The Point: Ch. 35 & 36

6. While reading a client's chart, the nurse notices that the client is documented to have paresthesia. The nurse plans care for a client with A. abnormal sensations B. involuntary twitch of muscle fibers C. absence of muscle movement suggesting nerve damage D. absence of muscle tone

A. Rationale: Abnormal sensations, such as burning, tingling, and numbness, are referred to as paresthesias. The absence of muscle tone suggesting nerve damage is referred to as paralysis. A fasciculation is the involuntary twitch of muscle fibers. A muscle that holds no tone is referred to as flaccid

33. The nurse is reading the admission note for a client with a bone fracture that requires surgery. The note indicates the presence of crepitus. The nurse interprets this as being A. a crackling sound B. a closed fracture C. ecchymosis D. bleeding

A. Rationale: Crepitus is a sound or sensation elicited by fragments of bone rubbing together, as in a fracture or in irregular joint surfaces. The sound/sensation can be described as "grating" or "crackling."

13. Fracture healing occurs in four areas, including the A. external soft tissue B. cartilage C. bursae D. fascia

A. Rationale: Fracture healing occurs in four areas, including the bone marrow, bone cortex, periosteum, and the external soft tissue, where a bridging callus (fibrous tissue) stabilizes the fracture. Cartilage is special tissue at the ends of bone. The bursae are fluid-filled sacs found in connective tissue, usually in the area of joints. Fascia is fibrous tissue that covers, supports, and separates muscles.

23. The nurse is conducting a community education program on hip fracture risk. The nurse evaluates that the participants understand the program when the participants determine that client at highest risk for a hip fracture is a(n) A. 80-year-old man recently widowed B. high school athlete C. 30-year-old pregnant woman D. toddler just starting to walk

A. Rationale: Hip fracture occurs with greater incidence in elderly people and is often a life-altering event that has a negative impact on the client's mobility and quality of life.

28. Which term refers to the shaft of the long bone? A. Diaphysis B. Epiphysis C. Scoliosis D. Lordosis

A. Rationale: The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone. Lordosis refers to an increase in lumbar curvature of spine. Scoliosis refers to lateral curving of the spine

22. 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? A. "We need an adequate amount of exposure to sunshine." B. "We need to consume a low-calcium, high-phosphorus diet." C. "We need to increase aerobic exercise." D. "Estrogen deficiency increases bone density."

A. Rationale: The only accurate statement is related to getting an adequate amount of exposure to sunshine. Aerobic exercise, such as swimming, does not prevent osteoporosis. The exercise needs to be weight bearing. A diet low in calcium and high in phosphorus will increase the risk for osteoporosis. Estrogen deficiency is linked to decreased bone mass.

35. The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding? A. tear in the joint capsule B. decreased bone density C. injury to the radial nerve D. fracture of the clavicle

A. Rationale: Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. X-rays are used to diagnose bone fractures. Bone densitometry is used to estimate bone mineral density. An electromyogram (EMG) provides information about the electrical potential of the muscles and nerves leading to them.

32. Which is an indicator of neurovascular compromise? A. Capillary refill of more than 3 seconds B. Pain upon active stretch C. Diminished pain D. Warm skin temperature

A. Rationale: Capillary refill of more than 3 seconds is an indicator of neurovascular compromise. Other indicators include cool skin temperature, pale or cyanotic color, weakness, paralysis, paresthesia, unrelenting pain, pain upon passive stretch, and absence of feeling. Cool skin temperature is an indicator of neurovascular compromise. Unrelenting pain is an indicator of neurovascular compromise. Pain upon passive stretch is an indicator of neurovascular compromise

1. Which term refers to muscle tension being unchanged with muscle shortening and joint motion? A. Isotonic contraction B. Isometric contraction C. Fasciculation D. Contracture

A. Rationale: Exercises such as swimming and cycling are isotonic. Isotonic contraction is when a muscle is shortened without a change in its tension. Isometric contraction is characterized by increased muscle tension, unchanged muscle length, and no joint motion. Contracture refers to abnormal shortening of the muscle, joint, or both Fasciculation refers to the involuntary twitch of muscle fibers

19. The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as A. Hallux valgus B. Pes cavus C. Hammertoe D. Flatfoot

A. Rationale: Hallux valgus is commonly referred to as a bunion. Hammertoes are usually pulled upward. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. The client with flatfoot demonstrates a diminished longitudinal arch of the foot.

30. Morton neuroma is exhibited by which clinical manifestation? A. Swelling of the third (lateral) branch of the median plantar nerve B. Longitudinal arch of the foot is diminished C. High arm and a fixed equinus deformity D. Inflammation of the foot-supporting fascia

A. Rationale: Morton neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a gummon disorder in which the longitudinal arch of the foot is diminished. Plantar fascitis is an inflammation of the foot-supporting fascia.

27. Which is a risk-lowering strategy for osteoporosis? A. Smoking cessation B. Diet low in calcium and vitamin D C. Increased age D. Low initial bone mass

A. Rationale: 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. Submit

33. A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate? A. "You may need to be evaluated for an underlying cause, such as renal failure" B. "You will need to engage in vigorous exercise three times a week for 30 minutes." C."You will need to avoid foods high in phosphorus and vitamin D" D. "You will need to decrease the amount of dairy products you consume

A. Rationale: The client may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The client needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The client is at risk for pathological fractures and therefore should not engage in vigorous exercise.

2. 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? A. denosumab B. alendronate C. raloxifene D. teriparatide

B. Rationale: Alendronate is a bisphosphonate medication. Raloxifene is a selective estrogen receptor modulator. Teriparatide is an anabolic agent, and denosumab is a monocional antibody agent.

34. The homecare nurse is evaluating the musculoskeletal system of a geriatric client whose previous assessment was within normal limits. The nurse initiates a call to the health care provider and/or emergency services when which change is found? A. increased joint stiffness B. decreased right-sided C. decreased flexibility D. decreased agility

B. Rationale: Although symmetrical decreases in muscle strength can be a part of the aging process, asymmetrical decreases are not. The nurse should contact the health care provider when decreased right-sided muscle strength is found, as this could indicate a stroke or transient ischemic attack. Decreased flexibility, decreased agility, and increased joint stiffness are all part of the aging process and therefore do not require the nurse to contact the health care provider.

5. Which common problem of the upper extremity results from entrapment of the median nerve at the wrist? A. Impingement syndrom B. Carpel tunnel syndrome C. Dupuytren contracture D. Ganglion

B. Rationale: Carpal tunnel syndrome is commonly due to repetitive hand activities. A ganglion is a collection of gelatinous material near the tendon sheaths and joints that appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. Dupuytren contracture is a slowly progressive contracture of the palmar fascia. Impingement syndrome is associated with the shoulder and may progress to a rotator cuff tear.

3. Which common problem of the upper extremity results from entrapment of the median nerve at the wrist? A. Dupuytren's contracture B. Carpel tunnel syndrome C. Impringement syndrome D. Ganglion

B. Rationale: Carpal tunnel syndrome is commonly due to repetitive hand activities. A ganglion is a collection of gelatinous material near the tendon sheaths and joints that appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. Dupuytren's contracture is a slowly progressive contracture of the palmar fascia. Impingement syndrome is associated with the shoulder and may progress to a rotator cuff tear.

11. Duputren's contracture causes flexion of which area(s)? A. Thumb B. Fourth and fifth fingers C. Ring finger D. Index and middle fingers

B. Rationale: Dupuytren's contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.

27. The nurse is assessing the muscle tone of a client with cerebral palsy. Which description does the nurse determine to be an expected assessment of this client's muscle tone? A. Flaccid B. Hypertonic C. Atonic D. Atrophied

B. Rationale: In clients with conditions characterized by upper motor neuron destruction, as in cerebral palsy, the muscles are often hypertonic. However, in conditions with lower motor neuron destruction, the muscles become atonic, atrophied, and/or flaccid.

22. Which is a circulatory indicator of peripheral neurovascular dysfunction? A. paralysis B. cool skin C. weakness D. paresthesia

B. Rationale: Indicators of peripheral neurovascular dysfunction related to circulation include pale, cyanotic, or mottled skin with a cool temperature. The capillary refill is more than 3 seconds. Weakness and paralysis are related to motion. Paresthesia is related to sensation

18. Which statement reflects the progress of bone healing? A. The age of the client influences the rate of fracture healing. B. Serial x-rays are used to monitor the progress of bone healing. C. Adequate immobilization is essential until ultrasound shows evidence of bone formation with ossification. D. All fracture healing takes place at the same rate no matter the type of bone fractured

B. Rationale: Serial x-rays are used to monitor the progress of bone healing. The type of bone fractured, the adequacy of blood supply, the surface contact of the fragments, and the general health of the client influence the rate of fracture healing. Adequate immobilization is essential until x-ray shows evidence of bone formation with ossification.

2. Which laboratory study indicates the rate of bone turnover? A. Serum phosphorus B. Serum osteocalcin C. Urine calcium D. Serum calcium

B. Rationale: Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Urine calcium concentration increases with bone destruction. Serum calcium concentration is altered in clients with osteomalacia and parathyroid dysfunction. Serum phosphorous concentration is inversely related to calcium concentration and is diminished in osteomalacia associated with malabsorption syndrome

21. The nurse is conducting a musculoskeletal assessment on a client documented to have rheumatoid arthritis. Which would the nurse anticipate finding when inspecting the client's fingers? A. Hard nodules of bony overgrowth B. Soft, subcutaneous nodules along the tendons C. Soft nodules along the palmar surface D. Hard nodules adjacent to the joints

B. Rationale: The subcutaneous nodules of rheumatoid arthritis are soft and occur within and along tendons that provide extensor function to the joints. The nodules of gout are hard and lie within and immediately adjacent to the joint capsule itself. Osteoarthritic nodules are hard and painless and represent bony overgrowth that results from destruction of the cartilaginous surface of bone within the joint capsule.

4. Which term refers to a disease of a nerve root? A. involucrum B. radiculopathy C. sequestrum D. contracture

B. Rationale: 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.

10. 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? A. Ensure adequate intake of vitamin D in the diet B. Have the client sit upright for at least 30 minutes following administration C. Encourage the client to get yearly dental exams D. Assess for the use of corticosteroids

B. Rationale: While all interventions are appropriate, the highest priority is having the client sit upright for 60 minutes following administration of the medication. This will prevent irritation and potential ulceratioof the esophagus. The client should have adequate intake of vitamin D and obtain yearly dental exams. The concurrent use of corticosteroids and alendronate is link to a complication of osteonecrosis.

30. What is the term for a rhythmic contraction of a muscle? A. Hypertrophy B. Clonus C. Atrophy D. Crepitus

B. Rationale: Clonus is a rhythmic contraction of the muscle. Atrophy is a shrinkage-like decrease in the size of a muscle. Hypertrophy is an increase in the size of a muscle. epitus is a grating or crackling sound or sensation that may occur with movement of ends of a broken bone or irregular joint surface

14. What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? A. Hammertoe B. Dupuytren contracture C. Callus D. Hallux valgus

B. Rationale: 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 interphalangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally.

7. When teaching a client how to prevent low back pain as a result of lifting, the nurse should instruct the client to: A. place the load away from the body. B. avoid overreaching. C. use a narrow base of support. D. bend the knees and loosen the abdominal muscles.

B. Rationale: Instructions for the client with low back pain should include that, when lifting, the client should avoid overreaching. The client should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back

9. Which should be included in the teaching plan for a client diagnosed with plantar fasciitis? A. The pain of plantar fascitis diminishes with warm water soaks. B. Management of plantar fasciitis includes stretching exercises. C. Complications of plantar fascitis include neuromuscular damage and decreased ankle range of motion. D. Plantar fasciitis presents as acute-onset pain localized to the ball of the foot that occurs when pressure is placed on it and diminishes when pressure is released.

B. Rationale: Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (e.g., heel cups, arch supports), and the use of nonsteroidal anti-inflammatory drugs. Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as acute-onset heel pain experienced upon taking the first steps in the morning. The pain Is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs.

31.

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

16. The nurse is educating a client on home care following removal of a ganglion cyst from the right wrist. Which statement by the client demonstrates that the nurse's teaching has been effective? A. "I will notify my doctor if I develop redness and purulent drainage for 2 days." B. "I will leave the dressing on until I follow up with my doctor as scheduled." C. "If my pain is not relieved I will use a heat pack and take some more medication." D. "If my hand becomes numb and cool I will elevate it above my heart."

B. Rationale: The first dressing is changed by the surgeon at a scheduled follow-up appointment. If the hand becomes cool and numb, the client needs to call the surgeon as soon as possible. The surgeon should be notified immediately if redness and purulent drainage develop. Medication should only be used as prescribed. The use of heat may increase swelling, which may increase pain

3. Which term refers to moving away from midline? A. Eversion B. Abduction C. Adduction D. Inversion

C. Rationale: Abduction is moving away from the midline. Adduction is moving toward the midline. Inversion is turning inward. Eversion is turning outward

15. Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist? A. EMG B. Bone densitometry C. Arthrography D. Meniscography

C. Rationale: Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. Meniscography is a distractor for this question. Bone densitometry is used to estimate bone mineral density. An MG provides information about the electrical potential of the muscles and nerves leading to them.

19. Which nerve is assessed when the nurse asks the client to spread all fingers? A. Median B. Radial C. Ulnar D. Peroneal

C. Rationale: Asking the client to spread all fingers allows the nurse to assess motor function affected by ulnar innervation, while pricking the fat pad at the top of the small finger allows assessment of the sensory function affected by the ulnar nerve. The peroneal nerve is assessed by asking the client to dorsiflex the ankle and to extend the toes. The radial nerve is assessed by asking the client to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints. The median nerve is assessed by asking the client to touch the thumb to the little finger.

24. Which hormone inhibits bone reabsorption and increases calcium deposit in the bone? A. Growth hormone B. Sex hormones C. Calcitonin D. Vitamin D

C. Rationale: Calcitonin, secreted by the thyroid gland in response to elevated blood calcium concentration, inhibits bone reabsorption and increases the deposit of calcium in the bone. The other answers do not apply.

5. After bone fracture, fibrocartilaginous callus formation normally occurs at the same time as which process? A. remodeling B. hematoma formation C. fibroblast migration D. inflammation

C. Rationale: Fibrocartilaginous callus formation occurs as fibroblasts and osteoblasts migrate into the fracture site, where they begin to reconstruct the bone; the bone is not yet able to bear weight at the end of this phase. Next, mature bone replaces the fibrocartilaginous callus. Together these processes are sometimes referred to as the reparative stage. Inflammation and hematoma formation occur in the days immediately after the fracture, as macrophages invade and debride the fracture area. Remodeling is the final stage of fracture repair, during which the new bone is reorganized into the bone's former structural arrangement

26. The nurse is evaluating a client's peripheral neurovascular status. Which would the nurse report to the health care provider as a circulatory indicator of peripht neurovascular dysfunction? A. paralysis B. weakness C. cool skin D. paresthesia

C. Rationale: Indicators of peripheral neurovascular dysfunction related to circulation include pale, cyanotic, or mottled skin with a cool temperature. The capillary refill is more than 3 seconds. Weakness and paralysis are related to motion. Paresthesia is related to sensation.

9. The nurse is caring for a client scheduled to have magnetic resonance imaging (MRI). The nurse contacts the health care provider to cancel the MRI when the nurse reads which element in the client's medical history? A. Tumor removal B. Skin graft C. Cochlear implant D. Colostomy

C. Rationale: Nonremovable cochlear devices can become inoperable when exposed to MRI. Therefore, it is contraindicated for a client with a cochlear implant to have an MRI. Also, transdermal patches (e.g., nicotine patch, nitroglycerin transdermal, scopolamine transdermal, clonidine transdermal) that have a thin layer of aluminized backing must be removed before MRI because they can cause burns. The primary provider should be notified before the patches are removed. Additionally, the client should remove all jewelry, hair clips, hearing aids, credit cards with magnetic strips, and other objects containing metal; otherwise, these objects can become dangerous projectiles or cause burns.

8. Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes? A. Median B. Ulnar C. Peroneal D. Radial

C. Rationale: The motor function of the peroneal nerve is assessed by asking the client to dorsiflex the ankle and to extend the toes, while pricking the skin between the great toe and center toe assesses sensory function. The radial nerve is assessed by asking the client to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints. The median nerve is assessed by asking the client to touch the thumb to the little finger. Asking the client to spread all fingers allows the nurse to assess motor function affected by ulnar innervation.

8. Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)? A. Vitamin D B. Raloxifene C. Calcitonin D. Teriparatide

C. Rationale: 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

18. In which deformity does the great toe deviate laterally? A. Plantar fasciitis B. Pes cavus C. Hallux valgus D. Hammertoe

C. Rationale: Hallux valgus is a deformity in which the great toe deviates laterally. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Pes cavus refers to a foot with an abnormally high arch and a fixed equines deformity of the forefoot. Plantar fascitis is an inflammation of the foot-supporting fascia.

17. In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? A. Vitamin supplements B. Wound packing C. Surgical debridement D. Wound irrigation

C. Rationale: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.

13. Lifestyle risk factors for osteoporosis include A. a low-protein, high fat diet. B. an estrogen deficiency or menopause. C. lack of exposure to sunshine. D. lack of aerobic exercise

C. Rationale: Lifestyle risk factors for osteoporosis include lack of exposure to sunshine, a diet low in calcium and vitamin D, cigarette smoking, consumption of alcohol and/or caffeine, and lack of weight-bearing exercise. Lack of weight-bearing exercise, not aerobic exercise, is a lifestyle risk factor for osteoporosis. A diet low in calcium and vitamin D, not a low-protein, high-fat diet, is a lifestyle risk factor for osteoporosis. An estrogen deficiency or menopause is an individual risk factor for osteoporosis. Other individual risk factors include female gender, non-Hispanic white or Asian race, increased age, low weight and body mass index, family history of osteoporosis, low initial bone mass, and contributing coexisting medical conditions and medications.

28. Which should be included in the teaching plan for a client diagnosed with plantar fasciitis? A. Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion. B.Plantar fasciitis presents as an acute onset of pain localized to the ball of the foot. C. Management of plantar fasciitis includes stretching exercises. D. The pain of plantar fasciitis diminishes with soaking the foot in warm water.

C. Rationale: Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (e.g., heel cups, arch supports), and using nonsteroidal anti-inflammatory drugs. Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced upon taking the first steps in the morning. The pain is Wcalized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs

29. The majority of bone infections are caused by which organism? A. Proteus B. Pseudomonas C. Staphylococcus aureus

C. Rationale: Over 50% of bone infections are caused by Staphylococcus aureus.

15. The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? A. Increase fiber in the diet B. Decrease the intake of vitamins A and D C. Walk or perform weight-bearing exercises D. Reduce stress

C. Rationale: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, quitting smoking, and consuming alcohol and caffeine in moderation

24. Which is a strategy for lowering risk for osteoporosis? A. Low initial bone mass B. Increased age C. Smoking cessation D. Diet low in calcium and vitamin D

C. Rationale: 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.

32. Most cases of osteomvelitis are caused by which microorganism? A. Escherichia coll B. Pseudomonas species C. Staphylococcus aureus D. Proteys species

C. Rationale: Staphylococcus aureus causes 70% to 80% of bone infections. Proteus species, Pseudomonas species, and E. coli are frequently found in osteomyelitis, they do not cause the majority of bone infections

29. Which body movement involves moving toward the midline? A. Abduction B. Eversion C. Adduction D. Pronation

C. Rationale:Adduction is moving toward the midline. Pronation is turning inward. Abduction is moving away from the midline. Eversion is turning outward.

21. A client diagnosed with osteoporosis is being discharged home. Which priority education should the nurse should provide? A. Increase calcium and vitamin D in the diet B. Participate in weight-bearing exercises C. Classify medications D. Remove all small rugs from the home

D. Rationale: A client with osteoporosis is at risk for fractures related to falls. The home environment needs to be evaluated for safety issues, such as rugs and other objects that could cause a fall. All other education is important in educating the client, but the risk for injury from a fall and potential for a fracture makes safety in the home environment a priority. Submit Quiz Clear Response

14. Which hormone inhibits bone resorption and increases the deposit of calcium in the bone? A. Vitamin D B. Sex hormones C. Growth hormone D. Calcitonin

D. Rationale: Calcitonin, secreted by the thyroid gland in response to elevated blood calcium levels, inhibits bone reabsorption and increases the deposit of calcium in the bone

20. Which is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes? A. Hypertrophy B. Fasciculation C. Remodeling D. Compartment syndrome

D. Rationale: Compartment syndrome is caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes. Remodeling is a process that ensures bone maintenance through simultaneous bone resorption and formation. Hypertrophy is an increase in muscle size. Fasciculation is the involuntary twitch of muscle fibers

11. Which term refers to a grating or crackling sound or sensation? A. Fasciculation B. Callus C. Clonus D. Crepitus

D. Rationale: Crepitus may occur with movement of the ends of a broken bone or irregular joint surface. Callus is fibrous tissue that forms at the fracture site. Clonus refers to thmic contraction of muscle. Fasciculation refers to the involuntary twitch of muscle fibers.

26. Dupuytren contracture causes flexion of which area(s)? A. Index and middle fingers B. Ring finger C. Thumb D. Fourth and fifth fingers

D. Rationale: Duputren contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.

12. The nurse is performing a musculoskeletal assessment of a client in a nursing home who had a stroke 2 years ago and who has right-sided hemiplegia. The nurse notes that the girth of the client's right calf is 2 inches less in diameter than the left calf. The nurse attributes the decreased girth to A. bruising in right lower extremity B. edema in left lower extremity C. increased use of left calf muscle D. atrophy of right calf muscle

D. Rationale: Girth of an extremity may increase as a result of exercise, edema, or bleeding into the muscle. However, a client with right-sided hemiplegia is unable to use the right lower extremity. This client may experience atrophy of the muscles from lack of use, which results in a subsequent decrease in the girth of the calf muscle

23. The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as which condition? A. Hammertoe B. Flatfoot C. Pes cavus D. Hallux valgus

D. Rationale: Hallux valgus is commonly referred to as a bunion. Hammertoes are usually pulled upward. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefnot. The client with flatfoot demonstrates a diminished longitudinal arch of the foot.

10. The nurse is conducting a musculoskeletal assessment of a client in a nursing home. The client is unable to dorsiflex the right foot or extend the toes. The nurse evaluates this finding as an injury to which nerve? A. Achilles B. Femoral C. Sciatic D. Peroneal

D. Rationale: Injury to the peroneal nerve as a result of pressure may cause foot drop or the inability to dorsiflex the foot and extend the toes.

31. Which term refers to mature compact bone structures that form concentric rings of bone matrix? A. cancellous bone B. endosteum C. trabecula D. lamellae

D. Rationale: Lamellae are mineralized bone matrices. Endosteum refers to the marrow cavity lining of hollow bone. Trabecula refers to latticelike bone structure. Cancellous bone refers to spongy, latticelike bone structure.

16. The nurse is assessing a young client during an annual sports physical at school. The assessment reveals that the client has lateral curving of the spine. The nurse reports to the health care professional that the assessment revealed A. diaphysis B. eiphysis C. lordosis D. scoliosis

D. Rationale: Scoliosis is a lateral curvature of the spine. Lordosis is an increase in the lumbar curvature of the spine. Diaphysis is the shaft of a long bone. Epiphysis is the end of a long bone.

25. Which description refers to an osteon? A. Bone resorption cell B. Bone-forming cell C. Mature bone cell D. Microscopic functional bone unit

D. Rationale: The center of an osteon contains a capillary, a microscopic functional bone unit. An osteoblast is a bone-forming cell. An osteoclast is a bone resorption cell. An osteocyte is a mature bone cell.

4. The nurse working in the emergency department receives a call from the x-ray department communicating that the client the nurse is caring for has a fracture in the shaft of the tibia. The nurse tells the physician that the client's fracture is in the A. lordosis B. scoliosis C. epiphysis D. diaphysis

D. Rationale: The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone. Lordosis refers to an increase in lumbar curvature of spine. Scoliosis refers to lateral curving of the spine.

17. An example of a flat bone is the A. metacarpals B. vertebra C. femur D. sternum

D. Rationale:An example of a flat bone is the sternum. A short bone is a metacarpal. The femur is a long bone. The vertebra is an irregular bone.

6. 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? A. wound packing B. vitamin supplements C. wound irrigation D. surgical debridement

D. Rationale: In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.

25. 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 A. bends at the hips and tightens the abdominal muscles. B. reaches over the head with the arms fully extended. C. uses a narrow base of support. D. places the load close to the body.

D. Rationale: Instructions for the client with low back pain should include that, when lifting, the client should avoid overreaching. The client should also keep the load close to the body, bend the knees, and tighten the abdominal muscles; use a wide base of support and use a back brace to protect the back. Bending at the hips increases the strain on the back musclewwhen lifting.

12. Morton neuroma is exhibited by which clinical manifestation? A. Dimipishment of the longitudinal arch of the foot B. Inflammation of the foot-supporting fascia C. High arm and a fixed equinus deformity D. Swelling of the third (lateral) branch of the median plantar nerve

D. Rationale: Morton neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a commoh disorder in which the longitudinal arch of the foot is diminished. Plantar fascitis is an inflammation of the foot-supporting fascia

1. Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? A. Osteoporosis B. Osteomalacia C. Osteomyelitis D. Osteitis deformans

D. Rationale: Osteitis deformans (Paget disease) results in bone that is highly vascularized and structurally weak, predisposing to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from the extension of a soft-tissue infection, direct bone contamination, or hematogenous spread.

20. 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? A. Administering the raloxifene in the evening B. Administering the raloxifene with food or milk C. Having the patient sit upright for 30-60 minutes following administration D. Holding the raloxifene and notifying the physician

D. Rationale: 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.

7. Skull sutures are an example of which type of joint? A. Amphiarthrosis B. Diarthrosis C. Aponeuroses D. Synarthrosis

D. Rationale: Skull sutures are considered synarthrosis joints and are immovable Amphiarthrosis joints allow limited movement, such as a vertebral joint. Diarthrosis joints are freely movable joints such as the hip and shoulder. Aponeuroses are broad, flat sheets of connective tissue.

34. A client with a musculoskeletal injury is instructed to increase dietary calcium. Which statement by the nurse is appropriate? A. "You need to increase the amount of red meat in your diet." B. "You need to increase the amount of non-citrus fruits in your diet." C. "You need to increase the amount of phosphorus in your diet." D. "You need to increase the amount of vitamin D in your diet."

D. Rationale: Vitamin D is needed for the absorption of calcium. Although fruits containing vitamin C assist in the absorption of calcium, non-citrus fruits are of little benefit for calcium absorption. Increasing phosphorus in the diet can cause calcium to be lost from the bone, decreasing bone density. Red meat does not facilitate calcium absorption