Prep-U Ch. 63: Caring for Clients with Orthopedic and Connective Tissue Disorders

A client has a diagnosis of rheumatoid arthritis and the primary provider has now prescribed cyclophosphamide. The nurse's subsequent assessments should address what potential adverse effect? A. Bone marrow suppression B. Acute confusion C. Sedation D. Malignant hyperthermia

A. Bone marrow suppression - When administering immunosuppressives such as Cytoxan, the nurse should be alert to manifestations of bone marrow suppression and infection. Confusion and sedation are atypical adverse effects. Malignant hyperthermia is a surgical complication and not a possible adverse effect.

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? A. Bunion B. Clawfoot C. Corn D. Hammer Toe

C. Corn - A corn is an area of hyperkeratosis (overgrowth of a horny layer of epidermis) produced by internal pressure (the underlying bone is prominent because of a congenital or acquired abnormality, commonly arthritis) or external pressure (ill-fitting shoes). The fifth toe is most frequently involved, but any toe may be involved.

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 - The nurse instructs the patient in the safe and correct way to lift objects using the strong quadriceps muscles of the thighs, with minimal use of weak back muscles (Fig. 42-3).

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

D. Administering large doses of I.V. antibiotics as ordered - Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited.

Which of the following are routes of administration for Calcitonin? Select all that apply. A. Nasal spray B. Subcutaneous C. Intramuscular injection D. Intravenous E. Oral

A, B, C - Calcitonin is administered by nasal spray or by subcutaneous or intramuscular injections.

What intervention is a priority for a client diagnosed with osteoarthritis? A. Physical therapy and exercise B. Hydrotherapy C. Colchicine D. Allopurinol

A. Physical therapy and exercise - Clients with osteoarthritis need to maintain joint mobility. To preserve joint function, individuals need to learn appropriate activities. Colchicine and allopurinol are used for gout, not osteoarthritis. Hydrotherapy is not a priority for care.

Which of the following clients should the nurse recognize as being at the highest risk for the development of osteomyelitis? A. A middle-age adult who takes ibuprofen daily for rheumatoid arthritis B. An elderly client with an infected pressure ulcer in the sacral area C. A 17-year-old football player who had orthopedic surgery 6 weeks prior D. An infant diagnosed with jaundice

B. An elderly client with an infected pressure ulcer in the sacral area - Clients who are at high risk of osteomyelitis include those who are poorly nourished, elderly, and obese. The elderly client with an infected sacral pressure ulcer is at the greatest risk for the development of osteomyelitis, as this client has two risk factors: age and the presence of a soft-tissue infection that has the potential to extend into the bone. The client with rheumatoid arthritis has one risk factor and the infant with jaundice has no identifiable risk factors. The client 6 weeks postsurgery is beyond the usual window of time for the development of a postoperative surgical wound infection.

A client with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the client has understood health education when the client makes what statement? A. "I'll make sure I get enough exposure to sunlight to keep up my vitamin D levels." B. "I'll try to be as physically active as possible between flare-ups." C. "I'll make sure to monitor my body temperature on a regular basis." D. "I'll stop taking my steroids when I get relief from my symptoms."

C. "I'll make sure to monitor my body temperature on a regular basis." - Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Clients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. As well, these drugs should not be independently adjusted by the client.

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? A. Bone scan B. Computed tomography (CT) C. Magnetic resonance imaging (MRI) D. Muscle biopsy

D. Muscle biopsy - As with other diffuse connective tissue disorders, no single test confirms polymyositis. An electromyogram is performed to rule out degenerative muscle disease. A muscle biopsy may reveal inflammatory infiltrate in the tissue. Serum studies indicate increased muscle enzyme activity.

A client presents to a clinic reporting of a leg ulcer that isn't healing; subsequent diagnostic testing suggests osteomyelitis. The nurse is aware that the most common pathogen to cause osteomyelitis is what? A. Proteus B. Pseudomonas C. Escherichia coli D. Staphylococcus aureus

D. Staphylococcus aureus - S. aureus causes over 50% of bone infections. Proteus, Pseudomonas, and E. coli are also causes, but to a lesser extent.

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. - Calcium supplements should be taken with meals or with a beverage high in vitamin C for increased absorption. Calcium supplements are taken daily, not weekly. There are no special instructions about staying upright when taking calcium supplements.

A nurse is working with a client with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the client is experiencing adverse effects of this drug? A. "I have this ringing in my ears that just won't go away." B. "I feel so foggy in the mornings and it takes me so long to wake up." C. "When I eat a meal that's high in fat, I get really nauseous." D. "I seem to have lost my appetite, which is unusual for me."

A. "I have this ringing in my ears that just won't go away." - Tinnitus is associated with salicylate therapy. Salicylates do not normally cause drowsiness, intolerance of high-fat meals, or anorexia.

A nurse is caring for an adult client diagnosed with a back strain. What health education should the nurse provide to this client? A. Avoid lifting more than one-third of body weight without assistance. B. Focus on using back muscles efficiently when lifting heavy objects. C. Lift objects while holding the object a safe distance from the body. D. Tighten the abdominal muscles and lock the knees when lifting of an object.

A. Avoid lifting more than one-third of body weight without assistance. - The nurse will instruct the client on the safe and correct way to lift objects—using the strong quadriceps muscles of the thighs, with minimal use of the weak back muscles. To prevent recurrence of acute low back pain, the nurse may instruct the client to avoid lifting more than one-third of his weight without help. The client should be informed to place the feet a hip-width apart to provide a wide base of support, the person should bend the knees, tighten the abdominal muscles, and lift the object close to the body with a smooth motion, avoiding twisting and jerking.

Which of the following was formerly called a bunion? A. Hallux valgus B. Plantar fasciitis C. Morton's neuroma D. Ganglion

A. Hallux valgus - Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.

A nurse is caring for a 78-year-old client with a history of osteoarthritis (OA). When planning the client's care, what goal should the nurse prioritize? A. The client will express satisfaction with her ability to perform ADLs. B. The client will recover from OA within 6 months. C. The client will adhere to the prescribed plan of care. D. The client will deny signs or symptoms of OA.

A. The client will express satisfaction with her ability to perform ADLs. - Pain management and optimal functional ability are major goals of nursing interventions for OA. Cure is not a possibility and it is unrealistic to expect a complete absence of signs and symptoms. Adherence to the plan of care is highly beneficial, but this is not the priority goal of care; adherence is of little benefit if the regimen has no effect on the client's functional status.

A nurse's plan of care for a client with rheumatoid arthritis includes several exercise-based interventions. What goal should the nurse prioritize? A. Maximize range of motion while minimizing exertion B. Increase joint size and strength C. Limit energy output in order to preserve strength for healing D. Preserve or increase range of motion while limiting joint stress

D. Preserve or increase range of motion while limiting joint stress - Exercise is vital to the management of rheumatic disorders. Goals should be preserving and promoting mobility and joint function while limiting stress on the joint and possible damage. Cardiovascular exertion should remain within age-based limits and individual ability, but it is not a goal to minimize exertion. Increasing joint size is not a valid goal.

A client with rheumatic disease has developed a gastrointestinal bleed. The nurse caring for the client should further assess the client for the adverse effects of what medications? A. Corticosteroids B. Immunomodulators C. Antimalarials D. Salicylate therapy

D. Salicylate therapy - GI bleeding is an adverse effect that is associated with salicylates. Steroids, antimalarials, and immunomodulators do not normally have this adverse effect.