Chapter 36
A nurse is caring for an adult client diagnosed with a back strain. What health education should the nurse provide to this client?
Avoid lifting more than one-third of body weight without assistance Rationale: The nurse will instruct the client on the safe and correct way to lift objects— using the strong quadriceps muscles of the thighs, with minimal use of the weaker back muscles. To prevent recurrence of acute low back pain, the nurse may instruct the client to avoid lifting more than one-third of the client's body weight without help. The client should be informed to place the feet hip-width apart to provide a wide base of support. The person should then bend the knees, tighten the abdominal muscles, and lift the object close to the body with a smooth motion, avoiding twisting and jerking
A client presents at the clinic with a report of morning numbness, cramping, and stiffness in the fourth and fifth fingers of the right hand. What disease process should the nurse suspect?
Dupuytren disease condition starts in one hand, but eventually both hands are affected
A nurse is planning the care of an older adult client with osteomalacia. What action should the nurse recommend in order to promote vitamin D synthesis?
Ensure adequate exposure to sunlight because sunlight is necessary for synthesizing vitamin D, clients should be encouraged to open some time in the sun
A nurse is providing discharge teaching for a client who underwent foot surgery. The nurse is collaborating with the occupational therapist and discussing the use of assistive devices. On what variables does the choice of assistive devices primarily depend?
a client's general condition, balance, and weight-bearing prescription the choice of the devices depends on the client's general condition and balance, and on the weight-bearing prescription. the client's strength, motivation, and weight restrictions are not what the choice of assistive devices is based on
Which of the following clients should the nurse recognize as being at the highest risk for the development of osteomyelitis?
an adult client with an infected pressure ulcer in the sacral area clients who are at high risk for osteomyelitis include those who are poorly nourished, older adults, and clients who are obese. The older adult client with an infected sacral pressure is at the greatest risk for the development of osteomyelitis, as this client has two risk factors: age and the presence of a soft-tissue infection that has the potential to extend into the bone.
A nurse is caring for a client with Paget disease and is reviewing the client's most recent laboratory values. Which of the following values are most characteristic of Paget disease?
an elevated serum alkaline phosphate level and a normal serum calcium level clients with Paget disease have normal calcium levels. Elevated alkaline phosphatase concentration and urinary hydroxyproline excretion reflect the increase osteoblastic activity associated with this condition. Alterations in PTH and calcitonin levels are atypical.
An older, female client with osteoporosis has been hospitalized. Prior to discharge, when teaching the client, the nurse should include information about which major complication of osteoporosis?
bone fracture bone fracture is a major complication of osteoporosis that results when loss of calcium and phosphate increased the fragility of bones. Estrogen deficiencies result from menopause, not osteoporosis.
A nurse is reviewing the pathophysiology that may underlie a client's decreased bone density. What hormone should the nurse identify as inhibiting bone resorption and promoting bone formation?
calcitonin calcitonin inhibits reabsorption and promotes bone formation, estrogen inhibits bone breakdown, and parathyroid increases bone reabsorption.
A nurse is teaching an educational class to a group of older adults at a community center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended intake of what nutrients? Select all that apply.
calcium and vitamin D a diet rich in calcium and vitamin D protects against skeletal demineralization. Intake of vitamin B12 and potassium does not directly include the risk for osteoporosis. Calcitonin is not considered to be a dietary nutrient.
A client tells the nurse that they haves pain and numbness in the thumb, first finger, and second finger of the right hand. The nurse discovers that the client is employed as an auto mechanic, and that the pain is increased while working. This may indicate that the client has what health problem?
carpel tunnel syndrome carpel tunnel syndrome may be manifested by numbness, pain, paresthesia, and weakness along the medial nerve
A nurse is teaching a client with osteomalacia about the role of diet. What would be the best choice for breakfast for a client with osteomalacia?
cereal with milk, a scrambled egg, and grapefruit the one that contains highest dietary sources of calcium and vitamin D
A nurse is caring for a client who is being assessed following reports of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? Select all that apply
computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasound X-ray a variety of diagnostic tests can be used to address lower back pain, including CT, MRI, US, and x-ray. Angiography is not related to the etiology of back pain.
A client has been admitted to the hospital with a spontaneous vertebral fracture related to osteoporosis. Which of the following nursing diagnoses must be addressed in the plan of care?
constipation related to vertebral fracture constipation is a problem related to immobility and medications used to treat vertebral fractures
A nurse is reviewing the care of a client who has a long history of lower back pain that has not responded to conservative treatment measures. The nurse should anticipate the administration of what drug?
cyclobenzaprine (Flexiril) short-term prescription muscle relaxants are effective in relieving acute low back pain
A client has returned to the unit after undergoing limb-sparing surgery to remove a metastatic bone tumor. The nurse providing postoperative care in the days following surgery assesses for what complication from surgery?
delayed wound healing delayed wound healing is a complication of surgery d/t tissue trauma from the surgery
A client's electronic health record notes that the client has hallux valgus. What signs and symptoms should the nurse expect this client to manifest?
deviation of a great toe laterally bunion
A nurse is caring for a client who is 12 hours' postoperative following foot surgery. The nurse assesses the presence of edema in the foot. What nursing measure should the nurse implement to control edema?
elevate the foot on several pillows to control the edema in the foot of a client who experienced foot surgery, the nurse will elevate the foot on several pillows when the client is sitting or laying. Intermittent ice packs should be applied to the surgical area during the first 24 to 48 hours after surgery to control edema and provide some pain relief.
A client presents at a clinic reports heel pain that impairs walking ability. The client is subsequently diagnosed with plantar fasciitis. This client's plan of care should include what intervention?
gently stretching the foot and the Achilles tendon plantar fasciitis leads to pain that is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon
A nurse is providing care for a client who has a recent diagnosis of Paget disease. When planning this client's nursing care, what should interventions address? Select all that apply.
impaired physical mobility acute pain disturbed auditory sensory perception risk for injury clients with Paget disease are at risk for decreased mobility, pain, hearing loss, and injuries resulting from decreased bone density
An older adult woman's current medication regimen includes alendronate. What outcome would indicate successful therapy?
increased bone mass Biophosphonates such as alendronate increase bone mass and decrease bone loss by inhibiting osteoclast function
A nurse is caring for a client who is being treated in the hospital for a spontaneous vertebral fracture related to osteoporosis. The nurse should address the nursing diagnosis of Acute Pain Related to Fracture by implementing what intervention?
intermittent application of heat to the client's back intermittent local heat and back rubs promote muscle relaxation following osteoporotic vertebral fracture. High fowlers is likely to exacerbate pain.
A nurse is discussing conservative management of tendonitis with a client. What is the nurse's best recommendation?
intermittent application of ice and heat conservative management of tendonitis include rest of the extremity, intermittent ice and heat to the joint, and NSAIDs. Weight reduction may prevent future injuries but will not relieve existing tendonitis
An older adult client sought care for the treatment of a swollen, painful knee joint. Diagnostic imaging and culturing of synovial fluid resulted in a diagnosis of septic arthritis. The nurse should prioritize what aspect of care?
intravenous administration of antibiotics IV ABX are the major treatment modality of septic arthritis; the nurse must ensure timely administration of these drugs
A nurse is providing care for a client who has osteomalacia. What major goal should guide the choice of medical and nursing interventions?
maintenance of adequate levels of activated vitamin D the primary defect in osteomalacia is a deficiency of the activated vitamin D, which promotes calcium absorption from the GI tract and facilitates mineralization of bone
A client with diabetes is attending a class on the prevention of associated diseases. What action should the nurse teach the client to reduce the risk of osteomyelitis?
monitor and control blood glucose levels since poor glycemic control can exacerbate the spread of infection from other sources, the client with diabetes should maintain blood glucose levels within a desired range. corticosteroids can exacerbate the risk of osteomyelitis. increased intake of calcium and vitamins as well as regular exercise are beneficial health promotion exercise, but they do not directly reduce the risk of osteomyelitis.
A nurse is assessing a client who reports a throbbing, burning sensation in the right foot. The client states that the pain is worst during the day but notes that the pain is relieved with rest. The nurse should recognize the signs and symptoms of what health problem?
morton neuroma morton neuroma is a swelling of the third (lateral) branch of the median plantar nerve, which causes a throbbing, burning pain, usually relieved with rest.
A client has come to the clinic for a routine annual physical. The nurse practitioner notes a palpable, painless projection of bone at the client's shoulder. The projection appears to be at the distal end of the humerus. The nurse should suspect the presence of:
osteochondroma is the most common benign bone tumor. it usually occurs as large projection of bone at the end of long bones (at the knee or shoulder)
An 80-year-old man in a long-term care facility has a chronic leg ulcer and states that the area has become increasingly painful in recent days. The nurse notes that the site is now swollen and warm to the touch. The client should undergo diagnostic testing for what health problem?
osteomyelitis when osteomyelitis develops from the spread of an adjacent infection, no signs of septicemia are present, but the area becomes swollen, warm, painful, and tender to touch.
A client with diabetes has been diagnosed with osteomyelitis. The nurse observes that the client's right foot is pale and mottled, cool to touch, with a capillary refill of greater than 3 seconds. The nurse should suspect what type of osteomyelitis?
osteomyelitis with vascular insufficiency
A client presents at a clinic reporting back pain that goes all the way down the back of the leg to the foot. The nurse should document the presence of what type of pain?
sciatica sciatica nerve pain travels down the back of the thigh to the foot of the affected leg
A nursing educator is reviewing the risk factors for osteoporosis with a group of recent graduates. What of the following risk factors should the educator describe?
small frame and female sex small-framed women are at greatest risk for osteoporosis. Diabetes, high protein intake, alcohol use, and infections are not along the most salient risk factors for osteoporosis
A client is undergoing diagnostic testing for osteomalacia. Which of the following laboratory results are most suggestive of this diagnosis?
low serum calcium and low phosphorus level
A client presents to a clinic reporting a leg ulcer that isn't healing; subsequent diagnostic testing suggests osteomyelitis. The nurse is aware that the most common pathogen to cause osteomyelitis is:
staphylococcus aureus S. aureus causes more than half of all bone infections. Proteus, Pseudomonas, and E. coli are also causes, but to a lesser extent
A nurse is collaborating with the physical therapist to plan the care of a client with osteomyelitis. What principle should guide the management of activity and mobility in this client?
stress on the weakened bone must be avoided the client with osteomyelitis has bone that is weakened by the infective process and must be protected by avoidance of stress on the bone
A 32-year-old client comes to the clinic reporting shoulder tenderness, pain, and limited movement. Upon assessment the nurse finds edema. An MRI shows hemorrhage of the rotator cuff tendons and the client is diagnosed with impingement syndrome. What action should the nurse recommend in order to promote healing?
support the affected arm on pillows at night the client should support the affected arm on pillows while sleeping to keep from turning onto the shoulder. Corticosteroids are not commonly prescribed and a sling is not normally necessary. ROM exercise are indicated, but putting the arm through its full ROM may cause damage during the healing process
A nurse is caring for a client with a bone tumor. The nurse is providing education to help the client reduce the risk for pathologic fractures. What should the nurse teach the client?
support the affected extremity with external support such as splints during nursing care, the affected extremities must be supported and handled gently. External supports (splints) may be used for additional protection. Prescribed weight-bearing restrictions must be followed. Assistive devices should be used to strengthen the unaffected extremities.
A nurse is caring for a 78-year-old client with a history of osteoarthritis (OA). When planning the client's care, what goal should the nurse prioritize?
the client will express satisfaction with the ability to perform ADLs pain management and optimal functional ability are major goals of nursing interventions for OA
A nurse is assessing a client for risk factors known to contribute to osteoarthritis. What assessment finding should the nurse interpret as a risk factor?
the clients body mass index is 34 (obese) risk factors of osteoarthritis include obesity and previous joint damage.
An orthopedic nurse is caring for a client who is postoperative day 1 following foot surgery. What nursing intervention should be included in the client's subsequent care?
the foot should be elevated in order to prevent edema pain experienced by clients who undergo foot surgery is related to inflammation and edema.
A nurse is providing a class on osteoporosis at the local center for older adults. Which statement related to osteoporosis is most accurate?
the use of corticosteroids increases the risk for osteoporosis corticosteroid therapy is a secondary cause of osteoporosis when taken for long-term use
