Question

Musculoskeletal Nursing

The nurse is caring for a patient who has had blood work done. Lab results show significantly elevated sed rate (ESR) and the presence of rheumatoid factor (RF). Which of the following illnesses is suspected when these findings are present?

                A. osteoporosis

                B. rheumatoid arthritis

                C. gout

                D. osteoarthritis

The nurse caring for a 55 year old client who is undergoing a total hip arthroplasty. The client is aware that there will be activity restrictions. Which of the following should not be included in the teaching plan?

1. Avoid hip flexion greater than 90 degrees
2. Use an abduction pillow while in bed
3. Sit in low chairs
4. Do not cross legs

The nurse is caring for an infant that has been diagnosed with congenital hip dislocation. Which of the following will be part of the patient's treatment?

                A. surgery to replace the femur head so it sits correctly in the acetabulum

                B. placing leg braces on the infant to support the hips during ambulation

                C. placing the infant in Bryant’s traction for six months

                D. placing the hip in a spica cast until the hip is stable

Which of the following classifications of anti- inflammatory medicines acts by overriding the body’s normal inflammatory response?

                A. anti-gout medications

                B. Steroids

                C. non-steroidal anti-Inflamatories (NSAIDs)

                D. salicylates

The nurse us caring for a patient who is two-days post op with a below the knee amputation of the left leg (BKA). When the nurses goes in to assess the patient, the patient is crying. The patient tells you that their left foot hurts terribly, but it is not there anymore. How will you respond?

                A. Reassure the patient that phantom pain is temporary and does not need medication.

                B. Explain phantom pain and administer pain medication as ordered.

                C. Check their level of consciousness and notify the physician immediately.

                D. Explain that they cannot be experiencing pain in a limb that has been amputated.

A patient comes to the clinic complaining of severe pain in his left great toe. Which of the following assessments would not be appropriate for the nurse to make?

1. Assess his vital signs
2. Assess his toe for color changes and heat
3. Assess for history of a tick bite
4. Assess his urinary output

This test is performed to obtain fluid for diagnostic purposes and to remove excess fluid.

                A. Arthrogram

                B. CT Scan

                C. Arthroscopy

                D. Arthrocentesis

The nurse is working in a long-term care facility.   A resident fell in his bathroom.   When the nurse exams him while he is lying on the floor, she notices that his right leg is shorter than his left leg.   His right leg is in a slightly flexed position and the foot is rotated outward.   What will the nurse do?

1. Leave the resident unmoved, notify the physician, and call an ambulance for a suspected hip fracture.
2. Lift the resident into bed, apply Buck’s traction to his right foot to keep his knee alignment, and notify the physician
3. Assist the resident back to bed to recover from a muscle strain
4. Splint the resident's leg to keep his knee from bending, assist him to bed to recover from a dislocated knee, and notify the physician

In providing dietary instructions to a client to minimize the risk of oteoporosis, the nurse should recommend which of the following foods?

       A.            Yogurt

       B.            Bread

       C.            Rice

       D.            Chicken

The nurse is preparing to wrap a patient's BKA stump. Which of the following statements about wrapping the stump is correct?

1. If the patient is not going to get out of bed, you do not need to wrap the stump.
2. You will wrap the elastic bandage around the stump and around the waist to keep it in place.
3. You will wrap the elastic bandage around the stump and around the thigh to keep it in place.  
4. The purpose of wrapping the stump is to protect it from trauma.

Answer 1

Musculoskeletal Nursing

The nurse is caring for a patient who has had blood work done. Lab results show significantly elevated sed rate (ESR) and the presence of rheumatoid factor (RF). Which of the following illnesses is suspected when these findings are present?

                A. osteoporosis

                B. rheumatoid arthritis

                C. gout

                D. osteoarthritis

Correct response is : Option B

Rheumatoid arthritis

Rheumatoid arthritis is a complex autoimmune disease in which immune system malfunctions and produces antibodies that attacks on the synovial membrane of joints. It often targets several joints at one time. People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, or sedimentation rate). Rheumatoid factors are proteins produced by immune system that can attack joints. High levels of rheumatoid factor, cyclic citrullinated peptide(CCP) antibody and rheumatoid factor (RF), and C reactive proteins (CRP) in the blood are most often associated with rheumatoid arthritis and some other autoimmune diseases.

Osteoporosis is a disease characterized by deterioration of bone tissue and loss of bone strength. Diagnosis is confirmed by x-ray, CT scan or a bone density scan.

In GOUT serum uric acid and creatinine is elevated.

Osteoarthritis is caused by mechanical wear and tear on joints and is diagnosed with imaging tests such as X-rays and MRIs which show the progressive damage and deterioration happening the joints. OA can’t be diagnosed with a specific blood test.

The nurse caring for a 55 year old client who is undergoing a total hip arthroplasty. The client is aware that there will be activity restrictions. Which of the following should not be included in the teaching plan?

A. Avoid hip flexion greater than 90 degrees

B. Use an abduction pillow while in bed

C. Sit in low chairs

D. Do not cross legs

Correct response is : Option C

Sitting on a low, soft or overstuffed furniture is not advised after total hip arthroplasty as it will cause excessive bending of hip and can result in hip from dislocation. They should always sit on a firm chair with straight back and armrests. Keep hips and knees at 90 degrees (i.e., knees below hips).

Hip arthroplasty patients are advised not to perform any activity that causes bending of the hips or knees more than 90 degrees, do not cross the legs, do not lift the leg to put on socks, and much more. These movement restrictions protect the new hip from dislocation.

A hip abduction pillow is advised after hip arthroplasty as it prevent hip joint/ bones from turning in or away from your body (internal and external rotation), keep leg and hip of patient straight when in bed and during sleep and speed up healing. Patient may need to use a hip abduction pillow for several weeks.

The nurse is caring for an infant that has been diagnosed with congenital hip dislocation. Which of the following will be part of the patient's treatment?

                A. surgery to replace the femur head so it sits correctly in the acetabulum

                B. placing leg braces on the infant to support the hips during ambulation

                C. placing the infant in Bryant’s traction for six months

D. placing the hip in a spica cast until the hip is stable

Correct response is : Option D

Congenital hip dislocation is a condition in which the hip socket, or acetabulum, is too shallow for the ball of the hip to stay firmly in place. It is important for infants to receive treatment as early as possible to try to decrease the risk of lifelong damage to the hip joint. Though all traction, spica and after surgery is used in management of congenital hip joint dislocation but protocol is progressive.

When an infant is diagnosed with congenital hip dislocation, a harness or brace is used to hold the femur in correct position and allow to strengthen the ligaments around the hip joint to develop normally but not to support during ambulation.

A hip spica cast is a cast that encases the lower torso and one or both legs to hold the relocated femur in place while it heals. This procedure is done initially to allow for development of ligaments or later if braces were not effective and after closed reduction or surgical management.

Buck's traction, which is also known as skin traction, is used not Braynt’s traction. It pulls on femur to help ready the soft tissue that surrounds the hip. This will allow the femur to move more easily into the acetabulum.

Surgical treatment is usually done after 18 months.

Which of the following classifications of anti- inflammatory medicines acts by overriding the body’s normal inflammatory response?

                A. anti-gout medications

                B. Steroids

                C. non-steroidal anti-Inflamatories (NSAIDs)

                D. salicylates

Correct response is : Option B

Steroids

Inflammation is part of the body’s immune response. It can be acute or chronic.

Steroids are synthetic drugs that closely resemble cortisol, a hormone naturally produced by body. Steroids work by decreasing inflammation and suppressing the activity of the immune system. They are used to treat a variety of inflammatory diseases and conditions. Basically they act against all steps of the inflammatory cascade from the activation of innate, e.g. phagocytic cells, over the formation of inflammatory mediators to the activation of lymphatic cells and modulation of the immune reaction. potent anti-inflammatory against all events of inflammation.

Anti Gout medications works by reducing production of uric acid (Allopurinol) or by promoting its excretion (Lesinurad).

NSAIDs work by inhibiting the activity of cyclooxygenase enzymes (COX-1 or COX-2). In cells, these enzymes are involved in the synthesis of prostaglandins, which are involved in inflammation, and thromboxane, which are involved in blood clotting

A salicylate is a salt or ester of salicylic acid. Salicylates work more like NSAID’s that is by inhibiting the actions of the cyclooxygenase (COX) enzyme.

The nurse us caring for a patient who is two-days post op with a below the knee amputation of the left leg (BKA). When the nurses goes in to assess the patient, the patient is crying. The patient tells you that their left foot hurts terribly, but it is not there anymore. How will you respond?

                A. Reassure the patient that phantom pain is temporary and does not need medication.

                B. Explain phantom pain and administer pain medication as ordered.

                C. Check their level of consciousness and notify the physician immediately.

                D. Explain that they cannot be experiencing pain in a limb that has been amputated.

Correct response is : Option B

Phantom limb pain is the most widely known post-amputation pain syndrome. Phantom limb pain occurs in up to 80% of amputees Many patients will show gradual improvement of phantom pain within the first year and some will resolve completely. Many patients however will have phantom pain for life. This pain needs acknowledgement and pain medication as ordered.

Phantom limb pain is true and reassurance will not work.

Level of consciousness is not altered; they are true pain experienced by person not due to altered consciousness.

Phantom pain is true probably due to nervous systems confusion over nerve signals and perceiving the signals as from amputated part.

A patient comes to the clinic complaining of severe pain in his left great toe. Which of the following assessments would not be appropriate for the nurse to make?

A. Assess his vital signs

B. Assess his toe for color changes and heat

C. Assess for history of a tick bite

D. Assess his urinary output

Correct response is B, it can be gout

An attack of gout can occur suddenly, often waking up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable

This test is performed to obtain fluid for diagnostic purposes and to remove excess fluid.

                A. Arthrogram

                B. CT Scan

                C. Arthroscopy

                D. Arthrocentesis

Correct response is : Option D

Arthrocentesis is removal of fluid from joint for diagnostic or therapeutic purposes.

The nurse is working in a long-term care facility.   A resident fell in his bathroom.   When the nurse exams him while he is lying on the floor, she notices that his right leg is shorter than his left leg.   His right leg is in a slightly flexed position and the foot is rotated outward.   What will the nurse do?

A. Leave the resident unmoved, notify the physician, and call an ambulance for a suspected hip fracture.

B. Lift the resident into bed, apply Buck’s traction to his right foot to keep his knee alignment, and notify the physician

C. Assist the resident back to bed to recover from a muscle strain

D. Splint the resident's leg to keep his knee from bending, assist him to bed to recover from a dislocated knee, and notify the physician

Correct response is : Option A

The patient is showing shortening of limb and external rotation signs of hip joint fracture hence should not be allowed to flex or bend knee and need to be transferred safely to avoid further dislocation and injury to adjacent tissues.

In providing dietary instructions to a client to minimize the risk of oteoporosis, the nurse should recommend which of the following foods?

       A.            Yogurt

       B.            Bread

       C.            Rice

       D.            Chicken

Correct response is : Option A

Yogurt is rich in calcium and vitamin D which will reduce or prevent osteoporosis.