musculoskeletal alteration/ adaptive quizzing

A client who has been taking ibuprofen (Advil) for rheumatoid arthritis asks the nurse if acetaminophen (Tylenol) can be substituted instead. An appropriate nursing response is: 1. "Acetaminophen is the preferred treatment for rheumatoid arthritis." 2. "Acetaminophen irritates the stomach more than ibuprofen does." 3. "Ibuprofen is an antiinflammatory and acetaminophen is not." 4. "Both are antipyretics and have the same effect."

3. NSAIDs are preferred for treatment of rheumatoid arthritis.

A client with newly diagnosed multiple myeloma asks, "How long do you think I have to live?" The most appropriate response by the nurse is: 1. "Let me ask your primary health care provider for you." 2. "I can understand why you are worried." 3. "Tell me about your concerns right now." 4. "It depends on whether the tumor has spread."

3. encourages the client to review facts and provides an opportunity to talk about feelings.

A client who has been diagnosed with Lyme disease is started on doxycycline (Vibramycin) as part of the therapy. What should the nurse do when administering this drug? 1. Administer the medication with meals or a snack. 2. Provide orange or other citrus fruit juice with the medication. 3. Give the medication an hour before milk products are ingested. 4. Offer antacids 30 minutes after administration if gastrointestinal side effects occur.

3. Any product containing aluminum, magnesium, or calcium ions should not be taken in the hour before or after an oral dose, because it decreases absorption by as much as 25% to 50%.

A client with multiple myeloma is scheduled to have a chest x-ray and bone scan. What is the primary responsibility of the nursing and radiology staff? 1. Explain procedures and their purposes. 2. Provide rest periods during the procedures. 3. Handle the client with supportive movements. 4. Monitor the client for dyspnea and tachycardia

3. Because of bone erosion, pathologic fractures are a common complication of multiple myeloma

A jogger sustains multiple fractures of the femur after being hit by a motor vehicle. A nurse responds to the scene of the accident to assist with care. The nurse recalls that, for this type of fracture, immediate life-threatening systemic complications can be minimized by: 1. Elevating the affected limb 2. Encouraging deep breathing and coughing 3. Handling and transporting the client gently 4. maintaining anatomic alignment of the client's limb

3. Gentle intervention reduces pain and shock and inhibits the release of bone marrow into the system, which can cause a fat embolism.

The nurse considers that a 70-year-old female can best limit further progression of osteoporosis by: 1. Taking supplemental calcium and vitamin D 2. Increasing the consumption of eggs and cheese 3. Taking supplemental magnesium and vitamin E 4. Increasing the consumption of milk and milk products

1. Research demonstrates that women past menopause need at least 1500 mg of calcium a day, which is almost impossible to obtain through dietary sources

The plan of care for a client with osteoporosis includes active and passive exercises, calcium supplements, and daily vitamins. How does a nurse determine that the desired effect of therapy has been achieved? 1. Mobility increases. 2. Fewer muscle spasms occur. 3. The heartbeat is more regular. 4. There are fewer bruises than before therapy.

1. This regimen limits bone demineralization and reduces bone pain, which promote increased activity.

A nurse is presenting a community education program about osteoporosis at a women's health conference. What factor should the nurse explain has contributed to the increased incidence of fractures associated with osteoporosis in the United States? 1. Dietary use of fat-free milk 2. Aging of the American population 3. Increased number of hysterectomies 4. Immobility associated with early retirement

2. Because more people are living longer, the problem of osteoporosis in older adults, especially older women, is increasing.

A client is admitted with acute gouty arthritis. Which medication does the nurse anticipate the health care provider may prescribe to prevent and treat an acute attack of gout? 1. Ibuprofen (Motrin) 2. Colchicine (Colsalide) 3. Probenecid (Benemid) 4. Hydrocortisone (Cortef)

2. Colchicine decreases the formation of lactic acid, which may promote the deposition of uric acid in the joints. It also decreases the inflammatory response.

The nurse is preparing an individualized teaching plan for a client with osteoarthritis. The nurse recognizes which abnormality as specific to osteoarthritis? 1. Ulnar drift 2. Heberden nodes 3. Swan neck deformity 4. Boutonnière deformity

2. Heberden nodules are the bony or cartilaginous enlargements of the distal interphalangeal joints that are associated with osteoarthritis. Ulnar drift, Swan neck deformity, and Boutonnière deformity occur with rheumatoid arthritis.

A nurse is taking the health history of a client who is to have surgery in one week. The nurse identifies that the client is taking ibuprofen (Advil) for discomfort associated with osteoarthritis and notifies the health care provider. Which drug does the nurse expect will most likely be prescribed instead of the Advil? 1. Naproxen (Aleve) 2. Ibuprofen (Motrin) 3. Ketorolac (Toradol) 4. Acetaminophen (Tylenol)

4. Acetaminophen is a nonopioid analgesic that inhibits prostaglandins, which serve as mediators for pain; it does not impact platelet function. Naproxen, ibuprofen, and ketorolac are nonselective nonsteroidal antiinflammatory drugs (NSAIDs) that are contraindicated for clients undergoing surgery

After becoming incontinent of urine, an older client is admitted to a nursing home. The client's rheumatoid arthritis contributes to severely painful joints. The primary consideration in the care of this client is the need for: 1. Control of pain 2. Immobilization of joints 3. Motivation and teaching 4. Bladder training and control

1. After the need to survive (air, food, water), the need for comfort and freedom from pain closely follow;

A client's osteoporosis has progressed dramatically in the last five years, and the client is especially prone to falling. Which statement best reflects the client's understanding of why the risk of falls has increased? 1. "I do not have the stamina that I used to have." 2. "At my age, I'm more prone to dizziness and falling." 3. "I have a curvature of my spine, and it is hard to keep my balance." 4. "Because I am bent over, I look down instead of up while I'm walking."

3. increased convexity in the curvature of the thoracic spine as viewed from the side (kyphosis) alters the center of gravity, which contributes to alterations in balance and gait.

What should the nurse consider as the goal of therapy when administering allopurinol (Zyloprim) to a client with gout? 1. Increase bone density 2. Decrease synovial swelling 3. Decrease uric acid production 4. Prevent crystallization of uric acid

4.

A nurse is completing the health history of a client admitted to the hospital with osteoarthritis. The nurse expects the client to report that which joints were involved initially? Select all that apply. 1. Hips 2. Knees 3. Ankles 4. Shoulders 5. Metacarpals

1, 2 Osteoarthritis affects the weight-bearing joints (e.g., hips and knees) first because they bear the most body weight. Although the distal interphalangeal joints are affected frequently, the remaining interphalangeal joints and metacarpals are not.

A nurse is performing a physical assessment of a client with gout. What parts of the client's body should the nurse assess for the presence of tophi (urate deposits)? Select all that apply. 1. Feet 2. Ears 3. Chin 4. Buttocks 5. Abdomen

1, 2 Uric acid has a low solubility; it tends to precipitate and form deposits at various sites where blood flow is least active, including cartilaginous tissue such as the ears. Urate deposits will not form at the chin, buttocks, and abdomen because the blood flow is ample, and it is not cartilaginous tissue.

A 7-year-old child sustains a fractured femur in a bicycle accident. The admission x-ray films reveal evidence of fractures of other long bones in various stages of healing. What does the nurse suspect as the cause of the fracture? 1. Child abuse 2. Vitamin D deficiency 3. Osteogenesis imperfecta 4. Inadequate calcium intake

1. Injuries in various stages of healing are the classic sign of child abuse.

As an acute episode of rheumatoid arthritis subsides, active and passive range-of-motion exercises are taught to the client's spouse. The nurse should teach that direct pressure should not be applied to the client's joints because this may precipitate: 1. Pain 2. Swelling 3. Nodule formation 4. Tophaceous deposits

1. Palpation will elicit tenderness because pressure stimulates nerve endings and causes pain.

A client with osteoporosis is encouraged to drink milk. The client refuses the milk, explaining that it causes gas and bloating. Which food should the nurse suggest that is rich in calcium and digested easily by clients who do not tolerate milk? 1. Eggs 2. Yogurt 3. Potatoes 4. Applesauce

2. Yogurt, which contains calcium, is digested more easily because it contains the enzyme lactase,

When a 12-year-old boy who sustained several tick bites on a camping trip becomes ill, he is told that he may have Lyme disease. He asks the nurse, "What is Lyme disease?" What is the best response by the nurse? 1. "I can see that you're concerned. Tell me what you want to know." 2. "The infection is caused by a spirochete. It can be cured with penicillin." 3. "The tick bites gave you an infection. There is medication that will treat it." 4. "You sound upset. Don't worry—we have medicine that will make you better."

3.

The nurse is caring for an elderly client who has a right hip fracture. What intervention should be included in the plan of care? 1. Nutrition supplements 2. Cardiac monitoring 3. Oxygen therapy 4. Venous thromboembolism prevention (VTE)

4. VTE causes most fatalities in elderly clients with hip fractures.

After treatment for Lyme disease, a child expresses fear of going camping again because of the ticks. What is the best response by the nurse? 1. "Tell me more about your fears about camping." 2. "Just think of all the fun you'll be missing if you don't go to camp." 3. "It's hard to believe you're afraid to go camping just because of a tick." 4. "Checking yourself frequently for ticks will help prevent another infection."

4.

A client with type 2 diabetes develops gout, and allopurinol (Zyloprim) is prescribed. The client is also taking metformin (Glucophage) and an over-the-counter nonsteroidal antiinflammatory drug (NSAID). When teaching about the administration of allopurinol, what should the nurse instruct the client to do? 1. Decrease the daily dose of NSAIDs. 2. Limit fluid intake to one quart a day. 3. Take the medication on an empty stomach. 4. Monitor blood glucose levels more frequently.

4. Allopurinol can potentiate the effect of oral hypoglycemics, causing hypoglycemia; the blood glucose level should be monitored more frequently.

A client with rheumatoid arthritis asks the nurse about ways to decrease morning stiffness. The nurse should suggest: 1. Wearing loose but warm clothing 2. Planning a short rest break periodically 3. Avoiding excessive physical stress and fatigue 4. Taking a hot tub bath or shower in the morning

4. Moist heat increases circulation and decreases muscle tension, which help relieve chronic stiffness.

When teaching about the dietary control of gout, the nurse evaluates that the dietary teaching is understood when the client states; "I will avoid eating: 1. Eggs." 2. Shellfish." 3. Fried poultry." 4. Cottage cheese."

4. Shellfish contains more than 100 mg of purine per 100 grams. should also avoid organ meats, wines, aged cheeses.

The nurse enters a client's room and finds the client on the floor crying for help. It is obvious to the nurse that the client has sustained a hip fracture. Which action should the nurse take next? 1. Administer pain medication 2. Place the affected extremity in traction 3. Immobilize the affected extremity 4. Notify the health care provider on call

3. The nurse should immobilize the affected extremity first. Further damage and internal bleeding could occur if the extremity is not immobilized.