Musculoskeletal Trauma, Problems and Diseases

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wiscflor
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12115
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Musculoskeletal Trauma, Problems and Diseases
Updated:
2010-03-27 00:38:47
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MS2 Exam 3
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MT
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  1. Condition caused by compressed median nerve beneath carpal ligament?
    Carpal Tunnel
  2. Most important factor about traction immobilization?
    NEVER INTERRUPT
  3. Skin vs Skeletal traction
    Skin - 5-10 pounds

    Skeletal - 5-45 pounds
  4. What is compartment syndrome?
    How is it relieved?
    Limited space issue from excessive swelling

    Fasciotomy
  5. Fracture result:
    People trying to break their fall.
    Colle's
  6. Fracture result:
    Can NOT cast because of the joints
    Humerus
  7. Fracture result:
    Can be opened or closed, can bleed out, and NO FOLEY
    Pelvis Fracture
  8. Fracture result:
    20% of patients die within the first year from secondary complications (DVT, PE, CVA)
    Hip Fracture
  9. Fracture results:
    Must have excellent pin care when using the stable devices
    Vertebral Fracture
  10. Fracture result:
    Usually caused by MVA, assaults and falls

    What is the primary issue?
    What is always at the bedside?
    Facial Fractures

    • Airway
    • Wire cutters
  11. Most common bacteria associated with osteomyelitis?
    Staphylococcus Aureus
  12. Osteomyelitis:
    Indirect vs Direct Entry
    Indirect - Blood borne infection

    Direct - Contamination from open fracture or surgery
  13. Osteomyelitis S/S:
    Local?
    Systemic?
    Chronic?
    Local - Unrelieved bone pain, swelling, tenderness and warmth

    Systemic - Fever, night sweats, chills, restlessness

    Chronic - Lasts more than 4 weeks, mix of local and systemic
  14. Osteochondroma vs. Osteosarcoma
    • Osteochondroma
    • Benign
    • Occurs in growth plate

    • Osteosarcoma
    • Malignant
    • Causes fractures
  15. What is a progressive muscle wasting with no known treatment?
    Muscular Dystrophy
  16. What is a slow, progressive non-inflammatory joint disorder?
    Osteoarthritis
  17. Osteoarthritis:
    Primary cause?
    Secondary cause?
    Primary - Idiopathic

    Secondary - Trauma, Overuse, Corticosteroid use
  18. Osteoarthritis treatment:
    First line?
    Second line?
    First - Tylenol and topical ointments

    Second - NSAID and Vioxx/Celebrex (can increase bleeding)
  19. What is an autoimmune disorder that causes deformation of the joints?
    Rheumatoid Arthritis
  20. Septic arthritis usually involves what joints?
    • Knee
    • Hip
  21. What is the most common site for gout?
    Big toe
  22. SLE is most common with what demographic?
    Women of child-bearing age

    (Often misdiagnosed and written off as fatigue)
  23. What is a non-degeneative, non-progressive and non-inflammatory problem?
    Fibromyalgia
  24. What autoimmune disease results in dry eye and dry mouth?
    Sjogren's Syndrome
  25. During assessment of the musculoskeletal system of a 74-year-old woman, a normal age-related finding noted by the nurse is

    1. loss of height.
    2. back pain.
    3. kyphosis.
    4. spinal crepitation.
    1. loss of height.
  26. X-rays indicate that a patient has a severely sprained ankle from a sports injury. When providing discharge instructions from the urgent care center, the nurse teaches the patient to

    1. apply continuous heat to the ankle for the first 24 hours and then continuous cold until the symptoms are relieved.
    2. use continuous cold for the first 24 hours and then continuous heat until the symptoms are relieved.
    3. alternate cold and heat for 30 minutes each until symptoms are relieved.
    4. apply cold for 20 to 30 minutes with breaks of 10 to 15 minutes during the first 2 days and then apply heat intermittently for 20 to 30 minutes.
    4. apply cold for 20 to 30 minutes with breaks of 10 to 15 minutes during the first 2 days and then apply heat intermittently for 20 to 30 minutes.
  27. The nurse determines that discharge teaching for the patient with a total hip replacement has been effective when the patient says,

    1. “I should keep my leg elevated above the level of my heart when I am sitting in a chair.”
    2. “It is necessary for me to use an elevated toilet seat at home.”
    3. “I need to perform as many activities of daily living for myself as I can to gain strength.”
    4. “Exercises for my leg include swinging my leg out and then across the other leg.”
    2. “It is necessary for me to use an elevated toilet seat at home.”
  28. The nurse teaches a 58-year-old patient who had an above-the-knee amputation how to care for the residual limb. Which of the following statements by the patient indicates that teaching was effective?

    1. “I should use only mild soap and water to clean the limb.”
    2. “I can apply lotion to the residual limb to keep the skin from cracking.”
    3. “Tincture of iodine or alcohol could be used to toughen the limb.”
    4. “I can elevate the residual limb on a pillow to prevent swelling when I am sitting or lying down.”
    1. “I should use only mild soap and water to clean the limb.”
  29. When caring for a patient following a lumbar laminectomy, the nurse should

    1. elevate the head of the bed 30 degrees and then turn the patient to the side.
    2. ask the patient to flex the knees and push the heels into the bed during turning.
    3. place a pillow between the patient’s legs before turning to the side.
    4. have the patient grasp the side rail on the opposite side of the bed to help with turning.
    3. place a pillow between the patient’s legs before turning to the side.
  30. The nurse determines that teaching about management of osteoarthritis of the feet and hands has been effective when the patient says,

    1. “I should exercise my hands every day, especially if they are painful and inflamed.”
    2. “I will be careful to avoid crowds and people with infections.”
    3. “I should avoid the use of glucosamine as it has been shown to have no therapeutic value.”
    4. “I can use heat to relieve the stiffness when I wake up in the morning.”
    4. “I can use heat to relieve the stiffness when I wake up in the morning.”
  31. A patient is undergoing diagnostic testing for symptoms of polyarthralgia, fatigue, and hair loss. Laboratory results include the presence of anti-DNA, antinuclear antibodies, and anti-Smith in the blood. The nurse recognizes that these findings are most likely to be related to

    1. rheumatoid arthritis.
    2. systemic lupus erythematosus.
    3. systemic sclerosis.
    4. chronic fatigue syndrome.
    2. systemic lupus erythematosus.
  32. Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus?

    1.Acute respiratory distress syndrome
    2.Migraine-like headaches
    3.Numbness in the right leg
    4.Muscle spasms in the right leg
    1.Acute respiratory distress syndrome
  33. The client who had an open femoral fracture was discharged to her home, where she developed fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg. The nurse interprets these findings as indicating which of the following?

    1.Pulmonary emboli
    2.Osteomyelitis
    3.Fat emboli
    4.Urinary tract infection
    2.Osteomyelitis
  34. The client in balanced suspension traction is transported to surgery for closed reduction and internal fixation of his fractured femur. When transporting the client to the operating room, which of the following would the nurse do?

    1.Transfer the client to a cart with manually suspended traction
    2.Call the surgeon to request an order for temporally removing the traction
    3.Send the client on his bed with extra help to stabilize the traction
    4.Remove the traction and send the client on a cart.
    3.Send the client on his bed with extra help to stabilize the traction
  35. Regardless of the type of cast material used, the nurse identifies a knowledge deficit when the client makes which of the following statements about the care of his cast?

    1.“I’ll leave the cast above my heart.”
    2.“I’ll exercise my joints above and below the cast.”
    3.“I can pull out cast padding to scratch inside the cast.”
    4.“I’ll apply ice for 10 minutes to control edema for the first 24 hours.”
    3.“I can pull out cast padding to scratch inside the cast.”
  36. Allopurinol is used to treat gout. The objective of therapy is to:

    1.Increase joint mobility
    2.Decrease synovial swelling
    3.Decrease uric acid production
    4.Prevent crystallization of uric acid
    3.Decrease uric acid production
  37. To control edema of the residual limb a week after a client has had an above-the-knee (AKA) amputation, the nurse should:

    1.Administer the prescribed diuretic
    2.Restrict the client’s oral fluid intake
    3.Rewrap the elastic bandage as necessary
    4.Keep the residual limb elevated on a pillow
    3.Rewrap the elastic bandage as necessary
  38. The nurse should explain to a client with a fractured hip that the chief reason for applying skin traction such as Buck’s traction before surgery is to:

    1.Relieve muscle spasm and pain
    2.Prevent contractures from developing
    3.Keep the client from turning and moving in bed
    4.Maintain the limb in a position of external rotation
    1.Relieve muscle spasm and pain
  39. Nursing care of a client with a fractured hip should include the assessment of pedal pulses. The important characteristics of pedal pulses are:

    1.Contractility and rate
    2.Color of skin and rhythm
    3.Amplitude and symmetry
    4.Local temperature and visible pulsations
    3.Amplitude and symmetry
  40. A regimen of rest, exercise, and physical therapy is ordered for a client with arthritis. This regimen will:

    1.Prevent arthritic pain
    2.Halt the inflammatory process
    3.Help prevent the crippling effects of the disease
    4.Provide for the return of joint motion after prolonged loss
    3.Help prevent the crippling effects of the disease
  41. At which of the following times would the nurse instruct the client to take Motrin, prescribed for left hip pain secondary to osteoarthritis to minimize gastric mucosal irritation?

    1.At bedtime
    2.On arising
    3.Immediately after a meal
    4.On a empty stomach
    3.Immediately after a meal
  42. When developing the plan of care for a client during the acute phase of rheumatoid arthritis, which of the following would the nurse identify as the HIGHEST priority?

    1.Relieving pain
    2.Preserving joint function
    3.Maintaining usual ways of accomplishing tasks
    4.Preventing joint deformity
    1.Relieving pain

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