Musculoskeletal quiz (chapters 40 & 42)

A nurse is providing an educational class to a group of older adults at a community senior center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended adequate intake of what nutrients? Select all that apply.

Calcium Vitamin D A diet rich in calcium and vitamin D protects against skeletal demineralization. Intake of vitamin B12and potassium does not directly influence the risk for osteoporosis. Calcitonin is not considered to be a dietary nutrient. (ch 42, p. 1144)

A nurse is caring for a patient who is being assessed following complaints of severe and persistent low back pain. The patient is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? that apply.

Computed tomography (CT) X-ray Ultrasound Magnetic resonance imaging (MRI) A variety of diagnostic tests can be used to address lower back pain, including CT, MRI, ultrasound, and X-rays. Angiography is not related to the etiology of back pain. (ch 42, p. 1133)

Which assessment parameter would the nurse expect to find when assessing the older adult with a musculoskeletal disorder? Select all that apply.

Decreased range of motion Decreased endurance Joint stiffness Significant assessment findings of the musculoskeletal system in the older adult would include joint stiffness and decreased height, range of motion, muscle strength, and endurance. (ch 40, p. 1093)

Ms. Cramer is in your clinic and the physician has scheduled a bone scan for her. A bone scan may be ordered to detect metastatic bone lesions, fractures, and certain types of inflammatory disorders. Select all of the following nursing considerations that are correct in preparing a client for a bone scan.

Ensuring that the client does not have any allergies to the isotope Encouraging the client to drink fluids to help distribute and eliminate the isotope Informing the client that the radiopaque isotope will be administered intravenously Inform the client that the radiopaque isotope will be administered intravenously, ensure that the client does not have any allergies to the isotope, and encourage the client to drink fluids to help distribute and eliminate the isotope are all considered in preparing a client for a bone scan. The client does not need to be NPO for 12 hours before the test. (ch 40, p. 1100)

The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.)

More than 3-second capillary refill Pale, cyanotic, or mottled color Cool temperature of the extremity Indicators of peripheral neurovascular dysfunction include pale, cyanotic, or mottled skin color; cool temperature of the extremities; and a capillary refill of more than 3 seconds. (ch 40, p. 1099)

Hypercalcemia is a dangerous complication of bone cancer. Therefore, nursing assessment includes evaluation of symptoms that require immediate treatment. Which of the following are signs/symptoms that are indictors of an elevated serum calcium? Select all that apply.

Muscle weakness Shortened QT interval Lack of muscle coordination Anorexia and constipation Hypercalcemia is a dangerous complication of bone cancer. The symptoms must be recognized and treatment initiated promptly. Symptoms include muscular weakness, incoordination, anorexia, nausea and vomiting, constipation, electrocardiographic changes (eg, shortened QT interval and ST segment, bradycardia, heart blocks), and altered mental states (eg, confusion, lethargy, psychotic behavior). (ch 42, p. 1153)

Which of the following are routes of administration for Calcitonin? Select all that apply.

Nasal spray Intramuscular injection Subcutaneous Calcitonin is administered by nasal spray or by subcutaneous or intramuscular injections. (ch 42, p. 1144)

A patient is diagnosed with osteomyelitis of the right leg. What signs and symptoms do the nurse recognize that are associated with this diagnosis? (Select all that apply.)

Pain Erythema Fever When the infection is bloodborne, the onset is usually sudden, occurring often with the clinical and laboratory manifestations of sepsis (e.g., chills, high fever, rapid pulse, general malaise). The systemic symptoms at first may overshadow the local signs. As the infection extends through the cortex of the bone, it involves the periosteum and the soft tissues. The infected area becomes painful, swollen, and extremely tender. The patient may describe a constant, pulsating pain that intensifies with movement as a result of the pressure of the collecting purulent material (i.e., pus). When osteomyelitis occurs from the spread of adjacent infection or from direct contamination, there are no manifestations of sepsis. The area is swollen, warm, painful, and tender to touch. (ch 42, p. 1148)

Red bone marrow produces which of the following? Select all that apply.

Platelets White blood cells (WBCs) Red blood cells (RBCs) The red bone marrow located within the bone cavities produces RBC, WBCs, and platelets through the process of hematopoiesis. The red bone marrow does not produce estrogen or corticosteroids. (ch 40, p. 1089)

A provider asks the nurse to teach a patient with low back pain how to sit in order to minimize pressure on the spine. Which of the following teaching points would the nurse include? Select all that apply.

Sit in a straight-backed chair with arm rests. Avoid hip extension. Place feet flat on the floor. Sit with the buttocks "tucked under." All choices are correct, except that a soft pillow support is recommended to eradicate the hollow of the back. Refer to Box 41-2 in the text. (ch 42, p. 1135)

What areas of the body may be examined when bone densitometry is done? Select all answers that are correct.

Spine Wrist Hip The hip, spine, wrist, finger, or heel bone may be examined during bone densitometry testing. The knee is not used for bone densitometry testing. (ch 40, p. 1100)

Which clinical manifestation would the nurse recognize as an indicator of peripheral neurovascular dysfunction? Select all that apply.

Toes mottled and cool Complaints of pins and needles in feet Clinical manifestations of peripheral neurovascular dysfunction include coolness, mottling, weakness, complaints of paresthesia or a pins and needles sensation, and unrelenting pain. Capillary refill of less than 3 seconds is a normal finding. (ch 40, p. 1099)

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?

The client will experience a tolerable level of pain. The client will demonstrate wound care. The client will maintain adequate nutritional intake. Pain is a priority problem for the client with osteomyelitis, and it can interfere with mobility of joint. In this situation, the client's jaw is the site of infection. Pain in this location can interfere with nutritional intake of the individual. Chronic osteomyelitis presents with a nonhealing ulcer over the infected bone with a connecting sinus that will intermittently and spontaneously drain pus. The client will need to be able to provide wound care in the home setting. Remaining free from injury and maintaining an effective airway clearance are not priority goals for the client. (ch 42, p. 1150)

Mr. Quinn has just been diagnosed with osteomyelitis. Osteomyelitis is an infection of the bone, resulting in limited blood supply to the bone, inflammation of and pressure on the tissue, bone necrosis, and formation of new bone around devitalized bone tissue. What are possible causes of osteomyelitis? Select all that apply.

Trauma, such as penetrating wounds or compound fractures Vascular insufficiency in clients with diabetes or peripheral vascular disease The following are all causes of osteomyelitis: trauma, such as penetrating wounds or compound fractures; vascular insufficiency in clients with diabetes or peripheral vascular disease; and surgical contamination, such as pin sites of skeletal traction. Osteoporosis is not a cause of osteomyelitis. (ch 42, p. 1147-1148)

The nurse is preparing the client with a right neck mass for magnetic resonance imaging (MRI). Which question should the nurse ask? Select all that apply.

"Are you wearing any jewelry?" "Have you removed your hearing aid?" "Do you have a pacemaker?" Magnetic resonance imaging (MRI) is a noninvasive imaging technique that uses magnetic fields, radiowaves, and computers to demonstrate abnormalities of soft tissue. Individuals with any metal implants, clips, or pacemakers are not candidates for MRI. Individuals do not need to be NPO and can take usual medications. (ch 40, p. 1099)