Musculoskeletal

The primary functions of cartilage are to reduce friction between articular surfaces, absorb shocks, and reduce stress on joint surfaces. Where in the human body is cartilage found?

All options are correct. R: Types of cartilage include costal cartilage, which connects the ribs and sternum; semilunar cartilage, which is one of the cartilages of the knee joint; fibrous cartilage, found between the vertebrae (intervertebral disks); and elastic cartilage, found in the larynx, epiglottis, and outer ear.

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan?

Assessing movement and sensation in the fingers of the right hand R: The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast pores to the skin below. Unlike a plaster cast, a Fiberglass cast dries quickly and can be handled without damage soon after application. The nurse should assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses, which are found in the legs.

What food can the nurse suggest to the client at risk for osteoporosis? Bananas Broccoli Chicken Carrots

Broccoli R: Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium.

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for: Capillary refill. Swelling and discoloration. Crepitus. Shortening and deformity.

Capillary refill. R: Assessment for neurovascular impairment includes checking for weak pulses or delayed capillary refill (normal is <3 seconds).

When an infection is bloodborne, the manifestations include which symptom? Hyperactivity Bradycardia Chills Hypothermia

Chills R: Manifestations of bloodborne infection include chills, high fever, rapid pulse, and generalized malaise.

A client comes to the emergency department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely?

Contusion R: The client's description of blunt trauma by a baseball bat and localized pain in conjunction with swelling and ecchymosis would most likely suggest a contusion. A fracture would be manifested by pain, loss of function, deformity, swelling, and spasm. A sprain would be manifested by pain and swelling; ecchymosis may appear later. A strain is characterized by inflammation, local tenderness, and muscle spasms.

After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do?

Discuss the complications that the client may experience if there is lack of cooperation with the care plan. R: The nurse should discuss the care plan and its rationale with the client. Calling the health care provider to report the client's noncompliance won't alter the client's degree of participation and shouldn't be used to force the client to comply. Doing nothing isn't acceptable. Although the client does have the right to make choices, it's the nurse's responsibility to provide education to help the client make informed decisions. Although the nurse should ultimately document the client's refusal, the nurse should first discuss the care plan with the client.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? Apply antiembolism stockings as indicated. Elevate the affected extremity and use cold applications. Breathe deeply and cough every 2 hours until ambulation is possible. Do ROM exercises as indicated.

Elevate the affected extremity and use cold applications. R: Elevating the affected extremity and using cold applications reduce swelling. Deep breathing and coughing helps with maintenance of effective respiratory rate and depth. ROM exercises maintain full ROM of unaffected joints. Antiembolism stockings help prevent deep vein thrombosis (DVT).

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign?

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. R: The nurse should assess for pain on passive flexion of each foot, which could indicate deep vein thrombosis.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?

Initiating weight-bearing exercise routines R: Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.

The client presents with nausea and vomiting, sluggish bowel sounds, and abdominal distention. How does the nurse interpret these findings?

Physiologic cast syndrome R: Physiological cast syndrome is characterized by impaired gastrointestinal function, such as nausea and vomiting, sluggish bowel sounds, and abdominal distention.

The nurse is conducting a medication reconciliation with a client admitted with a fracture. What medication predisposes a client for a risk for fractures? metoprolol prednisone furosemide digoxin

prednisone R: Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures. Furosemide, digoxin, and metoprolol do not interfere with bone resorption or predispose clients to fractures.

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care? -"Cover the cast with a blanket until the cast dries." -"A foul smell from the cast is normal." -"Keep your right leg elevated above heart level." -"Use a knitting needle to scratch itches inside the cast."

"Keep your right leg elevated above heart level." R: The nurse should instruct the client to elevate the leg to promote venous return and prevent edema. The cast shouldn't be covered while drying. Covering the cast will cause heat buildup and prevent air circulation. The client should be instructed not to insert foreign objects into the cast because of the risk of cutting the skin and causing an infection. A foul smell from a cast is never normal and may indicate an infection.

The nurse is preparing the client for computed tomography. Which information should be given by the nurse? "A radioisotope will be given through an IV." "Fluid will be removed from you affected joint." "You must remain very still during the procedure." "A small bit of tissue will be removed and sent to the lab."

"You must remain very still during the procedure." R: In computed tomography, a series of detailed x-rays are taken. The client must lie very still during the procedure. A contrast agent, not a radioisotope, may or may not be injected. Arthrocentesis involves the removal of fluid from a joint. A small bit of tissue is removed with a biopsy. Nuclear medicine imaging uses IV injection or ingestion of radioisotope substances.

A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? 3 months 3 to 6 weeks 7 to 10 days 6 months

3 to 6 weeks R: Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for 3 to 6 weeks. Oral antibiotics then follow for as long as 3 months.

Which would be contraindicated as a component of self-care activities for the client with a cast? -Cover the cast with plastic to insulate it -Do not attempt to scratch the skin under a cast -Cushioning rough edges of the cast with tape -Elevate the casted extremity to heart level frequently

Cover the cast with plastic to insulate it R: The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. The other activities are consistent with cast care.

The nurse caring for a client, who has been treated for a hip fracture, instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client? Do not flex the hip more than 30 degrees. Do not flex the hip more than 120 degrees. Do not flex the hip more than 90 degrees. Do not flex the hip more than 60 degrees.

Do not flex the hip more than 90 degrees. R: Proper alignment and supported abduction are encouraged for hip repairs. Flexion of the hip more than 90 degrees can cause damage to the a repaired hip fracture.

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

Elevating the stump for the first 24 hours R: Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery.

Dupuytren's contracture causes flexion of which area(s)?

Fourth and fifth fingers R: Dupuytren's contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.

The nurse is employed at a long-term care facility caring for geriatric clients. Which assessment finding is characteristic of an age-related change?

Loss of height R: A common age-related change is the loss of height due to the loss of bone mass and vertebral collapse. Cognitive decline is not an age-related change. Depression occurs in all age groups. Geriatric clients have a decrease in muscle mass.

Which is an inaccurate principle of traction? -The weights are not removed unless intermittent treatment is prescribed. -Skeletal traction is interrupted to turn and reposition the client. -The client must be in good alignment in the center of the bed. -The weights must hang freely.

Skeletal traction is interrupted to turn and reposition the client. R: Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely, with the client in good alignment in the center of the bed.

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? High-Fowler's to allow for maximum hip flexion Prone, with a pillow under the shoulders Supine, with the bed flat and a firm mattress in place Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees R: A medium to firm, not sagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress. Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head. A prone position should be avoided because it accentuates lordosis.

Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy? furosemide aspirin digoxin NPH insulin

aspirin R: Aspirin has anti-clotting properties, and bone is a very vascular tissue. The client taking aspirin in close proximity to a bone biopsy is at increased risk for excessive bleeding.

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD?

Calcitonin (Miacalcin) R: Calcitonin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Raloxifene reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Teriparatide has been recently approved by the FDA for the treatment of osteoporosis.

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention?

Compound R: A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

A nurse provides nutritional health teaching to an adult client who had two fractures in 1 year. Besides recommending supplemental calcium, the nurse suggests a high-calcium diet. What would the nurse recommend that the client increase intake of?

Yogurt and cheese. R: Yogurt and cheese are excellent sources of calcium. The other choices are low-calcium foods.

A client with a fracture develops compartment syndrome that requires surgical intervention. What treatment will the nurse would most likely prepare the client for? Bone graft Joint replacement Fasciotomy Amputation

Fasciotomy R: Surgical treatment of compartment syndrome is achieved with a fasciotomy, a surgical incision of the fascia and separation of the muscle to relieve pressure and restore tissue perfusion. Bone graft, joint replacement or amputation may be done for a client who experiences avascular necrosis.

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client?

Changing the client's position within prescribed limits. R: Changing the position of a client within prescribed limits helps relieve pressure on bony areas and promotes comfort. Analgesics help to relive pain but may not help relieve pressure on bony areas. Warm compresses aid blood circulation. The client should not exercise while on traction unless prescribed to regain strength in the affected limb.

What is the term for a rhythmic contraction of a muscle?

Clonus R: Clonus is a rhythmic contraction of the muscle. Atrophy is a shrinkage-like decrease in the size of a muscle. Hypertrophy is an increase in the size of a muscle. Crepitus is a grating or crackling sound or sensation that may occur with movement of ends of a broken bone or irregular joint surface.

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?

Comminuted R: A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.

Which of the following was formerly called a bunion?

Hallux valgus R: Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.

The nurse is assessing the muscle tone of a client with cerebral palsy. Which description does the nurse determine to be an expected assessment of this client's muscle tone?

Hypertonic R: In clients with conditions characterized by upper motor neuron destruction, as in cerebral palsy, the muscles are often hypertonic. However, in conditions with lower motor neuron destruction, the muscles become atonic, atrophied, and/or flaccid.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? A soft mattress is most supportive by conforming to the body. Sleep on the stomach to alleviate pressure on the back. Avoid twisting and flexion activities. Use the large muscles of the leg when lifting items.

Use the large muscles of the leg when lifting items. R: The large muscles of the leg should be used when lifting.

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct?

The recommended daily allowance of calcium may be found in a wide variety of foods. R: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.

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

Abduction R: The nurse educates the patient about protective positioning, which includes maintaining abduction and avoiding internal and external rotation, hyperextension, and acute flexion.

A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction? Thomas splint Buck's Balanced suspension Crutchfield tongs

Buck's R: An example of skin traction is Buck's traction. Crutchfield tongs, a Thomas splint, or balanced suspension traction are types of skeletal traction.

Which clinical manifestation would the nurse recognize as an indicator of peripheral neurovascular dysfunction? Select all that apply. Dorsoplantar flexion strong Capillary refill less than 3 seconds Complaints of pins and needles in feet Absence of pain Toes mottled and cool

Toes mottled and cool Absence of pain Complaints of pins and needles in feet R: Clinical manifestations of peripheral neurovascular dysfunction include coolness, mottling, weakness, paralysis, complaints of paresthesia or a pins and needles sensation, and unrelenting pain. Capillary refill of less than 3 seconds is a normal finding.

A client tells the health care provider about shoulder pain that is present even without any strenuous movement. The health care provider identifies a sac filled with synovial fluid. What condition will the nurse educate the client about? bursitis a fracture of the clavicle osteoarthritis of the shoulder ankylosing spondylitis

bursitis R: A bursa is a small sac filled with synovial fluid. Bursae reduce friction between areas, such as tendon and bone and tendon and ligament. Inflammation of these sacs is called bursitis. A fracture of the clavicle is a bone break. Osteoarthritis is an inflammatory disease. Ankylosing spondylitis is a form of arthritis affecting the spine.