Chapter 42: Musculoskeletal Disorders - NCLEX REVIEW
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? a) Temporomandibular disorder b) Trigeminal neuralgia c) Loose teeth d) Dislocated jaw
a) Temporomandibular disorder Explanation: The disorder can be confused with trigeminal neuralgia and migraine headaches. The client experiences clicking of the jaw when moving the joint, or the jaw can lock, which interferes with opening the mouth. Loose teeth will not cause a clicking of the jaw. The client does not have a dislocated jaw. pg.1236
The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? a) Walk or perform weight-bearing exercises b) Decrease the intake of vitamin A and D c) Reduce stress d) Increase fiber in the diet
a) Walk or perform weight-bearing exercises Explanation: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation. pg.1144
A client has Paget's disease. An appropriate nursing diagnosis for this client is: a) Fatigue b) Risk for falls c) Delayed wound healing d) Risk for infection
b) Risk for falls Explanation: The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility. pg.1147
Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis? a) Pruritus and uremic frost b) Petechiae over the chest and abnormal ABGs c) Leukocytosis and localized bone pain d) Thrombocytopenia and ecchymosis
c) Leukocytosis and localized bone pain Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. pg.1148
Which of the following was formerly called a bunion? a) Hallux valgus b) Ganglion c) Morton's neuroma d) Plantar fasciitis
a) Hallux valgus Explanation: Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist. pg. 1140
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? a) "This condition is associated with various sports." b) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." c) "Surgery is the only sure way to manage this condition." d) "Using arm splints will prevent hyperflexion of the wrist."
b) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Explanation: Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints. pg.1136
A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure? a) Instructing the client to ambulate twice daily b) Administering large doses of I.V. antibiotics as ordered c) Withholding all oral intake d) Administering large doses of oral antibiotics as ordered
b) Administering large doses of I.V. antibiotics as ordered Explanation: Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited. pg.1148
Which of the following inhibits bone resorption and promotes bone formation? a) Estrogen b) Calcitonin c) Corticosteroids d) Parathyroid hormone
b) Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis. pg.1143
When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location? a) Wrist-hand junction b) Femur-hip area c) Distal femur around the knee d) Proximal humerus
c) Distal femur around the knee Explanation: Malignant bone tumors usually are located around the knee in the distal femur or proximal fibula; a few are found in the proximal humerus. The wrist-hand junction and femur-hip area are not common sites. pg.1151
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? a) Impaired physical mobility b) Risk for infection c) Disturbed body image d) Inadequate nutrition
c) Disturbed body image Explanation: Amputation of a body part can result in disturbances in body image. pg.1153
Which of the following presents with an onset of heel pain with the first steps of the morning? a) Morton's neuroma b) Hallux valgus c) Plantar fasciitis d) Ganglion
c) Plantar fasciitis Explanation: Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heal pain experienced with the first steps in the morning. Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist. pg.1139
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? a) Arthroplasty b) Open reduction c) Needle aspiration d) Arthroscopy
d) Arthroscopy Explanation: Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made. pg.1100
Which group is at the greatest risk for osteoporosis? a) Asian women b) Men c) African American women d) Caucasian women
d) Caucasian women Explanation: Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Asian women of slight build are at risk for low peak BMD. African American women, who have a greater bone mass that Caucasian women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction. pg.1141
A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about taking a calcium supplement should the nurse include? a) Take the supplement with meals or with orange juice. b) Take the supplement on an empty stomach with a full glass of water. c) Remain in an upright position 30 minutes after taking the supplement. d) Take weekly on the same day and at the same time.
a) Take the supplement with meals or with orange juice. Explanation: Calcium supplements, such as Caltrate or Citracal, are over-the-counter medications. They should be taken with meals or with a beverage high in vitamin C. pg.1144
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? a) Proteus b) Staphylococcus aureus c) Salmonella d) Pseudomonas
b) Staphylococcus aureus Explanation: More than 50% of bone infections are caused by Staphylococcus aureus and increasingly of the variety that is methicillin resistant (i.e., methicillin-resistant Staphylococcus aureus [MRSA]) (Miller & Kaplan, 2009). Other pathogens include the gram-positive organisms streptococci and enterococci, followed by gram-negative bacteria, including pseudomonas. pg.1148
A patient diagnosed with osteoporosis is being discharged home. Which of the following is the priority education the nurse should provide? a) Classifying medications b) Increasing calcium and vitamin D in the diet c) Participating in weight-bearing exercises d) Removing all small rugs from the home
d) Removing all small rugs from the home Explanation: A patient with osteoporosis is at risk for fractures related to falls. The home environment needs to be evaluated for safety issues, such as rugs and other objects that could cause a fall. All other education is important in educating the patient, but the risk for injury with a fall and potential for a fracture makes safety in the home environment a priority. pg.1143
The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a) "You will receive IV antibiotics for 3 to 6 weeks." b) "Use your continuous passive motion machine (CPM) 2 hours each day." c) "You need to perform weight-bearing exercises twice a week." d) "You need to limit the amount of protein and calcium in your diet."
a) "You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks. pg.1148
When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with: a) Carpal tunnel syndrome b) Dupuytren's contracture c) Impingement syndrome d) Morton's neuroma
a) Carpal tunnel syndrome Explanation: Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome. pg.1136
What food can the nurse suggest to the client at risk for osteoporosis? a) Carrots b) Broccoli c) Bananas d) Chicken
b) Broccoli Explanation: Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium. pg.1141
Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis? a) Rapid pulse b) Tenderness over the affected area c) Persistent draining sinus d) High fever
c) Persistent draining sinus Explanation: Persistent draining sinus indicates a chronic infection in a client with osteomyelitis. High fever, rapid pulse, and tenderness or pain over the affected area is evidence of an acute infection. pg.1148
The nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan? a) Monitor vital signs every 4 hours. b) Administer pain medication per client request. c) Examine surgical dressing every hour. d) Perform neuromuscular assessment every hour.
d) Perform neuromuscular assessment every hour. Explanation: The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is critical. pg.2061
A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? a) Applying a cock-up splint and immobilization b) Changing the dressing c) Having the patient exercise the fingers to avoid future contractures d) Performing hourly neurovascular assessments for the first 24 hours
d) Performing hourly neurovascular assessments for the first 24 hours Explanation: Hourly neurovascular assessment of the exposed fingers for the first 24 hours following surgery is essential for monitoring function of the nerves and perfusion. pg.1137
On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session? a) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." b) "Bunions are congenital and can't be prevented." c) "Bunions are caused by a metabolic condition called gout." d) "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth."
a) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." Explanation: Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion. pg.1140
During a routine physical examination on a 75-year-old 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? a) "After age 40, height may show a gradual decrease as a result of spinal compression" b) "After menopause, the body's bone density declines, resulting in a gradual loss of height." c) "The posture begins to stoop after middle age." d) "There may be some slight discrepancy between the measuring tools used."
b) "After menopause, the body's bone density declines, resulting in a gradual loss of height." Explanation: The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question. pg.1143
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? a) Hammer Toe b) Corn c) Clawfoot d) Bunion
b) Corn Explanation: A corn is an area of hyperkeratosis (overgrowth of a horny layer of epidermis) produced by internal pressure (the underlying bone is prominent because of a congenital or acquired abnormality, commonly arthritis) or external pressure (ill-fitting shoes). The fifth toe is most frequently involved, but any toe may be involved. pg.1139
Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? a) Skull narrowing b) Long bone bowing c) Lordosis d) Waddling gait
b) Long bone bowing Explanation: Some clients with Paget's disease are asymptomatic with only some mild skeletal deformity. Other clients have marked skeletal deformities which may include enlargement of the skull, bowing of the long bones, and kyphosis. Waddling gait is associated with osteomalacia. pg.1146
A client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client's urination problem? a) Urinary tract infection (UTI) b) Renal calculi c) Benign prostatic hyperplasia d) Dehydration
b) Renal calculi Explanation: Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A UTI commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination. pg.1142
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? a) Potassium level b) Magnesium level c) Alkaline phosphatase d) Troponin levels
c) Alkaline phosphatase Explanation: Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly. pg.1152
The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? a) "I will bend at the waist when I am lifting objects from the floor." b) "Instead of turning around to grasp an object, I will twist at the waist." c) "I will lie prone with my legs slightly elevated." d) "I will avoid prolonged sitting or walking."
d) "I will avoid prolonged sitting or walking." Explanation: The nurse encourages the patient to alternate lying, sitting, and walking activities frequently, and advises the patient to avoid sitting, standing, or walking for long periods. pg.1133
A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true? a) Dorsiflexion exacerbates signs and symptoms of a ganglion. b) Surgical excision is the treatment of choice for a ganglion. c) A ganglion is a precursor to a primary bone tumor. d) A ganglion is the most common benign soft-tissue mass in the foot.
a) Dorsiflexion exacerbates signs and symptoms of a ganglion. Explanation: Dorsiflexion exacerbates signs and symptoms of a ganglion. A ganglion is the most common benign soft-tissue mass in the hand, not foot. It isn't a known precursor to a primary bone tumor. To treat a ganglion, the physician aspirates the ganglion, then injects a corticosteroid into the joint; the physician may also order nonsteroidal anti-inflammatory agents. Surgical excision is necessary only if signs and symptoms persist and the client's range of motion is impaired. pg.1137
Dupuytren's contracture causes flexion of which area(s)? a) Fourth and fifth fingers b) Ring finger c) Thumb d) Index and middle fingers
a) Fourth and fifth fingers Explanation: Dupuytren's contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger. pg.1137
The nurse recognizes that goal of treatment for metastatic bone cancer is to: a) Promote pain relief and quality of life b) Cure the diseased bone and cartilage c) Diagnose the extent of bone damage d) Reconstruct the bone with a prosthesis
a) Promote pain relief and quality of life Explanation: Treatment of metastatic bone cancer is palliative. pg.1152
The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? a) Osteomyelitis b) Avascular necrosis c) Fat embolism d) Compartment syndrome
a) Osteomyelitis Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. pg.1148