M/S Exam 6/CH 63

Which individuals would be at high risk for low back pain (select all that apply)?A. A 63-year-old man who is a long-distance truck driver B. A 36-year-old construction worker who is 6 ft 2 in and weighs 260 lb C. A 44-year-old female chef with prior compression fracture of the spine D. A 30-year-old nurse who works on an orthopedic unit and smokes E. A 28-year-old female yoga instructor who is 5 ft 6 in and weighs 130 lb

A,B,C,D

A nurse is planning discharge teaching on home safety for an older adult client who has osteoporosis. Which of the following information should the nurse include in the teaching? (Select all that apply) A. Remove throw rugs in walkways B. Use prescribed assistive devices C. Remove clutter from the environment D. Walk with caution on icy surfaces E. Maintain lighting of doorway areas

A,B,C,E

nurse is performing health screenings of clients at a health fair. Which of the following clients are at risk for osteoporosis? (Select all that apply) A. A 40yr old client who takes prednisone (Deltasone) for asthma B. A 30yr old client who jogs 3 miles daily C. A 45yr old client who takes phenytoin (Dilantin) for seizures D. A 65yr old client who has a sedentary lifestyle E. A 70yr old client who has smoked for 50 years

A,C,D,E

A nurse is providing care for a client who had a vertebroplasty of the thoracic spine. Which of the following is an appropriate action by the nurse? A. Apply heat to the client's puncture site B. Place the client in a supine position C. Turn client every 4hr D. Ambulate the client within the first hour post-proceedure

B

A nurse is providing dietary teaching about calcium-rich foods to a client who has osteoporosis. Which of the following foods should the nurse include in the instructions? A. White bread B. White beans C. White meat of chicken D. White rice

B

A patient diagnosed with osteosarcoma of the humerus demonstrates 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

A patient who has had surgical correction of bilateral hallux valgus is being discharged from the same-day surgery unit. The nurse will instruct the patient to A. expect continued pain in the feet. B. rest frequently with the feet elevated. C. soak the feet in warm water several times a day. D. expect the feet to be numb for the next few days.

B

In caring for a patient after a spinal infusion, the nurse would immediately report which of the following to the surgeon? A. the patient experiences 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 complains of pain at the bone graft donor site

B

What is 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

A patient with osteomyelitis undergoes surgical debridement with implantation of antibiotic beads. When the patient asks why the beads are used, the nurse should answer (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 IB antibiotics"

B,C

A nurse is admitting an older adult client who has suspected osteoporosis. Which of following an expected clinical findings? (Select all that apply) A. History of consuming one glass of wine daily B. Loss in height of 2in (5.1cm) C. Body Mass Index (BMI) of 21 D. Kyphotic curve at upper thoracic spinee. History of lactose intolerence

B,C,D,E

A patient with suspected disc herniation is experiencing 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

In which order will the nurse implement these collaborative interventions prescribed for a patient being admitted who has acute osteomyelitis with a temperature of 101.2 F? (Put in order) a. Obtain blood cultures from two sites. b. Send to radiology for computed tomography (CT) scan of right leg. c. Administer gentamicin (Garamycin) 60 mg IV. d. Administer acetaminophen (Tylenol) now and every 4 hours PRN for fever.

a, c, d, b

A patient is started on alendronate (Fosamax) once weekly for the treatment of osteoporosis. The nurse determines that further instruction about the drug is needed when what is said by the patient a. I should take the drug with a meal to prevent stomach irritation b. This drug will prevent further bone loss and increase my bone density c. I need to sit or stand upright for at least 30 minutes after taking the drug d. I will still need to take my calcium supplements while taking this new drug

a. I should take the drug with a meal to prevent stomach irritation

A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention will be included in the initial plan of care? a. Immobilization of the left leg b. Positioning the left leg in flexion c. Assisted weight-bearing ambulation d. Quadriceps-setting exercise repetitions

a. Immobilization of the left leg

Which actions will the nurse include in the plan of care when caring for a patient with metastatic bone cancer of the left femur (select all that apply)? a. Monitor serum calcium level. b. Teach about the need for strict bed rest. c. Avoid use of sustained-release opioids for pain. d. Support the left leg when repositioning the patient. e. Support family as they discuss the prognosis of patient

a. Monitor serum calcium level. d. Support the left leg when repositioning the patient. e. Support family as they discuss the prognosis of patient

A HCP diagnoses a patient with a plantar wart. What should the nurse know about this kind of abnormality a. Painful papillomatous growth on the sole of the foot b. Thickening of skin on the weight-bearing part of the foot c. Local thickening of skin caused by pressure on bony prominences d. Tumor on nerve tissue between the third and fourth metatarsal heads

a. Painful papillomatous growth on the sole of the foot

Which action will the nurse take when caring for a patient with osteomalacia? a. Teach about the use of vitamin D supplements. b. Educate about the need for weight-bearing exercise. c. Discuss the use of medications such as bisphosphonates. d. Emphasize the importance of sunscreen use when outside.

a. Teach about the use of vitamin D supplements.

An assessment finding for a 55-year-old patient that alerts the nurse to the presence of osteoporosis is a. a measurable loss of height. b. the presence of bowed legs. c. the aversion to dairy products. d. a statement about frequent falls.

a. a measurable loss of height.

The nurse evaluating effectiveness of prescribed calcitonin (Cibacalcin) and ibandronate (Boniva) for a patient with Pagets disease will consider the patients a. pain level. b. oral intake. c. daily weight. d. grip strength.

a. pain level.

What should the nurse teach the patient recovering from an episode of acute low back pain a. perform daily exercise as a lifelong routine b. Sit in a chair with the hips higher than the knees c. Avoid occupations in which the use of the body is required d. Sleep on the abdomen or on the back with the legs extended

a. perform daily exercise as a lifelong routine

Following laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. The first action that the nurse should take is to a. report the patients complaint to the surgeon. b. check the chart for preoperative assessment data c. check the vital signs for indications of hemorrhage. d. turn the patient to the side to relieve pressure on the right leg.

a. report the patients complaint to the surgeon.

Which female patients are at risk for developing osteoporosis (select all that apply)? a. 60-year-old white aerobics instructor b. 55-year-old Asian American cigarette smoker c. 62-year-old African American on estrogen therapy d. 68-year-old white who is underweight and inactive e. 58-year-old Native American who started menopause prematurely

b. 55-year-old Asian American cigarette smoker d. 68-year-old white who is underweight and inactive e. 58-year-old Native American who started menopause prematurely

Which action will the nurse take first when a patient is seen in the outpatient clinic with neck pain? a. Provide information about therapeutic neck exercises. b. Ask about numbness or tingling of the hands and arms. c. Suggest that the patient alternate the use of heat and cold to the neck to treat the pain. d. Teach about the use of nonsteroidal antiinflammatory drugs such as ibuprofen (Advil).

b. Ask about numbness or tingling of the hands and arms.

A 23-year-old patient with a history of muscular dystrophy is hospitalized with pneumonia. Which nursing action will be included in the plan of care? a. Logroll the patient every 2 hours. b. Assist the patient with ambulation. c. Discuss the need for genetic testing with the patient. d. Teach the patient about the muscle biopsy procedure.

b. Assist the patient with ambulation.

A patient with chronic osteomyelitis has been hospitalized for a surgical debridement procedure. What does the nurse explain to the patient as the rationale for the surgical treatment? a. Removal of the infection prevents the need for bone and skin grafting b. Formation of scar tissue has led to protected area of bacterial growth c. The process of depositing new bone blacks the vascular supply to the bone d. Antibiotics are not effective against microorganisms that cause chronic osteomyelitis

b. Formation of scar tissue has led to protected area of bacterial growth

A patient with osteomyelitis has a nursing diagnosis of risk for injury. What is an appropriate nursing intervention for this patient a. Use careful and appropriate disposal of soiled dressings b. Gently handle the involved extremity during movement c. Measure the circumference of the affected extremity daily d. Range-of-motion exercise every 4 hours to the involved extremity.

b. Gently handle the involved extremity during movement

A 50-year-old patient is being discharged after a week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information will be included in the discharge teaching? a.a How to apply warm packs to the leg to reduce pain b. How to monitor and care for the long-term IV catheter c. The need for daily aerobic exercise to help maintain muscle strength d. The reason for taking oral antibiotics for 7 to 10 days after discharge

b. How to monitor and care for the long-term IV catheter

The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the-knee amputation. Which statement by a patient indicates that additional patient teaching is needed? a. I will need to participate in physical therapy after surgery. b. I did not have this bone cancer until my leg broke a week ago. c. I wish that I did not have to have chemotherapy after this surgery. d. I can use the patient-controlled analgesia (PCA) to control postoperative pain.

b. I did not have this bone cancer until my leg broke a week ago.

A 39-year-old patient whose work involves frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates that the teaching has been effective? a. I will keep my back straight to lift anything higher than my waist. b. I will begin doing exercises to strengthen the muscles of my back. c. I can try to sleep with my hips and knees extended to prevent back strain. d. I can tell my boss that I need to change to a job where I can work at a desk.

b. I will begin doing exercises to strengthen the muscles of my back.

A 24 year old patient with a 12 year history of Becker muscular dystrophy is hospitalized with heart failure. What is an appropraite nursing intervention for this patient. a. Feed and bathe the patient b. Reposition frequently to avoid skin and respiratory complications c. Provide hand weighs for the patient to exercise the upper extremities d. Use orthopedic braces to promote ambulations and prevent muscle wasting

b. Reposition frequently to avoid skin and respiratory complications

Which action should the nurse take before administering gentamicin (Garamycin) to a patient who has acute osteomyelitis? a. Ask the patient about any nausea. b. Review the patients creatinine level. c. Obtain the patients oral temperature. d. Change the prescribed wet-to-dry dressing.

b. Review the patients creatinine level.

A laminectomy and spinal fusion are performed on a patient with a herniated lumbar intervertebral disc. During the postoperative period, which finding is of most concern to the nurse a. Paralytic ileus b. Urinary incontinence c. Greater pain at the graft site than at the lumber incision site d. Leg and arm movement and sensation unchanged from preoperative status

b. Urinary incontinence

Which statement describes osteosarcoma a. High rate of local recurrence. b. Very malignant and metastasizes early c. Arises in cancellous ends of long bones d. develops in the medullary cavity of long bones

b. Very malignant and metastasizes early

When administering alendronate (Fosamax) to a patient with osteoporosis, the nurse will a. ask about any leg cramps or hot flashes. b. assist the patient to sit up at the bedside. c. be sure that the patient has recently eaten. d. administer the ordered calcium carbonate.

b. assist the patient to sit up at the bedside.

Identify methods to specifically prevent osteoporosis in postmenopausal women (select all that apply) a. eating more beef b. eating 8 ounces of yogurt daily c. performing weight-bearing exercise d. spending 15 minutes in the sun each day e. taking postmenopausal estrogen replacement

b. eating 8 ounces of yogurt daily c. performing weight-bearing exercise

During a follow-up visit to a patient with acute osteomyelitis treated with IV antibiotics, the home health nurse is told by the patient's wife that she can hardly get the a patient to eat because his mouth is so sore. In assessing the patient's mouth, what is the most likely finding that the nurse should expect to find a. A dry, cracked tongue with central furrow b. white, curdlike membranous lesions of the mucosa c. Ulcers of the mouth and lips surrounded by a reddened base d. Single or clustered vesicles on the tongue and buccal mucosa

b. white, curdlike membranous lesions of the mucosa

Which information will the nurse include when teaching a patient with acute low back pain (select all that apply)? a. Sleep in a prone position with the legs extended. b. Keep the knees straight when leaning forward to pick something up. c. Avoid activities that require twisting of the back or prolonged sitting. d. Symptoms of acute low back pain frequently improve in a few weeks. e. Ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) can be used to relieve pain.

c. Avoid activities that require twisting of the back or prolonged sitting. d. Symptoms of acute low back pain frequently improve in a few weeks. e. Ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) can be used to relieve pain.

A patient who experienced an open fracture of humerus 2 weeks ago is having increased pain at the fracture site. To identify a possible causative agent of osteomyelitis at the site, what should the nurse expect testing to include a. x-rays b. CT scan c. Bone Biopsy d. WBC count and erythrocyte sedimentation rate (ESR)

c. Bone Biopsy

Which nursing action included in the care of a patient after laminectomy can the nurse delegate to experienced unlicensed assistive personnel (UAP)? a. Check ability to plantar and dorsiflex the foot. b. Determine the patients readiness to ambulate. c. Log roll the patient from side to side every 2 hours. d. Ask about pain control with the patient-controlled analgesia (PCA).

c. Log roll the patient from side to side every 2 hours.

A nurse who works on the orthopedic unit has just received the change-of-shift report. Which patient should the nurse assess first? a. Patient who reports foot pain after hammertoe surgery b. Patient with low back pain and a positive straight-leg-raise test c. Patient who has not voided 10 hours after having a laminectomy d. Patient with osteomyelitis who has a temperature of 100.5 F (38.1 C)

c. Patient who has not voided 10 hours after having a laminectomy

Before re-positioning the patient on the side after a lumbar laminectomy, what should be the nurse's first action a. raise the head of the bed 30 degrees b. Have the patient flex the knees and hips c. Place a pillow between the patient's legs d. Have the patient grasp the side rail on the opposite side of the bed

c. Place a pillow between the patient's legs

What are characteristics of Paget's disease (select of that apply) a. Results from vitamin D deficiency b. loss of total bone mass and substance c. abnormal remodeling and resorption of bone d. Most common in bones of spine, hips, and wrists e. generalized bone decalcification with bone deformity f. replacement of normal marrow with vascular connective tissue

c. abnormal remodeling and resorption of bone f. replacement of normal marrow with vascular connective tissue

In promoting healthy feet, the nurse should recognize which factor is associated with most foot problems a. poor foot hygiene b. congential deformities c. improperly fitting shoes d. peripheral vascular disease

c. improperly fitting shoes

A 67-year-old patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. The nurse chooses a nursing diagnosis of ineffective health maintenance when the nurse finds that the patient a. is frustrated with the length of treatment required. b. takes and records the oral temperature twice a day. c. is unable to plantar flex the foot on the affected side. d. uses crutches to avoid weight bearing on the affected leg.

c. is unable to plantar flex the foot on the affected side.

An appropriate nursing intervention for a patient who has acute low back pain and muscle spasms is to teach the patient to a. keep both feet flat on the floor when prolonged standing is required. b. twist gently from side to side to maintain range of motion in the spine. c. keep the head elevated slightly and flex the knees when resting in bed. d. avoid the use of cold packs because they will exacerbate the muscle spasms.

c. keep the head elevated slightly and flex the knees when resting in bed.

8. The nurse should reposition the patient who has just had a laminectomy and diskectomy by a. instructing the patient to move the legs before turning the rest of the body. b. having the patient turn by grasping the side rails and pulling the shoulders over. c. placing a pillow between the patients legs and turning the entire body as a unit. d. turning the patients head and shoulders first, followed by the hips, legs, and feet.

c. placing a pillow between the patients legs and turning the entire body as a unit.

The patient has lateral angulation of the large toe toward the second toe. The nurse knows that what will be included in the treatment. a. metatarsal arch support b. trimming with a scalpel after softening c. surgery to remove the bursal sac and bony enlargement d. Interaarticular corticosteroids and passive manual stretching

c. surgery to remove the bursal sac and bony enlargement

What does radicular pain that radiates down the buttock and below the knee, along the distribution of the sciatic nerve, generally indicate a. Cervical disc herniation b. acute lumboscaral strain c. Degenerative disc disease d. Herniated lumbar disc disease

d. Herniated lumbar disc disease

Following 7 days of IV antibiotic therapy, a patient with acute osteomyelitis of the tibia is prepared for discharge from the hospital. The nurse determines that additional instruction is needed when the patient makes which statement a. I will need to continue antibiotic therapy for 4 to 6 weeks b. I should notify the HCP if the pain in my leg becomes worse c. I shouldn't bear weight on my affected leg until healing is complete d. I do not need to do anything special while taking the antibiotic therapy

d. I do not need to do anything special while taking the antibiotic therapy

Which menu choice by a patient with osteoporosis indicates that the nurses teaching about appropriate diet has been effective? a. Pancakes with syrup and bacon b. Whole wheat toast and fresh fruit c. Egg-white omelet and a half grapefruit d. Oatmeal with skim milk and fruit yogurt

d. Oatmeal with skim milk and fruit yogurt

Which type of bone tumor is a benign overgrowth of bone and cartilage and may transform into malignant form a. Enchondroma b. Osteoclastoma c. Ewing's sarcoma d. Ostochondroma

d. Ostochondroma

Which assessment finding for a patient who has had a surgical reduction of an open fracture of the right radius is most important to report to the health care provider? a. Serous wound drainage b. Right arm muscle spasms c. Right arm pain with movement d. Temperature 101.4 F (38.6 C)

d. Temperature 101.4 F (38.6 C)

A 54-year-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia following densitometry testing. In teaching the woman about her osteoporosis, the nurse explains that a. estrogen replacement therapy must be started to prevent rapid progression to osteoporosis. b. continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. c. with a family history of osteoporosis, there is no way to prevent or slow gradual bone resorption. d. calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

d. calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

The nurse will determine that more teaching is needed if a patient with discomfort from a bunion says, I will a. give away my high-heeled shoes. b. take ibuprofen (Motrin) if I need it. c. use the bunion pad to cushion the area. d. only wear sandals, no closed-toe shoes.

d. only wear sandals, no closed-toe shoes.