Deck 54: Diagnosis and Treatment of Orthopedic Injuries and Conditions

Question 1

While being tackled, a 20-year-old football player puts out his hand to break his fall to the ground. Because the intense pain in his wrist did not subside by the end of the game, he was brought to an emergency department where diagnostic imaging indicated an incomplete tear of the ligament surrounding his wrist joint. At the time of admission, his wrist was swollen with a severely restricted range of motion. What will his care team most likely tell the player about his diagnosis and treatment?

A) "This strain will likely resolve itself with sufficient rest."
B) "You've suffered a severe sprain, and you might need a cast."
C) "Your wrist contusion will have to be observed for bleeding under the skin surface."
D) "It looks like a mild to moderate sprain, and you'll need to keep it immobilized for a few weeks."

Answer 1

"It looks like a mild to moderate sprain, and you'll need to keep it immobilized for a few weeks."

Question 2

A 41-year-old woman has been diagnosed as having a loose body of cartilage in her left knee. What data would most likely lead clinicians to this conclusion?

A) A visible hematoma is present on the anterior portion of the knee.
B) The woman experiences intermittent, painful locking of her joint.
C) Computed tomography indicates a complete tear of her knee ligament.
D) An x-ray shows that her femoral head and tibia are no longer articulated.

Answer 2

The woman experiences intermittent, painful locking of her joint.

Question 3

A 22-year-old woman has sustained a lateral blow to her right knee during a game, and subsequent imaging has confirmed a severe meniscus injury. Which of the following consequences should the woman expect over the course of recovery? Select all that apply.

A) Decreased lubrication in the knee joint
B) Decreased stability of the knee
C) Reduced shock absorption capacity
D) Presence of infectious microorganisms in the synovial capsule
E) Rapid restoration of the cartilage cells in the meniscus

Answer 3

Decreased lubrication in the knee joint
Decreased stability of the knee
Reduced shock absorption capacity

Question 4

The nurse knows that which of the following patients listed below is at high risk for developing a hip fracture?

A) A 77-year-old male who runs marathons and maintains a BMI of 25.
B) An 82-year-old female with macular degeneration and uses a walker to go to the bathroom.
C) A 64-year-old male with uncontrolled diabetes and chronic kidney disease on dialysis.
D) A 73-year-old nursing home patient with long-term continence issues but able to walk the hallways for exercise.

Question 5

A public health nurse is conducting a health promotion teaching session at a seniors' drop-in center. Which of the following teaching points about hip fractures in older adults is most justified?

A) "Current treatment options for hip fractures in older adults mean that surgery is no longer a common necessity."
B) "Because of their generally higher body mass, men are particularly susceptible to breaking a hip in a fall."
C) "Most hip fractures are actually a break at the very top of the thigh bone."
D) "Because bone density is largely determined by your genes, there's little you can do to prevent hip fractures other than avoiding falls."

Question 6

Which of the following recent admissions to an emergency department is most likely to be diagnosed with a greenstick fracture?

A) A 20-year-old football player who had an opposing player fall laterally on his leg
B) An 8-year-old boy who fell out of a tree and on to his arm
C) An 81-year-old woman with a history of osteoporosis who stumbled and fell on her hip
D) A 32-year-old woman who fell awkwardly on her arm while skiing

Question 7

The parents of an active 9-year-old are leaving the emergency department (ED) following cast placement for their son's lower extremity as a result of a fall in soccer. The nurse should emphasize that assessment of the cast is important and that they should bring their son back to the ED if they note which of the following signs and symptoms? Select all that apply.

A) Cold, pale toes on the side with the cast.
B) Patient complaining of tingling and numbness in the casted leg.
C) Swelling in the lower leg has remained the same since they left the ED 12 hours ago.
D) Pulses are palpable below the level of the cast.
E) Bruising noted in the lower foot and toes.

Question 8

A nurse is providing care for a client who has had a cast applied to her fractured arm 6 hours prior. The client is now complaining of severe pain that she describes as "even worse than when I broke my arm." What would be the nurse's best course of action?

A) Administration of analgesics and teaching the client about the normal course of pain after a fracture
B) Teaching the client simple range of motion exercises to promote circulation and perfusion
C) Taking the client's temperature due to the possibility of infection
D) Assessment of motor and sensory function with the goal of identifying compartment syndrome

Question 9

Following a motorcycle accident that resulted in bilateral femoral fractures, a 42-year-old male has been receiving skeletal traction for the past 8 days. His care providers would recognize that which of the following risks is paramount?

A) Risk of thromboemboli
B) Risk of compartment syndrome
C) Risk of permanent muscle atrophy
D) Risk of decreased bone density and increased future fracture risk

Question 10

A patient has been admitted with a fractured pelvis that occurred in an auto accident just a few hours ago. The nurse notices a slight change in behavior. Which of the following clinical manifestations would lead the nurse to suspect that the patient has fat emboli that has migrated? Select all that apply.

A) Complaints of substernal chest pain
B) Complaints of pain in the lower abdomen and back
C) Pulse rate 120 with temperature of 99.7°F
D) Profuse diaphoresis with pallor noted
E) Urine output of 30 mL/hour

Question 11

Following prosthetic joint replacement of the knee, the patient continues to complain of pain and discomfort above what would be expected. There is poor incisional healing. The clinic nurse is concerned when she sees that the incision is still draining after 3 weeks post-op. The nurse suspects a prosthetic joint infection. The nurse should anticipate the physician will prescribe

A) complete bed rest with immobilization of the knee.
B) high doses of nonsteroidal anti-inflammatory drugs.
C) antimicrobial treatment depending on the microbe.
D) wound irrigations with hydrogen peroxide twice daily.

Question 12

A 56-year-old male is obese and has poorly controlled type 2 diabetes mellitus. The home care nurse who changes the dressing on his chronic foot ulcer three times weekly has noted that the client's bone is now visible in the wound bed. The client has a fever and has not complained of any notable increase in pain to his foot. Which of the following statements best captures what is likely occurring?

A) The client is possibly experiencing direct penetration osteomyelitis in which microorganisms have entered through his foot wound.
B) Infectious microorganisms in his blood supply have proliferated in the distal portions of his skeletal system.
C) Vascular insufficiency has contributed to infection in both soft tissue and now his bone.
D) His immunocompromised status associated with diabetes has allowed skin flora to penetrate his foot bone via the surface wound.

Question 13

Which of the following individuals is likely to have the highest risk of developing tuberculosis osteomyelitis?

A) A 55-year-old female who is in renal failure secondary to poorly controlled type 1 diabetes
B) A 79-year-old man who is immunocompromised following a bone marrow transplant
C) A 30-year-old man who has undergone open reduction and internal fixation of his fractured tibia
D) A 68-year-old woman who had a laminectomy 4 days prior for treatment of her chronic back pain

Question 14

A patient asks the nurse why his hip fracture (head of the femur) bone has died (osteonecrosis). The nurse responds based on which of the following pathophysiological principles?

A) All fractured bones interrupt blood supply and thereby results in death of the bone no matter where it is located.
B) Most of the time when the head of the femur breaks, the entire neck region is disconnected to the rest of the bone so the blood vessels are severed.
C) Since the head of the femur has only limited collateral circulation, interruption in the blood flow from the fracture causes necrosis and irreversible damage.
D) When the femur head breaks, it dislocates and crushes the surrounding area causing the blood vessels to be occluded.

Question 15

A 51-year-old male with a history of hypertension has received a kidney transplant. The client's physician is explaining some of the consequences of the procedure, including the fact that he will need to be on long-term steroid therapy. Which of the following teaching points should the physician emphasize?

A) "One of the risks that these steroids bring is the possibility that part of a bone might die."
B) "Steroids will help your body to not reject your new kidney, but they bring a risk of bone infection."
C) "You're going to have to avoid contact sports because the steroids will make your bones very susceptible to breakage."
D) "If you notice sudden limb pain after taking your steroid pills, it could be an increase in pressure in the compartment around your muscles."

Question 16

A 35-year-old woman who has been in recovery from alcoholism for 2 years presents at her primary care physician's office with chronic hip pain. She reports that as part of her commitment to her recovery, she began exercising regularly about a year earlier. After a month or two, her hip began to hurt when she ran on the treadmill. She stretches, has had a physical trainer check her form to ensure that it is correct, and rests adequately between each workout. Six months ago, the pain began waking her at night, and now it is constant. She is not aware of any injury to her hip and has no other outward symptoms. Which of the following is most likely to be the cause of her pain?

A) Hematogenous osteomyelitis
B) Osteomyelitis with vascular insufficiency
C) Tuberculosis of the bone
D) Osteonecrosis

Question 17

When trying to explain to a patient diagnosed with a benign bone tumor, the nurse should emphasize the fact that benign tumors primarily

A) grow rapidly and can spread to the surrounding tissue.
B) cause growth of other tumors as they spread their cancer cells into the bloodstream.
C) tend to grow very slowly without destroying the supporting tissue.
D) occur as a result of tumors in other areas of the body metastasizing into the bone.

Question 18

A 13-year-old girl and her father come in to the local health clinic hoping to see an orthopedic doctor about the girl's stiff and warm knee. The father reports that she hurt it sliding into base during a softball game, and the daughter concurs, but with further discussion, it becomes clear that the slide made an existing pain worse. Her knee had been stiff, warm, and shiny and had been keeping her awake at night for a week or so before the game. Which of the following might be the cause of the girl's symptoms?

A) Osteosarcoma
B) Osteoma
C) Chondroma
D) Osteochondroma

Question 19

A 17-year-old male has been diagnosed with osteosarcoma of the upper tibia following several months of leg pain. Which of the following statements by the client demonstrates that he has an accurate understanding of his diagnosis?

A) "I guess it's good that at least my tumor's a benign type."
B) "I'm really nervous about having to get surgery and chemo."
C) "I'm gaining hope from the fact that it's really rare for someone to die from this."
D) "It still feels surreal that I'm going to have to get my leg amputated."

Question 20

A 56-year-old female with a diagnosis of breast cancer has developed bone metastases, which her oncologist would like to treat with radiation therapy. What is her physician's most likely primary goal in the treatment plan of the metastases?

A) Thorough elimination of neoplastic cells in the bone structure
B) Preservation of normal weight bearing and range of motion
C) Ensuring vascular supply to the bone is not affected
D) Prevention of pathologic fractures