NURS 317 Unit 6 Chapter 47 Flashcards
A nurse is teaching a client diagnosed with osteoarthritis about the joint capsule. Which statement made by the client indicates that teaching was successful?
A) “The menisci are fibrocartilaginous structures that produce synovial fluid.”
B) “The bursae are sac-like structures that sit between the articular cartilage surfaces.”
C) “The synovial fluid in my joint capsule acts as a lubricant and helps the movement of the joint’s articulating surfaces.”
D) “A moveable joint is called a synarthrosis
C) “The synovial fluid in my joint capsule acts as a lubricant and helps the movement of the joint’s articulating surfaces.”
Rationale:Synarthroses are joints in which bones are joined together by fibrous tissue, cartilage, or bone; they lack a joint cavity and have little or no movement. Synovial, or diarthrodial, joints are freely movable. The surfaces of the articulating ends of bones in synovial joints are covered with a thin layer of articular cartilage, and they are enclosed in a fibrous joint capsule. The joint capsule consists of two layers: an outer fibrous layer and an inner membrane, the synovium. The synovial fluid, which is secreted by the synovium into the joint capsule, acts as a lubricant and facilitates movement of the joint’s articulating surfaces. Bursae, which are closed sacs containing synovial fluid, prevent friction in areas where tendons are deflected over bone or where skin must move freely over bony tissue. Menisci are fibrocartilaginous structures that develop from portions of the articular disk that occupied the space between articular cartilage surfaces during fetal development. The menisci may have a free inner border, or they may extend through the joint, separating it into two cavities.
Which of the following covers bones and has an inner layer that contains osteoprogenitor cells?
A) Endosteum
B) Perichondrium
C) Fibrocartilage
D) Periosteum
D) Periosteum
Rationale:The periosteum covers the bones, except at their articular ends. The periosteum has an outer fibrous layer and an inner layer that contains osteoprogenitor cells. The endosteum is the membrane that lines the spaces of spongy bone, the marrow cavities, and the Haversian canals of compact bone. The pericondrium is a layer of fibrous connective tissue that covers the free surface of most hyaline cartilage. Fibrocartilage is found in intervertebral disks and in the symphysis pubis.
Which statements are true regarding the skeletal system? Select all that apply.
A) The skeleton relies on adipose tissue for cushioning.
B) There is a type of skeleton referred to as appendicular.
C) The skull is considered a part of the axial skeleton.
D) The skeletal system includes both bone and cartilage tissue.
E) Cartilage is prevalent in both prenatal and postnatal life.
B) There is a type of skeleton referred to as appendicular.
C) The skull is considered a part of the axial skeleton.
D) The skeletal system includes both bone and cartilage tissue.
E) Cartilage is prevalent in both prenatal and postnatal life.
Rationale:The skeletal system consists of the axial and appendicular skeletons. The axial skeleton, which is composed of the bones of the skull, thorax, and vertebral column, forms the axis of the body. The appendicular skeleton consists of the bones of the upper and lower extremities, including the shoulder and hip. The skeletal system contains both bone and cartilage tissue. Bones provide protection for internal organs and rigid support for the extremities. Cartilage provides for flexibility and cushioning of bony structures and for skeletal development in both prenatal and postnatal life.
A client asks the nurse if drinking more milk will prevent the release of calcium from her bones. The best response by the nurse would be that the release of calcium from the bone into the extracellular fluid is regulated by:
A) Phosphate
B) Parathyroid hormone
C) Vitamin D
D) Calcitonin
D) Calcitonin
Rationale:Calcitonin prevents the release of calcium from the bone into the extracellular fluid. One of vitamin D’s metabolites increases the intestinal absorption of calcium and promotes the actions of parathyroid hormone on resorption of calcium and phosphate from bone. Parathyroid hormone regulates the serum calcium levels and will pull it from the bone if serum levels are not maintained.
A client recently diagnosed with an injury to the articular cartilage of the knee asks the nurse how long it will take the injury to heal. Which statement is the best response from the nurse?
A) “Loss of cartilage may never fully heal.”
B) “You will need to see an orthopedic specialist in order to determine how long healing will take.”
C) “An injury to the articular cartilage will heal within 1 to 2 weeks.”
D) “Regeneration of most cartilage is slow. These injuries can take a long time to heal.”
D) “Regeneration of most cartilage is slow. These injuries can take a long time to heal.”
Rationale:Regeneration of most cartilage is slow. It is accomplished primarily by growth that requires the activity of perichondrium cells. In articular cartilage, which has no perichondrium, superficial injuries heal slowly
A basketball player fell awkwardly, which resulted in a tear to the anterior cruciate ligament (ACL). The school nurses will anticipate the player to exhibit which clinical manifestations? Select all that apply.
A) Large hematoma on the anterior knee surface
B) Intense pain
C) Immovable (locked) knee joint
D) Edema (swelling) of the knee
E) Abscess formation
B) Intense pain
D) Edema (swelling) of the knee
Rationale:Ligaments are pliable enough to permit movement at the joints, but they tear rather than stretch when exposed to excess stress. Torn ligaments are extremely painful and accompanied by local swelling. Torn ligaments do not form abscesses or large hematomas.
Which client reports would support a diagnosis of a torn ligament? Select all that apply.
A) Redness
B) Extreme pain
C) Coolness
D) Swelling
E) Tingling
B) Extreme pain
D) Swelling
Rationale:Torn ligaments are extremely painful and accompanied by local swelling. Redness is reflective of an infection; coolness is reflective of insufficient circulation; tingling is reflective of nerve involvement.
A client has tendonitis. What will the nurse teach the client about this disorder?
A) It is caused by overuse.
B) It is caused by ligaments rubbing on tendons.
C) It is caused by a bone fracture.
D) It is caused when tendons rupture
A) It is caused by overuse.
Rationale:Tendons have an outer connective tissue tube that is attached to the structures surrounding the tendon and an inner sheath that encloses the tendon. The space between the inner and outer sheath is filled with a fluid. Overuse of the tendon can result in tendonitis or inflammation of the tendon.
Magnetic resonance imaging of a client’s knee has revealed the presence of bursitis. The nurse should anticipate performing which intervention for bursitis?
A) Administering an antihistamine like diphenhydramine to minimize inflammation
B) Obtaining a surgical permit to repair the bursae
C) Placing an ice pack on the knee to decrease swelling
D) Applying Buck’s traction with 10-pound weights
C) Placing an ice pack on the knee to decrease swelling
Rationale:Bursae contain synovial fluid, and they exist to prevent friction on a tendon. They are necessary in areas where pressure is exerted because of close approximation of joint structures. Bursae may become injured or inflamed, causing discomfort, swelling, and limitation in movement of the involved area. Buck’s traction, diphenhydramine, and surgery are not the standard treatment for bursitis.
Which type of materials are not included in a cancellous bone? Select all that apply.
A) Cartilaginous
B) Soft
C) Densely calcified
D) Compact
A) Cartilaginous
C) Densely calcified
D) Compact
Rationale:A cancellous or spongy bone is made of material that is soft and light. Cancellous bone is not accurately described by the other options.
A client has developed increased resorption of bone with removal of mineral content. This is most likely the result of:
A) Osteocytes
B) Osteoclasts
C) Osteoblasts
D) Osteoprogenitors
B) Osteoclasts
Rationale:Osteoclasts are responsible for resorption of bone with removal of mineral content. Osteoprogenitor cells continually replace worn-out bone; osteocytes maintain bony structure; and osteoblasts are bone-building cells that secrete the bone matrix
The nurse is explaining to a client that there are “cushions” in his back to absorb any jarring movement of the spine. Which anatomical structure is the nurse referring to?
A) Tendons
B) Spinal fluid
C) Intervertebral disks
D) Vertebral foramen
C) Intervertebral disks
Rationale:Intervertebral disks are elastic fibrocartilaginous plates that are intermediate between dense connective tissue and hyaline cartilage, which cushion the spine like shock absorbers and help it move
A client with a history of osteoarthritis in his hip, which he refers to as “bad hip,” is also complaining of knee pain. The physiologic principle behind this would include the fact that:
A) if the hip is dislocated, then the knee is not staying in the correct alignment.
B) all joints of an extremity are innervated by the same peripheral nerves as they travel down the limb.
C) synovial tissue has received an injury that is referring pain to the knee.
D) there is more than likely a tear in the synovial membrane, which is impacting the amount of plasma diffusing between the vessels and the joint.
B) all joints of an extremity are innervated by the same peripheral nerves as they travel down the limb
Rationale:The nerve supply to joints is provided by the same nerve trunks that supply the muscles that move the joints. These nerve trunks also supply the skin over the joints. As a rule, all the joints of an extremity are innervated by the same peripheral nerves as they travel down an extremity. The blood supply to a joint arises from blood vessels that enter the subchondral bone at or near the attachment of the joint capsule and form an arterial circle around the joint. The synovial membrane has a rich blood supply, and constituents of plasma diffuse rapidly between these vessels and the joint cavity. Because many of the capillaries are near the surface of the synovium, blood may escape into the synovial fluid after relatively minor injuries. Healing and repair of the synovial membrane usually are rapid and complete. This is important because synovial tissue is injured in many surgical procedures that involve the joint.
A client with a spinal cord injury has experienced contractures and destructive changes in the joints of the lower extremities. The nurse determines which of the following is the most likely cause?
A) Joint swelling
B) Hypermobility of joints
C) Ligament and tendon damage
D) Loss of proprioception and reflex control of the muscles
D) Loss of proprioception and reflex control of the muscles
Rationale:The tendons and ligaments of the joint capsule are sensitive to position and movement, particularly stretching and twisting. These structures are supplied by the large sensory nerve fibers that form proprioceptor endings. Loss of proprioception and reflex control of muscular support lead to destructive changes in the joint.
Select the statement that best describes a synovial or diarthrodial joint. The joint:
A) is found only in the lower extremities.
B) is connected to bone by hyaline cartilage.
C) moves little or not at all.
D) moves freely.
D) moves freely.
Rationale:Synovial or diarthrodial joints are those that move freely and are located throughout the body. Synarthrosis joints are connected to the bone by hyaline cartilage and have little or no movement.
