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AHI > MS Questions > Flashcards

MS Questions Flashcards

1
Q

A nurse is performing a musculoskeletal assessment on an older adult living independently in a senior housing apartment. What normal physiological changes does the nurse expect? (Select all that apply)
A. Increased bony prominence
B. Slowed movement
C. Decreased range of motion
D. Narrowed gait
E. Cartilage regeneration

A

Answer: A, B, C
Widened gait
Cartilage breaks down over time - often need surgery

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2
Q

Increased risk for falls
Increased risk for fractures when fall and may need go to long-term care facility as a result
Increased risk for skin breakdown - prevent pressure ulcer
Allow more time for activity - ADLs
May need more assistance - including at home

A

What does that mean to our nursing care?

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3
Q

Cartilage degeneration
Decreased bone density
Kyphotic posture: hunchback - rounded back - leads to widened gait; prevent: exercise and good posture
Widened gait

A

What other normal physiologic changes should be expected in the older adult?

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4
Q

Electromyography (EMG)

A

Which diagnostic test is used to assess for muscle weakness?

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5
Q

Ultrasound

A

Which diagnostic test uses sound waves to produce an image of the tissue?

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6
Q

Arthroscopy

A

Which diagnostic test uses a fiberoptic scope inserted into the joint for direct visualization?

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7
Q

Radiography (X-ray, myelogram (contrast media into subarachnoid space to look at issues in vertebral column), arthrogram (x-ray of joints with contrast), CT)
Nuclear scans
MRI (Magnetic Resonance Imaging)
Electromyography (EMG)
Arthroscopy

A

Diagnostic tests

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8
Q

Good diagnostic tool for joints, soft tissue and bony tumors

A

MRI (Magnetic Resonance Imaging)

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9
Q

Used to evaluate diffuse or localized muscle weakness
Usually accompanied by nerve conduction studies for determining the electrical potential
May cause temporary discomfort - inserting needles
Mild sedation may be prescribed for selected patients
Skeletal muscle relaxants may be held several days prior to procedure: check func of nerves and muscles and want see baselin

A

Electromyography (EMG)

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10
Q

Diagnostic test or surgical procedure - direct visualization
Fiberoptic tube inserted into a joint for direct visualization or surgical repair
Nursing care after procedure:

A

Arthroscopy

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11
Q

Assess neurovascular status of the affected limb (pulses, temperature, color, cap refill, pain, movement, sensation) - done sev times
Pain control: Mild analgesic or opioid short amt times, ice for 24 hours, elevation of extremity for 12 to 24 hours
Observe for complications which may include swelling, increased joint pain, thrombophlebitis (blood clots big so go home on anticoag), infection

A

Nursing care after procedure: - Arthroscopy

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12
Q

Older age
Maternal history of osteoporosis
History of low trauma fracture after age of 50
Low body weight
Chronic low calcium or vitamin D intake
Estrogen or androgen deficiency
Smoking
High alcohol intake
Lack of physical activity or prolonged immobility
Carbonated drinks - high phosphate work inversely with Ca
Caffeine - Ca loss in urine
Postmenopausal, female

A

What are risk factors for osteoporosis?

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13
Q

Kyphosis
Reports of “getting shorter” - breakdown vertebrae
Pain
Assess for fractures (pain, swelling, misalignment) - easier

A

Other than fractures, what other signs and symptoms might the nurse expect when caring for this patient?

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14
Q

DEXA scan
Measures bone density - monitors progression; see if increased/not and how help

A

What diagnostic test is used to diagnose and monitor progression of osteoporosis?

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15
Q

Which statement by the patient regarding lifestyle changes indicates a need for further teaching?
A. “I will get rid of my scatter rugs”
B. “ I will cut back to 3 martinis a day”
C. “I will increase my calcium and vitamin D intake”
D. “I am going to walk every day”

A

Answer: B
A - Hazard free environment decreases risk of falling; scatter rugs increases risk for falls
B - 3 is too many; Heavy alcohol use increases risk of osteoporosis
C - Good to increase food intake even when on supplement
D - Walking is the most effective exercise at least 3-5 x a week; weight-bearing exercise

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16
Q

Nutrition therapy
Avoid tobacco
Drug therapy

A

What are other interventions for osteoporosis?

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17
Q

Vit D and calcium
Fruits and vegetables, increased fiber
Low-fat dairy and protein sources
Decrease carbonated beverages
Moderate intake of caffeine
Decrease alcohol intake

A

Nutrition therapy - What are other interventions for osteoporosis?

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18
Q

Calcium and vitamin D supplements
Bisphosphonates
Estrogen agonist/antagonists
Calcitonin

A

Drug therapy - What are other interventions for osteoporosis?

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19
Q

Slows bone resorption by binding with crystal elements in bone
Ex. Alendronate (Fosamax); risedronate (Actonel); ibandronate (Boniva)
-dronate
Take early in the morning, 8 oz. of water, sit upright for 30-60 min: can cause GERD

A

Bisphosphonates - Drug therapy - What are other interventions for osteoporosis?

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20
Q

Ex. raloxifene (Evista)
Inhibits bone resorption (breakdown of bones)
Stimulates osteoblast activity and inhibits PTH (parathyroid hormone - stim release of Ca)

A

Estrogen agonist/antagonists - Drug therapy - What are other interventions for osteoporosis?

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21
Q

Inhibits bone resorption (breakdown of bones) - keep Ca in bone

A

Calcitonin - Drug therapy - What are other interventions for osteoporosis?

22
Q

Progressive deterioration and loss of cartilage in one or more joints
Not systemic - not every single joint
Usually unilaterally; weightbearing joints/hands
Symptoms: pain; decrease mobility esp side having deterioration or loss cartilage; enlarged joints that swell

A

Osteoarthritis

23
Q

Which patients are at risk for developing OA? (Select all that apply)
A. Obese, older woman living alone
B. Slender, non smoking middle aged man
C. Middle aged man with 25 years working in construction
D. Young woman with a family history of cancer
E. Middle aged adult with multiple knee surgeries from high school soccer

A

Answer: A, C, E
Cancer not put you at risk

24
Q

Age - older; natural wear and tear
Genetics
Obesity - more wear and tear
Joint injury - if had lots injuries as younger
Occupation - phys one higher risk

A

What are the risk factors for osteoarthritis

25
Q

X-ray - diagnostic
MRI - diagnostic
CT scan - further look, diagnostic
May be slight increase in CRP (C reactive protein): inflammation

A

What diagnostic tests are used to diagnose osteoarthritis?

26
Q

Might need joint surgery if bad enough; just trying get them through
Medications
Rest - with exercise mixed in
Heat/Cold
Weight control - big

A

What are some non-surgical options?

27
Q

Acetaminophen
NSAIDS
Topical lidocaine patches
Steroid injections - prior to replacement to tide over - joint not last forever so hold on as long as can
Muscle relaxants

A

Medications - What are some non-surgical options?

28
Q

Postoperative care of a total knee replacement may include which of the following? (Select all that apply)
A. Hot compress to incisional area
B. Continuous passive movement (CPM) used immediately or several days post op
C. Ice packs to incisional area
D. Check CMS (circulation, movement, sensation)
E. Maintaining abduction

A

Answer: B, C, D
Do ice postop
Do abduction for hips

29
Q

The nurse is preparing an educational session for nursing students on the orthopedic unit. Which three signs of hip dislocation would be included? (Select all that apply)
A. Increased pain
B. Hip flexing at 45 degrees
C. Shortening of affected leg
D. Leg rotation
E. Skin breakdown near the incision

A

Answer: A, C, D

30
Q

Keep leg abducted - fixation device
Prevent hip flexion beyond 90 degrees - want move around tho

A

What interventions do we put in place to prevent this complication?

31
Q

Infection
Clot/DVT - not moving as much
Bleeding from surgery
Neurovascular compromise
Scar tissue formation - continuous passive motion machine - keep in motion

A

What are other complications in addition to hip dislocation?

32
Q

Position correctly
Hip: keep leg slightly abducted and prevent hip flexion beyond 90 degrees
Assess for pain, rotation, and extremity shortening

A

Dislocation: - Joint replacement (arthroscopy) complications

33
Q

Use aseptic technique for wound care and emptying of drains
Culture drainage fluid, if needed
Monitor temperature
Report excessive inflammation or drainage

A

Infection: - Joint replacement (arthroscopy) complications

34
Q

Use of sequential compression devices and/or compression hose
Teach leg exercises,
Encourage fluid intake,
Observe for signs of thrombosis (redness, swelling, or pain);
Administer anticoagulant as prescribed,
Do not massage legs if have clot - mobilize

A

Venous thromboembolism: - Joint replacement (arthroscopy) complications

35
Q

VS at least every 4 hours
Observe patient for bleeding
Assist with slow position changes

A

Bleeding and hypotension: - Joint replacement (arthroscopy) complications

36
Q

Check and document color, temperature, distal pulses, capillary refill, movement, and sensation
Compare the operative leg with the non-operative leg

A

Neurovascular compromise: - Joint replacement (arthroscopy) complications

37
Q

Continuous passive motion (CPM) machine
Keeps the knee in motion
Formation of scar tissue can decrease knee mobility and increase postoperative pain - need involve PT

A

Scar tissue formation (total knee arthroplasty): - Joint replacement (arthroscopy) complications

38
Q

Which interventions does the nurse encourage with a patient diagnosed with osteomalacia? (Select all that apply)
A. Increase intake of milk and enriched cereal
B. Drink 8 cups of coffee a day
C. Use of calcium supplement
D. Increase time outside
E. Use of vitamin B12 supplement

A

Answer: A, D
Rationale: loss of bone Caused by a vitamin D deficiency and causes the bones to soften

39
Q

Milk, eggs, swordfish, chicken, liver, enriched cereals and bread products

A

Increase vitamin D intake through diet - What interventions should be included?

40
Q

5 minutes each day

A

Daily sun exposure - What interventions should be included?

41
Q

Ergocalciferol
May need blood monitored

A

Vitamin D supplements - What interventions should be included?

42
Q

The nurse admits a patient diagnosed with Paget’s disease. The nurse anticipates that the patient will have which condition?
A. Progressive muscle weakness
B. Low body weight, thin build
C. Enlarged, thick skull
D. Bone infection

A

Answer: C
Rationale: Paget’s disease is a metabolic disease characterized by bones excessively breaking down and then being reformed. Bones are disorganized and weak. An Enlarged skull is a common sign.
When reformed are weaker because not same norm restructure
More at risk for fractures

43
Q

Bone and joint pain
Pathological fractures
Bowing of long bones
Enlarged, thick skull
There is an increased risk of bone cancer and fractures
Bones are overall weak
Goals of treatment: reduce pain, increase mobility and slow down bone resorption - help with Paget’s disease

A

What musculoskeletal changes does the nurse expect to find when assessing a patient with a history of Paget’s disease?

44
Q

NSAIDS, biphosphates, calcitonin
Heat, massage, exercise

A

Goals of treatment: reduce pain, increase mobility and slow down bone resorption - help with Paget’s disease

45
Q

Fever
Swelling
Erythema
Tenderness
Bone pain (constant, localized, pulsating and worse with movement)
Infection of bone and trying to avoid it

A

A patient is being admitted with possible osteomyelitis. What are the expected signs and symptoms?

46
Q

WBC - increase?
ESR (erythroctye sedimentation rate): inflamation
Blood cultures: +/not and see if gone into bone; couple days grow out to see bacteria

A

What labs should be ordered?

47
Q

IV antibiotics - long-period use
Wound care - source of infection: from wound and eventually into bone
Pain control - sig pain
Hyperbaric oxygen therapy (HBO) - helps with tissue perfusion; not work if lot of necrosis

A

What interventions should be included?

48
Q

Surgery - get rid necrotic tissue; debride

A

Used to increase tissue perfusion by exposing to high concentrations of oxygen

49
Q

What is more common, primary or secondary bone cancers?

A

Secondary is more common (metastasis from another site)

50
Q

Osteosarcoma is most common
Ewings sarcoma is most malignant
Age of onset is commonly 10-30 - younger
50% occur in the distal femur

A

Primary bone cancers

51
Q

Pain
Local swelling
Tender palpable mass is possible

A

What signs and symptoms do you expect when caring for a patient with bone cancer?

52
Q

Radiation
Chemotherapy
Possible Surgery

A

What are expected interventions?

AHI (77 decks)

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