Chapter 63: Musculoskeletal Problems
The patient asks the nurse which foods are good sources of calcium. Which food does the nurse recommend? A. Milk B. Carrot C. Lettuce D. Potatoes
A. Milk
A patient asks the nurse for nonsurgical methods to relieve pain caused by hammer toe. What is the best response by the nurse? A. Use a shoe with a stiff sole. B. Wear shoes with wide forefoot. C. Use a metatarsal arch support. D. Use longitudinal arch supports.
C. Use a metatarsal arch support.
The patient is prescribed calcium supplements. What does the nurse recommend to help increase calcium absorption into the bone? A. Aspirin B. Steroids C. Vitamin D D. Calcium citrate
C. Vitamin D
A patient is at risk for bone fracture related to osteoporosis. Which weight-bearing activity does the nurse instruct the patient to use to reduce risk of bone fracture? A. Do chair aerobics. B. Swim laps in the pool. C. Walk 30 minutes daily. D. Do isometric exercises.
C. Walk 30 minutes daily.
A patient that is postmenopausal that is at risk for breast cancer is prescribed a medication for the treatment of osteoporosis. Which medication will the nurse educate the patient about? A. Raloxifene B. Denosumab C. Teriparatide D. Human calcitonin
A. Raloxifene
A patient is prescribed bisphosphonates for the treatment of Paget's disease. What outcome does the nurse expect from the administration of this medication? A. Reduction in bone resorption B. Relief from pain and discomfort C. Decrease in the risk of breast cancer D. Increase in serum alkaline phosphatase levels
A. Reduction in bone resorption
A patient with diabetes mellitus is diagnosed with osteomyelitis of the foot. What medication does the nurse anticipate administering to the patient? A. Metformin B. Exenatide C. Tobramycin D. Hydromorphone
C. Tobramycin
The nurse is caring for a patient with Duchenne muscular dystrophy. What should be included in the teaching plan for this patient? Select all that apply. A. Teach use of orthotic jacket. B. Allow frequent inactive periods. C. Teach range-of-motion exercises. D. Ensure patient receives prolonged bed rest. E. Recommend genetic testing for family members.
A. Teach use of orthotic jacket. C. Teach range-of-motion exercises. E. Recommend genetic testing for family members.
The nurse is providing information to a patient with Paget's disease about the positive effects of physical therapy. Which activity does the nurse suggest to the patient? A. Running B. Walking C. Twisting and turning D. High-impact aerobics
B. Walking
The patient has a prescription for gentamicin 10 mg intravenously (IV) q6h. Available is a vial containing gentamicin 50 mg/mL. The nurse will draw up___mL of solution to be added to the IV piggyback solution. Record your answer using one decimal place. Use a leading zero, if applicable.
A: 0.2 mL
A patient with osteomyelitis in the left femur has been receiving gentamicin therapy for two weeks. During a follow up visit, which patient statement indicates that the treatment should be discontinued? A. "I don't have a fever now." B. "I have severe pain in my left leg." C. "I have a ringing sensation in my ear." D. "The pus from the wound has stopped draining."
C. "I have a ringing sensation in my ear."
A patient has been prescribed vitamin D 3 and vitamin D 2 supplements for treatment of osteomalacia. What does the nurse determine is the primary goal of treatment for this patient? A. Relief from back pain B. Regeneration of the bones C. Recalcification of the bones D. Replenishment of bone mass
C. Recalcification of the bones
Upon a patient's return from vertebral disc surgery, which of the following would the nurse report to the health care provider immediately? A. Constipation B. Paresthesias C. Severe headache D. Abdominal distention
C. Severe headache
Which factor makes women more prone to osteoporosis compared to men? A. Large-boned frame B. Estrogen deficiency C. High-impact aerobics D. Bisphosphonates intake
B. Estrogen deficiency
What is the correlation of bone resorption to bone deposition in osteoporosis? A. Bone resorption exceeds bone deposition. B. Bone deposition exceeds bone resorption. C. Bone deposition is equal to bone deposition. D. Bone resorption is followed by bone replacement.
A. Bone resorption exceeds bone deposition.
A patient is determined to have a vitamin D deficiency when the laboratory work is reviewed and supplementation is discussed. What should the nurse inform the patient might occur if the deficiency is uncorrected? A. Bone softening B. Low bone mass C. Bone replacement D. Infection of the bone
A. Bone softening
Peak bone mass occurs before which age? A. 10 B. 20 C. 30 D. 40
B. 20
Bisphosphonates have been recommended for a patient with osteoporosis. What patient education is important for the nurse to include? Select all that apply. A. Take them with a full glass of water. B. Drink only sips of water with the pill. C. Take them with a full meal at dinner. D. Take them 30 minutes before food or medications. E. Remain upright for at least 30 minutes after taking a dose. F. Take them first thing in the morning on an empty stomach.
A. Take them with a full glass of water. D. Take them 30 minutes before food or medications. E. Remain upright for at least 30 minutes after taking a dose.
The patient is taking medications for the treatment of asthma. Which medication does the nurse educate the patient about that contributes to the increased risk of osteoporosis? A. Calcitonin B. Analgesics C. Corticosteroids D. Bisphosphonates
C. Corticosteroids
A patient sustained a fall one week ago without a fracture and reports pain in the right hip, which increases in intensity with activity. The patient has a fever and the site of injury is swollen and tender to the touch. Which diagnostic tests would help determine the cause of the patient's condition? Select all that apply. A. X-ray of the hip B. Bone tissue biopsy C. White blood cell count D. Radionuclide bone scans E. Magnetic resonance imaging
B. Bone tissue biopsy D. Radionuclide bone scans E. Magnetic resonance imaging
A patient with acute osteomyelitis asks the nurse how this problem will be treated. Which response by the nurse is most appropriate? A. "Oral antibiotics often are required for several months." B. "Intravenous (IV) antibiotics usually are required for several weeks." C. "Surgery almost always is necessary to remove the dead tissue that is likely to be present." D. "Drainage of the foot and instillation of antibiotics into the affected area is the usual therapy."
B. "Intravenous (IV) antibiotics usually are required for several weeks."
A patient with osteomyelitis asks the nurse how this problem will be treated first. What is the best response by the nurse? A. "You will need oral antibiotics and antifungals for two to three months." B. "Intravenous antibiotics are the first treatment choice for this condition." C. "It is likely that a portion of your bone will be removed to treat the infection." D. "Surgery to remove the damaged tissue is the best way to treat this condition."
B. "Intravenous antibiotics are the first treatment choice for this condition."
A patient who is being treated for osteoporosis receives a prescription for a bisphosphonate drug. What instruction should the nurse give to the patient regarding its administration and aftereffects? A. "You may feel like throwing up and lose your appetite." B. "You should drink a full glass of water with the medicine." C. "You should lie down immediately after eating, for 15 minutes." D. "You should eat a meal within 15 minutes after taking the medicine."
B. "You should drink a full glass of water with the medicine."
A patient receiving intravenous (IV) vancomycin needs to have a trough drug level drawn. The medication will infuse over 60 minutes and the next dose is due to be given at 1300. The nurse should obtain a blood sample at which time? A. 1200 B. 1230 C. 1330 D. 1400
B. 1230
A patient recently diagnosed with osteoporosis is concerned about getting a bone fracture. On what preventive measures would the nurse educate the patient? Select all that apply. A. Eat foods such as bananas, salmon, and broccoli B. Increase exposure to sunlight to at least 20 minutes a day C. Increase calcium supplement intake to 300 to 600 mg/day D. Conduct weight-bearing exercises, such as tennis or walking E. Participate in high-impact exercises, such as aerobics or running F. Eat foods such as cottage cheese, sardines, and turnip greens
B. Increase exposure to sunlight to at least 20 minutes a day D. Conduct weight-bearing exercises, such as tennis or walking F. Eat foods such as cottage cheese, sardines, and turnip greens
The nurse is admitting a patient who has a new onset of lower back pain. To differentiate between the pain of a lumbar herniated disc and lower back pain from other causes, what would be the best question for the nurse to ask the patient? A. "Is the pain worse in the morning or in the evening?" B. "Is the pain sharp or stabbing, or burning or aching?" C. "Does the pain radiate down the buttock or into the leg?" D. "Is the pain totally relieved by analgesics, such as acetaminophen (Tylenol)?"
C. "Does the pain radiate down the buttock or into the leg?"
A patient diagnosed with osteoporosis has a daily diet that includes 1 cup of skim milk, 1 cup of soft-serve ice-cream, 1 cup of cooked spinach, 1 cup of almonds, 8 oz. of yogurt, and 1 egg. What should the nurse record as the patient's calcium intake? A. 400 mg/day B. 1080 mg/day C. 1521 mg/day D. 2000 mg/day
C. 1521 mg/day
A patient having a blood test remarks, "I think my head is getting bigger. My hats don't fit me anymore." The nurse suspects what diagnosis? A. Osteomalacia B. Osteoporosis C. Osteoarthritis D. Paget's disease
D. Paget's disease
A patient with hypertension is admitted to the nursing unit with osteomyelitis. Which symptom will the nurse most likely find on physical examination? A. Hypotension B. Abdominal pain C. Nausea and vomiting D. Limited range of motion of the extremity
D. Limited range of motion of the extremity
The nurse is caring for a patient who underwent spinal surgery a day ago. A change in which clinical factor needs to be immediately reported to the primary health care provider? A. Pain intensity B. Urinary voiding C. Bowel movements D. Movement of the leg
D. Movement of the leg
A patient is prescribed the nasal form of calcitonin in order to treat osteoporosis. What side effect of the medication should the nurse inform the patient is a possibility? A. Nausea B. Headache C. Facial flushing D. Nasal dryness
D. Nasal dryness
A patient that is postmenopausal asks the nurse why she would not be taking estrogen therapy for the primary treatment to prevent osteoporosis. What is the best response by the nurse? A. "Estrogen therapy can cause weight loss and gastritis." B. "Estrogen therapy causes leg cramps and hot flushes." C. "Estrogen therapy will cause nasal dryness and irritation." D. "Estrogen therapy places women at risk for breast and uterine cancer."
D. "Estrogen therapy places women at risk for breast and uterine cancer."
The nurse knows the risk of bone fractures increases for women as they age. Bone density tests are recommended for all women over which age? A. 45 B. 50 C. 55 D. 65
D. 65
The nurse is providing discharge teaching to a patient after a stress fracture of the foot. Which drug does the nurse inform the patient would increase the risk for osteoporosis? Select all that apply. A. Aspirin B. Lisinopril C. Metformin D. Hydrocodone E. Betamethasone F. Calcium carbonate
E. Betamethasone F. Calcium carbonate
Bone remodeling is consistent in reducing fractures unless the patient has which condition? A. Cancer B. Osteoporosis C. Osteomyelitis D. Osteochondroma
B. Osteoporosis
A patient is admitted with cellulitis and osteomyelitis. The nurse concludes that there is significant inflammation through which laboratory finding? A. Red blood cell count 4.5 B. Blood urea nitrogen (BUN) 24 C. White blood cell count 9500/mm 3 D. Erythrocyte sedimentation rate (ESR) 88
D. Erythrocyte sedimentation rate (ESR) 88
The nurse recommends taking calcium supplements to a patient with osteoporosis. Which supplement does the nurse recommend? A. Calcium lactate B. Calcium citrate C. Calcium gluconate D. Calcium carbonate
D. Calcium carbonate
The nurse is reinforcing health teaching about osteoporosis with a patient admitted to the hospital. Which risk factors for osteoporosis should the nurse include in the discussion? Select all that apply. A. Obesity B. Smoking C. Asian descent D. Hyperlipidemia E. Sedentary lifestyle
B. Smoking C. Asian descent E. Sedentary lifestyle
The nurse is reviewing the bone density score for a patient who is suspected of having osteopenia. Which score confirms this suspicion? A. T-score of -1 B. T-score of -2 C. T-score below -2.5 D. T-score between -2.5 with low body weight
B. T-score of -2
The patient has a prescription for gentamicin. The nurse would hold the dose and notify the health care provider if the patient developed which concern? A. Fever B. Tinnitus C. Epistaxis D. Constipation
B. Tinnitus
The nurse is reviewing proper body mechanics with a patient with a history of low back pain caused by a herniated lumbar disc. The nurse would determine proper understanding if the patient makes which statement? A. "Physical therapy may help to alleviate the pain." B. "I should try to get out of bed in one smooth, quick motion." C. "I will never bend down below waist level to avoid additional injury." D. "I should limit exercise to one to two times per week to avoid excess strain."
A. "Physical therapy may help to alleviate the pain."
The nurse reviews the medication profile of a patient who is being treated for osteomyelitis and determines that the patient is at risk of tendon rupture. The nurse makes this determination based on what medication that the patient is taking? A. Cefazolin B. Neomycin C. Tobramycin D. Ciprofloxacin
D. Ciprofloxacin
The nurse is reinforcing health teaching about osteoporosis with a patient admitted to the hospital. In reviewing this disorder, what should the nurse explain to the patient? A. Estrogen therapy must be maintained to prevent rapid progression of the osteoporosis. B. With a family history of osteoporosis, there is no way to prevent or slow bone resorption. C. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. D. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
D. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
The nurse is caring for a patient who is prescribed a muscle relaxant for acute low back pain. What should the nurse teach the patient about managing low back problems? A. Sleep in prone position. B. Maintain complete bed rest. C. Use a soft comfortable mattress. D. Place a foot on a stool during prolonged standing.
D. Place a foot on a stool during prolonged standing.
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 (CPAP) will be used to facilitate sleeping D. Remaining active will prevent skin breakdown and respiratory complications or distress
D. Remaining active will prevent skin breakdown and respiratory complications or distress
The nurse is caring for a patient hospitalized with exacerbation of chronic bronchitis and herniated lumbar disc. Which breakfast choice would be most appropriate for the nurse to encourage the patient to check on the breakfast menu to prevent constipation? A. Bran muffin B. Scrambled eggs C. Puffed rice cereal D. Buttered white toast
A. Bran muffin
A patient has been taking bisphosphonates for the treatment of osteoporosis and has demonstrated a low tolerance to the drug. What alternative medication does the nurse anticipate will be prescribe? A. Calcitonin B. Corticosteroids C. Cholestyramine D. Divalproex sodium
A. Calcitonin
The nurse is caring for an older adult patient that is being treated for Paget's disease. Which medications does the nurse expect to find in the patient's prescription? Select all that apply. A. Calcitonin B. Raloxifene C. Denosumab D. Teriparatide E. Bisphosphonates
A. Calcitonin E. Bisphosphonates
A patient with Paget's disease is encouraged to wear a brace to relieve back pain and provide support when in the upright position. What should the nurse instruct this patient to do? Select all that apply. A. Attend physical therapy. B. Avoid the use of bed board. C. Avoid falls and subsequent fractures. D. Examine the skin for damage due to friction. E. Lift light weights using good body mechanics.
A. Attend physical therapy. C. Avoid falls and subsequent fractures. D. Examine the skin for damage due to friction.
The nurse is admitting a patient to the acute care unit with a history of a herniated lumbar disc and low back pain. In completing a more thorough pain assessment, the nurse should ask the patient if which action aggravates the pain? A. Bending or lifting B. Application of warm moist heat C. Sleeping in a side-lying position D. Sitting in a fully extended recliner
A. Bending or lifting
Which patients should the nurse assess for signs and symptoms of osteomyelitis? Select all that apply. A. A 60-year-old diabetic who has a blunt injury B. A 14-year-old old boy who sustained an ankle sprain C. A 50-year-old man who underwent a total hip replacement D. A 20-year-old woman with a closed fracture of the humerus E. A 30-year-old man with a tibia fracture and a deep wound over it
A. A 60-year-old diabetic who has a blunt injury C. A 50-year-old man who underwent a total hip replacement E. A 30-year-old man with a tibia fracture and a deep wound over it
During a health screening event, which assessment finding would alert the nurse to the possible presence of osteoporosis? A. A measurable loss of height B. The presence of bowed legs C. Poor appetite and aversion to dairy products D. Development of unstable, wide-gait ambulation
A. A measurable loss of height
A nurse provides preoperative teaching to a patient who is scheduled for a laminectomy. What should the nurse include when discussing what will be done during the surgical procedure? A. A portion of the involved vertebral lamina B. The nerve root affected by the cord compression C. The spinous processes of the vertebrae in the affected area D. A major portion of the vertebrae involved in the area of herniation
A. A portion of the involved vertebral lamina
The nurse is caring for a patient following lumbar fusion. What nursing interventions should the nurse perform for this patient? Select all that apply. A. Assess extremity circulation. B. Use a soft mattress for comfort. C. Place patient in Fowler's position. D. Monitor peripheral neurologic signs. E. Report severe headache to the surgeon.
A. Assess extremity circulation. D. Monitor peripheral neurologic signs. E. Report severe headache to the surgeon.
A patient is demonstrating signs of Paget's disease. When obtaining a health history from the patient, which initial manifestation reported does the nurse recognize correlates with this diagnosis? A. Bone pain B. Weight loss C. Thinning of the skull D. Spontaneous fracture
A. Bone pain
A patient with morbid obesity with a history of hyperlipidemia comes in to the clinic stating that he or she has muscular weakness in the pelvic region and difficulty walking. What laboratory findings does the nurse expect to see? A. Calcium 7.0 mg/dL B. Phosphorus 5.5 mg/dL C. Alkaline phosphatase 12 U/L D. 25-hydroxy vitamin D 80 ng/mL
A. Calcium 7.0 mg/dL
A patient has lower back pain from a herniated lumbar disc. What would be an appropriate nursing intervention to treat this problem? A. Elevate the head of the bed 20 degrees and flex the knees. B. Provide gentle range of motion (ROM) to the lower extremities. C. Place the bed in reverse Trendelenburg, with the feet firmly against the footboard. D. Place a small pillow under the patient's upper back to gently flex the lumbar spine.
A. Elevate the head of the bed 20 degrees and flex the knees.
A patient is diagnosed with Paget's disease and asks the nurse to explain what the disease does to the bones. What is the best response by the nurse to describe the disease? A. Excessive bone resorption followed by bone regeneration B. Benign tumor, which is an overgrowth of cartilage and bone C. Structural deterioration of bone tissue leading to bone fragility D. Decalcification and softening of bones due to vitamin D deficiency
A. Excessive bone resorption followed by bone regeneration
An older adult patient is admitted with a vertebral compression fracture. For which procedure does the nurse anticipate preparing the patient? A. Kyphoplasty B. Spinal fusion C. Vertebroplasty D. Bone mineral density (BMD)
A. Kyphoplasty
The nurse is giving the patient gentamicin through a central line. What actions by the nurse are appropriate? Select all that apply. A. Monitor peak and trough levels B. Obtain daily blood cultures during therapy. C. Evaluate renal function before starting therapy. D. Assess patient for dehydration before starting therapy. E. Obtain electrocardiogram (ECG) before initiating therapy. F. Teach patient to contact the health care provider (HCP) if any visual, hearing, or urinary problems occur.
A. Monitor peak and trough levels C. Evaluate renal function before starting therapy. D. Assess patient for dehydration before starting therapy. F. Teach patient to contact the health care provider (HCP) if any visual, hearing, or urinary problems occur.
The nurse is caring for a patient in the postoperative phase of spinal surgery. What nursing action is most appropriate when turning a patient? A. Placing a pillow between the patient's legs and turning the body as a unit. B. Having the patient turn to the side by grasping the side rails to help turn over. C. Elevating the head of bed 30 degrees and having the patient extend the legs while turning. D. Turning the patient's head and shoulders and then the hips, keeping the patient's body centered in the bed.
A. Placing a pillow between the patient's legs and turning the body as a unit.
A patient has impaired physical mobility related to low back pain due to a herniated lumbar disc. What are appropriate nursing interventions for this diagnosis? Select all that apply. A. Sleep on a side-lying position. B. Apply heat to the affected area. C. Lean forward without bending at the knees. D. Sleep on the abdomen or in a supine position. E. Maintain a body mass index (BMI) of 18.5 to 24.9.
A. Sleep on a side-lying position. B. Apply heat to the affected area. E. Maintain a body mass index (BMI) of 18.5 to 24.9.
The nurse is assessing a patient for radicular pain related to a herniated lumbar disc. What assessment technique should the nurse perform to elicit the response for confirmation? A. Straight leg raises B. Anterior drawer test C. Passive range of motion exercises D. Costovertebral angle (CVA) tenderness
A. Straight leg raises
The nurse is assessing a patient with lower back pain. What prevention methods should the nurse teach the patient? Select all that apply. A. Use a pillow for sitting. B. Sleep in a prone position. C. Bend at the knees when lifting heavy objects. D. Consult health care provider about exercising. E. Lift objects by holding them away from the body.
A. Use a pillow for sitting. C. Bend at the knees when lifting heavy objects. D. Consult health care provider about exercising.
The nurse is developing a health promotion program regarding osteoporosis. Which population of postmenopausal women should the nurse target that are at risk for osteoporosis? A. White American B. Native American C. African American D. Mexican American
A. White American
The nurse is admitting a patient to the clinic that is suspected of having osteomalacia. Which diagnostic test should the nurse prepare the patient for to confirm the diagnosis? A. X-ray B. Quantitative ultrasound (QUS) C. Magnetic resonance imaging (MRI) scan D. Dual-energy x-ray absorptiometry (DXA)
A. X-ray
The nurse is educating a patient that is prescribed calcitonin. What dietary supplement should the nurse encourage the patient to take while on this medication? A. Protein B. Calcium C. Vitamins D. Amino acids
B. Calcium
The nurse is providing education to a community group on supplemental vitamin D. Which patients does the nurse recommend take 800 IU daily? Select all that apply. A. A 48-year-old female living in Florida B. A 50-year-old male living in Wisconsin C. A 16-year-old female who is bedridden D. A 50-year-old male working as a farmer E. A 65-year-old female retired school teacher F. A 35-year-old debilitated female in long term care
B. A 50-year-old male living in Wisconsin C. A 16-year-old female who is bedridden E. A 65-year-old female retired school teacher F. A 35-year-old debilitated female in long term care
A patient taking calcitonin reports facial flushing and nausea and is considering discontinuation of the medication. What can the nurse suggest that will reduce these side effects? A. Administering the drug by oral route B. Administering the drug intramuscular (IM) C. Administering the drug using the intravenous (IV) route D. Having the patient use the intranasal route for administration.
B. Administering the drug intramuscular (IM)
To reduce the incidence of pain for a patient with low back pain, the nurse includes which interventions? Select all that apply. A. Maintaining the patient on strict bed rest. B. Applying heat or ice to the area of most pain. C. Preventing the patient from lifting anything at the bedside. D. Administering prescribed nonsteroidal antiinflammatory drugs (NSAIDs). E. Placing a pillow between the patient's legs and turning the body as a unit.
B. Applying heat or ice to the area of most pain. D. Administering prescribed non steroidal antiinflammatory drugs (NSAIDs). E. Placing a pillow between the patient's legs and turning the body as a unit.
A patient is admitted to the nursing unit with a history of a herniated lumbar disc and lower-back pain. The nurse would suspect which causative factor of increasing pain? A. Humid weather B. Bending forward C. Frequent position changes D. Sleeping on a firm mattress
B. Bending forward
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
A patient is suspected of having Paget's disease. What diagnostic test will the nurse prepare the patient for that will confirm the diagnosis? A. X-rays B. Bone scan C. Blood serum tests D. Dual-energy x-ray absorptiometry (DXA)
B. Bone scan
When discussing the prevention of osteomalacia with an older adult patient, what should the nurse be sure to include? A. Preventing bone fragility B. Control of weight to prevent obesity C. Controlling the symptoms of bowel disease D. Taking estrogen supplements to prevent low estrogen levels
B. Control of weight to prevent obesity
A woman is considering estrogen therapy. About which priority risk factor does the nurse teach her? A. Estrogen causes loss of bone. B. Estrogen can cause a heart attack. C. Estrogen raises the risk of breast cancer. D. Estrogen increases menopausal symptoms.
B. Estrogen can cause a heart attack.
The nurse is caring for a pediatric patient who has Duchenne muscular dystrophy. Which treatment strategies would be beneficial for the child? Select all that apply. A. Performing limb salvage B. Fitting for an orthotic jacket C. Administering hyperbaric oxygen D. Prescribing corticosteroid therapy E. Recommending shock-absorbing shoe inserts
B. Fitting for an orthotic jacket D. Prescribing corticosteroid therapy
A patient reports swelling of the bursa and the formation of a callus over a bony enlargement of the forefoot. Which disorder does the nurse determines correlates with these findings? A. Hammertoe B. Hallux valgus C. Hallux rigidus D. Morton's neuroma
B. Hallux valgus
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
B. Hallux valgus
A patient who underwent spinal surgery reports a severe headache afterward. When changing the dressing to the incisional area, the nurse finds the drainage to be slightly yellow, and positive on a dipstick test. What is the best nursing intervention in this situation? A. Send the drainage sample for culture. B. Inform the primary health care provider. C. Administer an analgesic for the headache. D. Apply a new dressing on the incisional area.
B. Inform the primary health care provider.
A patient is being evaluated for the treatment of osteoporotic vertebral fractures. Which invasive procedure does the nurse prepare the patient for? A. Diskectomy B. Kyphoplasty C. Spinal fusion D. Laminectomy
B. Kyphoplasty
The nurse is caring for a patient admitted to the nursing unit with osteomyelitis of the tibia. Which symptom will the nurse most likely find when assessing the patient? A. Nausea and vomiting B. Localized pain and warmth C. Paresthesia in the affected extremity D. Generalized bone pain throughout the leg
B. Localized pain and warmth
A patient with acute osteomyelitis has been prescribed gentamicin therapy. Before initiating the therapy, what actions should the nurse take? Select all that apply. A. Monitor blood glucose levels. B. Monitor serum creatinine levels. C. Check for symptoms of dehydration. D. Determine number of red blood cells. E. Assess for symptoms of pulmonary edema.
B. Monitor serum creatinine levels. C. Check for symptoms of dehydration.
A school-age child with Paget's disease reports pain and swelling around the right knee after an injury 2 weeks ago that has become increasingly worse. What does the nurse suspect these findings are indicative of? A. Enchondroma B. Osteosarcoma C. Chondrosarcoma D. Osteochondroma
B. Osteosarcoma
The nurse is reviewing the diagnostic tests on a patient that is being treated for Paget's disease and observes a tumor-like overgrowth in the bone. Which complication of the disease does the nurse suspect? A. Enchondroma B. Osteosarcoma C. Ewing's sarcoma D. Chondrosarcoma
B. Osteosarcoma
A patient, hospitalized with osteomyelitis, has a prescription for bed rest. The nurse would place the highest priority on which intervention? A. Offer the patient a urinal every hour. B. Reposition the patient every two hours. C. Provide activities to prevent restlessness. D. Ambulate the patient to the bathroom every three hours.
B. Reposition the patient every two hours.
A patient is at risk of bone fracture from osteoporosis. Which high-impact activity should the nurse inform the patient to avoid because it may cause bone fracture? A. Walking B. Running C. Dancing D. Swimming
B. Running
A patient with acute osteomyelitis is prescribed gentamicin. Which clinical parameter in the patient indicates that the prescription needs to be reconsidered? A. Body temperature: 100° F B. Serum creatinine: 3.4 mg/dL C. White blood cell count: 11,000 cells/mcL D. Erythrocyte sedimentation rate (ESR): 20 mm/hr
B. Serum creatinine: 3.4 mg/dL
The nurse is planning health promotion teaching for a patient with asthma, low back pain from a herniated lumbar disc, and paranoid schizophrenia. The nurse determines that what would be the best exercise to include in an individualized exercise plan for the patient? A. Yoga B. Walking C. Calisthenics D. Weight lifting
B. Walking
The nurse has reviewed proper body mechanics with a patient with a history of low back pain caused by a herniated lumbar disc. Which statement made by the patient indicates a need for further teaching? A. "I should sleep on my side or back with my hips and knees bent." B. "I should exercise at least 15 minutes every morning and evening." C. "I should pick up items by leaning forward without bending my knees." D. "I should try to keep one foot on a stool whenever I have to stand for a period of time."
C. "I should pick up items by leaning forward without bending my knees."
The nurse is educating an older adult patient with osteoporosis that has a sedentary lifestyle. What should the nurse include when discussing this with the patient? A. "Avoid exposure to sunlight." B. "Reduce intake of meat and fish." C. "Quit smoking and reduce alcohol intake." D. "Refrain from any weight-bearing exercise."
C. "Quit smoking and reduce alcohol intake."
A patient with a tumor in the left leg states there is severe pain at the site of the tumor. The patient states, "Why is there so much pain?" What is the best response by the nurse? A. "This is a side effect of radiation therapy." B. "The pain medication must not be working." C. "The tumor may be pressing on nerves near the bone." D. "If one does not get enough exercise, the leg will stiffen up."
C. "The tumor may be pressing on nerves near the bone."
The nurse is helping the patient make a list of foods high in calcium. Which foods does the nurse recommend? Select all that apply. A. 3 oz pork B. One egg C. 8 oz yogurt D. 3 oz salmon E. One banana F. 1 oz cottage cheese
C. 8 oz yogurt D. 3 oz salmon F. 1 oz cottage cheese
The nurse determines that dietary teaching for a patient with osteoporosis has been successful when the patient selects which highest calcium meal? A. Chicken stir-fry with 1 cup each onions and green peas, and 1 cup of steamed rice B. Ham and Swiss cheese sandwich on whole wheat bread, steamed broccoli, and an apple C. A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk D. A two-egg omelet with 2 oz of American cheese, one slice of whole wheat toast, and a half grapefruit
C. A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk
The nurse is administering an intravenous infusion of zoledronic acid to a patient being treated for osteoporosis. How often should the nurse inform the patient they will be receiving this medication? A. Each month for six months B. Each time the patient fractures a hip C. Annually from the time of the last infusion D. When the after-effects of the previous dose wear off
C. Annually from the time of the last infusion
A patient with osteoporosis has been on bed rest for one month after a complicated surgery. What is the patient at risk for after returning to daily activities? A. Pneumonia B. Depression C. Bone fracture D. Pressure ulcer
C. Bone fracture
A patient is diagnosed with metastatic bone cancer in the left leg. What laboratory results should the nurse expect? A. Calcium 7.5 mg/dL B. Sodium 130 mEq/L C. Calcium 11.0 mg/dL D. Potassium 6.5 mEq/L
C. Calcium 11.0 mg/dL
An older adult patient with hyperlipidemia is also at a high risk for the development of osteomalacia. Which medication prescribed for the hyperlipidemia should the nurse question that increases this risk for the patient? A. Phenytoin B. Prednisone C. Cholestyramine D. Divalproex sodium
C. Cholestyramine
A patient with osteoporosis has a history of multiple fractures. Which prescription should the nurse question the health care provider about that is contraindicated in this patient? A. Calcitonin B. Raloxifene C. Corticosteroids D. Bisphosphonates
C. Corticosteroids
The nurse is reviewing the diagnostic test results for a patient with Paget's disease. What findings on the x-ray report does the nurse anticipate reviewing? A. Ribbons of decalcification B. Overgrowth of cartilage and bone C. Curved shape of the affected bone D. More than 25 percent to 40 percent of bone loss
C. Curved shape of the affected bone
A patient is prescribed zoledronic acid for the treatment of Paget's disease. What outcome does the nurse anticipate from the administration of this medication? A. Increased bone mass B. Decreased hypocalcemia C. Decreased bone resorption D. Decreased breast cancer risk
C. Decreased bone resorption
A patient has clinical manifestations that indicate the presence of Paget's disease. When reviewing the laboratory results, which results confirm this diagnosis? A. Increased serum calcium level B. Decreased serum 25-hydroxyvitamin D C. Elevated serum alkaline phosphatase levels D. Decreased serum calcium or phosphorus levels
C. Elevated serum alkaline phosphatase levels
The nurse is planning the care of an older adult patient being treated for Paget's disease. What nursing actions should be included in the plan of care? Select all that apply. A. Provide a soft mattress. B. Provide an assistive device. C. Encourage physical therapy. D. Encourage lifting and twisting. E. Encourage the patient to wear a corset brace.
C. Encourage physical therapy. E. Encourage the patient to wear a corset brace.
A patient diagnosed with osteomalacia is prescribed nutritional therapy and phosphorus supplements. Which other nonpharmacologic instruction is appropriate for the nurse to include on the patient's care plan? A. Instructing the patient to wear a corset B. Instructing the patient to use a firm mattress C. Encouraging the patient to expose self to sunlight D. Encouraging the patient to perform high-impact aerobics
C. Encouraging the patient to expose self to sunlight
A patient is admitted for a fractured hip. A nurse is reviewing the medical history with the patient on admission. Which conditions does the nurse tell the patient place this patient at risk for osteoporosis? Select all that apply. A. Depression B. Breast cancer C. Kidney disease D. Hyperthyroidism E. Diabetes mellitus F. Rheumatoid arthritis
C. Kidney disease D. Hyperthyroidism E. Diabetes mellitus F. Rheumatoid arthritis
Which distinct features of a new bone are revealed in the x-ray of a patient with Paget's disease? A. Brittle and porous B. Overgrowth of bone C. Large and disorganized D. Soft with ribbons of decalcification
C. Large and disorganized
A nurse is caring for a patient with a ruptured lumbar disk. What is the optimal position for the nurse to place patient? A. Lying on the back with a small pillow B. Lying on the abdomen with no pillow C. Lying on the side with the legs flexed D. Lying on the side with the legs straight
C. Lying on the side with the legs flexed
The nurse is assessing a patient who is taking alendronate for osteoporosis. What should the nurse inform the patient to be aware of when taking this medication? A. Helps replace low calcium levels B. Can lead to uncontrolled weight gain C. Must be taken with a full glass of water D. Is always given after primary treatment with estrogen therapy
C. Must be taken with a full glass of water
A patient is prescribed teriparatide. What information is accurate for the nurse to include in the patient's education related to medication frequency and route of administration? A. Once a week, orally B. Once a day, intramuscularly C. Once a day, subcutaneously D. Once a month, intravenously
C. Once a day, subcutaneously
A patient with morbid obesity is scheduled for bariatric surgery. Which condition needs to be assessed by the nurse who is providing preoperative care to the patient? A. Osteopenia B. Osteoporosis C. Osteomalacia D. Osteoarthritis
C. Osteomalacia
A patient hospitalized with osteomyelitis has a prescription for bed rest with bathroom privileges, with the affected foot elevated on two pillows. The nurse would place highest priority on which intervention? A. Ambulate the patient to the bathroom every two hours. B. Ask the patient about preferred activities to relieve boredom. C. Perform frequent position changes and range-of-motion exercises. D. Allow the patient to dangle legs at the bedside every two to four hours.
C. Perform frequent position changes and range-of-motion exercises.
A patient is receiving alendronate for treatment of osteoporosis. The nurse should provide education after noting which action by the patient? A. Takes the medication with 8 ounces of water B. Increases intake of calcium and vitamin D C. Takes the medication immediately before bed D. Continues to perform weight-bearing exercises
C. Takes the medication immediately before bed
A patient with osteoporosis is treated with analgesics and bisphosphonates. The nurse teaches the patient about safe administration of the drugs. Which patient action may interfere with the therapeutic action of the drug? A. Taking the bisphosphonates with a full glass of water B. Taking the bisphosphonates 30 minutes before a meal C. Taking the analgesics and bisphosphonates at the same time D. Remaining upright for 30 minutes after taking bisphosphonates
C. Taking the analgesics and bisphosphonates at the same time
The nurse is caring for an older patient with primary osteosarcoma of the distal femur. What does the nurse recognize about this diagnosis? A. Metastasis occurs in over 50% of individuals B. Chemotherapy is contraindicated preoperatively C. This malignancy often is associated with prior radiation D. This is a rare form of cancer in children and young adults
C. This malignancy often is associated with prior radiation
The nurse is planning health promotion teaching for a patient with asthma, low back pain from a herniated lumbar disc, and hypertension. The nurse determines which exercise would be best to include in an individualized exercise plan for the patient? A. Tennis B. Running C. Walking D. Weightlifting
C. Walking
The nurse completes a teaching session with factory workers on measures to prevent back pain. Which statement by one of the employees indicates the need for additional teaching? A. "Maintaining a healthy weight will help prevent back pain." B. "Sleeping in the side-lying position will help relax the back at night." C. "Sleeping on a firm mattress will better support my back and reduce back strain." D. "Standing straight and still during my shift will improve my posture and reduce back pain."
D. "Standing straight and still during my shift will improve my posture and reduce back pain."
The health care provider determines that a patient with Paget's disease needs help slowing down bone reabsorption. What medication does the nurse anticipate educating the patient regarding? A. Calcium B. Vitamin D C. Denosumab D. Alendronate
D. Alendronate
A patient with intervertebral disc damage caused by lumbar spinal stenosis is undergoing treatment and reports bladder incontinence and constant back pain. The nurse prepares the patient for what outpatient procedure? A. A laminectomy B. A radiofrequency discal nucleoplasty C. An intradiscal electrothermoplasty (IDET) D. An interspinous process decompression system
D. An interspinous process decompression system
A patient who had a total hip replacement less than one month ago comes into the clinic reporting constant bone pain that is unrelieved by rest and seems to worsen with activity. The nurse would expect the health care provider to prescribe a laboratory test to rule out which organism? A. Escherichia coli B. Streptococcus viridans C. Staphylococcus aureus D. Staphylococcus epidermidis
D. Staphylococcus epidermidis
A patient is diagnosed with osteomalacia. Which clinical manifestation does the nurse determine correlates with this diagnosis? A. Dementia B. Headaches C. Loss of hearing D. Weakness in the pelvic girdle
D. Weakness in the pelvic girdle
A patient is being treated for a spinal vertebral fracture due to osteoporosis. Which condition poses a risk to the patient? A. Loss of hearing B. Enlarged and thickened skull C. Second vertebral fracture within 18 months D. Wedging and fractures of the vertebrae over time
D. Wedging and fractures of the vertebrae over time
A woman has been diagnosed with osteoporosis after fracturing a hip. Which explanation does the nurse give to the patient about this disorder? A. Women have a higher intake of calcium. B. Pregnancy provides support for bone growth. C. Women begin losing bone mass later in life than men. D. Women have less bone mass because they have smaller frames.
D. Women have less bone mass because they have smaller frames.