HIT II Chapter 41 (MS Disorders)

Vertebrae and intervertebral discs are held together by (select all that apply): a. facet joints b. multiple ligaments c. intervertebral tendons d. articular joints e. paravertebral muscles

a. facet joints b. multiple ligaments e. paravertebral muscles

______ a flexion deformity of the interphalangeal joint, which may involve several toes. Tight socks or shoes may push an overlying toe back into the line of the other toes. a. hammer toe b. hallux valgus (bunion) c. callus

a. hammer toe

Symptoms of hypercalcemia include (select all that apply): a. muscular weakness b. tachycardia c. incoordination d. diarrhea e. anorexia

a. muscular weakness c. incoordination e. anorexia

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? a. Potassium level of 6.3 mEq/L b. Calcium level of 11.6 mg/dl c. Sodium level of 110 mEq/L d. Magnesium level of 0.9 mg/dl

b. Calcium level of 11.6 mg/dl Explanation: When the calcium-excreting capacity of the kidneys and GI tract is exceeded, the serum calcium level rises above normal, leading to hypercalcemia (a serum calcium level greater than 10.2 mg/dl).

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

c. Fourth and fifth fingers

Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? a. Deficient knowledge about osteoporosis and the treatment regimen b Acute pain related to fracture and muscle spasm c. Risk for constipation related to immobility d. Risk for injury related to fractures due to osteoporosis

d. Risk for injury related to fractures due to osteoporosis

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? a. Wound packing b. Wound irrigation c. Vitamin supplements d. Surgical debridement

d. Surgical debridement

True or False. Osteoporosis is a consequence of aging.

False, Osteoporosis is NOT a consequence of aging.

True or False. Absolute bed rest is recommended for patients with chronic low back pain.

False, absolute bed rest is NOT recommended for patients with chronic low back pain.

_____ is a metabolic bone disease characterized by inadequate mineralization of bone.

Osteomalacia

________ is an infection of the bone that results in inflammation, necrosis, and formation of new bone.

Osteomyelitis

_________ is the most prevalent bone disease in the world.

Osteoporosis

True or False. Night pain and/or fist clenching upon awakening is common in patients with carpal tunnel syndrome.

True, night pain and/or fist clenching upon awakening is common in patients with carpal tunnel syndrome.

True or False. Patients with chronic low back pain should resume typical activities of daily living (ADLs) as soon as possible.

True, patients with chronic low back pain should resume typical activities of daily living (ADLs) as soon as possible.

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? a. Decrease in estrogen b. Increase in calcitonin c. Decrease in parathyroid hormone d. Increase of vitamin D

a. Decrease in estrogen

During a routine physical examination of a client, the nurse observes a flexion deformity of the proximal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding? a. Hammer toe b. Mallet toe c. Hallux valgus d. Bunion

a. Hammer toe

A ______ a collection of neurologic gelatinous material near the tendon sheaths and joints—appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. a. ganglion b. dupuytren disease c. carpal tunnel syndrome

a. ganglion

Red flags that trigger prescribing diagnostic studies such as x-rays include (select all that apply): a. suspected spinal infection b. severe neurologic weakness c. urinary or fecal incontinence d. new onset of back pain in a patient with cancer e. joint stiffness in back

a. suspected spinal infection b. severe neurologic weakness c. urinary or fecal incontinence d. new onset of back pain in a patient with cancer

Patients with chronic low back pain should avoid (select all that apply): a. twisting b. bending c. frequent position changes d. lifting e. reaching

a. twisting b. bending d. lifting e. reaching

Peak adult bone mass is achieved between the ages of ______ years in both women and men a. 16 and 22 b. 18 and 25 c. 25 and 30

b. 18 and 25

_______ absorb dietary calcium less efficiently and excrete it more readily through their kidneys. a. younger adults b. children c. older adults

c. older adults

Monoclonal antibody that increases BMD and reduces the porosity of cortical bone by inhibiting the effects of TNF on osteoclasts, inhibiting their activites a. Bisphosphonates b. Alendronate c. Estrogen d. RANKL Inhibitor Denosumab

d. RANKL Inhibitor Denosumab

______ can cause pressure on nerve roots as they leave the spinal canal, which results in pain that radiates along the nerve. a. facet joint changes b. disc degeneration c. disc protrusion d. a or c only

d. a or c only

sequestrum

dead bone

The goal of primary bone tumor treatment is to:

destroy or remove the tumor rapidly

Acute

less than 3 months

Osteopenia

low bone mineral density

In _______ a primary proliferation of osteoclasts occurs, which induces bone resorption.

Paget disease

True or False. The intervertebral discs change in character as a person ages.

True, the intervertebral discs change in character as a person ages.

True or False. There is little evidence to support treatment of hammer toe when the patient does not report pain or other symptoms.

True, there is little evidence to support treatment of hammer toe when the patient does not report pain or other symptoms

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? a. Administering large doses of oral antibiotics as ordered b. Instructing the client to ambulate twice daily c. Withholding all oral intake d. Administering large doses of I.V. antibiotics as ordered

a. Administering large doses of oral antibiotics as ordered

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? a. Alendronate b. Raloxifene c. Teriparatide d. Denosumab

a. Alendronate

________ is a general term that describes impaired movement of the rotator cuff of the shoulder a. Impingement syndrome b. Bursae c. Loose bodies ("joint mice")

a. Impingement syndrome

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? a. Lower lumbar b. Upper lumbar c. Thoracic d. Cervical

a. Lower lumbar

_______ is the most common benign bone tumor. It usually occurs as a large projection of bone at the end of long bones (at the knee or shoulder), developing during growth. a. Osteochondroma b. Osteoporosis c. Osteomyelitis

a. Osteochondroma

The major defect in osteomalacia is a deficiency of __________ which promotes calcium absorption from the gastrointestinal tract and facilitates mineralization of bone.

activated vitamin D

The typical patient reports what (2) types of back pain?

acute and chronic

Use of ______ and excessive alcohol intake are examples of secondary causes of osteoporosis. a. antiplatelets b. corticosteroids c. antihypertensives

b. corticosteroids

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? a. Gastrocnemius b. Latissimus dorsi c. Quadriceps d. Rectus abdominis

c. Quadriceps

______ are more likely to have secondary causes of osteoporosis.

men

Postmenopausal women and older adults need to consume approximately _______ of daily calcium

1200 mg

______ are fluid-filled sacs that prevent friction between joint structures during joint activity and are painful when inflamed a. Bursae b. Discs c. Tendons

a. Bursae

Inhibit osteoclasts, causing decreased bone loss and increased bone mass a. Calcitonin b. Estrogen c. Corticosteroids d. RANKL Inhibitor Denosumab

a. Calcitonin

When an infection is bloodborne, the manifestations include which symptom? a. Chills b. Bradycardia c. Hypothermia d. Hyperactivity

a. Chills

Which term refers to a disease of a nerve root? a. Radiculopathy b. Involucrum c. Sequestrum d. Contracture

a. Radiculopathy

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? a. Renal calculi b. Urinary tract infection (UTI) c. Benign prostatic hyperplasia d. Dehydration

a. Renal calculi

More than 50% of bone infections are caused by a. Staphylococcus aureus and MRSA b. VREF c. Staphlycoccus epidermis

a. Staphylococcus aureus and MRSA

Patients with chronic low back pain should sit no more than ________ based on level of comfort. a. 5 to 10 minutes b. 20 to 50 minutes c. 1 hour

b. 20 to 50 minutes

The prevalence of osteoporosis in women older than 80 years is ____. a. 25% b. 50% c. 90%

b. 50%

A client is scheduled for surgery to fuse a joint. The nurse identifies this as which of the following? a. Osteotomy b. Arthrodesis c. Arthroplasty d. Open reduction internal fixation

b. Arthrodesis

_______: useful in identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral column and problems of vertebral discs a. X-ray of the spine b. Bone scan and blood studies c. Computed tomography (CT) scan d. Magnetic resonance imaging (MRI) scan

c. Computed tomography (CT) scan

A patient shows the nurse a round, firm nodule on the wrist. The pain is described as aching, with some weakness of the fingers. What treatment does the nurse anticipate assisting with? (Select all that apply.) a. Educating the patient on the use of gabapentin b. Active range-of-motion exercises c. Corticosteroid injections d. Surgical excision e. Aspiration of the cyst

c. Corticosteroid injections d. Surgical excision e. Aspiration of the cyst

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a. "Use your continuous passive motion machine for 2 hours each day." b. "You need to perform weight-bearing exercises twice a week." c. "You need to limit the amount of protein and calcium in your diet." d. "You will receive IV antibiotics for 3 to 6 weeks."

d. "You will receive IV antibiotics for 3 to 6 weeks."

Patients with chronic low back pain is taught to change positions _______.

frequently

Chronic

more than three months without improvement

involucrum

new bone formation

Carpal tunnel syndrome is commonly caused by:

repetitive hand and wrist movements

Muscle tendon sheaths also become inflamed with repetitive stretching, causing ________.

tendonitis.

Which group is at the greatest risk for osteoporosis? a. Men b. Caucasian women c. Asian women d. African American women

b. Caucasian women

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? a. Osteochondroma b. Enchondroma c. Osteoclastoma d. Osteoid osteoma

c. Osteoclastoma

The skeleton softens and weakens, causing pain, tenderness to touch, bowing of the bones, and pathologic fractures. a. Osteoporosis b. Helman's Syndrome c. Osteomalacia

c. Osteomalacia

________ an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced with the first steps in the morning. a. Pes cavus (clawfoot) b. Pes planus (flatfoot) c. Plantar fasciitis

c. Plantar fasciitis

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

c. Risk for falls

An _______ is a condition in which the free edge of a nail plate penetrates the surrounding skin. a. carpal tunnel syndrome b. callus c. ingrown toenail (onychocryptosis)

c. ingrown toenail (onychocryptosis)

The _______ are subject to the greatest mechanical stress and the greatest degenerative changes. a. upper cervical discs (C1-C3) b. middle thoracic discs (T4-T12) c. lower lumbar discs (L4-5 and L5-S1)

c. lower lumbar discs (L4-5 and L5-S1)

Primary osteoporosis occurs in women after _____ and in men later in life. a. 25 y.o. b. 31 y.o. c. menopause

c. menopause

________tumors arising from tissues elsewhere in the body may invade the bone and produce localized bone destruction (lytic lesions) or bone overgrowth (blastic lesions). a. osteochondroma b. chondrosarcomas c. metastatic bone disease

c. metastatic bone disease

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

d. Dupuytren's contracture

________ refers to a foot with an abnormally high arch and a fixed equines deformity of the forefoot. a. Pes cavus (clawfoot) b. Callus c. Ingrown toenail (onychocryptosis)

a. Pes cavus (clawfoot)

As a person ages, the fibrocartilage in the intervertebral disc becomes: a. dense and irregularly shaped b. less dense and loose c. less dense and more porous

a. dense and irregularly shaped

Symptoms of hypercalcemia include (select all that apply): a. nausea and vomiting b. weight gain c. constipation d. attentiveness e. bradycardia

a. nausea and vomiting c. constipation e. bradycardia

A _______ helps identify patients with carpal tunnel syndrome requiring intervention. a. positive Tinel sign b. negative Tinel sign c. positive Holman sign

a. positive Tinel sign

The patient may report pain radiating from an inflamed sciatic nerve which is known as: a. radiculopathy b. sciatica c. scoliosis

b. sciatica

Bone infections are more difficult to eradicate than soft tissue infections because:

bone is mostly avascular and less accessible to the body's natural immune response.

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

c. Alkaline phosphatase

Failure to develop optimal peak bone mass and low vitamin D levels contribute to the: a. development of osteopenia b. development of leukemia c. development of rheumatoid arthritis

a. development of osteopenia

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

b. small-framed, thin White or Asian women

Most back pain is self-limited and resolves ________ with analgesics, rest, and avoidance of strain. a. within 1 to 2 weeks b. within 4 to 6 weeks c. within 6 to 12 weeks

b. within 4 to 6 weeks

A client is diagnosed with carpal tunnel syndrome. Which assessment findings would the nurse expect? a. Pain radiating down the dorsal surface of the forearm b. Tenderness in the affected wrist c. Inability to flex index and middle fingers d. A decrease in grasp strength

c. Inability to flex index and middle fingers

________ may occur in a joint space as a result of articular cartilage wear and bone erosion. These fragments can interfere with joint movement ("locking the joint"). a. Impingement syndrome b. Bursae c. Loose bodies ("joint mice")

c. Loose bodies ("joint mice")

A _____ is a thickened area of the skin that has been exposed to persistent pressure or friction. a. ring b. hallux valgus (bunion) c. callus

c. callus

The _______ experiences pain, numbness, paresthesia, and, possibly, weakness along the median nerve distribution (thumb, index, and middle fingers). a. patient with loose bodies b. patient with tendonitis c. patient with carpal tunnel syndrome

c. patient with carpal tunnel syndrome

A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true? a. A ganglion is the most common benign soft-tissue mass in the foot. b. A ganglion is a precursor to a primary bone tumor. c. Surgical excision is the treatment of choice for a ganglion. d. Dorsiflexion exacerbates signs and symptoms of a ganglion.

d. Dorsiflexion exacerbates signs and symptoms of a ganglion.

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

d. Take the supplement with meals or with orange juice.

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

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

________: may demonstrate a fracture, dislocation, infection, osteoarthritis, or scoliosis a. X-ray of the spine b. Bone scan and blood studies c. Computed tomography (CT) scan d. Magnetic resonance imaging (MRI) scan

a. X-ray of the spine

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

c. Hallux valgus

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? a. C3, C4, and L1 b. L1, L2, and L4 c. L2, L3, and L5 d. L4, L5, and S1

d. L4, L5, and S1

______ of the bone and soft tissue are more common than malignant primary bone tumors. a. benign tumors b. systemic tumors c. metastatic tumors

a. benign tumors

_______: Rigid units of the spinal column. _______: Flexible units of the spinal column. a. vertebrae, intervertebral discs b. intervertebral discs, vertebrae c. facet joints, vertebrae

a. vertebrae, intervertebral discs

_______ 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. a. Impingement syndrome b. Carpal tunnel syndrome c. Loose bodies ("joint mice")

b. Carpal tunnel syndrome

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

b. Chlorpheniramine

________ is the most common and most often fatal primary malignant bone tumor. a. Osteochondroma b. Osteosarcoma c. Osteomyelitis

b. Osteosarcoma

_______ is a common disorder in which the longitudinal arch of the foot is diminished a. Pes cavus (clawfoot) b. Pes planus (flatfoot) c. Ingrown toenail (onychocryptosis)

b. Pes planus (flatfoot)

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? a. Yoga b. Walking c. Bicycling d. Swimming

b. Walking

Effective treatment of carpal tunnel syndrome (select all that apply): a. laser therapy b. application of wrist splints c. yoga d. ultrasound therapy e. injection of lidocaine

b. application of wrist splints

Malignant tumors of the hyaline cartilage are called ________. These tumors are the second most common primary malignant bone tumor. a. hyaline melanoma b. chondrosarcomas c. severe bone disease

b. chondrosarcomas

Symptoms of hypercalcemia include (select all that apply): a. tachycardia b. confusion c. increased focus d. lethargy e. psychotic behavior

b. confusion d. lethargy e. psychotic behavior

_________ results in a slowly progressive contracture of the palmar fascia that causes flexion of the fourth, fifth, and, sometimes, middle finger, rendering these fingers more or less useless a. ganglion b. dupuytren disease c. carpal tunnel syndrome

b. dupuytren disease

______ a deformity in which the great toe deviates laterally. There is a marked prominence of the medial aspect of the first metatarsophalangeal joint. a. ring b. hallux valgus (bunion) c. callus

b. hallux valgus (bunion)

Quantities of calcium larger than 1200 mg this may place patients at heightened risk of ______. a. renal calculi and liver disease b. renal calculi or cardiovascular disease c. kidney and lung disease

b. renal calculi or cardiovascular disease

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? a. "I will lie prone with my legs slightly elevated." b. "I will bend at the waist when I am lifting objects from the floor." c. "I will avoid prolonged sitting or walking." d. "Instead of turning around to grasp an object, I will twist at the waist."

c. "I will avoid prolonged sitting or walking."

All of the following are osteoporosis medications EXCEPT: a. Bisphosphonates b. Estrogen c. Corticosteroids d. RANKL Inhibitor Denosumab

c. Corticosteroids

Promotes estrogenic effects on bone, preserving BMD, with concomitant antiestrogenic effects on the uterus and breasts a. Bisphosphonates b. Alendronate c. Estrogen d. RANKL Inhibitor Denosumab

c. 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? a. Have the client make a fist and open the hand against resistance. b. Have the client stretch the fingers around a ball and squeeze with force. c. Have the client hold the palm of the hand up while the nurse percusses over the median nerve. d. Have the client pronate the hand while the nurse palpates the radial nerve.

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

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? a. Open reduction b. Needle aspiration c. Arthroplasty d. Arthroscopy

d. Arthroscopy

_________: used to evaluate spinal nerve root disorders (radiculopathies) a. X-ray of the spine b. Bone scan and blood studies c. Computed tomography (CT) scan d. Electromyogram (EMG) and nerve conduction studies

d. Electromyogram (EMG) and nerve conduction studies

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

d. Have the client sit upright for at least 30 minutes following administration Explanation: This will prevent irritation and potential ulceration of the esophagus.