Musculoskeletal chapters 44, 45, 47 (Osteoporosis, Osteomyelitis, Fractures, Assessment)

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? 1. acute osteomyelitis 2. chronic osteomyelitis 3. Fat embolism 4. Compartment syndrome

1

in later stages of osteomyelitis, ESR levels are? 1. elevated 2. decreased

1

prior to a DEXA scan, nurse will plan to instruct client, which of the following? 1. remove all metal objects on the day of the scan. 2. consume foods and beverages with a high content of calcium for 2 days before the test. 3. ingest 600 mg of calcium gluconate by mouth for 2 weeks before the test. 4. report any significant pain to her physician at least 2 days before the test.

1

which laboratory assessments will be present in osteomyelitis? 1. elevated WBC 2. elevated RBC 3. elevated platelets

1

A client has been prescribed denosumab. What health teaching about this drug is most appropriate for the nurse to include? 1. "Drink at least 8 ounces (240 mL) of water with it." 2. "Make appointments to come get your injection." 3. "Sit upright for 30 to 60 minutes after taking it." 4. "Take the drug on an empty stomach."

2

A client is undergoing computed tomography (CT) of a joint. What action by the nurse is most important before the test? 1. Administer sedation as prescribed. 2. Assess for seafood or iodine allergy. 3. Ensure that the client has no metal on the body. 4. Provide preprocedure pain medication.

2

A client with osteoporosis is going home where the client lives alone. What action by the nurse is best? 1. Refer the client to Meals on Wheels. 2. Arrange a home safety evaluation. 3. Ensure that the client has a walker at home. 4. Help the client look into assisted living.

2

A nurse cares for a client with a recently fractured tibia. Which assessment would alert the nurse to take immediate action? 1. Pain of 4 on a scale of 0-10 2. Numbness in the extremity 3. Swollen extremity at the injury site 4. Feeling cold while lying in bed

2

A nurse plans care for a client who is recovering from a below-the-knee amputation of the left leg. Which intervention would the nurse include in this client's plan of care? 1. Place pillows between the client's knees. 2. Encourage range-of-motion exercises. 3. Administer prophylactic antibiotics. 4. Implement strict bedrest in a supine position.

2

continuous and persistent, with exacerbation and remissions, are clinical manifestations of? 1. osteoporosis 2. chronic osteomyelitis 3. acute osteomyelitis

2

A nurse assesses clients in an osteoporosis clinic. Which client would the nurse assess first? 1. Client taking calcium with vitamin D who reports flank pain 2 weeks ago. 2. Client taking ibandronate who cannot remember when the last dose was. 3. Client taking raloxifene who reports unilateral calf swelling. 4. Client taking risedronate who reports occasional dyspepsia

3

A patient is taking Calcitonin for osteoporosis. The patient should be monitored for? 1. Hyperkalemia 2. Hypokalemia 3. Hypocalcemia 4. Hypercalcemia

3

The nurse is caring for a client who had a closed reduction of the left arm and notes a large wet area of drainage on the cast. What action is the most important? 1. Cut off the old cast. 2. Document the assessment. 3. Notify the primary health care provider. 4. Wrap the cast with gauze.

3

The nurse prepares to perform a neurovascular assessment on a patient with closed multiple fractures of the right humerus. Which technique does the nurse use? 1. assess patients LOC 2. assess patients ability to follow commands 3. assess sensation

3

Which condition may be detected by using the drop arm test? 1. fracture 2. dislocation 3. rotator cuff injury

3

Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing BMD? 1. Teriparatide (Forteo) 2. Vitamin D 3. Calcitonin (Miacalcin) 4. Raloxifene (Evista)

3

a nurse will focus on which priority problem in patents with osteoporosis? 1. decline in height 2. weakness 3. potential for fracture 4. muscle atrophy

3

a patient with osteoporosis would be taught which of the following to prevent osteomyelitis? 1. Prophylactic antibiotics 2. surgical detriment 3. oral hygiene

3

for a older female client with osteoporosis, and adequate amount of calcium per day is considered? 1. 1000 mg 2. 800 mg 3. 1200 mg

3

a postmenopausal client is asking about necessary vitamin D supplementation, which is correct? SATA 1. 500-1200 2. 15 min of sunlight 3. 800-1000 4. 20 min of sunlight

3,4

. A nurse is caring for a client who is recovering from an above-the-knee amputation and reports pain in the limb that was removed. How would the nurse respond? 1. "The pain you are feeling does not actually exist." 2. "This type of pain is common and will eventually go away." 3. "Would you like to learn how to use imagery to minimize your pain?" 4. "How would you describe the pain that you are feeling?"

4

A nurse assesses a client with a pelvic fracture. Which assessment finding would the nurse identify as a complication of this injury? 1. Hypertension 2. Diarrhea 3. Infection 4. Hematuria

4

A nurse plans care for a client who has an external fixator on the lower leg. Which intervention would the nurse include in the plan of care to decrease the client's risk for infection? 1. Washing the frame of the fixator once a day 2. Releasing fixator tension for 30 minutes twice a day 3. Avoiding moving the extremity by holding the fixator 4. Scheduling for pin care to be provided every shift

4

A nurse teaches assistive personnel (AP) about providing hygiene for a client in traction. Which statement would the nurse include as part of the teaching about this client's care? 1. "Remove the traction when re-positioning the client." 2. "Assess the client's skin when performing a bed bath." 3. "Provide pin care by using alcohol wipes to clean the sites." 4. "Ensure that the weights remain freely hanging at all times."

4

A patient diagnosed with osteoporosis is being discharged home. Which of the following is the priority education the nurse should provide? 1. Classifying medications 2. Increasing calcium and vitamin D in the diet 3. Participating in weight-bearing exercises 4. Removing all small rugs from the home

4

The nurse is performing a neurovascular assessment for an older client who has an extremity fracture. How many seconds would the nurse expect for a capillary refill in it is within normal range? 1. 20 seconds 2. 15 seconds 3. 10 seconds 4. 5 seconds

4

The nurse is teaching a client newly diagnosed with osteoporosis about dietary and lifestyle interventions to decrease risk factors for osteoporosis. Which is the best way to decrease the risk for osteoporosis? 1. Increase nutritional intake of calcium. 2. Engage in high-impact exercise, such as running. 3. Increase nutritional intake of phosphorus. 4. Walk for 30 minutes three times a week.

4

The nurse sees several clients with osteoporosis. For which client would alendronate not be a good option? 1. Client with diabetes who has a serum creatinine of 0.8 mg/dL 2. Client who recently fell and has vertebral compression fractures 3. Hypertensive client who takes calcium channel blockers 4. Client with a spinal cord injury who cannot tolerate sitting up

4

To prevent the development of osteoporosis, which objective is most appropriate? 1. Maintaining vitamin levelsb) 2. Maintaining protein levels 3. Promoting range-of-motion (ROM) exercises 4. Promoting weight-bearing exercises

4

A client had an arthroscopy 1 hour ago on the left knee. The nurse finds the left lower leg to be pale and cool, with a 1+ pedal pulse. What action would the nurse perform first? 1. Assess the neurovascular status of the right leg. 2. Document the findings in the patient's chart. 3. Elevate the left leg on at least two pillows. 4. Notify the primary health care providerimmediately.

1

A client who had a surgical fractured femur repair reports new-onset shortness of breath and increased respirations. What is the nurse's first action? 1. Place the client in a high-Fowler position. 2. Document the client's oxygen saturation level. 3. Start oxygen therapy at 2 L/min via nasal cannula. 4. Contact the primary health care provider

1

A nurse assesses an older adult who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless with an oxygen saturation of 88%. Which action would the nurse take first? 1. Administer oxygen via nasal cannula. 2. Re-position to a semi-Fowler position. 3. Increase the intravenous flow rate. 4. Assess response to pain medication.

1

A nurse cares for a client placed in skeletal traction. The client asks, "What is the primary purpose of this type of traction?" How would the nurse respond? 1. "Skeletal traction will assist in realigning your fractured bone." 2. "This treatment will prevent future complications and back pain." 3. "Traction decreases muscle spasms that occur with a fracture." 4. "This type of traction minimizes damage as a result of fracture treatment."

1

A nurse is caring for a client with diabetes mellitus who has fractured her arm. Which action would the nurse take first? 1. Remove the medical alert bracelet from the fractured arm. 2. Immobilize the arm by splinting the fractured site. 3. Place the client in a supine position with a warm blanket. 4. Cover any open areas with a sterile dressing.

1

A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing? 1. Surgical debridement 2. Vitamin supplements 3. Wound irrigation 4. Wound packing

1

A female client is preparing to have open magnetic resonance imaging (MRI) of the spine. What action(s) by the nurse is (are) most important to assess before the test? (Select all that apply.) 1. Ask if the client has a history of kidney disease. 2. Ask the client if she could possibly be pregnant. 3. Ensure that the patient has no metal or electronic implants. 4. Assess the client for the ability to communicate. 5. Assess the client for a history of claustrophobia.

1, 2, 3, 4

A nurse plans care for a client who is recovering from open reduction and internal fixation (ORIF) surgery for a right hip fracture. Which interventions would the nurse include in this client's plan of care? (Select all that apply.) 1. Elevate heels off the bed with a pillow. 2. Ambulate the client on the first postoperative day. 3. Push the client's patient-controlled analgesia button. 4. Re-position the client every 2 hours. 5. Use pillows to encourage subluxation of the hip.

1, 2, 4

symptoms of acute osteomyelitis include? 1. fever, night sweats, chills 2. restless 3. drainage 4. nausea, malaise 5. fatigue

1, 2, 4

A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply.) 1. Alcohol 2 Caffeine 3. Fat 4. Carbonated beverages 5. Vitamin D

1, 2, 4, 5

When assessing gait, what feature(s) would the nurse inspect? (Select all that apply.) 1. Balance 2. Ease of stride 3. Goniometer readings 4. Length of stride 5. Steadiness

1, 2, 4, 5

A nurse teaches a client with a fractured tibia about external fixation. Which advantage of external fixation for the immobilization of fractures would the nurse share with the client? (Select all that apply.) 1. It leads to minimal blood loss. 2. It allows for early ambulation. 3. It decreases the risk of infection. 4. It increases blood supply to tissues. 5. It promotes healing.

1, 2, 5

The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease? (Select all that apply.) 1. Draining sinus tracts 2. High fevers 3. Presence of foot ulcers 4. Swelling and redness 5. Tenderness or pain

1, 3

The nurse is caring for a client who recently sustained a sports injury to his right leg. What nursing interventions are appropriate for this client? (Select all that apply.) 1. Immobilize the right leg. 2. Apply heat immediately after the injury. 3. Use compression to support the leg. 4. Obtain an x-ray to detect possible fracture. 5. Elevate the right leg to decrease swelling. 6. Administer an opioid every 4 to 6 hours.

1, 3, 4, 5

The nurse is planning discharge instructions for the client with chronic osteomyelitis. What instructions should the nurse include in the discharge teaching? 1. Adherence to the antibiotic regimen 2. Correct intramuscular injection technique 3. Eating high-protein and high-carbohydrate foods 4. Keeping daily follow-up appointments 5. Proper use of the intravenous equipment

1, 3, 5

The nurse assesses which of the following clinical manifestations in a client with acute osteomyelitis? SATA 1. Night sweats 2. Cool extremities 3. Petechiae 4. Fever 5. Nausea 6. Restlessness

1, 4, 5, 6

label the following symptoms/facts as either a fat embolism manifestation or a compartment syndrome manifestation: 1. petechia 2. paresthesia 3. pale skin 4. confusion 5. pulseness 6. low O2 7. long bone fractures 8. increased pressure 9. numbness 10. ST change

1. FE 2. CS 3. CS 4. FE 5. CS 6. FE 7. FE 8. CS 9. CS 10. FE

For knee or extremity injuries, like sports injury, the mnemonic RICE is used which stands for? 1. R 2. I 3. C 4. E

1. rest 2. ice 3. compression 4. elevate

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? 1. penicillamine (Cuprimine) 2. raloxifene (Evista) 3. plicamycin (Mithracin)d) 4. methotrexate (Rheumatrex)

2

The nurse is taking the history of an adult female client. Which factor places the client at risk for osteoporosis? 1. Consuming 12 ounces of carbonated beverages daily 2. Working at a desk and playing the piano for a hobby 3. Having a hysterectomy and taking estrogen replacement therapy 4. Consuming one alcoholic drink per week

2

The nurse is teaching assistant personnel (AP) about care of an older ambulatory adult who has osteopenia. Which statement by the AP indicates understanding of the teaching? 1. "I will tell the client to change positions frequently to prevent pressure injury." 2. "I will remind the client to take frequent walks to strengthen bones." 3. "I will assist the client with activities of daily living as needed." 4. "I will apply warm compresses to the joints to relieve pain."

2

An older client's serum calcium level is 8.7 mg/dL (2.18 mmol/L). What possible etiology(ies) does the nurse consider for this result? (Select all that apply.) 1. Good dietary intake of calcium and vitamin D 2. Normal age-related decrease in serum calcium 3. Possible occurrence of osteoporosis or osteopenia 4. Potential for metastatic cancer or Paget disease 5. Recent bone fracture in a healing stage

2, 3

a nurse is discharging a patient with osteoporosis, which of the following will be included? 1. showing client ROM movements 2. instruct follow up DXA scan 3. elimination of throw rugs 4. conduct home evaluation for safety 5. adherence to drug regime

2, 3, 4, 5

a physical assessment of a patient with osteoporosis would revel? SATA 1. scoliosis 2. dowagers hump 3. kyphosis 4. back pain 5. reduction in height

2, 3, 4, 5

in what common bones would a nurse expect to find osteoporosis manifestations upon assessment? SATA 1. long bone 2. spine 3. wrist 4. finges 5. hip

2, 3, 5

local manifestations of osteomyelitis include? SATA 1. fractures 2. swelling, warmth, tenderness 3. bone pain 4. pain unrelieved by rest 5. pain worsening with activity 6. restricted movement 7. weakness

2, 4, 5, 6

Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis? SATA 1. swelling 2. sinus tract infection 3. tenderness 4. localized pain 5. constant bone pain 6. foot ulcers 7. drainage 8. fever

2, 4, 6, 7

venous thromboembolism is most common in which type of fracture? SATA 1. clavicle facture 2. pelvic fracture 3. rib fracture 4. shoulder fracture 5. hip fracture 6. femoral fracture

2, 5, 6

a diabetic patient is admitted to the health care facility with a foot ulcer. The nurse teaches wound care to the patient and the caregiver to prevent the risk for which condition? 1. Osteoporosis 2. Osteomyelitis 3. Osteoarthritis 4. fracture

2

what is the priority reason for educating a patient with osteomyelitis on the importance for oral hygiene?

periodontal gum infection, causes osteomyelitis in facial bones