ch. 49 Disorders of Musculoskeletal Function: Developmental and Metabolic Disorders

A 16-month-old boy has a normal weight for his age but a height far below the normal range. His list of symptoms includes a protruding abdomen, lethargy, bow legs, muscle weakness, and irritability. His teeth have not yet developed and he has difficulty standing. What is the child's most likely diagnosis?

Rickets

What should the nurse teach a client who is on bed rest ?

Immobility will lead to deconditioning of muscles.

Which assessment finding indicates a positive respiratory response to exercise?

Increased alveolar perfusion

A child with Osgood-Schlatter disease most often presents with which assessment finding?

Pain in front of the knee

The nurse is providing care for an adult client whose current medication regimen includes calcitonin and a bisphosphonate. The nurse should recognize the likely need for:

bone density testing on a scheduled basis.

A child has been diagnosed with myopathic neuromuscular scoliosis. What other concurrent diagnosis may the child have?

Cerebral palsy

Regarding embryonic development, in what week do the paddle-shaped limb buds of the lower extremities begin to appear?

4th week

Which statement will the nurse impart to the parent of a child with Legg-Calvé-Perthes disease?

"A genetic pattern for this disease has not been established."

What is the definition of a congenital deformity?

Abnormalities present at birth

Which client needs screening for osteoporosis?

The client who seems to have "shrunk" in height

A new mother asks, "Why are you examining my baby's hips?" What is the nurse's best response?

"Musculoskeletal screening is important to identify anything that needs intervention."

The nursing instructor is teaching about osteoporosis and tells students that reduced physical activity can contribute to the loss of bone mass. What does the nurse tell the students is the rationale for this?

"Reduced physical activity increases the rate of bone loss, as mechanical forces are important stimuli for normal bone remodeling."

What information would the nurse include when teaching potential parents about prevention of congenital deformities? Select all that apply.

- "Limit exposure to alcohol." - "Do not take any medication without first talking to your health care provider."

Which symptoms commonly occur with Osgood-Schlatter disease? Select all that apply.

- Knee pain - Edema of the knee - Tenderness in the knee and tibia

Which groups are at increased risk for decreased bone mass? Select all that apply.

- Premature infants - Low-birth-weight infants - Children with cystic fibrosis

Nursing students are studying metabolic disorders of the skeletal system and correctly identify which factor to be the major cause of osteoporosis?

Aging process

Which best describes metatarsus adductus?

An adducted forefoot that gives the foot a kidney-shaped appearance

An adult client with a diagnosis of diabetes mellitus performing isometric exercise to help control his blood glucose level will gain which benefit?

An increase in his basal metabolic level

Which clients should the nurse assess to determine if they have premature osteoporosis?

Anyone with an eating disorder.

The nurse is caring for several clients with symptoms of chronic fatigue. Which manifestation does not correlate with a diagnosis of chronic fatigue syndrome (CFS)?

Cough with blood-tinged sputum

Which of the following is a priority goal for a client with pes planus (flat feet)?

Decreased pain

Which cardiovascular response will the nurse assess in order to determine that a client has activity intolerance?

Dyspnea during activity

Disuse of a muscle and muscle atrophy contribute to the weakening and wasting of muscle tissue. What else do they contribute to?

Joint contractures

While getting up out of bed for the first time after surgery, a client reports feeling dizzy and faint. Which condition is the client most likely experiencing?

Orthostatic intolerance

Which statement will the nurse include when teaching about fetal development?

Ossification of the fetal skeleton begins in the ninth week.

After a week in which a client worked four 12-hour shifts and went home to two children with the flu, the client is feeling fatigued. How should this client's fatigue be categorized?

Physiologic

The health care provider is explaining the course of treatment to the parents of a 2-day-old infant born with congenital clubfoot. Which treatment options will likely be discussed?

Serial manipulations and casting of the affected extremity

Which teaching will the nurse provide for parents of a child who has clubfoot, or talipes?

Serial manipulations and casting of the affected extremity

How will the nurse teach the client to utilize metabolic equivalents when starting an exercise routine?

The client should understand that activities with higher metabolic equivalents have higher workloads.

Which assessment finding is a negative cardiac response to exercise?

The client's diastolic blood pressure increases.

The nurse suspects idiopathic scoliosis in a client based on which assessment finding?

Uneven shoulders or iliac crest

The nurse is providing teaching for parents of a 2-week-old infant just diagnosed with clubfoot. The nurse includes that the first treatment option is:

serial manipulations and casting.

The nurse caring for a child with a deficiency of vitamin D knows that the deficiency places the child at risk for:

Rickets

A client with osteomalacia asks, "How can I be deficient in vitamin D?" Which of the following is the nurse's best response?

"Tell me about your typical daily food intake."

Which of the following should the nurse teach a client about syndactyly?

"This is a simple webbing of the fingers or toes."

Which assessment technique/sign should the nurse utilize on a newborn to screen for developmental dysplasia of the hip?

Barlow

A client with confirmed low bone density asks the nurse if there is anything she can to decrease the risk of trauma. The best response would be:

Brisk walking three times per week on a flat surface

In contrast to osteoporosis, osteomalacia causes which outcome, without the loss of bone matrix?

Defective mineralization

The nurse is performing an admission assessment to a rehabilitation unit. Which assessment tools should she utilize to determine an alert client's normal activities, perceived level of activity tolerance, or level of fatigue?

Human Activity Profile

An older adult is being evaluated for chronic fatigue. Which assessment data by the nurse would support the diagnosis?

Inability to concentrate; awakens after a few hours of sleep and cannot return to sleep

Which statement correctly describes osteogenesis imperfecta, or brittle bone disease?

Osteogenesis imperfecta is caused by deficiencies in the synthesis of type I collagen.

A postmenopausal client questions the nurse about the diagnosis of osteoporosis. Which statement describes the pathology of osteoporosis?

The process of bone renewal after menopause is slowed in relation to the occurrence of bone breakdown.

The nurse has just finished teaching a client newly diagnosed with rheumatoid arthritis about the disease. The nurse determines that teaching is effective when the client states:

"Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular."

The parents of a 6-year-old child diagnosed with bilateral genu valgum (knock knees) ask the health care provider when treatment will begin to correct the problem. The best response would be:

"The child's measurements fit within the acceptable assessment period; treatment is not necessary at this time."

(T/F) A nursing student who is studying about disorders of the skeletal system is heard making the following statement, "Many skeletal disorders of early infancy are caused by intrauterine positions and need to be surgically fixed." Is this statement true or false?

False