Chap. 41 Management of Patients with Musculoskeletal Disorders

The health care provider has prescribed plicamycin to control serum calcium levels in a client with Paget's disease. The dose prescribed is 25 micrograms per kg. The client weighs 132 lbs. How many milligrams will the nurse expect the client to receive?

1.5 Explanation: The client weighs 60 kg (132 lbs/2.2 lbs per kg). The client will receive 1500 micrograms (60 kg x 25 micrograms/kg). 1500 micrograms/1000 micrograms per mg = 1.5 mg.

The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given? Teriparatide Denosumab Raloxifene Alendronate

Alendronate Explanation: Alendronate is a bisphosphonate medication. Raloxifene is a selective estrogen receptor modulator. Teriparatide is an anabolic agent, and denosumab is a monoclonal antibody agent.

Which is not a risk factor for osteoporosis? small-framed, thin White or Asian women being postmenopausal being male family history

Being male 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.

What food can the nurse suggest to the client at risk for osteoporosis?

Broccoli 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)? Vitamin D Calcitonin Raloxifene Teriparatide

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 inhibits bone resorption and promotes bone formation? Estrogen Calcitonin Corticosteroids Parathyroid hormone

Calcitonin Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis

The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response? Decrease in parathyroid hormone Increase of vitamin D Increase in calcitonin Decrease in estrogen

Decrease in estrogen Explanation: Age related processes that contribute to loss of bone mass and osteoporosis are decreases in estrogen, calcitonin, and vitamin D and an increase in parathyroid hormone.

Most cases of osteomyelitis are caused by which microorganism? Pseudomonas species Escherichia coli Staphylococcus aureus Proteus species

Staphylococcus aureus Staphylococcus aureus causes 70% to 80% of bone infections. While Proteus species, Pseudomonasspecies, and E. coli are frequently found in osteomyelitis, they do not cause the majority of bone infections.

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? Vitamin supplements Wound packing Wound irrigation Surgical debridement

Surgical debridement Explanation: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement. Reference:

The client has just been diagnosed with osteomyelitis. What are possible causes of osteomyelitis? Select all that apply. Trauma, such as penetrating wounds or compound fractures Progressive osteoporosis Vascular insufficiency in clients with diabetes or peripheral vascular disease Surgical contamination, such as pin sites of skeletal traction

Trauma, such as penetrating wounds or compound fractures Vascular insufficiency in clients with diabetes or peripheral vascular disease Surgical contamination, such as pin sites of skeletal traction Explanation: The following are all causes of osteomyelitis: trauma, such as penetrating wounds or compound fractures; vascular insufficiency in clients with diabetes or peripheral vascular disease; and surgical contamination, such as pin sites of skeletal traction. Osteoporosis is not a cause of osteomyelitis.

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure? Instructing the client to ambulate twice daily Administering large doses of I.V. antibiotics as ordered Withholding all oral intake Administering large doses of oral antibiotics as ordered

Administering large doses of I.V. antibiotics as ordered Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited.

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? To prevent fractures, the client should avoid strenuous exercise. Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. The recommended daily allowance of calcium may be found in a wide variety of foods.

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 osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class? Alendronate (Fosamax) Tamoxifen (Nolvadex) Calcium gluconate Raloxifene (Evista)

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.

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? "There may be some slight discrepancy between the measuring tools used." "After age 40, height may show a gradual decrease as a result of spinal compression" "The posture begins to stoop after middle age." "After menopause, the body's bone density declines, resulting in a gradual loss of height."

"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.

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? Alkaline phosphatase Magnesium level Potassium level Troponin levels

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.

Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis? Persistent draining sinus Rapid pulse High fever Tenderness over the affected area

Persistent draining sinus Persistent draining sinus indicates a chronic infection in a client with osteomyelitis. High fever, rapid pulse, and tenderness or pain over the affected area is evidence of an acute infection.