Ch. 36: Musculoskeletal Disorders

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 Rationale: Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid.

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years?

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

The hospice nurse is assigned to care for a patient with metastatic bone cancer who wants to remain at home. What is the therapeutic goal in the care of this patient?

Relieve pain and discomfort while promoting quality of life. Rationale: The treatment of advanced metastatic bone cancer is palliative. The therapeutic goal is to relieve the patient's pain and discomfort while promoting quality of life.

____________ is an inflammation of a fluid-filled sac in the joint.

bursitis

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?

Administering large doses of I.V. antibiotics as ordered Rationale: 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.

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 Rationale: Alendronate is a bisphosphonate medication.

________________ are administered on arising in the morning with a full glass of water on an empty stomach, and the patient must stay upright for 30 to 60 minutes.

Bisphonates

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 Rationale: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones.

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

Broccoli Rationale: 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?

Carpal tunnel syndrome Rationale: Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome.

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 Rationale: ge 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.

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 Rationale: Obesity predisposes the client to degenerative joint disease.

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

Plantar fasciitis Rationale: an inflammation of the foot-supporting fascia, present as an acute onset of heal pain experienced with the first steps in the morning

Which term refers to a disease of a nerve root?

Radiculopathy Rationale: When the client reports radiating pain down the leg, the client is describing radiculopathy.

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

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

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 Rationale: In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy

Symptoms of plantar fasciitis include acute heel pain experienced in the morning upon arising.

True

The nurse should recommend short periods of bed rest, in a prone position, for patients experiencing back pain resulting from a compression fracture.

false

Low back pain that radiates down the leg suggests the presence of nerve root involvement known as _____________.

sciatica

Nursing interventions for a patient undergoing foot surgery include a neurovascular assessment every 1 to 2 hours for the first 24 hours.

true

Osteoporosis frequently results in compression fractures of the spine, fractures of the neck or intertrochanteric region of the femur, and Colles fractures of the wrist.

true

Risk factors for osteoarthritis and its progression include older age, female gender, and obesity.

true

The most prevalent bone disease in the world is __________________.

osteoporosis

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

Morning heel pain Rationale: Plantar fasciitis is characterized by heel pain.

The community health nurse is assessing the risk factors for osteoporosis in a female client at a health fair. For each assessment finding, click to specify if the finding is a risk factor for osteoporosis or is not a risk factor for osteoporosis.

Risk Factors: 66 years of age, Asian heritage, postmenopausal status, takes fluticasone inhaler for asthma not risk factors: large frame, Nonsmoker, alcohol intake of 3 drinks/week, walks 2 miles, 3 days/week

Most cases of osteomyelitis are caused by which microorganism?

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

The most common causative organism of osteomyelitis is ________________.

staphylococcus aureus

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 Rationale: 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 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 Rationale: 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 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 Rationale: 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.