PrepU - Ch. 36: Management of Patients with MSK Disorders
Which are true about Lyme disease? Select all that apply. - Nephrotic syndromes occur in the later stages. - If untreated, the disease moves through three stages. - Cardiac and neurologic symptoms occur mid-stage, followed by arthritis and joint problems. - Early stage symptoms may include a red macule or papule at the site of the tick bite, a characteristic bullseye rash with round rings around the center, headache, neck stiffness, pain, fever, chills, malaise, nausea, vomiting, and sore throat.
- If untreated, the disease moves through three stages. - Cardiac and neurologic symptoms occur mid-stage, followed by arthritis and joint problems. - Early stage symptoms may include a red macule or papule at the site of the tick bite, a characteristic bullseye rash with round rings around the center, headache, neck stiffness, pain, fever, chills, malaise, nausea, vomiting, and sore throat. (If untreated, the disease moves through three stages. Early stage symptoms may include a red macule or papule at the site of the tick bite, a characteristic bullseye rash with round rings around the center, headache, neck stiffness, pain, fever, chills, malaise, nausea, vomiting, and sore throat. Cardiac and neurologic symptoms occur mid-stage, followed by arthritis and joint problems. There is no kidney involvement with Lyme disease.)
During a routine physical examination on an older 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) "After age 40, height may show a gradual decrease as a result of spinal compression" D) "The posture begins to stoop after middle age."
A) "After menopause, the body's bone density declines, resulting in a gradual loss of height." (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.)
A client diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. What is the best response by the nurse? A) "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." B) "CTS is a neuropathy that is characterized by pannus formation in the shoulder." C) "CTS is a neuropathy that is characterized by flexion contracture of the fourth and fifth fingers." D) "CTS is a neuropathy that is characterized by bursitis and tendinitis."
A) "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." (Carpal tunnel syndrome is an entrapment neuropathy that occurs when the median nerve at the wrist is compressed by a thickened flexor tendon sheath, skeletal encroachment, edema, or a soft tissue mass.)
On a visit to the family health care provider, 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) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." B) "Bunions are caused by a metabolic condition called gout." C) "Bunions are congenital and can't be prevented." D) "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth."
A) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." (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 caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given? A) Alendronate B) Teriparatide C) Denosumab D) Raloxifene
A) Alendronate (Alendronate is a bisphosphonate medication. Raloxifene is a selective estrogen receptor modulator. Teriparatide is an anabolic agent, and denosumab is a monoclonal antibody agent.)
A group of students are reviewing information about osteoporosis in preparation for a class discussion. The students demonstrate a need for additional review when they state which of the following as a risk factor? A) Hypothyroidism B) Prolonged immobility C) Prolonged corticosteroid use D) Excess caffeine intake
A) Hypothyroidism (Factors associated with an increased risk for osteoporosis include: family history of osteoporosis, chronic low calcium intake, excessive intake of caffeine, tobacco use, Cushing's syndrome, prolonged use of high doses of corticosteroids, prolonged periods of immobility, hyperthyroidism, hyperparathyroidism, eating disorders, malabsorption syndromes, breast cancer (especially if treated with chemotherapy that suppresses estrogen, excluding Tamoxifen, which may reduce the risk of fractures), renal or liver failure, alcoholism, lactose intolerance, and dietary deficiency of vitamin D and calcium.)
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? A) Perform neuromuscular assessment every hour. B) Examine the surgical dressing every hour. C) Monitor vital signs every 4 hours. D) Administer pain medication per client request.
A) Perform neuromuscular assessment every hour. (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? A) Plantar fasciitis B) Hallux valgus C) Ganglion D) Morton's neuroma
A) Plantar fasciitis (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.)
The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize? A) Quadriceps B) Rectus abdominis C) Gastrocnemius D) Latissimus dorsi
A) Quadriceps (The nurse instructs the patient in the safe and correct way to lift objects using the strong quadriceps muscles of the thighs, with minimal use of weak back muscles (Fig. 42-3).)
Which is a risk-lowering strategy for osteoporosis? A) Smoking cessation B) Increased age C) Diet low in calcium and vitamin D D) Low initial bone mass
A) Smoking cessation (Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D.)
Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? A) Upright gait B) Long bone bowing C) Lordosis D) Skull narrowing
B) Long bone bowing (Some clients with Paget's disease are asymptomatic with only some mild skeletal deformity. Other clients have marked skeletal deformities which may include enlargement of the skull, bowing of the long bones, and kyphosis.)
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? A) Bananas B) Vitamin D-fortified milk C) Red meat D) Green vegetables
B) Vitamin D-fortified milk (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.)
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? A) Increase in calcitonin B) Increase of vitamin D C) Decrease in estrogen D) Decrease in parathyroid hormone
C) Decrease in estrogen (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.)
Which group is at the greatest risk for osteoporosis? A) Asian American women B) African American women C) European American women D) Men
C) European American women (Small-framed, nonobese European American women are at greatest risk for osteoporosis. Asian American women of slight build are at risk for low peak bone mineral density. African American women, who have a greater bone mass than European American women and Asian American Women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.)
A healthcare provider asks a nurse to test a client for Tinel's sign to diagnose carpal tunnel syndrome. What should the nurse do to perform this assessment? A) Have the client stretch the fingers around a ball and squeeze with force. B) Have the client hold the palm of the hand up while the nurse percusses over the median nerve. C) Have the client pronate the hand while the nurse palpates the radial nerve. D) Have the client make a fist and open the hand against resistance.
C) Have the client pronate the hand while the nurse palpates the radial nerve. (If tingling, numbness, or pain is felt when the median nerve is percussed, then Tinel's sign is considered positive. To test for Tinel's sign have the client hold the palm of the hand up while the nurse percusses over the median nerve. The client making a fist and pushing will test strength resistance. The client stretching fingers around a ball will not test for Tinel's sign. Having the client pronate the hand and palpating the radial nerve is not Tinel's sign used for carpal tunnel syndrome diagnosis.)
Which of the following is the most common and most fatal primary malignant bone tumor? A) Rhabdomyoma B) Enchondroma C) Osteogenic sarcoma (osteosarcoma) D) Osteochondroma
C) Osteogenic sarcoma (osteosarcoma) (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.)
Most cases of osteomyelitis are caused by which microorganism? A) Pseudomonas species B) Escherichia coli C) Staphylococcus aureus D) Proteus species
C) Staphylococcus aureus (Staphylococcus aureus causes 70% to 80% of bone infections. Proteus species, Pseudomonas species, and E. coli are frequently found in osteomyelitis, they do not cause the majority of bone infections.)
A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? A) To prevent fractures, the client should avoid strenuous exercise. B) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. C) The recommended daily allowance of calcium may be found in a wide variety of foods. D) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss.
C) The recommended daily allowance of calcium may be found in a wide variety of foods. (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 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? A) Help the client walk to the nearest nurses' station. B) Raise the client's arm above the heart. C) Place the client in a sitting position. D) Immobilize the client's arm.
D) Immobilize the client's arm. (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.)
