Management of Patients With Musculoskeletal Disorders

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) Impingement syndrome b) Carpal tunnel syndrome c) Dupuytren's contracture d) Morton's neuroma

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.

Which group is at the greatest risk for osteoporosis? a) African American women b) Men c) Caucasian women d) Asian women

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.

The nurse is planning an education program for women of childbearing years. The nurse recognizes that primary prevention of osteoporosis includes: a) Having a DXA beginning at age 35 years b) Engaging in non-weight-bearing exercises daily c) Undergoing assessment of serum calcium levels every year d) Ensuring adequate calcium and vitamin D intake

Ensuring adequate calcium and vitamin D intake Explanation: Nutritional intake of calcium and vitamin D are essential for the prevention of osteoporosis.

Which of the following was formerly called a bunion? a) Hallux valgus b) Plantar fasciitis c) Morton's neuroma d) Ganglion

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.

Which of the following is a metabolic bone disease that is characterized by inadequate mineralization of bone? a) Osteomalacia b) Osteomyelitis c) Osteoarthritis d) Osteoporosis

Osteomalacia Explanation: Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from extension of soft tissue infection, direct bone contamination, or hematogenous spread. Osteoarthritis (OA), also known as degenerative joint disease, is the most common and frequently disabling of the joint disorders. OA affects the articular cartilage, subchondral bone, and synovium.

The nurse recognizes that goal of treatment for metastatic bone cancer is to: a) Diagnose the extent of bone damage b) Promote pain relief and quality of life c) Cure the diseased bone and cartilage d) Reconstruct the bone with a prosthesis

Promote pain relief and quality of life Explanation: Treatment of metastatic bone cancer is palliative.

A male client is to have an amputation. He is acutely ill and diagnosed with a gangrenous limb and related fever, disorientation, and electrolyte imbalances. Which of the following would be most important for the nurse to monitor in this client? a) Reduced urine output b) Signs of nausea and vomiting c) Occurrence of allergic reactions d) Signs of sepsis

Signs of sepsis Explanation: If the client is acutely ill with a gangrenous limb, related fever, disorientation, and electrolyte imbalances, the nurse should monitor for signs of sepsis and circulation in the limb for any changes such as severe pain, color changes, and lack of peripheral pulses. It is crucial for the nurse to inform the physician about the problems as they occur or else the surgery may become an emergency. Monitoring for signs of nausea and vomiting, occurrence of allergic reactions, and reduced urine output, although necessary, is not as crucial for the client.

Morton's neuroma is exhibited by which of the following clinical manifestations? a) Inflammation of the foot-supporting fascia b) High arm and a fixed equinus deformity c) Longitudinal arch of the foot is diminished d) Swelling of the third (lateral) branch of the median plantar nerve

Swelling of the third (lateral) branch of the median plantar nerve Explanation: Morton's neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? a) Initiating weight-bearing exercise routines b) Stopping estrogen therapy c) Taking a 300-mg calcium supplement to meet dietary guidelines d) Living a sedentary lifestyle to reduce the incidence of injury

Initiating weight-bearing exercise routines Explanation: Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.

Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client? ml

0.5 Explanation: 100 units x 1 ml/200 units = 0.5 ml.

Which of the following clinical manifestations would the nurse expect to find in a client who has Paget's disease? a) Dowager's hump b) Flexion deformity of the toe c) Bowing of the legs d) High arch of the foot

Bowing of the legs Explanation: Paget's disease is characterized by pain and bowing of the legs.

Which of the following inhibits bone resorption and promotes bone formation? a) Parathyroid hormone b) Corticosteroids c) Estrogen d) Calcitonin

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.

Which of the following clinical manifestations would the nurse expect to find in a client who has had osteoporosis for several years? a) Increased heel pain b) Bone spurs c) Diarrhea d) Decreased height

Decreased height Explanation: Clients with osteoporosis become shorter over time.

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) Fat embolism b) Avascular necrosis c) Osteomyelitis d) Compartment syndrome

Osteomyelitis Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection.

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis? a) plicamycin (Mithracin) b) methotrexate (Rheumatrex) c) penicillamine (Cuprimine) d) raloxifene (Evista)

Raloxifene (Evista) Explanation: Raloxifene (Evista) is used for the prevention and treatment of osteoporosis.

A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following? a) Proteus vulgaris b) Escherichia coli c) Psuedomonas aeruginosa d) Staphylococcus aureus

Staphylococcus aureus Explanation: S. aureus causes over 50% of bone infections. Other organisms include P. vulgaris and P. aeruginosa, as well as E. coli.

In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations? a) Wound irrigation b) Wound packing c) Surgical debridement d) Vitamin supplements

Surgical debridement Explanation: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? a) Decrease the intake of vitamin A and D b) Walk or perform weight-bearing exercises outdoors c) Increase fiber in the diet d) Reduce stress

Walk or perform weight-bearing exercises outdoors 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.

Which of the following diagnostics confirms Paget's disease? a) Blood calcium level b) X-ray c) Bone scan d) Bone biopsy

X-ray Explanation: X-rays confirm the diagnosis of Paget's disease. Local areas of demineralization and bone overgrowth produce characteristic mosaic patterns and irregularities. Bone scans demonstrate the extent of the disease. A bone biopsy may aid in the differential diagnosis.

The nurse recognizes that the client with osteomyelitis is at risk for: a) Metastatic bone disease b) Bone abscess formation c) Impingement syndrome d) Pathological fractures

Bone abscess formation Explanation: Bone abscess formation is a potential complication of osteomyelitis.

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) Proximal humerus c) Femur-hip area d) Distal femur around the knee

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.

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following? a) Hallux valgus b) Bunion c) Hammer toe d) Mallet toe

Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which of the following bone disorders? a) Osteoporosis b) Osteomalacia c) Osteitis deformans d) Osteomyelitis

Osteitis deformans Explanation: Osteitis deformans (Paget's disease) results in bone that is highly vascularized and structurally weak, predisposing to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from the extension of a soft tissue infection, direct bone contamination, or hematogenous spread.

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.

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.

Which of the following positions should be avoided in severe back pain? a) Prone b) Supine c) Head and thorax elevated 30 degrees d) Lateral recumbent

Prone Explanation: A prone position should be avoided because it accentuates lordosis (inward curvature of the spine). Lumbar flexion is increased by elevating the head and thorax 30 degrees 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.

Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women? a) Raloxifene b) Fosamax c) Denosumab d) Forteo

Raloxifene Explanation: Raloxifene is the only selective estrogen receptor modulator (SERM) approved for osteoporosis in post menopausal women as it does not increase the risk of breast or uterine cancer, but it does come with an increased risk of thromboembolism. Fosamax is a bisphosphonate. Forteo is a subcutaneously administered medication that is given one daily for the treatment of osteoporosis. Denosumab has recently been approved for treatment of postmenopausal women with osteoporosis who are at risk for fractures.

Choice Multiple question - Select all answer choices that apply. Which of the following are clinical manifestations of impingement syndrome? Select all that apply. a) Pain b) Limited movement c) Shoulder tenderness d) Muscle spasms e) Atrophy

• Pain • Shoulder tenderness • Limited movement • Muscle spasms • Atrophy Explanation: The patient experiences pain, shoulder tenderness, limited movement, muscle spasms, and atrophy. The process may progress to a rotator cuff tear

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? a) "Using arm splints will prevent hyperflexion of the wrist." 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) "This condition is associated with various sports."

"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.

A 70-year-old 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? a) Promoting range-of-motion (ROM) exercises b) Promoting weight-bearing exercises c) Maintaining protein levels d) Maintaining vitamin levels

Promoting weight-bearing exercises Explanation: When the mechanical stressors of weight bearing are absent, disuse osteoporosis can occur. Therefore, if the client does weight-bearing exercises, disuse complications can be prevented. Maintaining protein and vitamins levels is important, but neither will prevent osteoporosis. ROM exercises will help prevent muscle atrophy and contractures.

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? a) Thoracic b) Lower lumbar c) Upper lumbar d) Cervical

Lower lumbar Explanation: The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes.

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 menopause, the body's bone density declines, resulting in a gradual loss of height." b) "There may be some slight discrepancy between the measuring tools used." c) "The posture begins to stoop after middle age." d) "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." 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.

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) "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth." b) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." c) "Bunions are congenital and can't be prevented." d) "Bunions are caused by a metabolic condition called gout."

"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.

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a) "You need to perform weight-bearing exercises twice a week." b) "You will receive IV antibiotics for 3 to 6 weeks." c) "You need to limit the amount of protein and calcium in your diet." d) "Use your continuous passive motion machine (CPM) 2 hours each day."

"You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks.

Instructions for the patient with low back pain include that when lifting the patient should a) place the load away from the body. b) bend the knees and loosen the abdominal muscles. c) avoid overreaching. d) use a narrow base of support.

Avoid overreaching. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. When lifting, the patient with low back pain should keep the load close to the body. When lifting, the patient with low back pain should bend the knees and tighten the abdominal muscles.

The nurse recognizes that the client with osteomyelitis is at risk for: a) Bone abscess formation b) Impingement syndrome c) Metastatic bone disease d) Pathological fractures

Bone abscess formation Explanation: Bone abscess formation is a potential complication of osteomyelitis.

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? a) Bone fracture b) Loss of estrogen c) Negative calcium balance d) Dowager's hump

Bone fracture Correct Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct? a) The recommended daily allowance of calcium may be found in a wide variety of foods. b) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. c) To prevent fractures, the client should avoid strenuous exercise. d) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss.

The recommended daily allowance of calcium may be found in a wide variety of foods. 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 male patient with a musculoskeletal injury is instructed to alter his diet. The objective of this diet alteration is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which of the following food items should the nurse encourage the patient to include in the diet? a) Green vegetables b) Red meat c) Bananas d) Vitamin D-fortified milk

Vitamin D-fortified milk Explanation: The nurse should advise the patient 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.