NUR2214 Module 3 EAQs

Which fracture is most likely to be treated with implantation of a genetically engineered substance?

spine

Where does the nurse expect to find a conical mass, or corn, on the patient's body?

toe

Which finding does the nurse expect to observe in a patient with suspected common chronic osteomyelitis?

ulceration of skin

A 67-year-old patient is diagnosed with plantar fasciitis. What conservative management does the nurse suggest? Select all that apply.

"Strap the affected foot." "Apply an ice pack to the site." "Wear shoes with good support."

A healthcare provider prescribes a diagnostic workup for a client who may have myasthenia gravis. What is the initial nursing objective for the client during the diagnostic phase?

"The client will maintain present muscle strength."

The nurse instructor is teaching nursing students about the structure of a bone. What statement made by a student indicates a need for further instruction?

"The haversian canals run horizontally within the cortical bone."

The novice nurse is learning about interventions for carpal tunnel syndrome (CTS). Which statement indicates a need for further education?

"An occupational therapist (OT) will fit a brace with the wrist in neutral position or slight flexion."

An older adult patient is undergoing treatment for a fracture. Which pain medication must be avoided in this patient?

Meperidine

A client with osteoporosis is prescribed raloxifene. What should the nurse monitor in the client?

Monitor liver function tests

What is a round, benign cyst that is often found on the wrist?

ganglion

The nurse plans to use which tool to measure joint range of motion (ROM)?

goniometer

Which type of trauma increases a patient's risk for hospital-acquired infection?

open fracture

Which musculoskeletal disorder is the dorsiflexion of any metatarsophalangeal (MTP) joint that has plantar flexion of the proximal interphalangeal joint next to it?

hammertoe

Which type of fracture does not divide the bone into two portions because the break is through only part of the bone?

incomplete

Which type of traction is used for strain or sprain in the lower back?

pelvic belt

What is the first step in emergency care of a patient with an extremity fracture?

Assess the patient's airway, breathing, and circulation.

The nurse is caring for a patient immediately following a bunionectomy. What is the nurse's priority action?

Assessing the patient's neurovascular status

A woman fractured her left tibia and fibula one week ago and has a cast in place. She is taking acetaminophen (Tylenol) with codeine for pain and an oral contraceptive. She began experiencing left calf pain 3 days ago and began having shortness of breath and chest pain 15 minutes ago. When the shortness of breath and chest pain increase, she calls the emergency department and communicates this information to the triage nurse. What is the triage nurse's best response?

"Give me your name and address. I am sending an ambulance to your home. You need emergency care."

The nurse is teaching a patient with bunions on both feet about bone resection and fusion. Which statement made by the patient indicates that more teaching is needed?

"Healing time will take two weeks for each foot."

A nursing student is studying the skeletal system. Which statement indicates to the nursing instructor that the student understands a normal physiologic function of the skeletal system?

"Hematopoiesis occurs in the red marrow, which is where blood cells are produced."

The nurse provides teaching to a patient who has a callus. Which statement made by the patient indicates proper learning?

"I should be sure to pad that part of my foot so it doesn't have too much pressure on it."

The nurse teaches techniques to prevent fractures to a patient who has decreased bone density. Which statement made by the patient indicates effective learning?

"I should use a walking stick."

The nurse assesses a middle-aged female patient. Which statement made by the patient causes the nurse to teach the patient about preventing hallux valgus?

"I wear high heels to work every day."

The nurse manager is observing a nurse caring for a patient after surgery for carpal tunnel release. Which statement made by the nurse requires correction?

"It's important for you to keep your fingers as still as possible the first day after surgery."

The nurse is taking the medical history of a patient. Which patient statements indicate a likelihood of carpal tunnel syndrome (CTS)? Select all that apply.

"My wrist and fingers feel numb." "I have severe pain in my wrist at night." "I don't have much sensation around my wrist."

Which statement by a nursing student about the health economics associated with osteoporosis indicates a need for further teaching by the nursing instructor?

"Peripheral quantitative ultrasound (pQUS) is rarely used as a screening tool for osteoporosis detection because of its high cost."

The nurse is caring for a marathon runner with plantar fasciitis. What conservative management method does the nurse suggest?

"Strap the affected foot."

Arrange in the correct order the process of sequestrum formation as it occurs in osteomyelitis.

invasion of pathogenic microorganisms stimulation of antiflammatory response vascular thrombosis release of exudate into the bone tissue ischemia of bone tissue sequestrum formation

Arrange the following nursing actions pertaining to the emergency care of a patient who experiences a fracture in the correct sequence.

1. Assess airway, breathing, and circulation 2. Render cardiopulmonary resuscitation (CPR), if necessary 3. Control bleeding by direct pressure 4. Manage pain

The nurse is using a common scale to grade a patient's muscle strength. The patient is able to complete range of motion (ROM) with gravity eliminated. Which grade does the nurse document in this patient's record?

2

The nurse uses the 0-to-5 scale for grading muscle strength of a patient around the knee joint. If the patient can complete range of motion (ROM) against gravity but only without any resistance, what rating does this signify?

3

Which individual has the highest chance of developing carpal tunnel syndrome (CTS)?

A 60-year-old female

Which patient is at the highest risk for a fatigue fracture?

A patient who runs every day

What is the major concern related to pelvic injury?

loss of blood volume

Carpal tunnel syndrome (CTS) occurs when which nerve in the wrist is compressed?

median

A primary health care provider advises a patient to avoid wearing high heels. Which traumatic condition does the nurse suspect in the patient?

Achilles tendinopathy

The nurse is teaching a patient ways to increase vitamin D in the diet using natural foods (unfortified). Which food choices indicate the patient understands the teaching? Select all that apply.

milk tofu eggs liver

A patient who recently suffered a broken tibia presents with edema, a great deal of pain, pale skin, and a weakened pulse. Upon palpation, the area is noted to be tense. What is most likely the concern?

Acute compartment syndrome

The nurse is caring for a patient with a tibial fracture. For which complication common in a fracture of this type should the nurse monitor the patient?

Acute compartment syndrome (ACS)

The nurse is assessing the skeletal system of an African-American patient. What must the nurse know to assess the patient correctly?

African Americans have a decreased incidence of osteoporosis.

The nurse refers a patient with an amputation and the patient's family to which community resource?

Amputee Coalition of America (ACA)

A 65-year-old female patient has chronic hip pain and muscle atrophy from an arthritic disorder. Which musculoskeletal assessment finding does the nurse expect to see in the patient?

Antalgic gait

Which part of the body is affected by plantar fasciitis?

Arch of the foot

The nurse is creating a nursing plan for management of a pelvic fracture. For which complications will the nurse monitor this patient? Select all that apply.

Arterial bleeding Blood volume loss Abdominal rigidity Blood in urine and stool

A patient with an osteoporotic vertebral fracture is prescribed raloxifene. What should the nurse include in the assessment of this patient?

Assess for a history of venous thromboembolism.

A patient has undergone arthroscopy of the knee. What care should the nurse provide to the patient after the procedure?

Assess neurovascular status of the extremity every hour.

Which class of drugs would be administered to a patient experiencing a constant, dull, and burning phantom limb pain (PLP)?

Beta blockers

The nurse admits an older adult patient who sustained a left hip fracture and is in considerable pain. The nurse anticipates that the patient will be placed in which type of traction?

Buck's traction

How is the Tinel sign diagnostic test for carpal tunnel syndrome (CTS) performed?

By tapping lightly over the area of the median nerve in the wrist

A nurse is monitoring the blood pressure of a patient with gout. Upon inflating the cuff, the patient experiences pain and numbness in the wrist. Which musculoskeletal injury does the nurse suspect in the patient?

Carpal tunnel syndrome (CTS)

The patient presents with wrist pain that is worse at night and has started to radiate to the shoulder and neck. An x-ray reveals no damage to any bones in the wrist. The Phalen maneuver is positive. The patient works as a data manager and exercises three days a week roller blading. What is the most likely diagnosis?

Carpal tunnel syndrome (CTS)

Which group has the least risk of developing osteomalacia?

Caucasian population

A patient with a compound fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is most essential for the nurse to take first?

Check the dorsalis pedis pulse

Radiographic assessment of a patient with femoral fracture reveals spotty and diffuse osteoporosis. The patient gives a history of excessive sweating, intense burning pain, and edema. Which side effect of fractures does the nurse suspect?

Complex regional pain syndrome (CRPS)

Which complication resulting from a fracture might necessitate the use of an implanted device to block pain perception?

Complex regional pain syndrome (CRPS)

An 80-year-old patient with uncontrolled hypertension reports pain in the right foot and is diagnosed with a hallux valgus deformity. What is the most appropriate treatment?

Custom-made shoes

A patient is in traction after a major leg injury. What nursing care is necessary for the patient? Select all that apply.

Ensure the weights are freely hanging at all times Inspect the traction equipment every 8 to 12 hours

In a patient with compartment syndrome, what is the physiologic change that causes pallor?

Decreased oxygen to tissues

Care of the older adult may be affected by which physiologic change in the musculoskeletal system?

Decreased range of motion (ROM)

Which physiologic change related to compartment syndrome is responsible for symptoms of flexed posture and unequal pulses in a patient?

Increased production of lactic acid

A client has a diagnosis of multiple sclerosis and is currently in remission. The client is a parent of two active preschoolers. What should the nurse encourage the client to do?

Develop a flexible schedule for completion of routine daily activities.

The nurse is teaching the importance of nutrition to a 74-year-old patient who is lactose-intolerant and at risk for osteoporosis. What nutritional considerations does the nurse teach? Select all that apply.

Drink fruit juices fortified with calcium. Limit consumption of carbonated beverages. Avoid excessive intake of alcohol and caffeine.

Which disorder affects the hand or part of the hand?

Dupuytren contracture

Which is a deformity of the hand?

Dupuytren's contracture

How is endoscopic carpal tunnel release (ECTR) different from open carpal tunnel release (OCTR)? Select all that apply.

ECTR is less costly than OCTR. ECTR is less invasive than OCTR. ECTR is associated with a longer period of postoperative numbness than is OCTR.

Which teaching about prevention of carpal tunnel syndrome (CTS) will the nurse provide to other health care employees? Select all that apply.

Employees should be provided with specially designed wrist rest devices. Employees should be provided with geometrically designed computer keyboards. Employees should be provided with chairs at a height that facilitates good posture.

To prevent thrombophlebitis in the immediate postoperative period, which action is most important for a nurse to include in the client's plan of care?

Encourage early mobility.

Non-weight bearing with crutches has been prescribed for a client with a leg injury. The nurse provides teaching before ambulation is begun. To facilitate walking with crutches, what is the most important activity the nurse should teach the client?

Exercise the triceps, finger flexors, and elbow extensors.

A nurse provides discharge teaching to a client who had a total hip replacement. The client states that the plan is to go swimming at the community pool the day after discharge. How should the nurse respond?

Explain that the incision should not be immersed in water until it has healed.

A school-aged child has a cast applied to a fractured wrist. What action should the nurse take to hasten drying of the cast?

Expose the casted extremity.

The nurse is caring for a patient with an open wound from chronic osteomyelitis. How does the nurse ensure that this patient receives increased tissue perfusion?

Exposing the affected area to a high concentration of oxygen.

A 30-year-old patient suffers a pelvic fracture. His partial oxygen concentration (PaO 2) drops to 70 mm Hg. There is an increase in the erythrocyte sedimentation rate (ESR) and serum lipid levels. The serum calcium level drops to 7 mg/dL. Which complication should the nurse suspect?

Fat embolism syndrome (FES)

A nurse is caring for a group of clients with myasthenia gravis, Guillain-Barré syndrome, and amyotrophic lateral sclerosis (ALS). Which information should the nurse consider when planning care for this group of clients?

Increased risk for respiratory complications

A patient has a Buck extension traction. What type of injury does the patient most likely to have?

Fracture of the hip before surgery

Which type of fracture is most commonly complicated by delayed union because of poor perfusion?

Fractures of the tibia and fibula

A surgical repair was done shortly after injury in a patient with a rotator cuff injury using arthroscopy. What could a presurgical magnetic resonance imaging (MRI) of the shoulder reveal?

Full-thickness tear

Which statement is true regarding a ganglion cyst? Select all that apply.

Ganglion cysts can rapidly disappear and recur. Treatment includes the aspiration of cystic fluid with a fine needle. Ganglion cysts form due to the degeneration of synovium surrounding the tendon.

While evaluating the stance of a patient, the nurse observes a bow-legged deformity. How does the nurse document this condition?

Genu varum

Which occupational activity predisposes a person to carpal tunnel syndrome (CTS)?

Grasping during wrist flexion

What assessment finding typically indicates there is a fracture of the hip?

Groin pain

Which topics are included in patient teaching following a leg amputation? Select all that apply.

How to wrap the limb Range-of-motion exercises How to turn independently if possible Exercises to prepare the limb for prosthesis How to inspect the area for signs of inflammation or skin breakdown

The nurse enters a client's room and finds the client on the floor crying for help. It is obvious to the nurse that the client has sustained a hip fracture. Which action should the nurse take first?

Immobilize the affected extremity.

What interventions may be utilized to manage a patient with chronic osteomyelitis? Select all that apply.

Irrigating wounds through the window of a cast Exposing the affected area to hyperbaric oxygen therapy Packing the wound with bone cement bead impregnated with antibiotic

How is Dowager's hump formed?

Kyphosis of the spine

What is an early manifestation of fat embolism syndrome?

Low arterial oxygen

When assessing a female patient, the nurse learns that the patient has several risk factors for osteoporosis. Which risk factor will be the priority for patient teaching?

Low calcium intake

Which procedure does the nurse anticipate for the patient with suspected muscular dystrophy?

Muscle biopsy

The nurse plans to refer a patient diagnosed with osteoporosis to which community resource?

National Osteoporosis Foundation

A patient with a rotator cuff injury has undergone surgery. During analgesia, the peripheral nerve was blocked. What complication may be seen in the patient?

Numbing feeling of the arm

A nurse is assessing a client with a cast to the extremity. Which assessment finding is the priority?

Numbness

A patient has undergone a below-knee amputation of the right leg as a result of severe peripheral vascular disease. In the postoperative care teaching, the nurse instructs the patient to notify the health care provider if which change occurs?

Observation of a large amount of serosanguineous or bloody drainage

Which nursing action is appropriate when a patient requests spiritual guidance during a preoperative assessment?

Offer assistance to arrange for a hospital chaplain to talk with the patient before surgery

A diabetic patient is admitted to the health care facility with a foot ulcer. The nurse teaches wound care to the patient and the caregiver to prevent the risk for which condition?

Osteomyelitis

Which condition is the biggest risk factor for hip fracture?

Osteoporosis

To which resource should the nurse refer the patient to for upper extremity rehabilitation after trauma?

occupational therapy

What are the risk factors for primary osteoporosis? Select all that apply.

Parental history of osteoporosis Thin build with low body weight Chronic low calcium and vitamin D intake

A patient has had a sequestrectomy of the right fibula for osteomyelitis 1 day ago. Which assessment finding requires the nurse to contact the surgeon immediately?

Paresis of right lower extremity

A patient has recently undergone surgery to treat osteomyelitis. What are the signs of neurovascular compromise after the surgery? Select all that apply.

Paresthesia Pulselessness Uncontrollable pain Paresis or paralysis

A patient reports pain around the knee with stiffness when it is flexed. Which type of musculoskeletal trauma does the nurse suspect in the patient?

Patellofemoral pain syndrome

Which body part has an amphiarthrodial joint?

Pelvis

Which are benefits of external fixation of an open fracture when compared to other surgical techniques? Select all that apply.

There is minimal blood loss compared with internal fixation. It carries a low risk for the development of pin-site infection. The device maintains alignment in closed fractures that will not maintain position in a cast. The device allows early ambulation and exercise of the affected body part while relieving pain.

A client with a distal femoral shaft fracture is at risk for developing a fat embolus. The nurse knows to watch for what distinguishing sign that is unique to a fat embolus?

Petechiae

A patient who has severe peripheral vascular disease resulting in an above-the-knee amputation two months ago describes intense burning pain, numbness and tingling. The patient reports the symptoms worsen with exhaustion and stress. What is the patient most likely experiencing?

Phantom limb pain

A chemical sympathetic nerve block may be used to manage complex regional pain syndrome (CRPS). Which drug, administered intravenously, is used to block sympathetic nerve receptors?

Phentolamine

Which is true of partial-thickness rotator cuff tears?

They are more painful than full-thickness tears.

After rotator cuff surgery, when are pendulum exercises typically started?

on the third postoperative day

Which statements are true regarding the various types of casting materials for immobilization? Select all that apply.

Plaster is not commonly used for casting. Fiberglass can dry and become rigid in minutes.

A regimen of rest, exercise, and physical therapy is prescribed for a client with rheumatoid arthritis. What should the nurse teach the client is the intended purpose of the regimen?

Preventing the crippling effects of the disease

The nurse is assessing a patient to evaluate the movements of the wrist. What movement does the nurse assess?

Pronation and supination

Which individual is at risk of developing carpal tunnel syndrome?

Software engineer

A client who is recuperating from a spinal cord injury at the T4 level wants to use a wheelchair. What should the nurse teach the client to do in preparation for this activity?

Push-ups to strengthen arm muscles

A client with a fractured tibia and fibula is to be discharged from the emergency department with a right leg cast and crutches. In addition to the technical aspects of crutch walking, the nurse should teach the client to do what?

Remove loose rugs from the environment.

Which statement is true regarding the types of traction used for musculoskeletal trauma of the lower extremities?

Russell's traction is used for fractures of the hip.

Which joint in the client's body is an example of a gliding joint?

Sacroiliac

The nurse assessing a patient for spinal alignment observes a lateral curve of the spine. How does the nurse document this finding?

Scoliosis

A nurse is providing care for a newly admitted patient diagnosed with progressive muscular dystrophy. Which laboratory test does the nurse expect to be elevated?

creatinine kinase

What is the excessive stretching of a ligament?

Sprain

A client with severe varicose veins has surgery that involves ligation, dissection, and removal of incompetent vessels. In which position should the nurse place the client after surgery?

Supine with the legs elevated at a 15-degree angle

A client sustains a fractured right femur after an automobile accident and is admitted to the hospital's emergency department. Which assessment is the priority?

Take the client's pedal pulse in the affected extremity.

The nurse is assessing a patient who is reporting pain under the arch of the foot when getting out of bed in the morning. The nurse suspects the patient may have plantar fasciitis. What information does the nurse give to the patient to help manage the onset of the condition?

Telling the patient to manage his or her weight

The nurse is assessing a patient diagnosed with acute osteomyelitis. What features of this disorder does the nurse expect to find? Select all that apply.

Temperature above 101° F Swelling around the affected area Erythema around the affected area Pulsating pain that worsens with movement

A 5-year-old child is given fluoroquinolones. Which potential adverse effect unique to pediatric clients should the nurse anticipate?

Tendon rupture

Which drug may cause tooth and bone anomalies as a teratogenic effect?

Tetracycline

Which is one of the causes of secondary osteoporosis?

diabetes mellitus

The nurse is caring for a patient with complex regional pain syndrome (CRPS). Which clinical sign of CRPS is a manifestation of autonomic nervous system dysfunction seen in this complication?

edema

The nurse is preparing a patient with osteosarcoma for a nuclear bone scan. What information about this test should be taught to the patient?

The isotope is excreted through the intestinal tract.

Which aspect of a musculoskeletal assessment will the physical therapist and the nurse plan to collaborate on?

The need for ambulatory devices

Athletes are likely to experience which type of fracture?

fatigue

The nurse uses different noninvasive techniques to assess the viability of a patient's limb. What statement about these techniques is accurate?

Transcutaneous oxygen pressure is reliable for predicting healing.

A client has a total hip arthroplasty. What should the nurse do when caring for this client after surgery?

Use a pillow to keep the legs abducted.

Which statement about the blood supply and nerve fibers of bone is accurate?

Very few nerve fibers are connected to the bone.

The nurse is preparing a patient who underwent vertebroplasty for discharge. What measures should the patient take after discharge? Select all that apply.

Walking the next day after discharge Monitoring of the puncture site for infection

The nurse is completing an admission assessment on a patient scheduled for arthroscopic knee surgery. Which information will be most essential for the nurse to report to the health care provider?

Warm, red, and swollen knee

What teaching does the nurse provide to a patient who had outpatient surgery for hallux valgus?

Wear an orthopedic boot or shoe.

Which is a key feature of acute osteomyelitis?

fever

Which part of the body does the hallux valgus deformity affect?

foot

What complication of osteomyelitis is the most likely to occur?

formation of bone abscesses

Which fingers are affected by Dupuytren contracture?

fourth and fifth fingers

What causes corns?

friction

The nurse is taking the history of an adult female patient. Which factor places the patient at risk for osteoporosis?

Working at a desk and playing the piano for a hobby

A patient with a torn meniscus has undergone a meniscectomy. What intervention will prevent swelling? Select all that apply.

apply ice elevate the leg with one or two pillows

What is the most common assessment finding associated with osteoporosis?

bone fractures

An enlarged first metatarsal head is known as what?

bunion

The hallux valgus deformity can cause what other condition?

bunion

A nurse is assessing a perimenopausal patient's musculoskeletal system. The nutrition history is especially important because women generally do not get enough of which nutrient in their diet?

calcium

Which type of fracture extends through the skin?

compound

Which lifestyle change would benefit a patient who has osteoporosis?

walking

The nurse meets with a patient who reports having a ganglion. Which part of the body will the nurse inspect?

wrist

Why is carpal tunnel syndrome (CTS) beginning to be found in much younger patients than previously?

The use of handheld mobile devices has increased among children.

A patient who is an avid runner has suffered a muscle strain. Which management advice given by the nurse is most helpful to the patient?

"Alternate heat and cold on the ankle, stay off it, and take a nonsteroidal antiinflammatory drug (NSAID) for the pain."

When performing a physical assessment, the nurse notices the patient has an ingrown toenail. What does the nurse advise the patient? Select all that apply.

"When you do not trim your nails the right way, you can get a secondary infection." "Sometimes with ingrown toenails, the necrotic nail will have to be removed surgically." "It is important for you to trim your nails properly so that you do not get chronic hypertrophy of the nail lip."

The nurse is providing postoperative care to a patient immediately following an osteotomy for the correction of hammertoe. What information does the nurse tell the patient?

"You can put all of your weight on your foot in a few weeks."

Which statement about the human muscular system is accurate?

Muscle is surrounded by fascia.

What intervention is most commonly used to treat strains?

Muscle relaxants

In which stage of bone healing is callus formed?

stage three

The nurse is educating a patient who is scheduled for endoscopic carpal tunnel release (ECTR) surgery for carpal tunnel syndrome (CTS). Which statement made by the patient shows understanding of the procedure?

"This surgery will require a small incision, but the pain might be worse than it would be with open surgery."

The nurse is caring for a preoperative patient who is about to undergo a partial fasciectomy to treat Dupuytren contracture. The nurse ensures that the patient understands the procedure. Which statement made by the patient causes the nurse to do additional teaching?

"This surgery will tighten the fascia in my hand."

A patient has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction does the nurse include in this patient's teaching plan?

"Use pain medication as prescribed to control pain."

The nurse is reviewing the risk factors for Dupuytren contracture with a patient. Which finding causes the nurse to believe the patient may be at risk for developing this condition?

The patient has diabetes.

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information does the nurse include in the teaching plan?

"Wear helmets when riding a motorcycle."

What statements about amputation are correct? Select all that apply.

Lisfranc and Chopart amputations are types of midfoot amputations. In a Syme amputation, most of the foot is removed but the ankle remains. Lower extremity amputations are more common than upper extremity amputations.

A client is scheduled for a lumbar puncture. What nursing care should be implemented after the procedure?

Maintaining the client in the supine position for several hours

The serum calcium level of a patient with a femoral fracture is 12 mg/dL. What type of fracture does the nurse suspect that the patient has?

Pathologic fracture

An older adult patient has multiple tibial and fibular fractures of the left lower extremity after a motor vehicle crash. Which pain medication does the nurse anticipate will be requested for this patient?

Patient-controlled analgesia (PCA) with morphine

A client newly diagnosed with type 1 diabetes is taught to exercise on a regular basis. What is the primary reason for instruction on exercise?

To improve the cellular uptake of glucose

A student nurse is caring for an older adult who is recovering from hip replacement. The patient has recently spiked a high temperature and appears confused. For which complication should the nurse assess this patient?

infection

In which positions can the nurse assess a patient with a shoulder or upper arm fracture? Select all that apply.

sitting standing

What is the excessive stretching of a muscle or tendon?

strain