Ch 41: Management of Patients with Musculoskeletal Disorders (3)

The nurse is screening a client for genetic counseling. What musculoskeletal conditions does the nurse know to have a genetic influence? Select all that apply. pg.

- Marfan syndrome - osteoporosis - Stickler syndrome Explanation: Osteoporosis, Marfan syndrome, and Stickler syndrome are conditions that have a genetic influence. Osteoarthritis is not influenced by genetic factors. Diabetes mellitus is not a musculoskeletal disorder with known genetic influence.

Which of the following are routes of administration for Calcitonin? Select all that apply. pg.

- Nasal spray - Subcutaneous - Intramuscular injection Explanation: Calcitonin is administered by nasal spray or by subcutaneous or intramuscular injections.

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? pg.

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.

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)? pg.

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 common problem of the upper extremity results from entrapment of the median nerve at the wrist? pg.

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 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 nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder? pg.

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? pg.

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.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? pg.

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.

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? pg.

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.

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? pg.

Long bone bowing Explanation: 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 has Paget's disease. An appropriate nursing diagnosis for this client is: pg.

Risk for falls Explanation: The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility.

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? pg.

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? pg.

Use the large muscles of the leg when lifting items. Explanation: The large muscles of the leg should be used when lifting.

Which is not a risk factor for osteoporosis? pg.

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.

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 pg.

places the load close to the body. Explanation: 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.

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? pg.

"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.

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? pg.

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.

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? pg.

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.

Morton neuroma is exhibited by which clinical manifestation? pg.

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.

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? pg.

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.