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NSG 255 Orthopedics, Osteoporosis, and Hip Fractures: Exam Questions and Answers, Exams of Orthopedics

A comprehensive overview of key concepts related to orthopedics, osteoporosis, and hip fractures. It includes a series of exam questions and answers covering topics such as the musculoskeletal system, bone cells, types of joints, fracture classification, and treatment methods. Particularly useful for students studying nursing or related healthcare fields.

Typology: Exams

2024/2025

Available from 03/05/2025

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NSG 255 Orthopedics, Osteoporosis, and Hip Fractures
2025 EXAM QUESTIONS & 100% ACCURATE ANSWERS
what is the purpose of the musculoskeletal system?
-support and movement
-protection of organs
-mineral storage (Ca++ and PO4) which helps with fluid and electrolyte balance
-hemopoietic system (blood cell formation)
bone cells: what are osteoblasts and who has more?
builders that make new bone; young people have more
bone cells: what are the osteocytes?
mature bone cells
bone cells: what are the osteoclasts?
crushers that destroy and reform bone; old people have more
what do we call the place two bones come together?
articulation
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NSG 255 Orthopedics, Osteoporosis, and Hip Fractures

2025 EXAM QUESTIONS & 100% ACCURATE ANSWERS

what is the purpose of the musculoskeletal system?

  • support and movement
  • protection of organs
  • mineral storage (Ca++ and PO4) which helps with fluid and electrolyte balance
  • hemopoietic system (blood cell formation)

bone cells: what are osteoblasts and who has more?

builders that make new bone; young people have more

bone cells: what are the osteocytes?

mature bone cells

bone cells: what are the osteoclasts?

crushers that destroy and reform bone; old people have more

what do we call the place two bones come together?

articulation

what type of joint is fixed and immovable? it is found in the skull and sternum

synarthroses (its a sin to move this joint)

what type of joints have slight movement, but movement is limited? it is found in the intervertebral discs and pubic symphysis

amphiarthroses (amp the music up and I'll be swinging my hips/pelvis)

what type of joints are freely movable, packed with fluid between synovial joints and found in the limbs, shoulders, elbow, fingers, hips, and knees?

diarthroses - you need your movable joints to walk through diagon alley

where are the ball and socket joints?

shoulder and hip

where are the plane joints?

wrist and foot

where are the hinge joints?

knee and elbow

ligaments

which collagen connective tissue attaches muscle to bone?

tendons

name the surgery that either completely or partially replaces the joint

arthroplasty

name the surgery that removes the synovial membrane only - it is an elective surgery for palliative or preventative purposes

synovectomy

name of surgery that cuts into bone and resects it which is supposed to correct a deformity or relieve pain

osteotomy

remember photo of tibial wedge removed, YUCK

name of surgery done to decrease joint deformity and increase function; teacher calls it a "nip tuck"

tendon reassignment

surgery to fuse joints by fusing 2 bones to decrease pain and increase function

arthrodesis

surgery for carpal tunnel; resection of metatarsals heads; inflammation leads to the trapped nerves

nerve release

*note the surgery will need re-done because cut nerves regenerate (even though nerve damage cannot fix itself)

what is important in post op care after ortho surgery?

5 P's

pain, pallor, pulse, paresthesia, paralysis

discharge plans include home safety

care differs by joint; physical therapy differs by joint

positioning to reduce edema and promote healing

a break in the continuity of the bone

fracture

occurs when stress placed on bone is greater than the bone can absorb

this type of fracture is still aligned

non-displaced fracture

the two edges of this type of fracture are NOT aligned. it requires reduction to put them back in alignment

displaced fracture

this type of realignment requires surgery

open reduction

this type of realignment does NOT require surgery, only manipulation

closed reduction

this is the term for a fracture that heals at an abnormal angle - meaning the bone ends meet but are not aligned

angulation

how do you fix angulation?

rebreak it and put it back in alignment - done in surgery

*not necessary if ADLs are still able to be completed and patient is satisfied

how do we classify stable vs unstable fractures?

stable fractures have some of the periosteum still intact. the fracture is aligned or realigned through reduction and either naturally or through internal or external fixation. the ends won't displace.

unstable fractures are grossly misplaced (open fracture) or more than one piece (comminuted) and they are easily displaced

what is the temperature of the area?

hot usually means inflammation and cold means circulatory issue

what is the color of the area?

red means venous return circulatory issue, pales means circulatory issue, cyanotic means lack of o circulating

how do we assess the circulatory status?

1)- check capillary refill

  1. check pulse and grade 1 - 4+

if you cannot palpate a peripheral pulse, what should you do?

use a doppler

what type of diagnostic test do we move onto if problem continues or highly suspect fracture & x-ray negative?

Angiography (inject dye), bone scans, MRI's and CT scans

what does examine from joint to joint mean in regards to fractures?

examine from joint above fracture to joint below fracture; check function and ability

what are the 4 main complications of fractures?

infection

compartment syndrome

fat embolism

avascular necrosis

what is a bone infection called? what is required to treat a bone infection?

osteomyelitis; another surgery to take out old material, flush with antibiotics and put in new material

how do we diagnose compartment syndrome?

look at 5 P's

but EXTREME pain will be evident from the increased pressure in the compartment

what is the defining characteristic of fat embolism?

after a break or surgery in the long bone, fat embolism has same s/s as pulmonary embolism EXCEPT petechia on upper chest and neck

what makes avascular necrosis more common?

if you have CV issues

happens (most often) at the ends of the bones

will not heal

what is the purpose of traction?

it (1) relieves muscle spasm and (2) keeps the injury or extremity in alignment and (3) reduces a fracture or dislocation

what is the name of the traction with one pulling force that is a type of skin traction?

1 force in the longitudinal direction is Bucks Traction for femur or hip replacement

what is the name of the traction with 2 pulling forces that when applied will produce a 3rd area of pull?

Russell's Traction for femur or hip

two of more pulling forces is called?

balanced traction

traction must be maintained

continuously

Keep the weights off the

floor and moving freely through the pulleys.

what are the advantages for skin traction?

easy to apply

usually used for short periods of time

relieves muscle spasms

what are the disadvantages of skin traction?

only for short term

weight limit is less than 10 lbs

do you increase or decrease the weight if there is greater muscle spasm?

increase

what are nursing considerations when your patient is in traction?

}Remove boots/splints each shift to inspect 5 P's

}Assess for tenderness/redness

}Check under bony prominences

}Be sure no pressure areas noted

}Check CSM - circulation, sensation, movement

}Skin intact? Patient is often on their back

}Good back care

nursing considerations for skeletal traction

pin care - check for signs of infection

what is the difference between running and balanced traction?

running has a straight line of pull; balanced has more than 1 line of pull

when the pt is in traction, never put the HOB up higher than

45 degrees

when you move a traction patient up in bed, always get a

2nd person to help support the weights so the pull is continual

Pulses

Sensation

Motion

Interspace (edema)

Temperature

Hue (color)

what type of suspension traction can the patient pull himself off the bed for care?

balanced suspension traction; maintain continual traction but morning care on bedpan can be done with minimal turning

external fixation

is composed of metal pins and wires that are inserted into the bone and attached to external rods to stabilize the fracture while it heals (Fig. 62.13). It can be used to apply traction or to compress fracture fragments and immobilize reduced fragments when the use of a cast or traction is not appropriate. The external device holds fracture fragments in place similar to a surgically implanted internal device. External fixation is used mainly for complex fractures with extensive soft tissue damage, correction of congenital bony defects, nonunion or malunion, and limb lengthening.

External fixation is often used to try to salvage extremities that otherwise may require amputation. Because the use of an external device is a long-term process, ongoing assessment for pin loosening and infection is critical. Infection may require removal of the device. Teach the patient and caregiver about meticulous pin care. Although each HCP has a protocol for pin care cleaning, chlorhexidine is often used

when is external fixation necessary?

if injury is too extensive for internal fixation or if surgery for internal fixation would be life threatening

sometimes used after compartment syndrome fasciotomy

in cases when the injury is open and infected, internal fixation is CA

anytime there is loss of bone - we can't make the bone ends meet with internal fixation

Devices (pins, plates, intramedullary rods, metal and bioabsorbable screws) are surgically inserted to realign and maintain position of bony fragments (Fig. 62.14). These metal devices are biologically inert and made from stainless steel, vitallium, or titanium. Proper alignment and bone healing are evaluated regularly by x-rays.

Internal fixation

what is internal fixation often combined with?

open reduction (open reduction internal fixation ORIF)

This type of osteoporosis occurs due to loss of estrogen and it's protective effects on bone; only women

Primary or type I

This type of osteoporosis occurs due to other causes (ex: medications like tobacco, steroids, anticonvulsants, ETOH (alcohol), PPIs- interferes with calcium and bone metabolism.

Secondary

thyroid disease

diverticulitis - decreased Ca+ absorption

diabetes

dietary insufficiencies/restrictions

polypharmacy

risk factors for osteoporosis

}Genetics or Cultures

}Increased risk for Whites and Asians-Highest for northeastern European cultures

}Small framed thin people

}Increased risk for those with a family history

}Increased risk for those postmenopausal

}Increased risk for those with decreased calcium intake, decreased Vitamin D or lactose intolerance

}Cigarette Smoking

}Alcohol abuse

}History of multiple pregnancies

}Increased risk with liver, endocrine, renal disease

}Medications-steroids, thyroid, heparin, antiseizure or sedatives, PPIs, ETOH

s/s of osteoporosis

•Dowager's Hump

•Height loss

•Increased amount of fractures

•Occasionally spinal pain-lumbar

non medicine treatments for osteoporosis

increase intake of calcium rich foods (dairy, sardines, green leafy veggies, whole grains, nuts)

increased weight bearing exercise

what are foods high in calcium?

dairy

sardines

whole grains

dark leafy veggies

nuts

why is vitamin D supplement important?

Vitamin D is needed to increase the absorption of calcium

it is in fortified dairy products

what are the calcium supplements?

calcium carbonate - oscal or tums