chapter 36 management of patients with musculoskeletal disorders

Identify descriptors of the pathophysiologic process seen in osteomalacia. Select all that apply.

There is a deficiency of activated vitamin D (calcitriol). Calcium and phosphate are not moved to the bones. The bone mass is structurally weaker, and bone deformities occur.

Which client would the nurse identify as having the greatest risk for osteoporosis?

a small framed, thin 45 year old white woman

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."

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?

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

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?

0.5

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

An older woman's x rays reveal a diagnosis of osteoporosis. The nurse advises the woman that the radiolucency seen in the bones indicates a minimal level of demineralization of which percentage?

25%

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

Alkaline phosphatase

A client is evaluated for a diagnosis of Paget's disease. Which laboratory value would the nurse find to confirm the diagnosis?

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

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

Broccoli

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

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

Calcitonin

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD?

Calcitonin (Miacalcin)

A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder?

Chlorpheniramine

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

Dupuytren contracture causes flexion of which area(s)?

Fourth and fifth fingers

In which deformity does the great toe deviate laterally?

Hallux valgus

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

Which condition is a metabolic bone disease characterized by inadequate mineralization of bone?

Osteomalacia

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

The nurse is caring for a client with low back pain. Which education about body mechanics will the nurse provide the client? Select all that apply.

Push objects Avoid twisting the spine Lift with the leg muscles

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

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 is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which nursing diagnosis is appropriate for the client?

acute pain disturbed body image imbalanced nutrition: less than body requirements

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 IV antibiotics as ordered

During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches tall. The client states, "how is that possible? i was always 5 feet and 1/2?" Which statement is the best response by the nurse?

after menopause, the body's bone density declines, resulting in a gradual loss of height

When reviewing the history of a client of a client with a ganglion cyst, which factor would the nurse identify as most likely contributing to the client's current condition?

age below 50 years

When reviewing the history of a client with a ganglion cyst, which factor would the nurse identify as most likely contributing to the client's current condition?

age below 50 years

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

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

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

Which is not a risk factor for osteoporosis?

being male

The 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

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

broccoli

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

calcitonin

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

When an infection is blood-borne, the manifestations include which symptoms?

chills

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

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

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

decreased height

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

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

dupuytren contracture

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

dupuytren's contracture

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

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

Which group is at the greatest risk for osteoporosis?

european american women

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

hallux valgus

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

A health care 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

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

Which are true about lyme disease?

if untreated, the disease move through three stages; early stage symptoms may include a red macule or papule at the site of the tick bite, a characteristic bullseye rash with round rings around the center, headache, neck stiffness, pain, fever, chills, malaise, nausea, vomiting, and sore throat; cardiac and neurologic symptoms occur mid stage, followed by arthritis and joint problems

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?

immobilize the client's arm

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

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

long bone bowing

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?

lower lumbar

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

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 nurse is collaborating with the healthcare 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 antibiotics 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

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

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

plantar fasciitis

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?

presence of anemia female gender osteoporosis

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

promote pain relief and quality of life

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

Which term refers to a disease of a nerve root?

radiculopathy

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?

raloxifene (evista)

A client has Paget's disease. An appropriate nursing diagnosis for this client is:

risk for falls

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

risks: 66 years of age, asian heritage, takes fluticasone inhaler non-risks: large frame, nonsmoker, alcohol intake, walks 2 miles

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

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

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The would appearance has not improved. What action would the nurse anticipate to promote healing?

surgical debridement

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

surgical debridement

Morton neruoma is exhibited by which clinical manifestation?

swelling of the third (lateral) branch of the median plantar nerve

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?

temporomandibular disorder

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

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 objects, which food item should the nurse encourage the client to include in the diet?

vitamin d - fortified milk

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

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

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

you will receive IV antibiotics for 3 to 6 weeks