Musculoskeletal

a pt is scheduled for total ankle replacement. the nurse should tell the pt that after surgery he should avoid

bearing weight on affected leg for 6 weeks

the nurse suspects a neuro problem based on assessment of

decreased sensation distal to the fx site

the nurse is obtaining a health hx of a pt with a fracture. which condition poses the most concern r/t musculoskeletal system?

diabetes

the pt has lateral angulation of the larger toe toward the second toe. what should the nurse know will be included in the tx

surgery to remove the bursal sac and bone enlargement

a client is being discharged to home after application of a plaster leg cast. which statement indicates that the client understands proper care of the cast

"I need to avoid getting the cast wet."

parents bring their 2-week-old infant to a clinic for tx after a diagnosis of clubfoot made at birth. which statement by the parents indicates a need for further teaching regarding this disorder?

"I need to bring my infant back to the clinic in 1 mon for a new cast."

the parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. the parents ask the nurse if the child can perform ROM exercises at this time. the nurse should make which response?

"have the child perform simple isometric exercises during this time"

the nurse is assessing the casted extremity of a client. which sign is indicative of infection?

"hot spot" on cast

a 4 yr old child sustains a fall at home. after an x-ray, the child is determined to have a fractured arm and a plaster cast is applied. the nurse provides instructions regarding care for the child's cast. which statement by the parents indicates a need for further instructions?

"i can use lotion or powder around the cast edges to relieve itching"

in monitoring a client's response to DMARDSS. which assessment findings would the nurse consider acceptable responses?

- control of symptoms during periods of emotional stress - normal WBC, platelet, and neutrophil counts -radiological findings that show no progression of joint degeneration -an increased ROM in the affected joints 3 mon in therapy

the nurse is caring for a client who has had spinal fusion, with insertion of hardware. the nurse would be most concerned about which assessment finding?

101.6 fever

When is a fat embolism most likely to occur? a. 24 to 48 hours following a fractured tibia b. 36 to 72 hours following a skull fracture c. 4 to 5 days following a fractured femur d. 5 to 6 days following a pelvic fracture

24-48 hrs after a fractured tibia

which female pts are at risk for developing osteoporosis

55 yr old asian american cigarette smoker 68 yr old white who is underweight and inactive 58 native american who started menopause prematurely

the nurse is combining health screening for osteoporosis. which client is at greatest risk of developing this problem?

64 F who smokes

when preparing a pt for a discharge after intermaxillary fixation of a mandibular fracture, which statement indicates that patient teaching has been successful?

I may use a bulk-forming laxative if my liquid diet causes constipation

which serologic studies would be done to evaluate RA?

RF, ANA, ESR, anticyclic citrullinated peptide

which statement describes osteosarcoma

Very malignant and metastasizes early

a client has been on tx for RA for 3 weeks. during the administration of etanercept, which is most important for the nurse to assess?

WBC count and platelet counts

ligaments connect

bone to bone

a pt with a pelvic fx should be monitored for

changes in urine output

allopurinol is prescribed for a client and the nurse provides medication instructions to the client. which instruction should the nurse provide?

drink 3000 ml fluid a day

a 78 yr old woman has physiologic changes in her joints r/t aging. what is an appropriate intervention r/t common changes of aging?

have pt exercise to maintain muscle strength and void the risk for falls

how should the nurse assess the neuro status of the pt with a fractured humerus?

have the pt abduct the fingers, oppose the thumb and fingers, flex and extend the wrist

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse should take which action? 1. Administer an antiemetic. 2. Increase the intravenous fluids. 3. Place the child in a Sims's position. 4. Notify the health care provider (HCP).

notify the HCP

the nurse has conducted teaching with a client in an arm cast about s/s of compartment syndrome. the nurse determines that the client understands the info if the client states that he or she should report which early symptom of compartment syndrome?

numbness/tingling in fingers

a patient is brought to the ED with an injured lower left leg following a fall while rock climbing. the nurse identifies the presence of a fracture based on what cardinal sign of fracture?

obvious deformity

alendronate is prescribed for a client with osteoporosis, and the nurse is providing instructions on administration of the medication. which instruction should the nurse provide?

take the medication with a full glass of water after-rising in the water

a patient with a fractured femur develops the complication of malunion. what does the nurse recognize has happened to the patient?

the fracture heals in an unsatisfactory position

the nurse has given the client instructions about crutch safety. which statements indicate that the client understands the instructions?

-i should not use someone else's crutches - i need to remove any scatter rugs at home - i need to have spare crutches and tips available

Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply. 1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated. 4. Expect tingling and numbness in the extremity. 5. Use a hair dryer set on a warm to hot setting to dry the cast. 6. Use a soft, padded object that will fit under the cast to scratch the skin under the cast.

-keep cast clean and dry - allow the cast 24-72 hrs to dry -keep the cast and extremity elevated

which pt should nurse assess first?

68 yr old male with a new lower leg cast reporting the cast is too tight and he cannot feel his toes

what are characteristics of pagets disease

Abnormal remodeling and resorption of bone and replacement of normal marrow with vascular connective tissue.

When positioning the pt after a total hip arthroplasty with a posterior approach, it is important that the nurse maintain the affected extremity in what position

abduction and extension

When grading muscle strength, the nurse records a score of 3, which indicates a.no detection of muscular contraction. b.a barely detectable flicker of contraction. c.active movement against full resistance without fatigue. d.active movement against gravity but not against resistance.

active movement against gravity but not against resistance

a pt is scheduled for a bone scan. the nurse explains that this diagnostic test involves

administration of a radioisotope before the procedure

what emergency considerations must be included with facial features

airway patency, cervical spine injury

a pt who had a right total hip arthroplasty with a cemented prosthesis for tx of severe osteoarthritis of the hip. what activity should the nurse include on the pt's first post-op day?

ambulation with a walker and limited weight-bearing on R leg

the pt is told by the HCP that the size of the pt's muscle has decreased. how should the nurse document this?

atrophy

what is the function of a tendon

attach muscle to bone

the nurse is preparing discharge instructions for a client who sustained a skeletal muscle injury and is receiving baclofen. which instruction should be included in the teaching plan?

avoid the use of alcohol

a client is complaining of low back pain that radiates down the left posterior thigh. the nurse should ask the client if the pain is worsened or aggravated by which factor

bending or lifting

a pt who had an open fx of the humerus 2 weeks ago is having increased pain at the fx site. to identify a possible causative agent of osteomyelitis at the site, what dx should be taken?

bone biopsy

the nurse is administering an IV dose of methocarbamol to a client with a muscle skeletal injury. for which adverse effect should the nurse monitor

bradycardia

the pt works on a computer 8 hrs each day. what kind of injury would the nurse assess for in this pt?

carpal tunnel syndrome

the increased risk for falls in older adults is likely due to

changes in balance, decrease bone mass, loss of ligaments elasticity, decrease muscle mass/ strength

Which joint surgery is used to arthroscopically remove degenerative tissue in joints? a. Osteotomy b. Arthrodesis c. Debridement d. Synovectomy

debridement

a 72 yr old man tells the nurse that he can't perform most of the physical activities he could do 5 yrs ago because of overall joint aches and pains. what can the nurse do to help the pt prevent further deconditioning and decrease the risk for developing musculoskeletal problems?

discuss the use of stretching and strengthening exercises to decrease aches and pain so that exercise can be maintained

a pt with a fractured tibia accompanied by extensive soft tissue damage initially has a splint applied and held in place with an elastic bandage. what early sign would alert the nurse that the patient is developing compartment syndrome?

distal pain unrelieved by opioid analgesics

what test provides fast, precise measurement of the bone mass of the spine, femur, forearm, and total body to evaluate osteoporosis?

dual energy x-ray absorptiometry (DEXA)

identify ways to prevent osteoporosis in postmenopausal women

eating 8 ounces of yogurt daily performing weight bearing exercises

what is the best description of the periosteum?

fibrous connective tissue covering bone

a pt with a humeral fx is returning for a 4 week checkup. the nurse explains that initial evidence of healing on x-ray is indicated by

formation of callus

a pt with chronic osteomyelitis has been hospitalized for a surgical debridement procedure. what should the nurse explain to the pt is the reason for the surgical tx?

formation of scar tissue has led to a protected area of bacterial growth

a pt with osteomyelitis has a nursing diagnosis of risk for injury. what is an appropriate nursing intervention for this pt?

gently handle the involved extremity during movement

cyclobenzaprine is prescribed for a client for muscle spasms, and the nurse is reviewing the client's record. which disorder, if noted in the record, would indicate a need to contact the primary HCP about the administration of this med?

glaucoma

what should the nurse include in discharge instructions for the pt after a hip prosthesis with a posterior approach

have a family member help the pt put on shoes and socks

what does radicular pain that radiates down the butt and below the knee along sciatic nerve, generally indicate

herniated lumbar disc disease

the nurse teaches the pt with an above the knee amputation that the residual limb should not be routinely elevated because the position promotes

hip flexion contractures

the nurse performing ROM with a pt puts each joint through its full movement. which joints are capable of abduction and adduction.

hip, wrist, thumb, shoulder

after 7 days of IV antibiotic therapy, a pt with acute osteomyelitis of the tibia is prepared for discharge from the hospital. the nurse determines that additional instructions is needed when the pt makes which statement

i do not need to do anything special while taking the antibiotic therapy

the nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. which statement by the parents indicates a need for further instructions?

i should apply lotion under the brace to prevent skin breakdown.

a pt is started on alendronate once weekly for the tx of osteoporosis. which pt statement indicates that further instructions about the drug is needed

i should take the drug with a meal to prevent stomach irritation

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that this pain may be caused by: 1. Infection under the cast 2. The anxiety of the client 3. Impaired tissue perfusion 4. The newness of the fracture

impaired tissue perfusion

in promoting healthy feet, which factor does the nurse recognize as associated with most foot problems

improperly fitting shoes

what is a disadvantage of ORIF of a fracture compared to closed reduction?

infection

the athlete comes to the clinic with bursitis. what does the nurse know happens to the tissue to cause pain when bursitis occurs?

inflammation of synovial membrane sac at friction sites

A pt who had a below the knew amputations is to be fitted with a temporary prosthesis. It is most important for the nurse to teach the pt to do what? a. inspect the residual limb daily for irritation b. apply an elastic shrinker before applying the prosthesis c. perform range-of-motion exercises to the affected leg four times a day d. apply alcohol to the residual limb every morning and evening to toughen the skin

inspect the residual limb daily for irritation

Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's record, knowing that this medication would be used with caution in which disorder?

kidney disease

an older pt is describing increased stiffness in the shoulders,back, and hips. the loss of elasticity in what tissue contributes to this?

ligament

the nurse is analyzing the lab studies on a client receiving dantrolene to treat muscle spasms from an injury. which lab test would identify an adverse effect associated with the administration of this medication?

liver function tests

a pt is discharged from the outpatient clinic after application of a synthetic fiberglass long arm cast for a fractured ulna. before discharge, what instruction should the nurse provide the pt?

move the shoulder and fingers frequently

which type of bone tumor is a benign overgrowth of bone and cartilage that may transform into a malignant form?

osteochondroma

a pt with a comminuted fx of the tibia is to have an open reduction with ORIF of the fx. the nurse explains that ORIF is indicated when

other nonsurgical methods cannot achieve alignment

a pt with a stable, closed humeral fx has a temporary splint with a bulky padding applied with an elastic bandage. the nurse notifies the provider of possible early compartment syndrome when the pt has

pain when passively extending the fingers

the HCP diagnoses a pt with a plantar wart. what should the nurse know about this kind of abnormality

painful papillomatous growth on the sole of foot

the pt with osteoporosis had a spontaneous hip fx. how should the nurse document this?

pathologic fx

what should the nurse teach the pt recovering from an episode of acute low back pain

perform daily exercise as a lifelong routine

a pt with severe ulnar deviation of the hands undergoes an arthroplasty with reconstruction and replacement of finger joints. post-op. what is most important for the nurse to do

perform neuro assessments of the fingers 2-4 hours

what assessment findings distinguish a fat embolism from a PE in a pt with a fracture?

petechiae around the neck and upper chest

Before repositioning the pt on the side after a lumbar laminectomy, what should the nurse's first action?

place a pillow between the pt's leg

the pt describes having burning, sharp pain on the sole of the foot, especially in morning. this description describes what manifestation?

plantar fasciitis

twenty-four hours after a below the knee amputation, a patient uses the call system to tell the nurse that his dressing has fallen off. what should the nurse's first action be

re-apply compression dressing

a pt with OA is scheduled for THA. the nurse explains the purpose of the procedure is to

replace the joint, improve/maintain ROM

a 24 yr old pt with a 12 yr hx of becker muscular dystrophy is hospitalized with HF. what is an appropriate nursing intervention for this pt?

repo frequently to avoid skin and resp. complications

the nurse suspects an ankle sprain when a pt at the urgent care center describes

twisting his ankle while running bases

a laminectomy and spinal fusion are done on a pt with a herniate lumbar intervertebral disc. during the post-op period, which assessment finding is of most concern to the nurse

urinary incontinence

While having his height measured during a routine health examination, a 79-year-old man asks the nurse why he is "shrinking". How should the nurse explain decreased height that occurs with aging? a. Decreased muscle mass results in a stooped posture b. Loss of cartilage in the knees and hip joints cause a loss of height c. Long bones become less dense and shorten as bone tissue compacts d. Vertebrae become more compressed with thinning of intervertebral discs

vertebrae become more compressed with thinning of intervertebral discs

during a follow-up visit to a patient with acute osteomyelitis treated with IV antibiotics, the home health nurse is told by the pt's wife that she can hardly get the pt to eat because his mouth is so sore. in assessing the pt's mouth, what is the most likely finding the nurse should expect?

white, curdlike membranous lesions of the mucosa

which type of fracture can cause radial nerve and brachial artery damage and is reduced with a hanging arm cast?

fractured humerus

a pt with a fractured R hip has an anterior ORIF of the fracture. what should the nurse plan to do post-op?

get the pt up to the chair on the first day post-op

a pt with severe joint immobility is receiving physical and exercise therapy. to evaluate the effect of the tx, the nurse may assess joint ROM using what equipment

goniometer

what is the most common dx test used in musculoskeletal disorders

standard x-ray

the nurse has given instructions to a client returning home after knee arthroscopy. which statement by the client indicates that the instructions are understood?

"i need to report a fever or swelling to HCP."

cast instructions

- keep small toys and sharp objects away from cast. - elevate the extremity on pillows for the first 24-48 hrs after casting to prevent swelling. - contact the primary HCP if the child complains of numbness or tingling in the extremity

a young pt with a fractured femur has a hip spica cast applied. what is the most important action the nurse should take while the cast is drying?

assess the pt frequently for abdominal pain, nausea, vomiting

a child is placed in skeletal traction for treatment of a fractured femur. the nurse creates a plan of care and should include which intervention?

check the HCP prescriptions for the amount of weight to be applied

the nurse is caring for a client being treated for fat embolus after multiple fractures. which data would the nurse evaluate as the most favorable indication of resolution of fat embolus?

clear mentation

a woman with osteoporosis slipped on the ice and now her wrist hurts. if there is a fracture, what type of fracture is expected

colles' fracture

when obtaining info about pt's use of meds, the nurse is concerned that both bone and muscle function may be impaired when the pt reports taking what type of drug

corticosteroids

the nurse is admitting a client with multiple trauma injuries to the nursing unit. the client has a leg fracture and had a plaster cast applied. which position would be best for the casted leg?

elevated on pillows continuously for 24-45 hrs

the pt is diagnosed with torticollis. what should the nurse be prepared to provide for the pt?

enough pillows to support the pt's head

if surgery is needed, which procedure would the nurse first prepare the pt for in the presence of compartment syndrome?

fasciotomy

while performing PROM for a pt, the nurse puts the elbow joint through the movements of

flexion/ extension

a client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. the nurse responds knowing that which would most likely result from this improper crutch measurement?

injury to brachial plexus nerve

the bone cells that function in the formation of new bone tissue are called

osteoblasts

the nurse witnessed a vehicle hit a pedestrian. the victim is dazed and tries to get up. a leg appears fractured. which intervention should the nurse take?

stay with the victim and encourage him or her to remain still

when assessing the pt, the nurse notices that the pt has foot drop and the foot slaps down on the floor as the pt walks. how should the nurse document the gait?

steppage gait

on observation of the pt, the nurse notes the presence of a limping gait. how should the nurse further evaluate the pt?

measure length of limb

An immediate postoperative prosthetic fitting during surgery is used for a patient with a traumatic below-the-knee amputation. During the immediate postoperative period, what is a priority nursing intervention? A. Monitor the patients vital signs B. Assess the incision for hemorrhage C. Elevate the residual limb on pillows D. Have the patient flex and extend the knee every hour

monitor VS

a pt who fell in the bathroom of the hospital room reports pain in the upper right arm and elbow. which action should the nurse take first in managing a possible fracture before splinting the injury?

neurovascular check below the injury

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 1. Administer an analgesic. 2. Release the skin traction. 3. Apply ice to the extremity. 4. Notify the health care provider (HCP).

notify the HCP

the nurse is assisting a primary HCP examine a 3 week old infant with developmental dysplasia of a hip. what test or sign should the nurse expect the PHCP to assess?

ortolani's maneuver

the pt had a fx. at 3 weeks to 6 mon there is clinical union, and this is the first stage of healing that is sufficient to prevent movement of the fx site when the bones are gently stressed. how is this stage of fx healing documented?

ossification

A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension tractions is primarily:

provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels

the x-ray shows that the patient's fracture is at the remodeling stage. what characteristics of the fracture healing process occur at this stage?

radiologic union, absorption of excess bone cells, return to preinjury strength and shape, semisolid blood clot at the ends of fragments, deposition and absorption of bone in response to stress

When the nursing student asks the RN what an arthroplasty is, what is the best description the RN can give the student? a. Surgical fusion of a joint to relieve pain b. Correction of bone deformity by removal of a wedge or slice of bone c. Reconstruction or replacement of a joint to relieve pain and correct deformity d. Used in rheumatoid arthritis to remove the tissue involved in joint destruction

reconstruction or replacement of a joint to relieve pain and correct deformity

a pt with an extracapsular hip fracture is admitted to the orthopedic unit and placed in Buck's traction. how should the nurse explain the purpose of the traction to the pt?

reduces pain and muscle spasms before surgery

the nurse is caring for a client who had an above knee amputation 2 days ago. the residual limb was wrapped with an elastic compression bandage, which has come off. which immediate action should the nurse take

rewrap residual limb with an elastic compression bandage

an adolescent pt referred to the office by the school nurse is found to have a lateral curvature of the spine. the nurse documents this as

scoliosis

a client with diabetes mellitus has had a right below-knee amputation. given the client's history of diabetes which complication is the client at most risk for after surgery

separation of wound edges

an older adult woman is admitted to the ED after falling at home. the nurse cautions her not to put weight on the leg after finding what in the patient assessment

shortening and external rotation of the leg

in report, the nurse is told that the pt has a contracture of the RA. what would the nurse expect to find?

shortening of muscle or ligament

application of RIC is indicated for initial management of which type of injury?

sprains/strains

a pt is admitted with an open fracture of the tibia after a bicycle accident. what question should the nurse ask when assessing the pt?

the status of tetanus immunization

the nurse is evaluating a client in skeletal traction. when evaluating pin sites, the nurse would be most concerned with which finding?

thick, yellow drainage from pin sites

what is the reason a nurse should position a pt prone several times a day after an above-the-knee amputation with a delayed prosthetic fitting

to prevent flexion contractures

after a total knee arthroplasty, a pt has a continuous passive motion machine for the affected joint. what should the nurse explain to the pt is the purpose of this device

to promote early joint mobility and increase knee flexion

a pt reports pain in the foot of a leg that was recently amputated. what should the nurse recognize about this pain

treat with ordered analgesics

An abnormal assessment finding of the musculoskeletal system is a. equal leg length bilaterally. b. ulnar deviation and subluxation. c. full range of motion in all joints. d. muscle strength of 5/5 in all muscles.

ulnar deviation and sublaxation

the nurse is caring for a client with a diagnosis of gout. which lab value would the nurse expect to note in the client?

uric acid level 9.0 mg/dl

what should be included in the management during the first 48 hours after an acute soft tissue injury of the ankle?

use of elastic wrap, initial immobilization and rest, elevation of ankle above heart, administration of NSAIDDS

a 1 month old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. on assessment, the nurse understands that which finding should be noted in this condition?

limited ROM in the affected hip

in a patient with a stable vertebral fracture, what should the nurse teach the pt?

logroll to keep the spine straight when turning

Which kind of hip fracture is usually repaired with a hip prosthesis? a. Intracapsular b. Extracapsular c. Subtrochanteric d. Intertrochanteric

intracapsular

the pt asks, "what does the doctor mean when he says that I have an avulsion fracture in my leg?" I thought i had a sprain. what is the best response?

it means the ligament pulled a bone fragment loose