NR511 DAVIS EDGE WEEK 5-8

NR511 DAVIS EDGE WEEK 5-8 1 MUSCULOSKELETAL PROBLEMS Question 1. A 13-year-old obese (body mass index [BMI] above the 95th percentile) boy reports low-grade left knee pain for the past 2 months. He denies antecedent trauma but admits to frequent “horseplay” with his friends. The pain has progressively worsened, and he is now unable to bear weight at all on his left leg. His current complaints include left groin, thigh, and medial knee pain and tenderness. His examination demonstrates negative drawer, Lachman, and McMurray tests; left hip with decreased internal rotation and abduction; and external hip rotation with knee flexion. Based on the above scenario, the nurse practitioner should suspect: 1. A left meniscal tear. 2. A left anterior cruciate ligament (ACL) tear. 3. A slipped capital femoral epiphysis (SCFE). 4. Osgood-Schlatter disease. Rationales Option 1: There would be a positive McMurray sign in a meniscal tear. Option 2: There would be a positive Lachman and/or drawer test in an ACL tear. Option 3: SCFE is a displacement of the femoral head relative to the femoral neck that occurs through the physis (growth plate) of the femur. The vast majority of clients with this condition are obese, as the added weight increases shear stress across the physis. The mean age at diagnosis is 12 years for females and 13.5 years for males. Surgery is often required via in situ pin fixation (single screw) to stabilize the growth plate to prevent further slippage and avoid complications. Option 4: Osgood-Schlatter disease would result in swelling, pain, and tenderness at the tibial tubercle. Question 2. In assessing the skeletal muscles, the nurse practitioner turns the patient’s forearm so that the palm is up. This is called: 1. Supination. 2. Pronation. 3. Abduction. 4. Eversion. Rationales Option 1: Turning the forearm so that the palm is up is called supination. Option 2: Turning the forearm so that the palm is down is called pronation. Option 3: Moving a limb away from the midline of the body is called abduction. Option 4: Moving the sole of the foot outward at the ankle is called eversion. Question 3. Cass, age 67, tells the nurse practitioner (NP) that she has been diagnosed with a condition that causes sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of the diagnosis, but she knows it is caused by urate crystals that “get stuck in the joint and cause pain.” She is on hydrochlorothiazide (HCTZ) for management of her hypertension. The NP should suspect a diagnosis of: 1. Septic arthritis. 2. Gout. 3. Rheumatoid arthritis. 4. Charcot neuro-osteoarthropathy. Rationales Option 1: Like gout, septic arthritis presents with an acute onset of swelling, pain, and heat in a joint. However, unlike gout, it occurs most frequently in the knee, followed by the hip, shoulder, wrist, and ankle. Option 2: Gout is a disorder that involves abnormal metabolism of uric acid and results in hyperuricemia. High concentrations of urate precipitate into crystals that collect in tissue and joint spaces and can cause pain and inflammation. The patient’s symptoms may be aggravated by the use of HCTZ. Option 3: Rheumatoid arthritis typically affects multiple joints simultaneously and is a slow and progressive disease. Option 4: Charcot neuro-osteoarthropathy occurs in dia