Hinkle Ch. 36: Management of Patients with Musculoskeletal Disorders

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."

- "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.

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."

- "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.

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 small-framed, thin 45-year-old white woman Explanation: Small-framed, thin white women are at greatest risk for osteoporosis. African American women have a greater bone density and thus are less susceptible to osteoporosis. Men have an increased bone mass and do not have hormonal changes, and do not acquire osteoporosis as frequently and get it at a later age. Asthma does not increase the risk for osteoporosis.

What food can the nurse suggest to the client at risk for osteoporosis? - Carrots - Broccoli - Chicken - Bananas

- Broccoli Explanation: Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium.

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

- 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. Morton's neuroma is assessed as a painful condition that affects the ball of the foot. Dupuytren's contracture is when knots of tissue beneath the skin cause one or more fingers stay bent toward the palm. Impingement syndrome is a shoulder condition.

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

- Decrease in estrogen Explanation: Age related processes that contribute to loss of bone mass and osteoporosis are decreases in estrogen, calcitonin, and vitamin D and an increase in parathyroid hormone.

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 - Scoliosis - Paget's disease

- Degenerative joint disease Explanation: Obesity predisposes the client to degenerative joint disease. Obesity isn't a predisposing factor for muscular dystrophy, scoliosis, or Paget's disease.

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.

- Immobilize the client's arm. Explanation: Signs of a fracture in an extremity include pain, deformity, swelling, discoloration, and loss of function. When a nurse suspects a fracture, the extremity should be immobilized before moving the body part. It isn't appropriate for the nurse to move the client into a sitting position without further assessment. The client shouldn't walk to the nurses' station; the client should wait for help to arrive.

Which of the following is the most common and most fatal primary malignant bone tumor? - Osteogenic sarcoma (osteosarcoma) - Osteochondroma - Enchondroma - Rhabdomyoma

- Osteogenic sarcoma (osteosarcoma) Explanation: Osteogenic sarcoma (osteosarcoma) is the most common and most often fatal primary malignant bone tumor. Benign primary neoplasms of the musculoskeletal system include osteochondroma, enchondroma, and rhabdomyoma.

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

- Paget disease Explanation: Paget disease results in bone that is highly vascularized and structurally weak, predisposing the client to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. A ganglion is a collection of neurological gelatinous material. Osteomyelitis is an infection of bone that comes from the extension of a soft-tissue infection, direct bone contamination, or hematogenous spread.

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.

- 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 important to prevent complications from the surgery. The surgical dressing does not need to be examined hourly. Administering pain medication is important, but assessing the foot color and temperature are most important. Vital sign monitoring is important, but not a priority after foot surgery.

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

- 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.

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)

- Raloxifene (Evista) Explanation: An example of a selective estrogen receptor modifier (SERM) is raloxifene (Evista). Alendronate is a bisphosphonate; calcium gluconate is an oral calcium preparation; tamoxifen is an antiestrogen agent.

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

- Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees Explanation: A medium to firm, not sagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress (National Guideline Clearinghouse, 2010). Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head (Fig. 42-1). A prone position should be avoided because it accentuates lordosis.

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

- Supplemental calcium and increased doses of vitamin D Explanation: If osteomalacia is caused by malabsorption, increased doses of vitamin D, along with supplemental calcium, are usually prescribed. PTH, CSF, potassium, and pancreatic enzymes are not indicated.

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? - Trigeminal neuralgia - Temporomandibular disorder - Loose teeth - Dislocated jaw

- 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.

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 recommended daily allowance of calcium may be found in a wide variety of foods. Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.

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

- Vitamin D-fortified milk Explanation: The nurse should advise the client to include dietary sources of vitamin D, such as fatty fish, vitamin D-fortified milk, and cereals. These foods protect against bone loss and decrease the risk of fracture by facilitating the absorption of calcium from food and supplements. Red meat, bananas, and green vegetables do not facilitate calcium absorption from food and supplements.

Which is not a risk factor for osteoporosis? - being male - small-framed, thin White or Asian women - being postmenopausal - family history

- being male Explanation: Being male is not considered a risk factor. Some of the risk factors for osteoporosis are being a small-framed, thin White or Asian woman; being postmenopausal; family history; inactivity; chronic low calcium intake; and excessive caffeine or tobacco use.