Chapter 41 Management of pt. with musculoskeletal disorders 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? "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." "There may be some slight discrepancy between the measuring tools used." "The posture begins to stoop after middle age."

"After menopause, the body's bone density declines, resulting in a gradual loss of height." Explanation: 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 nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? "This condition is associated with various sports." "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." "Using arm splints will prevent hyperflexion of the wrist." "Surgery is the only sure way to manage this condition."

"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Explanation: 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.

On a visit to the family health care provider, a client is diagnosed with a bunion on the lateral side of the great toe at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session? "Bunions are congenital and can't be prevented." "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth." "Bunions are caused by a metabolic condition called gout."

"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." Explanation: Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion.

A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate? "You will need to engage in vigorous exercise three times a week for 30 minutes." "You will need to decrease the amount of dairy products you consume." "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."

"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? "Use your continuous passive motion machine for 2 hours each day." "You will receive IV antibiotics for 3 to 6 weeks." "You need to limit the amount of protein and calcium in your diet." "You need to perform weight-bearing exercises twice a week."

"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.

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. select the prescriptions for care that the nurse should anticipate for this client. * Place the left foot in a dependent position. * Perform neurovascular checks of lower extremities every 8 hours. * Administer IV antibiotic based on culture and sensitivity report. * Encourage ambulation with weight-bearing on the left leg. * 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.

*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. Explanation: 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.

Health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. Select the daily dosage of calcium and vitamin D that the nurse should recommend. 1,600 mg; 1,400 IU 1,200 mg; 1,000 IU 1,400 mg; 1,200 IU 1,800 mg; 1,600 IU

1,200 mg; 1,000 IU Explanation: The daily recommended dosage is 1,200 mg of calcium and 1,000 IU of vitamin D.

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia? A bone biopsy Demineralization of the bone Elevated levels of alkaline phosphatase Increased and decreased areas of bone metabolism

A bone biopsy Explanation: 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.

Which client would the nurse identify as having the greatest risk for osteoporosis? A 20-year-old male athlete with repeated injuries A 40-year-old overweight African American woman A 16-year-old male with a history of asthma A small-framed, thin 45-year-old white woman

A small-framed, thin 45-year-old white woman Explanation: 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.

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure? Withholding all oral intake Instructing the client to ambulate twice daily Administering large doses of oral antibiotics as ordered Administering large doses of I.V. antibiotics as ordered

Administering large doses of I.V. antibiotics as ordered Explanation: Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited.

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 Alendronate Raloxifene Teriparatide

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? Troponin levels Magnesium level Alkaline phosphatase Potassium level

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.

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? At least 4 weeks 6 months 7 to 10 days 3 months

At least 4 weeks Explanation: Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for at least 4 weeks, followed by another 2 weeks (or more) of IV antibiotics or oral antibiotics.

The nurse is caring for a client with osteoporosis. Which information will the nurse include when teaching actions to manage the condition? Select all that apply. Plan for smoking cessation Consider estrogen replacement therapy Engage in regular weight-bearing exercise Swim for 30 minutes four to five times a week Avoid excessive alcohol intake

Avoid excessive alcohol intake Plan for smoking cessation Engage in regular weight-bearing exercise Explanation: Care of the client with osteoporosis focuses on actions to improve bone density. These actions include avoiding the excessive intake of alcohol. Clients who use tobacco products should be advised to quit. Regular weight-bearing exercise promotes bone formation. Recommendations include 20 to 30 minutes of aerobic, bone-stressing exercise daily. Current guidelines recommend that hormone therapy with estrogen not be used for primary prevention of bone loss in female clients who are postmenopausal. Swimming is not a weight-bearing exercise.

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

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

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

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.

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? Potassium level of 6.3 mEq/L Calcium level of 11.6 mg/dl Sodium level of 110 mEq/L Magnesium level of 0.9 mg/dl

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.

Which common problem of the upper extremity results from entrapment of the median nerve at the wrist? Carpal tunnel syndrome Impingement syndrome Ganglion Dupuytren contracture

Carpal tunnel syndrome Explanation: Carpal tunnel syndrome is commonly due to repetitive hand activities. A ganglion is a collection of gelatinous material near the tendon sheaths and joints that appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. Dupuytren contracture is a slowly progressive contracture of the palmar fascia. Impingement syndrome is associated with the shoulder and may progress to a rotator cuff tear.

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? Carpal tunnel syndrome Morton's neuroma Dupuytren's contracture Impingement syndrome

Carpal tunnel syndrome Explanation: 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 nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder? Bupivacaine Chlorpheniramine Dexamethasone Dicloxacillin

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 Clawfoot Hammer Toe Corn

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 Increased heel pain Diarrhea Bone spurs

Decreased height Explanation: Clients with osteoporosis become shorter over time

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

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

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

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.

The nurse is planning an education program for women of childbearing years. What does the nurse recognize as the primary prevention of osteoporosis? Engaging in non-weight-bearing exercises daily Ensuring adequate calcium and vitamin D intake Undergoing assessment of serum calcium levels every year Having a DXA beginning at age 35 years

Ensuring adequate calcium and vitamin D intake Explanation: Nutritional intake of calcium and vitamin D are essential for the prevention of osteoporosis.

Which group is at the greatest risk for osteoporosis? African American women Men Asian American women European American women

European American women Explanation: 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.

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

Fourth and fifth fingers Explanation: Dupuytren's contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.

Which of the following was formerly called a bunion? Plantar fasciitis Morton's neuroma Hallux valgus Ganglion

Hallux valgus Explanation: Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. 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.

In which deformity does the great toe deviate laterally? Pes cavus Hammertoe Hallux valgus Plantar fasciitis

Hallux valgus Explanation: Hallux valgus is a deformity in which the great toe deviates laterally. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Pes cavus refers to a foot with an abnormally high arch, and a fixed equines deformity of the forefoot. Plantar fasciitis is an inflammation of the foot-supporting fascia.

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? Hammer toe Bunion Mallet toe Hallux valgus

Hammer toe Explanation: 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.

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 pronate the hand while the nurse palpates the radial nerve. Have the client hold the palm of the hand up while the nurse percusses over the median 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 is diagnosed with carpal tunnel syndrome. Which assessment findings would the nurse expect? Inability to flex index and middle fingers Pain radiating down the dorsal surface of the forearm A decrease in grasp strength Tenderness in the affected wrist

Inability to flex index and middle fingers Explanation: Clients with carpal tunnel syndrome describe pain or burning in one or both hands, which may radiate to the forearm and shoulder in severe cases. The pain tends to be more prominent at night and early in the morning. Shaking the hands may reduce the pain by promoting movement of edematous fluid from the carpal canal. Sensation may be lost or reduced in the thumb, index, middle, and a portion of the ring finger. The client may be unable to flex the index and middle fingers to make a fist. Flexion of the wrist usually causes immediate pain and numbness. In epicondylitis, clients report pain radiating down the dorsal surface of the forearm and a weak grasp. Clients with ganglion cysts experience pain and tenderness in the affected area.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? Taking a 300-mg calcium supplement to meet dietary guidelines Living a sedentary lifestyle to reduce the incidence of injury Stopping estrogen therapy Initiating weight-bearing exercise routines

Initiating weight-bearing exercise routines Explanation: 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.

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

L4, L5, and S1 Explanation: 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.

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? Lordosis Skull narrowing Upright gait Long bone bowing

Long bone bowing Explanation: 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 area of the spinal column is subject to the greatest mechanical stress and degenerative changes? Thoracic Cervical Lower lumbar Upper lumbar

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

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 Open nerve release Ultrasound therapy Laser therapy

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 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. Monitor vital signs every 4 hours. Examine the surgical dressing every hour. Administer pain medication per client request.

Perform neuromuscular assessment every hour. Explanation: 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.

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? Latissimus dorsi Gastrocnemius Quadriceps Rectus abdominis

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 (Fig. 42-3).

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

Radiculopathy Explanation: 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.

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? Tamoxifen (Nolvadex) Alendronate (Fosamax) Calcium gluconate Raloxifene (Evista)

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 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? Benign prostatic hyperplasia Urinary tract infection (UTI) Dehydration Renal calculi

Renal calculi Explanation: 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.

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

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

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? 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 Prone, with a pillow under the shoulders High-Fowler's to allow for maximum hip flexion

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees Explanation: 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.

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

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

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? Surgical debridement Vitamin supplements Wound irrigation Wound packing

Surgical debridement Explanation: 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.

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

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 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? Dislocated jaw Loose teeth Trigeminal neuralgia Temporomandibular disorder

Temporomandibular disorder Explanation: 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 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 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 clients receiving chemotherapy for cancer treatment on the oncology floor. 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. Explanation: This client is critically ill; the diagnosis and immunosuppression place the client at a high risk for infection. The most appropriate place for this client is in an intensive care unit, where the nurse can focus exclusively on health promotion. This client shouldn't be on the oncology floor. This client requires close monitoring. The nurse caring for this client shouldn't also be caring for other clients who may require frequent interventions

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. To prevent fractures, the client should avoid strenuous exercise. Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. 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. Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.

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. A soft mattress is most supportive by conforming to the body. Avoid twisting and flexion activities. Sleep on the stomach to alleviate pressure on the back.

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

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? Walk or perform weight-bearing exercises outdoors Increase fiber in the diet Reduce stress Decrease the intake of vitamin A and D

Walk or perform weight-bearing exercises outdoors Explanation: 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 nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest? Yoga Walking Swimming Bicycling

Walking Explanation: Weight-bearing exercises should be incorporated into the client's lifestyle activities. Walking is a low-impact method of weight-bearing exercise and would be the most universal or most likely form of exercise for the nurse to recommend. Bicycling, and swimming are not weight-bearing exercise and will not increase bone density. Yoga may or may not be weight-bearing exercise depending on the yoga poses being performed; it is not as likely as walking to be recommended by the nurse.

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? Wear properly fitting shoes. 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. Explanation: Hammer toe is a flexion deformity of the PIP joint and may involve several toes and may result from wearing poorly fitting shoes. They will not straighten by binding the toes or doing active range of motion exercises. Surgery is an option but should be discussed with an orthopedic surgeon or podiatrist.

A client is reporting jaw pain, and is experiencing muscle spasm and tenderness of the masseter and temporalis muscles. The physician has diagnosed a temporomandibular disorder (TMD). What would the treatment course for this client include? Select all that apply. corticosteroids custom-fitted mouth guard during sleep referral to a dentist who has experience managing clients with TMD analgesics

referral to a dentist who has experience managing clients with TMD analgesics custom-fitted mouth guard during sleep Explanation: Referral to a dentist who has experience managing clients with TMD, analgesics, and a custom-fitted mouth guard during sleep are all part of the treatment course. Corticosteroids are not part of the treatment regimen. Reference: