Musculoskeletal

Which patient seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce the risk for osteoarthritis (OA)?

a 56-year-old woman who works on an automotive assembly line

When administering alendronate (Fosamax) to a patient with osteoporosis, the nurse will

assist the patient to sit up at the bedside

A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action will be included in the plan of care?

assist the patient with ambulation

The nurse teaching a support group of women with rheumatoid arthritis (RA) about how to manage activities of daily living suggests they should

avoid activities requiring repetitive use of the same muscles and joints

Which action can the nurse delegate to unlicensed assistive personnel (UAP) who are working in the orthopedic clinic?

obtain blood sample for uric acid from a patient with gout

The nurse will determine more teaching is needed if a patient with discomfort from a bunion says, "I will

only wear sandals, no closed-toe shoes."

The nurse evaluating effectiveness of prescribed calcitonin and ibandronate (Boniva) for a patient with Paget's disease will consider the patient's

pain intensity

A patient who takes multiple medications develops acute gouty arthritis. The nurse will consult with the health care provider before giving the prescribed dose of

sertraline (Zoloft)

The nurse is planning care for a patient with hypertension and gout who has a red, painful right great toe. Which nursing action will be included in the plan of care?

use a footboard to hold bedding away from the toe

A patient complains of shoulder pain when the nurse moves the patient's arm behind the back. Which question should the nurse ask?

"Do you have difficulty when you are putting on a shirt?"

The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the-knee amputation. Which statement by a patient indicates additional patient teaching is needed?

"I did not have this bone cancer until my leg broke a week ago."

The nurse determines additional instruction is needed when a patient diagnosed with scleroderma makes which statement?

"I should lie down for an hour after each meal."

A patient whose employment requires frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates the teaching has been effective?

"I will begin doing exercise to strengthen and support my back."

After the nurse has taught a 28-yr-old with fibromyalgia, which statement by the patient indicates a good understanding of effective self-management?

"I will need to stop drinking so much coffee and soda."

After the nurse has finished teaching a patient with osteoarthritis (OA) of the right hip about how to manage the OA, which patient statement indicates a need for more teaching?

"I will take 1 G of acetaminophen (Tylenol) every 4 hours."

Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient has understood the nurse's teaching about the condition?

"I will use sunscreen when I am outside."

When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, "My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." The most appropriate response by the nurse is

"It is important to start methotrexate early to decrease the extent of joint damage."

A patient with two school-age children has recently been diagnosed with rheumatoid arthritis (RA) and tells the nurse that home life is very stressful. Which initial response by the nurse is most appropriate?

"Tell me more about the situations that are causing you stress."

A patient with left knee pain is diagnosed with bursitis. The nurse will explain that bursitis is an inflammation of

a fluid-filled sac found at some joints

Which information will the nurse include when teaching a patient with newly diagnosed systemic exertion intolerance disease (SEID) about self-management?

a gradual increase in daily exercise may help decrease fatigue

An assessment finding for a 55-yr-old patient that alerts the nurse to the presence of osteoporosis is

a loss of height

The nurse suggests that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day with

a warm bath followed by a short rest

Which information will the nurse include when preparing teaching materials for a patient with an exacerbation of rheumatoid arthritis?

applying cold packs before exercise may decrease joint pain

Which action will the nurse take first when a patient is seen in the outpatient clinic with neck pain?

ask about numbness or tingling of the hands and arms

The nurse notices a circular lesion with a red border and clear center on the arm of a summer camp counselor who is in the clinic complaining of chills and muscle aches. Which action should the nurse take to follow up on that finding?

ask the patient about recent outdoor activities

A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take?

assess the nodules for skin breakdown or infection

Which information will the nurse include when teaching a patient with acute low back pain

- expect symptoms of acute low back pain to improve in a few weeks - avoid activities that require twisting of the back or prolonged sitting - use ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to relieve pain

Which actions will the nurse include in the plan of care for a patient with metastatic bone cancer of the left femur

- monitor serum calcium - support the left leg when repositioning the patient - support family and patient as they discuss the prognosis

During assessment of the patient with fibromyalgia, the nurse would expect the patient to report which of the following

- sleep disturbances - multiple tender points - widespread bilateral, burning musculoskeletal pain

The nurse finds that a patient can flex the arms when no resistance is applied but is unable to flex when the nurse applies light resistance. The nurse should document the patient's muscle strength as level

3

A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review?

Anti-Smith antibody (Anti-Sm)

Which laboratory result will the nurse monitor to determine if prednisone has been effective for a patient with an acute exacerbation of rheumatoid arthritis?

C-reactive protein

The nurse will anticipate the need to teach a patient who has osteoarthritis (OA) about which medication?

Capsaicin cream (Zostrix)

The home health nurse is making a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates more patient teaching is needed?

The patient sleeps with two pillows under the head

The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order will the nurse question?

administer varicella vaccine

Which action will the nurse include in the plan of care for a patient with newly diagnosed ankylosing spondylitis?

advise the patient to sleep on the back with a flat pillow

Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis is likely to be an adverse effect of the medication?

blurred vision

A patient with gout has a new prescription for losartan (Cozaar) to control the condition. The nurse will plan to monitor

blood pressure

A 54-yr-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia following densitometry testing. In teaching the woman, the nurse explains that

calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise

After laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. The first action the nurse should take is to

check the chat for preoperative assessment data

Which finding from analysis of fluid from a patient's right knee arthrocentesis will be of concern to the nurse?

cloudy fluid

A patient with psoriatic arthritis and back pain is receiving etanercept (Enbrel). Which finding is most important for the nurse to report to the health care provider?

crackles are auscultated in the lung bases

The nurse notes crackling sounds and a grating sensation with palpation of an older patient's elbow. How will this finding be documented?

crepitation

Which finding will the nurse expect when assessing a patient who has osteoarthritis (OA) of the knee?

discomfort with joint movement

Which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) who are assisting with the care of a patient with scleroderma?

document the patient's oral intake

A patient reporting painful urination and knee pain is diagnosed with reactive arthritis. The nurse will plan to teach the patient about the need for several months of therapy with

doxycycline (Vibramycin)

The nurse who notes that a 59-yr-old female patient has lost 1 inch in height over the past 2 years will plan to teach the patient about

dual-energy x-ray absorptiometry (DXA)

Which result for a patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider?

elevated blood urea nitrogen (BUN)

Which action will the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)?

encourage the patient to take a nap in the afternoon

A patient with severe kyphosis is scheduled for dual-energy x-ray absorptiometry (DXA) testing. The nurse will plan to

explain the procedure

Which finding for a 77-yr-old patient seen in the outpatient clinic requires further nursing assessment and intervention?

history of recent loss of balance and fall

A patient is being discharged after 1 week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information will be included in the discharge teaching?

how to monitor and care for a long-term IV catheter

A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention will the nurse include in the initial plan of care?

immobilization of the left leg

A patient hospitalized with a fever and red, hot, painful knees is suspected of having septic arthritis. Information obtained during the nursing history that indicates a risk factor for septic arthritis is that the patient

is sexually active with multiple partners

A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. The nurse identifies a need for additional teaching related to health maintenance when the nurse finds that the patient

is unable to plantar flex the foot on the affected side

A patient has scleroderma manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. Which action will the nurse include in the plan of care?

keep the environment warm and draft free

An appropriate nursing intervention for a patient who has acute low back pain and muscle spasms is to teach the patient to

keep the head elevated slightly and flex the knees when resting in bed

The nurse assesses a 78-yr-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management. Which information requires a discussion with the health care provider about an urgent change in the treatment plan?

laboratory results indicate blood urea nitrogen (BUN) is elevated

Which nursing action is correct when performing the straight-leg raising test for an ambulatory patient with back pain?

lift the patient's leg to a 60-degree angle from the bed

Which nursing action included in the care of a patient after laminectomy can the nurse delegate to experienced unlicensed assistive personnel (UAP)?

log roll the patient from side to side every 2 hours

Which menu choice by a patient with osteoporosis indicates the nurse's teaching about appropriate diet has been effective?

oatmeal with skim milk and fruit yogurt

After completing the health history, the nurse assessing the musculoskeletal system will begin by

observing the patient's body build and muscle configuration

A nurse who works on the orthopedic unit has just received change-of-shift report. Which patient should the nurse assess first?

patient who has not voided 10 hours after a laminectomy

The nurse should reposition the patient who has just had a laminectomy and diskectomy by

placing a pillow between the patient's legs and turning the entire body as a unit

The nurse determines that colchicine has been effective for a patient with an acute attack of gout upon finding

reduced joint pain

Which action should the nurse take before administering gentamicin (Garamycin) to a patient with acute osteomyelitis?

review the patient's serum creatinine

A patient hospitalized with polymyositis has joint pain; erythematous facial rash; eyelid edema; and a weak, hoarse voice. The safety priority for the patient is addressing the

risk for aspiration

Anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about

self-administration of subcutaneous injections

A 25-yr-old female patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I never leave my house because I hate the way I look." The nurse will plan interventions with the patient to address the nursing diagnosis of

social isolation

A patient with rheumatoid arthritis (RA) complains to the clinic nurse about having chronically dry eyes. Which action by the nurse is appropriate?

suggest the patient use over-the-counter (OTC) artificial tears

Which action will the nurse take when caring for a patient with osteomalacia?

teach about the use of vitamin D supplements

Which assessment finding for a patient who has had surgical reduction of an open fracture of the right radius requires notification of the health care provider?

temperature 101.4 F (38.6 C)

A patient who had arthroscopic surgery of the right knee 7 days ago is admitted with a red, swollen, hot knee. Which assessment finding by the nurse should be reported to the health care provider immediately?

the blood pressure is 86/50 mm Hg

A patient has a new order for magnetic resonance imaging (MRI) to evaluate possible left femur osteomyelitis after hip arthroplasty surgery. Which information indicates the nurse should consult with the health care provider before scheduling the MRI?

the patient has a pacemaker

Which assessment finding for a patient using naproxen (Naprosyn) to treat osteoarthritis is likely to require a change in medication?

the patient has dark-colored stools

A patient with dermatomyositis is receiving long-term prednisone therapy. Which assessment finding by the nurse is important to report to the health care provider?

the patient has painful hematuria

Which medication information will the nurse identify as a potential risk to a patient's musculoskeletal system?

the patient has severe asthma requiring frequent therapy with oral corticosteroids

Which information obtained during the nurse's assessment of a patient's nutritional-metabolic pattern may indicates increased risk for musculoskeletal problems?

the patient is 5 ft, 2 in tall and weighs 180 lb

A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Which information from the patient's health history is important for the nurse to report to the health care provider related to the methotrexate?

the patient is trying to get pregnant before her disease becomes more severe

A patient with an acute attack of gout in the right great toe has a new prescription for probenecid. Which information about the patient's home routine indicates a need for teaching regarding gout management?

the patient takes one aspirin a day to prevent angina

Which assessment information obtained by the nurse indicates a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone?

the patient's blood glucose is 165 mg/dL

Which information in a 67-yr-old woman's health history will alert the nurse to the need for a more focused assessment of the musculoskeletal system?

the patient's mother became shorter with aging

Which laboratory result is important to communicate to the health care provider for a patient who is taking methotrexate to treat rheumatoid arthritis (RA)?

the white blood cell (WBC) count is 1500/µL