CH 45, Concepts of Care for Patients with Musculoskeletal Problems

Which response would the nurse provide to a patient with a chondrosarcoma who asks why the health care provider (HCP) has not prescribed chemotherapy to treat the cancer, as the patient's friend had bone cancer that was successfully treated with chemotherapy?

A. "Chemotherapy is not as effective against your type of bone cancer."

The family of a patient with metastatic Ewing sarcoma asks the nurse about treatment options because chemotherapy and radiation treatments are not working. Which question would the nurse ask first?

A. "Have you talked to the patient about his wishes?"

The nurse completes a teaching session on safe drug administration for a patient with Paget disease taking oral bisphosphonates. Which patient statement indicates a need for further teaching?

A. "I should go to sleep immediately after taking the drug."

Which statement demonstrates the need for further instruction for a patient who has been prescribed the drug alendronate?

A. "I will take this with food to prevent upsetting my stomach."

Which evidence-based instruction would the nurse include in a teaching session for a group of women in their early 20s regarding prevention of osteoporosis? Select all that apply.

A. "It is important to know how to read nutrition labels regarding calcium amounts." B. "Limit your intake of carbonated beverages." C. "Include green leafy vegetables in your diet." D. "It is important for you to get some regular sun exposure." E. "Include a weight-bearing exercise into your daily routine."

The nurse is caring for a marathon runner with plantar fasciitis who verbalizes a desire to continue training. Which conservative management method does the nurse suggest?

A. "Strap the affected foot."

Which part of the body is affected by plantar fasciitis?

A. Arch of the foot

A patient with an osteoporotic vertebral fracture is prescribed raloxifene. Which information would the nurse include in the assessment of this patient?

A. Assess for a history of venous thromboembolism.

Which condition is being prevented with the slow infusion of zoledronic acid over a 20-minute time period?

A. Atrial fibrillation

The nurse is assessing a patient with a hallux valgus deformity. Which term is used to refer to an enlargement of the first metatarsal head commonly seen with this kind of deformity?

A. Bunion

Which is the term for an enlarged first metatarsal head?

A. Bunion

A patient had surgery for a bone graft because of fibrosarcoma and is non-weight bearing with a lower extremity cast in place. Which cue gathered during an assessment requires the nurse to contact the health care provider (HCP)?

A. Capillary refill 6 seconds

Which treatment option for plantar fasciitis would the nurse discuss with a patient who has had no relief from NSAIDs and steroid treatments? Select all that apply.

A. Doing stretching exercises. B. Resting and icing the foot. C. Wearing shoes with orthotics.

The nurse is teaching the importance of nutrition to a 74-year-old patient who is lactose intolerant and at risk for osteoporosis. Which nutritional consideration does the nurse teach? Select all that apply.

A. Drink fruit juices fortified with calcium. B. Limit consumption of carbonated beverages. C. Avoid excessive intake of alcohol and caffeine.

Which is a key feature of acute osteomyelitis?

A. Fever

Which fingers are affected by Dupuytren contracture?

A. Fourth and fifth fingers

Which statement is true about a ganglion? Select all that apply.

A. It is painless on palpation but often causes joint discomfort. B. It is common in people between the ages of 15 and 50 years. C. A small needle is used to aspirate fluid from a small ganglion cyst.

Which risk factor is associated with primary osteoporosis? Select all that apply.

A. Parental history of osteoporosis B. Thin build with low body weight D. Chronic low calcium and vitamin D intake

A patient has had a sequestrectomy of the right fibula for osteomyelitis 1 day ago. Which assessment finding requires the nurse to contact the surgeon immediately?

A. Paresis of right lower extremity

The nurse is assessing a patient who is reporting pain under the arch of the foot when getting out of bed in the morning. The nurse suspects the patient may have plantar fasciitis. Which information does the nurse give to the patient to help manage the onset of the condition?

A. Telling the patient to manage his or her weight

Which finding would the nurse infer if the T-score of a patient is -2 in a bone mineral density (BMD) test?

A. The patient has osteopenia

Which part of the patient's body does the nurse expect to find a conical mass, or corn?

A. Toe

Which finding does the nurse expect to observe in a patient with suspected common chronic osteomyelitis?

A. Ulceration of the skin

Which group has the least risk for developing osteomalacia?

A. White population

The nurse is teaching a patient with bunions on both feet about bone resection and fusion. Which statement made by the patient indicates that more teaching is needed?

B. "Healing time will take 2 weeks for each foot."

Which statement if made by a patient with osteomyelitis would indicate to the nurse the need for further teaching?

B. "I feel much better; I'm glad that I don't need the antibiotic anymore."

An older-adult patient is discharged from the hospital for treatment of osteoporosis. Which patient teaching does the nurse include related to the patient' s home safety?

B. "Keep walkways free of clutter."

The nurse is providing postoperative care to a patient immediately after an osteotomy for the correction of hammertoe. Which information does the nurse tell the patient?

B. "You can put all of your weight on your foot in a few weeks."

An 80-year-old patient experiencing severe pain in the lower jaw is diagnosed with acute osteomyelitis. Which symptom is least likely to be found?

B. Body temperature of 102°F (38.8°C)

The patient has a flat, poorly defined mass on the sole of the foot. Which condition does this patient most likely have?

B. Callus

Which category of osteomyelitis is related to a bone infection that is caused by a skin infection of the adjacent tissues?

B. Contiguous

Which statement describes Dupuytren contracture?

B. Contracture of the hand because of palmar fibromatosis

When caring for a patient receiving pamidronate for breast cancer that has spread to the bone, the nurse understands that which cue indicates the patient is experiencing an adverse effect from the medication? Select all that apply.

B. Creatinine level 2.9 mg/dL C. Potassium level 5.5 mEq/L D. 24-hour urine output 450 mL

An 80-year-old patient with uncontrolled hypertension reports pain in the right foot and is diagnosed with a hallux valgus deformity. Which treatment is the most appropriate for this patient?

B. Custom-made shoes

Which is the most commonly used screening and diagnostic tool for measuring bone mineral density?

B. Dual x-ray absorptiometry (DXA or DEXA)

What is a round, benign cyst that is often found on the wrist?

B. Ganglion

Which type of foot disorder appears as a bump on the side of the big toe?

B. Hallux valgus

The nurse is developing a plan of care for a patient with metastatic bone cancer. Which is an appropriate goal of treatment to include in the plan of care for this patient?

B. Improve the quality of life, and promote pain relief.

Which risk factor is associated with primary osteoporosis?

B. Lack of physical exercise

Which medical term refers to bone infection caused by bacteria, viruses, or fungi?

B. Osteomyelitis

The nurse is caring for a patient with prostate cancer who has bone metastasis. The nurse anticipates that the health care provider will prescribe which medication?

B. Pamidronate

Which foot disorder is one of the most common causes of heel pain?

B. Plantar fasciitis

Which instruction would the nurse give to a patient with osteoporosis who has been prescribed alendronate? Select all that apply.

B. Take the medication early in the morning with 8 oz of water. D. Remain upright for 30 to 60 minutes after taking the medication. F. Discontinue the medication if chest discomfort develops.

A patient is diagnosed with chronic osteomyelitis. Which feature does the nurse expect to assess in the patient?

B. Ulceration resulting in the sinus tract

Which is the best way to decrease the risk for osteoporosis in a patient who has just been diagnosed with the disease?

B. Walk for 30 minutes three times a week.

Which lifestyle change would benefit a patient who has osteoporosis?

B. Walking

Which teaching does the nurse provide to a patient who had ambulatory care surgery for hallux valgus and is ready for discharge?

B. Wear an orthopedic boot or shoe.

The nurse is taking the history of an adult female patient. Which factor places the patient at risk for osteoporosis?

B. Working at a desk and playing the piano for a hobby

When caring for a male patient with metastatic bone cancer, the nurse would expect to assess which areas for metastases? Select all that apply.

Breast. Lungs. Soft tissue. Other bones. Prostate.

The nurse provides a patient with information about how to prevent osteomalacia. Which statement made by the patient indicates the need for further teaching?

C. "I should exclude chicken and swordfish from my diet."

Which statement made by a middle-age female patient causes the nurse to teach the patient about preventing hallux valgus?

C. "I wear high heels to work every day."

A patient with bone cancer is scheduled for a right upper extremity amputation. Which statement by the patient' s husband indicates an effective coping strategy?

C. "I'll have to find ways to help my wife focus on positive aspects of her body."

A patient has undergone surgery on a lower extremity for a primary bone tumor. Which intervention does the nurse perform for this patient?

C. Assess the neurovascular status of the extremity every 1 to 2 hours after the surgery.

After dental work, a female patient taking medications for osteoporosis reports pain, bleeding gums, and halitosis. Upon examination, the bone is found to be exposed. Which medication is the cause for this condition?

C. Bisphosphonates

Which is the most common assessment finding associated with osteoporosis?

C. Bone fractures

Which term describes a benign tumor arising from cartilage?

C. Chondroma

When the home health nurse is reviewing the health record of a patient with osteosarcoma to determine if safety goals have been met, which cue would lead the nurse to conclude that the plan of care needs to be revised?

C. Cluttered pathways

Which part of the body does the hallux valgus deformity affect?

C. Foot

Which complication of osteomyelitis is the most likely to occur?

C. Formation of bone abscesses

Which statement is true regarding a ganglion cyst? Select all that apply.

C. Ganglion cysts can rapidly disappear and recur. D. Treatment includes the aspiration of cystic fluid with a fine needle. E. Ganglion cysts form because of the degeneration of synovium surrounding the tendon.

Which condition is associated with a lateral drift of the great toe at the first metatarsophalangeal joint?

C. Hallux valgus

Which drug is a bisphosphonate that is approved by the U.S. Food and Drug Administration (FDA) and is commonly used for the prevention and treatment of osteoporosis?

C. Ibandronate

Which nursing intervention helps prevent the incidence of osteomyelitis in a patient receiving hemodialysis?

C. Instructing the patient to brush teeth after every meal

How is a Dowager hump formed?

C. Kyphosis of the spine

The nurse is assessing a patient with Ewing sarcoma. Which finding does the nurse expect to observe?

C. Leukocytosis

Which medical term defines the bone disease caused by reduced blood flow to the bones in the joints?

C. Osteonecrosis

A 40-year-old patient reports severe sharp pain in the arch of the foot, which aggravates when the patient either gets out of bed or gets up from a prolonged sitting posture. Which diagnosis does the nurse anticipate?

C. Plantar fasciitis

Which is a priority problem for the older-adult patient diagnosed with bone cancer?

C. Potential for injury related to weakness and drug therapy

After the cast from a nondisplaced ulnar bone fracture is removed from a patient in the eighth week after the injury, the patient reports pain and swelling at the site. Further investigations reveal a fracture of the right radial bone. Which disorder might be the reason behind the fracture?

C. Secondary osteoporosis

A patient whose fracture of the right ulnar bone was immobilized in a cast for nearly 8 weeks reports swelling and pain in the right forearm. Why would the patient be advised to undergo a bone mineral density (BMD) test?

C. To evaluate for secondary osteoporosis

The nurse is teaching a young patient about ways to prevent osteoporosis in later adulthood. Which information does the nurse provide?

D. "Limit the consumption of carbonated beverages."

Which statement about the health economics associated with osteoporosis indicates a need for further teaching?

D. "Peripheral quantitative ultrasound (pQUS) is rarely used as a screening tool for osteoporosis detection because of its high cost."

The nurse is caring for a patient with bone cancer of the right hip who has undergone radical resection of the tumor and has received a prosthetic implant. Which patient statement indicates effective coping after the procedure?

D. "Physical therapy and counseling will help me adjust to my prosthesis."

A patient is prescribed the bisphosphonate (BP) alendronate for osteoporosis. Which teaching does the nurse provide to the patient?

D. "Take the medication early in the morning with 8 oz of water."

Which response would the nurse provide to a patient undergoing testing for possible Ewing sarcoma who asks which test confirms the diagnosis of cancer?

D. "The diagnosis occurs after CT scan results.

In which type of sarcoma does the patient experience dull pain and swelling for a long period of time?

D. Chondrosarcoma

Which statement best defines a hammertoe?

D. Dorsiflexion of the metatarsophalangeal joint with plantar flexion of the proximal interphalangeal joint next to it

Which complication of osteoporosis can cause a patient to lose up to 3 inches of height in 20 years?

D. Dowager hump

Upon performing a physical examination of a patient, the nurse observes that the ring finger and the little finger are bent toward the palm and cannot be extended. Which condition does this finding indicate?

D. Dupuytren contracture

Which disorder affects the hand or part of the hand?

D. Dupuytren contracture

Which action would the nurse determine as a priority in a 75-year-old female patient diagnosed with osteoporosis?

D. Encouraging muscle strengthening and weight-bearing exercises

The nurse is caring for a patient with an open wound from chronic osteomyelitis. How does the nurse ensure that this patient receives increased tissue perfusion?

D. Exposing the affected area to a high concentration of oxygen

Which term is related to the presence of excess serum calcium?

D. Hypercalcemia

When planning care for a patient who underwent surgical resection of an osteosarcoma of the femur, the nurse understands that which action would be the highest priority to take the day after surgery?

D. Implement continuous passive motion (CPM)

Which phrase describes the pathophysiology of osteoporosis?

D. Increased osteoclastic activity over osteoblastic activity

Which action would the nurse take when a patient with osteoporosis receives a new prescription for alendronate?

D. Instruct the patient sit upright or stand for 30 minutes after taking the drug.

The nurse plans to refer a patient diagnosed with osteoporosis to which community resource?

D. National Osteoporosis Foundation

Which nursing action is appropriate when a patient requests spiritual guidance during a preoperative assessment?

D. Offer assistance to arrange for a hospital chaplain to talk with the patient before surgery.

Which chronic metabolic disease causes decreased bone density and possible fracture?

D. Osteoporosis

Which action would the nurse take for a patient with osteomyelitis who recently underwent a sequestrectomy with bone grafts?

D. Perform frequent neurovascular assessments.

A patient diagnosed with Dupuytren contracture reports functional impairment of the right hand. Which treatment is required to relieve his condition?

D. Surgical fasciectomy

Which treatment option for plantar fasciitis would the nurse discuss with a patient who has had no relief from NSAIDs and steroid treatments? Select all that apply.

Doing stretching exercises. Resting and icing the foot. Wearing shoes with orthotics.

A goal to increase independence is included in the plan of care for a patient receiving services after undergoing surgical resection and allograft because of fibrosarcoma. Which cue indicates to the home health nurse that the goal has been met? Select all that apply.

E. Hygiene needs met without assistance

Which cue would the nurse expect to see when reviewing laboratory results in a patient with possible Ewing sarcoma? Select all that apply.

E. White blood cell (WBC) count 18,100 cells/mm 3

Which information is priority for the nurse to provide when teaching a patient who is being discharged after undergoing a surgical resection of an osteosarcoma of the left leg? Select all that apply.

Home safety. Pain management. Left leg incision care. Follow-up appointments. Postoperative restrictions.

Which intervention may be used to manage a patient with chronic osteomyelitis? Select all that apply.

Irrigating wounds through the window of a cast. Exposing the affected area to hyperbaric oxygen therapy. Packing the wound with bone cement bead impregnated with antibiotic

The nurse is teaching a patient various ways to increase vitamin D in the diet using natural foods (unfortified). Which food choice indicates the patient understands the teaching? Select all that apply.

Milk. Tofu. Eggs. Liver.

A patient has recently undergone surgery to treat osteomyelitis. Which sign of neurovascular compromise does the nurse assess for after the surgery? Select all that apply.

Paresthesia. Pulselessness. Uncontrollable pain. Paresis or paralysis.

The nurse is assessing a patient diagnosed with acute osteomyelitis. Which feature of this disorder does the nurse expect to find? Select all that apply.

Temperature above 101°F (38.3°C). Swelling around the affected area. Erythema around the affected area. Pulsating pain that worsens with movement.

The nurse is teaching a patient with bunions on both feet about bone resection and fusion. Which statement made by the patient indicates that more teaching is needed?

b. "Healing time will take 2 weeks for each foot at a time