Porth (2020) 5th nur 317 Flashcards
Chapter 48
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?
The knee will require immobilization for about 6 weeks to heal from this injury.
Strengthening exercises and a diet higher in calcium will heal the condition.
This is a lifelong inflammatory condition that should be treated with steroids.
Rest and isometric exercises followed by ice are effective treatment measures.
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 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?
Surgical amputation of the affected area
Surgical arthroplasty and parenteral antimicrobial agents
Elevate legs and treat with narcotic analgesics for the discomfort
Short-term administration of antimicrobials and rest for the affected area
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.
Which assessment abnormalities will the nurse find in a client who has patellar subluxation? Select all that apply
Crepitus
Increased mobility
“Popping” sound
Swelling
Stiffness
Crepitus,
“Popping” sound,
Swelling,
Stiffness
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.
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.
Swelling
Joint locking
Shortened left leg
Heat
Limited movement
False motion
Shortened left leg, Limited movement
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.
Which statements are true regarding bone remodeling? Select all that apply.
Osteoclasts gradually remove dead bone.
Spongy bone replaces compact bone around the fracture.
Remodeled bone resembles original, unbroken bone.
There is no visual evidence that identifies a remodeled bone.
Mineralized bone is present along the lines of the injury.
Osteoclasts gradually remove dead bone.,
Mineralized bone is present along the lines of the injury.
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.
What is the term use to describe a tumor that while growing slowly does not destroy the surrounding tissues?
Osteosarcoma
Ewing sarcoma
Malignant
Benign
Benign
Rationale:A benign tumor grows slowly and does not destroy or invade the surrounding tissues. The other options are malignant tumors that do invade surrounding tissues and structures.
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:
Thromboemboli
Fracture blisters
Compartment syndrome
Complex regional pain syndrome
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 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?
Strained ligament
Nerve impingement
Bone cancer
Fractured bone
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.
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.
Regular pin site care
Weight-bearing gait
Isometric exercises
Bivalving the cast
Neurovascular assessment
Regular pin site care,
Isometric exercises,
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.
A nurse is floated to orthopedics to help with new admissions following a major accident on the highway. While caring for one client, the nurse notes a change in behavior, some disorientation, shortness of breath and tachycardia. Suspecting fat embolism, the priority for the health care provider should include which intervention(s)? Select all that apply.
Administer corticosteroids stat
Begin oxygenation
Page respiratory therapist to draw arterial blood gases
Administer sedative medication to calm the client
Suction the lungs to try to remove the fat emboli
Administer corticosteroids stat,
Begin oxygenation,
Page respiratory therapist to draw arterial blood gases
Rationale:The important part of the treatment of fat emolism syndrome is early diagnosis. Arterial blood gases should be assayed immediately after change in clinical manifestations. Treatment is directed toward correcting hypoxemia and maintaining adequate fluid balance. Mechanical ventiliation may be required; however, oxygen is usually the first course of action. Corticosteroids are administered to decrease the inflammatory response of lung tissues, decrease the edema, stabilize the lipid membranes to reduce lipolysis, and combat bronchospasm.
What is the term used to refer to the failure of bone to heal before the process of bone repair stops?
Nonunion
Delayed union
Misunion
Malunion
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.
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.
Aseptic necrosis of a bone segment caused by interruption of the blood supply
Rationale:Osteonecrosis, also known as avascular necrosis, is an aseptic destruction of a segment of bone that is due to an interruption in blood flow rather than an infection. It is relatively common and can occur in the medullary cavity of the metaphysis and the subchondral region of the epiphysis, especially in the hips, knees, shoulders, and ankles. Destruction of bone frequently is severe enough to require joint replacement surgery.
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.
Excessive stretch of a muscle
Unusual muscle contraction
Tear of a ligamentous structure
Hyperextension of a muscle
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.
Using Oestern and Tscherne’s classification, how would a closed fracture that presented superficial abrasions and a mild fracture pattern be graded?
Grade 3
Grade 0
Grade 1
Grade 2
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.
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?
Fat embolism syndrome (FES)
Compartment syndrome
Osteomyelitis
Reflex sympathetic dystrophy
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.
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.
Thromboemboli
Closed greenstick fracture
Open spiral fracture
Closed comminuted fracture
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.
Which manifestations are associated with metastatic bone cancer of the spine? Select all that apply.
Pain resulting from nerve entrapment
Vertebrae that are easily crumbled
Localized bone pain that is worse at night
Pathologic fractures
Swelling at the affected site
Pain resulting from nerve entrapment, Vertebrae that are easily crumbled, Localized bone pain that is worse at night, 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.
What intervention will the nurse perform first for the client who has a new fracture of the leg?
Prepare the client for surgery
Teach the client about X-ray examination
Administer antibiotics
Teach the client to use crutches
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.
Which diagnoses in a client’s medical history increase the risk of osteonecrosis? Select all that apply.
Rheumatoid arthritis
Systemic lupus erythematosus
Sickle cell disease
Vasculitis
Osteoarthritis
Rheumatoid arthritis, Systemic lupus erythematosus, Sickle cell disease, Vasculitis
Rationale:Rheumatoid arthritis, sickle cell disease, lupus, and vasculitis are all possible causes of osteonecrosis (bone death). Osteoarthritis is not a known cause for this bone pathology.
A client is diagnosed with a strained back. Which instructions should the nurse provide to this client? Select all that apply.
Bend knees to pick up objects.
Reduce activity for a few days.
Take ibuprofen for pain.
Wear a back brace for 3 weeks.
Use heat for muscle pain.
Bend knees to pick up objects.,
Reduce activity for a few days.,
Take ibuprofen for pain.
Rationale:A strain should be treated with mild analgesics, a short period of rest, and a gradual return to activities. Ice packs can reduce pain and swelling of the affected area; exercises, correct posture, and good body mechanics can reduce the risk for reinjury.
