Med Surg Ch. 41 Musculoskeletal Disorders

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." 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.

On a visit to the family physician, 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." Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion.

The 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." Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks.

Which of the following are common primary sites of tumors that metastasize to the bone? Select all that apply.

-Kidney -Prostate -Lung -Breast -Ovary The most common primary sites of tumors that metastasize to bone are the kidney, prostate, lung, breast, ovary, and thyroid.

A 65-year-old woman's X-rays reveal a diagnosis of osteoporosis. The nurse advises the woman that the radiolucency seen in the bones indicates a minimal level of demineralization of about:

25% Demineralization seen on X-rays occurs when bone loss of 25% to 40% occurs.

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

Which group is at the greatest risk for osteoporosis?

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

Which of the following clinical manifestations would the nurse expect to find in a client who has had osteoporosis for several years?

Decreased height Clients with osteoporosis become shorter over time.

Which suggestion would be most important to give a client who has a mild case of bunions?

Don proper footwear. The most important instruction a nurse should give clients with bunions or hammer toe is to don proper footwear. Low-heeled, well-fitted shoes are recommended. Regular use of analgesics is not necessary for bunions if pain is not severe and the client has little or no difficulty. The client need not avoid strenuous exercise, running, or foot creams if the footwear is appropriate.

A nurse notices a client lying on the floor at the bottom of the stairs. He's alert and oriented and states that he fell down several stairs. He denies pain other than in his arm, which is swollen and appears deformed. After calling for help, what should the nurse do?

Immobilize the client's arm. Signs of a fracture in an extremity include pain, deformity, swelling, discoloration, and loss of function. When a nurse suspects a fracture, she should immobilize the extremity before moving the body part. It isn't appropriate for the nurse to move the client into a sitting position without further assessment. The client shouldn't walk to the nurses' station; he should stay where he is until help arrives.

The nurse recognizes that goal of treatment for metastatic bone cancer is to:

Promote pain relief and quality of life Treatment of metastatic bone cancer is palliative.

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 A medium to firm, nonsagging 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 caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and his 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. This client is critically ill; his diagnosis and immunosuppression place him at a high risk for infection. The most appropriate place for this client is in an intensive care unit, where the nurse can focus exclusively on his health promotion. This client shouldn't be on the oncology floor. This client requires close monitoring. The nurse caring for this client shouldn't also be caring for other clients who may require frequent interventions.

Which of the following diagnostics confirms Paget's disease?

X-ray X-rays confirm the diagnosis of Paget's disease. Local areas of demineralization and bone overgrowth produce characteristic mosaic patterns and irregularities. Bone scans demonstrate the extent of the disease. A bone biopsy may aid in the differential diagnosis.

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?

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

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following?

Hammer toe Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.

Which term refers to a disease of a nerve root?

Radiculopathy 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.

The 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. The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is critical.

Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

Dupuytren contracture Dupuytren disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally.

Which is a risk-lowering strategy for osteoporosis?

Smoking cessation Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D.

A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct?

The recommended daily allowance of calcium may be found in a wide variety of foods. 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 patient comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the physician orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the patient about?

Duloxetine (Cymbalta) Nonprescription analgesics such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) and short-term prescription muscle relaxants (e.g., cyclobenzaprine [Flexeril]) are effective in relieving acute low back pain. Tricyclic antidepressants (e.g., amitriptyline [Elavil) and the newer dual-action serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine [Cymbalta]) (Karp et al., 2010) or atypical seizure medications (e.g., gabapentin [Neurontin], which is prescribed for pain from radiculopathy) are used effectively in chronic low back pain.

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action?

Walk or perform weight-bearing exercises outdoors 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.

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 Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made.

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)?

Calcitonin 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 was formerly called a bunion?

Hallux valgus Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.

A patient visits an orthopedic specialist because of pain that he feels beginning in his low back and radiating behind his right thigh and down below his right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between these intervertebral disks:

L4, L5, and S1 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.

Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis?

Leukocytosis and localized bone pain Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection.

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 Hourly neurovascular assessment of the exposed fingers for the first 24 hours following surgery is essential for monitoring function of the nerves and perfusion.

A client has Paget's disease. An appropriate nursing diagnosis for this client is:

Risk for falls The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility.