Prep U Chapter 36
A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? Changing the dressing Performing hourly neurovascular assessments for the first 24 hours Applying a cock-up splint and immobilization Having the patient exercise the fingers to avoid future contractures
B Hourly neurovascular assessment of the exposed fingers for the first 24 hours following surgery is essential for monitoring function of the nerves and perfusion.
The health care team caring for a client has determined that their osteoporosis is caused by malabsorption. What is the usual treatment for osteoporosis caused by malabsorption? Exogenous parathyroid hormone and multivitamins Supplemental potassium and pancreatic enzymes Supplemental calcium and increased doses of vitamin D Colony-stimulating factors and calcitonin
C If osteoporosis is caused by malabsorption, increased doses of vitamin D, along with supplemental calcium, are usually prescribed.
Which of the following diagnostics are used to evaluate spinal nerve root disorders (radiculopathies)? Bone scan Magnetic resonance imaging Computed tomography Electromyogram
D An electromyogram and nerve conduction studies are used to evaluate spinal nerve toot disorders (radiculopathies) for patients with low back pain. A bone scan may disclose information about infections, tumors, and bone marrow abnormalities. A computed tomography scan is useful in identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral column and problems of vertebral disks. Magnetic resonance imaging permits visualization of the nature and location of spinal pathology.
A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia? Elevated levels of alkaline phosphatase A bone biopsy Demineralization of the bone Increased and decreased areas of bone metabolism
B A definitive diagnosis is obtained by bone biopsy. Radiographic studies demonstrate demineralization of the bone. A bone scan detects increased and decreased areas of bone metabolism. Alkaline phosphatase levels are detected from a blood sample.
A client is scheduled for surgery to fuse a joint. The nurse identifies this as which of the following? Osteotomy Arthrodesis Arthroplasty Open reduction internal fixation
B An arthrodesis is a surgical procedure to fuse a joint. An osteotomy involves cutting and removing a wedge of the bone to change alignment. An arthroplasty is a total reconstruction or replacement of a joint with an artificial joint. Open reduction internal fixation is accomplished with wire, nails, plate and/or an intramedullary rod to hold bone fragments in place until healing is complete
Which assessment findings would the nurse expect in the client with osteomalacia?
Osteomalacia is characterized by decreased serum calcium and phosphorus and elevated alkaline phosphatase levels.
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? Lower lumbar Thoracic Upper lumbar Cervical
A The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes.
A 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." "You need to perform weight-bearing exercises twice a week." "Use your continuous passive motion machine for 2 hours each day." "You need to limit the amount of protein and calcium in your diet."
A Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks. Continuous passive range of motion is used for clients with osteoarthritis. Weight-bearing exercises are used with clients who have osteoporosis. Limiting protein and calcium is not part of the plan of care for clients with osteomyelitis.
A patient shows the nurse a round, firm nodule on the wrist. The pain is described as aching, with some weakness of the fingers. What treatment does the nurse anticipate assisting with? (Select all that apply.) Corticosteroid injections Active range-of-motion exercises Educating the patient on the use of gabapentin Surgical excision Aspiration of the cyst
A, D, E A ganglion—a collection of neurologic gelatinous material near the tendon sheaths and joints—appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. It frequently occurs in women younger than 50 years (Porth & Matfin, 2009). The swelling is locally tender and may cause an aching pain. When a tendon sheath is involved, weakness of the finger occurs. Treatment may include aspiration, corticosteroid injection, or surgical excision. After treatment, a compression dressing and immobilization splint are used.
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? Negative calcium balance Loss of estrogen Bone fracture Dowager's hump
C Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.
Which of the following was formerly called a bunion? Ganglion Plantar fasciitis Hallux valgus Morton's neuroma
C Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.
Most cases of osteomyelitis are caused by which microorganism? Escherichia coli Proteus species Staphylococcus aureus Pseudomonas species
C Staphylococcus aureus causes 70% to 80% of bone infections. Proteus species, Pseudomonas species, and E. coli are frequently found in osteomyelitis, they do not cause the majority of bone infections.
A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class? Alendronate (Fosamax) Calcium gluconate Tamoxifen (Nolvadex) Raloxifene (Evista)
D An example of a selective estrogen receptor modifier (SERM) is raloxifene (Evista). Alendronate is a bisphosphonate; calcium gluconate is an oral calcium preparation; tamoxifen is an antiestrogen agent
Which term refers to a disease of a nerve root? Contracture Sequestrum Involucrum Radiculopathy
D When the client reports radiating pain down the leg, the client is describing radiculopathy. Involucrum refers to new bone growth around the sequestrum. Sequestrum refers to dead bone in an abscess cavity. Contracture refers to abnormal shortening of muscle or fibrosis of joint structures.
The nurse is caring for a client with osteoporosis. Which information will the nurse include when teaching actions to manage the condition? Select all that apply. Avoid excessive alcohol intake Plan for smoking cessation Consider estrogen replacement therapy Engage in regular weight-bearing exercise Swim for 30 minutes four to five times a week
A, B, D Care of the client with osteoporosis focuses on actions to improve bone density. These actions include avoiding the excessive intake of alcohol. Clients who use tobacco products should be advised to quit. Regular weight-bearing exercise promotes bone formation. Recommendations include 20 to 30 minutes of aerobic, bone-stressing exercise daily. Current guidelines recommend that hormone therapy with estrogen not be used for primary prevention of bone loss in female clients who are postmenopausal. Swimming is not a weight-bearing exercise.
The client has just been diagnosed with osteomyelitis. What are possible causes of osteomyelitis? Select all that apply. Trauma, such as penetrating wounds or compound fractures Progressive osteoporosis Surgical contamination, such as pin sites of skeletal traction Vascular insufficiency in clients with diabetes or peripheral vascular disease
A, C, D The following are all causes of osteomyelitis: trauma, such as penetrating wounds or compound fractures; vascular insufficiency in clients with diabetes or peripheral vascular disease; and surgical contamination, such as pin sites of skeletal traction. Osteoporosis is not a cause of osteomyelitis.
When reviewing the history of a client with a ganglion cyst, which factor would the nurse identify as most likely contributing to the client's current condition? Recurrent dislocations Age below 50 years Employment as a cashier Participation as a softball pitcher
B Ganglion cysts form through defects in the tendon sheath or joint capsule and occur most commonly in women younger than 50 years of age. Being a softball pitcher would increase the client's risk for epicondylitis. Employment as a cashier would be a possible risk factor for carpal tunnel syndrome. Recurrent dislocations are the result of insufficient collagen deposits during the repair stage of a dislocation.
A nurse is caring for an older woman with a hip fracture. What are appropriate risk factors for the nurse to consider related to the client's hip fracture? Select all that apply. Muscular agility Female gender History of diverticulitis Presence of anemia Osteoporosis
B, D, E Anemia, female gender, and osteoporosis are risk factors for hip fractures. Muscular agility decreases the risk for hip fracture. A history of diverticulitis is not related to hip fractures.
Which of the following positions should be avoided in severe back pain? Supine Lateral recumbent Head and thorax elevated 30 degrees Prone
D Explanation: A prone position should be avoided because it accentuates lordosis (inward curvature of the spine). Lumbar flexion is increased by elevating the head and thorax 30 degrees using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head.
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? Magnesium level Potassium level Troponin levels Alkaline phosphatase
D Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly.
A provider prescribes a subcutaneous anabolic agent for an older adult client to prevent fractures associated with osteoporosis. What is the most likely prescribed drug? Alendronic acid Calcitonin Raloxifene Teriparatide
D Teriparatide (Forteo) is a subcutaneously administered anabolic agent that is taken once daily. The other drug choices are oral preparations.
On a visit to the family health care provider, a client is diagnosed with a bunion on the lateral side of the great toe at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session? "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth." "Bunions are caused by a metabolic condition called gout." "Bunions are congenital and can't be prevented."
A Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion.
A nurse is caring for a client with osteomyelitis. What complication should the nurse consider that the client is at risk to develop? Bone abscess formation Impingement syndrome Metastatic bone disease Pathological fractures
A Explanation: Bone abscess formation is a potential complication of osteomyelitis. Impingement syndrome is related to repetitive shoulder activities. Metastatic bone disease and pathological fractures are related to cancer.
A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication? Calcium level of 11.6 mg/dl Potassium level of 6.3 mEq/L Sodium level of 110 mEq/L Magnesium level of 0.9 mg/dl
A In clients with bone cancer, tumor destruction of bone commonly causes excessive calcium release. When the calcium-excreting capacity of the kidneys and GI tract is exceeded, the serum calcium level rises above normal, leading to hypercalcemia (a serum calcium level greater than 10.2 mg/dl). Hyperkalemia (a potassium level greater than 5 mEq/L) isn't caused by bone cancer and is seldom associated with chemotherapy. Hyponatremia (a sodium level less than 135 mEq/L) and hypomagnesemia (a magnesium level less than 1.3 mg/dl) are potential adverse effects of chemotherapy; these electrolyte disturbances don't result directly from bone cancer.
A client suffered a significant ankle fracture several months ago. Which indicator would the nurse use to determine that the client is exhibiting signs and symptoms of chronic osteomyelitis? Persistent draining sinus High fever Rapid pulse Tenderness over the affected area
A Persistent draining sinus indicates a chronic infection in a client with osteomyelitis. This is the symptom the nurse would use to differentiate between an acute and chronic infection. High fever, rapid pulse, and tenderness or pain over the affected area is evidence of an acute infection.
A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? Use the large muscles of the leg when lifting items. Sleep on the stomach to alleviate pressure on the back. A soft mattress is most supportive by conforming to the body. Avoid twisting and flexion activities.
A The large muscles of the leg should be used when lifting.
Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? Risk for constipation related to immobility Deficient knowledge about osteoporosis and the treatment regimen Risk for injury related to fractures due to osteoporosis Acute pain related to fracture and muscle spasm
C The most important concern for an elderly patient with osteoporosis is prevention of falls and fractures. Pain and constipation can be managed, and knowledge can be reinforced, but fractures can cause significant morbidity and mortality.
The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? Reports decreased joint pain Shows increased joint flexibility Reports ability to perform ADLs Has a weight gain of 5 pounds
D Obesity is a risk factor for osteoarthritis. Excess weight is a stressor on the weight-bearing joints. Weight reduction is often a part of the therapeutic regimen.
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? Osteomalacia Osteoporosis Osteomyelitis Osteitis deformans
D Osteitis deformans (Paget disease) results in bone that is highly vascularized and structurally weak, predisposing to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from the extension of a soft-tissue infection, direct bone contamination, or hematogenous spread.
The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize? Latissimus dorsi Rectus abdominis Gastrocnemius Quadriceps
D The nurse instructs the patient in the safe and correct way to lift objects using the strong quadriceps muscles of the thighs, with minimal use of weak back muscles (Fig. 42-3).
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? Ensure adequate intake of vitamin D in the diet Assess for the use of corticosteroids Encourage the client to get yearly dental exams Have the client sit upright for at least 30 minutes following administration
D While all interventions are appropriate, the highest priority is having the client sit upright for 60 minutes following administration of the medication. This will prevent irritation and potential ulceration of the esophagus. The client should have adequate intake of vitamin D and obtain yearly dental exams. The concurrent use of corticosteroids and alendronate is link to a complication of osteonecrosis.
Dupuytren's contracture causes flexion of which area(s)? Fourth and fifth fingers Index and middle fingers Thumb Ring finger
A Dupuytren's contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.
A nurse is teaching a client with osteoporosis about dietary selections. What client statement indicates the teaching was effective? "I will eat more dairy products to increase my calcium intake." "I will decrease my intake of red meat." "I will eat more fruits to increase my potassium intake." "I will decrease my intake of popcorn, nuts, and seeds."
A Osteoporosis causes a severe, general reduction in skeletal bone mass. To offset this reduction, the nurse should advise the client to increase calcium intake by consuming more dairy products for improved calcium intake. Decreasing red meat will help with increased cholesterol and triglycerides. Clients with osteoporosis do not need to decrease popcorn, nuts or seeds. The client will osteoporosis does not need more potassium.
The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which nursing diagnosis is appropriate for the client? Select all that apply. Acute pain Disturbed body image Imbalanced nutrition: less than body requirements Risk for injury Ineffective airway clearance
A, B, C In this situation, the client's jaw is the site of infection. Pain in this location can interfere with nutritional intake of the individual. Chronic osteomyelitis presents with a nonhealing ulcer over the infected bone with a connecting sinus that will intermittently and spontaneously drain pus. A draining ulcer on the face can make the individual very self-conscious about appearance, leading to disturbed body image. This client is not at risk for injury or ineffective airway clearance.
A patient is diagnosed with osteomyelitis of the right leg. What signs and symptoms does the nurse recognize that are associated with this diagnosis? (Select all that apply.) Fever Leukopenia Pain Erythema Purulent drainage
A, C, D When the infection is bloodborne, the onset is usually sudden, occurring often with the clinical and laboratory manifestations of sepsis (e.g., chills, high fever, rapid pulse, general malaise). The systemic symptoms at first may overshadow the local signs. As the infection extends through the cortex of the bone, it involves the periosteum and the soft tissues. The infected area becomes painful, swollen, and extremely tender. The patient may describe a constant, pulsating pain that intensifies with movement as a result of the pressure of the collecting purulent material (i.e., pus). When osteomyelitis occurs from spread of adjacent infection or from direct contamination, there are no manifestations of sepsis. The area is swollen, warm, painful, and tender to touch.
Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? Skull narrowing Long bone bowing Lordosis Upright gait
B Some clients with Paget's disease are asymptomatic with only some mild skeletal deformity. Other clients have marked skeletal deformities which may include enlargement of the skull, bowing of the long bones, and kyphosis.
A client comes back to the clinic with a continued complaint of back pain. What time frame does the nurse understand constitutes "chronic pain"? 1 year 3 months 4 weeks 6 months
B The typical client reports either acute back pain (lasting fewer than 3 months) or chronic back pain (3 months or longer without improvement) and fatigue.
What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? Bone spurs Increased heel pain Decreased height Diarrhea
C Clients with osteoporosis become shorter over time.
A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true? A ganglion is a precursor to a primary bone tumor. Surgical excision is the treatment of choice for a ganglion. Dorsiflexion exacerbates signs and symptoms of a ganglion. A ganglion is the most common benign soft-tissue mass in the foot.
C Dorsiflexion exacerbates signs and symptoms of a ganglion. A ganglion is the most common benign soft-tissue mass in the hand, not foot. It isn't a known precursor to a primary bone tumor. To treat a ganglion, the physician aspirates the ganglion, then injects a corticosteroid into the joint; the physician may also order nonsteroidal anti-inflammatory agents. Surgical excision is necessary only if signs and symptoms persist and the client's range of motion is impaired
The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do? Wear properly fitting shoes. Do active range of motion on the toes. Have surgery to fix them. Bind the toes so that they will straighten.
A Hammer toe is a flexion deformity of the PIP joint and may involve several toes and may result from wearing poorly fitting shoes. They will not straighten by binding the toes or doing active range of motion exercises. Surgery is an option but should be discussed with an orthopedic surgeon or podiatrist.
During a routine physical examination of a client, the nurse observes a flexion deformity of the proximal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding? Hammer toe Mallet toe Hallux valgus Bunion
A Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.
A client with diabetes punctured the foot with a sharp object. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? At least 4 weeks 6 months 7 to 10 days 3 months
A Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for at least 4 weeks, followed by another 2 weeks (or more) of IV antibiotics or oral antibiotics.
When teaching a client how to prevent low back pain as a result of lifting, the nurse should instruct the client to: avoid overreaching. place the load away from the body. use a narrow base of support. bend the knees and loosen the abdominal muscles.
A Instructions for the client with low back pain should include that, when lifting, the client should avoid overreaching. The client should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back.
The nurse is educating a client with low back pain on proper lifting techniques. The nurse recognizes that the education was effective when the client places the load close to the body. reaches over the head with the arms fully extended. uses a narrow base of support. bends at the hips and tightens the abdominal muscles.
A Instructions for the client with low back pain should include that, when lifting, the client should avoid overreaching. The client should also keep the load close to the body, bend the knees, and tighten the abdominal muscles; use a wide base of support; and use a back brace to protect the back. Bending at the hips increases the strain on the back muscles when lifting.
When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location? Distal femur around the knee Wrist-hand junction Proximal humerus Femur-hip area
A Malignant bone tumors usually are located around the knee in the distal femur or proximal fibula; a few are found in the proximal humerus. The wrist-hand junction and femur-hip area are not common sites.
Morton neuroma is exhibited by which clinical manifestation? Swelling of the third (lateral) branch of the median plantar nerve High arm and a fixed equinus deformity Inflammation of the foot-supporting fascia Diminishment of the longitudinal arch of the foot
A Morton neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.
A client comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the health care provider orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the client about? Duloxetine Gabapentin Amitriptyline Cyclobenzaprine
A Nonprescription analgesics such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) and short-term prescription muscle relaxants (e.g., cyclobenzaprine [Flexeril]) are effective in relieving acute low back pain. Tricyclic antidepressants (e.g., amitriptyline [Elavil) and the newer dual-action serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine [Cymbalta]) (Karp et al., 2010) or atypical seizure medications (e.g., gabapentin [Neurontin], which is prescribed for pain from radiculopathy) are used effectively in chronic low back pain
Which of the following is the most common and most fatal primary malignant bone tumor? Osteogenic sarcoma (osteosarcoma) Rhabdomyoma Osteochondroma Enchondroma
A Osteogenic sarcoma (osteosarcoma) is the most common and most often fatal primary malignant bone tumor. Benign primary neoplasms of the musculoskeletal system include osteochondroma, enchondroma, and rhabdomyoma.
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? Paget disease Ganglion Osteomyelitis Osteomalacia
A Paget disease results in bone that is highly vascularized and structurally weak, predisposing the client to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. A ganglion is a collection of neurological gelatinous material. Osteomyelitis is an infection of bone that comes from the extension of a soft-tissue infection, direct bone contamination, or hematogenous spread.
Which of the following presents with an onset of heel pain with the first steps of the morning? Plantar fasciitis Hallux valgus Morton's neuroma Ganglion
A Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heal pain experienced with the first steps in the morning. Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.
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. To prevent fractures, the client should avoid strenuous exercise. Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss.
A Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.
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." "I will bend at the waist when I am lifting objects from the floor." "Instead of turning around to grasp an object, I will twist at the waist." "I will lie prone with my legs slightly elevated."
A The nurse encourages the patient to alternate lying, sitting, and walking activities frequently, and advises the patient to avoid sitting, standing, or walking for long periods.
A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest? Walking Bicycling Yoga Swimming
A Weight-bearing exercises should be incorporated into the client's lifestyle activities. Walking is a low-impact method of weight-bearing exercise and would be the most universal or most likely form of exercise for the nurse to recommend. Bicycling, and swimming are not weight-bearing exercise and will not increase bone density. Yoga may or may not be weight-bearing exercise depending on the yoga poses being performed; it is not as likely as walking to be recommended by the nurse.
Which are true about Lyme disease? Select all that apply. Early stage symptoms may include a red macule or papule at the site of the tick bite, a characteristic bullseye rash with round rings around the center, headache, neck stiffness, pain, fever, chills, malaise, nausea, vomiting, and sore throat. Nephrotic syndromes occur in the later stages. If untreated, the disease moves through three stages. Cardiac and neurologic symptoms occur mid-stage, followed by arthritis and joint problems.
A, C, D If untreated, the disease moves through three stages. Early stage symptoms may include a red macule or papule at the site of the tick bite, a characteristic bullseye rash with round rings around the center, headache, neck stiffness, pain, fever, chills, malaise, nausea, vomiting, and sore throat. Cardiac and neurologic symptoms occur mid-stage, followed by arthritis and joint problems. There is no kidney involvement with Lyme disease.
A client has been admitted to the medical unit for the treatment of Paget disease. When reviewing the medication administration record, the nurse should anticipate what medication? Estrogen Bisphosphonates Calcium gluconate Alkaline phosphatase
B Bisphosphonates are the cornerstone of Paget therapy in that they stabilize the rapid bone turnover. Alkaline phosphatase is a naturally occurring enzyme, not a drug. Calcium gluconate and estrogen are not used in the treatment of Paget disease.
A group of students are reviewing information about osteoporosis in preparation for a class discussion. The students demonstrate a need for additional review when they state which of the following as a risk factor? Excess caffeine intake Hypothyroidism Prolonged immobility Prolonged corticosteroid use
B Factors associated with an increased risk for osteoporosis include: family history of osteoporosis, chronic low calcium intake, excessive intake of caffeine, tobacco use, Cushing's syndrome, prolonged use of high doses of corticosteroids, prolonged periods of immobility, hyperthyroidism, hyperparathyroidism, eating disorders, malabsorption syndromes, breast cancer (especially if treated with chemotherapy that suppresses estrogen, excluding Tamoxifen, which may reduce the risk of fractures), renal or liver failure, alcoholism, lactose intolerance, and dietary deficiency of vitamin D and calcium.
The nurse is educating a client on home care following removal of a ganglion cyst from the right wrist. Which statement by the client demonstrates that the nurse's teaching has been effective? "I will notify my doctor if I develop redness and purulent drainage for 2 days." "I will leave the dressing on until I follow up with my doctor as scheduled." "If my pain is not relieved I will use a heat pack and take some more medication." "If my hand becomes numb and cool I will elevate it above my heart."
B The first dressing is changed by the surgeon at a scheduled follow-up appointment. If the hand becomes cool and numb, the client needs to call the surgeon as soon as possible. The surgeon should be notified immediately if redness and purulent drainage develop. Medication should only be used as prescribed. The use of heat may increase swelling, which may increase pain.
A client is evaluated for a diagnosis of Paget's disease. Which laboratory value would the nurse find to confirm the diagnosis? Urinary creatinine of 0.95 mg/dL (83.98 mmol/L) Alkaline phosphate of 165 IU/L (2750 mmol/L) Calcium of 9.2 mg/dL (2.3 mmol/L) Magnesium level of 2 mg/dL (0.82 mmol/L)
B The normal range for alkaline phosphate level is 20 to 140 IU/L. An elevated serum concentration of alkaline phosphate reflects increased osteoblastic activity and is seen in clients with Paget's disease. A calcium level of 9.2 (2.3 mmol/L) is normal. A urinary creatinine level of 0.95 mg/dL (83.98 mmol/L) is normal. A magnesium level of 2 mg/dL (0.82 mmol/L) is normal.
A client with a musculoskeletal injury is instructed to alter the diet. The objective of altering the diet is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which food item should the nurse encourage the client to include in the diet? Bananas Vitamin D-fortified milk Green vegetables Red meat
B The nurse should advise the client to include dietary sources of vitamin D, such as fatty fish, vitamin D-fortified milk, and cereals. These foods protect against bone loss and decrease the risk of fracture by facilitating the absorption of calcium from food and supplements. Red meat, bananas, and green vegetables do not facilitate calcium absorption from food and supplements.
A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and the immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client? The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor. The nurse is caring for this client on the intensive care unit. The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor. The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit.
B This client is critically ill; the diagnosis and immunosuppression place the client at a high risk for infection. The most appropriate place for this client is in an intensive care unit, where the nurse can focus exclusively on health promotion. This client shouldn't be on the oncology floor. This client requires close monitoring. The nurse caring for this client shouldn't also be caring for other clients who may require frequent interventions.
The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as? Bunion Clawfoot Corn Hammer Toe
C A corn is an area of hyperkeratosis (overgrowth of a horny layer of epidermis) produced by internal pressure (the underlying bone is prominent because of a congenital or acquired abnormality, commonly arthritis) or external pressure (ill-fitting shoes). The fifth toe is most frequently involved, but any toe may be involved.
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? Denosumab Teriparatide Alendronate Raloxifene
C Alendronate is a bisphosphonate medication. Raloxifene is a selective estrogen receptor modulator. Teriparatide is an anabolic agent, and denosumab is a monoclonal antibody agent.
A client is informed of having a benign bone tumor but that this type of tumor that may become malignant. The nurse knows that this is characteristic of which type of tumor? Osteochondroma Enchondroma Osteoclastoma Osteoid osteoma
C An osteoclastoma is a giant cell tumor that may invade local tissue; usually soft and hemorrhagic and may become malignant. An osteochondroma occurs as a large projection of bone at the ends of long bones, developing during growth periods and then becoming static bone mass. An enchondroma is a hyaline cartilage tumor that develops in the hand, ribs, femur, tibia, humerus, or pelvis. An osteoid osteoma is a painful tumor surrounded by reactive bone tissue.
A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder? Bupivacaine Dexamethasone Chlorpheniramine Dicloxacillin
C Antihistamines such as chlorpheniramine are frequently prescribed when an allergy is a factor in causing a skin disorder. Antihistamines relieve itching and shorten the duration of allergic reaction. Corticosteroids such as dexamethasone are used to relieve inflammatory or allergic symptoms. Antibiotics such as dicloxacillin are used to treat infectious disorders. Local anesthetics such as bupivacaine are used to relieve minor skin pain and itching.
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? Open reduction Needle aspiration Arthroscopy Arthroplasty
C Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made.
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)? Vitamin D Teriparatide Calcitonin Raloxifene
C Calcitonin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Raloxifene reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Teriparatide has been recently approved by the FDA for the treatment of osteoporosis. Vitamin D increases the absorption of calcium.
The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as Hammertoe Pes cavus Hallux valgus Flatfoot
C Hallux valgus is commonly referred to as a bunion. Hammertoes are usually pulled upward. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. The client with flatfoot demonstrates a diminished longitudinal arch of the foot.
A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate? "You will need to decrease the amount of dairy products you consume." "You will need to avoid foods high in phosphorus and vitamin D." "You may need to be evaluated for an underlying cause, such as renal failure." "You will need to engage in vigorous exercise three times a week for 30 minutes."
C The client may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The client needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The client is at risk for pathological fractures and therefore should not engage in vigorous exercise.
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? "The posture begins to stoop after middle age." "After age 40, height may show a gradual decrease as a result of spinal compression" "After menopause, the body's bone density declines, resulting in a gradual loss of height." "There may be some slight discrepancy between the measuring tools used."
C The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question.
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD? Vitamin D Raloxifene (Evista) Teriparatide (Forteo) Calcitonin (Miacalcin)
D Calcitonin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Raloxifene reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Teriparatide has been recently approved by the FDA for the treatment of osteoporosis.
A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about a calcium supplement should the nurse include? Take weekly on the same day and at the same time. Remain in an upright position 30 minutes after taking the supplement. Take the supplement on an empty stomach with a full glass of water. Take the supplement with meals or with orange juice.
D Calcium supplements should be taken with meals or with a beverage high in vitamin C for increased absorption. Calcium supplements are taken daily, not weekly. There are no special instructions about staying upright when taking calcium supplements.
Which should be included in the teaching plan for a client diagnosed with plantar fasciitis? Plantar fasciitis presents as an acute onset of pain localized to the ball of the foot. The pain of plantar fasciitis diminishes with soaking the foot in warm water. Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion. Management of plantar fasciitis includes stretching exercises.
D Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (e.g., heel cups, arch supports), and using nonsteroidal anti-inflammatory drugs. Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced upon taking the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs.
Which is a risk-lowering strategy for osteoporosis? Increased age Low initial bone mass Diet low in calcium and vitamin D Smoking cessation
D Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D.
A nurse notices a client lying on the floor at the bottom of the stairs. The client is alert and oriented and denies pain other than in the arm, which is swollen and appears deformed. After calling for help, what should the nurse do? Place the client in a sitting position. Help the client walk to the nearest nurses' station. Raise the client's arm above the heart. Immobilize the client's arm.
D Signs of a fracture in an extremity include pain, deformity, swelling, discoloration, and loss of function. When a nurse suspects a fracture, the extremity should be immobilized before moving the body part. It isn't appropriate for the nurse to move the client into a sitting position without further assessment. The client shouldn't walk to the nurses' station; the client should wait for help to arrive.
Hypercalcemia is a dangerous complication of bone cancer. Therefore, nursing assessment includes evaluation of symptoms that require immediate treatment. Which of the following are signs/symptoms that are indictors of an elevated serum calcium? Select all that apply. a. Muscle weakness b. Anorexia and constipation c. Tachycardia d. Shortened QT interval e. Prolonged ST segment f. Lack of muscle coordination
A, B, D, F Hypercalcemia is a dangerous complication of bone cancer. The symptoms must be recognized and treatment initiated promptly. Symptoms include muscular weakness, incoordination, anorexia, nausea and vomiting, constipation, electrocardiographic changes (e.g., shortened QT interval and ST segment, bradycardia, heart blocks), and altered mental states (e.g., confusion, lethargy, psychotic behavior).
A healthcare provider asks a nurse to test a client for Tinel's sign to diagnose carpal tunnel syndrome. What should the nurse do to perform this assessment? Have the client pronate the hand while the nurse palpates the radial nerve. Have the client hold the palm of the hand up while the nurse percusses over the median nerve. Have the client stretch the fingers around a ball and squeeze with force. Have the client make a fist and open the hand against resistance.
B If tingling, numbness, or pain is felt when the median nerve is percussed, then Tinel's sign is considered positive. To test for Tinel's sign have the client hold the palm of the hand up while the nurse percusses over the median nerve. The client making a fist and pushing will test strength resistance. The client stretching fingers around a ball will not test for Tinel's sign. Having the client pronate the hand and palpating the radial nerve is not Tinel's sign used for carpal tunnel syndrome diagnosis.
Which group is at the greatest risk for osteoporosis? Asian American women Men European American women African American women
C Small-framed, nonobese European American women are at greatest risk for osteoporosis. Asian American women of slight build are at risk for low peak bone mineral density. African American women, who have a greater bone mass than European American women and Asian American Women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.
Primary prevention of osteoporosis includes: using a professional alert system in the home in case a client falls when she's alone. placing items within the client's reach. installing grab bars in the bathroom to prevent falls. optimal calcium intake and estrogen replacement therapy.
D Primary prevention of osteoporosis includes maintaining optimal calcium intake and using estrogen replacement therapy. Placing items within a client's reach, using a professional alert system in the home, and installing grab bars in bathrooms to prevent falls are secondary and tertiary prevention methods
A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks? L2, L3, and L5 L1, L2, and L4 C3, C4, and L1 L4, L5, and S1
D The lower lumbar disks, L4-L5 and L5-S1, are subject to the greatest mechanical stress and the greatest degenerative changes. Disk protrusion (herniated nucleus pulposus) or facet joint changes can cause pressure on nerve roots as they leave the spinal canal, which results in pain that radiates along the nerve.
When an infection is bloodborne, the manifestations include which symptom? Hypothermia Bradycardia Hyperactivity Chills
D Manifestations of bloodborne infection include chills, high fever, rapid pulse, and generalized malaise.
What food can the nurse suggest to the client at risk for osteoporosis? Bananas Chicken Broccoli Carrots
C Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium.
Which of the following is the first-line medication that would be used to treat and prevent osteoporosis? Bisphosphonates Anabolic agents Selective estrogen receptor modulators Calcitonin
A Bisphosphonates, along with calcium and vitamin D supplements, are the first-line medications given to prevent/treat osteoporosis. The other medications are prescribed after these drugs are used.
A client has low back pain and the healthcare provider needs to rule out the presence of a tumor. Which diagnostic procedure would the nurse anticipate to be ordered for the client? Bone scan Computed tomography Magnetic resonance imaging Electromyogram
A A bone scan is the preferred diagnostic procedure to disclose tumors in a patient with low back pain. A computerized tomography will identify soft tissue lesions and vertebral disc problems. Magnetic resonance imaging permits visualization of the nature and location of spinal pathology. An electromyogram is used to evaluate nerve root disorders.
What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? Decreased height Bone spurs Diarrhea Increased heel pain
A Clients with osteoporosis become shorter over time.
A client is recovering from surgery to correct a clawfoot. Which actions will the nurse take when caring for this client? Select all that apply. Inspect surgical site for redness. Elevate the foot on several pillows. Teach full weight-bearing exercises. Apply ice to the area for the first 24 to 48 hours. Instruct on the use of an assistive device to walk.
A, B, D, E When caring for a client recovering from foot surgery, the client should receive oral analgesics as prescribed. The foot should be elevated on pillows to reduce edema. Ice should be applied to the area for the first 24 to 48 hours. The client should be instructed on the use of an assistive device to safely ambulate. Weight bearing will be limited according to the type and extent of surgery. Weight bearing will not be as tolerated.
Which of the following are routes of administration for Calcitonin? Select all that apply. Subcutaneous Oral Intramuscular injection Intravenous Nasal spray
A, C, E Calcitonin is administered by nasal spray or by subcutaneous or intramuscular injections.
A client has Paget's disease. An appropriate nursing diagnosis for this client is: Fatigue Delayed wound healing Risk for infection Risk for falls
D The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility.
The health care team caring for a client has determined that their osteoporosis is caused by malabsorption. What is the usual treatment for osteoporosis caused by malabsorption? Exogenous parathyroid hormone and multivitamins Supplemental calcium and increased doses of vitamin D Supplemental potassium and pancreatic enzymes Colony-stimulating factors and calcitonin
B If osteoporosis is caused by malabsorption, increased doses of vitamin D, along with supplemental calcium, are usually prescribed.
A nurse is performing foot care for a client with chronic osteomyelitis and the client asks the nurse about the next treatment. What is the specific treatment for a client with chronic osteomyelitis? Drainage of localized foci of infection Surgical removal of the sequestrum Continued aseptic wound treatment Aggressive physical therapy
B A sequestrectomy, removal of enough involucrum to enable the surgeon to remove the sequestrum, is performed on clients with chronic osteomyelitis. In many cases, sufficient bone is removed to convert a deep cavity into a shallow saucer (saucerization). All dead, infected bone and cartilage must be removed before permanent healing can occur. Aggressive physical therapy is not recommended until healing has occurred. Draining the infection is not sufficient to heal chronic osteomyelitis. Continued wound care is not sufficient to heal the wound.
A client is diagnosed with carpal tunnel syndrome. Which of the following assessment findings would the nurse expect? Tenderness in the affected wrist Inability to flex index and middle fingers A decrease in grasp strength Pain radiating down the dorsal surface of the forearm
B Clients with carpal tunnel syndrome describe pain or burning in one or both hands, which may radiate to the forearm and shoulder in severe cases. The pain tends to be more prominent at night and early in the morning. Shaking the hands may reduce the pain by promoting movement of edematous fluid from the carpal canal. Sensation may be lost or reduced in the thumb, index, middle, and a portion of the ring finger. The client may be unable to flex the index and middle fingers to make a fist. Flexion of the wrist usually causes immediate pain and numbness. In epicondylitis, clients report pain radiating down the dorsal surface of the forearm and a weak grasp. Clients with ganglion cysts experience pain and tenderness in the affected area.
In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? Vitamin supplements Surgical debridement Wound packing Wound irrigation
B In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.
Health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. Select the daily dosage of calcium and vitamin D that the nurse should recommend. 1,600 mg; 1,400 IU 1,400 mg; 1,200 IU 1,800 mg; 1,600 IU 1,200 mg; 1,000 IU
D The daily recommended dosage is 1,200 mg of calcium and 1,000 IU of vitamin D.
A client with Paget's disease comes to the hospital and reports difficulty urinating. The emergency department health care provider consults urology. What should the nurse suspect is the most likely cause of the client's urination problem? Dehydration Benign prostatic hyperplasia Renal calculi Urinary tract infection (UTI)
C Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A UTI commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination.
The nurse is caring for a client with low back pain. Which education about body mechanics will the nurse provide the client? Select all that apply. Push objects Avoid twisting the spine Lift with the leg muscles Bend at the waist to lift objects Flex forward to reach for objects
A, B, C Body mechanics teaching to prevent low back pain includes instructing the client to push items and not pull them, avoid twisting the spine, and to lift with the leg muscles. Squatting should be done to lift objects, not bending at the waist. The forward flexion position to reach for objects should be avoided.
The nurse is educating a group of women on the prevention of osteoporosis. The nurse recognizes the education as being effective when the group members make which statement? "Estrogen deficiency increases bone density." "We need an adequate amount of exposure to sunshine." "We need to increase aerobic exercise." "We need to consume a low-calcium, high-phosphorus diet."
B The only accurate statement is related to getting an adequate amount of exposure to sunshine. Aerobic exercise, such as swimming, does not prevent osteoporosis. The exercise needs to be weight bearing. A diet low in calcium and high in phosphorus will increase the risk for osteoporosis. Estrogen deficiency is linked to decreased bone mass.
Which of the following inhibits bone resorption and promotes bone formation? Corticosteroids Estrogen Calcitonin Parathyroid hormone
C Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis.
To help minimize calcium loss from a hospitalized client's bones, the nurse should: provide the client dairy products at frequent intervals. provide supplemental feedings between meals. encourage the client to walk in the hall. reposition the client every 2 hours.
C Calcium absorption diminishes with reduced physical activity because of decreased bone stimulation. Therefore, encouraging the client to increase physical activity, such as by walking in the hall, helps minimize calcium loss. Turning or repositioning the client every 2 hours wouldn't increase activity sufficiently to minimize bone loss. Providing dairy products and supplemental feedings wouldn't lessen calcium loss — even if the dairy products and feedings contained extra calcium — because the additional calcium doesn't increase bone stimulation or osteoblast activity.
A client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings? Compartment syndrome Avascular necrosis Osteomyelitis Fat embolism
C Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. A client with avascular necrosis does not have fever and chills. Clients with fat emboli will have a rash and breathing complications. A client with compartment syndrome will have numbness, not a fever.
The nurse recognizes that goal of treatment for metastatic bone cancer is to: Diagnose the extent of bone damage Promote pain relief and quality of life Cure the diseased bone and cartilage Reconstruct the bone with a prosthesis
B Treatment of metastatic bone cancer is palliative.
The nurse is assessing a client who states, "I think I have bursitis in my shoulder." What assessment finding(s) would the nurse expect to find in a client with bursitis? Select all that apply. Bouchard nodes an affected area that is warm to the touch painful movement of a joint hyperuricemia a distinct lump
B, C, E Painful movement of a joint and a distinct lump are two of the findings consistent with bursitis. Bouchard nodes are bony enlargements of the distal interphalangeal joints and are seen with osteoarthritis. Hyperuricemia is found with gout. The affected area may be warm, not cool, to the touch in the case of a ruptured bursa.
A nurse is caring for a client with bone metastasis from a primary breast cancer. The client reports muscle weakness and nausea and is voiding large amounts frequently. The telemetry monitor is observed showing premature ventricular contractions. What should the nurse suspect based on the clinical manifestations? Hypokalemia Hyperkalemia Hypocalcemia Hypercalcemia
D Hypercalcemia is present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias such a premature ventricular contractions, seizures, and coma. Hypercalcemia must be identified and treated promptly. Hypocalcemia will not be seen with bone cancer. Hypokalemia and hyperkalemia are not common with bone metastasis.
A physician prescribes raloxifene to a hospitalized client. The client's history includes a right hip fracture, hysterectomy, deep vein thrombosis, and hypertension. Which action by the nurse demonstrates safe nursing care? Administering the raloxifene in the evening Having the patient sit upright for 30-60 minutes following administration Administering the raloxifene with food or milk Holding the raloxifene and notifying the physician
D Raloxifene is contraindicated in clients with a history of deep vein thrombosis. The nurse should hold the medication and notify the physician. Raloxifene can be given without regard to food or time of day. Raloxifene is a selective estrogen receptor modulation medication. Sitting upright for 30-60 minutes is indicated with drugs classified as bisphosphonates.
A nurse is caring for a client following removal of a Morton's neuroma. Which nursing intervention would be most appropriate? Assist the client with incentive spirometry. Assess the surgical dressing. Assist with passive range of motion exercises Perform neurovascular assessment of the hand.
B Morton's neuroma is a foot problem characterized by swelling of the median plantar nerve. The nurse will need to assess the surgical dressing. Assisting with incentive spirometry is not the most important intervention. Range of motion exercises should be active, not passive. A hand assessment is not needed with neuroma removal from the foot.
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? Prone, with a pillow under the shoulders Supine, with the bed flat and a firm mattress in place High-Fowler's to allow for maximum hip flexion Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees
D A medium to firm, not sagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress (National Guideline Clearinghouse, 2010). Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head (Fig. 42-1). A prone position should be avoided because it accentuates lordosis.
An older woman's X-rays reveal a diagnosis of osteoporosis. The nurse advises the woman that the radiolucency seen in the bones indicates a minimal level of demineralization of which percentage? 25% 10% 15% 20%
A Demineralization seen on X-rays occurs when bone loss of 25% to 40% occurs.
What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? Dupuytren contracture Hallux valgus Callus Hammertoe
A Dupuytren disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally.
A client with carpal tunnel syndrome has had limited improvement with the use of a wrist splint. The nurse knows that which procedure will show the greatest improvement in treatment for this client? Injection of lidocaine Open nerve release Ultrasound therapy Laser therapy
B Evidence-based treatment of acute carpal tunnel syndrome includes the application of splints to prevent hyperextension and prolonged flexion of the wrist. Should this treatment fail, open nerve release is a common surgical management option. A variety of treatments may be tried by the client, however, they may fail to improve the condition. These treatments include laser therapy, ultrasound therapy, and the injection of substances such as lidocaine. Though these can be used, surgery to release nerves is the best option.
The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients? Inadequate nutrition Impaired physical mobility Risk for infection Disturbed body image
D Amputation of a body part can result in disturbances in body image.
A client is scheduled for surgery to fuse a joint. The nurse identifies this as which of the following? Arthroplasty Open reduction internal fixation Osteotomy Arthrodesis
D An arthrodesis is a surgical procedure to fuse a joint. An osteotomy involves cutting and removing a wedge of the bone to change alignment. An arthroplasty is a total reconstruction or replacement of a joint with an artificial joint. Open reduction internal fixation is accomplished with wire, nails, plate and/or an intramedullary rod to hold bone fragments in place until healing is complete.
A high school student who was injured in a football game presents with knee pain with internal rotation of the foot. Which interventions are appropriate nursing actions? Select all that apply. Administer morphine sulfate. Apply ice packs to the affected knee. Apply a knee brace or wrap the affected knee. Elevate the affected leg. Assist the client to "walk off" the pain.
B, C, D The client has a torn lateral meniscus. Priority interventions include rest, ice, compression, and elevation of the affected extremity and the administration of NSAIDs -- not morphine -- for pain. The client should not walk on the injured knee.
An older adult client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate? Promoting range-of-motion (ROM) exercises Maintaining protein levels Promoting weight-bearing exercises Maintaining vitamin levels
C Explanation: When the mechanical stressors of weight bearing are absent, disuse osteoporosis can occur. Therefore, if the client does weight-bearing exercises, disuse complications can be prevented. Maintaining protein and vitamins levels is important, but neither will prevent osteoporosis. ROM exercises will help prevent muscle atrophy and contractures.
Which condition is a metabolic bone disease characterized by inadequate mineralization of bone? Osteoporosis Osteomyelitis Osteomalacia Osteoarthritis
C Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from extension of soft-tissue infection, direct bone contamination, or hematogenous spread. Osteoarthritis (OA), also known as degenerative joint disease, is the most common and frequently disabling of the joint disorders. OA affects the articular cartilage, subchondral bone, and synovium.
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? "Using arm splints will prevent hyperflexion of the wrist." "This condition is associated with various sports." "Surgery is the only sure way to manage this condition." "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
D Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints.
A nurse is performing discharge teaching for an elderly client diagnosed with osteoporosis. Which statement about home safety should the nurse include? "Most accidental injuries among the elderly are automobile-related. Elderly clients should have vision testing every 6 months while they're still driving." "Most falls among the elderly occur outside the home. Clients should confine themselves to their homes as much as practical." "Because of the increase in home burglaries involving the elderly, these clients should have burglar bars on every window in the home." "Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars."
D Falls in the home cause most injuries among the elderly. Elderly clients should take measures to decrease the clutter that can contribute to falls, such as removing objects such as throw rugs from the floor. Elderly clients should also install grab bars in the shower and next to the toilet. The threat of fire makes burglar bars on every window impractical.
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? Taking a 300-mg calcium supplement to meet dietary guidelines Stopping estrogen therapy Living a sedentary lifestyle to reduce the incidence of injury Initiating weight-bearing exercise routines
D Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.
