Chapter 63: Musculoskeletal Problems

Which action should the nurse take when caring for a patient with osteomalacia? a. teach about the use of Vit D supplements b. educate about the need for weight bearing exercises c. instruct the patient to avoid dairy products in the diet d. discuss the use of medications such as bisphosphonates

ANS: A Osteomalacia is caused by inadequate intake or absorption of Vit D

In which order should the nurse implement interventions prescribed for a patient admitted with acute osteomyelitis who has a temp of 101.2 F? a. obtain blood cultures from two sites b. administer dose of gentamicin 60 mg IV c. send to radiology for CT scan of right leg d. administer tylenol now and every 4 hours PRN for fever

ANS: A, B, D, C Highest priority for osteomyelitis is initiation of antibiotics, however, blood cultures should be obtained before administration. Addressing discomfort of fever is next highest priority

Which actions should the nurse include in the plan of care for a patient with metastatic bone cancer of the left femur? (select all that apply) a. monitor serum calcium b. teach about the need for strict bed rest c. explain the use of sustained release opioids d. support the left leg when repositioning the patient e. assist family and patient as they discuss the prognosis

ANS: A, C, D, E The nurse will monitor hypercalcemia cause by bone decalcification, supporting the leg helps reduce the risk for pathologic fractures, sustained release opioids are often associated with bone cancer. The prognosis for metastatic bone cancer is poor so the patient an family may need support

A nurse who works on the orthopedic unit has just received change of shift report. Which patient should the nurse assess first? a. patient who reports pain after hammertoe surgery b. patient who has not voided 8 hours after laminectomy c. patient with low back pain and positive straight leg raise test d. patient with osteomyelitis who has a temperature of 100.5 F (38.1 C)

ANS: B Difficulty in voiding may indicate damage to the spinal nerves and should be assessed and reported to the surgeon immediately

A patient whose employment requires frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates the teaching has been effective? a. "I will keep my back straight when I lift above my waist." b. "I will begin doing exercises to strengthen and support my back." c. "I will tell my boss I need a job where I can stay seated at a desk." d. "I can sleep with my hips and knees extended to prevent back strain."

ANS: B Exercises can help strengthen the muscles that support the back

A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irragation. Which intervention should the nurse include in the initial plan of care? a. quadriceps-setting exercises b. immobilization of the left leg c. positioning the left leg in flexion d. assisted weight bearing ambulation

ANS: B Immobilization of the affected leg helps to decrease pain and reduce the risk pathologic fracture

Which assessment finding for a 55 yr old patient should alert the nurse to the presence of osteoporosis? a. bowed legs b. loss of height c. report of frequent falls d. aversion to dairy products

ANS: B Osteoporosis occuring in the vertebrae produces a gradual loss of height

A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action should the nurse include in the plan of care? a. logroll q2hrs b. assist the patient with ambulation c. discuss the need for genetic testing with the patient d. teach the patient about the muscle biopsy procedure

ANS: B The goal for the patient with muscular dystrophy is to keep the patient actuve for as long as possible, assisting with ambulation will need to be added to the care plan

Which action should the nurse take first when a patient is seen in the outpatient clinical with neck pain? a. provide information about therapeutic neck exercises b. ask about numbness or tingling of the hands and arms c. suggest the patient alternate the use of heat and cold packs to the neck d. teach about the use of NSAIDs

ANS: B The nurse's initial action should be further assessment of related symptoms because cervical nerve root compression will require different treatment than musculoskeletal neck pain

A patient is being discharged after 1 wk of antibiotic therapy for acute osteomyelitis in the right leg. Which information should the nurse include in the discharge teaching? a. how to apply warm packs to the leg to reduce pain b. how to monitor and care for long term IV catheter c. the need for daily aerobic exercise to help maintain muscle strength d. the reason for taking oral antibiotics for 7-10 days after discharge

ANS: B The patient will be taking IV antibiotics for several months and need to recognize signs of infection at the site and daily care of the IV catheter

Which action should the nurse take when repositioning the patient who has just had a laminectomy and discectomy? a. instruct the patient to move the legs before turning the rest of the body b. place a pillow between the patient's legs and turn the entire body as a unit c. have the patient turn by grasping the side rails and pulling the shoulders over d. turn the patient's head and shoulders first, followed by the hips, legs, and feet

ANS: B The spine should be kept in correct alignment after laminectomy

What action should the nurse complete before administering alendronate to a patient with osteoporosis? a. ask about leg cramps or hot flashes b. assist the patient to sit up at the bedside c. be sure that the patient has recently eaten d. administer the ordered calcium carbonate

ANS: B To avoid esophageal erosions, the patient taking bisphosphonates should be upright for at least 30 min after taking the medication

A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. Which statement by the patient should indicate to the nurse the need for additional teaching related to health maintenance? a. "I'm frustrated with this endless treatment!" b. "I will take my oral temperature twice/day." c. "I think my left foot is starting to droop down." d. "I use crutches to avoid weight bearing on the left leg."

ANS: C Footdrop is an indication that the foot is not being supported in a neutral position by a splint

The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled AKA. Which patient statement indicates to the nurse that additional teaching is needed? a. "I will need to participate in physical therapy after surgery." b. "I wish I did not need chemotherapy after this surgery c. "I did not have this bone cancer until my leg broke a week ago." d. "I can use the PCA to manage postop pain."

ANS: C Osteogenic sarcoma may be diagnosed following a fracture, but it is not the cause of the injury.

Which action included in the care of a patient can the nurse delegate to an experienced UAP? a. check ability to plantar and dorsiflex the foot b. determine the patient's readiness to ambulate c. log roll the patient from side to side every 2 hours d. ask about pain management with the PCA

ANS: C Repositioning a patient is included in the education and scope of practice of a UAP, and experienced UAP will be familiar with how to maintain alignment in the postoperative patient

What should the nurse include in the teaching plan for a patient who has acute low back pain and muscle spasm? a. keep both feet flat on the floor when prolonged standing is required b. twist gently from side to side to maintain ROM in the spine c. keep the head elevated slightly and flex the knees when resting in bed d. avoid the use of cold packs because they will exacerbate the muscle spasms

ANS: C Resting with the health elevated and knees flexed will reduce the strain on the back and decrease muscle spasms

After laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. What action should the nurse take? a. elevate the right leg on two pillows b. obtain vital signs for indication of hemorrhage c. review the preoperative assessment data in the health record d. turn the patient to the left to relieve pressure on the right leg

ANS: C The postoperative movement and sensation of the extremities should be unchanged (or improved) from the preoperative assessment

Which information should the nurse include when teaching a patient with acute low back pain? (select all that apply) a. sleep in a prone position with legs extended b. keep the knees straight when leaning forward to pick something up c. expect symptoms of acute low back pain to improve in a few weeks d. avoid activities that require twisting of the back or prolonged sitting e. use ibuprofen or acetaminophen to relieve pain

ANS: C, D, E Acute back pain usually starts to improve within two weeks, patients should use NSAIDs or acetaminophen to manage pain and avoid activities that stress the back

A patient has had surgical reduction of an open fracture of the right radius. Which assessment findings should the nurse report immediately to the health care provider? a. serous wound drainage b. right arm muscle spasms c. pain with right arm movement d. temperature 101.4 F (38.6 C)

ANS: D An elevated temperature suggests possible osteomyelitis

What should the nurse assess to evaluate the effectiveness of alendronate therapy for a patient with Paget's disease? a. oral intake b. daily weight c. grip strength d. pain intensity

ANS: D Bone pain is a common early manifestation of Paget's disease, and the nurse should assess the intensity to determine if treatment is effective

Which action should the nurse take before administering gentamicin to a patient with acute osteomyelitis? a. ask the patient about any nausea b. obtain the patient's oral temperature c. change the prescribed wet to dry dressing d. review the patient's serum creatinine results

ANS: D Gentamicin is nephrotoxic and can cause renal failure as reflected in the patient's serum creatinine

A 55 yr old woman who recently reached menopause and has a family with a history of osteoporosis is diagnosed with osteopenia. Which information should the nurse explain to the patient? a. with a family history of osteoporosis, there is no way to prevent or slow bone resorption b. estrogen replacement therapy must be started to prevent rapid progression to osteoporosis c. continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis d. calcium loss from bones can be slowed by increasing calcium intake and weight bearing exercise

ANS: D Progression of osteoporosis can be slowed by increasing calcium intake and weight bearing exercises

Which menu choice by a patient with osteoporosis indicates the nurse's teaching about appropriate diet has been effective? a. pancakes with syrup and bacon b. whole wheat toast and fresh fruit c. egg white omelet and half a grapefruit d. oatmeal with skim milk and fruit yogurt

ANS: D Skim milk and yogurt are high in calcium

Which statement by a patient with discomfort from a bunion indicates to the nurse more teaching is needed? a. "I will give away my high-heeled shoes." b. "I can take ibuprofen as I need it." c. "I will use the bunion pad to cushion the area." d. "I can only wear sandals, no closed toe shoes."

ANS: D The patient can wear shoes that have a wide forefoot