Musculoskeletal Evolve

subtrochanteric fracture

A subtrochanteric fracture is one that occurs below the lesser trochanter.

Which statements are true regarding chondrosarcoma?

Chondrosarcoma is a malignant type of bone tumor that can arise from benign bone tumors. Chrondrosarcoma most commonly occurs in cartilage in the arm, leg, and pelvic bones. Ewing's sarcoma develops in the medullary cavity of long bones. Chondrosarcoma is mostly treated by wide surgical resection. Chondrosarcoma occurs mostly in older adults between ages 50 and 70 years.

Phalen's Test

Median Nerve Impingement (Carpal Tunnel Syndrome)

In which part of the client's body is the amphiarthroidial joint located? Pelvis Elbow Cranium Shoulder

Pelvis Amphiarthrodial joints are slightly movable joints located in the pelvis. The elbow joint is freely movable; it is referred to as a diarthrodial joint. The joint at the cranium is an immovable synarthrodial joint. The shoulder joint is movable (ball and socket) and is referred to as a diarthrodial joint.

Oral alendronate

a bisphosphonate, is the first line treatment for Paget disease

spastic gait

stiffness of legs, feet, & toes caused by one sided long term muscle contractions musculoskeletal abnormality, caused by cerebral palsy, that results in short steps and dragging of the foot.

Which type of bone tumor is commonly seen in elderly clients?

Chondrosarcoma occurs most commonly in cartilage in the arm, leg, and pelvic bones of older adults in the age group of 50 to 70 years old. Endochroma occurs in clients in the age group of 10 to 20 years old. Osteosarcoma and osteochondroma occur in the age group of 10 to 25 years old.

The nurse is assessing a client with severe nodule-forming rheumatoid arthritis for possible Felty syndrome. Which assessment findings are consistent with Felty syndrome? Itchy eyes Dry mouth Leukopenia Splenomegaly Photosensitivity

Felty syndrome occurs most commonly in clients with severe nodule-forming rheumatoid arthritis; it is characterized by splenomegaly and leukopenia. Itchy eyes, dry mouth, and photosensitivity are all signs of Sjögren syndrome.

A client's laboratory findings showed increase in serum alkaline phosphatase and urinary hydroxyproline levels. Which condition will the nurse most likely observe in the client's electronic medical chart? Osteomalacia Osteoporosis Osteomyelitis Osteitis deformans

In osteitis deformans, or Paget's disease, there will be an increase in serum alkaline phosphatase and urinary hydroxyproline levels. In osteomalacia, a decrease in vitamin D, calcium, and phosphorous levels is observed. In osteoporosis, there will be a decrease in calcium level and vitamin D; the alkaline phosphatase level is usually normal. Osteomyelitis is a bone infection in which there is an increase in white blood cell count and a blood culture test is performed to identify the infectious organism.

The nurse is teaching an elderly client isometric exercises. Which physiologic condition does the client have?

Muscle atrophy occurs due to muscular weakness; isometric exercises can help increase muscular strength. Kyphosis can be reduced by introducing the client to proper body mechanics and instructing the client to sit in supportive chairs with arms. Complications associated with decreased bone density can be reduced by teaching safety tips to prevent falls and by reinforcing the need to exercise. The nurse should assess the client's ability to perform activities of daily living and mobility in a client with a decreased ROM.

Four clients with osteomyelitis are prescribed antibiotics. Which client is at risk for Achilles tendon rupture?

Osteomyelitis is a severe infection of the bone, bone marrow, and surrounding soft tissue. Tendon rupture can occur with use of the fluoroquinolones. Therefore client B, prescribed ciprofloxacin, is at risk for Achilles tendon rupture. -------- Client A, prescribed gentamicin, is at risk for visual and hearing problems. Client C, prescribed cefazolin, is at risk for severe watery diarrhea and mouth sores. Client D, prescribed tobramycin, is at risk for nephrotoxicity.

What type of patient might need a fasciotomy?

The client with compartment syndrome will most likely need a fasciotomy. Compartment syndrome is a condition in which swelling and increased pressure within a limited space (a compartment) press on and compromise the function of blood vessels, nerves, or tendons that run through that compartment. Fasciotomy, surgical decompression of the affected compartment, is used to treat compartment syndrome. Acute respiratory distress syndrome can be treated with administration of oxygen to the client as well as mechanical ventilation. Anticoagulants, sequential compression devices, and compression gradient stockings are used to treat venous thromboembolism. Fat embolism syndrome is treated by correcting acidosis, administering fluids, and replacing lost blood.

A nurse is counseling a client who is at risk for developing osteoporosis. Which foods should the nurse recommend? Canned tuna Scrambled eggs Chicken breasts Broiled beef steak Baked sweet potato

chicken and beef One serving of white meat chicken or one serving of beef contains more than 200 mg of calcium. A serving of canned tuna, two eggs, and sweet potatoes contain each less than 200 mg of calcium.

A client who has paraplegia often loses calcium from the skeletal system. The nurse concludes that what factor contributes to calcium loss in this client? Decreased activity Inadequate fluid intake Decreased calcium intake Inadequate kidney function

Decreased Activity The bones respond to the stress of activity (walking, running, etc.) by laying down new bone substance along the lines of stress. Inactivity leads to reduced bone deposition and actual bone decalcification. ----- Fluid intake has no effect on bone decalcification. Calcium intake does not alter bone demineralization in clients with paraplegia. Kidney function may be altered as bone decalcification occurs and stones are formed in the kidneys, but this is not the cause of demineralization.

pes planus

a flat foot with no plantar arch

flexion contracture

inability to extend fully in limb paralysis

cartilaginous deterioration relief

moist heat

bone scan

nuclear scanning test that identifies new areas of bone growth or breakdown radionuclide test in which radioactive material is injected so that the client's entire skeleton can be viewed.

A client with rheumatoid arthritis is scheduled to participate in an exercise program that is established at the extended care facility where the client resides. The nurse evaluates that the client understands the purpose of the program when the client makes which statement? "I know the exercises are important, so I do them whenever I can." "I do my exercises when I go to physical therapy in the morning and afternoon." "Because I'm stiff in the morning, I do most of my exercises then, so I'm done for the day." "After I eat breakfast, I do one set of exercises slowly, and then I space the rest of them throughout the day."

"After I eat breakfast, I do one set of exercises slowly, and then I space the rest of them throughout the day." Spacing activity protects joints from overuse, misuse, and stress, limiting inflammation; it provides a balance between rest and activity. The exercise program should be planned; too much activity can precipitate an exacerbation, and too little may cause contractures. Spaced range-of-motion exercises should be incorporated into daily living activities, not just twice a day. The actions expressed in the response "Because I'm stiff in the morning, I do most of my exercises then, so I'm done for the day" will cause stress at the joints, which may precipitate an exacerbation

A nurse is caring for a client with compartment syndrome. Which nursing actions are appropriate? Assisting with splitting the cast Assessing urine output Evaluating the pain on a scale Applying splints to the injured part Placing cold compresses to the affected area

Assisting with splitting the cast Assessing urine output Evaluating the pain on a scale The nurse should assess urine output because the myoglobin released from damaged muscle cells may precipitate and cause obstruction in renal tubules.

Which medications are useful to relieve pain associated with muscle spasms? Cefazolin Carisoprodol Fondaparinux Methocarbamol Cyclobenzaprine

Central and peripheral muscle relaxants such as carisoprodol, methocarbamol, and cyclobenzaprine are used to reduce muscle spasm pain. Cefazolin is a bone-penetrating antibiotic used prophylactically before surgery. Fondaparinux is a low molecular weight heparin used to prevent venous thromboembolism (VTE) in client scheduled for orthopedic surgery.

A nurse is completing the health history of a client admitted to the hospital with osteoarthritis. The nurse expects the client to report that which joints were involved initially?

Osteoarthritis affects the weight-bearing joints (e.g., hips and knees) first, because they bear the most body weight. The resulting joint damage causes a series of physiologic responses (e.g., release of cytokines and proteolytic enzymes) that lead to more damage. ------- Although the ankles are weight-bearing joints and eventually are affected, the motion in the ankles is not as great as in the hips and knees; thus there is less degeneration. Shoulder joints are not the most likely to be involved first, because these are not weight-bearing joints. Although the distal interphalangeal joints are commonly affected, the remaining interphalangeal joints and metacarpals are not.

X-ray films reveal that a client has closed fractures of the right femur and tibia. In addition, multiple soft-tissue contusions are present. Which action is most important for the nurse to take? Perform a neurovascular assessment of the extremity. Reassure the client that these injuries are not that serious. Gather equipment needed for the application of skeletal traction. Prepare the client for a surgical reduction of the injured extremity.

Perform a neurovascular assessment of the extremity. Identifying the status of the damage is the priority. Before a treatment protocol is determined, the presence of nerve or vascular damage and compartment syndrome must be identified. ----------- False reassurance is never appropriate. Skeletal traction is used rarely. Closed fractures in the absence of soft tissue damage generally are reduced by manipulation. Closed fractures with soft tissue damage may require an external fixation device to reduce the fracture, immobilize the bone, and allow for treatment of the soft tissue damage. Preparing the client for surgery is premature; more data are necessary before a treatment option is determined.

After an amputation, the client's residual limb is bandaged snugly throughout the postoperative period. Which goal should the nurse identify as the primary reason for this intervention? Promoting shrinkage Preventing injury to the area Preventing suture line infection Promoting drainage of secretions

Promoting shrinkage Wrapping of the residual limb applies pressure that prevents swelling and shapes it for the fitting of a prosthesis in the future. ------ A sock is used to protect the residual limb from irritation and injury. Infection is not prevented in this manner; surgical asepsis should be maintained. Secretion drainage is not promoted by wrapping the limb; portable drainage systems are used for this purpose.

Three days after a cast is applied to a client's fractured tibia, the client reports that there is a burning pain over the ankle. The cast over the ankle feels warm to the touch, and the pain is not relieved when the client changes position. What is the nurse's priority action?

Report the client's concern to the primary healthcare provider. The client's concern indicates tissue hypoxia or breakdown and should be reported to the primary healthcare provider. Other data, such as elevated temperature or increased white blood cells, are not present to support the presence of an infection. Although administering the prescribed medication for pain will be done to provide relief of pain, the priority is to notify the primary healthcare provider. This is not a typical response to a cast and may indicate a complication.

A client has a total hip arthroplasty. What should the nurse do when caring for this client after surgery?

Using a pillow to keep the legs abducted ensures abduction of the leg to maintain position of the prosthesis and prevent dislocation.

compartment syndrome

compression of nerves and blood vessels within a closed space, dangerous excruciating pain with passive extension, pulses may be normal. emergency fasciotomy severe pain, pallor, poikilothermia, paresthesias, pulselessness and paralysis

A nurse is assessing a client with the diagnosis of osteoporosis. What part of the client's body should the nurse assess to identify osteoporotic changes? Long bones Facial bones Vertebral column Joints of the hands

vertebral column Compression fractures of the vertebrae are the most common fractures in clients with osteoporosis; a gradual collapse of vertebrae may be asymptomatic and observed as kyphosis. Changes in the long bones or facial bones associated with osteoporosis are not observable to the naked eye. Observable changes such as inflammation in the hand joints and natural alignment of the bones are associated with arthritis, not osteoporosis.

A client returns from the postanesthesia care unit after a right rotator cuff repair. What should the nurse do when performing a neurovascular assessment? Monitor for a pulse deficit. Obtain hourly blood pressure readings. Assess for capillary refill in the nail beds. Place the shoulder through range-of-motion exercises.

Capillary refill and quality of the pulse in the affected arm reflect the status of circulation distal to the operative site. A pulse deficit is the difference between the apical and radial rates. Monitoring for a pulse deficit is related to monitoring the function of the heart, not peripheral circulation. Obtaining hourly blood pressure readings is unnecessary. Placing the shoulder through range-of-motion exercises is contraindicated immediately after surgery. In this situation, range-of-motion exercises require a primary healthcare provider's prescription.

After reviewing the laboratory reports of a client with a severe joint injury, the nurse suspects fat embolism syndrome (FES). Which findings support the nurse's suspicion? Fat cells in the urine PaO 2 value of 58 mm Hg (7.73 kPa) Hematocrit value of 30% (0.30) Platelet count of 160,000/µL (160 x 10 9/L) Prothrombin time of 12 seconds

Fat cells in the urine, PaO 2 of 58 mm Hg (7.73 kPa), and hematocrit of 30% (0.30) are all indicative of fat embolism syndrome (FES). FES is characterized by the presence of systemic fat globules, which are distributed into tissues and organs after a traumatic skeletal injury. The presence of fat cells in the urine indicates FES. Fat emboli in the lungs cause a hemorrhagic interstitial pneumonitis that produces signs and symptoms of acute respiratory distress syndrome (ARDS) and decreased partial pressure of arterial oxygen. The normal partial pressure of arterial oxygen is 80 to 100 mm Hg (10.6-13.33 kPa). The normal hematocrit value is 40% to 50% (0.40-0.50). Poor oxygen exchange decreases the hematocrit value in a client with FES. The normal platelet count is in the range of 150,000 to 450,000 platelets per µL of blood (150-450 x 10 9/L). The platelet count is decreased in FES. A platelet count of 160,000/µL (160 x 10 9/L) is a normal finding. Normal prothrombin time is in the range of 12 to 13 seconds. Prothrombin time is prolonged in FES, but a prothrombin time of 12 seconds is normal.