Care of Patients with Musculoskeletal Problems
Which instruction does the nurse include in the discharge teaching plan of a client who has osteoporosis?
"Avoid using scatter rugs."
Which instruction is most important for the RN to provide to the nursing assistant assigned to care for a client with primary osteoporosis?
"Clean up clutter in the room."
What information does the nurse teach a women's group about osteoporosis?
"For 5 years after menopause you lose 2% of bone mass yearly."
The nurse has educated a client on Paget's disease. Which statement by the client indicates good understanding of causative factors?
"I may have a genetic predisposition."
A client is prescribed alendronate (Fosamax). WHich statement indicates that the client understands teaching about this drug?
"I should take this drug with a full glass of water."
A client diagnosed with primary bone sarcoma of the leg is scheduled for tumor removal. THe client expresses fear of loss of function. Which is the nurse's best response?
"It is normal to feel this way."
A client has been prescribed denosumab (Prolia). What instruction about this drug is most appropriate?
"Make appointments to come and get your shot."
The mother of a 16-year-old client diagnosed with Ewing's sarcoma expresses concern that her son seems to be angry at everyone in the family. How does the nurse respond?
"This is a normal stage in the grieving process."
A female client who is a carrier of the gene for Duchenne's muscular dystrophy asks whether any of her daughters will have this disease. Which is the nurse's best response?
"Your daughter cannot get the disease?"
A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What explanation by the nurse is best?
"Your feet have less blood flow, so healing is slower."
An adult client's susceptibility to osteoporosis is caused by which aspect of his or her history?
Active smoking
A client with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this client and family?
Adherence to the antibiotic regimen Eating high-protein and high-carbohydrate foods Proper use of the intravenous equipment
A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components?
Alcohol Caffeine Carbonated beverages Vitamin D
A client with Paget's disease is hospitalized for an unrelated issue. The client reports pain and it is not yet time for more medication. What comfort measures can the nurse delegate to the unlicensed assistive personnel (UAP)?
Applying a heating pad Providing a massage
A client with osteoporosis is going home, where the client lives alone. What action by the nurse is best?
Arrange a home safety evaluation
A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client admits to not doing the prescribed exercises. What action by the nurse is best?
Ask the client about fear or falling
When providing care for a client who has had a debridement for osteomyelitis, which intervention is most important for the nurse to implement?
Assess circulation in the distal extremities
A client is in the internal medicine clinic reporting bone pain. The client's alkaline phosphatase level in 180 units/L/ What action by the nurse is most appropriate?
Assess the client for leg bowing
A client has scoliosis with a 65-degree curve to the spine. What action by the nurse takes priority?
Assess the client's cardiac and respiratory systems
A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the client's psychosocial needs?
Assess the client's coping skills and support systems
A client is admitted with a bone tumor. The nurse finds the client weak and lethargic with decreased deep tendon reflexes. What actions by the nurse are best?
Assess the daily serum calcium level Consult the provider about a loop diuretic Instruct the client to call for help out of bed
The nurse studying osteoporosis learns that which drugs can cause this disorder?
Barbiturates Corticosteriods Loop diuretics
The nurse is assessing a client with Paget's disease. Which assessment finding leads the nurse to notify the health care provider immediately?
Base of the skull is enlarged with changes in vital signs
Two hours after limb surgery for a client with left leg bone sarcoma, the nurse notes that the toes of the left foot are more edematous, are cooler to the touch, and have a slower capillary refill. Which action does the nurse first take?
Check the splint for proper placement
The nurse is performing a medical history and physical assessment for a client. Which assessment findings lead the nurse to conclude that the client is at risk for development of osteoporosis?
Client is a white woman with a body mass index (BMI) of 19.4 Client fractured her wrist badly in a fall last year Client drinks at least four cans of diet cola every day Client has smoked two packs of cigarettes a day for 40 years
A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first?
Client taking raloxifene (Evista) who reports unilateral calf swelling
Which client does the nurse assess more carefully for risk for developing primary osteoporosis?
Client who drinks 6 cups of coffee daily
The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option?
Client with a spinal cord injury who cannot tolerate sitting up
A nurse is assessing an older client and discovers back pain with tenderness along T2 and T3. What action by the nurse is best?
Consult with the provider about an xray
Which nursing intervention is most effective in preventing transfer of an organism from the wound of a client with osteomyelitis to other clients?
Contact precautions
While caring for a client who has chronic osteomyelitis and wound drainage, which intervention is most important for the nurse to implement?
Cover the wound with a dressing
A client is seen at the clinic with the medical diagnosis of osteomalacia. When taking the client's history, what does the nurse assess for?
Dietary intake of vitamin D
The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease?
Draining sinus tract Presence of foot ulcers
A client is suspected to have muscular dystrophy. About what diagnostic testing does the nurse educate the client?
Electromyography Muscle biopsy Serum aldolase Serum creatinine kinase
A client newly diagnosed with Ewing's sarcoma is most likely to exhibit which laboratory finding?
Elevated alkaline phosphate (ALP)
A client in a nursing home refuses to take medications. She is at high risk for osteomalacia. What action by the nurse is best?
Ensure the client gets 15 minutes of sun exposure daily
A client is scheduled for a bone biopsy. What action by the nurse takes priority?
Ensuring that informed consent is on the chart
The nurse is caring for a client with rheumatoid arthritis. For which condition does the nurse assess most carefully?
Hallux valgus
A client has a metastatic bone tumor. What action by the nurse takes priority?
Handle the affected extremity with caution
A hospitalized client is being treated for for Ewing's sarcoma. What action by the nurse is most important?
Handling and disposing of chemotherapeutic agents per policy
When preparing to care for a client with a family history of Paget's disease, it is most important for the nurse to include education in which area?
Need for genetic testing
A client is admitted with a large draining wound on the leg. What action does the nurse take first?
Obtain cultures of the leg wound
The nurse is caring for a client with a lesion in the area of the tibia that is swollen and tender. Which client problem is the highest priority for nursing care?
Pain management related to physical injury
A client's susceptibility to osteomalacia is related to which risk factor?
Phosphate level of 1.0 mg/dL
An older client with diabetes is admitted with a heavily draining leg wound. The client's white blood cell count is 38,000/mm3 but the client is afebrile. What action does the nurse take first?
Place the client on contact isolation
A client has a bone density score of -2.8. What action by the nurse is best?
Planning to teach about bisphosphonates
A nurse is caring for four clients. After the hand-off report, which client does the nurse see first?
Post-microvascular bone transfer client whose distal leg is cool and pale
A client who has been diagnosed with osteomyelitis is beginning antibiotic therapy. Which information does the nurse include in the client's teaching plan?
Receiving antibiotic treatment at home from the home health nurse
A client has severe Paget's disease. WHich factor has the highest priority when the nurse intervenes in the care of this client?
Relief of pain
A nurse is providing education to a community women's group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover?
Strengthening exercises are important Take recommended calcium and vitamin D Walk 30 minutes at least 3 times a week
Which assessment finding relates most directly to a diagnosis of chronic osteomyelitis?
Ulceration of the skin
The nurse reviews the health history of a client with acute osteomyelitis. Which findings might have contributed to the diagnosis?
Urinary tract infection Hemodialysis Gastrointestinal infection
After the administration of each dose of zoledronic acid (Zometa), it is most important for the nurse to determine which finding?
Urine output
The RN has assigned a client with severe osteoporosis to an LPN. Which information about the care of the client is most important for the the RN to provide the LPN?
Use a lift sheet to reposition the client
Which exercise does the nurse recommend to a client at risk for osteoporosis?
Walking 30 minutes three times weekly
A client has an ingrown toenail. What about self-management measure does the nurse teach the client?
Warm moist soaks
Which client is at highest risk for the development of plantar fasciitis?
Young adult runner
