Chapter 40: PrepU - Nursing Assessment: Musculoskeletal Function, Chapter 41: PrepU - Nursing Management: Patients With Musculoskeletal Disorders, Chapter 42: Nursing Management: Patients With Musculoskeletal Trauma

A client is scheduled to undergo an electromyography. When performed, what will this test evaluate? 1- Muscle weakness 2- Muscle composition 3- Bone density 4- Metastatic bone lesions

1

A has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications? 1- common adverse effects 2- dietary restrictions 3- activity restrictions 4- loading-dose schedule

1

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? 1- Hip bone mineral density (BMD) testing 2- Assessment of serum calcium levels 3- Bone biopsy 4- Assessment of 25-hydroxy-vitamin D levels

1

Instructions for the client with low back pain include that, when lifting, the client should 1- avoid overreaching. 2- place the load away from the body. 3- use a narrow base of support. 4- bend the knees and loosen the abdominal muscles.

1

Skull sutures are an example of which type of joint? 1- Synarthrosis 2- Amphiarthrosis 3- Diarthrosis 4- Aponeuroses

1

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

1

Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy? 1- aspirin 2- furosemide 3- digoxin 4- NPH insulin

1

Which nerve is assessed when the nurse asks the client to spread all fingers? 1- Ulnar 2- Peroneal 3- Radial 4- Median

1

A client experiences a musculoskeletal injury that involves the structure that connects a muscle to the bone. The nurse understands that this injury involves which structure? 1- Ligament 2- Tendon 3- Cartilage 4- Joint

2

A client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for? 1- Lack of sleep and appetite 2- Serous drainage 3- Signs of depression 4- Signs of shock

2

A patient with a primary diagnosis of colorectal cancer has developed bone metastases in recent weeks. When reviewing this patient's daily blood work, the nurse should be aware that secondary bone tumors create a significant risk of what electrolyte imbalance? 1- Hypokalemia 2- Hypercalcemia 3- Hyponatremia 4- Hyperchloremia

2

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? 1- Increase fiber in the diet 2- Walk or perform weight-bearing exercises outdoors 3- Reduce stress 4- Decrease the intake of vitamin A and D

2

What is the term for a rhythmic contraction of a muscle? 1- Atrophy 2- Clonus 3- Hypertrophy 4- Crepitus

2

Which body movement involves moving toward the midline? 1- Pronation 2- Adduction 3- Abduction 4- Eversion

2

Which medication classification is prescribed when allergy is a factor causing the skin disorder? 1- Corticosteroids 2- Antihistamines 3- Antibiotics 4- Local anesthetics

2

Which term refers to mature compact bone structures that form concentric rings of bone matrix? 1- Endosteum 2- Lamellae 3- Trabecula 4- Cancellous bone

2

A client is recovering from a fractured hip. What would the nurse suggest that the client increase intake of to facilitate calcium absorption from food and supplements? 1- Amino acids 2- Vitamin B6 3- Vitamin D 4- Dairy products

3

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? 1- Gastrocnemius 2- Latissimus dorsi 3- Quadriceps 4- Rectus abdominis

3

The nurse is performing a musculoskeletal assessment of a client in a nursing home who had a stroke 2 years ago and who has right-sided hemiplegia. The nurse notes that the girth of the client's right calf is 2 inches less in diameter than the left calf. The nurse attributes the decreased girth to 1- edema in left lower extremity. 2- increased use of left calf muscle. 3- atrophy of right calf muscle. 4- bruising in right lower extremity.

3

A 22-year-old college basketball player is undergoing diagnostic testing following a knee injury, and his primary care provider has ordered arthrography. What teaching should the nurse provide in preparation for this procedure? 1- "A computer will create a three-dimensional image of your knee based on magnetic readings." 2- "You'll be given some anesthetic and then several tissue samples will be taken from your knee joint." 3- "You'll be given a small dose of radioactive solution, and the doctor will observe its distribution in your knee." 4- "The doctor will inject some contrast solution into your joint and take a series of X-rays."

4

A group of students are studying for an examination on joints. The students demonstrate understanding of the material when they identify which of the following as an example of a synarthrodial joint? 1- Between the vertebrae 2- In the fingers 3- At the hip 4- Skull at the temporal and occipital bones

4

A medical nurse has provided care for many patients who have bone disorders, and the nurse integrates health education around the maintenance of bone health into care. What should the nurse recommend to patients in an effort to promote bone health? 1- Moderate activity restriction for older adults 2- Daily use of low-dose ASA 3- A low-fat, low-carbohydrate diet 4- Adequate dietary intake of calcium

4

A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about taking a calcium supplement should the nurse include? 1- Take weekly on the same day and at the same time. 2- Remain in an upright position 30 minutes after taking the supplement. 3- Take the supplement on an empty stomach with a full glass of water. 4- Take the supplement with meals or with orange juice.

4

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? 1- Changing the dressing 2- Applying a cock-up splint and immobilization 3- Having the patient exercise the fingers to avoid future contractures 4- Performing hourly neurovascular assessments for the first 24 hours

4

An elderly patient has come to the clinic for a regular check-up. While reviewing a patient's history, the nurse notes that the patient has an increased thoracic curvature of the spine. What term describes this assessment finding? 1- Scoliosis 2- Epiphyses 3- Lordosis 4- Kyphosis

4

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? 1- Osteomalacia 2- Ganglion 3- Osteomyelitis 4- Paget disease

4

The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients? 1- Inadequate nutrition 2- Impaired physical mobility 3- Risk for infection 4- Disturbed body image

4

Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? 1- Callus 2- Hammertoe 3- Hallux valgus 4- Dupuytren contracture

4

Avascular necrosis of bone

A complication that occurs when bone loses its blood supply and dies; treatment may entail bone grafts, prosthetic replacement, or joint fusion.

Volkmann's contracture

Condition in which the muscles in the palm side of the forearm shorten, causing the fingers to form a fist and the wrist to bend

Complex regional pain syndrome

a chronic neuropathic pain syndrome

Greenstick (incomplete)

bone partially bent and partially broken; often occurs in children

compound fracture

break in the bone where the bone comes through the skin; open fracture

impacted fracture

broken bone ends are forced into each other

contusion

bruise, injury

Pyrexia

fever

Heterotrophic ossification

formation of bone in abnormal locations

comminuted fracture

fracture in which the bone is splintered or crushed

Sprain

injury to a ligament

acromioclavicular joint

irregular joint between the acromion process of the scapula and the distal clavicle

adduction

movement toward the midline

strain

muscle pull or tear

Pathologic fracture

occurs when a weakened bone breaks under normal strain

compression fracture

occurs when the bone is pressed together (compressed) on itself

First-degree strain

one or more muscles or tendons are stretched resulting in pain, mild swelling, and minor loss of function

A nurse who oversees care in a long-term care facility is aware that a high percentage of residents have osteoporosis, and that residents who do not have the disease must be assessed and monitored closely for this health problem. Which of the following older adults most clearly exemplifies the risk factors for osteoporosis? 1- A Caucasian woman who has low body mass index 2- An African American woman who is slightly obese 3- An Asian man whose mobility is limited to a wheelchair 4- A Caucasian man who has led a sedentary lifestyle

1

A nurse who provides care in an extended-care setting works primarily with adults aged 75 and older. When planning care and implementing safety measures for this population, the nurse should be cognizant of which of the following normal, age-related changes to the musculoskeletal system? 1- Decreased bone mass 2- Presence of osteochondromas 3- Decreased collagen in muscles 4- Increased elasticity of tendons

1

A patient comes to the clinic and informs the nurse of numbness, tingling, and a burning sensation in the arm from the elbow down to the fingers. What type of symptom would this be documented as? 1- Paresthesia 2- Flaccidity 3- Atonia 4- Effusion

1

A patient has just had an arthroscopy. What is a nursing intervention that is necessary for the nurse to implement following an arthroscopy? 1- Wrap the joint in compression dressing. 2- Flex and lower the joint. 3- Extend and lower the joint. 4- Apply heat.

1

An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification? 1- Osteoblasts 2- Cortical bone 3- Osteoclasts 4- Cancellous bone

1

Choose the correct statement about the endosteum, a significant component of the skeletal system: 1- Covers the marrow cavity of long bones 2- Supports the attachment of tendons to bones 3- Contains blood vessels and lymphatics 4- Facilitates bone growth

1

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding? 1- Hammer toe 2- Mallet toe 3- Hallux valgus 4- Bunion

1

Morton neuroma is exhibited by which clinical manifestation? 1- Swelling of the third (lateral) branch of the median plantar nerve 2- High arm and a fixed equinus deformity 3- Diminishment of the longitudinal arch of the foot 4- Inflammation of the foot-supporting fascia

1

Morton neuroma is exhibited by which clinical manifestation? 1- Swelling of the third (lateral) branch of the median plantar nerve 2- High arm and a fixed equinus deformity 3- Longitudinal arch of the foot is diminished 4- Inflammation of the foot-supporting fascia

1

The homecare nurse is evaluating the musculoskeletal system of a geriatric client whose previous assessment was within normal limits. The nurse initiates a call to the health care provider and/or emergency services when which change is found? 1- Decreased right-sided muscle strength 2- Decreased flexibility 3- Decreased agility 4- Increased joint stiffness

1

The nurse is caring for a 35-year-old man diagnosed with a back strain. What would be a priority point of discussion with this patient? 1- Avoid lifting heavy weights without assistance. 2- Focus on using back muscles during lifting. 3- Lift objects while holding the object away from the body. 4- Tighten the abdominal muscles and lock the knees during the lifting of an object.

1

The nurse is performing a neurological assessment. What will this assessment include? 1- Ask the client to plantar flex the toes. 2- Observe for capillary refill of the great toe. 3- Palpate the dorsalis pedis pulse. 4- Inspect the foot for edema.

1

The nurse is preparing the client for computed tomography. Which information should be given by the nurse? 1- "You must remain very still during the procedure." 2- "A small bit of tissue will be removed and sent to the lab." 3- "Fluid will be removed from you affected joint." 4- "A radioisotope will be given through an IV."

1

The nurse recognizes that rheumatoid arthritis is characterized by: 1- Ulnar deviation 2- Ballottement sign 3- Clonus 4- Fasciculations

1

There are thousands of components of the musculoskeletal system that facilitate mobility and independent function. The function of skeletal muscle is promoting: 1- movement of skeletal bones. 2- organ function. 3- involuntary function. 4- All options are correct.

1

Which nursing action is most important in caring for the client following an arthrogram? 1- Apply ice to the joint. 2- Keep the joint below the level of the heart. 3- Administer morphine sulfate. 4- Assist the client with passive range of motion.

1

Which of the following inhibits bone resorption and promotes bone formation? 1- Calcitonin 2- Estrogen 3- Parathyroid hormone 4- Corticosteroids

1

Which of the following is an example of a gliding joint? 1- Carpal bones in the wrist 2- Knee 3- Hip 4- Joint at base of thumb

1

Which of the following is the final stage of fracture repair? 1- Remodeling 2- Cartilage calcification 3- Cartilage removal 4- Angiogenesis

1

Which of the following is the most common site of joint effusion? 1- Knee 2- Elbow 3- Hip 4- Shoulder

1

Which of the following is the priority nursing diagnosis for the client preparing for a bone marrow biopsy? 1- Deficient knowledge: procedure 2- Acute pain 3- Risk for infection 4- Risk for ineffective peripheral tissue perfusion

1

Which term refers to a disease of a nerve root? 1- Radiculopathy 2- Involucrum 3- Sequestrum 4- Contracture

1

While doing an initial assessment on a patient, the patient tells the nurse that she has bone pain. The nurse asks the patient to describe the characteristics of the pain. Which of the following are typical characteristics of bone pain? 1- Dull, deep ache 2- Soreness or aching that may include cramping 3- Sharp and piercing pain that is relieved by immobilization 4- Spastic or sharp pain that radiates

1

Red bone marrow produces which of the following? Select all that apply. 1- Platelets 2- White blood cells (WBCs) 3- Red blood cells (RBCs) 4- Estrogen 5- Corticosteroids

1,2,3

The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.) 1- Pale, cyanotic, or mottled color 2- Cool temperature of the extremity 3- More than 3-second capillary refill 4- Tenting skin turgor 5- Limited range of motion

1,2,3

The nurse is providing care for a male patient who has undergone knee arthroplasty. As part of the nurse's morning assessment, the nurse is assessing for peripheral neurovascular dysfunction distal to the surgical site. When performing this assessment, what parameters should the nurse assess and document? Select all that apply. 1- The color of the patient's lower leg and foot 2- The patient's ability to move his foot 3- The patient's sensation in his foot and lower leg 4- The temperature of the patient's foot and lower leg 5- The presence or absence of hair on the patient's foot and lower leg

1,2,3,4

A client comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the health care provider orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the client about? 1- Amitriptyline 2- Duloxetine 3- Gabapentin 4- Cyclobenzaprine

2

A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening? 1- Trigeminal neuralgia 2- Temporomandibular disorder 3- Loose teeth 4- Dislocated jaw

2

A client is diagnosed with a bone tumor. What result would the nurse expect the blood tests to reveal? 1- Decreased alkaline phosphatase 2- Decreased serum calcium level 3- Decreased serum phosphorus 4- Decreased red blood cell count

2

A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration? 1- A serum calcium test 2- An electromyography 3- An arthroscopy 4- A magnetic resonance imaging (MRI)

2

A client visits the health care provider for a routine checkup. The history reveals that the client was diagnosed with a spinal curvature. Which region of the spine should the nurse assess for complications? 1- Cervical 2- Thoracic 3- Lumbar 4- Sacral

2

A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication? 1- Potassium level of 6.3 mEq/L 2- Calcium level of 11.6 mg/dl 3- Sodium level of 110 mEq/L 4- Magnesium level of 0.9 mg/dl

2

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate? 1- Yoga 2- Walking 3- Bicycling 4- Swimming

2

A nurse is taking a newly admitted patient's health history, and the patient states that she has had ongoing problems with a "pinched nerve." In addition to the potential for pain, the nurse should consider the fact that physical pressure that is placed on nerves can often lead to what? 1- Crepitus 2- Paresthesias 3- Muscle hypertrophy 4- Osteoporosis

2

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? 1- Place the client in a sitting position. 2- Immobilize the client's arm. 3- Help the client walk to the nearest nurses' station. 4- Raise the client's arm above the heart.

2

A patient has had a stroke and is unable to move the right upper and lower extremity. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding? 1- Rigidity 2- Flaccidity 3- Atonic 4- Tetanic

2

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? 1- "After age 40, height may show a gradual decrease as a result of spinal compression" 2- "After menopause, the body's bone density declines, resulting in a gradual loss of height." 3- "There may be some slight discrepancy between the measuring tools used." 4- "The posture begins to stoop after middle age."

2

The nurse is conducting a musculoskeletal assessment of a client in a nursing home. The client is unable to dorsiflex the right foot or extend the toes. The nurse evaluates this finding as an injury to which nerve? 1- Sciatic 2- Peroneal 3- Femoral 4- Achilles

2

The nurse is educating a client with low back pain on proper lifting techniques. The nurse recognizes that the education was effective when the client 1- reaches over the head with the arms fully extended. 2- places the load close to the body. 3- uses a narrow base of support. 4- bends at the hips and tightens the abdominal muscles.

2

The nurse is reading the admission note for a client with a bone fracture that requires surgery. The note indicates the presence of crepitus. The nurse interprets this as being 1- bleeding. 2- a crackling sound. 3- ecchymosis. 4- a closed fracture.

2

A 10-year-old boy who was brought to the emergency room after a skiing accident is diagnosed with a fracture of the distal end of the femur. Why is this type of fracture significant? 1- Osteoblast formation will stop during the time needed for fracture healing. 2- Red blood cell production will be temporarily reduced because of the damage to the medullar cavity. 3- Potential growth problems may result from damage to the epiphyseal plate. 4- Periosteal blood vessels will be damaged, thus compromising blood flow to the compact bone.

3

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? 1- "CTS is a neuropathy that is characterized by bursitis and tendinitis." 2- "CTS is a neuropathy that is characterized by flexion contracture of the fourth and fifth fingers." 3- "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." 4- "CTS is a neuropathy that is characterized by pannus formation in the shoulder."

3

A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells? 1- Remodeling 2- Resorption 3- Ossification and calcification 4- Epiphyses and diaphysis formation

3

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? 1- Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. 2- To prevent fractures, the client should avoid strenuous exercise. 3- The recommended daily allowance of calcium may be found in a wide variety of foods. 4- Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.

3

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? 1- Bursitis 2- Radiculopathy 3- Sciatica 4- Tendonitis

3

A patient tells the nurse, "I was working out and lifting weights and now that I have stopped, I am flabby and my muscles have gone!" What is the best response by the nurse? 1- "While you are lifting weights, endorphins are released, creating increase in muscle mass, but if the muscles are not used they will atrophy." 2- "The muscle mass has decreased from the lack of calcium in the cells." 3- "Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued." 4- "Once you stop exercising, the contraction of the muscle does not regain its strength."

3

An older adult patient has been admitted to a subacute geriatric medicine unit with a diagnosis of failure to thrive. The nurse is conducting a comprehensive assessment that focuses on the patient's musculoskeletal system. During this assessment, what will be the nurse's primary focus? 1- Risk factors for common diseases of the musculoskeletal system 2- The presence or absence of musculoskeletal diagnoses 3- The patient's level of function and activities of daily living 4- The integrity of the patient's integumentary system

3

Parathormone regulates the concentration of calcium in the blood by: 1- Stimulating osteoblastic activity. 2- Stimulating the liver to produce an insulin-like growth factor. 3- Promoting the movement of calcium from the bone. 4- Increasing the release of thyroid hormones.

3

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- Avascular necrosis 2- Fat embolism 3- Osteomyelitis 4- Compartment syndrome

3

The human body is designed to protect its vital parts. The nurse is aware that a fracture of what type of bone may interfere with the protection of vital organs? 1- Long bones 2- Short bones 3- Flat bones 4- Irregular bones

3

The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse? 1- The patient has osteoarthritis. 2- The patient has lupus erythematosus. 3- The patient has rheumatoid arthritis. 4- The patient has neurofibromatosis.

3

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? 1- "I will lie prone with my legs slightly elevated." 2- "I will bend at the waist when I am lifting objects from the floor." 3- "I will avoid prolonged sitting or walking." 4- "Instead of turning around to grasp an object, I will twist at the waist."

3

The nurse is caring for a patient with a bone tumor. The nurse provides education that teaches the patient to implement measures to reduce the risk of pathologic fractures. What intervention will assist the patient in fracture prevention? 1- Teaching the patient to achieve maximum weight-bearing capabilities 2- Maintaining strict bed rest 3- Supporting the affected extremity with external supports (splints) 4- Limiting the patient's reliance on assistive devices

3

The nurse is discussing conservative management of tendonitis with a patient. Which of the following is likely the most effective approach to managing tendonitis? 1- Weight reduction 2- Stress reduction 3- Intermittent application of ice and heat 4- Range-of-motion (ROM) exercise of the affected joint

3

The nurse is performing a neurovascular assessment of a client's injured extremity. Which would the nurse report? 1- Positive distal pulses 2- Capillary refill of 3 seconds 3- Dusky or mottled skin color 4- Skin warm to touch

3

The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as which condition? 1- Hammertoe 2- Pes cavus 3- Hallux valgus 4- Flatfoot

3

When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with: 1- Morton's neuroma 2- Dupuytren's contracture 3- Carpal tunnel syndrome 4- Impingement syndrome

3

Which cells are involved in bone resorption? 1- Chondrocytes 2- Osteoblasts 3- Osteoclasts 4- Osteocytes

3

Which client would the nurse identify as having the greatest risk for osteoporosis? 1- A 40-year-old overweight African American woman 2- A 16-year-old male with a history of asthma 3- A small-framed, thin 45-year-old white woman 4- A 20-year-old male athlete with repeated injuries

3

Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist? 1- Meniscography 2- Bone densitometry 3- Arthrography 4- EMG

3

Which of the following factors would the nurse need to keep in mind about the focus of the initial history when assessing a new client with a musculoskeletal problem? 1- Client's age 2- Client's lifestyle 3- Any chronic disorder or recent injury 4- Duration and location of discomfort or pain

3

A 49-year-old man with a history of poorly controlled type 1 diabetes has developed osteomyelitis adjacent to a chronic diabetic ulcer on his great toe. The patient has been informed that medical treatment for osteomyelitis requires a longer course of antibiotics than most other infections because: 1- Osteomyelitis is usually caused by simultaneous infection with several microorganisms, which must be treated sequentially. 2- Osteomyelitis requires treatment with topical antibiotics rather than IV antibiotics, necessitating a longer course of treatment. 3- Osteomyelitis is usually the result of fungal infection rather than bacterial infection. 4- Osteomyelitis involves the active infection of bone tissue, which is largely avascular.

4

A client arrives at the orthopedic physician's office stating knee pain sustained while playing soccer. A history and physical assessment is completed. The knee appears reddened with edema. Which other diagnostic testing would the nurse anticipate? 1- A bone densitometry 2- A bone scan 3- An arthrocentesis 4- An arthroscopy

4

A client is seen in the emergency room for a knee injury that happened during a basketball game. Diagnostic tests reveal torn cords of fibrous connective tissue that connect muscles to bones. What type of tear has this client sustained? 1- Fascia 2- Ligament 3- Bursa 4- Tendon

4

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? 1- Wound packing 2- Wound irrigation 3- Vitamin supplements 4- Surgical debridement

4

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? 1- Sleep on the stomach to alleviate pressure on the back. 2- A soft mattress is most supportive by conforming to the body. 3- Avoid twisting and flexion activities. 4- Use the large muscles of the leg when lifting items.

4

A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class? 1- Alendronate (Fosamax) 2- Calcium gluconate 3- Tamoxifen (Nolvadex) 4- Raloxifene (Evista)

4

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and the immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client? 1- The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor. 2- The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor. 3- The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit. 4- The nurse is caring for this client on the intensive care unit.

4

A nurse is conducting an assessment of a patient's musculoskeletal system and assessing for joint function. How should the nurse best perform this assessment? 1- Ask the patient to clearly describe any recent changes in mobility or flexibility. 2- Assess the patient's expectations around function and mobility. 3- Palpate and percuss each of the patient's joints bilaterally. 4- Assess the range of motion (ROM) of each of the patient's joints.

4

A nurse knows that a person with a 3-week-old femur fracture is at the stage where angiogenesis is occurring. What are the characterisitics of this stage? 1- The formation of a hematoma and fibrin. 2- Inflammation and the stimulation of osteoblasts and osteoclasts. 3- Cartilage cells forming matrix villa that regulate calcification of the cartilage. 4- New capillaries producing a bridge between the fractured bones.

4

A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis? 1- Proteus 2- Pseudomonas 3- Salmonella 4- Staphylococcus aureus

4

After a person experiences a closure of the epiphyses, which statement is true? 1- The bone grows in length but not thickness. 2- The bone increases in thickness and is remodeled. 3- Both bone length and thickness continue to increase. 4- No further increase in bone length occurs.

4

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? 1- The need to avoid ASA and anticoagulants 2- The need to resume normal physical activity as soon as possible 3- The importance of maintaining a healthy diet 4- The importance of adhering to further antibiotic treatment

4

An emergency department nurse is assessing an 80-year-old patient who has presented with a complaint of abdominal pain. The nurse performs a rapid inspection of the patient and notes multiple significant findings, including kyphosis. The nurse should understand that this assessment finding is suggestive of what musculoskeletal disease? 1- Malignant bone neoplasm 2- Paget's disease 3- Muscular dystrophy 4- Osteoporosis

4

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? 1- Wound packing 2- Wound irrigation 3- Vitamin supplements 4- Surgical debridement

4

The 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? 1- Examine surgical dressing every hour. 2- Administer pain medication per client request. 3- Monitor vital signs every 4 hours. 4- Perform neuromuscular assessment every hour.

4

The nurse is performing a musculoskeletal assessment on a patient with arthritis. During passive range-of-motion exercises, the nurse hears grating and cracking sounds. This assessment finding is referred to as what? 1- Fasciculations 2- Clonus 3- Effusion 4- Crepitus

4

The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as? 1- Lordosis 2- Scoliosis 3- Osteoporosis 4- Kyphosis

4

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? 1- "Use your continuous passive motion machine (CPM) 2 hours each day." 2- "You need to perform weight-bearing exercises twice a week." 3- "You need to limit the amount of protein and calcium in your diet." 4- "You will receive IV antibiotics for 3 to 6 weeks."

4

The nurse is reporting on the results of client blood work to the oncoming nurse. Upon reviewing the data, it is noted that the client has an elevated uric acid level. Which inflammatory process would the nurse screen for on shift rounds? 1- Rheumatoid arthritis 2- Lupus erythematosus 3- Osteoporosis 4- Gout

4

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- methotrexate (Rheumatrex) 3- plicamycin (Mithracin) 4- raloxifene (Evista)

4

The nurse working in the emergency department receives a call from the x-ray department communicating that the client the nurse is caring for has a fracture in the shaft of the tibia. The nurse tells the physician that the client's fracture is in the 1- epiphysis. 2- lordosis. 3- scoliosis. 4- diaphysis.

4

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? 1- Bone spurs 2- Diarrhea 3- Increased heel pain 4- Decreased height

4

Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis? 1- Thrombocytopenia and ecchymosis 2- Pruritus and uremic frost 3- Petechiae over the chest and abnormal ABGs 4- Leukocytosis and localized bone pain

4

Which hormone inhibits bone resorption and increases the deposit of calcium in the bone? 1- Growth hormone 2- Vitamin D 3- Sex hormones 4- Calcitonin

4

Which is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes? 1- Remodeling 2- Hypertrophy 3- Fasciculation 4- Compartment syndrome

4

Which laboratory study indicates the rate of bone turnover? 1- Urine calcium 2- Serum calcium 3- Serum phosphorous 4- Serum osteocalcin

4

Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? 1- Deficient knowledge about osteoporosis and the treatment regimen 2- Acute pain related to fracture and muscle spasm 3- Risk for constipation related to immobility 4- Risk for injury related to fractures due to osteoporosis

4

Which should be included in the teaching plan for a client diagnosed with plantar fasciitis? 1- Plantar fasciitis presents as acute-onset pain localized to the ball of the foot that occurs when pressure is placed on it and diminishes when pressure is released. 2- The pain of plantar fasciitis diminishes with warm water soaks. 3- Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion. 4- Management of plantar fasciitis includes stretching exercises.

4

Which term refers to the shaft of the long bone? 1- Epiphysis 2- Lordosis 3- Scoliosis 4- Diaphysis

4

Abduction

Movement away from the midline of the body

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. a. Muscle weakness b. Tachycardia c. Anorexia and constipation d. Prolonged ST segment e. Shortened QT interval f. Lack of muscle coordination

a,c,e,f

subluxation

partial dislocation of a joint