Chapter 41 prepu
In which deformity does the great toe deviate laterally?
Hammertoe Pes cavus Hallux valgus Plantar fasciitis
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?
Bind the toes so that they will straighten. Do active range of motion on the toes. Have surgery to fix them. Wear properly fitting shoes.
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?
Excess caffeine intake Prolonged corticosteroid use Hypothyroidism Prolonged immobility
Which of the following are common primary sites of tumors that metastasize to the bone? Select all that apply.
Kidney Prostate Lung Breast Ovary
A client is scheduled for surgery to fuse a joint. The nurse identifies this as which of the following?
Osteotomy Arthrodesis Arthroplasty Open reduction internal fixation
Which term refers to a disease of a nerve root?
Radiculopathy Involucrum Sequestrum Contracture
The majority of bone infections are caused by which organism?
Staphylococcus aureus Proteus Pseudomonas
Which of the following is the first-line medication that would be used to treat and prevent osteoporosis?
Bisphosphonates Calcitonin Selective estrogen receptor modulators Anabolic agents
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD?
Calcitonin (Miacalcin) Raloxifene (Evista) Teriparatide (Forteo) Vitamin D
A client is evaluated for a diagnosis of Paget's disease. Which laboratory value would the nurse find to confirm the diagnosis?
Calcium of 9.2 mg/dL (2.3 mmol/L) Urinary creatinine of 0.95 mg/dL (83.98 mmol/L) Alkaline phosphate of 165 IU/L (2750 mmol/L) Magnesium level of 2 mg/dL (0.82 mmol/L)
What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?
Callus Hammertoe Hallux valgus Dupuytren contracture
Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?
Callus Hammertoe Hallux valgus Dupuytren's contracture
The nurse recognizes that goal of treatment for metastatic bone cancer is to:
Promote pain relief and quality of life Reconstruct the bone with a prosthesis Diagnose the extent of bone damage Cure the diseased bone and cartilage
When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location?
Proximal humerus Wrist-hand junction Distal femur around the knee Femur-hip area
Dupuytren contracture causes flexion of which area(s)?
Thumb Index and middle fingers Fourth and fifth fingers Ring finger
A nurse is providing an educational class to a group of older adults at a community senior center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended intake of what nutrients? Select all that apply.
Vitamin B12 Potassium Calcitonin Calcium Vitamin D
Lifestyle risk factors for osteoporosis include
lack of aerobic exercise. a low-protein, high-fat diet. an estrogen deficiency or menopause. lack of exposure to sunshine.
A client is reporting jaw pain, and is experiencing muscle spasm and tenderness of the masseter and temporalis muscles. The physician has diagnosed a temporomandibular disorder (TMD). What would the treatment course for this client include? Select all that apply.
referral to a dentist who has experience managing clients with TMD analgesics custom-fitted mouth guard during sleep corticosteroids
The nurse is educating a client on home care following removal of a ganglion cyst from the right wrist. Which statement by the client demonstrates that the nurse's teaching has been effective?
"I will leave the dressing on until I follow up with my doctor as scheduled." "If my hand becomes numb and cool I will elevate it above my heart." "I will notify my doctor if I develop redness and purulent drainage for 2 days." "If my pain is not relieved I will use a heat pack and take some more medication."
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 lie prone with my legs slightly elevated." "I will bend at the waist when I am lifting objects from the floor." "I will avoid prolonged sitting or walking." "Instead of turning around to grasp an object, I will twist at the waist."
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 Increased and decreased areas of bone metabolism Elevated levels of alkaline phosphatase
A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true?
A ganglion is the most common benign soft-tissue mass in the foot. A ganglion is a precursor to a primary bone tumor. Surgical excision is the treatment of choice for a ganglion. Dorsiflexion exacerbates signs and symptoms of a ganglion.
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) Calcium gluconate Tamoxifen (Nolvadex) Raloxifene (Evista)
A client comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the health care provider orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the client about?
Amitriptyline Duloxetine Gabapentin Cyclobenzaprine
A client tells the nurse that he has pain and numbness to his thumb, first finger, and second finger of the right hand. The nurse discovers that the client is employed as an auto mechanic, and that the pain is increased while working. This may indicate that the client could possibly have what health problem?
Carpel tunnel syndrome Tendonitis Impingement syndrome Dupuytren contracture
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.)
Educating the patient on the use of gabapentin Active range-of-motion exercises Corticosteroid injections Surgical excision Aspiration of the cyst
Which common problem of the upper extremity results from entrapment of the median nerve at the wrist?
Ganglion Carpal tunnel syndrome Dupuytren contracture Impingement syndrome
Which common problem of the upper extremity results from entrapment of the median nerve at the wrist?
Ganglion Carpal tunnel syndrome Dupuytren's contracture Impingement syndrome
A nurse is providing care for a client who has a recent diagnosis of Paget disease. When planning this client's nursing care, interventions should address what? Select all that apply.
Impaired physical mobility Acute pain Disturbed auditory sensory perception Risk for injury Risk for unstable blood glucose
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?
Potassium level of 6.3 mEq/L Calcium level of 11.6 mg/dl Sodium level of 110 mEq/L Magnesium level of 0.9 mg/dl
Which of the following positions should be avoided in severe back pain?
Prone Supine Lateral recumbent Head and thorax elevated 30 degrees
A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following?
Proteus vulgaris Pseudomonas aeruginosa Escherichia coli Staphylococcus aureus
A client presents to a clinic reporting of a leg ulcer that isn't healing; subsequent diagnostic testing suggests osteomyelitis. The nurse is aware that the most common pathogen to cause osteomyelitis is what?
Staphylococcus aureus Proteus Pseudomonas Escherichia coli
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. Excessive osteoclastic activity causes the bones to become soft and bowed initially; later, the bones thicken but are not well formed, making the bones weak and prone to fracture.
Dupuytren's contracture causes flexion of which area(s)?
Thumb Index and middle fingers Fourth and fifth fingers Ring finger
A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening?
Trigeminal neuralgia Temporomandibular disorder Loose teeth Dislocated jaw
A health care provider diagnoses primary osteoporosis in a client who has lost bone mass. For which client is primary osteoporosis most common?
elderly man young child young menstruating woman elderly postmenopausal woman
Primary prevention of osteoporosis includes:
placing items within the client's reach. installing grab bars in the bathroom to prevent falls. optimal calcium intake and estrogen replacement therapy. using a professional alert system in the home in case a client falls when she's alone.
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. uses a narrow base of support. bends at the hips and tightens the abdominal muscles.
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.
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?
10% 15% 20% 25%
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?
Aggressive physical therapy Drainage of localized foci of infection Continued aseptic wound treatment Surgical removal of the sequestrum
Which of the following inhibits bone resorption and promotes bone formation?
Calcitonin Estrogen Parathyroid hormone Corticosteroids
An orthopedic nurse is caring for a client who is postoperative day 1 following foot surgery. What nursing intervention should be included in the client's subsequent care?
Dressing changes should not be performed unless there are clear signs of infection. The surgical site can be soaked in warm bath water for up to 5 minutes. The surgical site should be cleansed with hydrogen peroxide once daily. The foot should be elevated in order to prevent edema.
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 Latissimus dorsi Quadriceps Rectus abdominis
A client has come to the clinic for a routine annual physical. The nurse practitioner notes a palpable, painless projection of bone at the client's shoulder. The projection appears to be at the distal end of the humerus. The nurse should suspect the presence of which of the following?
Osteomyelitis Osteochondroma Osteomalacia Paget disease
Which condition is a metabolic bone disease characterized by inadequate mineralization of bone?
Osteoporosis Osteomyelitis Osteomalacia Osteoarthritis
A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include?
Sleep on the stomach to alleviate pressure on the back. A soft mattress is most supportive by conforming to the body. Avoid twisting and flexion activities. Use the large muscles of the leg when lifting items.
The nurse is screening a client for genetic counseling. What musculoskeletal conditions does the nurse know to have a genetic influence? Select all that apply.
osteoarthritis Marfan syndrome osteoporosis Stickler syndrome diabetes mellitus
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. Contract trunk muscles to stabilize the spine. Lift with the large leg muscles (quadriceps), not the back muscles.
A nurse is caring for an adult client diagnosed with a back strain. What health education should the nurse provide to this client?
Avoid lifting more than one-third of body weight without assistance. Focus on using back muscles efficiently when lifting heavy objects. Lift objects while holding the object a safe distance from the body. Tighten the abdominal muscles and lock the knees when lifting of an object.
What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years?
Bone spurs Diarrhea Increased heel pain Decreased height
An 80-year-old man in a long-term care facility has a chronic leg ulcer and states that the area has become increasingly painful in recent days. The nurse notes that the site is now swollen and warm to the touch. The client should undergo diagnostic testing for what health problem?
Osteomyelitis Osteoporosis Osteomalacia Septic arthritis
A nurse is caring for a client with a bone tumor. The nurse is providing education to help the client reduce the risk for pathologic fractures. What should the nurse teach the client?
Strive to achieve maximum weight-bearing capabilities. Gradually strengthen the affected muscles through weight training. Support the affected extremity with external supports such as splints. Limit reliance on assistive devices in order to build strength.
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 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." "Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars."
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 Raloxifene Teriparatide Denosumab
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?
Alendronic acid Calcitonin Raloxifene Teriparatide
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?
C3, C4, and L1 L1, L2, and L4 L2, L3, and L5 L4, L5, and S1
A nurse is reviewing the care of a client who has a long history of lower back pain that has not responded to conservative treatment measures. The nurse should anticipate the administration of what drug?
Calcitonin Prednisone Aspirin Cyclobenzaprine
A nurse is teaching a client with osteomalacia about the role of diet. What would be the best choice for breakfast for a client with osteomalacia?
Cereal with milk, a scrambled egg, and grapefruit Poached eggs with sausage and toast Waffles with fresh strawberries and powdered sugar A bagel topped with butter and jam with a side dish of grapes
A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively?
Changing the dressing Applying a cock-up splint and immobilization Having the patient exercise the fingers to avoid future contractures Performing hourly neurovascular assessments for the first 24 hours
A client with diabetes has been diagnosed with osteomyelitis. The nurse observes that the client's right foot is pale and mottled, cool to touch, with a capillary refill of greater than 3 seconds. The nurse should suspect what type of osteomyelitis?
Hematogenous osteomyelitis Osteomyelitis with vascular insufficiency Contiguous focus osteomyelitis Osteomyelitis with muscular deterioration
Which are true about Lyme disease? Select all that apply.
If untreated, the disease moves 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. Nephrotic syndromes occur in the later stages.
Which is a risk-lowering strategy for osteoporosis?
Low initial bone mass Diet low in calcium and vitamin D Smoking cessation Increased age
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?
Lower lumbar Upper lumbar Thoracic Cervical
A nurse is caring for a client who is being treated in the hospital for a spontaneous vertebral fracture related to osteoporosis. The nurse should address the nursing diagnosis of Acute Pain Related to Fracture by implementing what intervention?
Maintenance of high Fowler positioning whenever possible Intermittent application of heat to the client's back Use of a pressure-reducing mattress Passive range of motion exercises
A nurse is providing a class on osteoporosis at the local seniors' center. Which of the following statements related to osteoporosis is most accurate?
Osteoporosis is categorized as a disease of the elderly. A nonmodifiable risk factor for osteoporosis is a person's level of activity. Secondary osteoporosis occurs in women after menopause. Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis.
Which should be included in the teaching plan for a client diagnosed with plantar fasciitis?
Plantar fasciitis presents as an acute onset of pain localized to the ball of the foot. The pain of plantar fasciitis diminishes with soaking the foot in warm water. Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion. Management of plantar fasciitis includes stretching exercises.
A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis?
Proteus Pseudomonas Salmonella Staphylococcus aureus
Most cases of osteomyelitis are caused by which microorganism?
Staphylococcus aureus Proteus species Pseudomonas species Escherichia coli
A nurse is collaborating with the physical therapist to plan the care of a client with osteomyelitis. What principle should guide the management of activity and mobility in this client?
Stress on the weakened bone must be avoided. Increased heart rate enhances perfusion and bone healing. Bed rest results in improved outcomes in clients with osteomyelitis. Maintenance of baseline ADLs is the primary goal during osteomyelitis treatment.
The client has just been diagnosed with osteomyelitis. What are possible causes of osteomyelitis? Select all that apply.
Trauma, such as penetrating wounds or compound fractures Vascular insufficiency in clients with diabetes or peripheral vascular disease Surgical contamination, such as pin sites of skeletal traction Progressive osteoporosis
A client presents at a clinic reports heel pain that impairs walking ability. The client is subsequently diagnosed with plantar fasciitis. This client's plan of care should include what intervention?
Wrapping the affected area in lamb's wool or gauze to relieve pressure Gently stretching the foot and the Achilles tendon Wearing open-toed shoes at all times Applying topical analgesic ointment to plantar surface each morning
Bursitis is an inflammation of the bursa, a fluid-filled sac that cushions bone ends to enhance a gliding movement. What possible assessment findings would be present in a client with bursitis? Select all that apply.
painful movement of a joint a distinct lump Bouchard's nodes hyperuricemia
The health care provider has prescribed plicamycin to control serum calcium levels in a client with Paget's disease. The dose prescribed is 25 micrograms per kg. The client weighs 132 lbs. How many milligrams will the nurse expect the client to receive?
1.5 1500 15 2.4 All other answers
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?
Ensure adequate intake of vitamin D in the diet Assess for the use of corticosteroids Encourage the client to get yearly dental exams Have the client sit upright for at least 30 minutes following administration
A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder?
Dexamethasone Chlorpheniramine Dicloxacillin Bupivacaine
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?
Diabetes Hypertension Compression fractures Cardiac disease
A client is informed that he has 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?
Osteochondroma Enchondroma Osteoclastoma Osteoid osteoma
Morton neuroma is exhibited by which clinical manifestation?
Swelling of the third (lateral) branch of the median plantar nerve High arm and a fixed equinus deformity Longitudinal arch of the foot is diminished Inflammation of the foot-supporting fascia
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. Remain in an upright position 30 minutes after taking the supplement. Take the supplement on an empty stomach with a full glass of water. Take the supplement with meals or with orange juice.
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 bursitis and tendinitis." "CTS is a neuropathy that is characterized by flexion contracture of the fourth and fifth fingers." "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." "CTS is a neuropathy that is characterized by pannus formation in the shoulder."
A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate?
"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 may need to be evaluated for an underlying cause, such as renal failure." "You will need to engage in vigorous exercise three times a week for 30 minutes."
A nurse is providing care for a client who has osteomalacia. What major goal should guide the choice of medical and nursing interventions?
Maintenance of skin integrity Prevention of bone metastasis Maintenance of adequate levels of activated vitamin D Maintenance of adequate parathyroid hormone function
A client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications?
common adverse effects dietary restrictions activity restrictions loading-dose schedule
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder?
Osteomalacia Osteoporosis Osteomyelitis Osteitis deformans
What food can the nurse suggest to the client at risk for osteoporosis?
Carrots Broccoli Chicken Bananas
Which group is at the greatest risk for osteoporosis?
Men European American women Asian American women African American women
A client presents at the clinic with a report of morning numbness, cramping, and stiffness in his fourth and fifth fingers. What disease process should the nurse suspect?
Tendonitis A ganglion Carpal tunnel syndrome Dupuytren disease
When teaching a client how to prevent low back pain as a result of lifting, the nurse should instruct the client to:
avoid overreaching. place the load away from the body. use a narrow base of support. bend the knees and loosen the abdominal muscles.
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?
"Bunions are congenital and can't be prevented." "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth." "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." "Bunions are caused by a metabolic condition called gout."
A nurse is teaching a client with osteoporosis about dietary selections. What client statement indicates the teaching was effective?
"I will decrease my intake of red meat." "I will decrease my intake of popcorn, nuts, and seeds." "I will eat more fruits to increase my potassium intake." "I will eat more dairy products to increase my calcium intake."
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?
"This condition is associated with various sports." "Surgery is the only sure way to manage this condition." "Using arm splints will prevent hyperflexion of the wrist." "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?
"Use your continuous passive motion machine for 2 hours each day." "You need to perform weight-bearing exercises twice a week." "You need to limit the amount of protein and calcium in your diet." "You will receive IV antibiotics for 3 to 6 weeks."
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 increase aerobic exercise." "We need to consume a low-calcium, high-phosphorus diet." "Estrogen deficiency increases bone density." "We need an adequate amount of exposure to sunshine."
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.
1,800 mg; 1,600 IU 1,600 mg; 1,400 IU 1,400 mg; 1,200 IU 1,200 mg; 1,000 IU
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.
Presence of anemia Muscular agility Female gender Osteoporosis History of diverticulitis
Which client would the nurse identify as having the greatest risk for osteoporosis?
A 40-year-old overweight African American woman A 16-year-old male with a history of asthma A small-framed, thin 45-year-old white woman A 20-year-old male athlete with repeated injuries
A client comes back to the clinic with a continued complaint of back pain. What time frame does the nurse understand constitutes "chronic pain"?
4 weeks 3 months 6 months 1 year
A client with diabetes punctured his foot with a broken acorn in the yard. 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?
6 months 3 months 7 to 10 days 3 to 6 weeks
Which of the following clients should the nurse recognize as being at the highest risk for the development of osteomyelitis?
A middle-age adult who takes ibuprofen daily for rheumatoid arthritis An elderly client with an infected pressure ulcer in the sacral area A 17-year-old football player who had orthopedic surgery 6 weeks prior An infant diagnosed with jaundice
A nurse is caring for a client with osteomyelitis. What complication should the nurse consider that the client is at risk to develop?
Impingement syndrome Metastatic bone disease Bone abscess formation Pathological fractures
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.
Acute pain Disturbed body image Imbalanced nutrition: less than body requirements Risk for injury Ineffective airway clearance
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.
Administer morphine sulfate. Elevate the affected leg. Apply ice packs to the affected knee. Assist the client to "walk off" the pain. Apply a knee brace or wrap the affected knee.
A nurse is caring for a client with Paget disease and is reviewing the client's most recent laboratory values. Which of the following values is most characteristic of Paget disease?
An elevated level of parathyroid hormone and low calcitonin levels A low serum alkaline phosphatase level and a low serum calcium level An elevated serum alkaline phosphatase level and a normal serum calcium level An elevated calcitonin level and low levels of parathyroid hormone
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
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 Calcium gluconate Tamoxifen Raloxifene
A nurse is caring for a client following removal of a Morton's neuroma. Which nursing intervention would be most appropriate?
Assist the client with incentive spirometry. Assess the surgical dressing. Assist with passive range of motion exercises Perform neurovascular assessment of the hand.
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?
Avascular necrosis Fat embolism Osteomyelitis Compartment syndrome
Which aspect should a nurse include in the teaching plan for a client with osteomalacia?
Avoid dairy products Include calcium, phosphorus, and vitamin D supplements Avoid green, leafy vegetables Avoid any activity or exercise
Which suggestion would be most important to give a client who has a mild case of bunions?
Avoid strenuous exercise. Avoid foot creams. Don proper footwear. Regularly use analgesics.
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?
Inadequate nutrition Impaired physical mobility Risk for infection Disturbed body image
An elderly female with osteoporosis has been hospitalized. Prior to discharge, when teaching the client, the nurse should include information about which major complication of osteoporosis?
Bone fracture Loss of estrogen Negative calcium balance Dowager hump
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 Loss of estrogen Negative calcium balance Dowager's hump
A patient has been diagnosed with osteomalacia. What common symptoms does the nurse recognize that correlate with the diagnosis?
Bone fractures and kyphosis Bone pain and tenderness Muscle weakness and spasms Softened and compressed vertebrae
A client has low back pain and the healthcare provider needs to rule out the presence of a tumor. Which diagnostic procedure would the nurse anticipate to be ordered for the client?
Bone scan Computed tomography Magnetic resonance imaging Electromyogram
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?
Bunion Clawfoot Corn Hammer Toe
A client presents at a clinic complaining of back pain that goes all the way down the back of the leg to the foot. The nurse should document the presence of what type of pain?
Bursitis Radiculopathy Sciatica Tendonitis
When an infection is bloodborne, the manifestations include which symptom?
Chills Bradycardia Hypothermia Hyperactivity
A nurse is providing discharge teaching for a client who underwent foot surgery. The nurse is collaborating with the occupational therapist and discussing the use of assistive devices. On what variables does the choice of assistive devices primarily depend?
Client's general condition, balance, and weight-bearing prescription Client's general condition, strength, and gender Client's motivation, age, and weight-bearing prescription Client's occupation, motivation, and age
Which assessment findings would the nurse expect in the client with osteomalacia?
Column A Column B Column C Column D
Which assessment findings would the nurse expect to find in the client with osteomyelitis?
Column A Column B Column C Column D
A nurse is caring for a client who is being assessed following complaints of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? Select all that apply.
Computed tomography (CT) Angiography Magnetic resonance imaging (MRI) Ultrasound X-ray
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 Increase in calcitonin Decrease in parathyroid hormone Increase of vitamin D
A client has returned to the unit after undergoing limb-sparing surgery to remove a metastatic bone tumor. The nurse providing postoperative care in the days following surgery assesses for what complication from surgery?
Deficient fluid volume Delayed wound healing Hypocalcemia Pathologic fractures
Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis?
Deficient knowledge about osteoporosis and the treatment regimen Acute pain related to fracture and muscle spasm Risk for constipation related to immobility Risk for injury related to fractures due to osteoporosis
A client's electronic health record notes that the client has hallux valgus. What signs and symptoms should the nurse expect this client to manifest?
Deviation of a great toe laterally Abnormal flexion of the great toe An exaggerated arch of the foot Fusion of the toe joints
Which of the following is the most common and most fatal primary malignant bone tumor?
Osteogenic sarcoma (osteosarcoma) Osteochondroma Enchondroma Rhabdomyoma
Which of the following diagnostics are used to evaluate spinal nerve root disorders (radiculopathies)?
Electromyogram Bone scan Computed tomography Magnetic resonance imaging
A nurse is caring for a client who is 12 hours postoperative following foot surgery. The nurse assesses the presence of edema in the foot. What nursing measure should the nurse implement to control the edema?
Elevate the foot on several pillows. Apply warm compresses intermittently to the surgical area. Administer a loop diuretic as prescribed. Increase circulation through frequent ambulation.
The nurse is planning an education program for women of childbearing years. What does the nurse recognize as the primary prevention of osteoporosis?
Engaging in non-weight-bearing exercises daily Ensuring adequate calcium and vitamin D intake Undergoing assessment of serum calcium levels every year Having a DXA beginning at age 35 years
A nurse is planning the care of an older adult client with osteomalacia. What action should the nurse recommend in order to promote vitamin D synthesis?
Ensuring adequate exposure to sunlight Eating a low-purine diet Performing cardiovascular exercise while avoiding weight-bearing exercises Taking thyroid supplements as prescribed
A client has been admitted to the medical unit for the treatment of Paget disease. When reviewing the medication administration record, the nurse should anticipate what medication?
Estrogen Bisphosphonates Alkaline phosphatase Calcium gluconate
A nurse is reviewing the pathophysiology that may underlie a client's decreased bone density. What hormone should the nurse identify as inhibiting bone resorption and promoting bone formation?
Estrogen Parathyroid hormone (PTH) Calcitonin Progesterone
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. Administer pain medication per client request. Monitor vital signs every 4 hours. Perform neuromuscular assessment every hour.
Which of the following was formerly called a bunion?
Hallux valgus Plantar fasciitis Morton's neuroma Ganglion
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 Mallet toe Hallux valgus Bunion
The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as
Hammertoe Pes cavus Hallux valgus Flatfoot
The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as which condition?
Hammertoe Pes cavus Hallux valgus Flatfoot
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 make a fist and open the hand against resistance. Have the client stretch the fingers around a ball and squeeze with force. Have the client hold the palm of the hand up while the nurse percusses over the median nerve. Have the client pronate the hand while the nurse palpates the radial nerve.
A client is undergoing diagnostic testing for osteomalacia. Which of the following laboratory results is most suggestive of this diagnosis?
High chloride, calcium, and magnesium High parathyroid and calcitonin levels Low serum calcium and magnesium levels Low serum calcium and low phosphorus level
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort?
High-Fowler's to allow for maximum hip flexion Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees Prone, with a pillow under the shoulders Supine, with the bed flat and a firm mattress in place
A nurse is caring for a client with bone metastasis from a primary breast cancer. The client reports muscle weakness and nausea and 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 Hypocalcemia Hypokalemia Hyperkalemia
A client with diabetes is attending a class on the prevention of associated diseases. What action should the client perform to reduce the risk of osteomyelitis?
Increase calcium and vitamin intake. Perform meticulous foot care. Exercise 3 to 4 times weekly for at least 30 minutes. Take corticosteroids as prescribed.
The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action?
Increase fiber in the diet Walk or perform weight-bearing exercises Reduce stress Decrease the intake of vitamins A and D
An older adult woman's current medication regimen includes alendronate. What outcome would indicate successful therapy?
Increased bone mass Resolution of infection Relief of bone pain Absence of tumor spread
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?
Living a sedentary lifestyle to reduce the incidence of injury Stopping estrogen therapy Taking a 300-mg calcium supplement to meet dietary guidelines Initiating weight-bearing exercise routines
Which is a strategy for lowering risk for osteoporosis?
Low initial bone mass Diet low in calcium and vitamin D Smoking cessation Increased age
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?
Magnesium level Potassium level Alkaline phosphatase Troponin levels
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?
Maintaining protein levels Maintaining vitamin levels Promoting weight-bearing exercises Promoting range-of-motion (ROM) exercises
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder?
Osteomalacia Ganglion Osteomyelitis Paget disease
A nurse is assessing a client who reports a throbbing, burning sensation in the right foot. The client states that the pain is worst during the day but notes that the pain is relieved with rest. The nurse should recognize the signs and symptoms of what health problem?
Morton neuroma Pes cavus Hallux valgus Onychocryptosis
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?
Morton's neuroma Dupuytren's contracture Carpal tunnel syndrome Impingement syndrome
Which of the following are routes of administration for Calcitonin? Select all that apply.
Nasal spray Subcutaneous Intramuscular injection Intravenous Oral
A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct?
Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. To prevent fractures, the client should avoid strenuous exercise. 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.
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 Needle aspiration Arthroplasty Arthroscopy
A patient is diagnosed with osteomyelitis of the right leg. What signs and symptoms does the nurse recognize that are associated with this diagnosis? (Select all that apply.)
Pain Erythema Fever Leukopenia Purulent drainage
Which of the following are clinical manifestations of impingement syndrome? Select all that apply.
Pain Shoulder tenderness Limited movement Muscle spasms Atrophy
A client is diagnosed with carpal tunnel syndrome. Which assessment findings would the nurse expect?
Pain radiating down the dorsal surface of the forearm Tenderness in the affected wrist Inability to flex index and middle fingers A decrease in grasp strength
A client is diagnosed with carpal tunnel syndrome. Which of the following assessment findings would the nurse expect?
Pain radiating down the dorsal surface of the forearm Tenderness in the affected wrist Inability to flex index and middle fingers A decrease in grasp strength
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?
Participation as a softball pitcher Age below 50 years Employment as a cashier Recurrent dislocations
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. Immobilize the client's arm. Help the client walk to the nearest nurses' station. Raise the client's arm above the heart.
Which of the following presents with an onset of heel pain with the first steps of the morning?
Plantar fasciitis Hallux valgus Morton's neuroma Ganglion
Which should be included in the teaching plan for a client diagnosed with plantar fasciitis?
Plantar fasciitis presents as acute-onset pain localized to the ball of the foot that occurs when pressure is placed on it and diminishes when pressure is released. The pain of plantar fasciitis diminishes with warm water soaks. Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion. Management of plantar fasciitis includes stretching exercises.
Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women?
Raloxifene Fosamax Forteo Denosumab
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 Exogenous parathyroid hormone and multivitamins Colony-stimulating factors and calcitonin Supplemental potassium and pancreatic enzymes
A 32-year-old client comes to the clinic reporting shoulder tenderness, pain, and limited movement. Upon assessment the nurse finds edema. An MRI shows hemorrhage of the rotator cuff tendons and the client is diagnosed with impingement syndrome. What action should the nurse recommend in order to promote healing?
Support the affected arm on pillows at night. Take prescribed corticosteroids as prescribed. Put the shoulder through its full range of motion three times daily. Keep the affected arm in a sling for 2 to 4 weeks.
The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client? Select all that apply.
The client will experience a tolerable level of pain. The client will demonstrate wound care. The client will maintain adequate nutritional intake. The client will remain free from injury. The client will maintain effective airway clearance.
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 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 four clients receiving chemotherapy for cancer treatment on the oncology floor. The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit. The nurse is caring for this client on the intensive care unit.
A nurse is discussing conservative management of tendonitis with a client. What is the nurse's best recommendation?
Weight reduction Use of oral opioid analgesics Intermittent application of ice and heat Passive range of motion exercises
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?
Wound packing Wound irrigation Vitamin supplements Surgical debridement
In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?
Wound packing Wound irrigation Vitamin supplements Surgical debridement
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?
Yoga Walking Bicycling Swimming
Hypercalcemia is a dangerous complication of bone cancer. Therefore, nursing assessment includes evaluation of symptoms that require immediate treatment. Which of the following are signs/symptoms that are indictors of an elevated serum calcium? Select all that apply.
a. Muscle weakness b. Tachycardia c. Anorexia and constipation d. Prolonged ST segment e. Shortened QT interval f. Lack of muscle coordination
Which is not a risk factor for osteoporosis?
being male small-framed, thin White or Asian women being postmenopausal family history
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 mallet toe hallux valgus (bunion) Heberden's nodes
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?
Administering the raloxifene in the evening Holding the raloxifene and notifying the physician Administering the raloxifene with food or milk Having the patient sit upright for 30-60 minutes following administration
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?
Red meat Bananas Vitamin D-fortified milk Green vegetables
Morton neuroma is exhibited by which clinical manifestation?
Swelling of the third (lateral) branch of the median plantar nerve High arm and a fixed equinus deformity Diminishment of the longitudinal arch of the foot Inflammation of the foot-supporting fascia
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 age 40, height may show a gradual decrease as a result of spinal compression" "After menopause, the body's bone density declines, resulting in a gradual loss of height." "There may be some slight discrepancy between the measuring tools used." "The posture begins to stoop after middle age."
A nursing educator is reviewing the risk factors for osteoporosis with a group of recent graduates. What risk factor of the following should the educator describe?
Recurrent infections and prolonged use of NSAIDs High alcohol intake and low body mass index Small frame and female sex Male sex, diabetes, and high protein intake
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
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 Urinary tract infection (UTI) Benign prostatic hyperplasia Dehydration
A client has been admitted to the hospital with a spontaneous vertebral fracture related to osteoporosis. Which of the following nursing diagnoses must be addressed in the plan of care?
Risk for Aspiration Related to Vertebral Fracture Constipation Related to Vertebral Fracture Impaired Swallowing Related to Vertebral Fracture Decreased Cardiac Output Related to Vertebral Fracture
A client has Paget's disease. An appropriate nursing diagnosis for this client is:
Risk for infection Delayed wound healing Risk for falls Fatigue
Which classic symptom will the nurse assess for to detect the development of plantar fasciitis?
Shortened height Morning heel pain Elevated temperature Shortening of affected leg
A provider asks the nurse to teach a client with low back pain how to sit in order to minimize pressure on the spine. Which teaching points would the nurse include? Select all that apply.
Sit in a straight-backed chair with arm rests. Use a firm pillow placed behind the thoracic vertebrae to straighten the small of the back. Avoid hip extension. Place feet flat on the floor. Sit with the buttocks "tucked under."
Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely?
Skull narrowing Lordosis Long bone bowing Upright gait
An older adult client sought care for the treatment of a swollen, painful knee joint. Diagnostic imaging and culturing of synovial fluid resulted in a diagnosis of septic arthritis. The nurse should prioritize what aspect of care?
Administration of oral and IV corticosteroids as prescribed Prevention of falls and pathologic fractures Maintenance of adequate serum levels of vitamin D Intravenous administration of antibiotics
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 red meat in your diet." "You need to increase the amount of non-citrus fruits in your diet." "You need to increase the amount of vitamin D in your diet." "You need to increase the amount of phosphorus in your diet."
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 2 1 0.5 All other answers
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)?
Calcitonin Raloxifene Teriparatide Vitamin D
The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action?
Increase fiber in the diet Walk or perform weight-bearing exercises outdoors Reduce stress Decrease the intake of vitamin A and D
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?
Making sure the client is receiving a daily bath Ensuring that the client is eating enough Observing for safety hazards that could be a fall risk Making sure the client has adequate financial resources
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?
Prevent the patient from having to go to the hospital for care. Relieve pain and discomfort while promoting quality of life. Increase the activity level of the patient to prevent complications related to immobility. Ensure that the family accepts the patient's imminent death.
