Flashcards in LA#6 (Musculoskeletal) chapters 64, 65, 66, 67 in Med Surg Deck (149)
Based on the nurse’s understanding of the physiology of bone and cartilage, what is the injury that the nurse would expect to heal most rapidly?
a. Fractured nose
b. Severely sprained ankle
c. Fracture of the midhumerus
d. Torn cruciate ligament in the knee
Bone is dynamic tissue that is continually growing; therefore, the fracture of the midhumerus would heal most rapidly.
While assessing a patient’s musculoskeletal function, the nurse asks the patient to demonstrate active range of motion of the shoulder. What is the motion(s) at the shoulder that the patient should be able to perform but cannot do at the elbow?
Circumduction is a combination of flexion, extension, abduction, and adduction resulting in circular motion of a body part, and the elbow is not able to do this.
When the doctor tells a patient that the pain in his knee is caused by bursitis, the patient asks the nurse to explain what bursitis is. What is the best response that would explain bursitis to the patient?
a. An inflammation of the fibrocartilage that acts as a shock absorber in the knee
b. An inflammation of any connective tissue that is found supporting the joints of the body
c. An inflammation of the synovial membrane that lines the capsule between two bones of a joint
d. An inflammation of a small, fluid-filled bursa sac of protective connective tissue commonly found at joints
Bursae are fluid-filled sacs that cushion joints and bony prominences.
During assessment of the musculoskeletal system of a 74-year-old woman, what is a finding that reflects the normal age-related vertebral disc compression?
b. Back pain
c. Loss of height
d. Crepitation on movement
An age-related change is loss of height from disc compression and posture change.
Skeletal muscle accounts for approximately what percentage of a person’s body weight?
Skeletal muscle, which requires neuronal stimulation for contraction, accounts for about half of a human being’s body weight.
The wrist joint is an example of which one of the following joint types?
a. Hinge joint
b. Pivot joint
c. Condyloid joint
d. Gliding joint
The wrist joint is a condyloid joint.
During assessment of the musculoskeletal system, the nurse notes that the patient’s gait is disturbed. To further assess this problem, what should the nurse do?
a. Measure the length of both legs.
b. Perform muscle strength testing of the legs.
c. Ask the patient to demonstrate active range of motion of the legs.
d. Perform deep palpation on the hip joints to identify the presence of pain.
Measuring the length of both legs will give the nurse more information related to the disturbed gait.
While testing the patient’s muscle strength, the nurse finds that although the patient can move his limbs, he cannot apply muscle resistance to force. How should the nurse grade the muscle strength?
A level 3 grade indicates that the patient is unable to move against resistance but can move against gravity.
When assessing the musculoskeletal system, what is the nurse’s initial action?
a. Have the patient move the extremities against resistance.
b. Feel for the presence of crepitus during joint movement.
c. Observe the patient’s body build and muscle configuration.
d. Check active and passive range of motion for the extremities.
The usual technique in the physical assessment is to begin with inspection.
A patient is seen at the urgent care centre following a blunt injury to his left knee. The knee is grossly swollen and very painful, but the skin is intact. During an arthrocentesis on the patient’s knee, how would the nurse expect the aspirated fluid to appear?
b. Purulent and thick
c. Light yellow in colour
d. White, thick, and ropelike
The patient’s clinical manifestations suggest hemarthrosis, and the appearance of blood in the synovial fluid is expected.
A patient suffers an injury to the shoulder while playing football. To identify abnormalities of cartilage and soft tissue surrounding the joint, what would the nurse expect the patient to be evaluated with?
a. A bone scan
b. An arthrogram
c. Standard X-ray films
d. Magnetic resonance imaging (MRI)
MRI is most useful in assessing for soft tissue injuries.
Which of the following is an age-related change in the musculoskeletal system?
a. Increased diameter of muscle cells
b. Increased storage of glycogen
c. Loss of water from discs between vertebrae
d. Widening of intervertebral spaces
A normal age-related change is a loss of water from discs between the vertebrae. Muscle cells decrease in diameter with aging. Glycogen storage decreases with aging. The intervertebral spaces narrow rather than widen as a normal age-related change.
Which type of bone cell plays a role in bone remodelling?
Osteoclasts participate in bone remodeling by assisting in the breakdown of bone tissue.
The sacrum is classified as which type of bone?
a. Long bone
b. Short bone
c. Flat bone
d. Irregular bone
Irregular bones appear in a variety of shapes and sizes, for example, the vertebrae, sacrum, and mandible.
A 73-year-old woman tells the nurse that she is “slowing down” and does not try to push herself to do much these days because of her age. She spends most of the day and evening watching television and has hired someone to do most of her home maintenance chores. Recognizing that the woman is at risk for musculoskeletal problems, what is the best response to her comment?
a. “To improve your condition, you should join an exercise program, perhaps one at your local senior centre.”
b. “Mild, regular exercise will increase your strength and coordination and help increase your sense of well-being.”
c. “Many older people benefit from occasional exercise, which helps prevent muscle wasting and fatigue common in old age.”
d. “Many musculoskeletal changes occur with age that may limit physical activities. This is normal and to be expected.”
Prevention of musculoskeletal problems in the older adult includes regular and daily exercise.
A woman is seen at the urgent care centre after falling on her right arm and shoulder. What is an assessment finding noted by the nurse that would indicate the patient has a dislocated shoulder?
a. Bruising at the shoulder area
b. The right arm being shorter than the left arm
c. Decreased range of motion of the right shoulder
d. Increased pain caused by flexing and extending the elbow
A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency.
A cashier in a grocery store has muscle and tendon tears that have become inflamed, causing pain and weakness in her left hand and elbow. What should the nurse identify these symptoms as being related to?
b. Meniscus injury
c. Repetitive strain injury (RSI)
d. Carpal tunnel syndrome
The patient’s occupation and the inflammation, pain, and weakness in the elbow and hand suggest a RSI.
While working in an urgent care centre, the nurse sees many patients with sports-related injuries. In teaching these patients about health promotion during physical activity, what should the nurse emphasize?
a. Stretching and warm-up exercises are an important part of the exercise routine.
b. All joints at risk for injury should be wrapped with adhesive tape before exercising.
c. Low-impact activities should be substituted for strenuous, physically stressful exercise.
d. All strenuous exercise should be followed with a period of complete physical relaxation.
Stretching and warm-up exercises before vigorous activity significantly reduce sprains and strains.
A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. All of the following orders are written by the physician. Which one will the nurse act on first?
a. Administer naproxen (Naprosyn) 500 mg orally.
b. Wrap the ankle, and apply an ice pack.
c. Give acetaminophen with codeine (Tylenol No. 3).
d. Take the patient to the radiology department for X-ray films.
Immediate care after a sprain or strain injury includes the application of cold and compression to the injury to minimize swelling.
Following X-ray films of an injured wrist, the patient is informed that it is just badly sprained. In teaching the patient to care for the injury, what should the nurse teach the patient to do?
a. Apply a heating pad to reduce muscle spasms.
b. Wear an elastic compression bandage continuously.
c. Gently exercise the joint to prevent muscle shortening.
d. Keep the arm elevated above the heart, even during sleep.
Elevation of the arm will reduce the amount of swelling and pain; therefore, it is important to keep the arm elevated, even during sleep.
A 24-year-old man recently started an exercise regimen that includes running 5 to 7 km a day. He tells the nurse he has developed shin splints so severe that they limit his ability to run. What is an appropriate response?
a. “You may be increasing your running time too quickly and need to cut back a little bit.”
b. “You need to have X-ray films made of your lower legs to be sure you do not have stress fractures.”
c. “You should expect some leg pain while running.”
d. “You should try speed-walking rather than running.”
The patient’s information about running 5 to 7 km daily after starting an exercise program only 2 months previously suggests that the shin splints are caused by overuse.
A 20-year-old baseball pitcher has an arthroscopic repair of a rotator cuff injury performed as same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included?
a. “You have an appointment with a physiotherapist for tomorrow.”
b. “Leave the shoulder immobilizer on for the first few days to minimize pain.”
c. “The doctor will use the drop-arm test to determine the success of the procedure.”
d. “You should try to find a different position to play on the baseball team.”
Physiotherapy after a rotator cuff repair begins on the first postoperative day to prevent “frozen shoulder.”
A patient with a fractured radius asks when the cast can be removed. The nurse will instruct the patient that the cast can be removed only after the bone completes which process?
d. Callus formation
The cast may be removed when callus ossification has occurred.
A patient with a comminuted fracture of the right femur has Buck’s traction in place while waiting for surgery. What should the nurse do to assess for pressure areas on the patient’s back and sacral area and to provide skin care?
a. Have the patient lift the buttocks by bending and pushing with the left leg.
b. Turn the patient partially to each side with the assistance of another nurse.
c. Place a pillow between the patient’s legs, and turn gently to each side.
d. Loosen the traction, and have the patient turn onto the unaffected side.
The patient can lift the buttocks off the bed by using the left leg, or the patient could also be encouraged to use the overhead trapeze bar and the opposite siderail to assist in changing positions, without changing the right-leg alignment.
A patient in the emergency department is diagnosed with a patellar dislocation. What will the nurse’s initial patient teaching focus on?
a. Conscious sedation
b. A knee immobilizer
c. Gentle knee flexion
d. Cast application
The first goal of collaborative management is realignment of the knee to its original anatomical position, which will require anaesthesia or conscious sedation.
Following a motor vehicle accident, a patient arrives in the emergency department with massive right lower leg swelling. Which action will the nurse take first?
a. Elevate the leg on pillows.
b. Apply a compression bandage.
c. Place ice packs on the lower leg.
d. Check leg pulses and sensation.
The nurse’s initial action will be to assess the circulation to the leg and to observe for any evidence of injury such as fractures or dislocations.
Following the application of a hip spica cast for a patient with a fracture of the proximal third of the left femur, what is an appropriate nursing intervention?
a. Reposition the patient, using the support bar at the thighs.
b. Assess the patient for abdominal pain, and nausea and vomiting.
c. Psychologically prepare the patient for a long period of bed rest without ambulation.
d. Turn the patient to the prone position every 4 hours to promote drying of the posterior part of the cast.
Assessment of bowel tones, abdominal pain, and nausea and vomiting will detect the development of cast syndrome. To avoid breakage, the support bar should not be used for repositioning. After the cast dries, the patient can begin ambulating with the assistance of physiotherapy personnel. The patient should not be placed in the prone position until the cast has dried to avoid breaking the cast.
A patient is admitted to the emergency department with possible fractures of the bones of the left lower extremity. Before initiating treatment for the patient, what is it most important for the nurse to do?
a. Splint the lower leg.
b. Elevate the injured limb.
c. Check neurovascular status distal to the injury.
d. Assess the patient’s tetanus immunization status.
Musculoskeletal injuries have the potential to cause changes in the neurovascular status of an injured extremity. With musculoskeletal trauma, application of a cast or constrictive dressing, poor positioning, and the physiological response to the traumatic injury can cause nerve or vascular damage, usually distal to the injury. A thorough neurovascular assessment consists of a peripheral vascular assessment (colour, temperature, capillary refill, peripheral pulses, and edema) and a peripheral neurological assessment (sensation, motor function, and pain).
In developing a care plan for a patient with an open reduction and internal fixation (ORIF) of an open, displaced fracture of the tibia, what is a priority nursing diagnosis?
a. Risk for constipation related to immobilization
b. Activity intolerance related to prolonged immobility
c. Risk for impaired skin integrity related to immobility
d. Risk for infection related to disruption of skin integrity
A patient having an ORIF is at risk for problems such as wound infection and osteomyelitis.