Chapt 41- Problems Related to Musculoskeletal Function MCQ

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? A. Alendronate B. Raloxifene C. Teriparatide D. Denosumab

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

A nurse who oversees care in a long-term care facility is aware that a high percentage of residents have osteoporosis, and that residents who do not have the disease must be assessed and monitored closely for this health problem. Which of the following older adults most clearly exemplifies the risk factors for osteoporosis? A. A Caucasian woman who has low body mass index B. An African American woman who is slightly obese C. An Asian man whose mobility is limited to a wheelchair D. A Caucasian man who has led a sedentary lifestyle

A Lack of exercise is a risk factor for osteoporosis but small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. African American women, who have a greater bone mass than Caucasian women, are less susceptible to osteoporosis.

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? A. Lower lumbar B. Upper lumbar C. Thoracic D. Cervical

A The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes.

A client diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. What is the best response by the nurse? A. "CTS is a neuropathy that is characterized by pannus formation in the shoulder." B. "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." C. "CTS is a neuropathy that is characterized by bursitis and tendinitis." D. "CTS is a neuropathy that is characterized by flexion contracture of the fourth and fifth fingers."

B

What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? A. Callus B. Dupuytren contracture C. Hallux valgus D. Hammertoe

B

What food can the nurse suggest to the client at risk for osteoporosis? A. Carrots B. Broccoli C. Chicken D. Bananas

Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium. Other food sources high in calcium include dairy products, cheese, canned salmon with bones.

When an infection is bloodborne, the manifestations include which symptom? Bradycardia Hypothermia Hyperactivity Chills

D Manifestations of bloodborne infection include chills, high fever, rapid pulse, and generalized malaise.

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? A. Skull narrowing B. Upright gait C. Lordosis D. Long bone bowing

D 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 presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings? Compartment syndrome Avascular necrosis Osteomyelitis Fat embolism

C Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. A client with avascular necrosis does not have fever and chills. Clients with fat emboli will have a rash and breathing complications. A client with compartment syndrome will have numbness, not a fever.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? A soft mattress is most supportive by conforming to the body. Avoid twisting and flexion activities. Use the large muscles of the leg when lifting items. Sleep on the stomach to alleviate pressure on the back.

C The large muscles of the leg should be used when lifting.

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? "Instead of turning around to grasp an object, I will twist at the waist." "I will bend at the waist when I am lifting objects from the floor." "I will avoid prolonged sitting or walking." "I will lie prone with my legs slightly elevated."

C The nurse encourages the patient to alternate lying, sitting, and walking activities frequently, and advises the patient to avoid sitting, standing, or walking for long periods.

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? A. Wound packing B. Wound irrigation C. Vitamin supplements D. Surgical debridement

D In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? A. High-Fowler's to allow for maximum hip flexion B. Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees C. Prone, with a pillow under the shoulders D. Supine, with the bed flat and a firm mattress in place

B A medium to firm, not sagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress (National Guideline Clearinghouse, 2010). Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head (Fig. 42-1). A prone position should be avoided because it accentuates lordosis.

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? A. "This condition is associated with various sports." B. "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." C. "Using arm splints will prevent hyperflexion of the wrist." D. "Surgery is the only sure way to manage this condition."

B Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints.

A nurse is planning the care of a middle-aged female patient whose Csedentary lifestyle has contributed to ongoing problems with lower back pain. The nurse should recognize which of the following interventions as holding the potential for adequate and long-lasting pain control? Use of a back brace Antiseizure medications Weight loss Orthopedic footwear

C Weight reduction through diet modification may prevent recurrence of back pain. Antiseizure medications, back braces, and orthopedic footwear are not normally utilized in the treatment of back pain.

The nurse recognizes that goal of treatment for metastatic bone cancer is to: A. Promote pain relief and quality of life B. Reconstruct the bone with a prosthesis C. Diagnose the extent of bone damage D. Cure the diseased bone and cartilage

A Treatment of metastatic bone cancer is palliative.

The nurse is discussing conservative management of tendonitis with a patient. Which of the following is likely the most effective approach to managing tendonitis? Intermittent application of ice and heat Range-of-motion (ROM) exercise of the affected joint Weight reduction Stress reduction

A Conservative management of tendonitis includes rest of the extremity, intermittent ice and heat to the joint, and nonsteroidal anti-inflammatory drugs to control the inflammation and pain

Morton neuroma is exhibited by which clinical manifestation? A. Swelling of the third (lateral) branch of the median plantar nerve B. High arm and a fixed equinus deformity C. Diminishment of the longitudinal arch of the foot D. Inflammation of the foot-supporting fascia

A 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. This condition is also known as plantar digital neuroma or neurofibroma.

The nurse is caring for a 35-year-old man diagnosed with a back strain. What would be a priority point of discussion with this patient? A. Avoid lifting heavy weights without assistance. B. Focus on using back muscles during lifting. C. Lift objects while holding the object away from the body. D. Tighten the abdominal muscles and lock the knees during the lifting of an object.

A The nurse will instruct the patient on the safe and correct way to lift objects, using the strong quadriceps muscles of the thighs, with minimal use of the weak back muscles. To prevent recurrence of acute low back pain, the nurse may instruct the patient to avoid lifting excessive weights without help. The patient should be informed to place the feet a hip-width apart to provide a wide base of support, the person should bend the knees (instead of locking), tighten the abdominal muscles, and lift the object close to the body with a smooth motion, avoiding twisting and jerking.

Which term refers to a disease of a nerve root? A. Radiculopathy B. Involucrum C. Sequestrum D. Contracture

A When the client reports radiating pain down the leg, the client is describing radiculopathy. Involucrum refers to new bone growth around the sequestrum. Sequestrum refers to dead bone in an abscess cavity. Contracture refers to abnormal shortening of muscle or fibrosis of joint structures.

While the nurse is performing a physical assessment, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. What should this assessment indicate to the nurse? A. Morton's neuroma B. Dupuytren's contracture C. Carpal tunnel syndrome D. Impingement syndrome

C Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome. Median nerve originates from the brachial plexus and is the only nerve passing through the carpal tunnel. Morton's neuroma is assessed as a painful condition that affects the ball of the foot. Dupuytren's contracture is when knots of tissue beneath the skin cause one or more fingers stay bent toward the palm. Impingement syndrome is a shoulder condition.

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? A. Bone fracture B. Loss of estrogen C. Negative calcium balance D. Dowager's hump

A Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

Which assessment finding would the nurse expect to find in a patient diagnosed with acute osteomyelitis? a. Leukopenia and localized bone pain b. Leukocytosis and localized bone pain c. Leukopenia, and elevated fever d. Petechiae over the chest and abnormal arterial blood gas (ABG) results.

B Leukocytosis or elevated white blood cells and increased sedimentation rate are seen in acute osteomyelitis.

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? A. C3, C4, and L1 B. L2, L3, and L5 C. L1, L2, and L4 D. L4, L5, and S1

D 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.

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? A. Administering large doses of oral antibiotics as ordered B. Instructing the client to ambulate twice daily C. Withholding all oral intake D. Administering large doses of I.V. antibiotics as ordered

D 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.

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? A. Decrease in estrogen B. Increase in calcitonin C. Decrease in parathyroid hormone D. Increase of vitamin D

A 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.

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

A 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.

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 Loss of estrogen Negative calcium balance Dowager's hump

A Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

A client with carpal tunnel syndrome has had limited improvement with the use of a wrist splint. The nurse knows that which procedure will show the greatest improvement in treatment for this client? A. Open nerve release B. Ultrasound therapy C. Injection of lidocaine D. Laser therapy

A Evidence-based treatment of acute carpal tunnel syndrome includes the application of splints to prevent hyperextension and prolonged flexion of the wrist. Should this treatment fail, open nerve release is a common surgical management option. A variety of treatments may be tried by the client, however, they may fail to improve the condition. These treatments include laser therapy, ultrasound therapy, and the injection of substances such as lidocaine. Though these can be used, surgery to release nerves is the best option.

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? A. Increase fiber in the diet B. Walk or perform weight-bearing exercises outdoors C. Reduce stress D. Decrease the intake of vitamin A and D

B Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine in moderation.

A 25-year-old woman experienced an open fracture of the right fibula with major soft tissue damage of her lower leg in a motor vehicle accident. Surgical reduction and fixation of the fibula were performed with debridement of nonviable tissue and drain placement in the damaged soft tissue. Which of the following complications is this patient at risk for? a. Osteoporosis b. Osteomyelitis c. Fat emboli d. Compartment syndrome

B Osteomyelitis is an acute or chronic infection of the bone or bone marrow. This patient is at risk for this bone infection because of direct contamination with an open fracture, and direct bone contamination from bone surgery.

Which group is at the greatest risk for osteoporosis? A. Men B. European American women C. Asian American women D. African American women

B Small-framed, nonobese European American women are at greatest risk for osteoporosis. Asian American women of slight build are at risk for low peak bone mineral density. African American women, who have a greater bone mass than European American women and Asian American Women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.

A 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? A. Examine the surgical dressing every hour. B. Administer pain medication per client request. C. Monitor vital signs every 4 hours. D. Perform neuromuscular assessment every hour.

D The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is important to prevent complications from the surgery. The surgical dressing does not need to be examined hourly. Administering pain medication is important, but assessing the foot color and temperature are most important. Vital sign monitoring is important, but not a priority after foot surgery.

A nurse practitioner who works with many older adult patients integrates screening for osteoporosis into health promotion activities. What screening tool is most clinically useful when screening for osteoporosis? A. Hip bone mineral density (BMD) testing B. Assessment of serum calcium levels C. Bone biopsy D. Assessment of 25-hydroxy-vitamin D levels

A Current evidence-based guidelines recommend the use of hip BMD as the first-line screening test for osteoporosis. This is a clearer indicator of osteoporosis risk than is assessment of calcium levels. Bone biopsy and direct analysis of vitamin D levels are not used as screening methods.

After several weeks of antibiotic therapy for the treatment of osteomyelitis, a patient is preparing for discharge. When providing health education related to self-care, the nurse should emphasize which of the following topics? A. The need to resume normal physical activity as soon as possible B. The need to avoid ASA and anticoagulants C. The importance of adhering to further antibiotic treatment D. The importance of maintaining a healthy diet

C After initial treatment for osteomyelitis, the patient and family are taught about the importance of strictly adhering to the therapeutic regimen of antibiotics. This supersedes the importance of nutrition, even though this is important. There is no specific need to avoid ASA, and activity may be limited to reduce the risk of injury.

Which of the following assessment findings may indicate to the nurse an acute peripheral neurovascular dysfunction for the patient recovering from surgery of the foot? a. Pale skin, atrophy of the limb, with capillary refill of 2 seconds b. Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin c. Atrophy of limb, increased motion, and thickened toe nails d. Pale skin, weakness in motion, and loss of toe hairs

B Delayed capillary refill, pale cool skin, paresthesia, and weakness are associated with acute neurovascular dysfunction. Atrophy of a limb, thickened toe nails, and loss of toe hairs are associated with chronic ischemia.

A nurse leader is coordinating care for a group of medical-surgical patients. What patient should the nurse recognize as being at the highest risk for the development of osteomyelitis? A middle-aged adult who takes ibuprofen daily for rheumatoid arthritis An elderly patient with an infected pressure ulcer in the sacral area A 19-year-old football player who had orthopedic surgery 6 weeks prior An older adult patient with a diagnosis of chronic heart failure (CHF)

B Patients who are at high risk of osteomyelitis include those who are poorly nourished, elderly, and obese. The elderly patient with an infected sacral pressure ulcer is at the greatest risk for the development of osteomyelitis, as this patient has two risk factors: age and the presence of a soft-tissue infection that has the potential to extend into the bone. The patient with rheumatoid arthritis has one risk factor, the arthritis. The adult with CHF has no identifiable risk factors. The patient 6 weeks postsurgery is beyond the window of time for the development of a postoperative surgical wound infection.

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? A. Changing the dressing B. Performing hourly neurovascular assessments for the first 24 hours C. Applying a cock-up splint and immobilization D. Having the patient exercise the fingers to avoid future contractures

B Worth noting that neurovascular assessment is important after any type of hand/foot surgery

A client is diagnosed with carpal tunnel syndrome. Which of the following assessment findings would the nurse expect? A. Pain radiating down the dorsal surface of the forearm B. Tenderness in the affected wrist C. Inability to flex index and middle fingers D. A decrease in grasp strength

C Clients with carpal tunnel syndrome describe pain or burning in one or both hands, which may radiate to the forearm and shoulder in severe cases. The pain tends to be more prominent at night and early in the morning. Shaking the hands may reduce the pain by promoting movement of edematous fluid from the carpal canal. Sensation may be lost or reduced in the thumb, index, middle, and a portion of the ring finger. The client may be unable to flex the index and middle fingers to make a fist. Flexion of the wrist usually causes immediate pain and numbness. In epicondylitis, clients report pain radiating down the dorsal surface of the forearm and a weak grasp. Clients with ganglion cysts experience pain and tenderness in the affected area.

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

C 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.

Which client would the nurse identify as having the greatest risk for osteoporosis? A. A 40-year-old overweight African American woman B. A 16-year-old male with a history of asthma C. A small-framed, thin 45-year-old white woman D. A 20-year-old male athlete with repeated injuries

C Small-framed, thin white women are at greatest risk for osteoporosis. African American women have a greater bone density and thus are less susceptible to osteoporosis. Men have an increased bone mass and do not have hormonal changes, and do not acquire osteoporosis as frequently and get it at a later age. Asthma does not increase the risk for osteoporosis.

A 67-year-old woman with a history of osteoarthritis has been admitted to the postsurgical unit from the PACU following a bunionectomy. Which of the following nursing actions should the nurse integrate into this patient's immediate care? A. Apply ice to the affected foot on a schedule of 1 hour on and 1 hour off. B. Maintain the patient's foot in a dependent position. C. Keep the patient's foot elevated above the level of her heart. D. Change the patient's surgical dressing and irrigate the surgical site every 6 hours.

C The foot is elevated to the level of the heart to decrease edema and pain. The application of ice for a 1-hour period is likely to cause skin breakdown. It is unnecessary to perform frequent irrigation or dressing changes.