questions on musculoskeletal diseases
A patient is evaluated for a diagnosis of Paget's disease. Which of the following is a diagnostic finding for this disease? a) Calcium of 9.5 mg/dL b) Alkaline phosphate of 165 IU/L c) Magnesium level of 2 mEq/L d) Urinary creatinine of 0.95 mg/dL
Alkaline phosphate of 165 IU/L Explanation: An elevated serum alkaline phosphatase concentration reflects increased osteoblastic activity.
Which of the following are common primary sites of tumors that metastasize to the bone? Select all that apply. a) Lung b) Breast c) Prostate d) Ovary e) Kidney
Correct response: • Kidney • Prostate • Lung • Breast • Ovary
The nurse advises a patient that the best position to ease low back pain is: a) Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees. b) Supine, with the bed flat and a firm mattress in place. c) High-Fowler's to allow for maximum hip flexion. d) Prone, with a pillow under the shoulders.
Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees. Explanation: Lumbar flexion is increased by elevating the head and thorax 30 degrees 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. A prone position should be avoided because it accentuates lordosis (inward curvature of the spine).
A client has Paget's disease. An appropriate nursing diagnosis for this client is: a) Risk for falls b) Risk for infection c) Delayed wound healing d) Fatigue
a) Risk for falls
A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing? a) Surgical debridement b) Wound packing c) Wound irrigation d) Vitamin supplements
a) Surgical debridement
Which of the following was formerly called a bunion? a) Morton's neuroma b) Hallux valgus c) Plantar fasciitis d) Ganglion
b) Hallux valgus
Primary prevention of osteoporosis includes: a) using a professional alert system in the home in case a client falls when she's alone. b) optimal calcium intake and estrogen replacement therapy. c) installing grab bars in the bathroom to prevent falls. d) placing items within the client's reach.
b) optimal calcium intake and estrogen replacement therapy.
Which of the following is the first-line medication that would be used to treat and prevent osteoporosis? a) Anabolic agents b) Selective estrogen receptor modulators c) Bisphosphonates d) Calcitonin
c) Bisphosphonates
What food can the nurse suggest to the client at risk for osteoporosis? a) Chicken b) Carrots c) Broccoli d) Bananas
c) Broccoli
Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing bone mass density (BMD)? a) Vitamin D b) Raloxifene (Evista) c) Calcitonin (Miacalcin) d) Teriparatide (Forteo)
c) Calcitonin (Miacalcin)
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? a) Latissimus dorsi b) Gastrocnemius c) Quadriceps d) Rectus abdominis
c) Quadriceps
Which of the following terms refers to disease of a nerve root? a) Contracture b) Sequestrum c) Radiculopathy d) Involucrum
c) Radiculopathy
A client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client's urination problem? a) Benign prostatic hyperplasia b) Dehydration c) Renal calculi d) Urinary tract infection (UTI)
c) Renal calculi
Which sign may be helpful in identifying carpal tunnel syndrome? a) Babinski's b) Kernig's c) Tinel's d) Brudzinski's
c) Tinel's
The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? a) Reduce stress b) Increase fiber in the diet c) Walk or perform weight-bearing exercises outdoors d) Decrease the intake of vitamin A and D
c) Walk or perform weight-bearing exercises outdoors
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. a) 1,400 mg; 1,200 IU b) 1,800 mg; 1,600 IU c) 1,600 mg; 1,400 IU d) 1,200 mg; 1,000 IU
d) 1,200 mg; 1,000 IU
Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing bone mass density (BMD)? a) Raloxifene (Evista) b) Vitamin D c) Teriparatide (Forteo) d) Calcitonin (Miacalcin)
d) Calcitonin (Miacalcin)
When an infection is blood borne the manifestations include which of the following symptoms? a) Hypothermia b) Hyperactivity c) Bradycardia d) Chills
d) Chills
The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients? a) Risk for infection b) Inadequate nutrition c) Impaired physical mobility d) Disturbed body image
d) Disturbed body image
Which of the following is a flexion deformity caused by a slowly progressive contracture of the palmar fascia? a) Callus b) Hammertoe c) Hallux valgus d) Dupuytren's contracture
d) Dupuytren's contracture
During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following? a) Hallux valgus b) Mallet toe c) Bunion d) Hammer toe
d) Hammer toe
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? a) Have surgery to fix them. b) Bind the toes so that they will straighten. c) Do active range of motion on the toes. d) Wear properly fitting shoes.
d) Wear properly fitting shoes.
The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client? a) The client will demonstrate wound care. b) The client will remain free from injury. c) The client will experience a tolerable level of pain. d) The client will maintain effective airway clearance. e) The client will maintain adequate nutritional intake.
• The client will experience a tolerable level of pain. • The client will demonstrate wound care. • The client will maintain adequate nutritional intake.
A patient diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. In responding to the patient, how would the nurse best describe CTS? a) "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." b) "CTS is a neuropathy that is characterized by flexion contracture of the fourth and fifth fingers." c) "CTS is a neuropathy that is characterized by bursitis and tendinitis." d) "CTS is a neuropathy that is characterized by pannus formation in the shoulder."
a) "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist."
A patient comes back to the clinic with a continued complaint of back pain. What time frame does the nurse understand constitutes "chronic pain"? a) 3 months b) 6 months c) 1 year d) 4 weeks
a) 3 months
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? a) Negative calcium balance b) Bone fracture c) Dowager's hump d) Loss of estrogen
b) Bone fracture
Which of the following is a flexion deformity caused by a slowly progressive contracture of the palmar fascia? a) Hammertoe b) Dupuytren's contracture c) Callus d) Hallux valgus
b) Dupuytren's contracture
When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with: a) Dupuytren's contracture b) Morton's neuroma c) Impingement syndrome d) Carpal tunnel syndrome
d) Carpal tunnel syndrome
Which of the following clinical manifestations would the nurse expect to find in a client who has had osteoporosis for several years? a) Increased heel pain b) Bone spurs c) Diarrhea d) Decreased height
d) Decreased height
The provider asks a nurse to test a patient for Tinel's sign to diagnose carpal tunnel syndrome. The nurse asked the patient to: a) Stretch his fingers around a ball and squeeze with force. b) Pronate his hand while the nurse palpated the radial nerve. c) Make a fist and open his hand against resistance. d) Hold his palm up while the nurse percussed over the median nerve.
d) Hold his palm up while the nurse percussed over the median nerve.
A patient visits an orthopedic specialist because of pain that he feels beginning in his low back and radiating behind his right thigh and down below his right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between these intervertebral disks: a) L2, L3, and L5 b) C3, C4, and L1 c) L1, L2, and L4 d) L4, L5, and S1d) L4, L5, and S1
d) L4, L5, and S1
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which of the following bone disorders? a) Osteomyelitis b) Osteoporosis c) Osteomalacia d) Osteitis deformans
d) Osteitis deformans
Morton's neuroma is exhibited by which of the following clinical manifestations? a) Longitudinal arch of the foot is diminished b) High arm and a fixed equinus deformity c) Inflammation of the foot-supporting fascia d) Swelling of the third (lateral) branch of the median plantar nerve
d) Swelling of the third (lateral) branch of the median plantar nerve
Of the following, which is not a risk factor for osteoporosis? a) Being postmenopausal b) Being male c) Small-framed, thin White or Asian women d) Family history
b) Being male
A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about taking a calcium supplement should the nurse include? a) Remain in an upright position 30 minutes after taking the supplement. b) Take the supplement with meals or with orange juice. c) Take the supplement on an empty stomach with a full glass of water. d) Take weekly on the same day and at the same time.
b) Take the supplement with meals or with orange juice.
During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? a) "After menopause, the body's bone density declines, resulting in a gradual loss of height." b) "There may be some slight discrepancy between the measuring tools used." c) "The posture begins to stoop after middle age." d) "After age 40, height may show a gradual decrease as a result of spinal compression"
a) "After menopause, the body's bone density declines, resulting in a gradual loss of height."
Which client would the nurse identify as having the greatest risk for osteoporosis? a) A 16-year-old male with a history of asthma b) A 20-year-old male athlete with repeated injuries c) A small-framed, thin 45-year-old white woman d) A 40-year-old overweight African American woman
c) A small-framed, thin 45-year-old white woman
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? a) "Surgery is the only sure way to manage this condition." b) "This condition is associated with various sports." c) "Using arm splints will prevent hyperflexion of the wrist." d) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
d) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
Which of the following presents with an onset of heel pain with the first steps of the morning? a) Morton's neuroma b) Ganglion c) Hallux valgus d) Plantar fasciitis
d) Plantar fasciitis
A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and his immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client? a) The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit. b) The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor. c) The nurse is caring for this client on the intensive care unit. d) The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor.
c) The nurse is caring for this client on the intensive care unit.
Which of the following is the most common and most fatal primary malignant bone tumor? a) Osteogenic sarcoma (osteosarcoma) b) Osteochondroma c) Rhabdomyoma d) Enchondroma
a) Osteogenic sarcoma (osteosarcoma)
The nurse recognizes that the client with osteomyelitis is at risk for: a) Impingement syndrome b) Bone abscess formation c) Metastatic bone disease d) Pathological fractures
b) Bone abscess formation
A patient comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the physician orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the patient about? a) Cyclobenzaprine (Flexeril) b) Duloxetine (Cymbalta) c) Amitriptyline (Elavil) d) Gabapentin (Neurontin)
b) Duloxetine (Cymbalta)
The nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan? a) Examine surgical dressing every hour. b) Perform neuromuscular assessment every hour. c) Monitor vital signs every 4 hours. d) Administer pain medication per client request.
b) Perform neuromuscular assessment every hour.
A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? a) Changing the dressing b) Performing hourly neurovascular assessments for the first 24 hours c) Having the patient exercise the fingers to avoid future contractures d) Applying a cock-up splint and immobilization
b) Performing hourly neurovascular assessments for the first 24 hours
The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective? a) The patient reached over head with arms fully extended. b) The patient placed the load close to the body. c) The patient used a narrow base of support. d) The patient bent at the hips and tightened the abdominal muscles.
b) The patient placed the load close to the body.
On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session? a) "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth." b) "Bunions are congenital and can't be prevented." c) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." d) "Bunions are caused by a metabolic condition called gout."
c) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."
A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct? a) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. b) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. c) The recommended daily allowance of calcium may be found in a wide variety of foods. d) To prevent fractures, the client should avoid strenuous exercise.
a) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.
A 35-year-old client is visiting a rheumatology group practice. The client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications? a) Dietary restrictions b) Loading-dose schedule c) Common adverse effects d) Activity restrictions
c) Common adverse effects
A client with diabetes punctured hisfoot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? a) 3 months b) 3 to 6 weeks c) 7 to 10 days d) 6 months
b) 3 to 6 weeks
The nurse is planning an education program for women of childbearing years. The nurse recognizes that primary prevention of osteoporosis includes: a) Undergoing assessment of serum calcium levels every year b) Having a DXA beginning at age 35 years c) Ensuring adequate calcium and vitamin D intake d) Engaging in non-weight-bearing exercises daily
c) Ensuring adequate calcium and vitamin D intake
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? a) Living a sedentary lifestyle to reduce the incidence of injury b) Taking a 300-mg calcium supplement to meet dietary guidelines c) Initiating weight-bearing exercise routines d) Stopping estrogen therapy
c) Initiating weight-bearing exercise routines
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? a) Alkaline phosphatase b) Potassium level c) Magnesium level d) Troponin levels
a) Alkaline phosphatase
The nurse is caring for a patient with bone metastasis from a primary breast cancer. The patient complains of muscle weakness and nausea and is voiding large amounts frequently. Cardiac dysrhythmias are observed on the telemetry monitor. What should the nurse suspect based on these clinical manifestations? a) Hypercalcemia b) Hyperkalemia c) Hypokalemia d) Hypocalcemia
a) Hypercalcemia
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? a) Lower lumbar b) Thoracic c) Cervical d) Upper lumbar
a) Lower lumbar
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? a) Arthroplasty b) Arthroscopy c) Needle aspiration d) Open reduction
b) Arthroscopy
The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? a) Fat embolism b) Compartment syndrome c) Osteomyelitis d) Avascular necrosis
c) Osteomyelitis
The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a) "You need to limit the amount of protein and calcium in your diet." b) "You need to perform weight-bearing exercises twice a week." c) "Use your continuous passive motion machine (CPM) 2 hours each day." d) "You will receive IV antibiotics for 3 to 6 weeks."
d) "You will receive IV antibiotics for 3 to 6 weeks."
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? a) "I will lie prone with my legs slightly elevated." b) "I will avoid prolonged sitting or walking." c) "Instead of turning around to grasp an object, I will twist at the waist." d) "I will bend at the waist when I am lifting objects from the floor."
b) "I will avoid prolonged sitting or walking."
A nurse notices a client lying on the floor at the bottom of the stairs. He's alert and oriented and states that he fell down several stairs. He denies pain other than in his arm, which is swollen and appears deformed. After calling for help, what should the nurse do? a) Raise the client's arm above his heart. b) Help the client walk to the nearest nurses' station. c) Immobilize the client's arm. d) Place the client in a sitting position.
c) Immobilize the client's arm.
The nurse is caring for the client following removal of a Morton's neuroma. Which of the following nursing interventions would be inappropriate? a) Elevate the foot on two pillows. b) Assist the client with incentive spirometry. c) Perform neurovascular assessment of the hand. d) Assess the surgical dressing.
c) Perform neurovascular assessment of the hand.
Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? a) Risk for constipation related to immobility b) Acute pain related to fracture and muscle spasm c) Risk for injury related to fractures due to osteoporosis d) Deficient knowledge about osteoporosis and the treatment regimen
c) Risk for injury related to fractures due to osteoporosis