chp 42 prep u

During a routine physical examination on a 75-year-old 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?

"After menopause, the body's bone density declines, resulting in a gradual loss of height."

A client with diabetes punctured hisfoot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics?

3-6 weeks

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

Ergonomic changes can be incorporated into your workday to reduce stress on your wrist

A patient visits an orthopedic specialist because of pain that he feels beginning in his low back and radiating behind his right thigh and down below his right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between these intervertebral disks:

L4, L5, and S1

Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis?

Risk for injury related to fractures due to osteoporosis

The nurse advises a patient that the best position to ease low back pain is:

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees lateral also acceptable w. knees +hip flexed w. pillow between legs prone should be avoided

Morton's neuroma is exhibited by which clinical manifestations?

Swelling of the third (lateral) branch of the median plantar nerve

Morton's neuroma is exhibited by which of the following clinical manifestations?

Swelling of the third (lateral) branch of the median plantar nerve

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and his immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client?

The nurse is caring for this client on the intensive care unit.

Which sign may be helpful in identifying carpal tunnel syndrome?

Tinels or Phalens

Terparatide (Forteo)

anabolic agent

Alendronate (Fosamax)

bisphosphonate medication

Of the following, which is not a risk factor for osteoporosis? a. menopause b. caucasian or asian c. being male d. family history

c. being male

Which of the following was formerly called a bunion?

hallux valgus

arthroscopy

may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid

denosumab (Prolia)

monoclonal antibody agent

s/s of hypercalcemia

muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma.

corticosteroids + osteoporosis

puts pt at risk for developing osteoporosis

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?

quadriceps

Arthroplasty

restructure of the joint surface after diagnosis is made

A client has Paget's disease. An appropriate nursing diagnosis for this client is:

risk for falls

Hallux valgus

-aka bunion -deformity in which great toes deviates laterally

ganglion

-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

PTH

-increases bone turnover + resorption -increases w. agining

The provider asks a nurse to test a patient for Tinel's sign to diagnose carpal tunnel syndrome. The nurse asked the patient to:

Hold his palm up while the nurse percussed over the median nerve.

A male client is to have an amputation. He is acutely ill and diagnosed with a gangrenous limb and related fever, disorientation, and electrolyte imbalances. Which of the following would be most important for the nurse to monitor in this client?

Signs of sepsis

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? a. Arthroscopy b. Needle Aspiraion c. Open reduction d. Arthroplasty

a. Arthroscopy

What food can the nurse suggest to the client at risk for osteoporosis? a. chicken b. bananas c. broccoli d. red meat

c. broccoli

On a visit to the family physician, 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. bunions are congenital b. bunions are from wearing shoes that are too tight or big c. bunions are caused by gout d. some bunions are congenital while others are caused by wearing shoes that are too short or narrow

d. some bunions are congenital while others are caused by wearing shoes that are too short or narrow

A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing? a. wound packing b. supplementation c. wound irrigation d. surgical debridement

d. surgical debridement

Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis?

s/s of sepsis + localized infection (ex. Leukocytosis and localized bone pain)

Raloxifene (Evista)

selective estrogen receptor modulator

risk factors for osteoporosis

small-framed, thin White or Asian women postmenopausal family hx inactivity chronic low Ca intake excessive caffeine or tobacco use

Morton's neuroma

swelling of the third (lateral) branch of the median plantar nerve

plantar fasciitis

-inflammation of the foot-supporting fascia- -present as an acute onset of heal pain experienced with the first steps in the morning

Estrogen

-inhibits bone breakdown -decreases w. agining

calcitonin

-inhibits bone resorption and promotes bone formation -decreased in osteoporosis

A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?

0.5

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

IV antibiotics 3-6 wks

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

a. Calcitonin

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? a. elevated ABGs b. alkaline phosphatase c.

b. alkaline phosphatase

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? a. risk for falls b. risk for infectin c. inadequate nutrition d. disturbed body image

d. disturbed body image

Primary prevention of osteoporosis includes: a. optimal calcium intake and estrogen replacement therapy b. placing items within clients reach c. using a professional alert system in home d. installing grab bars

optimal calcium intake and estrogen replacement therapy other options are secondary and tertiary prevention metiods

open reduction

used for the treatment of a fracture

Needle aspiration

will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid

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? a. Raloxifene b. Alendronate c. Calcium gluconate d. Tamoxifen

a. Raloxifene

Which of the following are common primary sites of tumors that metastasize to the bone? Select all that apply. a. kidney b. lung c. breast d. ovary e. prostate

a. kidney b. lung e. prostate

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? a. avascular necrosis b. osteomyelitis c. osteoporosis

b. osteomyelitis

Which of the following aspects should a nurse include in the teaching plan for a patient with osteomalacia? a. Include the supplements of calcium, phosphorus, and vitamin D b. limit exposure to sunlight c. avoid mild exercise d. limit intake of dairy

a. Include the supplements of calcium, phosphorus, and vitamin D nurse should encourage the patients with osteomalacia to include the supplements of calcium, phosphorus, and vitamin D; adequate nutrition; exposure to sunlight; and progressive exercise and ambulation

Which group is at the greatest risk for osteoporosis? a. caucasian women b. men c. african american women

a. caucasian women

Which client would the nurse identify as having the greatest risk for osteoporosis? a. A small-framed, thin 45-year-old white woman b. African American woman c. Men d. pt w. asthma

a. small framed thin 45-year old white woman -african american women have larger bone density/ @ a decreased risk

In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations? a. surgical debridement b. wound packing c. wound irrigation d. supplementation

a. surgical debridement

Select all of the following that are descriptors of the pathophysiologic process seen in osteomalacia. a 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. b. A deficiency of activated vitamin D (calcitriol) c. Calcium and phosphate are not moved to the bones. d. The bone mass is structurally weaker, and bone deformities occur.

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

The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given? a. Raloxifene (Evista) b. Alendronate (Fosamax) c. Terparatide (Forteo) d. denosumab (Prolia)

b. Alendronate (Fosamax)

Which medication classification is prescribed when allergy is a factor causing the skin disorder? a. corticosteroids b. antihistamines c. antibiotics d. local anesthetics

b. antihistamines

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? a. estrogen deficiency b. bone fractures c. negative Ca balance d. Dowagers hump

b. bone fractures *neg Ca balance not a complication of osteoporosis

A patient has been prescribed alendronate (Fosamax) for the prevention of osteoporosis. Which of the following is the highest priority nursing intervention associated with the administration of the medication? a. ensure adequte intake of vit D b. have pt sit upright for 60 min. c. take corticosteroids w. it

b. have pt sit upright for 60 min.

The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective? a. keep a narrow base b. put the load close to the body c. bend hips and tighten abs

b. put the load close to the body also: bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? a. avoid twisting + flexion activities b. use large muscles of legs when lifting items c.

b. use large muscles of legs when lifting items

When an infection is blood borne the manifestations include which of the following symptoms? a. hypothermia b. bradycardia c. chills d. hyperreflexia

c. chills s/s: chills, high fever, rapid pulse, and generalized malaise

Most cases of osteomyelitis are caused by which of the following microorganisms? a. pseudomonas b E.coli c. staphylococcus d. proteus

c. staphylococcus

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:

carpal tunnel syndroms Tinels sign (numbness, tingling, and pain in response to light percussion over the median nerve)

Dowagers hump

caused by bone fractures develops when repeated vertebral fractures increase spinal curvature

A client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client's urination problem? a. renal calculi b. UTI c. benign prostatic hypertrophy d. dehydration

a. renal calculi

A male patient with a musculoskeletal injury is instructed to alter his diet. The objective of this diet alteration is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which of the following food items should the nurse encourage the patient to include in the diet? a. vitamin d fortified milk b. red meat c. bananas d. leafy green veggies

a. vitamin d fortified milk

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? a. walking or exercising outside b. decrease Ca intake c. drink a glass of wine with dinner every night.

a. walking or exercising outside walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation

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

a. Sit with the buttocks "tucked under." c. Avoid hip extension d. Place feet flat on the floor. e. Sit with the buttocks "tucked under."

Which of the following inhibits bone resorption and promotes bone formation? a. calcitonin b. PTH c. estrogen d. corticosteroids

a. calcitonin

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? a. lower lumber b. cervical c. upper sacral d. thoracic

a. lower lumber L4-L5 and L5-S1

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. mortons neuroma d. ganglion

a. plantar fasciitis