Care of Patients with Musculoskeletal Problems - Ch. 50 (Elsevier)

The hallux valgus deformity can cause what other condition? 1 Bunion 2 Corn 3 Callus 4 Dupuytren contracture

Answer: 1 Bunion Bunions are enlarged first metatarsal heads, caused by hallux valgus.

What should the nurse infer if the T-score of a patient is -2 in a bone mineral density (BMD) test? 1 The patient has osteopenia. 2 The patient has osteoporosis. 3 The patient's bone density is normal. 4 The patient has severe osteoporosis.

Answer: 1 Osteopenia The BMD test helps to compare the patient's bone density to a healthy 30-year-old adult's bone density. If the patient's BMD is equal to the control, then the T-score will be 0. A T score from -1 to -2.5 indicates osteopenia. A T-score lower than -2.5 indicates osteoporosis. The greater the negative number, the more severe osteoporosis would be.

A patient has had a sequestrectomy of the right fibula for osteomyelitis 1 day ago. Which assessment finding requires the nurse to contact the surgeon immediately? 1 Paresis of right lower extremity 2 Swelling of the right lower extremity 3 1+ to 2+ bilateral palpable pedal pulses 4 Pain of right lower extremity on movement

Answer: 1 Paresis of right lower extremity Paresis indicates a neurovascular compromise that must be reported immediately to the surgeon. The patient undergoing a sequestrectomy experiences increased swelling after the procedure; the affected extremity should be elevated to increase venous return and thus control swelling. Palpable pulses of 1+ to 2+ bilaterally are a sign of adequate blood flow. Pain on movement of the right lower extremity is an expected finding.

Which finding does the nurse expect to observe in a patient with suspected common chronic osteomyelitis? 1 Ulceration of the skin 2 Erythema of the affected area 3 Constant, localized, and pulsating bone pain 4 Fever; temperature usually above 101° F (38° C)

Answer: 1 Ulceration of the skin Ulceration of the skin is a feature of chronic osteomyelitis. Erythema of the affected area; fever; and constant, localized, pulsating bone pain are features of acute osteomyelitis.

The nurse is teaching a patient ways to increase vitamin D in the diet using natural foods (unfortified). Which food choices indicate the patient understands the teaching? Select all that apply. 1 Milk 2 Tofu 3 Eggs 4 Liver 5 Cheese 6 Cereals

Answer: 1, 2, 3, 4 Milk, tofu, eggs, liver. NOT cheese (calcium) nor cereal.

Which term describes a benign tumor arising from cartilage? 1 Osteosarcoma 2 Giant cell tumor 3 Endochondroma 4 Osteochondroma

Answer: 3 Endochondroma Endochondroma, or chondroma, is a benign tumor arising from cartilage. This type of tumor primarily affects the hands and the feet. Osteochondroma is a benign tumor but arises from both bone and cartilage. Osteosarcoma is a malignant bone tumor. Giant cell tumor is a benign tumor of the bone.

Which part of the body does the hallux valgus deformity affect? 1 Hand 2 Wrist 3 Foot 4 Ankle

Answer: 3 Foot

How is Dowager's hump formed? 1 Lordosis of the spine 2 Scoliosis of the spine 3 Kyphosis of the spine 4 Kyphoscoliosis of the spine

Answer: 3 Kyphosis of the spine Kyphosis of the spine is the outward curvature of the thoracic vertebrae. Excessive kyphosis leads to the hump-like appearance that is a characteristic manifestation of bone diseases such as osteoporosis. Lordosis is the inward curvature of the lumbar vertebrae, which does not form a hump. Scoliosis is the deviation of vertebral alignment in all dimensions. Kyphoscoliosis is the combination of kyphosis and scoliosis where a hump-like appearance develops.

What is the medical term for the bone disease caused by reduced blood flow to the bones in the joints? 1 Osteomyelitis 2 Osteomalacia 3 Osteonecrosis 4 Osteogenic sarcoma

Answer: 3 Osteonecrosis Osteonecrosis results from the temporary or permanent loss of blood supply to the bones that are in the joints. Without blood, the bone tissue dies, and ultimately the bone may collapse. Osteomyelitis is the medical term for a bone infection, usually caused by bacteria, viruses, or fungi. Osteomalacia is the softening of the bones and occurs due to a lack of vitamin D. Osteosarcoma or osteogenic sarcoma is the most common type of primary malignant bone tumor.

Which is a priority problem for the older adult patient diagnosed with bone cancer? 1 Reduced mobility related to weakness and fatigue 2 Altered self-esteem related to fear of death and dying 3 Potential for injury related to weakness and drug therapy 4 Pain of a chronic nature related to tumor invasion of other organs

Answer: 3 Potential for injury r/t tumor invasion of other organs

After removing the cast from a nondisplaced ulnar bone fracture in the 8th week after being injured, the patient reports pain and swelling at the site. Further investigations revealed a fracture of the right radial bone. What might be the reason behind the fracture? 1 Primary osteoporosis 2 Primary osteomyelitis 3 Secondary osteoporosis 4 Secondary osteomyelitis

Answer: 3 Secondary osteoporosis Secondary osteoporosis may result from certain medical conditions, medications, or lifestyle behavior like prolonged immobilization. The 8-week immobilization of the patient's arm resulted in secondary osteoporosis, leading to a fracture of the radial bone. Primary osteoporosis occurs due to age-related or idiopathic factors. Primary and secondary osteomyelitis is infection of the bone characterized by infective manifestations such as fever, pus discharge, and sinus tract formation.

The nurse is caring for a patient with bone cancer of the right hip who has undergone radical resection of the tumor and has received a prosthetic implant. Which patient statement indicates effective coping after the procedure? 1 "I won't be able to go out in public like I did before." 2 "I'll be able to return to work and drive without assistance." 3 "After I recover, I'll be just as strong as I was before the surgery." 4 "Physical therapy and counseling will help me adjust to my prosthesis."

Answer: 4

The nurse plans to refer a patient diagnosed with osteoporosis to which community resource? 1 I Can Cope 2 CanSurmount 3 American Bone Society 4 National Osteoporosis Foundation

Answer: 4

Which nursing action is appropriate when a patient requests spiritual guidance during a preoperative assessment? 1 Ask the family to pray for the patient during the procedure 2 Request that the surgeon review the procedure with the patient 3 Tell the patient to contact his or her religious leader after surgery 4 Offer assistance to arrange for a hospital chaplain to talk with the patient before surgery

Answer: 4

What is the pathophysiology of osteoporosis? 1 Increased osteocytic activity over osteoblastic activity 2 Increased osteoblastic activity over osteocytic activity 3 Increased osteoblastic activity over osteoclastic activity 4 Increased osteoclastic activity over osteoblastic activity

Answer: 4 Bone is a dynamic tissue that is constantly undergoing changes in a process referred to as bone remodeling. Osteoclasts resorb the bone, and osteoblasts build the bone. Osteoporosis occurs when osteoclastic activity is greater than osteoblastic activity, resulting in decreased bone density. Osteocytes are inert cells that do not participate in bone formation. Increased osteocytic activity will not cause bone resorption, while increased osteoblastic activity will enhance bone formation, thereby increasing bone density.

Which statement by a nursing student about the health economics associated with osteoporosis indicates a need for further teaching by the nursing instructor? 1 "The estimated cost of osteoporosis-related health care in the United States is about $18 billion annually." 2 "By 2040, this estimated annual cost is expected to be doubled or tripled as the baby boomers become older adults." 3 "Cost of dual-energy x-ray absorptiometry (DXA) screening is far less than the financial, social, and health care costs of osteoporosis." 4 "Peripheral quantitative ultrasound (pQUS) is rarely used as a screening tool for osteoporosis detection because of its high cost."

Answer: 4 If the student states that a pQUS is rarely used as a screening tool for osteoporosis detection because of its high cost, this indicates the need for further teaching. A pQUS is an effective and low-cost peripheral screening tool that can detect osteoporosis and predict risk for hip fracture. The other statements indicate understanding.

The nurse is teaching a young patient about ways to prevent osteoporosis in later adulthood. Which information does the nurse provide? 1 "Engage in a weight-loss program." 2 "Avoid exposure to the sun before 10:00 a.m." 3 "Consume a high-protein, low-carbohydrate diet." 4 "Limit the consumption of carbonated beverages."

Answer: 4 The consumption of 40 ounces of carbonated beverages causes calcium loss; patients should limit their intake of carbonated beverages to prevent osteoporosis later in life.

Which is a deformity of the hand? 1 Bunion 2 Plantar fasciitis 3 Morton's neuroma 4 Dupuytren's contracture

Answer: 4 Dupuytren's contrature Dupuytren's contracture is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. A bunion is a painful swelling on the first joint of the big toe. A sarcoma is a type of cancer that develops from certain tissues, like bone or muscle. Plantar fasciitis is one of the most common causes of heel pain. It involves pain and inflammation of a thick band of tissue, called the plantar fascia, which runs along the bottom of the foot and connects the heel bone to the toes. Morton's neuroma is an injury to the nerve between the toes, which causes thickening and pain. The injury is caused due to the growth of a small tumor in a digital nerve of the foot.

Which musculoskeletal disorder is the dorsiflexion of any metatarsophalangeal (MTP) joint that has plantar flexion of the proximal interphalangeal joint next to it? 1 Corn 2 Callus 3 Bunion 4 Hammertoe

Answer: 4 Hammertoe Hammertoe is a condition in which there is dorsiflexion of any MTP joint with plantar flexion of the proximal interphalangeal joint next to it. The second toe is most often affected. A bunion is the enlargement of the first metatarsal. A callus is a flat, poorly defined mass on the sole over a bony prominence caused by pressure. A corn is a painful conical mass.

Arrange in the correct order the process of sequestrum formation as it occurs in osteomyelitis. 1. Sequestrum formation 2. Vascular thrombosis 3. Ischemia of bone tissue 4. Stimulation of inflammatory response 5. Release of exudate into the bone tissue 6. Invasion of pathogenic microorganisms

Answer: Invasion, stimulation, vascular thrombosis, exudate, ischemia, sequestrum formation. Invasion of pathogenic microorganisms stimulates the inflammatory response in bone tissue. Once inflammation is established, there is vascular thrombosis and release of exudate (pus) into bony tissue. Ischemia of bone tissue follows and results in necrotic bone. This area of necrotic bone separates from surrounding bone tissue, and sequestrum is formed.

Where does the nurse expect to find a conical mass, or corn, on the patient's body? 1 Toe 2 Wrist 3 Fingers 4 Shoulder

Answer: 1

Which fingers are affected by Dupuytren contracture? 1 Fourth and fifth fingers 2 Second and fifth fingers 3 Thumb and second finger 4 Second and fourth fingers

Answer: 1 Fourth and fifth fingers

The nurse completes a teaching session on safe drug administration for a patient with Paget's disease taking oral bisphosphonates. Which patient statement indicates a need for further teaching? 1 "I should go to sleep immediately after taking the drug." 2 "I will use chlorhexidine mouth wash to maintain oral hygiene." 3 "I should not undergo any invasive treatment procedure while on the therapy." 4 "I should stop taking this medication 3 months prior to any invasive dental treatment."

Answer: 1 Oral bisphosphonates can cause stomach upset, inflammation, and erosions of the esophagus. This can be prevented by remaining upright for 30 to 60 minutes after taking the medication. Oral hygiene should be maintained as long as the drug is taken. Patients taking bisphosphonates are more prone to develop osteonecrosis of the jaw, so invasive surgical procedures are to be avoided. The drug should be stopped 3 months prior to any invasive dental treatment to prevent complications.

Which part of the body is affected by plantar fasciitis? 1 Arch of the foot 2 Metatarsal head 3 Back of the wrist 4 Side of the toenail

Answer: 1 Plantar fasciitis affects the plantar fascia, located in the arch of the foot. Ganglions appear on the backs of wrists. The side of the toenail is subject to ingrown nails. The metatarsal head is where bunions appear.

A patient with an osteoporotic vertebral fracture is prescribed raloxifene. What should the nurse include in the assessment of this patient? 1 Assess for a history of venous thromboembolism. 2 Assess the patient's complete blood count (CBC). 3 Observe the patient for drowsiness, agitation, or anxiety. 4 Perform an oral assessment before beginning treatment.

Answer: 1 Raloxifene (Evista) is an estrogen agonist and is often used in the treatment of osteoporotic vertebral fracture. This drug is not given to patients with a history of venous thromboembolism (VTE) because it increases the risk of VTE in the first 4 months of therapy.

A patient has recently undergone surgery to treat osteomyelitis. What are the signs of neurovascular compromise after the surgery? Select all that apply. 1 Paresthesia 2 Pulselessness 3 Purulent discharge 4 Uncontrollable pain 5 Paresis or paralysis 6 Presence of erythema

Answer: 1, 2, 4 5 The signs of neurovascular compromise are pulselessness, paresis or paralysis presented as weakness or inability to move, and paresthesia presented as an abnormal tingling sensation. In addition, the patient may also experience uncontrollable pain. Purulent discharge indicates infection rather than neurovascular compromise. Pallor, rather than erythema, is a sign of neurovascular compromise.

The nurse is assessing a patient diagnosed with acute osteomyelitis. What features of this disorder does the nurse expect to find? Select all that apply. 1 Temperature above 101° F 2 Drainage from the affected area 3 Swelling around the affected area 4 Erythema around the affected area 5 Pulsating pain that worsens with movement 6 Ulceration of the skin resulting in a sinus tract

Answer: 1, 3, 4, 5 In a patient with acute osteomyelitis, the nurse would assess fever with a temperature above 101° F. There is swelling, erythema, and tenderness around the affected area. The patient also experiences localized bone pain that is constant, pulsating, and worsens with movement. Ulceration resulting in sinus tract and drainage from the affected area are characteristic features of chronic osteomyelitis.

What interventions may be utilized to manage a patient with chronic osteomyelitis? Select all that apply. 1 Irrigating wounds through the window of a cast 2 Administering systemic antibiotic therapy for 2 weeks 3 Applying strict aseptic technique for dressing changes 4 Exposing the affected area to hyperbaric oxygen therapy 5 Packing the wound with bone cement bead impregnated with antibiotic

Answer: 1, 3, 5

The nurse is developing a plan of care for a patient with metastatic bone cancer. What is an appropriate goal of treatment to include in the plan of care for this patient? 1 Reconstruct the bone and aid in bone grafting. 2 Improve the quality of life and promote pain relief. 3 Determine the stage of cancer and extent of bone damage. 4 Cure the cancerous bone, cartilage, and metastatic lesions.

Answer: 2

The patient has a flat, poorly defined mass on the sole of the foot. What does this patient most likely have? 1 Corn 2 Callus 3 Bunion 4 Hypertrophic ungual labium

Answer: 2

An 80-year-old patient experiencing severe pain in the lower jaw is diagnosed with acute osteomyelitis. Which symptom may be least likely found? 1 Severe throbbing pain 2 Body temperature of 102°F 3 Swelling of the affected region 4 Erythema of the affected region

Answer: 2 Older adults may not have an extreme temperature elevation because of lower core body temperature and a compromised immune system that occurs with normal aging. Acute osteomyelitis is characterized by severe throbbing pain, swelling, and erythema of the affected region.

What is a round, benign cyst that is often found on the wrist? 1 Bunion 2 Ganglion 3 Hallux valgus 4 Plantar fasciitis

Answer: 2 Ganglion

What risk factor is associated with primary osteoporosis? 1 Diabetes mellitus 2 Lack of physical exercise 3 Increased levels of thyroid hormone 4 Long-term treatment with corticosteroids

Answer: 2 Lack of physical exercise Lack of physical exercise and sedentary lifestyle are some of the risk factors associated with primary osteoporosis in postmenopausal women. Weight-bearing exercises reduce bone resorption or loss, and in turn, stimulate bone formation, thus preventing osteoporosis. Diabetes mellitus, increased levels of thyroid hormone, and long-term treatment with corticosteroids are risk factors for secondary osteoporosis.

The nurse is caring for a patient with prostate cancer who has bone metastasis. The nurse anticipates that the health care provider will prescribe which medication? 1 Calcitonin 2 Pamidronate 3 Medroxyprogesterone 4 Tamsulosin hydrochloride

Answer: 2 Pamidronate Pamidronate is a bisphosphonate that is available intravenously and is approved for bone metastasis from the breast, lung, and prostate. Pamidronate protects bones and prevents fractures. Calcitonin is used for the treatment of postmenopausal osteoporosis, Paget's disease, and hypercalcemia associated with cancer. Medroxyprogesterone is indicated for treating menopausal symptoms and preventing osteoporosis. Tamsulosin hydrochloride is an alpha-adrenergic blocking agent used for the treatment of benign prostatic hyperplasia (BPH).

A patient is diagnosed with chronic osteomyelitis. What feature does the nurse expect to assess in the patient? 1 Swelling around the affected area 2 Ulceration resulting in the sinus tract 3 Presence of temperature above 101° F 4 Pulsating pain that worsens with movement

Answer: 2 Ulceration resulting in the sinus tract Ulceration resulting in the sinus tract is a characteristic feature of chronic osteomyelitis. Acute osteomyelitis is accompanied with fever (a temperature above 101° F). Acute osteomyelitis also features swelling around the affected area and pulsating pain that worsens with movement. Fever, swelling, and erythema are less common in chronic osteomyelitis.

Which is the best way to decrease the risk for osteoporosis in a patient who has just been diagnosed with the disease? 1 Increase nutritional intake of calcium. 2 Walk for 30 minutes three times a week. 3 Increase nutritional intake of phosphorus. 4 Engage in high-impact exercise, such as running.

Answer: 2 Walk for 30 minutes 3x/week. Walking for 30 minutes three to five times a week is the single most effective exercise for osteoporosis prevention. Walking is a safe way to promote weight-bearing and muscle strength. A variety of nutrients are needed to maintain bone health, so the promotion of a single nutrient will not prevent or treat osteoporosis. High-impact exercise and overtraining such as running may cause vertebral compression fractures and should be avoided. Calcium loss occurs at a more rapid rate when intake of phosphorus is high; people who drink large amounts of carbonated beverages each day (over 40 ounces) are at high risk for calcium loss and subsequent osteoporosis, regardless of age or gender.

Which is one of the causes of secondary osteoporosis? 1 Older age 2 Current smoking 3 Diabetes mellitus 4 High alcohol intake

Answer: 3 Diabetes mellitus Secondary osteoporosis may result from medical conditions such as diabetes mellitus, hyperthyroidism, and hyperparathyroidism; long-term drug therapy, such as with corticosteroids; or prolonged immobility. Primary osteoporosis is more common and occurs in postmenopausal women and in men in their 70s to 80s. The risk factors or causes of primary osteoporosis include older age, smoking, and high alcohol intake.

The nurse is taking the history of an adult female patient. Which factor places the patient at risk for osteoporosis? 1 Consuming one alcoholic drink per week 2 Working at a desk and playing the piano for a hobby 3 Consuming 12 ounces of carbonated beverages daily 4 Having a hysterectomy and taking estrogen replacement therapy

Answer: 2 Working at a desk and playing piano for a hobby Sedentary lifestyle and prolonged immobility produce rapid bone loss. The patient would have to consume large amounts of carbonated beverages daily (over 40 ounces) for this to be a risk factor for osteoporosis. Maintaining estrogen levels reduces the risk for osteoporosis. Alcohol has a direct toxic effect on bone tissue, resulting in decreased bone formation and increased bone resorption. For those who have excessive alcohol intake, alcohol calories decrease hunger and the need to take in adequate quantities of nutrients. This patient's alcoholic intake is not high, so it is not a risk factor.

Which instructions would the nurse give to a patient with osteoporosis who has been prescribed alendronate? Select all that apply. 1 Lie down and rest if dizziness or leg cramps occur. 2 Take the medication early in the morning with 8 ounces of water. 3 Take the prescribed doses orally once every 3 months. 4 Remain upright for 30-60 minutes after taking the medication. 5 Schedule liver function tests regularly while on this medication. 6 Discontinue the medication if chest discomfort develops.

Answer: 2, 4, 6 The nurse would instruct the patient to take alendronate in the morning on an empty stomach and with a full glass of water. The patient must remain upright for 30 to 60 minutes, either sitting or standing, to prevent esophagitis. The nurse should also advise the patient to discontinue the medication if chest discomfort occurs as a symptom of esophageal irritation. Dizziness and leg cramping are side effects of teriparatide, a parathyroid hormone preparation. Alendronate is taken either daily or weekly, depending on the dose, not once every 3 months. Patients taking alendronate need not have liver function tests but must have an oral assessment and preventive dentistry before beginning the therapy.

A patient whose fracture of the right ulnar bone was immobilized in a cast for nearly 8 weeks reports swelling and pain in the right forearm. Why would the patient be advised to undergo bone mineral density (BMD) test? 1 To evaluate for primary osteoporosis 2 To evaluate for primary osteomyelitis 3 To evaluate for secondary osteoporosis 4 To evaluate for secondary osteomyelitis

Answer: 3

What is the most common assessment finding associated with osteoporosis? 1 Bone pain 2 Bone abscess 3 Bone fractures 4 Bone enlargement

Answer: 3

The nurse is assessing a patient with Ewing's sarcoma. Which finding does the nurse expect to observe? 1 High fever 2 Bradycardia 3 Leukocytosis 4 Migraine headaches

Answer: 3 Ewing's sarcoma is a malignant tumor, and the patient may experience systemic manifestations including leukocytosis, anemia, and low-grade fever. Bradycardia and migraine headache are not symptoms of Ewing's sarcoma. A low-grade fever is a systemic manifestation of Ewing's sarcoma.

A patient with bone cancer is scheduled for a right upper extremity amputation. Which statement by the patient's husband indicates an effective coping strategy? 1 "I'll try to limit her visitors." 2 "The family will avoid direct discussion of my wife's amputation." 3 "I'll have to find ways to help my wife focus on positive aspects of her body." 4 "My family will use diversional methods to help her not focus on the amputation."

Answer: 3 Planning to help the patient focus on positive aspects of her body illustrates that the husband is coping with the change in his wife's body image in a positive way. Using diversional methods to help the patient not focus on the amputation is not an effective coping strategy; it limits the chance for the patient to discuss feelings about the amputation.

Which nursing intervention helps prevent the incidence of osteomyelitis in a patient receiving hemodialysis? 1 Using clean technique for needle cannulation 2 Using Standard Precautions 3 Instructing the patient to brush teeth after every meal 4 Maintaining clean dressing change technique for long-term intravenous (IV) catheters

Answer: 3 Proper dental hygiene helps prevent periodontal infection, which can be a causative factor in osteomyelitis of the facial bone. All patients undergoing hemodialysis require careful sterile technique before needle cannulation. Standard Precautions should be used for all patients and will not specifically prevent the incidence of osteomyelitis. Long-term IV catheters, such as those sometimes used for dialysis, can be a primary source of infection, so dressing changes are done using sterile, not clean, technique.

What complication of osteomyelitis is the most likely to occur? 1 Pathologic fractures 2 Development of malignancies 3 Formation of bone abscesses 4 Secondary arthritic changes

Answer: 3 The most common complication of osteomyelitis is the formation of bone abscesses. Infection stimulates the inflammatory response in the bone and the surrounding tissue which leads to necrosis. The necrotic bone forms a sequestrum when it gets separated from the surrounding bone tissue; this sequestrum acts as a focus for ongoing infection and forms a bone abscess. Pathologic fractures, malignant transformation, and secondary arthritic changes are usually seen in osteitis deformans and also with osteomalacia and bone tumors.

A patient has undergone surgery on a lower extremity for a primary bone tumor. What intervention does the nurse perform for this patient? 1 Assist the patient with ambulation from the first postoperative day. 2 Assist the patient to reach full weight-bearing by 1 month postoperatively. 3 Assess neurovascular status of the extremity every 1 to 2 hours after the surgery. 4 Initiate the use of a continuous passive motion (CPM) machine from the first postoperative day.

Answer: 3 The nurse must assess the neurovascular status of the extremity every 1 to 2 hours after surgery. A major complication of this surgery is rapid deterioration in circulation, which must be reported immediately. A continuous passive motion (CPM) machine is used from the first postoperative day for patients who had an upper extremity surgery. The patient is assisted to reach full weight-bearing by 3 months postoperatively. Ambulation does not start until partial weight bearing is applicable.

After dental work, a female patient taking medications for osteoporosis reports pain, bleeding gums, and halitosis. Upon examination, the bone is found to be exposed. Which medication is the cause for this condition? 1 Estrogen agonist 2 Estrogen antagonists 3 Bisphosphonates 4 Calcium supplement drugs

Answer: 3 Bisphosphonates Bisphosphonates are associated with osteonecrosis of the jaw that may cause apoptosis of the osteoclasts in the bone.