Ch 36 Management of Patients with Musculoskeletal Disorders

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.)

- Corticosteroid injections - Surgical excision - Aspiration of the cyst

What food can the nurse suggest to the client at risk for osteoporosis?

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

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?

Have the client hold the palm of the hand up while the nurse percusses over the median nerve. If tingling, numbness, or pain is felt when the median nerve is percussed, then Tinel's sign is considered positive. To test for Tinel's sign have the client hold the palm of the hand up while the nurse percusses over the median nerve. The client making a fist and pushing will test strength resistance. The client stretching fingers around a ball will not test for Tinel's sign. Having the client pronate the hand and palpating the radial nerve is not Tinel's sign used for carpal tunnel syndrome diagnosis.

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely?

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.

Which should be included in the teaching plan for a client diagnosed with PLANTAR FASCIITIS?

Management of plantar fasciitis includes STRETCHING EXERCISES. Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (e.g., heel cups, arch supports), and using nonsteroidal anti-inflammatory drugs. Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced upon taking the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs.

Which of the following is the most common and most fatal primary malignant bone tumor?

Osteogenic sarcoma (osteosarcoma) Osteogenic sarcoma (osteosarcoma) is the most common and most often fatal primary malignant bone tumor. Benign primary neoplasms of the musculoskeletal system include osteochondroma, enchondroma, and rhabdomyoma.

The nurse recognizes that goal of treatment for metastatic bone cancer is to:

Promote pain relief and quality of life Treatment of metastatic bone cancer is palliative.

A client has been treated for migraine headaches for several months and comes to the clinicreporting no improvement. The nurse is talking with the client and hears an audible click when the client is moving the jaw. What does the nurse suspect may be happening?

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?

Use the large muscles of the leg when lifting items. (quads) 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?

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.

The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do?

Wear properly fitting shoes. Hammer toe is a flexion deformity of the PIP joint and may involve several toes and may result from wearing poorly fitting shoes. They will not straighten by binding the toes or doing active range of motion exercises. Surgery is an option but should be discussed with an orthopedic surgeon or podiatrist.

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

"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 educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate?

"You may need to be evaluated for an underlying cause, such as renal failure." The client may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The client needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The client is at risk for pathological fractures and therefore should not engage in vigorous exercise.

The nurse is caring for a client with osteoporosis. Which information will the nurse include when teaching actions to manage the condition? Select all that apply.

- Avoid excessive alcohol intake - Plan for smoking cessation - Engage in regular weight-bearing exercise Care of the client with osteoporosis focuses on actions to improve bone density. These actions include avoiding the excessive intake of alcohol. Clients who use tobacco products should be advised to quit. Regular weight-bearing exercise promotes bone formation. Recommendations include 20 to 30 minutes of aerobic, bone-stressing exercise daily. Current guidelines recommend that hormone therapy with estrogen not be used for primary prevention of bone loss in female clients who are postmenopausal. Swimming is not a weight-bearing exercise.

The nurse is collaborating with the health care provider on a plan of care for a 54-year-old male client with osteomyelitis of the left femur secondary to uncontrolled type 1 diabetes.

- Perform neurovascular checks of lower extremities every 8 hours. - Administer IV antibiotic based on culture and sensitivity report. - Administer ibuprofen 400 mg orally three times daily, as needed for pain. - Make referral to dietitian to discuss nutrition for healing and blood glucose control. - Provide education on self-blood glucose monitoring and insulin administration. Osteomyelitis is a bone infection that produces pain, inflammation, swelling, and impaired mobility and requires prompt treatment to treat the infection and prevent loss of limb. The nurse should perform neurovascular checks of the affected leg every 8 hours to detect the development of nerve or vascular impairment. Osteomyelitis is treated with IV antibiotics determined by the identified pathogen on culture and sensitivity testing. Because there is reduced penetration of antibiotics in the bone tissue, IV antibiotic therapy may be needed for 6 to 12 weeks, followed by oral antibiotics. The pain of osteomyelitis can be controlled with oral analgesics, such as ibuprofen.The client should consume a healthy diet to promote bone healing and control blood glucose levels. Because uncontrolled blood glucose levels increase the risk for osteomyelitis and impair bone healing, the nurse should educate the client about self-blood glucose monitoring and insulin administration. The client's affected left leg should be elevated to reduce swelling and pain. The affected leg should not be placed in the dependent position. Because the bone is weakened by the infectious process, the client should avoid placing stress on the bone through weight-bearing activity.

A client with osteoporosis is prescribed calcitonin 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?

0.5mL 200 units / ml 100 units = 0.5ml

Dupuytren's contracture causes flexion of which area(s)?

4th & 5th fingers Dupuytren's contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?

A bone biopsy A definitive diagnosis is obtained by bone biopsy. Radiographic studies demonstrate demineralization of the bone. A bone scan detects increased and decreased areas of bone metabolism. Alkaline phosphatase levels are detected from a blood sample.

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 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.

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. 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 patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?

Alkaline phosphatase Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly.

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?

Arthroscopy Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made.

A client with diabetes punctured the foot with a sharp object. 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?

At least 4 weeks Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for at least 4 weeks, followed by another 2 weeks (or more) of IV antibiotics or oral antibiotics.

A nurse is caring for a client with osteomyelitis. What complication should the nurse consider that the client is at risk to develop?

Bone abscess formation Bone abscess formation is a potential complication of osteomyelitis. Impingement syndrome is related to repetitive shoulder activities. Metastatic bone disease and pathological fractures are related to cancer.

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?

Bone fracture Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

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 compression of the median nerve at the wrist. Rtl. 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.

Which of the following inhibits bone resorption and promotes bone formation?

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.

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)?

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. Vitamin D increases the absorption of calcium.

Which common problem of the upper extremity results from entrapment of the median nerve at the wrist?

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 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.

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?

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.

When an infection is bloodborne, the manifestations include which symptom?

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

An older adult female has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density?

Compression fractures In osteoporosis, loss of bone substance exceeds bone formation. The total bone mass and density is reduced, resulting in bones that become progressively porous, brittle, and fragile. Compression fractures of the vertebrae are common. Diabetes, hypertension, and cardiac disease may occur in response to the aging process but are not the result of osteoporosis.

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?

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 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 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?

Decreased height Clients with osteoporosis become shorter over time.

A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder?

Degenerative joint disease Obesity predisposes the client to degenerative joint disease. Obesity isn't a predisposing factor for muscular dystrophy, scoliosis, or Paget's disease.

When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location?

Distal femur around the knee Malignant bone tumors usually are located around the knee in the distal femur or proximal fibula; a few are found in the proximal humerus. The wrist-hand junction and femur-hip area are not common sites.

The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients?

Disturbed body image Amputation of a body part can result in disturbances in body image.

A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true?

Dorsiflexion exacerbates signs and symptoms of a ganglion. Dorsiflexion exacerbates signs and symptoms of a ganglion. A ganglion is the most common benign soft-tissue mass in the hand, not foot. It isn't a known precursor to a primary bone tumor. To treat a ganglion, the physician aspirates the ganglion, then injects a corticosteroid into the joint; the physician may also order nonsteroidal anti-inflammatory agents. Surgical excision is necessary only if signs and symptoms persist and the client's range of motion is impaired.

What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

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.

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. - Callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. - 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 is planning an education program for women of childbearing years. What does the nurse recognize as the primary prevention of osteoporosis?

Ensuring adequate calcium and vitamin D intake Nutritional intake of calcium and vitamin D are essential for the prevention of osteoporosis.

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?

Hammer toe Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.

The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?

Has a weight GAIN of 5 pounds Obesity is a risk factor for osteoarthritis. Excess weight is a stressor on the weight-bearing joints. Weight reduction is often a part of the therapeutic regimen.

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 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 female client is at risk for developing osteoporosis. Which action will reduce the client's risk?

Initiating weight-bearing exercise routines - Performing weight-bearing exercise increases bone health. - A sedentary lifestyle increases the risk of developing osteoporosis. - Estrogen is needed to promote calcium absorption. - The recommended daily intake of calcium is 1,000 mg, not 300 mg.

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?

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.

Using proper body mechanics to lift objects is essential to prevent exacerbations of low back pain. Which of the following is the most important teaching point?

Lift with the large leg muscles (quadriceps), not the back muscles. All teaching points are important but the most important involves limiting back strain by maximizing the use of the quadriceps muscle.

Which classic symptom will the nurse assess for to detect the development of plantar fasciitis?

Morning heel pain Plantar fasciitis is characterized by heel pain. [Fasciitis: inflammation of the fascia of a muscle/organ.]

A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit?

Observing for safety hazards that could be a fall risk Clients with osteomalacia exhibit a waddling type of gait, putting them at risk for falls and fractures. Safety would be the priority in this circumstance such as scatter rugs, loose boards, and stairs. Older adult clients do not require a daily bath, and it may dry the skin. Nutrition is a necessity to question but the priority would be safety. Whether the client has adequate financial resources would be referred to social service.

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?

Open nerve release 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.

A client is informed of having 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?

Osteoclastoma - Osteoclastoma: giant cell tumor that may invade local tissue; usually soft & hemorrhagic & MAY BECOME MALIGNANT. - Osteochondroma occurs as a large projection of bone @ ENDS of long bones, developing during growth periods & then BECOMING STATIC BONE MASS. - Enchondroma: hyaline cartilage tumor that develops in the hand, ribs, femur, tibia, humerus, or pelvis. - Osteoid osteoma: painful tumor surrounded by reactive bone tissue.

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively?

Performing hourly neurovascular assessments for the first 24 hours Hourly neurovascular assessment of the exposed fingers for the first 24 hours following surgery is essential for monitoring function of the nerves and perfusion.

Which of the following presents with an onset of heel pain with the first steps of the morning?

Plantar fasciitis Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heal pain experienced with the first steps in the morning. Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. 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.

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?

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 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?

RENAL CALCULI Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A UTI commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination.

Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis?

Risk for injury related to fractures due to osteoporosis The most important concern for an elderly patient with osteoporosis is prevention of falls and fractures. Pain and constipation can be managed, and knowledge can be reinforced, but fractures can cause significant morbidity and mortality.

Which is a risk-lowering strategy for osteoporosis?

Smoking cessation & Weight bearing exercises outdoors. 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 majority of bone infections are caused by which organism?

Staphylococcus aureus Over 50% of bone infections are caused by Staphylococcus aureus.

Most cases of osteomyelitis are caused by which microorganism?

Staphylococcus aureus Staphylococcus aureus causes 70% to 80% of bone infections. Proteus species, Pseudomonasspecies, and E. coli are frequently found in osteomyelitis, they do not cause the majority of bone infections.

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?

Supplemental calcium and increased doses of vitamin D 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.

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?

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

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 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 nurse is teaching a client about preventing osteoporosis. Which teaching point is correct?

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.

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? osteoporosis: bones become brittle/fragile from tissue loss.

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

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?

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.

When teaching a client how to prevent low back pain as a result of lifting, the nurse should instruct the client to:

avoid overreaching. 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 & tighten the abdominal muscles - use a WIDE BASE of support, and use a back brace to protect the back.

Osteosarcoma (osteogenic sarcoma)

malignant tumor of the bone the most common bone cancer in children and most commonly affects patients in the second decade of life during their growth spurt. Optimum treatment of osteosarcoma includes surgery and chemotherapy.

Primary prevention of osteoporosis includes:

optimal calcium intake and estrogen replacement therapy. Primary prevention of osteoporosis includes maintaining optimal calcium intake and using estrogen replacement therapy. Placing items within a client's reach, using a professional alert system in the home, and installing grab bars in bathrooms to prevent falls are secondary and tertiary prevention methods.

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

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.

Health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. Select the daily dosage of calcium and vitamin D that the nurse should recommend.

1,200 mg; 1,000 IU The daily recommended dosage is 1,200 mg of calcium and 1,000 IU of vitamin D.

The nurse is providing teaching to a client with a mild case of bunions. Which suggestion would be most important for the nurse to give this client?

Don proper footwear. The most important instruction a nurse should give clients with bunions or hammer toe is to don proper footwear. Low-heeled, well-fitted shoes are recommended. Regular use of analgesics is not necessary for bunions if pain is not severe and the client has little or no difficulty. The client need not avoid strenuous exercise, running, or foot creams if the footwear is appropriate.

Which group is at the greatest risk for osteoporosis?

European American women Small-framed, nonobese European American women are at greatest risk for osteoporosis. Asian American women of slight build are at risk for low peak bone mineral density. African American women, who have a greater bone mass than European American women and Asian American Women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.

In which deformity does the great toe deviate laterally?

Hallux valgus - Hallux valgus is a deformity in which the great toe deviates laterally. - A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. - Pes cavus refers to a foot with an abnormally high arch, and a fixed equines deformity of the forefoot. - Plantar fasciitis is an inflammation of the foot-supporting fascia.

The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as

Hallux valgus - Hallux valgus is commonly referred to as a bunion. - Hammertoes are usually pulled upward. - Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. - Flatfoot demonstrates a diminished longitudinal arch of the foot.

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 * 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 nodes are bony enlargements of the distal interphalangeal joints.

A nurse is caring for a client with bone metastasis from a primary breast cancer. The client reports MUSCLE WEAKNESS & NAUSEA & is voiding large amounts frequently. The telemetry monitor is observed showing premature VENTRICULAR CONTRACTIONS. What should the nurse suspect based on the clinical manifestations?

Hypercalcemia Hypercalcemia is present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias such a premature ventricular contractions, seizures, and coma. Hypercalcemia must be identified and treated promptly. Hypocalcemia will not be seen with bone cancer. Hypokalemia and hyperkalemia are not common with bone metastasis.

A group of students are reviewing information about osteoporosis in preparation for a class discussion. The students demonstrate a need for additional review when they state which of the following as a risk factor?

Hypothyroidism Factors associated with an increased risk for osteoporosis include: family history of osteoporosis, chronic low calcium intake, excessive intake of caffeine, tobacco use, Cushing's syndrome, prolonged use of high doses of corticosteroids, prolonged periods of immobility, HYPERthyroidism, HYPERparathyroidism, eating disorders, malabsorption syndromes, breast cancer (especially if treated with chemotherapy that suppresses estrogen, excluding Tamoxifen, which may reduce the risk of fractures), renal or liver failure, alcoholism, lactose intolerance, and dietary deficiency of vitamin D and calcium.

The community health nurse is assessing the risk factors for osteoporosis in a female client at a health fair.

Osteoporosis Risk Factors: -66 years of age -Asian heritage -Post menopause -Takes fluticasone inhaler for asthma Non-Risk Factors: -Large Frame -NonSmoker -Alcohol intake of 3 drinks/week -Walking 2 miles 3 days/week Risk factors for osteoporosis include older age (for women, the risk increases after age 50), Asian heritage, being a postmenopausal woman, & long-term corticosteroid use (such as fluticasone for the treatment of asthma). A small frame, increases the risk for osteoporosis. Being a nonsmoker does NOT increase the risk for osteoporosis. An alcohol intake of 3 or more drinks/day is a risk factor for osteoporosis; an intake of 3 alcoholic beverages/week does NOT increase the risk. A sedentary lifestyle also increases the risk for osteoporosis; however, walking 2 miles, 3 days/week is not considered sedentary.

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder?

Paget disease Paget disease results in bone that is highly vascularized and structurally weak, predisposing the client to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. A ganglion is a collection of neurological gelatinous material. Osteomyelitis is an infection of bone that comes from the extension of a soft-tissue infection, direct bone contamination, or hematogenous spread.

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?

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.

Which term refers to a disease of a nerve root?

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.

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. 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.

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 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.

Morton neuroma is exhibited by which clinical manifestation?

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 of the following was formerly called a bunion?

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.