Lewis Chapter 66: Musculoskeletal Conditions Flashcards
The nurse is teaching a client with osteopenia. What is important to include in the teaching plan?
a. Lose weight.
b. Stop smoking.
c. Eat a high-protein diet.
d. Start swimming for exercise.
What is the primary nursing responsibility in caring for a client with a suspected disc herniation who is experiencing acute pain and muscle spasms?
a. Encourage total bed rest for several days.
b. Teach the principles of back-strengthening exercises.
c. Stress the importance of straight-leg raises to decrease pain.
d. Promote the use of cold and hot compresses and pain medication.
When caring for a client after a spinal fusion, which of the following symptoms would the nurse immediately report to the physician?
a. The client experiences a single episode of emesis.
b. The client is unable to move the lower extremities.
c. The client is nauseated and has not voided in 4 hours.
d. The client reports pain at the bone graft donor site.
What instructions should the nurse give the client who is being discharged from same-day surgery after surgical correction of bilateral hallux valgus?
a. Rest frequently, with the feet elevated.
b. Soak the feet in warm water several times a day.
c. Expect the feet to be numb for several days postoperatively.
d. Expect continued pain in the feet, since this is not uncommon.
A client has been diagnosed with osteosarcoma of the humerus. Which of the following statements would indicate that he has an understanding of his treatment options?
a. “I accept that I have to lose my arm with surgery.”
b. “The chemotherapy before surgery will shrink the tumour.”
c. “This tumour is related to the melanoma I had 3 years ago.”
d. “I’m glad they can take out the cancer with such a small scar.”
The nurse is caring for a patient with osteomyelitis. Which of the following medications should the nurse anticipate that the patient will be prescribed?
A. thiamine
B. IV gentamicin
C. carbamazepine
D. oxycodone with acetaminophen
B. IV gentamicin
Gentamicin is an aminoglycoside type of antibiotic that is often used to treat osteomyelitis. The medication is given by the intravenous route for several weeks, and blood levels are monitored periodically to ensure that they are therapeutic.
During a public health screening day, which of the following assessment findings would alert the nurse to the presence of osteoporosis in an older patient?
A. The presence of bowed legs
B. A measurable loss of height
C. Poor appetite and aversion to dairy products
D. The development of unstable, wide-gait ambulation
B. A measurable loss of height
A gradual but measurable loss of height and the development of kyphosis, or “dowager’s hump,” are indicative of the presence of osteoporosis, in which the rate of bone resorption is greater than that of bone deposition.
The nurse is reinforcing health teaching about osteoporosis with an older patient who is hospitalized. Which of the following information will the nurse explain to the patient in relation to osteoporosis?
A. With a family history of osteoporosis, there is no way to prevent or slow bone resorption.
B. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.
C. Estrogen replacement therapy must be maintained to prevent rapid progression of the osteoporosis.
D. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
D. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
The rate of progression of osteoporosis can be slowed if the patient takes calcium supplements and eats foods high in calcium, or both, and engages in regular exercise.
The nurse determines that dietary teaching for an older patient who has osteoporosis has been most successful when the patient selects which one of the following highest calcium meals?
A. Chicken stir-fry with 237 g each of onions and snap peas, and 237 g of steamed rice
B. Ham and Swiss cheese sandwich on whole wheat bread, steamed broccoli, and an apple
C. A sardine (85 g) sandwich on whole wheat bread, 237 mL of fruit yogurt, and 237 mL of skim milk
D. A two-egg omelette with 57 g of cheese, one slice of whole wheat toast, and a half grapefruit
C. A sardine (85 g) sandwich on whole wheat bread, 237 mL of fruit yogurt, and 237 mL of skim milk
The highest calcium content is present in this lunch, containing milk and milk products and small fish with bones (sardines).
The nurse is caring for a patient who was admitted with osteomyelitis. Which of the following symptoms will the nurse most likely find on physical examination of the patient?
A. Nausea and vomiting
B. Localized pain and redness
C. Paresthesia in the affected extremity
D. Generalized bone pain throughout the leg
B. Localized pain and redness
Osteomyelitis is an infection of bone and bone marrow that can occur with trauma, surgery, or extension of nearby infection. Because it is an infection, the patient will exhibit typical signs of inflammation and infection, including localized pain and redness.
A patient with acute osteomyelitis asks the nurse how this problem will be treated. Which of the following responses by the nurse is most appropriate?
A. “Oral antibiotics are often required for several months.”
B. “Intravenous antibiotics are usually required for several weeks.”
C. “Surgery is almost always necessary to remove the dead tissue that is likely to be present.”
D. “Drainage of the foot and instillation of antibiotics into the affected area is the usual treatment.”
B. “Intravenous antibiotics are usually required for several weeks.”
The standard treatment for acute osteomyelitis consists of several weeks of intravenous antibiotic therapy. This extended treatment period is due to the fact that bone is denser and less vascular than other tissues, and therefore, it takes more time for the antibiotic therapy to eradicate all of the
A patient is hospitalized with osteomyelitis and is prescribed bed rest with bathroom privileges, and the affected foot is to be elevated on two pillows. Which of the following interventions is priority?
A. Ambulate the patient to the bathroom every two hours.
B. Ask the patient about preferred activities to relieve boredom.
C. Allow the patient to dangle legs at the bedside every two to four hours.
D. Perform frequent position changes and range-of-motion exercises.
D. Perform frequent position changes and range-of-motion exercises.
The patient is at risk for atelectasis of the lungs and for contractures because of prescribed bed rest. For this reason, the nurse should change the patient’s position frequently to promote lung expansion and perform range-of-motion exercises to prevent contractures
The nurse identifies a nursing diagnosis of pain related to muscle spasms for a patient who has low back pain from herniated lumbar disc. Which of the following interventions should the nurse implement?
A. Provide gentle range of motion to the lower extremities.
B. Limit extreme spine movement and flex the knees.
C. Place the bed in reverse Trendelenburg with the feet firmly against the footboard.
D. Place a small pillow under the patient’s upper back to gently flex the lumbar spine.
B. Limit extreme spine movement and flex the knees
The nurse should eliminate extreme spine movements and flex the knees to avoid extension of the spine and increasing the pain. The slight flexion provided by this position often is comfortable for patients with herniated lumbar discs.
The nurse is admitting a patient who has a new onset of lower back pain. To differentiate between the pain of lumbar herniated disc and lower back pain from other causes, which of the following would be the best question for the nurse to ask the patient?
A. “Is the pain worse in the morning or in the evening?”
B. “Is the pain sharp, stabbing, burning, or aching?”
C. “Does the pain radiate down the buttock or into the leg?”
D. “Is the pain completely relieved by analgesics, such as acetaminophen?”
C. “Does the pain radiate down the buttock or into the leg?”
Lower back pain associated with herniated lumbar disc is accompanied by radiation along the sciatic nerve and can be described commonly as travelling through the buttock, to the posterior thigh, or down the leg. This is because the herniated disc causes compression on spinal nerves as they exit the spinal column. The other questions asked by the nurse do not elicit these data.
The nurse is admitting a patient to the nursing unit with a history of herniated lumbar disc and low back pain. In completing a more thorough pain assessment, the nurse would ask the patient if which of the following actions aggravates the pain?
A. Bending or lifting
B. Application of warm moist heat
C. Sleeping in a side lying position
D. Sitting in a fully extended recliner
A. Bending or lifting
Back pain that is related to herniated lumbar disc often is aggravated by events and activities that increase the stress and strain on the spine, such as bending or lifting, coughing, sneezing, and lifting the leg with the knee straight (straight leg-raising test).
The nurse is providing teaching related to body mechanics to a patient with a history of low back pain caused by a herniated lumbar disc. Which of the following statements made by the patient indicates a need for further teaching?
A. “I should sleep on my side or back with my hips and knees bent.”
B. “I should exercise at least 15 minutes every morning and evening.”
C. “I should pick up items by leaning forward without bending my knees.”
D. “I should try to keep one foot on a stool whenever I have to stand for a period of time.”
C. “I should pick up items by leaning forward without bending my knees.”
The patient should avoid leaning forward without bending the knees. Bending the knees helps to prevent lower back strain and is part of proper body mechanics when lifting.
The nurse is caring for a patient following spinal surgery. Which of the following nursing interventions is most appropriate when turning the patient?
A. Placing a pillow between the patient’s legs and turning the body as a unit.
B. Having the patient turn to the side by grasping the side rails to help turn over.
C. Elevating the head of the bed 30 degrees and having the patient extend the legs while turning.
D. Turning the patient’s head and shoulders and then the hips, keeping the patient’s body centred in the bed.
A. Placing a pillow between the patient’s legs and turning the body as a unit.
Placing a pillow between the legs and turning the patient as a unit (logrolling) helps to keep the spine in good alignment and reduces pain and discomfort following spinal surgery.
The nurse is planning health-promotion teaching for a patient with asthma, low back pain from a herniated lumbar disc, and schizophrenia. The nurse determines that which of the following would be the best exercise to include in an individualized exercise plan for the patient?
A. Yoga
B. Walking
C. Calisthenics
D. Weight lifting
B. Walking
The patient would benefit from an aerobic exercise that considers the patient’s health status and fits the patient’s lifestyle. The best exercise of those listed is walking, which builds strength in the back and leg muscles without putting undue pressure or strain on the spine.
