Chapter 45: Concepts of Care for Patients with Musculoskeletal Problems

A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client admits to not doing the prescribed exercises. What action by the nurse is best?

Ask the client about fear of falling

A nurse notes crepitation when performing range-of-motion exercises on a client with a fractured left humerus. Which action should the nurse take next?

Immobilize the left arm

How is Dowager's hump formed?

Kyphosis of the spine

A nurse cares for a client with a fractured fibula. Which assessment should alert the nurse to take immediate action?

Numbness in the extremity

Which symptom specifically in older patients presenting with acute osteomyelitis would require immediate nursing intervention?

Pain

What is the primary role of the nurse when caring for the adult client with muscular dystrophy (MD)?

Supportive care

The nurse is teaching a client newly diagnosed with osteoporosis about dietary and lifestyle interventions to decrease risk factors for osteoporosis. Which is the best way to decrease the risk for osteoporosis?

Walk for 30 minutes three times a week

A client has an ingrown toenail. About what self-management measure does the nurse teach the client?

Warm moist soaks

The nurse is taking the history of an adult female client. Which factor places the client at risk for osteoporosis?

Working at a desk and playing the piano for a hobby

The nursing instructor asks a nursing student to identify risk factors that are shared by clients who have osteoporosis or osteomalacia. Which statement by the student is correct?

"High alcohol intake is a risk factor for both conditions."

The nurse completes a teaching session on safe drug administration for a patient with Paget's disease taking oral bisphosphonates. Which patient statement indicates a need for further teaching?

"I should go to sleep immediately after taking the drug."

The client with bone cancer is scheduled for a right upper extremity amputation. Which statement by the client's spouse indicates an effective coping strategy?

"I'll have to find ways to help my spouse focus on positive aspects of his or her body."

The nurse is teaching a young patient about ways to prevent osteoporosis in later adulthood. Which information does the nurse provide?

"Limit the consumption of carbonated beverages."

A client has been prescribed denosumab. What health teaching about this drug is most appropriate for the nurse to include?

"Make appointments to come get your injection."

A client has been prescribed denosumab (Prolia). What instruction about this drug is most appropriate?

"Make appointments to come get your shot."

The nurse teaches assistive personnel (AP) about care of an older adult diagnosed with osteoporosis. What teaching would the nurse include?

"Osteoporosis places the client is at risk for fractures."

The nurse is caring for a client with bone cancer of the right hip who has undergone radical resection of the tumor and has received a prosthetic implant. Which client statement indicates effective coping after the procedure?

"Physical therapy and counseling will help me adjust to my prosthesis."

What information does the nurse teach a women's group about osteoporosis?

"Primary osteoporosis occurs in postmenopausal women due to lack of estrogen."

A patient is prescribed the bisphosphonate (BP) alendronate for osteoporosis. What does the nurse teach the patient?

"Take the medication early in the morning with 8 ounces of water."

A mother is a carrier of muscular dystrophy (MD) and has a daughter. The client asks the nurse what the daughter's genetic risk is for having MD. What is the nurse's best response?

"There is a 50% chance that your daughter may carry the gene."

A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What explanation by the nurse is best?

"Your feet have less blood flow, so healing is slower."

A client with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this client and family? (Select all that apply.)

- Adherence to the antibiotic regimen - Eating high-protein and high-carbohydrate foods - Proper use of the intravenous equipment

A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply.)

- Alcohol - Caffeine - Carbonated beverages - Vitamin D

A client with Paget's disease is hospitalized for an unrelated issue. The client reports pain and it is not yet time for more medication. What comfort measures can the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

- Applying a heating pad - Providing a massage

A client is admitted with a bone tumor. The nurse finds the client weak and lethargic with decreased deep tendon reflexes. What actions by the nurse are best? (Select all that apply.)

- Assess the daily serum calcium level - Consult the provider about a loop diuretic - Instruct the client to call for help out of bed

The nurse reviews a list of drugs that can cause secondary osteoporosis.Which drugs are most commonly associated with this health problem? (Select all that apply.)

- Barbiturates - Corticosteroids - Loop diuretics

The nurse studying osteoporosis learns that which drugs can cause this disorder? (Select all that apply.)

- Barbiturates - Corticosteroids - Loop diuretics

The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease? (Select all that apply.)

- Draining sinus tracts - Presence of foot ulcers

A client is suspected to have muscular dystrophy. About what diagnostic testing does the nurse educate the client? (Select all that apply.)

- Electromyography - Muscle biopsy - Serum aldolase - Serum creatinine kinase

The nurse is assessing a client with osteomalacia. Which findings will the nurse expect to observe? Select all that apply.

- Hypophosphatemia - Looser's lines or zones - Unsteady gait

A nurse teaches a client with a fractured tibia about external fixation. Which advantages of external fixation for the immobilization of fractures should the nurse share with the client? (Select all that apply.)

- It leads to minimal blood loss - It allows for early ambulation - It promotes healing

What are the risk factors for primary osteoporosis? Select all that apply

- Parental history of osteoporosis - Thin build with low body weight - Chronic low calcium and vitamin D intake

The patient is diagnosed with possible osteoporosis. Which diagnostic tests should the nurse anticipate will be ordered? (Select all that apply.)

- Phosphorus - Serum calcium - Thyroid function - DXA

A nurse is providing education to a community women's group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply.)

- Strengthening exercises are important. - Take recommended calcium and vitamin D. - Walk for 30 minutes at least three times a week.

When checking a patient with fractures, a wound, and extensive soft tissue damage for signs of infection, which results indicate that there is no infection present?

- lack of fever - negative wound culture - no increase in WBC count

Arrange in the correct order the process of sequestrum formation as it occurs in osteomyelitis.

1. Invasion of pathogenic microorganisms 2. Stimulation of inflammatory response 3. Vascular thrombosis 4. Release of exudate into the bone tissue 5. Ischemia of bone tissue 6. Sequestrum formation

A trauma nurse cares for several clients with fractures. Which client should the nurse identify as at highest risk for developing deep vein thrombosis?

A 74-year-old man who smokes and has a fractured pelvis

A nurse cares for a client who had a long-leg cast applied last week. The client states, I cannot seem to catch my breath and I feel a bit light-headed. Which action should the nurse take next?

Administer oxygen to keep saturations greater than 92%

A nurse assesses an older adult client who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless. The clients vital signs are heart rate 98 beats/min, respiratory rate 32 breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%. Which action should the nurse take first?

Administer oxygen via nasal cannula

A client has a metastatic bone tumor in the left leg. What action by the nurse is appropriate?

Administer pain medication as prescribed.

A client with osteoporosis is going home, where the client lives alone. What action by the nurse is best?

Arrange a home safety evaluation

A client with osteoporosis is going home where the client lives alone. What action by the nurse is best?

Arrange a home safety evaluation.

A client has been advised to perform weight-bearing exercises to help slow bone loss, but has not followed this advice. What response by the nurse is appropriate at this time?

Ask the client about fear of falling.

A client is in the internal medicine clinic reporting bone pain. The client's alkaline phosphatase level is 180 units/L. What action by the nurse is most appropriate?

Assess the client for leg bowing

A client has scoliosis with a 65-degree curve to the spine. What action by the nurse takes priority?

Assess the client's cardiac and respiratory systems

A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the client's psychosocial needs?

Assess the client's coping skills and support systems.

An emergency department nurse cares for a client who sustained a crush injury to the right lower leg. The client reports numbness and tingling in the affected leg. Which action should the nurse take first?

Assess the pedal pulses

After dental work, a female patient taking medications for osteoporosis reports pain, bleeding gums, and halitosis. Upon examination, the bone is found to be exposed. Which medication is the cause for this condition?

Bisphosphosphonates

An 80-year-old patient experiencing severe pain in the lower jaw is diagnosed with acute osteomyelitis. Which symptom may be least likely found?

Body temperature of 102°F

A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first?

Client taking raloxifene (Evista) who reports unilateral calf swelling

A nurse assesses clients in an osteoporosis clinic. Which client would the nurse assess first?

Client taking raloxifene who reports unilateral calf swelling.

The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option?

Client with a spinal cord injury who cannot tolerate sitting up

The nurse is caring for several clients with osteoporosis. For which client would bisphosphonates not be a good option?

Client with a spinal cord injury who cannot tolerate sitting up.

A nurse is assessing an older client and discovers back pain with tenderness along T2 and T3. What action by the nurse is best?

Consult with the provider about an x-ray

A nurse plans care for a client who is recovering from a below-the-knee amputation of the left leg. Which intervention should the nurse include in this clients plan of care?

Encourage range-of-motion exercises

The nurse admits a client diagnosed with Paget's disease. The nurse anticipates that the client will have which condition?

Enlarged thick skull

A client in a nursing home refuses to take medications. She is at high risk for osteomalacia. What action by the nurse is best?

Ensure the client gets 15 minutes of sun exposure daily

A client is scheduled for a bone biopsy. What action by the nurse takes priority?

Ensuring that informed consent is on the chart

The nurse is caring for an older adult client diagnosed with osteomalacia. The nurse anticipates that the physician will request which medication?

Ergocalciferol (calciferol)

What complication of osteomyelitis is the most likely to occur?

Formation of bone abscesses

A client has a metastatic bone tumor. What action by the nurse takes priority?

Handle the affected extremity with caution

A hospitalized client is being treated for Ewing's sarcoma. What action by the nurse is most important?

Handling and disposing of chemotherapeutic agents per policy

The nurse plans to refer a client diagnosed with osteoporosis to which community resource?

Hospital support group

fter teaching a client who is recovering from a vertebroplasty, the nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching?

I can drive myself home after the procedure.

The nurse is developing a plan of care for a patient with metastatic bone cancer. What is an appropriate goal of treatment to include in the plan of care for this patient?

Improve the quality of life and promote pain relief

Which nursing intervention helps to prevent the incidence of osteomyelitis for a client receiving hemodialysis?

Instructing the client to brush teeth after every meal

An older adult client is discharged from the hospital for treatment of osteoporosis. What will the nurse include in client teaching related to the client's home safety?

Keep walkways free of clutter

The nurse is assessing a client with Ewing's sarcoma. Which finding will the nurse expect to observe?

Leukocytosis

The nurse is assessing a patient with Ewing's sarcoma. Which finding does the nurse expect to observe?

Leukocytosis

A nurse cares for a client in skeletal traction. The nurse notes that the skin around the clients pin sites is swollen, red, and crusty with dried drainage. Which action should the nurse take next?

Obtain a prescription to culture the drainage

A client is admitted with a large draining wound on the leg. What action does the nurse take first?

Obtain cultures of the leg wound

The nurse is caring for a client with prostate cancer who has bone metastasis. The nurse anticipates that the physician will prescribe which medication?

Pamidronate (Aredia)

The client has had a sequestrectomy of the right fibula for osteomyelitis 1 day ago. Which assessment finding requires the nurse to immediately contact the surgeon?

Paresis of right lower extremity

The nurse knows that a patient with Paget's disease is at greatest risk for developing which complication?

Pathologic bone fractures

An older client with diabetes is admitted with a heavily draining leg wound. The client's white blood cell count is 38,000/mm3 (38 × 109/L) but the client is afebrile. Which nursing action is most appropriate at this time?

Place the client on Contact Precautions.

An older client with diabetes is admitted with a heavily draining leg wound. The client's white blood cell count is 38,000/mm3 but the client is afebrile. What action does the nurse take first?

Place the client on contact isolation

A client has a bone density score of -2.8. What action by the nurse is best?

Planning to teach about bisphosphonates

A phone triage nurse speaks with a client who has an arm cast. The client states, My arm feels really tight and puffy. How should the nurse respond?

Please come to the clinic today to have your arm checked by the provider.

A nurse is caring for four clients. After the hand-off report, which client does the nurse see first?

Post-microvascular bone transfer client whose distal leg is cool and pale

A nurse is caring for four clients. After the hand-off report, which client would the nurse see first?

Post-microvascular bone transfer client whose distal leg is cool and pale

Which is problem for the older adult client diagnosed with bone cancer?

Potential for injury related to weakness and drug therapy

A home health nurse assesses a client with diabetes who has a new cast on the arm. The nurse notes the clients fingers are pale, cool, and slightly swollen. Which action should the nurse take first?

Raise the arm above the level of the heart

The patient is diagnosed with osteoporosis. Which intervention by the nurse would be appropriate?

Recommend walking for 30 minutes 3 to 5 times a week

The nurse is caring for a young client who has been diagnosed with osteopenia. Which risk factor in the client's history most likely contributed to the bone loss?

Rheumatoid arthritis

After teaching a client with a fractured humerus, the nurse assesses the clients understanding. Which dietary choice demonstrates that the client correctly understands the nutrition needed to assist in healing the fracture?

Roast beef with low-fat milk and a vitamin C supplement

The nurse is performing an assessment of a client with possible plantar fasciitis in the right foot. What assessment finding would the nurse expect in the right foot?

Severe pain in the arch of the foot

The nurse suspects that a client may have plantar fasciitis if the client has which finding?

Severe pain in the arch of the foot, especially when getting out of bed

The nurse is instructing a client who has been prescribed calcium citrate (Citracal). The nurse plans to include which instruction?

Take Citracal with food

A patient whose fracture of the right ulnar bone was immobilized in a cast for nearly 8 weeks reports swelling and pain in the right forearm. Why would the patient be advised to undergo bone mineral density (BMD) test?

To evaluate for secondary osteoporosis

Which finding does the nurse expect to observe in a patient with suspected common chronic osteomyelitis?

Ulceration of the skin

Which finding will the nurse expect to observe for a client with suspected common chronic osteomyelitis?

Ulceration of the skin

A patient is diagnosed with chronic osteomyelitis. What feature does the nurse expect to assess in the patient?

Ulceration resulting in the sinus tract