EXAM 4 : Chapter 41 (Nursing Management: Patients With Musculoskeletal Disorders)
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?
"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
A client with a musculoskeletal injury is instructed to increase dietary calcium. Which statement by the nurse is appropriate?
"You need to increase the amount of vitamin D in your diet."
A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?
"You will receive IV antibiotics for 3 to 6 weeks."
A nurse is providing an educational class to a group of older adults at a community senior center. The topic of the class is nutrition. The nurse informs the group that their recommended adequate intake (RAI) level of calcium daily is what?
1,200 mg
A client comes back to the clinic with a continued complaint of back pain. What time frame does the nurse understand constitutes "chronic pain"?
3 months
A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?
A bone biopsy
The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which nursing diagnosis is appropriate for the client? Select all that apply.
Acute pain Disturbed body image Imbalanced nutrition: less than body requirements
When reviewing the history of a client with a ganglion cyst, which factor would the nurse identify as most likely contributing to the client's current condition?
Age below 50 years
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?
Alendronate
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?
Alkaline phosphatase
A nurse is caring for a client with osteomyelitis. What complication should the nurse consider that the client is at risk to develop?
Bone abscess formation
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
A patient has been diagnosed with osteomalacia. What common symptoms does the nurse recognize that correlate with the diagnosis?
Bone pain and tenderness
A client has low back pain and the healthcare provider needs to rule out the presence of a tumor. Which diagnostic procedure would the nurse anticipate to be ordered for the client?
Bone scan
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)?
Calcitonin
Which of the following inhibits bone resorption and promotes bone formation?
Calcitonin
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD?
Calcitonin (Miacalcin)
A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication?
Calcium level of 11.6 mg/dl
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?
Carpal tunnel syndrome
When an infection is bloodborne, the manifestations include which symptom?
Chills
When an infection is bloodborne, the manifestations include which symptom?
Chills Manifestations of bloodborne infection include chills, high fever, rapid pulse, and generalized malaise.
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 estrogen
A community health nurse is participating in a health forum under the auspices of the local seniors' center. The subject of osteoporosis has come up during a discussion with participants, and the nurse is providing a brief overview of the concept of bone density and the changes in bone density that occur with age. What age-related change in hormone levels contributes to the high incidence and prevalence of osteoporosis among older adults?
Decreased levels of calcitonin
The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients?
Disturbed body image
What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?
Dupuytren contracture
Which group is at the greatest risk for osteoporosis?
European American Women
Which group is at the greatest risk for osteoporosis?
European American women
Dupuytren contracture causes flexion of which area(s)?
Fourth and fifth fingers
Dupuytren's contracture causes flexion of which area(s)?
Fourth and fifth fingers
Following diagnostic testing, a 69-year-old male patient has been diagnosed with Paget's disease. When planning the subsequent care that this patient is likely to require, what nursing diagnosis should most likely be prioritized by the nurse?
Impaired physical mobility related to Paget's disease
A client is diagnosed with carpal tunnel syndrome. Which assessment findings would the nurse expect?
Inability to flex index and middle fingers
Which aspect should a nurse include in the teaching plan for a client with osteomalacia?
Include calcium, phosphorus, and vitamin D supplements
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?
Initiating weight-bearing exercise routines
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?
Keep the patient's foot elevated above the level of her heart.
Which of the following are common primary sites of tumors that metastasize to the bone? Select all that apply.
Kidney Prostate Lung Breast Ovary
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?
L4, L5, and S1
Using proper body mechanics to lift objects is essential to prevent exacerbations of low back pain. Which of the following is the most important teaching point?
Lift with the large leg muscles (quadriceps), not the back muscles.
Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely?
Long bone bowing
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?
Lower lumbar
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?
Open nerve release
A client is informed of having a benign bone tumor but that this type of tumor that may become malignant. The nurse knows that this is characteristic of which type of tumor?
Osteoclastoma
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?
Osteomyelitis
The nurse is collaborating with the health care provider on a plan of care for a 54-year-old male client with osteomyelitis of the left femur secondary to uncontrolled type 1 diabetes.
Perform neurovascular checks of lower extremities every 8 hours. *Administer IV antibiotic based on culture and sensitivity report. *Administer ibuprofen 400 mg orally three times daily, as needed for pain. *Make referral to dietitian to discuss nutrition for healing and blood glucose control. *Provide education on self-blood glucose monitoring and insulin administration.
Which of the following presents with an onset of heel pain with the first steps of the morning?
Plantar fasciitis
An 80-year-old female patient has been admitted to the hospital and lives with numerous health problems, which include osteoporosis. The patient's medication regimen includes calcitonin nasal spray, vitamin D and calcium supplements, and a bisphosphonate that is administered weekly. When administering the patient's bisphosphonate, the nurse should:
Position the patient in high Fowler's after giving the drug.
Which of the following positions should be avoided in severe back pain?
Prone
The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize?
Quadriceps
Which term refers to a disease of a nerve root?
Radiculopathy
A client with Paget's disease comes to the hospital and reports difficulty urinating. The emergency department health care provider consults urology. What should the nurse suspect is the most likely cause of the client's urination problem?
Renal calculi
A client has Paget's disease. An appropriate nursing diagnosis for this client is:
Risk for falls
A patient presents at the clinic complaining of back pain that goes all the way down the back of her leg to her foot. What is this type of pain referred to as?
Sciatica
Which is a risk-lowering strategy for osteoporosis?
Smoking cessation
Most cases of osteomyelitis are caused by which microorganism?
Staphylococcus aureus
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort?
Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees
In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?
Surgical debridement
A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct?
The recommended daily allowance of calcium may be found in a wide variety of foods.
A client was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. What would not be a part of teaching plan for this condition?
applications of ice
When teaching a client how to prevent low back pain as a result of lifting, the nurse should instruct the client to:
avoid overreaching.
To help minimize calcium loss from a hospitalized client's bones, the nurse should:
encourage the client to walk in the hall
Lifestyle risk factors for osteoporosis include
lack of exposure to sunshine
Primary prevention of osteoporosis includes:
optimal calcium intake and estrogen replacement therapy.
The nurse is educating a client with low back pain on proper lifting techniques. The nurse recognizes that the education was effective when the client
places the load close to the body.
An adult client is seeking care for acute lower back pain. The client states hearing conflicting advice on exercise and activity during periods of back pain. What activity management strategy should the clinic nurse recommend to this client?
resting for a day or tow and then gradually increasing activity
An adult client is seeking care for acute lower back pain. The client states hearing conflicting advice on exercise and activity during periods of back pain. What activity management strategy should the clinic nurse recommend to this client?
resting for a day or two and then gradually increasing activity
A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate?
"You may need to be evaluated for an underlying cause, such as renal failure."
Which of the following was formerly called a bunion?
Hallux vagus
In which deformity does the great toe deviate laterally?
Hallux valgus
The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as
Hallux valgus
Which of the following was formerly called a bunion?
Hallux valgus
A healthcare provider asks a nurse to test a client for Tinel's sign to diagnose carpal tunnel syndrome. What should the nurse do to perform this assessment?
Have the client hold the palm of the hand up while the nurse percusses over the median nerve.
A client has been prescribed alendronate for the prevention of osteoporosis. Which is the highest priority nursing intervention associated with the administration of the medication?
Have the client sit upright for at least 30 minutes following administration
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?
Hip bone mineral density (BMD) testing
A physician prescribes raloxifene to a hospitalized client. The client's history includes a right hip fracture, hysterectomy, deep vein thrombosis, and hypertension. Which action by the nurse demonstrates safe nursing care?
Holding the raloxifene and notifying the physician **Raloxifene is contraindicated in clients with a history of deep vein thrombosis. The nurse should hold the medication and notify the physician. Raloxifene can be given without regard to food or time of day. Raloxifene is a selective estrogen receptor modulation medication. Sitting upright for 30-60 minutes is indicated with drugs classified as bisphosphonates.
A patient with a primary diagnosis of colorectal cancer has developed bone metastases in recent weeks. When reviewing this patient's daily blood work, the nurse should be aware that secondary bone tumors create a significant risk of what electrolyte imbalance?
Hypercalcemia
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder?
Paget disease
The nurse is caring for a patient with a bone tumor. The nurse provides education that teaches the patient to implement measures to reduce the risk of pathologic fractures. What intervention will assist the patient in fracture prevention?
Supporting the affected extremity with external supports (splints)
A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing?
Surgical debridement
A nurse is performing foot care for a client with chronic osteomyelitis and the client asks the nurse about the next treatment. What is the specific treatment for a client with chronic osteomyelitis?
Surgical removal of the sequestrum
Morton neuroma is exhibited by which clinical manifestation?
Swelling of the third (lateral) branch of the median plantar nerve
A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about a calcium supplement should the nurse include?
Take the supplement with meals or with orange juice.
A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include?
Use the large muscles of the leg when lifting items.
On a visit to the family health care provider, a client is diagnosed with a bunion on the lateral side of the great toe at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?
"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."
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?
"I will avoid prolonged sitting or walking."
A client is evaluated for a diagnosis of Paget's disease. Which laboratory value would the nurse find to confirm the diagnosis?
Alkaline phosphate of 165 IU/L (2750 mmol/L)
A client with diabetes punctured the foot with a sharp object. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics?
At least 4 weeks
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?
Avoid lifting heavy weights without assistance.
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?
Perform neuromuscular assessment every hour.
A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively?
Performing hourly neurovascular assessments for the first 24 hours
Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis?
Risk for injury related to fractures due to osteoporosis
A client has been treated for migraine headaches for several months and comes to the clinic reporting no improvement. The nurse is talking with the client and hears an audible click when the client is moving the jaw. What does the nurse suspect may be happening?
Temporomandibular disorder
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?
The importance of adhering to further antibiotic treatment
A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and the immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client?
The nurse is caring for this client on the intensive care unit.
The nurse is educating a group of women on the prevention of osteoporosis. The nurse recognizes the education as being effective when the group members make which statement?
"We need an adequate amount of exposure to sunshine."
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?
Arthroscopy
Which should be included in the teaching plan for a client diagnosed with plantar fasciitis?
Management of plantar fasciitis includes stretching exercises.
The nurse is screening a client for genetic counseling. What musculoskeletal conditions does the nurse know to have a genetic influence? Select all that apply.
Marfan syndrome osteoporosis Stickler syndrome
Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women?
Raloxifene
A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest?
Walking