Ch. 49 Study Guide
A physiotherapist is aware of the benefits of minimizing bed rest and is teaching a cardiac client's daughter about the rationale for early mobilization. Which teaching point would the physiotherapist be unable to justify during his teaching?
"A bedridden person's heart beats faster and can cause an increase in blood pressure."
An adult with flat feet is complaining about pain. Which statements will best help this client? Select all that apply.
"Be fitted for good shoes with arch supports." "Surgery may be needed if symptoms do not decrease." "Losing weight may ease the pain."
What questions should the nurse ask a 55-year-old woman to ascertain her risk for osteoporosis? Select all that apply.
"Do you have a family history of osteoporosis?" "What medications do you take on a regular basis?" "Do you smoke?" "Do you sit most of the day?"
A parent asks the nurse, "What is femoral anteversion? I was told my daughter has this." What is the best response by the nurse?
"How old is your daughter?"
A client presented to the emergency department after getting "hit in the head with a baseball" while watching his grandson play. An x-ray of the head reveals poor quality of bone. The ED physician suspects the client has Paget disease. Which signs/symptoms help confirm this diagnosis? Select all that apply.
"I've had a lot of headaches lately." "Every now and then, I get a ringing in my ears." "I have gotten dizzy and had to sit down while shopping."
Which information should the nurse teach the parent of a child diagnosed with osteogenesis imperfecta? Select all that apply.
"This is a hereditary disease." "This is a disease characterized by defective collagen." "Your child will need to be protected from trauma." "Hearing loss is very common."
A parent complains of her son being "pigeon-toed." How should the nurse respond to this parent?
"Your son should be evaluated to determine what type of abnormality he has."
The nursing student who is studying about osteoporosis correctly identifies which female to be at highest risk for suffering a fracture?
A 68-year-old who gets bumped several times while riding the bus
While educating the client starting bisphosphonates for osteoporosis, the client asks, "So what adverse reaction can this drug cause?" Which response by the nurse is most accurate?
A hip fracture
Which clients are at increased risk for development of osteoporosis? Select all that apply.
A postmenopausal 65-year-old woman A 20-year-old female with hyperthyroidism A client with Cushing syndrome A client with adult onset diabetes mellitus. A young adult who has alcoholism
The nurse knows that an individual diagnosed with chronic fatigue syndrome (CFS) may complain of which clinical manifestation listed below?
Achy joints and muscles, low-grade temperature over the past few weeks.
A nursing instructor is teaching about osteoporosis and correctly lists which of these to be risk factors? Select all that apply.
Age Gender Genetics Activity Nutrition
An adult client with a diagnosis of diabetes mellitus performing isometric exercise to help control his blood glucose level will gain which benefit?
An increase in his basal metabolic level
The nurse knows that which client might experience fatigue relative to either physiologic, psychological, and/or pathologic aspects? Select all that apply.
An older adult client on tranquilizers for sleep in the noisy nursing home environment. An adult who performs manual outdoor labor as a roofer. An adolescent client with a diagnosis of leukemia who is on a chemotherapy regimen.
Which clients are at risk for developing osteomalacia? Select all that apply.
An older adult female who "can't stand to drink milk" and refuses calcium supplements since she has a history of kidney stones A person who lives in a colder region of the northwest who doesn't get out much during the winter months for fear of falling A female client whose father had a genetic predisposition to primary hyperparathyroidism resulting in increased calcium resorption from the bone
Scoliosis is an abnormal curvature of the spine. Why is it first noticed?
Because of the deformity it causes
The health care provider has evaluated a client diagnosed with osteoporosis and determined that pharmacologic therapy will benefit the client. Select the medication options that the provider may prescribe. Select all that apply.
Bisphosphonates Selective estrogen receptor modulators (SERMs) Calcitonin RANKL inhibitor denosumab Recombinant parathyroid hormone
Which test should be included when screening a client for potential causes of rickets?
Blood urea nitrogen (BUN) and creatinine
What diagnostic/lab testing helps to confirm the diagnosis of Paget's disease? Select all that apply.
Bone deformities Changes noted on x-ray Increased serum alkaline phosphatase Bone scans
A client is suspected of having osteomalacia based on clinical manifestations and lab/diagnostic work-up (low calcium levels, transverse lines on X-ray). The nurse would expect the client to have which clinical manifestations? Select all that apply.
Bone pain. Muscle weakness.
A client reports a feeling of chronic fatigue to the nurse. Which conditions in the client's history could contribute to this manifestation? Select all that apply.
Cancer Diabetes mellitus Hypertension Obesity
Which disorder places a client at increased risk for secondary osteoporosis? Select all that apply.
Celiac disease Hyperparathyroidism Multiple myeloma Long-term corticosteroid use
The nurse is caring for several clients who have chronic fatigue. Which intervention is the appropriate match for the cause of the clients' fatigue?
Clients with end-stage renal disease receiving erythropoietin
The nurse is performing an assessment on a 12-month-old infant and notices an outward bowing of the knees when the medial malleoli of the ankles are touching. What action should the nurse take at this time?
Document the findings
When reviewing the history of clients scheduled for clinical visits today, which client(s) should the provider consider at risk for possible osteopenia? Select all that apply.
Female, 40-years old, laboratory value abnormal with high calcium level, low vitamin D level Client with a recent history of malignant myeloma currently under treatment
A nurse is conducting parent education on complications associated with childhood obesity. Which musculoskeletal developmental disorder associated with obesity would the nurse include in this education?
Genu valgum
When performing a musculoskeletal assessment on a young boy, the nurse notices that the boy has decreased space between the knees so that the medial malleoli cannot be brought together. The nurse documents this as:
Genu valgum
When assessing a client diagnosed with Paget disease focused in the skull, the nurse should anticipate which findings? Select all that apply.
Headaches Intermittent tinnitus Vertigo Hearing loss
Which disorders place a client at increased risk for secondary osteoporosis? Select all that apply.
Hyperparathyroidism Multiple myeloma Long-term corticosteroid use
Which symptoms does the nurse identify as supporting a diagnosis of chronic fatigue syndrome (CFS) when assessing a client with fatigue? Select all that apply.
Increasing fatigue that is not due to ongoing exertion Short-term memory loss and short attention span Tender lymph nodes in neck and axillae
When explaining to a class of nursing students the effects of dysregulation of the RANKL/RANK/OPG pathway, the instructor emphasizes that this plays a prominent role in the pathogenesis of which bone diseases? Select all that apply.
Neoplasia of the bone Osteoporosis
The health care provider suspects a child with knee pain may have a slipped capital femoral epiphysis. The nurse should anticipate which treatments will be prescribed for this child? Select all that apply.
No weight bearing on the femur Bed rest Traction
Which assessment findings assist in diagnosing Legg-Calvé-Perthes disease? Select all that apply.
Pain in the thigh Pain in the knee Difficulty walking Limpness
The nursing instructor is teaching about osteoporosis and informs the class that certain groups of children are also at a higher risk for decreased bone mass. Which group of children are at risk for developing osteoporosis? Check all that apply.
Premature infants Children on corticosteroids Infants with a low birth weight Children with cystic fibrosis
Which would be considered the primary goal of treatment for an adult with "flat feet"?
Relief of fatigue
When assessing an 8-year-old child who is diagnosed with genu valgum, the nurse will educate the family about treatments to prevent which risk factor associated with this diagnosis (if left untreated)?
Rheumatoid arthritis
The nurse concludes that the participants of a community education class on prevention of osteoporosis are understanding the information when they identify which cause as a potential risk factor? Select all that apply.
Smoking High-protein diet Alcoholism Excessive caffeine intake
A client is being investigated for chronic fatigue syndrome. What findings should the nurse assess for to confirm/support this diagnosis? Select all that apply?
Sore throat Muscle aches Sore joints Low-grade fever
A clinic nurse plans care for a newly diagnosed client with osteoarthritis. The nurse should provide educational materials about which topics? Select all that apply.
Splints to protect and rest the involved joint Use of heat and cold when appropriate for muscle spasms and pain How to use a cane or walker if hip/knees joints are involved
The nurse notices that a child appears to have flatfoot and determines that additional assessment is needed. Which assessment finding would meet criteria for flatfoot?
Talus points medially
The infant child of a family who has recently immigrated to the United States from South Asia has been diagnosed with rickets. Bone density scanning would yield which characterization of the infant's bones?
The child's bones are far softer than those of healthy children.
A child's history and a subsequent physical document that the child has a grade I metatarsus adductus deformity. When assessing the child, the nurse anticipates finding which result?
The foot can be manipulated into a straight position.
A nurse is providing a client with preoperative education. The nurse knows that which teaching point should be included in the instruction regarding deep breathing and coughing exercises?
The resistance of your bed limits your lung expansion.
A client newly diagnosed with rheumatoid arthritis is crying and tells the nurse she does not know how to manage the disease. Select the most important information for the nurse to provide. Select all that apply.
Treatment goals Education Posture Physical rest Therapeutic use of heat and cold
A 7-year-old child has been diagnosed with renal failure due to autoimmune glomerulonephritis. Knowing the potential complications of this disease, the nurse should closely monitor the client for signs and symptoms of:
rickets.
