PrepU CH 36: Management of Patients with Musculoskeletal Disorders
Which of the following inhibits bone resorption and promotes bone formation? Estrogen Calcitonin Corticosteroids Parathyroid hormone
Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1136.
The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as? Clawfoot Corn Bunion Hammer Toe
Corn Explanation: A corn is an area of hyperkeratosis (overgrowth of a horny layer of epidermis) produced by internal pressure (the underlying bone is prominent because of a congenital or acquired abnormality, commonly arthritis) or external pressure (ill-fitting shoes). The fifth toe is most frequently involved, but any toe may be involved. Chapter 36: Management of Patients with Musculoskeletal Disorders, Common Foot Problems, p. 1120.
In which deformity does the great toe deviate laterally? Pes cavus Hammertoe Hallux valgus Plantar fasciitis
Hallux valgus Explanation: Hallux valgus is a deformity in which the great toe deviates laterally. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Pes cavus refers to a foot with an abnormally high arch and a fixed equines deformity of the forefoot. Plantar fasciitis is an inflammation of the foot-supporting fascia. Chapter 36: Management of Patients with Musculoskeletal Disorders, Common Foot Problems, p. 1121.
A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks? C3, C4, and L1 L1, L2, and L4 L2, L3, and L5 L4, L5, and S1
L4, L5, and S1 Explanation: The lower lumbar disks, L4-L5 and L5-S1, are subject to the greatest mechanical stress and the greatest degenerative changes. Disk protrusion (herniated nucleus pulposus) or facet joint changes can cause pressure on nerve roots as they leave the spinal canal, which results in pain that radiates along the nerve. Chapter 36: Management of Patients with Musculoskeletal Disorders, Low Back Pain, p. 1114.
A client with carpal tunnel syndrome has had limited improvement with the use of a wrist splint. The nurse knows that which procedure will show the greatest improvement in treatment for this client? Open nerve release Injection of lidocaine Laser therapy Ultrasound therapy
Open nerve release Explanation: Evidence-based treatment of acute carpal tunnel syndrome includes the application of splints to prevent hyperextension and prolonged flexion of the wrist. Should this treatment fail, open nerve release is a common surgical management option. A variety of treatments may be tried by the client, however, they may fail to improve the condition. These treatments include laser therapy, ultrasound therapy, and the injection of substances such as lidocaine. Though these can be used, surgery to release nerves is the best option. Chapter 36: Management of Patients with Musculoskeletal Disorders, Common Upper Extremity Disorders, p. 1118.
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 Rectus abdominis Quadriceps Latissimus dorsi
Quadriceps Explanation: The nurse instructs the patient in the safe and correct way to lift objects using the strong quadriceps muscles of the thighs, with minimal use of weak back muscles (Fig. 42-3). Chapter 36: Management of Patients with Musculoskeletal Disorders, Low Back Pain, p. 1114.
A 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? Administer pain medication per client request. Perform neuromuscular assessment every hour. Examine the surgical dressing every hour. Monitor vital signs every 4 hours.
Perform neuromuscular assessment every hour. Explanation: The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is important to prevent complications from the surgery. The surgical dressing does not need to be examined hourly. Administering pain medication is important, but assessing the foot color and temperature are most important. Vital sign monitoring is important, but not a priority after foot surgery. Chapter 36: Management of Patients with Musculoskeletal Disorders, Common Foot Problems, p. 1122.
Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women? Denosumab Fosamax Forteo Raloxifene
Raloxifene Explanation: Raloxifene is the only selective estrogen receptor modulator (SERM) approved for osteoporosis in post menopausal women as it does not increase the risk of breast or uterine cancer, but it does come with an increased risk of thromboembolism. Fosamax is a bisphosphonate. Forteo is a subcutaneously administered medication that is given one daily for the treatment of osteoporosis. Denosumab has recently been approved for treatment of postmenopausal women with osteoporosis who are at risk for fractures. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1138.
The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? Increase fiber in the diet Decrease the intake of vitamin A and D Reduce stress Walk or perform weight-bearing exercises outdoors
Walk or perform weight-bearing exercises outdoors Explanation: Risk-lowering strategies for osteoporosis include 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 in moderation. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1134.
A client has come to the clinic with foot pain. The physician has described the client's condition as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder? mallet toe hallux valgus (bunion) Heberden nodes hammer toe
hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal joint. Mallet toe is a flexion deformity of the distal interphalangeal joint. Bunion is a deformity of the great toe at its metatarsophalangeal joint. Heberden nodes are bony enlargements of the distal interphalangeal joints. Chapter 36: Management of Patients with Musculoskeletal Disorders, Common Foot Problems, p. 1120.
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? Alkaline phosphatase Potassium level Magnesium level Troponin levels
Alkaline phosphatase Explanation: 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. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1137.
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)? Raloxifene Calcitonin Teriparatide Vitamin D
Calcitonin Explanation: 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. Vitamin D increases the absorption of calcium. Chapter 36: Management of Patients with Musculoskeletal Disorders, Pathophysiology, p. 1136.
The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response? Decrease in parathyroid hormone Increase in calcitonin Decrease in estrogen Increase of vitamin D
Decrease in estrogen Explanation: Age related processes that contribute to loss of bone mass and osteoporosis are decreases in estrogen, calcitonin, and vitamin D and an increase in parathyroid hormone. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, pp. 1135-1136.
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? Calcium gluconate Tamoxifen (Nolvadex) Raloxifene (Evista) Alendronate (Fosamax)
Raloxifene (Evista) Explanation: An example of a selective estrogen receptor modifier (SERM) is raloxifene (Evista). Alendronate is a bisphosphonate; calcium gluconate is an oral calcium preparation; tamoxifen is an antiestrogen agent. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1138.
In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? Wound irrigation Wound packing Vitamin supplements Surgical debridement
Surgical debridement Explanation: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement. Chapter 36: Management of Patients with Musculoskeletal Disorders, Medical Management, p. 1143.
A client was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. What would not be a part of teaching plan for this condition? encouraging the client to eat a healthy diet regular exercise and stress reduction applications of ice avoiding caffeine and alcohol
applications of ice Explanation: Application of ice is not part of the treatment regimen. Encouraging the client to eat a healthy diet, avoiding caffeine and alcohol, regular exercise, and stress reduction are part of the teaching plan. Chapter 36: Management of Patients with Musculoskeletal Disorders, Fibromyalgia, p. 1091.
During a routine physical examination of a client, the nurse observes a flexion deformity of the proximal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding? Mallet toe Hallux valgus Hammer toe Bunion
Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint. Chapter 36: Management of Patients with Musculoskeletal Disorders, Common Foot Problems, p. 1120.
Identify descriptors of the pathophysiologic process seen in osteomalacia. Select all that apply. Calcium and phosphate are not moved to the bones. Excessive osteoclastic activity causes the bones to become soft and bowed initially; later, the bones thicken but are not well formed, making the bones weak and prone to fracture. The bone mass is structurally weaker, and bone deformities occur. There is a deficiency of activated vitamin D (calcitriol).
Calcium and phosphate are not moved to the bones. The bone mass is structurally weaker, and bone deformities occur. There is a deficiency of activated vitamin D (calcitriol). Explanation: In the pathophysiologic process seen in osteomalacia, there is a deficiency of activated vitamin D (calcitriol), calcium and phosphate are not moved to the bones, the bone mass is structurally weaker, and bone deformities occur. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1140.
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? Needle aspiration Open reduction Arthroplasty Arthroscopy
Arthroscopy Explanation: Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be 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. Arthroplasty is the restructure of the joint surface after diagnosis is made. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1145.
Which common problem of the upper extremity results from entrapment of the median nerve at the wrist? Dupuytren contracture Impingement syndrome Carpal tunnel syndrome Ganglion
Carpal tunnel syndrome Explanation: Carpal tunnel syndrome is commonly due to repetitive hand activities. A ganglion is a collection of gelatinous material near the tendon sheaths and joints that appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. Dupuytren contracture is a slowly progressive contracture of the palmar fascia. Impingement syndrome is associated with the shoulder and may progress to a rotator cuff tear. Chapter 36: Management of Patients with Musculoskeletal Disorders, Common Upper Extremity Disorders, p. 1118.
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? Taking a 300-mg calcium supplement to meet dietary guidelines Living a sedentary lifestyle to reduce the incidence of injury Initiating weight-bearing exercise routines Stopping estrogen therapy
Initiating weight-bearing exercise routines Explanation: 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. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1134.
A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit? Making sure the client is receiving a daily bath Making sure the client has adequate financial resources Observing for safety hazards that could be a fall risk Ensuring that the client is eating enough
Observing for safety hazards that could be a fall risk Explanation: Clients with osteomalacia exhibit a waddling type of gait, putting them at risk for falls and fractures. Safety would be the priority in this circumstance such as scatter rugs, loose boards, and stairs. Older adult clients do not require a daily bath, and it may dry the skin. Nutrition is a necessity to question but the priority would be safety. Whether the client has adequate financial resources would be referred to social service. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, pp. 1140-1141.
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? Prone, with a pillow under the shoulders High-Fowler's to allow for maximum hip flexion Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees 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 Explanation: A medium to firm, not sagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress. Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head (Fig. 42-1). A prone position should be avoided because it accentuates lordosis. Chapter 36: Management of Patients with Musculoskeletal Disorders, Low Back Pain, p. 1115.
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. Explanation: 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. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1145.
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? Vitamin D-fortified milk Bananas Green vegetables Red meat
Vitamin D-fortified milk Explanation: The nurse should advise the client to include dietary sources of vitamin D, such as fatty fish, vitamin D-fortified milk, and cereals. These foods protect against bone loss and decrease the risk of fracture by facilitating the absorption of calcium from food and supplements. Red meat, bananas, and green vegetables do not facilitate calcium absorption from food and supplements. Chapter 36: Management of Patients with Musculoskeletal Disorders, Medical Management, p. 1137.
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? "I will bend at the waist when I am lifting objects from the floor." "Instead of turning around to grasp an object, I will twist at the waist." "I will lie prone with my legs slightly elevated." "I will avoid prolonged sitting or walking."
"I will avoid prolonged sitting or walking." Explanation: The nurse encourages the patient to alternate lying, sitting, and walking activities frequently, and advises the patient to avoid sitting, standing, or walking for long periods. Chapter 36: Management of Patients with Musculoskeletal Disorders, Low Back Pain, pp. 1115-1116.
A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate? "You will need to engage in vigorous exercise three times a week for 30 minutes." "You will need to avoid foods high in phosphorus and vitamin D." "You will need to decrease the amount of dairy products you consume." "You may need to be evaluated for an underlying cause, such as renal failure."
"You may need to be evaluated for an underlying cause, such as renal failure." Explanation: 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. Chapter 36: Management of Patients with Musculoskeletal Disorders, osteomalacia, p. 1140.
A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder? Dicloxacillin Bupivacaine Chlorpheniramine Dexamethasone
Chlorpheniramine Explanation: Antihistamines such as chlorpheniramine are frequently prescribed when an allergy is a factor in causing a skin disorder. Antihistamines relieve itching and shorten the duration of allergic reaction. Corticosteroids such as dexamethasone are used to relieve inflammatory or allergic symptoms. Antibiotics such as dicloxacillin are used to treat infectious disorders. Local anesthetics such as bupivacaine are used to relieve minor skin pain and itching. Chapter 36: Management of Patients with Musculoskeletal Disorders.
What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? Hammertoe Callus Hallux valgus Dupuytren contracture
Dupuytren contracture Explanation: Dupuytren disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally. Chapter 36: Management of Patients with Musculoskeletal Disorders, Common Upper Extremity Disorders, p. 1119.
Which group is at the greatest risk for osteoporosis? Asian American women African American women Men European American women
European American women Explanation: Small-framed, nonobese European American women are at greatest risk for osteoporosis. Asian American women of slight build are at risk for low peak bone mineral density. African American women, who have a greater bone mass than European American women and Asian American Women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1134.
The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? Reports ability to perform ADLs Reports decreased joint pain Has a weight gain of 5 pounds Shows increased joint flexibility
Has a weight gain of 5 pounds Explanation: Obesity is a risk factor for osteoarthritis. Excess weight is a stressor on the weight-bearing joints. Weight reduction is often a part of the therapeutic regimen. Chapter 36: Management of Patients with Musculoskeletal Disorders, Osteoarthritis (Degenerative Joint Disease), p. 1122.
Which of the following presents with an onset of heel pain with the first steps of the morning? Morton's neuroma Ganglion Hallux valgus Plantar fasciitis
Plantar fasciitis Explanation: Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heal pain experienced with the first steps in the morning. Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a 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. Chapter 36: Management of Patients with Musculoskeletal Disorders, Common Foot Problems, p. 1121.
Morton neuroma is exhibited by which clinical manifestation? Swelling of the third (lateral) branch of the median plantar nerve Inflammation of the foot-supporting fascia Diminishment of the longitudinal arch of the foot High arm and a fixed equinus deformity
Swelling of the third (lateral) branch of the median plantar nerve Explanation: Morton neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia. Chapter 36: Management of Patients with Musculoskeletal Disorders, Promoting Home, Community-Based, and Transitional Care, p. 1121.
While the nurse is performing a physical assessment, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. What should this assessment indicate to the nurse? Morton's neuroma Dupuytren's contracture Impingement syndrome Carpal tunnel syndrome
Carpal tunnel syndrome Explanation: Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome. Morton's neuroma is assessed as a painful condition that affects the ball of the foot. Dupuytren's contracture is when knots of tissue beneath the skin cause one or more fingers stay bent toward the palm. Impingement syndrome is a shoulder condition. Chapter 36: Management of Patients with Musculoskeletal Disorders, Common Upper Extremity Disorders, p. 1118.
When an infection is bloodborne, the manifestations include which symptom? Hypothermia Bradycardia Chills Hyperactivity
Chills Explanation: Manifestations of bloodborne infection include chills, high fever, rapid pulse, and generalized malaise. Chapter 36: Management of Patients with Musculoskeletal Disorders, Musculoskeletal Infections, p. 1142.
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. Imbalanced nutrition: less than body requirements Acute pain Ineffective airway clearance Risk for injury Disturbed body image
Imbalanced nutrition: less than body requirements Acute pain Disturbed body image Explanation: 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. Chapter 36: Management of Patients with Musculoskeletal Disorders, Musculoskeletal Infections, p. 1142.
Most cases of osteomyelitis are caused by which microorganism? Escherichia coli Proteus species Staphylococcus aureus Pseudomonas species
Staphylococcus aureus Explanation: Staphylococcus aureus causes 70% to 80% of bone infections. While Proteus species, Pseudomonas species, and E. coli are frequently found in osteomyelitis, they do not cause the majority of bone infections. Chapter 36: Management of Patients with Musculoskeletal Disorders, Preoperative and Intraoperative Nursing Management, p. 1126.
A client has been treated for migraine headaches for several months and comes to the clinic reporting no improvement. The nurse is talking with the client and hears an audible click when the client is moving the jaw. What does the nurse suspect may be happening? Trigeminal neuralgia Temporomandibular disorder Loose teeth Dislocated jaw
Temporomandibular disorder Explanation: The disorder can be confused with trigeminal neuralgia and migraine headaches. The client experiences clicking of the jaw when moving the joint, or the jaw can lock, which interferes with opening the mouth. Loose teeth will not cause a clicking of the jaw. The client does not have a dislocated jaw. Chapter 36: Management of Patients with Musculoskeletal Disorders.
A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? A soft mattress is most supportive by conforming to the body. Use the large muscles of the leg when lifting items. Avoid twisting and flexion activities. Sleep on the stomach to alleviate pressure on the back.
Use the large muscles of the leg when lifting items. Explanation: The large muscles of the leg should be used when lifting. Chapter 36: Management of Patients with Musculoskeletal Disorders, Low Back Pain, p. 1114.
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? Negative calcium balance Dowager's hump Bone fracture Loss of estrogen
Bone fracture Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1134.
A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? "You need to limit the amount of protein and calcium in your diet." "Use your continuous passive motion machine for 2 hours each day." "You will receive IV antibiotics for 3 to 6 weeks." "You need to perform weight-bearing exercises twice a week."
"You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks. Continuous passive range of motion is used for clients with osteoarthritis. Weight-bearing exercises are used with clients who have osteoporosis. Limiting protein and calcium is not part of the plan of care for clients with osteomyelitis. Chapter 36: Management of Patients with Musculoskeletal Disorders, Musculoskeletal Infections, pp. 1142-1143.
Dupuytren contracture causes flexion of which area(s)? Index and middle fingers Ring finger Fourth and fifth fingers Thumb
Fourth and fifth fingers Explanation: Dupuytren contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger. Chapter 36: Management of Patients with Musculoskeletal Disorders, Dupuytren Disease, p. 1118.
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? Place the client in a sitting position. Immobilize the client's arm. Raise the client's arm above the heart. Help the client walk to the nearest nurses' station.
Immobilize the client's arm. Explanation: Signs of a fracture in an extremity include pain, deformity, swelling, discoloration, and loss of function. When a nurse suspects a fracture, the extremity should be immobilized before moving the body part. It isn't appropriate for the nurse to move the client into a sitting position without further assessment. The client shouldn't walk to the nurses' station; the client should wait for help to arrive. Chapter 36: Management of Patients with Musculoskeletal Disorders, Musculoskeletal Infections, p. 1145.
Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? Lordosis Skull narrowing Long bone bowing Upright gait
Long bone bowing Explanation: Some clients with Paget's disease are asymptomatic with only some mild skeletal deformity. Other clients have marked skeletal deformities which may include enlargement of the skull, bowing of the long bones, and kyphosis. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1141.
Which is not a risk factor for osteoporosis? small-framed, thin White or Asian women being postmenopausal being male family history
being male Explanation: Being male is not considered a risk factor. Some of the risk factors for osteoporosis are being a small-framed, thin White or Asian woman; being postmenopausal; family history; inactivity; chronic low calcium intake; and excessive caffeine or tobacco use. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1136.
A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? 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 an X-ray of the bones every 3 years is recommended to detect bone loss. 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. Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary. Chapter 36: Management of Patients with Musculoskeletal Disorders, Metabolic Bone Disorders, p. 1134.
The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do? Bind the toes so that they will straighten. Do active range of motion on the toes. Wear properly fitting shoes. Have surgery to fix them.
Wear properly fitting shoes. Explanation: Hammer toe is a flexion deformity of the PIP joint and may involve several toes and may result from wearing poorly fitting shoes. They will not straighten by binding the toes or doing active range of motion exercises. Surgery is an option but should be discussed with an orthopedic surgeon or podiatrist. Chapter 36: Management of Patients with Musculoskeletal Disorders, Osteoarthritis (Degenerative Joint Disease), pp. 1123-1124.
Which of the following was formerly called a bunion? Hallux valgus Plantar fasciitis Ganglion Morton's neuroma
Hallux valgus Explanation: Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a 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. Chapter 36: Management of Patients with Musculoskeletal Disorders, Common Foot Problems, p. 1121.
The community health nurse is assessing the risk factors for osteoporosis in a female client at a health fair. > For each assessment finding, click to specify if the finding is a risk factor for osteoporosis or is not a risk factor for osteoporosis. takes fluticasone inhaler for asthma postmenopausal status alcohol intake of 3 drinks/week Nonsmoker large frame Asian heritage walks 2 miles, 3 days/week 66 years of age
Not a Risk Factor for Osteoporosis alcohol intake of 3 drinks/week Nonsmoker large frame walks 2 miles, 3 days/week Risk Factor for Osteoporosis takes fluticasone inhaler for asthma postmenopausal status Asian heritage 66 years of age Explanation: After the identification of a client's risk factors for osteoporosis, the nurse can develop a plan of care to reduce or prevent osteoporosis. Risk factors for osteoporosis include older age (for women, the risk increases after age 50), Asian heritage, being a postmenopausal woman, and long-term corticosteroid use (such as fluticasone for the treatment of asthma). A small frame, not a large frame, increases the risk for osteoporosis. Being a nonsmoker does not increase the risk for osteoporosis. An alcohol intake of 3 or more drinks/day is a risk factor for osteoporosis; an intake of 3 alcoholic beverages/week does not increase the risk. A sedentary lifestyle also increases the risk for osteoporosis; however, walking 2 miles, 3 days/week is not considered sedentary. Chapter 36: Management of Patients with Musculoskeletal Disorders, Osteoporosis, pp. 1134-1140.
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 places the load close to the body. reaches over the head with the arms fully extended. uses a narrow base of support. bends at the hips and tightens the abdominal muscles.
places the load close to the body. Explanation: Instructions for the client with low back pain should include that, when lifting, the client should avoid overreaching. The client should also keep the load close to the body, bend the knees, and tighten the abdominal muscles; use a wide base of support; and use a back brace to protect the back. Bending at the hips increases the strain on the back muscles when lifting. Chapter 36: Management of Patients with Musculoskeletal Disorders, Low Back Pain, p. 1114.
