Patho Exam 2 Musculoskeletal System

In examining a school-aged child, which sign leads the nurse to refer the child to a specialist in musculoskeletal abnormalities?

Malalignment of spinous processes Explanation: Scoliosis is a lateral curvature of the spine in the upright position. Pain in the thigh with difficulty walking is associated with Legg-Calvé-Perthes disease. Neuromuscular weakness bilaterally is associated with nerve impingements.

A nurse is teaching the parent of a child with a diagnosis of Legg-Calve¨-Perthes disease about the prescribed treatment. Which statement by the parent indicates adequate understanding?

"My child will need to use crutches until the hip heals."

A nurse is caring for a client with ankylosing spondylitis. For which associated symptom does the nurse assess?

Kyphosis Explanation: Loss of motion in the spinal column is characteristic of the disease. Loss of lumbar lordosis occurs as the disease progresses, followed by kyphosis of the thoracic spine and extension of the neck.

In a child, the epiphyses and metaphysis are separated by:

A growth plate

A client arrives with a shoulder dislocation related to sword fighting practice. Which nursing educational topic is most accurate regarding this injury?

"Dislocations become recurrent. They recur with the same motion but require less and less force each time."

The nurse is administering the disease-modifying antirheumatic drug (DMARD) methotrexate to a client with rheumatoid arthritis (RA). When the client questions why the drug is needed, how should the nurse reply?

"Early use of these medications may prevent resistance to treatment later."

Which information is important for the nurse to teach the female client about the development of osteoporosis?

"Estrogen deficiency contributes to the development of osteoporosis."

A nurse is teaching a group of nursing students about the presentation of systemic lupus erythematosus (SLE). Which statement is the nurse likely to make?

"More women than men are affected by lupus." Explanation: There is a female predominance of 10:1 in those with SLE. This ratio is closer to 30:1 during childbearing years. SLE is more common in blacks, Hispanics, and Asians than in whites, and the incidence in some families is higher than in others.

A nursing faculty member is explaining the function of red bone marrow to students. Which statement made by a student indicates that teaching was successful?

"Red bone marrow is the site of blood cell formation." Explanation: Red bone marrow contains developing red blood cells and is the site of blood cell formation.

A month after surgical repair of a rotator cuff tear of the shoulder, a client tells the nurse, "This is not getting any better. I still have a lot of pain and limited motion." Which response by the nurse is most accurate?

"The shoulder joint is complex and can take up to 6 months to heal depending on the injury." Explanation: A rotator cuff repair may take several months to fully heal, depending on the sport and injury. After an extended period of joint rest, the client will need a rehabilitation program to regain strength, flexibility, and endurance. If the initial injury was mild, conservative treatment with anti-inflammatory agents, corticosteroid injections, and physical therapy would be implemented before surgical intervention.

A nurse is caring for a client with a fractured elbow. Which instruction is important to give the client to prevent cartilage degeneration while the elbow is immobilized?

"To prevent cartilage atrophy, slowly and gradually resume exercising." Explanation: Cartilage atrophy is rapidly reversible with activity after a period of immobilization; impact exercise during the period of remobilization can prevent reversal of the atrophy. Slow and gradual remobilization may be important in preventing cartilage injury.

A client is concerned about bone strength and development and asks the nurse if dietary sources of vitamin D will cause immediate activity within the skeletal system. The best response by the nurse would be:

"Vitamin D has little or no activity until it has been converted to physiologically active compounds."

The nurse determines that additional client education is needed when a client with gout makes which statement?

"When I have an exacerbation of my symptoms, a glass of red wine will be helpful."

A nurse is caring for a client with ankylosing spondylitis. For which associated symptom does the nurse assess?

Kyphosis

A physician is providing care for several clients on a hospital-based medical ward. Which client is most likely to experience chronic fatigue?

51-year-old woman admitted for exacerbation of her multiple sclerosis. Explanation: Neurologic conditions such as multiple sclerosis are particularly associated with chronic fatigue. Infections, wounds, and fistulae will undoubtedly cause fatigue but are less likely to contribute to the long-term presentation associated with chronic fatigue.

We have both red and yellow bone marrow in our bodies. What is yellow bone marrow largely composed of?

Adipose cells Explanation: Yellow bone marrow is composed largely of adipose cells. Hematopoietic cells are in red bone marrow. Cancellous cells are in spongy bone. Osteogenic cells line the latticelike pattern that forms bone marrow.

A client is experiencing severe pain in his back to the point of being immobile and running a temperature. The client also has swelling in his lower back (vertebrae). Following biopsy, the results show spinal tuberculosis. The nurse will anticipate explaining which priority intervention to this client?

Administer the four-drug antimicrobial medications

The health care provider is caring for a client diagnosed with an osteosarcoma who asks, "What does this mean?" Which response best describes the diagnosis?

Aggressive; malignant bone tumor Explanation: Osteosarcoma is an aggressive and highly malignant bone tumor with an unknown cause. It is the most common malignant bone tumor, representing one-fifth of all primary bone tumors

The health care provider is caring for a client diagnosed with an osteosarcoma who asks, "What does this mean?" Which response best describes the diagnosis?

Aggressive; malignant bone tumor Explanation: Osteosarcoma is an aggressive and highly malignant bone tumor with an unknown cause. It is the most common malignant bone tumor, representing one-fifth of all primary bone tumors.

Nursing students are studying metabolic disorders of the skeletal system and correctly identify which factor to be the major cause of osteoporosis?

Aging process

Which intervention will the nurse caring for a client on bed rest implement to prevent deep vein thrombosis (DVT)?

Anticoagulants and regular repositioning Explanation: DVT is a major complication of bed rest. It can occur due to several factors: venous stasis, hypercoagulability that results from reduced circulating volume, and vessel injury from external pressure. Interventions to prevent DVT include anticoagulant therapy, early mobility or routine position changes, sequential compression stockings, and maintaining adequate hydration.

A client suffers a musculoskeletal injury while participating in a sporting event. Which treatment is most appropriate initially?

Applying ice and sitting out the rest of the game

A child presents to the emergency room with suspected trauma to the growth plate in the ankle during a soccer game. Which step is the best intervention?

Assess the child for pain and prepare for diagnostic studies.

A nurse is caring for a client who has systemic lupus erythematosus (SLE). Which of the following causes the disease?

Autoimmune process Explanation: The cause of SLE is unknown. It is characterized by the formation of autoantibodies and immune complexes.

What is the term use to describe a tumor that while growing slowly does not destroy the surrounding tissues?

Benign

When explaining to the client diagnosed with gout how the xanthine oxidase inhibitors work, the health care provider would include which statement?

Blocks the production of uric acid by the body Explanation: Xanthine oxidase inhibitors block the synthesis of uric acid. In this classification, the most commonly prescribed to lower urate levels is allopurinol. The uricosuric agents prevent the tubular reabsorption of urate and increase its excretion in the urine. Uricase agents convert insoluble uric acid to a soluble product than can be excreted easily. Pegloticase is an infusible uricase agent that works rapidly to reduce serum uric acid.

What is a priority concern for a client who has a hip dislocation?

Blood supply to the femoral head Explanation: The major cause for concern for a client with a hip dislocation is that the dislocated position puts tension on the blood supply to the femoral head and avascular necrosis may result. Restoring or preserving circulation is the priority. Tendonitis and edema are not usually a concern. Pain is a secondary concern.

A client with confirmed low bone density asks the nurse if there is anything she can to decrease the risk of trauma. The best response would be:

Brisk walking three times per week on a flat surface

The physician is reviewing lab results for his client with cancer and finds the client to be hypercalcemic. What will the physician prescribe?

Calcitonin

While discussing hormonal control of bone formation, one should note that which hormone lowers blood calcium levels and decreases bone resorption?

Calcitonin

While discussing hormonal control of bone formation, one should note that which hormone lowers blood calcium levels and decreases bone resorption?

Calcitonin Explanation: Whereas parathyroid hormone (PTH) increases blood calcium levels, the hormone calcitonin lowers blood calcium levels by inhibiting the release of calcium from bone into the extracellular fluid and by decreasing bone resorption. Vitamin D functions as a hormone in regulating body calcium; it increases calcium absorption from the intestine and promotes the actions of PTH on bone. PTH and prolactin stimulate vitamin D production by the kidney. Changes in the concentration of phosphate ions may affect serum calcium levels due to their inverse relationship. Phosphate is not a hormone.

The student is studying the types of mature bones. The spongy bone found in the interior of bones and composed of spicules is:

Cancellous

A gymnastics student hurts the ankle and is diagnosed with a torn cartilage. The health care worker states it may take months for this injury to heal. What is the basic physiologic reason behind the prolonged recovery of cartilage?

Cartilage lacks blood vessels. Explanation: Cartilage is avascular tissue, a fact that stands in contrast to bone tissue. Both bone and cartilage contain cells that secrete an extracellular matrix, which forms the structure of the tissue. Cartilage is more flexible than bone, but it also exhibits considerable tensile strength. Cartilage repair is a particularly slow process and may in fact not occur in some cases. In contrast to cartilage, the extracellular matrix of bone is mineralized, producing a hard tissue capable of providing support for the body and protection for its vital structures.

The nurse is assessing a client who sustained a fractured radius. A cast was applied to the extremity approximately 1 hour ago, and the client is now complaining of increased pain and numbness to the finger tips. The client is most likely experiencing:

Compartment syndrome

The nurse is caring for a client who states that he is suddenly having severe pain at a leg fracture site. The nurse notes increased swelling in the limb and difficulty palpating a pulse. The nurse suspects that the client may have:

Compartment syndrome Explanation: The hallmark symptom of acute compartment syndrome is severe pain out of proportion to the original injury. One of the most important causes of compartment syndrome is bleeding and edema caused by fractures and bone surgery. Edema or swelling may make it difficult to palpate a pulse. Reflex sympathetic dystrophy, while characterized by pain out of proportion to the injury, does not exhibit decreased pulses. Fracture blisters are areas of epidermal necrosis with separation of epidermis from the underlying dermis by edema fluid. They are a warning sign of compartment syndrome. Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the bloodstream.

A 70-year-old female client comes to the clinic with back pain. An x-ray reveals vertebral fractures and she is diagnosed with osteoporosis. Which factor most likely contributed to her condition?

Decreased estrogen levels

The nurse is caring for a client with several fractures that have been immobilized. Which assessment finding would be most indicative of a potential complication?

Deep, severe, unrelenting pain Explanation: Complications of fractures include compartment syndrome, when swelling after the injury impairs blood and nerve function. As the tissue is compressed, the extremity becomes edematous, has reduced capillary refill, is cold, and the pain is described as severe (and out of proportion to the original injury); additionally, the pain is not relieved by medication or positioning. Some elevation of vital signs is not unusual with acute pain and does not automatically indicate a complication.

A client has developed osteomyelitis and asks the health care provider how the problem occurred. Which response is most accurate?

Direct contamination of an open wound Explanation: Osteomyelitis represents an acute or chronic infection of the bone and marrow. All types of organisms—including parasites, viruses, bacteria, and fungi—can cause osteomyelitis, but certain pyogenic bacteria and mycobacteria are the most common. Organisms may reach the bone by seeding through the bloodstream (hematogenous spread), direct penetration or contamination of an open fracture or wound (exogenous origin), or extension from a contiguous site. Vitamin intake or deficiency will not cause infection.

Osteoporosis is a disease caused by demineralization of bone. What is the clinical method of choice for diagnosing osteoporosis?

Dual-energy x-ray absorptiometry (DXA) of the spine and hip Explanation: The clinical method of choice for bone mineral density (BMD) studies is dual-energy x-ray absorptiometry (DXA) of the spine and hip. The other answers will not diagnose osteoporosis.

A nursing student who is studying about disorders of the skeletal system is heard making the following statement, "Many skeletal disorders of early infancy are caused by intrauterine positions and need to be surgically fixed." Is this statement true or false?

False Explanation: Although it is true that many disorders of early infancy are caused by intrauterine positions, they are mostly resolved as the child grows.

The nurse is caring for a client with a fracture in his appendicular skeleton. Which bone is in this skeleton?

Femur

When caring for a client with ankylosing spondylitis, the nurse tells the client that stiffness may be relieved by which intervention?

Gentle exercise

The student is examining a wedge of compact bone tissue and its blood distribution. The spaces in the cortex that move parallel through the long axis of the bone and contain blood vessels are known as:

Haversian canals Explanation: The distribution of blood in the bone cortex occurs through the Haversian and Volkmann canals. Haversian canals are spaces in the bone of the cortex that move parallel through the long axis of the bone. Volkmann canals run perpendicular to the long axis of the cortex to connect adjacent Haversian canals. Osteocytes lie in a small lake filled with extracellular fluid called a lacuna. Canaliculi are extracellular fluid-filled passage ways that permeate the calcified matrix and connect the lacunae of adjacent osteocytes.

An older adult client has had mobility and independence significantly impaired by the progression of rheumatoid arthritis (RA). What is the primary pathophysiologic process that has contributed to this client's decline in health?

Immunologically mediated joint inflammation

The nurse is explaining to a client that there are "cushions" in his back to absorb any jarring movement of the spine. Which anatomical structure is the nurse referring to?

Intervertebral disks Explanation: Intervertebral disks are elastic fibrocartilaginous plates that are intermediate between dense connective tissue and hyaline cartilage, which cushion the spine like shock absorbers and help it move.

A child is being treated for hematogenous osteomyelitis. Which statement is an accurate description of this type of osteomyelitis?

Introduction of microorganisms from the bloodstream Explanation: Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the bloodstream. Dead bone tissue is indicative of osteonecrosis, not osteomyelitis. Hematogenous osteomyelitis is normally accompanied by the classic signs and symptoms of infection; the destruction of the vascular network in the endosteum is not a hallmark of the hematogenous variant of osteomyelitis.

Which of the following should the nurse teach about secondary osteoporosis?

It is secondary to many conditions.

The pediatric nurse is providing teaching to a parent of a child with toeing-out (slew foot). Which statement should the nurse include in the teaching?

It will most likely self-correct as the child becomes proficient in walking. Explanation: Toeing-out (slew foot) is a common problem in children that usually corrects itself as the child becomes proficient in walking. Occasionally a night splint is utilized. Sleeping in the supine position does not impact toeing-out.

Which signs and symptoms should prompt a young woman's primary care provider to assess for systemic lupus erythematosus (SLE)?

Joint pain and proteinuria Explanation: Renal involvement occurs in approximately one half to two-thirds of persons with SLE, and arthralgia is a common early symptom of the disease. Nephrotic syndrome causes proteinuria with resultant edema in the legs and abdomen, and around the eyes. Although the manifestations of SLE are diffuse, these do not typically include alterations in hemostasis, gastrointestinal symptoms, dysmenorrhea, or miscarriage.

Athletic injuries fall into two types: acute or overuse injuries. Where do overuse injuries commonly occur?

Knee

What type of cell is responsible for building bone in the body?

Osteoblasts

Following a fall, an 83-year-old male has fractured his femoral head. His care provider has stated that the healing process is occurring at a reasonable pace, and that the man will regain full function after healing and rehabilitation. Which cells are most responsible for restoring the integrity of the man's broken bone?

Osteoblasts Explanation: The osteoblasts, or bone-building cells, are responsible for the formation of the bone matrix and would participate in the healing process. Osteocytes are mature bone cells. Osteoclasts reabsorb bone cells. An osteoma is a bone tumor.

A client has developed increased resorption of bone with removal of mineral content. This is most likely the result of:

Osteoclasts

An older adult client is admitted for the treatment of pneumonia. The nurse notes the home medications include nasal calcitonin, vitamin D, and calcium chloride. Which disease process is this client likely treating with these medications?

Osteoporosis Explanation: Common pharmacologic treatments for osteoporosis include nasal calcitonin, vitamin D supplements, and calcium supplements. This combination of drugs does not address the etiology or manifestations of scleroderma, osteoarthritis, or rheumatoid arthritis.

A client sustained a fall that resulted in an injury to the right shoulder, and the emergency doctor suspects a rotator cuff injury. The client would most likely manifest: Select all that apply.

Pain Muscle atrophy Difficulty abducting the affected arm Explanation: The major clinical features of rotator cuff disorders are pain (especially at night), tenderness, and occasionally muscle atrophy. Pain and impingement may be noted when motions of the arm squeeze and pinch cuff tendons between the humerus and the overlying arch. With rotator cuff tears, there may be difficulty abducting and rotating the arm.

A client with a closed reduction of a wrist fracture has a plaster cast applied. Which nursing intervention is the highest priority immediately after the procedure?

Performing a peripheral circulation assessment

After a week in which a client worked four 12-hour shifts and went home to two children with the flu, the client is feeling fatigued. How should this client's fatigue be categorized?

Physiologic Explanation: The client's fatigue is physiologic, as it's due to lack of sleep and constant activity. If it were psychological, it would be associated with depression. If it were pathologic, there would be a disease condition associated with the client's feelings of fatigue.

The nurse is assessing a client who reports a long history of fatigue. Which assessment finding is most suggestive of chronic fatigue syndrome (CFS)?

The client reports mental and physical exhaustion and decreased activity level

A nurse assesses a client for fatigue. Which manifestations are characteristic of acute fatigue? Select all that apply.

Rapid onset Relieved by rest Explanation: Acute physical fatigue usually occurs with increased muscle activity and develops rapidly. It may be present with acute viral or bacterial infections and occurs more rapidly with people who are physically deconditioned, such as those on bedrest. There is usually a clear cause of the fatigue and it improves with rest.

A client with a compound fracture of the femur is in balanced skeletal traction. Which assessment data must be reported immediately?

Redness and heat at fracture site Explanation: Osteomyelitis is an infection in the bone. With a compound fracture, infecting organisms can easily enter the bone through open tissue. Manifestations include chills, fever, malaise, pain of the affected extremity, local tenderness, redness, and swelling. Clear drainage at pin sites is common and does not indicate infection without other indicators.

The nurse caring for a child with a deficiency of vitamin D knows that the deficiency places the child at risk for:

Rickets Explanation: Rickets is associated with a Vitamin D deficiency whereas scurvy is associated with a Vitamin C deficiency. Hip dysplasia is not associated with a Vitamin D deficiency. Paget disease is not associated with children.

The joint capsule consists of an outer fibrous layer and an inner synovium. What does the inner synovium do to facilitate movement?

Secretes synovial fluid Explanation: The synovium secretes a slippery fluid with the consistency of egg white called synovial fluid. This fluid acts as a lubricant and facilitates the movement of the articulating surfaces of the joint. The synovium surrounds, rather than connects, the tendons that pass through the joints. The synovium forms folds that surround the margins of articulations but do not cover the weight-bearing articular cartilage. The tendons and ligaments of the joint capsule, rather than the synovium layer, are sensitive to position and movement, particularly stretching and twisting.

The health care provider is explaining the course of treatment to the parents of a 2-day-old infant born with congenital clubfoot. Which treatment options will likely be discussed?

Serial manipulations and casting of the affected extremity

The provider diagnoses the client with a rheumatic disorder after the client states he is having joint pain. The provider explains that which joint is most frequently affected by this disorder?

Synovial

A client is diagnosed with a strained back. Which instructions should the nurse provide to this client? Select all that apply.

Take ibuprofen for pain. Bend knees to pick up objects. Reduce activity for a few days.

The nurse is providing client education related to intra-articular corticosteroid injections. Which instruction should the nurse include?

The injections will be given only 3 to 4 times per year because they can increase joint destruction.

The nurse is providing client education related to intra-articular corticosteroid injections. Which instruction should the nurse include?

The injections will be given only 3 to 4 times per year because they can increase joint destruction. Explanation: The client needs to be educated regarding the limited use of the injections and the risk of these injections causing additional joint destruction. The client should not be encouraged to run, but can participate in muscle-strengthening exercises. The statements regarding discomfort and daily administration are not correct.

The nurse is caring for clients with autoimmune conditions. Which client will the nurse assess first?

client with systemic lupus erythematosus reporting chest pain

The nurse is caring for clients with autoimmune conditions. Which client will the nurse assess first?

client with systemic lupus erythematosus reporting chest pain Explanation: The client with systemic lupus erythematosus (SLE) and chest pain is the priority client to assess. Pericarditis and other cardiac problems are possible. Articular symptoms of rheumatoid arthritis (RA) are pain and stiffness; this is not a priority from the clients presented. The client with SLE reporting a facial rash is not presenting with any other symptoms and is not a priority. The client with RA and vasculitis can experience neuropathy which can result in numbness and tingling. If this were a new symptom, this client would be the second one the nurse would assess.

A 16-year-old adolescent suffered a fracture of the ulna. The fracture does not protrude through the skin and there are several pieces of broken bone evident on the x-ray. Which term should the nurse use to describe this fracture?

closed comminuted fracture

A child with Osgood-Schlatter disease most often presents with which assessment finding?

pain in front of the knee

The nurse is assessing an infant with a possible head injury. When palpating the skull, the nurse feels for the joints that exist between the bones of the skull. How will the nurse document the name for these joints?

sutures

The nurse is assessing an infant with a possible head injury. When palpating the skull, the nurse feels for the joints that exist between the bones of the skull. How will the nurse document the name for these joints?

sutures Explanation: Synarthroses are joints that lack a joint cavity and move little or not at all and are either fibrous or cartilaginous joints. The fibrous joints are divided into sutures, gomphoses, and syndesmoses. Sutures are only found in the skull. Gomphoses connect teeth to the jaw. Synchondroses are joints that have a layer of cartilage separating two ossification centers such as in a growth plate. Symphyses are joints in which two separate bones are connected by cartilage such as the pubic symphysis.