NRSG305 Musculoskeletal PrepU Questions
It is suspected that a client has osteomalacia. What should the nurse teach the client about potential causes of this condition? "Insufficient calcium absorption and phosphate deficiency are the causes." "Decreased nutrition is the primary cause." "The etiology is idiopathic." "This condition is genetically influenced."
"Insufficient calcium absorption and phosphate deficiency are the causes." Osteomalacia is a generalized bone condition in which there is inadequate mineralization of bone caused by insufficient calcium absorption from the intestine resulting from the following: lack of dietary calcium, deficiency of vitamin D, or resistance to the action of vitamin D. Phosphate deficiency is also cited as a cause.
The client asks, "What is reduction?" How will the nurse respond? "It refers to realigning the bone." "It means the fracture will be casted." "It is what happens when the fracture is immobilized." "It means the fracture is healed."
"It refers to realigning the bone." Reduction is the term for when bones are realigned to restore their original structure.
A client sought care because of increasing pain and inflammation in the toe and ankle of one foot. Diagnostic testing has resulted in a diagnosis of gouty arthritis. When educating the client about the treatment and management of the disease, what should the nurse teach the client? "Your doctor will likely prescribe acetaminophen with codeine to manage your pain." "Losing some weight and reducing your alcohol intake will likely be beneficial." "In a lot of cases, clients with gout are able to control their symptoms through physiotherapy." "It's important that you have your bloodwork drawn weekly and that you adjust your diet."
"Losing some weight and reducing your alcohol intake will likely be beneficial." For many clients with gout, changes in lifestyle may be needed, such as maintenance of ideal weight, moderation in alcohol consumption, and avoidance of purine-rich foods. Weekly blood work is not necessary and NSAIDs are preferred to opioids for pain management. Physiotherapy is not a major treatment modality for gout.
A nurse is teaching a group of nursing students about the presentation of systemic lupus erythematosus (SLE). Which statement is the nurse likely to make? "Lupus is a disease of older individuals." "More women than men are affected by lupus." "Lupus is more common in white people." "Drug-induced lupus requires lifelong treatment."
"More women than men are affected by lupus." There is a female predominance of 10:1 in those with SLE. This ratio is closer to 30:1 during childbearing years. SLE is more common in blacks, Hispanics, and Asians than in whites, and the incidence in some families is higher than in others.
A nurse is caring for a client with a fractured elbow. Which instruction is important to give the client to prevent cartilage degeneration while the elbow is immobilized? "It is important to begin with vigorous exercise of the affected area as soon as the cast is removed." "To prevent cartilage atrophy, slowly and gradually resume exercising." "Once the elbow has been casted, you will not be able to exercise that joint for 3-6 months." "If you take a nonsteroidal anti-inflammatory medication prior to exercise, you will be able regain mobility faster."
"To prevent cartilage atrophy, slowly and gradually resume exercising." Cartilage atrophy is rapidly reversible with activity after a period of immobilization; impact exercise during the period of remobilization can prevent reversal of the atrophy. Slow and gradual remobilization may be important in preventing cartilage injury.
The nurse determines that additional client education is needed when a client with gout makes which statement? "When I have an exacerbation of my symptoms, a glass of red wine will be helpful." "Increasing my intake of water each day will help stop the symptoms." "I will plan to eat more white meat rather than red meat." "I should avoid eating shellfish to decrease the risk of an episode."
"When I have an exacerbation of my symptoms, a glass of red wine will be helpful." The statement about drinking alcohol to decrease the symptoms would need more follow-up, since it is a strong contributor to an exacerbation of gout. The other statements are valid.
A physician is providing care for several clients on a hospital-based medical ward. Which client is most likely to experience chronic fatigue? 51-year-old woman admitted for exacerbation of her multiple sclerosis. 33-year-old man with cellulitis to his lower leg. 45-year-old female paraplegic with a necrotic ischial wound. 68-year-old woman admitted for a rectovaginal fistula.
51-year-old woman admitted for exacerbation of her multiple sclerosis. Neurologic conditions such as multiple sclerosis are particularly associated with chronic fatigue. Infections, wounds, and fistulae will undoubtedly cause fatigue but are less likely to contribute to the long-term presentation associated with chronic fatigue.
Which individual is likely to have the highest risk of developing tuberculosis osteomyelitis? A 55-year-old female who is in renal failure secondary to poorly controlled type 1 diabetes. A 79-year-old man who is immunocompromised following a bone marrow transplant. A 30-year-old man who has undergone open reduction and internal fixation of his fractured tibia. A 68-year-old woman who had a laminectomy 4 days prior for treatment of her chronic back pain.
A 79-year-old man who is immunocompromised following a bone marrow transplant. Older age and immunocompromised status are noted risk factors for the development of tuberculosis osteomyelitis. Postoperative status and diabetes are not noted to be strongly associated with the pathology.
In a client diagnosed with osteomalacia, what would be recommended to aid with improvement of the condition? Increasing dietary consumption of vitamin D Losing 5 to 10 pounds of weight Decreasing exposure to the natural UV radiation of the sun Undergoing a bone marrow transplant
Increasing dietary consumption of vitamin D Clients with osteomalacia need to have increased vitamin D, and exposure to natural sunlight will help increase the absorption. Losing weight and a bone marrow transplant will not be helpful.
Which signs and symptoms should prompt a young woman's primary care provider to assess for systemic lupus erythematosus (SLE)? Chronic nausea and vomiting that is unresponsive to antiemetics Joint pain and proteinuria A history of thromboembolic events and varicose veins Dysmenorrhea and recent spontaneous abortion
Joint pain and proteinuria Renal involvement occurs in approximately one half to two-thirds of persons with SLE, and arthralgia is a common early symptom of the disease. Nephrotic syndrome causes proteinuria with resultant edema in the legs and abdomen, and around the eyes. Although the manifestations of SLE are diffuse, these do not typically include alterations in hemostasis, gastrointestinal symptoms, dysmenorrhea, or miscarriage.
What would be the best treatment option for a soft tissue contusion on the right ankle? Keep the ankle elevated for the first 24 hours Apply heat compresses for 15 minutes at a time for 24 hours. Surgery will be the expected treatment and we need to have a consent form signed. Administration of pain medications as needed.
Keep the ankle elevated for the first 24 hours For a soft tissue contusion, the treatment would consist of elevating the affected areas and applying ice—not heat—for the first 24 hours. Pain medications may be helpful, but the nonpharmacologic treatments would best treat the condition. Surgery is not required.
Athletic injuries fall into two types: acute or overuse injuries. Where do overuse injuries commonly occur? Knee Wrist Neck Fingers
Knee Overuse injuries have been described as chronic injuries, including stress fractures that result from constant high levels of physiologic stress without sufficient recovery time. They commonly occur in the elbow ("Little League elbow" or "tennis elbow") and in tissue in which tendons attach to the bone, such as the heel, knee, and shoulder.
The nurse is assessing a female client's risk for osteoporosis. Which factor places this client at greatest risk? Menopause Black race Male gender Obesity
Menopause Numerous studies have shown that bone mass loss occurs with aging regardless of sex, race, or body size. However, after menopause there is a rapid decline in bone mass due to estrogen deficiency. Therefore, menopause places this client at greater risk than gender, race, and body size.
The nurse is caring for a client with newly diagnosed systemic lupus erythematosus (SLE). Which over-the-counter medication does the nurse recognize is useful in treating inflammation, arthritis, and pleuritis? Nonsteroidal anti-inflammatory drugs (NSAIDs) Hydroxychloroquine Cyclophosphamide Belimumab
Nonsteroidal anti-inflammatory drugs (NSAIDs) Treatment with medications may be as simple as a drug to reduce inflammation, such as an NSAID. NSAIDs can control fever, arthritis, and mild pleuritis.
A 75-year-old female has been admitted to the hospital with a hip fracture. She states, "All I did was fall into my chair, not even very hard." Upon diagnostic testing, the client's bones shows loss of trabeculae from cancellous bone and thinning of the cortex. Which diagnosis is most likely? Osteonecrosis Osteomyelitis Osteoporosis Osteomalacia
Osteoporosis Osteoporotic changes occur in the diaphysis and metaphysis where a loss of trabeculae from cancellous bone and thinning of the cortex is to such an extent that minimal stress causes fractures. Osteonecrosis is due to ischemia, osteomyelitis is an infection, and osteomalacia is a metabolic disorder caused by phosphate deficiency.
A client presents with sudden onset of deep, localized pain and swelling in the proximal femur while undergoing diagnostic workup for suspected lung cancer. The nurse suspects the client may have developed which type of neoplasm of the skeletal system? Exostosis Osteochondroma Enchondroma Osteosarcoma
Osteosarcoma Osteosarcoma is an aggressive and highly malignant bone tumor that normally requires surgery and chemotherapy. Exostosis and osteochondroma are synonymous terms for types of benign neoplasms that often require no treatment. Enchondroma is also benign and may self-resolve.
Which groups are at increased risk for decreased bone mass? Select all that apply. Premature infants Low-birth-weight infants Children with cystic fibrosis Athletes
Premature infants Children with cystic fibrosis Low-birth-weight infants Risk factors for decreased bone mass includes prematurity, low birth weight, and cystic fibrosis.
A client with a fractured clavicle is told that the bone will heal well if immobilized for the next 6 to 8 weeks, but there will be a large "bump" where the break occurred. This bump will be caused by: localized infection. formation of scar tissue. accumulation of dead white cells. formation of a bony callus.
formation of a bony callus. The bony callus is still present due to the misalignment of the ends of the bone (occurs only with clavicle or improperly placed healing). This is not formed by scar tissue and is not the result of scarring or dead white cells.
A client reporting bone pain has sought care. Diagnostic testing reveals that the client has developed osteonecrosis. When addressing the most likely cause of this complication, the nurse should focus on: the quality and quantity of blood flow to the site. the client's red cell, hemoglobin, and hematocrit levels. the client's recent use of nonsteroidal anti-inflammatory drugs (NSAIDs). any weight bearing that the client has performed in recent days.
the quality and quantity of blood flow to the site. Ischemia is the essential cause of osteonecrosis. Anemia is not a noted cause and NSAIDs are not linked to the disease. Weight bearing does not cause osteonecrosis, even when heavy or repeated.
Which assessment finding leads the nurse to suspect a child has Blount disease (tibia vara)? unilateral rotational deformity of the proximal tibia bilateral rotational deformity of the hip joints inability to walk by age 4 bilateral inward angulation of the knees
unilateral rotational deformity of the proximal tibia Blount disease, also known as tibia vara, is supported by unilateral rotational deformity of the proximal tibia. Inward angulation of the knees suggests genu valgum (knock knees). Rotational hip deformities suggest femoral torsion, which is not related to Blount disease, and this condition does not delay the child's ability to ambulate.