Chapter 41: Management of Patients With Musculoskeletal Disorders PrepU
Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? -Long bone bowing -Upright gait -Skull narrowing -Lordosis
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.
Which term refers to a disease of a nerve root? -Involucrum -Contracture -Radiculopathy -Sequestrum
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.
Most cases of osteomyelitis are caused by which microorganism? -Proteus species -Staphylococcus aureus -Pseudomonas species -Escherichia coli
Staphylococcus aureus Staphylococcus aureus causes 70% to 80% of bone infections. While Proteus species, Pseudomonas species, and E. coli are frequently found in osteomyelitis, they do not cause the majority of bone infections.
A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? -"You need to limit the amount of protein and calcium in your diet." -"You will receive IV antibiotics for 3 to 6 weeks." -"You need to perform weight-bearing exercises twice a week." -"Use your continuous passive motion machine for 2 hours each day."
"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.
A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing? -Vitamin supplements -Wound irrigation -Wound packing -Surgical debridement
Surgical debridement In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.
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? -Dupuytren's contracture -Carpal tunnel syndrome -Morton's neuroma -Impingement syndrome
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.
A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia? -Demineralization of the bone -Elevated levels of alkaline phosphatase -Increased and decreased areas of bone metabolism -A bone biopsy
A bone biopsy A definitive diagnosis is obtained by bone biopsy. Radiographic studies demonstrate demineralization of the bone. A bone scan detects increased and decreased areas of bone metabolism. Alkaline phosphatase levels are detected from a blood sample.
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." -"After menopause, the body's bone density declines, resulting in a gradual loss of height." -"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." 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.
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? -"CTS is a neuropathy that is characterized by bursitis and tendinitis." -"CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." -"CTS is a neuropathy that is characterized by flexion contracture of the fourth and fifth fingers." -"CTS is a neuropathy that is characterized by pannus formation in the shoulder."
"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.
What food can the nurse suggest to the client at risk for osteoporosis? -Carrots -Broccoli -Bananas -Chicken
Broccoli Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium.
Which of the following inhibits bone resorption and promotes bone formation? -Corticosteroids -Parathyroid hormone -Estrogen -Calcitonin
Calcitonin Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, 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.
What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? -Diarrhea -Decreased height -Bone spurs -Increased heel pain
Decreased height Clients with osteoporosis become shorter over time.
A client is informed that he has 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? -Osteochondroma -Osteoclastoma -Osteoid osteoma -Enchondroma
Osteoclastoma An osteoclastoma is a giant cell tumor that may invade local tissue; usually soft and hemorrhagic and may become malignant. An osteochondroma occurs as a large projection of bone at the ends of long bones, developing during growth periods and then becoming static bone mass. An enchondroma is a hyaline cartilage tumor that develops in the hand, ribs, femur, tibia, humerus, or pelvis. An osteoid osteoma is a painful tumor surrounded by reactive bone tissue.
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? -Perform neuromuscular assessment every hour. -Administer pain medication per client request. -Examine the surgical dressing every hour. -Monitor vital signs every 4 hours.
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.
Which of the following presents with an onset of heel pain with the first steps of the morning? -Morton's neuroma -Plantar fasciitis -Hallux valgus -Ganglion
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.
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 -Diminishment of the longitudinal arch of the foot -Inflammation of the foot-supporting fascia
Swelling of the third (lateral) branch of the median plantar nerve 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 client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening? -Trigeminal neuralgia -Temporomandibular disorder -Dislocated jaw -Loose teeth
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.
The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? -Decrease the intake of vitamin A and D -Increase fiber in the diet -Walk or perform weight-bearing exercises outdoors -Reduce stress
Walk or perform weight-bearing exercises outdoors Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine in moderation.
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? -loading-dose schedule -activity restrictions -common adverse effects -dietary restrictions
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.
The nurse is educating a client with low back pain on proper lifting techniques. The nurse recognizes that the education was effective when the client -reaches over the head with the arms fully extended. -bends at the hips and tightens the abdominal muscles. -places the load close to the body. -uses a narrow base of support.
places the load close to the body. 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. Bending at the hips increases the strain on the back muscles when lifting.