PrepU Chapter 36: Management of Patients with Musculoskeletal Disorders

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

Calcitonin (Miacalcin) 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.

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

Calcitonin (Miacalcin) Explanation: 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.

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

Chills Manifestations of bloodborne infection include chills, high fever, rapid pulse, and generalized malaise.

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

Hallux valgus Explanation: 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.

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

The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? Reports decreased joint pain Has a weight gain of 5 pounds Reports ability to perform ADLs Shows increased joint flexibility

Surgical debridement Explanation: In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.

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

The most common primary sites of tumors that metastasize to bone are the kidney, prostate, lung, breast, ovary, and thyroid.

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

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

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? Morton's neuroma Impingement syndrome Carpal tunnel syndrome Dupuytren's contracture

Carpal tunnel syndrome Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome. Morton's neuroma is assessed as a painful condition that affects the ball of the foot. Dupuytren's contracture is when knots of tissue beneath the skin cause one or more fingers stay bent toward the palm. Impingement syndrome is a shoulder condition.

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

Decreased height Explanation: Clients with osteoporosis become shorter over time.

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

Fourth and fifth fingers Explanation: Dupuytren's contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.

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? Latissimus dorsi Gastrocnemius Quadriceps Rectus abdominis

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.

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? Surgical debridement Wound irrigation Vitamin supplements Wound packing

d. Surgical debridementIn chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.

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? Denosumab Alendronate Teriparatide Raloxifene

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

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." "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."

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

The health care team is caring for a client with osteomalacia. It has been determined that the osteomalacia is caused by malabsorption. What treatment should the nurse anticipate? Exogenous parathyroid hormone and multivitamins Supplemental potassium and pancreatic enzymes Colony-stimulating factors and calcitonin Supplemental calcium and increased doses of vitamin D

upplemental calcium and increased doses of vitamin D Explanation: If osteomalacia is caused by malabsorption, increased doses of vitamin D, along with supplemental calcium, are usually prescribed. PTH, CSF, potassium, and pancreatic enzymes are not indicated.

A client comes back to the clinic with a continued complaint of back pain. What time frame does the nurse understand constitutes "chronic pain"? 4 weeks 3 months 6 months 1 year

3 months Explanation: The typical client reports either acute back pain (lasting fewer than 3 months) or chronic back pain (3 months or longer without improvement) and fatigue.

A client with carpal tunnel syndrome has had limited improvement with the use of a wrist splint. The nurse knows that which procedure will show the greatest improvement in treatment for this client? Ultrasound therapy Laser therapy Injection of lidocaine Open nerve release

Open nerve release Explanation: Evidence-based treatment of acute carpal tunnel syndrome includes the application of splints to prevent hyperextension and prolonged flexion of the wrist. Should this treatment fail, open nerve release is a common surgical management option. A variety of treatments may be tried by the client, however, they may fail to improve the condition. These treatments include laser therapy, ultrasound therapy, and the injection of substances such as lidocaine. Though these can be used, surgery to release nerves is the best option.

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

Walk or perform weight bearing exercises outdoors Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine in moderation.

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? "There may be some slight discrepancy between the measuring tools used." "After menopause, the body's bone density declines, resulting in a gradual loss of height." "After age 40, height may show a gradual decrease as a result of spinal compression" "The posture begins to stoop after middle age."

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

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

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

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

Dupuytren contracture Explanation: 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 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? L2, L3, and L5 L1, L2, and L4 C3, C4, and L1 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.

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

Promoting weight-bearing exercises Explanation: 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.

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

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees A medium to firm, not sagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress (National Guideline Clearinghouse, 2010). Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head (Fig. 42-1). A prone position should be avoided because it accentuates lordosis.

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

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. Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?Dupuytren's contracture Dupuytren's disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren's 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 interphangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally.

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? "Instead of turning around to grasp an object, I will twist at the waist." "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."

"I will avoid prolonged sitting or walking." Explanation: 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.

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

Long bone bowing Some clients with Paget's disease are asymptomatic with only some mild skeletal deformity. Other clients have marked skeletal deformities which may include enlargement of the skull, bowing of the long bones, and kyphosis.

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

"You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks. Continuous passive range of motion is used for clients with osteoarthritis. Weight-bearing exercises are used with clients who have osteoporosis. Limiting protein and calcium is not part of the plan of care for clients with osteomyelitis.

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

Calcitonin Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis.

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. Perform neuromuscular assessment every hour. Monitor vital signs every 4 hours.

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.

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. 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. To prevent fractures, the client should avoid strenuous exercise.

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

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 Swimming Bicycling Walking

Walking Explanation: 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.

A client was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. What would not be a part of teaching plan for this condition? avoiding caffeine and alcohol encouraging the client to eat a healthy diet regular exercise and stress reduction applications of ice

applications of ice Application of ice is not part of the treatment regimen. Encouraging the client to eat a healthy diet, avoiding caffeine and alcohol, regular exercise, and stress reduction are part of the teaching plan.