Chapter 48 disorder of musculoskeletal function: trauma infection and neoplasm

Which client needs screening for osteoporosis?

The client who seems to have "shrunk" in height

Which intervention should the nurse include in the initial care plan for a child who is "toeing out"?

Assess the child periodically.

A nurse is providing care for a client who has had a cast applied to her fractured arm 6 hours prior. The client is now reporting severe pain that she describes as "even worse than when I broke my arm." What would be the nurse's best course of action?

Assessment of motor and sensory function with the goal of identifying compartment syndrome.

The nurse is screening a newborn for developmental dysplasia of the hip. Which assessment finding supports this diagnosis?

Asymmetrical gluteal and thigh folds

The parents of a 6-year-old child diagnosed with bilateral genu valgum (knock knees) ask the health care provider when treatment will begin to correct the problem. The best response would be:

"The child's measurements fit within the acceptable assessment period; treatment is not necessary at this time."

The nursing student is studying hip fractures. The faculty member knows that the student understands the topic when she states:

"Femoral neck fractures, with marked displacement, are associated with an increased incidence of avascular necrosis."

It is suspected that a client has osteomalacia. What should the nurse teach the client about potential causes of this condition?

"Insufficient calcium absorption and phosphate deficiency are the causes."

A client comes into the orthopedic clinic complaining of severe pain in the hip that was not caused by a fall. On inspection, the femur and tibia are bowed. There is also a reduced angle of the femoral neck which gives the client a "waddling gait" appearance. The doctor suspects Paget disease, to which the client asks how it was acquired. The nurse will respond:

"It's most likely a genetic predisposition. Do you know if anyone else in your family has this problem?"

What information would the nurse include when teaching potential parents about prevention of congenital deformities? Select all that apply.

"Limit exposure to alcohol." "Do not take any medication without first talking to your health care provider."

A new mother asks, "Why are you examining my baby's hips?" What is the nurse's best response?

"Musculoskeletal screening is important to identify anything that needs intervention."

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."

Which of the following is appropriate for the nurse to tell the parent of a child born with polydactyly?

"This is the most common congenital abnormality."

Following genetic testing and a thorough history from the child's mother and father, a 5 month-old boy has been diagnosed with osteogenesis imperfecta. What teaching point should the care team provide to the mother and father?

"You'll need to be very careful to avoid causing fractures to his fragile bones."

The nurse knows that which client listed below is at high risk for developing a hip fracture?

82-year-old female with macular degeneration who uses a walker to go to the bathroom.

Which individual is likely to have the highest risk of developing tuberculosis osteomyelitis?

A 79-year-old man who is immunocompromised following a bone marrow transplant.

A parent brings his child to the emergency department after the child sustains a fall from a tree. The child has severe right arm pain. A radiograph shows a complete break in the humerus with multiple pieces of bone at the fracture line and the skin is not broken. This type of fracture is classified as:

A closed, comminuted fracture

What is the definition of a congenital deformity?

Abnormalities present at birth

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

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 client would be considered high risk for falling and fracturing the hip?

An 81-year-old woman taking medication for osteoporosis

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.

While taking a client history, which finding may lead the nurse to suspect the client is at risk for developing osteonecrosis?

Bone marrow ischemia due to radiation therapy for cancer

Which statement reflects an aspect of the bone growth and development that occurs during the first two decades of life?

Cartilage cells at the metaphyseal end of the bone plate are replaced by bone cells.

A child has been diagnosed with myopathic neuromuscular scoliosis. What other concurrent diagnosis may the child have?

Cerebral palsy

A client presents to the emergency department following an accident where he fell off a chair. The client reports initial hip numbness followed by increasing pain and muscle cramping. Which type of injury does the triage nurse suspect?

Closed hip fracture

A basketball player collided hard with another player and suffered a soft tissue injury to the forearm from the impact. The injury did not break the skin. The nurse should recognize the presence of which type of injury?

Contusion

Which activity is most likely to create a spiral fracture?

Falling on a ski hill with bindings that do not release

The nurse is caring for a client who sustained a femur fracture 3 days before. The nurse notes that the client, who was previously oriented, now doesn't know where he is. The nurse suspects which condition?

Fat embolism syndrome (FES)

Which symptoms commonly occur with Osgood-Schlatter disease? Select all that apply.

Knee pain Edema of the knee Tenderness in the knee and tibia

A 6-year-old child has developed idiopathic osteonecrotic disease of the proximal (capital) femoral epiphysis. The health care provider would document this finding as which diagnosis?

Legg-Calvé-Perthes disease

Which of these is a clinical manifestation of osteoporosis?

Loss of mineralized bone mass

Osteosarcoma is an aggressive malignancy of the bone. What is the primary clinical feature of osteosarcoma?

Nighttime awakening from pain

While measuring the height of a 12-year-old girl, the primary care provider noted a deviation of the girl's spine. This was quantified as being a right curve scoliosis of approximately 10 degrees deviation. Which treatment option is most appropriate?

Observation and no active treatment.

Which client is most likely to experience complications in bone healing due to avascular necrosis?

Older adult with an intertrochanteric fracture of the hip

The primary care provider has positioned an infant in the supine position with both knees flexed and applied gentle downward pressure to both knees. The knee and thigh have been abducted while an upward and medial pressure was applied to the proximal thigh. What examination technique has been performed on this infant?

Ortolani maneuver

A client presents with sudden onset of deep, localized pain and swelling in the proximal femur while undergoing diagnostic workup for suspected lung cancer. The nurse suspects the client may have developed which type of neoplasm of the skeletal system?

Osteosarcoma

Which assessment findings assist in diagnosing Legg-Calvé-Perthes disease? Select all that apply.

Pain in the thigh Pain in the knee Difficulty walking Limpness

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

Which groups are at increased risk for decreased bone mass? Select all that apply.

Premature infants Low-birth-weight infants Children with cystic fibrosis

A young adult client who is a competitive skier complains of knee pain when climbing stairs or sitting with the knees bent. What will the nurse teach the client about the diagnosis of chondromalacia?

Rest and isometric exercises followed by ice are effective treatment measures.

Following a motorcycle accident which resulted in bilateral femoral fractures, a client has been placed in skeletal traction. The health care providers would recognize which risk is priority to assess for regularly?

Risk of thromboemboli

An infant is born with a clubfoot. The nurse should anticipate which treatment measures will be instituted?

Serial manipulations and casting

What are typical assessment findings the nurse expects to observe in a client with a simple fracture of the leg? Select all that apply.

Swelling Loss of function Pain

A client presents to the emergency department after suffering an injury while playing sports. The client is diagnosed with a sprain. Select the best explanation of the injury.

Tear of a ligamentous structure

A curvature of the spine that does not correct with bending is known as:

structural scoliosis.

A 17-year-old male has been diagnosed with osteosarcoma of the upper tibia following several months of leg pain. Which statement by the client demonstrates that he has an accurate understanding of his diagnosis?

"I'm really nervous about having to get surgery and chemo."

What would the nurse include in the teaching plan for a client who asks "What is a subluxation?"

"The bone is partially out of the joint when it is subluxated."

Which client is at increased risk for developing avascular necrosis? Select all that apply.

10-year-old boy with Legg-Calvè-Perthes disease 57-year-old man with long history of alcohol abuse 79-year-old woman taking alendronate

Which client presenting to the emergency department would most likely be diagnosed with a pathologic stress fracture?

A postmenopausal female who was diagnosed with breast cancer with metastasis to bone

The health care provider is evaluating a client with a suspected benign bone tumor. Which description on the radiology results correlates with this finding?

A uniform and well-defined area with well-demarcated edges

Which clients should the nurse assess to determine if they have premature osteoporosis?

Anyone with an eating disorder.

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

A child tripped while running in the yard and reports pain with weight bearing. The next morning, the foot is swollen, discolored, and painful to touch and pressure of walking. About which problem will the health care provider likely be talking to the parents and the child related to this injury?

Fractured bone

Using Oestern and Tscherne's classification, how would a closed fracture that presented superficial abrasions and a mild fracture pattern be graded?

Grade 1

A client experienced a humeral fracture during an physical assault, and treatment has now begun. During the healing process, which physiologic process(es) will take place? Select all that apply.

Granulation tissue replaces the hematoma at the healing site. The client will develop a callus of cartilage and woven bone near the fracture site. The client will develop a hematoma in the first 48 hours after the injury.

Which statement is true about treatment of developmental dysplasia of the hip?

Treatment needs to be individualized

A 56-year-old male is obese and has poorly-controlled type 2 diabetes mellitus. The home care nurse who changes the dressing on his chronic foot ulcer three times weekly has noted that the client's bone is now visible in the wound bed. The client has a fever and has not complained of any notable increase in pain to his foot. Which statement best captures what is likely occurring?

Vascular insufficiency has contributed to infection in both soft tissue and now his bone.

A newly admitted client's health record states that the client's health history includes tubercular osteomyelitis. Where is the most likely anatomical site of this infection?

Vertebrae

A public health nurse is counseling a group young mothers about causes of altered bone growth in children. What factors should the nurse include? Select all that apply.

Vitamin C deficiency Vitamin D deficiency Type 1 diabetes

A 28-year-old client who participates in triathlon competitions has been diagnosed with a meniscus tear in the left knee, and arthroscopic repair is recommended. The client wishes to continue competing and wants to avoid any invasive procedures. What is the nurse's best response?

Without corrective procedures now, joint degeneration could result in requiring joint replacement later in life.

A client returns to the doctor's office for evaluation 6 weeks after a tibial fracture. Which assessment indicates the potential for nonunion?

X-ray shows minimal calcification at the fracture.

Following prosthetic joint replacement of the knee, the client continues to complain of pain and discomfort above what would be expected. There is poor incisional healing. The clinic nurse is concerned when she sees that the incision is still draining after 3 weeks post-op. The nurse suspects a prosthetic joint infection. The nurse should anticipate the physician will prescribe:

antimicrobial treatment depending on the microbe.

A client tells the nurse about being very concerned because the health care provider noted that the client's fractured arm is healing with malunion. The nurse recognizes this as:

healing with deformity, angulation, or rotation that is visible on x-ray films.

Following a knee replacement surgery, a nurse's next door neighbor asks, "I don't think I am healing right. Can you come look at my knee?" Upon assessment, the nurse notices the client is warm to touch and has a fever; the incision is inflamed and not well approximated with foul-smelling drainage around the incision line. At this point, the nurse tells the client she needs to go see her surgeon because the client may have:

osteomyelitis.

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

pain in front of the knee

A client with a fractured hip is in Buck's traction awaiting surgery. Which observation by the nurse requires immediate intervention?

sheets hanging over the traction ropes

An 80-year-old client is admitted to the hospital with a displaced intracapsular hip fracture. The physician explains to the client's family that this type of fracture is best treated by:

surgical hip replacement and early mobilization.

Which assessment finding leads the nurse to suspect a child has Blount disease (tibia vara)?

unilateral rotational deformity of the proximal tibia

The nurse is educating caregivers of children ranging from infant through adolescent about how to prevent injury. Which leading cause of nonfatal injury in this age group will the nurse emphasize?

unintentional falls