Chapter 41: PrepU - Nursing Management: Patients With Musculoskeletal Disorders

A 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? 1- common adverse effects 2- dietary restrictions 3- activity restrictions 4- loading-dose schedule

1

Morton neuroma is exhibited by which clinical manifestation? 1- Swelling of the third (lateral) branch of the median plantar nerve 2- High arm and a fixed equinus deformity 3- Diminishment of the longitudinal arch of the foot 4- Inflammation of the foot-supporting fascia

1

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? 1- Increase fiber in the diet 2- Walk or perform weight-bearing exercises outdoors 3- Reduce stress 4- Decrease the intake of vitamin A and D

2

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? 1- Wound packing 2- Wound irrigation 3- Vitamin supplements 4- Surgical debridement

4

The 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? 1- Examine surgical dressing every hour. 2- Administer pain medication per client request. 3- Monitor vital signs every 4 hours. 4- Perform neuromuscular assessment every hour.

4

A nurse practitioner who works with many older adult patients integrates screening for osteoporosis into health promotion activities. What screening tool is most clinically useful when screening for osteoporosis? 1- Hip bone mineral density (BMD) testing 2- Assessment of serum calcium levels 3- Bone biopsy 4- Assessment of 25-hydroxy-vitamin D levels

1

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding? 1- Hammer toe 2- Mallet toe 3- Hallux valgus 4- Bunion

1

The nurse is caring for a 35-year-old man diagnosed with a back strain. What would be a priority point of discussion with this patient? 1- Avoid lifting heavy weights without assistance. 2- Focus on using back muscles during lifting. 3- Lift objects while holding the object away from the body. 4- Tighten the abdominal muscles and lock the knees during the lifting of an object.

1

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD? 1- Calcitonin (Miacalcin) 2- Raloxifene (Evista) 3- Teriparatide (Forteo) 4- Vitamin D

1

Which of the following inhibits bone resorption and promotes bone formation? 1- Calcitonin 2- Estrogen 3- Parathyroid hormone 4- Corticosteroids

1

Which term refers to a disease of a nerve root? 1- Radiculopathy 2- Involucrum 3- Sequestrum 4- Contracture

1

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? 1- "After age 40, height may show a gradual decrease as a result of spinal compression" 2- "After menopause, the body's bone density declines, resulting in a gradual loss of height." 3- "There may be some slight discrepancy between the measuring tools used." 4- "The posture begins to stoop after middle age."

2

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 1- reaches over the head with the arms fully extended. 2- places the load close to the body. 3- uses a narrow base of support. 4- bends at the hips and tightens the abdominal muscles.

2

Which medication classification is prescribed when allergy is a factor causing the skin disorder? 1- Corticosteroids 2- Antihistamines 3- Antibiotics 4- Local anesthetics

2

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? 1- "I will lie prone with my legs slightly elevated." 2- "I will bend at the waist when I am lifting objects from the floor." 3- "I will avoid prolonged sitting or walking." 4- "Instead of turning around to grasp an object, I will twist at the waist."

3

The nurse is discussing conservative management of tendonitis with a patient. Which of the following is likely the most effective approach to managing tendonitis? 1- Weight reduction 2- Stress reduction 3- Intermittent application of ice and heat 4- Range-of-motion (ROM) exercise of the affected joint

3

When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with: 1- Morton's neuroma 2- Dupuytren's contracture 3- Carpal tunnel syndrome 4- Impingement syndrome

3

A 49-year-old man with a history of poorly controlled type 1 diabetes has developed osteomyelitis adjacent to a chronic diabetic ulcer on his great toe. The patient has been informed that medical treatment for osteomyelitis requires a longer course of antibiotics than most other infections because: 1- Osteomyelitis is usually caused by simultaneous infection with several microorganisms, which must be treated sequentially. 2- Osteomyelitis requires treatment with topical antibiotics rather than IV antibiotics, necessitating a longer course of treatment. 3- Osteomyelitis is usually the result of fungal infection rather than bacterial infection. 4- Osteomyelitis involves the active infection of bone tissue, which is largely avascular.

4

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? 1- Wound packing 2- Wound irrigation 3- Vitamin supplements 4- Surgical debridement

4

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? 1- Sleep on the stomach to alleviate pressure on the back. 2- A soft mattress is most supportive by conforming to the body. 3- Avoid twisting and flexion activities. 4- Use the large muscles of the leg when lifting items.

4

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? 1- Alendronate (Fosamax) 2- Calcium gluconate 3- Tamoxifen (Nolvadex) 4- Raloxifene (Evista)

4

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? 1- The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor. 2- The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor. 3- The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit. 4- The nurse is caring for this client on the intensive care unit.

4

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? 1- Changing the dressing 2- Applying a cock-up splint and immobilization 3- Having the patient exercise the fingers to avoid future contractures 4- Performing hourly neurovascular assessments for the first 24 hours

4

A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis? 1- Proteus 2- Pseudomonas 3- Salmonella 4- Staphylococcus aureus

4

After several weeks of antibiotic therapy for the treatment of osteomyelitis, a patient is preparing for discharge. When providing health education related to self-care, the nurse should emphasize which of the following topics? 1- The need to avoid ASA and anticoagulants 2- The need to resume normal physical activity as soon as possible 3- The importance of maintaining a healthy diet 4- The importance of adhering to further antibiotic treatment

4

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? 1- Osteomalacia 2- Ganglion 3- Osteomyelitis 4- Paget disease

4

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? 1- "Use your continuous passive motion machine (CPM) 2 hours each day." 2- "You need to perform weight-bearing exercises twice a week." 3- "You need to limit the amount of protein and calcium in your diet." 4- "You will receive IV antibiotics for 3 to 6 weeks."

4

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis? 1- penicillamine (Cuprimine) 2- methotrexate (Rheumatrex) 3- plicamycin (Mithracin) 4- raloxifene (Evista)

4

Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? 1- Deficient knowledge about osteoporosis and the treatment regimen 2- Acute pain related to fracture and muscle spasm 3- Risk for constipation related to immobility 4- Risk for injury related to fractures due to osteoporosis

4

Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? 1- Callus 2- Hammertoe 3- Hallux valgus 4- Dupuytren contracture

4

A nurse who oversees care in a long-term care facility is aware that a high percentage of residents have osteoporosis, and that residents who do not have the disease must be assessed and monitored closely for this health problem. Which of the following older adults most clearly exemplifies the risk factors for osteoporosis? 1- A Caucasian woman who has low body mass index 2- An African American woman who is slightly obese 3- An Asian man whose mobility is limited to a wheelchair 4- A Caucasian man who has led a sedentary lifestyle

1

Instructions for the client with low back pain include that, when lifting, the client should 1- avoid overreaching. 2- place the load away from the body. 3- use a narrow base of support. 4- bend the knees and loosen the abdominal muscles.

1

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? 1- Trigeminal neuralgia 2- Temporomandibular disorder 3- Loose teeth 4- Dislocated jaw

2

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? 1- Potassium level of 6.3 mEq/L 2- Calcium level of 11.6 mg/dl 3- Sodium level of 110 mEq/L 4- Magnesium level of 0.9 mg/dl

2

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate? 1- Yoga 2- Walking 3- Bicycling 4- Swimming

2

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? 1- Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. 2- To prevent fractures, the client should avoid strenuous exercise. 3- The recommended daily allowance of calcium may be found in a wide variety of foods. 4- Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.

3

A patient presents at the clinic complaining of back pain that goes all the way down the back of her leg to her foot. What is this type of pain referred to as? 1- Bursitis 2- Radiculopathy 3- Sciatica 4- Tendonitis

3

The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? 1- Avascular necrosis 2- Fat embolism 3- Osteomyelitis 4- Compartment syndrome

3

The nurse is caring for a patient with a bone tumor. The nurse provides education that teaches the patient to implement measures to reduce the risk of pathologic fractures. What intervention will assist the patient in fracture prevention? 1- Teaching the patient to achieve maximum weight-bearing capabilities 2- Maintaining strict bed rest 3- Supporting the affected extremity with external supports (splints) 4- Limiting the patient's reliance on assistive devices

3

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? 1- Gastrocnemius 2- Latissimus dorsi 3- Quadriceps 4- Rectus abdominis

3

The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as which condition? 1- Hammertoe 2- Pes cavus 3- Hallux valgus 4- Flatfoot

3

A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about taking a calcium supplement should the nurse include? 1- Take weekly on the same day and at the same time. 2- Remain in an upright position 30 minutes after taking the supplement. 3- Take the supplement on an empty stomach with a full glass of water. 4- Take the supplement with meals or with orange juice.

4

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? 1- Inadequate nutrition 2- Impaired physical mobility 3- Risk for infection 4- Disturbed body image

4

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? 1- Bone spurs 2- Diarrhea 3- Increased heel pain 4- Decreased height

4

Hypercalcemia is a dangerous complication of bone cancer. Therefore, nursing assessment includes evaluation of symptoms that require immediate treatment. Which of the following are signs/symptoms that are indictors of an elevated serum calcium? Select all that apply. a. Muscle weakness b. Tachycardia c. Anorexia and constipation d. Prolonged ST segment e. Shortened QT interval f. Lack of muscle coordination

a,c,e,f

Morton neuroma is exhibited by which clinical manifestation? 1- Swelling of the third (lateral) branch of the median plantar nerve 2- High arm and a fixed equinus deformity 3- Longitudinal arch of the foot is diminished 4- Inflammation of the foot-supporting fascia

1

A client comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the health care provider orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the client about? 1- Amitriptyline 2- Duloxetine 3- Gabapentin 4- Cyclobenzaprine

2

Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis? 1- Thrombocytopenia and ecchymosis 2- Pruritus and uremic frost 3- Petechiae over the chest and abnormal ABGs 4- Leukocytosis and localized bone pain

4

Which should be included in the teaching plan for a client diagnosed with plantar fasciitis? 1- Plantar fasciitis presents as acute-onset pain localized to the ball of the foot that occurs when pressure is placed on it and diminishes when pressure is released. 2- The pain of plantar fasciitis diminishes with warm water soaks. 3- Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion. 4- Management of plantar fasciitis includes stretching exercises.

4

A nurse notices a client lying on the floor at the bottom of the stairs. The client is alert and oriented and denies pain other than in the arm, which is swollen and appears deformed. After calling for help, what should the nurse do? 1- Place the client in a sitting position. 2- Immobilize the client's arm. 3- Help the client walk to the nearest nurses' station. 4- Raise the client's arm above the heart.

2

A patient with a primary diagnosis of colorectal cancer has developed bone metastases in recent weeks. When reviewing this patient's daily blood work, the nurse should be aware that secondary bone tumors create a significant risk of what electrolyte imbalance? 1- Hypokalemia 2- Hypercalcemia 3- Hyponatremia 4- Hyperchloremia

2

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? 1- "CTS is a neuropathy that is characterized by bursitis and tendinitis." 2- "CTS is a neuropathy that is characterized by flexion contracture of the fourth and fifth fingers." 3- "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." 4- "CTS is a neuropathy that is characterized by pannus formation in the shoulder."

3

Which client would the nurse identify as having the greatest risk for osteoporosis? 1- A 40-year-old overweight African American woman 2- A 16-year-old male with a history of asthma 3- A small-framed, thin 45-year-old white woman 4- A 20-year-old male athlete with repeated injuries

3