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Orthopedic Nurse Certification Exam (25 Sets) Questions with Verified Answers,100% CORRECT
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Ortho certification Exam 99 Questions with Verified Answers,100% CORRECT
Ortho certification Exam 99 Questions with Verified Answers What is a major difference between osteo and rheumatoid arthritis - CORRECT ANSWER Osteoarth... [Show More] ritis is local versus systemic Which test is used for diagnosing osteoarthritis - CORRECT ANSWER X-rays Which describes joint crepitation - CORRECT ANSWER Grating sound What is a presenting symptom of hip osteoarthritis - CORRECT ANSWER Groin pain What is a Herberdens node - CORRECT ANSWER Osteophyte formation Which of the following is often found in degenerative disc disease - CORRECT ANSWER A normal physical exam Mrs. Rockwood is having more and more problems with her osteoarthritis her right shoulder and back have been really bothering her she enjoys housekeeping and takes pride in her clean house and is having difficulty getting it accomplished what would you suggest - CORRECT ANSWER Space the cleaning out throughout the week cleaning one room Per day Mrs. Rockford is prescribed physical and occupational therapy is to help with her pain. What information should the nurse include in teaching? - CORRECT ANSWER Take oral pain medication 45 minutes before your therapy session What is a management goal of osteoarthritis - CORRECT ANSWER Maintain joint function and mobility What is an advantage of NSAIDS WITH COX2 selectivity - CORRECT ANSWER Les G.I. toxicity Mrs. Myers a 57-year-old factory worker comes to the clinic complaining of right shoulder pain for two days. Denies trauma. Start of the day after she cleaned the kitchen cabinets. I sees her left hand to come her hair because of her pain. More bothersome at night and has had to sleep in a recliner for comfort. She's on Synthroid and has been on estrogen replacement for five years. She is prescribed NSAIDS what shows understanding - CORRECT ANSWER I should take it with food An MRI is ordered what should be included in pretest teaching - CORRECT ANSWER Remove all jewelry An MRI shows osteoarthritis and right shoulder what might be expected method of treatment - CORRECT ANSWER Heat or ice If surgery becomes an indication for a shoulder what would be a treatment goal - CORRECT ANSWER Improvement of function What is a surgical procedure for shoulder arthritis - CORRECT ANSWER Hemi arthroplasty What is a consideration of a complication of Osteoarthritis - CORRECT ANSWER Loss of joint function Mr. Baldwin has severe left shoulder arthritis related to repetitive heavy lifting at work. He wants conservative treatment not surgery. What is a likely treatment option for Mr. Baldwin - CORRECT ANSWER Corticosteroid injections Which of the following will Mr. Baldwin likely need since is left is his dominant arm - CORRECT ANSWER Therapy Mrs. Ray is a 62-year-old female admitted post shoulder arthroplasty the nurse is assisting her and placement of the sling how should the abduction sling be applied - CORRECT ANSWER Across the hips and slightly forward How long should someone wear a sling after post shoulder arthroplasty - CORRECT ANSWER 4 to 6 weeks What is a safety issue for those with upper extremity surgery - CORRECT ANSWER Ambulation. Because of balance Following a shoulder arthroplasty what can one accomplish with occupational therapy - CORRECT ANSWER ADLs After shoulder arthroplasty what indicates a need for further teaching regarding signs and symptoms of shoulder dislocation - CORRECT ANSWER I should not worry about decreased ability to move A patient is scheduled to have a cemented total shoulder arthroplasty. History includes sleep apnea obesity hypertension. Patient arrives with PCA patient states that she is in severe pain and doesn't want to push some buttons and the nurses instructed the patient on PCA use what is the next step - CORRECT ANSWER Call the doctor and make the suggestion for an NSAID an oral opioid What non-pharmacological modalities can a nurse use to help relieve pain from a total shoulder arthroplasty - CORRECT ANSWER Supports affected arm on with pillows How would you describe what a trapeze bar on the bed is. For a total shoulder patient - CORRECT ANSWER Using the trapeze bar allows you to move yourself around in bed by using only the unaffected arm What position after a total shoulder arthroplasty Should the shoulder be placed in - CORRECT ANSWER A sling Discharge teaching plan for a total left shoulder regarding future restriction - CORRECT ANSWER With nothing other than a glass with your affected hand If a patient feels they do not need to do exercises at home what is the best response - CORRECT ANSWER Exercises will help your arm become strong After a total left shoulder patient wants to know how she will perform her usual household duties what is the best intervention - CORRECT ANSWER Assist her and her family and the readjusting role expectations A diagnosis of herniated nucleus pulposus The etiology of this condition is likely from what - CORRECT ANSWER Degeneration of the disc What is now rarely used as a diagnostic for HNP since the availability of MRI - CORRECT ANSWER A myelogram After lumbar percutaneous discectomy and what must you do immediately postop - CORRECT ANSWER Logroll when turning An important nursing intervention in the postop. For a lumbar percutaneous discectomy - CORRECT ANSWER Perform frequent neurovascular checks Patient had two pain pills one hour ago and his IV pain medication ordered for breakthrough pain. The patient rates his pain seven out of 10 what else can be done - CORRECT ANSWER Give the IV pain medication The patient rings the call late for his pain medication exactly when it's due but does this most likely indicate - CORRECT ANSWER But his pain medicine is inadequate What should be included in discharge teaching for lumbar percutaneous discectomy - CORRECT ANSWER Proper body mechanics are essential in all activities Patient complains of numbness of the right lateral phi and top of the lower leg. He is unable to walk on his heels upon request which nerve root is likely affected - CORRECT ANSWER L5 L5 nerve root irritation is evidenced by - CORRECT ANSWER Sensory deficit in the lateral aspect of the thigh, anterior aspect of the lower leg, and the space between the great and second toes. Never deficit is noticed by week hip extensors difficulty with your walking we ankle inversion Sensory deficit in the medial forearm and diminished or absent and finger flexion would be what cervical level - CORRECT ANSWER C8 What is removed in a total knee replacement - CORRECT ANSWER The distal femur and proximal tibial bone A typical therapy of gold prior to discharge after a right total knee would be - CORRECT ANSWER Muscle strengthening To establish a diagnosis of osteoporosis a DEXA a scan may be completed how will this show osteoporosis - CORRECT ANSWER The bone density of the person will be compared to that of a healthy young adult and age matched adults Patient education regarding Actonel should include - CORRECT ANSWER After taking this medication you should remain in an upright position for at least 30 minutes Bio phosphonate should be taken - CORRECT ANSWER On an empty stomach 30 minutes before breakfast and then remain upright for at least 30 minutes If a patient has lactose intolerant they should be taught about non-dairy food sources of calcium what is a food source that has high calcium - CORRECT ANSWER One cup of spinach If a mother has osteoporosis a 50-year-old daughter is at risk for this condition what factors place her at an increased risk - CORRECT ANSWER Smoking cigarettes A 35-year-old patient that has intermittent swelling and pain in the joints of her hands feet and knees has been treating herself with non-steroid all anti-inflammatory drugs a friend who is a nurse suspects she might have rheumatoid arthritis based upon this early symptom - CORRECT ANSWER Fatigue. Rheumatoid arthritis usually begins gradually accompanied by systemic manifestations such as anorexia weight loss fatigue muscle aching and stiffness joints most commonly affected our fingers and wrist knees and feet Bloodwork or labs that would likely be elevated during a rheumatoid arthritis flare up would include - CORRECT ANSWER An elevation in ESR A newly diagnosed rheumatoid arthritis is typically given a non-steroid old anti-inflammatory drug and methotrexate because - CORRECT ANSWER It will help maximize the control of inflammation One of the most common side effects of methotrexate occur in which body system - CORRECT ANSWER Gastrointestinal Name the deformity th - CORRECT ANSWER Boutonniere deformity's PIP joint - CORRECT ANSWER Proximal interphalngeal D IP joint - CORRECT ANSWER Distal interphalangeal joint Hyper extension of the PIP joint with flexion of the metacarpal phalangeal in D IP joints - CORRECT ANSWER Swans neck deformity A patient who is on Coumadin after total knee what should the nurse instruct the patient about urine - CORRECT ANSWER Report tea colored urine immediately A 12-year-old patient experiences and Epicondyler fracture and a long arm cast as applied if the cast needs to be splint after application to allow for tissue swelling the nurse will buy them of the cast by splitting it in which direction - CORRECT ANSWER Medially and laterally The use of bucks traction is used to - CORRECT ANSWER Minimize muscle spasms A patient is placed in the CPM machine following a total knee arthroplasty he nurse recognizes one benefit of the CPM is decreased - CORRECT ANSWER Joint hemarthrosis Following application of a short arm cast the nurse will assess sensation and motion in the patient's digits numbness and tingling in between the thumb and index finger may indicate compromise of which nerve - CORRECT ANSWER Radial A patient receiving Mitroxantrone for treatment of an exacerbation of MS the nurse should be aware - CORRECT ANSWER The patient's urine may turn a blue green color and Initially A patient is diagnosed with osteoio osteoma The nurses able to confirm this is a benign tumor that - CORRECT ANSWER Causes night paying that can be relieved by aspirin The most common primary malignant bone tumor and children is the - CORRECT ANSWER Osteosarcoma greater occurrence in boys than girls A patient is diagnosed with slipped capital femoral epiphysis. The nurse recognizes this patient is at high-risk the normal of developing - CORRECT ANSWER Degenerative arthritis Patient teaching for Osgood Schlatter disease - CORRECT ANSWER Symptoms will stop by the end of skeletal growth this disease is self-limiting condition of preadolescence the symptoms stop when the epiphyses is fully ossified A type of implant that would be considered a biological implant - CORRECT ANSWER An allograft bone Which of the following nerves may sustain injury when the patient is placed in a lateral position and there is an adequate padding under the fibular head - CORRECT ANSWER Peroneal nerve The best way to evaluate balance is two says strength of the opposing muscle groups while using and performing what kind of measurement devices - CORRECT ANSWER Isometric measuring devices Extreme involves - CORRECT ANSWER Muscle or tendon trauma A sprain involves - CORRECT ANSWER Ligament trauma Most important therapeutic modality used in treating muscle strains is - CORRECT ANSWER Rest Antioxidants that protect the body from oxidation stress and provide nutritional support during times of increased activity - CORRECT ANSWER Vitamins BC and E Carb loading is important one to four hours prior to athletic performance which food is a good source of carbohydrates with low glycemic index - CORRECT ANSWER Apples Which substance has been been banned from used by participants and athletic events by the national sports regulating agencies - CORRECT ANSWER Cardiovascular and antihypertensives The best way to evaluate pounds is to sell strength of the opposing muscle groups are using performing which of the following - CORRECT ANSWER Isometric measuring device What is the difference between a strain and sprain - CORRECT ANSWER Strain involves muscle or tendon drama. Sprain is a ligament drama On exam patient complains of point tenderness and muscle spasms x-ray reveals no fracture patient unable to move ankle palpation reveals bolts at ankle what is the likely injury - CORRECT ANSWER 3rd° angle strain What is the most important treatment modality and treating muscle strains - CORRECT ANSWER Rest Cryotherapy decreases blood flow to the vessels by causing them to contract what should be known about cryotherapy - CORRECT ANSWER Cold compress should be maintained for 30 minutes on and 15 minutes off for 72 hours What should be taught regarding ace bandage wrapping - CORRECT ANSWER Should be applied tight enough to promote venous return When I'm tanning a history during evaluation of a sports injury why is the mechanism of injury important - CORRECT ANSWER Helps determine diagnostic imaging that would be helpful All strains are these type of injuries - CORRECT ANSWER Ligament injuries There are three grades of muscle injury what would a grade to muscle injury involved - CORRECT ANSWER 10 to 50% of muscle fibers are toward palpation reveals a defect of the muscle There are three grades of injury describing a ligament what would describe a grade one ligament injury - CORRECT ANSWER 0 to 20% of ligament fibers are torn What is a common characteristic of a stress fracture - CORRECT ANSWER Full and painless range of motion at the adjacent joints The apprehension test is used to test instability of what body part - CORRECT ANSWER The shoulder Lesions may be detected on x-ray of the shoulder following dislocation what is the name of the lesion on the glenoid rim - CORRECT ANSWER Bankhart Where is a hill Sachs lesion - CORRECT ANSWER Humeral head Where is a Bennett's lesion found - CORRECT ANSWER In an avulsion fracture of the hand Neurovascular assessment is important phone shoulder dislocation which artery may become impinged as a result of shoulder dislocation - CORRECT ANSWER Radial Dequervein tenosynovitis is caused by repetitive and forceful exertions of the wrist and hand which of the following test is positive in dequerveins tenosynovitis - CORRECT ANSWER Finkelstein's test. Owner deviation of hand and thumb flexed against Palm Gate used to comedy pain on weight-bearing - CORRECT ANSWER Antalgic PRICEMM - CORRECT ANSWER Rotator cuff repair will exhibit pain and which position - CORRECT ANSWER Abduction and external rotation Diagnosis of right full fitness rotator cuff pair what symptoms would be associated with this injury - CORRECT ANSWER Dropping on to waste upon passive abduction After rotator cuff repair for rehabilitation after the surgery is - CORRECT ANSWER 6 to 12 months Sensitive to touch stiffness at The elbow function is normal what is likely the problem with elbow - CORRECT ANSWER Medial epicondylitis Stiffness on the inside of the elbow is likely - CORRECT ANSWER Medial epicondylitis occurs with repeated stress on the muscle tendon units during pitching golfing results in pain and stiffness Tennis players are at risk for elbow problems a high risk for lateral epicondylitis - CORRECT ANSWER 40-year-old tennis player who plays daily [Show Less]
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Orthopedic Nursing review Course 234 Questions with Verified Answers,100% CORRECT
Orthopedic Nursing review Course 234 Questions with Verified Answers Rheumatoid Arthritis - CORRECT ANSWER * Systemic, Multi system inflammatory disorde... [Show More] r * Affects synovial membrane of the joints * Periods of exacerbation and remissions Rheumatoid Arthritis Presentation - CORRECT ANSWER * Uniform joint space narrowing * Peak onset ages 40-60 * Hypertrophied synovium (lining) thickens an invades surrounding tissue * Nodules in the joints * Morning Stiffness and stiffness after rest * Generalized fatigue * Ulnar deviation Rheumatoid Arthritis Epidemiology/Pathophysiology - CORRECT ANSWER * Genetic predisposition * Laxity, sublaxation and contractures Osteoarthritis - CORRECT ANSWER Slow, progressive, non-inflammatory Affects spine, fingers, knees and hips Osteophyte or bone spurs are common with what disease? - CORRECT ANSWER Osteoarthritis The gold standard test for this disease is radiographic changes - CORRECT ANSWER Osteoarthritis Symptoms Osteoarthritis - CORRECT ANSWER * Asymmetric joints * AM Stiffness * Stiffness with inactivity * Stiffness with weather changes * Antalgic gait-limp or giving way sensation * Joint crepitus * Knock kneed or bow-legged * Heberden's Nodes * Bouchard's Nodes Valgus knees is the same as - CORRECT ANSWER Knock knees Varus knees is the same as - CORRECT ANSWER Bow legged Heberden's Nodes are in what joint? - CORRECT ANSWER Distal (DIP) Bouchard's nodes are in what joint? - CORRECT ANSWER Proximal (PIP) This is the first drug of choice for treating Osteoarthritis - CORRECT ANSWER Acetaminopehn (Tylenol) Total Hip Arthroplasty: Anterior approach benefits and cons - CORRECT ANSWER Pro: less soft tissue disturbance Less precautions after SX 3-4 inch incision Cons: Technically challenging Anterior Hip precautions - CORRECT ANSWER * Avoid hip extension * Avoid external rotation Total Hip Arthroplasty: Posterior-Lateral approach benefits and cons - CORRECT ANSWER Pro: Tried and True method/Traditional Requires more physician training Cons: More precautions after SX 8-12 inch incision Posterior Hip Precautions - CORRECT ANSWER * No flexion > 90 degrees * No adduction * No internal rotation (leg crossing) Hip dislocation presentation - CORRECT ANSWER * Shortening/Rotation of affected extremity * Pain with inability to bear weight How many vertebae are in the C spine? - CORRECT ANSWER 7 How many vertebrae are in the T spine? - CORRECT ANSWER 12 How many vertebrae are in the L spine? - CORRECT ANSWER 5 How many vertebrae are in the S spine? - CORRECT ANSWER 5 What is a herniated nucleus pulposis (HNP)? - CORRECT ANSWER The rupture of a disc in the spine * the rupture causes leaking with pain and pressure What are signs and symptoms of a herniated disc? - CORRECT ANSWER * Back Pain-increased with sitting/driving *Lower extremity pain with numbness * Muscle weakness -nerve distribution * Pain with the straight leg raise test What is the classic test to determine herniated disc? - CORRECT ANSWER Straight Leg Raise What is the gold standard conservative treatment for a herniated disc? - CORRECT ANSWER * Bed rest-Max of 3 days What are the symptoms of Cauda Equina Syndrome? - CORRECT ANSWER * New onset of bowel or bladder incontinence * Numbness in the saddle area or perineum What is the cause of Cauda Equina Syndrome? - CORRECT ANSWER Pressure on the plexus nerve in the lumbar spine What is the treatment for Cauda Equina Syndrome? - CORRECT ANSWER Immediate decompressive laminectomy This spinal disorder is a Pars Interarticularis defect? - CORRECT ANSWER Spondylolysis This spinal disorder is an anterior translation of one vertebra on another (or slipped forward)? - CORRECT ANSWER Spondylolisthesis This is a posterior hump in the thoracic spine - CORRECT ANSWER Kyphosis This spinal disorder is associated with Scheurmann's Disease, is neuromuscular and presents with ankylosing spondylitis? - CORRECT ANSWER Kyphosis What does NPO mean? - CORRECT ANSWER Nil Per Os/Nothing by mouth What is the standard time frame for a patient to be NPO prior to SX? - CORRECT ANSWER 6 hours What are the main allergies that should be checked for prior to SX? - CORRECT ANSWER Shellfish * Bedadine * Seafood * Medications * Metal * Latex This SX associated condition can occur do to the following: IV access, blood loss, fluid overload, urine output - CORRECT ANSWER Fluid Volume Deficit This condition is an inherited hypermetabolic syndrome? - CORRECT ANSWER Malignant hyperthermia Triggers for Malignant hyperthermia are: - CORRECT ANSWER * Neuromuscular blocking agents-SUCCINYLCHOLINE * Certain anesthetic agents What is the first drug of choice for treating malignant hyperthermia? - CORRECT ANSWER Dantrolene What are the 7 drugs treatments for malignant hyperthermia? - CORRECT ANSWER 1) Dantrolene 2) Ice IV Saline solution 3) Ice bags around patient 4) Gastric/rectal lavage 5) Lab work 6) Malignant hyperthermia cart 7) Hotline # 1-800-MHHYPER What are standard time frames for nosocomial surgical site infections to occur? - CORRECT ANSWER * Within 30 days follwing SX * Up to 1 year if an implant is placed When using a tourniquet to exsanguinate blood, how long should it be left in place? - CORRECT ANSWER 90-120 minutes Osteosarcoma is a tumor that arises from what structure? - CORRECT ANSWER Bone Chondrosarcoma is a tumor that arises from what structure? - CORRECT ANSWER Cartilage What are the most common areas of the body for osteosarcoma tumor formation? - CORRECT ANSWER Distal femur and proximal tibia * jaw, shoulder, hip and knee are other common areas Chondrosarcomas are most commonly found in what areas of the body? - CORRECT ANSWER Femur and Pelvis This type of sarcoma accounts for 16% of primary bone cancers? - CORRECT ANSWER Ewing's Sarcoma Ewing's Saromas are typically found in what areas of the body? - CORRECT ANSWER Long bones * legs, arms, ribs, pelvis and spine This tumor stage is a low-grade cell, totally within the bone with no metastasis? - CORRECT ANSWER IA This tumor stage is a low-grade cell, but has grown through the wall of the bone with no metastasis? - CORRECT ANSWER IB This tumor stage is a high-grade cell and is totally within the bone with no metastasis? - CORRECT ANSWER IIA This tumor stage is a high-grade cell but has grown through the wall of the bone with no metastasis? - CORRECT ANSWER IIB This tumor stage is when the caner is any grade and has metastasized? - CORRECT ANSWER III This CA treatment is used preoperatively to shrink bone tumors to facilitate resection? - CORRECT ANSWER Chemotherapy Common side effects of this treatment include: * Stomatitis * Anemia * Nausea/vomiting * Alopecia * Neutropenia * Thrombocytopenia * Neuropathy * Diarrhea/consitpation - CORRECT ANSWER Chemotherapy When faced with amputation of a limb do to a cancerous tumor, what is the golden rule regarding saving the limb? - CORRECT ANSWER Life over limb The most common metabolic bone abnormalities are caused by what? - CORRECT ANSWER Abnormal quantities of minerals such as Calcium, and Phosporous Cells used in bone formation: This cell builds bone - CORRECT ANSWER Osteoblasts Cells used in bone formation: This cell takes away bone (chewers) - CORRECT ANSWER Osteoclasts Cells used in bone formation: These cells maintain normal bone and mineral levels - CORRECT ANSWER Osteocytes This vitamin is important for immune system function, decreases inflammation regulates genes and cells and promotes insulin sensitivity? - CORRECT ANSWER Vitamin D These 2 hormones increase serum calcium? - CORRECT ANSWER * Parathyroid hormone * Calcitirol This hormone is the primary regulator of serum calcium levels? - CORRECT ANSWER Parathyroid hormone This condition triggers the rapid release of PTH from the parathyroid? - CORRECT ANSWER Hypocalcemia This medication is the only medication on the market to build bone? - CORRECT ANSWER Fortaoe This condition effecting the thyroid occurs as a result of too much calcium? - CORRECT ANSWER Primary Hyperparathyroidism (PHPT) This condition effecting the thyroid occurs as a result of not enough calcium? - CORRECT ANSWER Secondary Hyperparathyroidsim (SHPT) Signs and symptoms of Hyperparathyroidism are caused by hypercalcemia, what are the signs and symptoms? - CORRECT ANSWER * Stones-Renal stones * Bones-Diffuse bone & joint pain; fractures * Abdominal Groans-Constipation, ABD pain, Pancreatitis, ulcers. * Moans- Easily fatigued * Psychiatric Overtones-Cognitive decline, confusion Diagnosing Hyperparathyroidsim: A serum calcium level > than ? - CORRECT ANSWER 10 mg/dl Diagnosis Hyperparathyroidsim: These things upon testing are indicative of Hyperparathyroidism - CORRECT ANSWER * Serum Calcium > 10 mg/dl * Increase in urinary calcium excretion in 24 hr urine test * Increase in alkaline phosphates * Increase in PTH Radioimmunoassay * Decrease DEXA bone density What are conservative treatment measures for Hyperparathyrodism? - CORRECT ANSWER * Adequate hydration * Avoid thiazide diuretics * Adequate Calcium intake What is the Surgical treatment option for Hyperparathyroidsim? - CORRECT ANSWER Parathyroidectomy-Remove the adenoma and leave 1/2 of the lobe for calcium production. Why is it important to leave 1/2 the lobe when having a parathyroidectomy? - CORRECT ANSWER It is needed for calcium production This thyroid condition is usually caused by damage to the parathyroid during surgery, or by some malabsorption disorders? - CORRECT ANSWER Hypoparathyroidism What are the signs and symptoms of Hypoparathyroidism? - CORRECT ANSWER * Muscle spasm/tetany/excitability * Increase in deep tendon reflexes * Dry skin/hair loss * Weakened tooth enamel Diagnosis Hypoparathyroidism: What are lab tests that are indicative of Hypoparathyroidsm? - CORRECT ANSWER * Decrease serum Calcium * Increase Serum Phosphorus * Decrease in PTH * Decrease in Vitamin D * Decrease in urinary Calcium * Increased bone density due to retained calcium What is an acute sign of Hypoparathyroidism? - CORRECT ANSWER Hypocalcemia=Tetany The goal of emergent management of Hypoparathyroidism is to prevent what? - CORRECT ANSWER Prevent Laryngeal spasms, tetany and seizures What medications should be given to emergently control Hypoparathyroidism? - CORRECT ANSWER * IV Calcium Gluconate * Chloride What are some long term Hypoparathyroid management treatments? - CORRECT ANSWER * Lifelong vitamin D therapy * Lifelong Calcium supplements * Muscle relaxants to control spasm This condition is abnormal bone mineralization? - CORRECT ANSWER Osteomalacia Osteomalacia is most commonly due to a disturbance of what vitamin? - CORRECT ANSWER Vitamin D What are the common risk factors for Osteoporosis? - CORRECT ANSWER * Sedentary Lifestyle * Vitamin D and Calcium deficiencies * Excessive alcohol use * Medications: Corticosteroids, antacids, anti-convulsants (Dilantin) Diagnosing Osteoporosis: What key laboratory testing results that indicate Osteoporosis? - CORRECT ANSWER * Increase in 24 hr urine Calcium * Biochemical markers of bone resorption What are the ranges for normal bone density scans? - CORRECT ANSWER +1 to -1 This surgical treatment for Osteoporosis consists of bone cement being injected through the pedicles to the vertebral body? - CORRECT ANSWER Vertebroplasty This surgical treatment for Osteoporosis consists of inflating the bladder of the vertebral body and injecting cement into the vertebral body? - CORRECT ANSWER Kyphoplasty This disease is also known as Osteitis Deformans (Bone Deformity)? - CORRECT ANSWER Paget's Disease This disease is classified by accelerated and abnormal bone remodeling, large irregular shaped bones and fragile bones? - CORRECT ANSWER Paget's Disease This condition associated with Paget's Disease causes a hearing deficit (conductive hearing loss)? - CORRECT ANSWER Acoustic Neuroma Paget's Disease causes a bizarre appearance of bones, what is the appearance? - CORRECT ANSWER Mosaic Pattern This condition in sudden in onset, generally involves one joint and causes Urate crystal nodules (tophi) - CORRECT ANSWER Gout What are self management approaches to gout? - CORRECT ANSWER * Hydration > 2 liters * Weight reduction * Weight bearing restrictions in the acute phase What are pharmacologic treatments for gout? - CORRECT ANSWER * NSAIDS-Indometicin * Colochicine * Allopurinol * Probenecid * Oral glucocorticosteriod * Febuxostat What joint does Gout normally present in? - CORRECT ANSWER MTP * 1st metetarsal This disease is tick borne? - CORRECT ANSWER Lyme Disease What is a sign of early presentation of Lyme Disease? - CORRECT ANSWER Distinct Skin rash with local lesions * HX of walking through woods What is the first stage of Lyme Disease? - CORRECT ANSWER * Erythema Migran (bulls eye) rash 7-10 days * Headache/fever/malaise * TX with antibiotics Late stage presentation of Lyme Disease - CORRECT ANSWER * Chronic arthritis * Bells Palsy * Poor Memory What is the gold standard test for diagnosing Lyme Disease? - CORRECT ANSWER The ELISA screen for antibodies How is Lyme Disease treated? - CORRECT ANSWER Antibiotics * PNC and Rocephin This condition is linked to the HLA-B27 gene? - CORRECT ANSWER Ankylosing Spondylitis What are clinical presentations of Ankylosing Spondylitis? - CORRECT ANSWER * HX of dull achiness with stiff neck or back * Ascending stiffness of the spine (starts at the bottom) * Fatigue and impaired sleep What are common signs and symptoms of Psoriatic Arthritis? - CORRECT ANSWER * Sausage digits * Asymmetric swelling/erythema * Pitted/discolored nails * Scaly lesions on knees/elbows/trunk Systemic Sclerosis is also known as? - CORRECT ANSWER Scleroderma What is the clinic presentation of Systemic Sclerosis? - CORRECT ANSWER C-Calcinosis (calcium deposits under the skin) R-Raynaud's Phenomenon (digits feel numb& cold) E-Esophageal Dysfunction S-Sclerodactyly (tightening of skin) T-Tenangiectasia (dilated blood vessels) 2 out of the 5 symptoms confirm the disease What is the treatment for Systemic Sclerosis? - CORRECT ANSWER * No cure * Stop smoking * Skin and dental care * Physical therapy This disease is an inflammatory myopathy of the skeletal muscle? - CORRECT ANSWER Polymyositis/Dermatomyositis What are signs of Polymyositis? - CORRECT ANSWER * V-shaped rash on neck or chest * Falls unrelated to balance * Heliotrope Rash This is the most classic and profound symptoms of Systemic Lupus Erythematosus? - CORRECT ANSWER Butterfly rash on face Other symptoms of Systemic Lupus are? - CORRECT ANSWER * Photosensitivity * Arthritis * Fever * Anemia * Joint Pain * Hair Loss * Ulcers in Mouth What are treatment options for Systemic Lupus? - CORRECT ANSWER * No Cure * NSAIDS * Plasmaphoresis * Biologics Pain at 11 out of 18 tender points on the body confirms what diagnosis? - CORRECT ANSWER Fibromyalgia The treatment for this condition involves wearing shoes on the wrong feet and serial casting in severe childhood cases - CORRECT ANSWER Metatarsus Adductus Genu Valgus is also known as what? - CORRECT ANSWER Knock knees Genu Valgus is common in what age group? - CORRECT ANSWER 3-5 years old Improves by age 7 Genu Varus is also known as what? - CORRECT ANSWER Bow legged Genu Varus can spontaneously resolve by what age? - CORRECT ANSWER 18-24 months What is the key measurement for Genu Valgus and Genu Varus presentation? - CORRECT ANSWER 2.5 cm This disease is common in pole vaulters and runners? - CORRECT ANSWER Osgood-Schlatter Disease This disease involves a palpable lump at the tibia tubercle and pain with forced knee flexion/extension? - CORRECT ANSWER Osgood-Schlatter Disease This disorder is common in children < 3 years, mainly effects females and common in the first born? - CORRECT ANSWER Developmental Dysplasia of the Hip (DDH) This disorder presents as problematic diapering, a leg length discrepancy and unequal skin folds? - CORRECT ANSWER Developmental Dysplasia of the Hip (DDH) This test requires the hip to be pushed out posteriorly? - CORRECT ANSWER Barlow's This test is also known as the "click test" with hip abduction and lifting to reduce the hip? - CORRECT ANSWER Ortolani's Nursing care for Developmental Dysplasia of the Hip includes this method? - CORRECT ANSWER C-Criculation M-Movement S-Sensation T-Temperature Cast syndrome is also known as? - CORRECT ANSWER Superior Mesenteric Artery Syndrome What are the signs and symptoms of Superior Mesenteric Artery Syndrome? - CORRECT ANSWER Feeling of fullness/Abd distention Nausea/Vomiting Dehydration Nursing care measures to prevent Superior Mesenteric Artery Syndrome? - CORRECT ANSWER Turn frequently Small frequent meals Avascular Nerosis of the Femoral Head is also known as? - CORRECT ANSWER Legg Calve Perthes Disease This condition is the posterior displacement of the proximal femoral epiphysis? - CORRECT ANSWER Slipped Capital Femoral Epiphysis When diagnosing Slipped Capital Femoral Epiphysis, what does the x-ray look like? - CORRECT ANSWER Ice cream off the cone This form of scoliosis is the most common and has familial tendencies? - CORRECT ANSWER Idiopathic This form of scoliosis is a malformation of the bony vertebral segments? - CORRECT ANSWER Congenital This form of scoliosis involves paralysis of the trunk muscles and a HX of Cerebral Palsy or Muscular Dystrophy? - CORRECT ANSWER Neuromuscular/Paralytic What degree of scoliosis curvature requires just observation? - CORRECT ANSWER <20 degrees What degree of scoliosis curvature requires a TLSO brace? - CORRECT ANSWER 20-40 degrees What degree of scoliosis curvature requires surgical fixation? - CORRECT ANSWER >40 degrees Osteogenesis Imperfecta is also known as? - CORRECT ANSWER Brittle Bone Disease What are signs of Osteogenesis Imperfecta? - CORRECT ANSWER Blue Sclera Shepherd crook deformity Deafness Dentinogesis Thin, translucent skin VonRecklinghausen is also known as? - CORRECT ANSWER Neurofirbromatosis Cafe-au-lait spots are associated with which form of Neurofibromatosis? - CORRECT ANSWER VonRecklinghausen Vestibular Neurofibromatosis is associated with what nerve damage? - CORRECT ANSWER 8th cranial nerve 8th cranial nerve damage from Vestibular Neurofibromatosis causes what? - CORRECT ANSWER Deafness/Acoustic neuromas This motor disorder is the result of hypoxia to the brain? - CORRECT ANSWER Cerebral Palsy What are the three types of Cerebral Palsy? - CORRECT ANSWER Spastic-Cortial Tract Dyskinetic-Athetoid Ataxic-Cerebellum What are the three main lab studies used in diagnosing Cerebral Palsy? - CORRECT ANSWER Barium Swallow EEG Gait analysis This condition is a neural tube defect? - CORRECT ANSWER Myelomeningocele-Spina Bifida What are the issues with neural tube defects? - CORRECT ANSWER Spinal malformation Lumbar spinous processes fail to fuse 90% hydrocephalus Spina Bifida presentation includes? - CORRECT ANSWER Latex allergy Insensative skin-watch water temperature This form of Muscualr Dystrophy is the most common form? - CORRECT ANSWER Duchene's Duchene's Muscualr Dystrophy presentation? - CORRECT ANSWER + Gower's sign-climbing up the body with hands to stand. Loss of independent ambulation How is Muscular Dystrophy diagnosed? - CORRECT ANSWER Muscle biopsy This disease is a demyelination of axons in the brain and spinal cord? - CORRECT ANSWER Multiple Sclerosis What are presentation signs of Multiple sclerosis? - CORRECT ANSWER Episodic global neurological symptoms Ataxia Fatigue Cognitive impairment Bowel and bladder issues How is Multiple Sclerosis Diagnosed? - CORRECT ANSWER MRI showing plaques Spinal Tap Evoked potentials This condition is an autoimmune Neuromuscular disorder commonly effecting the eyes? - CORRECT ANSWER Myasthenia Gravis What are symptoms of Myasthenia Gravis? - CORRECT ANSWER Fluctuating muscle weakness-gittery eyes Limb/axial muscles This height is the height in which half of all humans will die from falling? - CORRECT ANSWER 35 feet An adult should go to a trauma center is they fall from this minimum height? - CORRECT ANSWER 20 feet or 2 stories Injuries from MVCs are from 3 separate impacts, what are they? - CORRECT ANSWER Vehicle strikes object Occupant collides with the inside of the vehicle Occupants internal organs collide with the rigid of the body Mild pain is generally rated as this number out of 10 - CORRECT ANSWER 0-3 Moderate pain is generally rated as this number out of 10 - CORRECT ANSWER 4-6 Severe pain is generally rates as this number out of ten - CORRECT ANSWER 7-10 Salter-Harris pediatric fracture classifications: This Grade of fracture is straight across the bone? - CORRECT ANSWER Grade I Salter-Harris pediatric fracture classifications: This grade of fracture is above the physis (Away from the joint)? - CORRECT ANSWER Grade II Salter-Harris pediatric fracture classifications: This grade of fracture is lower or below the physis? - CORRECT ANSWER Grade III Salter-Harris pediatric fracture classifications: This grade of fracture is through the metaphysis/physis/epiphysis? - CORRECT ANSWER Grade IV Salter-Harris pedicatric fracture classifications: This grade of fracture is rammed or compressed? - CORRECT ANSWER Grade V SALTR in pediatric fracture classifications is used to remember grade levels. What does each letter stand for? - CORRECT ANSWER S-Stright across A-Above the physis or away from the join L-Lower or below the physis T-Through any of the physes R-Rammed or compressed What are skin breakdown concerns with casting? - CORRECT ANSWER Inadequate padding Foreign objects being placed in the cast What is the major concern when using a spica or full body cast? - CORRECT ANSWER Cast syndrome What is cast syndrome? - CORRECT ANSWER Compression of the third or transverse nerve portion of the duodenum between the aorta and the superior mesenteric artery What is compartment syndrome? - CORRECT ANSWER An intramuscular pressure in a confined space brought on by trauma or over activity What does compartment syndrome do? - CORRECT ANSWER Impedes blood flow and function of tissues within the confined space. Causes neuromuscular compromise There are how many anatomic compartments in the body? - CORRECT ANSWER 46 How many anatomic compartments are in the extremities of the bday? - CORRECT ANSWER 36 What are the early signs of compartment syndrome? - CORRECT ANSWER Pain Pressue Pallor What are the late signs of compartment syndrome? - CORRECT ANSWER Parasthesia Paralysis Pulselessness This condition is a mechanical blockage of blood vessels by circulating fat particles? - CORRECT ANSWER Fat emboli When/where are fat emboli most likely to occur? - CORRECT ANSWER Long bone fractures Pelvic fractures Total hip arthroplasty Signs and symptoms of a fat emboli are? - CORRECT ANSWER Change in mental status Respiratory distress Petechiae of skin & mucosa above the nipple line These types of dislocations are considered an orthopedic emergency? - CORRECT ANSWER Elbow Knee This type of amputation has the best success of re-implant? - CORRECT ANSWER Guillotine This velocity GSW causes lacerations and crushing injuries with no exit wound? - CORRECT ANSWER Low velocity This velocity GSW passes through the body causing entry and exit wounds? - CORRECT ANSWER High velocity This syndrome is also known as Regional Sympathetic Dystrophy? - CORRECT ANSWER Complex Regional Pain Syndrome Complex Regional Pain Syndrome is characterized by what symptoms? - CORRECT ANSWER Pain and tenderness associated with vasomotor instability. Skin changes Rapid development of bone demineralization:osteoporosis What is the clinical presentation of Complex Regional Pain Syndrome? - CORRECT ANSWER Intense burning pain that s out of proportion to injury. Unable to tolerate light tough Unable to tolerate weight of sleeves and pants When assessing a client with a fractured extremity, the assessment should focus on which area of the fracture? - CORRECT ANSWER The distal area What other injury should you assess for with an anterior shoulder dislocation? - CORRECT ANSWER Brachial Plexus Injury What type of fracture compromises 90% of distal radius fractures? - CORRECT ANSWER Colle's Fracture (wrist) This type of fracture is a "dinner fork" deformity or, fracture of the distal radius with dorsal angulation? - CORRECT ANSWER Colle's fracture (wrist) During a sensory exam, the axillary nerve can be assessed where? - CORRECT ANSWER Lateral Deltoid During a sensory exam, the radial nerve can be assessed where? - CORRECT ANSWER Web space between the thumb and index finger During a sensory exam, the median nerve can be assessed where? - CORRECT ANSWER Tips of the thumb, index and long fingers During a sensory exam, the ulnar nerve can be assessed where? - CORRECT ANSWER Tips of the ring and small fingers This is the only artery that supplies blood to the forearm? - CORRECT ANSWER Brachial This is the only artery that supplies blood to the leg? - CORRECT ANSWER Popliteal This is defined as a traumatic injury to a muscle or tendon? - CORRECT ANSWER Strain This grade of strain is characterized by stretching of a tendon, possible micro-tears of fibers, mild pain and possible swelling? - CORRECT ANSWER Grade 1 This grade of strain is characterized by some tearing of a tendon or muscle fibers, moderate pain with swelling and ecchymosis? - CORRECT ANSWER Grade 2 This grade of strain is characterized by complete rupture of a tendon or muscle fibers, severe pain with swelling and ecchymosis? - CORRECT ANSWER Grade 3 This injury is defined as traumatic injury to a joint when ligaments supporting it are overstretched or torn? - CORRECT ANSWER Sprain Sprains are caused by what? - CORRECT ANSWER A sudden twisting or hyperextension of the joint This grade of sprain is involves a stable joint with stretching of a ligament and possible micro-tears of fibers? - CORRECT ANSWER Grade 1 This grade of sprain involves minimal or no joint stability with some tearing of ligamentous fibers? - CORRECT ANSWER Grade 2 This grade of sprain involves an unstable joint and a complete rupture of the ligament? - CORRECT ANSWER Grade 3 This type of injury is caused by a sudden direct blow to one side of the head? - CORRECT ANSWER Brachial Plexus Injury Clinical presentation of a brachial plexus injury includes? - CORRECT ANSWER Numbness, tingling and weakness of upper extremities Conservative treatment for a brachial plexus injury includes? - CORRECT ANSWER Ongoing weekly NV exam until WNL What is a +Painful Arc? - CORRECT ANSWER Pain with active abduction 60-120 degrees What is a +Impingement Sign? - CORRECT ANSWER Abduction 90 degrees and internal rotation What is a +Hawkins Test? - CORRECT ANSWER Forward flexion 90 degrees and internal rotation What is a +Drop Arm Test? - CORRECT ANSWER Indicates complete rotator cuff tear What is conservative treatment for a rotator cuff injury? - CORRECT ANSWER P-RICE-MM Physical Therapy Cortisone injections of chronic What is clinical presentation of Shoulder Instability? - CORRECT ANSWER + Apprehension and relocation test-anterior instability +Sulcus sign-inferior instability What is the mechanism of injury for AC Joint Separation? - CORRECT ANSWER Fall on out stretched arm This condition is also known as golfers elbow? - CORRECT ANSWER Medial Epicondylitis This condition is also known as tennis elbow? - CORRECT ANSWER Lateral Epicondylitis What is the mechanism of injury for Medial Epicondylitis? - CORRECT ANSWER Overuse of wrist flexors What is the mechanism of injury for Lateral Epicondylitis? - CORRECT ANSWER Overuse of wrist extensors A scaphoid fracture is also known as this? - CORRECT ANSWER Snuff box fracture Where is the snuff box located? - CORRECT ANSWER The base of the thumb What is the gold standard surgical treatment for trigger finger? - CORRECT ANSWER A1 pulley release What is the mechanism of injury for a meniscal injury? - CORRECT ANSWER Torsional or rotational injury This is felt with a meniscal injury? - CORRECT ANSWER A pop or a snap What is the clinical presentation of a meniscal injury? - CORRECT ANSWER Inability to fully extend knee Inability to bear weight on lower extremity Buckling or locking of affected joint + McMurray or Apley test Jumping or hopping of the bione over the torn meniscus These tests are positive indicators of an ankle sprain? - CORRECT ANSWER + Anterior drawer + Talar tilt Explain the Thompson Test - CORRECT ANSWER Patient lies on stomach with one foot and ankle off the exam table. Examiner squeezes gastrocnemius If no plantar flexion of foot-suspect achilles tendon tear or rupture. This condition is a hyperextension of the great toe MTP joint or a sprain /tear of the plantar joint complex? - CORRECT ANSWER Turf Toe What is the most common cause of Turf Toe? - CORRECT ANSWER Improperly fitting shoes What is the appropriate amount of water to consume to maintain hydration to avoid sports injuries? - CORRECT ANSWER 2 quarts You should drink_____ cups of water for every pound lost during sport activities? - CORRECT ANSWER 2-3 [Show Less]
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Orthopedic Certification Test 70 Questions with Verified Answers,100% CORRECT
Orthopedic Certification Test 70 Questions with Verified Answers Cartilage is made of - CORRECT ANSWER collagen and protein Joint Cartilage is made o... [Show More] f - CORRECT ANSWER extracellular matrix and chondrocytes Extracellular matrix contains primarily - CORRECT ANSWER type 2, 4, and 6 collagens as well as aggrecan proteoglycans Type 2 collagen is responsible for - CORRECT ANSWER protecting the ends of bone within a joint Aggrecan proteoglycan is mainly responsible for - CORRECT ANSWER retaining water molecules, allowing resistance to affects of strenuous use of the joint Chondrocytes within joint cartilage is responsible for - CORRECT ANSWER the strength and resistance to loading What is the pathophysiology of osteoarthritis? - CORRECT ANSWER when cartilage becomes damaged it starts to lose elasticity, making it more susceptible to injury. With increasing stress and wear the bone starts to become affected causing thickening of bone and formation of bone spurs and osteophytes. Abnormal bone formations can break loose with cartilage fragments and float within joint space. Debris cause synovium to mount and inflammatory response to break down cartilaginous debris. What does the inflammatory response during degeneration of cartilage increase? - CORRECT ANSWER the breakdown of remaining healthy cartilage, leading to further degeneration Osteoarthritis symptoms: - CORRECT ANSWER pain that is exacerbated with activity and better with rest (early dz), stiffness, swelling, pain and stiffness worse in the morning (no more than 30 min), pain worse with prolong inactivity or weather changes Hip osteoarthritis symptoms: - CORRECT ANSWER pain in low back and groin, limping and knee pain from compensation Knee osteoarthritis symptoms: - CORRECT ANSWER locking, cracking, grinding, "give out" feeling, increasing pain with ascending and descending stairs Finger osteoarthritis symptoms: - CORRECT ANSWER swelling, nodules, stiffness, difficulty gripping What are causes of secondary osteoarthritis? - CORRECT ANSWER joint injury (fracture or sprain), chronic stress, joint instability, nervous system disorders (ex. charcot neuropathy), blood and endocrine disorders (diabetes, gout, thyroid disorders, osteoarthritis, growth hormone disorders), medications (oral steroids, meds for gout), inflammation (RA causing secondary osteoarthritis) What are diagnostic tests for osteoarthritis? - CORRECT ANSWER blood work to eliminate other disorders such as RA and to establish base line and possible secondary osteoarthritis diseases, X-rays, possible MRI, evaluation of synovial fluid What is the most common and cost-efficient diagnostic test for osteoarthritis? - CORRECT ANSWER x-ray What would an x-ray show to diagnose osteoarthritis? - CORRECT ANSWER joint space narrowing, bone spurs, osteophytes What does synovial fluid of osteoarthritis look like? - CORRECT ANSWER straw colored, no more than 2000 white blood cells, and synovial glucose should be equal to serum glucose What are alternative treatments for osteoarthritis? - CORRECT ANSWER glucosamine, SAM-e oral, copper and magnetic bracelets, acupuncture, tai chi, pilates, yoga, herbs, and supplements What is glucosamine? - CORRECT ANSWER helps to regenerate joint cartilage in osteoarthritis, some studies support reduce of pain and inflammation What is SAM-e oral? - CORRECT ANSWER thought to reduce osteoarthritis pain, studies vary What are copper and magnetic bracelets used for in osteoarthritis? - CORRECT ANSWER anecdotal reports only, studies don't support, no harmful effects What are herbs used to help with osteoarthritis? - CORRECT ANSWER garlic, echinacea, gingko, St. John's wort, ginger, turmeric, and cayenne. Ginger, turmeric, and cayenne have more supportive studies What is the number one modifiable risk factor for osteoarthritis? - CORRECT ANSWER weight What are key points to obtain in history of a patient with osteoarthritis? - CORRECT ANSWER pain (location, onset/duration, type), activity (response to pain, alleviating and exacerbating activities, fatiguability), effect on sleep, nutritional status, unintended weight gain/loss, caffeine consumption, affect on ADLs (self care, occupational, family roles), effect on sexual relations, self-concept and image, independence, hobbies, coping mechanisms, support system, knowledge of disorder, comorbidity, meds, compliance, and treatments tried, past medical history including family, social history (alcohol use, tobacco, drugs) What are side effects of acetaminophen use with osteoarthritis? - CORRECT ANSWER dose should be no larger than 4000 mg/day, liver toxicity (too much or alcohol) What are side effects of NSAIDs such as ibuprofen and naproxyn with osteoarthritis? - CORRECT ANSWER gastric ulceration and bleeding, renal impairment, newer COX-2 NSAIDs like celebrex reduce GI risks What are side effects of non-narcotic, centrally-acting analgesics such as tramadol with osteoarthritis? - CORRECT ANSWER vertigo, headache, nausea, constipation, habituation What are side effects of opioid (narcotic) analgesics such as codeine and propoxyphene with osteoarthritis? - CORRECT ANSWER constipation, disorientation, vertigo, high abuse potential, use with caution in elderly, can be safely used with NSAIDs but no more than 2 weeks at a time What is most successful in joints that demonstrate signs of inflammation and when other more conservative modalities fail? - CORRECT ANSWER injection of an osteoarthritic joint Injection with a glucocorticoid can provide what with osteoarthritis? - CORRECT ANSWER 3 to 4 weeks of relief How many injections can a single joint receive in a year? - CORRECT ANSWER no more than 3 What are some topical analgesics that are used in combo with other treatments? - CORRECT ANSWER capsaicin cream (most studied), aspercreme, bengay, icy hot, flexall Where should topical analgesics not be applied? - CORRECT ANSWER to a break in the skin or placed over a joint that is tightly occluded What is viscosupplementation that is used for osteoarthritis? - CORRECT ANSWER involve series of injections into joint over a weeks, reserved for cases where other treatments have failed What is viscosupplementation composed of? - CORRECT ANSWER hyaluronic acid, a substance found in the body that gives synovial fluid thickness and cushion What are the goals of viscosupplementation? - CORRECT ANSWER improbe lubrication of joints, decrease pain and allow for increase mobility and activity What side should a cane be used on? - CORRECT ANSWER opposite side of the affected hip How should someone with osteoarthritis go up the stairs? - CORRECT ANSWER lead with the good hip then bring the bad hip and cane up/down to the step the good foot is already on Modifiable risk factors for post op complications post total joint replacement are? - CORRECT ANSWER smoking, obesity, malnutrition, heath and conditioning pre surgery, not discontinuing meds meds pre surgery What comorbidities place patient at higher risk for operative complications with total joint? - CORRECT ANSWER diabetes, CAD, hypertension, congestive heart failure, COPD, asthma, autoimmune disease How does an abductor pillow keep the patients body? - CORRECT ANSWER hips in extension, legs in abduction and slight external rotation What are alternative therapies for chronic degenerative back pain? - CORRECT ANSWER spinal manipulation (best for newer pain), TENS (transcutaneous electric nerve stimulation) unit, acupuncture, biofeedback, massage When is spinal manipulation not recommended with degenerative back pain? - CORRECT ANSWER if there are radicular symptoms or signs of chronic neurological deficit or compression How long should ice be used for acute pain? - CORRECT ANSWER the first 48-72 hours and then heat after What are post-surgical hip precautions for anterior approach? - CORRECT ANSWER no external rotation of knees/ankles, no turning towards operative side with walking, no abduction of surgical hip and no crossing legs (ankle on knee or knee on knee), LESS PRECAUTIONS What are post-surgical hip precautions for posterior approach? - CORRECT ANSWER no bending at waist greater than 90 degrees, don't sit cross-legged, no internal rotation on surgical side, must sleep with pillow between knees and external rotation of legs Positioning for hip surgery with anterior approach means: - CORRECT ANSWER patient lying supine, hip extended and in external rotation, and knee flexed, can also be done with posterior approach positioning Positioning for hip surgery with posterior approach means: - CORRECT ANSWER patient lies on unaffected side, with affected hip in flexion, adduction and internal rotation Surgical positioning for thoracic spine surgery means: - CORRECT ANSWER prone position, elbows slightly flexed and be alert to pressure spots on face, same with lumbar spine procedures Surgical positioning for total knee replacement means: - CORRECT ANSWER supine position, with headrest to align cervical spine in comfortable and natural position, arms to side Surgical positioning for open hip reduction: - CORRECT ANSWER supine position Surgical positioning for shoulder replacement: - CORRECT ANSWER supine, reclined position with head secured Surgical positioning for knee scope: - CORRECT ANSWER supine with foot of bed lowered at knee level Surgical positioning for shoulder scope: - CORRECT ANSWER lateral position Osteoarthritis of shoulder is often caused by: - CORRECT ANSWER chronic rotator cuff tear When is a CPM machine applied? - CORRECT ANSWER within the first 24 hours, for max benefit apply at least 6 hours in a 24 hour period What is the purpose of a CPM machine? - CORRECT ANSWER reduce stiffness and aide in the return of ROM What is chondromalacia patellae? - CORRECT ANSWER seen in younger age groups, also known as patellofemoral syndrome, the underside of the kneecap is roughened causing pain with all movement and the kneecap moves over the femur What causes chrondromalacia patellae? - CORRECT ANSWER heavy joint use like marathon runner, also trauma and poorly developed thigh muscles or quads Who are candidates for shoulder fusion? - CORRECT ANSWER when shoulder osteoarthritis as failed at conservative treatments and shoulder pain and loss of ROM persist, good for patients < 40 and have labor intensive occupations or participate in sports Who is shoulder fusion the best choice for? - CORRECT ANSWER patients who are non-complaint in post surgical rehab program What are bunions known as? - CORRECT ANSWER hallux valgus, lateral deviation of the metatarsal phalangeal joint of the greater toe What causes bunions? - CORRECT ANSWER the MTP joint degenerates over time due to poorly fitting footwear (narrow, tight-fitting, heels), or a birth deformity What are treatments for bunions? - CORRECT ANSWER wider fitting shoes, shoe inserts, NSAIDS, injections When is surgery an option for bunions? - CORRECT ANSWER only if 2nd-5th toes become affected and outward pointing and pain persists What is racemic epinephrine? - CORRECT ANSWER acts on adrenergic receptor sites causing reduction in airway inflammation and edema. What is racemic epinephrine commonly used for? - CORRECT ANSWER Croup and when stridor is present. What is Iprtropium and what is is used to treat? - CORRECT ANSWER Anticholinergic used to treat asthma and COPD. What is Sameterol and what is it used for? - CORRECT ANSWER Long acting beta agonisht used to treat asthma and COPD. What is Theophylline and what is it used for? - CORRECT ANSWER Xanthine derivative and is used to treat apnea of prematurit and sometimes COPD or asthma. [Show Less]
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Orthopedic Nurse Certification Exam 234 Questions with Verified Answers,100% CORRECT
Orthopedic Nurse Certification Exam 234 Questions with Verified Answers Dermatomyositis - CORRECT ANSWER chronic systemic immunological disease involvin... [Show More] g inflammation of the skin, connective tissue, and muscles, causes widespread skin rash and permanent bumps underneath skin Polymyositis/Dermatomyositis S/S - CORRECT ANSWER -Muscle weakness -Red or purple symmetric rash (heliotrope) -Scaly, smooth, or raised rash on knuckles and sides of hand (gottron's papules) -Joint redness, pain, and inflammation and decreased ROM -Weakened pharyngeal muscles Polymyositis/Dermatomyositis Care - CORRECT ANSWER -Biopsy for dx -Long term corticosteroids -Immunosuppressive drugs -IV immunoglobulin (hydrate patient well, may get HA) Fibromyalgia S/S - CORRECT ANSWER *Chronic musculoskeletal syndrome* -Widespread burning and gnawing, joint and muscle pain, fatigue, "tender points" (↑ sensitivity to touch) -*Begins with a flu-like viral illness* -Lower pain threshold *ABSENCE of inflammation* -Cognitive difficulties -RLS -IBS Fibromyalgia Diagnosis - CORRECT ANSWER Two criteria are met: pain is experienced in 11 of the 18 tender pints on palpation and a history of widespread pain for at least 3 months Fibromyalgia treatment - CORRECT ANSWER -Rest -Lyrica, Cymbalta, Savella -Antidepressants -Benzos -Massage -Heat and cold packs -Stretching -Limit sugar, caffeine, and alcohol Osteoarthritis (OA) - CORRECT ANSWER -Formation of bone spurs and osteophytes -Inflammation of the joint -Breakdown of cartilage Symptoms of OA - CORRECT ANSWER -Pain & Stiffness: worse in the morning for <30 min, prolonged inactivity or weather changes -Locking, cracking, grinding, or feeling of giving out of knees -Swelling, nodules or stiffness of fingers and difficulty gripping, Herberden's nodes, Bouchard's nodes, bowlegged, knock-knees Goals of management of OA - CORRECT ANSWER -Reduce pain and inflammation -Maintain joint function Diagnostics of OA - CORRECT ANSWER -X-ray -MRI -Joint aspiration -CT Treatment of OA - CORRECT ANSWER -Maintain ROM -Increase muscle strength -Reduce stress on joints -Heat and cold -Glucosamine -Stretching -Weight control -Topical analgesic-Capsaicin cream, bengay, Icy hot -Corticosteroid injection: lasts 3-4 weeks -Viscosupplementation: Lasts 6 months -Arthroscopy Salicylate - CORRECT ANSWER -Aspirin -Anti-inflammatory, Analgesic, Antipyretic -Administer with food or full glass of water -Monitor for bleeding NSAIDs - CORRECT ANSWER -Ibuprofen, naproxen, indomethacin, ketorolac, diclofenac, celecoxib -Anti-inflammatory, Analgesic, Antipyretic -Administer with food -Monitor for signs of bleeding or GI upset Doxycycline - CORRECT ANSWER -Decreases action of enzymes on cartilage degradation Minocycline - CORRECT ANSWER -Antirheumatic effect Capsaicin cream - CORRECT ANSWER -Must be used at regular intervals for maximal effect -Aloe Vera cream may decrease burning sensation -Do not use with external heat source Corticosteroids intraarticular injections - CORRECT ANSWER -Depo-Medrol, Aristospan -Antiinflammatory, Analgesic -Joint may feel worse right after injection -Avoid overusing joint immediately after injection -Improvement last weeks to months after injection Systemic Corticosteroids - CORRECT ANSWER -Hydrocortisone, Methylprednisolone, dexamethasone, Prednisone, Triamcinolone -Antiinflammatory, Analgesic -Use only with severe exacerbation -Symptoms return with abrupt withdraw -Monitor BP, weight, CBC, Serum potassium -Limit sodium intake DMARDs - CORRECT ANSWER -Methotrexate: Monitor CBC and hepatic and renal function and for anemia. Teratogenic -Azulfidine: May cause orange-yellow skin or urine. Take with full glass of water. Continue after symptoms relieved. Monitor CBC -Arava: Monitor hepatic function. Avoid pregnancy -Penicillamine: Monitor WBC, platelets, UA. Take 1hr before or 2hrs after eating and an hour away from any med Gold Compund - CORRECT ANSWER -Rule out pregnancy -Monitor CBC, UA, hepatic and renal function -Therapeutic response may take 3-6 months -Report pruritus, rash, sore mouth, indigestion, metallic taste Plaquenil - CORRECT ANSWER -Monitor CBC and hepatic function -May take up to 6 months to work -Report visual difficulties, muscular weakness, and decreased hearing or tinnitus Complications after Total Joint Replacement - CORRECT ANSWER PE DVT Trendelenburg Sign and Gait - CORRECT ANSWER pelvis tilts because weight-bearing leg cannot maintain alignment of pelvis through hip abduction (superior gluteal nerve--->gluteus medial and minimus) Chronic back pain treatment - CORRECT ANSWER -No Bed rest -Stretching -ROM -Non-weight bearing exercises -Cold for first 48-72 hrs then heat -TENS Post op hip precautions - CORRECT ANSWER Anterior approach- no exteral rotation of knees/ankles, no turning towars operative side while walking, no abduction Posterior approach- no bending >90. Do not sit cross-legged, no internal rotation Chronic Rotator Cuff Tear - CORRECT ANSWER -OA of shoulder -Pain increases through time Rotator Cuff Injury - CORRECT ANSWER -Symptoms: shoulder weakness, pain, decreased ROM, pain with abduction between 60-120 degrees, a positive drop arm test (abducted 90 deg and pt to slowly lower arm, if drops, then posistive) -Dx: MRI -Tx: Rest, Ice, and heat, NSAIDs, Corticosteroid injections, and PT, if not effective or a complete tear then surgery, post op a sling and pendulum exercises. -6 months to recover from surgery CPM Machine - CORRECT ANSWER -Used to reduce stiffness and for return of ROM -Applied 6hr out of 24hrs -If resisted the cycle will stop Chondromalacia Patellae - CORRECT ANSWER -Patellofemoral syndrome -Underside or backside of kneecap is roughened -Causes pain when the kneecap runs over femur -Caused by heavy use of joint, trauma, week thighs or quads Bunions - CORRECT ANSWER -Hallux Valgus -Lateral deviation of the MTP(metatarsal phalangeal) of great toe -Due to poor fitting shoes -Tx: wider fitting shoes, shoe inserts, anti-inflammatory and analgesics spondylolisthesis - CORRECT ANSWER -Pain worse with waist movements and lifting -Can radiate to leg and if severe cause bowel and bladder changes Herniated disc - CORRECT ANSWER -Pain sudden, radiates to leg and is worse with sitting, bending forward and sneezing -May have sensory changes and strength in extremity Spinal Stenosis - CORRECT ANSWER -Pain is worse when back is straight or extended lying supine or when walking -Pain can radiate to both legs narrowing of the spinal canal with compression of nerve roots Low back pain Conservative therapy - CORRECT ANSWER -Nsaids -Muscle relaxer -Narcotics -Activity restrictions: No heavy or repetitive lifting, no twisting, no bending at the waist -No bedrest -Ice/heat -Massage -Stretching -Topical creams -PT Tests for Low back pain - CORRECT ANSWER -Toe-Walk test: If unable to toe walk, S1 problem -Heel walk: L5 problem -Patellar reflex decreased: L5 prob -Achilles reflex decreased: L1 prob -Straight leg test: nerve entrapment at any lumbar level C6 Nerve - CORRECT ANSWER -Neck injury or degeneration -Pain and decreased sensation that radiates down the arm into the thumb -Muscle weakness in the biceps and wrist extension brachioradialis reflex decreased C7 Nerve - CORRECT ANSWER -Pain or numbness that travels to the third finger -Decreased triceps reflex Cervical Traction - CORRECT ANSWER -Used at home to decrease pain -Used in hospital to immobilize pre or postsurgical Cervical collar - CORRECT ANSWER -Used to immobilize neck -OA -Cervical spondylosis -Whiplash injuries DIP joint - CORRECT ANSWER -Distal interphalangeal joint -Finger joint most distal from the body PIP joint - CORRECT ANSWER -Proximal interphalangeal joint -Finger joint closest to the body MCP - CORRECT ANSWER -Metacarpophalangeal joint -Finger joint that connects the metacarpal bones to the phalanges -Proximal to the PIP joints Herberden's nodes - CORRECT ANSWER -Bony growth at the DIP joint -Seen in OA -Rarely painful and not progressive Bouchard's nodes - CORRECT ANSWER -Bony nodule growth at the PIP joint -Seen in OA MTP joint - CORRECT ANSWER -Metatarsophalangeal joint -Joint at the base of the toes where to toe meets the foot Hallux Rigidus - CORRECT ANSWER Condition in which degenerative arthritis affects the metatarsophalangeal (MTP) joint at the base of the big toe, causing pain and stiffness Spondylolisthesis - CORRECT ANSWER Forward slipping of one vertebra over another herniated nucleus pulposus - CORRECT ANSWER -Herniated disk -Disc bulges through the spinal canal, narrowing it Stellate fracture - CORRECT ANSWER A fracture that forms a star-like pattern Acetabulum - CORRECT ANSWER Hip socket Gustilo-Anderson classification system - CORRECT ANSWER Type 1-soft tissue damage minimal <1cm Type 4- High level of amputation nonunion fracture - CORRECT ANSWER Break in a bone that has failed to unite and heal after 5 months mallet finger injury - CORRECT ANSWER -Jammed finger Tx: splint finger for 8 weeks and then splint nightly Contraindications for Open reduction - CORRECT ANSWER -Infection -Loss of bone density -Bony fragments to small for fixation device -Limited surrounding soft tissue -Multiple uncontrolled comorbidities Indications for limb amputation - CORRECT ANSWER -Crush injury with >6hs loss of blood supply -If main nerve supplying the limb is completely severed 5 stages of fracture healing - CORRECT ANSWER • Stage 1 - Fracture hematoma (24-72 hrs.) • Stage 2 - occurs in 3 days to 2 weeks when granulation forms at tissue • Stage 3 - 2 weeks to 6 weeks; new vascularization forms (Callus formation) • Stage 4 - may take 3 weeks to 6 months callus is resorbed and made to bone (Ossification) • Stage 5 - 4-5 weeks after fracture up to 1 yr. Consolidation and reformation of bone Cast care - CORRECT ANSWER -Don't cover until dry, handle with palms of hands, don't rest on hard surfaces, -Keep above level of heart, -Check pulses, color , sensation. -Complication of cast is numbness, tingling, no pulses, bluish color of the skin Electrical bone growth stimulation - CORRECT ANSWER -Used to facilitate healing process, especially for fracture nonunion or delayed union -Can be noninvasive or invasive -Works by increasing calcium uptake of bone and increasing the production MESS - CORRECT ANSWER Mangles Extremity Severity Score 1. Amount of injury 2. Blood supply affected 3. Amount of shock sustained 4. Age of patient >7 means amputation Autoamputation - CORRECT ANSWER The spontaneous detachment of a body part transcutaneous oxygen pressure determination - CORRECT ANSWER Noninvasive and used to predict healing Ankle-Brachial Index (ABI) - CORRECT ANSWER Ratio of the ankle systolic pressure to the brachial systolic pressure; an objective measurement of arterial disease that provides quantification of the degree of stenosis An ABI of <1 indicates narrowing of a vessel in the leg Angiogram - CORRECT ANSWER The radiographic visualization of blood vessels after the injection of radiopaque substance. Phantom Limb Pain - CORRECT ANSWER -Can be self limiting -Tx: medication, desensitization, electrical stimulation, counseling, hypnosis, acupuncture, and nerve block Stump care - CORRECT ANSWER -Once daily washing -Avoid excessive washing -Thoroughly dry -Massage -If break in the skin then air for 1hr 4 times a day -Ace bandages -Shrinker socks -Rigid dressing Pelvic Fracture - CORRECT ANSWER -High mortality rate -Abd may have swelling, tenderness, deformity, unusual pelvic movement and ecchymosis -Asses bowel and bladder function Dx: X-ray and CT Tx: Bed rest with use of pelvic sling for a few days in a stable, nondisplaced fracture. External fixation or ORIF for open or nonstable fracture. Hip Fracture - CORRECT ANSWER -1 in 5 people die within a year -S/S: External rotation, muscle spasm, shortening of affected extremity, severe pain around fracture site Interventions: Buck's traction before surgery, surgery Stable Vertebral Fracture - CORRECT ANSWER -Logrolling -Monitor signs of spinal cord involvement -Brace -Possible Vertebroplasty or balloon kyphoplasty Syme's amputation - CORRECT ANSWER the removal of the foot at the ankle Guillotine amputation - CORRECT ANSWER Limb or portion of a limb is severed from the body, and the wound is left open; a type of open amputation. Osteomyelitis - CORRECT ANSWER -Infection of the bone -Sequestra (dead bone separated from living bone) form and blood supply is cut off from it -Involucrum (new bone growth from new blood supply) forms Osteomyelitis S/S - CORRECT ANSWER -Bone pain -Swelling -Tenderness -Warmth -Restricted movement -Fever -Night sweats -Chills -Restlessness -Nausea -Malaise -Pus at site Osteomyelitis Diagnostics - CORRECT ANSWER -Biopsy -Elevated WBC, CRP, and ESR -CT -MRI Osteomyelitis Treatment - CORRECT ANSWER -IV antibiotics after culture drawn -I&D -Oral Cipro for chronic osteomyelitis -Antibiotic beads -Wound vac -Hyperbaric O2 -If severe then amputation Gentamicin Considerations - CORRECT ANSWER -Used for osteomyelitis -Effects renal function -Toxicity causes inner ear problems Tobramycin and neomycin reactions - CORRECT ANSWER -Hearing deficit -Impaired renal function -Neurotoxicity Cephalosporins reactions - CORRECT ANSWER -Hives -Watery diarrhea -Blood in stools -Throat or mouth sores Levaquin reaction - CORRECT ANSWER Tendonitis or tendon rupture Arthrodesis - CORRECT ANSWER Surgical fusion of a joint which stabilizes but immobilizes the joint Disarticulation - CORRECT ANSWER Amputation through a joint Colles fracture - CORRECT ANSWER -Fracture of the distal radius at the wrist -Tx: immobilization, open or closed reduction with a sugar-tong splint, Ice, Elevation, anti-inflammatories -Confirmed with x-ray and repeat x-ray in one week, if improved then apply short-arm cast 4-6 weeks Diaphyseal or shaft fracture - CORRECT ANSWER -Fracture of the middle of the shaft of humerus -Closed reduction is common with cast or splint and sling Anatomic neck fracture - CORRECT ANSWER -Break at the metaphysis of the humerus -Sling application and rehab Surgical neck fracture - CORRECT ANSWER -Fracture below the anatomic neck or below the metaphysis -Closed reduction and sling application Scaphoid fracture - CORRECT ANSWER -A break in the scaphoid bone in the thumb -X-ray may not show fracture -Tenderness in the anatomical snuff box -Tx: immobilization with a radial gutter splint or ventral splint with thumb spica, possible open reduction and screw placement Boxer's fracture - CORRECT ANSWER -5th metacarpal fracture -X-ray is diagnostic -Ulnar gutter splint extending distal to PIP joint Anatomical Snuff box - CORRECT ANSWER Abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus Subluxation - CORRECT ANSWER partial dislocation Avulsion fracture - CORRECT ANSWER fragment of bone chipped away from the main bone greenstick fx - CORRECT ANSWER incomplete fx impacted fracture - CORRECT ANSWER fracture in which one bone fragment is pushed into another Torus fracture - CORRECT ANSWER -Buckle fracture -Buckles on one side of bone and other side is unaffected Occult Fracture - CORRECT ANSWER a bone fracture that cannot be detected by X-ray until several weeks after the injury ('occult' means 'hidden') Nonunion - CORRECT ANSWER Fracture fails to heal despite treatment. No x-ray evidence of callus formation. Malunion - CORRECT ANSWER Fracture heals in expected time but in unsatisfactory position, possibly resulting in deformity or dysfunction. Angulation - CORRECT ANSWER Fracture heals in abnormal position in relation to midline of structure (type of malunion) Pseudoarthrosis - CORRECT ANSWER Type of nonunion occurring at fracture site in which a false joint is formed with abnormal movement at site. Traction Puposes - CORRECT ANSWER -Reduce pain and muscle spasm -Immobilize -Reduce a fracture or dislocation -Treat a pathologic joint condition -Promote active and passive exercise -Expand a joint space during procedure Myositis Ossificans - CORRECT ANSWER Deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury Autogenous bone - CORRECT ANSWER Bone graft taken from the patient, usually iliac crest Allographic bone - CORRECT ANSWER Cadaver bone is used for fracture Synthetic bone substitute - CORRECT ANSWER Substitutes include ceramics and sea coral Bioactive cells and proteins - CORRECT ANSWER Used for nonunion fractures Shin splints - CORRECT ANSWER -Medial tibial stress syndrome -Stress on the tibia -Seen most in runners, basketball or tennis -Risk factors: training too hard, not stretching, flat feet, -improper fitting shoes -Tx: Rest, stretching program, slow return to activity, ice, compression, orthotics -Preventions: Stretching and elevation of legs after workout, changing footwear every 6 months or 400 miles Sprain - CORRECT ANSWER injury to a ligament caused by joint trauma but without joint dislocation or fracture Strain - CORRECT ANSWER Muscle or tendon group is overstretched or over contracted without trauma weekend warrior - CORRECT ANSWER -Person who does no regular physical activity on most days of the week but then does a lot of activity on one day -At risk for Achilles tendonitis or tear Achilles tendinitis - CORRECT ANSWER -A painful inflammation of the Achilles tendon caused by excessive stress being placed on that tendon -Risk factors: improper fitting shoes, overuse, inadequate stretching, tight or weak calf muscles, running on hard surfaces or hills, flat feet, sharp plant and pivot activities tennis elbow - CORRECT ANSWER -Lateral epicondylitis -Tx: Rest, ice, stretching, massage, strengthening, anti-inflammatory meds, splints/braces at the wrist and proximal forearm, surgery rare Ankle sprain - CORRECT ANSWER 1st degree: mild pain and swelling, normal rage of motion and minimal gait impairment, return to activity no sooner than 10 days after tx 2nd degree: moderate pain and swelling, decreased range of motion and positive finding in the ankle exam, return to activity wit ankle support 2 weeks after tx 3rd degree: severe pain and swelling and all ankle tests are positive, unable to weight bear initially, return to activity 4 weeks after tx with continued ankle bracing golfer's elbow - CORRECT ANSWER -Medial epicondylitis T-x: Rest, ice, stretching, massage, strengthening, anti-inflammatory meds, forearm brace or compression, steroid injection and proximal forearm, surgery rare Turf toe - CORRECT ANSWER -Hyperextension of the great toe -Tx: Rest, avoid competitive sports up to 6 weeks, ice elevation, toe splint insert, anti-inflammatories, and if severe a walking boot Anterior Drawer Test - CORRECT ANSWER -Assesses the integrity of the anterior talofibular ligament -Stabilize the lower leg and pull the heel anteriorly. -Positive if there is significant laxity or a sharp endpoint is felt Talar Tilt Test - CORRECT ANSWER -Inversion and eversion of the foot to determine the stability of the ankle joint -Positive if there is laxity compared to the unaffected ankle and if there is a tight endpoint in either direction Squeeze Test - CORRECT ANSWER -Assess damage to the medial ankle compartment made up of several ligamentous structures. -Positive if there is pain in the ankle when the middles of the tibia and fibula are squeezed together Plantar fasciitis - CORRECT ANSWER -An inflammation of the plantar fascia on the sole of the foot -Risk factors: Extended exposure on hard surfaces, extreme foot arch, obesity, diabetes, age, pregnancy, footwear with poor arch support, arthritis -Tx: RICE, stretching, weight loss, orthotics, steroid injections Metatarsalgia - CORRECT ANSWER -Pain in the bones of the foot or ball of the foot -Caused by high-impact trauma such as jumping -Risk factors: Intense training, poorly fitting shoes, obesity, age, high foot arch, hammertoe, bunions, Morton' neuroma rotator cuff tendinitis - CORRECT ANSWER -An inflammation of the tendons of the rotator cuff -Swimmer's shoulder -Tx: RICE, slings, stretching, strengthening, technique evaluation, anti-inflammatory and analgesic, steroid injections and possible surgery, Arthroscopy or open repair Heat cramps - CORRECT ANSWER -Muscle spasms that result from a loss of large amounts of salt and water through perspiration -Most often experienced in the abdomen or legs -Tx: electrolyte replacement Heat exhaustion - CORRECT ANSWER -Condition resulting from exposure to heat and excessive loss of fluid through sweating -Cool and clammy skin -Tx: Cool drinks, rest and cooling devices Heat stroke - CORRECT ANSWER -A dangerous condition in which the body loses its ability to cool itself through perspiration -Skin will be dry, red and hot, vitals abnormal, change in LOC -Tx: medical emergency, IV fluids and external cooling ACL Injury treatment and diagnostics - CORRECT ANSWER -Nonsurgical: If stable with daily activities, secondary injury is absent, patient will stop with sports activities. Include: RICE, PT, activity modification, knee brace -Surgery: if the above conditions are not met -Diagnostics: Lachman's test, Pivot shift test Lachman's test - CORRECT ANSWER -Apply posterior pressure on the distal thigh and pulling the proximal lower leg anteriorly while the knee is slightly flexed. -Positive if increased laxity compared to uninjured knee Pivot shift test - CORRECT ANSWER -Internal rotation of the ankle combined with medial force to assess the stability of the ACL -Positive if subluxation occurs Meniscal Injury - CORRECT ANSWER -Painful popping and locking -Diagnostics: McMurray test and MRI -Tx: Ice, immobilization, crutches with WBAT, knee brace, Meniscectomy(NSAIDs and PT post op) McMurray Test - CORRECT ANSWER -Compression of the meniscus of the knee combined with internal and external rotation while the patient is face-up to assess the integrity of the meniscus -Positive if it elicits a pain or pop PCL Injury - CORRECT ANSWER -Sustained when knee is forcefully hyperextended or anterior forced is applied to a flex knee -Diagnostics: Posterior drawer test and quadricep active drawer test, MRI Osteochondritis dissecans - CORRECT ANSWER -Fragment of cartilage and underlying bone is detached from articular surface. -Tx: resting (6 weeks) and immobilization, NSAIDs or analgesics, PT, Surgery if conservative treatment unsuccessful Little Leagures Elbow - CORRECT ANSWER -Tendonitis of the elbow -Pain and or knot in elbow, locking and decreased ROM -Tx: RICE and PT Burner or stinger - CORRECT ANSWER Pinched nerve from stretch or compression to brachial plexus Osgood-Schlatter disease - CORRECT ANSWER -Inflammation or irritation of the tibia at its point of attachment with the patellar tendon -Self-limiting upon skeletal maturity Shoulder dislocation treatment - CORRECT ANSWER Closed reduction followed by immobilization. PT to strengthen surrounding musculature Osteoporosis - CORRECT ANSWER loss of bone density Osteoporosis risk factors - CORRECT ANSWER ->50 years old -Women -White or Asian -Consumption of alcohol or caffeine -Smoking -Low BMI -Steroids -Excessive use of thyroid, heparin, sedatives, Antiseizure meds -Decreased weight bearing activity -Decreased calcium intake -Amenorrhea Osteoporosis treatment - CORRECT ANSWER -Calcium 1200mg/day( Calcium carbonate: take with food, Calcium citrate) -Vitamin D supplementation -Weight-bearing exercise -Bisphosphonates (Fosamax and Actonel) -Calcitonin: Inject at night, alternate nasal site -Fluoride -Evista: Side effects are leg cramps, hot flashes and blood clots -Forteo: Subcutaneous injection daily, side effects are leg cramps and dizziness Bisphosphonates Considerations - CORRECT ANSWER -Fosamax, Boniva, Actonel, Reclast -Take with full glass of water -Take 30 min before food or other meds -Remain upright for 30 min after taking -Side effects: Anorexia, weight loss, Gastritis, Osteonecrosis of jaw Osteoporosis Symptoms - CORRECT ANSWER -No symptoms until bone fracture occurs -Decrease height -Kyphosis -Dowager's hump -DEXA scan measures bone mineral density (BMD) Dowager's hump - CORRECT ANSWER -Forward curvature of the spine resulting in a stoop, typically in women with osteoporosis, caused by collapse of the front edges of the thoracic vertebrae. Foods high in Calcium - CORRECT ANSWER -Milk -Cheese -Dark green veggies -Dried figs -Soy -Legumes Foods high in vitamin d - CORRECT ANSWER Fortified and full fat dairy products; fish oil; synthesized in skin when exposed to sunlight Foods high magnesium - CORRECT ANSWER Vegetables, nuts, fish, meat, grains Gout - CORRECT ANSWER -Hereditary metabolic disease that is a form of acute arthritis, characterized by excessive uric acid in the blood and around the joints -S/S: Swollen, red, acutely painful joint, Podagra, kidney stones, tophi Podagra - CORRECT ANSWER Gout in the big toe Gout risk factors - CORRECT ANSWER -Male sex -Increasing age -High intake of alcohol, red meat, and fructose -Drugs: Diuretics, Aspirin, B-complex vitamins, chemo -Obesity -HLD Gout treatment - CORRECT ANSWER -Prophylactic drugs: colchicines, probenecid, allopurinol -Acute attacks: Indomethacin (take with food), NSAIDS Paget's disease - CORRECT ANSWER -Osteitis deformans -Increased bone breakdown and then remodeling -S/S: Bone pain, fatigue, waddling gait, shortening, head enlarging, HA, Dementia, Visual deficits, loss of hearing, spinal cord compression -Dx: Elevated serum alkaline phosphatase, X-ray -Tx: manages disease but does not cure, PT thermotherapy, stretching and medications (bisphosphonate, Anti-inflammatories and analgesics) osteomalacia - CORRECT ANSWER -Decrease in the mineral composition of the bone causing softening of the bone -Caused by decreased Vitamin D (seizure drugs and fluoride can cause this) -Bone pain, muscle pain, fractures -Can be reversed with vitamin D and calcium, intake eggs, meat and oily fish, Weight bearing exercise and sunlight exposure -Lab findings: Decreased serum calcium or phosphorus, decreased serum 25-hyroxyvitamin D, and elevated serum alkaline phosphatase Hypoparathyroidism - CORRECT ANSWER -Deficient production of parathyroid hormone -Marked by hypocalcemia- vague pain symptoms, anxiety, muscle rigidity, increased deep tendon reflexes, muscle spasm, muscle cramps, paresthesia, muscle twitching. -X-ray may show increased bone density Hyperparathyroidism - CORRECT ANSWER -Excessive levels of parathyroid hormone -Pulls calcium from bone into the blood -Symptoms: Hypercalcemia, fractures, decreased muscle tone, muscle weakness, pain, decreased bone density on x-ray -Tx: same as osteoporosis with correction of hypercalcemia Rickets - CORRECT ANSWER -Vitamin D deficiency -Symptoms: Failure to thrive, bowing of long bones, forehead protrusion, palpable knots between the ribs, -X-ray show increased epiphyseal space Chvostek's sign - CORRECT ANSWER Hypocalcemia (facial muscle spasm upon tapping) Trousseau's sign - CORRECT ANSWER A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes. rheumatoid arthritis - CORRECT ANSWER -A chronic autoimmune disorder in which the joints and some organs of other body systems are attacked -Usually affects bilaterally -Positive RF Rheumatoid Arthritis Treatment - CORRECT ANSWER -goal of tx: reduce inflammation and pain, promote joint function, and prevent joint destruction and deformity -Pharmacological management includes NSAIDs to reduce inflammation and pain -Corticosteroid meds may be desirable during severe flare-ups or when the patient's condition is not responding to NSAIDs -COX-2 inhibitors -Plaquenil -Disease-modifying antirheumatic meds (DMARDs) are slow-acting and take weeks or months to become effective, however, they have the ability to slow the progression of joint destruction and deformity -PT interventions include passive and active ROM, heating and cooling agents, splinting, patient education, energy conservation, body mechanics, and joint protection techniques rheumatoid arthritis symptoms - CORRECT ANSWER Slow onset of: -Fatigue -Symmetrical swollen, stiff, painful joints -Worse in morning and better with activity -Boutonniere fingers (PIP flexion, DIP extension) -Swan fingers (PIP extension, DIP flexion) -Ulnar deviation -Subcutaneous nodules (over bony prominences and tendons) -Dry eyes and mouth -Dilated nail capillaries -Interstitial lung disease Juvenile Rheumatoid Arthritis (JRA) - CORRECT ANSWER -Disorder similar to adult-onset RA, with earlier onset and more severe symptoms -Most grow out of it but damage sustained is permanent -Morning stiffness Juvenile Rheumatoid Arthritis (JRA) Types - CORRECT ANSWER 1. pauciarticular: Does not affect more than 4 joints. If developed before age 6, chronic eye disease possible 2. polyarticular: 5 or more joints, sudden and severe onset, at risk for permanent joint deformity 3. systemic: Recurring spiking fevers and truncal rash, pericarditis possible Systemic lupus erythematosus (SLE) - CORRECT ANSWER -Chronic autoimmune inflammatory disease of collagen in skin, joints, and internal organs -S/S: Butterfly rash over cheeks, discoid lesions, vascular changes in the digits, erythematous plaques, splinter hemorrhages in nail bed, thinning of scalp hair, in the joints decreased mobility redness and swelling, Jaccoud's deformity Polymyositis - CORRECT ANSWER -Idiopathic inflammatory myopathy -Inflammation of many muscles -Leads to atrophy -Diagnosis: history of muscle weakness, creatine kinase levels, EMG testing and biopsy -Tx: oral corticosteroids -Complications: neck muscle weakness causing swallowing difficulties and difficulty breathing Ankylosing Spondylitis (AS) - CORRECT ANSWER -Inflammatory response that causes degenerative changes in the spinal vertebrae; sacroiliac joints; connective tissues such as tendons and ligaments in the hips, shoulders, knees, feet, and ribs; and tissues of the lungs, eyes, and heart valves -Does not affect joints symmetrically and RF is negative Ankylosing Spondylitis Treatment - CORRECT ANSWER TREATMENT -Physical therapy and exercise -NSAIDs (e.g., indomethacin) for pain -Tumor necrosis factor (TNF) inhibitors or sulfasalazine can be used in refractory cases. Bursitis - CORRECT ANSWER -Inflammation of a bursa -Pain, warmth, limited ROM, and inflammation of joints -Tx: Stretching, warm-up, RICE, anti-inflammatories, aspiration of bursa, injection with steroid, removal of bursa ankylosing spondylitis tests - CORRECT ANSWER 1. Wright-schober test: positive if lumbar spin flexion is < 5cm 2. Respiratory excursion test: positive if distance between the nipples does not increase by at least 3cm 3. Cervical kyphosis- cannot touch back of head to wall while rest of body is against the wall Psoriatic arthritis - CORRECT ANSWER -An inflammatory arthritis associated with psoriasis of the skin -Tx: Appropriate footwear, Topical tx of skin lesions, anti-inflammatories, aspirin, DMARDs, biological modifiers, and steroids, sea salts, massage, acupuncture, glucosamine, SAM-e and magnet therapy systemic sclerosis - CORRECT ANSWER -A diffuse connective tissue disease that may involve any system causing inflammation, degeneration, and fibrosis -Softens bone and causes atrophy -Carpal tunnel is likely to develop Scleroderma - CORRECT ANSWER an autoimmune disorder in which the connective tissues become thickened and hardened, causing the skin to become hard and swollen Swan neck deformity - CORRECT ANSWER hyperextension of PIP joint and flexion of DIP joint Boutonniere deformity - CORRECT ANSWER flexion of PIP joint and hyperextension of DIP joint Duchenne muscular dystrophy - CORRECT ANSWER -A condition with symmetrical weakness and wasting of pelvic, shoulder, and proximal limb muscles -Toe walking, clumsiness, large calf muscles, positive Gower's sign, ankle reflexes greater then knee reflexes -Diagnostics: muscle biopsy, EMG testing, elevated CPK levels and MRI -Management: PT, orthotic brace, corticosteroids Benign Tumors - CORRECT ANSWER -Osteochondroma: May turn into malignant -Osteoclastoma -Enchondroma Malignant Tumors - CORRECT ANSWER -Osteosarcoma -Chondrosarcoma: Wide surgical resection done as it rarely responds to radiation and chemo -Ewing's sarcoma Carpal tunnel Syndrome - CORRECT ANSWER -Compression of the median nerve -S/S: Weakness, pain, numbness, impaired sensation, clumsiness, Tinel's sign, Phalen's sign -Tx: Rest, Splints to keep in neutral position, PT, Corticosteroid injection, Carpal tunnel release Tinel's sign - CORRECT ANSWER A distal tingling sensation on percussion of median nerve of the inner wrist; characteristic of carpal tunnel syndrome Phalen's sign - CORRECT ANSWER The patient flexes the wrists maximally and holds position for up to 60 seconds by pushing both wrists together. Positive sign is tingling into the first 3 digits of the hand indicating carpal tunnel syndrome Spinal stenosis - CORRECT ANSWER -Narrowing of the spinal canal -S/S: Low back pain that radiates to the buttock and leg, pain worse with walking or prolonged standing, Numbness, tingling, weakness, and heaviness in legs and buttocks, pain relief when bending forward or sitting L3-L4 Disc Herniation symptoms - CORRECT ANSWER -Pain Back to buttocks to posterior thigh to inner calf -Patellar Reflex affected -Motor function of Quadriceps and anterior tibialis affected -Sensation of inner aspect of lower leg and anterior part affected L4-L5 Disc Herniation symptoms - CORRECT ANSWER -Pain Back to buttocks to dorsum of foot and big toe -Motor function of anterior tibialis, extensor hallucis longus, and gluteus Medius affected -Sensation of Dorsum of foot and beg toe affected L5-S1 disc herniation symptoms - CORRECT ANSWER -Pain back to buttocks to sole of foot and heel -Achilles reflex affected -Motor function of Gastrocnemius, hamstring, gluteus maximus, affected -Sensation affected of heel and lateral foot Diagnostic Studies of DDD - CORRECT ANSWER -X-rays -MRI -Myelogram -CT -Epidural venogram or diskogram -EMG of extremities Degenerative Disc Disease (DDD) - CORRECT ANSWER progressive degeneration that is a normal process of aging; results in the intervertebral discs losing their elasticity, flexibility, and shock-absorbing capabilities. DDD management - CORRECT ANSWER -Limit extreme spinal movement by wearing a brace -Local ice or heat -Ultrasound -Massage -Traction -TENS -NSAIDS -Oral corticosteroids -Opioids -Muscle relaxants -Antiseizure drugs -Epidural corticosteroid injections -Back exercises -Possible surgery Post-Op Vertebral Disc Surgery care - CORRECT ANSWER -Pillow under thighs when lying supine -Pillow in-between knees when side-lying -Opioids -Valium -Monitor for CSF leakage (high glucose in CSF) -Monitor for incontinence due to nerve damage -Thoracic-lumbar-sacral orthosis (TLSO) for spinal fusion -Monitor respiratory distress and neuro status of upper extremities for a cervical surgery Hallux Valgus - CORRECT ANSWER -Bunion -Tx: Wearing wide forefoot shoes, surgical removal of bursal sac and correction of lateral angulation of great toe Hallux rigidus - CORRECT ANSWER -Painful stiffness of first MTP joint caused by osteoarthritis or local trauma -Tx: Intraarticular corticosteroid injections and passive manual stretching of joint Hammer and Claw Toes - CORRECT ANSWER -Hammer toe is a deformity of PIP joint on 2nd to 5th toes causing toe to be permanently bent, resembling a hammer -Claw toe is a similar deformity with dorsiflexion of the proximal phalanx on the MTP joint combined with flexion of both PIP and DIP joints. -Complaints include burning on bottom of foot and pain and difficulty walking when wearing shoes -Conservative treatment includes passive manual stretching of PIP joint and use of metatarsal arch support. -Surgical correction consists of resection of base of middle phalanx and head of proximal phalanx, bringing raw bone ends together -Kirschner wire maintains straight position Morton's Neuroma - CORRECT ANSWER -Neuroma in web space between 3rd and 4th metatarsal heads, causing sharp, sudden attacks of pain and burning sensations -Tx: surgical excision Gower's sign - CORRECT ANSWER Difficulty rising to standing position; has to walk up legs using hands; occurs in Muscular dystrophy Cerebral Palsy - CORRECT ANSWER -A loss or deficiency of motor control with involuntary spasms caused by permanent brain damage present at birth -TX: Physical therapy, Speech therapy, assistive devices, muscle relaxers for muscle spasms Developmental dysplasia of the hip (DDH) - CORRECT ANSWER -S/S: asymmetrical gluteal and thigh folds. limited abduction of hips. Barlow and ortolani tests given. Trendelenburg sign used in toddler. complaint of clicking sound with diaper changes -Tx: Closed reduction. Pavlik harness used in newborns. Closed reduction with anesthesia if harness unsuccessful followed by cast. If diagnosed beyond two years old then open surgical reduction followed by placement of body Spica cast Ortolani's sign - CORRECT ANSWER -TESTING: congenital dislocation of hip of infant -POSITION: (supine) flex infant's hips and grasp legs so thumbs are against the insides of the knees and thighs and the fingers are placed along the outsides of the thighs to the buttocks; thighs are abducted and pressure is applied against the greater trochanters; resistance will begin to be felt to abduction and lateral rotation at approximately 30- 40 deg (+) TEST: feel a "click" or "jerk" ***only valid for the first few weeks after birth Barlow's sign - CORRECT ANSWER w/ baby supine the hips and knees are flexed, with the thumb on the lesser trochanter in the grown and the middle finger of the same hand on the greater trochanter laterally, gently apply pressure down on the knee while simultaneously applying lateral pressure with the thumb the dislocatable hip becomes displaced with a palpable clunk as the head slips over the posterior aspect of the acetabulum; this is a provocative test which actively dislocates an unstable hip Pes Cavus - CORRECT ANSWER -Abnormally high arch of the foot -"Clawfoot" -May indicate a neuromuscular disorder, muscle spasm, spinal etiology -Tx: orthotics and arch supports, possible surgery Congenital Torticollis - CORRECT ANSWER characterized by a unilateral contracture of the sternocleidomastoid muscle. causative factors include malposition in utero, breech position and birth trauma. usually dx'd within first three weeks of life. lateral flexion to same side as contracture, rotation toward opposite side. treatment conservative for the first year with emphasis on stretching, active ROM, position and caregiver education. possible surgery. Pigeon Toe - CORRECT ANSWER -A condition which causes the toes to point inward when walking -Under the age of 2 self limiting -Age 3 and above need surgery talipes equinovarus - CORRECT ANSWER -(clubfoot) congenital deformity of the foot in which it is plantar flexed and inverted -Neuromuscular disease and hip dysplasia -Tx: manual manipulation followed by splinting or casting. prognosis good with early treatment Bowlegs - CORRECT ANSWER -Genu varum -Usually self resolving but if not then bracing. -Surgery if growth is affected or is asymmetrical Knock Knees - CORRECT ANSWER genu valgum Self limiting Limb length discrepancy (LLD) - CORRECT ANSWER -Treatment only considered if greater 1-inch difference and causes significant gait disturbance and pain. -Tx: Shoe lefts, leg shortening surgery for the immature, leg lengthening for the mature Legg-Calve-Perthes Disease - CORRECT ANSWER degeneration of femoral head due to avascular necrosis. disease is self limiting and has 4 phases: condensation, fragmentation, re-ossification and remodeling. presents with pain, decreased ROM, antalgic gait, positive Trendelenburg sign. primary treatment focus is to relieve pain and maintain femoral head in proper position and includes bracing and PT Spina bifida - CORRECT ANSWER a congenital defect that occurs during early pregnancy when the spinal canal fails to close completely around the spinal cord to protect it. Four types 1. Occulta 2. Closed-neural tube defect 3. Meningocele 4. Myelomeningocele myelomeningocele - CORRECT ANSWER -Most severe form of spina bifida in which the spinal cord and meninges protrude through the spine and cause paralysis -Talipes equinovarus, calcaneus, cavus are common -Muscle atrophy and loss of bone density in extremities below the level of the spinal cord involvement Salter-Harris Classification - CORRECT ANSWER SALTER-HARRIS - Physeal Injuries (SMACK - Same, Metaphysis, Articulation, Continuous, Krush) (SALTR - Same, Above, Lower, Through, Really bad) 1 - fracture through physis 2 - fracture through physis into metaphysis 3 - intra-articular fracture through physis into epiphysis 4 - intra-articular fracture through epiphysis, physis, and metaphysis 5 - crush injury osteogenesis imperfecta - CORRECT ANSWER -Brittle bone disease; excessively brittle bones due to lack of protein, collagen. Hereditary -Tx: Prevention of fractures, PT, nutrition Scoliosis - CORRECT ANSWER -Abnormal lateral curvature of the spine -Observation in child with less than 20 degree curvature -Brace with 20-40 degrees -Surgery with >40 degrees Osteosarcoma - CORRECT ANSWER -Malignant tumor of the bone -Metastasis to the lung common -Causes bone pain, may have palpable mass -Suspected on x-ray and confirmed by biopsy -MRI, CT and bone scans used to rule out metastasis -Tx: Surgical removal and chemo. prognosis good if no metastasis Soft tissue sarcoma - CORRECT ANSWER -Cancers of the muscle, fat, fibrous tissue, blood and lymphatic vessels, or other supporting tissue, including the synovial tissues that line the cavities of joints -Typically a visible or palpable growing mass -Diagnosis by biopsy metastatic bone disease - CORRECT ANSWER -Cancer originates somewhere else and metastasizes to the bone -Anemia present -Diagnosis by MRI and bone scan -Treatment surgical excision Multiple Myeloma - CORRECT ANSWER -Malignant tumor of bone marrow cells -Symptoms: bone pain and anemia, increased calcium, ESR, creatinine, and BUN with decreased platelets -Diagnosis: biopsy of bone marrow -Tx: Chemo, bone marrow transplant for younger patients, median survival 2 years -Complications: skeletal deformity, immunosuppression, fractures, amyloidosis Intralesional excision - CORRECT ANSWER Used if benign tumor or if total resection not an option Marginal excision: - CORRECT ANSWER removes the tumor at its border Wide excision - CORRECT ANSWER the tumor plus a wide margin of normal tissue around it is excised Radical resection - CORRECT ANSWER procedure to excise a cancerous tumor, as well as all nearby lymph nodes, soft tissue, muscle, and even bone Compartment syndrome - CORRECT ANSWER Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue. 3 types 1. Crush 2. Chronic 3. Acute-Medical emergency Compartment Syndrome S/S - CORRECT ANSWER -Pain out of proportion to injury or with passive stretch(w/hyperextension) -Pressure -Paresthesia -Pallor -Paralysis -Pulselessness Compartment Syndrome Interventions - CORRECT ANSWER -Relieve anything causing increased pressure -Notify Dr. of changes in the 6 Ps -Monitor urine output as AKI can occur from damaged muscles -Do not elevate extremity -Do not put ice on it -Fasciotomy may be performed. Incision is left open until swelling reduces enough to close. Crush Compartment Syndrome - CORRECT ANSWER Damage to the body compartment from an external source. Damaged muscle release myoglobin which overwhelm kidneys which cause systemic issues as well as the pain and swelling Fat Embolism Syndrome (FES) - CORRECT ANSWER -Embolization of fat globules that occurs in a small percentage of patients with fractures especially long bone fracture -S/S: Respiratory changes, change in LOC, petechiae, pallor to cyanosis, and thrombocytopenia -Tx: Normalize metabolic acidosis and maintain respiratory function, hydrate, cough and deep breath, O2 Prevention: Reposition as little as possible Chronic compartment syndrome - CORRECT ANSWER -Due to heavy exercise or overuse of limb -Tx: PT, orthotics, anti-inflammatories, and diuretics, and if needed surgical fasiotomy Virchow's triad - CORRECT ANSWER Risk factors for DVT: venous stasis, endothelial injury, hypercoagulable state Malignant hyperthermia - CORRECT ANSWER -A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs. -Life threatening emergency -Tx: Oxygen, IV dantrolene, external cooling devices Ankylosis - CORRECT ANSWER joint stiffness Epiphysis - CORRECT ANSWER Widened area of the long bone Diaphysis - CORRECT ANSWER Main shaft of long bone Metaphysis - CORRECT ANSWER where diaphysis and epiphysis meet Epiphyseal plate - CORRECT ANSWER cartilaginous area at the ends of long bones where lengthwise growth takes place in the immature skeleton isometric contraction - CORRECT ANSWER Muscle contracts but there is no movement, muscle stays the same length Isotonic contraction - CORRECT ANSWER A muscle contraction that pulls on the bones and produces movement of body parts. Dorsiflexion - CORRECT ANSWER bending of the foot or the toes upward Plantar flexion - CORRECT ANSWER bends the foot downward at the ankle Pes Planus - CORRECT ANSWER -Flat foot -Tx: Longitudinal arch supports, possible surgery Lordosis - CORRECT ANSWER abnormal anterior curvature of the lumbar spine (sway-back condition) DXA - CORRECT ANSWER -Dual-energy absorptiometry -Painless -Measures bone mineral density Bone scan - CORRECT ANSWER -The injection of a radioactive substance to enable visualization of a bone via the image produced by emission of radioactive particles -Radioisotope given 2hrs before scan -Increase fluids after scan electromyogram (EMG) - CORRECT ANSWER -Recording of skeletal muscle movements -Pt lies supine -Needle insertion -No stimulants or sedatives for 24hrs before procedure [Show Less]
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Orthopedic Nursing Exam 87 Questions with Verified Answers,100% CORRECT
Orthopedic Nursing Exam 87 Questions with Verified Answers 5 Steps in Bone Healing - CORRECT ANSWER 1. Hematoma 2. Fibrocartilaginous Callus Formation ... [Show More] 3. Bony Callus Formation 4. Remodeling Hematoma - CORRECT ANSWER -inflammatory process -cell migration to area Fibrocartilaginous Callus Formation - CORRECT ANSWER -starts within 48 hours -granulation replaces hematoma -osteoblasts build a web of collagen fibers (3 weeks) Bony Callus Formation - CORRECT ANSWER -starts in 3-4 weeks -new bone -osteoclasts invade: reabsorbs excess callus as it is replaced by mature bone Remodeling - CORRECT ANSWER -2-4 months -plates/bars are laid down -repaired along lines of stress Factors in Bone Healing - CORRECT ANSWER - calcium - vitamin D - Alkaline Phosphate - Decreased circulation - No osteoporosis - no infection Diagnostic Radiology - CORRECT ANSWER - Xray - MRI - Bone Scan - Myelogram Myelogram - CORRECT ANSWER - check for allergies (Shell fish) - dye used CSF - CORRECT ANSWER - clear - appears on a dressing as a green halo Dislocation - CORRECT ANSWER - loss of articulation of the bone ends in the joint caps Subluxation - CORRECT ANSWER - partial dislocation where bone ends still partially touch Nursing Care - Joint Trauma - CORRECT ANSWER - Risk for Injury - Acute Pain - Impaired Physical Mobility Ice / Heat - CORRECT ANSWER - 20 minutes on, 20 minutes off Bursitis - CORRECT ANSWER - inflammation of bursa Epicondylitis - CORRECT ANSWER - Tennis Elbow - inflammation of tendon at point of origin to bone Carpal Tunnel Syndrome - CORRECT ANSWER - compression of median nerve and inflammation of the lining of the synovial sheath - less room compresses nerves and causes pain Treatment for Repetitive Injuries - CORRECT ANSWER - Conservative - Surgery Conservative Treatment for Repetitive Injuries - CORRECT ANSWER - immobilize and rest - ice for 20-48 hours and then heat - medicate ( NSAIDS/Corticosteroids) Surgical Treatment for Repetitive Injuries - CORRECT ANSWER - bursitis & epicondylitis : remove calcified deposits - Carpal Tunnel : resect carpal ligament to enlarge tunnel (make opening bigger) Fracture - CORRECT ANSWER - a break in the continuity of the bone symptoms - pain, deformity, edema, crepitus Complete vs. Incomplete Fractures - CORRECT ANSWER total segment transaction vs partial With vs Without Displacement Fracture - CORRECT ANSWER unstable vs stable -same position or shifted Simple vs Compound Fracture - CORRECT ANSWER closed vs open Fracture Impact - CORRECT ANSWER - muscles - blood vessels - nerves - tendons - results : soft tissue damage, blood loss, edema Goal of Reduction - CORRECT ANSWER - fix fracture - approximate segments - restore normal position Closed Reduction - CORRECT ANSWER - manual manipulation of skin Open Reduction - CORRECT ANSWER - surgical manipulation of bone Immobilization - CORRECT ANSWER - goal : fixation/alignment of segments Methods of Immobilization - CORRECT ANSWER - Internal fixation - External fixation Internal Fixation - CORRECT ANSWER - pins, plates, rods, hardware - advantages = fast ambulation - disadvantages = surgery is required External Fixation - CORRECT ANSWER - casts, splints, external fixation devices (rods outside limb) - advantages = may not require surgery, may allow for more movement - disadvantages = cast require slow ambulation, no movement of limb, EFD requires surgery ORIF - CORRECT ANSWER - open reduction internal fixation Principles of Cast Care - CORRECT ANSWER - elevation - turn/rotate - skin edges - pad PRN - pain control - window/bivalve - hot spots/drainage - neuro checks - cool air to relieve itching Traction - CORRECT ANSWER - maintain the pulling force and direction of traction - perform neuro checks - assess for common complications of immobility - teach reasoning behind traction Neuromuscular Checks - CORRECT ANSWER - 5 P's -pulses, pain, pallor, paresthesia,paresis Maintenance of Traction - CORRECT ANSWER - maintain body alignment with direction of pull - do not wedge the pts foot or place against floorboard - weights hang freely and do not touch the floor - nothing obstructing the ropes - knots on rope are not in contact with the pulley Skin Traction - CORRECT ANSWER - short term - apply to skin - low weight (under 10 lbs) - immobilize and align - muscle spasms - splint/straps/wrap Nursing Care for Skin Traction - CORRECT ANSWER - skin assessment (look for pressure areas) - protect pressure sites - remove weights if intermittent traction - relieve muscle spasms Skeletal Traction - CORRECT ANSWER - long term - apply to the bone - infection risk - more weight (25+ lbs) - immobilizers - pins/wires/tongs Nursing Care with Bone Traction - CORRECT ANSWER - NEVER remove the weights - Provide pin care per policy - report signs of infection at pin sites Bone Grafting - CORRECT ANSWER harvesting bone to facilitate healing Autograft - CORRECT ANSWER - from patient Allograft - CORRECT ANSWER from donor Sites Utilized for Bone Grafting - CORRECT ANSWER - iliac crest or the tibia ORIF with ICBG - CORRECT ANSWER - open reduction internal fixation with iliac crest bone graft Nursing Care Priorities with Fractures - CORRECT ANSWER - hemorrhage - neurovascular assessment - elevation - mobilization - SCD's - Lovenox (heparin) - O2 - IS q1hr, WA, DB + C - pain control - stool softeners - fluid replacement - monitor for infection Systems of the Body with Priority - CORRECT ANSWER - skull (LOC, Pupils, Orientation) - facial (respiratory) - rib (respiratory) Healing Complications - CORRECT ANSWER - delayed union - non-union - malunion Delayed Union - CORRECT ANSWER - abnormal length of healing time (< than 6 months) Non-Union - CORRECT ANSWER - no healing within 6-8 months Malunion - CORRECT ANSWER - presence of false joint - growth of fragments of bone in a faulty position Osetomyelitis - CORRECT ANSWER - bone infection - symptoms = fever, chills, redness, and drainage - interventions = antibiotic therapy & hang hygiene with aseptic technique Fat Embolus - CORRECT ANSWER - long bone fractures - release of fat from exposed marrow - fat breaks into fatty acid and attracts platelets - occludes small vessels - ischemia - increased capillary permeability/rupture - fluid shift = edema Signs and Symptoms of Fat Emboli - CORRECT ANSWER - respiratory failure - hypoxia (tachycardia, tachypnea, fever) - cerebral dysfunction (LOC, seizures, focal neurological deficits) - petechiae ( chest, upper arms, axilla) Nursing Care of Fat Emboli - CORRECT ANSWER - O2/pulse OX/ABGs - Corticosteroids (decrease inflammatory response) Compartment Syndrome - CORRECT ANSWER - within first 48 hours - increased internal or external pressure in or on compartment - entrapped nerves/blood vessels/muscle below the fascia - Hypoxia, capillary dilation, edema, necrosis Symptoms of Compartment Syndrome - CORRECT ANSWER - severe unrelenting pain - cyanosis - weakness - parathesia Warning for Compartment Syndrome - CORRECT ANSWER - arteries are outside the compartment so arterial pulses usually remain intact Treatment of Compartment Syndrome - CORRECT ANSWER - decompressive fasciotomy - antibiotics - wet sterile NS dressings x 7-10 days - pain management DVT - CORRECT ANSWER - decreased blood flow - injury to vessel wall - altered blood coagulation To diagnose DVT - CORRECT ANSWER - positive Homans Sign - doppler studies Treat with : Anticoagulants Avascular Necrosis - CORRECT ANSWER - a result of obstructed blood flow - loss of bone - can occur prior to surgery or 4-6 months post surgery Hip Fracture - CORRECT ANSWER - located proximal 1/3 of femur - head, neck, trochanter region Intracapsular Hip Fracture - CORRECT ANSWER - within the joint - head or neck Arthroplasty Extracapsular Hip Fracture - CORRECT ANSWER - outside the joint - trochanter region ORIF (screw and hardware) Nursing Care of Hip Fractures - CORRECT ANSWER - NO ADDUCTION - foam splint or pillow between legs - turn to unaffected side - neurovascular checks Q4 - ambulate within 24 hours, use walker - no flexion > 90 degrees (raised toilet seat) - standard fracture care Hip Resurfacing - CORRECT ANSWER - new - replaces total hip replacement - preserves more bone - shave and cap the bone - insert cobalt chrome implant Advantages to Hip Resurfacing - CORRECT ANSWER - reduces post-op complications of dislocation and inaccurate leg length - potential to last longer - if fails, they can do THR Total Knee Replacement - CORRECT ANSWER - 8-12 inch incision on front of joint - damaged tissue on femur, tibia, and patella removed - hardware applied Hardware of a Total Knee Replacement - CORRECT ANSWER - femoral component = strong metal - tibial component = durable plastic, held in metal tray - plastic patellar component Minimally Invasive Knee Replacement - CORRECT ANSWER - requires 3 inch incision on the side of the knee - patients require 1/3 less therapy - does not cut through quadriceps or tendons so less scarring - rehab to recovery is 6 weeks total Computer Assisted Orthopedic Surgery - CORRECT ANSWER - computer images are used to align knee implants - less wear on prothesis Uni-Compartment Knee Arthroplasty - CORRECT ANSWER - damage on one side of the knee - only replace damaged compartment with implant Shoulder Surgery - CORRECT ANSWER - arthroplasty (minimally invasive) Amputations - CORRECT ANSWER - major problem is contractures Spinal Fractures - CORRECT ANSWER - cord decompression is priority (spinal traction, steroids, airway stability) Complete Spinal Cord Injuries - CORRECT ANSWER - across the entire cord Incomplete Spinal Cord Injuries - CORRECT ANSWER - partial damage to cord Levels of Spinal Cord Injuries - CORRECT ANSWER - at or above C8 = tetrapalgeia (quadriplegic) - at or below T1 - paraplegic - C1-C3 = death from cardio respiratory collapse - C3-C5 = death from respiratory paralysis Spinal Shock - CORRECT ANSWER - cervical or high thoracic injuries - causes massive vasodilation - flaccid paralysis below injury - body temperature same as environment - can start immediately and last 4-6 weeks (months) Spinal Shock Symptoms - CORRECT ANSWER BP - hypotension Pulse - bradycardia Autonomic Dysreflexia - CORRECT ANSWER - Spinal cord injuries at or above T6 - triggered by stimuli that causes abdominal discomfort - neurologic emergency Autonomic Dysreflexia Symptoms - CORRECT ANSWER BP - Severe Hypertension Pulse - Bradycardia Back Pain Conservative Treatments - CORRECT ANSWER - exercise - meditation - steroid injections Back Pain Surgical Treatments - CORRECT ANSWER - laminectomy Nursing Care for Laminectomies - CORRECT ANSWER - incision - neuro checks - positioning = straight alignment - log rolling - post op interventions Boomeritis - CORRECT ANSWER - not a official Dx - inflammation found in the boomer generation related to people not knowing when to slow down with aging [Show Less]
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ONC General Practice Exam 50 Questions with Verified Answers,100% CORRECT
ONC General Practice Exam 50 Questions with Verified Answers To establish the diagnosis of osteoporosis, a patient's primary care provider orders a DEXA... [Show More] scan (dual energy x-ray absorptiometry). The patient asks the nurse, "How will the test show if I have osteoporosis?" The nurse's response should be based on knowledge that which of the following accurately describes this procedure? a. The patient will be given a radioactive isotope several hours before the scan, and its uptake into the patient's bones will be measured. b. The patient's bone density will be compared to the reference range of healthy young adults. c. The amount of calcium in the patient's bones will be compared to the patient's serum values of osteocalcin and alkaline phosphatase. d. The patient's peak bone mass will be measured by comparing the ratio of cortical to cancellous bone in her distal forearm. - CORRECT ANSWER b. The patient's bone density will be compared to the reference range of healthy young adults. Rationale: DEXA compares a patient's bone density in the hip and spine to that of a mean young adult normal reference range (known as the T-score). DEXA is a noninvasive diagnostic that does not require the use of a radioisotope. There are also no associated laboratory studies, and assessment of the distal forearm is not completed as part of DEXA scanning. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 96 A patient is newly diagnosed with osteoporosis and risedronate sodium (Actonel®) is prescribed. The nurse should give which of these instructions about the drug to the patient? a. "Take the Actonel at night immediately before you got to bed." b. "Take a multivitamin that contains 400 IU of vitamin D every day to promote absorption of the Actonel." c. "After taking Actonel, remain in an upright position for at least 30 minutes." d. "Before taking Actonel, eat a small amount of food to prevent stomach irritation." - CORRECT ANSWER c. "After taking Actonel, remain in an upright position for at least 30 minutes." Rationale: Bisphosphonates such as Actonel need to be taken on an empty stomach at least 30 minutes before breakfast, and the patient should remain in an upright position. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 380, Table 14-1 A patient is suspected of having osteomalacia and is undergoing diagnostic testing. The patient understands this disease is caused by inadequate intake of vitamin D, but asks the nurse what other factors may have contributed to development of this condition. Based on the patient's history, the nurse should identify which of the following as a risk factor for decreased synthesis of vitamin D? a. Having renal disease b. Having light skin c. Living at low altitude d. Living on a farm - CORRECT ANSWER a. Having renal disease Rationale: Adults affected by chronic diseases of the liver, kidney, and small intestine have decreased bone mineralization related to vitamin D deficiency. Dark skin does not synthesize vitamin D as easily as fair skin. Persons who live at high altitudes also do not synthesize vitamin D as readily as those living at lower altitudes. Living on a farm has no direct impact, but living in long-term care facilities with limited exposure to sunlight can affect vitamin D synthesis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383 The mother of a 50-year-old patient has been diagnosed with osteoporosis. The patient asks about her own risk for the disease. Based on discussion with the patient about her history and lifestyle, the nurse should identify which of the following as a risk factor for osteoporosis? a. She is 10 pounds overweight. b. She smokes one pack of cigarettes per day. c. She drinks two cups of coffee every morning. d. She never had children. - CORRECT ANSWER b. She smokes one pack of cigarettes per day. Rationale: Smoking has been shown to increase the incidence of osteoporosis by influencing the onset of menopause and the lowering of bone mineral density. Being overweight does not contribute to osteoporosis; two cups of coffee a day is moderate intake of caffeine and not considered a risk factor. Never having had children is only a factor if it contributes to early menopause. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379 A close friend of the nurse has experienced intermittent swelling and pain in the joints of the hands, feet, and knees over the past year. The nurse suspects the friend has rheumatoid arthritis (RA) and encourages evaluation by a healthcare provider. What other, early symptom should lead the nurse to suspect RA? a. Hip pain b. Photosensitivity c. Weight gain d. Fatigue - CORRECT ANSWER d. Fatigue Rationale: Fatigue, lethargy, and weight loss are common early symptoms of RA. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 341 After an acute episode of painful swelling of multiple joints accompanied by disabling morning stiffness, a patient is diagnosed with psoriatic arthritis. The nurse should recognize that blood test results are likely to include which of the following? a. Erythrocyte sedimentation rate 20 mm/hr b. Rheumatoid factor 12 IU/ml c. Serum uric acid 7.6 mg/dL d. White blood cell count 7000 cells/microliter - CORRECT ANSWER c. Serum uric acid 7.6 mg/dL Rationale: Hyperuricemia (greater than 7 mg/dL in men, 6 mg/dL in women) is possible in psoriasis because of rapid cell turnover. While ESR may be elevated in psoriatic arthritis during acute inflammation, a value of 20 mm/hr is normal (0-22 for men, 0-29 for women). Less than 14 IU/ml is considered a normal RF value, as is 7000 white cells/microliter (normal 4000-11,000). Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 363 A patient with newly diagnosed rheumatoid arthritis is prescribed diclofenac (Voltaren®) and methotrexate. The nurse should understand these two medications are prescribed together primarily to a. maximize the patient's activity level. b. minimize steroidal side effects. c. minimize the patient's immune response. d. maximize control of inflammation. - CORRECT ANSWER d. maximize control of inflammation. Rationale: NSAIDs are used to improve joint function by decreasing acute inflammation and pain. However, they cannot alter the course of RA or prevent joint damage. Thus they are prescribed for use while the patient awaits therapeutic effects of a DMARD such as methotrexate or a biologic response modifier. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 342-344 A patient newly diagnosed with ankylosing spondylitis receives a prescription for etanercept (Enbrel®). Which of the following statements should the nurse include in patient teaching on this medication? a. "This medication will be given once a week for your condition." b. "This medication can cause GI upset and mild diarrhea." c. "Be sure to use birth control while taking this Enbrel." d. "Schedule an eye exam every year while taking Enbrel because of the risk of corneal damage." - CORRECT ANSWER a. "This medication will be given once a week for your condition." Rationale: Enbrel is typically prescribed for subcutaneous injection every week, with the initial dose of 50 mg for ankylosing spondylitis. This biologic response modifier is not likely to cause GI upset and diarrhea; these problems are more likely with DMARDs. Birth control is recommended during use of the DMARD leflunamide (Arava®) because of its teratogenic effects. Corneal damage is possible with the DMARD hydrochloroquine (Plaquenil®), but it is not related to use of Enbrel. Reference: Drugs.com. (n.d.) Enbrel Dosage. Retrieved from https://www.drugs.com/dosage/enbrel.html A patient with long-standing RA develops flexion of the proximal interphalangeal (PIP) joints and hyperextension of the distal interphalangeal (DIP) joints on the third and fourth fingers of her right hand. The nurse should recognize these changes as characteristic of a. swan-neck deformities. b. boutonniere deformities. c. Bouchard's nodes. d. Heberden's nodes. - CORRECT ANSWER b. boutonniere deformities. Rationale: A boutonniere deformity occurs due to rupture of the extensor tendon mechanism of the finger over the proximal interphalangeal (PIP) joint. This causes hyperextension of the distal interphalangeal (DIP) joint). In a swan-neck deformity, the PIP is in hyperextension and the DIP in flexion. Bouchard's and Heberden's nodes are associated with osteoarthritis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 530 A patient who underwent total knee arthroplasty for rheumatoid arthritis is prescribed rivaroxaban (Xarelto®) for VTE prophylaxis. The patient tells the nurse, "I was prescribed Coumadin for my last surgery. Why am I receiving a different medication?" The nurse's response should be based on the knowledge that Xarelto a. has a longer half-life. b. has a specific reversal agent. c. does not affect prothrombin time. d. does not increase bleeding risk. - CORRECT ANSWER c. does not affect prothrombin time. Rationale: The factor Xa medications such as rivaroxaban do not have notable effects on prothrombin time and thus do not require serial INR monitoring. These drugs also do not have specific reversal agents. They do have shorter half-lives than Coumadin. All anticoagulant medications can increase bleeding risk. Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 140 A 12-year-old patient experiences an epicondylar fracture in a softball game and a long-arm cast is applied. If the cast needs to be split after application to allow for tissue swelling, the nurse will bivalve the cast by splitting it a. anteriorly and medially. b. posteriorly and laterally. c. anteriorly and posteriorly. d. medially and laterally. - CORRECT ANSWER d. medially and laterally. Rationale: A bivalved cast is split medially and laterally to create anterior and posterior portions. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 30 A patient with a hip fracture is placed in 5 pounds of Buck's traction and surgery is scheduled for the next morning. The nurse should know the Buck's traction is used to a. minimize muscle spasm. b. increase blood flow to fracture fragments. c. decrease the risk of thrombosis. d. maximize the patient's bed mobility. - CORRECT ANSWER a. minimize muscle spasm. Rationale: Buck's traction is used for immobilization of unrepaired hip fractures, with some relief of muscle spasms. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 254, 551 A patient is out of bed and ambulating late on the day of surgery following total knee arthroplasty. The nurse should recognize that early ambulation a. prevents drainage from the incision. b. decreases the risk of clot formation. c. decreases the need for physical therapy. d. reverse the effects of anesthesia. - CORRECT ANSWER b. decreases the risk of clot formation. Rationale: Prophylaxis to decrease the risk of VTE is universally recommended. Commonly used strategies are often multimodal and include a combination of medications, mechanical compression, and early mobilization. Other options are not effects of early ambulation. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 578 Following application of a short-arm cast on a patient with a buckle fracture of the wrist, the nurse will assess sensation and motion in the patient's digits. The nurse should recognize numbness and tingling between the thumb and index finger may indicate compromise of which nerve? a. Peroneal b. Ulnar c. Radial d. Median - CORRECT ANSWER c. Radial Rationale: The radial nerve gives sensation to the dorsum of the hand from the thumb to the third finger. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 20 A patient arrives on the surgical unit following spinal fusion. The nurse should institute spine precautions that require a. logrolling for bed mobility. b. forward-bending exercises to strengthen the spine. c. sitting for frequent periods in a recliner. d. rotational exercises to increase spine flexibility. - CORRECT ANSWER a. logrolling for bed mobility. Rationale: Logrolling provides uniform support for the back as the patient is turned from side to side. Other activities cause spinal rotation that can disrupt the surgical site in the spine. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 456 A patient is receiving mitoxantrone (Novantrone®) for treatment of an exacerbation of multiple sclerosis. In administering the drug, the nurse should be aware that a. there is a lifetime dose limit due to its renal toxicity. b. the patient may experience permanent hair loss. c. the patient's urine may turn a blue-green color initially. d. it should be stored in the unit medication refrigerator. - CORRECT ANSWER c. the patient's urine may turn a blue-green color initially. Rationale: The nurse should know the patient's urine may turn a blue-green color for a few days following each dose of mitoxantrone. The patient's sclera also may have a slight blue color. This information should be provided to the patient and family. Reference: National Multiple Sclerosis Society. (n.d.). Novantrone. Retrieved from https://www.nationalmssociety.org/Treating-MS/Medications/Novantrone (See Novantrone Medication Guide for Patients) A patient is diagnosed with osteoid osteoma. The nurse should be able to confirm this is a benign tumor that a. requires wide excision in 90% of affected patients. b. causes night pain that can be relieved by aspirin. c. usually develops into a large osteoblastic lesion. d. occurs most often in the spine and femur. - CORRECT ANSWER b. causes night pain that can be relieved by aspirin. Rationale: As a primary benign tumor, osteoid osteoma is characterized by night pain often relieved by aspirin or NSAIDs. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 425 While discussing the treatment plan for an adolescent with a malignancy of the distal femur, the nurse should explain to the family that the most common malignant bone tumor in children and adolescents is a. osteoblastoma. b. chondrosarcoma. c. osteosarcoma. d. osteochondroma - CORRECT ANSWER c. osteosarcoma. Rationale: Osteosarcoma is the most common primary malignant bone tumor in children, with occurrence greater in boys than girls. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 430 A patient is diagnosed with slipped capital femoral epiphysis (SCFE). The nurse should recognize the patient is at higher than normal risk of developing a. progressive deformity. b. severe growth failure. c. joint contracture. d. secondary osteoarthritis. - CORRECT ANSWER d. secondary osteoarthritis. Rationale: The patient with SCFE is at risk for developing secondary osteoarthritis related to chondrolysis, AVN, or deformity from SCFE. The other conditions are not considerations with SCFE. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 314 A 12-year-old cross-country runner has been diagnosed with Osgood-Schlatter disease. While reviewing the overall treatment plan with the patient and family, the nurse should include information about which of the following? a. Symptoms will stop by the end of skeletal growth. b. Long-term damage to the knee can result if inflammation persists. c. Pain may be relieved by flexion exercises. d. Surgery will offer the best hope of symptom relief. - CORRECT ANSWER a. Symptoms will stop by the end of skeletal growth. Rationale: Osgood-Schlatter disease is a self-limiting condition of pre-adolescence; symptoms stop when apophysis is fully ossified. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 302 The nurse is providing pre-operative teaching to a patient scheduled for an open reduction-internal fixation (ORIF) of the femur. Which of the following biologic implants should the nurse recognize is used to fill in bony defects? a. Cannulated screw b. Cortical strut c. Polypropylene cup d. Compression plate - CORRECT ANSWER b. Cortical strut Rationale: Biologic implants include bone and allograft tissue such as a cortical strut. The other options are not biologic implants. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 134; Orthopaedic Surgery Manual (3rd ed.), 2017, p. 92 While caring for a patient undergoing a shoulder arthroscopy, the nurse assists with positioning the patient in a lateral decubitus position. Which of the following nerves should the nurse recognize may sustain injury when the patient is placed in the lateral position and there is inadequate padding under the fibular head? a. Saphenous b. Tibial c. Sural d. Peroneal - CORRECT ANSWER d. Peroneal Rationale: Peroneal nerve damage is caused by compression over the lateral aspect of the fibular head or from prolonged plantar flexion of the foot. The saphenous nerve runs superficially at the medial thigh and may be impaired by direct compression from a tourniquet or arthroscopic leg holder. The tibial nerve diverges at the popliteal fossa and travels down the leg to the medial aspect of the ankle. The sural nerve is found laterally at the ankle and foot. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 129; Orthopaedic Surgery Manual (3rd ed.), 2017, p. 50 Two days before scheduled total hip arthroplasty, a patient comes to the surgeon's office for the final preoperative assessment. Which of the following statements by the patient should require further investigation by the nurse? a. "It's hard for me to get moving in the morning because I'm so stiff." b. "Every evening I drink a glass of wine." c. "I had a nasty tooth pulled last week." d. "The arthritis in my feet has been giving me trouble this week." - CORRECT ANSWER c. "I had a nasty tooth pulled last week." Rationale: Acute infection may be a contraindication for THA due to increased risk of bacteria infecting the replaced hip. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 553 The patient undergoes right total hip arthroplasty with a posterolateral approach. Following a short stay in the post-anesthesia unit, the patient is transferred to the orthopaedic surgical unit. Which of these observations made by the nurse should indicate the positioning of the patient's right extremity is correct? a. Leg is in adducted position. b. Hip is flexed 90 degrees. c. Leg is in neutral position. d. Hip is internally rotated. - CORRECT ANSWER c. Leg is in neutral position. Rationale: Following THA with a posterolateral approach, the patient should not flex the hip beyond 90 degrees, cross the operative leg past the body's midline (adduction), or internally rotate the surgical hip. The leg should be maintained in neutral position. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 556 A patient who had total knee arthroplasty two days ago is now suspected of having deep vein thrombosis. The nurse should identify a positive Homan's sign if a. the knee is pressed against the bed and the leg is extended. b. the foot is dorsiflexed and the leg is extended. c. a tourniquet is applied below the knee and the leg is flexed 90 degrees. d. the foot is laterally rotated and the leg is flexed 90 degrees. - CORRECT ANSWER b. the foot is dorsiflexed and the leg is extended. Rationale: Homan's sign is marked by discomfort in the upper calf with forced dorsiflexion of the foot. Although often assessed, it is not specific to or sensitive for deep vein thrombosis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 61 A nursing assistant reports to the nurse that a patient who had total shoulder arthroplasty is complaining of pain. The nurse takes all of the following actions. Which action should the nurse take FIRST? a. Administer the medication prescribed for breakthrough pain. b. Determine if the PCA pump is working properly. c. Examine the patient's operative site. d. Assess the patient's pain. - CORRECT ANSWER d. Assess the patient's pain. Rationale: Research has shown that the most common reason for unrelieved pain is the failure of staff to routinely assess pain. Pain must be assessed before it can be treated. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p.166 A 10-year-old child was skiing with family members. After experiencing a forward fall, the child immediately complained of lower leg pain and was taken to the nearest emergency department. X-rays confirmed a nondisplaced fracture of the tibial shaft. The nurse should expect the child to receive which of the following treatments? a. Long-leg cast b. Open reduction, internal fixation c. Percutaneous pinning d. Adduction bracing - CORRECT ANSWER a. Long-leg cast Rationale: Non-displaced tibial shaft fractures in children may be immobilized conservatively by using a long-leg cast. A short-leg cast also may be used. Other options are not appropriate for tibial shaft fractures in childhood. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 408, Table 15-9 Following surgical fixation of a distal femur fracture, a patient is receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse should know that compared to traditional pain management strategies, PCA has the advantage of a. allowing quick titration of the analgesia. b. providing a safe route for meperidine (Demerol®) administration. c. reducing the need for nurse assessment. d. delivering medication safely for opioid-naïve patients. - CORRECT ANSWER a. allowing quick titration of the analgesia. Rationale: Advantages to the PCA include the ability to titrate the drug quickly, maintenance of analgesic serum concentration with supplemental continuous infusion, predictable absorption rate, and patient control. Assessment and reassessment are keys to the effective, safe use of PCA, and should be completed in accordance with hospital policy. Meperidine use is not recommended in PCA because of effects of the metabolic normeperidine. PCA is not recommended for opioid-naïve patients. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 172 Following traumatic injury, a patient is diagnosed with fat embolism syndrome (FES). The nurse should recognize risk factors for FES include which of the following? a. Older age b. Long bone fracture c. Previous fracture d. Smoking - CORRECT ANSWER b. Long bone fracture Rationale: Long bone fractures are a risk factor in approximately 90% of cases of FES. The other options are not risk factors for FES. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 203 A 24-year-old female underwent surgery for multiple fractures caused by a motor vehicle crash. A week into her recovery, she is diagnosed with deep vein thrombosis in the left calf. The patient's spouse asks, "How could this happen?" In answering this question, with of the following in the patient's lifestyle and history should the nurse identify as increasing the risk for DVT? a. Patient age b. Body mass index 23.6 c. History of iron deficiency d. Contraceptive use - CORRECT ANSWER d. Contraceptive use Rationale: Use of estrogen (e.g., contraceptives, estrogen replacement therapy) increases a person's risk for DVT. Obesity (BMI 30 or higher; BMS 25-29.9 is overweight) and age over 40 are also risk factors. History of iron deficiency is not a factor in the development of DVT Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 201 A computer programmer complains of numbness, tingling, and burning pain in the thumb, index, and long fingers of the dominant right hand. The symptoms have lasted 3 months and awaken the patient several times each night. The diagnosis of carpal tunnel syndrome (CTS) is made. The nurse should assess the patient to determine if she also has symptoms in which of these areas commonly affected in CTS? a. Radial styloid process b. Ulnar styloid process c. Radial side of the ring finger d. Ulnar side of the little finger - CORRECT ANSWER c. Radial side of the ring finger Rationale: The radial side of the ring finger is enervated by the median nerve. Paresthesia over the sensory distribution of the medial nerve is the most frequent symptom of CTS. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 546 A patient comes to the clinic with complaint of the left index finger locking in a flexed position. The patient states, "I often hear a popping sound when I try to bend or straighten my finger." The patient's history includes type 2 diabetes, hypertension, and hypercholesterolemia. X-rays rule out bony pathology and the patient is diagnosed with trigger thumb. Which of the following should the nurse include in educating this patient about trigger finger? a. "Apply moist heat for 20 minutes every 6-8 hours to reduce pain and swelling." b. "Try to keep fasting blood glucose results below 100 mg/dL." c. "Your provider has ordered physical therapy to decrease inflammation." d. "The steroid injection you received can be repeated every 3 months." - CORRECT ANSWER b. "Try to keep fasting blood glucose results below 100 mg/dL." Rationale: Patients with diabetes have a fourfold increased chance of developing trigger finger; they should make every effort to maintain normal blood glucose. Ice may be applied for 20 minutes at a time every 4-6 hours to reduce pain and swelling. Physical therapy may used to increase ROM, but the mechanics of trigger finger will not be affected unless steroid patches are used through iontophoresis. Corticosteroid injections are not usually successful in patients with diabetes; however, injections are usually limited to two lifetime injections in the triggering area. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 539 A patient presents to the clinic with complaints of numbness, tingling, and burning pain in the thumb, index finger, and middle finger of the right hand. The nurse tells the patient Phalen's test will be performed to help determine the presence of carpal tunnel syndrome (CTS). This nurse should FIRST a. ask the patient to flex both wrists. b. ask the patient to extend both wrists. c. tap lightly over the volar surface of the patient's wrists. d. tap lightly over the dorsal surface of the patient's wrists. - CORRECT ANSWER a. ask the patient to flex both wrists. Rationale: The nurse should ask the patient to flex the both wrists and push the dorsal surfaces together for at least 1 minute. If the maneuver causes tingling in the distribution of the median nerve, CTS is considered probable. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 53 A patient comes to the clinic with complaint of increasing left leg pain. The patient denies any known injury. After physical assessment and x-rays, the patient is diagnosed with degenerative disc disease. Which of the following instructions should the nurse provide as part of conservative treatment? a. "Sit as often as possible to rest your back." b. "Limit the addition of salt to your meals." c. "Avoid use of tobacco products." d. "Modify your activities within comfort levels." - CORRECT ANSWER d. "Modify your activities within comfort levels." Rationale: Patients with DDD are encouraged to modify their activities within comfort levels to avoid acute exacerbations and to allow acute symptoms to resolve. Sitting will not help in resolution of the symptoms; sitting more than 30 minutes may actually result in worse pain. Limited use of salt or tobacco products would have not impact. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 461 A patient with herniated nucleus pulposus underwent lumbar fusion and discectomy after repeated attempts at conservative treatment had been ineffective. In preparing for discharge, the patient asks why additional physical therapy is needed. The nurse's response should be based on the knowledge that physical therapy after this procedure would be particularly beneficial for a. improving disc height. b. increasing muscle mass. c. stabilizing the trunk. d. maintaining balance. - CORRECT ANSWER c. stabilizing the trunk. Rationale: PT should be encouraged after this type of surgery, with the primary goal of trunk stabilization to prevent recurrence of disc herniation. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 460 A newborn boy has been diagnosed with developmental dysplasia of the hip (DDH). When counseling the family in the clinic, which of these factors in the infant's history should the nurse explain to the parents may be associated with DDH? a. Breech birth b. Male gender c. African-American ethnicity d. Low birth weight - CORRECT ANSWER a. Breech birth Rationale: About 30%-50% of children with DDH have a history of breech presentation. The other factors are not associated with DDH. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 280 The nurse is evaluating a young child in the clinic for Type l osteogenesis imperfecta. The child presents with a history of blue sclera and a number of fractures when starting to walk. Which of the following should the nurse understand about this disorder when counseling the family? a. Patients with Type l osteogenesis imperfecta do not have a normal life expectancy. b. Fractures will increase after puberty in Type l osteogenesis imperfecta. c. Type l osteogenesis imperfecta is an autosomal dominant condition. d. Pulmonary insufficiency is often seen in patients with Type I osteogenesis imperfecta. - CORRECT ANSWER c. Type l osteogenesis imperfecta is an autosomal dominant condition. Rationale: Type 1 osteogenesis imperfecta is autosomal dominant and patients with the disorder have a normal life expectancy. It is the mildest form of OI and fractures will decrease after puberty. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 304-305 When screening a child for scoliosis, the school nurse identifies multiple cafe-au-lait spots and freckling in the axillae and skin folds. The nurse should recommend a follow-up assessment by a pediatric orthopedist to evaluate the child for which of the following? a. Muscular dystrophy b. Neurofibromatosis c. Myelodysplasia d. Osteogenesis imperfecta - CORRECT ANSWER b. Neurofibromatosis Rationale: Cafe-au-lait spots and freckling in the skin folds are classic cutaneous manifestations of neurofibromatosis. They are not seen in the other disease processes. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 299-300 The nurse is providing education to the family of a newborn with bilateral clubfeet. Which of the following casting methods should the nurse identify as used for the treatment of talipes equinovarus? a. Mehta casting b. Ponseti casting c. Risser casting d. Spica casting - CORRECT ANSWER b. Ponseti casting Rationale: Ponseti serial casting is the standard for clubfoot casting. Mehta and Risser casts are torso casts used for spinal deformity. A spica is usually a hip or shoulder cast. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 279 A 19-year-old football player at a local college sustains an acute left anterior shoulder dislocation when he attempts to block a high pass during a football game. After initial evaluation by the team physician, the patient is transferred to the local hospital's emergency department. The nurse who first assesses the patient should be aware that the shoulder is the most easily dislocated joint because of the relatively weak articulation of the a. acromioclavicular joint. b. scapulothoracic juncture. c. sternoclavicular juncture. d. glenohumeral joint. - CORRECT ANSWER d. glenohumeral joint. Rationale: Dislocation of the glenohumeral joint accounts for 50% of all major joint dislocations. This joint allows greater range of motion than other ball-and-socket joints but has less stability. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 476 A football player leaves the game in pain after a hard tackle. He is taken to the emergency department (ED) and diagnosed with posterior sternoclavicular separation. With this type of injury, the nurse in the ED should know it is critical to frequently assess the patient's a. circulation. b. sensation. c. respirations. d. range of motion. - CORRECT ANSWER c. respirations. Rationale: SC joint separations can result in lethal complications from a pneumothorax. The nurse must monitor the patient's breathing. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 499 A basketball player with a grade II lateral ankle sprain is placed in a CAM boot after being seen in the Urgent Care Center. The patient asks the nurse if weight can be placed on the ankle. The nurse's response should be based on knowledge of which of the following provider orders for this patient? a. Non weight-bearing b. Full weight-bearing c. 10 pounds partial weight-bearing d. Weight-bearing as tolerated - CORRECT ANSWER d. Weight-bearing as tolerated Rationale: A patient with a grade II ankle sprain should have orders for weight-bearing as tolerated; some patients may need an assistive device as well. Protected weight-bearing is needed for a grade III ankle sprain. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 588, Table 23.1 A patient who recently started training for a marathon comes to the office with diagnosis of foot and ankle pain. After physical examination, the patient is diagnosed with Achilles tendinitis. The nurse should expect which of the following treatments to be prescribed for this patient? a. Rest b. Injection c. Cast application d. Surgery - CORRECT ANSWER a. Rest Rationale: Noninvasive modalities are the foundation of treatment for Achilles tendinitis, especially rest and anti-inflammatory medications. Avoidance of uneven surfaces and inclines, along with a decrease in pace, is suggested during early rehabilitation. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 590 The day after a basketball game, the patient is seen in the clinic with right knee pain. The patient describes going up for rebound and twisting the knee on landing. Assessment suggests the patient has a bucket handle tear of the body of the meniscus. An MRI is ordered. The nurse should recognize which of the following patient symptoms as also suggestive of this type of injury? a. Crepitus b. Locking c. Swelling d. Instability - CORRECT ANSWER b. Locking Rationale: A bucket handle tear of the meniscus is a tear in the body of the meniscus that resembles a bucket handle. This type of tear frequently causes locking of the knee as the "handle" catches and prevents extension of the joint. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 580 A high school wrestler with a long history of anterior shoulder dislocations is scheduled for outpatient surgery for shoulder arthroscopy with possible repair. The patient and parents discuss the procedure with the surgeon and anesthesiologist, and they decide to have an interscalene block instead of general anesthesia. Following this type of brachial plexus block, the nurse should monitor for signs of a. Horner's syndrome. b. compartment syndrome. c. Ehlers Danlos syndrome. d. Marfan syndrome. - CORRECT ANSWER a. Horner's syndrome. Rationale: Monitoring patients with a brachial plexus block includes evaluation of low oxygen saturation, chest heaviness, drooping of the eyes, and hoarseness; this set of symptoms is called Horner's syndrome. Marfan syndrome is a genetic disorder of connective tissue, not an acute complication of surgery. Ehlers Danlos syndrome is also a genetic disorder of connective tissue. Compartment syndrome is possible after orthopaedic surgery, but it is not a complication of a brachial plexus block. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 175 A patient reports "jamming" a finger on his right hand yesterday during a basketball game. The patient is seen in the Urgent Care Center and diagnosed with mallet finger. When the nurse reviews use of a prescribed splint for the injured finger, the patient asks how often he needs to wear the splint. The nurse should respond, a. "During sports activities." b. "As needed based on symptoms." c. "At all times." d. "At nighttime." - CORRECT ANSWER c. "At all times." Rationale: Many types of finger splints can be used to treat mallet finger. The importance of using the splint at all times must be stressed to the patient, as consistent use is essential for proper healing with this type of injury. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 529 A patient with long-standing Paget's disease is seen in the clinic for routine laboratory testing. The nurse should expect which of the following to be included in the blood panel for this patient? a. Alpha-fetoprotein b. Vitamin D c. Parathyroid hormone d. Alkaline phosphatase - CORRECT ANSWER d. Alkaline phosphatase Rationale: Alkaline phosphatase is needed to monitor ongoing bone remodeling and ongoing assessment of skeletal deformity in Paget's disease. Alpha-fetoprotein is used to help diagnose and monitor therapy for some cancers of the liver, testicles, and ovaries. Serum vitamin D is assessed for suspected rickets or osteomalacia. Parathyroid hormone can also identify deficiencies and osteomalacia. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 391 A female patient diagnosed with hypoparathyroidism returns to the clinic for a follow-up appointment. In reviewing the patient's documented history from the last visit, which of the following should the nurse expect to identify? a. Constipation b. Frequent urination c. Anorexia d. Flaking skin - CORRECT ANSWER d. Flaking skin Reference: Dry, flaking skin may occur with hypoparathyroidism. GI symptoms include increased gastric motility with cramping and diarrhea. Anorexia, nausea, and vomiting are associated with hyperparathyroidism due to hypercalcemia. Frequent urination with polyuria can occur with hyperparathyroidism due to calcium loss that impairs renal water conservation. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 389 A patient with Parkinson's disease is seen in the clinic for routine re-assessment. The patient's spouse tells the nurse, "My husband is no longer showing any interest in sex." The nurse's response should be based on knowledge that sexual dysfunction in Parkinson's disease can be caused by loss of a. serotonin. b. dopamine. c. norepinephrine. d. glutamate. - CORRECT ANSWER b. dopamine. Rationale: PD may cause sexual dysfunction due to the loss of dopamine, the principal neurochemical mediator of reward and pleasure in the brain. Reference: Parkinson's Foundation. (n.d.). Sexual Health. Retrieved from https://www.parkinson.org/Living-with-Parkinsons/Managing-Parkinsons/Sexual-Health A child with Duchenne muscular dystrophy is brought to the clinic by his mother for a routine visit. The nurse, who had previously reviewed her carrier status with the boy's mother, should also discuss the mother's risk for a. cardiomyopathy. b. renal insufficiency. c. hepatic failure. d. osteoporosis. - CORRECT ANSWER a. cardiomyopathy. Rationale: Female carriers of DMD have a higher-than-average risk of developing cardiomyopathy. The American Academy of Pediatrics recommends that carriers should undergo a complete cardiac evaluation in late adolescence or early adulthood, or sooner if symptoms occur. They should also be evaluated every 5 years starting at ages 25-30. The other conditions are not linked to carrier status. Reference: Muscular Dystrophy Association. (n.d.). Duchenne Muscular Dystrophy (DMD). 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Ortho NCLEX Exam 41 Questions with Verified Answers,100% CORRECT
Ortho NCLEX Exam 41 Questions with Verified Answers A retired 66- year- old female patient is being evaluated for osteoporosis as part of a yearly physi... [Show More] cal exam. The patient states that she is a smoker, watches television for most of the day, and has been hospitalized twice with fractures within the last year. Based on this information, the nurse suspects which condition? A.Low bone mass leading to increased bone fragility B.Degeneration of the articular cartilage C.Recurrent attacks of acute arthritis D.Personality changes caused by chronic nature of illness - CORRECT ANSWER A. Low bone mass leading to increased bone fragility ' Low bone mass, structural deterioration of bone tissue leading to bone fragility, and increased susceptibility to fractures are seen with osteoporosis. The patient also has risk factors associated with osteoporosis: smoking, sedentary lifestyle, and being female and menopausal. Degenerative changes are associated with frequent exacerbations of arthritis. There is no indication of personality change in this patient. The nurse determines that a 55- year-old female patient is experiencing menopause and is also at risk for osteoporosis. What foods other than milk can the nurse suggest to this patient to increase calcium intake? A. Seafood, wheat, corn, green vegetables B. Chicken vegetables, green vegetables, pasta, broccoli C. Green vegetables, sardines, salmon with bone, molasses D. Fresh fruits, English muffins, black beans, asparagus - CORRECT ANSWER Answer C is correct. Women of menopausal age are at risk for osteoporosis, and foods high in calcium should be encouraged. A diet with green vegetables, sardines, salmon with bone, and molasses provides high- quality calcium and is recommended for a patient experiencing menopause in order to decrease the risk of osteoporosis. A diet with seafood, wheat, corn, and green vegetables is more concentrated in carbohydrates than proteins containing more calcium. A diet with chicken, green vegetables, sardines, and broccoli contains some calcium but is lower than the other option. Foods such as fresh fruits, English muffins, black beans, and asparagus are inadequate in calcium. A patient with osteoporosis has been advised to increase the amount of calcium in her diet. Which food provides the most calcium? An 8- oz glass of milk An ounce of cheddar cheese A half cup of raw broccoli A 4- ounce salmon croquette - CORRECT ANSWER Answer A is correct. An 8-ounce glass of milk contains 290mg of calcium. Answers B, C, and D contain lesser amounts; therefore, they are incorrect. (Note: An ounce of cheddar cheese contains 205 mg of calcium; half a cup of raw broccoli contains 175mg of calcium; and 4 ounces of salmon croquette contains 165 mg of calcium). Which of the following instructions should be included for the patient taking calcium supplements? A.The patient should take her calcium with meals B.The patient should take all her daily calcium supplements at one time C.The patient should take her calcium supplement after meals to prevent stomach upset D.The patient can use calcium- based antacids for supplement. - CORRECT ANSWER Rationale: Answer D is correct. Many people prefer to supplement their calcium intake with calcium- based antacids. If calcium supplements are used, they should be administered 30 minutes before meals to maximize absorption, so answer A is wrong. Calcium absorption is better if it is administered throughout the day rather than in a single dose, making answer B wrong. Calcium supplements do not cause stomach upset, so answer C is wrong. Alendronate (Fosamax) is ordered for a patient with osteoporosis. Which information should the nurse teach the patient about the medication? A. Acts as a selective estrogen receptor modulator B. Reduces risk of invasive breast cancer C. May be obtained as a nasal spray D. Inhibits bone resorption - CORRECT ANSWER Alendronate (Fosamax), a bisphosphonate, is a potent inhibitor of bone resorption that preserves bone mass and increases bone density. Raloxifene (Evista) is an example of a selective estrogen receptor modulator that is used to treat osteoporosis, and which also reduces the risk of invasive breast cancer. Calcitonin (Miacalcin) is dispensed as a nasal spray. The nurse is caring for a patient with osteoporosis who is being discharged on alendronate (Fosamax). Which statement would indicate effective teaching? A. "I should take the medication immediately before bed" B. "I should remain in an upright position for 30 minutes after taking the medication" C. "The medication is more effective if I take it with milk or dairy products" D. If I skip a dose, I can take two tablets the next time" - CORRECT ANSWER Answer: B- Rationale should remain upright for 30 mins. How long does a patient taking bisphosphonates need to stay upright after administration? A. 10 minutes B. 20 minutes C. 30 minutes D. 120 minutes - CORRECT ANSWER 30 minutes Bisphosphonates are administered on arising in the morning with a full glass of water on an empty stomach, and the patient must stay upright for 30 to 60 minutes. When caring for a client with hypocalcemia, the nurse should assess for: A. A decreased level of consciousness B. Tetany C. Bradycardia D. Respiratory Depression - CORRECT ANSWER Answer B is correct. The most common complication of hypocalcemia is overstimulation of the nerves and muscles. Tetany, which can progress to convulsions, indicated that the patient's condition is worsening. Answer A is incorrect because a decreased level of consciousness is not associated with hypocalcemia. Tachycardia, not bradycardia, is associated with hypocalcemia, making answer C incorrect. Answer D is incorrect because respiratory depression is not directly related to hypocalcemia. A patient has been diagnosised with osteomalacia. What symptoms does the nurse recognize that correlate with the diagnosis? A. Bone fractures and kyphosis B. Bone pain and tenderness C. Muscle Weakness and spasms D. Softened and compressed vertebrae - CORRECT ANSWER Rationale: Answer B is correct. The patient who is taking alendronate (Fosamax) is at high risk for developing which disorder? A. Cardiovascular disease B. Breast cancer C. Inflammation of the esophagus D. Stroke - CORRECT ANSWER Answer: C Rationale: Esophagitis and esophageal ulcers have been reported with use of all of the bisphosphonates. The other answer selections apply to hormone replacement therapy. The patient who has completed radiation therapy treatments for a form of cancer is at high risk for developing: A. Osteomalacia B. Osteosarcoma C. Paget's disease of the bone D. Osteochondroma - CORRECT ANSWER Answer: B Rationale: Patients who have received radiation for other forms of cancer are at high risk for developing osteosarcoma. Osteomalacia is caused by a vitamin D deficiency. Paget's disease is a metabolic disorder of bone remodeling. Osteochondroma is a benign bone tumor that has its onset in childhood An expected outcome of an older patient with acute osteomyelitis is: A. Pain B. Fatigue C. Low-grade fever D. Elevated leukocyte count - CORRECT ANSWER Answer: C Rationale: Common presenting symptoms of osteomyelitis are pain, fever, edema, elevated leukocyte count, fatigue, and general malaise. However, older adults may not have an extreme temperature elevation because of lower core body temperature and compromised immune system that occur with normal aging. Certain transdermal patches must be removed before an MRI is performed because they can cause burns. True False - CORRECT ANSWER True. Rationale: Transdermal patches (eg, NicoDerm, Transderm Nitro, Transderm Scopolamine, and Catapres-TTS) that have a thin layer of aluminized backing must be removed before an MRI because they can cause burns A patient is admitted for an MRI, a CT scan, and a myelogram. Which of the following medication orders should be questioned for the patient who is to have a myelogram? A. Ampicillin 250mg PO q6H B. Motrin 400mg PO q4h PRN for headache C. Seconal 50mg HS PRN sleep D. Darvon 65mg PO q4h for pain - CORRECT ANSWER Rationale: Answer C is correct. Seconal is a barbiturate, and CNS depressants and stimulants, as well as phenothiazines, should not be given for 48 hours prior to a mylegram because they decrease the sizure threshold. Ampicillin is an antibiotic, Motrin is an NSAID, and Darvon is an analgesic, so they can all be given, making answers A,B, and D wrong. Which findings indicates a need for further assessment of the patient scheduled for a magnetic resonance imaging (MRI)? A. The patient is an insulin- dependent diabetic B. The patient refuses a corner bed C. The patient is allergic to shellfish D. The patient has a history of asthma - CORRECT ANSWER An MRI requires the patient to be confined in a small enclosure for a period of time. The patient's refusal to accept the corner bed could indicate claustrophobia, so the patient needs further assessment. An MRI is not contraindicated for patients with diabetes or asthma; therefore, answers A and D are incorrect. Answer C is incorrect because no contrast medium is used. The prevalence of osteoporosis in women aged more than 80 years is 50%. True False - CORRECT ANSWER True. Rationale: The prevalence of osteoporosis in women aged more than 80 years is 50%. The primary defect in osteomalacia is a deficiency in which vitamin? A. B12 B. D C. E D. C - CORRECT ANSWER b. D Rationale: The primary defect in osteomalacia is a deficiency of activated vitamin D, which promotes calcium absorption from the GI tract and facilitates mineralization of bone. The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? A. "I will lie down prone with my legs slightly elevated." B. "I will bend at the waist when I am lifting objects from the floor." C. "I will avoid prolonged sitting or walking." D. "Instead of turning around to grasp an object, I will twist at the waist." - CORRECT ANSWER Answer C What findings can be identified with the use of radiography of the spine? A. Fracture, dislocation, infection, osteoarthritis, or scoliosis B. Infections, tumors, and bone marrow abnormalities C. Soft tissue lesions adjacent to the vertebral column D. Spinal nerve root disorders - CORRECT ANSWER A. Fracture, dislocation, infection, osteoarthritis, or scoliosis Radiography of the spine may demonstrate a fracture, dislocation, infection, osteoarthritis, or scoliosis. Bone scan and blood studies may disclose infections, tumors, and bone marrow abnormalities. Computed tomography is useful in identifying soft tissue lesions adjacent to the vertebral column. An electromyogram is used to evaluate spinal nerve root disorders. The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine What does the nurse understand this common finding is known as? A.Lordosis B.Scoliosis C.Osteoporosis D.Kyphosis - CORRECT ANSWER Rationale: Answer D is correct. The nurse observes that an 18- year- old female patient has asymmetry of the shoulders and hips, and the hem of her dress is uneven. The nurse suspects that the patient may be presenting with which disorder? A. Congenital hip dislocation B. Scoliosis C. Fractured tibia D. Degenerative disc disease - CORRECT ANSWER Rationale: Answer B is correct. A classic sign of scoliosis is asymmetrical dress or skirt hem caused by unevenness of affected shoulder and hip, due to a lateral curvature of the spine. The spinal deformity causes the asymmetry. Congenital hip dislocation is diagnosed during infancy. Signs of a fractured tibia would include painful ambulation, not unevenness of the shoulder and hip. Degenerative disc disease is typically experienced by older adults and causes a uniform decline in height. An important question to ask a patient with low back pain is: A. "How does your back pain affect your activities of daily living?" B. "Tell me about your pain and what interventions are helpful in managing your pain." C. "How long have you had back pain?" D. "Have you ever had magnetic resonance imaging to find a cause for your back pain?" - CORRECT ANSWER Answer: B Rationale: The primary concern for patients with back pain is continuous pain. Obtaining a thorough assessment of the patient's pain level and effective interventions to treat pain is an important element of the nursing assessment. Which of the following is characterized by an increased forward curvature of the thoracic spine? A. Lordosis B. Kyphosis C. Scoliosis D. Crepitus - CORRECT ANSWER Kyphosis Rationale: Common deformities of the spine include kyphosis, which is an increased forward curvature of the thoracic spine. Most back pain is self-limited and resolves within __ weeks with analgesics, rest, stress reduction, and relaxation. A. 1 B. 2 C. 3 D. 4 - CORRECT ANSWER D. 4 Rationale: Most back pain is self-limited and resolves within 4 weeks with analgesics, rest, stress reduction, and relaxation. The physician orders Rocephin 2g in 100ml to infuse over 45 mins for a post-op total hip patient. The IV is to infuse via a macro drip (10 gtts per ml). The nurse should set the IV rate at: A. 12 gtts/min B. 22 gtts/min C. 32 gtts/min D. 42 gtts/min - CORRECT ANSWER Rationale: Answer B is correct. The total to be infused (100ml) divided by the total time in minutes (45 minutes) times the drip factor (10gtt) equals 22 gtts per minute. The other answers are mathematically incorrect. The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? Select all that apply. A.Checking the urine for hematuria B.Palpating peripheral pulses in both lower extremities C.Testing the stool for occult blood D.Assessing level of consciousness E.Assessing pupillary response - CORRECT ANSWER Rationale: Correct answer is A,B, and C While horseback riding a patient fell from the hose sustaining a pelvic fracture. What complications should the nurse know to monitor for that are common to pelvic fractures? A. Paresthesia and ischemia B. Hemorrhage and shock C. Paralytic ileus and a lacerated urethra D. Thrombophlebitis and infection - CORRECT ANSWER Answer B Which of the following findings is most typical of a client with a fractured hip? A. Pain in the hip and affected leg B. Diminished sensation in the affected leg C. Absence of pedal and femoral pulses in the affected extremity D. Misalignment of the affected extremity - CORRECT ANSWER Answer D is correct. The most typical sign of a fractured hip is misalignment. Pain, paresthesia, and pulselessness are characteristics associated with all fractures, so answers A,B,C, are wrong. An elderly female is admitted with a fractured right femoral neck. Which assessment finding is expected? A. Free movement of the right leg B. Abduction of the right leg C. Internal rotation of the right hip D. Shortening of the right leg - CORRECT ANSWER Rationale: Answer D is correct. The symptoms of this fracture include shortened, adducted, and external rotation. Answer A is incorrect because the patient usually is unable to move the leg due to pain. Answer B is incorrect because the symptom is adduction, not abduction. Answer C is wrong because it's external rotation, not internal rotation. A patient with an open reduction and internal fixation for a fractured hip is to being ambulation. The hip was repaired using a compression plate and screws. The patient will most likely begin ambulation with: A. Full weight bearing on the affected leg B. Nonweight bearing on the affected leg C. Toe touch weight bearing on the affected leg D. Weight bearing as tolerated on the affected leg - CORRECT ANSWER Answer C is correct. The patient with ORIF of a fractured hip will begin ambulation with toe touch weight bearing on the affected leg. Answer A is incorrect because it places to much weight on the newly repaired hip. Answer B is incorrect because the patient allowed to bear minimal weight on the affected leg. Answer D is incorrect because it can place too much or too little pressure on the newly repaired hip. The nurse is performing a post-op assessment of an elderly patient with a total hip repair. Although he has not requested medication for pain, the nurse suspects that the patient's discomfort is severe and prepares to administer pain medication. Which of the following signs would not support the nurse's assessment of acute post- op pain? A. Increased blood pressure B. Inability to concentrate C. Dilated pupils D. Decreased heart rate - CORRECT ANSWER Rationale: Answer D is correct. The patient in acute pain experiences physiological arousal similar to the fight or flight response- for example, an increased (not decreased) heart rate, an increased BP, and dilated pupils. Answers A,B, and C are wrong because increased BP, inability to concentrate, and dilated pupils are reactions to pain. The question asks which does not support as assessment of post-op pain, so answer D is correct. To prevent dislocation of a hip prosthesis following a total hip replacement, the nurse should: A. Maintain the patient's affected leg in an adducted position B. Maintain the patient's affected hip in a flexed position C. Tell the patient to remain in supine position D. Place an abduction pillow between the patient's leg - CORRECT ANSWER Rationale: Answer D is correct. The patient's leg should be maintained in an abducted position to prevent dislocation of the prosthesis. This is accomplished by the use of an abduction pillow. Answers A and B will increase the likelihood of dislocation of the prosthesis; therefore, they are incorrect. Answer C is unnecessary; therefore, it is incorrect. The nurse at an orthopedic joint clinic is preparing pre-operative teaching for a patient scheduled for total hip replacement surgery. Which would be included in the teaching plan? A. Avoid sitting in a chair B. Make sure that commode seats are at low levels C. Avoid crossing the legs when sitting D. Physical Therapy will assist with adduction exercises - CORRECT ANSWER Rationale: Answer C is correct. The patient with joint hip replacement should avoid adduction of the legs and flexion of the hips greater than 90 degrees to ensure continued placement of the prosthetic joint. It is recommended for these patients to use recliners for seating instead of straight chairs., therefore A is incorrect. Commode seats will have to be raised and abduction of the legs is required, making B and D incorrect choices. The nurse is preparing a teaching plan for a patient who is being discharged following a total hip replacement. The nurse would include which part of the following content as a part of the teaching plan? Select all that apply A. Avoid low, cushioned chairs B. Use a device that raises toilet seat C. Avoid bending greater than 90 degrees D. Turn at the waist to reach objects E. Do not cross the legs - CORRECT ANSWER Rationale: A,B,C,E are correct. Following a total hip replacement, the patient must be instructed to avoid activities such as sitting in low, cushioned chairs; crossing legs; and using a standard- height toilet. These activities cause adduction of the less or greater than 90 degrees' flexion at the hip, leading to possible dislocation. Turning at the waist violates principles of general body mechanics. The primary purpose for using a continuous passive movement (CPM) apparatus for a patient with a total knee repair is to help: A. Prevent contractures B. Promote flexion of the artificial joint C. Decrease the pain associated with early ambulation D. Alleviate lactic acid production in the leg muscles - CORRECT ANSWER Answer B is correct. The primary purpose of the continuous passive motion machine is to promote flexion of the artificial joint. Answers A,C, and D do not describe the purpose of the CPM machine; therefore, they are incorrect. A patient with a total knee replacement returns from surgery. Which findings require immediate nursing intervention? A. The is 30ml bloody drainage from the surgical drain B. The continuous passive motion machine is set on 90-degree flexion C. The patient is unable to ambulate to the bathroom D. The patient is complaining of muscle spasm - CORRECT ANSWER Answer B is correct. The CPM machine should not be set at 90-degree flexion until the fifth postoperative day. Answers A, C, and D are expected findings and do not require immediate nursing intervention, so they are incorrect Is the following statement True or False? Testing for crepitus can produce further tissue damage and should be avoided. - CORRECT ANSWER True Testing for crepitus can produce further tissue damage and should be avoided. An elderly patient with a fractured hip is placed in Buck's traction. The primary purpose for Buck's traction for the patient is: A. To decrease muscle spasm B. To prevent the need for surgery C. To alleviate the pain associated with the fracture D. To prevent bleeding associated with the hip fractures - CORRECT ANSWER Rationale: Answer A is correct. Buck's traction is a skin traction used to decrease muscle spasms. Buck's traction will not prevent the need for surgery, making answer B wrong. It also will not alleviate the pain associated with the fracture or prevent bleeding, so answers C and D are wrong. Is the following statement true or false? The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs. - CORRECT ANSWER True The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs. Removal of the weights completely defeats their purpose and may result in injury to the patient. A patient complains of tingling and numbness in his right leg following application of a long leg cast. The patient's discomfort is most likely the result of: A. Reduced venous return B. Bone healing C. Arterial insufficiency D. Nerve compression - CORRECT ANSWER Rationale: Answer D is correct. Numbness and tingling in a n extremity immobilized by a cast are most likely the result of nerve compression. Answer A is incorrect because reduced venous return results in swelling in the extremity. Answer B is incorrect because numbness and tingling are not associated with bone healing. Answer C is incorrect because arterial insufficiency results in diminished or absent pulses in the extremity. Which activity is most appropriate for a three- year old with a cast? A. Barbie doll and accessories B. Toy telephone C. Coloring book and crayons D. Puzzles - CORRECT ANSWER Rationale: Answer B is correct. The toy telephone is large enough that it cannot be placed beneath the cast, and it promotes social and language development. Answers A,C, and D contain small pieces that can be placed beneath the cast, so they are incorrect. [Show Less]
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1 Adults Orthopedic Nursing Exam 78 Questions with Verified Answers,100% CORRECT
1 Adults Orthopedic Nursing Exam 78 Questions with Verified Answers 4 steps of bone healing - CORRECT ANSWER hematoma, fibrocartilaginous callus formati... [Show More] on, bony callus formation, remodeling factor in bone healing responsible for bone cell formation - CORRECT ANSWER Ca+2 needed to absorb calcium - CORRECT ANSWER vitamin D if this lab value is elevated we look for bone disease - CORRECT ANSWER alkaline phosphatase uptake of dye shows inflammatory process - CORRECT ANSWER bone scan if a patient is allergic to shellfish then what might be of concern regarding diagnostic radiology? - CORRECT ANSWER certain types of dye 6 factors in bone healing - CORRECT ANSWER calcium, vitamin D, no osteoporosis, no infection, good blood circulation, alkaline phosphatase what type of fluid makes a halo type appearance on a dressing? - CORRECT ANSWER CSF after a lumbar puncture what position should the patient be in? - CORRECT ANSWER HOB elevated; bedrest loss of articulation of the bone ends in the joint caps - CORRECT ANSWER dislocation partial dislocation where bone ends still partially touch - CORRECT ANSWER subluxation what type of exercises are performed if a patient has joint trauma (these help strengthen the muscle) - CORRECT ANSWER isometric T or F for joint trauma only give NSAIDs when the patient requests - CORRECT ANSWER FALSE inflammation of bursa - CORRECT ANSWER bursitis tennis or golfers elbow; inflammation of tendon at point of origin to bone - CORRECT ANSWER epicondylitis compression of median nerve and inflammation of the lining of synovial sheath - CORRECT ANSWER carpal tunnel syndrome what test is done for carpal tunnel? - CORRECT ANSWER phalen test treatments for repetitive injuries ... - CORRECT ANSWER immobilize and rest ice for 24-48hours and then heat -medications like NSAIDS -corticosteroid injections into the joint symptoms accompanied with a bone fracture - CORRECT ANSWER pain, edema, crepitus, deformity unstable vs stable - CORRECT ANSWER with or without displacement complete vs incomplete - CORRECT ANSWER total segment vs partial segment simple vs compound - CORRECT ANSWER closed vs open manipulation of the skin to fix the fracture - CORRECT ANSWER closed reduction surgical manipulation of bone to fix a fracture - CORRECT ANSWER open reduction advantages and disadvantages of internal fixation - CORRECT ANSWER advantages: fast ambulation; good stabilization disadvantages: surgery required 7 principles of cast care: - CORRECT ANSWER elevation; turn/rotate; skin edges/pad prn; pain control; window/bivalve (relieves pressure); neurovascular checks; hot spots/drainage 5Ps of neurovascular checks - CORRECT ANSWER pallor, pulses, parasthesia, paresis, pain numbness/tingling - CORRECT ANSWER paresthesia T or F in traction weights hang freely and do not touch the floor - CORRECT ANSWER true skin traction requires what weight? (range) - CORRECT ANSWER 5-10 pounds with traction comes immobility, so we must monitor for... - CORRECT ANSWER DVT, pneumonia, ileus, renal calculi type of traction that is intermittent and can be removed throughout the day (2) - CORRECT ANSWER lumbar and cervical skin traction is ____ term and skeletal traction is ____ term - CORRECT ANSWER short; long weight range for skeletal traction - CORRECT ANSWER 25-35 T or F infection risk is greater with skeletal traction - CORRECT ANSWER true 3 components of care for skeletal traction - CORRECT ANSWER never remove weights; clean the pins; check pins for infection components of nursing care for skin traction - CORRECT ANSWER skin assessments; protect pressure sites auto graft: from ____ allo grat: from ____ - CORRECT ANSWER patient donor bone grafts are usually taken from what site? - CORRECT ANSWER iliac crest or tibia what type of fracture takes priority? skull, facial, or ribs? - CORRECT ANSWER skull abnormal healing time, but is usually under 6 months - CORRECT ANSWER delayed union no bone healing within 6-9 months - CORRECT ANSWER non-union growth of bone fragments in faulty position - CORRECT ANSWER malunion bone infection resulting in high fever and chills; redness to ulceration and drainage - CORRECT ANSWER osteomylitis 25% of patients with long bone fractures end up with ___ ________ - CORRECT ANSWER fat embolus when might a fat embolism occur? - CORRECT ANSWER 1 hr to one week release of fat from exposed bone marrow attract platelets and occludes small vessels causing ischemia, increased capillary permeability and fluid shift - CORRECT ANSWER fat embolus S&Sx of fat embolus - CORRECT ANSWER respiratory depression, cerebral dysfunction, petechiae treatment of fat embolus - CORRECT ANSWER oxygen therapy and corticosteroids increased internal or external pressure due to a poor cast fitting, edema, or hemorrhage - CORRECT ANSWER compartment syndrome why do arterial pulses remain normal if someone has compartment syndrome? - CORRECT ANSWER because the major arteries are usually outside the compartment symptoms of compartment syndrome (first 48) (4) - CORRECT ANSWER unrelenting pain, cyanosis, weakness, paresthesia treatment for compartment syndrome where you surgically slice through the skin until the patient bleeds - CORRECT ANSWER decompressive fasciotomy where is avascular necrosis most common? - CORRECT ANSWER femoral head avascular necrosis can occur prior to surgery or.... - CORRECT ANSWER 4-6 months after fracture it is considered a hip fracture if it is in what location... - CORRECT ANSWER proximal 1/3 of the femur how soon should you ambulate someone who has had a hip fracture - CORRECT ANSWER 24 hours no flexion of > ____ degrees; only bend as far as a raised toilet seat - CORRECT ANSWER 90 if someone has a hip fracture, neurovascular checks should be done every ____ hr - CORRECT ANSWER 4 nursing care of hip fractures (6) - CORRECT ANSWER 1. no adduction 2. turn to unaffected side 3. ambulate within 24 hours 4. don't bend more than 90 degrees 5. neurovascular checks Q4 6. use foam splint or pillows between the legs newer technique for hip repair; shaving and capping of the bone; reduces post op complications, potential to last longer, and if it fails we have a back up plan - CORRECT ANSWER hip resurfacing the incision for a knee replacement is 8-___ inches on the front of the joint - CORRECT ANSWER 12 T or F in a total knee replacement, the quadriceps muscle and tendon are cut, and damaged tissue is removed - CORRECT ANSWER true what is the major problem with amputations - CORRECT ANSWER contractures who is more likely to get spinal graters 1. female 19yrs 2. female 39 3. male 24 4. male 15 - CORRECT ANSWER male 24 what is the priority in a spinal fracture...to decompress the ____ - CORRECT ANSWER cord complete spinal injury means... - CORRECT ANSWER its across the whole cord spinal injury at or above C8 causes - CORRECT ANSWER quadraplegia spinal injury at or above T1 causes - CORRECT ANSWER paraplegia spinal injury at C1-C3 causes - CORRECT ANSWER death from cardiovascular and respiratory collapse spinal injury at C3-C5 causes - CORRECT ANSWER death from respiratory failure in spinal shock, what happens to your BP and heart rate - CORRECT ANSWER decrease! both decrease spinal shock is cause by... - CORRECT ANSWER massive vasodilation following a cervical or high thoracic injury how long can spinal shock last? - CORRECT ANSWER it can start immediately and last up to 4-6 weeks if a patient has a spinal cord injury at or above t6 they are at risk for what for the rest of their life? - CORRECT ANSWER autonomic dysreflexia the #1 cause for triggering autonomic dysreflexia is a... - CORRECT ANSWER full bladder autonomic dysreflexia causes _____cardia and _____tension - CORRECT ANSWER brady; hyper logrolling technique is used in patients who have just had what surgical procedure? - CORRECT ANSWER laminectomy [Show Less]
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Orthopedic Nursing Care Exam 74 Questions with Verified Answers,100% CORRECT
Orthopedic Nursing Care Exam 74 Questions with Verified Answers What is the most commonly reported injuries? - CORRECT ANSWER Contusions, Strains, and S... [Show More] prains. Contusion - CORRECT ANSWER Blunt force-bleeding into soft tissue, but skin remains intact. (Swelling, discoloration of skin) Least serious Strain - CORRECT ANSWER Stretching injury to a muscle or a muscle-tendon unit. Caused by mechanical overloading. (Pain, limited motion, muscle spasms/weakness, swelling.) Most common: lower abck and Hamstring muscle Sprain - CORRECT ANSWER Stretch/tear of ligaments surrounding joint. (Loss of the ability to move or use the joint, feeling a "pop" or tear, discoloration, pain, rapid swelling.) Most common: ankles and knees RICE - CORRECT ANSWER Rest Ice Compression Elevation 24-48hrs do RICE. Joint dislocation - CORRECT ANSWER Trauma or illness forces ends of the bones from normal position. (Pain, deformity, limited motion, shorter limb) Care: Reduction by manual traction or surgery immobilization, hip dislocation requires immediate reduction to prevent complications to prevent necrosis. Subluxation - CORRECT ANSWER partial dislocation is which the bones of the joint remain in partial contact Necrosis - CORRECT ANSWER Death of bone tissue Electrical Bone Stimulation - CORRECT ANSWER Used to treat fractures that aren't healing appropriately, increases migration of osteoblasts and osteoclasts to fracture site.Application of an electrical current What to do for fracture of the skull? - CORRECT ANSWER Assess patient for neurologic changes, document LOC, depressed skull fracture can cause neurologic damage. Fracture Care - CORRECT ANSWER Emergency Care: Immobilize the fracture, maintain tissue perfusion, prevent infection. Medications: Analgesics, NSAIDs, antibiotics,anticoagulants, stool softeners, antacids. Surgery: External fixation device, ORIF Fracture of the Face - CORRECT ANSWER Manifestations: Hematoma, pain, edema, bony deformity. Focus on airway, assess neurologic, body image disturbance, assess pain Fracture of the Spine - CORRECT ANSWER Cervical, lumbar, thoracic, or sacral...damage to spinal cord. MOST SEVERE, can result in ischemia and cause permanent paralysis. Fracture of the Clavicle - CORRECT ANSWER Usually midclavicular, can damage subclavian vessels or lung. Seen most common with falls Fracture of Humerus - CORRECT ANSWER Complications: nerve and ligament damage, frozen or stiff joints, and malunion--fractured fragments are not in good position... Fractures of the proximal humerus are more common in older adults. Fracture of the Elbow - CORRECT ANSWER Usually distal humerus, common complications: nerve or artery damage, hemiartrosis, Volkmann's contracture (claw deformity of hand and fingers). Fall or direct blow is main report. Fracture of the radius and/or ulna - CORRECT ANSWER Complication: compartment syndrome, delayed healing, decreased wrist and finger movement, infection. Care: alleviate pain, immobilization, education. ***Tell MD if changes in sensation Wrist Fractures - CORRECT ANSWER Colle's Fracture: the distal radius fractures after a fall onto an outstretched hand. Patient presents with bony deformity, pain, numbness, weakness, decreased ROM of fingers. Hand Fractures - CORRECT ANSWER Usually metacarpals and phalanges (Pain, edema, decreased ROM) Complications: compartment syndrome, nerve damage, ligament damage, delayed union. Fracture of the Ribs - CORRECT ANSWER Blunt chest trauma, Can damage the spleen, liver, subclavian artery, or vein. Flail chest; Complications: pulmonary contusion, pnuemothorax and or hemothorax, pneumonia, intra-abdominal bleeding Flail Chest - CORRECT ANSWER results from the fracture of two or more adjacent ribs in two or more places and the formation of a free-floating segment that moves in the opposite direction of the rib cage.Care: coughing, deep breathing, and splinting. Fracture of the Pelvis - CORRECT ANSWER Caused by trauma, patient presents with back or hip pain. Complications: hemorrhage, damage to pelvic and extra-pelvic organs. Care: Tx discomfort, maintaining immobilization, and identify potential complications. Fracture of the Shaft of the femur - CORRECT ANSWER Edema, deformity, pain in the thigh, inability to move hip or knee. Complications: hypovolemia, fat embolism, hip and/or knee dislocation, muscle atrophy, ligament damage. Provide pain meds, provide reassurance and decreasing anxiety, assist with exercises of the lower legs, feet, and toes. Circulation and sensation in affected extremity;skeletal traction, internal or external fixation Intracapsular Fractures - CORRECT ANSWER involve the head or neck of the femur...MOST SERIOUS Extracapsular Fractures - CORRECT ANSWER Involves the trochanteric region Fracture of the Hip - CORRECT ANSWER Intracapsular or extracapsular. Risks: Lower body weakness, problems walking/balance, taking 4 or more meds or psychoacitve meds. Nursing: maintain skin integrity, prevent infection, alleviate pain, manifest circulation, increase mobility Causes of repetitive use Injuries - CORRECT ANSWER Twisting and turning wrist Pronating and supinating forearm Kneeling Raising arms over head Dislocation - CORRECT ANSWER injury in which the ends of the bones are displaced out of their normal position and joint articulation is lost Carpal Tunnel - CORRECT ANSWER a cannal through which flexor tendons and the median nerve pass from the wrist to the hand. Sybdrome: compression of the median nerve as a result of inflammation and swelling of the synovial lining. Alleviated by shaking or massaging the fingers. Bursitis - CORRECT ANSWER an enclosed sac found between muscles, tendons, and bony prominences, inflammation of these. Caused by friction between bursa and surrounding tissue. Common Places: Shoulder, hip, knee, elbow. Epicondylitis - CORRECT ANSWER inflammation of the tendon at its point of origin into the humerus. Increase mobility and alleviate pain Hematoma Formation - CORRECT ANSWER First Phase of Fracture healing. Localized necrosis, heightened inflammatory response. Inflammation, bleeding and hemotoma. Fibroblasts, lymphocytes (inflammation), macrophages migrate to fracture site. Fibrocartilaginous Callus Formation - CORRECT ANSWER Second Phase of Fracture Healing. Occurs within 48 hours of injury, granulation tissue replaces hematoma. base is laid for bone growth, and they cannot yet bear weight. Bony Callus Formation - CORRECT ANSWER Third Phase of Fracture healing. Occurs 3-4 weeks after injury, formation and gradual mineralization of collagen fibers and bone matrix Remodeling - CORRECT ANSWER Last stage of Fracture healing (4th). Removal of excess callus, remodeling by osteoblasts and osteoclasts. Compact bone replaces spongey bone. Compartment syndrome - CORRECT ANSWER Occurs when pressure within a confined space constricts and entraps the structures within. Can lead to limb loss, sepsis, ARF. Early signs: pain, normal or decreased peripheral pulse. Later signs: cyanosis, parethesias, paresis, severe pain. Tx: alleviate pressure, removal of cast, fasciotomy. Do NOT elevate or use ice Fat embolism Syndrome - CORRECT ANSWER Characterized by neurologic dysfunction, pulmonary insufficiency, and a petechial rash on the chest, axilla, and upper arms. Bone fracture results in a rise of pressure in the bone marrow, fet globules enter the bloodstream and combine with platelets. They occlude small blood vessels, and cause tissue ischemia. Signs: confusion, changes in LOC, petechiae, soft palate, conjunctiva. TX: Intubation, fluid balance, corticosteriods. Deep Venous Thrombosis (DVT) - CORRECT ANSWER Blood clot forms along the intimal lining of a large vein, accompanied by inflammation of the vein wall. Can lead to venous insufficiency, pulmonary embolism. Signs: Swelling, pain, tenderness, or cramping of the affected extremity.Can be asymptomatic TX: prevention is best. Delayed Union - CORRECT ANSWER Prolonged healing of the bones beyond the usual time period. Diagnosed with serial x-ray studies. May lead to nonunion. Usually affects long bones Delayed Nonunion - CORRECT ANSWER can cause persistant pain and movement at the fracture site. may require surgical intervention, such as internal fixation and bone grafting. Electronic or ultrasonic stimulation of the fracture site may be effective to promote healing. Usually affects long bones Complex Regional Pain Syndrome - CORRECT ANSWER may occur after musculoskeletal or nerve trauma. Causes extremity pain that is severe, diffues, and burning. Initially appearing inflamed, edematous but later becomes cool and pale. Muscle wasting, skin and nail changes and bone abnormalities can occur. TX: Sympathetic nervous system blocking agent. Traction - CORRECT ANSWER applies a straightening or pulling force to return or maintain the fractured bones in normal anatomic position. Casts - CORRECT ANSWER Rigid device applied to immobilize the injured bones and promote healing. Immobilizes the joint above the joint below the fractured bone so that the bone will not move during healing. Nursing: Monitor for "hot spots", pain, and drainage. Neurovascular assess, and teaching care of this device. External Fixator - CORRECT ANSWER consists of a frame connected to pins that are inserted perpindicular to the long axis of the bone. The number of pins depends on the type and site of fracture.Monitor Neurovascular assess and infection Closed "Simple" fracture - CORRECT ANSWER skin is intact Open "Compound" fracture - CORRECT ANSWER The skin intergrity is interrupted. Allows bacteria to move into open area and can cause complications. Complete fractures - CORRECT ANSWER Involve the entire width of the bone Incomplete fractures (Greenstick) - CORRECT ANSWER involve only part of the width of the bone. Oblique fracture line - CORRECT ANSWER ar an angle to the bone Avulsed fracture - CORRECT ANSWER when the fracture pulls bone and other tissue awayfrom the point of attachment Spiral fracture line - CORRECT ANSWER curves around the bone Comminuted Bone - CORRECT ANSWER bone breaks into many pieces Compressed Bone - CORRECT ANSWER Bone is crushed Impacted Bone - CORRECT ANSWER Broken bone ends are forced into each other Depressed Bone - CORRECT ANSWER the broken bone is forced inward Stable (nondisplaced) Fracture - CORRECT ANSWER fracture where bones maintain their anatomic alighment Unstable (Displaced) Fracture - CORRECT ANSWER Fracture occurs when the bones move out of the correct amatomical alignment Faciotomy - CORRECT ANSWER Surgical insicion of a muscle or Fascia to relieve pressure within the compartment.. Afterwards the incision is left open, leading to possible infection Volkmann's Contracture - CORRECT ANSWER uncommon complication of elbow or forearm fractures, can result from unresolved compartment syndrome. Signs: Ischemia, degeneration, and contraction of forearm muscles Manual Traction - CORRECT ANSWER applied by physically pulling on the extremity. often is used to reduce a fracture or dislocation. Skin traction (straight traction) - CORRECT ANSWER used to control muscle spasms and to immbolize a part of the body during transport or before surgery. Non-invasive and relatively comfortable for the patient. Most common: Bucks traction: used to immobilize the leg before surgery tp repair a hip or proximal femur fx. Balanced Suspension Traction - CORRECT ANSWER more than once force of pull to raise and support the injured extremity off the bed and maintain its alignment. Increases mobility while maintaining bone position. Skeletal Traction - CORRECT ANSWER Pulling force is applied directly through pins inserted into the bone, allows more weight to be used to maintain the proper alignment. Risk of infection is greater and may cause more discomfort. Internal Fixation - CORRECT ANSWER fracture is reduced (placed back into alignment) and nails, screws, plates, or pins are inserted to hold the bone in place. All done inside. Can be done by (ORIF) Neurovascular assess and monitor infection Stump Care - CORRECT ANSWER Massage, air exposure, keeping area and socks/wraps clean. Amputation - CORRECT ANSWER Partial or total removal of an extremity. Acute process or chronic condition. PVD is the main cause of lower extremity loss. Risk factors: HTN, Diabetes, smoking, hyperlipidemia. Traumatic Amputation - CORRECT ANSWER Highest among young men, result from: vehicle crashes, machinery accidents, combat-related, frostbite, burns, electrocutions. Interruption in blood flow causes loss, may be acute or chronic. Acute trauma Amputation - CORRECT ANSWER the limb is partially or completely severed, and tissue death ensues. Replantation may be possible (fingers, small body parts, and somtimes limbs) Chronic Disease - CORRECT ANSWER Impaired circulation, venous pooling begins, proteins leak into the interstitium, and edema develops. Stasis ulcers develop and become infected b/c impaired healing. Infection leads to gangrene and ultimately requires amputation. Levels of Amputation - CORRECT ANSWER determined by local and systemic factors. Ultimately the joints are preserved when possible to allow greater function. Local factors: ischemia, gangrene Systemic Factors: cardiovascular, renal, and severity of diabetes Types of Amputation - CORRECT ANSWER Open (guillotine): performed when infection is present, not closed but remaining open to drain, when infection is gone surgery will take place to close wound. Closed (flap): closed with a flap of skin that is sutured in place over the stump. Post-amputation care - CORRECT ANSWER rigid or compression dressing is applied to prevent infection and minimize edema. dressing is made by placing a cast on the stump and molding the stump to fit a prosthesis. Complications of Amputation - CORRECT ANSWER Infection: drainage odor, redness, increased discomfort, chills, + wound and blood cultures. Delayed healing:`electolytes imbalance or infections prolong process, smoking, circulatory or cardiac problems. Chronic Stump pain: Neuroma formation- severe burning pain;TENS, surgical procedure, meds Phantom Pain, and Contracures Contracture - CORRECT ANSWER abnormal flexion and fixation of a joint caused by muscle atrophy and shortening. Most common site is above the joint of the amputation. Exercising is VERY important. AKA: should lie prone for periods of the day. BKA: can prop the leg up with a pillow. [Show Less]
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Orthopedic Nursing Exam 114 Questions with Verified Answers,100% CORRECT
Orthopedic Nursing Exam 114 Questions with Verified Answers Closed reduction - CORRECT ANSWER is a procedure to set (reduce) a broken bone without cutti... [Show More] ng the skin open. The broken bone is put back in place, which allows it to grow back together. It works best when it is done as soon as possible after the bone breaks. traction - CORRECT ANSWER set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system. traction-countertraction - CORRECT ANSWER The resistance, or back-pull, made to traction or pulling on a limb continuous-traction - CORRECT ANSWER is applied for up to several hours at a time. This long duration requires that only small amounts of weight be used. intermittent traction (ITT) - CORRECT ANSWER a method in which the traction force and time are changed to make the therapy more effective skin traction - CORRECT ANSWER applying splints, bandages, or adhesive tapes to the skin directly below the fracture, weights are fastened to it. buck's traction - CORRECT ANSWER a temporary type of lightweight traction applied to the distal end of a fractured lower limb; the foot of the bed is raised so that the body makes counterextension; often used to reduce muscle spasm. cervical traction - CORRECT ANSWER is a modality that is applied to your neck to gently stretch it and separate the disc and joint surfaces in your cervical spine. pelvic traction - CORRECT ANSWER the pelvic traction belt is wrapped around the pelvic portion with the traction straps hanging below on the bottom side. the rings on the traction straps are hooked a pelvic traction spreader bar pelvic. ... the age weight and the ailment of the patient usually one-eighth of the body weight is used traction skeletal traction/bone traction - CORRECT ANSWER Skeletal traction involves placing a pin, wire, or screw in the fractured bone. After one of these devices has been inserted, weights are attached C A R O L - CORRECT ANSWER C-continuous, A-alignment, R-resistance, O-opposing, L-line crutchfield tongs - CORRECT ANSWER A traction device whose pins are inserted into the skull to distract and/or immobilize the neck. CMS checks - CORRECT ANSWER circulation-motion-sensation halo traction - CORRECT ANSWER The halo traction equipment is made up of three pieces: a ring around your head, a special vest. Weights attached to the halo at head end of bed over a pulley system. open reduction - CORRECT ANSWER incision into the skin, down to the bone to expose the bone. a device is attached to the bone to stabilize it. skeletal traction external fixation device - CORRECT ANSWER device may be used to keep fractured bones stabilized and in alignment. The device can be adjusted externally to ensure the bones remain in an optimal position during the healing process. (KEEP CLEAN!) pin care - CORRECT ANSWER use soap & water..wash from pin outward (away from pin entrance) O R I F - CORRECT ANSWER Open Reduction Internal Fixation (ORIF) is a type of surgery used to fix broken bones. ...an internal fixation device is placed on the bone. Percutaneous hip pinning complications - CORRECT ANSWER DVT/PE, UTI, urinary retention, mental status changes, wound infection, immobility complications, delayed/nonunion Diagnostic Tests - CORRECT ANSWER can show growth deformity, tumors, & fractures standard AP, X-ray - CORRECT ANSWER An X-ray picture in which the beams pass from front-to-back (anteroposterior). standard PA, X-ray - CORRECT ANSWER (posteroanterior) film in which the rays pass through the body from back-to-front. bone scan - CORRECT ANSWER uptake of a radioactive substance is measured in bone to see any area(s) of concern...called "hot spots" computed tomography (CT) - CORRECT ANSWER a diagnostic imaging test used to create detailed images of internal organs, bones, soft tissue and blood vessels. magnetic resonance imaging (MRI) - CORRECT ANSWER is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body in both health and disease. 2D/3D, with or w/out contrast arthroscopy - CORRECT ANSWER the visual examination of the internal structure of a joint DEXA scan - CORRECT ANSWER procedure that measures bone mineral density (BMD) to examine for osteoporosis strain - CORRECT ANSWER A condition resulting from damaging a muscle or tendon sprain - CORRECT ANSWER injury to a ligament Dislocation - CORRECT ANSWER displacement of a bone from its joint ECCHYMOSIS - CORRECT ANSWER bruise Stages of bone healing - CORRECT ANSWER 1) clot formation at fx site 2) fibroblasts & osteoblasts arrive 3) fibrocartilage callus forms 4) new bone forms 5) repair & bone remodeling until bone intact malunion fracture - CORRECT ANSWER when the two bony ends of the fracture fails to heal together correctly avascular necrosis - CORRECT ANSWER an area of bone tissue death caused by insufficient blood flow infection of the bone - CORRECT ANSWER osteomyelitis Fat embolism - CORRECT ANSWER Freely floating fat globule in the blood stream, which can obstruct blood circulation to vital organs (e.g., heart, brain). Usually caused by injury to subcutaneous tissue or a bone fracture that allows fat release. Compartment Syndrome - CORRECT ANSWER involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles Acute Compartment Syndrome (ACS) - CORRECT ANSWER A serious condition in which increased pressure within a compartment compromises circulation to the area. Can be from internal or external source. • Blood or fluid accumulate in compartment • Causes: reduction of compartment size (i.e. cast too tight, bulky dressings), an increase in muscle compartment contents because of edema or hemorrhage i.e. crushing injuries • Forearm and leg- most often involved • Muscle damage is irreversible in 4-6 hours; nerve damage is irreversible in 12-24 hours. the main compartments in the lower leg are: - CORRECT ANSWER 1) anterior compartment 2) lateral compartment 3) deep posterior compartment 4) superficial posterior compartment the main compartments of the forearm are: - CORRECT ANSWER F= Superficial Flexor F= Deep Flexor E= Extensor (compartment syndrome) internal factors - CORRECT ANSWER fracture, bleeding, blunt trauma, vascular occlusion, burns, surgical positioning,snake bite, drug injections,IV/A-lines /IO infusion, (infant) (compartment syndrome) external factors - CORRECT ANSWER cast, tight bandage, lying on a limb Volkman's Ischemic Contracture - CORRECT ANSWER flexion deformity of the wrist and fingers secondary to vascular damage or forearm compartment syndrome (compartment syndrome) THE 7 P's - CORRECT ANSWER Pins & needles feeling Pain Puffiness (edema) Pallor or pink Polor (cold to touch) Pulselessness Paralysis CMS aka Neurovascular - CORRECT ANSWER Circulation=pulses/capfill Motion=ROM Sensation=feeling anything?? peroneal nerve sensation/motion - CORRECT ANSWER prick the web space between the great toe and second/have patient dorsiflex ankle and great toes at the metatarsal phalangeal joints tibial nerve sensation/motion - CORRECT ANSWER prick the medial & lateral surfaces of the sole of the foot/have patient planter flex ankles & toes radial nerve sensation/motion - CORRECT ANSWER prick the web space between the thumb & index finger/have patient hyperextend thumb then wrist & hyperextend the four fingers at the MCP joints ulnar nerve sensation/motion - CORRECT ANSWER prick the distal fat pad of the small finger/have patient abduct all fingers Intra-Compartment Pressure Monitoring - CORRECT ANSWER -normal pressure is roughly 0-10mmHg of mercury -concern comes when the pressure is above 30mmHG After a fasciotomy... - CORRECT ANSWER -exposed muscle is typically covered with a bulky damp saline gauze dressing which is changed q 6-8h using sterile technique -as swelling subsides the wound will be closed either by secondary intention or tertiary intention (surgical closure) Why do you not elevate with compartment syndrome? - CORRECT ANSWER place the affected limb or limbs at the level of the heart. Elevation is contraindicated because it decreases arterial flow and narrows the arterial-venous pressure gradient What is racemic epinephrine? - CORRECT ANSWER acts on adrenergic receptor sites causing reduction in airway inflammation and edema. What is racemic epinephrine commonly used for? - CORRECT ANSWER Croup and when stridor is present. What is Iprtropium and what is is used to treat? - CORRECT ANSWER Anticholinergic used to treat asthma and COPD. What is Sameterol and what is it used for? - CORRECT ANSWER Long acting beta agonisht used to treat asthma and COPD. What is Theophylline and what is it used for? - CORRECT ANSWER Xanthine derivative and is used to treat apnea of prematurit and sometimes COPD or asthma. ORIF - CORRECT ANSWER utilizes open surgery to set the fracture followed by the use of plates, pins, and screws to hold the bones in place. total hip replacement - CORRECT ANSWER involves surgically removing both the femoral head and acetabular cartilage, and replacing them with an artificial femoral head and acetabular cup. anterior - CORRECT ANSWER This incision starts at the top of the pelvic bone (iliac crest) and extends down toward the top of the thigh Usually no or minimal muscles are cut posterior - CORRECT ANSWER A curved incision on the side of the hip, just behind the greater trochanter to the top of the femur Muscles are cut anterior - CORRECT ANSWER Shorter hospital stay Shorter recovery No hip precautions Posterior - CORRECT ANSWER Longer hospital stay Longer recovery Hip precautions ORIF - CORRECT ANSWER No abduction pillow needed WB as ordered No Hip Precautions Rapid mobility and ambulation as tolerated total hip replacement - CORRECT ANSWER Abduction pillow needed WB as ordered Full hip precautions minimally for 6 weeks Rapid mobility and ambulation as tolerated NWB - CORRECT ANSWER ◦0%-no pressure (injured leg off the floor) TTWB (toe touch) - CORRECT ANSWER 20%- Do not place any body weight on the leg. Imagine there is an egg under the foot that you are not to crush. PWB - CORRECT ANSWER ◦50%-The doctor will decide on the amount of weight. Often it is less than half your weight. FWB - CORRECT ANSWER ◦100%-Full body weight may be placed leg or arm total hip replacement - CORRECT ANSWER Can full weight bear Long Posterior incision Worry is dislocation ◦Must watch flexion and adduction screws - CORRECT ANSWER CANNOT full weight bear Small lateral incision Pillow under knee for comfort Displaced/Nondisplaced - CORRECT ANSWER Treated the same: ◦Hold fragments together ◦Let them heal on their own Cannot bear full weight ◦Screw can cut through bone ◦Usually 3 small incision ◦Pillow under the knee for comfort ◦Thigh may swell thigh after hip surgery calf after knee surgery - CORRECT ANSWER where is DVT most common after replacements Anticoagulants (heparin) Thrombolytics - CORRECT ANSWER treatment of DVT ◦-Anticoagulants ◦-Thrombolytics ◦ - Embolectomy ◦ - Placement of IVC filter - CORRECT ANSWER treatment of PE 5 - CORRECT ANSWER Range of motion highest score Patient - CORRECT ANSWER Who does the active ROM? Nurse - CORRECT ANSWER Who does the passive ROM? Fall resistance - CORRECT ANSWER 5 ROM Some resistance - CORRECT ANSWER 4 ROM No resistance - CORRECT ANSWER 3 ROM Weak - CORRECT ANSWER 2 ROM No - CORRECT ANSWER 1 ROM Isometric exercise - CORRECT ANSWER Active exercise through contraction Quadriceps Gluteal setting Kegels exercises - CORRECT ANSWER List of isometric exercises Hip level and angle of the elbow - CORRECT ANSWER Height of cane Hip level - CORRECT ANSWER Height of walker 3 point gait - CORRECT ANSWER What type of gait is used if 1 leg is amputated? If patient is with poor coordination - CORRECT ANSWER When do we use swhing through and to gait? Immobilization - CORRECT ANSWER Purpose of casting Expose to dry, no fan drying - CORRECT ANSWER How to dry cast? Circulation, motion, sensation - CORRECT ANSWER CMS acronym Bivalving - CORRECT ANSWER Cast is too tight Reduce spasm and pain Prevent deformities Immobilization - CORRECT ANSWER Purpose of traction - CORRECT ANSWER Examples of skin traction Buck traction - CORRECT ANSWER Immobilize leg in a fractured hip Balance skeletal traction - CORRECT ANSWER Immobilize the hips, fracture of the femur Foot plate - CORRECT ANSWER How to prevent foot drop in traction Sprain - CORRECT ANSWER stretch or tear of a ligament Ligament - CORRECT ANSWER Bone to bone Tendon - CORRECT ANSWER bone to muscle Strain - CORRECT ANSWER stretch or tear of a muscle or tendon Dislocation/Subluxation - CORRECT ANSWER partial dislocation or incomplete dislocation Carpal Tunnel - CORRECT ANSWER pressure on median nerve in wrist Rotator cuff - CORRECT ANSWER a group of tendons and muscles in shoulder Meniscus - CORRECT ANSWER cartilage that acts as a cushion in the knee joint Bursitis - CORRECT ANSWER Irritation and inflammation of the bursa (elbow pad) Bursa - CORRECT ANSWER fluid filled sac Contusion - CORRECT ANSWER results from direct blow causing capillary bleeding into subcutaneous layer Simple or closed fracture - CORRECT ANSWER no break in skin Compound or open fracture - CORRECT ANSWER fracture breaking skin Greenstick fracture - CORRECT ANSWER bend like fracture in children Stress fracture - CORRECT ANSWER a fracture caused by underlying diseases Gas Gangrene - CORRECT ANSWER necrosis with formation of gas bubbles and edema [Show Less]
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ONC Certification study Cards Exam 165 Questions with Verified Answers,100% CORRECT
ONC Certification study Cards Exam 165 Questions with Verified Answers What age does bone density peak for most people? - CORRECT ANSWER age 30 A 14 ... [Show More] year old fell during a baseball game suffering first degree ankle sprain, physician rec standard conservative tx for 24 hours then contrast baths, which correctly describes contrast baths - CORRECT ANSWER soak foot in cold water for 15 min followed by warm for 15 min QID during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER use of ankle splints which of the following is the definitive diagnostic test for juvenile idiopathic/rheumatoid arthritis - CORRECT ANSWER there is no definitive test for this which of the following is a method to relive pressure on the back for people whose work requires prolonged standing? - CORRECT ANSWER place one foot on a small stool or box what is the greatest risk in the immediate postoperative period for patients who suffer orthopedic traume requiring reconstructive surgery of the lower extremeties? - CORRECT ANSWER pulmonary embolism which of the following statements by the parent of a child with systemic juvenile idiopathic/rheumatoid arthritis (still's diesease) indicates a need for further education about the diesease - CORRECT ANSWER my child no longer has symptoms so i dont think she needs the medications which of the following patients is the best candidate for surgical repair of a ruptured achilles tendon? - CORRECT ANSWER 40 year old male in good general health using the symptom based diagnostic criteria of the american college of rheumatology for diagnosis of fibromyalgia, which of the minimal scores is consistent with the diagnosis - CORRECT ANSWER widespread pain index score of > or equal to 7 and symptom severity score of > or equal to 5 which of the follow heat producing therapies is most indicated for pain and stiffness of large joints such as shoulder or hip? - CORRECT ANSWER short wave diathermy what soft tissue penetrance does superficial heat such as paraffin baths or moist heat packs provide? - CORRECT ANSWER 1-2cm when using cryotherapy for an athletes foot, what is the max length of time the foot should be immersed in an ice bath at each treatment? - CORRECT ANSWER 20 minutes when using vapocoolant spray to facilitate stretching of the muscle after a hamstring injury, how far away from the skin should the spray container be held when spraying the skin? - CORRECT ANSWER 12 incehs which of the following tx is contraindicated for patients with a pacemaker? - CORRECT ANSWER TENS treatment A football player is to use a whirlpool bath to relieve muscle pain and stiffness what temperature should the water be maintained at? - CORRECT ANSWER 95-104 degrees fahrenheit women of childbearing age taking oral methotrexate for tx of rheumatoid arthritis should utilize birth control for what period - CORRECT ANSWER during tx and through one ovulatory cycle after tx which of the following is correct advice for patient during periods of exacerbation of rheumatoid arthritis affecting the knees? - CORRECT ANSWER avoid positions of flexion at what stage of rheumatoid arthritis is a patient if there is bone thinning with slight damage to the bone and slight cartilage damage wtih atrophy of adjacent muscles and limitations in join mobility? - CORRECT ANSWER stage 2 a patient with rheumatoid arthritis has been advised to do isometric exercises prior to beginning a program of dynamic and weight bearing exercises, what percentage of max contraction should be used for isometric exercises? - CORRECT ANSWER 70% a patient has a splint on the wrist and forearm but has developed "window" edema between the securing straps. In addition to elevating the extremity, which of the following is the best initial solution - CORRECT ANSWER replace straps with bias cut wrapping, from distal end to proximal a 60 year old woman has osteoarthritis of both knees. which of the following most suggests the need for intervention? - CORRECT ANSWER patient is 5'6" and weights 250 pounds a child is having serial plaster casts for treatment of talipes equinovarus (clubfoot) what should the parents be advised to do before bringing the child in for a cast change? - CORRECT ANSWER soak the cast off which of the following imaging techniques is most effective for diagnosing osteomyelitis from and infected injury? - CORRECT ANSWER MRI a 12 year old child with seropositive polyarticular juvenile idiopathic/rheumatoid arthritis has severe morning pain and stiffness and is reluctant to get out of bed. what intervention would be most helpful? - CORRECT ANSWER set an electric blanket to turn on 10 min before the child arises a 16 year old girl playing soccer fell, resulting in a lateral patellar dislocation with hemarthosis. The knee was relocaed and hemarthrosis aspirated how long should the extension brace be worn? - CORRECT ANSWER 3-4 weeks what is the most common cause of acute compartment syndrome? - CORRECT ANSWER tibial diaphysis or distal radius fracture what is the most common indication of advanced osteoporosis - CORRECT ANSWER kyphosis when assessing a patient gait, the ortho nurse notes that the patient appears unsteady and uncoordinated with a wide base measurement and lifts feet higher than normal while stepping with feet flat onto floor. how is gait characterized? - CORRECT ANSWER atAxia children with duchennes muscular dystrophy should be assessed for bone density beginning at about what age? - CORRECT ANSWER 3 years a patient with psoriasis develops marked edema of the fingers and toes (dactylitis) what does this probably indicate? - CORRECT ANSWER psoriatic arthritis a patient must wear a wrist immobilization splint, but the splint tends to migrate as the patient moves the fingers and elbow, which of the initial measures indicated to reduce friction and migration? - CORRECT ANSWER cover skin with stockinet or elastic tubular bandage like tubigrip for which of the following common complications should an infant with achondroplasia be monitored? - CORRECT ANSWER hydrocephalus and otitis media a patient complains of bouts of recurring pain, erythema and swelling at the base of the right big toe with sudden onset and symptoms persisting 3-10 days what are the symptoms consistent with? - CORRECT ANSWER acute gout during the physical examination of a patient, the orthopedic tech notes nodules on the dorsolateral aspects of teh distal interphalangeal joints (herberden's nodules) what does this finding indicate - CORRECT ANSWER osteoarthritsi a patient who has rheumatoid arthritis and whose functional status is class 3, should be able to perform which of the following? - CORRECT ANSWER can carry out usual activities involving self care but limited in work and other activities a 16 year old adolecent playing basketball sprains his ankle (grade II inversion injury) what tx is most likely? - CORRECT ANSWER RICE for tx of osteoporosis, which of the following agents stimuates the formation of bone? - CORRECT ANSWER teriparatide (forteo) according to the 3 step world health organization analgesic ladder "a patient complaining of moderate to severe pain unresponsive to NSAIDS may require which of the following medications? - CORRECT ANSWER CODEINE How should a child with juvenile idiopathic/rheumatoid arthritis be positioned in bed? - CORRECT ANSWER no support under knees and no or ver low pillow under head (to maintain extension) a bed bound patient has a 1.5 inch foam overlay over her mattress, the nurse places her hand under teh overlay and finds that it has compressed to 0.75 inches, what does this indicate? - CORRECT ANSWER bottoming out With the times up and go test to assess ambulation and mobility, which time shows an increase risk for falls? - CORRECT ANSWER 14 seconds a patient has had an open reduction of a potts fracture and has a still damp short leg cast, a small spot of blood appears on the cast what action should the nurse take? - CORRECT ANSWER time date and circle the spot a patient with systemic lupus has developed swollen tender joints, increased fatigue and weakness, low grade fever, mild depression, and loss of appetite. She has a rash present on her face. lab finding show increased ESR which of following is likely tx? - CORRECT ANSWER nsaids and corticosteroids a 70 year old patient with fracture of the proximal femur develops sudden onset of hypoxia, tachypnea, high fever, buccal and conjuctival petichaiae and tachycardia 24 hours after injury, initial blood gasses indicate respiratory alkalosis, which complication is most likely the cause. - CORRECT ANSWER fat embolism syndrome. a patient with bone mets from prostate cancer is to be treated with zoledronic acid (reclast, Zometa) whcih lab test must be done prior to initiated treatment? - CORRECT ANSWER creatinine/Creatinine clearance a woman who is jogging trips on an uneven path and experiences a moderately severe ankle sprain. Splint is applied to support the anlkle in a neutral position. how long does she have to wear the splint? - CORRECT ANSWER 5 days 56 YO female has pain and swelling of the small joints of the hands and wrist. Which test confirms rheumatoid arthritis? - CORRECT ANSWER rheumatoid factor and anti citrullinated protein antibody ACPA a patient who is post amputation of a lower limb and insists he needs no physical therpay or rehab is probably experiencing what? - CORRECT ANSWER denial which of the following is a cause of secondary osteoporosis in adolescenets - CORRECT ANSWER juvenile idiopathic/rheumatoid arthritis 8 year old child is relearning to walk after serious injury. which response to "i cant do this" shows reflective listening? - CORRECT ANSWER New exercises can be scary because you don't know whats going to happen a 42 YO client who experience a traumatic BE amputation has been fitted for a prosthesis what is the first task to be completed? - CORRECT ANSWER education on prosthetic use, including overuse and nerve entrapment a patient using crutches for two point ambulation without weight bearing must be able to ascend and descend the stairs to his front door before discharge. what is teh correct procedure - CORRECT ANSWER place the well foot first on the higher step then crutches then injured foot 56 YO arthritic woman is chari bound with total score on the braden of 16 sensory prec 4 moisture 3 activity 2 mobility 3 nutrition 2 and friction and sheer 2 what is accurate descritption of this patients risk? - CORRECT ANSWER breakpoint for risk (moderate) 36 year old female has bee training to run a marathon but develops increasing pain while running and point tenderness in shine. x ray is negative for fx what further test is indicated? - CORRECT ANSWER bone scan 36 year old male falls on elbow, extremely painful and flexed at 60 degree angle. spasms are occuring but circulation is good. what do you do? - CORRECT ANSWER attempt to securely splint arm without attempting to change flexion patient with end stage bone cancer has elected hospice and palliative care. having extreme sever bone pain from tumor, physican order radiotherapy to reduce tumor size and reduce pain. is this acceptable under hospice? - CORRECT ANSWER yes if purpose is to relive pain, it is essentially palliative patient is to begin zometa for bone metastasis, what lab test is indicated prior to each dose? - CORRECT ANSWER creatinine/clearance which infection control precautions should be used when caring for a patient with osteomyelitis and a fistula infected with staph aureus? - CORRECT ANSWER standard and contact what is the most common complication of pagets diesease? - CORRECT ANSWER fracture a patient with a hip spica cast complains of feeling severely claustrophobic which intervention is most effective - CORRECT ANSWER cut a windown above patient abdomen patient is receiving high doses of vitamin d to treat oseomalacia what dietary intervention is also indicated - CORRECT ANSWER diet high in vitamin c and phosphorus a patient is screen for oseoporosis by a bone mineral density test which of the following score indidcates osteopenia? - CORRECT ANSWER -1.5 when assessing a patient gait and posture how far apart should a patient s heels be as they pass while walking? - CORRECT ANSWER 2-4 inches what is the primary concern for the orthopedica nurse when monitoring a patient with a new cast on a an upper extremity - CORRECT ANSWER neurvascular status which of the following neurovascular injuries is associated with distal radius fracture - CORRECT ANSWER median nerve injury a patient experienced a traumatic posterior acetabular (hip) dislocation in an auto accident. which complication is most often associated with this type of dislocation. - CORRECT ANSWER Sciatic nerve injury the ortho nurse is assessing a patients elbow ROM which actions are within the elbows normal ROM? - CORRECT ANSWER flexion, extension, pronation, supination which of the following results in indicative of developmental /congenital hip dysplasia in a 6 month old child. - CORRECT ANSWER positive allis sign a newborn was diagnosed with Osteogenesis imperfecta type 1 at birth based on rib fracture blue sclera and short limbs. what critical info should the parents receive before going home? - CORRECT ANSWER correct methods of handling, bathing, and placing child in the crib two year old chilld dis place in bryant traction because of femur fx which position is correct? - CORRECT ANSWER buttocks slightly elevated off of the bed an adolescent female has been fitted with a milwaukee brace for kyphoscoliosis but she has developed skin irritation with areas of denuded skin and tenderness over pelvic bones from wearing the brace what caused this? - CORRECT ANSWER pelvic piece is too loose a foot drop splint used for peroneal nervne palsy would be classified as which type of orthotic? - CORRECT ANSWER functional a patient with an injured leg imagines how it feel sto extend and flex the limb in normal range of motion and imagines walking and using the limb, what is this technique? - CORRECT ANSWER visualization which of the follwing is the correct postoperative positioning of a patient who has undergone a posterior cervical fusion with wiring after cervical fracture - CORRECT ANSWER flat of head elevated with neck in neutral position which of teh following is most indicative that chronic carpal tunnell syndrome is progressing? - CORRECT ANSWER atrophy (flattening) of teh thenar muscle of the thumb a patient with degenerative arthritis and a herniated intervertabral disc has undergone an ACDF to relive sever pain. postop the patient exhibitys hoarseness and cannot cough effectively.. what could the complication be? - CORRECT ANSWER injury to recurrent laryngeal nerve 56 year old female with osteopenia tell the ortho nurse that she plans to start an exercise program to prevent more bone loss. what exercise would be best? - CORRECT ANSWER bicycling which of the following is an advantage to applying a cast for a wrist fracture rather than a splint? - CORRECT ANSWER better immobilization the nurse is evaluating a patient for VTE following a total hip replacement. which indicates positive homans sign? - CORRECT ANSWER pain in calf when foot is dorsiflexed a patient with osteoarthritis in both feet form old injuries states she can barely walk because of pain and stiffness when she first gets up in the AM. what would be most helpful? - CORRECT ANSWER advice pt to do ROM exercises for both feet before arising pt involved in an auto accident has unstable pelvic fx, what intervention does teh nurse expect patient will most likely requirei - CORRECT ANSWER transfusions foot ball player fell on knee during scrimmage resulting in non displaced fracture of knee. extension brace has been applied but the knee is becoming increasingly painful and "tight" what is most likely the cause of the pain? - CORRECT ANSWER hemarthosis pt who suffered a traumatic fx has developed signs of acute compartment syndrome. compartment pressure is 32 mm hg and bp is 110/60 what is patients delta pressure? - CORRECT ANSWER 28 mm hg (diastolic-CP = DP) patient involved in a skiiing accident incurred a rupture of the ACL what inital tx is usually indicated? - CORRECT ANSWER knee brace a trauma victim has been admitted to the unit with fractures of the upper two ribs on the right side resulting from an auto accident. patient should be assess for what secondary injury or injuries? - CORRECT ANSWER tracheal/bronchial/great vessel trauma an infant has congenital metatarsus adductus with curvature of less than 13 degrees what should the ortho nurse expect to teach parents.... - CORRECT ANSWER stretching exercises when checking nerve function in the hand the "ok" sign and abductor pollicis brevis test are used for which nerve? - CORRECT ANSWER median 32 year old woman with autoimmunde myesthenia gravis has fluctuation but increasing muscle weakness and has begun to sleep in her chair because she sleeps better sitting upright. she yawns and sighs frequently which intervention is most appropriate with these symptoms? - CORRECT ANSWER respiratory assessment with pulmonary function tests. 35 year old female involved in a side impact automobile collision suffered pronouced cervical rotation and complains of severe right sided neck pain and severe unremitting right side headache and exhibits ecchymosis and swelling of right neck and right opthalmic ptosis with contraction of the pupil what is most likely reason for symptoms. - CORRECT ANSWER carotid dissection the use of which of the following medications puts patient at risk for defective vitamin D metabolism and osteomalacia? - CORRECT ANSWER phenytoin what triad of s/s is associated with familial x linked hypophostphatemia (XLH) - CORRECT ANSWER stunted growth, deformities of the lower extremeties, and hypophosphatemia which of the following is the best dietary source of vitamin d - CORRECT ANSWER fortified dairy products which of the following disorders can result in renal osteodystrophy - CORRECT ANSWER chronic kidney diesease patient receiving antimalarials for rheumatoid arthritis should be monitored for which opthalmic disorder - CORRECT ANSWER macular degeneration which site of pain is usually present at the onset of ankylosing spondylosis - CORRECT ANSWER sacroilliac pain a patient with RA plans to do aquatic exercises at a local pool what water temp is optimal? - CORRECT ANSWER 85-94 degrees fahrenheit boutonniere deformity is characteristic of which disorder? - CORRECT ANSWER RA! amyloidosis (protein in the organs) secondary to RA is associated with which of the following? - CORRECT ANSWER kidney failure patient scheduled for hyaluronic acid (Orthovisc) injection to teh knee for tx of osteoarthritis. what allergy should nurse question for prior to tx? - CORRECT ANSWER chicken patient has injury to the right knee, what is the correct instruction for the patient use of cane? - CORRECT ANSWER cane in left hand and move cane and right leg forward together when examining a patient, the nurse notes that passive exercise results in cogwheeling (jerky incremental movements) cogwheeling is characteristic of which of the following dieseases? - CORRECT ANSWER parkinsons diesease which of teh following is a primary use of electrical muscle stimualtion? - CORRECT ANSWER relieve muscle spasms and increase muscle size an athlete wtih a hip flexor injury in returning to sports activities but must wear a hip spica wrap. how should the athlete stand when the wrap is applied? - CORRECT ANSWER foot on the affected side turned slightly inward what is the initial symptom for most patients eventually diagnosed with sclerodoma? - CORRECT ANSWER raynaud phenomenon what is the first line treatment for macrophage activation syndrome associated with systemic juvenile/rheumatoid arthritis (still diesease) - CORRECT ANSWER cycosporin A what surgical option is most commonly used to treat severe kyphosis associated with anklosing spondylosis - CORRECT ANSWER osteotomy (lumbar) which of the following is the most common primary malignant tumor of teh bone - CORRECT ANSWER osteosarcoma what is the tender point test used for? - CORRECT ANSWER to differentiate fibromyalgia from other disorders what is the first line drug for polyarticular juvenile idiopathic/RA? - CORRECT ANSWER NSAIDS what structure is damaged when a strain occurs? - CORRECT ANSWER muscle a tennis player has developed bursitis of the left elbow with marked pain, swelling and stiffness. what tx is most critical - CORRECT ANSWER rest and temporary immobilization which type of dislocation poses the most risk for development of avasular necrosis - CORRECT ANSWER hip what grade is assigned to an open (compound) fracture in which the wound is 2cm in length and extensive soft tissue damage is evident? - CORRECT ANSWER grade II (greater than 1cm and tissue damage is evident) which of the following ismost indicative of a closed fracture in lower extremity? - CORRECT ANSWER inability to walk immediately and in the ER when assessing sensation of the radial nerve for a pt with a fracture of the humerus where should the nurse prick the skin? - CORRECT ANSWER midway between thumb and index finger screen for osteoporosis should begin routinely for all women at what age - CORRECT ANSWER 65 which of the following in addition to rest is teh most important intervention of fat pad contusion? (policemans heel) - CORRECT ANSWER shock absorbing insoles or heel pads which joint is the most commonly injured in sports - CORRECT ANSWER ankle a female golfer has developed a mortons neuroma of the right foot and has been advised to wear a wide toed shoe,, what other footwear modification is needed? - CORRECT ANSWER metatarsal rasie a child with polyartivular JI/RA is non responsive to other drugs and is going to receive a TNF blocking agent (Infliximab) remicade what test must be completed prior to admin of med - CORRECT ANSWER TB test which of the following injuries is common to ballet dancers because of postions the foot in placed in? - CORRECT ANSWER sinus tarsi syndrome a 30 year old expert in martial arts developed turf toe from excess flexion of great toe. once injury has healed what precautions should the patient use to prevent reinjury - CORRECT ANSWER wear a brace to support the toe or hard soled shoes in the adult which type of bone produces the greatest number of red blood cells? - CORRECT ANSWER flat bones following closed reduction of a should dislocation what exercises are indicated after initial resting period - CORRECT ANSWER gentle rang of motion a construction worker fell feet first form an eight foot ladder onto a concrete floor. which type of spinal fracture should be suspected? - CORRECT ANSWER axial burst which type of skull fracture results in widening of the sutures in children under age 3? - CORRECT ANSWER diastatic a womn experience sever hyperextension of the head and neck when he hair was caught in mechanical equipment at her place of employment what type of injury is common with this type of hyperextension? - CORRECT ANSWER primary brainstem lesion a conscious and responsive pt is brought to hospital by friends following fall off a roof resulting in severe back pain. what is initial intervention - CORRECT ANSWER immobilize pt when grading reflexes in lower extremeties, how is normal reflex activity graded - CORRECT ANSWER 2 when assessing a patient right lower ext for sensation the patient reports that the pinprick feels like pressure only and does not feel the sharp compared to the normal response felt on the left side, how is this response graded? - CORRECT ANSWER absent the risk for fat embolism is highest with which of the following fractures? - CORRECT ANSWER comminuted fracture of the tibia patient who has a thigh wound or amputation of teh lower extremity and is incontinent of stool is most at risk for what type of infection? - CORRECT ANSWER gas gangrene (clostridium perfrigens) children with oligoarticular JI/RA ar particularly at risk for which of the following - CORRECT ANSWER anterior uveitis (inflammation of middle layer of eye) and chronic iridocyclitis (inflammation of the iris) a patient with acute lower backpain spent one day on bedrest and is now able to move about but still has marked lower back pain. what are the time limits for sitting in a chair for a pt with acute lower back pain? - CORRECT ANSWER 20-50 min at a time which of the following is an indication that a patient with chronic low back pain is experiencing dependecy issues? - CORRECT ANSWER patient wife lays out clothes and assists him to dress. early signs of muscular dystrophy - CORRECT ANSWER significant incoordination, clumsiness, balance difficulties, muscle weakness, difficulty with stairs, and problems getting into standing position tx and self care of cerebral palsy - CORRECT ANSWER no known cure, physical and occupational therapy as well as speech very early, use of braces walkers, and wheelchairs, pain medications and muscle relaxers for spasms and pain. goal is maximize independent functioning as much as possible. pavlik harness teaching - CORRECT ANSWER used in first few months of life in developmental hip dysplasia in infants, maintains hips and knees at 90 degrees and fully abducted hips. show parents that position is necessary in maintaining the let in the hip socket. natural comfortable position for the newborn and parents should not be alarmed by it or worry about hurting child. teach correct technique of bathing dressing, applying harness and skin care of infant tx options of developmental hip dysplasia by age - CORRECT ANSWER newborns-closed reduction maneuvers or pavlik harnessfor a few months. later diagnosis tx may be closed reduction with anesthesia followed by placement of cast. DDH that persists or after 2 years of age requires surgical reduction followed by body spica cast Define Pes cavus in child - CORRECT ANSWER abnormaly arched feet, or clawfoot. if seen in children under 6 neuromuscular problem is suspect and must be ruled out first as it is rare in children. Elimitate muscle spasm or weakness and spinal etiology as cause. as child grows finding shoes difficult and frequent ankle sprains. pain is only complain later in life and orthotics and arch supports are primary tx in childhood congenital muscular torticollis - CORRECT ANSWER constant unilateral contraction or tightness in the steronucleomastoid muscle in teh neck. parents note lack of head movement to one side or a knot that is felt along the proximal attachment side of the tightened muscle on the sternum. tx is primarily PT , massage bracing and postioning. Signicant proportion of children with this will also have hip dysplasia describe pigeon toeing - CORRECT ANSWER not described as a disorder under age of 2 secondary to a slightly rotated tibial bone. usualy does not require tx. in child over the age of 3 may signify twisting of femur. bracing and PT have not proven effective. surgery is only indicated if condition causes pain, disability or significant assymetry. describe clubfoot - CORRECT ANSWER tallipes equinovarus can be unilateral or bilateral. foot postioned abnomally in 3 different directions. 1. heel points medially and is inverted. 2. ankle points in the inferior direction. third. entire foot appears supinated (plantar surface up) tx is manual manipulation with splinting and casting with frequent follow up and gradual anatomic positioning. prognosis good with early tx bowlegs and knock knees "Genu Varum" - CORRECT ANSWER anomaly in which tibia and fibula are angled medially in relation to femur. most noted in children under 2 usually resolve themselves if not bracing is successful into the third decade. Surgery is only indicated if affecting growth or is assymetrical. reassurance of parents is priority that thsehse conditions are most often outgrown primary concern in child born without limb - CORRECT ANSWER assure health and stabilization of newborn then, parents needs counseling, reassurance, education, and support. medical specialty evaluation is necessary for to further reassure parents and alleviate anxiety Leg-Calve-Perthes diesease LCP - CORRECT ANSWER head of femur deteriorates due to temporary lack of bood supply. more males than females ages 3-9. other risk factors are short stature, low birth weight, second hand smoke exposure, and first borns. more often unilateral. TX. self limiting,but with bracing, pain management and physical therapy prognosis is good. Education on healing time and diesease progression are essential. Complications of noncompliance: decreased ROM, early onset osteoarthritis three Tx options for limb length discrepancies - CORRECT ANSWER TX only a consideration greater than 1 inch descrepancy or if gait disturbance and pain 1. shoe lift are initial tx of choice 2. leg shortening surgical procedure primary for skelatally immature. however, results not immediate and complication of miscalculation is high 3. leg lengthening tx for skeletally mature reliable and compliant pt. lengthy process and frequent follow up. infection risk high due to external fixator use spina bifida - CORRECT ANSWER congenital disorder in which development of brain or spinal cord and covering is abnormal. four types: occulta, closed neural tube defect, meningocele and myelomeningocele ortho considerations of myelomeningocele - CORRECT ANSWER most severe form of spina bifida. requires multi medical team approach to tx as well as patient and caregiver education. deformities will most likely develop in lower extremeties such as tallipes equinovarus (clubfoot) calcaneus (veritcally oriented calcaneus) and cavus (fixed plantar flexion of foot), Muscle atrophy and bone density loss common. Hip dysplasia is common as well as contractures and spinal curvatures. osteogenesis imperfecta define, tx, self care - CORRECT ANSWER "brittle bone Diesease" hereditary child born with possible fracutre and sustain fractures frequently with activities that normally would not cause bone to break. TX: focuses on prevention, developing and maintaining bone mass, and working on muscle strength and minimizing complications. Appropriate reduction and immobilization. Self Care: Acute: Cast care, Pain Management can include ice heat, TENS, medications, and nerve blocks. Chronic: appropriate low impact exercise, PT and nutrition counseling Salter Harris Classification system - CORRECT ANSWER decribes fracture in children and involvement in growth plate. 5 types (stages) type 1: fracture through plate itself increasing width of plate not disrupting epiphysis or metaphysis. type II: fracture through physis and metaphysis, not involving epipysis. type III: involves a fracture through the phsysis and epiphysis type IV: fracture pass vertically through all 3 Type V: fractures completely compress of crush the physis with no fx of other 2 difference in child amputees vs adult - CORRECT ANSWER heal faster, earlier prosthetic fitting, smaller learning curve scoliosis mgmt - CORRECT ANSWER observation is less than 20 degree curvature back brace with up to 40 degree curvature and complaint of pain or gait impairment greater than 40 degrees surgical candidate Rheumatoid Arthritis - CORRECT ANSWER genetic autoimmune diesease. Immune system attacks body. patient complaints of persistent joint pain. Body attack synovium of joint causing swelling and thickening of the area. Damage extends to surrounding joint structure including bone. Can be progressive or be exacerbated and remissed. hands, wrists, shoulders, knees, and feet are most often affected bilaterally swan neck deformity, boutonniere deformity - CORRECT ANSWER swan neck: fingers- DIP and MCP joints in flexion while PIP joint is hyperextended. TX is splints, anti rheumatic drugs or surgical option such as tendon release (RA deformity) Boutonniere-fingers-Hyperextension of DIP jointand Flexion of PIP joint. TX is NSAIDS, Diesease modifying anti rheumatics, splinting and OT. Surgery is last resort. Seen in RA and "Jamming a Finger" Pharmacologic TX for RA - CORRECT ANSWER Cornerstone tx: Diesease modifying anti rheumatic drugs. Slow progression and joint deformities. encourage remission. Acute exacerbations: NSAIDS, COX-2 inhibitors, and corticosteroids. Plaquenil is shown to help modify course of RA New class of medications called Biologics, injectable and IV only. All used in cominations for best disease control. Nursing MGMT of RA - CORRECT ANSWER Controlling pain and maintaining function are most important. patient education especially on pain management and compromised immune system management are very important. ADLS including self care and hobbies Juvenile Rheumatoid Arthritis-3 types - CORRECT ANSWER similar to adult RA but patients under 16 and most children grow out of diesease. Polyarticular-most common- involves greater than 5 joints, sudden onset, most likely to have permanant joint damage. pauciarticular- 4 or less joints more often in lower extrememties. has major complication before age 6 of chronic eye problems systemic JRA- recurring spiking fevers and truncal rash in addition to joint pain. can get pericarditis Challenges and considerations Nursing MGMT of JRA - CORRECT ANSWER younger the child the harder to describe symptoms they are feeling. therapy and splinting are essential. maintaining self esteem and school participation must be done. everyone in contact should be educated Ortho exam findings and considerations in pt with systemic lupus erythematosus - CORRECT ANSWER butterfly rash on cheeks, erythemous plaques on body, Differences of RA and SLE - CORRECT ANSWER both autoimmune disorders. musculoskelatal system is primary target in RA SLE affects more distal joints while RA does distal as well as all other joints. SLE onset is earlier in life than RA during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER [Show Less]
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Orthopedic Nursing Exam 159 Questions with Verified Answers,100% CORRECT
Orthopedic Nursing Exam 159 Questions with Verified Answers First step in bone healing - CORRECT ANSWER hematoma which means that there is bleeding and ... [Show More] it can effect the HH second step in bone healing - CORRECT ANSWER inflammatory phase fibrocartilage callus formation starts within 48 hours third stage in bone healing - CORRECT ANSWER reparative stage bony callus formation starts 3-4 weeks fourth stage stage of bone healing - CORRECT ANSWER 2-4 months extra structured remodeling fracture and symptoms - CORRECT ANSWER break in continuity of the bone pain deformity edema crepitus complete vs incomplete - CORRECT ANSWER total vs partial segment transection with vs without displacement - CORRECT ANSWER unstable vs stable lined up vs not lined up simple vs compound - CORRECT ANSWER closed vs open puncture of skin fractures impact - CORRECT ANSWER muscle blood vessels nerves tendons results in soft tissue damage blood loss edema etc the first step - CORRECT ANSWER reduction goal of reduction - CORRECT ANSWER approximate the segments of bone and return them to normal position closed reduction - CORRECT ANSWER manual manipulation of bone through the skin no surgery open reduction - CORRECT ANSWER surgical manipulation of bone second step - CORRECT ANSWER immobilization goal of immobilization - CORRECT ANSWER fixation of the reduced segments internal fixation - CORRECT ANSWER pins plates rod advantage faster ambulation disadvantage surgery required external fixation - CORRECT ANSWER casts splints external fixation devices advantage may not require surgery disadvantage casts may slow ambulation moment ion limb external fixation device requires surgery high risk of infection Principles of cast care - CORRECT ANSWER neurovascular checks elevate skins edges pad neurovascular checks - CORRECT ANSWER 5 Ps pulses pain pallor parastysia paralysis below where the cast is hands feet fingers toes capillary refill temperature elevate - CORRECT ANSWER reduce edema in the cast skin edges pad - CORRECT ANSWER handle with palms cool air to relieve itching no sharp objects traction - CORRECT ANSWER pulling to imobilize and align segments General nursing interventions for traction - CORRECT ANSWER maintain the pulling force and direction of traction maintain body alignment weights hang freely and do not touch floor nothing is obstructing rope no knot in pully do not wedge the patients feet or place against foot board because it will take away the tension when in traction - CORRECT ANSWER perform neuromuscular assessments frequently 5ps assess for common complications of immobility pressure ulcer DVTs PEs respirations bowel obstruction teach about purpose of traction skin traction - CORRECT ANSWER short term immobilize alignment muscle spasms helps with apply to skin splints straps wrap low weight 5-7lbs example bucks nursing care for skin - CORRECT ANSWER skin assessment protect pressure sites may remove weights if intermittent traction relieve muscle spasms always check orders skeletal traction - CORRECT ANSWER long term immobilizes apply to bone directly weights pins wire tongs more weight 25-35lbs infection risk nursing care for skeletal traction - CORRECT ANSWER never remove weights pin site care per policy frequent assessments report signs of infection Nursing care priorities with fractures - CORRECT ANSWER -hemorrhage -fluid replacement -neurovascular assessment -elevation -immobilization -pain control -monitor for infection complications of fractures - CORRECT ANSWER infection fat embolism compartment syndrome DVT infection osteomyelitis - CORRECT ANSWER ORIF more common symptoms high fever and chills pain and swelling redness warmth and possible drainage increased WBC osteomyelitis nursing care - CORRECT ANSWER strict hand hygiene aseptic practices antibiotic therapy fat embolism syndrome - CORRECT ANSWER release of fat from exposed marrow fat breaks into fatty acids attracts platelets occludes small vessels ischemia increased capillary permeability/rupture fluid shift signs symptoms fat embolism syndrome - CORRECT ANSWER respiratory distress hypoxia tachycardia decreased oxygen saturation tachypnea dyspnea fever possible fluid shift cerebral dysfunction LOC changes confusion restlessness petechiae skin chest supper arm nursing care of FES - CORRECT ANSWER prompt recognition of SS respiratory support set up oxygen pulse ox ABCs corticosteroids to decrease inflammatory response compartment syndrome cause - CORRECT ANSWER poor fitting casts edema hemorrhage edema increases pressure internal or external pressure on the compartment - CORRECT ANSWER entrapped nerves blood vessels muscles below fascia - CORRECT ANSWER hypoxia capillary dilation edema necrosis signs and symptoms of compartment syndrome - CORRECT ANSWER severe unrelenting pain never gets under control 5ps effected negatively notify physician immediately treatment of compartment syndrome - CORRECT ANSWER decompressive fasciotomy antibiotics wet sterile saline dressings pain management debreed necrotic tissue open 7-10 days deep vein thrombosis - CORRECT ANSWER decreased blood flow unilateral swelling and pain DVT cause - CORRECT ANSWER injury to vessel wall altered blod coagulation DVT diagnosis - CORRECT ANSWER doppler study DVT treatment - CORRECT ANSWER Immediately: -Unfractioned heparin -Enoxaparin -Dalteparin -Fondaparinux Then: -Warfarin for 3 months -Compression stockings for 1-2 years -IVC filters (possibly) hip fracture - CORRECT ANSWER proximal 1/3 of femur head neck trochanter intracapsular hip fracture - CORRECT ANSWER within joint intracapsular hip fracture requires - CORRECT ANSWER arthroplasty hip replacement extracapsular hip fracture - CORRECT ANSWER outside of join trochanter region extra capsular hip fracture treatment - CORRECT ANSWER ORIF nursing care hip fracture - CORRECT ANSWER no adduction maintain alignment to prevent dislocation no movement toward beyond midline abductor wedge pillow between legs turn toward unaffected side at least Q4 neurovascular checks 5Ps no flexion >90 raised toilet seat ambulate within 24 hours use walkers - CORRECT ANSWER discharge teaching - CORRECT ANSWER avoid: crossing legs bending at waist to reach sitting in low seats bed rest spinal fractures - CORRECT ANSWER ABCs airway stability cord decompression crutch field tongs spinal traction steroids At or above C8 - CORRECT ANSWER tetrapelegia At or below T1 - CORRECT ANSWER paraplegia C1-3 - CORRECT ANSWER death cardiorespiratory collapse C3-5 - CORRECT ANSWER death from respiratory paralysis spinal shock - CORRECT ANSWER cervical or high thoracic injuries cause massive vasodialation spinal cord response flaccid paralysis below injury parasympathetic take over bradycardia HYPOTENSION immediately after - 4-6 weeks Autonomic dysreflexia - CORRECT ANSWER SCIs at or above T6 Triggered by stimuli that cause abdominal discomfort urinary retention stimuli cant go up spinal cord pressure ulcers fecal impaction mass sympathetic What is orthopaedic surgery - CORRECT ANSWER any type of surgery involving musculoskeletal system Are orthopaedic surgeries high risk - CORRECT ANSWER yes, development of surgical site infection could lead to wound break down and surgical failure What is the role of the orthopaedic nurse - CORRECT ANSWER - assist vet - a lot to go wrong - high pressure for equip to work What can cause fractures - CORRECT ANSWER direct, indirect or disease What can the direction of the fracture line be - CORRECT ANSWER transverse, longitudinal, spiral or oblique What can the extent of the fracture damage - CORRECT ANSWER complete, incomplete, fissure What can the extent of the tissue damage be - CORRECT ANSWER open, closed, compound What can the number of fracture lines be - CORRECT ANSWER simple, comminuted, multiple or segmental What can position of bone fragments be - CORRECT ANSWER non displaced or overriding What is the feature of a spiral fracture - CORRECT ANSWER fracture line spirals around long axis of bone What is the feature of oblique fracture - CORRECT ANSWER fracture is diagonal to long axis of bone What is a feature of transverse fractures - CORRECT ANSWER fracture is at right angles to location of fracture line What is a feature of incomplete fractures - CORRECT ANSWER cortex is broken but periosteum remains intact on one side of bone What is a comminuted fracture - CORRECT ANSWER one fracture site but more than 2 fragments What is a segmental fracture - CORRECT ANSWER more than one fracture line on shaft of long bone What are the 4 stages of fracture healing - CORRECT ANSWER 1. haematoma formation 2. fibrocartilage callus formation 3. bony callus formation 4. bone remodelling What factors affect healing - CORRECT ANSWER - insufficient support - poor nutrition - poor perfusion - infection - pain - immobilisation/weight bearing What does ASIF mean - CORRECT ANSWER Association for the Study of Internal Fixation What is ASIF used for - CORRECT ANSWER internal fixation - instant stability provided - limb can heal and return to normal What is included in the ASIF kit - CORRECT ANSWER 1. drill bit 2. drill sleeve 3. countersink 4. depth gauge 5. tap 6. screw driver What is a glide hole - CORRECT ANSWER drilled using a drill bit that has same external diameter as screw being placed What is a pilot hole - CORRECT ANSWER drilled using a drill bit that has the same diameter as the core of the screw What is the drill sleeve - CORRECT ANSWER prevents drill bit from collecting debris from surround tissues What does the countersink do - CORRECT ANSWER cuts an indent that allows the head of the screw to be flush with surface of the bone What is the depth gauge used for - CORRECT ANSWER measure depth of a drilled hole and to determine length of screw that will be placed What is the tap used for - CORRECT ANSWER used to tap tread in a drilled hole before a screw placed What is the screw driver used for - CORRECT ANSWER place and tighten screws, hexagonal shape at end What are cortical screws - CORRECT ANSWER thread is small and close together What are cancellous screws - CORRECT ANSWER thread wider and further apart What are self tapping screws - CORRECT ANSWER flat sections by screw tip that cut their own thread as being placed What are non self tapping screws - CORRECT ANSWER rounded ends and require the use of a tap to cut thread before placed What is a partial threaded screw - CORRECT ANSWER thread only covers part of the screw shaft. Used to bring bone fragments together What is a fully threaded screw - CORRECT ANSWER thread covers the full length of screw shaft What are different types of plates - CORRECT ANSWER - sherman plate - venables plate - dynamic compression plate What are types of intramedullary pins - CORRECT ANSWER - steinmann pins - arthrodesis wire - kirschner wire - rush pin What are key principles of surgical fractures - CORRECT ANSWER - reduce fracture - align fragments - immobilise fragments - restore soft tissue function Osteoarthritis (OA) - CORRECT ANSWER degenerative joint disease; most common joint disorder. combination of carilage degradation, bone stifening, and inflammation of the synovium causes pain and functional impairment joints feel wrose the more they are used throughout the day. Modifiable Risk Factors of OA - CORRECT ANSWER obesity repeptitive use Non-Modifiable Risk Factors for OA - CORRECT ANSWER increased age female previous joint damage deformity genetic susceptibility Symptoms of OA - CORRECT ANSWER Deep, aching joint pain, occurring especially after exercise or weight-bearing; relieved with rest. Joint pain during cold weather Stiffness when arising in the morning Crepitus of the joint during motion Joint swelling Altered gait Limited range of motion Muscle weakness around arthritic joints. Over time, pain is present even when you are at rest Pain that is worse when you start activities after a period of no activity. Goals of Treatment of OA - CORRECT ANSWER increase the strength of the joints maintain or improve joint movement reduce the disabling effects of the disease relieve pain the treatment depends on which joints are involved Lifestyle Recommendations for OA - CORRECT ANSWER Exercise helps maintain joint and overall movement. Water exercises Applying heat and cold Eating a healthy, balanced diet Getting rest Losing weight if you are overweight Protecting the joints Diagnosis & Treatment of OA - CORRECT ANSWER a physical exam may show: -joint swelling (bones around the joints may feel larger than normal) -limited ROM -tenderness when the joint is pressed -normal movement is often painful. *no blood test are helpful in diagnosing OA *an x-ray of affected joints will show a loss of join space. *in advanced cases, there will be a wearing down of the ends of the bone and bone spurs.. Medications for OA - CORRECT ANSWER OTC pain relievers: Tylenol NSAIDS: asprin, ibuprofen, and naproxen Celebrex (a COX-2 inhibitor) may work as well as other NSAIDs Corticosterioids injected right into the joint- relief lasts only a short time. Supplements: glucosamine and chondroitin sulfate Capsaicin (Zostrix): skin cream may help relieve pain; relief usually begins within 1-2 weeks. Artificial joint fluid can be injected into knee. May relieve pain for 3-6 months. Prognosis: Prevention of OA - CORRECT ANSWER weight loss can reduce the risk of knee OA in overweight women. Osteoporosis - CORRECT ANSWER A condition in which the body's bones become weak and break easily. "porous bone" risks for osteoporosis - CORRECT ANSWER age, gender, genetics, nutrition, and physical activity women are at increase risk due to small bone structure, low levels os testosterone and low estrogen after menopause. symptoms of osteoporosis - CORRECT ANSWER no symptoms in the early stages later symptoms include: -bone pain or tenderness -fractures with little or no trauma; one of the most common causes of hip fracture. -loss of height over time -low back pain due to fracture of the spinal bones -neck pain due to fractures of the cervical bones. -stooped posture Medical Treatment for Osteoporosis - CORRECT ANSWER control pain from the disease slow down or stop bone loss prevent bone fractures with medications that strengthen bone minimize the risk of fall that might cause fractures Medications for Osteoporosis - CORRECT ANSWER Biphosponates: (Fusomax) slows bone loss. Calcitonin: prevents the breakdown of bone; helps pull calcium from the blood and into the bone. Hormone Replacement Therapy: helps calcium absorption (rarely used today) women after menopause. risk of estrogen based breast cancer. Parathyroid Hormone: causes the body to absorb more calcium. only used in severe cases where there is a lot of fractures and other medications are not working. prevention of osteoporosis - CORRECT ANSWER -calcium & viatmin D3 supplements (vitamin D is needed to absorb calcium) -healthy, well balanced diet -avoid drinking excess alcohol -don't smoke -get regular weight bearing exercise Nursing Interventions for patients osteoporosis/back pain - CORRECT ANSWER -pain management -exercise to improve physical mobility -work modifications; body mechanics -stress reduction -dietary plan and encouragement of weight reduction. Joint Replacement Surgeries - CORRECT ANSWER Total Hip Replacement (THR) Total Knee Replacement (TKR) both are ORIF surgeries. Open Reduction Internal Fixation (ORIF) - CORRECT ANSWER correction and alignment of a fracture through surgery and exposure of the fractur then applying either metal screws, nails, plates, wires, or pins. some fractures require the use of multiple types of hardware. Total Joint Replacement (TJR) - CORRECT ANSWER knee or hip. include the replacement of both articular surfaces within a joint or with a metal or synthetic material. Auto Transfuser - CORRECT ANSWER a drain that is used with excessive blood loss. as is drains it pulls fluid out and filters out the RBCs and delivers a tranfusion to the patient. patient is able to get their own blood transfused back into them. mostly in hip replacements, or knee replacement. Post-Op care: Knee Replacement - CORRECT ANSWER Assessment: standard post op in addition to.... -assess pain -assess extremity for edema, pulses, color, cap refill, and temp of toes. -assess surgical site, dressing, and drain -assess for indicators of DVT -assess for infection *be sure to pay special attention to the extremity that was not operated on. Evaluation to reduce edema. Assist with ambulation as soon as ordered by MD Continuous Passive Motion Machine Cryotherapy Continuous Passive Motion (CPM) - CORRECT ANSWER educate patient of the importance. used to increase circulation and ROM of the knee joint. works on the principle of flexion and extension. helps to gradually increase flexibilty. it is removed at short periods of time to encourage patient movement for PT and rest. Cryotherapy - CORRECT ANSWER therapeutic use of cold. encourage the use of ice to minimize pain and swelling in conjuction with CPM. Hip Repair - CORRECT ANSWER can only have toe touching weight bearing post-op. no other precautions. can walk, and use walker. total hip replacement - CORRECT ANSWER two types. anterior approach surgery posterior appraoch surgery Anterior Approach Surgery - CORRECT ANSWER no special precautions post-op, smaller incision toward front of thigh. don't have to cut tendons so there is less complications. Posterior Approach Surgery - CORRECT ANSWER large incision on the side of hip, more invasive *prevent hip flexion of 90 degrees or more at all times do not sit straight up, use a raised toilet seat, sit back at an angle when sitting down. *CANNOT ADDUCT the legs together; abductor pillow will be used *prevent internal rotaton if patient c/o increased pain w/ inward rotation of foot and sortening of leg, NOTFIY MD STAT Hip Fracture: Post-Op Care - CORRECT ANSWER -standard post op care -prevent dislocation (posterior approach) -prevent infection wound & respriatory -prevent DVT -pain control Buck's Traction - CORRECT ANSWER external; applied to skin used in temporary management of fractures of: -femoral neck, femoral shaft in older children -undisplaced fractures of the the acetabulum -after reduction of a hip dislocation can use tape or pre-made boot. do not use more than 10 lbs used temporarily until surgery can be done/short term intervention. Skeletal Traction - CORRECT ANSWER traction apparatus is applied directly to the bone with pins. Purpose of traction: - CORRECT ANSWER reduce muscle spasms; decreases pain reduce, align, and immobilize fractures reduce deformity increase space between opposing forces Principles of Effective Traction - CORRECT ANSWER traction must be continuous to reduce and immobile fractures skeletal traction is NEVER interrupted weights are not removed unless intermitten traction is prescribed ropes must be unobstructed and weights must hang freely knots or the footplate must NOT touch the foot of the bed. (MUST KNOW FOR TEST) Nursing Care of the Patient in Traction - CORRECT ANSWER Properly apply and maintain traction; meticulous nursing care needed. Monitor for complications of skin breakdown, nerve pressure, respiratory problems and circulatory impairment (hazards of immobility) -assess for pain -inspect the skin at least 3 x a day; frequent skin care -palpate skin around traction pins to assess for tenderness q8h; pin care. -assess neurovascular integrity (CMS)- circulation, movement, & sensation. -assess circulation by checking pulses, color, cap refil, and temp of toes. ask pt to move their toes, and theck if they have normale sensation in the toes. -assess for indicators of DVT; SCD's for prevention -assess for indcators of infection -continue ROM on unaffected limbs; monitor for development of contractures r/t lack of activity -trapeze to help with mobility -coping: knowledge. Associated Problems with Fractures - CORRECT ANSWER -pain -loss of function -deformity -shortening of the extremity -crepitus -local swelling and discoloration -diagnosis by x-ray Nursing interventions for Fractures - CORRECT ANSWER -assess injury and soft tissue -calm and reassure the child and parent -assess for pain and point of tenderness, sensation, motion, and pulses. Complete Fracture - CORRECT ANSWER a break that extends through the entire thickness of the bone Incomplete Fracture - CORRECT ANSWER bone is not broken all the way through Simple fracture - CORRECT ANSWER an uncomplicated fracture in which the broken bones to not pierce the skin Compound Fracture - CORRECT ANSWER break in the bone where the bone comes through the skin; open fracture Emergency Management of Fractures - CORRECT ANSWER -Immobilize the body part Splinting: joints distal and proximal to the suspected fracture site must be supported and immobilized -Assess neurovascular status before and after splinting -Open fracture: cover with sterile dressing to prevent contamination -Do not attempt to reduce the fracture Complications of Fractures - CORRECT ANSWER Shock Fat embolism Compartment syndrome Delayed union and nonunion Avascular necrosis Reaction to internal fixaction devices Complex regional pain syndrome (CRPS) Heterotrophic ossification Factors that affect fracture healing - CORRECT ANSWER blood supply, nutrtion, excess movement. Fat Embolism - CORRECT ANSWER bone marrow fat escapes into the bloodstream. S&S: hypoxia, decreased oxygen saturation level, tachypnea, tachycardia, cyanosis, and mental status changes. Compartment Syndrome - CORRECT ANSWER swelling in a muscle, causes extreme pain d/t inability the compatment to expain r/t stiffness of fascia; causes decreased blood flow and results in tissue damage. Avascular Necrosis - CORRECT ANSWER death of bone tissue d/t lack of blood supply Complex Regional Pain Syndrome (CRPS) - CORRECT ANSWER chronic pain of a limb hetertrophic ossification - CORRECT ANSWER bone formation in soft tissue. Medical Management - CORRECT ANSWER Reduction: -closed -open Immobilization: internal or external fixation. open fractures require treatment to prevent infection -tetanus, antibiotics, cleaning and debridement of wound -closure of the primary wound may be delayed to permit edema, wound drainage, further assessment and debridement if needed. External Fixation Device - CORRECT ANSWER used to manage open fractures with soft-tissue damage provide support for complicated or comminuted fractures reassure patient concerned by appearance of device discomfort is usually minimal, and early mobility is possible with these devices. Interventions for Fractures - CORRECT ANSWER elevate to reduce edema monitor for S&S of complications, including infection. provide pin care patient teaching Cast - CORRECT ANSWER external immobilizing device uses: -immobilize a reduced fracture -correct a deformity -apply uniform pressure to soft tissues -provide support to stabilize a joint materials: -firberglass, plaster (rarely used now) Teaching Needs of the Patient with a Cast: Prior to Cast Application - CORRECT ANSWER -explain need for the cast and the process for applying the cast -for plaster casts eplain that it will take 24-72 hours for to dry completely and until then it must be kept off of hard surfaces -explain purpose and goals of the cast -describe expectations during the casting process: ie the heat from hardening plaster (if used) Teaching Needs of the Patient With a Cast - CORRECT ANSWER cast care: keep clean and dry; do not cover with plastic positioning: keep the cast & extremity elevated, use slings if needed -hygiene -activity and mobility -explain exercises -do not scratch or stick anything under the cast: call MD for medication if needed. -cushion rough edges -require follow-up care -cast removal *report the following S&S: -persistent pain or swelling -changes in sensation, movement, skin color, or temp. -signs of infection or pressure areas CMS - CORRECT ANSWER circulation movement stimulation/sensation Assess the 5 P's of Neurovascular Assessment - CORRECT ANSWER pain: should be decreasing -on palpation, and on movement pallor: pale skin or poor cap refill paresthesia: pins and needles sensation pulses: diminished or absent paralysis: should be able to wiggle toes/fingers Assist with Ambulation - CORRECT ANSWER canes: held on strong side of body. cane moves, then weak leg, then strong leg. crutches: weight bearing is no an axillae, it is on the hands > should not lean forward. walker: provides greatest support and stability. Relieve pain - CORRECT ANSWER elevate to reduce edema apply ice or cold intermittently, administer analgesics isometric exercise to maintain strength & prevent atrophy heal skin wounds and maintain skin integrity; treat wounds to skin before the cast is applied. Amputation - CORRECT ANSWER the surgical or traumatic removal of a body part. used to relieve symptoms, improve function, or save the persons life. usually as a result of advanced PVD r/t DM, fulminating gas gangrene, crushing injuries, electrical burns, frostbite, congenital deformities, chronic osteomylitis, or malignant tumor. level is determine by ciruclation of the limb and functional usefulness. Assessment of Amputation - CORRECT ANSWER neurovascular status and function of affected extremity or residual limb and the unaffected extremity. -signs and symptoms of infection -nutritional status -concurrent health problems > diabetes, smoker? -psychological status of coping Nursing Interventions for Amuptations: Pain - CORRECT ANSWER -administer analgesic or other medications as prescribed -changing postion -putting a light sand bag on residual limb -alternative methods of pain relief- distraction, tens unit, meditation. -NOTE: pain may be an expression of grief and latered body image. Amputations: Promoting wound healing/Pre-prosthetic care - CORRECT ANSWER -handle limb gently -residual limb shaping -proper bandaging: wrap w/ ace from distal to proximal toward the heart to improve venous return and decrease edema. -massage -toughening of the residual limb. Amputations: Complications - CORRECT ANSWER -hemorrhage: r/t surgical severing of major blood vessels -infections -skin breakdown -phantom limb pain: r/t disruption of peripheral nerve endings in the limb. -flexion contracture of the hip: r/t positioning and protective flexion withdrawal pattern associated with pain (encourage turning and position prone.) Resolving Grief and Enhancing Body Image - CORRECT ANSWER encourage communication and expression of feelings create an accepting, supportive atmosphere provide support and listen encourage patient to look at, feel, and care for the resdiual limb help patient set realistic goals help patient resume self-care and independence referral to counselors and support groups Amputations: Rehabilitation - CORRECT ANSWER psychological support prostheses fitting and use physical therapy vocational/occupational training and counseling use a multidisciplinary team approach patient teaching. [Show Less]
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Orthopedics Nurses Certification Exam 1|107 Questions with Verified Answers,100% CORRECT
Orthopedics Nurses Certification Exam 1|107 Questions with Verified Answers A nurse who has worked on an orthopedic unit for several years is encouraged... [Show More] by the nurse manager to become certified in orthopedic nursing. What will certification in nursing require and/or provide (select all that apply)? a. A certain amount of clinical experience b. Successful completion of an examination c. Membership in specialty nursing organizations d. Professional recognition of expertise in a specialty area e. An advanced practice role that requires graduate education - CORRECT ANSWER a, b, d What accurately describes the health care system in which future nurses will be employed? a. With improvements in medicine there will be fewer patients with chronic illnesses. b. Rapidly changing technology and expanding knowledge will simplify the health care environment. c. The Quality and Safety Education for Nurses (QSEN) project measures the ability of nursing graduates to be prepared for the reality of practice. d. The Joint Commission establishes National Patient Safety Goals and evidence-based solutions for nurses to promote meeting these goals by all caring for the patient. - CORRECT ANSWER d The following is an example of an evidence-based practice (EBP) clinical question. "In adult seizure patients, is restraint or medication more effective in protecting them from injury during a seizure?" Which word(s) in the question identify(ies) the C part of the PICOT format? a. Restraint b. Or medication c. During a seizure d. Adult seizure patients e. Protecting them from injury - CORRECT ANSWER b Two nurses are establishing a smoking cessation program to assist patients with chronic lung disease to stop smoking. To offer the most effective program with the best outcomes, the nurses should initially a. search for an article that describes nursing interventions that are effective for smoking cessation. b. develop a clinical question that will allow them to compare different cessation methods during the program. c. keep comprehensive records that detail each patient's progress and ultimate outcomes from participation in the program. d. use evidence-based clinical practice guidelines developed from reviews of randomized controlled trials of smoking cessation methods. - CORRECT ANSWER d Which standardized nursing terminologies specifically relate to the steps of the nursing process (select all that apply)? a. Omaha System b. Nursing Minimum Data Set (NMDS) c. Perioperative Nursing Data Set (PNDS) d. Nursing Outcomes Classification (NOC) e. Nursing Interventions Classification (NIC) f. NANDA International: Nursing Diagnoses - CORRECT ANSWER d, e, f The nurse working in a health care facility where uniform electronic health records are used explains to the patient that the primary purpose of such a record is to a. reduce the cost of health care by eliminating paper records. b. prevent medical errors associated with traditional paper records and handwritten orders and prescriptions. c. force the use of standardized medical vocabularies and nursing terminologies so that outcomes of patient care can be measured. d. provide a single record in which all aspects of a patient's medical information are readily available to any health care provider involved in the patient's care. - CORRECT ANSWER d Which actions are done primarily by an informatics nurse (select all that apply)? a. Designs and builds computer systems b. Studies the validity of nursing information c. Trains health care providers to provide nursing care d. Communicates and accesses information for nursing staff e. Builds systems that support the processing of nursing information - CORRECT ANSWER a, c During the diagnosis phase of the nursing process, both nursing diagnoses and collaborative problems are identified. Which are collaborative problem statements (select all that apply)? a. Fatigue related to sleep deprivation b. Infection related to immunosuppression c. Excess fluid volume related to high sodium intake d. Constipation related to irregular defecation habits e. Hypoxia related to chronic obstructive pulmonary disease f. Risk for cardiac dysrhythmias related to potassium deficiency - CORRECT ANSWER b, e, f A patient with a seizure disorder is admitted to the hospital after a sustained seizure. When she tells the nurse that she has not taken her medication regularly, the nurse makes a nursing diagnosis of ineffective self-health management related to lack of knowledge regarding medication regimen and identifies the Nursing Outcomes Classification (NOC) outcome of Compliance behavior, with the indicator Performs treatment regimen as prescribed, at a target rate of 3 (sometimes demonstrated). When the nurse tries to teach the patient about the medication regimen, the patient tells the nurse that she knows about the medication but she does not always have the money to refill the prescription. Where was the mistake made in the nursing process with this patient? a. Planning b. Diagnosis c. Evaluation d. Assessment e. Implementation - CORRECT ANSWER d Identify the five rights of delegating nursing care (select all that apply). a. Right time b. Right task c. Right patient d. Right person e. Right dosage f. Right circumstance g. Right supervision and evaluation h. Right direction and communication - CORRECT ANSWER b, d, f, g, h Delegation is a process used by the RN to provide safe and effective care in an efficient manner. Which nursing interventions should not be delegated to unlicensed assistive personnel (UAP) but should be performed by the RN (select all that apply)? a. Administering patient medications b. Ambulating stable patients c. Performing patient assessment d. Evaluating the effectiveness of patient care e. Feeding patients at mealtime f. Performing sterile procedures g. Providing patient teaching h. Obtaining vital signs on a stable patient i. Assisting with patient bathing - CORRECT ANSWER a, c, d, f, g Which nursing actions are in response to the National Patient Safety Goals (select all that apply)? a. Use restraints to prevent patient falls. b. Administer all medications ordered by physicians. c. Wash hands before and after every patient contact. d. Conduct a "time-out" when too tired to provide care. e. Use SBAR for communicating with health professionals. f. Evaluate the initial existence of pressure ulcers before patient dismissal. - CORRECT ANSWER c, e Which quality of care measures influence the payment for health care services by third-party payers (select all that apply)? a. Clinical outcomes b. Regulatory agencies c. Use of evidence-based practice d. Adoption of information technology e. Occurrence of preventable conditions - CORRECT ANSWER a, c, d, e In addition to promoting the transport of glucose from the blood into the cell, what does insulin do? a. Enhances the breakdown of adipose tissue for energy b. Stimulates hepatic glycogenolysis and gluconeogenesis c. Prevents the transport of triglycerides into adipose tissue d. Accelerates the transport of amino acids into cells and their synthesis into protein - CORRECT ANSWER d Which tissues require insulin to enable movement of glucose into the tissue cells (select all that apply)? a. Liver b. Brain c. Adipose d. Blood cells e. Skeletal muscle - CORRECT ANSWER c, e Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones? a. Decrease glucose production b. Stimulate glucose output by the liver c. Increase glucose transport into the cells d. Independently regulate glucose level in the blood - CORRECT ANSWER b What characterizes type 2 diabetes (select all that apply)? a. β -Cell exhaustion b. Insulin resistance c. Genetic predisposition d. Altered production of adipokines e. Inherited defect in insulin receptors f. Inappropriate glucose production by the liver - CORRECT ANSWER a, b, c, d, e, f Which laboratory results would indicate that the patient has prediabetes? a. Glucose tolerance result of 132 mg/dL b. Glucose tolerance result of 240 mg/dL c. Fasting blood glucose result of 80 mg/dL d. Fasting blood glucose result of 120 mg/dL - CORRECT ANSWER d The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included (select all that apply)? a. Maintain a healthy weight. b. Exercise for 60 minutes each day. c. Have blood pressure checked regularly. d. Assess for visual changes on monthly basis. e. Monitor for polyuria, polyphagia, and polydipsia. - CORRECT ANSWER a, e In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. Fatigue b. Polydipsia c. Polyphagia d. Recurrent infections - CORRECT ANSWER b Which patient should the nurse plan to teach how to prevent or delay the development of diabetes? a. An obese 50-year-old Hispanic woman b. A child whose father has type 1 diabetes c. A 34-year-old woman whose parents both have type 2 diabetes d. A 12-year-old boy whose father has maturity onset diabetes of the young (MODY) - CORRECT ANSWER c Priority Decision: When caring for a patient with metabolic syndrome, what should the nurse give the highest priority to teaching the patient about? a. Achieving a normal weight b. Performing daily aerobic exercise c. Eliminating red meat from the diet d. Monitoring the blood glucose periodically - CORRECT ANSWER a During routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132 mg/dL (7.33 mmol/L). At a follow-up visit, a diagnosis of diabetes would be made based on which laboratory results (select all that apply)? a. A1C of 7.5% b. Glycosuria of 3+ c. FPG >126 mg/dL (7.0 mmol/L). d. Random blood glucose of 126 mg/dL (7.0 mmol/L) e. A 2-hour oral glucose tolerance test (OGTT) of 190 mg/dL (10.5 mmol/L) - CORRECT ANSWER a, c The nurse determines that a patient with a 2-hour OGTT of 152 mg/dL has a. diabetes. b. elevated A1C. c. impaired fasting glucose. d. impaired glucose tolerance. - CORRECT ANSWER d When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient? a. Pull back on the plunger after inserting the needle to check for blood. b. Consistently use the same size of insulin syringe to avoid dosing errors. c. Clean the skin at the injection site with an alcohol swab before each injection. d. Rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies. - CORRECT ANSWER b A patient with type 1 diabetes uses 20 U of 70/30 neutral protamine Hagedorn (NPH/regular) in the morning and at 6:00 pm . When teaching the patient about this regimen, what should the nurse emphasize? a. Hypoglycemia is most likely to occur before the noon meal. b. Flexibility in food intake is possible because insulin is available 24 hours a day. c. A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia. d. Premeal glucose checks are required to determine needed changes in daily dosing. - CORRECT ANSWER c Lispro insulin (Humalog) with NPH insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered? a. Only once a day b. 1 hour before meals c. 30 to 45 minutes before meals d. At mealtime or within 15 minutes of meals - CORRECT ANSWER d A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient does what? a. Withdraws the NPH dose into the syringe first b. Injects air equal to the NPH dose into the NPH vial first c. Removes any air bubbles after withdrawing the first insulin d. Adds air equal to the insulin dose into the regular vial and withdraws the dose - CORRECT ANSWER a Delegation Decision: The following interventions are planned for a diabetic patient. Which intervention can the nurse delegate to unlicensed assistive personnel (UAP)? a. Discuss complications of diabetes. b. Check that the bath water is not too hot. c. Check the patient's technique for drawing up insulin. d. Teach the patient to use a meter for self-monitoring of blood glucose. - CORRECT ANSWER b The home care nurse should intervene to correct a patient whose insulin administration includes a. warming a prefilled refrigerated syringe in the hands before administration. b. storing syringes prefilled with NPH and regular insulin needle-up in the refrigerator. c. placing the insulin bottle currently in use in a small container on the bathroom countertop. d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration. - CORRECT ANSWER d When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump? a. Tight glycemic control can be maintained. b. Errors in insulin dosing are less likely to occur. c. Complications of insulin therapy are prevented. d. Frequent blood glucose monitoring is unnecessary. - CORRECT ANSWER a Priority Decision: A patient taking insulin has recorded fasting glucose levels above 200 mg/dL (11.1 mmol/L) on awakening for the last five mornings. What should the nurse advise the patient to do first? a. Increase the evening insulin dose to prevent the dawn phenomenon. b. Use a single-dose insulin regimen with an intermediate-acting insulin. c. Monitor the glucose level at bedtime, between 2:00 am and 4:00 am , and on arising. d. Decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect. - CORRECT ANSWER c Which class of oral glucose-lowering agents is most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose? a. Insulin b. Biguanide c. Meglitinide d. Sulfonylurea - CORRECT ANSWER b The patient with type 2 diabetes is being put on acarbose (Precose) and wants to know why she is taking it. What should the nurse include in this patient's teaching (select all that apply)? a. Take it with the first bite of each meal. b. It is not used in patients with heart failure. c. Endogenous glucose production is decreased. d. Effectiveness is measured by 2-hour postprandial glucose. e. It delays glucose absorption from the gastrointestinal (GI) tract. - CORRECT ANSWER a, d, e Priority Decision: The nurse is assessing a newly admitted diabetic patient. Which observation should be addressed as the priority by the nurse? a. Bilateral numbness of both hands b. Stage II pressure ulcer on the right heel c. Rapid respirations with deep inspiration d. Areas of lumps and dents on the abdomen - CORRECT ANSWER c Individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to a. eat regular meals at regular times. b. restrict calories to promote moderate weight loss. c. eliminate sucrose and other simple sugars from the diet. d. limit saturated fat intake to 30% of dietary calorie intake. - CORRECT ANSWER a What should the goals of nutrition therapy for the patient with type 2 diabetes include? a. Ideal body weight b. Normal serum glucose and lipid levels c. A special diabetic diet using dietetic foods d. Five small meals per day with a bedtime snack - CORRECT ANSWER b The nurse assesses the diabetic patient's technique of self-monitoring of blood glucose (SMBG) 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention? a. Doing the SMBG before and after exercising b. Puncturing the finger on the side of the finger pad c. Cleaning the puncture site with alcohol before the puncture d. Holding the hand down for a few minutes before the puncture - CORRECT ANSWER c A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included? a. OGTT for all minority populations every year b. FPG for all individuals at age 45 and then every 3 years c. Testing people under the age of 21 for islet cell antibodies d. Testing for type 2 diabetes in all overweight or obese individuals - CORRECT ANSWER b Priority Decision: A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient? a. Administer the usual insulin dosage. b. Hold fluid intake until the nausea subsides. c. Come to the clinic immediately for evaluation and treatment. d. Monitor the blood glucose every 1 to 2 hours and call if it rises over 150 mg/dL (8.3 mmol/L). - CORRECT ANSWER a The nurse should observe the patient for symptoms of ketoacidosis when a. illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids. b. glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss. c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy. d. the patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy. - CORRECT ANSWER c What are manifestations of diabetic ketoacidosis (DKA) (select all that apply)? a. Thirst b. Ketonuria c. Dehydration d. Metabolic acidosis e. Kussmaul respirations f. Sweet, fruity breath odor - CORRECT ANSWER a, b, c, d, e, f What describes the primary difference in treatment for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)? a. DKA requires administration of bicarbonate to correct acidosis. b. Potassium replacement is not necessary in management of HHS. c. HHS requires greater fluid replacement to correct the dehydration. d. Administration of glucose is withheld in HHS until the blood glucose reaches a normal level. - CORRECT ANSWER c The patient with newly diagnosed diabetes is displaying shakiness, confusion, irritability, and slurred speech. What should the nurse suspect is happening? a. DKA b. HHS c. Hypoglycemia d. Hyperglycemia - CORRECT ANSWER c The patient with diabetes has a blood glucose level of 248 mg/dL. Which manifestations in the patient would the nurse understand as being related to this blood glucose level (select all that apply)? a. Headache b. Unsteady gait c. Abdominal cramps d. Emotional changes e. Increase in urination f. Weakness and fatigue - CORRECT ANSWER a, c, e, f A diabetic patient is found unconscious at home and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do? a. Have the patient drink some orange juice. b. Administer 10 U of regular insulin subcutaneously. c. Call for an ambulance to transport the patient to a medical facility. d. Administer glucagon 1 mg intramuscularly (IM) or subcutaneously. - CORRECT ANSWER d Priority Decision: Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dL. Which is the best response by the nurse? a. "That is a good range for your glucose levels." b. "You should call your health care provider because you need to have your insulin increased." c. "That level is too low in view of your recent hypoglycemia and you should increase your food intake." d. "You should take only half your insulin dosage for the next few days to get your glucose level back to normal." - CORRECT ANSWER a Which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes? a. It can be prevented by tight glucose control. b. It occurs with a higher frequency and earlier onset than in the nondiabetic population. c. It is caused by the hyperinsulinemia related to insulin resistance common in type 2 diabetes. d. It cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake. - CORRECT ANSWER b What disorders and diseases are related to macrovascular complications of diabetes (select all that apply)? a. Chronic kidney disease b. Coronary artery disease c. Microaneurysms and destruction of retinal vessels d. Ulceration and amputation of the lower extremities e. Capillary and arteriole membrane thickening specific to diabetes - CORRECT ANSWER b, d The patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient (select all that apply)? a. Painless foot ulcers b. Erectile dysfunction c. Burning foot pain at night d. Loss of fine motor control e. Vomiting undigested food f. Painless myocardial infarction - CORRECT ANSWER b, e, f Following the teaching of foot care to a diabetic patient, the nurse determines that additional instruction is needed when the patient makes which statement? a. "I should wash my feet daily with soap and warm water." b. "I should always wear shoes to protect my feet from injury." c. "If my feet are cold, I should wear socks instead of using a heating pad." d. "I'll know if I have sores or lesions on my feet because they will be painful." - CORRECT ANSWER d A 72-year-old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult? a. It is more difficult to achieve strict glucose control than in younger patients. b. It usually is not treated unless the patient becomes severely hyperglycemic. c. It does not include treatment with insulin because of limited dexterity and vision. d. It usually requires that a younger family member be responsible for care of the patient. - CORRECT ANSWER a To what is the increase in emerging and untreatable infections attributed (select all that apply)? a. The evolution of new infectious agents b. Use of antibiotics to treat viral infections c. Human population encroachment into wilderness areas d. Transmission of infectious agents from humans to animals e. An increased number of immunosuppressed and chronically ill people - CORRECT ANSWER a, b, c, e What are the recommended measures to prevent the transmission of health care-associated infections (HAIs) (select all that apply)? a. Empty bedpans as soon as possible b. Limit fresh flowers in patient rooms c. Remove urinals from bedside tables d. Use personal protective equipment e. Hand washing or alcohol-based sanitizing f. Have patients wear sandals in the shower - CORRECT ANSWER d, e A patient with diarrhea has been diagnosed with Clostridium difficile. Along with standard precautions, which kind of transmission-based precautions will be used when the nurse is caring for this patient? a. Droplet precautions b. Contact precautions c. Isolation precautions d. Airborne precautions - CORRECT ANSWER b A 78-year-old patient has developed Haemophilus influenzae . In addition to standard precautions, what should the nurse use to protect herself and other patients when working within 3 feet of the patient? a. Mask b. Gown c. Gloves d. Shoe covers - CORRECT ANSWER a An 82-year-old male patient with pneumonia who is in the intensive care unit (ICU) is beginning to have decreased cognitive function. What should the nurse first suspect as a potential cause of this change? a. Fatigue b. Infection c. ICU psychosis d. Medication allergy - CORRECT ANSWER b The nurse realizes that the patient understands the teaching about decreasing the risk for antibiotic-resistant infection when the patient says which of the following? a. "I know I should take the antibiotic for one day after I feel better." b. "I want an antibiotic ordered for my cold so I can feel better sooner." c. "I always save some pills because I get the illness again after I first feel better." d. "I will follow the directions for taking the antibiotic so I will get over this infection." - CORRECT ANSWER d Which type of immunity is the result of contact with the antigen through infection and is the longest lasting type of immunity? a. Active innate immunity b. Passive innate immunity c. Active acquired immunity d. Passive acquired immunity - CORRECT ANSWER c What accurately describes passive acquired immunity (select all that apply)? a. Pooled gamma globulin b. Immunization with antigen c. Temporary for several months d. Immediate, lasting several weeks e. Maternal immunoglobulins in neonate f. Boosters may be needed for extended protection - CORRECT ANSWER a, c, d How does an antigen stimulate an immune response? a. It is captured, processed, and presented to a lymphocyte by a macrophage. b. It circulates in the blood, where it comes in contact with circulating lymphocytes. c. It is a foreign protein that has antigenic determinants different from those of the body. d. It combines with larger molecules that are capable of stimulating production of antibodies. - CORRECT ANSWER a Which T lymphocytes are involved in direct attack and destruction of foreign pathogens? a. Dendritic cells b. Natural killer cells c. T helper (CD4) cells d. T cytotoxic (CD8) cells - CORRECT ANSWER d How does interferon help the body's natural defenses? a. Directly attacks and destroys virus-infected cells b. Augments the immune response by activating phagocytes c. Induces production of antiviral proteins in cells that prevent viral replication d. Is produced by viral infected cells and prevents the transmission of the virus to adjacent cells - CORRECT ANSWER c What is included in the humoral immune response? a. Surveillance for malignant cell changes b. Production of antigen-specific immunoglobulins c. Direct attack of antigens by activated B lymphocytes d. Releasing cytokines responsible for destruction of antigens - CORRECT ANSWER b Where and into what do activated B lymphocytes differentiate? a. Spleen; natural killer cells that destroy infected cells b. Bone marrow; plasma cells that secrete immunoglobulins c. Thymus; memory B-cells that retain a memory of the antigen d. Bursa of Fabricius; helper cells that in turn activate additional B lymphocytes - CORRECT ANSWER b Which immunoglobulin is responsible for the primary immune response and forms antibodies to ABO blood antigens? a. IgA b. IgD c. IgG d. IgM - CORRECT ANSWER d Which immunoglobulins will initially protect a newborn baby of a breastfeeding mother (select all that apply)? a. IgA b. IgD c. IgE d. IgG e. IgM - CORRECT ANSWER a, d Which characteristic describes immunoglobulin E (select all that apply)? a. Assists in parasitic infections b. Responsible for allergic reactions c. Present on the lymphocyte surface d. Assists in B-lymphocyte differentiation e. Predominant in secondary immune response f. Protects body surfaces and mucous membranes - CORRECT ANSWER a, b What are the important functions of cell-mediated immunity (select all that apply)? a. Fungal infections b. Transfusion reactions c. Rejection of transplanted tissues d. Contact hypersensitivity reactions e. Immunity against pathogens that survive outside cells - CORRECT ANSWER a, c, d A 69-year-old woman asks the nurse whether it is possible to "catch" cancer because many of her friends of the same age have been diagnosed with different kinds of cancer. In responding to the woman, the nurse understands that what factor increases the incidence of tumors in older adults? a. An increase in autoantibodies b. Decreased activity of the bone marrow c. Decreased differentiation of T lymphocytes d. Decreased size and activity of the thymus gland - CORRECT ANSWER d What describes the occurrence of a type IV or delayed hypersensitivity transplant reaction? a. Antigen links with specific IgE antibodies bound to mast cells or basophils releasing chemical mediators b. Cellular lysis or phagocytosis through complement activation following antigen-antibody binding on cell surfaces c. Sensitized T lymphocytes attack antigens or release cytokines that attract macrophages that cause tissue damage d. Antigens combined with IgG and IgM too small to be removed by mononuclear phagocytic system deposit in tissue and cause fixation of complement - CORRECT ANSWER c What are examples of type I or IgE-mediated hypersensitivity reactions (select all that apply)? a. Asthma b. Urticaria c. Angioedema d. Allergic rhinitis e. Atopic dermatitis f. Contact dermatitis g. Anaphylactic shock h. Transfusion reactions i. Goodpasture syndrome - CORRECT ANSWER a, b, c, d, e, g Which type of hypersensitivity reaction occurs with rheumatoid arthritis and acute glomerulonephritis? a. Type I or IgE-mediated hypersensitivity reaction b. Type II or cytotoxic hypersensitivity reaction c. Type III or immune-complex mediated hypersensitivity reaction d. Type IV or delayed hypersensitivity reaction - CORRECT ANSWER c For the patient with allergic rhinitis, which therapy should the nurse expect to be ordered first? a. Corticosteroids b. Immunotherapy c. Antipruritic drugs d. Sympathomimetic/decongestant drugs - CORRECT ANSWER d A patient was given an IM injection of penicillin in the gluteus maximus and developed dyspnea and weakness within minutes following the injection. Which additional assessment findings indicate that the patient is having an anaphylactoid reaction (select all that apply)? a. Wheezing b. Hypertension c. Rash on arms d. Constricted pupils e. Slowed strong pulse f. Feeling of impending doom - CORRECT ANSWER a, f Which rationale describes treatment of atopic allergies with immunotherapy? a. It decreases the levels of allergen-specific T helper cells. b. It decreases the level of IgE so that it does not react as readily with an allergen. c. It stimulates increased IgG to bind with allergen-reactive sites, preventing mast cell-bound IgE reactions. d. It gradually increases the amount of allergen in the body until it is no longer recognized as foreign and does not elicit an antibody reaction. - CORRECT ANSWER c Which description about a nurse who develops a contact dermatitis from wearing latex gloves is accurate? a. This demonstrates a type I allergic reaction to natural latex proteins. b. Use powder-free latex gloves to prevent the development of symptoms. c. Use an oil-based hand cream when wearing gloves to prevent latex allergy. d. This demonstrates a type IV allergic reaction to chemicals used in the manufacture of latex gloves. - CORRECT ANSWER d A 28-year-old male Gulf War veteran tells the nurse he gets a headache, sore throat, shortness of breath, and nausea when his girlfriend wears perfume and when he was painting her apartment. He is afraid he has cancer. What does the nurse suspect may be the patient's problem? a. He has posttraumatic stress disorder. b. He has multiple chemical sensitivities. c. He needs to wear a mask when he paints. d. He is looking for an excuse to break up with his girlfriend. - CORRECT ANSWER b Although the cause of autoimmune disorders is unknown, which factors are believed to be present in most conditions (select all that apply)? a. Younger age b. Male gender c. Inheritance of susceptibility genes d. Initiation of autoreactivity by triggers e. Frequent viruses throughout the lifetime - CORRECT ANSWER c, d Why is plasmapheresis indicated in the treatment of autoimmune disorders? a. Obtain plasma for analysis and evaluation of specific autoantibodies b. Decrease high lymphocyte levels in the blood to prevent immune responses c. Remove autoantibodies, antigen-antibody complexes, and inflammatory mediators of immune reactions d. Add monocytes to the blood to promote removal of immune complexes by the mononuclear phagocyte system - CORRECT ANSWER c Before the patient receives a kidney transplant, a crossmatch test is ordered. What does a positive crossmatch indicate? a. Matches tissue types for a successful transplantation b. Determines paternity and predicts risk for certain diseases c. Establishes racial background and predicts risk for certain diseases d. Cytotoxic antibodies to the donor contraindicate transplanting this donor's organ - CORRECT ANSWER d What is the most common cause of secondary immunodeficiency disorders? a. Chronic stress b. T-cell deficiency from HIV c. Drug-induced immunosuppression d. Common variable hypogammaglobulinemia - CORRECT ANSWER c Which characteristics are seen with acute transplant rejection (select all that apply)? a. Treatment is supportive b. Only occurs with transplanted kidneys c. Organ must be removed when it occurs d. The recipient's T cytotoxic lymphocytes attack the foreign organ e. Long-term use of immunosuppressants necessary to combat the rejection f. Usually reversible with additional or increased immunosuppressant therapy - CORRECT ANSWER d, e, f The patient is experiencing fibrosis and glomerulopathy a year after a kidney transplant. Which type of rejection is occurring? a. Acute b. Chronic c. Delayed d. Hyperacute - CORRECT ANSWER b What are the most common immunosuppressive agents used to prevent rejection of transplanted organs? a. Cyclosporine, sirolimus, and muromonab-CD3 b. Prednisone, polyclonal antibodies, and cyclosporine c. Azathioprine, mycophenolate mofetil, and sirolimus d. Tacrolimus, prednisone, and mycophenolate mofetil - CORRECT ANSWER d The patient has received a bone marrow transplant. Soon after the transplant there is a rash on the patient's skin. She says her skin is itchy and she has severe abdominal pain. What best summarizes what is happening to the patient and how she will be treated? a. Graft rejection occurring; treat with different immunosuppressive agents b. Dry skin and nausea are side effects of immunosuppresants; decrease the dose c. Transplanted bone marrow is rejecting her tissue; prevent with immunosuppressive agents d. Dry skin from the dry air and nausea from the food in the hospital; treat with humidifier and home food - CORRECT ANSWER c In a patient with leukocytosis with a shift to the left, what does the nurse recognize as causing this finding? a. The complement system has been activated to enhance phagocytosis. b. Monocytes are released into the blood in larger-than-normal amounts. c. The response to cellular injury is not adequate to remove damaged tissue and promote healing. d. The demand for neutrophils causes the release of immature neutrophils from the bone marrow. - CORRECT ANSWER d What does the mechanism of chemotaxis accomplish? a. Causes the transformation of monocytes into macrophages b. Involves a pathway of chemical processes resulting in cellular lysis c. Attracts the accumulation of neutrophils and monocytes to an area of injury d. Slows the blood flow in a damaged area, allowing migration of leukocytes into tissue - CORRECT ANSWER c What effect does the action of the complement system have on inflammation? a. Modifies the inflammatory response to prevent stimulation of pain b. Increases body temperature, resulting in destruction of microorganisms c. Produces prostaglandins and leukotrienes that increase blood flow, edema, and pain d. Increases inflammatory responses of vascular permeability, chemotaxis, and phagocytosis - CORRECT ANSWER d Priority Decision: Key interventions for treating soft tissue injury and resulting inflammation are remembered using the acronym RICE. What are the most important actions for the emergency department nurse to do for the patient with an ankle injury? a. Reduce swelling, shine light on wound, control mobility, and elicit the history of the injury b. Rub the wound clean, immobilize the area, cover the area protectively, and exercise that leg c. Rest with immobility, apply a cold compress, apply a compress bandage, and elevate the ankle d. Rinse the wounded ankle, image the ankle, carry the patient, and extend the ankle with imaging - CORRECT ANSWER c What is characteristic of chronic inflammation? a. It may last 2 to 3 weeks. b. The injurious agent persists or repeatedly injures tissue. c. Infective endocarditis is an example of chronic inflammation. d. Neutrophils are the predominant cell type at the site of inflammation. - CORRECT ANSWER b During the healing phase of inflammation, which cells would be mostly likely to regenerate? a. Skin b. Neurons c. Cardiac muscle d. Skeletal muscle - CORRECT ANSWER a What is the primary difference between healing by primary intention and healing by secondary intention? a. Secondary healing requires surgical debridement for healing to occur. b. Primary healing involves suturing two layers of granulation tissue together. c. Presence of more granulation tissue in secondary healing results in more scarring. d. Healing by secondary intention takes longer because more steps in the healing process are necessary. - CORRECT ANSWER c A patient had abdominal surgery 3 months ago and calls the clinic with complaints of severe abdominal pain and cramping, vomiting, and bloating. What should the nurse most likely suspect as the cause of the patient's problem? a. Infection b. Adhesion c. Contracture d. Evisceration - CORRECT ANSWER b A patient had a complicated vaginal hysterectomy. The student nurse provided perineal care after the patient had a bowel movement. The student nurse tells the nurse there was a lot of light brown, smelly drainage seeping from the perianal area. What should the nurse suspect when assessing this patient? a. Dehiscence b. Hemorrhage c. Keloid formation d. Fistula formation - CORRECT ANSWER d Which nutrients aid in capillary synthesis and collagen production by the fibroblasts in wound healing? a. Fats b. Proteins c. Vitamin C d. Vitamin A - CORRECT ANSWER c What role do the B-complex vitamins play in wound healing? a. Decrease metabolism b. Protect protein from being used for energy c. Provide metabolic energy for the inflammatory process d. Coenzymes for fat, protein, and carbohydrate metabolism - CORRECT ANSWER d The patient is admitted from home with a stage II pressure ulcer. This wound is classified as a yellow wound using the red-yellow-black concept of wound care. What is the nurse likely to observe when she does her wound assessment? a. Serosanguineous drainage b. Adherent gray necrotic tissue c. Clean, moist granulating tissue d. Creamy ivory to yellow-green exudate - CORRECT ANSWER d What type of dressing will the nurse most likely use for the patient in Question 14? a. Dry, sterile dressing b. Absorptive dressing c. Negative pressure wound therapy d. Telfa dressing with antibiotic ointment - CORRECT ANSWER b The patient's wound is not healing, so the health care provider is going to send the patient home with negative pressure wound therapy or a "wound vac" device. What will the caregiver need to understand about the use of this device? a. The wound must be cleaned daily. b. The patient will be placed in a hyperbaric chamber. c. The occlusive dressing must be sealed tightly to the skin. d. The diet will not be as important with this sort of treatment. - CORRECT ANSWER c Priority Decision: During care of patients, what is the most important precaution for preventing transmission of infections? a. Wearing face and eye protection during routine daily care of the patient b. Wearing nonsterile gloves when in contact with body fluids, excretions, and contaminated items c. Wearing a gown to protect the skin and clothing during patient care activities likely to soil clothing d. Hand washing after touching fluids and secretions and removing gloves, as well as between patient contacts - CORRECT ANSWER d Which patient is at the greatest risk for developing pressure ulcers? a. A 42-year-old obese woman with type 2 diabetes b. A 78-year-old man who is confused and malnourished c. A 30-year-old man who is comatose following a head injury d. A 65-year-old woman who has urge and stress incontinence - CORRECT ANSWER c Priority Decision: What is the most important nursing intervention for the prevention and treatment of pressure ulcers? a. Using pressure-reduction devices b. Massaging pressure areas with lotion c. Repositioning the patient a minimum of every 2 hours d. Using lift sheets and trapeze bars to facilitate patient movement - CORRECT ANSWER c The patient is transferring from another facility with the description of a sore on her sacrum that is deep enough to see the muscle. What stage of pressure ulcer does the nurse expect to see on admission? a. Stage I b. Stage II c. Stage III d. Stage IV - CORRECT ANSWER d A patient's documentation indicates he has a stage III pressure ulcer on his right hip. What should the nurse expect to find on assessment of the patient's right hip? a. Exposed bone, tendon, or muscle b. An abrasion, blister, or shallow crater c. Deep crater through subcutaneous tissue to fascia d. Persistent redness (or bluish color in darker skin tones) - CORRECT ANSWER c Delegation Decision: Which nursing interventions for a patient with a Stage IV sacral pressure ulcer are mostappropriate to assign or delegate to a licensed practical nurse (LPN) (select all that apply)? a. Assess and document wound appearance. b. Teach the patient pressure ulcer risk factors. c. Choose the type of dressing to apply to the ulcer. d. Measure the size (width, length, depth) of the ulcer. e. Assist the patient to change positions at frequent intervals. - CORRECT ANSWER d, e To prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise? a. Only after a 15-g carbohydrate snack is eaten b. About 1 hour after eating when blood glucose levels are rising c. When glucose monitoring reveals that the blood glucose is in the normal range d. When blood glucose levels are high, because exercise always has a hypoglycemic effect - CORRECT ANSWER b [Show Less]
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NRS 210 Orthopedic Nursing Exam 23 Questions with Verified Answers,100% CORRECT
NRS 210 Orthopedic Nursing Exam 23 Questions with Verified Answers Which type of bone cell is responsible for the formation of bone? - CORRECT ANSWER Os... [Show More] teoblast The patient is told by the HCP that the size of the patient's muscle has decreased. How should the nurse document this occurrence? - CORRECT ANSWER Atrophy An older patient is describing increased stiffness in the shoulders, back, and hips. The loss of elasticity in what tissue contributes to this? - CORRECT ANSWER Ligament What is the best description of the periosteum? - CORRECT ANSWER Fibrous connective tissue covering bone What is the function of a tendon? - CORRECT ANSWER Attaches muscle to bone In performing ROM with a patient, the nurse puts each joint through its full movement. Which joints are capable of abduction and adduction. - CORRECT ANSWER Hip Wrist Thumb Shoulder While having his height measured during a routine health examination, a 79-year-old man asks the nurse why he is "shrinking". How should the nurse explain the decreased height that occurs with aging? - CORRECT ANSWER Vertebrae become more compressed with thinning of intervertebral discs A 78-year-old woman has physiologic changes in her joints related to aging. What is an appropriate nursing intervention related to common changes of aging in the musculoskeletal system? - CORRECT ANSWER Have the patient exercise to maintain muscle strength and avoid risk for falls When obtaining information about the patient's use of medications, the nurse recognizes that both bone and muscle function may be impaired when the patient reports taking what type of drug? - CORRECT ANSWER Corticosteriods During muscle strength testing, the patient has active movement against gravity and some resistance to pressure. What score should the nurse give this finding? - CORRECT ANSWER 4 On observation of the patient, the nurse notes the presence of a limping gait. How should the nurse further evaluate the patient? - CORRECT ANSWER Measure the length of the limbs A patient with severe joint immobility is receiving physical and exercise therapy. To evaluate the effect of the treatment, the nurse may assess joint range of motion with that equipment? - CORRECT ANSWER Goniometer The patient was referred to the office by the school nurse for a lateral curvature of the spine. The nurse knows this is called.. - CORRECT ANSWER Scoliosis In report, the nurse is told that the patient has a contracture of the right arm. What does the nurse know this meanS? - CORRECT ANSWER Shortening of a muscle or ligament The patient is diagnosed with torticollis. What should the nurse be prepared to provide for the patient? - CORRECT ANSWER Enough pillows to support the patient's head comfortably The patient has a burning, sharp pain on the sole of the foot, especially in the morning. The nurse knows that this describes what common musculoskeletal problem? - CORRECT ANSWER Plantar fasciitis When assessing the patient, the nurse notices that the patient has footdrop and the foot slaps down on the floor as the patient walks. How does the nurse document this gait? - CORRECT ANSWER Stappage gait What is the most common diagnostic test used to assess musculoskeletal disorders? - CORRECT ANSWER Standard X-ray What test provides fast, precise measurement of the bone mass of the spine, femur, forearm, and total body to evaluate osteoporosis? - CORRECT ANSWER Dual energy x-ray absorptiometry (DXA) Which serologic studies would be done to evaluate rheumatoid arthritis? - CORRECT ANSWER Complement Rheumatoid factor Antinuclear antibody Enoxaparin (Lovenox) - CORRECT ANSWER LMWH 12-24 hours after surgery; continues for 7-10 days post Anticoagulant and Antithrombotic Prevents the conversion of fibrinogen to fibrin and prothrombin clotting cascade Warfarin (Coumadin) - CORRECT ANSWER Starts on day of surgery Measured daily Dose based on INR Take in late afternoon Anticoagulant Apixaban (Eliquis) & Rivaroxaban (Xarelto) - CORRECT ANSWER Decrease risk of stroke, DVT, PE No regular blood monitoring No diet restirctions No frequent does adjustment Fairly new drugs so several long-term unknowns Must still monitor for bleeding and alert providers if taking [Show Less]
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ONC Orthopedic Trauma Sports Injuries Practice Exam 50 Questions with Verified Answers,100% CORRECT
ONC Orthopedic Trauma Sports Injuries Practice Exam 50 Questions with Verified Answers A 48-year-old athlete sustains a ruptured Achilles tendon during ... [Show More] triathlon training. In discussing the personal and medical history with the patient, the nurse should recognize which of the following as a risk factor for this injury? - CORRECT ANSWER Ongoing treatment for gout A patient with a ruptured Achilles tendon has undergone surgical repair and will require 6 weeks of cast immobilization. As part of the patient's discharge plan, it is MOST important for the nurse to assess the patient's ability to - CORRECT ANSWER . ambulate with an assistive device. healthy 47-year-old injured the right knee while skiing. A moderate partial tear of the anterior cruciate ligament (ACL) is confirmed with MRI. The patient has opted for non- surgical treatment. Which of the following should the nurse recognize as an appropriate intervention to manage the injury - CORRECT ANSWER Knee aspiration and prescription for diclofenac (Voltaren) A softball pitcher underwent surgical repair of the right anterior cruciate ligament 3 days ago and is now being seen in the surgeon's office. Which of the following findings should the nurse identify as suspicious of infection? - CORRECT ANSWER Increased pain, new drainage, and low grade fever An ice skater sustains a first-degree ankle sprain. Which of the following treatments should the nurse expect to be included in the patient's plan of care? - CORRECT ANSWER Elastic bandage and crutches 12-year-old boy playing Pee Wee football is tackled and sustains a fracture to the left clavicle. The nurse should teach the patient and his parents about use of which of the following interventions as part of non-surgical treatment for this injury? - CORRECT ANSWER Padded sling Little League baseball pitcher has been diagnosed with a partial tear of the ulnar collateral ligament (UCL) of the pitching arm. The nurse should reinforce instruction on which of the following as part of a conservative course of treatment for this patient? - CORRECT ANSWER Rest between games and a limited number of pitches per game A marathon runner develops foot pain and is diagnosed with plantar fasciitis. Which of the following statements by the patient should the nurse recognize as correct concerning this condition? - CORRECT ANSWER "Plantar fasciitis is chronic, and complete resolution takes several months to a year." rugby player is unable to rise and walk after experiencing an aggressive tackle. In the emergency department, the patient is diagnosed with a dislocated right hip. The nurse's assessment should be based on knowledge that which of the following structures can be affected by this injury? - CORRECT ANSWER Sciatic nerve and femoral head A patient is taken to the emergency department after experiencing a knee injury during a weekend game of flag football. Magnetic resonance imaging (MRI) with MR gadolinium contrast is ordered. Which of the following should the nurse ensure is completed before the patient goes for the study? - CORRECT ANSWER Take a detailed health and renal history. A high school basketball player complains of severe left knee pain after falling during a game. A tear of the meniscus is suspected. The nurse should know which of the following maneuvers would be performed to assess for a meniscal tear? - CORRECT ANSWER McMurray's sign A runner complains of pain over the calcaneus and is diagnosed with plantar fasciitis. Consistent with this diagnosis, the nurse identifies which of the following? - CORRECT ANSWER "Start-up" pain after rest A professional football player undergoes reconstruction of the left anterior cruciate ligament. He identifies his current pain as 4 on 0-10 intensity scale and has full movement and sensation after epidural anesthesia. Six hours after surgery, the patient is unable to void. Which of the following should the nurse identify as a risk factor for postoperative urinary retention for this patient? - CORRECT ANSWER . Epidural anesthesia and 800 cc intravenous fluids A minor league baseball pitcher undergoes surgical rotator cuff repair. As the nurse prepares the patient for discharge, which statement by the patient should the nurse recognize as indicating he understands the postoperative treatment plan? - CORRECT ANSWER "I'll wear a sling and limit activities for a few months A tennis player is diagnosed with lateral epicondylitis of the right arm. A tennis elbow band is recommended, and the patient asks the nurse about the benefits of this treatment. The nurse's response should be based on knowledge that the tennis elbow band - CORRECT ANSWER Reduces inflammation and pain of extensor tendons. A gymnast diagnosed with chondromalacia patella is advised to avoid activities that worsen the pain. The nurse also should reinforce the need for the patient to perform which of the following types of exercise? - CORRECT ANSWER . Quadriceps strengthening During a recent competition, a weight lifter says he felt a sudden burning pain in his lower back that has since resolved to tenderness. When seen in the emergency department, he is diagnosed with a second-degree muscle strain. Although he is advised to rest the injured area, he insists he wants to return to competition in the morning. Which of the following statements by the nurse should be appropriate in this situation? - CORRECT ANSWER If this injury is not properly treated, a more dramatic injury could occur A high school football player experiences a right shoulder dislocation during practice and is taken to the emergency department. The nurse's assessment should be based on awareness of the risk for injury to the - CORRECT ANSWER brachial nerve. A professional hockey player diagnosed with femoroacetabular impingement (FAI) has had no success with conservative treatment. Surgery is planned. The patient asks the nurse about the purpose of the arthroscopy. The nurse's response should be based on knowledge that the goal of surgery for this condition is to - CORRECT ANSWER correct deformity of the femoral head. A high school soccer player complains of acute calf pain within 10 minutes after the start of each game. After assessment of compartment pressures by the orthopaedic physician, the patient is diagnosed with exercise-induced chronic compartment syndrome. The nurse should provide education to prepare the patient for which of the following procedures - CORRECT ANSWER Fasciotomy An elite long-distance runner comes to the clinic with complaint of pain and tenderness over the anteromedial knee. After a diagnosis of pes anserinus bursitis, the patient is instructed to rest the knee and avoid activities that cause pain. The nurse should recognize the next step in rehabilitation will be a stretching and conditioning program that includes which of the following? - CORRECT ANSWER . Quadriceps sets A basketball player sprains her right ankle in landing after a rebound. The nurse assists in the physical examination of the patient. The nurse should recognize which of the following maneuvers will be used to assess ligament stability? - CORRECT ANSWER Anterior drawer test A golfer for the local college team is diagnosed with medial epicondylitis. Which of the following statements by the nurse should represent appropriate self-care instructions for this patient - CORRECT ANSWER . "Apply ice for 20 minutes every 2 hours while awake." A high school cheerleader falls during performance of a pyramid stunt at practice. Complaining of severe neck pain, she is taken to the emergency department. CT scan confirms stable fractures at cervical vertebrae 5 and 6, and the patient is placed in a halo vest. Which of the following statements by the nurse should represent appropriate instructions for this patient and her parents? - CORRECT ANSWER "Get up with a physical therapist when you are ready to ambulate." A professional golfer is diagnosed with a torn rotator cuff and conservative treatment is discussed. Which of the following statements by the nurse should be appropriate for the patient's self-care instructions? - CORRECT ANSWER "Avoid any activity that reproduces your symptoms." An intoxicated college student punches a wall and sustains a closed boxer's fracture of the right hand. An ulnar gutter splint is applied. Which of the following should the nurse include in discharge teaching for this patient? - CORRECT ANSWER . Maintenance of absorbent padding between the fingers A postmenopausal female slips on the ice outside her home and falls on her outstretched right hand. X-ray confirms a Colles' fracture, which is treated with external fixation. Based on knowledge of risks associated with this type of fracture, the nurse should be alert to deficits of which of the following nerves? - CORRECT ANSWER Median A patient diagnosed with hallux valgus asks the nurse about appropriate foot wear. Which of the following should the nurse recommend? - CORRECT ANSWER Wide shoe with extra depth in the toe box In preparing to discharge a patient diagnosed with a grade 3 ankle sprain, the urgent care nurse should reinforce which of the following instructions regarding the patient's weight-bearing status? - CORRECT ANSWER Protected weight bearing A 29-year-old female is diagnosed with DeQuervain's tenosynovitis. The patient asks the nurse how this condition develops. After reviewing the patient's personal and medical history, the nurse should suspect the injury is MOST likely related to - CORRECT ANSWER repetitive lifting of her infant. A patient is diagnosed with a scaphoid fracture after falling in an icy parking lot. After a cast is placed for immobilization, the patient asks the nurse how long he will have to wear the cast. Which of the following should represent the nurse's correct response concerning the average time for immobilization? - CORRECT ANSWER 6 to 8 weeks A 32-year-old male patient experienced traumatic amputation below the right knee in a motor vehicle crash. During the patient's recovery, the nurse should encourage him to stop smoking and limit coffee intake because nicotine and caffeine - CORRECT ANSWER cause vasoconstriction and delay healing. An elevator mechanic and father of three children suffers multiple fractures of both upper and lower extremities in a work-related accident. What intervention by the nurse should demonstrate greatest awareness of the patient's psychosocial needs following this injury? - CORRECT ANSWER Spend time with the patient and involve the interprofessional team. A construction worker presents with a suspected torn rotator cuff. Through shared decision making, nonsurgical management is identified as the treatment plan. Which of the following should the nurse include in patient teaching? - CORRECT ANSWER Follow up with a physical therapist and avoid aggravating activities. A patient who uses a commercial ironing press for 35 hours a week has been diagnosed with carpal tunnel syndrome. The patient asks the nurse how this causes the numbness and pain he is experiencing. The nurse's response should be based on the knowledge that an enlarged ligament compresses the - CORRECT ANSWER median nerve. After tripping over a retaining wall in the garden and falling on an extended elbow, a female patient is diagnosed with a supracondylar fracture. The nurse should conduct a detailed neurovascular assessment based on awareness that displacement with this injury may cause - CORRECT ANSWER compartment syndrome. A patient admitted with a hip fracture cannot be sent to surgery for fracture repair until medical clearance can be provided. When the nurse sets up Buck's traction per order, the patient's family asks why the boot is needed. The nurse's answer should be based on knowledge that Buck's traction - CORRECT ANSWER decreases muscle spasms. Following open reduction and internal fixation (ORIF) of a right hip fracture, a patient receives orders to begin anticoagulation therapy. The nurse should recognize the need to review prothrombin time results for which of the following medications? - CORRECT ANSWER Warfarin (Coumadin) A patient had a long leg cast applied for a tibial plateau fracture. Within a short time after arrival on the orthopaedic unit, the patient begins to complain of unrelenting pain. The nurse should contact the physician for an order to bivalve the cast based on the patient's recognized risk of developing - CORRECT ANSWER compartment syndrome. A 10-year-old child is diagnosed with osteochondritis dissecans. The child's parents are advised to modify the child's activity. The nurse should provide instruction on which of the following additional strategies for conservative management? - CORRECT ANSWER Bracing Following a motor vehicle crash, a patient is hospitalized with a nondisplaced pelvic fracture. Which of the following activity should the nurse recognize as MOST likely for this patient? - CORRECT ANSWER Ambulation with rolling walker Following a fall during mountain climbing, a patient is sent by helicopter to the nearest trauma center. Diagnosed with multiple fractures of the right femoral shaft and tibia, the patient is to be placed in skeletal traction. Which of the following weights should the nurse expect to maintain on the patient's traction? - CORRECT ANSWER . 20 pounds A nurse is working with a student in caring for a patient in a long-arm cast after diagnosis with multiple forearm and humeral fractures. The student asks about the surgeon's choice of Plaster of Paris casting material. Which of the following should be the nurse's correct response? - CORRECT ANSWER "The surgeon uses plaster for multiple cast changes A 4-year-old child is diagnosed with a pathologic tibial fracture. Based on the child's health history, the nurse should recognize the fracture is MOST likely due to osteopenia associated with which of the following chronic medical conditions? - CORRECT ANSWER Cerebral palsy Physical abuse is suspected to be a factor in the diagnosed injuries of a 4-year-old admitted to the emergency department. The nurse should recognize which of the following types of fracture as the MOST likely result of abuse in a child of this age? - CORRECT ANSWER Physeal fracture A patient who works for a moving company is diagnosed with a herniated lumbar disk. Conservative treatment is initiated and the nurse provides patient education about this condition. Which of the following statements should be MOST important for the nurse to include? - CORRECT ANSWER Contact your doctor at once if you experience any progressive weakness in your legs." A patient with a femoral neck fracture undergoes hemiarthroplasty. Among the strategies to decrease the risk of postoperative venous thromboembolism, the nurse should reinforce instruction on performing which of the following exercises? - CORRECT ANSWER Ankle pumps A farmer is brought to the emergency department after three fingers on his right hand are amputated in a machine. Paramedics have the amputated fingers, and they tell the nurse the patient was adamant about having the fingers re-implanted. How should the nurse maintain the amputated fingers to provide the best opportunity for re-implantation? - CORRECT ANSWER Wrap them in sterile gauze and place in a plastic bag. A patient whose legs had been trapped under heavy equipment for several hours is brought to the emergency department. Because of the nature of the crush injury, the nurse is concerned about development of rhabdomyolysis. Which of the following should the nurse assess carefully to determine if this complication is developing? - CORRECT ANSWER Urine output After 3 weeks in training, an 18-year-old military recruit is diagnosed with a stress fracture of the talus in his left foot. A fracture shoe is prescribed and the patient is placed on protected weight-bearing with crutches. The recruit asks the nurse how long the activity restrictions will be necessary. Which of the following should represent the nurse's correct response? - CORRECT ANSWER "The bone should be healed in about 6-8 weeks." [Show Less]
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Orthopedic Nursing Care Exam 46 Questions with Verified Answers,100% CORRECT
Orthopedic Nursing Care Exam 46 Questions with Verified Answers Contusion - CORRECT ANSWER blunt force, bleeding into soft tissue but skin remains intac... [Show More] t swelling, discoloration of skin (hematoma, bruise) - CORRECT ANSWER What are manifestations of a contusion strain - CORRECT ANSWER stretching injury to the muscle or muscle tendon pain, swelling, limited motion, spasms, weakness - CORRECT ANSWER what are manifestations of a strain sprain - CORRECT ANSWER stretch or tear of joint ligament loss of ability to move or use the joint feeling a pop or tear discoloration, pain, rapid swelling - CORRECT ANSWER what are manifestations of a sprain Rest Ice Compression Elevation - CORRECT ANSWER what are the initial measure to treat a musculoskeletal injury Rest, Ice, Compression, Elevation (R.I.C.E) teach effective use of OTC analgesics and NSAID use - CORRECT ANSWER What are nursing interventions for a patient with a musculoskeletal injury with a nursing DX of acute pain? teach correct use of crutches, walkers, canes, or slings encourage follow-up care - CORRECT ANSWER What are nursing interventions for a patient with a musculoskeletal injury with a nursing DX of impaired physical mobility? wide range of motion, complexity, and exposed position - CORRECT ANSWER Why is the shoulder joint vulnerable to injuries? tendinitis, bursitis, and partial and complete muscle tears - CORRECT ANSWER What are some rotator cuff disorders? pain (night/pressure), limited ROM - CORRECT ANSWER What are manifestations of rotator cuff damage ligament tears, meniscal injury, and patella dislocation (MCL, ACL, Meniscus) - CORRECT ANSWER What are some common knee injuries immediate pain, popping/tearing sensation, knee giving out, swelling - CORRECT ANSWER what are some manifestations of knee injures dislocation - CORRECT ANSWER injury in which the ends of bones are displaced out of their normal position and joint articulation is lost subluxation - CORRECT ANSWER partial dislocation in which the bones of the joint remain in partial contact pain, deformity, limited motion of affected joint - CORRECT ANSWER what are some manifestations of a joint dislocation? fall, blow (Pathologic conditions) infection, RA, paralysis and neuromuscular disease - CORRECT ANSWER what are some causes of joint dislocation X-ray/MRI, reduce/realign, R.I.C.E., NSAIDS, moist heat, physical therapy, surgery - CORRECT ANSWER What are treatment options for joint trauma Monitor neurovascular status by assessing the 5 Ps (pain, pulses, pallor, paralysis, and paresthesia. maintain immobilization as ordered after reduction. - CORRECT ANSWER What are some nursing interventions for a patient with joint trauma with a nursing DX of Risk for Peripheral Neurovascular Dysfunction carpal tunnel syndrome - CORRECT ANSWER Compression of the median nerve as a result of inflammation and swelling of the synovial lining of the tendon sheaths numbness and tingling of the thumb, index finger, and lateral ventral surface of the middle finger. pain that interfere with sleep affected hand may become weak and unable to hold utensils or perform actives that require precission - CORRECT ANSWER What are some manifestations of carpal tunnel syndrome bursitis - CORRECT ANSWER Inflammation of the bursa shoulder, knee, hip, and elbow - CORRECT ANSWER What are common sites of bursar inflammation hot, red, edematous, pain with flexion and extension - CORRECT ANSWER what are some manifestations of bursitis epicondylitis - CORRECT ANSWER inflammation of tendon at point of origin into humerus point tenderness, pain radiating down the dorsal surface of the forearm, and a history of receptive use - CORRECT ANSWER what are some manifestations of epicondylitis fracture - CORRECT ANSWER break in continuity of the bone deformity, swelling, pain/tenderness, numbs, guarding, crepitus, hypovolemic shock, muscle spasms, and ecchymosis - CORRECT ANSWER what are some manifestations of fractures local: immobilization, timely correction, ice/electrical stimulus systemic: adequate growth hormone, blood supply, no infection/disease, younger in age, activity prior to fracture - CORRECT ANSWER What are positive factors influencing bone healing local: delayed correction, open fracture, foreign body at fracture site systemic: immunocompromised, decreased circulation, malnutrition, osteoporosis, older in age - CORRECT ANSWER what are negative factors influencing bone healing compartment syndrome - CORRECT ANSWER occurs when increased pressure within this confined space constricts the structures within it, compromising circulation and tissue function early: pain, normal or decreased peripheral pulse later: cyanosis, tingling, loss of sensation (paresthesias), weakness (paresis), diminished reflexes, severe pain, renal failure - CORRECT ANSWER What are manifestations of compartment syndrome within the first 48 hours of injury, when edema is at its peak - CORRECT ANSWER when does compartment syndrome usually develop interventions to alleviate pressure, removal of the cast/restrictive dressing, Fasciotomy (surgery) - CORRECT ANSWER treatment of compartment syndrome fat embolism syndrome - CORRECT ANSWER Rare complication characterized by neurologic dysfunction, pulmonary insufficiency and a petechial rash on the chest, axilla, and upper arms dyspnea, tacypnea, hypoxia, confusion, restlessness - CORRECT ANSWER what are manifestations of fat embolism syndrome early stabilization/surgical, prompt identification of S&S, intubation/mechanical ventilation, corticosteroids - CORRECT ANSWER treatment of fat embolism deep venous thrombosis (DVT) - CORRECT ANSWER condition in which a blood clot forms along the intimal lining of a large vein, accompanied by inflammation of the vein wall red, swelling, tenderness, local pain, or no S&S, tacypnea - CORRECT ANSWER what are manifestations of DVT prevention: early immobilization/ ambulation, stockings, anti-coagulation. Treatment: anticoagulation/ support respiratory system - CORRECT ANSWER treatment of DVT traction, casts, surgery, electrical bone stimulation - CORRECT ANSWER what are treatments for fractures amputation - CORRECT ANSWER partial or total removal of an extremity peripheral vascular disease (major cause), infection, trauma, - CORRECT ANSWER causes of amputation infection, delayed healing, chronic stump pain, phantom pain, contracture - CORRECT ANSWER complications of amputation contracture - CORRECT ANSWER abnormal flexion and fixation of a joint caused by muscle atrophy and shortening.. [Show Less]
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ONC Pediatric/Congenital/Neuromuscular Conditions/Operative Orthopedics Practice Exam,100% CORRECT
ONC Pediatric/Congenital/Neuromuscular Conditions/Operative Orthopedics Practice Exam A surgical nurse is reviewing types of orthopaedic hardware wit... [Show More] h a nursing student. Which of the following screws should the nurse identify as using a guide wire for both drilling and screw insertion while maintaining proper bone position? a. Cancellous screw b. Cannulated screw c. Compression screw d. Cortical screw - CORRECT ANSWER b. Cannulated screw Rationale: A cannulated screw is the only one in this list with a hole that allows the screw to be inserted over a guide wire. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 111 A surgical nurse is preparing a patient for shoulder surgery. The nurse should identify which of the following as the appropriate position for this patient during the procedure? a. Prone b. Beach chair c. Lithotomy d. Jackknife - CORRECT ANSWER b. Beach chair Rationale: Beach chair and lateral are the two positions commonly used for shoulder surgery. Prone is for back surgery, lithotomy for obstetric/gynecologic procedures, and jackknife for rectal surgeries. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, pp. 45, 163 A surgical nurse is reviewing risk factors for surgical site infection (SSI) with orienting nurses. Which of the following should the nurse identify as a predisposing factor for SSI? a. Dose of cefazolin (Ancef®) 15 minutes before skin incision b. Total surgery time less than 2 hours c. Patient history of type 2 diabetes controlled by diet d. Patient fracture requiring external fixation - CORRECT ANSWER d. Patient fracture requiring external fixation Rationale: A fracture that requires external fixation can increase a patient's risk for developing SSI. All the other options assist in reducing the chance of developing an SSI. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, pp. 75-76 A surgical nurse is preparing for an orthopaedic procedure that will involve grafting. Which of the following graft materials should the nurse identify as harvested from one individual and implanted into another individual of the same species? a. Allograft b. Autograft c. Xerograft d. Xenograft - CORRECT ANSWER a. Allograft Rationale: Allograft is harvested from one person and implanted into another person. Autograft comes from the same person, and xenograft is from a different species. Xerograft does not exist. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 92 A surgical nurse is circulating during performance of cemented total hip arthroplasty. Which of the following should the nurse identify as the most frequently occurring patient reaction to the use of polymethylmethacrylate (PMMA) cement during this procedure? a. Hemorrhage b. Hematoma c. Transitory increase in pain d. Transitory decrease in blood pressure - CORRECT ANSWER d. Transitory decrease in blood pressure Rationale: A transitory decrease in blood pressure is the most common patient reaction to use of PMMA cement. Other options occur infrequently. In particular, the transitory increase in pain may result from heat released during cement polymerization; however, it is not common. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 23 To avoid brachial plexus injury during upper extremity surgery, the surgical nurse should position the patient's arm in which of the following? a. Abduction of arm at less than 90 degrees b. Adduction of arm at more than 90 degrees c. Palms facing downward when arm is out on arm board d. Palms facing upward when arm tucked at side - CORRECT ANSWER a. Abduction of arm at less than 90 degrees Rationale: Upper extremity neuropathies arise from injury to the brachial plexus. To prevent injury to the brachial plexus, the surgical team must ensure the arm board is level with the OR bed. When an arm is placed on the arm board, it must not extend beyond a 90-degree angle to the body. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 127 The surgical nurse is preparing a patient for correction of a scoliotic deformity. The nurse should know the __________ approach is used to perform this procedure. a. Lateral b. Anterior c. Posterior d. Thoracic - CORRECT ANSWER c. Posterior Rationale: The classical surgical approach is posterior. Other positions are not indicated for deformity correction. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 452 As part of the orientation of a new nurse to the OR, the surgical nurse is reviewing the correct sequence of events for insertion of screws during internal fixation. The surgical nurse should correctly identify which of the following? a. Drill, measure, screw, tap b. Measure, drill, tap, screw c. Drill, measure, tap, screw d. Measure, tap, drill, screw - CORRECT ANSWER c. Drill, measure, tap, screw\ Rationale: A gliding hole is drilled and the size of the drill bit corresponds to the appropriately sized screw. A bone tap is inserted to push the screw past the far cortex, and then the final twisting of the screw buries the head so it is better seated in the far cortex and so the head does not protrude. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 111 A patient is scheduled for open rotator cuff repair. The surgical nurse should know this procedure would be performing using which of the following surgical approaches? a. Anteromedial b. Anterosuperior c. Lateral d. Posterior - CORRECT ANSWER b. Anterosuperior Rationale: Anterosuperior rotator cuff tears usually have a biceps tendon disorder. An open repair is needed to perform a biceps tenodesis which has been shown to provide better outcomes with better pain relief and shoulder function. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 165 The surgical nurse is assisting in internal fixation of a mid-shaft femoral fracture. The nurse should identify which of the following intramedullary nails as least stable? a. Reamed medullary nail b. Unreamed medullary nail c. Unreamed hollow medullary nail d. Flexible medullary nail - CORRECT ANSWER a. Reamed medullary nail Rationale: Reaming will cause the nail to enter into the canal eccentrically, which may lead to the distal fracture fragment being either too medial or too lateral. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 116 A surgeon asks for a periosteal elevator to visualize a fractured bone. The nurse should identify which of the following instruments for this purpose? a. Babcock b. Meyerding c. Verbrugge d. Cobb - CORRECT ANSWER d. Cobb Rationale: The Cobb is a chisel-like instrument that is designed to lift, or elevate, the periosteum from the bone. A Babcock is a grasping instrument made to grasp soft tissue or bowel. A Meyerding is a type of retractor used in spine surgeries, and a Verbrugge is a bone-holding forcep. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 59 Which of the following should demonstrate the surgical nurse's understanding of tourniquet safety during performance of a total knee arthroplasty? a. The surgeon should be notified of tourniquet time at 120 minutes. b. The tourniquet is inflated with limb in dependent position. c. The tourniquet is inflated to 300-350 mm Hg. d. The surgeon should not need to exsanguinate the lower limb. - CORRECT ANSWER c. The tourniquet is inflated to 300-350 mm Hg. Rationale: The tourniquet is inflated to 300-350 mm Hg for use on the thigh. The surgeon needs to be notified at regular, established intervals of the duration of the tourniquet time; general agreement indicates the tourniquet should not be inflated longer than 90 minutes for a lower extremity procedure. The limb must be elevated and exsanguinated for this procedure. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 130 In assisting with a lower extremity surgery, the surgical nurse should be aware that which of the following nerves can be compressed during surgery because of its superficial position at the lateral aspect of the fibular head? a. Pudendal b. Peroneal c. Tibial d. Sural - CORRECT ANSWER b. Peroneal Rationale: The common peroneal nerve arises from the sciatic nerve; it travels around the fibular neck and laterally around the fibular head. Most peroneal nerve injuries come from compression in this prominent region of the lateral ankle. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 128 The surgical nurse is preparing a patient to receive a Bier block before a procedure. The nurse should recognize this type of anesthesia as most appropriate for which of the following? a. Plantar fascia release b. Hammer toe release c. Bunionectomy d. Carpal tunnel release - CORRECT ANSWER d. Carpal tunnel release Rationale: The Bier block is used primarily for upper extremity surgery. This includes procedures such as carpal tunnel release and Depuytren contracture release. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 125 The parents of a child with cerebral palsy tell the nurse their son appears to have chronic pain secondary to muscle spasms. Which of the following interventions should the nurse recognize as the best initial intervention for managing the child's pain? a. Administer oral muscle relaxants b. Administer oral opioids c. Immobilize the affected extremity d. Reduce changes in position - CORRECT ANSWER a. Administer oral muscle relaxants Rationale: The source of pain is from the muscle spasms and contractions. Opioids often are not effective for this type of pain. Immobilization or reduced changes in position may not prevent muscular irritation and spasms. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 278 Parents bring their 2-year-old child with cerebral palsy (CP) to the pediatrician's office for follow up. Identified symptoms include poor muscle tone of all extremities and inability to sit upright, as well as uncontrolled movements throughout the body. The nurse should recognize these symptoms as consistent with which type of CP? a. Ataxic b. Athetoid c. Spastic d. Mixed - CORRECT ANSWER b. Athetoid Rationale: Athetoid CP (also known as dyskinetic or dystonic CP) is marked by motor restlessness and postural instability. The involuntary, uncontrollable movements are not typical of the other types of CP. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 273 The doctor has documented problems with reciprocal motion in the medical record of a child with Duchenne's muscular dystrophy. When the child's mother asks about this descriptor, the nurse should indicate lack of reciprocal motion reflects the child's a. difficulty running or climbing stairs. b. proximal muscle weakness. c. frequent tripping and falling. d. inability to perform fine motor activities. - CORRECT ANSWER a. difficulty running or climbing stairs. Rationale: Running or climbing stairs requires the child to use one limb, then the other (reciprocal motion) ; this is frequently difficult for a child with Duchenne's muscular dystrophy. Frequent falling or tripping can occur, but the child will describe this as the feet "being swept away" from under the child, a phenomenon not involving reciprocal movement. Proximal weakness and inability to perform fine motor activities are unrelated to this symptom. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 283-284 The nurse is caring for an infant born with myelomeningocele at the sacral level. What motor/sensory function should the nurse expect in this infant? a. No motion in legs b. Weak knee flexion c. Mild weakness of ankles and toes d. Sensation in the anterior thigh - CORRECT ANSWER c. Mild weakness of ankles and toes Rationale: Mild weakness of the ankles and toes is associated with effects on the sacral level. Thoracic effects include no motion in the legs. Mid to lower lumbar effects (L3-L5) include weak knee flexion and sensation to below the knee. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 296 Parents bring their child with Duchenne's muscular dystrophy into the clinic for regular follow up. The nurse should know that the child's abnormal gait is due to muscle weakness in the a. ankle b. thighs. c. tibialis anterior. d. hip girdle. - CORRECT ANSWER d. hip girdle. Rationale: In a child who is ambulatory, observation of walking will reveal an abnormal gait due to weakness of the hip girdle muscles. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 284, table 11.4 A patient newly diagnosed with multiple sclerosis is discussing lifestyle changes with the nurse. Which of the following statements by the patient should indicate to the nurse that more education is needed? a. "I should go to bed and get up at the same time every day." b. "I should limit my intake of Omega-3 fatty acids to avoid exacerbations." c. "Exercise in water may help me move in ways I cannot move on land." d. "I might experience worsening of symptoms in humid weather." - CORRECT ANSWER b. "I should limit my intake of Omega-3 fatty acids to avoid exacerbations." Rationale: There is some evidence that a diet low in saturated fats and supplemented by Ometa-3 (from fatty fishes, cod-liver oil, or flaxseed oil) and Omega-6 (fatty acids from sunflower or safflower seed oil and possibly evening primrose oil) may have some benefit for people with MS; thus there is no reason to limit intake of Omega-3 fatty acids. As part of good sleep hygiene, experts recommend patients with MS go to bed and get up at the same time every day (and no more than 1 hour later on weekends). Water exercise may be especially beneficial to people with MS. Persons with MS can experience a temporary worsening of symptoms in hot, humid weather. Reference: National Multiple Sclerosis Society. (n.d.). The Omega-3 Factor. Retrieved from https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Diet-Nutrition/Omega-3 A patient's husband brings her to the clinic for evaluation. He tells the nurse he is afraid his wife has Parkinson's disease. Which of the following, if described by the patient's husband, should the nurse recognize as suggestive of Parkinson's disease? a. Use of a loud voice b. Diarrhea c. Narcolepsy d. Angry facial expression - CORRECT ANSWER d. Angry facial expression Rationale: Facial masking is often described as a serious, depressed, or mad look on the face; although it can also be caused by some medications, it is common in patients with PD. A patient with suspected PD may experience constipation and trouble sleeping, and speak in a low or hoarse voice. Reference: Parkinson's Foundation. (n.d.). 10 Early Signs of Parkinson's Disease. Retrieved from https://www.parkinson.org/understanding-parkinsons/10-early-warning-signs A child recently diagnosed with juvenile myasthenia gravis is prescribed pyridostigmine (Mestinon®). In discussing possible medication side effects with the child's parents, the nurse should include which of the following? a. Headache b. Weight gain c. Diarrhea d. Mood changes - CORRECT ANSWER c. Diarrhea Rationale: Pryidostigmine tends to be a well-tolerated oral medication. However, it can have side effects such as abdominal cramps, diarrhea and, in very rare instances, worsening weakness. Mood changes and weight gain are likely to be associated with use of corticosteroids, while headache may result from treatment with intravenous immunoglobulin (IV Ig). Reference: Myasthenia Gravis Foundation of America. (n.d.). For Parents. Retrieved from https://myasthenia.org/Living-Your-Best-Life-With-MG/For-Parents A patient comes to the office with complaints of unaccustomed fatigue, new muscle weakness, joint pain, and increased difficulty tolerating cold temperatures. As part of his history, the nurse learns the patient migrated from Nigeria last year. Which of the following conditions should the nurse suspect is affecting this patient? a. Multiple sclerosis b. Muscular dystrophy c. Post-polio syndrome d. Parkinson's disease - CORRECT ANSWER c. Post-polio syndrome Rationale: There are long-term physical consequences to having had poliomyelitis. New symptoms recognized by the medical community that may relate to prior polio include unaccustomed fatigue - either rapid muscle tiring or feeling of total body exhaustion; new weakness in muscles, both those originally affected and those seemingly unaffected; pain in muscles and/or joints; sleeping problems; breathing or swallowing problems; and/or decreased ability to tolerate cold temperatures. In addition, only Afghanistan, Pakistan, and Nigeria have never stopped transmission of polio. Reference: Post-Polio Health International. (n.d.). Remember Polio? Retrieved from http://www.post-polio.org/edu/pabout.html Additional source: World Health Organization. (2018). Does Polio Still Exist? Is It Curable? Retrieved from https://www.who.int/features/qa/07/en/ A 12-year-old boy is being seen for routine follow up after previous diagnosis with Becker muscular dystrophy. The nurse is discussing disease management with the boy's mother. Which of the following statements by the mother should the nurse recognize as indicating a need for additional education? a. "I will apply his orthotics at night to keep the Achilles tendons stretched." b. "I will provide a high-protein, low-carbohydrate diet for muscle development." c. "I will tell the anesthesiologist that he has MD to avoid complications." d. "I will take my son for a cardiac evaluation before starting exercise." - CORRECT ANSWER b. "I will provide a high-protein, low-carbohydrate diet for muscle development." Rationale: A combination of immobility and weak abdominal muscles can lead to severe constipation, so the diet should be high in fluid and fiber, with fresh fruits and vegetables dominant. Orthotics can support the ankle and foot, or extend over the knee. They can be applied at night to keep feet from pointing downward and keep the Achilles tendons stretched. Because people with MD may have adverse reactions to some types of anesthesia, it's important to let the surgical team know the patient has MD. Because of the risk of cardiac involvement in MD, the affected child should have a cardiac evaluation before starting exercise. Reference: Muscular Dystrophy Association. (n.d.). Becker Muscular Dystrophy: Medical Management. Retrieved from https://www.mda.org/disease/becker-muscular-dystrophy/medical-management In reviewing the child's medical record, the nurse notes hemiplegia is the specific diagnosis for a child with cerebral palsy. Which of the following should the nurse expect to identify in this patient? a. Ambulation in normal time b. Tongue thrusting c. Hearing loss d. Minimally affected speech - CORRECT ANSWER a. Ambulation in normal time Rationale: The child with hemiplegia is able to ambulate within normal time. Minimally affected speech is typical of a child with spastic diplegia. Options b and c are associated with dyskinetic cerebral palsy. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 274, table 11.2 A nurse is presenting information about Parkinson's disease for staff in a long-term care center. The nurse should identify a lack of which of the following as the cause of most symptoms of PD? a. Dopamine b. Serotonin c. Acetylcholine d. Glutamate - CORRECT ANSWER a. Dopamine Rationale: Most symptoms of PD are caused by a lack of dopamine in the brain. Many drugs used for treatment of PD either try to replenish dopamine or mimic its effects. Reference: Parkinson's Foundation. (n.d.). Prescription Medications. Retrieved from https://www.parkinson.org/Understanding-Parkinsons/Treatment/Prescription-Medications A patient with multiple sclerosis tells the nurse she has read that MS can affect her cognitive abilities. The nurse should suggest activities such as board games and handiwork to enhance the patient's cognitive a. dissonance. b. distortion. c. load. d. reserve. - CORRECT ANSWER d. reserve. Rationale: The concept of cognitive reserve helps to explain why individuals with the same degree of brain changes due to aging or a neurological disease like MS may have very different cognitive function. Research has shown a lifetime of intellectual enrichment from education as well as stimulating work and leisure activities helps to lessen or slow the impact of disease- or aging-related changes in the brain. Reference: National Multiple Sclerosis Society. (n.d.). Cognitive Health. Retrieved from https://www.nationalmssociety.org/Living-Well-With-MS/Cognitive-Health The nurse's care of a patient with early amyotrophic lateral sclerosis (ALS) would be guided by the knowledge that which of the following can occur as a result of the disease? a. Hearing loss b. Urinary urgency c. Visual disturbances d. Episodic diarrhea - CORRECT ANSWER b. Urinary urgency Rationale: The patient with ALS can experience urinary urgency and will need bathroom assistance. Hearing and vision generally remain normal. The patient may experience abdominal bloating and constipation. Reference: Muscular Dystrophy Association. (n.d.). Amyotrophic Lateral Sclerosis: Signs and Symptoms. Retrieved from https://www.mda.org/disease/amyotrophic-lateral-sclerosis/signs-and-symptoms The treatment of a child's femoral shaft fracture involves application of a hip spica cast. The nurse should instruct the caregivers to monitor for which of the following? a. Heel pressure b. Cast slippage c. Cast softening d. Skin breakdown - CORRECT ANSWER d. Skin breakdown Rationale: Skin breakdown is a significant risk with application of a spica cast. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 296 The nurse is reviewing pediatric orthopaedic problems with a class of nursing students. Which of the following should the nurse identify as the site of the most common upper extremity fracture in children? a. Clavicle b. Humerus c. Scapula d. Ulna - CORRECT ANSWER a. Clavicle Rationale: Clavicle (collarbone) fractures are extremely common in children. Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 28 When discussing the occurrence of slipped capital femoral epiphysis (SCFE) with the parents of a child newly diagnosed with the disorder, the nurse should explain that SCFE a. is more common in girls than boys. b. often occurs suddenly related to sports injury. c. is more common in toddlers and pre-schoolers. d. occurs commonly in adolescents and pre-adolescents. - CORRECT ANSWER d. occurs commonly in adolescents and pre-adolescents. Rationale: SCFE is the most common disorder of the hip in adolescents. Age range for boys is 10-17 years, with a peak incidence at ages 13-14. Age range for girls is 8-15 years, with a peak incidence at age 11. It occurs two to three times more often in boys than in girls. This condition most likely occurs after a failed stress fracture experienced earlier in life. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 313-314 The nurse regularly sees a child with oligoarthritis. In addition to care from a rheumatologist, the nurse should ensure the child's parents understand the need to follow up regularly with which specialist? a. Cardiologist b. Neurologist c. Ophthalmologist d. Dermatologist - CORRECT ANSWER c. Ophthalmologist Rationale: Eye involvement is a common occurrence in children with oligoarthritis, a form of juvenile idiopathic arthritis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 336 In an attempt to treat Legg-Calve-Perthes disease, the surgeon plans to place the affected child in an abduction orthosis. The nurse should confirm with the child's parents that the purpose of this treatment is to a. limit weight bearing. b. maintain the femoral head in internal rotation. c. reposition the femoral head in the acetabulum. d. release the adductor muscles. - CORRECT ANSWER b. maintain the femoral head in internal rotation. Rationale: An abduction orthosis will maintain the femoral head in an abducted, internally rotated position. Weight bearing is allowed in the orthosis. Surgery, rather than an orthosis, would be needed to reposition the femoral head (varus osteotomy of the femur) or release the adductors. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 290 In discussing developmental dysplasia of the hip (DDH) with the caregivers of an affected child, the nurse should identify which of the following as a potential complication of this disorder? a. Growth disturbance of the distal femur b. Avascular necrosis of the distal femur c. Valgus deformity of the ipsilateral knee d. Varus deformity of the ipsilateral knee - CORRECT ANSWER c. Valgus deformity of the ipsilateral knee Rationale: DDH has been found to have a higher incidence of medial compartment narrowing of the knee which results in a valgus deformity. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 281 The nurse is caring for a 12 year old with slipped capital femoral epiphysis (SCFE). Parents ask about activity restrictions after surgery. The nurse should tell the parents that after surgery the child will be a. able to walk with no assistive device immediately. b. in a long-leg brace for a month. c. using crutches for ambulation initially. d. able to play soccer in several weeks. - CORRECT ANSWER c. using crutches for ambulation initially. Rationale: A long-leg brace is not necessary, but activities such as unassisted weight bearing and soccer are not appropriate for the immediate recovery phase. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 316 The nurse is counseling the parents of a child who has been diagnosed with osteogenesis imperfecta. As they discuss ways to help the child attain independent mobility, the nurse should recommend which of the following? a. Thick casting for stability b. Gentle daily exercise to extremities c. Early participation in organized sports d. Avoidance of early weight bearing - CORRECT ANSWER b. Gentle daily exercise to extremities Rationale: Limiting weight bearing and casting will not aid in strong bone formation. Gentle exercises will keep the extremities functional and are unlikely to lead to fractures. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 307 The nurse provides information for the parent of a 10 year old with Blount's disease (tibia vara). Which of the following should the nurse include in the discussion of conservative management of this disorder? a. Restrict participation in usual activities. b. Follow-up x-rays are needed every 6 months. c. A brace may be worn during the day and removed at night. d. Manage the child's weight because obesity is a factor. - CORRECT ANSWER d. Manage the child's weight because obesity is a factor. Rationale: Participation in normal activities should not be discouraged for the child with BD. Follow-up x-rays should be done every 3 months, and the brace is to be worn full time. Inactivity can lead to weight gain, and obesity can be a factor in development of BD. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 270-271 The nurse is providing a class on childhood injuries for the staff at a local daycare center. Which of the following should the nurse identify as the joint most commonly affected by dislocation in children ages 2-5? a. Hip b. Knee c. Ankle d. Elbow - CORRECT ANSWER d. Elbow Rationale: Dislocation of the elbow often results from swinging activities that have the weight of the child pulling on the arm and elbow joint. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 517-518 A newborn diagnosed with clubfoot is scheduled to begin surgical treatment. Which of the following should the nurse stress with the parents? a. Performance of cast care b. Application of Bryant's traction c. Application of orthotics d. Careful handling of the infant - CORRECT ANSWER a. Performance of cast care Rationale: Because clubfoot treatment typically involves frequent cast applications, nursing interventions should focus on teaching patients cast care and signs of skin issues. Bryant's traction is sometimes used for treatment of developmental dysplasia of the hip. Orthotics may be used in treatment of myelomeningocele. Careful handling is particularly stressed for the child with osteogenesis imperfecta. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 280 A mother is troubled by the deformity in her infant's right foot and questions the treatment plan after diagnosis of metatarsus adductus. The nurse should explain likely treatment with a. passive hamstring stretching. b. serial casting. c. external fixation. d. tendon release. - CORRECT ANSWER b. serial casting. Rationale: Metatarsus adductus is managed by serial casting or bracing. The deformity yields more quickly when the cast is extended above the flexed knee, and the infant is also less likely to kick it off. Hamstring stretching is part of treatment for Osgood-Schlatter disease. Tendon release may be considered for painful contractures in a patient with muscular dystrophy. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 294 Developmental dysplasia of the hip (DDH) is suspected in an ambulatory 20-month-old child. If described by the child's mother, which of the following should the nurse associate with likely DDH? a. Scissoring of the legs b. Leg kicking in unison c. Toe walking d. Foot stiffness - CORRECT ANSWER c. Toe walking Rationale: In an ambulatory child, toe walking, limping, or pain may be apparent and suggests DDH. Options a and b are associated with cerebral palsy, and option d may be noted in clubfoot. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 281 A 3 month old has been placed in a Pavlik harness. In response to the parent's question about the length of time for this treatment, the nurse should indicate which of the following? a. 2-4 weeks b. 6-12 weeks c. 4-6 months d. 8-12 months - CORRECT ANSWER b. 6-12 weeks Rationale: This infant is being treated for developmental dysplasia of the hip. The Pavlik harness should be worn full-time by the infant for 6-12 weeks after achieving hip stability. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 282 A 12-year-old boy has been diagnosed with Osgood-Schlatter disease. In answering the parents' questions about the cause of this condition, the nurse should identify which of the following? a. Autosomal-dominant gene defect b. Repeated pathologic fractures c. Fibrous alterations in muscles d. Rapid pre-pubertal growth - CORRECT ANSWER d. Rapid pre-pubertal growth Rationale: Rapid growth and increased physical activity predispose the early adolescent to the development of Osgood-Schlatter disease. An autosomal-dominant gene defect is the cause of most cases of osteogenesis imperfecta. Repeated bouts of infarction and subsequent pathologic fractures account for the development of Legg-Calve-Perthes disease. Fibrous, fatty alterations in the muscles are associated with arthrogryposis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 302 The mother of a child with juvenile idiopathic arthritis is discussing strategies for the child's success in school with the nurse. Which of the following statements by the mother should indicate to the nurse that additional teaching is needed? a. "I will buy high-quality running shoes to decrease my child's ankle pain." b. "I will work with my child's teacher to ensure enough travel time between classes." c. "I will get a large backpack so my child can carry books between school and home." d. "I will allow my child to use the home computer to complete long reports." - CORRECT ANSWER c. "I will get a large backpack so my child can carry books between school and home." Rationale: A child with JIA should have two sets of books so he or she does not have to carry them between school and home. Other options represent good support strategies by the mother. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 339 A 12-year-old child has been diagnosed with a scoliotic curve of 15 degrees. The nurse should confirm which of the following with the child's parents as part of the plan of care for this patient? a. Observe regularly for progression. b. Fabricate a brace for nighttime use. c. Add counterweights to halo traction. d. Schedule posterior spinal fusion. - CORRECT ANSWER a. Observe regularly for progression. Rationale: Most curves less than 15-20 degrees are observed for progression at 6-month intervals during peak growth and annually otherwise; they are unlikely to progress further. Other options are appropriate for greater curves. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 451 The nurse is providing a class on signs of physical abuse for the staff at a local daycare center. Which of the following should the nurse identify as most likely to receive fractures of the hands or feet as a result of physical abuse? a. 8 year old b. 6 year old c. 4 year old d. 2 year old - CORRECT ANSWER d. 2 year old Rationale: Fractures of the hands or feet in infants and young toddlers commonly result from physical abuse. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 311, Table 11.9 Parents bring their 6-year-old child to the clinic for evaluation of pain localized to the groin and the medial aspect of the thigh. They tell the nurse the child's pain has continued for several months and has been aggravated by activity. The nurse observes the child has an antalgic limp. Which of the following should the nurse expect as the diagnosis? a. Blount's disease b. Legg-Calve-Perthes disease c. Achondroplasia d. Neurofibromatosis - CORRECT ANSWER b. Legg-Calve-Perthes disease Rationale: A child with Legg-Calve-Perthes disease may present with mild pain localized to the groin or medial aspect of the thigh or knee. The child often has had pain and a limp for several months before being seen by a healthcare provider. Blount's disease involves a pathologic bowing of the legs; it is considered a growth disorder involving the proximal tibial growth plate. Achondroplasia is also a disorder of the growth and remodeling of bone and cartilage. The identified symptoms are not typical of neurofibromatosis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 289 The nurse is discussing bracing with the parents of a child with scoliosis. The nurse should tell the parents that a new brace needs to be fabricated for a growing child every a. 2-4 months b. 6 months c. 10 months d. 12-18 months - CORRECT ANSWER d. 12-18 months Rationale: As the child grows, a new brace needs to be fabricated every 12-18 months. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 451 When bracing is prescribed for a child with Blount's disease, the child's caregivers ask the nurse the purpose of this treatment. Which of the following should the nurse identify? a. Provide medial stability for the knee joint b. Internally rotate the leg c. Relieve stress on the medial tibial metaphysis d. Counteract lateral compressive forces - CORRECT ANSWER c. Relieve stress on the medial tibial metaphysis Rationale: Bracing is an option to relieve excessive stress on the medial tibial metaphysis, to provide lateral stability to the knee joint, and to externally rotate the leg. A locked brace counteracts the pathologic medial compressive forces, allowing resumption of normal growth and correction of deformity. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 271 A child with suspected Osgood-Schlatter disease complains of pain when bicycling. Which of the following sites for the child's pain should the nurse identify as supporting this diagnosis? a. Lateral malleolus b. Tibial tubercle c. Greater trochanter d. Achilles tendon - CORRECT ANSWER b. Tibial tubercle Rationale: Patients with Osgood-Schlatter disease commonly complain of pain over the tibial tubercle, which increases with activities such as running or bicycle riding. Pain in the other sites is not consistent with Osgood-Schlatter disease. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 302 [Show Less]
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ORTHOPEDIC NURSING 3 Exam 50 Questions with Verified Answers,100% CORRECT
ORTHOPEDIC NURSING 3 Exam 50 Questions with Verified Answers There is also abnormal formation of the hip joint in which the ball at the top of the thigh... [Show More] one (the femoral head) is not stable within the socket (the acetabulum) and sublaxation is incomplete contract between the articular of the femoral head and acetabulum in babies or young children - CORRECT ANSWER CHD Is usually caused by an injury to the brain during pregnancy, around the time of birth, or shortly after. It can also have a variety of conditions such as motor and postural abnormalities that are noted during early development - CORRECT ANSWER Cerebral palsy An inherited connective tissue diorder which include an extremely tall, slender build, a narrow face, loose joints, and spinal or chest wall abnormalities and can harm many different body systems, including your heart and blood vessels, eyes, skin, and skeleton. In some cases, the damage may be relatively mild, but in others, it can be severe - CORRECT ANSWER Marfan syndrome Congenital deformity of the foot, the most common form is talipes equinovares in which the foot is fixed in an abducted and inverted position with plantar flexion - CORRECT ANSWER Clubfoot (+) test indicate that the hip is unstable with increased risk of dislocation. This maneuver is performed by abducting the hip while pushing the thih posteriorly. If the hip goes out of the socket it is called dislocable and the test is termed "positive" - CORRECT ANSWER Barlow's sign (+) sign refers to the feeling of the femoral head slipping forward into the acetabulum when forward pressure is exerted from behind the greater tronchanter and the knee is held laterally. The sign indiciate dislocation - CORRECT ANSWER Ortalani's sign Laminectomy is a surgical procedure which involves - CORRECT ANSWER Removal of parts of one or more vertebrae What kind of cast is best known for coxa plana in which long leg cast to both lower extremities is best applied - CORRECT ANSWER Spica cast A prolonged muscle contraction in which the neck muscles, particularly the sternocleidomastoid muscle, contract involuntarily causing the head to turn. It can be genetic (inherited), or be acquired secondary to damage to the nervous system or muscles - CORRECT ANSWER Torticollis A method that delivers excellent correction of clubfoot without the associated risks and complications of major foot surgery - CORRECT ANSWER Ponsetti method In clubfoot, before the application of the final cast, the physician usually performs a non-invasive surgery, where there is an Achilles tendon lengthening. The incision is so small that no stictching is required - CORRECT ANSWER Tenotomy A kind of fracture which represent the distal radius w/ dorsal and radial angulation and backward displacement and does not extend on joint space associate w/ ulnar styloid - CORRECT ANSWER Colle's fracture A kind of fracture in which the location is in the humerus bone, elbow or upper arm. Where the dunlop traction is applied to facilitate alignment - CORRECT ANSWER Supracondylar fracture Sometime called infantile paralysis, is an acute viral infectious disease spread from person to person, primarily via the fecal-oral route. Is caused by infection with a member of the genus enterovirus known as poliovirus - CORRECT ANSWER Poliomyelitis The most common type of arthritis and a progressive loss of joint cartilage. Which commonly affects the hands, feet, spine, hips, and knees. Also known as the wear-tear biological tagging theory - CORRECT ANSWER BONUS A bone condition which affects the blood vessels. This causes an increase in blood supply to the area, and as a resul may feel warmer than usual. - CORRECT ANSWER Coxa plana A slipped disk along the spinal cord. The condition occurs when all or part of the soft center of a spinal disk is forced through a weakened part of the disk - CORRECT ANSWER Kyphosis The act of pulling and drawing which is associated with the counter traction - CORRECT ANSWER Traction Is a break in the continuity of a bone, separating it into two or more parts, which is reffered to as fragments - CORRECT ANSWER Fracture A type of fracture in which one side of a bone is broken and the other side is bent - CORRECT ANSWER Greenstick A type of brace which is indicated for clubfoot - CORRECT ANSWER Dennis brown A type of hardware that is indicated for fracture of the patella - CORRECT ANSWER Tension bond wiring A type of cast that is indicated for fracture of shaft of the humerus - CORRECT ANSWER Functional cast The most common malignant bone tumor is - CORRECT ANSWER Osteogenic osteosarcoma Mother juan asks the nurse when the cast will be removed. The nurse responds: - CORRECT ANSWER Removed in weekly basis, usally within 6 weeks A 3 month old infant who has severe torticollis presents with the head rotated to the left and the side bent to the right. Which of the following muscle is shortened - CORRECT ANSWER Right middle trazpezius Pre op explanation for scoliosis and post op after surgery explained. Until a cast or brace is applied, she will be positioned - CORRECT ANSWER Sitting upright To prevent edema on the site of sprain, the nurse should do which of the following - CORRECT ANSWER Apply cold compress for 72 hours A fracture is suspected when the nurse observes the following except - CORRECT ANSWER Increase in the length of the limb Nursing responsibility after lumbar laminectomy - CORRECT ANSWER Use logrolling technique Indications that client with frature of the leg and experiencing compartment syndrome - CORRECT ANSWER Increased pressure on the limited space Carpel tunnel syndrome occurs due to the injury of which of the following nerve - CORRECT ANSWER Median nerve A 2 year old has a fracture on the left femur. He is placed in Bryant's traction and the reason for elevations of both of his legs is - CORRECT ANSWER His weight is not adequate to provide sufficient countertraction, so his body must be used Patient with scoliosis attain to have a maximum effect of milwaukee brace, the nurse gives instructions except - CORRECT ANSWER Wear brace for 23 hours in a day Effective BST must be maintained, the nursing measures must be obtained except - CORRECT ANSWER Remove weight intermittently In right hip replacement for arthritis, the patient is placed in which fo the following positions after hip prosthesis - CORRECT ANSWER The right legt adducted A patient has been diagnosed to have rheumatoid arthritis; the following s/sx - CORRECT ANSWER Pain on non-use of joint nodules, elevated ESR Which of the nuring action is inappropriate when caring for the client with cast - CORRECT ANSWER Support newly casted extremity with the palm of the hand Baby james 2 years old was diagnosed to have CHD. What type of traction will apply to the patient - CORRECT ANSWER Bryant's traction One day, Mr. Suave fell from a mango tree sustained of fracture on his left wrist and finger with bleeding. What would be the management? - CORRECT ANSWER Short arm posterior mold OR nurse davis used to lift things without proper body mechanics. In your knowledge about ortho nuring. What would be the possible result of this - CORRECT ANSWER HNP In Phil Orthopedic center, patient with cervical spine fracture applied head halter traction. What would be the possible position - CORRECT ANSWER Prone position Patient Chris was diagnosed of having Buerger's disease, upon assessment you noticed the following s/sx except - CORRECT ANSWER BONUS Arnold was admitted at POC due to fracture in his left lower extremity. X-ray shows fracture at the distal third of the tibia and fibula was broken and the upper third was bent. What kind of fracture does Arnold have? - CORRECT ANSWER Greenstick One week old juan was born with a talipes equinovarus (clubfoot). For application of the cast, the nurse teaches how to keep the cast clean and dry and the importance of maintaining circulation in the leg. The nurse explains that she should - CORRECT ANSWER Blanch the big toe of the affected food and observe for a rapid return of color once each day Mother juan asks the nurse when the cast will be removed. The nurse responds - CORRECT ANSWER Removed in weekly basis, usually within 6 weeks Mother is concered about the development of his son because of the delayed moving of his legs during early infancy. The nurse reassure that the legs are not used because development proceeds from the - CORRECT ANSWER Arms to the upper trunk and the from legs to lower trunk The nurse examines a CHD neonate would indentify Galeazzi's sign when there there is - CORRECT ANSWER Shortening of the limb on the affected side CHD left gluteal fold is higher than the right leg is suspected: to confirm the diagnosis, the nurse should observe for - CORRECT ANSWER Resistance of the left le when both legs are flexed and then abducted Osteogenesis imperfecta commonly known as - CORRECT ANSWER Brittle bone [Show Less]
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Musculoskeletal Nursing Orthopedic Surgery Exam 144 Questions with Verified Answers,100% CORRECT
Musculoskeletal Nursing Orthopedic Surgery Exam 144 Questions with Verified Answers Emergency medical technicians transport a client to the emergency de... [Show More] partment and inform the nurse that the client fell from a two-story building. The comatose client has a large contusion on the left side of the chest, a hematoma in the left parietal area, and a compound fracture of the left femur. The client was intubated and is maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority? - CORRECT ANSWER assessing the left leg Lifestyle risk factors for osteoporosis include - CORRECT ANSWER lack of exposure to sunshine The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication? - CORRECT ANSWER fat embolism syndrome Which is one of the most common causes of death in clients diagnosed with fat emboli syndrome? - CORRECT ANSWER acute respiratory distress syndrome The health care provider is preparing to bivalve the client's cast. Which supplies should the nurse assemble? - CORRECT ANSWER elastic compression bandages The nurse is providing instructions to the client following application of a fiberglass cast. Which statement by the client indicates further education is needed? - CORRECT ANSWER "Under no circumstances should I get my cast wet." The client is admitted to the hospital with a diagnosis of left femoral neck fracture. Which treatment modality would the nurse expect the health care provider to order? - CORRECT ANSWER Buck's traction A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. The nurse identifies this as which type of cast?` - CORRECT ANSWER Gauntlet cast Which intervention would the nurse implement with the client in skeletal traction? - CORRECT ANSWER ensure the pins or wires are covered with caps, position trapeze within the client's reach, instruct the client on isometric exercises for immobilized extremity The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client? - CORRECT ANSWER The client will experience a tolerable level of pain. The client will demonstrate wound care. The client will maintain adequate nutritional intake. A client who has fractured the radial head asks the nurse about factors that will promote bone healing. Which statement should the nurse include when responding to the client? - CORRECT ANSWER "Immobilization of the fracture will promote healing by maximizing contact of bone fragments." "Fractured bones require a good blood supply and adequate nutrition for healing." "Weight bearing stimulates healing of the long bones of the leg, if the fracture is stabilized." A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? - CORRECT ANSWER "I cannot seem to catch my breath." "I have a pins-and-needles sensation in my toes." Dorsoplantar weak and unequal bilaterally T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90% Which of the following describes failure of the ends of a fractured bone to unite in normal alignment? - CORRECT ANSWER Nonunion Which of the following are associated with compartment syndrome? - CORRECT ANSWER Trauma from accidents Surgery Casts Tight bandages Crushing injuries Which assessment findings would the nurse expect to find in the client with osteomyelitis? - CORRECT ANSWER Column B What areas of the body may be examined when bone densitometry is done? - CORRECT ANSWER hip, spine, wrist A client who was injured while playing basketball reports an extremely painful elbow, which is very edematous. What type of injury has the client experienced? - CORRECT ANSWER sprain A client has undergone a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? - CORRECT ANSWER Advise the client to use a trochanter roll. Advise the client to adduct the stump so it presses against the other leg when the client is lying on the stomach. Which statements describe open reduction of a fracture? - CORRECT ANSWER It is performed in the operating room. The bone is surgically exposed and realigned. The client usually receives general or spinal anesthetic. A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? - CORRECT ANSWER Muscle spasms will be relieved. The bones of the left leg will be aligned. Immobilization of the left leg will be maintained A client comes to the clinic 2 days after sustaining a sprain to the left ankle. What intervention can the nurse encourage the client to perform that will help improve circulation? - CORRECT ANSWER applying heat A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip? - CORRECT ANSWER The left leg is shorter than the right. Limited range of motion of the left hip. The skin of the lower left leg is pale. A client diagnosed with osteoporosis is being discharged home. Which priority education should the nurse should provide? - CORRECT ANSWER Remove all small rugs from the home What assessment findings of the leg are consistent with a fracture of the femoral neck? - CORRECT ANSWER Shortened, adducted, and externally rotated A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? - CORRECT ANSWER Pneumonia, skin breakdown, sepsis, delirium A client with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care? - CORRECT ANSWER Prepare to remove the cast. Provide support to the injured extremity. A client with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate? - CORRECT ANSWER document the findings A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until the femur can be rodded in surgery. For what early complication(s) should the nurse monitor this client? - CORRECT ANSWER Deep vein thrombosis Compartment syndrome Fat embolism An older adult client has fallen in the home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the client's presurgical care, the nurse should be aware of the client's heightened risk of what complication? - CORRECT ANSWER avascular necrosis The nurse is providing care for a client who has had a below-the-knee amputation. The nurse enters the client's room and finds the client resting in bed with the residual limb supported on a pillow. What is the nurse's most appropriate action? - CORRECT ANSWER Explain the risks of flexion contracture to the client A client has suffered a muscle strain and is reporting pain at 6 on a 10-point scale. The nurse should recommend what action? - CORRECT ANSWER Applying a cold pack to the injured site A client has had a brace prescribed to facilitate recovery from a knee injury. What are the potential therapeutic benefits of a brace? - CORRECT ANSWER Preventing additional injury Providing support Controlling movement A physician writes a prescription to discontinue skeletal traction on an orthopedic client. The nurse should anticipate what subsequent intervention? - CORRECT ANSWER application of a cast A client has just begun been receiving skeletal traction and the nurse is aware that muscles in the client's affected limb are spastic. How does this change in muscle tone affect the client's traction prescription? - CORRECT ANSWER Extra weight is needed initially to keep the limb in proper alignment. A client is scheduled for a total hip replacement and the surgeon has explained the risks of blood loss associated with orthopedic surgery. The risk of blood loss is the indication for which of the following actions? - CORRECT ANSWER Autologous blood donation A nurse is caring for an older adult client who is preparing for discharge following recovery from a total hip replacement. What outcome must be met prior to discharge? - CORRECT ANSWER client is able to perform transfers safely A nurse is caring for a client who is being assessed following reports of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? - CORRECT ANSWER CT, Magnetic resonance imaging, Ultrasound, X-ray A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? - CORRECT ANSWER Assess the fingers for color and temp, assess for a pressure sore, determine the exact site of the pain A client has low back pain and the healthcare provider needs to rule out the presence of a tumor. Which diagnostic procedure would the nurse anticipate to be ordered for the client? - CORRECT ANSWER bone scan A provider asks the nurse to teach a client with low back pain how to sit in order to minimize pressure on the spine. Which teaching points would the nurse include? - CORRECT ANSWER Avoid hip extension. Place feet flat on the floor. Sit with the buttocks "tucked under." Sit in a straight-backed chair with arm rests A nurse is caring for a client after stabilization of a radial fracture. Which actions by the nurse would be appropriate for the client following arm casting? - CORRECT ANSWER Handle the cast with the palms of hands Circulate room air with a portable fan Petal and smooth the edges of the cast The nurse provides care for a client in balanced suspension traction. The client reports pain in the affected extremity, and the nurse administers medication. One hour later the client states, "I don't know why, but the pain isn't getting any better." Which action does the nurse take first? - CORRECT ANSWER perform a neuromuscular assessment The nurse provides care for an older adult client eight days after an open reduction and internal fixation of the right hip. The nurse intervenes if which observation is made? - CORRECT ANSWER the client is not wearing elastic stockings The nurse prepares a client for a total hip replacement. What information will likely postpone the surgery? - CORRECT ANSWER the client reports burning on urination The nurse teaches a client with a BKA to care for the residual limb at home. The nurse advises the client to take which action? - CORRECT ANSWER expose the residual limb to air The nurse teaches a client diagnosed with a fractured left demur that is in a cast. The client asks how to keep the muscles if the legs strong during the time the cast os on the left leg. Which response by the nurse is best? - CORRECT ANSWER "I'll teach you how to do isometric exercises with your left leg" The nurse provides care for a client with DJD (osteoarthritis). The client receives a new prescription for celecoxib. The nurse is most concerned if the client makes which statement? - CORRECT ANSWER "I am allergic to aspirin" An older adult client is diagnosed with a fractured femur. The nurse recognizes which observation is an early sign of fat embolism? - CORRECT ANSWER Altered mental status The nurse provides care for a client with a newly applied plaster cast to the lower extremity. The nurse takes which action? - CORRECT ANSWER Elevates the leg on pillows and leaves the cast open to air A client asks the nurse, "What is the difference between RA and osteoarthritis?" Which response by the nurse is best? - CORRECT ANSWER "Rheumatoid arthritis is a systemic disease and osteoarthritis is not." The nurse assesses a client diagnosed with osteoarthritis. The nurse expects to observe which signs/ symptoms? - CORRECT ANSWER Pain usually provoked by activity, and stiffness of the joints after periods of rest The clinic nurse counsels a client reporting low back pain. Which client statement requires a follow-up by the nurse? - CORRECT ANSWER "I work full-time as a package handler at Amazon" The nurse evaluates care given to a client after a left BKA. The nurse intervenes if which observation is made? - CORRECT ANSWER The dressing to the surgical site is dated two days prior A client diagnosed with Type 1 Diabetes is scheduled for a right BKA due to a gangrenous toe. The client asks the nurse why the amputation is so extensive. The nurse's response is based on which understanding? - CORRECT ANSWER A below the skeeter's amputation results in better circulation and healing The nurse provides care for an older adult client after a total hip replacement due to degenerative joint disease. The nurse intervenes if which observation is made? - CORRECT ANSWER The client is sitting on a chair with no arms Prednisone 2 mg daily is prescribed for a client with RA. Which important point does the nurse include when teaching the client about this medication? - CORRECT ANSWER The dosage of prednisone must be increased and decreased gradually The home care nurse makes a home visit to a client diagnosed with osteoarthritis. The nurse asks the client's spouse if the client is having any problems. The nurse further assesses if the spouse makes which statement? - CORRECT ANSWER "My spouse has not been participating in regular activities." The nurse provides care for a client immediately following a right BKA. The nurse is most concerned if which observation is made? - CORRECT ANSWER The client reports persistent pain at the operative site The nurse provides care for a client in Buck traction. Which is the most important nursing action to maintain effective traction? - CORRECT ANSWER Allow weights to hang freely at all times An older adult client has an open reduction and internal fixation of the left femoral head after a fracture. Which action by the nurse is best? - CORRECT ANSWER Encourage the client to cough and deep breathe every 2 hours The nurse provides care for a client after an amputation with an immediate prosthetic fitting. The nurse includes which activity in the client's plan of care? - CORRECT ANSWER Provide cast care on the affected extremity A client experiences an acute bout of gouty arthritis. The nurse expects the client's affected foot to have which appearance? - CORRECT ANSWER Red Three hours after arriving in the orthopedic unit, a client reports a hot feeling under the cast. Which action does the nurse take first? - CORRECT ANSWER Assesses the circulation in the casted extremity and changes the client's position Total hip arthroplasty is scheduled for a client with DJD of the left femoral head. Following surgery, it is most important for the nurse to place the client's left leg in which position? - CORRECT ANSWER Abducted with toes pointing upward Aspirin is prescribed for a client. The nurse administers this medication with which liquid? - CORRECT ANSWER A glass of milk The nurse witnesses a car hit a pedestrian in the parking lot. As the nurse approaches the pedestrian, the pedestrian cries out, "I think my leg is broken!" Which action does the nurse take first? - CORRECT ANSWER Inspects the affected leg for evidence of bleeding The nurse provides care for an older adult client reporting a new onset of bone pain, rapidly increasing in intensity, as well as fatigue and difficulty walking. The client reports a decrease in height and the labs show a high alkaline phosphatase level. The nurse prepares to teach the client about which disease process? - CORRECT ANSWER Paget disease The nurse provides care for a client with RA. Which finding assumes the highest priority for the nurse when assessing and planning the client's care? - CORRECT ANSWER Slight contracture of the right wrist Which nursing intervention is most appropriate for a client diagnosed with RA and reporting generalized pain? - CORRECT ANSWER Assist the client with heat application and ROM exercises The nurse makes a home health care visit to a client with a fractured right femur. The nurse assesses the client's ability to safely use crutches. The nurse intervenes if which observation is made? - CORRECT ANSWER Before the client sits in a chair, the client stands on the unaffected leg and transfers both crutches to the hand on the affected side of the body The nurse is in the outpatient clinic instructs a client receiving probenecid. It is most important for the nurse to make which statement? - CORRECT ANSWER Drink 6-8 glasses of water a day ________ permits visualization of the segments of the spinal cord; used when MRIs are not clear or patient cannot tolerate laying flat or has claustrophobia; bed rest for 2 hours afterwards, hydrate heavily afterwards to remove dye - CORRECT ANSWER Myelogram _______ is the same as a myelogram but allows you to see the intervertebral discs of the spinal cord; usually done in OR after someone has an epidural - CORRECT ANSWER Discogram ____ is performed when patient has joint pain; checks progression of diseases; contrast involved - CORRECT ANSWER Arthrogram _________ is carried out to obtain synovial fluid for purposes of examination or to relieve pain due to effusion. Helpful in the diagnosis of septic arthritis and other inflammatory arthropathies. Normally, synovial fluid is clear, pale, straw-colored and scanty in volume - CORRECT ANSWER Arthrocentesis _________ allows direct visualization of a joint through the use of a fiberoptic endoscope; useful to adjunct diagnosing of joint disorders. Biopsy and treatment of tears, defects, and disease processes may be performed through this procedure. - CORRECT ANSWER Arthroscopy _________-evaluates bone mineral density; by x-ray or ultrasounds; DEXA scan - CORRECT ANSWER Bone densitometry ______ or an EMG; pins and needles inserted into your muscles and nerves to check electrical potential to rule out muscle damage - CORRECT ANSWER Electromyography Which baseline labs should be gathered before Heparin administration? - CORRECT ANSWER PTT, CBC w/ diff, Hgb/Hct, RBC What would be given if the patient started bleeding uncontrollably? - CORRECT ANSWER protamine sulfate What oral medication will your patient likely be on when Heparin therapy is stopped? - CORRECT ANSWER Warfarin What is the reversal agent for Warfarin? - CORRECT ANSWER Vitamin K _______ is an enzyme produced by an osteoblast, needed for mineralization of the bone. If it is elevated, healing fractures, bone cancers, osteoporosis, vitamin D deficiencies may be the cause. - CORRECT ANSWER Alkaline Phosphatase ______ is a study in which they watch red blood cells fall and count the rate in which they become sediment. If elevated, RA, osteomyelitis, inflammation may be present. - CORRECT ANSWER ESR/ Sed Rate What does a CBC include? - CORRECT ANSWER WBC, RBC, Hgb, Hct, Platelet count _____ is the bending of a joint, like flexing a muscle - CORRECT ANSWER Flexion _____ is stretching something out, like straightening a joint - CORRECT ANSWER Extension ______ is moving away from the body - CORRECT ANSWER Abduction ____ is bringing closer to the body - CORRECT ANSWER Adduction _____ is rotating a joint, like your head - CORRECT ANSWER Rotation ______ is rotating a joint all the way around, 360 degrees - CORRECT ANSWER Circumduction _____ is turning upward, like lying supine, or palms facing upward - CORRECT ANSWER Supination _____ is the opposite of supination, like palms facing down - CORRECT ANSWER Pronation _____ is turning in of a body part, like inverting something - CORRECT ANSWER Inversion _____ is turning out, like ballerina feet - CORRECT ANSWER Eversion ____ is pushing forward, like bench press - CORRECT ANSWER Protraction ____ is pulling back - CORRECT ANSWER Retraction ____ is an injury of the ligaments around a joint caused by twisting or wrenching a motion beyond its ROM. Blood vessels are torn which causes swelling and pain - CORRECT ANSWER Sprain ______ is an injury to a muscle due to overuse, over stretching, or excessive stress; painful with no swelling - CORRECT ANSWER Strain When should intermittent heat be used for care of a soft tissue injury? - CORRECT ANSWER after the acute inflammatory phase _____ is a Fracture that is completely in two different pieces, completely separated - CORRECT ANSWER Complete ______ is a fracture in which a Fragment remains attached, and only a portion of the bone is broken - CORRECT ANSWER Incomplete _____ is a fracture in which bones are broken and no longer in anatomical position; something will have to be manipulated before casting for it to grow back correctly - CORRECT ANSWER Displaced ____ is a fracture that remains in good anatomical position - CORRECT ANSWER Non-displaced _____ is a fracture that is Crossways at right angles to long axis of bone, straight across - CORRECT ANSWER Transverse _____ is a fracture that is a slanting break - CORRECT ANSWER Oblique ______ is a fracture that is Twisted around the shaft of the bone (usually child abuse injuries will be this type) - CORRECT ANSWER Spiral _______ is a fracture in which One side is broken, the other is just bent; occurs in young children with soft bones - CORRECT ANSWER Greenstick _____ is a fracture Resulting from strong pulling effect of tendon or ligaments at the bone attachment - CORRECT ANSWER Avulsion _____ is a fracture broken into multiple small pieces, may happen in jam or crush injury - CORRECT ANSWER Comminuted _____ is a fracture in which fragments are driven into each other; legs on dash when in car wreck, or fall and land on legs - CORRECT ANSWER Impacted _____ is a fracture in which the line extends through the articular surface of the bone - CORRECT ANSWER Intra-articular _____ is a fracture across long axis of the bone - CORRECT ANSWER Longitudinal ______ is a fracture that is Spontaneous at site of bone disease (tumor or osteomyelitis) - CORRECT ANSWER Pathologic _____ is a fracture that occurs as a result of repeated stress to the bones; overtraining in runner or severe bone disease - CORRECT ANSWER Stress What are the 5 P's? - CORRECT ANSWER pain, pallor, paresthesias, paralysis, pulselessness _____ is the restoring of a bone to proper anatomical alignment - CORRECT ANSWER Reduction ______ is done after a fracture is reduced to maintain proper position and alignment until union occurs - CORRECT ANSWER Immobilization ______ is the application of a pulling force to an injured or diseased body part - CORRECT ANSWER Traction ______ is the shrinkage-like decrease in the size of the muscle - CORRECT ANSWER Atrophy ____ is a fluid-filled sac found in connective tissue - CORRECT ANSWER Bursa _____ is the rhythmic contraction of muscle - CORRECT ANSWER Clonus ______ is a grating or crackling sound or sensation - CORRECT ANSWER Crepitus Which types of bone cells function to build bone? - CORRECT ANSWER Osteoblasts Which type of bone cells, that are located in the lacunae, are mature cells that function in bone maintenance? - CORRECT ANSWER Osteocytes Which type of bone cells, that are located in Howship's lacunae are multinuclear cells that function in destroying, resorbing, and remodeling bone? - CORRECT ANSWER Osteoclasts ____ is the process of formation of the bone matrix and deposition of minerals - CORRECT ANSWER Ossification What are the functions of the musculoskeletal system? - CORRECT ANSWER protection of vital organs, mobility and movement, facilitation of return of blood to the heart, production of blood cells, reservoir for immature blood cells, and reservoir for vital minerals What is the production of blood cells called? - CORRECT ANSWER hematopoiesis Where do immature blood cells live? - CORRECT ANSWER the musculoskeletal system (bones) Muscles are attaches to bones and other structures by ______. - CORRECT ANSWER tendons What is the fibrous tissue that encases muscles called? - CORRECT ANSWER Fascia _______ is the contractile unit of skeletal muscle that contains actin and myosin - CORRECT ANSWER Sarcomere Amputations - CORRECT ANSWER Indications: -ciculatory impairment -tramatic and thermal injuries -malignant tumors -uncontrolled infection -congenital disorder Two major groups: -surgical, due to effects of peripheral vascular disease and diabetes -tramatic, due to accidents/injuries Nurses Role in Prevention - CORRECT ANSWER Surgical: skin inspections, no extreme temperatures, manage glucose, wear shoes Traumatic: avoid risks/increase safety Amputations Goals of Surgery - CORRECT ANSWER -removing infected, damaged, or ischemic tissue while preserving extremity function -amputation below the knee & elbow joints allow for better prosthetic devices as well as improved function -AKA: above the knee amputation -BKA: below the knee amputation Pre-Op Teaching Plan - CORRECT ANSWER Patient aware of what is going to happen, what will happen after surgery/plan for post-op, where will patient be discharged and where, prosthetic devices, phantom pain (still medicate like regular pain but gradually diminish over time), general post-op nursing care, mobility issues, risk for infection, wound care, risk for depression or impaired body image Grieving Process - CORRECT ANSWER -depression & inability to look at extremity is normal & expected after the initial surgery -the patient needs to be supported during the grieving process -nurse's role: provide support, help identify support systems for the patient Amputation Managment - CORRECT ANSWER Post operative: prevention of complications -short term: hemorrhage (decreased blood pressure increased heart rate and check dressings) -long term: contracture (need to stretch muscles) -Body image disturbance r/t amputation -Impaired skin integrity r/t immobility and improperly fitted prosthesis -Pain related to phantom limb sensation -Impaired physical mobility r/t amputation of lower limb Prevent long term complications - CORRECT ANSWER Flexion contracture a can easily occur and delay rehab. Place client in prone position with hip & leg in extension for 30 minutes 3-4 times per day Shape residual limb to prepare for prosthesis -compression bandage -Shrinker stockings Pain Management - CORRECT ANSWER Phantom pain: -patient feels as if amputated limb is still present -the pain is a real sensation and should be medicated with prescribed analgesic Total Joint Replacement - CORRECT ANSWER Preformed to relieve pain, improve ROM, and correct deformities, instability Replacement arthroplasty is available for elbow, shoulder, fingers, hip, knee, ankle, and foot Two primary types of implants: -cemented is recommended for older adults -cementless is recommended for adults with life expectancy of 25 years or more, bone grows on to prosthetic to provide more security Total Joint Replacement Nursing Mangement - CORRECT ANSWER Preoperative: -stop anticoagulants & antiplatelets -patient must be free of infection and acute joking inflammation (due to high risk of post-op infection) -education (during hospital stay & home management) positioning, risk for infection, rehab Postoperative: -internal rotation, adduction, & 90 degree flexion of hip must be avoided for 4-6 weeks to prevent dislocation (adduction pillows & use raised toilet seats, no driving or tub baths, avoid bending over & never cross legs) -knee may have compression immobilizer (use of CPM, continuous passive motion, machine) -elbows & shoulder rehab may be harder and longer -verbally need Coumadin or Lovenox (high risk for DVT) for a month -NSAIDs for inflammation -narcotic analgesics for pain management -IV & PO antibiotics (risk for infection) -teach use of walker & cane (remember positioning restrictions) -neuro vascular checks are essential -TC&BD or use of incentive spirometer Total Joint Replacement Nursing Diagnosis - CORRECT ANSWER -impaired physical immobility r/t pain & surgical procedure -pain r/t surgical procedure -self care deficit r/t physical restrictions -risk for infection r/t surgical procedure -ineffective management r/t lack of knowledge of follow-up care [Show Less]
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ONC Degenerative Disease Practice Exam 50 Questions with Verified Answers,100% CORRECT
ONC Degenerative Disease Practice Exam 50 Questions with Verified Answers A patient with a history of osteoarthritis states she has been using exercise ... [Show More] as a means to delay progression of the disease. However, she now complains of increased pain in her knees. Given this complaint, which of the following forms of exercise should the nurse suspect the patient uses? a. Swimming b. Water aerobics c. Running d. Stationary bicycling - CORRECT ANSWER c. Running Rationale: Activity modification in the treatment of OA may include switching from high-impact exercise such as running and competitive sports to low-impact exercise such as swimming and walking. Running could exacerbate joint symptoms. Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 71 A patient recently underwent left hip arthroplasty. The nurse should do which of the following to decrease the patient's risk of venous thromboembolism (VTE)? a. Elevate the foot of the patient's bed. b. Place an abductor pillow between the patient's legs. c. Encourage the patient to begin ambulation. d. Ensure the patient has adequate pain management. - CORRECT ANSWER c. Encourage the patient to begin ambulation. Rationale: Patients undergoing orthopaedic surgery are at increased risk for VTE. Prevention strategies are mechanical, physical, and pharmacological. Physically, the formation of clots can be prevented with early ambulation and bed exercises such as ankle pumps. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 201; An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 139 Following total shoulder arthroplasty, a patient is wearing a complicated sling that is unfamiliar to the nurse. What should be the nurse's best strategy when the patient asks for help in dressing? a. Find instructions on the Internet about how to remove the sling. b. Tell the patient to have a family member help with dressing. c. Tell the nursing assistant the patient needs help with dressing. d. Ask the occupational therapist to review removal and application of the sling. - CORRECT ANSWER d. Ask the occupational therapist to review removal and application of the sling. Rationale: Patients who have shoulder surgery must adhere to postoperative precautions, especially when completing ADLs. If the patient must wear a sling, an occupational therapist will be an excellent resource in discussing removal and application of the device. Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 175 The nurse is caring for a patient who underwent total knee arthroplasty. The nurse should identify which of the following as a primary risk factor for possible development of deep vein thrombosis (DVT)? a. Poor nutritional status b. Venous stasis c. Low oxygen saturation d. History of lung disease - CORRECT ANSWER b. Venous stasis Key: b Rationale: The pathophysiology of deep vein thrombosis is explained by Virchow's Triad of venous stasis, trauma, and hypercoagulability state. Venous stasis is caused by immobility and leads to blood pooling, which can contribute to clot formation. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 200 In providing a staff inservice on pain management after total knee arthroplasty, the nurse should remind attendees that poor postoperative pain management can contribute to a. increased patient satisfaction. b. increased risk of infection. c. decreased blood pressure and heart rate. d. decreased effectiveness of rehabilitation. - CORRECT ANSWER d. decreased effectiveness of rehabilitation. Rationale: Poor pain management can lead to decreased effectiveness of the rehabilitation program, with physiologic, economic, and psychological consequences. Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 130 A new nurse receives orders to administer enoxaparin (Lovenox) to a patient following resurfacing hip arthroplasty. In reviewing a medication reference for information about enoxaparin, the nurse should learn a. this medication is given intramuscularly. b. this drug is interchangeable with heparin. c. the injection site should not be massaged after drug administration. d. the platelet count need not be monitored during use of this drug. - CORRECT ANSWER c. the injection site should not be massaged after drug administration. Key: c Rationale: It is recommended to alternate sites of administration; do not rub injection site after administration. Enoxaparin should not be given intramuscularly (IM) but should be administered by subcutaneous injection. As a low molecular weight heparin, enoxaparin can contribute to development of thrombocytopenia. The nurse should monitor results of complete blood counts and assess for signs of bleeding. Reference: Hochadel, M. (2016). Mosby's drug reference for health professions (5th ed.). St. Louis, MO: Elsevier. pp. 557-559 A patient with chronic sepsis of the right knee is in the clinic to discuss surgical options. The nurse should expect which of the following procedures to be discussed? a. Total knee arthroplasty b. Arthrodesis c. Synovectomy d. Tibial osteotomy - CORRECT ANSWER b. Arthrodesis Rationale: Arthrodesis, or knee fusion, is one of the last options to give the patient a stable, painless knee. Indications include chronic sepsis, failed TKA, and periarticular tumor. The other procedures would not be indicated for a septic joint. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 577 A perioperative nurse is preparing to receive a patient for total hip arthroplasty. The nurse should expect the patient to need antibiotic-impregnated cement based on which of the following in the patient's medical history? a. Diabetes b. Hypertension c. Long-term use of NSAIDs d. Chronic opioid use - CORRECT ANSWER a. Diabetes Rationale: Antibiotic-impregnated cement may be used in patients with diabetes, those taking immunosuppressive medications, or patients undergoing revision surgery. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 575 A 62-year-old seeks evaluation for unrelenting pain and a progressive loss of shoulder function in the last year. The nurse should know which of the following is MOST LIKELY to be recommended for treatment? a. Treatment with NSAIDs b. Intra-articular steroid injection c. Total shoulder arthroplasty d. Physical therapy three times a week - CORRECT ANSWER c. Total shoulder arthroplasty Rationale: TSA is indicated due to the progressive loss of function and unrelenting pain. NSAIDs and injections are temporary treatments that will not address the underlying problem. Physical therapy is a conservative treatment not indicated given the progressive loss of function. Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 26 The nurse is preparing to discharge a patient following total knee arthroplasty. Which of the following should the nurse include in patient education? a. Maintaining a desirable weight b. Using opioids for long-term pain management c. Getting used to a more sedentary lifestyle d. Having a family member perform range of motion on the knee - CORRECT ANSWER a. Maintaining a desirable weight Rationale: Maintaining a healthy weight will prolong the life of the new prosthesis by putting less stress on it. The other options are not appropriate for discharge care. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 349 The nurse is preparing to discharge a 36-year-old construction worker who underwent total hip arthroplasty. Which of the following should the nurse identify as a life-altering change expected for this patient? a. The need for assistance during rehabilitation b. Use of an assistive device such as walker or crutches c. Having to seek a different job d. Using antibiotics before dental work - CORRECT ANSWER c. Having to seek a different job Rationale: Due to the heavy lifting typical to a construction worker, the patient should change jobs to prevent damage to the hip joint. The other options are temporary, not life-altering. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 553 Some weeks after undergoing total ankle arthroplasty for traumatic arthritis, a patient has an office visit. The patient's condition during an office visit is consistent with osteomyelitis. Which of the following should the nurse recognize as indicative of early osteomyelitis? a. A pathologic fracture of the affected bone b. Drainage from an abscess on the affected limb c. X-ray changes showing areas of bony destruction d. Acute pain and swelling accompanied by fever - CORRECT ANSWER d. Acute pain and swelling accompanied by fever Rationale: Osteomyelitis starts as an acute infection with an inflammatory reaction within the infected bone. Early signs would be acute pain, swelling, and fever. Pathologic fracture and abscess formation are late signs of osteomyelitis. X-ray changes are not apparent until after the infection has been present long enough to cause bony destruction. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 220-221 A patient who has been recently diagnosed with osteoarthritis (OA) tells the nurse his mother had rheumatoid arthritis. He asks, "What is the difference?" The nurse's response should be based on knowledge that OA is characterized by which of the following? a. Positive anti-CCP antibodies b. Use of DMARD therapy c. Asymmetrical joint involvement d. Development of a swan neck deformity - CORRECT ANSWER c. Asymmetrical joint involvement Rationale: OA is marked by asymmetric joint involvement; e.g., the right knee and the left hip could be affected. The other options are all characteristic of rheumatoid arthritis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 342 A patient complains of pain in his neck, and numbness and tingling in the upper extremities. The nurse should expect the diagnosis of cervical degenerative disc disease to be verified by a. electromyogram (EMG). b. computerized axial tomography (CT). c. magnetic resonance imaging (MRI). d. bone mineral density testing (BMD). - CORRECT ANSWER c. magnetic resonance imaging (MRI). Rationale: Cervical degenerative disc disease is best evaluated by MRI. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 456, 462 Following surgery to stabilize the cervical spine, the patient has a halo brace placed. The nurse should understand proper adjustment of the pins ensures they do not a. come loose. b. pierce the skin. c. create large holes. d. puncture the skull. - CORRECT ANSWER d. puncture the skull. Rationale: The pins are pushed through the skin and rest against the skull. Proper tightening of the pins ensures they do not puncture the skull. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 470 The nurse is presenting a class about osteoarthritis for older women at the community center. Which of the following should the nurse identify as the most often cited disability among older women with osteoarthritis? a. Immobility b. Swelling c. Pain d. Stiffness - CORRECT ANSWER c. Pain Rationale: Disabling pain is the most often cited disability among older women, and the most common reason persons with OA seek medical care. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 347 A patient reviews modifiable risk factors for symptomatic knee osteoarthritis with the nurse. Which of the following, if identified by the patient, should indicate to the nurse the need for further education on this topic? a. Obesity b. Injury c. Mechanical stress d. Crepitus - CORRECT ANSWER d. Crepitus Reference: Obesity, injury, and mechanical stress are modifiable risk factors for knee OA. Crepitus is a sign of OA, not a risk factor for the disease. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 347 The nurse is orienting a new graduate nurse to the orthopaedic unit. In caring for a patient who has undergone cervical discectomy and fusion, the nurse should explain to the new graduate that the incision for this procedure is made routinely on the front left of the neck to minimize the risk of injury to the a. carotid artery. b. axillary nerve. c. internal Haversian system. d. recurrent laryngeal nerve. - CORRECT ANSWER d. recurrent laryngeal nerve. Rationale: The recurrent laryngeal nerve is protected anatomically on the left side of the neck. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 457, 459 The nurse is discussing possible surgical options for a patient with osteoarthritis of the knee. Which of the following, if identified by the patient, should indicate to the nurse the need for further education? a. Proximal tibial osteotomy b. Unicompartmental knee arthroplasty c. Total knee arthroplasty d. Patellectomy - CORRECT ANSWER d. Patellectomy Rationale: Patellectomy is not an appropriate surgery for OA of the knee. The other procedures may be considered, depending on patient symptoms and surgeon recommendation. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 349 A nurse is discussing the unpredictable course of osteoarthritis with a patient recently diagnosed with knee OA. The nurse should recognize which of the following statements by the patient as indicating a need for further education? a. "I should try to maintain my ideal weight." b. "I should avoid exercise to decrease stress on the joint." c. "I should use proper body mechanics at work." d. "I should take over-the-counter medications to decrease joint pain." - CORRECT ANSWER b. "I should avoid exercise to decrease stress on the joint." Rationale: Exercise is important to maintain joint mobility and help in weight loss. It is not beneficial to be sedentary. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 350 A nurse identifies arthritic deformities on the distal interphalangeal joints of a patient with osteoarthritis. The nurse should recognize these as a. Bouchard's nodes. b. Pott's deformity. c. Colles instability. d. Heberden's nodes. - CORRECT ANSWER d. Heberden's nodes. Rationale: Heberden's nodes indicate osteophyte formation and loss of joint space in the distal interphalangeal joints of persons with OA. Bouchard's nodes appear on the proximal interphalangeal joints. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 347-348 The nurse is discussing diagnosis of different forms of arthritis with a patient with suspected osteoarthritis. The nurse should identify which of the following as best able to differentiate between OA and rheumatoid arthritis? a. Radiographs b. Erythrocyte sedimentation rate (ESR) c. Synovial fluid analysis d. Serum uric acid - CORRECT ANSWER c. Synovial fluid analysis Rationale: Synovial fluid analysis differentiates OA from inflammatory arthritis. Joint fluid is clear yellow in OA, with high viscosity due to normal amounts of hyaluronic acid. White blood cell count is low. Synovial fluid in rheumatoid arthritis, an inflammatory condition, is straw-colored and slightly cloudy, with flecks of fibrin and white blood cells. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 341, 348 A patient diagnosed with a spinal disorder is undergoing conservative treatment. Which of the following should the nurse recognize as one spinal condition that would require immediate surgical management? a. Cauda equina syndrome b. Idiopathic scoliosis c. Postural kyphosis d. Cervical herniation - CORRECT ANSWER a. Cauda equina syndrome Rationale: Conservative treatment for spinal disorders is attempted before considering surgery, with the exception of cauda equina syndrome. This condition is marked by saddle anesthesia, acute paraplegia, and/or bowel or bladder incontinence; it is a surgical emergency. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 462, 464 The nurse is caring for a patient with a herniated intervertebral disc in the lumbar spine. The nurse should expect the patient to report the lumbar pain is usually aggravated by a. axial loading. b. rotation. c. extension. d. standing. - CORRECT ANSWER d. standing. Reference: Pain from a herniated lumbar disc is usually aggravated by standing, walking, bending, and coughing or sneezing. Pain from cervical disc herniation may be aggravated by rotation, extension, lateral bending, and axial loading. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 462 A patient with a herniated intervertebral disc has been prescribed a corset for short-term use. The nurse providing instruction on the use of the corset should caution the patient that long-term use will a. increase inflammation paradoxically. b. weaken the muscles of the affected area. c. cause permanent damage to the affected nerve root. d. increase muscle spasms. - CORRECT ANSWER b. weaken the muscles of the affected area. Rationale: A brace or corset may be used on a short-term basis, but long-term use is contraindicated because it will weaken the back and abdominal muscles of the affected area. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 457, 462 A patient with spinal stenosis asks the nurse about positions that may help with pain relief. The nurse should identify which of the following as MOST LIKELY to alleviate pain? a. Forward flexed b. Straight standing c. Prone d. Supine - CORRECT ANSWER a. Forward flexed Rationale: A forward flexed posture, such as leaning on a grocery cart while shopping, opens the spinal canal slightly and may alleviate pressure on nerves for a person with spinal stenosis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 462 The nurse should instruct the patient with spinal stenosis to avoid which of the following spinal positions during activity? a. Flexion b. Rotation c. Extension d. Circumduction - CORRECT ANSWER c. Extension Rationale: Extension activities should be avoided because they cause further spinal compression for the patient with spinal stenosis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 462 A patient has a history of failed back syndrome after multiple spinal surgeries. After providing information about appropriate activities for the patient, the nurse should recognize which of the following statements by the patient as indicating a need for further education? a. "I will pace activities to provide rest intervals." b. "I will use a brace as prescribed by my provider." c. "I will participate in a supervised exercise program." d. "I will limit spinal movement to decrease pain." - CORRECT ANSWER d. "I will limit spinal movement to decrease pain." Rationale: A patient with failed back syndrome should be encouraged to participate in activities that promote mobilization and self-care. Minimizing spinal movement does not increase mobility, flexibility, and strength; the patient needs further education Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 466 During a preoperative joint arthroplasty program, the nurse is assessing a patient with hip osteoarthritis. The nurse should recognize which of the following as an abnormal gait that indicates progressive degeneration of the patient's hip? a. Trendelenburg gait b. Ataxic gait c. Antalgic gait d. Scissor gait - CORRECT ANSWER a. Trendelenburg gait Rationale: Progressive degeneration of the hip commonly results in a Trendelenburg gait, caused by weakness of the hip abductor muscles. The pelvis droops on the unaffected side at the moment of heel strike on the affected side. Muscle atrophy results from disuse and decreased range of motion of the affected hip. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 55 During a preoperative patient education program on joint arthroplasty, the nurse discusses cemented vs. non-cemented prostheses. The nurse should identify which of the following as a benefit of the CEMENTED prosthesis? a. Fewer problems with loosening b. Decreased intraoperative blood loss c. Early weight bearing d. Increased joint range of motion - CORRECT ANSWER c. Early weight bearing Rationale: The cemented prosthesis allows earlier weight bearing than the non-cemented prosthesis; this allows earlier mobility to patient tolerance and decreases the risk of mobility-related complications. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 554-555 After undergoing total hip arthroplasty via a posterolateral approach, the patient receives instructions on how to decrease the risk for dislocation. The nurse should include which of the following instructions? a. "Avoid hyperextension of the hip." b. "Do not internally rotate the hip." c. "Maintain the hip in at least 90 degrees of flexion." d. "Do not abduct the hip." - CORRECT ANSWER b. "Do not internally rotate the hip." Rationale: The posterolateral approach results in less muscle damage but may be more prone to dislocation than other approaches. This patient must avoid internal rotation, adduction, and hip hyperflexion. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 556 Following a preoperative joint arthroplasty class, a patient tells the nurse, "My surgeon expects to use a porous coated prosthesis. What does that mean?" The nurse should identify this type of prosthetic as having a. two metal articulating surfaces. b. separate prosthetic elements for best fit. c. polymethylmethacrylate cement in the femoral shaft. d. a surface that allows for bony ingrowth. - CORRECT ANSWER d. a surface that allows for bony ingrowth. Rationale: "Porous coated" refers to the surface of the components that allow for bony ingrowth of the prosthesis where it articulates with the bone. This is typical of non-cemented components. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 554 Following total knee arthroplasty, the patient is taught to perform ISOMETRIC exercises. The nurse should identify which of the following as an appropriate exercise for this patient? a. Quadriceps setting b. Straight leg raises c. Standing calf raises d. Leg extension - CORRECT ANSWER a. Quadriceps setting Rationale: Isometric exercises include quadriceps setting, gluteal setting, and dorsiflexion/plantar flexion of the ankle (ankle pumps). Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 578 A patient with knee osteoarthritis tells the nurse she has begun using glucosamine and chondroitin sulfate for treatment of this disorder but has had no response. The nurse should suggest the patient discontinue the supplements if a positive response has not been experienced in a. 2 weeks. b. 6 weeks. c. 12 weeks. d. 6 months. - CORRECT ANSWER b. 6 weeks. Rationale: Studies show persons with mild-to-moderate OA who took these supplements experienced pain management similar to NSAIDs. However, if no symptom change has occurred after 6 weeks of usage, the patient should discontinue the supplements. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 349-350 Following total knee arthroplasty, a patient is started on a continuous passive motion (CPM) machine. In providing patient education, the nurse should identify decreased as a benefit of the CPM machine. a. development of adhesions during healing b. bleeding at the surgical site c. analgesic requirements d. wound dehiscence - CORRECT ANSWER a. development of adhesions during healing Rationale: Passive motion has been shown to stimulate healing of articular cartilage and reduce the development of adhesions. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 249 A nurse is discussing shoulder osteoarthritis with a group of student nurses on the orthopaedic unit. Which statement by one of the students should the nurse identify as indicating the need for further instruction concerning causes of joint deformity in shoulder OA? a. "Joint deformity occurs secondary to loss of articular cartilage." b. "Collapse of subchondral bone can cause shoulder deformity." c. "Atrophy of adjacent muscles can cause shoulder deformity." d. "Joint deformity of the shoulder can result from prolonged immobility." - CORRECT ANSWER d. "Joint deformity of the shoulder can result from prolonged immobility." Rationale: Joint immobility does not lead to shoulder deformity. However, loss of articular cartilage, collapse of subchondral bone, and atrophy of adjacent muscles can result in joint deformity in the osteoarthritic shoulder. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 482 Following shoulder surgery, an important goal of care for the patient is to reduce stress on the operative area. Which of the following positions should the nurse choose to accomplish this goal? a. Place the operative arm on pillows. b. Keep the head of the bed flat. c. Remove the sling while the patient is in bed. d. Place ice on the incision. - CORRECT ANSWER a. Place the operative arm on pillows. Rationale: Positioning to reduce stress on the operative shoulder includes elevating the head of the bed, supporting the operative arm with pillows, and maintaining correct alignment of the shoulder while the patient is in bed. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 485-486 In educating a patient who has just been diagnosed with carpal tunnel syndrome, the nurse should identify which of the following as the affected nerve? a. Ulnar b. Radial c. Median d. Tibial - CORRECT ANSWER c. Median Rationale: Carpal tunnel syndrome is a median nerve entrapment neuropathy. The median nerve is compressed under the transverse carpal ligament in the wrist. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 546 A patient returns from total knee arthroplasty with an epidural catheter in place for analgesic delivery. The nurse should perform a thorough assessment based on knowledge of which of the following as a potential complication of epidural analgesia? a. Hypertension b. Urinary incontinence c. Coagulopathy d. Neurologic impairment - CORRECT ANSWER d. Neurologic impairment Rationale: Neurologic impairment can occur if the epidural catheter migrates to the cerebrospinal fluid. In addition, an epidural hematoma can develop and put pressure on the spinal nerves. The nurse should perform regular neurovascular assessments to quickly determine any deficits. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 173 patient is scheduled to undergo shoulder surgery. The nurse should expect which of the following as an appropriate nerve block for this patient? a. Axillary b. Interscalene c. Supraclavicular d. Mid-scapular - CORRECT ANSWER b. Interscalene Rationale: An interscalene block is used for shoulder surgery and arthroscopic procedures of the upper extremity. Supraclavicular blocks can be used for lower arm contracture release or tendon repairs, but the increased risk for pneumothorax has led to their disuse. Axillary blocks have the same indication as supraclavicular blocks. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 175 The nurse is discussing risk factors for venous thromboembolism with a group of nursing students providing care to patients after joint arthroplasty. Which of the following statements by one of the students should indicate to the nurse a need for further education? a. "A postmenopausal woman who takes estrogen replacement may be at greater risk for blood clots." b. "A patient who is in surgery for more than 30 minutes is at increased risk for blood clots." c. "Obesity is a significant risk factor for blood clots." d. "Risk for blood clots is minimal until a patient reaches age 60." - CORRECT ANSWER d. "Risk for blood clots is minimal until a patient reaches age 60." Rationale: Risk for clots increases after age 40, and becomes even greater after age 60. However, other risk factors identified in this question can affect a patient no matter what age. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 200 A nurse is caring for a patient who underwent total hip arthroplasty. The nurse should suspect the patient may have developed a pulmonary embolus based on which of the following assessment findings? a. Confusion and dyspnea b. Bradycardia and chest pain c. Hypotension and bradypnea d. Rubor and diaphoresis - CORRECT ANSWER a. Confusion and dyspnea Rationale: Assessment of a patient with suspected PE may identify a feeling of apprehension, restlessness, confusion, anxiety, or lightheadedness. The patient may exhibit dyspnea, cough, hemoptysis, decreased/abnormal breath sounds, abnormal respiratory rate/pattern, tachypnea, hypoxia, or cyanosis. Cardiac signs may include tachycardia, palpitations, split S2, hypotension, syncope, and chest pain. The patient's skin may be cool or warm; the patient may be diaphoretic, with pallor, cyanosis, and sluggish capillary refill. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 201 A patient is scheduled to undergo total hip arthroplasty. The nurse should understand this patient is MOST LIKELY at risk for development of postoperative fat embolism syndrome due to which of the following? a. Length of the procedure b. Performance of intramedullary reaming c. Excessive blood loss d. Maintenance of intraoperative hypotension - CORRECT ANSWER b. Performance of intramedullary reaming Rationale: Intramedullary reaming during joint arthroplasty is a risk factor for FES. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 203 Following total knee arthroplasty, a patient has progressed from a walker to a single cane. To ensure correct fit, the nurse should know the patient's elbow must be flexed to an angle of a. 5-10 degrees. b. 15-20 degrees. c. 25-30 degrees. d. 35-40 degrees. - CORRECT ANSWER c. 25-30 degrees. Rationale: For correct fit of a cane, the patient's elbow must be flexed to a 25-30 degree angle. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 238 The nurse is teaching a patient how to go down the stairs with crutches as he prepares for discharge after total knee arthroplasty. Which of the following sequences should the nurse correctly use in instructing the patient? a. Crutches, operative leg, unaffected leg b. Crutches, unaffected leg, operative leg c. Unaffected leg, crutches, operative leg d. Operative leg, crutches, unaffected leg - CORRECT ANSWER a. Crutches, operative leg, unaffected leg Rationale: The patient advances the crutches to the next step, followed by the operative leg. Then the stronger or unaffected leg is advanced. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 237 A patient has been diagnosed with mild early osteoarthritis of the hands. Assuming there are no contraindications for this patient, which of the follow should the nurse identify as a recommendation of the American College of Rheumatology for INITIAL treatment of osteoarthritic pain? a. Ibuprofen (Motrin®) 400 mg four times daily b. Acetaminophen (Tylenol®) 1000 mg four times daily c. Celecoxib (Celebrex®) 100 mg twice daily d. Tramadol (Ultram®) 25 mg twice daily - CORRECT ANSWER b. Acetaminophen (Tylenol®) 1000 mg four times daily Rationale: Acetaminophen is recommended as the initial drug of choice for treating OA pain in doses up to 1000 mg four times daily if the patient has no liver disease. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 348 A patient had correction of a bunion deformity at the outpatient surgery center. Prior to discharge, she tells the nurse she will likely have surgery on the other foot in the future. The nurse should identify which of the following as a likely etiology for the patient's diagnosis of hallux valgus? a. Elevated arch b. Use of narrow-toed shoes c. History of osteoarthritis d. Plantar fasciitis - CORRECT ANSWER b. Use of narrow-toed shoes Rationale: Use of narrow-toed or high-heeled shoes is a possible etiology for development of hallux valgus. Severe flatfoot deformity, rheumatoid arthritis, and chronic tightness of the Achilles tendon are additional risk factors. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 598 A patient has come to the clinic with complaints of foot pain. The nurse should identify a flexion deformity of the distal interphalangeal joint of the toe as a a. hammer toe deformity. b. claw toe deformity. c. mallet toe deformity. d. trigger toe deformity. - CORRECT ANSWER c. mallet toe deformity. Rationale: A flexion deformity of the DIP joint of the toe is called mallet toe deformity. Hammer toe deformity is a plantar flexion deformity of the PIP. Claw toe deformity combines a hammer toe deformity and dorsiflexion (hyperextension) deformity of the MTP joint. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 601 The nurse is discussing minimally invasive hip arthroplasty with a patient who has osteoarthritis. Which of the following statements by the patient should indicate to the nurse a need for further teaching about this procedure? a. "This surgery will cause less trauma to surrounding tissues." b. "One of the risks of this procedure is tibial nerve palsy." c. "I will be satisfied with the appearance of the smaller incision." d. "I expect a shorter stay in the hospital." - CORRECT ANSWER b. "One of the risks of this procedure is tibial nerve palsy." Rationale: One of the risks of minimally invasive hip surgery is sciatic or femoral nerve palsy. The other statements are true. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 555 A day after undergoing total hip arthroplasty, a patient falls on the way to the bathroom. Which of the following assessment findings should lead the nurse to suspect the patient had dislocated the hip? a. Shortened extremity in external rotation b. Shortened extremity in internal rotation c. Abducted extremity d. Adducted extremity - CORRECT ANSWER a. Shortened extremity in external rotation Rationale: Signs of dislocation included acute groin pain in the operative hip, a shortened extremity in external rotation, and the patient's complaint of a "popping" sensation at the hip. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 564 [Show Less]
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Orthopedic Practice Exam Multiple Choice 205 Questions with Verified Answers,100% CORRECT
Orthopedic Practice Exam Multiple Choice 205 Questions with Verified Answers Origin of bone is from: a. Ectoderm. b. Mesoderm. c. Endoderm. d. All o... [Show More] f the above. - CORRECT ANSWER b. Mesoderm Acute osteomyelitis is commonly caused by: a. Staph aureus. b. S. pyogenes. c. H. influenzae. d. Salmonella. - CORRECT ANSWER a. Staph aureus Acute osteomyelitis usually begins at: a. Epiphysis. b. Metaphysis. c. Diaphysis. d. Any of the above. - CORRECT ANSWER b. Metaphysis. What is not True of acute pyogenic osteomyelitis: a. Trauma is a predisposing factor. b. Common infecting agent is Staph. Aureus. c. Infection is usually blood borne. d. All are true. - CORRECT ANSWER d. All are true. What is not True of Brodie's abscess: a. A form of chronic osteomyelitis. b. Intermittent pain and swelling. c. Common to diaphysis. d. Excision is very often required. - CORRECT ANSWER c. Common to diaphysis. Tuberculosis of the spine most likely originates from: a. Intervertebral disk. b. Cancellous vertebral body. c. Ligamentous structures. d. Paravertebral soft tissue. - CORRECT ANSWER b. Cancellous vertebral body. In Pott's spine, the disease starts in the: a. Intervertebral disk. b. Anterior vertebral margin. c. Posterior vertebral margin. d. Paravertebral soft tissue. - CORRECT ANSWER b. Anterior vertebral margin. Melon seed bodies in joint fluid are characteristic of: a. Rheumatoid arthritis. b. Tuberculous arthritis. c. Septic arthritis. d. None of the above. - CORRECT ANSWER b. Tuberculous arthritis. The earliest sign of TB hip in X-ray is: a. Narrow joint space. b. Irregular moth eaten femoral head. c. Periarticular osteoporosis. d. Dislocation. - CORRECT ANSWER c. Periarticular osteoporosis. Healing of tuberculous arthritis can lead to: a. Calcification. b. Fibrous ankylosis. c. Boney ankylosis. d. None of the above. - CORRECT ANSWER b. Fibrous ankylosis. Osteoid osteoma originates from: a. Periosteum. b. Cortex. c. Medullary cavity. d. All of the above. - CORRECT ANSWER b. Cortex. Sun ray appearance of osteosarcoma is because of: a. Periosteal reaction. b. Osteonecrosis. c. Calcification along vessels. d. None of the above. - CORRECT ANSWER c. Calcification along vessels. Bone metastasis in male commonly arises from cancer of: a. Lung. b. Prostate. c. Kidney. d. Thyroid. - CORRECT ANSWER b. Prostate. Osteoblastic bone secondaries commonly arise from cancer of: a. Breast. b. Lung. c. Prostate. d. Adrenal - CORRECT ANSWER c. Prostate. Bone metastasis can be best evaluated by: a. X-ray. b. 99mTC bone scan. c. 111Indium scan. d. Calcium-alkaline phosphatase elevation - CORRECT ANSWER b. 99mTC bone scan. The synonym for Paget's disease is: a. Osteitis fibrosa. b. Osteitis proliferans. c. Osteitis deformans. d. None of the above - CORRECT ANSWER c. Osteitis deformans. Multiple myeloma tumor cells resemble: a. Granulocytes. b. Plasma cells. c. Lymphocytes. d. Chondrocytes - CORRECT ANSWER b. Plasma cells. An adamantinoma historically contains: a. Squamous cell rests. b. Pallisading cells. c. Cells resembling basilar cells. d. All of the above. - CORRECT ANSWER d. All of the above. Osteomalacia predominantly affects the: a. Spine. b. Pelvis. c. Skull bones. d. Metatarsals. - CORRECT ANSWER a. Spine. The enzyme found in osteoclasts but not in osteoblasts is: a. Alkaline phosphatase. b. Acid phosphatase. c. Elastase. d. Cytochrome oxidase. - CORRECT ANSWER b. Acid phosphatase. A Gigli saw is: a. An electrically driven circular bone saw. b. A pneumatically driven bone saw. c. A short straight bone saw. d. A long twisted wire bone saw. - CORRECT ANSWER d. A long twisted wire bone saw. Osteoclasis can be used to: a. Correct deformity of the tibia due to rickets. b. Curette an osteoclastoma. c. Correct deformity. d. Correct a ricketery rosary - CORRECT ANSWER a. Correct deformity of the tibia due to rickets. In Dupuytren's contracture which one of the following statements incorrect: a. It is a contracture of the flexor tendons to the ring and little fingers. b. It is a contracture of the palmar fascia. c. It may occur in the plantar fascia. d. There is an association with cirrhosis of the liver. - CORRECT ANSWER a. It is a contracture of the flexor tendons to the ring and little fingers. In an adult patient with a fracture of the shaft of the femur: a. No blood can be lost without obvious swelling. b. No blood can be lost without obvious bruising. c. Two liters of blood can be lost without obvious swelling or bruising. d. There is no possibility of death from hemorrhagic shock. - CORRECT ANSWER c. Two liters of blood can be lost without obvious swelling or bruising. A greenstick fracture: a. Occurs chiefly in the elderly. b. Does not occur in children. c. Is a spiral fracture- of tubular bone. d. Is a fracture where part of the cortex is intact and part is crumpled or cracked. - CORRECT ANSWER d. Is a fracture where part of the cortex is intact and part is crumpled or cracked. Spiral fracture is due to: a. Blunt trauma. b. Axial compression. c. Twist. d. Direct impact. - CORRECT ANSWER c. Twist. The single most important factor in fracture healing is: a. Correct bone alignment. b. Accurate reduction. c. Immobilization. d. Organization of clot. - CORRECT ANSWER c. Immobilization. Immobilization is not required in fracture involving: a. Scapula. b. Wings of ilium. c. Rib. d. Proximal humerus in elderly. e. All of the above. - CORRECT ANSWER e. All of the above. Internal reduction is considered in presence of: a. Reduction impossible to the achieved or maintained. b. Healing is expected to be delayed. c. Pathological fracture. d. All of the above. - CORRECT ANSWER d. All of the above. Which one of these statements is True in diagnosis of congenital hip dislocation in the first few days of life: a. It is impossible to diagnose it. b. The sign of telescoping is the best way of diagnosing it. c. It is possible to diagnose it by the Van Rosen/Barlow Test. d. The Trendelenberg test is the most useful. - CORRECT ANSWER c. It is possible to diagnose it by the Van Rosen/Barlow Test. Trendelenburg's sign is used in the diagnosis of: a. Varicose veins. b. Congenital dislocation of the hip. c. Carcinoma of the stomach. d. Pulmonary embolism. - CORRECT ANSWER b. Congenital dislocation of the hip. If an unstable hip is detected at birth the management policy is: a. Do nothing and re-examine every six months as only a minority of hips develop into a persistent dislocation. b. Use a splint to keep the hip joint in 45° flexion and adduction. c. Use a splint to keep the hip joint in 90° flexion and abduction. d. Advise operative stabilization. - CORRECT ANSWER c. Use a splint to keep the hip joint in 90° flexion and abduction. The essential examination of the hip in order to clinch the diagnosis of chronic slipped femoral epiphysis is: a. Measuring for shortening of the leg. b. Palpation of the femoral head. c. A-P plain x-ray view of the hip. d. Lateral x-ray view of the hip. - CORRECT ANSWER d. Lateral x-ray view of the hip. Shenton's line is a sign applicable to: a. The detection of shortening of the leg on physical examination. b. A radiological feature of the pelvis applied to the diagnosis of congenital dislocation of the hip. c. A radiological feature of the lungs applied to the diagnosis of pulmonary vein thrombosis. d. A physical sign applied to the diagnosis of adrenal deficiency. - CORRECT ANSWER b. A radiological feature of the pelvis applied to the diagnosis of congenital dislocation of the hip. Perthes' disease is common to age group of: a. 1-5. b. 6-10. c. 11-15. d. 16-20. - CORRECT ANSWER b. 6-10. The average duration of Perthes' disease is: a. 1-2 years. b. 3- 4 years. c. 1 month - 6 months. d. 6 months - 1 year. - CORRECT ANSWER a. 1-2 years. In Perthes' disease the hip movements restricted are: a. Abduction and external rotation. b. Abduction and internal rotation. c. Adduction and external rotation. d. All of the above. - CORRECT ANSWER b. Abduction and internal rotation. The sequestrum in X-ray appears: a. Dense. b. Light. c. Isodense as surrounding bone. d. Any of the above. - CORRECT ANSWER a. Dense. The term delayed union is employed when the fracture fails to unite within: a. 1.5 times the normal union time. b. Twice the normal union time. c. 2.5 times the normal union time. d. None of the above. - CORRECT ANSWER a. 1.5 times the normal union time. First bone to ossify in foetal life is: a. Femur. b. Tibia. c. Clavicle. d. Sternum. - CORRECT ANSWER c. Clavicle. What is True of clavicle fracture: a. Non-union is rare. b. Malunion is of no functional significance. c. Reduction even if achieved is difficult to maintain. d. All are true. - CORRECT ANSWER d. All are true. The joint most likely to have recurrent dislocation is: a. Ankle. b. Knee. c. Shoulder. d. Patella. - CORRECT ANSWER c. Shoulder. Anterior dislocation of shoulder may be complicated by: a. Brachial plexus injury. b. Tear of rotator cuff. c. Fracture head of humerus. d. All of the above. - CORRECT ANSWER d. All of the above. What is not True about fracture surgical neck of humerus: a. Occurs due to fall on outstretched hand. b. Common to children. c. Osteoporosis is an important risk factor. d. Non-union is uncommon. - CORRECT ANSWER b. Common to children. Radial nerve palsy may occur in fr of humerus involving: a. Surgical neck. b. Shaft. c. Lower end. d. At all of the above locations. - CORRECT ANSWER b. Shaft. The most common form of supracondylar fracture humerus in children is of which type: a. Flexion. b. Extension. c. Combination of A & B d. None of the above. - CORRECT ANSWER b. Extension. Myositis ossificans commonly occurs around: a. Shoulder. b. Elbow. c. Wrist. d. Knee. - CORRECT ANSWER b. Elbow. Volkman's ischemia commonly occurs following: a. Fracture shaft humerus. b. Supracondylar fracture. c. Colles' fracture. d. Monteggia fracture. - CORRECT ANSWER b. Supracondylar fracture. The single dependable sign of early Volkmann's contracture is: a. Cyanosis of fingers. b. Obliteration of radial pulse. c. Paralysis of flexor muscles of forearm. d. Pallor of fingers. e. Pain. - CORRECT ANSWER e. Pain. Cubitus valgus of elbow commonly follows fracture of: a. Lateral condyle. b. Medial condyle. c. Capitalum. d. Lower third of humerus. - CORRECT ANSWER a. Lateral condyle. Fracture involving which part of humerus can cause delayed ulnar palsy: a. Shaft. b. Surgical neck. c. Medial epicondyle. d. Lateral epieondyle. - CORRECT ANSWER d. Lateral epieondyle. The deformity of wrist in Colles' fracture is: a. Madelung's deformity. b. Dinner fork deformity. c. Buttonaire deformity. d. None of the above. - CORRECT ANSWER b. Dinner fork deformity. Colles' fracture can be complicated by late rupture of: a. Extensor pollicis longus. b. Abductor pollicis longus. c. Adductor pollicis longus. d. Flexor pollicis longus. - CORRECT ANSWER a. Extensor pollicis longus. What is True of Sudeck's atrophy of hand: a. Hand is painful and swollen. b. Osteoporosis of carpals and metacarpals. c. There is increased blood flow to para-articular areas. d. Cervical sympathectomy may be of help. e. All are true. - CORRECT ANSWER e. All are true. The carpal bone most commonly fractured is: a. Triquetrum. b. Hamate. c. Capitate. d. Scaphoid. - CORRECT ANSWER d. Scaphoid. Which nerve is compressed in carpal tunnel syndrome: a. Ulnar. b. Median. c. Radial. d. All of the above. - CORRECT ANSWER b. Median. The most common injury following pelvic fracture is of: a. Bladder. b. Urethra. c. Rectum. d. Vagina. - CORRECT ANSWER b. Urethra. Limb shortening with adduction and internal rotation occurs in which type of hip dislocation: a. Anterior. b. Posterior. c. Central. d. All of the above. - CORRECT ANSWER b. Posterior. Nelaton's line joins anterior superior iliac spine to: a. Xiphisternum. b. Pubic tubercle. c. Ischial tuberosity. d. Ischial spine. - CORRECT ANSWER c. Ischial tuberosity. Bryant's triangle helps to assess: a. Fracture neck of femur. b. Iliac crest displacement. c. Trochanteric displacement. d. None of the above. - CORRECT ANSWER c. Trochanteric displacement. Normal neck-shaft angle of femur is: a. 90°. b. 120°. c. 150°. d. 170°. - CORRECT ANSWER b. 120°. Fracture femoral neck can be diagnosed from: a. Limb shortening. b. External rotation. c. Abduction. d. A + B. - CORRECT ANSWER d. A + B. Which of the following is not True of intertrochanteric fracture of femur: a. Limb shortening. b. Malunion. c. Avascular necrosis of femoral head. d. Internal fixation is preferred. - CORRECT ANSWER c. Avascular necrosis of femoral head. Most common complication of fracture shaft femur is: a. Malunion. b. Nonunion. c. Knee stiffness. d. Fat embolism. - CORRECT ANSWER c. Knee stiffness. Spontaneous bleeding into joints in haemophilia occurs when factor VI level is less than: a. 50%. b. 25%. c. 10%. d. 5%. - CORRECT ANSWER d. 5%. Recurrence of Baker's cyst should make the surgeon suspect: a. Neoplastic change. b. Undiagnosed pathology within knee. c. Incomplete removal of the cyst. d. The communication to the joint is persisting. - CORRECT ANSWER b. Undiagnosed pathology within knee. Flexion of distal interphalangeal joint with fixing the proximal interphalangeal joint (PIP) tests: a. Flexor digitorum profundus. b. Flexor digitorum superficials. c. Palmaris longus. d. All of the above. - CORRECT ANSWER a. Flexor digitorum profundus. Stenosing tenovaginitis commonly affects: a. Abductor pollicis. b. Flexor pollicis longus. c. Opponens pollicis. d. All of the above. - CORRECT ANSWER a. Abductor pollicis. A sequestrum is a. a piece of soft dead tissue b. a piece of dead skin c. a dead tooth d. a piece of dead bone e. a retained swab - CORRECT ANSWER d. a piece of dead bone Union of a simple uncomplicated transverse fracture of the tibia in an adult normally takes a. 6 weeks b. 8 weeks c. 12 weeks d. 18 weeks e. 26 weeks - CORRECT ANSWER c. 12 weeks Fractures which do not impact include a. fracture of tile vault of the skull b. a compression fracture c. a simple fracture d. a transverse fracture of the patella e. fracture of the neck of the femur - CORRECT ANSWER d. a transverse fracture of the patella Colles' fracture is a. a fracture of the clavicle b. a fracture about the ankle joint c. common in elderly women d. a fracture of the head of the radius e. fracture of die scaphoid - CORRECT ANSWER c. common in elderly women Bennett's fracture is a. reversed Colles' fracture b. fracture of the scaphoid bone in the wrist c. fracture of the radial styloid (chauffeur's fracture) d. fracture dislocation of the first metacarpal e. cause of mallet finger - CORRECT ANSWER d. fracture dislocation of the first metacarpal Supracondylar fracture of the humerus in a child a. is due to a fall on the point of the elbow b. is usually compound c. requires admission of the patient after reduction d. requires immediate open reduction e. is a fracture dislocation - CORRECT ANSWER c. requires admission of the patient after reduction A fracture of the midshaft of the clavicle is best treated by a. clavicle rings b. a figure-of-eight bandage c. open reduction and plating d. an intramedullary nail e. a broad arm sling and analgesics - CORRECT ANSWER e. a broad arm sling and analgesics A Pott's fracture is a type of fracture of the a. wrist b. ankle c. spine d. foot e. skull - CORRECT ANSWER b. ankle Treatment of a severe comminuted fracture of the patella includes a. physiotherapy alone b. insertion of a figure-of-eight tension band c. patellectomy d. inserting screws or wire e. skin traction - CORRECT ANSWER c. patellectomy Malunion of a fracture is a. a fracture which unites in a position of deformity b. delayed union of a fracture c. non-union of a fracture d. followed by pseudoarthrosis - CORRECT ANSWER a. a fracture which unites in a position of deformity Volkmann's contracture a. affects the palmar fascia b. develops at the ankle in a case of chronic venous ulcer c. follows ischemia of the forearm muscles d. is due to excessive scarring of the skin of the axilla following a burn e. follows ulnar nerve palsy - CORRECT ANSWER c. follows ischemia of the forearm muscles A Brodie's abscess is a. a subperiosteal abscess due to infection of the mastoid air cells b. a type pf breast abscess c. a chronic abscess of the bone d. an abscess arising in the inguinal lymph nodes e. an abscess forming in an infected varicose vein - CORRECT ANSWER c. a chronic abscess of the bone The initial abnormality in primary osteoarthritis is a. in the synovial membrane b. sclerosis of cartilage c. fibrillation of cartilage d. an osteophyte e. a pannus - CORRECT ANSWER c. fibrillation of cartilage The initial abnormality in rheumatoid arthritis is a. fibrillation of cartilage b. sclerosis of cartilage c. in the synovial membrane d. in the capsule e. proliferation of bone - CORRECT ANSWER c. in the synovial membrane Pott's paraplegia is due to a. hematomyelia following trauma b. damage to the cord by a piece of bone when vertebrae collapse in tuberculosis of the spine c. tuberculous pus and angulation in tuberculosis of the spine d. damage to die corda equina after a fall e. fracture dislocation of cervical vertebrae - CORRECT ANSWER c. tuberculous pus and angulation in tuberculosis of the spine Still's disease is a. spastic diplegia b. rheumatoid arthritis in childhood c. rheumatoid arthritis in the elderly d. post-traumatic bone formation in the lateral ligament of the knee e. synonymous with Reiter's disease - CORRECT ANSWER b. rheumatoid arthritis in childhood A benign tumor forming osteoid is a. a synovioma b. a chondroma c. an osteoma d. a fibroma e. an adenoma - CORRECT ANSWER c. an osteoma Ewing's tumor affecting the humerus a. is a metastasis from carcinoma of the thyroid b. should be treated by immediate amputation c. looks like a cut onion on x-ray d. has a soap-bubble appearance on x-ray e. displays sun-ray spicules on x-ray - CORRECT ANSWER c. looks like a cut onion on x-ray Barlow's sign is related to the diagnosis of a. talipes equinus varus b. congenital dislocation of the hip c. ulnar nerve palsy d. genu varum e. fractured neck of femur - CORRECT ANSWER b. congenital dislocation of the hip The reported incidence of unstable hips per 1000 at birth is as much as a. 0.5 b. 2-5 c. 8-20 d. 25-30 e. 35-40 - CORRECT ANSWER c. 8-20 The word talipes refers to a. long feet with spidery toes b. knock knee c. flat feet d. hammer toes e. club feet - CORRECT ANSWER e. club feet Bone dysplasia is due strictly to a. faulty nutrition b. osteomyelitis c. parathyroid tumor d. trauma e. faulty development - CORRECT ANSWER e. faulty development Idiopathic scoliosis is a a. lateral curvature of the spine b. rotation of the spine c. lateral curvature with rotation of the spine d. flexion deformity of the spine e. congenital disease with hemivertebrae - CORRECT ANSWER c. lateral curvature with rotation of the spine A Milwaukee brace can be used in a. sacro-iliac strain b. derangement of the teeth c. a patient with an above knee amputation d. scoliosis e. fractured clavicle - CORRECT ANSWER d. scoliosis Legg-Calve-Perthe's disease is a. osteochondritis of the spine b. tuberculosis of the hip joint c. slipped proximal femoral epiphysis d. osteochondritis of the proximal femoral epiphysis e. osteomalacia - CORRECT ANSWER d. osteochondritis of the proximal femoral epiphysis The name associated with joint neuropathy is that of a. Cushing b. Osier c. Moon d. Charcot e. Addison - CORRECT ANSWER d. Charcot [Show Less]
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ONC Sports Injuries/Orthopedic Trauma Practice Exam 50 Questions with Verified Answers,100% CORRECT
ONC Sports Injuries/Orthopedic Trauma Practice Exam 50 Questions with Verified Answers A 48-year-old athlete sustains a ruptured Achilles tendon during ... [Show More] triathlon training. In discussing the personal and medical history with the patient, the nurse should recognize which of the following as a risk factor for this injury? a. Long distance swimming exercises b. Ongoing treatment for gout c. Attending a weekly spinning class d. Antihistamine use for seasonal allergies - CORRECT ANSWER Key: b Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 591 Rationale: Risk factors associated with Achilles tendon rupture include prior history of Achilles tendonitis, previous local cortisone injections, systemic inflammatory arthritis (gout or rheumatoid arthritis), and use of fluoroquinolone antibiotics. A patient with a ruptured Achilles tendon has undergone surgical repair and will require 6 weeks of cast immobilization. As part of the patient's discharge plan, it is MOST important for the nurse to assess the patient's ability to a. check pedal pulse daily. b. demonstrate plantar flexion technique. c. ambulate with an assistive device. d. perform the Thompson's test. - CORRECT ANSWER Key: c Rationale: Patient discharge education following Achilles tendon repair should focus on safe, non-weight-bearing ambulation with an assistive device. Casting will immobilize the foot, preventing pedal pulse assessment or plantar flexion. Thompson's test is a diagnostic assessment for tendon rupture. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 592 A healthy 47-year-old injured the right knee while skiing. A moderate partial tear of the anterior cruciate ligament (ACL) is confirmed with MRI. The patient has opted for non- surgical treatment. Which of the following should the nurse recognize as an appropriate intervention to manage the injury? a. Bracing and CT scan to evaluate for stress fracture b. Prescription for pregabalin (Lyrica) and rivaroxaban (Xarelto) c. Knee aspiration and prescription for diclofenac (Voltaren) d. Doppler ultrasound of lower leg and enoxaparin (Lovenox) - CORRECT ANSWER Key: c Rationale: Conservative treatment of moderate (Grade II) ACL injury includes aspiration, immobilization, cryotherapy, and NSAID treatment. Use of anticoagulants is contraindicated due to bleeding associated with the ACL injury. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 581 A softball pitcher underwent surgical repair of the right anterior cruciate ligament 3 days ago and is now being seen in the surgeon's office. Which of the following findings should the nurse identify as suspicious of infection? a. Swelling and warmth in the lateral knee b. Loss of appetite, constipation, and drowsiness c. Serosanguinous drainage after exercise d. Increased pain, new drainage, and low grade fever - CORRECT ANSWER Key: d Rationale: Signs and symptoms of surgical site infection include increased pain, drainage, and fever. Slight drainage, local warmth, and some discharge are not unexpected during the early postoperative course. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 585 An ice skater sustains a first-degree ankle sprain. Which of the following treatments should the nurse expect to be included in the patient's plan of care? a. Pneumatic compression boot b. Short leg fiberglass cast c. Elastic bandage and crutches d. Warm compresses and massage therapy - CORRECT ANSWER Key: c Rationale: A common treatment for first degree sprain includes the use of an elastic bandage and assisted ambulation to protect the joint while healing. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 420 A 12-year-old boy playing Pee Wee football is tackled and sustains a fracture to the left clavicle. The nurse should teach the patient and his parents about use of which of the following interventions as part of non-surgical treatment for this injury? a. Padded sling b. Soft abduction immobilizer c. Sandbag between scapulae d. Cervical collar - CORRECT ANSWER Key: a Rationale: For a child, non-surgical, conservative treatment includes application of a sling. A soft immobilizer may be used for an adult with this injury. A sandbag is used for adult injuries of the sternoclavicular joint. A cervical collar is not indicated for this injury. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 403, Table 15.9 A Little League baseball pitcher has been diagnosed with a partial tear of the ulnar collateral ligament (UCL) of the pitching arm. The nurse should reinforce instruction on which of the following as part of a conservative course of treatment for this patient? a. Muscle stretching exercise to loosen calcium deposits b. Daily long-toss routine to strengthen the supraspinatus muscle c. Shoulder immobilizer and application of cold therapy device d. Rest between games and a limited number of pitches per game - CORRECT ANSWER Key: d Rationale: Rest is critical, not only between games but also through limiting the number of pitches thrown per game and the number of games played. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 513 A marathon runner develops foot pain and is diagnosed with plantar fasciitis. Which of the following statements by the patient should the nurse recognize as correct concerning this condition? a. "Plantar fasciitis is chronic, and complete resolution takes several months to a year." b. "This condition is acute and complete resolution takes two to four weeks." c. "Plantar fasciitis is a non-treatable condition." d. "This condition requires both non-surgical and surgical treatment." - CORRECT ANSWER Key: a Rationale: Patient education for plantar fasciitis should include the pathology of the disease process to help the patient understand the chronic nature of the problem. Complete resolution can take several months to a year. Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 594 A rugby player is unable to rise and walk after experiencing an aggressive tackle. In the emergency department, the patient is diagnosed with a dislocated right hip. The nurse's assessment should be based on knowledge that which of the following structures can be affected by this injury? a. Peroneal nerve and popliteal artery b. Sciatic nerve and femoral head c. Tibial nerve and popliteal artery d. Distal femoral and proximal tibial condyles - CORRECT ANSWER Key: b Rationale: Hip dislocation is considered a medical emergency because delayed reduction can lead to a compromised sciatic nerve and permanent disability due to possible avascular necrosis of the femoral head. Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 418 A patient is taken to the emergency department after experiencing a knee injury during a weekend game of flag football. Magnetic resonance imaging (MRI) with MR gadolinium contrast is ordered. Which of the following should the nurse ensure is completed before the patient goes for the study? a. Assess C-reactive protein values. b. Cover jewelry piercings with 3-inch wide paper tape. c. Allow the patient nothing to eat for 3 hours before the procedure. d. Take a detailed health and renal history. - CORRECT ANSWER Key: d Rationale: MR gadolinium is contraindicated in patients with chronic renal disease because of the risk for nephrogenic systemic fibrosis. All jewelry and piercings with metal should be removed. C-reactive protein has no bearing on this study, and the patient does not need to be NPO. Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 72 A high school basketball player complains of severe left knee pain after falling during a game. A tear of the meniscus is suspected. The nurse should know which of the following maneuvers would be performed to assess for a meniscal tear? a. Anterior drawer test b. Bulge sign c. Homan's sign d. McMurray's sign - CORRECT ANSWER Key: d Rationale: Common assessment findings for meniscal tears of the knee include a positive McMurray's sign; additional findings may include edema, pain with movement, and the inability to extend the knee. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 416 A runner complains of pain over the calcaneus and is diagnosed with plantar fasciitis. Consistent with this diagnosis, the nurse identifies which of the following? a. "Start-up" pain after rest b. Pain along the posterior tibial tendon c. Pain with passive plantar flexion d. Improved pain by nighttime - CORRECT ANSWER Key: a Rationale: Pain with plantar fasciitis is often worse first thing in the morning or when taking the first few steps after rest ("start-up" pain). Pain also occurs with passive dorsiflexion and generally worsens by nighttime. Pain along the posterior tibial tendon is associated with pes planus (flatfoot). Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 594 A professional football player undergoes reconstruction of the left anterior cruciate ligament. He identifies his current pain as 4 on 0-10 intensity scale and has full movement and sensation after epidural anesthesia. Six hours after surgery, the patient is unable to void. Which of the following should the nurse identify as a risk factor for postoperative urinary retention for this patient? a. Prior history of urinary tract infection b. Epidural anesthesia and 800 cc intravenous fluids c. Dehydration and electrolyte imbalance after being NPO d. Slow progression to regular diet in PACU - CORRECT ANSWER Key: b Rationale: Epidural anesthesia and perioperative fluids of 750 cc or more are risk factors for postoperative urinary retention. Other options are not related. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 594 A minor league baseball pitcher undergoes surgical rotator cuff repair. As the nurse prepares the patient for discharge, which statement by the patient should the nurse recognize as indicating he understands the postoperative treatment plan? a. "I'll wear a sling and limit activities for a few months." b. "I'll remove my sling at night to help get a good night's sleep." c. "I will be most comfortable if I lie flat in bed." d. "I expect to be pitching again in 4 to 6 weeks." - CORRECT ANSWER Key: a Rationale: Following rotator cuff repair, a sling or abduction pillow will need to be worn postoperatively. Activities will be restricted; athletes are not allowed to return to sports for up to 6 months. Lying flat is usually more uncomfortable so a recliner is often preferred. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 481 A tennis player is diagnosed with lateral epicondylitis of the right arm. A tennis elbow band is recommended, and the patient asks the nurse about the benefits of this treatment. The nurse's response should be based on knowledge that the tennis elbow band a. reduces risk of invasive iontophoresis therapy. b. reduces inflammation and pain of extensor tendons. c. stabilizes wrist flexor and extension mechanism. d. stimulates transcutaneous nerve conduction. - CORRECT ANSWER Key: b Rationale: Use of a tennis elbow band will displace the tissues on the proximal forearm, thus reducing the inflammation and pain along the extensor tendons. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 512 A gymnast diagnosed with chondromalacia patella is advised to avoid activities that worsen the pain. The nurse also should reinforce the need for the patient to perform which of the following types of exercise? a. Gluteal sets b. Prone leg lifts c. Quadriceps strengthening d. Iliotibial band stretching - CORRECT ANSWER Key: c Rationale: Quadriceps muscle strengthening is the single most important objective of therapy for a patient with chondromalacia. Other listed exercises will not affect quadriceps strength. For example, prone leg lifts strengthen the hip extensor muscles. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 578 During a recent competition, a weight lifter says he felt a sudden burning pain in his lower back that has since resolved to tenderness. When seen in the emergency department, he is diagnosed with a second-degree muscle strain. Although he is advised to rest the injured area, he insists he wants to return to competition in the morning. Which of the following statements by the nurse should be appropriate in this situation? a. "If you wear a weightlifting belt, you should avoid additional injury." b. "Keep the ice pack on until you are called to compete tomorrow." c. "You will probably be OK to compete if you feel better in the morning." d. "If this injury is not properly treated, a more dramatic injury could occur." - CORRECT ANSWER Key: d Rationale: Immobilization of the injured area is critical. If it is not treated properly, a more dramatic injury can occur. The patient should not compete again so quickly after experiencing a second-degree muscle strain. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 419 A high school football player experiences a right shoulder dislocation during practice and is taken to the emergency department. The nurse's assessment should be based on awareness of the risk for injury to the a. median nerve. b. axillary nerve. c. ulnar nerve. d. brachial nerve. - CORRECT ANSWER Key: d Rationale: The brachial plexus and axillary artery are at risk for injury with shoulder dislocation. Median nerve injury is possible with wrist dislocation, and ulnar nerve and brachial artery injuries are possible with elbow dislocation. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 418 A professional hockey player diagnosed with femoroacetabular impingement (FAI) has had no success with conservative treatment. Surgery is planned. The patient asks the nurse about the purpose of the arthroscopy. The nurse's response should be based on knowledge that the goal of surgery for this condition is to a. correct deformity of the femoral head. b. reshape the greater trochanter of the femur. c. remove infected bursae. d. replace articular cartilage. - CORRECT ANSWER Key: a Rationale: Hip arthroscopy involves reshaping the femoral head or acetabulum to correct the deformity and improve range of motion. Reference: Hessel, J.A. (2014). Femoroacetabular impingement in athletes. Orthopaedic Nursing, 33(3), 137-141. A high school soccer player complains of acute calf pain within 10 minutes after the start of each game. After assessment of compartment pressures by the orthopaedic physician, the patient is diagnosed with exercise-induced chronic compartment syndrome. The nurse should provide education to prepare the patient for which of the following procedures? a. Arthroscopy b. Ligament reconstruction c. Fasciotomy d. Tendon release - CORRECT ANSWER Key: c Rationale: Although not currently emergent, the patient's condition could worsen if compartment pressures are unrelieved. An elective fasciotomy is indicated to open the affected muscle compartments. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 204 An elite long-distance runner comes to the clinic with complaint of pain and tenderness over the anteromedial knee. After a diagnosis of pes anserinus bursitis, the patient is instructed to rest the knee and avoid activities that cause pain. The nurse should recognize the next step in rehabilitation will be a stretching and conditioning program that includes which of the following? a. Deep knee bends b. Plyometrics c. Lunges d. Quadriceps sets - CORRECT ANSWER Key: d Rationale: The strengthening and conditioning program will begin with isometric exercises (e.g., quadriceps sets) and electrical muscle stimulation, with resistive exercises later incorporated as the patient's symptoms allow. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 579 A basketball player sprains her right ankle in landing after a rebound. The nurse assists in the physical examination of the patient. The nurse should recognize which of the following maneuvers will be used to assess ligament stability? a. Lachman test b. Anterior drawer test c. Abduction stress test d. Clunk test - CORRECT ANSWER Key: b Rationale: The anterior drawer test is performed to assess the stability of the anterior talofibular ligament at the ankle. Lachman test is used to assess damage to the anterior cruciate ligament. The abduction stress test evaluates the medial collateral ligament in the knee. The posterior clunk test is used to assess shoulder instability. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 589 A golfer for the local college team is diagnosed with medial epicondylitis. Which of the following statements by the nurse should represent appropriate self-care instructions for this patient? a. "Apply ice for 20 minutes every 2 hours while awake." b. "Take the prescribed opioid analgesic every 4 hours." c. "Wear the ordered air splint when you go to bed." d. "Begin isotonic exercises immediately as first-line treatment." - CORRECT ANSWER Key: a Rationale: Ice can be applied for 20 minutes at a time every 2 hours, using a cross-friction massage technique. NSAIDs will be given as analgesics. An air splint is not indicated for this condition. The affected area should be rested; avoidance of repetitive activity is first-line treatment. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 512 A high school cheerleader falls during performance of a pyramid stunt at practice. Complaining of severe neck pain, she is taken to the emergency department. CT scan confirms stable fractures at cervical vertebrae 5 and 6, and the patient is placed in a halo vest. Which of the following statements by the nurse should represent appropriate instructions for this patient and her parents? a. "Adjust the vest as needed for comfort." b. "Clean pin sites with full-strength hydrogen peroxide." c. "Get up with a physical therapist when you are ready to ambulate." d. "Maintain bedrest for the first week after hospital discharge." - CORRECT ANSWER Key: c Rationale: PT is helpful with early mobilization because the weight of the halo vest and loss of motion in the cervical spine can affect safe ambulation. Pin sites are typically cleaned with chlorhexidine, although some physicians will order half-strength hydrogen peroxide. Bedrest is not indicated for this injury. The vest should be adjusted only by a health care provider. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 470 A professional golfer is diagnosed with a torn rotator cuff and conservative treatment is discussed. Which of the following statements by the nurse should be appropriate for the patient's self-care instructions? a. "Physical therapy will be ordered if your condition does not improve." b. "Avoid any activity that reproduces your symptoms." c. "Occupational therapy will be ordered to help you with dressing." d. "Take your oral steroid medications as prescribed." - CORRECT ANSWER Key: b Rationale: As part of conservative treatment for rotator cuff injury, the patient should avoid any activity that causes pain or reproduces symptoms. Physical therapy should be attempted in all patients with rotator cuff tears. Occupational therapy is not part of conservative treatment but may be ordered after surgery. Intraarticular steroids may be indicated but oral steroids are not ordered for patients with rotator cuff injury. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 481 An intoxicated college student punches a wall and sustains a closed boxer's fracture of the right hand. An ulnar gutter splint is applied. Which of the following should the nurse include in discharge teaching for this patient? a. Maintenance of absorbent padding between the fingers b. Splint removal for bathing c. Use of opioids every 4 hours for the first 24 hours d. Application of steroid patches to decrease swelling - CORRECT ANSWER Key: a Rationale: Absorbent padding should be maintained between the fingers to prevent maceration due to sweating. The splint is not to be removed for bathing until directed by the physician. Because the patient was intoxicated, opioid analgesics need to be used sparingly for the first 24 hours after injury. Steroid patches are not indicated for this injury. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 534 A postmenopausal female slips on the ice outside her home and falls on her outstretched right hand. X-ray confirms a Colles' fracture, which is treated with external fixation. Based on knowledge of risks associated with this type of fracture, the nurse should be alert to deficits of which of the following nerves? a. Psoas b. Axillary c. Ulnar d. Median - CORRECT ANSWER Key: d Rationale: Damage to the median nerve may occur because of its proximity to the fracture site in this type of injury. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 544 patient diagnosed with hallux valgus asks the nurse about appropriate foot wear. Which of the following should the nurse recommend? a. Wide shoe with extra depth in the toe box b. Wide, firm leather shoe c. Compression stockings with medium width athletic shoe d. Walking boot during the day - CORRECT ANSWER Key: a Rationale: Nonsurgical treatment includes wearing proper footwear, which should be wide, low- heeled, have an extra depth toe box, and be made of soft leather. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 598 In preparing to discharge a patient diagnosed with a grade 3 ankle sprain, the urgent care nurse should reinforce which of the following instructions regarding the patient's weight-bearing status? a. Weight bearing as tolerated b. Protected weight bearing c. Full weight bearing d. Non weight bearing - CORRECT ANSWER Key: b Rationale: Treatment for a grade 3 ankle sprain includes protected weight bearing (e.g., with a boot). Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 588 A 29-year-old female is diagnosed with DeQuervain's tenosynovitis. The patient asks the nurse how this condition develops. After reviewing the patient's personal and medical history, the nurse should suspect the injury is MOST likely related to a. frozen shoulder after her surgery. b. a recent ankle sprain. c. prolonged marathon training. d. repetitive lifting of her infant. - CORRECT ANSWER Key: d Rationale: DeQuervain's is a painful tenosynovitis of the wrist. It is often called "mother's thumb" due to repetitive lifting and carrying of an infant. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 540 A patient is diagnosed with a scaphoid fracture after falling in an icy parking lot. After a cast is placed for immobilization, the patient asks the nurse how long he will have to wear the cast. Which of the following should represent the nurse's correct response concerning the average time for immobilization? a. 2 weeks b. 3 to 4 weeks c. 30 days d. 6 to 8 weeks - CORRECT ANSWER Key: d Rationale: For a scaphoid fracture, a thumb spica short or long arm cast will be placed. Immobilization will be for 6-8 weeks. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 543 A 32-year-old male patient experienced traumatic amputation below the right knee in a motor vehicle crash. During the patient's recovery, the nurse should encourage him to stop smoking and limit coffee intake because nicotine and caffeine a. cause vasoconstriction and delay healing. b. cause vasodilation and increase bleeding. c. decrease blood pressure and increase fall risk. d. decrease balance and reduce muscle tone. - CORRECT ANSWER Key: a Rationale: Both nicotine and caffeine cause vasoconstriction (narrowing of blood vessels) that could delay healing and increase risk for infection. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 413 An elevator mechanic and father of three children suffers multiple fractures of both upper and lower extremities in a work-related accident. What intervention by the nurse should demonstrate greatest awareness of the patient's psychosocial needs following this injury? a. Provide privacy and minimize patient contact. b. Request career counseling resources from the social worker. c. Promote recovery by strict adherence to the visiting policy. d. Spend time with the patient and involve the interprofessional team. - CORRECT ANSWER Key: d Rationale: Nursing interventions for patients and families in crisis include provision of information, compassion, and hope. An adequate amount of time spent at the bedside can be reassuring. Clinical consults and referral to clergy, social work, and psychologists promote a larger support network. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 396 A construction worker presents with a suspected torn rotator cuff. Through shared decision making, nonsurgical management is identified as the treatment plan. Which of the following should the nurse include in patient teaching? a. Follow up with a physical therapist and avoid aggravating activities. b. Encourage a second opinion for surgical repair. c. Continue with work activity even if reproduces symptoms. d. Follow up with pain specialist for an interscalene nerve block. - CORRECT ANSWER Key: a Rationale: Nonsurgical/conservative management of a torn rotator cuff includes physical therapy, analgesia, rest, and avoidance of aggravating activities. Also, subacromial corticosteroid injections can be used for treatment. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 481 A patient who uses a commercial ironing press for 35 hours a week has been diagnosed with carpal tunnel syndrome. The patient asks the nurse how this causes the numbness and pain he is experiencing. The nurse's response should be based on the knowledge that an enlarged ligament compresses the a. median nerve. b. ulnar nerve. c. radial nerve. d. peroneal nerve. - CORRECT ANSWER Key: a Rationale: Carpal tunnel syndrome is caused by entrapment of the median nerve by the enlarged transverse carpal ligament. Common symptoms include numbness and tingling in the thumb, index finger, and middle and radial side of the ring finger. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 546 After tripping over a retaining wall in the garden and falling on an extended elbow, a female patient is diagnosed with a supracondylar fracture. The nurse should conduct a detailed neurovascular assessment based on awareness that displacement with this injury may cause a. saphenous nerve weakness. b. compartment syndrome. c. delayed union and numbness. d. ulnar deviation and hemarthrosis. - CORRECT ANSWER Key: b Rationale: For a patient with a supracondylar fracture, the nurse's assessment should include a neurovascular assessment because displacement may cause compartment syndrome. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 404 A patient admitted with a hip fracture cannot be sent to surgery for fracture repair until medical clearance can be provided. When the nurse sets up Buck's traction per order, the patient's family asks why the boot is needed. The nurse's answer should be based on knowledge that Buck's traction a. realigns fracture fragments. b. relieves pressure over the greater trochanter. c. decreases muscle spasms. d. restores anatomic alignment of the leg. - CORRECT ANSWER Key: c Rationale: Buck's traction is a type of skin traction applied at low weights to decrease spasms of muscles surrounding the fracture. The leg is not manipulated when Buck's traction is applied, so there is no intent to realign fracture fragments or restore anatomic alignment of the leg. The patient may experience pressure over the greater trochanter as a symptom of the fracture. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 551 Following open reduction and internal fixation (ORIF) of a right hip fracture, a patient receives orders to begin anticoagulation therapy. The nurse should recognize the need to review prothrombin time results for which of the following medications? a. Fondaparinux (Arixtra) b. Enoxaparin (Lovenox) c. Rivaroxaban (Xarelto) d. Warfarin (Coumadin) - CORRECT ANSWER Key: d Warfarin is the only listed medication requiring careful monitoring of prothrombin time to ensure the drug level is therapeutic. The other medications do not require this monitoring. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 202 A patient had a long leg cast applied for a tibial plateau fracture. Within a short time after arrival on the orthopaedic unit, the patient begins to complain of unrelenting pain. The nurse should contact the physician for an order to bivalve the cast based on the patient's recognized risk of developing a. venous thromboembolism. b. compartment syndrome. c. fat embolism syndrome. d. deep vein thrombosis. - CORRECT ANSWER Key: b Rationale: Unrelieved pain, pain with passive stretch, or pain disproportionate to the injury is an early sign of compartment syndrome. Swelling and/or unrelieved external pressure (as from a cast) can contribute to its development. Pressure must be relieved by splitting the cast. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 205 A 10-year-old child is diagnosed with osteochondritis dissecans. The child's parents are advised to modify the child's activity. The nurse should provide instruction on which of the following additional strategies for conservative management? a. Bracing b. Non-weight-bearing c. Knee manipulation d. Heat therapy - CORRECT ANSWER Key: a Rationale: Conservative management includes modified activity coupled with immobilization via casting, bracing, or knee splinting. Partial weight-bearing should be maintained with the knee in slight flexion during ambulation. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 583 Following a motor vehicle crash, a patient is hospitalized with a nondisplaced pelvic fracture. Which of the following activity should the nurse recognize as MOST likely for this patient? a. Strict bedrest b. Toe-touch weight-bearing c. Ambulation with rolling walker d. Bed-to-chair transfers only - CORRECT ANSWER Key: c Rationale: A patient with a nondisplaced fracture may be allowed protected weight-bearing with the use of crutches, walker, and/or wheelchair. Strict bedrest is unlikely. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 411 Following a fall during mountain climbing, a patient is sent by helicopter to the nearest trauma center. Diagnosed with multiple fractures of the right femoral shaft and tibia, the patient is to be placed in skeletal traction. Which of the following weights should the nurse expect to maintain on the patient's traction? a. 2 pounds b. 5 pounds c. 10 pounds d. 20 pounds - CORRECT ANSWER Key: d Rationale: Skeletal traction applies force directly to the bone and allows the use of 20-30 pounds of force. Skin traction (e.g., Buck's traction) is typically limited to 5-7 pounds. Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 112 A nurse is working with a student in caring for a patient in a long-arm cast after diagnosis with multiple forearm and humeral fractures. The student asks about the surgeon's choice of Plaster of Paris casting material. Which of the following should be the nurse's correct response? a. "Plaster casts maintain their integrity when exposed to water." b. "The surgeon prefers plaster for its durability." c. "Plaster casts dry more quickly than other materials." d. "The surgeon uses plaster for multiple cast changes." - CORRECT ANSWER Rationale: Plaster cast may be used for severely displaced fractures or when multiple cast changes are expected. Synthetic cast materials dry more quickly than Plaster of Paris, and synthetic casts maintain their integrity when exposed to water. Synthetic cast materials are also more durable than Plaster of Paris. Reference: Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 115 A 4-year-old child is diagnosed with a pathologic tibial fracture. Based on the child's health history, the nurse should recognize the fracture is MOST likely due to osteopenia associated with which of the following chronic medical conditions? a. Diabetes mellitus b. Cerebral palsy c. Juvenile arthritis d. Myelomeningocele - CORRECT ANSWER Key: b Rationale: Pathologic fractures often occur through osteopenic bone in children with neuromuscular disorders, such as cerebral palsy, spina bifida, osteogenesis imperfecta, and dysplasia. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 308 Physical abuse is suspected to be a factor in the diagnosed injuries of a 4-year-old admitted to the emergency department. The nurse should recognize which of the following types of fracture as the MOST likely result of abuse in a child of this age? a. Physeal fracture b. Hand fracture c. Tibial fracture d. Diaphyseal fracture - CORRECT ANSWER Key: a Physeal (growth plate) fractures in young children are most suggestive of abuse. Lower extremity fractures (to include tibial and diaphyseal fractures) in a non- ambulatory child may suggest physical abuse. Hand and foot fractures in infants and toddlers also may suggest abuse. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 311 A patient who works for a moving company is diagnosed with a herniated lumbar disk. Conservative treatment is initiated and the nurse provides patient education about this condition. Which of the following statements should be MOST important for the nurse to include? a. "Apply ice packs and elevate your leg if you have sudden swelling and warmth in one of your legs." b. "I will refer you to a vocational counselor to discuss new career opportunities." c. "I think it might be beneficial for you to discuss your feelings with a psychologist." d. "Contact your doctor at once if you experience any progressive weakness in your legs." - CORRECT ANSWER Key: d Rationale: Progressive neurological weakness, increased pain, incontinence of bowel and bladder, perineal and perianal numbness, and loss of rectal sphincter tone are characteristics of cauda equina syndrome. This is an emergency; the patient should be evaluated within 2-4 hours to prevent permanent nerve damage. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 455 A patient with a femoral neck fracture undergoes hemiarthroplasty. Among the strategies to decrease the risk of postoperative venous thromboembolism, the nurse should reinforce instruction on performing which of the following exercises? a. Straight leg raises b. Gluteal sets c. Ankle pumps d. Quadriceps sets - CORRECT ANSWER Key: c Rationale: Ankle pumps cause contraction of the calf muscle, which encourages blood return to the heart. If blood is not pooling in the lower extremities, clots are less likely to develop. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 202 A farmer is brought to the emergency department after three fingers on his right hand are amputated in a machine. Paramedics have the amputated fingers, and they tell the nurse the patient was adamant about having the fingers re-implanted. How should the nurse maintain the amputated fingers to provide the best opportunity for re-implantation? a. Place them in a sterile bag on dry ice. b. Wrap them in sterile gauze and place in a plastic bag. c. Keep them directly on fresh ice. d. Place them in a sterile container and cover with saline. - CORRECT ANSWER Key: b Rationale: On scene, amputated parts should be wrapped in gauze (either dry or moistened with saline) and placed in a plastic bag or container. The bag should not be placed directly on ice, and dry ice should never be used; the parts cannot be allowed to freeze. The nurse should maintain the fingers in the same condition. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 412 A patient whose legs had been trapped under heavy equipment for several hours is brought to the emergency department. Because of the nature of the crush injury, the nurse is concerned about development of rhabdomyolysis. Which of the following should the nurse assess carefully to determine if this complication is developing? a. Liver function tests b. Fingerstick glucose c. C-reactive protein d. Urine output - CORRECT ANSWER Key: d Rhabdomyolysis is a result of muscle destruction from the primary crush injury, which causes a release of myoglobin and potassium that can lead to renal dysfunction and failure. Identification of this condition is based on assessment of urine output and color, along with serial blood counts. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 415 After 3 weeks in training, an 18-year-old military recruit is diagnosed with a stress fracture of the talus in his left foot. A fracture shoe is prescribed and the patient is placed on protected weight-bearing with crutches. The recruit asks the nurse how long the activity restrictions will be necessary. Which of the following should represent the nurse's correct response? a. "Activity restrictions typically last 2-4 weeks." b. "The bone should be healed in about 6-8 weeks." c. "Stop using crutches in a week, but continue to use the fracture shoe." d. "Continue protected weight-bearing for at least 4 months." - CORRECT ANSWER Key: b Rationale: Treatment for all fractures of the foot start with resting the bone, usually 6-8 weeks. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 593 [Show Less]
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ONCB Metabolic/Inflammatory/Tumors Practice Exam 50 Questions with Verified Answers,100% CORRECT
ONCB Metabolic/Inflammatory/Tumors Practice Exam 50 Questions with Verified Answers Category: Metabolic bone disorders A nurse is caring for a 58-y... [Show More] ear-old female patient. Which of the following should the nurse recognize as a risk factor for development of osteomalacia in this patient? a. Excessive sunlight exposure b. Gastric bypass surgery c. Unmanaged hypertension d. Sickle cell disease - CORRECT ANSWER b. Gastric bypass surgery Rationale: Osteomalacia primarily results from conditions related to vitamin D disturbances, including malabsorption syndromes that result from procedures such as gastric bypass surgery. It can also occur from inadequate sunlight exposure. It is not related to hypertension or sickle cell disease. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383 Category: Metabolic bone disorders In providing education for a child with hypoparathyroidism, a nurse should identify the risk for which of the following complications? a. Diplopia b. Acute dystonia c. Tardive dyskinesia d. Dental abnormalities - CORRECT ANSWER d. Dental abnormalities Rationale: Dental abnormalities such as caries, enamel hypoplasia, pitting, and delayed eruption of teeth can occur as complications of hypoparathyroidism. The other listed conditions are not associated with hypoparathyroidism. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 389 Category: Metabolic bone disorders A patient is suspected to have Paget's disease. The patient asks the nurse how this diagnosis will be confirmed. The nurse replies, "This diagnosis is confirmed with a. radiological findings." b. urine testing." c. blood testing." d. MRI findings." - CORRECT ANSWER a. radiologic findings Rationale: Primary diagnosis of Paget's disease is confirmed with radiological findings. Early phases are marked by the presence of osteolytic lesions, mostly in the skull and long bones. Adjoining overgrowth of bone appears coarse and irregular in shape. After symptoms are identified, x-rays show a characteristic mosaic pattern. Radioactive bone scan can assist with diagnosis. Although urine and blood testing are performed, results do not provide a definitive diagnosis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 390 Category: Metabolic bone disorders A nurse is providing a class at the senior center about risk factors for osteoporosis. Which of the following should the nurse include in the discussion? a. Increased body weight b. Decreased protein intake c. Caffeine intake d. Use of nonsteroidal anti-inflammatory drugs - CORRECT ANSWER c. caffeine intake Rationale: Intake of caffeine and alcohol increases the risk of osteoporosis. Use of certain drugs, such as corticosteroids, heparin, anticonvulsants, and immunosuppressants, also increases disease risk. A high-protein diet and small body/low weight are additional risk factors. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379 Category: Metabolic bone disorders When reviewing laboratory results for a patient with hypoparathyroidism, a nurse should expect which of the following? a. Increased serum phosphate b. Increased serum calcium c. Decreased serum magnesium d. Decreased serum chloride - CORRECT ANSWER a. Increased serum phosphate Rationale: Serum phosphate is increased, typically greater than 5.4 mg/dL. Serum calcium is decreased, while serum chloride and serum magnesium are both increased. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 389 Category: Metabolic bone disorders A 65-year-old Caucasian female sustained a right wrist fracture from a fall in her garden. During her follow-up appointment in the orthopaedic clinic, she tells the nurse, "I am glad I don't have osteoporosis like my neighbor." What should be the nurse's MOST appropriate response? a. "You are so lucky it was your wrist and not your hip." b. "When is the last time you had a bone mineral density test?" c. "You should be sure the paths are clear in your garden." d. "Because you are active outdoors, you are not at risk for osteoporosis." - CORRECT ANSWER b. "When is the last time you had a bone mineral density test?" Rationale: Wrist fractures are a type of fragility fracture experienced as a complication of osteoporosis. Age, sex, and ethnicity place this patient at risk for this disease. Bone mineral density testing is used to evaluate for the presence of osteoporosis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 379-380 Category: Metabolic bone disorders A 2-year-old child has been diagnosed with rickets. When talking with the child's parents, the nurse should tell them the disease can affect all bones but the most common deformities are located in the a. spine and lower extremities. b. feet and hands. c. upper extremities. d. pelvic girdle. - CORRECT ANSWER a. spine and lower extremities Rationale: The most common deformities occur in the spine and long bones of the lower extremities, possibly leading to deformity and the need for surgical intervention. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 385 Category: Metabolic bone disorders The nurse is providing education on musculoskeletal conditions at a community center. The nurse should include discussion of the critical need for adequate vitamin D intake to decrease risk for: a. Paget's disease. b. osteomyelitis. c. osteomalacia. d. systemic sclerosis. - CORRECT ANSWER c. osteomalacia Rationale: Osteomalacia is often due to inadequate intake of vitamin D. It can also be related to abnormal metabolism of vitamin D due to hepatic or renal disease and the side effect of medications used to treat these diseases. Vitamin D is not a factor in the other listed diseases. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383 Category: Metabolic bone disorders In assessing a patient, which of the following findings should the nurse identify as suggestive of a diagnosis of hypoparathyroidism? a. Newly negative Trousseau's phenomenon b. Hypoactive deep tendon reflexes (DTRs) c. Bradycardia d. Newly positive Chvostek's sign - CORRECT ANSWER d. Newly positive Chvostek's sign Rationale: Positive Chvostek's sign is ipsilateral contraction of the facial muscles elicited by tapping the facial nerve just anterior to the ear. This sign cannot be considered diagnostic of hypoparathyroidism unless it was known to be previously absent. Other findings may include positive Trousseau's phenomenon and hyperactive DTRs. Tachycardia can occur if hypoparathyroidism is left untreated. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 389 Category: Metabolic bone disorders The nurse is providing education about Paget's disease for a newly diagnosed patient and his family. Which of the following should the nurse identify as a possible result of this disease? a. Hearing loss b. Hyperkinetic gait c. Increased gastric motility d. Femoral neck deformity - CORRECT ANSWER a. Hearing loss Rationale: Bone deformities of the skull are associated with Paget's disease. They can cause pressure on cranial nerves, leading to hearing loss, vertigo, and vision problems. The patient with Paget's disease may develop a waddling gait; a hyperkinetic gait is associated with forms of chorea (e.g., Huntington's disease). Increased gastric motility is associated with hypoparathyroidism, while femoral neck deformity is associated with osteomalacia. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 390 Category: Metabolic bone disorders The nurse is caring for a patient with primary hyperparathyroidism. Which of the following should the nurse expect as a symptom of this patient's hypercalcemia? a. Diarrhea b. Nausea c. Dry, flaky skin d. Brittle nails - CORRECT ANSWER b. Nausea Rationale: Hypercalcemia may result in nausea, vomiting, and constipation because of the diminished contractility of the muscular walls of the GI tract. Dry, flaky skin and brittle nails are symptoms of hypocalcemia. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 387 Category: Metabolic bone disorders The nurse is providing staff education about Paget's disease. The nurse should identify the early osteolytic lesions of Paget's disease as most commonly affecting the a. skull and long bones. b. long bones and hands. c. hands and vertebrae. d. vertebrae and skull. - CORRECT ANSWER a. skull and long bones Rationale: Characteristic lesions of early Paget's disease affect the skull and long bones most commonly. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 390 Category: Metabolic bone disorders The nurse is speaking with female athletes at the local high school. To decrease their risk of developing osteoporosis, the nurse should recommend which of the following? a. Calcium intake of at least 1800 mg per day b. A regular regimen of weight-bearing exercise c. Decreased caloric intake to maintain ideal body weight d. Involvement in tai chi or yoga for flexibility - CORRECT ANSWER b. A regular regimen of weight-bearing exercise Rationale: An appropriate, regular weight-bearing exercise regimen will decrease risk of osteoporosis. Recommended daily calcium intake for adolescent females is 1300 mg. A balanced diet is needed, with appropriate caloric intake based on activity level. Flexibility exercises will not have a positive effect on bone mineral density. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379, 381 Category: Metabolic bone disorders A 2-month-old child develops rickets. The child's mother asks why her child developed rickets. The nurse's response should be based on understanding of the impact of which of the following? a. Parents' vegetarian diet b. Child's poor vitamin C intake c. Child's recent treatment with corticosteroids d. Parents' residence in southern U.S. - CORRECT ANSWER a. Patients' vegetarian diet Rationale: Rickets results from deficient bone mineralization due to inadequate calcium deposition. This is related also to a vitamin D deficiency. Children of vegetarian parents, or of parents who avoid milk products, are at increased risk of developing rickets. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 385 Category: Metabolic bone disorders In discussing risk factors for osteoporosis with a group of women at a community center, a nurse should identify which of the following as most likely contributing to the development of the disease? a. Hypertension b. Hyperlipidemia c. Anorexia nervosa d. Sleep apnea - CORRECT ANSWER c. Anorexia nervosa Rationale: Anorexia nervosa creates a nutritional imbalance, affecting the body's abilities to build and maintain bone quality and strength. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379 Category: Metabolic bone disorders A patient recently diagnosed with osteoporosis is prescribed alendronate (Fosamax®). Before the patient starts taking the medication, the nurse should encourage the patient to complete a. cardiac evaluation. b. renal function testing. c. bone densitometry. d. dental evaluation. - CORRECT ANSWER d. dental evaluation Rationale: Incidence of osteonecrosis of the jaw (ONJ) has increased since patients began taking bisphosphonates such as alendronate in 2003. Extensive dental evaluation is now recommended before initiation of bisphosphonate therapy. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 381 Category: Metabolic bone disorders A patient diagnosed with osteomalacia is scheduled for assessment of vitamin D values in the blood. The nurse should know vitamin D is most effectively measured in which of the following months? a. June b. July c. August d. September - CORRECT ANSWER d. September Rationale: Vitamin D levels are most effectively measured from September through March due to the long-term effect of fat-soluble vitamin D properties of both dietary and vitamin D synthesis in the skin during sunlight exposure. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383 Category: Metabolic bone disorders An 80-year-old patient has been diagnosed with osteoporosis. The patient's daughter asks the nurse how her mother got this disease. Which of the following should the nurse identify as a risk factor for this patient's development of osteoporosis? a. History of thyroid disease b. Onset of menarche at age 11 c. History of obesity d. Onset of menopause at age 58 - CORRECT ANSWER a. History of thyroid disease Rationale: Chronic health conditions such as thyroid disease, endocrine disorders, and renal failure are risk factors for development of osteoporosis. Onset of menarche at age 13 or later is considered a risk factor for osteoporosis, as is early menopause. Thin persons are at greater risk of osteoporosis than persons who are obese. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 379-380 Category: Metabolic bone disorders The nurse is reviewing the complications of hyperparathyroidism with a group of newly licensed nurses during their orientation. Which of the following conditions should the nurse include? a. Seizure activity b. Cardiac dysrhythmias c. Delirium d. Osteoporosis - CORRECT ANSWER d. Osteoporosis Rationale: Hyperparathyroidism causes bones to become brittle due to osteoporosis. The other conditions are possible complications of the hypocalcemia (low serum calcium) of hypoparathyroidism. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 386 Category: Metabolic bone disorders The nurse is presenting a case study about a patient with Paget's disease at the unit staff meeting. In discussing the patient's perioperative course after undergoing total hip arthroplasty, the nurse should identify increased bleeding risk due to a. removal of osteolytic lesions. b. hypervascularity of affected bone. c. diminished bone activity. d. calcification of involved bone. - CORRECT ANSWER b. hypervascularity of affected bone Rationale: Medication administered during the postoperative period may increase the risk of bleeding due to excessive hypervascularity of affected bone in Paget's disease. Osteolytic lesions are identified on x-ray in early disease but they are not removed. With Paget's disease, bone activity is increased. Bone calcification is a chronic result of Paget's disease but does not increase bleeding risk. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 390-391 Category: Musculoskeletal tumors After x-rays confirm a femoral mid-shaft fracture, a patient is also diagnosed with a small, isolated, asymptomatic endochondroma of the distal femur. When the patient's family asks the nurse about possible treatment, the nurse should confirm the surgeon's plan as discussed with the patient should include which of the following? a. Schedule radiofrequency ablation. b. Plan injection of high-dose steroids. c. Follow with serial x-rays. d. Plan surgical excision. - CORRECT ANSWER c, Follow with serial x-rays Rationale: For isolated, asymptomatic endochondroma, the plan of care typically includes follow up with serial x-rays. Most lesions will need no surgical intervention unless growth is noted. Other identified treatments are likely with different benign lesions. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 425 Category: Musculoskeletal tumors A patient is determined to have bone metastasis following a diagnosis of prostate cancer. Which of the following medications should the nurse know may be prescribed for this patient to reduce pain and decrease the potential for pathological fractures? a. Teriparatide (Forteo®) b. Calcitonin (Miacalcin®) c. Raloxifene (Evista®) d. Zoledronic acid (Reclast®) - CORRECT ANSWER d. Zoledronic acid (Reclast) Rationale: The use of bisphosphonates to help reduce the risk of pathological fractures (except in spinal cord compression) is now recommended for patients with bone metastasis. Zoledronic acid has been show to significantly decrease osteoclastic activity and help relieve the pain of bone metastasis. Other listed medications are not bisphosphonates. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 441 Category: Musculoskeletal tumors A 13-year-old male presents with fever, anemia, leukocytosis, and increased erythrocyte sedimentation rate (ESR). The nurse should know bone marrow biopsy is likely to confirm the presence of which of the following? a. Osteosarcoma b. Ewing's sarcoma c. Multiple myeloma d. Schwannoma - CORRECT ANSWER b. Ewing's sarcoma Rationale: Ewing's sarcoma is often confused with osteomyelitis as affected patients typically present with fever, anemia, leukocytosis, and increased ESR. Diagnosis is by bone marrow biopsy. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 431 Category: Musculoskeletal tumors A nurse is reviewing diagnostic results for a patient with suspected multiple myeloma. Which of the following results should the nurse expect for this patient? a. X-ray report of multiple lytic lesions b. Pathology report of spindle-shaped tumor cells c. X-ray report of "ground glass" appearance d. Pathology report of densely packed small cells with round nuclei - CORRECT ANSWER a. X-ray report of multiple lytic lesions Rationale: X-rays of bones affected by multiple myeloma will show multiple lytic lesions. "Ground glass" tumor appearance is associated with fibrous dysplasia (ossifying fibroma). Spindle-shaped cells are typical of numerous tumors but not of multiple myeloma, which is characterized by uncontrolled proliferation of highly differentiated B-lymphocytes. Small cells with round nuclei are typical of Ewing's sarcoma. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 442 Category: Musculoskeletal tumors A young child and his parents are seen in the clinic. After assessment by the provider, a malignancy is suspected. The nurse should recognize which of the following as the MOST common primary malignant bone tumor in children? a. Hemangioma b. Mesenchymal chondrosarcoma c. Osteosarcoma d. Multiple myeloma - CORRECT ANSWER c. Osteosarcoma Rationale: Osteosarcoma is the most common malignant bone tumor in children, occurring slightly more often in boys than in girls (1.5/1). Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 430 Category: Musculoskeletal tumors A patient questions the many laboratory tests that have been ordered to aid in diagnosis of his suspected musculoskeletal tumor. A nurse should explain that analysis for Bence-Jones protein in the urine is performed to rule out which of the following conditions? a. Osteosarcoma b. Multiple myeloma c. Malignant lymphoma of the bone d. Epithelioid sarcoma - CORRECT ANSWER b. Multiple myeloma Rationale: Abnormal proteins in blood and urine, including Bence-Jones protein, are considered diagnostic of multiple myeloma. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 442 Category: Musculoskeletal tumors The nurse is caring for an adult patient with soft tissue sarcoma. When the patient asks about treatment options, the nurse's response should be based on the knowledge that for the majority of affected patients, chemotherapy has a. enabled rapid return to usual activities. b. provided local control of the tumor. c. been administered weekly for tumor management. d. shown no increase in cure rate. - CORRECT ANSWER d. show no increase in cure rate Rationale: Chemotherapy for sarcomas is being evaluated continually in an attempt to find the best combination of drugs. In the majority of adults with soft tissue sarcomas, however, chemotherapy has shown no increase in the cure rate. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 438 Category: Musculoskeletal tumors A patient with osteosarcoma is scheduled to begin chemotherapy. The nurse should discuss the patient's increased risk for infection related to which of the following hematopoietic changes? a. Neutropenia b. Leukocytosis c. Thrombocytopenia d. Anemia - CORRECT ANSWER a. Neutropenia Rationale: Hematopoietic changes in response to chemotherapy may include neutropenia, leukopenia, and thrombocytopenia. Infection control precautions must be implemented for the patient who is neutropenic. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 439 Category: Musculoskeletal tumors A patient with a previous diagnosis of breast cancer now has been diagnosed with bony metastasis. The nurse should know the metastasis MOST likely occurred by a. direct extension of the primary tumor. b. hematogenous spread of the primary tumor. c. lymphatic dissemination. d. lytic dissemination. - CORRECT ANSWER c. lymphatic dissemination Rationale: Lymphatic dissemination is a typical path for bone metastasis from breast cancer. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 440 Category: Musculoskeletal tumors Following excision of a bony lesion, a patient undergoes reconstruction with allograft (cadaveric human bone) and rigid internal fixation. As part of the patient's discharge instructions, the nurse should include the need to remain non-weight-bearing for a. 6-12 weeks. b. 14-16 weeks. c. 5-6 months. d. 9-12 months. - CORRECT ANSWER a. 6-12 weeks Rationale: Following reconstruction with allograft, the patient must remain non-weight-bearing for 6-12 weeks. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 436 Category: Inflammatory disorders A patient is diagnosed with early rheumatoid arthritis (RA). In performing a physical assessment, the nurse should recognize which of the following as a sign of early disease in the hands? a. Boutonniere deformity b. Swan-neck deformity c. Ulnar deviation d. Spindle-shaped fingers - CORRECT ANSWER d. Spindle-shaped fingers Rationale: Spindle-shaped fingers are a sign of early disease. The other signs are characteristic of later RA. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 341 Category: Inflammatory disorders A patient is being discharged after diagnosis with rheumatic fever. The nurse should provide teaching on which of the following medications prescribed for home use? a. Methotrexate b. Allopurinol c. Aspirin d. Hyaluron - CORRECT ANSWER c. aspirin Rationale: Salicylates such as aspirin are indicated for routine treatment of inflammation in patients with rheumatic fever. The other medications are not appropriate for treatment of this condition. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 353 Category: Inflammatory disorders A patient is being seen in the clinic for suspected ankylosing spondylitis. The nurse should recognize which of the following symptoms as most frequently associated with this disorder? a. Tender joints in feet and lower back with restricted back motion b. Pain in shoulder that is aggravated by repetitive movements c. Popping sounds with movement, and palpable nodules d. Fever, elevated white blood cell count, and pain with compression - CORRECT ANSWER a. Tender joints in feet and lower back with restricted back motion Rationale: The patient with ankylosing spondylitis (AS) has discomfort and stiffness in the spine, with restricted back motion. Pain also may occur at the plantar fascia and Achilles tendon insertions into the calcaneus. The other descriptions are not associated with AS. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 360 Category: Inflammatory disorders A patient has silver scales on patches of bright red skin on the elbows, legs, and face. The patient's joints are swollen and nails are pitted, ridged, and discolored. Based on the likely diagnosis, a nurse should expect to a. begin treatment immediately to obtain a cure of the condition. b. control symptoms and begin treatment to suppress the condition. c. consult dermatology for likely skin grafting. d. begin antifungal treatment. - CORRECT ANSWER b. control symptoms and begin treatment to suppress the condition. Rationale: Early treatment will slow progression of psoriatic arthritis, the condition exhibited by this patient. Medications such as NSAIDs may be used to control symptoms until disease-modifying agents can have effects. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 363 Category: Inflammatory disorders A patient diagnosed with systemic lupus erythematosus (SLE) asks the nurse, "I have read about possible organ damage from lupus. What organ is affected most often?" The nurse should identify which of the following? a. Liver b. Pancreas c. Lung d. Kidney - CORRECT ANSWER d. Kidney Rationale: The kidney is the most common organ affected by SLE. About 75% of patients with SLE develop renal disease, usually within the first 2 years after diagnosis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 368 Category: Inflammatory disorders The patient previously diagnosed with fibromyalgia syndrome tells the nurse that she has not exercised for several years. Which of the following should the nurse suggest? a. Jogging every other day b. Use of stair-stepper 10 minutes daily c. Low-impact aerobic exercise three times a week d. Weight-lifting every other day - CORRECT ANSWER c. Low-impact aerobic exercise three times a week Rationale: The patient with fibromyalgia syndrome should exercise at the highest level possible without worsening symptoms. The patient should begin with gentle, warm-up flexibility exercises and progress to stretching. Low-impact aerobic exercise is encouraged three times a week. The other identified activities have greater intensity or frequency than is warranted for this patient. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 373 Category: Inflammatory disorders The nurse is reviewing the medications of a patient with gout. The nurse should recognize that use of which of the following medications could have contributed to the development of gout? a. Hydrochlorothiazide (HCTZ) b. Atenolol (Tenormin®) c. Metformin (Glucophage®) d. Esomeprazole (Nexium®) - CORRECT ANSWER a. Hydrochlorothiazide (HCTZ) Rationale: Use of certain common drugs can contribute to development of secondary gout. These medications include thiazide diuretics, salicylates, nicotinic acid, and alcohol. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 354 Category: Inflammatory disorders A patient newly diagnosed with rheumatoid arthritis asks the nurse about the difference between RA and osteoarthritis. The nurse should tell the patient RA is marked by a. morning stiffness of less than 1 hour. b. joint laxity. c. symmetric joint swelling. d. asymmetric joint inflammation. - CORRECT ANSWER c. symmetric joint swelling Rationale: Symmetric joint involvement is typical of RA. Swelling generally lasts more than 2 hours. Asymmetric joint involvement is characteristic of osteoarthritis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 342 Category: Inflammatory disorders A patient presents at the clinic with complaints of intermittent vasospasms and erythema of the fingertips, as well as difficulty in swallowing. A nurse should suspect the patient has a. reactive arthritis. b. systemic lupus erythematosus. c. polymyalgia rheumatica. d. systemic sclerosis. - CORRECT ANSWER d. systemic sclerosis Rationale: Systemic sclerosis is a multisystem disease affecting the microvasculature and connective tissue, causing alterations in the skin and in a variety of internal organs. It is often accompanied by CREST syndrome: calcinosis, Raynaud's phenomenon (intermittent vasospasm of fingertips), esophageal dysmotility, sclerodactyly, and telangiectasias. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 364 Category: Inflammatory disorders A patient has been diagnosed with fibromyalgia syndrome. The nurse should provide education on which of the following medications prescribed to increase the effectiveness of the nonsteroidal anti-inflammatory medication being taking by this patient? a. Tricyclic antidepressant b. Corticosteroid c. Antimalarial agent d. Salicylate - CORRECT ANSWER a. Tricyclic antidepressant Rationale: NSAIDs have not proven beneficial when used alone, but their use with a tricyclic antidepressant may improve effectiveness. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 373 Category: Inflammatory disorders A 28-year-old woman presents with complaints of transitory joint pain, especially in her hands, wrists, and knees. She tells the nurse she also has been experiencing weakness, intermittent fever, fatigue, and mood swings. The nurse should recognize these symptoms are consistent with development of a. osteomalacia. b. systemic lupus erythematosus. c. polymyalgia rheumatica. d. systemic onset rheumatoid arthritis. - CORRECT ANSWER b. systemic lupus erythematosus. Rationale: The described symptoms are consistent with SLE. The patient also may complain of hair loss, rash, pleuritic chest pain, migraine headaches, visual disturbances and photosensitivity, cognitive dysfunction ("lupus fog"), and sores in the mouth. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 369-370 Category: Inflammatory disorders A patient is receiving an infusion of infliximab (Remicade®) for treatment of rheumatoid arthritis. When the patient begins to complain of headache, body ache, and chills, the nurse should a. administer Solu-Medrol® solution. b. use subcutaneous administration instead. c. slow the infusion rate. d. call the Rapid Response Team. - CORRECT ANSWER c. slow the infusion rate Rationale: Slowing the infusion rate and administering diphendydramine (Benadryl®) can help with the clinical syndrome of fever, chills, body aches, and headaches that may accompany administration of infliximab. Although Solu-Medrol can be used to treat RA, it is not administered to counteract reactions to infliximab. Infliximab is only given by infusion. The RRT is not needed in this situation. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 343 Category: Inflammatory disorders A 3-year-old has juvenile arthritis. In discussing activities with the parents that will encourage the child to exercise small and large muscles, the nurse should identify which of the following as effective in meeting this goal based on the patient's developmental level? a. Blocks b. Board games c. Collections d. Bicycling - CORRECT ANSWER a. Blocks Rationale: For toddlers with arthritis, activities such as blocks, puzzles, and art projects will encourage the use of small and large muscles. Other activities are appropriate to older children. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 339 Category: Inflammatory disorders An adult patient with rheumatoid arthritis (RA) has numerous joint deformities as a result of disease progression. A nurse should recognize which of the following as a "zigzag" deformity of the wrist? a. Swan-neck deformity b. Boutonniere deformity c. Ulnar deviation d. Phalangeal retraction - CORRECT ANSWER c. Ulnar deviation Rationale: The "zigzag" wrist deformity common to RA is ulnar deviation. Swan-neck and boutonniere deformities, as well as phalangeal retraction, occur in the fingers. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 340 Category: Inflammatory disorders A patient previously diagnosed with rheumatoid arthritis (RA) is seen in the clinic. Which of the following should the nurse expect to see documented in the patient's medical record? a. Early involvement of small joints b. Few white cells in the synovial fluid c. Presence of Heberden's nodes d. Asymmetric narrowing of the joint space Incorrect - CORRECT ANSWER a. Early involvement of small joints Rationale: The small joints (PIPs, MCPs, MTPs) are involved first in RA; other affected joints include the wrists, knees, and cervical spine. The other options are characteristic of osteoarthritis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 342 Category: Inflammatory disorders In reviewing the planned treatment with a patient diagnosed with polymyalgia rheumatica, a nurse should discuss which of the following as the drug of choice? a. Disease-modifying agent b. Corticosteroid c. Antimalarial agent d. Nonsteroidal anti-inflammatory drug (NSAIDs) - CORRECT ANSWER b. corticosteroids Rationale: Corticosteroids are the drug of choice for treatment of PMR. Currently no data document steroid-sparing effects of other medications for this condition. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 351 Category: Inflammatory disorders A patient in the clinic is being assessed for presence of Lyme disease. The nurse should know early disease is characterized by the presence of a. erythema migrans. b. variable heart block. c. nerve palsy. d. sleep disturbances. - CORRECT ANSWER a. erythema migrans Rationale: The typical Lyme disease rash, known as erythema migrans, is characteristic of early localized disease (stage 1). Cardiac and neurologic involvement are typical of later stages of the disease. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 357 Category: Inflammatory disorders The nurse is providing education for a patient diagnosed with reactive arthritis. The nurse should instruct the patient to avoid alcohol, particularly because of which of the following medications prescribed for this disorder? a. Indomethacin (Indocin®) b. Corticosteroid eye drops c. Topical skin cream d. Methotrexate (Rheumatrex®) - CORRECT ANSWER d. Methotrexate (Rheumatrex®) Rationale: The nurse should instruct the patient on the safe use of all medications, including the avoidance of alcohol while taking methotrexate. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 362 Category: Inflammatory disorders A nurse's education of a patient with suspected gout should be based on the understanding that the only method for definitive diagnosis of gout is a. performance of foot x-rays. b. assessment of rheumatoid factor. c. performance of a bone scan. d. analysis of synovial fluid. - CORRECT ANSWER d. analysis of synovial fluid Rationale: Synovial fluid demonstrates the characteristic needle- or rod-shaped monosodium urate crystals that are typical of gout. Elevated serum urate is of limited value in establishing the diagnosis because about 30% of patients have normal values at the time of an acute gout attack. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 355 Category: Inflammatory disorders A patient is diagnosed with polymyositis. Which of the following should be most important for the nurse to include in patient education? a. Skin protection strategies b. Good sleep practices c. Aspiration precautions d. Balance of rest and activity - CORRECT ANSWER c. Aspiration precautions Rationale: Patients with PM often complain of difficulty swallowing and describe regurgitation of food. Education should include aspiration precautions for patient safety. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 368 [Show Less]
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Orthopedics NCLEX Exam 16 Questions with Verified Answers,100% CORRECT
Orthopedics NCLEX Exam 16 Questions with Verified Answers Fractures • Signs and symptoms - CORRECT ANSWER o Continuous pain; unnatural movement; defo... [Show More] rmity is possible o Shortening of the extremity b/c of muscle spasm o Crepitus may occur from bones grating together o Swelling and discoloration—worry about compartment syndrome Fractures • Treatment - CORRECT ANSWER o Immobilize the bond ends plus the adjacent joints otherwise causes continuous damage to occur o To prevent further injury—support fracture above and below the site; and move extremity as little as possible o A splint will help prevent fat emboli and muscle spasm o With an open fracture you want to cover it, preferably with something sterile b/c at high risk for infection o Neurovascular checks are done such as pulses, color, movement, sensation, capillary refill, and temp— these are VERY important Fracture Complications - CORRECT ANSWER Shock b/c bleeding can occur Fracture o Fat embolism - CORRECT ANSWER • Seen with long bones and crushing injuries; symptoms will depend on where it goes in the body • Petechiae or rash over the chest; conjunctival hemorrhages • Occur in young males more b/c they are risk takers • Snow storm on CXR (patchy infiltrates); usually occurs in the first 36 hours Fracture o Compartment syndrome - CORRECT ANSWER • This is when a fracture has not been elevated and has not had ice packs; fluid accumulates in the tissue and impairs tissue perfusion. The muscle becomes swollen and hard and the pt complains of severe pain that is not relieved with pain meds • Unpredictable; pain is DISPROPORTIONATE to the injury • If undetected may result in nerve damage and possible amputation • Common areas that this occurs are forearms and quadriceps; can get it without a fracture Treatment • Loosen the cast/bi-valve the cast; only remove case if have bad neuro checks • Fasciotomy will cut down to the tissue to relieve pressure ***be careful of the answer remove cast*** • Orthopedic nurses have cast cutters ready available; instruct the pt the cast saw does not touch the skin, but it does vibrate Fracture Healing concerns - CORRECT ANSWER • Delayed union—healing doesn't occur at a normal rate • Non-union: failure of bone ends to unite; may require bone grafting from person or cadaver s/s of both: persistent discomfort and movement • Cast care - CORRECT ANSWER o Ice packs on sides NOT on top especially first 24 hours b/c cast is still wet o No indentations o Use palm of hands for 1st 24hours b/c cast material is wet o Keep uncovered and dry o Do not rest on hard surface or sharp edge o Cover cast close to the groin with plastic to prevent infection; be mindful of underlying diseases with cast care Elevate and neurovascular checks • If pt complains of pain, neurovascular checks and if pain meds are not helping think compartment syndrome • Traction - CORRECT ANSWER • Decreases muscle spasms, reduces (realigns the bone), and immobilizes • Traction should be continuous; weights should hang freely • Keep pt pulled up in bed and centered with good alignment—especially with the elderly • Exercise non-immobilized joints • Ropes should move freely and knows should be secured • Egg crate use for comfort • Foot boards are okay as long as they don't interfere with traction • Skin traction - CORRECT ANSWER • This is when tape or some type of material is stuck to the skin and the weights pull against it; skin is NOT penetrated • Types: Buck's traction—used most often with hip fractures; the leg is pulled straight out from the bottom by weighted traction o Russell's—used most often with FEMORAL fractures; leg is help up by a brace then traction is pulling from the bottom of the leg with 3 pulleys • Must do a good skin assessment • With foot drop may need a boot to prevent it and keep it flexed • Skeletal traction - CORRECT ANSWER • The traction is applied to the bones with wires and pins • Used when prolonged traction is needed • Types: Steinman pins, Crutchfield, Gardner-wells tongs, Halo vest • Must monitor the pin sites and do pin care; this is a sterile technique; remove any crusts around pin sites b/c bacteria loves this area; serous drainage is okay b/c it's clear fluid but should be monitored • If pin comes out call doctor! And make sure area where pin was is stabilize Total Hip Replacement • Pre-op care - CORRECT ANSWER o Buck's traction is used frequently pre-op to immobilize; elderly, malnourished pts may be in traction for several days to build up nutrition • Post-op care o Nursing considerations - CORRECT ANSWER • Neurovascular checks; monitor drain (don't want fluid accumulate in tissues) but not all have drains • Pt can do isotonic exercises while in bed—squeeze and release muscles to build tone • No weight-bearing until physician okays it • Hydration is VERY important b/c pt is initially immobile • Stresses should be minimal Fracture Surgery o Complications - CORRECT ANSWER • Dislocation will cause circulatory and nerve damage; s/s are shortening of leg, abnormal rotation, can't move extremity, PAIN • Infection • Prophylactic antibiotics (just like with a heart valve replacement) • Remove Foley and suction ASAP if not needed; b/c these will serve as a portal for infection • Avascular necrosis—death of tissue due to poor circulation; can't control but need to pick up quickly • Immobility problems—walking is the BEST exercise Amputations - CORRECT ANSWER performed at the most distal point that will heal; the doctor tries to preserve the knee and elbow b/c if have a joint with a prosthesis will have much more mobility • Immediate post-op care o Keep a tourniquet at bedside incase of hemorrhage; must stop bleeding o Elevate on pillow for first 24 hours; then elevate foot of bed but don't keep propped up forever to prevent hip contracture o Prevent knee/hip contracture by moving and straightening by extension of the joints; prone position extends knee and hip joints o Phantom pain is REAL!! • The first intervention to decrease phantom pain is diversional activity BEFORE pain meds • Seen more with AKAs; usually subsides in 3 months but some will forever have phantom pain ***Pain: use other things first prior to pill; the definition of pain is what the pt says it is; ALWAYS assess the pt's pain by having them rate their pain on a pain scale (0-10) and document it*** o Pressure dressing post-op to prevent hemorrhage then also helps to shape limbs The first intervention to decrease phantom pain is diversional activity - CORRECT ANSWER BEFORE pain meds Amputation • Rehabilitation - CORRECT ANSWER o Limb shaping is important to be fit for prosthesis; shaped like a cone o A limb sock to prevent rubbing against skin is worn under the prosthesis o It's important to strengthen the upper body b/c a below the waist amputation needs upper body strength to move with crutches o NOT okay to bear weight on a new stump/prosthesis o It's okay to massage the stump to help promote circulation and decrease tenderness o Teach pt to toughen stump to get it ready for prosthesis by pressing into a soft pillow; then a firm pillow; then the mattress; then a chair—progress as tolerated so it's not tender with prosthesis • Walker—put in front, down on floor, walk in to it • Crutches—do not rest on armpit, bear weight on hand or forearm—up with good leg first; down with bad leg first • Cane—held on unaffected side/strong side [Show Less]
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Orthopedic NP Review Course Exam 591 Questions with Verified Answers,100% CORRECT
Orthopedic NP Review Course Exam 591 Questions with Verified Answers Signs of inflammation - CORRECT ANSWER swelling, warmth, erythema, loss of function... [Show More] , tenderness Articular inflammation - CORRECT ANSWER Anatomic structure: synovium, cartilage, capsule (whithin the joint) Painful site: diffuse, deep Pain on movement: Active/passive, all planes Swelling: common Periarticular inflammation - CORRECT ANSWER Anatomic structure: Tendon, bursa, ligament, muscle, bone (outside the joint) Painful site: focal "point" Pain on movement: Active, in a few planes Swelling: uncommon Inflammatory joint diseases features - CORRECT ANSWER Pain (when?): Yes (AM) Swelling: soft tissue Erythema: sometimes Warmth: sometimes AM stiffness: prominent Systemic features: Sometimes Increased ESR, CRP: Frequent Synovial fluid WBC: >2000 Ex: Septic, RA, SLE, Gout Noninflammatory joint disease features - CORRECT ANSWER Pain (when?): Yes (PM) Swelling: bony Erythema: absent Warmth: absent AM stiffness: minor (<30') Systemic features: absent Increased ESR, CRP: uncommon Synovial fluid WBC: <2000 Ex: OA, AVN Acute Monoarthritis - CORRECT ANSWER Inflammation (swelling, tenderness, warmth) in one joint Occasionally polyarticular diseases can present with monoarticular onset: RA, JRA, Reactive and enteropathic arthritis, Sarcoid arthritis, viral arthritis, psoriatic arthritis Acute Monoarthitis Etiology - CORRECT ANSWER THE MOST CRITICAL DIAGNOSIS TO CONSIDER: INFECTION! Septic Crystal deposition (gout, pseudogout) Traumatic (fracture, internal derangement) Other (hemarthrosis, osteonecrosis, presentation of polyarticular disorders) Questions to ask: History helps in Differential Dx - CORRECT ANSWER Pain come suddenly, minutes? - fracture Over several hours or 1-2 days? - infectious, crystals, inflammatory arthropathy. History of IV drug abuse or a recent infection? - septic joint. Previous similar attacks? - crystals or inflammatory arthritis. Prolonged courses of steroids? - infection or osteonecrosis of the bone. Indications for arthrocentesis - CORRECT ANSWER The single most useful diagnostic study in initial evaluation of monoarthritis: SYNOVIAL FLUID ANALYSIS -Suspicion of infection -Suspicion of crystal-induced arthritis -Suspicion of hemarthrosis -Differentiating inflammatory from noninflammatory arthritis Tests to perform on synovial fluid - CORRECT ANSWER -Low threshold for doing Gram stain and cultures. -Total leukocyte count/differential: inflammatory vs. non-inflammatory. -Polarized microscopy to look for crystals Synovial fluid analysis - CORRECT ANSWER -Less viscous seen with inflammation -Cloudy - infection, WBC, Crystals -Reddish = blood -Glucose - significantly lower w/infection and inflammation -Protein increased with infection -LDH - increased with infection, RA, gout -Uric acid = gout Septic Joint - CORRECT ANSWER -Most articular infections - a single joint -15-20% cases polyarticular -Most common sites: knee, hip, shoulder -20% patients afebrile -Joint pain is moderate to severe -Joints visibly swollen, warm, often red -Comorbidities: RA, DM, SLE, cancer, etc Septic Joint - Nongonococcal - CORRECT ANSWER -80-90% monoarticular -Most develop from hematogenous spread -Most common: Gram positive aerobes (80%); majority with Staph aureus (60%); gram negative 18% Septic Joint: Gonococcal - CORRECT ANSWER -Most common cause of septic arthritis -Often preceded by disseminated gonococcemia -Sexually active individual, 5-7 days h/o fever, chills, skin lesions, migratory arthralgias and tenosynovitis -> persistent monoarthritis -Women often menstruating or pregnant -Genitourinary disease often asymptomatic Gout - CORRECT ANSWER -Caused by monosodium urate crystals -Most common type of inflammatory monoarthritis -Typically: first MTP joint, ankle, midfoot, knee -Pain very severe; cannot stand bed sheet -May be with fever and mimic infection -The cutaneous erythema may extend beyond the joint and resemble bacterial cellulitis Risk factors for gout - CORRECT ANSWER -Primary gout: obesity, HLD, DM, HTN, atherosclerosis -Secondary gout: alcoholism, drug therapy (diuretics, cytotoxics), myeloproliferative disorders, chronic renal failure Gout presenting s/s - CORRECT ANSWER -Systemic: fever rare but may occur, chills and malaise -MS: Acute onset of monoarticular joint pain. First MTP most common. Usually affected in 90% of patients with gout. Other joints include knees, foot and ankle. Less common in upper extremities (Postulated that decreased solubility of MSU at lower temps of peripheral structures such as toe and ear) -Skin: warmth, erythema and tenseness of skin overlaying joint. May have pruritis and desquamation. -GU: Renal colic with renal calculi formation in patients with hyperuricemia Gout Dx - CORRECT ANSWER Uric Acid (limited value as majority of hyperuricemic pts will never develop gout; levels may be normal during acute attack) CBC (mild leukocytosis in acute attacks, but may be higher than 25,000/mm) ESR (mild elevation or may be 2-3 x normal) 24 hr urine uric acid (only useful in pts being considered for uricosuric therapy or if cause of marked hyperuricemia needs investigation) Trial of colchicine (Positive response may occur in other types of arthritis to include pseudogout Gout treatment goals - CORRECT ANSWER -Gout can be treated without complications -Therapeutic goals include: terminating attacks; providing control of pain and inflammation; preventing future attacks; preventing complications such as renal stones, tophi, and destructive arthropathy Acute gout attack treatment - CORRECT ANSWER -NSAIDS most commonly used, all work the same, Indocin most commonly used, remember to use with caution with CAD, GI bleed, RF -Indocin 50 mg PO BID-TID for 2-3 days and then taper -Ibuprofen 400mg PO q4-6hr max 3.2g/day -Ketorolac 60 mg IM or 30mg IV x1 dose in pts <65 (30mg IM or 15mg IV in single dose in pts >65 yo, or w pts who are renally impaired -Continue meds until pain and inflammation have resolved for 48 hr Colchicine for acute gout - CORRECT ANSWER -Inhibits microtubule aggregation which disrupts chemotaxis and phagocytosis -Inhibits crystal-induced production of chemotatic factors -Administered orally in hourly doses of 0.5 to 0.6 mg until pain and inflammation have resolved or until GI side effects (diarrhea) prevent further use. Max dose 6mg/24hr -2mg IV then 0.5mg q6hr until cumulative dose of 4mg over 24hr Corticosteroids for acute gout - CORRECT ANSWER Used for pts who cannot tolerate NSAIDs, or failed NSAID/colchicine therapy. Daily doses of prednisone 40-60 mg a day for 3-5 days then taper 1-2 weeks. Improvement seen in 12-24 hr. ACTH (Adrenocorticotropic hormone) for acute gout - CORRECT ANSWER Peripheral anti-inflammatory effects and induction of adrenal glucocorticoid release. 40-80 IU IM followed by second dose if necessary Intra-articular injection with steroids for acute gout - CORRECT ANSWER Beneficial in pt with 1-2 large joints affected. Good option for elderly pt with renal or PUD (peptic ulcer disease) or other illness. Triamcinolone 10-40mg or Dexamethasone 2-10mg alone or in combination with Lidocaine Non-Pharm Tx for acute gout - CORRECT ANSWER Immobilization of joint. Ice packs. Abstinence of ETOH (consumption can increase serum urate levels by increasing uric acid production. When used in excess it can be converted to lactic acid which inhibits uric acid excretion in the kidney). Dietary modification (low carb, increase protein and unsaturated fats, decrease in dietary purine-meat and seafood. Dairy and vegetables do not seem to affect uric acid - bing cherries and vitamin C) Gout prophylaxis - CORRECT ANSWER Frequent attacks >3/year, tophi development or urate overproduction. Avoid use of meds that contribute to hyperuricemia: Thiazide and loop diuretics, low-dose salicylates, niacin, cyclopsorine, ethambutol (Losartan promotes urate diuresis and may even normalize urate levels. This action does not extend to other members of the ARB class. Useful in elderly with HTN + gout). Colchine 0.6 mg daily-BID. Use alone or in combination with urate lowering drugs. Prophylaxis w/o urate lowering drugs may allow tophi to develop. Gout prophylaxis: Urate lowering drugs - CORRECT ANSWER Used for documented urate overproduction. Goal is for serum urate concentartion to 6mg/dL or less. Start of therapy can precipitate acute attack; therefore, may need to use colchicine as long as six months. -Xanthine oxidase inhibitors: Allopurinol. Blocks conversion of xanthine to uric acid. Works for underexrectors and overproducers. Start typically 300mg/day and titrate weekly 100mg/day until optimal urate levels achieved. Start lower doses with renally impaired pts. -Uricosuric drugs: Probeneicd or Sulfinpyrazone. Increased renal clearance of uric acid by inhibiting tubular absorption. SE may prohibit use (GI and renal). Need measurement of 24hr urine in anyone for whom Probenecid therapy is initiated. New therapies for gout management - CORRECT ANSWER -Uricase (enzyme that oxidized uric acid to a more soluble form. Natural Uricase from Aspergillus flavus and Candida utilis under investigation) -Febuxostat (new class of Xanthine Oxidase inhibitor. More selective than allopurinol. Little dependence on renal excretion) -Losartan (ARB given as 50mg/dL can be urisuric. When given with HCTZ, it can blunt the effect of the diuretic and potentiate its antihypertensive action -Fenofibrate (studies note when used in combo with Allopurinol produced additional lowering of the urate) Gout Complications - CORRECT ANSWER Renal failure (ARF can be caused by hyperuricemia, chronic urate nephropathy Nephrolitiasis Joint deformity Recurrent Gout Calcium pyrophosphate deposition disease (CPPD) - CORRECT ANSWER Can cause monarthritis clinically indistinguishable from gout - Pseudogout. Often precipitated by illness or surgery. Pseudogout is most common in the knee (50%) and wrist. Reported in any joint (including MTP -metatarsophalangeal). CPPD disease may be asymptomatic (deposition of CPP in cartilage). Associated conditions for CPPD - CORRECT ANSWER Hyperparathyroidism Hypercalcemia Hypocalciuria Hemochromatosis Hypothyroidism Gout Aging Polyarthritis - CORRECT ANSWER Definite inflammation (swelling, tenderness, warmth of >5 joints) A patient with 2-4 joints is said to have paucior oligoarticular arthritis Acute Polyarthritis - CORRECT ANSWER Infection: gonococcal; meingococcal; lyme disease; rheumatic fever; bacterial endocarditis; viral (rubella, parvovirus, Hep B) Inflammatory: RA; JRA; SLE; reactive arthritis; psoriatic arthritis; polyarticular gout; sarcoid arthritis Inflammatory Arthritis features - CORRECT ANSWER Morning stiffness >1 hr Fatigue: profound Activity: improves symptoms Rest: worsens symptoms Systemic: Yes Corticosteroid: yes Noninflammatory arthritis features - CORRECT ANSWER Morning stiffness: < 30 min Fatigue: minimal Activity: worsens symptoms Rest: improves symptoms Systemic: no Corticosteroid: no Temporal patterns in polyarthritis - CORRECT ANSWER Migratory pattern: Rheumatic fever, gonococcal (disseminated gonococcemia), early phase of Lyme disease Additive pattern: RA, SLE, psoriasis Intermittent: gout, reactive arthritis Patterns of joint involvement - CORRECT ANSWER Symmetric polyarthritis involving small and large joints: viral, RA, SLE, one type of psoriatic (the RA-like) Asymmetric, oligo- and polyarthritis involving mainly large joints, preferably lower extremities, esp knee and ankle: reactive arthritis, one type of psoriatic, enteropathic arthritis. DIP (distal interphalageal joint, the first knuckle from the top of the finger) joints: Psoriatic Viral arthritis - CORRECT ANSWER Younger patients Usually presents with prodrome, rash History of sick contact Polyarthritis similar to acute RA Prognosis good; self-limiting Ex: Parvovirus B-19, Rubella, Hep B & C, acute HIV, Epstein-Barr virus, mumps Parvovirus B-19 - CORRECT ANSWER The virus of "fifth disease", erythema infectiosum (EI). Children "slapped cheek"; adults flu-like illness, maculopapular rash on extremeties. Joint involved more in adults (20% of cases). Abrupt onset symmetric polyarthralgia/polyarhtritis with stiffness in young women exposed to kid with E.I. May persist for a few weeks to months. Acute Sarcoid Arthritis - CORRECT ANSWER Chronic inflammatory disorder - noncaseating granulomas at involved sites. 15-20% arthritis; symmetrical: wrists, PIPs (proximal interphalangeal), ankles, knees. Common with hilar adenopathy. Erythema nodosum. Lodgren's syndrome: acute arthritis, erythema nodosum, bilateral hilar adenopathy Psoriatic Arthritis - CORRECT ANSWER Prevalence of arthritis in Psoriasis 5-7% Dactilytis ("sausage fingers"), nail changes. Subtypes: asymmetric, oligoarticular associated dactylitis; predominant DIP (distal interphalangeal) involvement - nail changes; polyarthritis "RA-like" - lacks RF (rheumatoid factor) or nodules; arthritis mutilans - destructive erosive hands/feet; axial involvement - spondylitis - 50% HLAB 27 (+); HIV-associated - more severe HLA-B27 - CORRECT ANSWER HLA-B27 is a blood test to look for a protein that is found on the surface of white blood cells. The protein is called human leukocyte antigen B27 (HLA-B27). Human leukocyte antigens (HLAs) are proteins that help the body's immune system tell the difference between its own cells and foreign, harmful substances. Reactive arthritis - CORRECT ANSWER Infection-induced systemic disease with inflammatory synovitis from which viable organisms cannot be cultured. Associated with HLA B27 Asymmetric, oligoarticular, knees, ankles, feet. 40% have axial disease (spondyloarthropathy). Enthesitis: inflammation of tendon-bone junction (Achilles tendon, dactylitis). Extraarticular: rash, nails, eye involvement Spondyloarthropathy - CORRECT ANSWER Spondyloarthropathy or spondyloarthrosis refers to any joint disease of the vertebral column. As such, it is a class or category of diseases rather than a single, specific entity. It differs from spondylopathy, which is a disease of the vertebra itself. Rheumatoid Arthritis - CORRECT ANSWER Symmetric, inflammatory polyarthritis, involving large and small joints. Acute, severe onset 10-15%; subacute 20%. Hand characteristically involved. Acute hand deformity: fusiform (tapering at both ends, spindle shaped) swelling of fingers due to synovitis of PIPs. RF may be negative at onset and may remain negative in 15-20%. RA is a clinical diagnosis, no lab test is diagnostic, just supportive. ACR (American College of Rhuematology) criteria for RA diagnosis - CORRECT ANSWER Must have 4 out of 7: Early morning stiffness > 1 hr; > 3 joint arthritis; Symmetrical arthritis; Wrist, MCP, PCP arthritis; RA nodules; Rheumatoid factor +; X-ray changes: periarticular osteopenia/marginal erosions Rheumatoid factor - CORRECT ANSWER RF, an IgM antibody is seen in the serum of 75% of pts with RA. High titers of RF are associated with severe disease. RF is also found in other diseases like syphilis, sarcoidosis, infective endocarditis, TB, leprosy, parasitic infections; in advanced age and in asymptomatic relative of pts with rheumatoid disease. Antinuclear antibody are seen in 20% of pts with RA, though their titer is lower than in SLE. DMARDS - CORRECT ANSWER Biologics: Non-TNF (Abatacept, Rituximab, Tocilizumab, Tofacitinib, Anakinra) & Anti-TNF (Adalimumab, Certolizumab, Etanercept, Golimumab, Infliximab) Non-Biologics: Hydroxychoroqine, Leflunomide, Methotrexate, Minocycline, Sulfasalazine DMARDs (disease modifying anti-rheumatic drugs) - CORRECT ANSWER These drugs need frequent monitoring: blood, liver, lung and kidney are frequent sites of adverse effects. Interval of lab testing varies with the drug - 4-8 wk intervals are common. Most pts need to be seen 3-6 times/yr Prognosis of RA - CORRECT ANSWER 2 divergent course: 50-75% experience remission in 2 years (these pts are negative for rheumatoid factor and have goof functional status even during disease activity). Conservative therapy is advised for this group. Pt who have severe disease have a worse prognosis, and on an average die 10-15 yrs earlier than people e/o RA. Since most of the joint damage occurs in the first 2 yrs, these patients should be started on a disease modifying agent early )You are doing a preop physical for a routine THA on a 43 yo F w RA since age 20. PMH b/l TKA. No other medical problems. Current mes: NSAID, low-dose prednisone, MTX (methotrexate), and HCQ (Hydroxychloroquine, sold under the brand name Plaquenil). General PE normal. MS exam, extensive deformities, mild synovitis. In addition to routine tests, what test should be ordered before surgery? - CORRECT ANSWER Cervical spine films AP&Lateral, NOT flexion and extension. We don't want to miss a C1-C2 sublaxation. RA can cause asymptomatic instability of the neck - manipulation under anesthesia can cause spinal cord injury! Clues to look for C1-C2 sublaxation - CORRECT ANSWER Long-standing RA or JRA. May have NO symptoms. C2-C3 radicular pain in the neck and occiput. Spinal cord compression: quadriparesis or paraparesis, sphincter dysfunction, sensory deficits, TIAs secondary to compromise of the vertebral arteries Pre-Op exam of RA patient - CORRECT ANSWER C1-C2 sublaxation Cricoaryternoid arthritis w adductor spasm of the vocal cords and a narrow airway. Pulmonary fibrosis. Risk for GI bleeding. Need for stress steroid coverage. Discontinue NSAIDs several days preop. Discontinue methotrexate 1-2 weeks preop** (coverage with analgesic meds or if necessary short-term, low dose steroid if RA flares) 68 yo F w 3 yr ho RA new pt. Presents w 4 wks increasing fatigue, dizziness, dyspnea, and anorexia. Joint pain and stiffness are mild and unchanged. Managed with ibuprofen and hydroxychloroquine until 4 mo ago, when a flare cause a switch to piroxicam and prednisone. PMH: peptic ulcer 10 yrs ago, mild HTN. Exam shows a thin, pale, apathetic woman w T 98.4F, BP 110/65, HR 110. Symmetrical 1+ synovitis of the wrist, MCP, PIP and MTP joints. Exam of heart, lungs, and abdomen is unremarkable. What system much you inquire more about today? - CORRECT ANSWER GI** NSAID gastropathy is sneaky and can be fatal! Clues of impending disaster: high risk for NSAID gastropahty; presentation suggestive of blood loss (pale, dizzy, weak, tachycardia w low BP); no evidence of flare in RA to explain recent symptoms of increased fatigue Synovitis - CORRECT ANSWER Synovitis is the medical term for inflammation of the synovial membrane. This membrane lines joints that possess cavities, known as synovial joints. The condition is usually painful, particularly when the joint is moved. The joint usually swells due to synovial fluid collection. NSAID gastropathy - CORRECT ANSWER gastric ulcers are more common than duodenal ulcers. No reliable warming signs. 80% of serious events occur w/o prior symptoms. Risk of hospitalization for NSAID ulcers in RA in 2.5 to 5.5 X higher than general pop. 107,000 pts are hospitalized and 16,000 death occur annually in US because of NSAID-induced GI complications Risk factors for NSAID ulcers - CORRECT ANSWER older age. Prior h/o peptic ulcer or GI symptoms w NSAIDs. Concomitant use of prednisone. NSAID dose: more prostaglandin suppression = greater risk fo serious events. Disability level: the sicker the pt the higher the risk Treatment of NSAID gastropathy - CORRECT ANSWER Acute bleed or perforation: Stop NSAID, endoscopy or surgery, start omeprazole. Ulcer w/o bleed or perforation, and needs or wants continued NSAID: omeprazole 20 mg qd - 76% healed; OR misoprostol 200 uq qid - 71% healed Prevention of NSAID gastropathy - CORRECT ANSWER Avoid the problem: stop the NSAID and use alternative treatment: low-dose prednisone, Tylenol, Nonacetylated salicylates. Use a selective cyclooxygenase-2 inhibitor. Antacids and H2 blockers are not the answer! May mask symptoms but DO NOT prevent serious events 52 yo M w destructive RA treated w NSAID and low-dose prednisone. MTX (methotrexate) started 4 mo ago, now 15mg/wk. Presents w 3-wk h/o fever, dry cough, and increasing SOB. Exam: low grade fever, fine rales in both lungs, normal CBC and liver enzymes, low albumin, diffuse interstitial infiltrates on CXR. What next? - CORRECT ANSWER Give oral steroid for hypersensitivity pneumonitis and stop methotrexate. DMARDs have a dark side. Methotrexate may cause serious problems: lung, liver, bone marrow. Be on the look out for toxicity w all the DMARDs Erythematosis, Lupus - CORRECT ANSWER Lupus is an autoimmune disease in which the body creates antigens that attack different body tissues. 3 types of lupus: Discoid, Systemic, and Drug-induced SLE (systemic lupus erythematosus) symptoms - CORRECT ANSWER Skin rash Arthritis Fever Anemia Joint pain Photosensitivity Hair loss Ulcers in the mouth Kidney damage Arthritis of SLE - CORRECT ANSWER Musculoskeletal manifestation 90% Most have arthralgia May have acute inflammatory synovitis RA-like. Do not develop erosion. Other clinical features help with DD: malar rash, photosensitivity, rashes, alopecia, oral ulceration SLE diagnostic tests - CORRECT ANSWER LE cell; ANA titer; Anti-DNA; Complement fixation; ESR/CRP. Criteria to DX: Malar, discoid rash; photosensitivity; arthritis; renal disorder; immunological disorder; DNA, ANA Lupus Criteria - CORRECT ANSWER Need 4 of 11: M - malar rash D - discoid rash S - serositis O - oral ulcers A - arthritis P - photosensivity B - blood abnormalities R - renal A - ANA antibiodies I - immune abnormalitis N - neurologic Fibromyalgia ACR criteria - CORRECT ANSWER Heightened myodenia (pain to touch). History of chronic widespread pain >3 mo. Exhibit >11 of 18 tender points. ACR criteria are both sensitive (88.4%) and specific (81.1%) Fibromyalgia treatment - CORRECT ANSWER Aerobic exercise; Cog behavioral tx; pt education; strength training; acupuncture; biofeedback; hypnotherapy; antidepressants; analgesics; anticonvulsants (pregabalin - Lyrica); SNRI (duloxitine - Cymbalta) In early June a 15 yo boy comes to your practice w his mother. He had been fine until about 5 days ago when he developed a fever. He has a stiff neck and a rash on his back. He and his family live in Connecticut near the New York State border. His mother reports he was playing in the woods recently. He has a bulls-eye rash on his arm. What is the diagnosis? - CORRECT ANSWER Lyme disease. Erythema migranes rash, along with fever and stiff neck, along with the geographic local of the patient suggests Lyme disease. Other s/s: fatigue, headache, muscle and joint pain. Borrelia burgdorferi is the causative agent of Lyme disease (spirocete, same family as syphillis). Treat with amoxicillin or doxycycline for 3-4 weeks. Lyme Disease - CORRECT ANSWER Epidemiology: tick borne disease (Borrelia burgdorferi in deer tick); Multi-system, inflammatory; in 2010, 94% of cases from Northeast with cases noted in MN & WI. Early presentation: distinct skin rash - local lesion; recent h/o pt walking in wooded areas. Later stages: cardiac/neurologic/arthritis complications Stages of Lyme disese - CORRECT ANSWER 1st: erythema migrans (bulls eye) rash 7-10 days; headache/fever/malaise; treated w antibiotics. 2nd: days to mo later, early disseminated w a hematogenous spread (spread in the blood). Later stage: If untreated 10% develop chronic arthritis; bells palsy/myopericarditis/poor memory Lyme Disease - CORRECT ANSWER Pt hx: exposure to tick bite - wooded areas. Dx test: ELISA test screen for antibodies (once positive, will always be positive even after treatment). Tx: Antibiotics - PCN/Rocephin; NSAIDs; intra-articular corticosteroids for Lyme arthritis; medical specialist monitoring for systemic conditions. Patient education for Lyme disease - CORRECT ANSWER Walk in the center of path in the woods in high risk areas; wear light colored clothing so ticks are easier to see; wear long pants tucked into socks; check for ticks; use repellant; PROMPT eval for suspicious symptoms A 21 yo M presented w acute pain and swelling of 1 knee. On exam, the joint is tender and restricted in movement. Xray of the knee showed periarticular OA. On investigation, he had a raised ESR of 102, and mild anemia (Hb 10.6) but no detectable serum RA factor. The knee effusion was aspirated; the fluid contained a polymorphonuclear leucocytosis but no organisms or RA factor. No diagnosis was made at this stage but he was treated empirically with indomethacin; his arthritis improved. What was his diagnosis? - CORRECT ANSWER Possibly Ankylosing spondylitis. Our 21 yo M presented w acute pain and swelling of 1 knee returns 15 mo later and now has developed an iritis in his left eye, low back pain and stiffness. His peripheral joints were normal but pain could be elicited in both sacroilian joints. X-rays of his pelvis showed the classic changes of ankyosing spondylitis and tissue typing revealed that he was HLA-B27 positive. He has intermittent backache over the last 5 years, although daily exercises have limited the stiffness. He has developed bony ankylosis between the lumbar vertebrae. anylosing spondylitis - CORRECT ANSWER Etiology: unknown - link to HLA-B27 gene; chronic inflammatory disease; axial skeleton; Synovial inflammation -> fibroblast response -> dense fibrous scars -> vertebrae fuse. Epidemiology: onset age 25-34 yo; occurs in males 5X greater than females. Clinical presentation: long h/o dull achiness w stiff back or neck, ascending stiffness of spine, fatigue and impaired sleep. Diagnostic testing: radiographs show bamboo spine (later stages, calcification formation between vertebra); elevated ESR, decreased PFT (pulmonary function test) if there is thoracic involvement. Pharamcologic tx: NSAIDs/DMARDS/AntiTNF blockers; non-narcotic analgesics prn; muscle relaxants prn. Non-Pharmacologic tx: balance activity and rest periods; PT; daily stretching exercises; assistive devices - canes Systemic Sclerosis - CORRECT ANSWER AKA scleroderma Etiology: autoimmune disorder; multi-system (microvascular and connective tissue). Vasculopathy and fibrosis. Alterations in skin and internal organs. Limited (CREST syndrome) and diffuse types. Incidence: est 100,000 in US. Usually age 30-50. Women > men. All races and ethnic groups. Pulmonary fibrosis is the leading cause of death for this disease. Limited scleroderma (CREST syndrome) - CORRECT ANSWER C- Calcinosis (CA deposits under skin) R - Raynaud's phenomenon E - esophageal dysfunction S - sclerodactyly (tightening of the skin) T - telangiectasia (dilated blood vessels) 2 out of 5 symptoms confirm the disese Anticentromere antibodies + < 90% Clinical presentation of diffuse scleroderma - CORRECT ANSWER Edema of hands. Thickened skin w loss of skin folds. Stiff joints. Decreased thoracic excursion. H/O of Raynaud's. GI issue/esophageal dysfunction. Causes changes to internal organs. Anti topoisimerase-I or Anti-Scl-70 antibodies + in < 40%. CXR, PFTs may show changes. treatment of systemic sclerosis - CORRECT ANSWER No cure. Avoid cold. Cease smoking. Skin care. Good dental care (Sjorn's syndrome common). PT - maintain ROM, facial mobility. GI management. Meds: modify disease/symptomatic treatment. ACEI for renal crisis. Vasodilators to increase blood flow to fingers, prevent/tx pulm HTN. Immunosupressants. Sometimes requires dialysis, kidney transplant. Progression and complications of systemic sclerosis - CORRECT ANSWER Once in remission - relapse is uncommon. Lung impairment - leading cause of death. Loss of hand grips. GI: hypomotility -> malabsorption/constipation; esophageal fibrosis -> dysphagia. Dermatomyositis/Polymyositis - CORRECT ANSWER Inflammatory myopathy of skeletal muscles. S/S: fatigue; fall unrelated to balance; heliotrope rash; shawl sign; V-sign. Dx test: elevated CK (muscle damage); EMG - inflammation; biopsy - necrosis. Tx: Corticosteroids; immunosuppressives; IV IgG; topicals for rash; bed rest - slow return; ROM activities. Differential diagnosis in inflammatory arthritis - CORRECT ANSWER Eye involvement: conjunctivitis in reactive arthritis, uveitis in enteropathic and sarcoidosis, episcleritis in RA. Oral ulcerations: painful in reactive arthritis and enteropathic, not painful in SLE. Nail lesions: pitting (psoriasis), onycholysis (reactive arthritis). Alopecia (SLE) Onycholysis - CORRECT ANSWER Onycholysis is when a person's nail or nails detach from the skin underneath. Although not a serious health condition by itself, onycholysis can be a symptom of a potentially serious illness. Anatomy of the spine - CORRECT ANSWER 7 cervical vertebra 12 thoracic 5 lumbar 5 sacral fused vertebra (Sacrum and Coccyx). THe vertebral column i sthe part of the axial skeleton that surrounds and protects the spinal cord, while bearing the weight of the head, neck, and trunk. The vertebral column is not straight; its curves accomodate the thoracic and abdominopelvic viscera and also balance the weight of the trunk and head over the lower limbs. Cervical is concave on the posterior surface, thoracic is convex on the posterior surface, lumbar is concave, and the sacrum is convex. T4 = nipple line T10 = umbilicus L4 = iliac crest The adult human vertebral column consists of 26 bones total. Generally, 1 spinal nerve emerges at each vertebrae, save in the cervical spine where there are 7 vertebrae but 8 cervical nerves. Scoliosis - CORRECT ANSWER Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. kyphosis - CORRECT ANSWER excessive outward curvature of the spine, causing hunching of the back. Cervical spine - CORRECT ANSWER 7 vertebrae 8 cervical nerve root Atlas C1 Axis C2 has the odontoid process which fits inside C1. The 1st cervical vertebrae is called the atlas; its superior articular processes have facets that articulate with the occipital condyles of the skull in a type of joint that permits forward-backward motion of the head. The body of the 2nd cervical vertebrae, the axis, has a prominent odontoid process that extends superiorly and articulates with a facet on the atlas, providing a pivot point to allow rotational movement of the head. The facet of the superior articular process of the axis articulates with a similar flat surface on an inferior articular process of the atlas. Like other individual vertebrae, the axis has a prominent dorsal spinous process, which is notched as it is in cervical vertebrae 3-6 and is referred to as bifid; the atlas has a smaller dorsal process known as the posterior tubercle. Laterally, a transverse process provides attachment sites for muscle, while the transverse foramen allows passage of vertebral arteries and veins. Vertebrae - CORRECT ANSWER Each individual vertebrae consists of a vertebral body or centrum that transfers weight to the next lower vertebrae, a vertrebral arch forming the posterior margin of the vertebral canal, and variable types of processes that either provide attachment points for muscles or articulate with ribs. The 5 sacral vertebrae begin fusing after puberty and are usually completely fused by age 25-30. The coccyx is not completely fused until late in adulthood. Recommended preop testing - CORRECT ANSWER Hgb for major surgery w significant expected blood loss or CBC count if the cost is not substantially increased; Serum Cr level for people older than 40; EKG in pts older than 40; CXR in pts older than 60; no labs must be repeated if results were normal Preop cardiac considerations - CORRECT ANSWER For emergency noncardiac surgery, preop heart testing should not be done; rather, the pt should immediately undergo the emergency procedure. Pts w severe or symptomatic cardiovascular disease and/or active cardiac conditions should undergo eval & tx before noncardiac surgery. These conditions include unstable CAD, blockage of 2 or more coronary vessels, decompensated HF, significant cardiac arrhythmias, or severe valvular disease. Geriatric considerations - CORRECT ANSWER Careful PE; malnutrition suspected - CBC, albumin, cholesterol; UA, CBC, Chem panel, coag studies; lytes if on diuretic; EKG & CXR Geriatric guidelines - CORRECT ANSWER Complete H&P; cog assessment; depression screening; risk factors for postop delirium; substance abuse/dependence screening, ETOH; cardiac eval following American College of Cardiology/AHA algorithm for pts underdoing noncardiac surgery; risk factors for postop pulmonary complications and implementing suitable prevention strategies; functional status and fall history documented; calculate frailty at baseline; assessing nutritional status and considering implementation of preoperative interventions for high-risk patients; complete Rx hx, preop adjustments, monitoring for polypharm; identify patient's treatment goals and expectations; assess family and social support system; performing suitable diagnostic tests prn. Functional Capacity Evaluation (FCE) - CORRECT ANSWER 1-4 metabolic equivalents (METs) include eating, dressing, using the bathroom, walking indoors, walking 1-2 blocks on level ground, and doing light housework. 4-10 METs include climbing stairs or walking up a hill; running a short distance; scrubbing floors or moving furniture; and recreational activities, such as golf, bowling, dancing, and playing tennis. ASA Physical Status Classification System - CORRECT ANSWER ASA 1 Normal healthy patient ASA 2 Patients with mild systemic disease ASA 3 Patients with sever systemic disease ASA 4 Patients with severe systemic disease that is a constant threat to life ASA 5 Moribund patients who are not expected to survive w/o the operation ASA 6 A declared brain-dead patient whos organs are being removed for donor purposes Malignant hyperthermia - CORRECT ANSWER An inherited disorder of skeletal muscle triggered in humans or animals in most stances by inhalation agents and/or succinylcholine, resulting in hypermetabolism, skeletal muscle damage, hyperthermia, and death if untreated. Underlying physiologic mechanism - abnormal handling of intracellular Ca+ levels. Triggering agents: potent volatile anesthetics (e.g. Halothan, Sevoflurane, desflurane). Non-triggering: IV agents, opioids, non-depolarizing agents succinylcholine, ketamine, propofol, anxiolytics Clinical signs of malignant hyperthermia - CORRECT ANSWER specific signs: muscle rigidity; increased CO2 production; rhabdomyolysis; marker temperature elevation. Non-specific signs: tachycardia; tachypnea; acidosis (respiratory/metabolic); hyperkalemia Immediate tx of malignant hyperthermia - CORRECT ANSWER DC INH agents, succinylcholine; hyperventilate w 100% O2; bicarb 1-2 mg/kg prn; get additional help; dantrolene 2.5 mg/kg IV push, repeat prn; cool patient: gastric lavage, surface, wound; tx arrhythmias; do NOT use Ca+ channel blockers Continued tx of malignant hyperthermia after initial phase - CORRECT ANSWER Give dantrolene 1 mg/kg every 4-6 hrs for 24-48 hrs; monitor for recrudescence - rate is 25%; follow lyte panel, blood gases, CK, core temp, urine output & color; coag studies. Biochemical markers: blood gases esp p CO2, pH; myoglobin levels in serum and urine; PT, PTT, INR, fibrin split products, liver enzymes, BUN; monitor for signs of myoglobin and rhabdomyolysis and institute therapy to prevent renal failure. Malignant hyperthermia (MH) prevention - CORRECT ANSWER Avoid MH trigger agents in MH susceptible or those suspected of being susceptible. Preop personal/family hx of anesthetic problems, neuromuscular disorders to identify those who may be MH-susceptible. Temp/end tidal CO2 monitoring during general anesthesia. Recognition of masseter muscle rigidity. Prompt investigation of unexplained tachycardia, herpcarbia, hyperthermia. Availability of Dantrolene. ORs should perform regular MH drills to be prepared. [Show Less]
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