CH 36 Prep U

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? - "There may be some slight discrepancy between the measuring tools used." - "The posture begins to stoop after middle age." - "After age 40, height may show a gradual decrease as a result of spinal compression" - "After menopause, the body's bone density declines, resulting in a gradual loss of height."

"After menopause, the body's bone density declines, resulting in a gradual loss of height."

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? - "Instead of turning around to grasp an object, I will twist at the waist." - "I will bend at the waist when I am lifting objects from the floor." - "I will avoid prolonged sitting or walking." - "I will lie prone with my legs slightly elevated."

"I will avoid prolonged sitting or walking." Explanation: 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. :

What food can the nurse suggest to the client at risk for osteoporosis? - Bananas - Broccoli - Carrots - Chicken

Broccoli

When an infection is bloodborne, the manifestations include which symptom? - Hypothermia - Bradycardia - Hyperactivity - Chills

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

What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? - Callus - Hammertoe - Hallux valgus - Dupuytren contracture

Dupuytren contracture Explanation: 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.

What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? - Hallux valgus - Hammertoe - Dupuytren contracture - Callus

Dupuytren contracture Explanation: 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.

Dupuytren contracture causes flexion of which area(s)? - Fourth and fifth fingers - Thumb - Index and middle fingers - Ring finger

Dupuytren contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger

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? - Have the client hold the palm of the hand up while the nurse percusses over the median nerve. - Have the client pronate the hand while the nurse palpates the radial nerve. - Have the client make a fist and open the hand against resistance. - Have the client stretch the fingers around a ball and squeeze with force.

Have the client hold the palm of the hand up while the nurse percusses over the median nerve. Explanation: 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.

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? - L1, L2, and L4 - C3, C4, and L1 - L2, L3, and L5 - L4, L5, and S1

L4, L5, and S1

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? - Osteomyelitis - Osteomalacia - Paget disease - Ganglion

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.

A client has Paget's disease. An appropriate nursing diagnosis for this client is: - Fatigue - Risk for infection - Risk for falls - Delayed wound healing

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

The majority of bone infections are caused by which organism? - Proteus - Staphylococcus aureus - Pseudomonas

Staphylococcus aureus

Morton neuroma is exhibited by which clinical manifestation? - Swelling of the third (lateral) branch of the median plantar nerve - High arm and a fixed equinus deformity - Inflammation of the foot-supporting fascia - Longitudinal arch of the foot is diminished

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.

A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about a calcium supplement should the nurse include? - Take the supplement on an empty stomach with a full glass of water. - Take the supplement with meals or with orange juice. - Take weekly on the same day and at the same time. - Remain in an upright position 30 minutes after taking the supplement.

Take the supplement with meals or with orange juice. Explanation: Calcium supplements should be taken with meals or with a beverage high in vitamin C for increased absorption. Calcium supplements are taken daily, not weekly. There are no special instructions about staying upright when taking calcium supplements.

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? Select all that apply.

The client will experience a tolerable level of pain. The client will maintain adequate nutritional intake. The client will demonstrate wound care.

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and the immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client? - The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor. - The nurse is caring for this client on the intensive care unit. - The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit. - The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor.

The nurse is caring for this client on the intensive care unit.

When teaching a client how to prevent low back pain as a result of lifting, the nurse should instruct the client to: - place the load away from the body. - avoid overreaching. - bend the knees and loosen the abdominal muscles. - use a narrow base of support.

avoid overreaching. Explanation: Instructions for the client with low back pain should include that, when lifting, the client should avoid overreaching. The client should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back.

The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as which condition? - Pes cavus - Hallux valgus - Flatfoot - Hammertoe

- Hallux valgus

group of students are reviewing information about osteoporosis in preparation for a classdiscussion. The students demonstrate a need for additional review when they state which of thefollowing as a risk factor? - Prolonged immobility - Excess caffeine taken - Hypothyroidism - Prolonged corticosteroid use

- Hypothyroidism

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? - Denosumab - Teriparatide - Raloxifene - Alendronate

Alendronate Explanation: Alendronate is a bisphosphonate medication. Raloxifene is a selective estrogen receptor modulator. Teriparatide is an anabolic agent, and denosumab is a monoclonal antibody agent.

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? - Alkaline phosphatase - Potassium level - Magnesium level - Troponin levels

Alkaline phosphatase Explanation: Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly.

A client is scheduled for surgery to fuse a joint. The nurse identifies this as which of the following? - Arthroplasty - Osteotomy - Open reduction internal fixation - Arthrodesis

Arthrodesis Explanation: An arthrodesis is a surgical procedure to fuse a joint. An osteotomy involves cutting and removing a wedge of the bone to change alignment. An arthroplasty is a total reconstruction or replacement of a joint with an artificial joint. Open reduction internal fixation is accomplished with wire, nails, plate and/or an intramedullary rod to hold bone fragments in place until healing is complete.

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? - Needle aspiration - Open reduction - Arthroplasty - Arthroscopy

Arthroscopy Explanation: 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

A client with diabetes punctured the foot with a sharp object. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? - 7 to 10 days - At least 4 weeks - 3 months - 6 months

At least 4 weeks IV antibiotic therapy is administered for at least 4 weeks, followed by another 2 weeks (or more) of IV antibiotics or oral antibiotics.

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)? - Calcitonin - Raloxifene - Vitamin D - Teriparatide

Calcitonin Explanation: 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. Vitamin D increases the absorption of calcium.

hich of the following inhibits bone resorption and promotes bone formation?

Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis.

A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication? - Calcium level of 11.6 mg/dl - Sodium level of 110 mEq/L - Magnesium level of 0.9 mg/dl - Potassium level of 6.3 mEq/L

Calcium level of 11.6 mg/dl Explanation: In clients with bone cancer, tumor destruction of bone commonly causes excessive calcium release. When the calcium-excreting capacity of the kidneys and GI tract is exceeded, the serum calcium level rises above normal, leading to hypercalcemia (a serum calcium level greater than 10.2 mg/dl). Hyperkalemia (a potassium level greater than 5 mEq/L) isn't caused by bone cancer and is seldom associated with chemotherapy. Hyponatremia (a sodium level less than 135 mEq/L) and hypomagnesemia (a magnesium level less than 1.3 mg/dl) are potential adverse effects of chemotherapy; these electrolyte disturbances don't result directly from bone cancer

A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder? - Bupivacaine - Dexamethasone - Dicloxacillin - Chlorpheniramine

Chlorpheniramine Explanation: Antihistamines such as chlorpheniramine are frequently prescribed when an allergy is a factor in causing a skin disorder. Antihistamines relieve itching and shorten the duration of allergic reaction. Corticosteroids such as dexamethasone are used to relieve inflammatory or allergic symptoms. Antibiotics such as dicloxacillin are used to treat infectious disorders. Local anesthetics such as bupivacaine are used to relieve minor skin pain and itching

The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as? - Bunion - Hammer Toe - Corn - Clawfoot

Corn Explanation: A corn is an area of hyperkeratosis (overgrowth of a horny layer of epidermis) produced by internal pressure (the underlying bone is prominent because of a congenital or acquired abnormality, commonly arthritis) or external pressure (ill-fitting shoes). The fifth toe is most frequently involved, but any toe may be involved.

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? - Decreased height - Bone spurs - Increased heel pain - Diarrhea

Decreased height

When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location? - Distal femur around the knee - Proximal humerus - Wrist-hand junction - Femur-hip area

Distal femur around the knee Explanation: Malignant bone tumors usually are located around the knee in the distal femur or proximal fibula; a few are found in the proximal humerus. The wrist-hand junction and femur-hip area are not common sites

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? - Risk for infection - Inadequate nutrition - Impaired physical mobility - Disturbed body image

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

Which group is at the greatest risk for osteoporosis?

European American women

Which should be included in the teaching plan for a client diagnosed with plantar fasciitis? - The pain of plantar fasciitis diminishes with soaking the foot in warm water. - Management of plantar fasciitis includes stretching exercises. - Plantar fasciitis presents as an acute onset of pain localized to the ball of the foot. - Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion.

Management of plantar fasciitis includes stretching exercises. Explanation: 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

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? - Injection of lidocaine - Ultrasound therapy - Laser therapy - Open nerve release

Open nerve release Explanation: 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.

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? - Osteomyelitis - Compartment syndrome - Fat embolism - Avascular necrosis

OsteomyelitisRationale: 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.

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? - Changing the dressing - Applying a cock-up splint and immobilization - Having the patient exercise the fingers to avoid future contractures - Performing hourly neurovascular assessments for the first 24 hours

Performing hourly neurovascular assessments for the first 24 hours

Following a knee arthroplasty, a patient has a continuous passive motion machine for the affected joint. The nurse explains to the patient that this device is used to: - Promote early joint mobility and increase knee flexion. - Relieve edema and pain at the incision site. - Prevent venous stasis and the formation of a deep venous thrombosis. - Improve arterial circulation to the affected extremity to promote healing.

Promote early joint mobility and increase knee flexion.

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize? - Quadriceps - Rectus abdominis - Latissimus dorsi - Gastrocnemius

Quadriceps Explanation: The nurse instructs the patient in the safe and correct way to lift objects using the strong quadriceps muscles of the thighs, with minimal use of weak back muscles

A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class? - Alendronate (Fosamax) - Calcium gluconate - Raloxifene (Evista) - Tamoxifen (Nolvadex)

Raloxifene (Evista) Explanation: An example of a selective estrogen receptor modifier (SERM) is raloxifene (Evista). Alendronate is a bisphosphonate; calcium gluconate is an oral calcium preparation; tamoxifen is an antiestrogen agent.

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? - Prone, with a pillow under the shoulders - Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees - Supine, with the bed flat and a firm mattress in place - High-Fowler's to allow for maximum hip flexion

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees rationale: 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 A prone position should be avoided because it accentuates lordosi

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? - Wound packing - Wound irrigation - Vitamin supplements - Surgical debridement

Surgical debridement

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 may the nurse suspect be happening? - Temporomandibular disorder - Loose teeth - Trigeminal neuralgia - Dislocated jaw

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.

A patient with a fractured femur experiences the complication of malunion. The nurse recognizes that with this complication - The fracture fails to heal properly despite treatment. - Fracture healing progresses more slowly than expected. - Loss of bone substances occurs as a result of immobilization. - The fracture heals in an unsatisfactory position.

The fracture heals in an unsatisfactory position.

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? - Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. - Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. - To prevent fractures, the client should avoid strenuous exercise. - The recommended daily allowance of calcium may be found in a wide variety of foods.

The recommended daily allowance of calcium may be found in a wide variety of foods.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? - Use the large muscles of the leg when lifting items. - Avoid twisting and flexion activities. - Sleep on the stomach to alleviate pressure on the back. - A soft mattress is most supportive by conforming to the body.

Use the large muscles of the leg when lifting items.

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? - Vitamin D-fortified milk - Red meat - Green vegetables - Bananas

Vitamin D-fortified milk

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest? - Walking - Swimming - Yoga - Bicycling

Walking

The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do? - Bind the toes so that they will straighten. - Do active range of motion on the toes. - Have surgery to fix them. - Wear properly fitting shoes.

Wear properly fitting shoes.

A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate? - "You may need to be evaluated for an underlying cause, such as renal failure." - "You will need to decrease the amount of dairy products you consume." - "You will need to engage in vigorous exercise three times a week for 30 minutes." - "You will need to avoid foods high in phosphorus and vitamin D."

You may need to be evaluated for an underlying cause, such as renal failure." Explanation: The client may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The client needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The client is at risk for pathological fractures and therefore should not engage in vigorous exercise

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? - "You need to perform weight-bearing exercises twice a week." - "Use your continuous passive motion machine for 2 hours each day." - "You need to limit the amount of protein and calcium in your diet." - "You will receive IV antibiotics for 3 to 6 weeks."

You will receive IV antibiotics for 3 to 6 weeks." Explanation: 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.

Which term refers to a disease of a nerve root? - Radiculopathy - Sequestrum - involucrum - Contracture

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

Primary prevention of osteoporosis includes: - installing grab bars in the bathroom to prevent falls. - using a professional alert system in the home in case a client falls when she's alone. - optimal calcium intake and estrogen replacement therapy. - placing items within the client's reach.

optimal calcium intake and estrogen replacement therapy. Explanation: Primary prevention of osteoporosis includes maintaining optimal calcium intake and using estrogen replacement therapy. Placing items within a client's reach, using a professional alert system in the home, and installing grab bars in bathrooms to prevent falls are secondary and tertiary prevention methods.