NURS 317 Unit 6 Path Chapter 48 Flashcards
A client with a compound fracture of the lower leg has a limb-lengthening system attached for stabilization. Which basic care activities can the nurse expect to provide? Select all that apply.
A) Bivalving the cast
B) Isometric exercises
C) Regular pin site care
D) Neurovascular assessment
E) Weight-bearing gait
B) Isometric exercises
C) Regular pin site care
D) Neurovascular assessment
Rationale:A limb-lengthening system is an external fixation device that can be used to stabilize complex fractures, allow for lengthening of shortened limbs, and provide access to care for soft tissue injuries. The device stays in place until the bone is healed. Pin site care to prevent infection is provided because pins inserted into the bone through the skin provide an access path for organisms. The device is not designed for weight-bearing activities, but clients should perform isometric exercises to promote muscle strength. Neurovascular assessment is important to monitor the health of the affected extremity. There is no cast involved in external fixation
What intervention will the nurse perform first for the client who has a new fracture of the leg?
A) Administer antibiotics
B) Teach the client to use crutches
C) Teach the client about X-ray examination
D) Prepare the client for surgery
C) Teach the client about X-ray examination
Rationale:The client who has a new fracture will need an X-ray exam to confirm the diagnosis and determine what treatment is necessary. This needs to be done before any other treatment.
A client presents to the emergency department after suffering an injury while playing sports. The client is diagnosed with a sprain. Select the best explanation of the injury.
A) Tear of a ligamentous structure
B) Unusual muscle contraction
C) Hyperextension of a muscle
D) Excessive stretch of a muscle
A) Tear of a ligamentous structure
Rationale:A sprain, which involves the joint ligaments or capsule surrounding the joint, resembles a strain, but the pain and swelling subside more slowly. It usually is caused by abnormal or excessive movement of a joint. With a sprain, the ligaments may be incompletely torn or, in a severe sprain, completely torn or ruptured. A strain involves hyperextension of a muscle, unusual muscle contraction, and excessive stretch of a muscle.
Which assessment abnormalities will the nurse find in a client who has patellar subluxation? Select all that apply
A) Stiffness
B) Crepitus
C) “Popping” sound
D) Swelling
E) Increased mobility
A) Stiffness
B) Crepitus
C) “Popping” sound
D) Swelling
Rationale:There is often a sensation that the patella is “popping” out when the dislocation occurs. Other findings include swelling, crepitus, stiffness, and loss of range of motion. Increased mobility would not occur.
The nurse is assessing a client who sustained a fractured radius. A cast was applied to the extremity approximately 1 hour ago, and the client is now complaining of increased pain and numbness to the finger tips. The client is most likely experiencing:
A) Fracture blisters
B) Compartment syndrome
C) Complex regional pain syndrome
D) Thromboemboli
B) Compartment syndrome
Rationale:Compartment syndrome occurs as a result of increased pressure within a limited space (e.g., abdominal and limb compartments) that compromises the circulation and function of the tissues within the space. The hallmark symptom of an acute compartment syndrome is severe pain that is out of proportion to the original injury or physical findings. Nerve compression may cause changes in sensation (e.g., paresthesias such as burning or tingling or loss of sensation), diminished reflexes, and eventually the loss of motor function. Fracture blisters are skin bullae and blisters. The complex regional pain syndrome or reflex sympathetic dystrophy is caused by involvement of nerve fibers.
A young adult client who is a competitive skier complains of knee pain when climbing stairs or sitting with the knees bent. What will the nurse teach the client about the diagnosis of chondromalacia?
A) The knee will require immobilization for about 6 weeks to heal from this injury.
B) This is a lifelong inflammatory condition that should be treated with steroids.
C) Rest and isometric exercises followed by ice are effective treatment measures.
D) Strengthening exercises and a diet higher in calcium will heal the condition.
C) Rest and isometric exercises followed by ice are effective treatment measures.
Rationale:Chondromalacia is softening of the articular cartilage, most often on the posterior surface of the patella in active young adults. Treatment includes rest, isometric strengthening exercises, and ice therapy after exercise. Surgery to remove the softened bone would be performed only after conservative therapy has not been successful.
A 16-year-old male football player suffered a fracture of his radius and ulna. Assessment of the fracture includes the following data: (1) the fracture does not protrude through the skin, and (2) both bones broke completely through into two pieces. Select the best description of the injury.
A) Closed greenstick fracture
B) Open spiral fracture
C) Thromboemboli
D) Closed comminuted fracture
D) Closed comminuted fracture
Rationale:Closed comminuted fracture is a closed fracture because it does not break through the skin. It is comminuted because it broke cleanly into two pieces. A closed greenstick fracture is a fracture that is a partial break in bone continuity, common in young children whose bones are not yet fully ossified. An open spiral fracture is a fracture that breaks through the skin. Thromboemboli is a clot, not a fracture.
Using Oestern and Tscherne’s classification, how would a closed fracture that presented superficial abrasions and a mild fracture pattern be graded?
A) Grade 3
B) Grade 0
C) Grade 1
D) Grade 2
C) Grade 1
Rationale:Superficial abrasions and a mild fracture pattern would be graded as grade 1. This is the only option that accurately grades the described wound.
Which manifestations are associated with metastatic bone cancer of the spine? Select all that apply.
A) Vertebrae that are easily crumbled
B) Swelling at the affected site
C) Pain resulting from nerve entrapment
D) Localized bone pain that is worse at night
E) Pathologic fractures
A) Vertebrae that are easily crumbled
C) Pain resulting from nerve entrapment
D) Localized bone pain that is worse at night
E) Pathologic fractures
Rationale:The major symptom of bone metastasis is pain in a specific bone area; this is validated with evidence of an impending pathologic fracture. It usually develops gradually, over weeks, and is more severe at night. Pain is caused by stretching of the periosteum of the involved bone or by nerve entrapment. The affected bone of the pathologic fracture appears to be eaten away on x-ray images; in severe cases, it crumbles on impact, much like dried toast. Observable swelling is not associated with bone metastasis.
Which statements are true regarding bone remodeling? Select all that apply.
A) Mineralized bone is present along the lines of the injury.
B) Remodeled bone resembles original, unbroken bone.
C) Osteoclasts gradually remove dead bone.
D) Spongy bone replaces compact bone around the fracture.
E) There is no visual evidence that identifies a remodeled bone.
A) Mineralized bone is present along the lines of the injury.
C) Osteoclasts gradually remove dead bone.
Rationale:During remodeling, dead portions of the bone are gradually removed by osteoclasts. Compact bone replaces spongy bone around the periphery of the fracture, and there is reorganization of mineralized bone along the lines of mechanical stress. The final structure of the remodeled area resembles that of the original unbroken bone; however, a thickened area on the surface of the bone may remain as evidence of a healed fracture.
A child tripped while running in the yard and reports pain with weight bearing. The next morning, the foot is swollen, discolored, and painful to touch and pressure of walking. About which problem will the health care provider likely be talking to the parents and the child related to this injury?
A) Nerve impingement
B) Bone cancer
C) Strained ligament
D) Fractured bone
D) Fractured bone
Rationale:The signs and symptoms of a fracture include pain, tenderness at the site, swelling, loss of function, deformity of the affected part, and abnormal mobility. If nerve impingment occurs, there will be numbness of the affected area. A sprain is a stretch or tear in a ligament. Ligaments are bands of fibrous tissue that connect bones to bones at joints. A strain is also a stretch or tear, but it happens in a muscle or a tendon. Signs and symptoms of bone cancer include bone pain, swelling and tenderness near the affected area, fatigue and unintended weight loss.
The nurse is caring for a client who sustained a femur fracture 3 days before. The nurse notes that the client, who was previously oriented, now doesn’t know where he is. The nurse suspects which condition?
A) Compartment syndrome
B) Reflex sympathetic dystrophy
C) Osteomyelitis
D) Fat embolism syndrome (FES)
D) Fat embolism syndrome (FES)
Rationale:The FES refers to multiple life-threatening manifestations from the presence of fat droplets in the small blood vessels of the lung, kidney, brain, and other organs after a long bone (femur) or pelvic fracture. Initial symptoms of FES begin to develop within a few hours to 3 to 4 days after injury. The first symptoms include subtle changes in behavior and signs of disorientation. Reflex sympathetic dystrophy represents soft tissue complications of musculoskeletal injuries. Compartment syndrome is a condition of increased pressure within a limited space. Osteomyelitis represents an acute or chronic infection of the bone.
What is the term used to refer to the failure of bone to heal before the process of bone repair stops?
A) Misunion
B) Malunion
C) Delayed union
D) Nonunion
D) Nonunion
Rationale:Nonunion is the term used to identify the failure of bone to heal before the process of bone repair stops. Delayed union refers to the failure of fracture to heal within predicted time. Malunion occurs when there is a deformity at the fracture site. Misunion is not a term generally used to identify complications of fracture healing.
A client sustains a musculoskeletal injury of the left hip. In addition to pain, which manifestations would the nurse expect to accompany a dislocation? Select all that apply.
A) Limited movement
B) Shortened left leg
C) Joint locking
D) Heat
E) False motion
Swelling
A) Limited movement
B) Shortened left leg
Rationale:Manifestations common among musculoskeletal injuries are pain and swelling. Differences arise from the type of injury. A dislocation occurs when the bone ends of a joint are separated. Symptoms include pain, deformity, and limited movement. Strains occur in muscles from overstretching and usually have no external evidence, but there is pain, stiffness, and swelling. Sprains occur when the ligaments supporting a joint are torn. Mild sprains involve only a few strands of the ligament, whereas a severe sprain can completely separate the ligament from the bone. Swelling, pain, heat, discoloration, and limited function are common signs of sprain. A fracture involves break in the integrity of a bone. Signs and symptoms of fracture include pain, tenderness at the site, swelling, loss of function, deformity, and abnormal mobility (or false motion), which occurs when the affected part bends across the break. A loose body is a small piece of bone or cartilage in the joint. It can cause catching and locking of the joint.
A 50-year-old male has been diagnosed with contiguous spread osteomyelitis of the right hip acetabulum. What would be an expected treatment for this condition?
A) Short-term administration of antimicrobials and rest for the affected area
B) Elevate legs and treat with narcotic analgesics for the discomfort
C) Surgical arthroplasty and parenteral antimicrobial agents
D) Surgical amputation of the affected area
C) Surgical arthroplasty and parenteral antimicrobial agents
Rationale:Treatment includes antibiotics and selective use of surgical interventions. Usually, antimicrobial agents are used prophylactically in persons undergoing bone surgery. For persons with osteomyelitis, early antimicrobial treatment—before there is extensive destruction of bone—produces the best results. The choice of agents and method of administration depend on the microorganisms causing the infection. Usually antibiotics are first given parenterally and then orally. If it does not respond to antibiotic therapy, surgical decompression is used to release intramedullary pressure and remove drainage from the periosteal area.
