Module 6 EAQs

A postmenopausal woman has been administered raloxifene for osteoporosis. Which parameter would the nurse assess to ensure the efficacy of the medication and continuation of use? A. Body weight B. Bone density C. Calcium levels in urine D. Esophageal functioning

B. Bone density Rationale: An increase in bone density indicates a good therapeutic response to raloxifene. Thus this parameter should be assessed during therapy for osteoporosis. Body weight may or may not increase with bone weight, and this parameter should not be used to assess a positive response to the medication. Calcium levels in the blood indicate response to the therapy rather than calcium levels in urine. Esophageal dysfunction is a contraindication to bisphosphonate therapy.

Which hormone promotes bone resorption in a client and potentially leads to decreased bone densities? A. Estrogen B. Calcitonin C. Growth hormone D. Parathyroid hormone (PTH)

D. Parathyroid hormone (PTH) Rationale: When serum calcium levels lower, secretion of PTH increases and stimulates bones to promote osteoclastic activity, which promotes bone resorption. Estrogens stimulate osteoblastic (bone-building) activity and inhibit PTH. Calcitonin inhibits bone resorption and increases the renal excretion of calcium and phosphorus as needed to maintain balance in the body. Growth hormones secreted by the anterior lobe of the pituitary gland are responsible for increasing bone length

The nurse is assessing a client with a moon-shaped face and thin arms and legs. The nurse expects which other assessment findings? (SATA) A. Weight loss B. Gastric ulcer C. Pain in bones D. Poor appetite E. Muscle weakness

B. Gastric ulcer C. Pain in bones E. Muscle weakness Rationale: The presence of such symptoms as a moon-shaped face and thin arms and legs indicates Cushing syndrome. In Cushing syndrome, the cortisol level rises resulting in gastric ulcer formation caused by increased hydrochloric acid secretion and decreased production of protective gastric mucus. Osteoporosis is common in Cushing syndrome; therefore bone pain is common. Clients may also feel muscle weakness. Clients with Cushing syndrome experience increased appetite and weight gain, therefore they display truncal obesity and a 'buffalo hump.'

A nurse is creating a plan of care for a client with rheumatoid arthritis who has severe pain and swelling of the hand joints. Which details about range-of-motion exercises would the plan include? A. Passively performing the exercises for the client B. Discontinuing the exercises if the client reports discomfort C. Applying heat or cold before the exercises D. Increasing the vigor of the exercises to restore mobility

C. Applying heat or cold before the exercises Rationale: Heat and cold applications reduce inflammation and discomfort. Passively performed exercises by the nurse will depend on the client's tolerance. Avoiding exercise will increase the destructive effects of immobility. Exercises are necessary to prevent contractures and permanent joint damage, but they cannot restore mobility that has been lost.

Which synovial joint movement is involved in turning a client's palm downward? A. Eversion B. Inversion C. Pronation D. Supination

C. Pronation Rationale: Pronation is the movement involved in turning the palm downward. Eversion involves turning the sole outward away from the midline of the body. Inversion involves turning the sole inward towards the midline of the body. Supination involves turning the palm upward.

Which surgery is used as a prophylactic measure and as a palliative treatment for clients with rheumatoid arthritis (RA)? A. Osteotomy B. Arthrodesis C. Synovectomy D. Debridement

C. Synovectomy Rationale: Synovectomy is a type of joint surgery that involves the removal of thickened synovial membrane. It is used as a prophylactic measure and as a palliative treatment for rheumatoid arthritis (RA) because it prevents the serious destruction of joint surfaces. Osteotomy involves removing a wedge of bone to correct deformity and relieve pain. Arthrodesis is the surgical fusion of a joint. Debridement involves the surgical removal of degenerative debris from a joint.

Which findings are consistent with hypercalcemia after prolonged immobility? (SATA) A. Bone pain B. Convulsions C. Muscle spasms D. Tingling of extremities E. Depressed deep tendon reflexes

A. Bone pain E. Depressed deep tendon reflexes Rationale: Increased serum calcium comes from bone demineralization, which results in bone pain. Depressed or absent deep tendon reflexes are associated with hypercalcemia. The body's excitable tissues are affected most (e.g., nerves, muscles, heart, intestinal smooth muscles). Convulsions are not a sign of hypercalcemia; convulsions can occur with hypocalcemia, hypernatremia, and hyponatremia. Muscle spasms are not a sign of hypercalcemia; muscle spasms can occur with hypocalcemia, hyponatremia, and hypokalemia. Tingling of extremities is not a sign of hypercalcemia; paresthesias are associated with hypocalcemia and hyperkalemia.

Which structure protects a client's internal organs, supports blood cell production, and stores minerals? A. Joints B. Bones C. Muscles D. Cartilages

B. Bones Rationale: Bones are the framework of the body; they support and protect internal organs. They also help in stem cell production from bone marrow, and they store minerals. Joints (articulations) help articulate the bones. Muscles are the bundles of fibrous tissue that contract to produce movement and maintain body posture. Cartilage is a hyaline, elastic, and fibrous tissue that often functions as a shock absorber.

Which change in the joint may result in joint pain for older adults? A. Dehydration of discs B. Loss of muscle mass C. Decreased elasticity in the ligaments D. Increased cartilage erosion

C. Decreased elasticity in the ligaments Rationale: Joint pain in an older adult is due to increased cartilage erosion. A loss in height and shortening of the trunk is due to a loss of water from the discs. A decrease in muscle cells causes a decrease in muscle strength. An increased rigidity in the neck, shoulders, back, hips, and knees is due to a loss of elasticity in the ligaments.

After completing physical assessments and review of laboratory data, which client would the nurse identify as having findings consistent with rheumatoid arthritis? A. Client A B. Client B C. Client C D. Client D

Client D Rationale: Erythrocyte sedimentation rate (ESR) is a nonspecific index of inflammation. Its normal value is less than 30 mm/hr. Client D, who has elevated levels of ESR to 65 mm/hr, may present with rheumatoid arthritis, osteomyelitis, rheumatic fever, or respiratory tract infections. Uric acid is an end product of purine metabolism. The normal range of uric acid is 2.3 to 7.6 mg/dL (137-452 μmol/L). An elevation in the uric acid value in client A to 8.5 mg/dL may result in gout. The normal value of Creactive protein (CRP) is 6.8 to 820 mcg/dL (68-8200 mcg/L). Client B, who presents with a normal level of CRP at 800 mcg/dL (8000 mcg/L), will not have inflammatory diseases, infections, or active, widespread malignancy. Client C, who has elevated levels of anti-DNA antibody at 90 IU/mL, may be more susceptible to systemic lupus erythematosus (SLE). The normal value of anti-deoxyribonucleic acid (DNA) antibody is less than 70 IU/mL; it helps detect serum antibodies that react with DNA.

Which tissue connects the client's tibia to the femur at the knee joint? A. Fascia B. Bursae C. Tendons D. Ligaments

D. Ligaments Rationale: A ligament is a dense, fibrous connective tissue that connects bone to bone, such as the tibia to the femur at the knee joint. Ligaments provide stability while permitting controlled movement at the joint. Fascia is a connective tissue that can withstand limited stretching; it provides strength to muscle tissues. Bursae are small sacs of connective tissue lined with synovial membrane and synovial fluid that are located at bony prominences and joints to relieve pressure. A tendon is a dense, fibrous connective tissue that attaches muscle to bone

Which type of synovial joint movement is involved in moving the client's first and fifth metacarpals anteriorly from the flattened palm? A. Flexion B. Extension C. Abduction D. Opposition

D. Opposition Rationale: Opposition is a synovial movement that involves moving the first and fifth metacarpals anteriorly from the flattened palm (cupping position). Flexion involves bending the joint as a result of muscle contractions that result in decreasing the angle between two bones. Extension involves the straightening of the joint that increases the angle between two bones. Abduction involves the movement of a part away from the midline of the body.

At which joint would the nurse be able to palpate spongy swelling caused by excess synovial fluid? A. Biaxial joint B. Pivotal joint C. Synovial joint D. Temporomandibular joint

D. Temporomandibular joint Rationale: The temporomandibular joint is palpated by asking the client to open their mouth; the nurse checks for any pain or weakness in the face. Common abnormal findings include tenderness, crepitus (a grating sound), and a spongy swelling caused by excess synovial fluid. Biaxial joints help in the gliding movement of the wrist. Pivot joints permit rotation in the radioulnar area. Synovial joints provide movement at the point of contact of articulating bones such as the hip, shoulders, and knees

The primary health care provider prescribed medications to four clients with osteoporosis. Which client would the nurse instruct to remain upright for 30 minutes after receiving the medication? A. Client A (Alendronate) B. Client B (Zoledronic acid) C. Client C (Calcium supplements) D. Client D (Raloxifene)

A. Client A (Alendronate) Rationale: Alendronate therapy may cause esophageal ulcers. The nurse instructs client A to remain upright for 30 minutes after medication administration to prevent esophageal ulcers. Standing upright for 30 minutes after medication administration will move the medication fast in the stomach. Client B who is prescribed zoledronic acid is instructed to have a dental examination before medication administration. Client C who is prescribed calcium supplements is advised to take a third of the daily dose at bedtime. Client D who is prescribed raloxifene is advised to have a liver function test done.

Which finding in older adult clients is associated with aging? A. Decrease in height B. Decreased neck rigidity C. Increased fine-motor dexterity D. Increased range of motion (ROM)

A. Decrease in height Rationale: Loss of height and deformity and shortening of the trunk are common in older adults because of vertebral compression and degeneration. Rigidity in the neck, shoulders, back, hips, and knees increases with age because of loss of elasticity in ligaments, tendons, and cartilage. A decline in fine-motor dexterity occurs in the older adult because of slow impulse conduction along motor units. Range of motion (ROM) is limited in the older adult because of cartilage erosion, increased friction between the bones, and overgrowth of bone around joint margins.

The plan of care for a client with osteoporosis includes active and passive exercises, calcium supplements, and daily vitamins. Which finding would indicate that the therapy is helping? A. Mobility increases. B. Fewer muscle spasms occur. C. The heartbeat is more regular. D. There are fewer bruises than before therapy

A. Mobility increases. Rationale: This regimen limits bone demineralization and reduces bone pain, thereby promoting increased mobility and activity. The occurrence of fewer muscle spasms is unrelated to osteoporosis; it would be an expected outcome if the client were receiving calcium for hypocalcemia. A more regular heartbeat is unrelated to osteoporosis or its therapy. The occurrence of fewer bruises than before therapy is unrelated to osteoporosis; it would be expected if the client were receiving vitamin C for capillary fragility.

Which activities would be encouraged of a child with juvenile idiopathic arthritis to prevent loss of joint function? (SATA) A. Riding a bicycle B. Walking to school C. Watching videos after school D. Swimming in the community pool E. Playing computer games after school

A. Riding a bicycle B. Walking to school D. Swimming in the community pool Rationale: Riding a bicycle and walking are low-impact activities that help maintain joint mobility while not requiring too much weight bearing by the joints. Swimming helps maintain muscle tone while providing freedom of movement without the need to bear weight on the joints. Prolonged sitting, while watching videos or playing computer games, can lead to stiffness and flexion contractures.

Which advice will the nurse provide to the client after a health care provider prescribes aspirin for a client with severe arthritis? A. Take the medicine with meals. B. See a dentist if bleeding gums develop C. Switch to acetaminophen if tinnitus occurs. D. Avoid spicy foods while taking the medication.

A. Take the medicine with meals. Rationale: Acetylsalicylic acid is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response. Bleeding gums should be reported to the health care provider, not the dentist. Acetaminophen does not contain the anti-inflammatory properties present in aspirin; tinnitus should be reported to the health care provider. Avoiding spicy foods is unnecessary as long as aspirin is taken with food.

The health care provider prescribed raloxifene for a client with osteoporosis. Which manifestation would the nurse monitor in this client? A. Check serum creatinine B. Monitor urinary calcium C. Monitor liver function tests D. Observe for anxiety and drowsiness

C. Monitor liver function tests Rationale: Raloxifene increases the risk for hepatic disease. The nurse would monitor the client's liver function test when prescribed this medication. Check serum creatinine for clients prescribed zoledronic acid. Monitor urinary calcium in clients prescribed calcium supplements. Observe for anxiety and drowsiness in clients prescribed risedronate.

To prevent thrombophlebitis in the immediate postoperative period, which action is important for the nurse to include in the client's plan of care? A. Increase fluid intake. B. Restrict fluids. C. Encourage early mobility. D. Elevate the foot of the bed

C. Encourage early mobility. Rationale: In the immediate postoperative period, mobility is encouraged because veins require the assistance of the surrounding muscle beds to help pump blood toward the heart. This reduces venous stasis and the risk of thrombophlebitis. Increased fluid intake, if not contraindicated, will prevent dehydration and venous stasis. Restriction of fluids may promote venous stasis and increase risk. Elevating the foot of the bed will not prevent thrombophlebitis.

Which physiological change of the musculoskeletal system would the nurse associate with aging? (SATA) A. Slowed movement B. Cartilage degeneration C. Increased bone density D. Increased range of motion E. Increased bone prominence

A. Slowed movement B. Cartilage degeneration E. Increased bone prominence Rationale: The physiological changes of the musculoskeletal system related to aging are slowed movements, cartilage degeneration, increased bone prominence, decreased bone density, and decreased range of motion.

The nurse provides moist heat for a client with cartilage degeneration. Which rational explains the use of this nursing intervention? A. Pronation B. Eversion C. Adduction D. Supination

B. Eversion Rationale: Eversion is a synovial joint movement that describes turning the sole outward away from the midline of the body. Pronation is a synovial joint movement that describes turning the palm downward. Adduction is a synovial joint movement that describes movement toward midline of the body. Supination is a synovial joint movement that describes turning the palm upward.

The nurse recommends that, when in bed, a client who has osteoarthritis should lie in the supine or prone position. The client states that these positions are uncomfortable for the knees and hips. Which action would the nurse take? A. Encourage the client to maintain extension for specific periods of time. B. Urge the client to lie in whatever position is most comfortable. C. Insert a pillow under the client's knees to relieve discomfort. D. Place the client in the semi-Fowler position most of the time.

A. Encourage the client to maintain extension for specific periods of time. Rationale: Flexion contractures of the hips and knees can develop unless some periods of full extension are maintained. The most comfortable position that usually is assumed is one of flexion, which leads to contractures and should be avoided. Placing a pillow under the knees can cause flexion contractures of the hips and knees. Remaining in the semi-Fowler position can cause flexion contractures of the hips.

The nurse is completing the health history of a client admitted to the hospital with osteoarthritis. Which joint would the nurse expect the client to report as having been involved first? (SATA) A. Hips B. Knees C. Ankles D. Shoulders E. Metacarpals

A. Hips B. Knees Rationale: Osteoarthritis affects the weight-bearing joints (e.g., hips and knees) first because they bear the most body weight. The resulting joint damage causes a series of physiologic responses (e.g., release of cytokines and proteolytic enzymes) that lead to more damage. Although the ankles are weight-bearing joints and eventually are affected, the motion in the ankles is not as great as in the hips and knees; thus there is less degeneration. Shoulder joints are not the most likely to be involved first, because these are not weight-bearing joints. Although the distal interphalangeal joints are commonly affected, the remaining interphalangeal joints and metacarpals are not.

Which nursing intervention would the nurse include in the plan of care for an older adult client with decreased bone density? A. Teaching the client isometric exercises B. Advising the client to take a warm shower C. Providing supportive armchairs to the client D. Demonstrating weight-bearing exercises to the client

D. Demonstrating weight-bearing exercises to the client Rationale: Decreased bone density leads to osteoporosis; weight-bearing exercises help build and maintain bone density. Isometric exercises are indicated for clients with muscular atrophy. Clients with cartilaginous degeneration are advised to take moist heat showers to increase blood flow to the region. Correction of posture problems by sitting in a supportive armchair provides support to the bony structures for a client with kyphosis.

Which example demonstrates clinical decision-making by the nurse? A. "I palpated the right hip of the client, which appeared red, and noted a warm feeling." B. "I identified impaired skin integrity in a pressure ulcer document upon finding redness in the client's hip." C. "I discussed the use of salt with a client who has a history of hypotension history and suffers from light-headedness and dizziness." D. "I assessed weakness and hunger in a client with a history of diabetes history who suffers with light-headedness and blurred vision."

B. "I identified impaired skin integrity in a pressure ulcer document upon finding redness in the client's hip." Rationale: Clinical decision-making is a problem-solving activity that focuses on defining a problem and selecting an appropriate action. As a part of clinical decision-making, the nurse identified impaired skin integrity in a pressure ulcer document on finding redness in the client's hip. Diagnostic reasoning and inference is an analytical process that involves determining the client's health problems. An example is the nurse palpating and observing a warm sensation in the client's right hip that has turned red. Another example is the nurse who finds that a client who has a history of hypotension now feels light-headedness and dizziness. A further example is the nurse who assesses symptoms of diabetes in a client who has a history of the disease and now suffers blurred vision.

An assessment of an 89-year-old client yields a history of severe congenital spinal deformity. Which condition would describe the nurse's finding? A. Lordosis B. Kyphosis C. Presbycusis D. Osteoporosis

B. Kyphosis Rationale: Kyphosis is an increase in the curvature of the thoracic spine and may result from a congenital abnormality. Lordosis, also known as swayback, is an increased lumbar curvature and may not be a congenital abnormality. Presbycusis is the loss of acuity for high-frequency tones and is not related to the spine. Osteoporosis is a condition in which the bones become brittle and fragile from the loss of tissue and bone mass.

Which factor in the client's history increases the risk for osteoporosis? A. Estrogen therapy B. Hypoparathyroidism C. Prolonged immobility D. Excessive calcium intake

C. Prolonged immobility Rationale: Prolonged immobility results in bone demineralization because there is decreased bone production by osteoblasts and increased resorption by osteoclasts. Estrogen helps prevent bone demineralization. Hypoparathyroidism decreases mobilization of calcium from the bones, thereby reducing the serum level of calcium. Decreased calcium intake or absorption may precipitate osteoporosis

Which injury would the nurse suspect in a young adult client who reports that a knee occasionally gives way, sometimes locks, and "clicks " when walking? A. Cracked patella B. Ruptured Achilles tendon C. Torn cartilage D. Stress fracture

C. Torn cartilage Rationale: These adaptations are consistent with torn cartilage; this injury is common among basketball players. A fractured patella will cause pain and usually manifests itself at the time of the injury. A ruptured Achilles tendon is painful and prevents plantar flexion of the foot; adaptations usually are manifested at the time of the injury. A stress fracture is associated with pain, not with a clicking or locking of the knee

After teaching a client about the use of calcitonin (nasal route) as treatment for osteoporosis, which client statement indicates effective learning? A. "I should expect some nausea when taking this medication." B. "I should stop the medication when the symptoms subside." C. "I should not take calcium supplements when taking calcitonin." D. "I should not spray the medication into the same nostril on 2 consecutive days.

D. "I should not spray the medication into the same nostril on 2 consecutive days. Rationale: Clients using a nasal form of calcitonin should spray the medication daily into alternate nostrils. The client's statement regarding the medication should not be sprayed into the same nostril on 2 consecutive days indicates effective learning. Nausea does not occur with the nasal spray. Clients should use the spray as directed and not stop the treatment without informing the primary health care provider. Clients should take calcium supplements during the course of the therapy to prevent secondary hyperparathyroidism.

The nurse teaches a client about wearing thigh-high anti-embolism elastic stockings. Which instruction would be correct to include? A. 'You do not need to wear them while you are awake, but it is important to wear them at night.' B. 'You will need to apply them in the morning before you lower your legs from the bed to the floor.' C. 'If they bother you, you can roll them down to your knees while you are resting or sitting down.' D. 'You can apply them either in the morning or at bedtime, but only after the legs are lowered to the floor.

B. 'You will need to apply them in the morning before you lower your legs from the bed to the floor.' Rationale: Applying anti-embolism elastic stockings in the morning before the legs are lowered to the floor prevents excessive blood from collecting and being trapped in the lower extremities as a result of the force of gravity. Elastic stockings are worn to prevent the formation of emboli and thrombi, especially in clients who have had surgery or who have limited mobility, by applying constant compression. It is contraindicated for antiembolism elastic stockings to be applied and worn at night, rolled down, or applied after the legs are lowered to the floor.

A client with a diagnosis of malabsorption syndrome exhibits a symptom of spastic muscle spasms. Which electrolyte is responsible for this symptom? A. Sodium B. Calcium C. Potassium D. Phosphorus

B. Calcium Rationale: The muscle contraction-relaxation cycle requires an adequate serum calcium/phosphorus ratio; the reduction of the ionized serum calcium level associated with malabsorption syndrome causes tetany (spastic muscle spasms). Sodium is the major extracellular cation. The major route of sodium excretion is the kidneys, under the control of aldosterone. Although it plays a part in neuromuscular transmission, potassium is not related to the development of tetany. Potassium is the major intracellular cation. Potassium is part of the sodium-potassium pump and helps balance the response of nerves to stimulation. Potassium is not related to the development of tetany. Although phosphorus is closely related to calcium, because they exist in a specific ratio, phosphorus is not related to the development of tetany

A primary health care provider schedules a bone scan for a client with osteoporosis. Which nursing action is beneficial for the client? (SATA) A. Placing the client in the supine position B. Verifying presence or absence of a shellfish allergy C. Ensuring the client does not have metal on their clothing D. Instructing the client to empty their bladder before the scan E. Informing the client that the postprocedure headache resolves in 2 days

A. Placing the client in the supine position D. Informing the client to empty their bladder before the scan Rationale: A bone scan is done to assess osteomyelitis, osteoporosis, primary and metastatic malignant lesions of bone, and certain fractures. The nurse has to place that client in the supine position for 1 hour for easy assessment while performing the bone scan. The nurse should instruct the client to empty the bladder before scanning. The client undergoing a computed tomography (CT) scan must be screened for a shellfish allergy to reduce the incidences of anaphylactic shock associated with the radiocontrast agent. Radio waves and a magnetic field are used during magnetic resonance imaging (MRI); therefore, the nurse should ensure that the client has no metal on the clothing before the procedure. The main risk of a myelogram is a spinal headache that usually resolves within 2 days of the procedure.

The nurse is caring for a client whose mobility is restricted to a wheelchair after a motor vehicle accident. The client has been prescribed physiotherapy as a part of rehabilitation care. Which interventions would the nurse consider when the client is discharged from the health care facility? (SATA) A. Focus firmly on the challenges faced by the client. B. Refrain from including children in the support system. C. Assist the family in identifying community support systems. D. Encourage the primary caregiver to set a routine time for respite. E. Consider the primary caregiver's experience in the discharge plan

C. Assist the family in identifying community support systems. D. Encourage the primary caregiver to set a routine time for respite. E. Consider the primary caregiver's experience in the discharge plan Rationale: The nurse would assist the family in identifying support within the community. The family may need assistance with meals, physiotherapy exercises, and care for younger children. The nurse would encourage the primary caregiver to set a routine time for respite. The nurse would consider the primary caregiver's experience and abilities with nursing care while planning client discharge. The nurse would not only focus on the weaknesses and challenges faced by the client but also on the client's strengths. Children should be included in the support system, and the client and family should spend time sharing their stories with each other.

Which rationale describes why the nurse would advise a client to have a dental examination before beginning prescribed therapy with zoledronic acid? A. To prevent kidney failure B. To prevent atrial fibrillation C. To prevent bronchoconstriction D. To prevent maxillary osteonecrosis

D. To prevent maxillary osteonecrosis Rationale: Zoledronic acid is a bisphosphonate used to treat osteoporosis that can cause maxillary osteonecrosis. The client should have a dental examination before starting the medication therapy to prevent maxillary osteonecrosis. The client's serum creatinine should be checked before and after administration of the medication to prevent kidney failure. To prevent atrial fibrillation, the medication should not be infused too quickly. The medication should not be given to a client who is sensitive to aspirin as it may cause bronchoconstriction.

Which condition is consistent with a client's report of posterior leg pain while walking that worsens upon rest? A. Crepitus B. Ankylosis C. Contracture D. Tendonitis

D. Tendonitis Rationale: The Achilles tendon attaches the calf muscle to the heel. An inflammation to the Achilles tendon, Achilles tendonitis, may lead to pain in the posterior leg upon movement that worsens at rest. A frequent, audible crackling sound with palpable grating that accompanies movement is crepitus. Chronic joint inflammation and destruction resulting in stiffness is ankylosis. A contracture is a condition in which the muscles and joints become rigid because of fibrosis of the supporting soft tissues.

Which population-level action would the nurse use to support tertiary prevention for clients with osteoporosis? A. Develop an educational campaign to support early identification of osteoporosis. B. Provide routine screening for osteoporosis at local health fairs and community sites. C. Support development of low-impact physical activity options for those diagnosed with osteoporosis. D. Encourage local providers to include discussion of strategies that reduce osteoporosis risk during annual wellness visits.

C. Support development of low-impact physical activity options for those diagnosed with osteoporosis. Rationale: Tertiary level prevention includes those aimed at rehabilitation or support including development of low-impact physical activity options in the community for osteoporosis. This would help decrease the risk for fractures, which is more common for those with osteoporosis. Campaigns that support early identification of osteoporosis and screening for osteoporosis are both secondary preventions. Discussion of strategies to reduce risk at annual wellness visits would support primary prevention efforts.

Which position would the nurse utilize to assess the client' s hip joint extension and buttocks? A. Dorsal recumbent B. Prone C. Lateral recumbent D. Supine

Rationale: To assess the extension of hip joint and buttocks, the client should be positioned in prone position (as seen in the second figure). The dorsal recumbent position (as seen in the first figure) is used for an abdominal assessment. The lateral recumbent position (as seen in the third figure) is used to assess murmurs. The supine position as seen in the fourth figure) is used to assess the heart, abdomen, extremities, and pulses.

Which finding during a home health visit would prompt the nurse to provide a client with home safety instructions? A. Area rugs on the floor B. Clogged, dirty fireplace C. Multiple electrical cords D. Multiple prescribed medications E. Wheeled walker with uneven legs

A. Area rugs on the floor B. Clogged, dirty fireplace C. Multiple electrical cords D. Multiple prescribed medications E. Wheeled walker with uneven legs Rationale: There are multiple potential hazards in the home clients should be educated about to avoid injury. Area rugs and multiple electrical cords on the floor pose a fall risk. A clogged, dirty fireplace could lead to carbon monoxide poisoning. Polypharmacy can cause mental status changes, confusion, and orthostatic blood pressure changes; these can increase the client's fall risk. If the nurse observes a wheeled walker with uneven legs, the physical therapist would be notified as they can follow-up to evaluate the mobility aid's safety.

Which diagnostic test would be used for the direct visualization of ligaments, menisci, and articular surfaces of joints? A. Arthroscopy B. Muscle biopsy C. Ultrasonography D. Electromyography

A. Arthroscopy Rationale: Arthroscopy is a diagnostic test that uses an arthroscope to directly visualize the ligaments, menisci, and articular surfaces of a joint. A muscle biopsy is conducted to diagnose atrophy and inflammation. An ultrasonography is used to view soft tissue disorders, traumatic joint injuries, and osteomyelitis. An electromyography may be performed to evaluate diffuse or localized muscle weakness.

A pregnant client is prescribed heparin to prevent the risk of thromboembolism. Which is a possible adverse effect of this medication when used during pregnancy? (SATA) A. Osteoporosis B. Suppression of contractions in labor C. Increased risk of serious bleeding D. Stimulation of uterine contraction E. Compression fractures of the spine

A. Osteoporosis C. Increased risk of serious bleeding E. Compression fractures of the spine Rationale: Heparin is an anticoagulant. When heparin is taken during pregnancy, it may cause osteoporosis, which in turn can cause compression fractures of the spine. There is an increased risk of serious bleeding to any patient for whom heparin therapy is ordered. The use of aspirin in the near term of pregnancy can suppress contractions in labor. The increased risk of serious bleeding also occurs with use of aspirin during pregnancy. The use of prostaglandin during pregnancy can cause stimulation of uterine contraction and can cause abortion.

The nurse teaches a client who is premenopausal and obese about strategies to prevent osteoporosis. Which strategy identified by the client indicates that the teaching is effective? A. Start a rapid, strict weight-reduction diet B. Join a tennis league and practice every day C. Take 1200 international units of vitamin D a day D. Sign up for a swimming class three times a week

B. Join a tennis league and practice every day Rationale: High-impact exercises (e.g., tennis, running, aerobics, dancing) are best for building bone mass. Weight loss should be slow and reasonable; restricting calories promotes production of the hormone leptin, which stimulates bone loss. The recommended intake of vitamin D for adults younger than 50 years of age (premenopausal women) is 800 international units; 1200 mg is the recommended daily dose of calcium for adults older than 50 years of age (postmenopausal women). Signing up for a swimming class three times a week may promote overall health and vigor, but it will not increase the strength or mass of bone.

For which physiological condition would the nurse teach an older adult client about the use of isometric exercises? A. Kyphosis B. Muscle atrophy C. Decreased bone density D. Decreased range of motion (ROM

B. Muscle atrophy Rationale: Muscle atrophy occurs due to muscular weakness; isometric exercises can help increase muscular strength. Introducing the client to proper body mechanics and instructing the client to sit in supportive chairs with arms reduces kyphosis. Teaching safety tips to prevent falls and reinforcing the need to exercise reduces complications associated with decreased bone density. The nurse should assess the client's ability to perform activities of daily living and mobility in a client with a decreased ROM.

How does the skeletal system of a toddler differ from that of an older adult? A. Toddlers' bones are less pliable than the bones of older persons. B. Toddlers' bones can withstand falls better than the bones of older adults. C. Toddlers' bones are more susceptible to osteoporosis than the bones of older adults. D. Toddlers' bones are more susceptible to bone loss than the bones of older persons.

B. Toddlers' bones can withstand falls better than the bones of older adults. Rationale: The bones of toddlers can better withstand falls than the bones of older adults. Toddlers' bones are more pliable than the bones of older people. Older adults, especially women, are more prone to developing osteoporosis, which increases the risk of fractures. Older adults, especially women, are more susceptible to bone loss.

Which physiological change occurs in older adults and warrants the nurse teaching the client about safety tips to prevent falls? A. Slowed movement B. Cartilage degeneration C. Decreased bone density D. Decreased range of motion (ROM)

C. Decreased bone density Rationale: Teaching safety tips to prevent falls would best help a client with decreased bone density. If a client experiences slow movements, the nurse should not rush the client because the client may become frustrated if hurried. Providing a client with cartilage degeneration with a moist heat source such as a shower or a warm compress is beneficial because this action may increase blood flow to the area. The nurse should assess a client's ability to perform activities of daily living and mobility to help improve the self-care skills of clients with a decreased range of motion.

The nurse is assessing a client with arthritis. Which statement made by the client indicates a precipitating factor? A. "The pain is usually present in my fingers and knees." B. "I observed swelling and redness near the pain area." C. "I feel the pain in each and every joint of my hands and legs." D. "I run for 30 minutes every day; this exercise increases my pain.

D. "I run for 30 minutes every day; this exercise increases my pain. Rationale: A precipitating factor is an activity or factor that worsens the symptoms. If running for 30 minutes each day increases the client's pain, this action is a precipitating factor. By saying, "The pain is usually present in my fingers and knees," the client is providing information about the location. Swelling and redness are concomitant symptoms of pain. The quality factor indicates the description of the symptom; this is exemplified by the statement, "I feel the pain in each and every joint of my hands and legs."

After a below-the-knee amputation, a client is refusing to eat, talk, or perform any rehabilitative activities. Which approach would the nurse take when interacting with this client? A. Explain why there is a need to increase activity B. Emphasize that with a prosthesis, there will be a return to the previous lifestyle. C. Appear cheerful and noncritical regardless of the client's response to attempts at intervention. D. Acknowledge that the client's withdrawal is an expected and necessary part of initial grieving.

D. Acknowledge that the client's withdrawal is an expected and necessary part of initial grieving Rationale: The withdrawal provides time for the client to assimilate what has occurred and to integrate the change in body image. The client is not ready to hear explanations about why there is a need to increase activity until assimilation of the surgery has occurred. Emphasizing a return to the previous lifestyle does not acknowledge that the client must grieve; it also does not allow the client to express any feelings that life will never be the same again. In addition, it may be false reassurance. The client might feel that the nurse has no comprehension of the situation or understanding of feelings if the nurse appears cheerful and noncritical regardless of the client's response to attempts at intervention.

Which client's plan of care needs revision? A. Client A B. Client B C. Client C D. Client D

D. Client D Rationale: An anterior cruciate ligament (ACL) tear is a traumatic tearing of a ligament by deceleration forces to the legs and knees. Client D, who has an ACL tear, is treated with physical therapy, rehabilitation, and a knee brace. Ice compresses may not completely relieve the client's pain, and the pain may be elevated upon performing balancing exercises. Inflammation along the anterior aspect of the calf from periostitis due to improper shoes is known as shin splints. Client A, who has shin splints, can be treated with rest, cool ice compresses, proper shoes, and a gradual increase in activity. A tear within a muscle or in the tendinoligamentous structures around the shoulder is known as a rotator cuff tear. Client B, who has a rotator cuff tear, should be treated with gradual mobilization with range-of-motion (ROM) and strengthening exercises. A ligament injury indicates tearing and stretching of a ligament. Client C, who has a ligament injury, must rest adequately and protect the affected extremity by using a brace.

While assessing an immobilized client, the nurse notes that the client has shortened muscles over a joint, preventing full extension. Which is this condition known as? A. Osteoarthritis B. Osteoporosis C. Muscle atrophy D. Contracture

D. Contracture Rationale: Immobilized clients are at high risk for the development of contractures. Contractures are characterized by permanent shortening of the muscle covering a joint. Osteoarthritis is a disease process of the weight-bearing joints caused by wear and tear. Osteoporosis is a metabolic disease process in which the bones lose calcium. Muscle atrophy is a wasting and/or decrease in the strength and size of muscles because of a lack of physical activity or a neurological or musculoskeletal disorder.