Unit 17: Musculoskeletal QUIZLET Q's

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

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

After several weeks of antibiotic therapy for the treatment of osteomyelitis, a patient is preparing for discharge. When providing health education related to *self-care*, the nurse should emphasize which of the following topics? a. The need to avoid ASA and anticoagulants b. The need to resume normal physical activity as soon as possible c. The importance of maintaining a healthy diet d. The importance of adhering to further antibiotic treatment

*d. The importance of adhering to further antibiotic treatment* After initial treatment for osteomyelitis, the patient and family are taught about the importance of strictly adhering to the therapeutic regimen of antibiotics. This supersedes the importance of nutrition, even though this is important. There is no specific need to avoid ASA, and activity may be limited to reduce the risk of injury.

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD? a. Calcitonin (Miacalcin) b. Raloxifene (Evista) c. Teriparatide (Forteo) d. Vitamin D

*a. Calcitonin (Miacalcin) * Calcitonin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Raloxifene reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Teriparatide has been recently approved by the FDA for the treatment of osteoporosis.

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing? a. Wound packing b. Wound irrigation c. Vitamin supplements d. Surgical debridement

*d. Surgical debridement* In chronic osteomyelitis, *surgical debridement* is used when the wound *fails to respond to antibiotic therapy. * Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? a. "I will lie prone with my legs slightly elevated." b. "I will bend at the waist when I am lifting objects from the floor." c. "I will avoid prolonged sitting or walking." d. "Instead of turning around to grasp an object, I will twist at the waist."

*c. "I will avoid prolonged sitting or walking." * The nurse encourages the patient to alternate lying, sitting, and walking activities frequently, and advises the patient to avoid sitting, standing, or walking for long periods.

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. Gastrocnemius b. Latissimus dorsi c. Quadriceps d. Rectus abdominis

*c. 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.

A nurse practitioner who works with many older adult patients integrates screening for osteoporosis into health promotion activities. What screening tool is most clinically useful when screening for osteoporosis? a. Hip bone mineral density (BMD) testing b. Assessment of serum calcium levels c. Bone biopsy d. Assessment of 25-hydroxy-vitamin D levels

* a. Hip bone mineral density (BMD) testing* Current evidence-based guidelines recommend the use of hip BMD as the first-line screening test for osteoporosis. This is a clearer indicator of osteoporosis risk than is assessment of calcium levels. Bone biopsy and direct analysis of vitamin D levels are not used as screening methods.

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

*Staphylococcus aureus* Staphylococcus aureus causes over 50% of bone infections. Other organisms include Proteus vulgaris and Pseudomonas aeruginosa, as well as E. coli.

The provider asks a nurse to test a patient for Tinel's sign to diagnose carpal tunnel syndrome. The nurse asked the patient to: a. Make a fist and open his hand against resistance. b. Stretch his fingers around a ball and squeeze with force. c. Hold his palm up while the nurse percussed over the median nerve. d. Pronate his hand while the nurse palpated the radial nerve.

*c. Hold his palm up while the nurse percussed over the median nerve.* If tingling, numbness, or pain is felt when the median nerve is percussed, then Tinel's sign is considered positive.

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? a. "This condition is associated with various sports." b. "Surgery is the only sure way to manage this condition." c. "Using arm splints will prevent hyperflexion of the wrist." d. "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

*d. "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." 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*.

Which group is at the greatest risk for osteoporosis? Men Caucasian women Asian women African American women

*Caucasian women * Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Asian women of slight build are at risk for low peak bone mineral density. African American women, who have a greater bone mass than Caucasian women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.

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

*a. Calcitonin* 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.

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 age 40, height may show a gradual decrease as a result of spinal compression" b. "After menopause, the body's bone density declines, resulting in a gradual loss of height." c. "There may be some slight discrepancy between the measuring tools used." d. "The posture begins to stoop after middle age."

*b. "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.

Which client would the nurse identify as having the greatest risk for osteoporosis? a. A 40-year-old overweight African American woman b. A 16-year-old male with a history of asthma c. A small-framed, thin 45-year-old white woman d. A 20-year-old male athlete with repeated injuries

*c. A small-framed, thin 45-year-old white woman * Small-framed, thin white women are at greatest risk for osteoporosis. African American women have a greater bone density and thus are less susceptible to osteoporosis. Men have an increased bone mass and do not have hormonal changes, and do not acquire osteoporosis as frequently and get it at a later age. Asthma does not increase the risk for osteoporosis.

An adult patient with a history of severe lower back pain has sought care because of a recent exacerbation of his health problem that has been unrelieved by a visit to his chiropractor. The patient states that he has heard conflicting advice on exercise and activity during periods of back pain. What activity management strategy should the clinic nurse recommend to this patient? a. Bed rest for several days, if possible b. Maintaining or immediately increasing activity levels c. Resting for a day or two and then gradually increasing activity d. Alternating periods of activity and rest until relief is obtained

*c. Resting for a day or two and then gradually increasing activity * With severe pain, the nurse instructs the patient to limit activities for 1 to 2 days. Extended periods of inactivity are not effective and result in deconditioning. As the patient achieves comfort, activities are gradually resumed, and an exercise program is initiated.

A patient presents at the clinic complaining of back pain that goes all the way down the back of her leg to her foot. What is this type of pain referred to as? a. Bursitis b. Radiculopathy c. Sciatica d. Tendonitis

*c. Sciatica * Sciatic nerve pain travels down the back of the thigh to the foot of the affected leg. Radiculopathy is disease of a nerve root. Tendonitis is inflammation of muscle tendons. Bursitis is inflammation of a fluid-filled sac in a joint.

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? a. Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. b. To prevent fractures, the client should avoid strenuous exercise. c. The recommended daily allowance of calcium may be found in a wide variety of foods. d. 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. * 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.* - milk, broccoli, green leafy veggies, celery, tofu, butter nut, sesame seeds, squash, kidney beans 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 client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure? a. Administering large doses of oral antibiotics as ordered b. Instructing the client to ambulate twice daily c. Withholding all oral intake d. Administering large doses of I.V. antibiotics as ordered

*d. Administering large doses of I.V. antibiotics as ordered* Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited.

A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks? a. C3, C4, and L1 b. L1, L2, and L4 c. L2, L3, and L5 d. L4, L5, and S1

*d. L4, L5, and S1* The lower lumbar disks, L4-L5 and L5-S1, are subject to the greatest mechanical stress and the greatest degenerative changes. Disk protrusion (herniated nucleus pulposus) or facet joint changes can cause pressure on nerve roots as they leave the spinal canal, which results in pain that radiates along the nerve.