CH.68 - MUSCULOSKELETAL PROBLEMS

A patient with osteomyelitis is to receive vancomycin (Vancocin) 500 mg IV every 6 hours. The vancomycin is diluted in 100 mL of normal saline and needs to be administered over 1 hour. The nurse should set the IV pump to deliver how many milliliters per minute? (Round to the nearest hundredth.)

1.67 To administer 100 mL in 60 minutes, the IV pump will need to provide 1.67 mL/min.

A patient is started on alendronate (Fosamax) once weekly for the treatment of osteoporosis. Which patient statement indicates that further instruction about the drug is needed? a. "I should take the drug with a meal to prevent stomach irritation." b. "This drug will prevent further bone loss and increase my bone density." c. "I need to sit or stand upright for at least 30 minutes after taking the drug." d. "I will still need to take my calcium supplements while taking this new drug."

a. "I should take the drug with a meal to prevent stomach irritation."

Which actions should the nurse include in the plan of care for a patient with metastatic bone cancer of the left femur? (Select all that apply.) a. Monitor serum calcium. b. Teach about the need for strict bed rest. c. Explain the use of sustained-release opioids. d. Support the left leg when repositioning the patient. e. Assist family and patient as they discuss the prognosis.

a. Monitor serum calcium. c. Explain the use of sustained-release opioids. d. Support the left leg when repositioning the patient. e. Assist family and patient as they discuss the prognosis.

The HCP diagnoses a patient with a plantar wart. What should the nurse know about this kind of abnormality? a. Painful papillomatous growth on the sole of the foot b. Thickening of skin on the weight-bearing part of the foot c. Local thickening of skin caused by pressure on bony prominences d. Tumor on nerve tissue between the third and fourth metatarsal heads

a. Painful papillomatous growth on the sole of the foot

What should the nurse teach the patient recovering from an episode of acute low back pain? a. Perform daily exercise as a lifelong routine. b. Sit in a chair with the hips higher than the knees. c. Avoid occupations in which the use of the body is required. d. Sleep on the abdomen or on the back with the legs extended.

a. Perform daily exercise as a lifelong routine.

Which action should the nurse take when caring for a patient with osteomalacia? a. Teach about the use of vitamin D supplements. b. Educate about the need for weight-bearing exercise. c. Instruct the patient to avoid dairy products in the diet. d. Discuss the use of medications such as bisphosphonates.

a. Teach about the use of vitamin D supplements.

A patient whose employment requires frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates the teaching has been effective? a. "I will keep my back straight when I lift above than my waist." b. "I will begin doing exercises to strengthen and support my back." c. "I will tell my boss I need a job where I can stay seated at a desk." d. "I can sleep with my hips and knees extended to prevent back strain."

b. "I will begin doing exercises to strengthen and support my back."

Which female patients are at risk for developing osteoporosis (select all that apply)? a. 60-year-old white aerobics instructor b. 55-year-old Asian American cigarette smoker c. 62-year-old black who takes estrogen therapy d. 68-year-old white who is underweight and inactive e. 58-year-old Native American who started menopause prematurely

b. 55-year-old Asian American cigarette smoker d. 68-year-old white who is underweight and inactive e. 58-year-old Native American who started menopause prematurely

Which action should the nurse take first when a patient is seen in the outpatient clinic with neck pain? a. Provide information about therapeutic neck exercises. b. Ask about numbness or tingling of the hands and arms. c. Suggest the patient alternate the use of heat and cold to the neck. d. Teach about the use of nonsteroidal antiinflammatory drugs (NSAIDs).

b. Ask about numbness or tingling of the hands and arms.

What action should the nurse complete before administering alendronate (Fosamax) to a patient with osteoporosis? a. Ask about any leg cramps or hot flashes. b. Assist the patient to sit up at the bedside. c. Be sure that the patient has recently eaten. d. Administer the ordered calcium carbonate.

b. Assist the patient to sit up at the bedside.

A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action should the nurse include in the plan of care? a. Logroll the patient every 2 hours. b. Assist the patient with ambulation. c. Discuss the need for genetic testing with the patient. d. Teach the patient about the muscle biopsy procedure.

b. Assist the patient with ambulation.

Identify ways to prevent osteoporosis in postmenopausal women (select all that apply). a. Eating more beef b. Eating 8 ounces of yogurt daily c. Performing weight-bearing exercise d. Spending 15 minutes in the sun each day e. Taking postmenopausal estrogen replacement

b. Eating 8 ounces of yogurt daily c. Performing weight-bearing exercise

A patient with chronic osteomyelitis has been hospitalized for a surgical debridement procedure. What should the nurse explain to the patient is the reason for the surgical treatment? a. Removal of the infection prevents the need for bone and skin grafting. b. Formation of scar tissue has led to a protected area of bacterial growth. c. The process of depositing new bone blocks the vascular supply to the bone. d. Antibiotics are not effective against microorganisms that cause chronic osteomyelitis.

b. Formation of scar tissue has led to a protected area of bacterial growth.

A patient with osteomyelitis has a nursing diagnosis of risk for injury. What is an appropriate nursing intervention for this patient? a. Use careful and appropriate disposal of soiled dressings. b. Gently handle the involved extremity during movement. c. Measure the circumference of the affected extremity daily. d. Range-of-motion (ROM) exercise every 4 hours to the involved extremity.

b. Gently handle the involved extremity during movement.

A patient is being discharged after 1 week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information should the nurse include in the discharge teaching? a. How to apply warm packs to the leg to reduce pain b. How to monitor and care for a long-term IV catheter c. The need for daily aerobic exercise to help maintain muscle strength d. The reason for taking oral antibiotics for 7 to 10 days after discharge

b. How to monitor and care for a long-term IV catheter

A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention should the nurse include in the initial plan of care? a. Quadriceps-setting exercises b. Immobilization of the left leg c. Positioning the left leg in flexion d. Assisted weight-bearing ambulation

b. Immobilization of the left leg

Which assessment finding for a 55-yr-old patient should alert the nurse to the presence of osteoporosis? a. Bowed legs b. Loss of height c. Report of frequent falls d. Aversion to dairy products

b. Loss of height

A nurse who works on the orthopedic unit has just received change-of-shift report. Which patient should the nurse assess first? a. Patient who reports foot pain after hammertoe surgery. b. Patient who has not voided 8 hours after a laminectomy. c. Patient with low back pain and a positive straight-leg-raise test. d. Patient with osteomyelitis who has a temperature of 100.5° F (38.1° C).

b. Patient who has not voided 8 hours after a laminectomy.

Which action should the nurse take when repositioning the patient who has just had a laminectomy and discectomy? a. Instruct the patient to move the legs before turning the rest of the body. b. Place a pillow between the patient's legs and turn the entire body as a unit. c. Have the patient turn by grasping the side rails and pulling the shoulders over. d. Turn the patient's head and shoulders first, followed by the hips, legs, and feet.

b. Place a pillow between the patient's legs and turn the entire body as a unit.

A 24-year-old patient with a 12-year history of Becker muscular dystrophy is hospitalized with heart failure. What is an appropriate nursing intervention for this patient? a. Feed and bathe the patient to avoid exhausting the muscle. b. Reposition frequently to avoid skin and respiratory complications. c. Provide hand weights for the patient to exercise the upper extremities. d. Use orthopedic braces to promote ambulation and prevent muscle wasting.

b. Reposition frequently to avoid skin and respiratory complications.

A laminectomy and spinal fusion are done on a patient with a herniated lumbar intervertebral disc. During the postoperative period, which assessment finding is of most concern to the nurse? a. Paralytic ileus b. Urinary incontinence c. Greater pain at the graft site than at the lumbar incision site d. Leg and arm movement and sensation unchanged from preoperative status

b. Urinary incontinence

Which statement describes osteosarcoma? a. High rate of local recurrence b. Very malignant and metastasizes early c. Arises in cancellous ends of long bones d. Develops in the medullary cavity of long bones

b. Very malignant and metastasizes early

During a follow-up visit to a patient with acute osteomyelitis treated with IV antibiotics, the home health nurse is told by the patient's wife that she can hardly get the patient to eat because his mouth is so sore. In assessing the patient's mouth, what is the most likely finding that the nurse should expect to find? a. A dry, cracked tongue with a central furrow b. White, curdlike membranous lesions of the mucosa c. Ulcers of the mouth and lips surrounded by a reddened base d. Single or clustered vesicles on the tongue and buccal mucosa

b. White, curdlike membranous lesions of the mucosa

The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the-knee amputation. Which patient statement indicates to the nurse that additional teaching is needed? a. "I will need to participate in physical therapy after surgery." b. "I wish I did not need to have chemotherapy after this surgery." c. "I did not have this bone cancer until my leg broke a week ago." d. "I can use the patient-controlled analgesia (PCA) to manage postoperative pain."

c. "I did not have this bone cancer until my leg broke a week ago."

A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. Which statement by the patient should indicate to the nurse the need for additional teaching related to health maintenance? a. "I'm frustrated with this endless treatment!" b. "I will take my oral temperature twice a day." c. "I think my left foot is starting to droop down." d. "I use crutches to avoid weight bearing on the left leg."

c. "I think my left foot is starting to droop down."

What are characteristics of Paget's disease (select all that apply)? a. Results from vitamin D deficiency b. Loss of total bone mass and substance c. Abnormal remodeling and resorption of bone d. Most common in bones of spine, hips, and wrists e. Generalized bone decalcification with bone deformity f. Replacement of normal marrow with vascular connective tissue

c. Abnormal remodeling and resorption of bone f. Replacement of normal marrow with vascular connective tissue

A patient who had an open fracture of the humerus 2 weeks ago is having increased pain at the fracture site. To identify a possible causative agent of osteomyelitis at the site, what diagnostic test should the nurse expect? a. X-rays b. CT scan c. Bone biopsy d. White blood cell (WBC) count and erythrocyte sedimentation rate (ESR)

c. Bone biopsy

Which information should the nurse include when teaching a patient with acute low back pain? (Select all that apply.) a. Sleep in a prone position with the legs extended. b. Keep the knees straight when leaning forward to pick something up. c. Expect symptoms of acute low back pain to improve in a few weeks. d. Avoid activities that require twisting of the back or prolonged sitting. e. Use ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to relieve pain.

c. Expect symptoms of acute low back pain to improve in a few weeks. d. Avoid activities that require twisting of the back or prolonged sitting. e. Use ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to relieve pain.

In promoting healthy feet, which factor does the nurse recognize as associated with most foot problems? a. Poor foot hygiene b. Congenital deformities c. Improperly fitting shoes d. Peripheral vascular disease

c. Improperly fitting shoes

What should the nurse include in the teaching plan for ae patient who has acute low back pain and muscle spasms? a. Keep both feet flat on the floor when prolonged standing is required. b. Twist gently from side to side to maintain range of motion in the spine. c. Keep the head elevated slightly and flex the knees when resting in bed. d. Avoid the use of cold packs because they will exacerbate the muscle spasms.

c. Keep the head elevated slightly and flex the knees when resting in bed.

Which action included in the care of a patient after laminectomy can the nurse delegate to experienced unlicensed assistive personnel (UAP)? a. Check ability to plantar and dorsiflex the foot. b. Determine the patient's readiness to ambulate. c. Log roll the patient from side to side every 2 hours. d. Ask about pain management with the patient-controlled analgesia (PCA).

c. Log roll the patient from side to side every 2 hours.

Before repositioning the patient on the side after a lumbar laminectomy, what should be the nurse's first action? a. Raise the head of the bed 30 degrees. b. Have the patient flex the knees and hips. c. Place a pillow between the patient's legs. d. Have the patient grasp the side rail on the opposite side of the bed.

c. Place a pillow between the patient's legs.

After laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. What action should the nurse take? a. Elevate the right leg on two pillows. b. Obtain vital signs for indication of hemorrhage. c. Review the preoperative assessment data in the health record. d. Turn the patient to the left to relieve pressure on the right leg.

c. Review the preoperative assessment data in the health record.

The patient has lateral angulation of the large toe toward the second toe. What should the nurse know will be included in the treatment? a. Metatarsal arch support b. Trimming with a scalpel after softening c. Surgery to remove the bursal sac and bony enlargement d. Intraarticular corticosteroids and passive manual stretching

c. Surgery to remove the bursal sac and bony enlargement

Which statement by a patient with discomfort from a bunion indicates to the nurse that more teaching is needed? a. "I will give away my high-heeled shoes." b. "I can take ibuprofen (Motrin) if I need it." c. "I will use the bunion pad to cushion the area." d. "I can only wear sandals, no closed-toe shoes."

d. "I can only wear sandals, no closed-toe shoes."

After 7 days of IV antibiotic therapy, a patient with acute osteomyelitis of the tibia is prepared for discharge from the hospital. The nurse determines that additional instruction is needed when the patient makes which statement? a. "I will need to continue antibiotic therapy for 4 to 6 weeks." b. "I should notify the health care provider (HCP) if the pain in my leg becomes worse." c. "I shouldn't bear weight on my affected leg until healing is complete." d. "I do not need to do anything special while taking the antibiotic therapy."

d. "I do not need to do anything special while taking the antibiotic therapy."

A 54-yr-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia. Which information should the nurse explain to the patient? a. With a family history of osteoporosis, there is no way to prevent or slow bone resorption. b. Estrogen replacement therapy must be started to prevent rapid progression to osteoporosis. c. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. d. Calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

d. Calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

What does radicular pain that radiates down the buttock and below the knee, along the distribution of the sciatic nerve, generally indicate? a. Cervical disc herniation b. Acute lumbosacral strain c. Degenerative disc disease d. Herniated lumbar disc disease

d. Herniated lumbar disc disease

Which menu choice by a patient with osteoporosis indicates the nurse's teaching about appropriate diet has been effective? a. Pancakes with syrup and bacon b. Whole wheat toast and fresh fruit c. Egg-white omelet and a half grapefruit d. Oatmeal with skim milk and fruit yogurt

d. Oatmeal with skim milk and fruit yogurt

Which type of bone tumor is a benign overgrowth of bone and cartilage that may transform into a malignant form? a. Enchondroma b. Osteoclastoma c. Ewing's sarcoma d. Osteochondroma

d. Osteochondroma

What should the nurse assess to evaluate the effectiveness of alendronate (Fosamax) therapy for a patient with Paget's disease? a. Oral intake b. Daily weight c. Grip strength d. Pain intensity

d. Pain intensity

Which action should the nurse take before administering gentamicin (Garamycin) to a patient with acute osteomyelitis? a. Ask the patient about any nausea. b. Obtain the patient's oral temperature. c. Change the prescribed wet-to-dry dressings. d. Review the patient's serum creatinine results.

d. Review the patient's serum creatinine results.

A patient has had surgical reduction of an open fracture of the right radius. Which assessment findings should the nurse report immediately to the health care provider? a. Serous wound drainage b. Right arm muscle spasms c. Pain with right arm movement d. Temperature 101.4° F (38.6° C)

d. Temperature 101.4° F (38.6° C)