Exam 1 - Chapter 41 Musculoskeletal Disorders
A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? "Use your continuous passive motion machine for 2 hours each day." "You need to perform weight-bearing exercises twice a week." "You need to limit the amount of protein and calcium in your diet." "You will receive IV antibiotics for 3 to 6 weeks."
"You will receive IV antibiotics for 3 to 6 weeks."
Health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. Select the daily dosage of calcium and vitamin D that the nurse should recommend. 1,800 mg; 1,600 IU 1,600 mg; 1,400 IU 1,400 mg; 1,200 IU 1,200 mg; 1,000 IU
1,200 mg; 1,000 IU
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? Open reduction Needle aspiration Arthroplasty Arthroscopy
Arthroscopy
A client with diabetes punctured the foot with a sharp object. 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? 6 months 3 months 7 to 10 days At least 4 weeks
At least 4 weeks
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)? Calcitonin Raloxifene Teriparatide Vitamin D
Calcitonin
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD? Calcitonin (Miacalcin) Raloxifene (Evista) Teriparatide (Forteo) Vitamin D
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 physician prescribes raloxifene to a hospitalized client. The client's history includes a right hip fracture, hysterectomy, deep vein thrombosis, and hypertension. Which action by the nurse demonstrates safe nursing care? Administering the raloxifene in the evening Holding the raloxifene and notifying the physician Administering the raloxifene with food or milk Having the patient sit upright for 30-60 minutes following administration
Holding the raloxifene and notifying the physician Raloxifene is contraindicated in clients with a history of deep vein thrombosis. The nurse should hold the medication and notify the physician. Raloxifene can be given without regard to food or time of day. Raloxifene is a selective estrogen receptor modulation medication. Sitting upright for 30-60 minutes is indicated with drugs classified as bisphosphonates.
A nurse is caring for a client with bone metastasis from a primary breast cancer. The client reports muscle weakness and nausea and is voiding large amounts frequently. The telemetry monitor is observed showing premature ventricular contractions. What should the nurse suspect based on the clinical manifestations? Hypercalcemia Hypocalcemia Hypokalemia Hyperkalemia
Hypercalcemia Hypercalcemia is present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias such a premature ventricular contractions, seizures, and coma. Hypercalcemia must be identified and treated promptly. Hypocalcemia will not be seen with bone cancer. Hypokalemia and hyperkalemia are not common with bone metastasis.
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? Living a sedentary lifestyle to reduce the incidence of injury Stopping estrogen therapy Taking a 300-mg calcium supplement to meet dietary guidelines Initiating weight-bearing exercise routines
Initiating weight-bearing exercise routines Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.
The nurse is discussing conservative management of tendonitis with a patient. Which of the following is likely the most effective approach to managing tendonitis? Weight reduction Stress reduction Intermittent application of ice and heat Range-of-motion (ROM) exercise of the affected joint
Intermittent application of ice and heat
A 67-year-old woman with a history of osteoarthritis has been admitted to the postsurgical unit from the PACU following a bunionectomy. Which of the following nursing actions should the nurse integrate into this patient's immediate care? Maintain the patient's foot in a dependent position. Apply ice to the affected foot on a schedule of 1 hour on and 1 hour off. Keep the patient's foot elevated above the level of her heart. Change the patient's surgical dressing and irrigate the surgical site every 6 hours.
Keep the patient's foot elevated above the level of her heart.
A client is informed of having a benign bone tumor but that this type of tumor that may become malignant. The nurse knows that this is characteristic of which type of tumor? Osteochondroma Enchondroma Osteoclastoma Osteoid osteoma
Osteoclastoma An osteoclastoma is a giant cell tumor that may invade local tissue; usually soft and hemorrhagic and may become malignant. An osteochondroma occurs as a large projection of bone at the ends of long bones, developing during growth periods and then becoming static bone mass. An enchondroma is a hyaline cartilage tumor that develops in the hand, ribs, femur, tibia, humerus, or pelvis. An osteoid osteoma is a painful tumor surrounded by reactive bone tissue.
A client with Paget's disease comes to the hospital and reports difficulty urinating. The emergency department health care provider consults urology. What should the nurse suspect is the most likely cause of the client's urination problem? Renal calculi Urinary tract infection (UTI) Benign prostatic hyperplasia Dehydration
Renal calculi
A client has Paget's disease. An appropriate nursing diagnosis for this client is: Risk for infection Delayed wound healing Risk for falls Fatigue
Risk for falls
Following diagnostic testing, a 69-year-old male patient has been diagnosed with Paget's disease. When planning the subsequent care that this patient is likely to require, what nursing diagnosis should most likely be prioritized by the nurse? Risk for peripheral neurovascular dysfunction related to Paget's disease Impaired physical mobility related to Paget's disease Risk for impaired skin integrity related to Paget's disease Unilateral neglect related to Paget's disease
Risk for impaired skin integrity related to Paget's disease
A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate? "You will need to decrease the amount of dairy products you consume." "You will need to avoid foods high in phosphorus and vitamin D." "You may need to be evaluated for an underlying cause, such as renal failure." "You will need to engage in vigorous exercise three times a week for 30 minutes."
"You may need to be evaluated for an underlying cause, such as renal failure." The client may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The client needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The client is at risk for pathological fractures and therefore should not engage in vigorous exercise.
The nurse is collaborating with the health care provider on a plan of care for a 54-year-old male client with osteomyelitis of the left femur secondary to uncontrolled type 1 diabetes. Click to highlight the prescriptions for care that the nurse should anticipate for this client. * Place the left foot in a dependent position. * Perform neurovascular checks of lower extremities every 8 hours. * Administer IV antibiotic based on culture and sensitivity report. * Encourage ambulation with weight-bearing on the left leg. * Administer ibuprofen 400 mg orally three times daily, as needed for pain. * Make referral to dietitian to discuss nutrition for healing and blood glucose control. * Provide education on self-blood glucose monitoring and insulin administration.
Perform neurovascular checks of lower extremities every 8 hours. * Administer IV antibiotic based on culture and sensitivity report. Administer ibuprofen 400 mg orally three times daily, as needed for pain. * Make referral to dietitian to discuss nutrition for healing and blood glucose control. * Provide education on self-blood glucose monitoring and insulin administration.
A nurse is providing an educational class to a group of older adults at a community senior center. The topic of the class is nutrition. The nurse informs the group that their recommended adequate intake (RAI) level of calcium daily is what? 1,000 mg 1,100 mg 1,200 mg 1,300 mg
1,200 mg
The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given? Alendronate Raloxifene Teriparatide Denosumab
Alendronate
A client is evaluated for a diagnosis of Paget's disease. Which laboratory value would the nurse find to confirm the diagnosis? Calcium of 9.2 mg/dL (2.3 mmol/L) Urinary creatinine of 0.95 mg/dL (83.98 mmol/L) Alkaline phosphate of 165 IU/L (2750 mmol/L) Magnesium level of 2 mg/dL (0.82 mmol/L)
Alkaline phosphate of 165 IU/L (2750 mmol/L)
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? Bone fracture Loss of estrogen Negative calcium balance Dowager's hump
Bone fracture
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. Elevate the affected leg. Apply ice packs to the affected knee. Assist the client to "walk off" the pain. Apply a knee brace or wrap the affected knee.
Elevate the affected leg. Apply ice packs to the affected knee. Apply a knee brace or wrap the affected knee.
A client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings? Avascular necrosis Fat embolism Osteomyelitis Compartment syndrome
Osteomyelitis
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? Gastrocnemius Latissimus dorsi Quadriceps Rectus abdominis
Quadriceps
Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women? Raloxifene Fosamax Forteo Denosumab
Raloxifene
Which is a risk-lowering strategy for osteoporosis? Low initial bone mass Diet low in calcium and vitamin D Smoking cessation Increased age
Smoking cessation
Most cases of osteomyelitis are caused by which microorganism? Staphylococcus aureus Proteus species Pseudomonas species Escherichia coli
Staphylococcus aureus
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? Teaching the patient to achieve maximum weight-bearing capabilities Maintaining strict bed rest Supporting the affected extremity with external supports (splints) Limiting the patient's reliance on assistive devices
Supporting the affected extremity with external supports (splints)
A nurse is performing foot care for a client with chronic osteomyelitis and the client asks the nurse about the next treatment. What is the specific treatment for a client with chronic osteomyelitis? Aggressive physical therapy Drainage of localized foci of infection Continued aseptic wound treatment Surgical removal of the sequestrum
Surgical removal of the sequestrum A sequestrectomy, removal of enough involucrum to enable the surgeon to remove the sequestrum, is performed on clients with chronic osteomyelitis. In many cases, sufficient bone is removed to convert a deep cavity into a shallow saucer (saucerization). All dead, infected bone and cartilage must be removed before permanent healing can occur. Aggressive physical therapy is not recommended until healing has occurred. Draining the infection is not sufficient to heal chronic osteomyelitis. Continued wound care is not sufficient to heal the wound.
The client has just been diagnosed with osteomyelitis. What are possible causes of osteomyelitis? Select all that apply. Trauma, such as penetrating wounds or compound fractures Vascular insufficiency in clients with diabetes or peripheral vascular disease Surgical contamination, such as pin sites of skeletal traction Progressive osteoporosis
Trauma, such as penetrating wounds or compound fractures Vascular insufficiency in clients with diabetes or peripheral vascular disease Surgical contamination, such as pin sites of skeletal traction
When teaching a client how to prevent low back pain as a result of lifting, the nurse should instruct the client to: avoid overreaching. place the load away from the body. use a narrow base of support. bend the knees and loosen the abdominal muscles.
avoid overreaching.
A client with diabetes punctured his foot 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? 6 months 3 months 7 to 10 days 3 to 6 weeks
3 to 6 weeks
When an infection is bloodborne, the manifestations include which symptom? Chills Bradycardia Hypothermia Hyperactivity
Chills Manifestations of bloodborne infection include chills, high fever, rapid pulse, and generalized malaise.
Which is not a risk factor for osteoporosis? being male small-framed, thin White or Asian women being postmenopausal family history
being male
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. Acute pain Disturbed body image Imbalanced nutrition: less than body requirements Risk for injury Ineffective airway clearance
Acute pain Disturbed body image Imbalanced nutrition: less than body requirements Pain is a priority problem for the client with osteomyelitis that can interfere with mobility of joint. In this situation, the client's jaw is the site of infection. Pain in this location can interfere with nutritional intake of the individual. Chronic osteomyelitis presents with a nonhealing ulcer over the infected bone with a connecting sinus that will intermittently and spontaneously drain pus. A draining ulcer on the face can make the individual very self-conscious about appearance, leading to disturbed body image. This client is not at risk for injury or ineffective airway clearance.
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? Magnesium level Potassium level Alkaline phosphatase Troponin levels
Alkaline phosphatase Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly.
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? Inadequate nutrition Impaired physical mobility Risk for infection Disturbed body image
Disturbed body image
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: Osteomyelitis is usually caused by simultaneous infection with several microorganisms, which must be treated sequentially. Osteomyelitis requires treatment with topical antibiotics rather than IV antibiotics, necessitating a longer course of treatment. Osteomyelitis is usually the result of fungal infection rather than bacterial infection. Osteomyelitis involves the active infection of bone tissue, which is largely avascular.
Osteomyelitis involves the active infection of bone tissue, which is largely avascular.
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? High-Fowler's to allow for maximum hip flexion Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees Prone, with a pillow under the shoulders Supine, with the bed flat and a firm mattress in place
Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees
A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about a calcium supplement should the nurse include? Take weekly on the same day and at the same time. Remain in an upright position 30 minutes after taking the supplement. Take the supplement on an empty stomach with a full glass of water. Take the supplement with meals or with orange juice.
Take the supplement with meals or with orange juice. Calcium supplements should be taken with meals or with a beverage high in vitamin C for increased absorption. Calcium supplements are taken daily, not weekly. There are no special instructions about staying upright when taking calcium supplements.
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? The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor. The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor. The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit. The nurse is caring for this client on the intensive care unit.
The nurse is caring for this client on the intensive care unit. This client is critically ill; the diagnosis and immunosuppression place the client at a high risk for infection. The most appropriate place for this client is in an intensive care unit, where the nurse can focus exclusively on health promotion. This client shouldn't be on the oncology floor. This client requires close monitoring. The nurse caring for this client shouldn't also be caring for other clients who may require frequent interventions.
A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. To prevent fractures, the client should avoid strenuous exercise. The recommended daily allowance of calcium may be found in a wide variety of foods. Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.
The recommended daily allowance of calcium may be found in a wide variety of foods.
To help minimize calcium loss from a hospitalized client's bones, the nurse should: reposition the client every 2 hours. encourage the client to walk in the hall. provide the client dairy products at frequent intervals. provide supplemental feedings between meals.
encourage the client to walk in the hall. Calcium absorption diminishes with reduced physical activity because of decreased bone stimulation. Therefore, encouraging the client to increase physical activity, such as by walking in the hall, helps minimize calcium loss. Turning or repositioning the client every 2 hours wouldn't increase activity sufficiently to minimize bone loss. Providing dairy products and supplemental feedings wouldn't lessen calcium loss — even if the dairy products and feedings contained extra calcium — because the additional calcium doesn't increase bone stimulation or osteoblast activity.
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? Osteomalacia Ganglion Osteomyelitis Paget disease
Paget disease
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.) Pain Erythema Fever Leukopenia Purulent drainage
Pain Erythema Fever Leukopenia Purulent drainage
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? Potassium level of 6.3 mEq/L Calcium level of 11.6 mg/dl Sodium level of 110 mEq/L Magnesium level of 0.9 mg/dl
Calcium level of 11.6 mg/dl In clients with bone cancer, tumor destruction of bone commonly causes excessive calcium release. When the calcium-excreting capacity of the kidneys and GI tract is exceeded, the serum calcium level rises above normal, leading to hypercalcemia (a serum calcium level greater than 10.2 mg/dl). Hyperkalemia (a potassium level greater than 5 mEq/L) isn't caused by bone cancer and is seldom associated with chemotherapy. Hyponatremia (a sodium level less than 135 mEq/L) and hypomagnesemia (a magnesium level less than 1.3 mg/dl) are potential adverse effects of chemotherapy; these electrolyte disturbances don't result directly from bone cancer.
The nurse is collaborating with the health care provider on a plan of care for a 54-year-old male client with osteomyelitis of the left femur secondary to uncontrolled type 1 diabetes. Click to highlight the prescriptions for care that the nurse should anticipate for this client. * Place the left foot in a dependent position. * Perform neurovascular checks of lower extremities every 8 hours. * Administer IV antibiotic based on culture and sensitivity report. * Encourage ambulation with weight-bearing on the left leg. * Administer ibuprofen 400 mg orally three times daily, as needed for pain. * Make referral to dietitian to discuss nutrition for healing and blood glucose control. * Provide education on self-blood glucose monitoring and insulin administration.
Perform neurovascular checks of lower extremities every 8 hours. *Administer IV antibiotic based on culture and sensitivity report. Administer ibuprofen 400 mg orally three times daily, as needed for pain. *Make referral to dietitian to discuss nutrition for healing and blood glucose control. *Provide education on self-blood glucose monitoring and insulin administration.
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? Wound packing Wound irrigation Vitamin supplements Surgical debridement
Surgical debridement
A client with a musculoskeletal injury is instructed to alter the diet. The objective of altering the diet is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which food item should the nurse encourage the client to include in the diet? Red meat Bananas Vitamin D-fortified milk Green vegetables
Vitamin D-fortified milk
A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest? Yoga Walking Bicycling Swimming
Walking Weight-bearing exercises should be incorporated into the client's lifestyle activities. Walking is a low-impact method of weight-bearing exercise and would be the most universal or most likely form of exercise for the nurse to recommend. Bicycling, and swimming are not weight-bearing exercise and will not increase bone density. Yoga may or may not be weight-bearing exercise depending on the yoga poses being performed; it is not as likely as walking to be recommended by the nurse.
A nurse is planning the care of a middle-aged female patient whose sedentary lifestyle has contributed to ongoing problems with lower back pain. The nurse should recognize which of the following interventions as holding the potential for adequate and long-lasting pain control? Use of a back brace Orthopedic footwear Weight loss Antiseizure medications
Weight loss
