Ch 36 Musculoskeleton

A. Degenerative joint disease

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? A. Degenerative joint disease B. Muscular dystrophy C. Scoliosis D. Paget's disease

B. Temporomandibular disorder

A client has been treated for migraine headaches for several months and comes to the clinic reporting 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? A. Trigeminal neuralgia B. Temporomandibular disorder C. Loose teeth D. Dislocated jaw

D. Administering large doses of I.V. antibiotics as ordered

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

C. Alkaline phosphate of 165 IU/L (2750 mmol/L)

A client is evaluated for a diagnosis of Paget's disease. Which laboratory value would the nurse find to confirm the diagnosis? A. Calcium of 9.2 mg/dL (2.3 mmol/L) B. Urinary creatinine of 0.95 mg/dL (83.98 mmol/L) C. Alkaline phosphate of 165 IU/L (2750 mmol/L) D. Magnesium level of 2 mg/dL (0.82 mmol/L)

C. Osteomyelitis

A client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings? A. Avascular necrosis B. Fat embolism C. Osteomyelitis D. Compartment syndrome

D. L4, L5, and S1

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? A. C3, C4, and L1 B. L1, L2, and L4 C. L2, L3, and L5 D. L4, L5, and S1

D. Arthroscopy

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? A. Open reduction B. Needle aspiration C. Arthroplasty D. Arthroscopy

C. Hallux valgus

The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as A. Hammertoe B. Pes cavus C. Hallux valgus D. Flatfoot

A. Osteogenic sarcoma (osteosarcoma)

Which of the following is the most common and most fatal primary malignant bone tumor? A. Osteogenic sarcoma (osteosarcoma) B. Osteochondroma C. Enchondroma D. Rhabdomyoma

A. Raloxifene

Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women? A. Raloxifene B. Fosamax C. Forteo D. Denosumab

D. At least 4 weeks

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? A. 6 months B. 3 months C. 7 to 10 days D. At least 4 weeks

D. Use the large muscles of the leg when lifting items.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? A. Sleep on the stomach to alleviate pressure on the back. B. A soft mattress is most supportive by conforming to the body. C. Avoid twisting and flexion activities. D. Use the large muscles of the leg when lifting items.

A. Bone fracture

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? A. Bone fracture B. Loss of estrogen C. Negative calcium balance D. Dowager's hump

D. Take the supplement with meals or with orange juice.

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. Surgical removal of the sequestrum

A nurse is performing foot care for a client with chronic osteomyelitis and the client asks the nurse about the next treatment. What is the specific treatment for a client with chronic osteomyelitis? A. Aggressive physical therapy B. Drainage of localized foci of infection C. Continued aseptic wound treatment D. Surgical removal of the sequestrum

B. Walking

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? A. Yoga B. Walking C. Bicycling D. Swimming

A. Alendronate

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? A. Alendronate B. Raloxifene C. Teriparatide D. Denosumab

B. Walk or perform weight-bearing exercises outdoors

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

A. Applications of ice

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? A. Applications of ice B. Encouraging the client to eat a healthy diet C. Avoiding caffeine and alcohol D. Regular exercise and stress reduction

C. Vitamin D-fortified milk

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? A. Red meat B. Bananas C. Vitamin D-fortified milk D. Green vegetables

C. Open nerve release

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? A. Laser therapy B. Ultrasound therapy C. Open nerve release D. Injection of lidocaine

D. Initiating weight-bearing exercise routines

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? A. Living a sedentary lifestyle to reduce the incidence of injury B. Stopping estrogen therapy C. Taking a 300-mg calcium supplement to meet dietary guidelines D. Initiating weight-bearing exercise routines

C. Have the client hold the palm of the hand up while the nurse percusses over the median nerve.

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? A. Have the client make a fist and open the hand against resistance. B. Have the client stretch the fingers around a ball and squeeze with force. C. Have the client hold the palm of the hand up while the nurse percusses over the median nerve. D. Have the client pronate the hand while the nurse palpates the radial nerve.

B. Calcium level of 11.6 mg/dl

A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication? A. Potassium level of 6.3 mEq/L B. Calcium level of 11.6 mg/dl C. Sodium level of 110 mEq/L D. Magnesium level of 0.9 mg/dl

D. Perform neuromuscular assessment every hour.

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? A. Examine the surgical dressing every hour. B. Administer pain medication per client request. C. Monitor vital signs every 4 hours. D. Perform neuromuscular assessment every hour.

B. Chlorpheniramine

A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder? A. Dexamethasone B. Chlorpheniramine C. Dicloxacillin D. Bupivacaine

C. "You may need to be evaluated for an underlying cause, such as renal failure."

A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate? A. "You will need to decrease the amount of dairy products you consume." B. "You will need to avoid foods high in phosphorus and vitamin D." C. "You may need to be evaluated for an underlying cause, such as renal failure." D. "You will need to engage in vigorous exercise three times a week for 30 minutes."

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

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? A. Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. B. To prevent fractures, the client should avoid strenuous exercise. C. The recommended daily allowance of calcium may be found in a wide variety of foods. D. Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.

C. Alkaline phosphatase

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

B. Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees

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

A. Skull narrowing

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

C. Fourth and fifth fingers

Dupuytren contracture causes flexion of which area(s)? A. Thumb B. Index and middle fingers C. Fourth and fifth fingers D. Ring finger

D. 1,200 mg; 1,000 IU

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. A. 1,800 mg; 1,600 IU B. 1,600 mg; 1,400 IU C. 1,400 mg; 1,200 IU D. 1,200 mg; 1,000 IU

D. Surgical debridement

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? A. Wound packing B. Wound irrigation C. Vitamin supplements D. Surgical debridement

C. Hallux valgus

In which deformity does the great toe deviate laterally? A. Hammertoe B. Pes cavus C. Hallux valgus D. Plantar fasciitis

D. Lack of exposure to sunshine.

Lifestyle risk factors for osteoporosis include A. Lack of aerobic exercise. B. A low-protein, high-fat diet. C. An estrogen deficiency or menopause. D. Lack of exposure to sunshine.

A. Swelling of the third (lateral) branch of the median plantar nerve

Morton neuroma is exhibited by which clinical manifestation? A. Swelling of the third (lateral) branch of the median plantar nerve B. High arm and a fixed equinus deformity C. Diminishment of the longitudinal arch of the foot D. Inflammation of the foot-supporting fascia

C. Optimal calcium intake and estrogen replacement therapy.

Primary prevention of osteoporosis includes: A. Placing items within the client's reach. B. Installing grab bars in the bathroom to prevent falls. C. Optimal calcium intake and estrogen replacement therapy. D. Using a professional alert system in the home in case a client falls when she's alone.

A. Decrease in estrogen

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? A. Decrease in estrogen B. Increase in calcitonin C. Decrease in parathyroid hormone D. Increase of vitamin D

B. Broccoli

What food can the nurse suggest to the client at risk for osteoporosis? A. Carrots B. Broccoli C. Chicken D. Bananas

A. Chills

When an infection is bloodborne, the manifestations include which symptom? A. Chills B. Bradycardia C. Hypothermia D. Hyperactivity

B. Column B

Which assessment findings would the nurse expect in the client with osteomalacia? A. Column A B. Column B C. Column C D. Column D

C. Carpal tunnel syndrome

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? A. Morton's neuroma B. Dupuytren's contracture C. Carpal tunnel syndrome D. Impingement syndrome

A. Hammer toe

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? A. Hammer toe B. Mallet toe C. Hallux valgus (bunion) D. Heberden nodes

C. Osteoclastoma

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? A. Osteochondroma B. Enchondroma C. Osteoclastoma D. Osteoid osteoma

D. "You will receive IV antibiotics for 3 to 6 weeks."

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

C. "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow.

On a visit to the family health care provider, a client is diagnosed with a bunion on the lateral side of the great toe at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session? A. "Bunions are congenital and can't be prevented." B. "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth." C. "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." D. "Bunions are caused by a metabolic condition called gout."

C. "I will avoid prolonged sitting or walking."

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? A. "I will lie prone with my legs slightly elevated." B. "I will bend at the waist when I am lifting objects from the floor." C. "I will avoid prolonged sitting or walking." D. "Instead of turning around to grasp an object, I will twist at the waist."

D. Wear properly fitting shoes.

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? A. Bind the toes so that they will straighten. B. Do active range of motion on the toes. C. Have surgery to fix them. D. Wear properly fitting shoes.

B. Places the load close to the body.

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 A. Reaches over the head with the arms fully extended. B. Places the load close to the body. C. Uses a narrow base of support. D. Bends at the hips and tightens the abdominal muscles.

C. Quadriceps

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

B. European American women

Which group is at the greatest risk for osteoporosis? A. Men B. European American women C. Asian American women D. African American women

A. Calcitonin

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

A. Prone

Which of the following positions should be avoided in severe back pain? A. Prone B. Supine C. Lateral recumbent D. Head and thorax elevated 30 degrees

A. Hallux valgus

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

D. Management of plantar fasciitis includes stretching exercises.

Which should be included in the teaching plan for a client diagnosed with plantar fasciitis? A. Plantar fasciitis presents as an acute onset of pain localized to the ball of the foot. B. The pain of plantar fasciitis diminishes with soaking the foot in warm water. C. Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion. D. Management of plantar fasciitis includes stretching exercises.

A. Radiculopathy

Which term refers to a disease of a nerve root? A. Radiculopathy B. Involucrum C. Sequestrum D. Contracture

D. Dupuytren's contracture

Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? A. Callus B. Hammertoe C. Hallux valgus D. Dupuytren's contracture