CU- patho musculskeletal

Which type of fracture involves healing of more than two pieces of bone?

Comminuted fracture

A client is admitted to the emergency department with a muscle strain to the back. What is an appropriate statement for the nurse to make to this client?

"A strain is a stretching injury. You need to rest your back."

The nurse is providing discharge instructions to a client who experienced a ligamentous sprain. The nurse determines that teaching was effective when the client states:

"I should rest, apply ice, compression, and elevation to the extremity.""

Following a fracture, the nurse is educating the client and his family about bone healing. The nurse begins by stating:

"In order to initiate the cellular events essential to bone healing, within a day or so, your body will develop a blood clot at the fracture site."

While being tackled, a 20 year-old football player put out his hand to break his fall to the ground. Because the intense pain in his wrist did not subside by the end of the game, he was brought to an emergency department where diagnostic imaging indicated an incomplete tear of the ligament surrounding his wrist joint. At the time of admission, his wrist was swollen with a severely restricted range of motion. What will his care team most likely tell the player about his diagnosis and treatment?

"It looks like a mild to moderate sprain and you'll need to keep it immobilized for a few weeks."

A 51 year-old male with a history of hypertension has received a kidney transplant. The client's physician is explaining some of the consequences of the procedure, including the fact that he will need to be on long term steroid therapy. Which of the following teaching points should the physician emphasize?

"One of the risks that these steroids bring is the possibility that part of a bone might die."

A month after surgical repair of a rotator cuff tear of the shoulder, a patient tells the nurse, "This is not getting any better. I still have a lot of pain and limited motion." Which of the following is the nurse's best response?

"The shoulder joint is complex and can take up to a year to heal completely."

Which of the following should the nurse teach a patient about syndactyly?

"This is a simple webbing of the fingers or toes."

What should the nurse include in the teaching plan for a client with a grade 4 sprain?

"You will need to keep your joint immobilized for 4 to 6 weeks."

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."

Which person is most at risk for hip fractures?

66-year-old Caucasian female with history of alcoholism

The nurse knows that which of the following patients listed below is at high risk for developing a hip fracture?

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

Which of the following is the definition of a congenital deformity?

Abnormalities present at birth

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

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

Which of the following clients 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

Which of the following recent admissions to an emergency department is most likely to be diagnosed with a *greenstick fracture*?

An 8 year-old boy who fell out of a tree and on to his arm.

Following prosthetic joint replacement of the knee, the patient 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 three 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 patient suffers a musculoskeletal injury while participating in a sporting event. Which of the following is the appropriate initial treatment?

Applying ice and sitting out the rest of the game

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 complaining of 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.

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

Blood supply to the femoral head

A 16-year-old male football player suffered a fracture of his radius and ulna. Assessment of the fracture includes the following data: the fracture does not protrude through the skin, and both bones broke completely through into two pieces. Select the best description of the injury.

Closed comminuted fracture

A client presents to the emergency department following an accident where he fell off a chair. He reports hip numbness, increasing pain, and muscle cramping. The triage nurse suspects:

Closed hip fracture

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 which of the following?

Compartment syndrome

What term describes an injury to the soft tissue of the body?

Contusion

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

Deep, throbbing, unrelenting pain

A client has developed osteomyelitis and asks the health care provider how the problem occurred. The best response would be:

Direct contamination of an open wound

Fat emboli syndrome can occur after a fracture of a long bone. What are the clinical features of this syndrome?

Encephalopathy

Which of the following activities is most likely to create a *spiral fracture*?

Falling on a ski hill with bindings that do not release

A client who was involved in an automobile accident experienced major trauma and sustained a fractured femur. The nurse notices the following changes 4 hours after admission to the critical care unit: • Disorientation • Dyspnea • Tachycardia • Low-grade temperature • Diaphoresis • Substernal chest pain The nurse suspects:

Fat embolism syndrome (FES)

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

Fat embolism syndrome (FES)

The client experiences a meniscus injury. The physical therapist understands this involves which of the following joints?

Knee

The pathophysiology student is reviewing the stages of the healing process. The student explains that the process follows which order?

Formation of a large clot; neovascularization; continued formation of the callus; reconstruction

A client tells the nurse she is very concerned because the health care provider informed her that her fractured arm is healing with malunion. The nurse recognizes this as:

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

The client develops osteomyelitis that has originated from infectious organisms that reach the bone through the bloodstream. This is known as which type of osteomyelitis?

Hematogenous

What would be the best treatment option for a soft tissue contusion on the right ankle?

Keep the ankle elevated for the first 24 hours

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

Knee

The physical therapy student is explaining complication of fracture healing. Which of the following is a contributing factor to failure of a bone to heal before the process of bone repair stops?

Mobility at fracture site

A patient sustains a musculoskeletal injury of the wrist. Which of the following manifestations would the nurse expect to accompany the strain?

Pain and stiffness

A 56 year-old female with a diagnosis of breast cancer has developed bone metastases, which her oncologist would like to treat with radiation therapy. What is her physician's most likely primary goal in the treatment plan of the metastases?

Prevention of pathologic fractures.

A nurse is planning care for patients with musculoskeletal disorders. Which of the following goals is appropriate for the patients?

Promoting adequate nutrition for a patient with a recent fracture

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

Redness and heat at fracture site

What is the purpose of the meniscus?

Shock absorption

Tuberculosis can spread from the lungs into the musculoskeletal system. What is the most common site in the skeletal system for tuberculosis to be found?

Spine

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 client was involved in an auto accident and is brought to the hospital by ambulance. The admitting diagnosis is right hip dislocation. Select the most appropriate intervention for this client:

The client will need emergency intervention to reduce the fracture and prevent complications.

The osteoporosis patient asks the nurse to explain what a bisphosphonate medication does. The nurse will respond:

This medication helps prevent bone resorption which will help prevent fractures.

The nurse assesses the neurovascular status of a patient who had surgery to repair a fractured hip. Which of the following assessment data for the affected leg indicates that the patient has developed a neurological complication?

Tingling sensations

Which of the following 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 healthcare provider."

Which of the following interventions for a patient with metastatic bone disease can help prevent pathologic fractures? *Select all that apply*

• Bisphosphonates • Radiation therapy

A 22 year-old woman has sustained a lateral blow to her right knee during a game, and subsequent imaging has confirmed a *severe meniscus injury*. Which of the following consequences should the woman expect over the course of recovery? *Select all that apply*

• Decreased lubrication in the knee joint • Reduced shock absorption capacity • Decreased stability of the knee

The nursing student who is studying about osteoporosis correctly identifies which of the following to be conditions associated with secondary osteoporosis? *Check all that apply*

• Endocrine conditions • Malabsorption disorders • Malignancies • Alcoholism • certain medications

Which of the following can influence the growth of cells in the epiphyseal growth plate? *Select all that apply*

• Epiphyseal separation • Blood vessel rupture • Nutritional deficiencies • Thyroid hormone deficiency

A child in gymnastics class has fallen off the balance beam and hurt her ankle. X-rays are negative for fracture, so the health care provider has diagnosed a severe sprain. Which of the following treatment measures should be taught to the family and child? *Select all that apply*

• Immobilization for several weeks • Elevate the ankle on pillows • Apply ice packs to the ankle

Which of the following are associated with metastatic bone cancer of the spine? *Select all that apply*

• Localized bone pain that is worse at night • Pain resulting from nerve entrapment • Pathological fractures • Vertebrae that are easily crumbled

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

• Loss of function • Pain • Swelling

While explaining to a group of nursing students the difference between benign and malignant bone tumors, the instructor will emphasize that a benign tumor: *Select all that apply*

• May be asymptomatic and detected incidentally • May cause the client to have a pathological fracture

Child/parents are coming into the physician's office to get the results of some diagnostic testing relating to their knee pain and unusual stiffness and fatigue. The physician suspects the child may have slipped capital femoral epiphysis. The nurse should anticipate that the treatment will involve: (Select all that apply).

• No weight bearing on the femur. • Bedrest. • Traction.

Several factors can influence the growth of cells in the epiphyseal growth plate. Factors that may affect this bone growth include: *Select all that apply*

• Normal levels of thyroid and growth hormone • Epiphyseal separation as a result of trauma to the site • Vitamin C deficiency • Vitamin D deficiency

Which statements are true regarding bone remodeling? *Select all that apply*

• Osteoclasts gradually remove dead bone. • Mineralized bone is present along the lines of the injury.

A patient sustains a musculoskeletal injury of the left ankle. In addition to pain, which of the following manifestations would accompany a sprain? *Select all that apply*

• Swelling • Discoloration • Limited movement • Heat

A patient is seen in the emergency department and is diagnosed with a strained back. Which of the following instructions should the nurse provide? *Select all that apply*

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

Which events in a client's history increase risk of developing osteoarthritis? *Select all that apply*

• torn meniscus in left knee at age 19 • obesity following pregnancy at age 24 • hip dislocation at age 35