Ch. 42 - Management of Musculoskeletal Disorders
On a visit to the family physician, 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."
A client with gout has been advised to lose weight. She informs the nurse that she plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate?
"There might be some difficulties with your plan and fasting."
A client with diabetes punctured hisfoot 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
Ms. Dowe was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. Which of the following would not be a part of teaching plan for her condition?
Applications of ice
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
A 35-year-old client is visiting a rheumatology group practice. The client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications?
Common adverse effects
Which of the following would the nurse most commonly assess in a client with ankylosing spondylitis?
Low back pain
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?
Lower lumbar
A client with ankylosing spondylitis has a stooped position and is being positioned in the bed prior to the nurse taking vital signs. The nurse listens to the client's lungs after positioning. What finding does the nurse hear when listening to lung sounds?
Lung sounds are diminished in the apical area.
A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate?
Maintain good posture.
The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about?
Methotrexate (Rheumatrex)
Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis?
Persistent draining sinus
A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing?
Surgical debridement
In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations?
Surgical debridement
Morton's neuroma is exhibited by which of the following clinical manifestations?
Swelling of the third (lateral) branch of the median plantar nerve
A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about taking a calcium supplement should the nurse include?
Take the supplement with meals or with orange juice.
After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following?
The belief is that it is an autoimmune disorder with an unknown trigger.
A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and his 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.
A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct?
The recommended daily allowance of calcium may be found in a wide variety of foods.
Which sign may be helpful in identifying carpal tunnel syndrome?
Tinel's
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.
Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia?
Widespread chronic pain
Instructions for the patient with low back pain include that when lifting the patient should
avoid overreaching.
Lifestyle risk factors for osteoporosis include
lack of exposure to sunshine.
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?
Initiating weight-bearing exercise routines
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
A client is experiencing symptoms that are suspected to be related to systemic lupus erythematosus. What cutaneous symptom occurs in about 50% of clients affected by this disease?
Butterfly-shaped rash on the face over the bridge of the nose and cheeks
The nurse is gathering objective data for a client at the clinic complaining of arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as?
Swan neck deformity
A nurse is caring for a female client following a motor vehicle accident resulting in paraplegia. The client is ready for discharge to home with her husband, who states, "I'm scared to carry her because I'm afraid I'll either hurt my back or drop her." A nurse identifies a need for discharge teaching of the husband in regard to:
ergonomic principles and body mechanics.
During a routine physical examination on a 75-year-old 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."
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."
The 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."
A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?
0.5
A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?
A bone biopsy
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.
The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given?
Alendronate (Fosamax)
Which medication classification is prescribed when allergy is a factor causing the skin disorder?
Antihistamines
Of the following, which is not a risk factor for osteoporosis?
Being male
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?
Bone fracture
What food can the nurse suggest to the client at risk for osteoporosis?
Broccoli
Which of the following inhibits bone resorption and promotes bone formation?
Calcitonin
Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing BMD?
Calcitonin (Miacalcin)
When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with:
Carpal tunnel syndrome
Which common problem of the upper extremity results from entrapment of the median nerve at the wrist?
Carpal tunnel syndrome
Which group is at the greatest risk for osteoporosis?
Caucasian women
When an infection is blood borne the manifestations include which of the following symptoms?
Chills
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
Which is a flexion deformity caused by a slowly progressive contracture of the palmar fascia?
Dupuytren's contracture
Which of the following is a flexion deformity caused by a slowly progressive contracture of the palmar fascia?
Dupuytren's contracture
The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find?
Elevated erythrocyte sedimentation rate
Which of the following was formerly called a bunion?
Hallux valgus
The nurse notes that the patient's left great toe deviates laterally. This finding would be recognized as which of the following?
Hallux valgus (bunion)
Ms. Simpson has come to the clinic with foot pain. The physician has described her problem as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder?
Hammer toe
Ms. Wilson is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). You are teaching her and her family information about managing her disease. All of the following would be included, except?
If you have problems with a medication, you may stop it until your next physician visit.
A nurse notices a client lying on the floor at the bottom of the stairs. He's alert and oriented and states that he fell down several stairs. He denies pain other than in his arm, which is swollen and appears deformed. After calling for help, what should the nurse do?
Immobilize the client's arm.
A nursing student asks the instructor how to identify rheumatoid nodules in a client with rheumatoid arthritis. Which of the following characteristics would the instructor include?
Located over bony prominence
Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely?
Long bone bowing
A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit?
Observing for safety hazards that could be a fall risk
Which of the following is the most common and most fatal primary malignant bone tumor?
Osteogenic sarcoma (osteosarcoma)
The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications?
Osteomyelitis
The 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.
Which of the following presents with an onset of heel pain with the first steps of the morning?
Plantar fasciitis
A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis?
Positive Anti-dsDNA antibody test
Which of the following would a nurse encourage a client with gout to limit?
Purine-rich foods
Which of the following terms refers to disease of a nerve root?
Radiculopathy
Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women?
Raloxifene
Ms. Malcolm has come to your clinic complaining of jaw pain. This is also associated with muscle spasm and tenderness of the masseter and temporalis muscles. The physician has diagnosed a temporomandibular disorder (TMD). What would the treatment course for this client include? Select all that apply.
Referral to a dentist who has experience managing clients with TMD. Analgesics. Custom-fitted mouth guard during sleep.
A client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client's urination problem?
Renal calculi
A client has Paget's disease. An appropriate nursing diagnosis for this client is:
Risk for falls
A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What does the nurse understand that this clinical manifestation is?
Sicca syndrome
Which is a risk-lowering strategy for osteoporosis?
Smoking cessation
Most cases of osteomyelitis are caused by which of the following microorganisms?
Staphylococcus
A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following?
Staphylococcus aureus
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?
The client will experience a tolerable level of pain. The client will demonstrate wound care. The client will maintain adequate nutritional intake.
The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective?
The patient placed the load close to the body.
The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?
Walk or perform weight-bearing exercises outdoors
A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate?
Walking
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.
