NUR 323 FINAL EXAM QUESTIONS AND
CORRECT ANSWERS
MSK Bone Formation, Maintenance, and Healing Process ✅-Formation: osteogenesis
(new bone formed by calcium and phosphorus binding to collagen); osteoblast cells:
build new
-Maintenance: bone turnover or the balance between resorption and formation
(osteoclasts: chewers)
-Healing: 4 stages; hematoma (1-2 days after injury), cartilaginous callus (2-3 weeks,
bone not strong yet), bony callus (3-4 weeks, safe to remove cast/brace),
remodeling/reshaping (9 months-1 year)
MSK Muscle Components and Repair ✅-Contraction: occurs resulting for electrical
stimuli (nerves)
-Tone: baseline contracted state
-Actions: agonists muscle causes specific movement or antagonist (muscle type must
relax to allow agonist to work)
-Function and strength: Use of muscle maintains muscle mass and strength (exercise);
loss of muscle mass is loss of strength (disuse)
-Repair: requires rest or immobilization to heal followed by exercise to rebuild mass and
strength
MSK Articulations ✅can be immovable (cartilaginous, fibrous) or moveable (ball and
socket, hinge, pivot, etc)
-ligament binds bone together and tendon binds muscles to bones
MSK Assessment ✅-Posture: curvature or deviation in curvature of spine
-Gait: smoothness and rhythm with ambulation
-Bone Integrity: deformities and alignments of bone and joints
-Joint function: ROM, deformities, stability, tenderness, nodular formations
-Muscles: strength and size (measures of girth to monitor exercise, edema, or bleeding
in muscle)
-Skin: edema, temperature, color, and integrity (cuts and bruises mean decreased
circulation and inflammation)
-Neurovascular: FREQUENT BASIS due to tissue and nerve damage; circulation (color,
temp, capillary refill), motion (weakness or paralysis, unilateral or bilateral), sensation
(paresthesia, pain, absence of feeling)
MSK Types of Pain ✅-Bone: dull and deep, not associated with movement but alters
sleep
-Fracture: sharp and piercing, relieved by immobilization
-Infection: sharp with muscle spasms or pressure on sensory nerve
-Joint: worsens with movement, pain in and around joint
-Muscle: sore, aching, cramping
,MSK S/S ✅-Altered Sensation: burning, tingling, numbness; may be due to pressure
on nerves or circulatory impairment (8 characteristics)
-Swelling
-Redness
-Deformity or alignment
-Evidence of pressure tension on skin
-Posture
-Gait
-Joint Function
-Muscle strength and size (mass)
*Compare affected side to unaffected side*
MSK Treatment modalities ✅immobilization until sufficient healing has occurred
-Splints: used for stable fractures and soft tissue injury or unstable fractures until
treatment determined. Allows for swelling and can be easily removed for assessment
-Casts: Rigid and molded to body which provides complete immobilization and
restriction to specific movements (fiberglass or plaster)
-Braces: provides support, controls movement, and prevents additional injury. Custom
fit and for longer-term use
Patient care:
-Prior: perform skin and neurovascular assessment, educate patient on expectations
and purpose
-After: assessments every 1 hour first 24 hours then 1-4 hours for neurovascular
function (main concern), motion, and sensation
MSK 6 P's of neurovascular change ✅Pain, poikilothermia, pallor, pulselessness,
paresthesia, and paralysis
MSK nursing actions ✅RICE
-Edema: elevate, ice, cold therapy
-Pain: analgesics, ice, cold therapy; notify provider if unrelenting pain (compartment
syndrome) or if there is burning over bony prominences (pressure ulcer or too tight)
-Cast: be alert to foul smell or soft discoloration on cast
-Encourage movement if joint is not completely immobile
MSK definitions ✅-Strain is a musculotendinous injury.
-Contusion is blunt force injury to soft tissue.
-Fracture is a break in the continuity of a bone.
-Sprain is an injury to ligaments and other soft tissues at a joint
MSK "RICE" ✅used for soft tissue injuries of the musculoskeletal system
-Rest, ice, compression, elevation
,MSK Fracture ✅Closed: a broken bone that does not penetrate the skin
-may need surgery for proper bone alignment
-surgery is not an emergency, can be preformed days or weeks after
-may be sever soft-tissue injury
Open/compound: bone fragment sticks out through the skin or wound penetrates to
broken bone
-requires immediate surgery
-healing issues due to risk of infection
MSK Fracture s/s ✅-Pain
-Loss of function
-Deformity
-Shortening of the extremity
-Crepitus (cracking/popping)
-Local swelling and discoloration
-Diagnosis by symptoms and radiography
-Patient usually reports an injury to the area
MSK Fracture Treatment ✅Reduction: procedure to reduce a bone fracture so bone
fragments are realigned
-Closed: non-surgical
Open: surgical involving hardware and internal fixation devices (ORIF) or can be
external
MSK Fracture Complications ✅•Shock - Usually caused by losing too much blood
•Fat Embolism:
lead to multisystem dysfunction and iscommonly associated with traumatic fracture of
long bones & pelvis or postoperatively, after intramedullary nailing
•Compartment syndrome
•Delayed union:
failure of a fracture to heal within the expected time
•Non-union: no signs of healing after >3-6 months
-Avascular necrosis: death of tissue secondary to poor perfusion & hypoxemia
-Reaction to internal fixation devices
-Heterotopic Ossification: presence of bone in soft tissue where bone normally does not
exist.
-Complex regional pain syndrome (CRPS): a chronic pain condition after an injury or
trauma to that limb, most often affects one limb (arm, leg, hand, or foot)
EARLY:
-DVT: blood clot in deep vein in leg and can travel to lungs (PE)
-PE: blockage in one of the pulmonary arteries
, MSK Fracture Compartment Syndrome ✅Increased pressure within a muscle
compartment of an arm or leg due to injury (bleed in muscles) which causes nerve
damage and decreased blood supply
-s/s: *severe pain*, numbness, and decreased ROM
-Treatment: surgery (fasciotomy) where a compartment is cut open to allow the tissues
to swell, decrease pressure, and restore blood flow
-Complications: *muscle loss*, amputation, infection, nerve damage, and *kidney
failure*
MSK Fracture Clavicle Rehab ✅-strap or sling
-exercises
-limit activities
-do not elevate arm above shoulder for 6 weeks
MSK Fracture Humeral Neck and Shaft Rehab ✅-slings and bracing
-activity limitation
-pendulum exercise
MSK Fracture Elbow (Olecranon) Rehab ✅-monitor NV compromise and compartment
syndrome
-Volkmann's contracture possible
-active exercises and ROM (4-6 weeks after healing or 1 week with ORIF)
MSK Fracture Hand, Radial, Ulnar, Wrist Rehab ✅-early rehab exercises
-active ROM exercises of fingers and shoulders
MSK Hip Fracture Rehab ✅-surgery to reduce and fixate fracture
-care similar to other orthopedic surgeries
MSK Fracture Femoral Shaft Rehab ✅-Lower leg, foot, and hip exercises to preserve
muscle function and improve circulation
-Early ambulation stimulates healing.
-Physical therapy, ambulation and weight bearing are prescribed.
-Active and passive knee exercises are begun as soon as possible to prevent restriction
of knee movement.
MSK Hip Fracture ✅-RF: over age 60, increase with age, Caucasians 2-3 x more,
women
-more likely to die than person without hip fracture (20% die within a year, 1/4 total
recovery)
MSK Hip Fracture Types ✅Femoral Neck: 1-2 inches from hip joint
-older adults
-results in avascular necrosis due to cut blood supply from femur
