Nursing Management: Patients With Musculoskeletal Disorders
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
Which is a risk-lowering strategy for osteoporosis?
Smoking cessation
In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?
Surgical debridement
Morton neuroma is exhibited by which clinical manifestation?
Swelling of the third (lateral) branch of the median plantar nerve
A client with a musculoskeletal injury is instructed to alter the diet. The objective of altering the diet is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which food item should the nurse encourage the client to include in the diet?
Vitamin D-fortified milk
Which is not a risk factor for osteoporosis?
being male
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.
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 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 factory worker has approached the occupational health nurse with complaints of numbness and night pain in his dominant hand and wrist. Based on these complaints and the nature of worker's tasks in the factory, the nurse suspects carpal tunnel syndrome. The nurse should recommend that the worker:
Avoid flexing his wrist repeatedly.
Which of the following inhibits bone resorption and promotes bone formation?
Calcitonin
Which group is at the greatest risk for osteoporosis?
Caucasian women
A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder?
Chlorpheniramine
The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as?
Corn
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
What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years?
Decreased height
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
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.
A client is informed that he has 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
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder?
Paget disease
Which term refers to a disease of a nerve root?
Radiculopathy
Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women?
Raloxifene
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 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 Caucasian woman who has low body mass index
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?
Alkaline phosphatase
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)?
Calcitonin
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
Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?
Dupuytren's contracture
A 42-year-old man presents at the clinic complaining of pain in his heel so bad it inhibits his ability to walk. The patient is diagnosed with plantar fasciitis. Patient teaching provided by the nurse would include what instructions to decrease the pain associated with this condition?
Gently stretching the foot and the Achilles tendon
In which deformity does the great toe deviate laterally?
Hallux valgus
Which of the following was formerly called a bunion?
Hallux valgus
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
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 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 planning the care of a middle-aged female patient whose sedentary 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?
Weight loss
A client is scheduled for surgery to fuse a joint. The nurse identifies this as which of the following?
Arthrodesis
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?
Initiating weight-bearing exercise routines
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
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.
During a routine physical examination on an older 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."
Health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. Select the daily dosage of calcium and vitamin D that the nurse should recommend.
1,200 mg; 1,000 IU
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 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?
An elderly patient with an infected pressure ulcer in the sacral area
A nurse caring for a patient with Paget's disease is analyzing the patient's laboratory values. Which of the following values is most often seen in a patient with Paget's disease?
An elevated serum alkaline phosphatase level and a normal serum calcium level
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
What food can the nurse suggest to the client at risk for osteoporosis?
Broccoli
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
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
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 nurse notices a client lying on the floor at the bottom of the stairs. The client is alert and oriented and denies pain other than in the arm, which is swollen and appears deformed. After calling for help, what should the nurse do?
Immobilize the client's arm.
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 of the following is the most common and most fatal primary malignant bone tumor?
Osteogenic sarcoma (osteosarcoma)
A 49-year-old man with a history of poorly controlled type 1 diabetes has developed osteomyelitis adjacent to a chronic diabetic ulcer on his great toe. The patient has been informed that medical treatment for osteomyelitis requires a longer course of antibiotics than most other infections because:
Osteomyelitis involves the active infection of bone tissue, which is largely avascular.
Which of the following are clinical manifestations of impingement syndrome? Select all that apply.
Pain Shoulder tenderness Limited movement Muscle spasms Atrophy
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
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 caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client? Select all that apply.
The client will experience a tolerable level of pain. The client will demonstrate wound care. The client will maintain adequate nutritional intake.
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
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?
Lower lumbar
