can be identified in a client using Phalen's test? 1 Atrophy 2 Bone tumor 3 Rotator cuff injury 4 Carpal tunnel syndrom

4 Phalen's test is used to detect carpal tunnel syndrome. A muscle biopsy is done for the diagnosis of atrophy. A computed tomography scan is done to diagnose a bone tumor. The drop arm test is performed to detect rotator cuff injuries.

Which condition can be identified in a client using Phalen's test? 1 Atrophy 2 Bone tumor 3 Rotator cuff injury 4 Carpal tunnel syndrome

4 Phalen's test is used to detect carpal tunnel syndrome. A muscle biopsy is done for the diagnosis of atrophy. A computed tomography scan is done to diagnose a bone tumor. The drop arm test is performed to detect rotator cuff injuries.

Which type of joint is present in between the client's tarsal bones? 1 Pivot 2 Hinge 3 Saddle 4 Gliding

4 The gliding joint is present in between the tarsal bones. The pivot joint is present in the proximal radioulnar joint. The hinge joint is present in the elbows and knees. The saddle joint is present in between the carpometacarpal joints of the thumb.

Which finding in older adult clients is associated with aging? 1 Decrease in height 2 Decreased neck rigidity 3 Increased fine-motor dexterity 4 Increased range of motion (ROM)

1 Loss of height and deformity and shortening of the trunk are common in older adults because of vertebral compression and degeneration. Rigidity in the neck, shoulders, back, hips, and knees increases with age because of loss of elasticity in ligaments, tendons, and cartilage. A decline in fine-motor dexterity occurs in the older adult because of slow impulse conduction along motor units. Range of motion (ROM) is limited in the older adult because of cartilage erosion, increased friction between the bones, and overgrowth of bone around joint margins.

Which estrogen antagonist would the health care provider prescribe a client for the prevention and treatment of osteoporosis in postmenopausal women? 1 Raloxifene 2 Denosumab 3 Alendronate 4 Zoledronic acid

1 Raloxifene prevents and treats osteoporosis in postmenopausal women by increasing bone mineral density, reducing bone desorption, and reducing incidences of osteoporotic vertebral fractures. Denosumab is a monoclonal antibody used to treat osteoporosis when other medications are not effective. Alendronate and zoledronic acid are commonly used for the prevention and treatment of osteoporosis.

When teaching a client about their disease process, which term would the nurse use to describe bone loss greater than normal but less than that caused by osteoporosis? 1 Osteopenia 2 Osteomyelitis 3 Osteomalacia 4 Osteoarthritis

1 The definition of osteopenia is bone loss that is more than normal but not yet at the level for a diagnosis of osteoporosis. Osteomyelitis is infection of bone or bone marrow. Osteomalacia is softening of bones due to calcium or vitamin D deficiency. Osteoarthritis is cartilage deterioration in the joints.

Which physiological changes of the musculoskeletal system would the nurse associate with aging? Select all that apply. One, some, or all responses may be correct. 1 Slowed movement 2 Cartilage degeneration 3 Increased bone density 4 Increased range of motion 5 Increased bone prominence

1,2,5 The physiological changes of the musculoskeletal system related to aging are slowed movements, cartilage degeneration, increased bone prominence, decreased bone density, and decreased range of motion.

Which bones are examples of a client's flat bones? Select all that apply. One, some, or all responses may be correct. 1 Sacrum 2 Scapula 3 Sternum 4 Humerus 5 Mandible

2,3 Flat bones such as the scapula and sternum are compact bones separated by a layer of cancellous bone that contains bone marrow. Bones such as the sacrum and mandible are irregular bones; they appear in a variety of shapes and sizes. The humerus is a long bone with a central shaft and two widened ends.

How would the nurse respond to a client who expresses malignancy fears associated with the pending bone biopsy report? 1 "Worrying is not going to help the situation." 2 "Let's wait until we hear what the biopsy report says." 3 "It is very upsetting to have to wait for a biopsy report." 4 "Operations are not performed unless there are no other options."

3 "It is very upsetting to have to wait for a biopsy report," addresses the fact that the client's feelings of anxiety are valid. Stating, "Worrying is not going to help the situation," or "Let's wait until we hear what the biopsy report says," does not address the client's concerns and may inhibit the expression of feelings. Telling the client that operations are not performed unless there are no other options is irrelevant and does not address the client's concerns.

Which hormone aids in regulating intestinal calcium and phosphorous absorption? 1 Insulin 2 Thyroxine 3 Glucocorticoids 4 Parathyroid hormone

3 Adrenal glucocorticoids aid in regulating intestinal calcium and phosphorous absorption by increasing or decreasing protein metabolism. Insulin acts together with growth hormone to build and maintain healthy bone tissue. Thyroxine increases the rate of protein synthesis in all types of tissues. Parathyroid hormone secretion increases in response to decreased serum calcium concentration and stimulates the bones to promote osteoclastic activity.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

Which clinical sign would the nurse expect to identify when assessing a client with a fracture of the femoral neck? 1 Adduction with internal rotation 2 Abduction with external rotation 3 Shortening of the affected extremity with external rotation 4 Lengthening of the affected extremity with internal rotation

3 As a result of contraction and pulling of the muscles on the two bone fragments, there is a characteristic shortening of the femur with external rotation of the extremity. Lateral motion of the leg does not occur; the leg externally rotates. The extremity externally rotates as the muscles contract; shortening, not lengthening, occurs.

Which medication is used in the treatment of a client with intervertebral disc disease? 1 Etidronate 2 Zoledronic acid 3 Cyclobenzaprine 4 Salmon calcitonin

3 Intervertebral disc disease often causes myalgia. Muscle relaxants, such as cyclobenzaprine, are used in its treatment. Etidronate, zoledronic acid, and salmon calcitonin are effective in the treatment of osteoporosis.

Several minutes after the start of a red blood cell infusion, the client reports itching. The nurse observes hives on the client's chest. Which action would the nurse take? 1 Administer an antihistamine. 2 Flush the red blood cells with 5% dextrose. 3 Slow the rate of infusion. 4 Stop the transfusion.

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Which type of joint permits movement in any direction? 1 Pivot 2 Hinge 3 Biaxial 4 Ball-and-socket

4 Ball-and-socket joints permit movement in any direction. Pivot joints permit rotation. Hinge joints allow motion in one plane. Biaxial joints permit gliding movement.

Which joint is an example of a condyloid joint? 1 Wrist joint 2 Elbow joint 3 Shoulder joint 4 Sacroiliac joint

1 The wrist joint is an example of a condyloid joint. It is a joint between the radial and carpals. The elbow joint is an example of a hinge joint. The shoulder joint is an example of a ball and socket joint. The sacroiliac joint is an example of a gliding joint.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

Which foot disorder is caused by continual pressure over bony prominences? 1 Corn 2 Wart 3 Hammertoe 4 Hallux rigidus

1 A corn is a foot disorder caused by continual pressure over bony prominences. A plantar wart is a foot disorder caused by a virus. Hammertoe is a foot disorder caused by flexion and deformity in the joints. Hallux rigidus is caused by osteoarthritis.

Which finding during a home health visit would prompt the nurse to provide a client with home safety instructions? Select all that apply. One, some, or all responses may be correct. 1 Area rugs on the floor 2 Clogged, dirty fireplace 3 Multiple electrical cords 4 Multiple prescribed medications 5 Wheeled walker with uneven legs

1,2,3,4,5 There are multiple potential hazards in the home clients should be educated about to avoid injury. Area rugs and multiple electrical cords on the floor pose a fall risk. A clogged, dirty fireplace could lead to carbon monoxide poisoning. Polypharmacy can cause mental status changes, confusion, and orthostatic blood pressure changes; these can increase the client's fall risk. If the nurse observes a wheeled walker with uneven legs, the physical therapist would be notified as they can follow-up to evaluate the mobility aid's safety.

When developing the plan of care for a client with rheumatoid arthritis, which client consideration would the nurse include? 1 Surgery 2 Comfort 3 Education 4 Motivation

2 Because pain is an all-encompassing and often demoralizing experience, the nurse would want to keep the client as pain-free as possible. Surgery corrects deformities and facilitates movement, which is not an immediate need. Concentration and motivation are difficult when a client is in severe pain.

While providing care for a client with a second-degree left ankle sprain, the nurse raises the injured part above heart level. Which statement provides the reason behind this nursing intervention? 1 To promote bone density 2 To prevent further edema 3 To reduce pain perception 4 To increase muscle strength

2 A client with a second-degree sprain may have a deeply torn ankle ligament with swelling and tenderness. Elevation of the injured lower limb above heart level helps mobilization of the excess fluid from the area and prevents further edema. Strengthening exercises help build bone density and muscle strength and significantly reduce the risk of sprains and strains. Cryotherapy and adequate rest help reduce pain by reducing the transmission and perception of pain impulses.Test-Taking Tip: Elevation of the affected area above heart level prevents the drift of fluids to the site. Find the answer choice that seems the most reasonable.

Which structures protect a client's internal organs, support blood cell production, and store minerals? 1 Joints 2 Bones 3 Muscles 4 Cartilages

2 Bones are the framework of the body; they support and protect internal organs. They also help in stem cell production from bone marrow, and they store minerals. Joints (articulations) help articulate the bones. Muscles are the bundles of fibrous tissue that contract to produce movement and maintain body posture. Cartilage is a hyaline, elastic, and fibrous tissue that often functions as a shock absorber.

A client returns from surgery, after a right below-the-knee amputation, with the residual limb straight, but elevated on a pillow to prevent edema. In which position would the nurse place the client after the first postoperative day? 1 Any position, as long as the residual limb remains immobilized 2 Turn client to the prone position for 15 to 20 minutes at least three times a day 3 For short periods, position the client in the right side-lying position 4 Maintain elevation of the residual limb for a total of 3 days

2 Positioning the client in the prone position for short periods helps prevent hip flexion contractures. Do not immobilize the client's residual limb, but do not keep the joint bent for prolonged periods. Begin exercises to prevent contractures as soon as possible. Positioning the client in the right side-lying position can cause trauma to the incision site and should be avoided. Do not elevate the client's residual limb for more than 48 hours because hip flexion contractures can result.

Which hormone increases the rate of protein synthesis? 1 Estrogen 2 Thyroxine 3 Parathormone 4 Vitamin D

2 Thyroxine increases the rate of protein synthesis in all the body tissues. Estrogen stimulates bone-building, which is known as osteoblastic activity. Parathormone promotes osteoclastic activity in a state of hypocalcemia. Vitamin D and its metabolites are produced in the body and transported in the blood to promote the absorption of calcium and phosphorus from the small intestine.

Which diagnostic study is used to detect deep vein thrombosis in the client's lower extremities? 1 Thermography 2 Plethysmography 3 Duplex venous Doppler 4 Somatosensory evoked potential

3 Duplex venous Doppler records an ultrasound of the veins, including blood flow abnormalities of the lower extremities, aiding detection of deep vein thrombosis. Thermography, which measures the heat radiating from the skin surface, is used to determine client response to anti-inflammatory medication therapy and inflamed joints. Plethysmography is used to record variations in volume and pressure of blood passing through tissues; the test is nonspecific. Somatosensory evoked potential is used to identify subtle dysfunction of lower motor neurons and primary muscle disease.

Which element would the nurse focus on when teaching crutch-walking to a client who has a casted leg fracture? 1 Establishing a schedule for pain medication 2 Maintaining a fixed schedule of daily activities 3 Modifying the home environment to prevent accidents 4 Understanding that a more sedentary lifestyle is necessary

3 Modifications in the home may be needed to permit safe use of crutches. Pain medications should not be required on a regular basis. The client may vary the schedule of activities based on abilities and responses to activities. The client does not have to be sedentary; crutches are used for ambulation.

Which is an example of a short bone? 1 Tibia 2 Femur 3 Tarsals 4 Humerus

3 Tarsals are short bones, unlike the tibia, femur, and humerus, which are long bones. Short bones do not have epiphysis and diaphysis.

Which joint helps in the gliding movement of the wrist? 1 Pivot joint 2 Hinge joint 3 Biaxial joint 4 Ball and socket joint

3 The biaxial joint helps in the gliding movement of the wrist. Pivot joints permit rotation in the radioulnar area. Hinge joints allow for flexion and extension. Ball and socket joints permit movement in the shoulders and hips.

Which instruction would the nurse provide to an older client using ice and heat to treat pain from back strain? Select all that apply. One, some, or all responses may be correct. 1 Switch positions every 4 hours. 2 Use a heating pad for the first 24 hours. 3 Apply for 30-minute time intervals. 4 Place the ice pack directly to injury site. 5 Take ibuprofen every 4 hours PRN.

3 To prevent skin damage, ice and heat should only be applied for 20- to 30-minute intervals. Clients should be instructed to shift positions every hour to prevent skin breakdown. Ice should be used the first 24 to 48 hours followed by heat. Ice should never be directly applied to the skin as it can cause injury to the tissue. The client can take ibuprofen if approved by the health care provider.

Which hormone promotes bone resorption in a client and potentially leads to decreased bone densities? 1 Estrogen 2 Calcitonin 3 Growth hormone 4 Parathyroid hormone (PTH)

4 When serum calcium levels lower, secretion of PTH increases and stimulates bones to promote osteoclastic activity, which promotes bone resorption. Estrogens stimulate osteoblastic (bone-building) activity and inhibit PTH. Calcitonin inhibits bone resorption and increases the renal excretion of calcium and phosphorus as needed to maintain balance in the body. Growth hormones secreted by the anterior lobe of the pituitary gland are responsible for increasing bone length.

For which purpose is a goniometer used? 1 To assess range of motion 2 To reduce phantom limb sensation 3 To prevent hip flexion contractures 4 To immobilize a joint during fracture

1 A goniometer is a device that measures the angle of a joint and is used to assess range of motion. Mirror therapy is used to reduce phantom limb sensation. Buck's traction boot is a type of skin traction used to prevent hip flexion contractures. Splints are used to immobilize a joint after a fracture.

Which action by a 70-year-old female client would best limit further progression of osteoporosis? 1 Taking supplemental calcium and vitamin D 2 Increasing the consumption of eggs and cheese 3 Taking supplemental magnesium and vitamin E 4 Increasing the consumption of milk products

1 Research demonstrates that women past menopause need at least 1500 mg of calcium a day, which is almost impossible to obtain through dietary sources because the average daily consumption of calcium is 300 to 500 mg. Vitamin D promotes the deposition of calcium into the bone. Consumption of eggs and cheese does not contain adequate calcium to meet requirements to prevent osteoporosis; these foods do not contain vitamin D unless fortified. If large amounts of magnesium are present, calcium absorption is impeded because magnesium and calcium absorption are competitive; vitamin E is unrelated to osteoporosis. Milk and milk products may not be consumed in quantities adequate to meet requirements to prevent osteoporosis.

Which synovial joint movement is described as turning the sole away from the midline of the body? 1 Pronation 2 Eversion 3 Adduction 4 Supination

2 Eversion is a synovial joint movement that describes turning the sole outward away from the midline of the body. Pronation is a synovial joint movement that describes turning the palm downward. Adduction is a synovial joint movement that describes movement toward midline of the body. Supination is a synovial joint movement that describes turning the palm upward.

Which clinical manifestation would the nurse expect when a client experiences fat embolism syndrome (FES)? 1 Nausea 2 Dyspnea 3 Orthopnea 4 Paresthesia

2 FES is clinically manifested by dyspnea because of low levels of arterial oxygen. Nausea and orthopnea are not seen in FES. However, tachypnea, headache, and lethargy are seen in clients with FES. Paresthesia occurs with compartment syndrome.

The registered nurse (RN) is giving home care instructions to a client who was treated for injuries due to a fall. Which statement made by the client indicates a need for additional instruction? 1 "I should walk on soft scatter rugs at home." 2 "I should drink 3000 mL of water every day." 3 "I should eat fruits and vegetables six times a day." 4 "I should exercise the joints above and below the cast daily."

1 A client with injuries due to a fall must avoid having throw or scattered rugs at home to reduce the incidence of falls. The registered nurse (RN) would encourage the client to drink 3000 mL of water per day to promote optimal bladder and bowel function. The client would eat six small meals with foods rich in fiber, such as fruits and vegetables, to prevent constipation. The RN has to encourage the client to perform exercise above and below the cast daily for a speedy recovery. Test-Taking Tip: The client must be conscious and avoid slippery surfaces while walking to prevent falls. Select the correct answer that is consistent with this type of thinking.

Which diagnostic test is used for the direct visualization of ligaments, menisci, and articular surfaces of joints? 1 Arthroscopy 2 Muscle biopsy 3 Ultrasonography 4 Electromyography

1 Arthroscopy is a diagnostic test that uses an arthroscope to directly visualize the ligaments, menisci, and articular surfaces of a joint. A muscle biopsy is conducted to diagnose atrophy and inflammation. An ultrasonography is used to view soft tissue disorders, traumatic joint injuries, and osteomyelitis. An electromyography may be performed to evaluate diffuse or localized muscle weakness.

A student athlete reports muscle pain after a practice session. Which product of muscle metabolism would the nurse explain as being a cause of pain? 1 Lactic acid 2 Acetoacetic acid 3 Hydrochloric acid 4 Beta-hydroxybutyric acid

1 The ache in muscles that have been vigorously worked without adequate oxygen supply is caused in part by the buildup of lactic acid. During rest, the lactic acid is oxidized completely to carbon dioxide and water, providing adenosine triphosphate for further muscular contraction. Beta-hydroxybutyric acid and acetoacetic acid are not products of muscle contraction; they are ketone bodies resulting from incomplete oxidation of fatty acids. Hydrochloric acid is not a product of muscle contraction; it is present in the stomach to facilitate the digestive process.Test-Taking Tip: Look for answers that focus on the client or are directed toward feelings.

When performing a physical assessment on a client, which term would the nurse use to describe a flat, poorly defined mass on the sole over a bony prominence and caused by pressure? 1 Plantar wart 2 Callus 3 Ingrown nail 4 Hypertrophic ungual labium

2 In foot problems, a callus description is a flat, poorly defined mass on the sole over a bony prominence that is caused by pressure. Plantar wart is a painful papillomatous growth caused by a virus. A sliver of toenail penetrating the skin and causing inflammation results in ingrown nail. A hypertrophic ungual labium is a chronic hypertrophy of the nail lip caused by improper nail trimming.

Which condition is characterized by infection of a client's bone or bone marrow? 1 Osteomalacia 2 Osteomyelitis 3 Herniated disc 4 Spinal stenosis

2 Osteomyelitis is infection of bone or bone marrow. Osteomalacia is a condition characterized by softening of bones due to calcium or vitamin D deficiency. Herniated disc is caused by structural damage of the intervertebral discs in which the nucleus pulposus seeps through a torn or stretched annulus. Spinal stenosis is narrowing of the spinal canal.

Which diagnostic study would the health care provider use to investigate the cause of an inflamed joint and determine a client's response to anti-inflammatory medication therapy? 1 Duplex venous Doppler 2 Plethysmography 3 Thermography 4 Somatosensory evoked potential

3 Thermography uses an infrared detector that measures the degree of heat radiating from the skin's surface. Health care providers use this method to investigate the cause of an inflamed joint and in determining the client's response to anti-inflammatory medication therapy. Use of plethysmography is to record variations in volume and pressure of blood passing through tissues. Duplex venous Doppler records blood flow abnormalities to the lower extremities, which helps detect deep vein thrombosis. Somatosensory evoked potential use identifies subtle dysfunction of lower motor neuron and primary muscle disease.

Which nursing intervention prevents foot drop in a client with osteomyelitis? 1 Elevating the foot with the use of pillows 2 Consistently flexing the affected extremity 3 Encouraging the client to change positions 4 Neutral positioning of the foot with the use of a splint

4 A client with osteomyelitis is at an increased risk for foot drop, which results in an abnormal gait. Neutral positioning of the foot with the use of a splint can reduce the risk of foot drop in the client with osteomyelitis. Elevating the client's foot on pillows can reduce the risk of edema. Asking the client with osteomyelitis to flex the affected extremity can result in flexion contracture. Encouraging the client with osteomyelitis to change positions helps prevent complications associated with immobility and promotes comfort; carefully handle the involved limb and avoid excessive manipulation, which may lead to a pathological fracture.