Chapter 36 Musculoskeletal Disorders

Which of the following are clinical manifestations of impingement syndrome? Select all that apply. Shoulder tenderness Pain Muscle spasms Limited movement Atrophy

Shoulder tenderness Pain Muscle spasms Limited movement Atrophy

A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? Select all that apply. Skin breakdown Sepsis Necrosis of the humerus Delirium Pneumonia

Skin breakdown Delirium Pneumonia

An older adult client experienced a fall and required treatment for a fractured hip on the orthopedic unit. Which of the following are contributory factors to the incidence of falls and fractured hips among the older adult population? Select all that apply. Hearing loss Slowed reflexes Adverse medication effects Muscle weakness Loss of visual acuity

Slowed reflexes Adverse medication effects Muscle weakness Loss of visual acuity

Identify descriptors of the pathophysiologic process seen in osteomalacia. Select all that apply. Excessive osteoclastic activity causes the bones to become soft and bowed initially; later, the bones thicken but are not well formed, making the bones weak and prone to fracture. The bone mass is structurally weaker, and bone deformities occur. There is a deficiency of activated vitamin D (calcitriol). Calcium and phosphate are not moved to the bones.

The bone mass is structurally weaker, and bone deformities occur. There is a deficiency of activated vitamin D (calcitriol). Calcium and phosphate are not moved to the bones.

The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client? Select all that apply. The client will experience a tolerable level of pain. The client will remain free from injury. The client will maintain adequate nutritional intake. The client will maintain effective airway clearance. The client will demonstrate wound care.

The client will experience a tolerable level of pain. The client will maintain adequate nutritional intake. The client will demonstrate wound care.

Which client(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply. The client with hemorrhage in the site of injury The client with elevated pressure within the muscles The client using ice to control pain in the extremity The client with a plaster cast applied immediately after injury The client who sustained a clavicle fracture

The client with hemorrhage in the site of injury The client with elevated pressure within the muscles The client with a plaster cast applied immediately after injury

A nurse is planning the care of an older adult client who will soon be discharged home after treatment for a fractured hip. In an effort to prevent future fractures, the nurse should encourage what actions? Select all that apply. Use of falls prevention precautions Regular bone density testing Weight-bearing exercise A high-calcium diet Use of corticosteroids as prescribed

Use of falls prevention precautions Regular bone density testing Weight-bearing exercise A high-calcium diet

The client has just been diagnosed with osteomyelitis. What are possible causes of osteomyelitis? Select all that apply. Vascular insufficiency in clients with diabetes or peripheral vascular disease Progressive osteoporosis Trauma, such as penetrating wounds or compound fractures Surgical contamination, such as pin sites of skeletal traction

Vascular insufficiency in clients with diabetes or peripheral vascular disease Trauma, such as penetrating wounds or compound fractures Surgical contamination, such as pin sites of skeletal traction

Hypercalcemia is a dangerous complication of bone cancer. Therefore, nursing assessment includes evaluation of symptoms that require immediate treatment. Which of the following are signs/symptoms that are indictors of an elevated serum calcium? Select all that apply. c. Anorexia and constipation a. Muscle weakness e. Shortened QT interval f. Lack of muscle coordination b. Tachycardia d. Prolonged ST segment

c. Anorexia and constipation a. Muscle weakness e. Shortened QT interval f. Lack of muscle coordination

A client who plays tennis is experiencing elbow discomfort. Following assessment, the client receives a diagnosis of tendinitis, epicondylitis, or tennis elbow. What symptoms and signs did the client have? Select all that apply. pain radiating down the dorsal surface of the forearm weak grasp pain more prominent at night pain or burning in one or both hands

pain radiating down the dorsal surface of the forearm weak grasp

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply. pneumonia diarrhea skin breakdown wound infection

pneumonia skin breakdown wound infection

A client who has fractured the radial head asks the nurse about factors that will promote bone healing. Which statement should the nurse include when responding to the client? Select all that apply. "Weight bearing stimulates healing of the long bones of the leg, if the fracture is stabilized." "Immobilization of the fracture will promote healing by maximizing contact of bone fragments." "Adults heal faster than children because adult bodies are physiologically more mature." "Corticosteroids will decrease the bone and soft tissue inflammation associated with the fracture." "Fractured bones require a good blood supply and adequate nutrition for healing."

"Weight bearing stimulates healing of the long bones of the leg, if the fracture is stabilized." "Immobilization of the fracture will promote healing by maximizing contact of bone fragments." "Fractured bones require a good blood supply and adequate nutrition for healing."

A high school student who was injured in a football game presents with knee pain with internal rotation of the foot. Which interventions are appropriate nursing actions? Select all that apply. Administer morphine sulfate. Apply a knee brace or wrap the affected knee. Assist the client to "walk off" the pain. Apply ice packs to the affected knee. Elevate the affected leg.

Apply a knee brace or wrap the affected knee. Apply ice packs to the affected knee. Elevate the affected leg.

Which of the following are associated with compartment syndrome? Select all that apply. Crushing injuries Surgery Tight bandages Trauma from accidents Casts

Crushing injuries Surgery Tight bandages Trauma from accidents Casts

A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until his femur can be rodded in surgery. For what early complications should the nurse monitor this client? Select all that apply. Complex regional pain syndrome Deep vein thrombosis Compartment syndrome Fat embolism Systemic infection

Deep vein thrombosis Compartment syndrome Fat embolism

A patient is diagnosed with osteomyelitis of the right leg. What signs and symptoms does the nurse recognize that are associated with this diagnosis? (Select all that apply.) Leukopenia Fever Purulent drainage Erythema Pain

Fever Erythema Pain

The RICE acronym is helpful for remembering treatment interventions for musculoskeletal injuries. Which of the following are components of the RICE acronym? Select all that apply. Ice Edema Rest Compression Elevation Corticosteroids

Ice Rest Compression Elevation

The nurse is screening a client for genetic counseling. What musculoskeletal conditions does the nurse know to have a genetic influence? Select all that apply. Marfan syndrome Stickler syndrome osteoporosis osteoarthritis diabetes mellitus

Marfan syndrome Stickler syndrome osteoporosis

A nurse is caring for a construction worker who fell from the second story of a building site and fractured the femoral neck. Which nursing diagnosis is a priority for the client? Select all that apply. Risk for infection Impaired physical mobility Disturbed body image Urinary incontinence Risk for injury

Risk for infection Impaired physical mobility Risk for injury

Bursitis is an inflammation of the bursa, a fluid-filled sac that cushions bone ends to enhance a gliding movement. What possible assessment findings would be present in a client with bursitis? Select all that apply. Bouchard's nodes a distinct lump hyperuricemia painful movement of a joint

a distinct lump painful movement of a joint

A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? Select all that apply. Both feet warm with capillary refill < 3 seconds "I cannot seem to catch my breath." "I have a pins-and-needles sensation in my toes." T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90% Dorsoplantar weak and unequal bilaterally

"I cannot seem to catch my breath." "I have a pins-and-needles sensation in my toes." T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90% Dorsoplantar weak and unequal bilaterally

The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which nursing diagnosis is appropriate for the client? Select all that apply. Ineffective airway clearance Acute pain Imbalanced nutrition: less than body requirements Risk for injury Disturbed body image

Acute pain Imbalanced nutrition: less than body requirements Disturbed body image

A provider asks the nurse to teach a client with low back pain how to sit in order to minimize pressure on the spine. Which teaching points would the nurse include? Select all that apply. Avoid hip extension. Sit in a straight-backed chair with arm rests. Sit with the buttocks "tucked under." Use a firm pillow placed behind the thoracic vertebrae to straighten the small of the back. Place feet flat on the floor.

Avoid hip extension. Sit in a straight-backed chair with arm rests. Sit with the buttocks "tucked under." Place feet flat on the floor.

A client has been admitted to the medical unit for the treatment of Paget disease. When reviewing the medication administration record, the nurse should anticipate what medication? Calcium gluconate Estrogen Alkaline phosphatase Bisphosphonates

Bisphosphonates

A nurse is caring for a client who is being assessed following complaints of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? Select all that apply. Computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasound X-ray Angiography

Computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasound X-ray

A patient shows the nurse a round, firm nodule on the wrist. The pain is described as aching, with some weakness of the fingers. What treatment does the nurse anticipate assisting with? (Select all that apply.) Corticosteroid injections Aspiration of the cyst Active range-of-motion exercises Educating the patient on the use of gabapentin Surgical excision

Corticosteroid injections Aspiration of the cyst Surgical excision

A nurse is providing care for a client who has a recent diagnosis of Paget disease. When planning this client's nursing care, interventions should address what? Select all that apply. Disturbed auditory sensory perception Risk for unstable blood glucose Acute pain Risk for injury Impaired physical mobility

Disturbed auditory sensory perception Acute pain Risk for injury Impaired physical mobility

Which are true about Lyme disease? Select all that apply. If untreated, the disease moves through three stages. Nephrotic syndromes occur in the later 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.

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.

A patient sustains an open fracture of the left arm after an accident at the roller skating rink. What does emergency management of this fracture involve? (Select all that apply.) Immobilizing the affected site Covering the area with a clean dressing if the fracture is open Splinting the injured limb Wrapping the arm in an ace bandage Asking the patient if he or she is able to move the arm

Immobilizing the affected site Covering the area with a clean dressing if the fracture is open Splinting the injured limb

A bone graft may be used for which of the following reasons? Select all that apply. Joint stabilization Reduction of a fracture Defect filling Stimulation of bone healing Improvement of motion

Joint stabilization Defect filling Stimulation of bone healing

Which of the following are common primary sites of tumors that metastasize to the bone? Select all that apply. Lung Ovary Kidney Breast Prostate

Lung Ovary Kidney Breast Prostate

A client has been diagnosed with a rotator cuff tear. What are the options for treating this condition? Select all that apply. NSAIDs arthroscopic surgery activity modification and joint rest traction

NSAIDs arthroscopic surgery activity modification and joint rest

Which of the following are routes of administration for Calcitonin? Select all that apply. Nasal spray Intravenous Intramuscular injection Oral Subcutaneous

Nasal spray Intramuscular injection Subcutaneous

The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? (Select all that apply.) Assessing pupillary response Palpating peripheral pulses in both lower extremities Assessing level of consciousness Checking the urine for hematuria Testing the stool for occult blood

Palpating peripheral pulses in both lower extremities Checking the urine for hematuria Testing the stool for occult blood

A nurse is caring for an older woman with a hip fracture. What are appropriate risk factors for the nurse to consider related to the client's hip fracture? Select all that apply. Muscular agility Presence of anemia History of diverticulitis Osteoporosis Female gender

Presence of anemia Osteoporosis Female gender

A nurse is caring for a client who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.) Introducing the client to local amputee support groups Encouraging the client to have family and friends view the residual limb to decrease self-consciousness Encouraging family and friends to refrain from visiting temporarily because this may increase the client's embarrassment Encouraging the client to care for the residual limb Allowing the client to express grief

Introducing the client to local amputee support groups Encouraging the client to care for the residual limb Allowing the client to express grief

A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip? Select all that apply. The left leg is shorter than the right. The client is able to bend the knee but not move toes. The skin of the lower left leg is pale. The skin over the left hip is warm. Limited range of motion of the left hip.

The left leg is shorter than the right. The skin of the lower left leg is pale. Limited range of motion of the left hip.

A nurse is providing an educational class to a group of older adults at a community senior center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended intake of what nutrients? Select all that apply. Vitamin D Potassium Vitamin B12 Calcitonin Calcium

Vitamin D Calcium

A client is reporting jaw pain, and is experiencing muscle spasm and tenderness of the masseter and temporalis muscles. The physician has diagnosed a temporomandibular disorder (TMD). What would the treatment course for this client include? Select all that apply. referral to a dentist who has experience managing clients with TMD corticosteroids custom-fitted mouth guard during sleep analgesics

referral to a dentist who has experience managing clients with TMD custom-fitted mouth guard during sleep analgesics

A nurse in a busy emergency department provides care for many clients who present with contusions, strains, or sprains. What are treatment modalities that are common to all of these musculoskeletal injuries? Select all that apply. Elevating the injured limb Resting the affected extremity Compression dressings Massage Applying ice Corticosteroids

Elevating the injured limb Resting the affected extremity Compression dressings Applying ice