PrepU - Ch. 41 Management of Patients With Musculoskeletal Disorders

Test 1 20. A client diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. What is the best response by the nurse? A) B) C) D)

"CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." Carpal tunnel syndrome is an entrapment neuropathy that occurs when the median nerve at the wrist is compressed by a thickened flexor tendon sheath, skeletal encroachment, edema, or a soft tissue mass.

Test 1 17. What food can the nurse suggest to the client at risk for osteoporosis? A) B) C) D)

Broccoli Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium.

Test 3 5. Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD? A) B) C) D)

Calcitonin (Miacalcin) Calcitonin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Raloxifene reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Teriparatide has been recently approved by the FDA for the treatment of osteoporosis.

Test 3 10. When an infection is bloodborne, the manifestations include which symptom? A) B) C) D) Hypothermia

Chills Manifestations of bloodborne infection include chills, high fever, rapid pulse, and generalized malaise.

Test 1 3. The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response? A) Decrease in Parathyroid Hormone B) Increase of Vitamin D C) Increase in Calcitonin D) Decrease in Estrogen

D Decrease in Estrogen Age related processes that contribute to loss of bone mass and osteoporosis are decreases in estrogen, calcitonin, and vitamin D and increase in parathyroid hormone.

Test 4 16. Which term refers to a disease of a nerve root? A) B) C) D)

Radiculopathy When the client reports radiating pain down the leg, the client is describing radiculopathy. Involucrum refers to new bone growth around the sequestrum. Sequestrum refers to dead bone in an abscess cavity. Contracture refers to abnormal shortening of muscle or fibrosis of joint structures

Test 3 3. The community health nurse is assessing the risk factors for osteoporosis in a female client at a health fair. For each assessment finding, click to specify if the finding is a risk factor for osteoporosis or is not a risk factor for osteoporosis. A) 66 years of age B) Large frame C) Asian heritage D) Postmenopausal status E) Nonsmoker F) Alcohol intake of 3 drinks/week G) Takes fluticasone inhaler for asthma H) Walks 2 miles, 3 days/week

Risk factors for osteoporosis - older age (for women, the risk increases after age 50) - Asian heritage - being a postmenopausal woman - Long-term corticosteroid use (Taking fluticasone inhaler for the treatment of asthma) - A small frame, not a large frame, increases the risk for osteoporosis. NOT Risk factors for osteoporosis - Being a Nonsmoker - having a large frame - Alcohol intake of 3 alcoholic beverages/week (BUT Alcohol intake of 3 or more drinks/day is a risk factor for osteoporosis) - Walking 2 miles, 3 days/week (A Sedentary lifestyle increases the risk for osteoporosis)

Test 4 4. A client has Paget's disease. An appropriate nursing diagnosis for this client is: A) B) C) D)

Risk for falls The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility.

Test 3 9. A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? A) B) C) D) Avoid twisting and flexion activities.

Use the large muscles of the leg when lifting items. The large muscles of the leg should be used when lifting.

Test 2 7. The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? A) B) C) D)

"I will avoid prolonged sitting or walking." The nurse encourages the patient to alternate lying, sitting, and walking activities frequently, and advises the patient to avoid sitting, standing, or walking for long periods

Test 1 9. A nurse is teaching a client with osteoporosis about dietary selections. What client statement indicates the teaching was effective? A) B) C) D)

"I will eat more dairy products to increase my calcium intake." Osteoporosis causes a severe, general reduction in skeletal bone mass. To offset this reduction, the nurse should advise the client to increase calcium intake by consuming more dairy products for improved calcium intake. Decreasing red meat will help with increased cholesterol and triglycerides. Clients with osteoporosis do not need to decrease popcorn, nuts or seeds. The client will osteoporosis does not need more potassium.

Test 1 14. A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? A) B) C) D) "You need to limit the amount of protein and calcium in your diet."

"You will receive IV antibiotics for 3 to 6 weeks." Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks. Continuous passive range of motion is used for clients with osteoarthritis. Weight-bearing exercises are used with clients who have osteoporosis. Limiting protein and calcium is not part of the plan of care for clients with osteomyelitis.

Test 1 4. A client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications? A) Common Adverse Effects B) Loading-dose schedule C) Activity restrictions D) Dietary restrictions

A Common Adverse Effects The most common adverse effects of NSAIDs are related to the GI tract: nausea, vomiting, diarrhea, and constipation. GI bleeding, which in some cases is severe, has been reported with the use of these drugs. Use of NSAIDs does not pose significant dietary or activity restrictions nor is there a loading-dose schedule.

Test 1 13. A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? A) B) C) D)

Bone fracture Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

Test 2 19. What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? A) B) C) D)

Decreased height Clients with osteoporosis become shorter over time.

Test 4 14. During a routine physical examination of a client, the nurse observes a flexion deformity of the proximal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding? A) B) C) D)

Hammer toe Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.

Test 4 13. A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks? A) B) C) D)

L4, L5, and S1 The lower lumbar disks, L4-L5 and L5-S1, are subject to the greatest mechanical stress and the greatest degenerative changes. Disk protrusion (herniated nucleus pulposus) or facet joint changes can cause pressure on nerve roots as they leave the spinal canal, which results in pain that radiates along the nerve.

Test 2 2. Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? A) B) C) D)

Long bone bowing Some clients with Paget's disease are asymptomatic with only some mild skeletal deformity. Other clients have marked skeletal deformities which may include enlargement of the skull, bowing of the long bones, and kyphosis.

Test 1 15. Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? A) B) C) D)

Lower lumbar The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes.

Test 2 10. Which should be included in the teaching plan for a client diagnosed with plantar fasciitis? A) B) C) D)

Management of plantar fasciitis includes stretching exercises. Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (e.g., heel cups, arch supports), and using nonsteroidal anti-inflammatory drugs. Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced upon taking the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs.

Test 4 2. The nurse is screening a client for genetic counseling. What musculoskeletal conditions does the nurse know to have a genetic influence? Select all that apply. A) B) C) D)

Marfan syndrome osteoporosis Stickler syndrome Osteoporosis, Marfan syndrome, and Stickler syndrome are conditions that have a genetic influence. Osteoarthritis is not influenced by genetic factors. Diabetes mellitus is not a musculoskeletal disorder with known genetic influence.

Test 1 19. A client with carpal tunnel syndrome has had limited improvement with the use of a wrist splint. The nurse knows that which procedure will show the greatest improvement in treatment for this client? A) B) C) D) Injection of lidocaine

Open nerve release Evidence-based treatment of acute carpal tunnel syndrome includes the application of splints to prevent hyperextension and prolonged flexion of the wrist. Should this treatment fail, open nerve release is a common surgical management option. A variety of treatments may be tried by the client, however, they may fail to improve the condition. These treatments include laser therapy, ultrasound therapy, and the injection of substances such as lidocaine. Though these can be used, surgery to release nerves is the best option.

Test 1 11. A nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan? A) B) C) D) Examine the surgical dressing every hour.

Perform neuromuscular assessment every hour. The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is important to prevent complications from the surgery. The surgical dressing does not need to be examined hourly. Administering pain medication is important, but assessing the foot color and temperature are most important. Vital sign monitoring is important, but not a priority after foot surgery.

Test 4 1. Morton neuroma is exhibited by which clinical manifestation? A) B) C) D)

Swelling of the third (lateral) branch of the median plantar nerve Explanation: Morton neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.

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Test 2 9.A client has been treated for migraine headaches for several months and comes to the clinic reporting no improvement. The nurse is talking with the client and hears an audible click when the client is moving the jaw. What does the nurse suspect may be happening? A) B) C) D)

Temporomandibular disorder The disorder can be confused with trigeminal neuralgia and migraine headaches. The client experiences clicking of the jaw when moving the joint, or the jaw can lock, which interferes with opening the mouth. Loose teeth will not cause a clicking of the jaw. The client does not have a dislocated jaw.

Test 1 12. A client with a musculoskeletal injury is instructed to alter the diet. The objective of altering the diet is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which food item should the nurse encourage the client to include in the diet? A) B) C) D)

Vitamin D-fortified milk The nurse should advise the client to include dietary sources of vitamin D, such as fatty fish, vitamin D-fortified milk, and cereals. These foods protect against bone loss and decrease the risk of fracture by facilitating the absorption of calcium from food and supplements. Red meat, bananas, and green vegetables do not facilitate calcium absorption from food and supplements.

Test 2 8. The community health nurse is assessing the risk factors for osteoporosis in a female client at a health fair. For each assessment finding, click to specify if the finding is a risk factor for osteoporosis or is not a risk factor for osteoporosis. A) B) C) D)

g Risk factors for osteoporosis include older age (for women, the risk increases after age 50), Asian heritage, being a postmenopausal woman, and long-term corticosteroid use (such as fluticasone for the treatment of asthma). A small frame, not a large frame, increases the risk for osteoporosis. Being a nonsmoker does not increase the risk for osteoporosis. An alcohol intake of 3 or more drinks/day is a risk factor for osteoporosis; an intake of 3 alcoholic beverages/week does not increase the risk. A sedentary lifestyle also increases the risk for osteoporosis; however, walking 2 miles, 3 days/week is not considered sedentary.

Test 1 2. Which client would the nurse identify as having the greatest risk for osteoporosis? A) A small-framed, thin 45-year-old white woman B) A 16 yo male with a history of asthma C) A 20 yo male athlete with repeated D) A 40 yo overweight African American woman

A A small-framed, thin 45-year-old white woman Small-framed, thin white women are at greatest risk for osteoporosis. African American women have a greater bone density and thus are less susceptible to osteoporosis. Men have an increased bone mass and do not have hormonal changes, and do not acquire osteoporosis as frequently and get it at a later age. Asthma does not increase the risk for osteoporosis.

Test 3 14. A client has been treated for migraine headaches for several months and comes to the clinic reporting no improvement. The nurse is talking with the client and hears an audible click when the client is moving the jaw. What does the nurse suspect may be happening? A) B) C) D)

Temporomandibular disorder The disorder can be confused with trigeminal neuralgia and migraine headaches. The client experiences clicking of the jaw when moving the joint, or the jaw can lock, which interferes with opening the mouth. Loose teeth will not cause a clicking of the jaw. The client does not have a dislocated jaw.

Test 1 8. A client is informed of having a benign bone tumor but that this type of tumor that may become malignant. The nurse knows that this is characteristic of which type of tumor? A) Osteoclastoma B) Enchondroma C) Osteoid Osteoma D) Osteochondroma

A Osteoclastoma Osteoclastoma - is a giant cell tumor that may invade local tissue; usually soft and hemorrhagic and may become malignant. Osteochondroma - occurs as a large projection of bone at the ends of long bones, developing during growth periods and then becoming static bone mass. Enchondroma - is a hyaline cartilage tumor that develops in the hand, ribs, femur, tibia, humerus, or pelvis. Osteoid Osteoma - is a painful tumor surrounded by reactive bone tissue.

Test 1 16. The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? A) B) C) D) Needle aspiration

Arthroscopy Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made.

Test 3 16. The nurse is collaborating with the health care provider on a plan of care for a 54-year-old male client with osteomyelitis of the left femur secondary to uncontrolled type 1 diabetes. Click to highlight the prescriptions for care that the nurse should anticipate for this client. A) Perform neurovascular checks of lower extremities every 8 hours. B) Administer IV antibiotic based on culture and sensitivity report. C) Encourage ambulation with weight-bearing on the left leg. D) Administer ibuprofen 400 mg orally three times daily, as needed for pain. E) Make referral to dietitian to discuss nutrition for healing and blood glucose control. F) Provide education on self-blood glucose monitoring and insulin administration.

B C E F - Perform neurovascular checks of lower extremities every 8 hours - Administer IV antibiotic based on culture and sensitivity report - Administer ibuprofen 400 mg orally three times daily, as needed for pain - Make referral to dietitian to discuss nutrition for healing and blood glucose control - Provide education on self-blood glucose monitoring and insulin administration Osteomyelitis is a bone infection that produces pain, inflammation, swelling, and impaired mobility and requires prompt treatment to treat the infection and prevent loss of limb. The nurse should perform neurovascular checks of the affected leg every 8 hours to detect the development of nerve or vascular impairment. Osteomyelitis is treated with IV antibiotics determined by the identified pathogen on culture and sensitivity testing. Because there is reduced penetration of antibiotics in the bone tissue, IV antibiotic therapy may be needed for 6 to 12 weeks, followed by oral antibiotics. The pain of osteomyelitis can be controlled with oral analgesics, such as ibuprofen.The client should consume a healthy diet to promote bone healing and control blood glucose levels. Because uncontrolled blood glucose levels increase the risk for osteomyelitis and impair bone healing, the nurse should educate the client about self-blood glucose monitoring and insulin administration. The client's affected left leg should be elevated to reduce swelling and pain. The affected leg should not be placed in the dependent position. Because the bone is weakened by the infectious process, the client should avoid placing stress on the bone through weight-bearing activity.

Test 1 6. A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? A) "Using arm splints will prevent Hyperflexion of the wrist" B) "This condition is associated with various sports" C) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." D) "Surgery is the only sure way to manage this condition"

C "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints.

Test 1 5. The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given? A) Raloxifene B) Teriparatide C) Alendronate D) Denosumab

C Alendronate Alendronate - is a bisphosphonate medication. Raloxifene - is a selective estrogen receptor modulator. Teriparatide - is an anabolic agent, Denosumab - is a monoclonal antibody agent.

Test 1 1. A patient shows the nurse a round, firm nodule on the wrist. The pain is described as aching, with some weakness of the fingers. What treatment does the nurse anticipate assisting with? (Select all that apply.) A) Active Range-of-Motion exercises B) Educating the pt on the use of Gabapentin C) Aspiration of the cyst D) Surgical excision E) Corticosteroid injections

C D E Aspiration of the cyst Surgical excision Corticosteroid injections A ganglion—a collection of neurologic gelatinous material near the tendon sheaths and joints—appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. It frequently occurs in women younger than 50 years. The swelling is locally tender and may cause an aching pain. When a tendon sheath is involved, weakness of the finger occurs. Treatment may include aspiration, corticosteroid injection, or surgical excision. After treatment, a compression dressing and immobilization splint are used.

Test 2 18. While the nurse is performing a physical assessment, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. What should this assessment indicate to the nurse? A) B) C) D)

Carpal Tunnel Syndrome Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome. Morton's neuroma is assessed as a painful condition that affects the ball of the foot. Dupuytren's contracture is when knots of tissue beneath the skin cause one or more fingers stay bent toward the palm. Impingement syndrome is a shoulder condition.

Test 1 7. During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? A) "The posture begins to stop after middle age." B) "After age 40, height may show a gradual decrease as a result of spinal compression" C) "There may be some slight discrepancy between the measuring tools used." D) "After menopause, the body's bone density declines, resulting in a gradual loss of height."

D "After menopause, the body's bone density declines, resulting in a gradual loss of height." The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question.

Test 1 10. Which of the following presents with an onset of heel pain with the first steps of the morning? A) B) C) D)

Plantar fasciitis Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heal pain experienced with the first steps in the morning. Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.

Test 4 18. The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients? A) B) C) D) Impaired physical mobility

Disturbed body image Amputation of a body part can result in disturbances in body image.

Test 3 13. What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? A) B) C) D)

Dupuytren contracture Dupuytren disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally.

Test 3 15. Which group is at the greatest risk for osteoporosis? A) B) C) D)

European American women Small-framed, nonobese European American women are at greatest risk for osteoporosis. Asian American women of slight build are at risk for low peak bone mineral density. African American women, who have a greater bone mass than European American women and Asian American Women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.

Test 2 14. A healthcare provider asks a nurse to test a client for Tinel's sign to diagnose carpal tunnel syndrome. What should the nurse do to perform this assessment? A) B) C) D)

Have the client hold the palm of the hand up while the nurse percusses over the median nerve. If tingling, numbness, or pain is felt when the median nerve is percussed, then Tinel's sign is considered positive. To test for Tinel's sign have the client hold the palm of the hand up while the nurse percusses over the median nerve. The client making a fist and pushing will test strength resistance. The client stretching fingers around a ball will not test for Tinel's sign. Having the client pronate the hand and palpating the radial nerve is not Tinel's sign used for carpal tunnel syndrome diagnosis.

Test 2 17. A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? A) B) C) D)

Initiating weight-bearing exercise routines Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.

Test 4 20. A client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings? A) B) C) D)

Osteomyelitis Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. A client with avascular necrosis does not have fever and chills. Clients with fat emboli will have a rash and breathing complications. A client with compartment syndrome will have numbness, not a fever.

Test 3 18. Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? A) B) C) D)

Paget disease Paget disease results in bone that is highly vascularized and structurally weak, predisposing the client to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. A ganglion is a collection of neurological gelatinous material. Osteomyelitis is an infection of bone that comes from the extension of a soft-tissue infection, direct bone contamination, or hematogenous spread.

Test 4 5. A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? A) B) C) D)

Performing hourly neurovascular assessments for the first 24 hours Hourly neurovascular assessment of the exposed fingers for the first 24 hours following surgery is essential for monitoring function of the nerves and perfusion.

Test 3 1. A client with Paget's disease comes to the hospital and reports difficulty urinating. The emergency department health care provider consults urology. What should the nurse suspect is the most likely cause of the client's urination problem? A) B) C) D) Benign prostatic hyperplasia

Renal calculi Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A UTI commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination.

Test 3 8. Which is a risk-lowering strategy for osteoporosis? A) B) C) D)

Smoking cessation Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D.

Test 3 11. A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? A) B) C) D) Supine, with the bed flat and a firm mattress in place

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees A medium to firm, not sagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress (National Guideline Clearinghouse, 2010). Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head (Fig. 42-1). A prone position should be avoided because it accentuates lordosis.

Test 1 18. In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? A) B) C) D)

Surgical debridement In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.

Test 4 11. A nurse is performing foot care for a client with chronic osteomyelitis and the client asks the nurse about the next treatment. What is the specific treatment for a client with chronic osteomyelitis? A) B) C) D) Drainage of localized foci of infection

Surgical removal of the sequestrum A sequestrectomy, removal of enough involucrum to enable the surgeon to remove the sequestrum, is performed on clients with chronic osteomyelitis. In many cases, sufficient bone is removed to convert a deep cavity into a shallow saucer (saucerization). All dead, infected bone and cartilage must be removed before permanent healing can occur. Aggressive physical therapy is not recommended until healing has occurred. Draining the infection is not sufficient to heal chronic osteomyelitis. Continued wound care is not sufficient to heal the wound.

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