Chapter 41: Management of Patients With Musculoskeletal Disorders

x A client diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. What is the best response by the nurse? "CTS is a neuropathy that is characterized by bursitis and tendinitis." "CTS is a neuropathy that is characterized by flexion contracture of the fourth and fifth fingers." "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." "CTS is a neuropathy that is characterized by pannus formation in the shoulder."

"CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." Carpal tunnel syndrome is an entrapment neuropathy that occurs when the median nerve at the wrist is compressed by a thickened flexor tendon sheath, skeletal encroachment, edema, or a soft tissue mass.

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? Decrease in estrogen Increase in calcitonin Decrease in parathyroid hormone Increase of vitamin D

Decrease in estrogen Age related processes that contribute to loss of bone mass and osteoporosis are decreases in estrogen, calcitonin, and vitamin D and an increase in parathyroid hormone.

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? Bone spurs Diarrhea Increased heel pain Decreased height

Decreased height Clients with osteoporosis become shorter over time.

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

Dupuytren contracture Dupuytren disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally.

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? hammer toe mallet toe hallux valgus (bunion) Heberden's nodes

hammer toe Hammer toe is a flexion deformity of the proximal interphalangeal joint. Mallet toe is a flexion deformity of the distal interphalangeal joint. Bunion is a deformity of the great toe at its metatarsophalangeal joint. Heberden's nodes are bony enlargements of the distal interphalangeal joints.

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." The nurse encourages the patient to alternate lying, sitting, and walking activities frequently, and advises the patient to avoid sitting, standing, or walking for long periods.

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? 6 months 3 months 7 to 10 days 3 to 6 weeks

3 to 6 weeks Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for 3 to 6 weeks. Oral antibiotics then follow for as long as 3 months.

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? Alendronate Raloxifene Teriparatide Denosumab

Alendronate Alendronate is a bisphosphonate medication. Raloxifene is a selective estrogen receptor modulator. Teriparatide is an anabolic agent, and denosumab is a monoclonal antibody agent.

A nurse is caring for a client following removal of a Morton's neuroma. Which nursing intervention would be most appropriate? Assist the client with incentive spirometry. Assess the surgical dressing. Assist with passive range of motion exercises Perform neurovascular assessment of the hand.

Assess the surgical dressing. Morton's neuroma is a foot problem characterized by swelling of the median plantar nerve. The nurse will need to assess the surgical dressing. Assisting with incentive spirometry is not the most important intervention. Range of motion exercises should be active, not passive. A hand assessment is not needed with neuroma removal from the foot.

What food can the nurse suggest to the client at risk for osteoporosis? Carrots Broccoli Chicken Bananas

Broccoli Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium.

Which common problem of the upper extremity results from entrapment of the median nerve at the wrist? Ganglion Carpal tunnel syndrome Dupuytren's contracture Impingement syndrome

Carpal tunnel syndrome Carpal tunnel syndrome is commonly due to repetitive hand activities. A ganglion is a collection of gelatinous material near the tendon sheaths and joints that appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. Dupuytren's contracture is a slowly progressive contracture of the palmar fascia. Impingement syndrome is associated with the shoulder and may progress to a rotator cuff tear.

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 Antihistamines such as chlorpheniramine are frequently prescribed when an allergy is a factor in causing a skin disorder. Antihistamines relieve itching and shorten the duration of allergic reaction. Corticosteroids such as dexamethasone are used to relieve inflammatory or allergic symptoms. Antibiotics such as dicloxacillin are used to treat infectious disorders. Local anesthetics such as bupivacaine are used to relieve minor skin pain and itching.

A high school student who was injured in a football game presents with knee pain with internal rotation of the foot. Which interventions are appropriate nursing actions? Select all that apply. Administer morphine sulfate. Elevate the affected leg. Apply ice packs to the affected knee. Assist the client to "walk off" the pain. Apply a knee brace or wrap the affected knee.

Elevate the affected leg. Apply ice packs to the affected knee. Apply a knee brace or wrap the affected knee. The client has a torn lateral meniscus. Priority interventions include rest, ice, compression, and elevation of the affected extremity and the administration of NSAIDs -- not morphine -- for pain. The client should not walk on the injured knee.

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? C3, C4, and L1 L1, L2, and L4 L2, L3, and L5 L4, L5, and S1

L4, L5, and S1 The lower lumbar disks, L4-L5 and L5-S1, are subject to the greatest mechanical stress and the greatest degenerative changes. Disk protrusion (herniated nucleus pulposus) or facet joint changes can cause pressure on nerve roots as they leave the spinal canal, which results in pain that radiates along the nerve.

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. Administer pain medication per client request. Monitor vital signs every 4 hours. Perform neuromuscular assessment every hour.

Perform neuromuscular assessment every hour. The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is important to prevent complications from the surgery. The surgical dressing does not need to be examined hourly. Administering pain medication is important, but assessing the foot color and temperature are most important. Vital sign monitoring is important, but not a priority after foot surgery.

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 protein levels Maintaining vitamin levels Promoting weight-bearing exercises Promoting range-of-motion (ROM) exercises

Promoting weight-bearing exercises When the mechanical stressors of weight bearing are absent, disuse osteoporosis can occur. Therefore, if the client does weight-bearing exercises, disuse complications can be prevented. Maintaining protein and vitamins levels is important, but neither will prevent osteoporosis. ROM exercises will help prevent muscle atrophy and contractures.

Which is a risk-lowering strategy for osteoporosis? Low initial bone mass Diet low in calcium and vitamin D Smoking cessation Increased age

Smoking cessation Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D.

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? Wound packing Wound irrigation Vitamin supplements Surgical debridement

Surgical debridement In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.

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? Trigeminal neuralgia Temporomandibular disorder Loose teeth Dislocated jaw

Temporomandibular disorder The disorder can be confused with trigeminal neuralgia and migraine headaches. The client experiences clicking of the jaw when moving the joint, or the jaw can lock, which interferes with opening the mouth. Loose teeth will not cause a clicking of the jaw. The client does not have a dislocated jaw.

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

Use the large muscles of the leg when lifting items. The large muscles of the leg should be used when lifting.

A client with a musculoskeletal injury is instructed to alter the diet. The objective of altering the diet is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which food item should the nurse encourage the client to include in the diet? Red meat Bananas Vitamin D-fortified milk Green vegetables

Vitamin D-fortified milk The nurse should advise the client to include dietary sources of vitamin D, such as fatty fish, vitamin D-fortified milk, and cereals. These foods protect against bone loss and decrease the risk of fracture by facilitating the absorption of calcium from food and supplements. Red meat, bananas, and green vegetables do not facilitate calcium absorption from food and supplements.

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? Yoga Walking Bicycling Swimming

Walking Weight-bearing exercises should be incorporated into the client's lifestyle activities. Walking is a low-impact method of weight-bearing exercise and would be the most universal or most likely form of exercise for the nurse to recommend. Bicycling, and swimming are not weight-bearing exercise and will not increase bone density. Yoga may or may not be weight-bearing exercise depending on the yoga poses being performed; it is not as likely as walking to be recommended by the nurse.

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. places the load close to the body. uses a narrow base of support. bends at the hips and tightens the abdominal muscles.

places the load close to the body. Instructions for the client with low back pain should include that, when lifting, the client should avoid overreaching. The client should also keep the load close to the body, bend the knees, and tighten the abdominal muscles; use a wide base of support; and use a back brace to protect the back. Bending at the hips increases the strain on the back muscles when lifting.

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

Calcitonin Calcitonin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Raloxifene reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Teriparatide has been recently approved by the FDA for the treatment of osteoporosis. Vitamin D increases the absorption of calcium.

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

Radiculopathy When the client reports radiating pain down the leg, the client is describing radiculopathy. Involucrum refers to new bone growth around the sequestrum. Sequestrum refers to dead bone in an abscess cavity. Contracture refers to abnormal shortening of muscle or fibrosis of joint structures.

The nurse is educating a client on home care following removal of a ganglion cyst from the right wrist. Which statement by the client demonstrates that the nurse's teaching has been effective? "I will leave the dressing on until I follow up with my doctor as scheduled." "If my hand becomes numb and cool I will elevate it above my heart." "I will notify my doctor if I develop redness and purulent drainage for 2 days." "If my pain is not relieved I will use a heat pack and take some more medication."

"I will leave the dressing on until I follow up with my doctor as scheduled." The first dressing is changed by the surgeon at a scheduled follow-up appointment. If the hand becomes cool and numb, the client needs to call the surgeon as soon as possible. The surgeon should be notified immediately if redness and purulent drainage develop. Medication should only be used as prescribed. The use of heat may increase swelling, which may increase pain.

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

"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints.

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 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.

The nurse is caring for this client on the intensive care unit. This client is critically ill; the diagnosis and immunosuppression place the client at a high risk for infection. The most appropriate place for this client is in an intensive care unit, where the nurse can focus exclusively on health promotion. This client shouldn't be on the oncology floor. This client requires close monitoring. The nurse caring for this client shouldn't also be caring for other clients who may require frequent interventions.

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? common adverse effects dietary restrictions activity restrictions loading-dose schedule

common adverse effects The most common adverse effects of NSAIDs are related to the GI tract: nausea, vomiting, diarrhea, and constipation. GI bleeding, which in some cases is severe, has been reported with the use of these drugs. Use of NSAIDs does not pose significant dietary or activity restrictions nor is there a loading-dose schedule.

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? "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." "There may be some slight discrepancy between the measuring tools used." "The posture begins to stoop after middle age."

"After menopause, the body's bone density declines, resulting in a gradual loss of height." The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question.

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 Morton neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. To prevent fractures, the client should avoid strenuous exercise. 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.

The recommended daily allowance of calcium may be found in a wide variety of foods. Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.