Ch 41 Brunner
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 Explanation: 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.
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 Explanation: 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 nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan?
Perform neuromuscular assessment every hour. Explanation: The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is important to prevent complications from the surgery. The surgical dressing does not need to be examined hourly. Administering pain medication is important, but assessing the foot color and temperature are most important. Vital sign monitoring is important, but not a priority after foot surgery.
Which of the following presents with an onset of heel pain with the first steps of the morning?
Plantar fasciitis Explanation: 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.
Which term refers to a disease of a nerve root?
Radiculopathy Explanation: 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.
Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women?
Raloxifene Explanation: Raloxifene is the only selective estrogen receptor modulator (SERM) approved for osteoporosis in post menopausal women as it does not increase the risk of breast or uterine cancer, but it does come with an increased risk of thromboembolism. Fosamax is a bisphosphonate. Forteo is a subcutaneously administered medication that is given one daily for the treatment of osteoporosis. Denosumab has recently been approved for treatment of postmenopausal women with osteoporosis who are at risk for fractures.
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?
Raloxifene (Evista) Explanation: 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.
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort?
Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees Explanation: 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.
Morton neuroma is exhibited by which clinical manifestation?
Swelling of the third (lateral) branch of the median plantar nerve Explanation: 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.
The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client? Select all that apply.
The client will experience a tolerable level of pain. The client will demonstrate wound care. The client will maintain adequate nutritional intake. Explanation: Pain is a priority problem for the client with osteomyelitis, and it can interfere with mobility of joint. 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. The client will need to be able to provide wound care in the home setting. Remaining free from injury and maintaining an effective airway clearance are not priority goals for the client.
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 Explanation: 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.
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. Explanation: 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.
To help minimize calcium loss from a hospitalized client's bones, the nurse should:
encourage the client to walk in the hall. Explanation: 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 has come to the clinic with foot pain. The physician has described the client's condition as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder?
hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal joint. Mallet toe is a flexion deformity of the distal interphalangeal joint. Bunion is a deformity of the great toe at its metatarsophalangeal joint. Heberden's nodes are bony enlargements of the distal interphalangeal joints.
Which of the following is the most common and most fatal primary malignant bone tumor?
Osteogenic sarcoma (osteosarcoma) Explanation: 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.
Which is not a risk factor for osteoporosis?
being male Explanation: Being male is not considered a risk factor. Some of the risk factors for osteoporosis are being a small-framed, thin White or Asian woman; being postmenopausal; family history; inactivity; chronic low calcium intake; and excessive caffeine or tobacco use.
A client has Paget's disease. An appropriate nursing diagnosis for this client is:
Risk for falls Explanation: The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility.
What food can the nurse suggest to the client at risk for osteoporosis?
Broccoli Explanation: Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium.
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)?
Calcitonin Explanation: 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.
Which of the following are clinical manifestations of impingement syndrome? Select all that apply.
Pain Shoulder tenderness Limited movement Muscle spasms Atrophy Explanation: The patient experiences pain, shoulder tenderness, limited movement, muscle spasms, and atrophy. The process may progress to a rotator cuff tear.
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?
Initiating weight-bearing exercise routines Explanation: 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.
Dupuytren contracture causes flexion of which area(s)?
Fourth and fifth fingers Explanation: Dupuytren contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.
The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as
Hallux valgus Explanation: 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.
Which of the following are common primary sites of tumors that metastasize to the bone? Select all that apply.
Kidney Prostate Lung Breast Ovary Explanation: The most common primary sites of tumors that metastasize to bone are the kidney, prostate, lung, breast, ovary, and thyroid.
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 2.9mmol/L Explanation: 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 0.53mmol/L) are potential adverse effects of chemotherapy; these electrolyte disturbances don't result directly from bone cancer.
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 hold the palm of the hand up while the nurse percusses over the median nerve. Explanation: 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.
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?
Immobilize the client's arm. Explanation: 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.
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?
Lower lumbar Explanation: The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes.
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?
Renal calculi Explanation: 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.
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?
Bisphosphonates Explanation: 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 nurse is providing care for a client who has a recent diagnosis of Paget disease. When planning this client's nursing care, interventions should address what? Select all that apply.
Impaired physical mobility Acute pain Disturbed auditory sensory perception Risk for injury Explanation: Clients with Paget disease are at risk of decreased mobility, pain, hearing loss, and injuries resulting from decreased bone density. Paget disease does not affect blood glucose levels.
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?
"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Explanation: 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.
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD?
Calcitonin (Miacalcin) Explanation: 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.
Which group is at the greatest risk for osteoporosis?
European American women Explanation: 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.
A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively?
Performing hourly neurovascular assessments for the first 24 hours Explanation: Hourly neurovascular assessment of the exposed fingers for the first 24 hours following surgery is essential for monitoring function of the nerves and perfusion.
A provider asks the nurse to teach a client with low back pain how to sit in order to minimize pressure on the spine. Which teaching points would the nurse include? Select all that apply.
Sit in a straight-backed chair with arm rests. Avoid hip extension. Place feet flat on the floor. Sit with the buttocks "tucked under." Explanation: All choices are correct, except that a soft pillow support is recommended to eradicate the hollow of the back.
A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing?
Surgical debridement Explanation: In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.
A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening?
Temporomandibular disorder Explanation: The disorder can be confused with trigeminal neuralgia and migraine headaches. The client experiences clicking of the jaw when moving the joint, or the jaw can lock, which interferes with opening the mouth. Loose teeth will not cause a clicking of the jaw. The client does not have a dislocated jaw.
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?
Vitamin D-fortified milk Explanation: 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 client diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. What is the best response by the nurse?
"CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." Explanation: Carpal tunnel syndrome is an entrapment neuropathy that occurs when the median nerve at the wrist is compressed by a thickened flexor tendon sheath, skeletal encroachment, edema, or a soft tissue mass.
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." Explanation: 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.
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 leave the dressing on until I follow up with my doctor as scheduled." Explanation: 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 nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate?
"You may need to be evaluated for an underlying cause, such as renal failure." Explanation: 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.
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.
1,200 mg; 1,000 IU Explanation: The daily recommended dosage is 1,200 mg of calcium and 1,000 IU of vitamin D.
Which client would the nurse identify as having the greatest risk for osteoporosis?
A small-framed, thin 45-year-old white woman Explanation: Small-framed, thin white women are at greatest risk for osteoporosis. African American women have a greater bone density and thus are less susceptible to osteoporosis. Men have an increased bone mass and do not have hormonal changes, and do not acquire osteoporosis as frequently and get it at a later age. Asthma does not increase the risk for osteoporosis.
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?
Alkaline phosphatase Explanation: 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 client is scheduled for surgery to fuse a joint. The nurse identifies this as which of the following?
Arthrodesis Explanation: 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 nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder?
Chlorpheniramine Explanation: 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.
What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?
Dupuytren contracture Explanation: 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.
Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?
Dupuytren's contracture Explanation: Dupuytren's disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren's 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 interphangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally.
A client has been prescribed alendronate for the prevention of osteoporosis. Which is the highest priority nursing intervention associated with the administration of the medication?
Have the client sit upright for at least 30 minutes following administration Explanation: 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.
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?
Osteomyelitis Explanation: 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 hospice nurse is assigned to care for a patient with metastatic bone cancer who wants to remain at home. What is the therapeutic goal in the care of this patient?
Relieve pain and discomfort while promoting quality of life. Explanation: The treatment of advanced metastatic bone cancer is palliative. The therapeutic goal is to relieve the patient's pain and discomfort while promoting quality of life.
In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?
Surgical debridement Explanation: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.
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 is caring for this client on the intensive care unit. Explanation: 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.
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. Explanation: 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.
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. Explanation: The large muscles of the leg should be used when lifting.
A nurse is caring for a client who is being assessed following complaints of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? Select all that apply.
Computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasound X-ray Explanation: A variety of diagnostic tests can be used to address lower back pain, including CT, MRI, ultrasound, and x-rays. Angiography is not related to the etiology of back pain.
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?
Corn Explanation: 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 planning an education program for women of childbearing years. What does the nurse recognize as the primary prevention of osteoporosis?
Ensuring adequate calcium and vitamin D intake Explanation: Nutritional intake of calcium and vitamin D are essential for the prevention of osteoporosis.
When an infection is bloodborne, the manifestations include which symptom?
Chills Explanation: Manifestations of bloodborne infection include chills, high fever, rapid pulse, and generalized malaise.
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." Explanation: 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.
During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?
"After menopause, the body's bone density declines, resulting in a gradual loss of height." Explanation: 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 common problem of the upper extremity results from entrapment of the median nerve at the wrist?
Carpal tunnel syndrome Explanation: Carpal tunnel syndrome is commonly due to repetitive hand activities. A ganglion is a collection of gelatinous material near the tendon sheaths and joints that appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. Dupuytren's contracture is a slowly progressive contracture of the palmar fascia. Impingement syndrome is associated with the shoulder and may progress to a rotator cuff tear.
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 Surgical excision Aspiration of the cyst Explanation: 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.
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?
Disturbed body image Explanation: Amputation of a body part can result in disturbances in body image.
In which deformity does the great toe deviate laterally?
Hallux valgus Explanation: Hallux valgus is a deformity in which the great toe deviates laterally. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Pes cavus refers to a foot with an abnormally high arch, and a fixed equines deformity of the forefoot. Plantar fasciitis is an inflammation of the foot-supporting fascia.
Which should be included in the teaching plan for a client diagnosed with plantar fasciitis?
Management of plantar fasciitis includes stretching exercises. Explanation: 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 condition is a metabolic bone disease characterized by inadequate mineralization of bone?
Osteomalacia Explanation: 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 performing discharge teaching for an elderly client with osteoporosis. Which instruction about a calcium supplement should the nurse include?
Take the supplement with meals or with orange juice. Explanation: 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 of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis?
Risk for injury related to fractures due to osteoporosis Explanation: 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.
A patient comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the physician orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the patient about?
Duloxetine (Cymbalta) Explanation: Nonprescription analgesics such as paracetamol 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.
A client with diabetes punctured his foot with a broken acorn in the yard. 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?
3 to 6 weeks Explanation: Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for 3 to 6 weeks. Oral antibiotics then follow for as long as 3 months.
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?
Arthroscopy Explanation: 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.
While the nurse is performing a physical assessment, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. What should this assessment indicate to the nurse?
Carpal tunnel syndrome Explanation: Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome. Morton's neuroma is assessed as a painful condition that affects the ball of the foot. Dupuytren's contracture is when knots of tissue beneath the skin cause one or more fingers stay bent toward the palm. Impingement syndrome is a shoulder condition.
Which of the following was formerly called a bunion?
Hallux valgus Explanation: 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.
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?
L4, L5, and S1 Explanation: 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.
