Chapter 41: Management of Patients With Musculoskeletal Disorders

A client with osteoporosis is prescribed calcitonin 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?

0.5 ml

The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given? Teriparatide Alendronate Raloxifene Densomab

Alendronate

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? Potassium level Magnesium level Alkaline phosphatase Troponin levels

Alkaline phosphatase

Which of the following inhibits bone resorption and promotes bone formation? Calcitonin Estrogen Parathyroid hormone Corticosteroids

Calcitonin

While the nurse is performing a physical assessment, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. What should this assessment indicate to the nurse? Dupuytren's contracture Morton's neuroma Impingement syndrome Carpal tunnel syndrome

Carpal tunnel syndrome

When an infection is bloodborne, the manifestations include which symptom? Hyperactivity Hypothermia Chills Bradycardia

Chills

Which assessment findings would the nurse expect in the client with osteomalacia? Column A Column B Column C Column D

Column B

Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? Callus Hallux valgus Dupuytren's contracture Hammertoe

Dupuytren's contracture

Which of the following diagnostics are used to evaluate spinal nerve root disorders (radiculopathies)? Magnetic resonance imaging Bone scan Computed tomography Electromyogram

Electromyogram

Which group is at the greatest risk for osteoporosis? African American women Asian American women European American women Men

European American women

Dupuytren contracture causes flexion of which area(s)? Ring finger Thumb Index and middle fingers Fourth and fifth fingers

Fourth and fifth fingers

The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as Hallux valgus Hammertoe Pes cavus Flatfoot

Hallux valgus

Which of the following was formerly called a bunion? Ganglion Hallux valgus Plantar fasciitis Morton's neuroma

Hallux valgus

A client has been prescribed alendronate for the prevention of osteoporosis. Which is the highestpriority nursing intervention associated with the administration of the medication? Ensure adequate intake of vitamin D in the diet Encourage the client to get yearly dental exams Assess for the use of corticosteroids Have the client sit upright for at least 30 minutes following administration

Have the client sit upright for at least 30 minutes following administration

Lifestyle risk factors for osteoporosis include a low-protein, high-fat diet. an estrogen deficiency or menopause. lack of exposure to sunshine. lack of aerobic exercise.

Lack of exposure to sunshine

A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit? Making sure the client has adequate financial resources Observing for safety hazards that could be a fall risk Ensuring that the client is eating enough Making sure the client is receiving a daily bath

Observing for safety hazards that could be a fall risk

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? Paget disease Ganglion Osteomalacia Osteomyelitis

Paget disease

A nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan? Examine the surgical dressing every hour. Monitor vital signs every 4 hours. Administer pain medication per client request. Perform neuromuscular assessment every hour.

Perform neuromuscular assessment every hour.

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? Having the patient exercise the fingers to avoid future contractures Performing hourly neurovascular assessments for the first 24 hours Applying a cock-up splint and immobilization Changing the dressing

Performing hourly neurovascular assessments for the first 24 hours

A nurse is caring for an older woman with a hip fracture. What are appropriate risk factors for the nurse to consider related to the client's hip fracture? Select all that apply. Muscular agility History of diverticulitis Presence of anemia Osteoporosis Female gender

Presence of anemia Osteoporosis Female gender

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing? Wound irrigation Vitamin supplements Surgical debridement Wound packing

Surgical debridement

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest? Walking Bicycling Yoga Swimming

Walking

During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? "The posture begins to stoop after middle age." "After menopause, the body's bone density declines, resulting in a gradual loss of height." "There may be some slight discrepancy between the measuring tools used." "After age 40, height may show a gradual decrease as a result of spinal compression"

"After menopause, the body's bone density declines, resulting in a gradual loss of height."

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." "This condition is associated with various sports." "Using arm splints will prevent hyperflexion of the wrist." "Surgery is the only sure way to manage this condition."

"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? "I will lie prone with my legs slightly elevated." "I will bend at the waist when I am lifting objects from the floor." "I will avoid prolonged sitting or walking." "Instead of turning around to grasp an object, I will twist at the waist."

"I will avoid prolonged sitting or walking."

Health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. Select the daily dosage of calcium and vitamin D that the nurse should recommend. 1,600 mg; 1,400 IU 1,800 mg; 1,600 IU 1,400 mg; 1,200 IU 1,200 mg; 1,000 IU

1,200 mg; 1,000 IU

The health care provider has prescribed plicamycin to control serum calcium levels in a client with Paget's disease. The dose prescribed is 25 micrograms per kg. The client weights 132 lbs. How many milligrams will the nurse expect the patient to receive?

1.5

A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? 3 months 7 to 10 days 6 months 3 to 6 weeks

3 to 6 weeks

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia? Demineralization of the bone Increased and decreased areas of bone metabolism Elevated levels of alkaline phosphatase A bone biopsy

A bone biopsy

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure? Administering large doses of I.V. antibiotics as ordered Instructing the client to ambulate twice daily Withholding all oral intake Administering large doses of oral antibiotics as ordered

Administering large doses of I.V. antibiotics as ordered

A client is evaluated for a diagnosis of Paget's disease. Which laboratory value would the nurse find to confirm the diagnosis? Calcium of 9.2 mg/dL (2.3 mmol/L) Urinary creatinine of 0.95 mg/dL (83.98 mmol/L) Alkaline phosphate of 165 IU/L (2750 mmol/L) Magnesium level of 2 mg/dL (0.82 mmol/L)

Alkaline phosphate of 165 IU/L (2750 mmol/L)

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? Arthroscopy Needle aspiration Open reduction Arthroplasty

Arthroscopy

A patient has been diagnosed with osteomalacia. What common symptoms does the nurse recognize that correlate with the diagnosis? Bone pain and tenderness Muscle weakness and spasms Softened and compressed vertebrae Bone fractures and kyphosis

Bone pain and tenderness

Which of the following are common primary sites of tumors that metastasize to the bone? Select all that apply. Breast Lung Prostate Kidney Ovary

Breast Lung Prostate Kidney Ovary

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD? Vitamin D Teriparatide (Forteo) Raloxifene (Evista) Calcitonin (Miacalcin)

Calcitonin (Miacalcin)

A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication? Sodium level of 110 mEq/L Calcium level of 11.6 mg/dl Potassium level of 6.3 mEq/L Magnesium level of 0.9 mg/dl

Calcium level of 11.6 mg/dl

A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder? Dexamethasone Chlorpheniramine Dicloxacillin Bupivacaine

Chlorpheniramine

Which assessment findings would the nurse expect to find in the client with osteomyelitis?

Column B

A client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications? activity restrictions dietary restrictions common adverse effects loading-dose schedule

Common adverse effects

The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as? Clawfoot Hammer Toe Corn Bunion

Corn

The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response? Increase of vitamin D Increase in calcitonin Decrease in parathyroid hormone Decrease in estrogen

Decrease in estrogen

A healthcare provider asks a nurse to test a client for Tinel's sign to diagnose carpal tunnel syndrome. What should the nurse do to perform this assessment? Have the client pronate the hand while the nurse palpates the radial nerve. Have the client hold the palm of the hand up while the nurse percusses over the median nerve. Have the client stretch the fingers around a ball and squeeze with force. Have the client make a fist and open the hand against resistance.

Have the client hold the palm of the hand up while the nurse percusses over the median nerve.

Using proper body mechanics to lift objects is essential to prevent exacerbations of low back pain. Which of the following is the most important teaching point? Contract trunk muscles to stabilize the spine. Lift with the large leg muscles (quadriceps), not the back muscles. Avoid lifting above waist level. Limit time lifting up to reach something.

Lift with the large leg muscles (quadriceps), not the back muscles.

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? Upright gait Skull narrowing Lordosis Long bone bowing

Long bone bowing

Which should be included in the teaching plan for a client diagnosed with plantar fasciitis? Plantar fasciitis presents as acute-onset pain localized to the ball of the foot that occurs when pressure is placed on it and diminishes when pressure is released. Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion. Management of plantar fasciitis includes stretching exercises. The pain of plantar fasciitis diminishes with warm water soaks.

Management of plantar fasciitis includes stretching exercises.

Hypercalcemia is a dangerous complication of bone cancer. Therefore, nursing assessment includes evaluation of symptoms that require immediate treatment. Which of the following are signs/symptoms that are indictors of an elevated serum calcium? Select all that apply. f. Lack of muscle coordination d. Prolonged ST segment a. Muscle weakness e. Shortened QT interval b. Tachycardia c. Anorexia and constipation

Muscle weakness Anorexia and constipation Shortened QT interval Lack of muscle coordination

A client is informed that he has a benign bone tumor but that this type of tumor that may become malignant. The nurse knows that this is characteristic of which type of tumor? Osteoclastoma Enchondroma Osteoid osteoma Osteochondroma

Osteoclastoma

A client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings? Compartment syndrome Avascular necrosis Osteomyelitis Fat embolism

Osteomyelitis

An older adult client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate? Maintaining vitamin levels Promoting weight-bearing exercises Maintaining protein levels Promoting range-of-motion (ROM) exercises

Promoting weight-bearing exercises

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize? Gastrocnemius Latissimus dorsi Quadriceps Rectus abdominis

Quadriceps

Which term refers to a disease of a nerve root? Sequestrum Involucrum Contracture Radiculopathy

Radiculopathy

A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class? Calcium gluconate Tamoxifen (Nolvadex) Alendronate (Fosamax) Raloxifene (Evista)

Raloxifene (Evista)

A client with Paget's disease comes to the hospital and reports difficulty urinating. The emergency department health care provider consults urology. What should the nurse suspect is the most likely cause of the client's urination problem? Renal calculi Benign prostatic hyperplasia Urinary tract infection (UTI) Dehydration

Renal calculi

A client has Paget's disease. An appropriate nursing diagnosis for this client is: Risk for infection Fatigue Risk for falls Delayed wound healing

Risk for falls

A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following? Staphylococcus aureus Escherichia coli Proteus vulgaris Pseudomonas aeruginosa

Staphylococcus aureus

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? Prone, with a pillow under the shoulders Supine, with the bed flat and a firm mattress in place High-Fowler's to allow for maximum hip flexion Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees

A nurse is performing foot care for a client with chronic osteomyelitis and the client asks the nurse about the next treatment. What is the specific treatment for a client with chronic osteomyelitis? Surgical removal of the sequestrum Aggressive physical therapy Drainage of localized foci of infection Continued aseptic wound treatment

Surgical removal of the sequestrum

Morton neuroma is exhibited by which clinical manifestation? Swelling of the third (lateral) branch of the median plantar nerve High arm and a fixed equinus deformity Longitudinal arch of the foot is diminished Inflammation of the foot-supporting fascia

Swelling of the third (lateral) branch of the median plantar nerve

A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about a calcium supplement should the nurse include? Take the supplement on an empty stomach with a full glass of water. Take the supplement with meals or with orange juice. Take weekly on the same day and at the same time. Remain in an upright position 30 minutes after taking the supplement.

Take the supplement with meals or with orange juice

A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening? Loose teeth Temporomandibular disorder Dislocated jaw Trigeminal neuralgia

Temporomandibular disorder

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and the immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client? The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor. The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor. The nurse is caring for this client on the intensive care unit. The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit.

The nurse is caring for this client on the intensive care unit.

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? The recommended daily allowance of calcium may be found in a wide variety of foods. Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. To prevent fractures, the client should avoid strenuous exercise. Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss.

The recommended daily allowance of calcium may be found in a wide variety of foods.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? Avoid twisting and flexion activities. A soft mattress is most supportive by conforming to the body. Use the large muscles of the leg when lifting items. Sleep on the stomach to alleviate pressure on the back.

Use the large muscles of the leg when lifting items.

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? Increase fiber in the diet Decrease the intake of vitamin A and D Walk or perform weight-bearing exercises outdoors Reduce stress

Walk or perform weight-bearing exercises outdoors

The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do? Have surgery to fix them. Wear properly fitting shoes. Bind the toes so that they will straighten. Do active range of motion on the toes.

Wear properly fitting shoes

When teaching a client how to prevent low back pain as a result of lifting, the nurse should instruct the client to: avoid overreaching. use a narrow base of support. place the load away from the body. bend the knees and loosen the abdominal muscles.

avoid overreaching.

Which is not a risk factor for osteoporosis? being male small-framed, thin White or Asian women being postmenopausal family history

being male

To help minimize calcium loss from a hospitalized client's bones, the nurse should: provide the client dairy products at frequent intervals. encourage the client to walk in the hall. reposition the client every 2 hours. provide supplemental feedings between meals.

encourage the client to walk in the hall.

A client has come to the clinic with foot pain. The physician has described the client's condition as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder? mallet toe Heberden's nodes hammer toe hallux valgus (bunion)

hammer toe

A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks? L4, L5, and S1 L1, L2, and L4 C3, C4, and L1 L2, L3, and L5

l4, L5, and S1

The nurse is educating a client with low back pain on proper lifting techniques. The nurse recognizes that the education was effective when the client: reaches over the head with the arms fully extended. bends at the hips and tightens the abdominal muscles. uses a narrow base of support. places the load close to the body.

places the load close to the body

A client is reporting jaw pain, and is experiencing muscle spasm and tenderness of the masseter and temporalis muscles. The physician has diagnosed a temporomandibular disorder (TMD). What would the treatment course for this client include? Select all that apply. corticosteroids analgesics referral to a dentist who has experience managing clients with TMD custom-fitted mouth guard during sleep

referral to a dentist who has experience managing clients with TMD custom-fitted mouth guard during sleep