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A client is having a myelography. What action by the nurse is most important?
a. Assess serum aspartate aminotransferase (AST) levels.
b. Ensure that informed consent is on the chart.
c. Position the client flat after the procedure.
d. Reinforce the dressing if it becomes saturated.

This diagnostic procedure is invasive and requires informed consent. The AST does not need to be assessed
prior to the procedure. The client is positioned with the head of the bed elevated after the test to keep the
contrast material out of the brain. The dressing should not become saturated; if it does, the nurse calls the


A client is undergoing computed tomography (CT) of a joint. What action by the nurse is most important
before the test?
a. Administer sedation as prescribed.
b. Assess for seafood or iodine allergy.
c. Ensure that the client has no metal on the body.
d. Provide preprocedure pain medication.

Because CT uses iodine-based contrast material, the nurse assesses the client for allergies to iodine or seafood
(which often contains iodine). The other actions are not needed.


A client had an arthroscopy 1 hour ago on the left knee. The nurse finds the left lower leg to be pale and
cool, with 1+/4+ pedal pulses. What action by the nurse is best?
a. Assess the neurovascular status of the right leg.
b. Document the findings in the clients chart.
c. Elevate the left leg on at least two pillows.
d. Notify the provider of the findings immediately.

The nurse should compare findings of the two legs as these findings may be normal for the client. If a
difference is observed, the nurse notifies the provider. Documentation should occur after the nurse has all the
data. Elevating the left leg will not improve perfusion if there is a problem.


A hospitalized clients strength of the upper extremities is rated at 3. What does the nurse understand about
this clients ability to perform activities of daily living (ADLs)?
a. The client is able to perform ADLs but not lift some items.
b. No difficulties are expected with ADLs.
c. The client is unable to perform ADLs alone.
d. The client would need near-total assistance with ADLs.

This rating indicates fair muscle strength with full range of motion against gravity but not resistance. The
client could complete ADLs independently unless they required lifting objects.


A client is distressed at body changes related to kyphosis. What response by the nurse is best?
a. Ask the client to explain more about these feelings.
b. Explain that these changes are irreversible.
c. Offer to help select clothes to hide the deformity.
d. Tell the client safety is more important than looks.

Assessment is the first step of the nursing process, and the nurse should begin by getting as much information
about the clients feelings as possible. Explaining that the changes are irreversible discounts the clients feelings.
Depending on the extent of the deformity, clothing will not hide it. While safety is more objectively important
than looks, the client is worried about looks and the nurse needs to address this issue.


The nurse knows that hematopoiesis occurs in what part of the musculoskeletal system?
a. Cancellous tissue
b. Collagen matrix
c. Red marrow
d. Yellow marrow

Hematopoiesis occurs in the red marrow, which is part of the cancellous tissues containing both types of bone


A nurse is providing community education about preventing traumatic musculoskeletal injuries related to car
crashes. Which group does the nurse target as the priority for this education?
a. High school football team
b. High school homeroom class
c. Middle-aged men
d. Older adult women

Young men are at highest risk for musculoskeletal injury due to trauma, especially due to motor vehicle
crashes. The high school football team, with its roster of young males, is the priority group.


A school nurse is conducting scoliosis screening. In screening the client, what technique is most
a. Bending forward from the hips
b. Sitting upright with arms outstretched
c. Walking across the room and back
d. Walking with both eyes closed

To assess for scoliosis, a spinal deformity, the student should bend forward at the hips. Standing behind the
student, the nurse looks for a lateral curve in the spine. The other actions are not correct.


The clients chart indicates genu varum. What does the nurse understand this to mean?
a. Bow-legged
b. Fluid accumulation
c. Knock-kneed
d. Spinal curvature

Genu varum is a bow-legged deformity. A fluid accumulation is an effusion. Genu valgum is knock-kneed. A
spinal curvature could be kyphosis or lordosis.


The nurse is assessing four clients with musculoskeletal disorders. The nurse should assess the client with
which laboratory result first?
a. Serum alkaline phosphatase (ALP): 108 units/L
b. Serum aspartate aminotransferase (AST): 26 units/L
c. Serum calcium: 10.2 mg/dL
d. Serum phosphorus: 2 mg/dL

A normal serum phosphorus level is 3 to 4.5 mg/dL; a level of 2 mg/dL is low, and this client should be
assessed first. The values for serum ALP, AST, and calcium are all within normal ranges.


A nursing student studying the musculoskeletal system learns about important related hormones. What
information does the student learn? (Select all that apply.)
a. A lack of vitamin D can lead to rickets.
b. Calcitonin increases serum calcium levels.
c. Estrogens stimulate osteoblastic activity.
d. Parathyroid hormone stimulates osteoclastic activity.
e. Thyroxine stimulates estrogen release.

ANS: A, C, D

Vitamin D is needed to absorb calcium and phosphorus. A deficiency of vitamin D can lead to rickets.
Estrogen stimulates osteoblastic activity. Parathyroid hormone stimulates osteoclastic activity. Calcitonin
decreases serum calcium levels when they get too high. Thyroxine increases the rate of protein synthesis in all
tissue types.


A student nurse learns about changes that occur to the musculoskeletal system due to aging. Which changes
does this include? (Select all that apply.)
a. Bone changes lead to potential safety risks.
b. Increased bone density leads to stiffness.
c. Osteoarthritis occurs due to cartilage degeneration.
d. Osteoporosis is a universal occurrence.
e. Some muscle tissue atrophy occurs with aging.

ANS: A, C, E
Many age-related changes occur in the musculoskeletal system, including decreased bone density,
degeneration of cartilage, and some degree of muscle tissue atrophy. Osteoporosis, while common, is not
universal. Bone density decreases with age, not increases.


An older clients serum calcium level is 8.7 mg/dL. What possible etiologies does the nurse consider for this
result? (Select all that apply.)
a. Good dietary intake of calcium and vitamin D
b. Normal age-related decrease in serum calcium
c. Possible occurrence of osteoporosis or osteomalacia
d. Potential for metastatic cancer or Pagets disease
e. Recent bone fracture in a healing stage

This slightly low calcium level could be an age-related decrease in serum calcium or could indicate a
metabolic bone disease such as osteoporosis or osteomalacia. A good dietary intake would be expected to
produce normal values. Metastatic cancer, Pagets disease, or healing bone fractures will elevate calcium.


When assessing gait, what features does the nurse inspect? (Select all that apply.)
a. Balance
b. Ease of stride
c. Goniometer readings
d. Length of stride
e. Steadiness

ANS: A, B, D, E
To assess gait, look at balance, ease and length of stride, and steadiness. Goniometer readings assess flexion
and extension or joint range of motion.


A client has a bone density score of 2.8. What action by the nurse is best?
a. Asking the client to complete a food diary
b. Planning to teach about bisphosphonates
c. Scheduling another scan in 2 years
d. Scheduling another scan in 6 months

A T-score from a bone density scan at or lower than 2.5 indicates osteoporosis. The nurse should plan to teach
about medications used to treat this disease. One class of such medications is bisphosphonates. A food diary is
helpful to determine if the client gets adequate calcium and vitamin D, but at this point, dietary changes will
not prevent the disease. Simply scheduling another scan will not help treat the disease either.


A nurse is assessing an older client and discovers back pain with tenderness along T2 and T3. What action
by the nurse is best?
a. Consult with the provider about an x-ray.
b. Encourage the client to use ibuprofen (Motrin).
c. Have the client perform hip range of motion.
d. Place the client in a rigid cervical collar.

Back pain with tenderness is indicative of a spinal compression fracture, which is the most common type of
osteoporotic fracture. The nurse should consult the provider about an x-ray. Motrin may be indicated but not
until there is a diagnosis. Range of motion of the hips is not related, although limited spinal range of motion
may be found with a vertebral compression fracture. Since the defect is in the thoracic spine, a cervical collar is
not needed.


A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client
admits to not doing the prescribed exercises. What action by the nurse is best?
a. Ask the client about fear of falling.
b. Instruct the client to increase calcium.
c. Suggest other exercises the client can do.
d. Tell the client to try weight lifting.

Fear of falling can limit participation in activity. The nurse should first assess if the client has this fear and then
offer suggestions for dealing with it. The client may or may not need extra calcium, other exercises, or weight


The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good
a. Client with diabetes who has a serum creatinine of 0.8 mg/dL
b. Client who recently fell and has vertebral compression fractures
c. Hypertensive client who takes calcium channel blockers
d. Client with a spinal cord injury who cannot tolerate sitting up

Clients on bisphosphonates must be able to sit upright for 30 to 60 minutes after taking them. The client who
cannot tolerate sitting up is not a good candidate for this class of drug. Poor renal function also makes clients
bad candidates for this drug, but the client with a creatinine of 0.8 mg/dL is within normal range. Diabetes and
hypertension are not related unless the client also has renal disease. The client who recently fell and sustained
fractures is a good candidate for this drug if the fractures are related to osteoporosis.


A client has been prescribed denosumab (Prolia). What instruction about this drug is most appropriate?
a. Drink at least 8 ounces of water with it.
b. Make appointments to come get your shot.
c. Sit upright for 30 to 60 minutes after taking it.
d. Take the drug on an empty stomach.

Denosumab is given by subcutaneous injection twice a year. The client does not need to drink 8 ounces of
water with this medication as it is not taken orally. The client does not need to remain upright for 30 to 60
minutes after taking this medication, nor does the client need to take the drug on an empty stomach.


A client in a nursing home refuses to take medications. She is at high risk for osteomalacia. What action by
the nurse is best?
a. Ensure the client gets 15 minutes of sun exposure daily.
b. Give the client daily vitamin D injections.
c. Hide vitamin D supplements in favorite foods.
d. Plan to serve foods naturally high in vitamin D.

Sunlight is a good source of vitamin D, and the nursing staff can ensure some sun exposure each day. Vitamin
D is not given by injection. Hiding the supplement in food is unethical. Very few foods are naturally high in
vitamin D, but some are supplemented.


A client is in the internal medicine clinic reporting bone pain. The clients alkaline phosphatase level is 180
units/L. What action by the nurse is most appropriate?
a. Assess the client for leg bowing.
b. Facilitate an oncology workup.
c. Instruct the client on fluid restrictions.
d. Teach the client about ibuprofen (Motrin).

This client has manifestations of Pagets disease. The nurse should assess for other manifestations such as
bowing of the legs. Other care measures can be instituted once the client has a confirmed diagnosis.


An older client with diabetes is admitted with a heavily draining leg wound. The clients white blood cell
count is 38,000/mm3 but the client is afebrile. What action does the nurse take first?
a. Administer acetaminophen (Tylenol).
b. Educate the client on amputation.
c. Place the client on contact isolation.
d. Refer the client to the wound care nurse.

In the presence of a heavily draining wound, the nurse should place the client on contact isolation. If the client
has discomfort, acetaminophen can be used, but this client has not reported pain and is afebrile. The client may
or may not need an amputation in the future. The wound care nurse may be consulted, but not as the first


A nurse is caring for four clients. After the hand-off report, which client does the nurse see first?
a. Client with osteoporosis and a white blood cell count of 27,000/mm3
b. Client with osteoporosis and a bone fracture who requests pain medication
c. Post-microvascular bone transfer client whose distal leg is cool and pale
d. Client with suspected bone tumor who just returned from having a spinal CT

This client is the priority because the assessment findings indicate a critical lack of perfusion. A high white
blood cell count is an expected finding for the client with osteoporosis. The client requesting pain medication
should be seen second. The client who just returned from a CT scan is stable and needs no specific
postprocedure care.


A client has a metastatic bone tumor. What action by the nurse takes priority?
a. Administer pain medication as prescribed.
b. Elevate the extremity and apply moist heat.
c. Handle the affected extremity with caution.
d. Place the client on protective precautions.

Bones invaded by tumors are very fragile and fracture easily. For client safety, the nurse handles the affected
extremity with great care. Pain medication should be given to control pain. Elevation and heat may or may not
be helpful. Protective precautions are not needed for this client.


A hospitalized client is being treated for Ewings sarcoma. What action by the nurse is most important?
a. Assessing and treating the client for pain as needed
b. Educating the client on the disease and its treatment
c. Handling and disposing of chemotherapeutic agents per policy
d. Providing emotional support for the client and family

All actions are appropriate for this client. However, for safety, the nurse should place priority on proper
handling and disposal of chemotherapeutic agents.


A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the
clients psychosocial needs?
a. Assess the clients coping skills and support systems.
b. Explain that the surgery leads to a longer life expectancy.
c. Refer the client to the social worker or hospital chaplain.
d. Reinforce physical therapy to aid with ambulating normally.

The first step in the nursing process is assessment. The nurse should assess coping skills and possible support
systems that will be helpful in this clients treatment. Explaining that a limb salvage procedure will extend life
does not address the clients psychosocial needs. Referrals may be necessary, but the nurse should assess first.
Reinforcing physical therapy is also helpful but again does not address the psychosocial needs of the client.


A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What
explanation by the nurse is best?
a. Your feet have less blood flow, so healing is slower.
b. The bones in your feet are hard to operate on.
c. The surrounding bones and tissue are damaged.
d. Your feet bear weight so they never really heal.

The feet are the most distal to the heart and receive less blood flow than other organs and tissues, prolonging
the healing time after surgery. The other explanations are not correct.


A client has scoliosis with a 65-degree curve to the spine. What action by the nurse takes priority?
a. Allow the client to rest in a position of comfort.
b. Assess the clients cardiac and respiratory systems.
c. Assist the client with ambulating and position changes.
d. Position the client on one side propped with pillows.

This degree of curvature of the spine affects cardiac and respiratory function. The nurses priority is to assess
those systems. Positioning is up to the client. The client may or may not need assistance with movement.


A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first?
a. Client taking calcium with vitamin D (Os-Cal) who reports flank pain 2 weeks ago
b. Client taking ibandronate (Boniva) who cannot remember when the last dose was
c. Client taking raloxifene (Evista) who reports unilateral calf swelling
d. Client taking risedronate (Actonel) who reports occasional dyspepsia

The client on raloxifene needs to be seen first because of the manifestations of deep vein thrombosis, which is
an adverse effect of raloxifene. The client with flank pain may have had a kidney stone but is not acutely ill
now. The client who cannot remember taking the last dose of ibandronate can be seen last. The client on
risedronate may need to change medications.


What information does the nurse teach a womens group about osteoporosis?
a. For 5 years after menopause you lose 2% of bone mass yearly.
b. Men actually have higher rates of the disease but are underdiagnosed.
c. There is no way to prevent or slow osteoporosis after menopause.
d. Women and men have an equal chance of getting osteoporosis.

For the first 5 years after menopause, women lose about 2% of their bone mass each year. Men have a slower
loss of bone after the age of 75. Many treatments are now available for women to slow osteoporosis after