Chapter 36: Management of Patients with Musculoskeletal Disorders QUESTIONS

21. A nurse is providing care for a client who has a recent diagnosis of Paget disease. When planning this client's nursing care, what should interventions address? Select all that apply. A. Impaired physical mobility B. Acute pain C. Disturbed auditory sensory perception D. Risk for injury E. Risk for unstable blood glucose

ANS: A. Impaired physical mobility B. Acute pain C. Disturbed auditory sensory perception D. Risk for injury

22. A nurse is caring for a client who is being assessed following reports of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? Select all that apply. A. Computed tomography (CT) B. Angiography C. Magnetic resonance imaging (MRI) D. Ultrasound E. X-ray

ANS: A. Computed tomography (CT) C. Magnetic resonance imaging (MRI) D. Ultrasound E. X-ray

4. A nurse is teaching an educational class to a group of older adults at a community center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended intake of what nutrients? Select all that apply. A. Vitamin B12 B. Potassium C. Calcitonin D. Calcium E. Vitamin D

ANS: D. Calcium E. Vitamin D

1. A nurse is caring for an adult client diagnosed with a back strain. What health education should the nurse provide to this client? A. Avoid lifting more than one-third of body weight without assistance. B. Focus on using back muscles efficiently when lifting heavy objects. C. Lift objects while holding the object a safe distance from the body. D. Tighten the abdominal muscles and lock the knees when lifting an object.

ANS: A Avoid lifting more than one-third of body weight without assistance.

37. An older, female client with osteoporosis has been hospitalized. Prior to discharge, when teaching the client, the nurse should include information about which major complication of osteoporosis? A. Bone fracture B. Loss of estrogen C. Negative calcium balance D. Dowager hump

ANS: A Bone fracture

11. A client tells the nurse that they haves pain and numbness in the thumb, first finger, and second finger of the right hand. The nurse discovers that the client is employed as an auto mechanic, and that the pain is increased while working. This may indicate that the client has what health problem? A. Carpel tunnel syndrome B. Tendonitis C. Impingement syndrome D. Dupuytren contracture

ANS: A Carpel tunnel syndrome

6. A nurse is teaching a client with osteomalacia about the role of diet. What would be the best choice for breakfast for a client with osteomalacia? A. Cereal with milk, a scrambled egg, and grapefruit B. Poached eggs with sausage and toast C. Waffles with fresh strawberries and powdered sugar D. A bagel topped with butter and jam with a side dish of grapes

ANS: A Cereal with milk, a scrambled egg, and grapefruit

35. A nurse is providing discharge teaching for a client who underwent foot surgery. The nurse is collaborating with the occupational therapist and discussing the use of assistive devices. On what variables does the choice of assistive devices primarily depend? A. Client's general condition, balance, and weight-bearing prescription B. Client's general condition, strength, and gender C. Client's motivation, age, and weight-bearing prescription D. Client's occupation, motivation, and age

ANS: A Client's general condition, balance, and weight-bearing prescription

27. A client's electronic health record notes that the client has hallux valgus. What signs and symptoms should the nurse expect this client to manifest? A. Deviation of a great toe laterally B. Abnormal flexion of the great toe C. An exaggerated arch of the foot D. Fusion of the toe joints

ANS: A Deviation of a great toe laterally

17. A nurse is caring for a client who is 12 hours' postoperative following foot surgery. The nurse assesses the presence of edema in the foot. What nursing measure should the nurse implement to control the edema? A. Elevate the foot on several pillows. B. Apply warm compresses intermittently to the surgical area. C. Administer a loop diuretic as prescribed. D. Increase circulation through frequent ambulation.

ANS: A Elevate the foot on several pillows.

19. A nurse is planning the care of an older adult client with osteomalacia. What action should the nurse recommend in order to promote vitamin D synthesis? A. Ensuring adequate exposure to sunlight B. Eating a low-purine diet C. Performing cardiovascular exercise while avoiding weight-bearing exercises D. Taking thyroid supplements as prescribed

ANS: A Ensuring adequate exposure to sunlight

28. An older adult woman's current medication regimen includes alendronate. What outcome would indicate successful therapy? A. Increased bone mass B. Resolution of infection C. Relief of bone pain D. Absence of tumor spread

ANS: A Increased bone mass

12. A nurse is assessing a client who reports a throbbing, burning sensation in the right foot. The client states that the pain is worst during the day but notes that the pain is relieved with rest. The nurse should recognize the signs and symptoms of what health problem? A. Morton neuroma B. Pes cavus C. Hallux valgus D. Onychocryptosis

ANS: A Morton neuroma

15. An 80-year-old man in a long-term care facility has a chronic leg ulcer and states that the area has become increasingly painful in recent days. The nurse notes that the site is now swollen and warm to the touch. The client should undergo diagnostic testing for what health problem? A. Osteomyelitis B. Osteoporosis C. Osteomalacia D. Septic arthritis

ANS: A Osteomyelitis

24. A nurse is collaborating with the physical therapist to plan the care of a client with osteomyelitis. What principle should guide the management of activity and mobility in this client? A. Stress on the weakened bone must be avoided. B. Increased heart rate enhances perfusion and bone healing. C. Bed rest results in improved outcomes in clients with osteomyelitis. D. Maintenance of baseline ADLs is the primary goal during osteomyelitis treatment.

ANS: A Stress on the weakened bone must be avoided.

25. A 32-year-old client comes to the clinic reporting shoulder tenderness, pain, and limited movement. Upon assessment the nurse finds edema. An MRI shows hemorrhage of the rotator cuff tendons and the client is diagnosed with impingement syndrome. What action should the nurse recommend in order to promote healing? A. Support the affected arm on pillows at night. B. Take prescribed corticosteroids as prescribed. C. Put the shoulder through its full range of motion three times daily. D. Keep the affected arm in a sling for 2 to 4 weeks.

ANS: A Support the affected arm on pillows at night.

40. A nurse is caring for a 78-year-old client with a history of osteoarthritis (OA). When planning the client's care, what goal should the nurse prioritize? A. The client will express satisfaction with the ability to perform ADLs. B. The client will recover from OA within 6 months. C. The client will adhere to the prescribed plan of care. D. The client will deny signs or symptoms of OA.

ANS: A The client will express satisfaction with the ability to perform ADLs.

20. A client presents to a clinic reporting a leg ulcer that isn't healing subsequent diagnostic testing suggests osteomyelitis. The nurse is aware that the most common pathogen to cause osteomyelitis is: A. Staphylococcus aureus. B. Proteus. C. Pseudomonas. D. Escherichia coli.

ANS: A. Staphylococcus aureus.

8. Which of the following clients should the nurse recognize as being at the highest risk for the development of osteomyelitis? A. A middle-aged adult who takes ibuprofen daily for rheumatoid arthritis B. An older adult client with an infected pressure ulcer in the sacral area C. A 17-year-old football player who had orthopedic surgery 6 weeks prior D. An infant diagnosed with jaundice

ANS: B An older adult client with an infected pressure ulcer in the sacral area

30. A client has been admitted to the hospital with a spontaneous vertebral fracture related to osteoporosis. Which of the following nursing diagnoses must be addressed in the plan of care? A. Risk for aspiration related to vertebral fracture B. Constipation related to vertebral fracture C. Impaired swallowing related to vertebral fracture D. Decreased cardiac output related to vertebral fracture

ANS: B Constipation related to vertebral fracture

16. A client has returned to the unit after undergoing limb-sparing surgery to remove a metastatic bone tumor. The nurse providing postoperative care in the days following surgery assesses for what complication from surgery? A. Deficient fluid volume B. Delayed wound healing C. Hypocalcemia D. Pathologic fractures

ANS: B Delayed wound healing

3. A client presents at a clinic reports heel pain that impairs walking ability. The client is subsequently diagnosed with plantar fasciitis. This client's plan of care should include what intervention? A. Wrapping the affected area in lamb's wool or gauze to relieve pressure B. Gently stretching the foot and the Achilles tendon C. Wearing open-toed shoes at all times D. Applying topical analgesic ointment to plantar surface each morning

ANS: B Gently stretching the foot and the Achilles tendon

29. A nurse is caring for a client who is being treated in the hospital for a spontaneous vertebral fracture related to osteoporosis. The nurse should address the nursing diagnosis of Acute Pain Related to Fracture by implementing what intervention? A. Maintenance of high Fowler positioning whenever possible B. Intermittent application of heat to the client's back C. Use of a pressure-reducing mattress D. Passive range of motion exercises

ANS: B Intermittent application of heat to the client's back

18. A client with diabetes is attending a class on the prevention of associated diseases. What action should the nurse teach the client to reduce the risk of osteomyelitis? A. Increase calcium and vitamin intake. B. Monitor and control blood glucose levels. C. Exercise 3 to 4 times weekly for at least 30 minutes. D. Take corticosteroids as prescribed.

ANS: B Monitor and control blood glucose levels.

33. A client with diabetes has been diagnosed with osteomyelitis. The nurse observes that the client's right foot is pale and mottled, cool to touch, with a capillary refill of greater than 3 seconds. The nurse should suspect what type of osteomyelitis? A. Hematogenous osteomyelitis B. Osteomyelitis with vascular insufficiency C. Contiguous focus osteomyelitis D. Osteomyelitis with muscular deterioration

ANS: B Osteomyelitis with vascular insufficiency

39. A nurse is assessing a client for risk factors known to contribute to osteoarthritis. What assessment finding should the nurse interpret as a risk factor? A. The client has a 30 pack-year smoking history. B. The client's body mass index is 34 (obese). C. The client has primary hypertension. D. The client is 58 years old.

ANS: B The client's body mass index is 34 (obese).

36. A client has come to the clinic for a routine annual physical. The nurse practitioner notes a palpable, painless projection of bone at the client's shoulder. The projection appears to be at the distal end of the humerus. The nurse should suspect the presence of: A. osteomyelitis. B. osteochondroma. C. osteomalacia. D. Paget disease.

ANS: B osteochondroma.

7. A nurse is caring for a client with Paget disease and is reviewing the client's most recent laboratory values. Which of the following values are most characteristic of Paget disease? A. An elevated level of parathyroid hormone and low calcitonin levels B. A low serum alkaline phosphatase level and a low serum calcium level C. An elevated serum alkaline phosphatase level and a normal serum calcium level D. An elevated calcitonin level and low levels of parathyroid hormone

ANS: C An elevated serum alkaline phosphatase level and a normal serum calcium level

13. A nurse is reviewing the pathophysiology that may underlie a client's decreased bone density. What hormone should the nurse identify as inhibiting bone resorption and promoting bone formation? A. Estrogen B. Parathyroid hormone (PTH) C. Calcitonin D. Progesterone

ANS: C Calcitonin

2. A nurse is discussing conservative management of tendonitis with a client. What is the nurse's best recommendation? A. Weight reduction B. Use of oral opioid analgesics C. Intermittent application of ice and heat D. Passive range of motion exercises

ANS: C Intermittent application of ice and heat

32. A nurse is providing care for a client who has osteomalacia. What major goal should guide the choice of medical and nursing interventions? A. Maintenance of skin integrity B. Prevention of bone metastasis C. Maintenance of adequate levels of activated vitamin D D. Maintenance of adequate parathyroid hormone function

ANS: C Maintenance of adequate levels of activated vitamin D

10. A client presents at a clinic reporting back pain that goes all the way down the back of the leg to the foot. The nurse should document the presence of what type of pain? A. Bursitis B. Radiculopathy C. Sciatica D. Tendonitis

ANS: C Sciatica

31. A nursing educator is reviewing the risk factors for osteoporosis with a group of recent graduates. What of the following risk factors should the educator describe? A. Recurrent infections and prolonged use of NSAIDs B. High alcohol intake and low body mass index C. Small frame and female sex D. Male sex, diabetes, and high protein intake

ANS: C Small frame and female sex

9. A nurse is caring for a client with a bone tumor. The nurse is providing education to help the client reduce the risk for pathologic fractures. What should the nurse teach the client? A. Strive to achieve maximum weight-bearing capabilities. B. Gradually strengthen the affected muscles through weight training. C. Support the affected extremity with external supports such as splints. D. Limit reliance on assistive devices in order to build strength.

ANS: C Support the affected extremity with external supports such as splints.

23. A nurse is reviewing the care of a client who has a long history of lower back pain that has not responded to conservative treatment measures. The nurse should anticipate the administration of what drug? A. Calcitonin B. Prednisone C. Aspirin D. Cyclobenzaprine

ANS: D Cyclobenzaprine

26. A client presents at the clinic with a report of morning numbness, cramping, and stiffness in the fourth and fifth fingers of the right hand. What disease process should the nurse suspect? A. Tendonitis B. A ganglion C. Carpal tunnel syndrome D. Dupuytren disease

ANS: D Dupuytren disease

38. An older adult client sought care for the treatment of a swollen, painful knee joint. Diagnostic imaging and culturing of synovial fluid resulted in a diagnosis of septic arthritis. The nurse should prioritize what aspect of care? A. Administration of oral and IV corticosteroids as prescribed B. Prevention of falls and pathologic fractures C. Maintenance of adequate serum levels of vitamin D D. Intravenous administration of antibiotics

ANS: D Intravenous administration of antibiotics

14. A client is undergoing diagnostic testing for osteomalacia. Which of the following laboratory results are most suggestive of this diagnosis? A. High chloride, calcium, and magnesium levels B. High parathyroid and calcitonin levels C. Low serum calcium and magnesium levels D. Low serum calcium and low phosphorus level

ANS: D Low serum calcium and low phosphorus level

34. An orthopedic nurse is caring for a client who is postoperative day 1 following foot surgery. What nursing intervention should be included in the client's subsequent care? A. Dressing changes should not be performed unless there are clear signs of infection. B. The surgical site can be soaked in warm bath water for up to 5 minutes. C. The surgical site should be cleansed with hydrogen peroxide once daily. D. The foot should be elevated in order to prevent edema.

ANS: D The foot should be elevated in order to prevent edema.

5. A nurse is providing a class on osteoporosis at the local center for older adults. Which statement related to osteoporosis is most accurate? A. High levels of vitamin D can cause osteoporosis. B. A nonmodifiable risk factor for osteoporosis is a person's level of activity. C. Secondary osteoporosis occurs in women after menopause. D. The use of corticosteroids increases the risk of osteoporosis.

ANS: D The use of corticosteroids increases the risk of osteoporosis.