Med surg. chapter 42

During a routine physical examination on a 75-year-old 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?

"After menopause, the body's bone density declines, resulting in a gradual loss of height."

A patient diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. In responding to the patient, how would the nurse best describe CTS?

"CTS is a neuropathy that is characterized by compression of the median nerve at the wrist."

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."

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."

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."

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."

A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?

0.5

Which client would the nurse identify as having the greatest risk for osteoporosis?

A small-framed, thin 45-year-old white woman

The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given?

Alendronate (Fosamax)

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?

Alkaline phosphatase

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

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

Which common problem of the upper extremity results from entrapment of the median nerve at the wrist?

Carpal tunnel syndrome

Which group is at the greatest risk for osteoporosis?

Caucasian women

A 35-year-old client is visiting a rheumatology group practice. The client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications?

Common adverse effects

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

Decreased height

Which is a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

Dupuytren's contracture

Dupuytren's contracture causes flexion of which area(s)?

Fourth and fifth fingers

The provider asks a nurse to test a patient for Tinel's sign to diagnose carpal tunnel syndrome. The nurse asked the patient to:

Hold his palm up while the nurse percussed over the median nerve.

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.

Which of the following aspects should a nurse include in the teaching plan for a patient with osteomalacia?

Include the supplements of calcium, phosphorus, and vitamin D

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?

Initiating weight-bearing exercise routines

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

Leukocytosis and localized bone pain

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.

Which of the following should be included in the teaching plan for a patient diagnosed with plantar fasciitis?

Management of plantar fasciitis includes stretching exercises.

Which of the following classic symptoms would the nurse assess for to detect the development of plantar fasciitis?

Morning heel pain

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 presents with an onset of heel pain with the first steps of the morning?

Plantar fasciitis

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

Promote pain relief and quality of life

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 is a risk-lowering strategy for osteoporosis?

Smoking cessation

Which of the following is a risk-lowering strategy for osteoporosis?

Smoking cessation

Most cases of osteomyelitis are caused by which of the following microorganisms?

Staphylococcus

A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis?

Staphylococcus aureus

The nurse advises a patient that the best position to ease low back pain is:

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees.

In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations?

Surgical debridement

Morton's neuroma is exhibited by which clinical manifestations?

Swelling of the third (lateral) branch of the median plantar nerve

Morton's neuroma is exhibited by which of the following clinical manifestations?

Swelling of the third (lateral) branch of the median plantar nerve

A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening?

Temporomandibular disorder

The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective?

The patient placed the load close to the body.

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.

Which sign may be helpful in identifying carpal tunnel syndrome?

Tinel's

A male patient with a musculoskeletal injury is instructed to alter his diet. The objective of this diet alteration is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which of the following food items should the nurse encourage the patient to include in the diet?

Vitamin D-fortified milk

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?

Walk or perform weight-bearing exercises outdoors

Which of the following are routes of administration for Calcitonin? Select all that apply.

• Nasal spray • Subcutaneous • Intramuscular injection

To help minimize calcium loss from a hospitalized client's bones, the nurse should:

encourage the client to walk in the hall.

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

Broccoli

A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit?

Observing for safety hazards that could be a fall risk

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.

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?

Lower lumbar

An older adult female has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density?

Compression fractures