Chapter 63: Caring for Clients with Orthopedic and Connective Tissue Disorders

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 menopause, the body's bone density declines, resulting in a gradual loss of height."

A nurse is working with a client with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the client is experiencing adverse effects of this drug?

"I have this ringing in my ears that just won't go away."

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?

"I will avoid prolonged sitting or walking."

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

"You will receive IV antibiotics for 3 to 6 weeks."

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?

Alendronate

Which of the following clients should the nurse recognize as being at the highest risk for the development of osteomyelitis?

An elderly client with an infected pressure ulcer in the sacral area

What is the priority intervention for a client who has been admitted repeatedly with attacks of gout?

Assess diet and activity at home

An elderly female with osteoporosis has been hospitalized. Prior to discharge, when teaching the client, the nurse should include information about which major complication of osteoporosis?

Bone fracture

A nurse is reviewing the pathophysiology that may underlie a client's decreased bone density. What hormone should the nurse identify as inhibiting bone resorption and promoting bone formation?

Calcitonin

A client tells the nurse that he has pain and numbness to his thumb, first finger, and second finger of the right hand. The nurse discovers that the client is employed as an auto mechanic, and that the pain is increased while working. This may indicate that the client could possibly have what health problem?

Carpel tunnel syndrome

A nurse is providing discharge teaching for a client who underwent foot surgery. The nurse is collaborating with the occupational therapist and discussing the use of assistive devices. On what variables does the choice of assistive devices primarily depend?

Client's general condition, balance, and weight-bearing prescription

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years?

Decreased height

A nurse is caring for a client who is 12 hours postoperative following foot surgery. The nurse assesses the presence of edema in the foot. What nursing measure should the nurse implement to control the edema?

Elevate the foot on several pillows.

A nurse is planning the care of an older adult client with osteomalacia. What action should the nurse recommend in order to promote vitamin D synthesis?

Ensuring adequate exposure to sunlight

A clinic nurse is caring for a client newly diagnosed with fibromyalgia. When developing a care plan for this client, what nursing diagnosis should the nurse prioritize?

Fatigue Related to Pain

A client presents at a clinic reports heel pain that impairs walking ability. The client is subsequently diagnosed with plantar fasciitis. This client's plan of care should include what intervention?

Gently stretching the foot and the Achilles tendon

Which of the following was formerly called a bunion?

Hallux valgus

A client has been prescribed alendronate for the prevention of osteoporosis. Which is the highest priority nursing intervention associated with the administration of the medication?

Have the client sit upright for at least 30 minutes following administration

Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis?

Leukocytosis and localized bone pain

A nurse is providing care for a client who has osteomalacia. What major goal should guide the choice of medical and nursing interventions?

Maintenance of adequate levels of activated vitamin D

A nurse is creating a teaching plan for a client who has a recent diagnosis of scleroderma. What topics should the nurse address during health education? Select all that apply.

Managing Raynaud's-type symptoms Smoking cessation The importance of vigilant skin care

An 80-year-old man in a long-term care facility has a chronic leg ulcer and states that the area has become increasingly painful in recent days. The nurse notes that the site is now swollen and warm to the touch. The client should undergo diagnostic testing for what health problem?

Osteomyelitis

A client with diabetes has been diagnosed with osteomyelitis. The nurse observes that the client's right foot is pale and mottled, cool to touch, with a capillary refill of greater than 3 seconds. The nurse should suspect what type of osteomyelitis?

Osteomyelitis with vascular insufficiency

What intervention is a priority for a client diagnosed with osteoarthritis?

Physical therapy and exercise

A nurse's plan of care for a client with rheumatoid arthritis includes several exercise-based interventions. What goal should the nurse prioritize?

Preserve or increase range of motion while limiting joint stress

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease?

Raynaud's phenomenon

A client with rheumatoid arthritis comes to the clinic reporting pain in the joint of his right great toe and is eventually diagnosed with gout. When planning teaching for this client, what management technique should the nurse emphasize?

Restrict consumption of foods high in purines.

A client's decreased mobility has been attributed to an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This client has been diagnosed with what health problem?

Rheumatoid arthritis (RA)

A client presents at a clinic complaining of back pain that goes all the way down the back of the leg to the foot. The nurse should document the presence of what type of pain?

Sciatica

Which is a risk-lowering strategy for osteoporosis?

Smoking cessation

Most cases of osteomyelitis are caused by which microorganism?

Staphylococcus aureus

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort?

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

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

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?

Surgical debridement

A community health nurse is performing a visit to the home of a client who has a history of rheumatoid arthritis (RA). On what aspect of the client's health should the nurse focus most closely during the visit?

The client's functional status

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct?

The recommended daily allowance of calcium may be found in a wide variety of foods.

The nurse is caring for a client who is being treated for fibromyalgia. What intervention will best assist the client to restore normal sleep patterns?

Tricyclic antidepressants

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate?

Walking

Which is not a risk factor for osteoporosis?

being male

As part of the assessment process for a patient suspected of having gout, the nurse evaluated his serum uric acid levels. Select the value that is considered above the saturation point for crystal formation.

d. 0.40 mmol/L

A client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which activities might bring on an acute attack?

eating organ meats and sardines

A client's x-ray looks similar to the image depicted. The nurse would recognize that the client likely has a:

hammer toe

Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia

may feel as if their symptoms are not taken seriously.

A client is undergoing diagnostic testing to determine the etiology of recent joint pain. The client asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse?

"OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

A client with SLE asks the nurse why she has to come to the office so often for "check-ups." What would be the nurse's best response?

"Taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working."