CH 38, 39, 40, 41, and 42 Muscle Skeletal

This is present in 85% of those with ankylosing spondylitis

HLA-B27 antigen

This can decrease in testing with chronic inflammation:

Hematocrit

The nursing goal for a patient with skeletal traction is to avoid infection and development of what at the site of pain insertion?

Osteomyelitis

Name four purposes for having a cast application:

Reducing a fracture, correcting it formally, applying uniform pressure to underlying soft tissue, and providing support and stability for weak joints

What is an open reduction?

The correction and alignment of the fracture after surgical dissection and exposure of the fracture

What is an amputation?

The removal of a body part

What is Volkmann contracture?

Volkmann contracture is a serious complication of impaired circulation in the arm. Contracture of the fingers and wrist occurs as a result of obstructed arterial blood flow to the forearm and the hand. The patient is unable to extend the fingers, describes abnormal sensation, and exhibit signs of diminished circulation to the hand. Permanent damage develops within a few hours of action is not taken.

A patient is having repeated tears of the joint capsule in the shoulder, and the physician prescribed an arthrogram. What intervention should the nurse provide after the procedure is completed? (Select all that apply.) a. Apply compression bandage to the area b. Apply heat to the area for 48 hours c. Administer a mild analgesic d. Inform the patient that a clicking or cracking noise in the joint may persist for a couple of days e. Actively exercise the area immediately after the procedure

a. Apply compression bandage to the area c. Administer a mild analgesic d. Inform the patient that a clicking or cracking noise in the joint may persist for a couple of days

A patient with an acute exacerbation of arthritis is temporarily confined to bed. What position can the nurse recommend to prevent flexion deformities? a. Prone b. Semi-Fowler's c. Side-lying with pillows supporting the shoulders and legs d. Supine with pillows under the knees

a. Prone

An artificial joint for total hip replacement involves an implant that consists of:

an acetabular socket, a femoral shaft, a spherical ball

A patient is prescribed a DMARD that is successful in the treatment of rheumatoid arthritis but has side effects, including retinal eye changes. What medication does the nurse anticipate educating the patient about? a. Azathiprine b. Diclofenac c. Hydroxychloroquine d. Aurothioglucose

c. Hydroxychloroquine

After a bone density test, an older adult female patient tells the nurse, "I don't understand why I have osteoporosis because I eat well and take my calcium." What is the best response by the nurse? a. "Everyone gets osteoporosis and there is nothing you can do to prevent it" b. "Men lose more bonus than women but women still lose some" c. "In order to prevent bone loss, you will have to take hormones" d. "The loss is from withdrawal of estrogen in a decrease in activity levels"

d. "The loss is from withdrawal of estrogen in a decrease in activity levels"

A patient is receiving gold sodium thiomalate for the treatment of rheumatoid arthritis. What does the nurse understand about the action of this compound? a. The drug inhibits DNA synthesis b. The drug inhibits lysosomal enzymes c. The drug inhibits platelet aggregation d. The drug inhibits T- and B-cell activity

d. The drug inhibits T- and B-cell activity

What are the clinical manifestations of gout?

Manifestations of gout include acute gouty arthritis (recurrent attacks of severe articular and periarticular inflammation), tophi (crystalline deposits accumulating in articular tissue, osseous tissue, soft tissue, and cartilage), gouty nephropathy (renal impairment), and uric acid urinary calculi.

What nursing management options exist for fibromyalgia?

Nurses need to pay special attention to supporting patient with fibromyalgia and providing encouragement as they begin their program of therapy. Patient support groups may be helpful. Careful listening to patients' descriptions of their concerns and symptoms is essential to help them make the changes that are necessary to improve their quality of life.

What is the theory of degradation as it relates to the pathophysiology of rheumatic diseases?

One theory of degradation is that genetic or hormonal influences, mechanical factors, and prior joint damage cause cartilage failure. Degradation of cartilage ensues, and increased mechanical stress on bone ends causes stiffening of bone tissue. Another theory is that bone stiffening occurs and results in turn initiates the processes of degradation.

What are the differences in the function of osteoblasts, osteocytes, and osteoclasts?

Osteoblasts function in the bone formation by secreting bone matrix. The matrix consist of collagen and ground substances (glycoproteins and proteoglycans) that provide a framework in which in organic mineral salts are deposited. These minerals are primarily composed of calcium and phosphorus. Osteocytes are mature bone cells involved in bone maintenance; they are located in lacunae (bone matrix units). Osteoclasts, located in shallow Howship lacunae (small pits in bones), are multinuclear cells involved in dissolving and resorbing bone.

What is a fasciotomy?

The incision and diversion of the muscle fascia to relieve muscle construction, as in compartment syndrome, or to reduce fascia contracture

What is the nerve that is tested when you prick the distal fat pad of the small finger?

Ulnar

List the danger signs of possible circulatory construction that the nurse should assess for in a cast extremity:

Unrelieved pain, swelling, discoloration, tingling, numbness, inability to move fingers or toes, or any temperature changes

The nurse suspects compartment syndrome for a casted extremity. What characteristic symptoms would the nurse assess that would confirm the suspicion? (Select all that apply.) a. Decreased sensory function b. Excruciating pain c. Loss of motion d. Capillary refill less than 3 seconds e. 2+ peripheral pulses in the affected distal pulse

a. Decreased sensory function b. Excruciating pain c. Loss of motion

The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does a patient present with that would indicate circulation is impaired? (Select all that apply.) a. Pale, cyanotic, or molten color b. Cool temperature of the extremity c. More than 3-second capillary refill d. Tenting skin turgor e. Limited range of motion

a. Pale, cyanotic, or molten color b. Cool temperature of the extremity c. More than 3-second capillary refill

A patient is seen in the office for reports of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of RA? (Select all that apply.) a. Positive C-reactive protein (CRP) b. Positive antinuclear antibody (ANA) c. Red blood cell count of <4.0 million/mcL d. Serum complement level (C3) of >130 mg/dL e. Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels of 7 units/L

a. Positive C-reactive protein (CRP) b. Positive antinuclear antibody (ANA) d. Serum complement level (C3) of >130 mg/dL

A patient comes to the clinic and informs the nurse of numbness, tingling, and a burning sensation in the arm from the elbow down to the fingers. What type of symptom would this be documented as? a. paresthesia b. flaccidity c. atonia d. effusion

a. paresthesia

A patient has a fracture that is being treated with open rigid compression plate fixation devices. How will the progress of bone healing be monitored? a. Remove the plate and determine if the bone is growing back b. Perform serial x-rays c. Perform an arthroscopy d. The bone will heal on its own without intervention

b. Perform serial x-rays

A patient arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the patient to describe the pain? a. A dull, deep, boring ache b. Sharp and piercing c. Similar to "muscle cramps" d. Sore and aching

b. Sharp and piercing

What type of clinical manifestations does a patient with polymyalgia rheumatic present with?

PMR is characterized by severe proximal muscle discomfort with mild joint swelling. Severe aching in the neck, shoulder, and pelvic muscles is common. Stiffness, noticeable most often in the morning and after periods of inactivity, can becomes so severe that patients struggle putting on a coat or combing their hair. Systemic features include low-grade fever, weight loss, malaise, anorexia, and depression.

What is the nerve that is being tested when you prick the medial and lateral surface of the sole?

Tibial

After a total hip replacement, stair-climbing is kept to a minimum for how many months?

3 to 6

The approximate percentage of total body calcium present in the bones is:

98%

Identify at least five musculoskeletal problems that can cause acute low back pain:

A cute lumbosacral strain, unstable lumbosacral ligaments, with lumbosacral muscles, osteoarthritis of the spine, spinal stenosis, enter vertebral disc problems, and unequal leg length

The primary deficit in osteomalacia is what? This promotes calcium absorption from the gastrointestinal tract.

A deficiency in activated vitamin D

Patients who experience a fracture of the humeral neck are advised that healing will take an average ____ weeks, with restricted vigorous activity for an additional _____ weeks

10, 4

Approximately how many mg of calcium daily is essential to maintain adult bone mass?

1000 to 1200

The recommended adequate intake level of calcium for all individuals is how many milligrams daily?

1000 to 1500

The nurse expects that ______ of weight can be used for a patient in skeletal traction

25 pounds

Primary osteoporosis in women usually begins between the ages of what?

45 and 55, after menopause

Compare the advantages of a fiberglass cast to those of a plaster cast:

A fiberglass cast is light and weight and water resistant. It is more durable than plaster and water resistant.

A positive test of this is associated with systemic lupus erythematosus

Antinuclear antibody (ANA)

What type of break occurs when a fragment of the bone is pulled off by a ligament or tendon?

Avulsion

Compare and contrast open and closed reduction as management techniques for fractures

Closed reduction is performed without a surgical incision and can be done when there is a dislocation of a fracture. Cast may be applied after the procedure. Open reduction is usually performed with plate and screws to provide mobilization of the bone, especially if there is displacement of the fracture.

What is the most common fracture of the distal radius?

Colles' fracture

What type of break occurs when bone is splintered into several fragments?

Comminuted

What is compartment syndrome?

Compartment syndrome occurs when the circulation and function of tissue within a confined area is compromised. Treatment requires that the cast is bivalved; a fasciotomy may be necessary.

Name three major complications of an extremity that is casted, braced, or splinted:

Compartment syndrome, pressure ulcers, and disuse syndrome

What type of break occurs when it is across the entire section of the bone?

Complete

What type of break occurs when the fractured bone is compressed by another bone?

Compressed

List three early and serious complications associated with bedrest and reduced skeletal muscle contraction for a patient with an open fracture:

Deep vein thrombosis, thromboembolism, and pulmonary embolus

What type of break occurs when fragments are driven inward?

Depressed

Osteomyelitis with vascular insufficiency, which most commonly affects the feet, is the most often among patients with:

Diabetes, peripheral vascular disease

Used to elevate spinal nerve root disorders (radiculopathies):

Electromyogram (EMG)

What type of break occurs when the fracture occurs through the epiphysis?

Epiphyseal

What type of break occurs when it's through an area of diseased bone?

Pathologic

What is the nerve that is tested when you prick the skin midway between the great and second toe?

Peroneal

What is an internal fixation?

The stabilization of the reduced fracture by the use of metal screws, plates, wires, nails, and pins

A patient is being placed on a purine-restricted diet. What food should be suggested by the nurse? a. Dairy products b. Organ meats c. Raw vegetables d. Shellfish

a. Dairy products

Three range of motion activities are avoided for patient with a lower extremity amputation:

abduction, external rotation, flexion

A patient had a stroke and is unable to move the right upper and lower extremities. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding? a. Rigidity b. Flaccidity c. Atonic d. Tetanic

b. Flaccidity

A nurse is caring for a patient who presents with the symptoms of blanching of fingers when exposed to cold. What rheumatic disorder does the nurse prepare to assess the patient for? a. Ankylosing spondylitis b. Raynaud phenomenon c. Reiter syndrome d. Sjogren syndrome

b. Raynaud phenomenon

A patient sustained an open fracture with extensive soft tissue damage. The nurse determines that this fracture would be classified as what grade? a. I b. II c. III d. IV

c. III

The most common symptom of rheumatic disease that causes a patient to seek medical attention is:

pain

This is the substance that is tested for that's associated with gout:

uric acid

Joint dislocation can lead to a vascular necrosis if it is not treated. What rationale should be provided to the patient with a potential for developing a vascular necrosis?

AVN is tissue death due to anoxia and diminished blood supply

The major consequence of osteoporosis is:

Bone fracture

May disclose infections, tumors, and bone marrow abnormalities:

Bone scan

The nurse assesses for perineal nerve injury by checking the patients cast a leg for the primary symptoms of:

Burning, numbness, tingling

This is frequently positive for RA and SLE

C-reactive protein (CRP)

Three medications used to treat Paget disease are:

Calcitonin, biphosphonates, plicamyin

Bone formation is enhanced by:

Calcium intake, muscular activity, weight-bearing

The most effective cleansing solution for care of a pin site is:

Chlorhexidine solution

Useful and identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral column and problems of vertebral discs:

Computed tomography (CT) scan

An increase in this may indicate renal damage, as in scleroderma

Creatinine

What describes the grating, crackling sound heard over irregular joint surfaces like the knee?

Crepitus

What is the difference between isotonic and isometric contractions?

During isometric contraction, almost all the energy is released in the form of heat; during isotonic contraction, some of the energy is expended in mechanical work. In some situations, the need to generate heat is the primary stimulus for muscle contraction.

Name three early and three delayed complications of fractures:

Early: shock, fat embolism, compartment syndrome, deep vein thrombosis, thromboembolism, DIC, and infection Delayed: delayed union and nonunion, avascular necrosis of bone, reaction to internal fixation devices, complex regional pain syndrome, and heterotrophic ossification

What is the difference between exacerbation and remission?

Exacerbation is a period of time when the symptoms of a disorder occur or increase in intensity and frequency. Remission is a period of time when symptoms are reduced or absent

The nurse caring for a postoperative hip replacement patient knows that the patient should not cross their legs at any time for how long after surgery?

Four months

What type of break occurs when one side of a bone is broken and the other side is bent?

Greenstick

What is impingement syndrome and what measures are necessary to promote shoulder healing?

Impingement syndrome is a general term that describes impaired movement of the rotator cuff of the shoulder. Impingement usually occurs from repetitive overhead movement of the arm or from acute trauma resulting in irritation and eventual inflammation of the rotator cuff tendons or the subacromial bursa as the grate against the coracoacromial arch

What is the difference between the pathophysiology of inflammatory rheumatic disease and that of degenerative rheumatic disease?

In inflammatory rheumatic disease, the inflammation occurs as the result of an immune response. Newly formed synovial tissue is infiltrated with inflammatory cells (pannus formation), and joint degeneration occurs as a secondary process. In degenerative rheumatic disease, synovitis results from mechanical irritation. A secondary inflammation occurs.

What is the difference between kyphosis, lordosis, and scoliosis?

Kyphosis: increase in the convex curvature of the thoracic spine, lordosis: increase in concave curvature of the lumbar spine, scoliosis: lateral curving of the spine

The intravertebral disc's that are subject to the greatest mechanical stress and greatest degenerative changes are:

L4, L5, S1

Permits visualization of the nature and location of spinal pathology:

Magnetic resonance imaging (MRI) scan

What is the nerve that is tested when you prick the top or distal surface of the index finger?

Median

What methods for preventing hip prosthesis dislocation with the nurse educator a patient about?

Methods for preventing hip prosthesis dislocation include the following: -Keep the knees apart at all times -Put a pillow between the legs when sleeping -Never crossed legs when seated -Avoid bending forward when seated in a chair -Avoid bending forward to pick up an object on the floor -Use a high seated chair and a raised toilet seat -Do not flex the hip to put on clothing such as pants, stockings, socks, or shoes

Permits visualization of segments of the spinal cord that may have herniated or maybe compressed (infrequently performed; indicated when MRI scan is contraindicated)

Myelogram

What type of break occurs when it is at an angle across the bone?

Oblique

What type of break occurs when it extends through the skin?

Open

The most common benign bone tumor is:

Osteochondroma

What are the five "P's" that should be assessed as part of the neurovascular check?

Pain, pallor, pulselessness, paresthesia, paralysis

What is the process of fracture healing, including the three stages of progression?

Phase I, reactive phase; phase II, repetitive phase; phase III, remodeling phase.

What potential immobility-related complications may develop when a patient is in skeletal traction?

Pressure ulcers, atelectasis, pneumonia, constipation, anorexia, urinary stasis and infection, and venous thromboemboli with PE or DVT

What is the nerve that is tested when you prick the skin midway between the thumb and second finger?

Radial

What type of exercises and precautions are used to promote mobility for a patient with a rheumatic disease?

Range of motion, isometric, dynamic, aerobic, and pool exercises are used to promote mobility for patients with rheumatic diseases.

This is present in 80% of those who have RA:

Rheumatoid factor

A patient is an early shock from a fracture. What five activities are involved in the treatment?

Stabilizing the fracture to prevent further hemorrhage, restoring blood volume and circulation, relieving the patient's pain, providing proper immobilization, and protecting against further injury.

In the inflammatory process in rheumatic diseases, a triggering event starts the process by activating:

T lymphocytes

What is a meniscectomy?

The excision of damaged joint fibrocartilage

Describe the clinical manifestations associated with septic arthritis:

The patient with acute septic arthritis presents with a warm, painful, swollen joint with decreased range of motion. Systemic chills, fever, and leukocytosis are sometimes present. Although any joint may be infected, 50% of cases involve a knee

What is a bone graft?

The placement of bone tissue to promote healing, to stabilize, or to replace diseased bone

What is an arthroplasty?

The repair of joint problems through the operating arthroscope (an instrument that allows the surgeon to operate within the joint without a large incision) or through open joint surgery

The nurse feels a grating sensation in a patient's extremity. What is the sensation caused by? How would the nurse document the sensation?

The sensation is caused by the rubbing of bone fragments against each other; the nurse would document it as crepitus

After a total hip replacement, patient is usually able to resume daily activities after:

Three months

Describe the assessment technique used for Tinel sign:

Tinel sign may be elicited in patients with carpal tunnel syndrome by percussing lightly over the median nerve, located on the inner aspect of the wrist. If the patient reports tingling, numbness, and pain, the test for Tinel sign is considered positive.

Useful in detecting tears and ligaments, muscles, tendons, and soft tissues in the back

Ultrasound

The nurse knows you assess a patient for deep vein thrombosis by assessing the lower extremities for:

Unilateral calf tenderness, warmth, redness, swelling

How does vitamin D regulate the balance between bone formation and bone reabsorption?

Vitamin D increases calcium in the bone by promoting calcium absorption from the gastrointestinal tract and by accelerating the mobilization of calcium from the bone.

What immediate nursing in medical management techniques are used for an open fracture?

With an open fracture, the wound is covered with a sterile dressing to prevent contamination of deeper tissues. No attempt is made to reduce the fracture, even if one of the bone fragments is protruding through the wound. Splints are applied for immobilization.

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation? a) Abduction b) Adduction c) Internal rotation d) Flexion

a) Abduction

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? a. 24 hours b. 72 hours c. 1 week d. 2 to 3 weeks

a. 24 hours

The nurse is caring for a patient with a total hip replacement. How should the nurse assess the patient to turn? a. 45° onto the unoperated side if the affected hip is kept abducted b. Assist from the prone to the supine position only, and the patient must keep the affected have extended and abducted c. Any comfortable position is acceptable as long as the affected leg is extended d. Assist to the operative side if the affected his remains extended

a. 45° onto the unoperated side if the affected hip is kept abducted

A patient has a cast removed after bone healing takes place. What should the nurse educate the patient to do after removal? (Select all that apply.) a. Apply an emollient lotion to soften the skin b. Control swelling with elastic bandages, after directed c. Gradually resume activities and exercise d. Use friction to remove dead surface skin by rubbing the area with a towel e. Use a razor to shave the dead skin off

a. Apply an emollient lotion to soften the skin b. Control swelling with elastic bandages, after directed c. Gradually resume activities and exercise

Patient sustained a fracture of the arm. When does the nurse anticipate pendulum exercise should begin? a. As soon as tolerated, after a reasonable period of immobilization b. In 2 to 3 weeks, when callus ossification prevents easy movements of bony fragments c. In about 4 to 5 weeks, after new bone is well established d. In 2 to 3 months, after normal activities are resumed.

a. As soon as tolerated, after a reasonable period of immobilization

The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? (Select all that apply.) a. Checking the urine for hematuria b. Palpating peripheral pulses in both lower extremities c. Testing the stool for occult blood d. Assessing level of consciousness e. Assessing pupillary response

a. Checking the urine for hematuria b. Palpating peripheral pulses in both lower extremities c. Testing the stool for occult blood

A patient sustained an open fracture of the left arm after an accident at the rollerskating rink. What does emergency management of this fracture involve? (Select all that apply.) a. Cover the area with a clean dressing if the fractures open b. Immobilize the affected site c. Splint the injured limb d. Have the patient demonstrate mobility of the arm e. Wrap the arm in a compression bandage

a. Cover the area with a clean dressing if the fractures open b. Immobilize the affected site c. Splint the injured limb

The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.) a. Decreased ventilation owing to lung scarring b. Dysphagia owing to hardening of the esophagus c. Productive cough d. Butterfly-shaped rash on the face

a. Decreased ventilation owing to lung scarring b. Dysphagia owing to hardening of the esophagus c. Productive cough

A nurse is caring for a patient who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.) a. Encouraging the patient to care for the residual limb b. Allowing the expression of grief c. Encourage the patient to have family and friends view the residual limb to decrease self-consciousness d. Encouraging family and friends to refrain from visiting temporarily because this may increase the patient's embarrassment e. Introducing the patient to local amputee support groups

a. Encouraging the patient to care for the residual limb b. Allowing the expression of grief e. Introducing the patient to local amputee support groups

The nurse is caring for a patient with bone metastasis from a primary breast cancer. The patient reports muscle weakness and nausea and his voiding large amounts frequently. Cardiac dysrhythmias are observed on the telemetry monitor. What should the nurse suspect based on these clinical manifestations? a. Hypercalcemia b. Hypocalcemia c. Hypokalemia d. Hyperkalemia

a. Hypercalcemia

A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient? a. Hypovolemic shock b. Infection c. Knee and hip dislocation d. Pain resulting from muscle spasm

a. Hypovolemic shock

The nurse is caring for a patient who sustained an open fracture of the right femur in an automobile crash. What does the nurse recognize is the most serious complication of an open fracture? a. Infection b. Muscle atrophy caused by loss of supporting bone structure c. Necrosis of adjacent soft tissue caused by blood loss d. Nerve damage

a. Infection

A patient is diagnosed with osteomyelitis of the right leg. What signs and symptoms does the nurse recognize that are associated with this diagnosis? (Select all that apply.) a. Pain in the right leg b. Erythema of the right leg c. Fever d. Leukopenia e. Purulent drainage

a. Pain in the right leg b. Erythema of the right leg c. Fever

A patient comes to the clinic with an inflamed wrist. How should the nurse splint the joint to immobilize it? a. Slight dorsiflexion b. Extension c. Hyperextension d. Internal rotation

a. Slight dorsiflexion

A patient had a total hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? a. The left leg is internally rotated b. Leg length is the same as the right leg c. The patient has discomfort when moving in the bed d. Diminished peripheral pulses on the affected extremity

a. The left leg is internally rotated

The leading cause of musculoskeletal-related disability in the United States is:

arthritis

Common pulmonary complications for the older adult patient following a hip fracture include:

atelectasis, pneumonia

A patient comes back to the clinic with continued reports of back pain. What time frame does the nearest understand constitutes "chronic pain"? a. 4 weeks b. 3 months c. 6 months d. 1 year

b. 3 months

A patient had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters a patient's room and observes the dressing in bed covers saturated with blood. What is the first action by the nurse? a. Notify the healthcare provider b. Apply a tourniquet c. Use skin clips to close the wound d. Reinforce the dressing

b. Apply a tourniquet

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse informed the patient that the acute inflammatory stage will last? a. Less than 24 hours b. Between 24 and 48 hours c. About 72 hours d. At least 1 week

b. Between 24 and 48 hours

Patient has been diagnosed with osteomalacia. What common symptoms does the nurse recognize correlate with the diagnosis? a. Bone fractures and kyphosis b. Bone pain and tenderness c. Muscle weakness and spasms d. Softened and compressed vertebrae

b. Bone pain and tenderness

A patient comes to the clinic reporting low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the physician prescribes a serotonin norepinephrine reuptake inhibitor. Which medication does the nurse anticipate educating the patient about? a. Amitriptyline b. Duloxetine c. Gabapentin d. Cyclobenzaprine

b. Duloxetine

The nurse is concerned about the potential debilitating complication of peroneal nerve injury. What symptoms does the nurse recognize as a result of this complication? a. Permanent paresthesia b. Footdrop c. Deep vein thrombosis d. Infection

b. Footdrop

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? a. Have the patient extend both hands while the nurse compares the volume of both radial pulses b. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg c. Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patients toes d. Have the patient squeeze the nurses hands with their hands to evaluate any difference in strength

b. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg

While riding a bicycle down a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse monitor for that are common to pelvic fractures? a. Paresthesia and ischemia b. Hemorrhage and shock c. Paralytic ileus and a lacerated urethra d. Thrombophlebitis

b. Hemorrhage and shock

The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock with the nurse recognize can occur with this type of injury? a. Cardiogenic b. Hypovolemic c. Neurogenic d. Septicemic

b. Hypovolemic

The nurse assesses a patient after total right hip arthroplasty and observes a shortening of the extremity, and the patient reports severe pain in the right side of the groin. What is the priority action of the nurse? a. Apply Buck traction b. Notify the physician c. Externally rotate the extremity d. Bend the knee and rotate the knee internally

b. Notify the physician

A patient has a long-leg cast applied. Where does the nurse understand a common pressure problem may occur? a. Dorsalis pedis b. Peroneal nerve c. Popliteal artery d. Posterior tibialis

b. Peroneal nerve

The hospice nurse is assigned to care for a patient with metastatic bone cancer who wants to remain at home. What is the therapeutic goals in the care of this patient? a. Prevent the patient from having to go to the hospital for care b. Relieve pain and discomfort while promoting quality-of-life c. Increase the activity level of the patient to prevent complications related to immobility d. Ensure that the family except the patient imminent death

b. Relieve pain and discomfort while promoting quality-of-life

The nurse is educating the patient with gout about ways to prevent reoccurrence of an attack. What foods should the nurse encourage the patient to avoid? a. Baked chicken b. Steak c. Asparagus d. Pineapple

b. Steak

Patient reports experiencing low back pain. What position can nurse just to relieve this discomfort? a. High Fowlers to allow for maximum hip flexion b. Supine, with the knee slightly flexed and the head of the bed elevated 30° c. Prone, with a pillow under the shoulders d. Supine, with the bed flat in a firm mattress in place

b. Supine, with the knee slightly flexed and the head of the bed elevated 30°

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? a) "I will bend at the waist when I am lifting objects from the floor." b) "Instead of turning around to grasp an object, I will twist at the waist." c) "I will lie prone with my legs slightly elevated." d) "I will avoid prolonged sitting or walking."

c) "I will lie prone with my legs slightly elevated."

A patient diagnosed with carpal tunnel syndrome asked the nurse about numbness in the fingers and pain in the wrist. In responding to the patient, how would the nurse best describes CTS? a. "CTS is a neuropathy that is characterized by bursitis and tendinitis." b. "CTS is a neuropathy that is characterized by flexion contractures of the fourth and fifth fingers." c. "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." d. "CTS is a neuropathy that is characterized by pannus formation in the shoulder."

c. "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist."

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? a. Magnesium level b. Potassium level c. Alkaline phosphatase d. Troponin levels

c. Alkaline phosphatase

The nurse is assessing the feet of a patient in observes an overgrowth of the horny layer of the epidermis. What condition will the nurse educate the patient about? a. Bunion b. Clawfoot c. Corn d. Hammer toe

c. Corn

Patient shows the nurse around, firm nodule at the wrist. The pain is described as aching, with some weakness of the fingers. Which treatment does the nurse anticipate assisting with? (Select all that apply.) a. Educating the patient on the use of gabapentin b. Active range of motion exercises c. Corticosteroid injections d. Surgical excision e. Aspiration of a cyst

c. Corticosteroid injections d. Surgical excision e. Aspiration of a cyst

A patient was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the patient reports pain with inspiration. What is the anticipated treatment for this patient? a. Chest strapping b. Mechanical ventilation c. Coughing and deep breathing with pillow splinting d. Thoracentesis

c. Coughing and deep breathing with pillow splinting

The nurse is caring for a patient postoperatively following orthopedic surgery. The nurse assesses an oxygen saturation of 89%, confusion, and a rash on the upper torso. What does the nurse suspect is occurring with this patient? a. Polyethylene-induced infection b. Pneumonia c. Fat emboli syndrome d. Disseminated intravascular coagulation

c. Fat emboli syndrome

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? a. Atelectasis b. Hypovolemia c. Pulmonary embolism d. Urinary tract infection

c. Pulmonary embolism

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize? a. Gastrocnemius b. Latissimus dorsi c. Quadriceps d. Rectus abdominis

c. Quadriceps

The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does the finding indicate to the nurse? a. The patient has osteoarthritis b. The patient has lupus erythematosus c. The patient has rheumatoid arthritis d. The patient has neurofibromatosis

c. The patient has rheumatoid arthritis

The rheumatoid arthritis reaction produces enzymes that break down:

collagen

This substance is a protein that is decreased in RA and SLE when tested:

complement

A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis? a) Proteus b) Staphylococcus aureus c) Salmonella d) Pseudomonas

d) Pseudomonas

The nurse is caring for a patient after arthroscopic surgery for rotator cuff tear. The nurse informed the patient that full activity can usually resume after what period of time? a. 3 to 4 weeks b. 8 weeks c. 3 to 4 months d. 6 to 12 months

d. 6 to 12 months

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? a. Arthrocentesis b. Bone scan c. Electromyography d. Arthroscopy

d. Arthroscopy

A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes a patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse determine is likely occurring with this patient? a. Spontaneous pneumothorax b. Cardiac tamponade c. Pneumonia d. Fat Emboli

d. Fat Emboli

A patient had hand surgery to correct a Dupuytren contracture. What nursing intervention is a priority postoperatively? a. Changing the dressing b. Applying a cock-up splint and immobilization c. Having the patient exercise the fingers to avoid future contractures d. Performing hourly neurovascular assessments for the first 24 hours

d. Performing hourly neurovascular assessments for the first 24 hours

The nurse suspects that a patient with an arm cast has developed a pressure ulcer. Where should the nurse assess for the presence of the ulcer? a. Lateral malleolus b. Olecranon c. Radial styloid d. Ulna styloid

d. Ulna styloid

A patient falls while skiing and sustains a supracondylar fracture of the humerus. What serious complication of this injury should the nurse monitor for? a. Hemarthrosis b. Paresthesia c. Malunion d. Volkmann's ischemic contracture

d. Volkmann's ischemic contracture

The most common complication of hip fractures in the older adult patient is:

deep vein thrombosis

The residual limb should never be placed on a pillow to avoid:

flexion contracture of the hip

Layman's term for onychocryptosis, a common foot condition, is:

ingrown toenail

Synovial fluid from an inflamed joint is characteristically:

milky, cloudy, dark yellow

The femur fracture that commonly leads to a vascular necrosis or nonunion due to an abundance supply of blood vessels in the area is a fracture of the:

neck

Patients with open fractures risk three major complications:

osteomyelitis, tetanus, gas gangrene

The major hormonal regulators of calcium homeostasis are:

parathyroid hormone, calcitonin

Red bone marrow is located in the shaft of four long and flat bones:

sternum, ilium, vertebrae, ribs

A muscle tear that is microscopic and due to overuse is called a:

strain

In RA, the autoimmune reaction primarily occurs in the:

synovial tissue

The longest immobilization time necessary for fracture union occurs with a fracture of the:

tibial shaft

What are the clinical manifestations of degenerative joint disease (osteoarthritis)?

The primary clinical manifestations of OA are joint pain, stiffness, and functional impairment.

Unrelieved pain for a patient in a cast must be immediately reported to avoid:

The process, impaired tissue perfusion, pressure ulcer formation, possible paralysis

What is a hemi-arthroplasty?

The replacement of one of the articular surfaces

What are the general functions of the musculoskeletal system?

The musculoskeletal system provides a protection for vital organs, including the brain, heart, and lungs; provides a sturdy framework to support body structures; and makes mobility possible.

What is the role of the sex hormones testosterone and estrogen on bone remodeling?

The sex hormones testosterone and estrogen have important effects on bone remodeling. Estrogen stimulates osteoblasts and inhibits Osteoclasts; therefore, bone formation is enhanced and resorption is habited. Testosterone has both direct and indirect effects on bone growth information. It directly causes skeletal growth and adolescents and has continued affects on skeletal muscle growth throughout the lifespan.

The nurse completes a neurovascular assessment of either the fingers or toes of a casted extremity to determine circulatory status. What expected outcomes does the nurse anticipate will occur?

The toes or fingers should be pink, warm, and easily moved. There should be minimal swelling and discomfort. The blanch test should be carried out to determine rapid capillary refill.

List for reasons for a patient to have traction application:

To minimize muscle spasms; to reduce, align, and immobilize fractures; to lessen deformities; and to increase space between opposing surfaces within a joint

A patient arrives at the clinic with reports of pain in the left great toe. The nurse assesses a swollen, warm, erythematous left great toe. What does the nurse determine that the symptoms are most likely related to? a. Rheumatoid arthritis b. Osteoarthritis c. Fibromylagia d. Gout

dd. Gout

A patient with an arm cast reports pain in the extremity. What is a priority nursing action to reduce the incidence of complication? (Select all that apply.) a. Assess the fingers for color and temperature b. Administer prescribed analgesic to promote comfort in allay anxiety c. Assess for a pressure sore d. Determine the exact site of the pain e. Cut the cast with a cast saw

a. Assess the fingers for color and temperature c. Assess for a pressure sore d. Determine the exact site of the pain

A patient has a fracture of the right femur sustained in a motor vehicle crash. What process of fracture healing does the nurse understand will occur with this patient? a. Reactive phase, reparative phase, remodeling phase b. Primary phase, secondary phase, third phase c. First intention, secondary intention, third intention d. Active phase, dormant phase, restructure phase

a. Reactive phase, reparative phase, remodeling phase

The nurse is educating a patient about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms they should report. Which COX-2 inhibitor is the nurse educating the patient about? a. Ibuprofen b. Celecoxib c. Piroxicam d. Tolmetin sodium

b. Celecoxib

The nurse is caring for a pregnant patient with pregnancy-induced hypertension. When assessing the reflexes in the ankle, the nurse observes rhythmic contractions of the muscle when dorsiflexing the foot. What would the nurse document this finding as? a. Positive Babinski reflex b. Clonus c. Hypertrophy d. Ankle reflex

b. Clonus

A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, what should the laboratory results reveal? a. Glucosuria b. Hyperuricemia c. Hyperproteinuria d. Ketonuria

b. Hyperuricemia

A patient tells the nurse, "I am working out and lifting weights and now that I have stopped, I am flabby and my muscles have gone!" What is the best response by the nurse? a. "While you are lifting weights, endorphins are released, creating increase in muscle mass, but if the muscles are not used they will atrophy" b. "The muscle mass has decreased from the lack of calcium in the cells" c. "Your muscles were in a state of hypertrophy from the weightlifting, but it will persist only if the exercises continued" d. "Once you stop exercising, the contraction of the muscle does not regain its strength"

c. "Your muscles were in a state of hypertrophy from the weightlifting, but it will persist only if the exercises continued"

A patient tells the healthcare provider about shoulder pain that is present even without any strenuous movement. The healthcare provider identifies a sac filled with synovial fluid. What condition should the nurse educate the patient about? a. A fracture of the clavicle b. Osteoarthritis of the shoulder c. Chronic bursitis d. Ankylosing spondylitis

c. Chronic bursitis

A patient is taking nonsteroidal anti-inflammatory drugs for the treatment of osteoarthritis. What education should the nurse give the patient about the medication? a. Take the medication on an empty stomach in order to increase effectiveness b. Since the medication is able to be obtained over the counter, it has few side effects c. Take the medication with food to avoid stomach upset d. Inform the physician if there is ringing in the ears

c. Take the medication with food to avoid stomach upset

What is a tendon transfer?

The insertion of a tendon to improve function

The nurse is performing an assessment on an older adult patient in observes the patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as? a. Lordosis b. Scoliosis c. Osteoporosis d. Kyphosis

d. Kyphosis

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? a. Bone scan b. Computed tomography c. Magnetic resonance imaging d. Muscle biopsy

d. Muscle biopsy

A patient has a serum study that is positive for the rheumatoid factor. What does the nurse understand is the significance of this test result? a. The test results are diagnostic for Sjogren syndrome b. The test results are diagnostic for systemic lupus erythematosus c. The test results are specific for rheumatoid arthritis d. The test results are suggestive of rheumatoid arthritis

d. The test results are suggestive of rheumatoid arthritis