Chapter 36
3 months
A client comes back to the clinic with a continued complaint of back pain. What time frame does the nurse understand constitutes "chronic pain"? · 1 year · 6 months · 3 months · 4 weeks
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? · Degenerative joint disease · Muscular dystrophy · Paget's disease · Scoliosis
Remove all small rugs from the home
A client diagnosed with osteoporosis is being discharged home. Which priority education should the nurse should provide? · Remove all small rugs from the home · Participate in weight-bearing exercises · Classify medications · Increase calcium and vitamin D in the diet
Observing for safety hazards that could be a fall risk
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? · Ensuring that the client is eating enough · Observing for safety hazards that could be a fall risk · Making sure the client is receiving a daily bath · Making sure the client has adequate financial resources
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? · Swimming · Yoga · Bicycling · Walking
· Teriparatide
A provider prescribes a subcutaneous anabolic agent for an older adult client to prevent fractures associated with osteoporosis. What is the most likely prescribed drug? · Raloxifene · Alendronic acid · Calcitonin · Teriparatide
Promoting weight-bearing exercises
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? · Promoting weight-bearing exercises · Maintaining vitamin levels · Maintaining protein levels · Promoting range-of-motion (ROM) exercises
Compression fractures
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? · Cardiac disease · Compression fractures · Hypertension · Diabetes
Long bone bowing
Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? · Long bone bowing · Lordosis · Skull narrowing · Upright gait
"After menopause, the body's bone density declines, resulting in a gradual loss of height."
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? · "The posture begins to stoop after middle age." · "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" · "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."
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? · "The posture begins to stoop after middle age." · "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"
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. · 1,400 mg; 1,200 IU · 1,800 mg; 1,600 IU · 1,600 mg; 1,400 IU · 1,200 mg; 1,000 IU
Surgical debridement
In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? · Surgical debridement · Wound irrigation · Wound packing · Vitamin supplements
lack of exposure to sunshine.
Lifestyle risk factors for osteoporosis include · a low-protein, high-fat diet. · lack of aerobic exercise. · an estrogen deficiency or menopause. · lack of exposure to sunshine.
· Osteomalacia
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? · Ganglion · Osteomyelitis · Paget disease · Osteomalacia
Disturbed body image
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 · Impaired physical mobility · Inadequate nutrition · Risk for infection
Has a weight gain of 5 pounds
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 · Shows increased joint flexibility · Reports ability to perform ADLs · Reports decreased joint pain
"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? · "Instead of turning around to grasp an object, I will twist at the waist." · "I will avoid prolonged sitting or walking." · "I will bend at the waist when I am lifting objects from the floor." · "I will lie prone with my legs slightly elevated."
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 · bends at the hips and tightens the abdominal muscles. · reaches over the head with the arms fully extended. · uses a narrow base of support. · places the load close to the body.
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 · reaches over the head with the arms fully extended. · places the load close to the body. · bends at the hips and tightens the abdominal muscles. · uses a narrow base of support.
"We need an adequate amount of exposure to sunshine."
The nurse is educating a group of women on the prevention of osteoporosis. The nurse recognizes the education as being effective when the group members make which statement? · "We need to consume a low-calcium, high-phosphorus diet." · "Estrogen deficiency increases bone density." · "We need an adequate amount of exposure to sunshine." · "We need to increase aerobic exercise."
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? Gastrocnemius Quadriceps Latissimus dorsi Rectus abdominis
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? · Walk or perform weight-bearing exercises outdoors · Decrease the intake of vitamin A and D · Increase fiber in the diet · Reduce stress
Broccoli
What food can the nurse suggest to the client at risk for osteoporosis? · Chicken · Carrots · Bananas · Broccoli
Raloxifene
Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women? · Denosumab · Fosamax · Raloxifene · Forteo
Raloxifene
Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women? · Raloxifene · Forteo · Fosamax · Denosumab
Prone
Which of the following positions should be avoided in severe back pain? · Prone · Head and thorax elevated 30 degrees · Lateral recumbent · Supine
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? · Take weekly on the same day and at the same time. · Take the supplement on an empty stomach with a full glass of water. · Take the supplement with meals or with orange juice. · Remain in an upright position 30 minutes after taking the supplement.
Has a weight gain of 5 pounds
The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? · Shows increased joint flexibility · Reports decreased joint pain · Has a weight gain of 5 pounds · Reports ability to perform ADLs
Calcitonin
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)? · Raloxifene · Vitamin D · Teriparatide · Calcitonin
Calcitonin
Which of the following inhibits bone resorption and promotes bone formation? · Calcitonin · Estrogen · Corticosteroids · Parathyroid hormone
Risk for injury related to fractures due to osteoporosis
Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? · Acute pain related to fracture and muscle spasm · Deficient knowledge about osteoporosis and the treatment regimen · Risk for injury related to fractures due to osteoporosis · Risk for constipation related to immobility
Inability to flex index and middle fingers
A client is diagnosed with carpal tunnel syndrome. Which assessment findings would the nurse expect? · A decrease in grasp strength · Tenderness in the affected wrist · Pain radiating down the dorsal surface of the forearm · Inability to flex index and middle fingers
Osteitis deformans
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? · Osteomyelitis · Osteomalacia · Osteoporosis · Osteitis deformans
· Supplemental calcium and increased doses of vitamin D
The health care team caring for a client has determined that their osteoporosis is caused by malabsorption. What is the usual treatment for osteoporosis caused by malabsorption? · Colony-stimulating factors and calcitonin · Supplemental potassium and pancreatic enzymes · Exogenous parathyroid hormone and multivitamins · Supplemental calcium and increased doses of vitamin D
Decreased height
What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? · Decreased height · Bone spurs · Increased heel pain · Diarrhea
Osteomalacia
Which condition is a metabolic bone disease characterized by inadequate mineralization of bone? · Osteoporosis · Osteomyelitis · Osteoarthritis · Osteomalacia
staphylococcus aureus
A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following? · Proteus vulgaris · Escherichia coli · Pseudomonas aeruginosa · Staphylococcus aureus
Chills
When an infection is bloodborne, the manifestations include which symptom? · Hyperactivity · Chills · Hypothermia · Bradycardia
Have the client sit upright for at least 30 minutes following administration
A client has been prescribed alendronate for the prevention of osteoporosis. Which is the highest priority nursing intervention associated with the administration of the medication? · Assess for the use of corticosteroids · Ensure adequate intake of vitamin D in the diet · Have the client sit upright for at least 30 minutes following administration · Encourage the client to get yearly dental exams
Administering large doses of oral 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? · Administering large doses of oral antibiotics as ordered · Instructing the client to ambulate twice daily · Withholding all oral intake · Administering large doses of I.V. antibiotics as ordered
Arthrodesis
A client is scheduled for surgery to fuse a joint. The nurse identifies this as which of the following? · Arthrodesis · Open reduction internal fixation · Osteotomy · Arthroplasty
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? · Fat embolism · Osteomyelitis · Avascular necrosis · Compartment syndrome
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? · L4, L5, and S1 · L2, L3, and L5 · C3, C4, and L1 · L1, L2, and L4
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? · Bananas · Green vegetables · Red meat · Vitamin D-fortified milk
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? · Bananas · Red meat · Vitamin D-fortified milk · Green vegetables
· "You need to increase the amount of vitamin D in your diet."
A client with a musculoskeletal injury is instructed to increase dietary calcium. Which statement by the nurse is appropriate? · "You need to increase the amount of vitamin D in your diet." · "You need to increase the amount of non-citrus fruits in your diet." · "You need to increase the amount of red meat in your diet." · "You need to increase the amount of phosphorus in your diet."
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? · Open nerve release · Injection of lidocaine · Laser therapy · Ultrasound therapy
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? · Vitamin supplements · Wound irrigation · Surgical debridement · Wound packing
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? · Avoid twisting and flexion activities. · Sleep on the stomach to alleviate pressure on the back. · A soft mattress is most supportive by conforming to the body. · Use the large muscles of the leg when lifting items.
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? · Use the large muscles of the leg when lifting items. · Avoid twisting and flexion activities. · Sleep on the stomach to alleviate pressure on the back. · A soft mattress is most supportive by conforming to the body.
Raloxifene (Evista)
A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class? · Alendronate (Fosamax) · Raloxifene (Evista) · Calcium gluconate · Tamoxifen (Nolvadex)
A bone biopsy
A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia? · A bone biopsy · Demineralization of the bone · Elevated levels of alkaline phosphatase · Increased and decreased areas of bone metabolism
Initiating weight-bearing exercise routines
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? · Stopping estrogen therapy · Initiating weight-bearing exercise routines · Living a sedentary lifestyle to reduce the incidence of injury · Taking a 300-mg calcium supplement to meet dietary guidelines
Initiating weight-bearing exercise routines
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? · Taking a 300-mg calcium supplement to meet dietary guidelines · Living a sedentary lifestyle to reduce the incidence of injury · Initiating weight-bearing exercise routines · Stopping estrogen therapy
Hypothyroidism
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 · Prolonged corticosteroid use · Excess caffeine intake · Prolonged immobility
· Apply ice packs to the affected knee. · Elevate the affected leg. · Apply a knee brace or wrap the affected knee.
A high school student who was injured in a football game presents with knee pain with internal rotation of the foot. Which interventions are appropriate nursing actions? Select all that apply. · Apply ice packs to the affected knee. · Elevate the affected leg. · Assist the client to "walk off" the pain. · Apply a knee brace or wrap the affected knee. · Administer morphine sulfate.
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? · Examine the surgical dressing every hour. · Monitor vital signs every 4 hours. · Administer pain medication per client request. · Perform neuromuscular assessment every hour.
The nurse is caring for this client on the intensive care unit.
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. · The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor. · The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor. · The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit.
Bone abscess formation
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 · Pathological fractures · Impingement syndrome · Metastatic bone disease
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? · Bone fracture · Negative calcium balance · Loss of estrogen · Dowager's hump
· Female gender · Osteoporosis · Presence of anemia
A nurse is caring for an older woman with a hip fracture. What are appropriate risk factors for the nurse to consider related to the client's hip fracture? Select all that apply. · Female gender · Muscular agility · Osteoporosis · History of diverticulitis · Presence of anemia
"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? · "You may need to be evaluated for an underlying cause, such as renal failure." · "You will need to decrease the amount of dairy products you consume." · "You will need to avoid foods high in phosphorus and vitamin D." · "You will need to engage in vigorous exercise three times a week for 30 minutes."
"Most falls among the elderly occur outside the home. Clients should confine themselves to their homes as much as practical."
A nurse is performing discharge teaching for an elderly client diagnosed with osteoporosis. Which statement about home safety should the nurse include? · "Most falls among the elderly occur outside the home. Clients should confine themselves to their homes as much as practical." · "Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars." · "Most accidental injuries among the elderly are automobile-related. Elderly clients should have vision testing every 6 months while they're still driving." · "Because of the increase in home burglaries involving the elderly, these clients should have burglar bars on every window in the home."
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? · Continued aseptic wound treatment · Aggressive physical therapy · Surgical removal of the sequestrum · Drainage of localized foci of infection
· "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? · "You need to perform weight-bearing exercises twice a week." · "You will receive IV antibiotics for 3 to 6 weeks." · "Use your continuous passive motion machine for 2 hours each day." · "You need to limit the amount of protein and calcium in your diet."
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? · To prevent fractures, the client should avoid strenuous exercise. · Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. · The recommended daily allowance of calcium may be found in a wide variety of foods. · Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.
Immobilize the client's arm.
A nurse notices a client lying on the floor at the bottom of the stairs. The client is alert and oriented and denies pain other than in the arm, which is swollen and appears deformed. After calling for help, what should the nurse do? · Place the client in a sitting position. · Help the client walk to the nearest nurses' station. · Raise the client's arm above the heart. · Immobilize the client's arm.
Bone pain and tenderness
A patient has been diagnosed with osteomalacia. What common symptoms does the nurse recognize that correlate with the diagnosis? · Softened and compressed vertebrae · Muscle weakness and spasms · Bone pain and tenderness · Bone fractures and kyphosis
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? · Prone, with a pillow under the shoulders · 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 · High-Fowler's to allow for maximum hip flexion
Holding the raloxifene and notifying the physician
A physician prescribes raloxifene to a hospitalized client. The client's history includes a right hip fracture, hysterectomy, deep vein thrombosis, and hypertension. Which action by the nurse demonstrates safe nursing care? · Having the patient sit upright for 30-60 minutes following administration · Administering the raloxifene with food or milk · Holding the raloxifene and notifying the physician · Administering the raloxifene in the evening
Teriperatide
A provider prescribes a subcutaneous anabolic agent for an older adult client to prevent fractures associated with osteoporosis. What is the most likely prescribed drug? · Calcitonin · Raloxifene · Teriperatide · Alendronic acid
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? · Decrease in estrogen · Decrease in parathyroid hormone · Increase in calcitonin · Increase of vitamin D
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? · Teriparatide · Denosumab · Raloxifene · Alendronate
· Plan for smoking cessation · Engage in regular weight-bearing exercise · Avoid excessive alcohol intake
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. · Swim for 30 minutes four to five times a week · Plan for smoking cessation · Consider estrogen replacement therapy · Engage in regular weight-bearing exercise · Avoid excessive alcohol intake
· Disturbed body image · Imbalanced nutrition: less than body requirements
The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which nursing diagnosis is appropriate for the client? Select all that apply. · Disturbed body image · Ineffective airway clearance · Risk for injury · Imbalanced nutrition: less than body requirements · Acute pain
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? · Open reduction · Arthroscopy · Arthroplasty · Needle aspiration
· "I will increase the amount of walking I do every day." · "I will need to lose some weight."
The nurse provides teaching to a client with osteoarthritis (OA). Which statement(s) indicate that teaching about pain management and functional ability were effective? Select all that apply. · "I will increase the amount of walking I do every day." · "I will take the pain medication after exercising." · "I will spend more time resting." · "I will avoid using a cane to walk." · "I will need to lose some weight."
encourage the client to walk in the hall.
To help minimize calcium loss from a hospitalized client's bones, the nurse should: · reposition the client every 2 hours. · encourage the client to walk in the hall. · provide the client dairy products at frequent intervals. · provide supplemental feedings between meals.
Lift with the large leg muscles (quadriceps), not the back muscles.
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? · Avoid lifting above waist level. · Limit time lifting up to reach something. · Lift with the large leg muscles (quadriceps), not the back muscles. · Contract trunk muscles to stabilize the spine.
avoid overreaching.
When teaching a client how to prevent low back pain as a result of lifting, the nurse should instruct the client to: · place the load away from the body. · bend the knees and loosen the abdominal muscles. · avoid overreaching. · use a narrow base of support.
European American women
Which group is at the greatest risk for osteoporosis? · European American women · Men · Asian American women · African American women
Smoking cessation
Which is a risk-lowering strategy for osteoporosis? · Smoking cessation · Diet low in calcium and vitamin D · Increased age · Low initial bone mass