AMSN Musculoskeletal and Orthopedic Conditions 2 — Questions and Answers
Question 1: Fat embolism syndrome (FES) is a serious complication most commonly associated with:
- Hip replacement surgery in elderly women
- Long bone fractures, particularly femur and tibia (Correct answer)
- Vertebral compression fractures
- Rotator cuff repair
Correct answer: Long bone fractures, particularly femur and tibia
Fat embolism syndrome most commonly occurs after fractures of long bones (femur, tibia) when fat globules enter the bloodstream.
Question 2: A patient with FES develops petechiae on the chest, axillae, and conjunctivae 48 hours after a femur fracture. The nurse recognizes this as:
- An allergic reaction to analgesics
- A classic sign of fat embolism syndrome (Correct answer)
- A sign of disseminated intravascular coagulation (DIC)
- Normal ecchymosis from trauma
Correct answer: A classic sign of fat embolism syndrome
Petechiae on the chest, axillae, and conjunctivae are a classic clinical sign of fat embolism syndrome caused by fat microglobules obstructing dermal capillaries.
Question 3: A patient in skeletal traction requires nursing care. Which action is correct?
- Remove weights briefly during patient repositioning
- Ensure weights hang freely and do not rest on the floor (Correct answer)
- Tape the traction ropes to prevent slipping
- Reposition the patient to the lateral position every 2 hours
Correct answer: Ensure weights hang freely and do not rest on the floor
Traction weights must hang freely at all times to maintain proper traction force; resting weights on the floor negates the therapeutic effect.
Question 4: A patient asks the nurse why ice packs are applied to a sprained ankle in the first 48 hours. The best response is:
- 'Ice prevents infection at the injury site.'
- 'Cold reduces blood flow and decreases inflammation and swelling.' (Correct answer)
- 'Ice numbs the nerves to completely eliminate pain.'
- 'Cold promotes circulation to speed healing.'
Correct answer: 'Cold reduces blood flow and decreases inflammation and swelling.'
Cold therapy reduces blood flow via vasoconstriction, decreasing local inflammation, edema, and pain in the acute phase of injury.
Question 5: A patient with gout is having an acute attack. Which dietary teaching is most appropriate?
- Increase intake of organ meats and shellfish
- Increase fluid intake and avoid purine-rich foods and alcohol (Correct answer)
- Start a high-protein diet to promote healing
- Limit fluid intake to reduce kidney workload
Correct answer: Increase fluid intake and avoid purine-rich foods and alcohol
Adequate hydration promotes uric acid excretion; avoiding purines (organ meats, shellfish) and alcohol reduces uric acid production during a gout attack.
Question 6: A patient with osteoarthritis is prescribed celecoxib (Celebrex). The nurse should monitor for which serious adverse effect?
- Hypoglycemia
- Cardiovascular events and GI bleeding (Correct answer)
- Nephrotoxicity from daily vitamin use
- Pulmonary hypertension
Correct answer: Cardiovascular events and GI bleeding
COX-2 inhibitors like celecoxib carry a black box warning for increased risk of cardiovascular events (MI, stroke) and GI bleeding.
AMSN Musculoskeletal and Orthopedic Conditions 2
Fat embolism syndrome (FES) is a serious complication most commonly associated with: