Chapter 62
Which patient statement indicates the need for further teaching about measures to prevent back pain for factory workers? "Maintaining a healthy weight will help to prevent back pain." "Sleeping in the side-lying position will help to relax the back at night." "Sleeping on a firm mattress will better support my back and reduce back strain." "Standing straight and still during my shift will improve my posture and reduce back pain.
"Standing straight and still during my shift will improve my posture and reduce back pain." Standing in the same position for prolonged periods of time can put stress on the back and cause back pain. The nurse should encourage the workers to shuffle side to side or change positions as much as their jobs allow in order to prevent back strain. The nurse should inform the workers that maintaining a healthy weight reduces pressure on all body joints and helps to facilitate the abdominal muscles supporting the spine. Sleeping in the side-lying position with the knees flexed and a pillow in between helps to prevent strain on the tendons and soft tissues, which can also prevent back pain. Sleeping on a firm mattress will better support the back and keep the spine aligned at night.
Which statement by the student nurse indicates understanding of primary osteosarcoma? Metastasis occurs in over 50% of individuals. Chemotherapy is contraindicated preoperatively. This malignancy is often associated with prior radiation. This is a rare form of cancer in children and young adults."
"This malignancy is often associated with prior radiation. In the older patient, osteosarcoma is often associated with Paget's disease and prior radiation. After diagnosis, metastasis occurs in only about 10% to 20% of individuals. Chemotherapy is often given preoperatively to reduce the tumor size before surgery. Osteosarcoma is the most common cancerous bone tumor in children and young adults.
Which information will the nurse include when teaching a patient about osteoporosis? 1 Estrogen therapy must be maintained to prevent rapid progression of the osteoporosis. 2 With a family history of osteoporosis, there is no way to prevent or slow bone resorption. 3 Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. 4 Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
4 Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise. The rate of progression of osteoporosis can be slowed if the patient takes calcium supplements or foods high in calcium and engages in regular weight-bearing exercise. Even if the patient has a family history of osteoporosis, there are methods to prevent and slow bone resorption. Estrogen therapy is no longer used to prevent osteoporosis because of the associated increased risk of heart disease and breast and uterine cancer. Corticosteroids interfere with bone metabolism and would not be effective.
During a health screening event, which assessment finding would alert the nurse to the possible presence of osteoporosis? 1 The presence of bowed legs 2 A measurable loss of height 3 Poor appetite and aversion to dairy products 4 Development of unstable, wide-gait ambulation
A measurable loss of height
Which treatment plan does the nurse expect will initially be prescribed for a patient with osteomyelitis? Aggressive, prolonged IV antibiotic therapy Oral antibiotics and antifungals for two to three months Implantation of acrylic bead chains containing antibiotics Surgical removal of the poorly perfused tissue and dead bone
Aggressive, prolonged IV antibiotic therapy The standard treatment for osteomyelitis consists of several weeks of IV antibiotic therapy. This is because bone is denser and less vascular than other tissues, and it takes time for the antibiotic therapy to eradicate all of the microorganisms. Oral antibiotics are not as effective as IV antibiotics for this severe infection. If the antibiotics fail to resolve the infection, surgery may be indicated; however, this is not the first line of treatment. Acrylic bead chains containing antibiotics may be implanted to help combat the infection but are not the initial treatment.
The nurse expects that which outpatient procedure will be ordered for a patient with intervertebral disc damage caused by lumbar spinal stenosis who reports bladder incontinence and constant back pain? A laminectomy A radiofrequency discal nucleoplasty An intradiscal electrothermoplasty (IDET} An interspinous process decompression system (X-stop)
An interspinous process decompression system (X-stop) Surgery is indicated because of the bladder incontinence, and X-stop is an outpatient technique used in patients with constant pain caused by lumbar spinal stenosis. Laminectomy requires a minimal hospital stay after completion. Radiofrequency discal nucleoplasty (coblation nucleoplasty) is not specifically for patients with lumbar spinal stenosis, and pain relief varies. An IDET is not specifically for patients with lumbar spinal stenosis or constant pain.
The nurse teaches a patient with osteoporosis about dietary modifications to improve calcium intake. Which patient food choices indicate the need for additional teaching? A. One glass of milk, cottage cheese, and one cup yogurt B. Boiled egg, carrot and lettuce salad, and a fresh cut apple C. Spinach soup and roasted salmon with cheddar cheese dip D. Steamed broccoli salad, steamed oysters, and one cup ice cream
B. Boiled egg, carrot and lettuce salad, and a fresh cut apple
which action may increase pain for a patient with a history of a herniated lumbar disc and low back pain? Bending or lifting Application of warm moist heat Sleeping in a side-lying position Sitting in a fully extended recliner
Bending or lifting Back pain that is related to a herniated lumbar disc often is aggravated by events and activities that increase the stress and strain on the spine, such as bending or lifting, coughing, sneezing, and lifting the leg with the knee straight (straight leg-raising test). Application of moist heat, sleeping position, and ability to sit in a fully extended recliner do not aggravate the pain of a herniated lumbar disc.
When the patient is diagnosed with muscular dystrophy, what information should the nurse include in the teaching about this disorder? A. Prolonged bed rest will be used to decrease fatigue B. An orthotic jacket will limit mobility and may contribute to deformity C. Continuous positive airway pressure will be used to facilitate sleeping D. Remain active to prevent skin breakdown and respiratory complications
D. Remain active to prevent skin breakdown and respiratory complications With muscular dystrophy, it is important for the patient to remain active for as long as possible. Prolonged bed rest should be avoided because immobility leads to further muscle wasting. An orthotic jacket may be used to provide stability and prevent further deformity. Continuous positive airway pressure (CPAP) is used as respiratory function decreases, before mechanical ventilation is needed to sustain respiratory function.
Which laboratory finding indicates significant inflammation in the patient with cellulitis and osteomyelitis? Red blood cell count 4.5 Blood urea nitrogen (BUN) 24 White blood cell count 9500/mm 3 Erythrocyte sedimentation rate (ESR) 88
Erythrocyte sedimentation rate (ESR) 88 ***ESR indicates inflammation and is usually elevated in patients with osteomyelitis
Which interventions will benefit a pediatric patient who has Duchenne muscular dystrophy? Select all that apply. Performing limb salvage Fitting for an orthotic jacket Administering hyperbaric oxygen Prescribing corticosteroid therapy Recommending shock-absorbing shoe inserts
Fitting for an orthotic jacket Prescribing corticosteroid therapy A patient with muscular dystrophy has a risk of spinal collapse due to progressive weakening of the neck muscles. Fitting for an orthotic jacket provides support to the muscles and decreases the risk of spinal collapse. Corticosteroid therapy maintains airways and improves respiratory functioning. Limb salvage is prescribed for the patient who has osteosarcoma. Hyperbaric oxygen is used as adjuvant therapy in the patient with chronic osteomyelitis. Shock-absorbing shoe inserts help to prevent back pain, especially in females.
Which interventions will benefit a pediatric patient who has Duchenne muscular dystrophy? Select all that apply. Performing limb salvage Fitting for an orthotic jacket Administering hyperbaric oxygen Prescribing corticosteroid therapy Recommending shock-absorbing shoe inserts
Fitting for an orthotic jacket Prescribing corticosteroid therapy A patient with muscular dystrophy has a risk of spinal collapse due to progressive weakening of the neck muscles. Fitting for an orthotic jacket provides support to the muscles and decreases the risk of spinal collapse. Corticosteroid therapy maintains airways and improves respiratory functioning. Limb salvage is prescribed for the patient who has osteosarcoma. Hyperbaric oxygen is used as adjuvant therapy in the patient with chronic osteomyelitis. Shock-absorbing shoe inserts help to prevent back pain, especially in females. Which statement by the student nurse indicates understanding of primary osteosarcoma?"Metastasis occurs in over 50% of individuals.""Chemotherapy is contraindicated preoperatively.""This malignancy is often associated with prior radiation.""This is a rare form of cancer in children and young adults."
The nurse is assessing a patient with a painful deformity of the great toe with swelling of the bursa and formation of callus over the bony enlargement. What condition does the nurse suspect from these findings? A. Hammer toe B. Hallux valgus C. Hallux rigidus D. Morton's neuroma
Hallus valgus
Which statement by the student nurse indicates understanding of treatment for acute osteomyelitis? Oral antibiotics often are required for several months. IV antibiotics are usually required for several weeks. Surgery is almost always necessary to remove the dead tissue that is likely to be present. Drainage of the foot and instillation of antibiotics into the affected area is the usual therapy
IV antibiotics are usually required for several weeks.
A patient with osteomyelitis may present with which assessment finding?
Limited range of motion of the extremity due to localized pain
Which nursing intervention is the priority for a patient hospitalized with osteomyelitis who has a prescription for bed rest with bathroom privileges, with the affected foot elevated on two pillows? Ambulate the patient to the bathroom every two hours. Ask the patient about preferred activities to relieve boredom. Perform frequent position changes and range-of-motion (ROM) exercises. Allow the patient to dangle legs at the bedside every two to four hours. Perform frequent position changes and range-of-motion (ROM) exercises. Allow the patient to dangle legs at the bedside every two to four hours.
Perform frequent position changes and range-of-motion (ROM) exercises.
Which statement by the student nurse indicates understanding of teaching about proper body mechanics for a patient with a history of low back pain caused by a herniated lumbar disc? Physical therapy may help to alleviate the pain. I should try to get out of bed in one smooth, quick motion. I will never bend down below waist level to avoid additional injury. I should limit exercise to one to two times per week to avoid excess strain.
Physical therapy may help to alleviate the pain.
Which technique will the nurse use to turn a patient in the postoperative phase of spinal surgery? Place a pillow between the patient's legs and turn the body as a unit. Have the patient turn to the side by grasping the side rails to help to turn over. Elevate the head of bed 30 degrees, and have the patient extend the legs while turning. Turn the patient's head and shoulders and then the hips, keeping the patient's body centered in the bed.
Place a pillow between the patient's legs and turn the body as a unit. Placing a pillow between the legs and turning the patient as a unit logrolling helps to keep the spine in good alignment and reduces pain and discomfort following spinal surgery. Having the patient turn by grasping the side rail to help puts strain on the back. Turning with head of bed at 30 degrees with legs extended will misalign the spine and likely cause damage. Elevating the head of the bed and turning the head, shoulders, and hips separately will misalign the spine and cause pain.
Which action may help to prevent exacerbation of low back pain? Sleeping in prone position Maintaining complete bed rest Using a soft comfortable mattress Placing a foot on a stool during prolonged standing
Placing a foot on a stool during prolonged standing The nurse should tell the patient to place a foot on a stool during prolonged standing to avoid straining the lower back. The patient should be asked to sleep in supine or side-lying positions with knees and hips flexed to prevent unnecessary pressure on support muscles, ligaments, and lumbosacral joints. The patient should avoid complete bed rest; it is better for the patient to continue daily activities. A firm mattress or a bed board is recommended instead of a soft mattress.
The nurse determines that dietary teaching for a patient with osteoporosis has been successful when the patient selects which highest calcium meal? Chicken stir-fry with 1 cup each onions and green peas, and 1 cup of steamed rice Ham and Swiss cheese sandwich on whole wheat bread, steamed broccoli, and an apple A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk A two-egg omelet with 2 oz of American cheese, one slice of whole wheat toast, and a half grapefruit
Sardine sandwich The highest calcium content is present in the lunch containing milk and milk products (yogurt) and small fish with bones (sardines). Chicken, onions, green peas, rice, ham, whole wheat bread, broccoli, apple, eggs, and grapefruit each have less than 75 mg of calcium per 100 g of food. Swiss cheese and American cheese have more calcium, but not as much as the sardines, yogurt, and milk.Text Reference - p. 1555
which instructions will the nurse include when teaching a patient who has impaired physical mobility related to low back pain due to herniated lumbar disc? Select all that apply. Sleep on a side-lying position. Apply heat to the affected area. Lean forward without bending at the knees. Sleep on the abdomen or in a supine position. Maintain a body mass index (BMI) of 18.5 to 24.9.
Sleep on a side-lying position. Apply heat to the affected area. Maintain a body mass index (BMI) of 18.5 to 24.9. The nurse should encourage the patient to maintain a healthy body weight, apply heat or ice to the painful area, and sleep in a side-lying position to help to alleviate pain and improve mobility. Bending should occur at the waist while bending the knees to support the lower back. Sleeping on the abdomen will hyperextend the back and increase pain and decrease mobility.
which factors place a patient at higher risk for developing osteoporosis?
Smoking, asian descent, sedentary lifestyle
Which nonsurgical pain relief measures will the nurse suggest to a patient with hammer toe? Use a shoe with a stiff sole. Wear shoes with wide forefoot. Use a metatarsal arch support. Use longitudinal arch supports.
Use a metatarsal arch support. The nurse will advise the patient with hammer toe to use a metatarsal arch support and perform passive manual stretching of the proximal interphalangeal (PIP) to relieve pain. Shoes with stiff soles are recommended for patients with hallux rigidus. Patients with hallux valgus, or bunions, should wear shoes with a wide forefoot to relieve pressure on the bursal sac. Patients with pes planus, or flatfoot, are asked to use resilient longitudinal arch supports to relieve pain in the foot or leg.
Which form of exercise will the nurse suggest for a patient with low back pain from a herniated lumbar disc? Yoga Walking Calisthenics Weightlifting
Walking The patient would benefit from an aerobic exercise that takes into account the patient's health status and fits the patient's lifestyle. The best exercise is walking, which builds strength in the back and leg muscles without putting undue pressure or strain on the spine. Yoga, calisthenics, and weightlifting would all put pressure on or strain the spine.
which factor may increase pain for a patient with a history of herniated lumbar disc and lower back pain? Humid weather bending forward frequent postion changes sleeping on a firm mattress
bending forward
a laminectomy involves which surgical method? decompression of the affected nerve root lifting the vertebrae off the pinched nerve a laser is used on the damaged part of the disc excision of a portion of the involved vertebral lamina
excision of a portion of the involved vertebral lamina
which disorder may present with swelling of the bursa and the formation of callus over a bony enlargement of the forefoot
hallux valgus
a patient with osteomyelitis of the tibia may initially present with which assessment finding
localized pain and warmth
which position is recommended for a patient with low back pain related to a ruptured lumbar disc? lying on the back with a small pillow lying on the abdomen with no pillow lying on the side with legs flexed lying on the side with the legs straight
lying on the side with legs flexed it is the most comfortable and therapeutic position for a patient with a ruptured, or herniated, disk. this position lessens muscular stress and tension on the injured area and can help to promote healing
which instructions will the nurse include when teaching a patient with lower back pain about pain prevention measures select all that apply use a pillow for sitting sleep in a prone psotion bend at the knees when lifting heavy objects consult health care provider about excising lift objects by holding them away from the body
use a pillow for sitting bend at the knees when lifting heavy objects consult health care provider about exercising