Medsurg 1 Module 3 Exam-Musculoskeletal Questions

Of the clients listed below, who is at risk for developing rheumatoid arthritis (RA)? Select all that apply. 1. Adults between the ages of 20 and 50 years. 2. Adults who have had an infectious disease with the Epstein-Barr virus. 3. Adults that are of the male gender. 4. Adults who possess the genetic link, specifically HLA-DR4. 5. Adults who also have osteoarthritis.

1, 2, 4 Rheumatoid arthritis (RA) affects women three times more often than men, between the ages of 20 and 55 years. Research has determined that RA occurs in clients who have had infectious disease, such as the Epstein-Barr virus. The genetic link, specifically HLA-DR4, has been found in 65% of clients with RA. People with osteoarthritis are not necessarily at risk for developing rheumatoid arthritis.

A client with rheumatoid arthritis states, "I can't do my household chores without becoming tired. My knees hurt whenever I walk." Which nursing diagnosis would be most appropriate? 1. Activity intolerance related to fatigue and pain. 2. Self-care deficit related to increasing joint pain. 3. Ineffective coping related to chronic pain. 4. Disturbed body image related to fatigue and joint pain.

1. Activity intolerance related to fatigue and pain. Based on the client's complaints, the most appropriate nursing diagnosis would be Activity intolerance related to fatigue and pain. Nursing interventions would focus on helping the client conserve energy and decrease episodes of fatigue. Although the client may develop a self-care deficit related to the activity intolerance and increasing joint pain, the client is voicing concerns about household chores and difficulty around the house and yard, not self-care issues. Over time, the client may develop ineffective coping or body image disturbance as the disorder becomes chronic with increasing pain and fatigue.

The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which of the following client statements indicates that the client still has a knowledge deficit? 1. "I can use heat and cold as often as I want." 2. "With heat, I should apply it for no longer than 20 minutes at a time." 3. "Heat-producing liniments can be used with other heat devices." 4. "Ten to 15 minutes per application is the maximum time for cold applications."

3. "Heat-producing liniments can be used with other heat devices." produce a burn if used with other heat devices that could intensify the heat reaction. Heat and cold can be used as often as the client desires. However, each application of heat should not exceed 20 minutes, and each application of cold should not exceed 10 to 15 minutes. Application for longer periods results in the opposite of the intended effect: vasoconstriction instead of vasodilation with heat, and vasodilation instead of vasoconstriction with cold.

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for: 1. Limited motion of joints. 2. Deformed joints of the hands. 3. Early morning stiffness. 4. Rheumatoid nodules.

3. Early morning stiffness Initially, most clients with early symptoms of rheumatoid arthritis complain of early morning stiffness or stiffness after sitting still for a while. Later symptoms of rheumatoid arthritis include limited joint range of motion; deformed joints, especially of the hand; and rheumatoid nodules.

A client is in the acute phase of rheumatoid arthritis. Which of the following should the nurse identify as lowest priority in the plan of care? 1. Relieving pain. 2. Preserving joint function. 3. Maintaining usual ways of accomplishing tasks. 4. Preventing joint deformity.

3. Maintaining usual ways of accomplishing tasks

The teaching plan for the client with rheumatoid arthritis includes rest promotion. Which of the following would the nurse expect to instruct the client to avoid during rest periods? 1. Proper body alignment. 2. Elevating the part. 3. Prone lying positions. 4. Positions of flexion.

4. Positions of flexion Positions of flexion should be avoided to prevent loss of functional ability of affected joints. Proper body alignment during rest periods is encouraged to maintain correct muscle and joint placement. Lying in the prone position is encouraged to avoid further curvature of the spine and internal rotation of the shoulders.

Which clinical manifestation of osteoarthritis​ (OA) should the nurse include when teaching about​ osteoarthritis? (Select all that​ apply.) A. Joint pain with activity B. Pain and stiffness at night C. Abrupt onset D. Mild fever E. Crepitus with movement of joint

A. Joint pain with activity B. Pain and stiffness at night E. Crepitus with movement of joint

Which health promotion activity supports a healthy lifestyle for clients with​ osteoarthritis? (Select all that​ apply.) A. Maintaining a normal weight B. Using proper body mechanics C. Using assistive devices as needed D. Increasing dietary intake of calcium E. Using soft chairs and recliners for rest

A. Maintaining a normal weight C. Using assistive devices as needed

Which is a common risk factor for​ osteoarthritis? (Select all that​ apply.) A. Overuse of joints from sports or strenuous activities B. Obesity C. Ingestion of large amounts of purine D. Autoimmune disorder E. Activities affecting​ weight-bearing joints

A. Overuse of joints from sports or strenuous activities B. Obesity E. Activities affecting​ weight-bearing joints

What is a common symptom of compartment syndrome? A. Passive pain at rest B. Pain with movement C. Pallor D. Paresthesia

A. Passive pain at rest

The nurse recognizes that the stretching or tearing of a muscle or tendon occurs in which condition? A. Strains B. Dislocations C. Fractures D. Sprains

A. Strains

When there is a significant amount of blood loss, for what complication should the nurse monitor? A. Bradycardia B. Hypotension C. Metabolic alkalosis D. Hyperkalemia

B. Hypotension

After performing a physical​ assessment, the nurse suspects that a client is experiencing manifestations of osteoarthritis​ (OA). Which finding supports the​ nurse's suspicion?​ (Select all that​ apply.) A. Leg tremors B. Joint tenderness C. Reduced joint flexibility D. Crepitation E. Joint stiffness

B. Joint tenderness C. Reduced joint flexibility D. Crepitation E. Joint stiffness

After surgery for an open displaced femur fracture, what action does the nurse frequently perform? A. ROM exercises B. Neurovascular assessments C. Dressing changes D. Pain assessments

B. Neurovascular assessments

The nurse identifies with pathophysiological finding in a third-degree sprain? A. Stretched muscle or tendon fibers B. Torn/ruptured ligaments C. Torn/ruptured muscle or tendon fibers D. Stretched ligaments

B. Torn/ ruptured ligaments

A patient has been in surgery for a femur fracture and now has an external fixator device. Postoperatively, he begins to exhibit dyspnea, pleuritic chest pain, anxiety, and tachycardia. The nurse suspects which complication? A. Pneumothorax B. Deep vein thrombosis C. Fat embolism D. Myocardial infarction

C. Fat embolism

The nurse is teaching a class about the joints commonly affected by osteoarthritis​ (OA). Which joints should the nurse​ include? A. Ankles, feet, and spine B. Knees, feet, and spine C. Hands, knees, and hips D. Neck, shoulders, and ankles

C. Hands, knees, and hips

A patient is scheduled for total ankle replacement. The nurse should tell the patient that after surgery he should avoid a. lifting heavy objects. b. sleeping on the back. c. abduction exercises of the affected ankle. d. bearing weight on the affected leg for 6 weeks.

d. bearing weight on the affected leg for 6 weeks

A patient with a stable, closed humeral fracture has a temporary splint with bulky padding applied with an elastic bandage. The nurse notifies the provider of possible early compartment syndrome when the patient has a. increasing edema of the limb. b. muscle spasms of the lower arm. c. bounding pulse at the fracture site. d. pain when passively extending the fingers.

d. pain when passively extending the fingers

A patient with suspected disc herniation has acute pain and muscle spasms. The nurse's responsibility is to a. encourage total bed rest for several days. b. teach principles of back strengthening exercises. c. stress the importance of straight-leg raises to decrease pain. d. promote use of cold and hot compresses and pain medication.

d. promote use of cold and hot compresses and pain medication

In teaching a patient with systemic lupus erythematosus about the disorder, the nurse knows the pathophysiology includes a. circulating immune complexes formed from IgG autoantibodies reacting with IgG. b. an autoimmune T-cell reaction that results in destruction of the deep dermal skin layer. c. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles. d. the production of a variety of autoantibodies directed against components of the cell nucleus.

d. the production of a variety of autoantibodies directed against components of the cell nucleus

The nurse suspects an ankle sprain when a patient at the urgent care center describes a. being hit by another soccer player during a game. b. having ankle pain after sprinting around the track. c. dropping a 10-lb weight on his lower leg at the health club. d. twisting his ankle while running bases during a baseball game.

d. twisting his ankle while running bases during a baseball game

What are signs of rhabdomyolysis? A. Bloody urine and abdominal pain B. Anuria, nausea, and severe flank pain C. Low serum myoglobin, fever, and severe headaches D. Elevated serum myoglobin, tea-colored urine, and severe flank pain

D. Elevated serum myoglobin, tea-colored urine, and severe flank pain

Which persons are at high risk for chronic low back pain? (select all that apply) a. A 63-yr-old man who is a long-distance truck driver b. A 30-yr-old nurse who works on an orthopedic unit and smokes c. A 55-yr-old construction worker who is 6 ft, 2 in and weighs 250 lb d. A 44-yr-old female chef with prior compression fracture of the spine e. A 28-yr-old female yoga instructor who is 5 ft, 6 in and weighs 130 lb

a. A 63-yr-old man who is a long-distance truck driver b. A 30-yr-old nurse who works on an orthopedic unit and smokes c. A 55-yr-old construction worker who is 6 ft, 2 in and weighs 250 lb d. A 44-yr-old female chef with prior compression fracture of the spine

A patient with a pelvic fracture should be monitored for a. changes in urine output. b. petechiae on the abdomen. c. a palpable lump in the buttock. d. sudden increase in blood pressure.

a. changes in urine output

A patient with a humeral fracture is returning for a 4-week checkup. The nurse explains that initial evidence of healing on x-ray is indicated by a. formation of callus. b. complete bony union. c. hematoma at the fracture site. d. presence of granulation tissue.

a. formation of callus

The nurse teaches the patient with an above-the-knee amputation that the residual limb should not be routinely elevated because this position promotes a. hip flexion contracture. b. clot formation at the incision. c. skin irritation and breakdown. d. increased risk for wound dehiscence.

a. hip flexion contracture

A patient who has had surgical correction of bilateral hallux valgus is being discharged from the same-day surgery unit. The nurse will teach the patient to a. rest frequently with the feet elevated. b. wear shoes continually except when bathing. c. soak the feet in warm water several times a day. d. expect the feet to be numb for the next few days.

a. rest frequently with the feet elevated

A patient with osteomyelitis undergoes surgical debridement with implantation of antibiotic beads. When the patient asks why the beads are used, the nurse answers (select all that apply) a. "Oral or IV antibiotics are not effective in most cases of bone infection." b. "The beads are an adjunct to debridement and antibiotics for deep infections." c. "The beads are used to deliver antibiotics directly to the site of the infection." d. "This is the safest method to deliver long-term antibiotic therapy for bone infection." e. "Ischemia and bone death related to osteomyelitis are impenetrable to IV antibiotics."

b. "The beads are an adjunct to debridement and antibiotics for deep infections." c. "The beads are used to deliver antibiotics directly to the site of the infection."

A patient with osteosarcoma of the humerus shows understanding of his treatment options when he states a. "I accept that I have to lose my arm with surgery." b. "The chemotherapy before surgery will shrink the tumor." c. "This tumor is related to the melanoma I had 3 years ago." d. "I'm glad they can take out the cancer with such a small scar."

b. "The chemotherapy before surgery will shrink the tumor."

When administering medications to the patient with chronic gout, the nurse recognizes which drug is used as a treatment for this disease? a. Colchicine b. Allopurinol c. Sulfasalazine d. Cyclosporine

b. Allopurinol

What is most important to include in the teaching plan for a patient with osteopenia? a. Lose weight. b. Stop smoking. c. Eat a high-protein diet. d. Start swimming for exercise.

b. Stop smoking

In caring for a patient after a spinal fusion, the nurse would report which finding to the health care provider? a. The patient has a single episode of emesis. b. The patient is unable to move the lower extremities. c. The patient is nauseated and has not voided in 4 hours. d. The patient reports of pain at the bone graft donor site.

b. The patient is unable to move the lower extremities

In assessing the joints of a patient with osteoarthritis, the nurse understands that Bouchard's nodes a. are often red, swollen, and tender. b. indicate osteophyte formation at the PIP joints. c. are the result of pannus formation at the DIP joints. d. occur from deterioration of cartilage by proteolytic enzymes.

b. indicate osteophyte formation at the PIP joints

A patient with rheumatoid arthritis has articular involvement. The nurse recognizes these characteristic changes include (select all that apply) a. bamboo-shaped fingers. b. metatarsal head dislocation in feet. c. noninflammatory pain in large joints. d. asymmetric involvement of small joints. e. morning stiffness lasting 60 minutes or more.

b. metatarsal head dislocation in feet e. morning stiffness lasting 60 minutes or more

A patient with osteoarthritis is scheduled for total hip arthroplasty. The nurse explains the purpose of this procedure is to (select all that apply) a. fuse the joint. b. replace the joint. c. prevent further damage. d. improve or maintain ROM. e. decrease the amount of destruction in the joint.

b. replace the joint d. improve or maintain ROM

In teaching a patient with Sjögren's syndrome about drug therapy for this disorder, the nurse includes instruction about the use of which drug? a. Pregabalin (Lyrica) b. Etanercept (Enbrel) c. Cyclosporine (Restasis) d. Cyclobenzaprine (Flexeril)

c. Cyclosporine (Restasis)

The nurse suspects a neurovascular problem based on assessment of a. exaggerated strength with movement. b. increased redness and heat below the injury. c. decreased sensation distal to the fracture site. d. purulent drainage at the site of an open fracture.

c. decreased sensation distal to the fracture site

A patient with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when a. the patient is unable to tolerate prolonged immobilization. b. the patient cannot tolerate the surgery for a closed reduction. c. other nonsurgical methods cannot achieve adequate alignment. d. a temporary cast would be too unstable to provide normal mobility.

c. other nonsurgical methods cannot achieve adequate alignment