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Flashcards in Musculoskeletal Deck (150)
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The nurse is caring for an elderly client diagnosed with a herniated nucleus pulposus of L4-L5. Which scientific rationale explains the incidence of a ruptured disc in the elderly?
1. The client did not use good body mechanics when lifting an object.
2. There is an increased blood supply to the back as the body ages.
3. Older clients develop atherosclerotic joint disease as a result of fat deposits.
4. Clients develop intervertebral disc degeneration as they age.

4. Less blood supply, degeneration of the disc, and arthritis are reasons elderly people develop back problems.


The 34-year-old male client presents to the outpatient clinic complaining of numbness and pain radiating down the left leg. Which further data would the nurse assess?
1. Posture and gait.
2. Bending and stooping.
3. Leg lifts and arm swing.
4. Waist twists and neck mobility.

1. Posture and gait will be affected if the client is experiencing sciatica, pain radiating down a leg resulting from pressure on the sciatic nerve.


The occupational health nurse is preparing an in-service for a group of workers in a warehouse. Which information should be included to help prevent on-the job-injuries?
1. Increase sodium and potassium in the diet during the winter months.
2. Use the large thigh muscles when lifting and hold the weight near the body.
3. Use soft-cushioned chairs when performing desk duties.
4. Have the employee arrange for assistance with household chores.

2. These are instructions to prevent back injuries as a result of poor body mechanics.


The occupational health nurse is planning health promotion activities for a group of
factory workers. Which activity would be an example of primary prevention for clients
at risk for low back pain?
1. Teach back exercises to workers after returning from an injury.
2. Place signs in the work area about how to perform first aid.
3. Start a weight-reduction group that would meet at lunchtime.
4. Administer a nonnarcotic analgesic to a client complaining of back pain.

3. Excess weight increases the workload on the vertebrae. Weight loss activities would help to prevent back injury.


The client with a cervical neck injury as a result of a motor-vehicle injury is complaining
of unrelieved pain after administration of a narcotic analgesic. Which alternative method of pain control would be an independent nursing action?
1. Medicate the client with a muscle relaxant.
2. Heat alternating with ice applied by a physical therapist.
3. Watch television or listen to music.
4. Discuss surgical options with the health-care provider.

3. This is distraction and is an alternative method often recommended for the promotion of client comfort


The client diagnosed with cervical neck disc degeneration has undergone a laminectomy.
Which interventions should the nurse implement?
1. Position the client prone with the knees slightly elevated.
2. Assess the client for difficulty speaking or breathing.
3. Measure the drainage in the Jackson-Pratt bulb every day.
4. Encourage the client to postpone the use of narcotic medications.

2. The surgical position of the wound places the client at risk for edema of tissues in the neck. Difficulty speaking or breathing would alert the nurse to a potentially life-threatening problem.


The client is 12-hours post-lumbar laminectomy. Which nursing interventions should
be implemented?
1. Assess ability to void and log roll every two (2) hours.
2. Medicate with IV steroids and keep the bed in a Trendelenburg position.
3. Place sand bags on each side of the head and give cathartic medications.
4. Administer IV anticoagulants and place on O2 at eight (8) L/min.

1. The lumbar nerves innervate the lower abdomen. The bladder is in the lower abdomen. The client will be required to lie flat, and this is a difficult position for many clients, especially males, to be in to void. Clients are log rolled every 2 hours.


The nurse is working with an unlicensed nursing assistant. Which action by the assistant
warrants immediate intervention?
1. The assistant feeds a client 2 days postoperative cervical laminectomy a regular diet.
2. The assistant calls for help when turning to the side a client who is post-lumbar
3. The assistant is helping the client who weighs 300 pounds and diagnosed with back
pain to the chair.
4. The assistant places the call light within reach of the client who had a disc fusion.

3. The legs of any client diagnosed with back pain can give out and collapse at any time, but a large client diagnosed with back pain would be at increased risk of injuring the assistant as well as the client. The nurse should intervene before the client or assistant become injured.


The nurse is caring for clients on an orthopedic floor. Which client should be assessed first?
1. The client diagnosed with back pain who is complaining of a “4” on a 1–10 scale.
2. The client who has undergone a myelogram who is complaining of a slight
3. The client 2 days postop disc fusion that has a T 100.4, P 96, R 24, and BP 138/78.
4. The client diagnosed with back pain who is being discharged and whose ride is here.

3. This client is postop and now has a fever. This client should be assessed and the HCP should be notified.


The nurse is administering 0730 medications to clients on a medical orthopedic unit.
Which medication would be administered first?
1. The daily cardiac glycoside to a client diagnosed with back pain and heart failure.
2. The routine insulin to a client diagnosed with neck strain and Type 1 diabetes.
3. The oral proton pump inhibitor to a client scheduled for a laminectomy this A.M.
4. The fourth dose of IV antibiotic for a client diagnosed with a surgical infection.

2. Clients with Type 1 diabetes are insulin dependent. This medication should be administered before the client eats.


The nurse writes the problem of “pain” for a client diagnosed with lumbar strain. Which nursing interventions should be included in the plan of care? Select all that apply.
1. Assess pain on a 1–10 scale.
2. Administer pain medication PRN.
3. Provide a regular bed pan for elimination.
4. Assess surgical dressing every four (4) hours.
5. Perform a position change by the log roll method every two (2) hours.

1. An objective method of quantifying the client's pain should be used.

2. Once the nurse has determined that the client is stable and not experiencing complications, the nurse can medicate the client.


The nurse working on a medical-surgical floor feels a pulling in the back when lifting
a client up in the bed. Which should be the first action taken by the nurse?
1. Continue working until the shift is over and then try to sleep on a heating pad.
2. Go immediately to the emergency department for treatment and muscle relaxants.
3. Inform the charge nurse and nurse manager on duty and document the occurrence.
4. See a private health-care provider on the nurse’s off time but charge the hospital.

3. The first action is to notify the charge nurse so that a replacement can be arranged to take over care of the clients. The nurse should notify the nurse manager or house supervisor. An occurrence report should be completed documenting the situation. This provides the nurse with the required documentation to begin a worker's compensation case for payment of medical bills.


The occupational health nurse is teaching a class on the risk factors for developing
osteoarthritisoa (OA). Which is a modifiable risk factor for developing OA?
1. Being overweight.
2. Increasing age.
3. Previous joint damage.
4. Genetic susceptibility.

1. Obesity is a well-recognized risk factor for
the development of OA and it is modifiable
in that the client can lose weight.


The client is diagnosed with osteoarthritis. Which sign/symptom would the nurse
expect the client to exhibit?
1. Severe bone deformity.
2. Joint stiffness.
3. Waddling gait.
4. Swan neck fingers.

2. Pain, stiffness, and functional impairment
are the primary clinical manifestations of
OA. Stiffness of the joints is commonly experienced
after resting but usually lasts less
than 30 minutes and decreases with movement.


The client diagnosed with OA is a resident in a long-term care facility. The resident is
refusing to bathe because she is hurting. Which instruction should the nurse give the
unlicensed nursing assistant?
1. Allow the client to stay in bed until the pain becomes bearable.
2. Tell the assistant to give the client a bed bath this morning.
3. Try to encourage the client to get up and go to the shower.
4. Notify the family that the client is refusing to be bathed.

3. Pain will decrease with movement, and
warm or hot water will help decrease the
pain. The worse thing the client can do is
not move.


The client has been diagnosed with OA for the last seven (7) years and has tried multiple
medical treatments and alternative treatments but still has significant joint pain.
Which psychosocial client problem would the nurse identify?
1. Severe pain.
2. Body-image disturbance.
3. Knowledge deficit
4. Depression.

4. The client experiencing chronic pain often
experiences depression and hopelessness.


The client diagnosed with OA is prescribed a nonsteroidal anti-inflammatory drug (NSAID). Which instruction should the nurse teach the client?
1. Take the medication on an empty stomach.
2. Make sure the client tapers the medication when discontinuing.
3. Apply the medication topically over the affected joints.
4. Notify the health-care provider if vomiting blood.

4. NSAIDs are well known for causing gastric
upset and increasing the risk for peptic
ulcer disease, which could cause the client
to vomit blood.


Which client goal would be most appropriate for a client diagnosed with OA?
1. Perform passive range-of-motion exercises.
2. Maintain optimal functional ability.
3. Client will walk three (3) miles every day.
4. Client will join a health club.

2. The two main goals of treatment for OA
are pain management and optimizing functional
ability of the joints to ensure movement
of the joints.


Which member of the health-care team should the nurse refer the client diagnosed with OA who is complaining of not being able to get in and out of the bathtub?
1. Physiatrist.
2. Social worker.
3. Physical therapist.
4. Counselor.

3. The physical therapist is able to help the
client with transferring, ambulation, and
other lower-extremity difficulties.


The nurse is discussing the importance of an exercise program for pain control to a
client diagnosed with OA. Which intervention should the nurse include in the teaching?
1. Wear supportive tennis shoes with white socks when walking.
2. Carry a complex carbohydrate while exercising.
3. Alternate walking briskly and jogging when exercising.
4. Walk at least 30 minutes three (3) times a week.

1. Safety should always be discussed when
teaching about exercises. Supportive shoes
will prevent shin splints. Colored socks
have dye that may cause athlete’s foot,
which is why white socks are recommended.


The HCP prescribes glucosamine and chondroitin for a client diagnosed with OA.
What is the scientific rationale for prescribing this medication?
1. It will help decrease the inflammation in the joints.
2. It improves tissue function and retards breakdown of cartilage.
3. It is a potent medication that decreases the client’s joint pain.
4. It increases the production of synovial fluid in the joint.

2. This is the rationale for administering
these medications.


The nurse is admitting the client with OA to the medical floor. Which statement by
the client indicates an alternative form of treatment for OA?
1. “I take medication every two (2) hours for my pain.”
2. “I use a heating pad when I go to bed at night.”
3. “I wear a copper bracelet to help with my OA.”
4. “I always wear my ankle splints when I sleep.”

3. Alternative forms of treatment have not
been proved efficacious in the treatment of
a disease. The nurse should be nonjudgmental
and open to discussions about alternative
treatment, unless it interferes with
the medical regimen.


The client is complaining of joint stiffness, especially in the morning. Which diagnostic
tests would the nurse expect the health-care provider to order to R/O osteoarthritis?
1. Full body magnetic resonance imaging scan.
2. Serum studies for synovial fluid amount.
3. X-ray of the affected joints.
4. Serum erythrocyte sedimentation rate (ESR).

3. X-rays reveal loss of joint cartilage, which
appears as a narrowing of the joint space in
clients diagnosed with OA.


The nurse is caring for the following clients. After receiving the shift report, which
client should the nurse assess first?
1. The client with a total knee replacement who is complaining of a cold foot.
2. The client diagnosed with osteoarthritis who is complaining of stiff joints.
3. The client who needs to receive a scheduled intravenous antibiotic.
4. The client diagnosed with back pain who is scheduled for a lumbar myelogram.

1. A cold foot on a client who has had surgery
may indicate a neurovascular compromise
and must be assessed first.


The nurse is discussing osteoporosis with a group of women. Which factor will the
nurse identify as a nonmodifiable risk factor?
1. Calcium deficiency.
2. Tobacco use.
3. Female gender.
4. High alcohol intake.

3. A nonmodifiable risk factor is a factor that
the client cannot do anything to alter or
change. Approximately 50% of all women will experience an osteoporosis-related
fracture in their lifetime.


The client diagnosed with osteoporosis asks the nurse, “Why does smoking cigarettes
cause my bones to be brittle?” Which response by the nurse would be most appropriate?
1. “Smoking causes nutritional deficiencies that contribute to osteoporosis.”
2. “Tobacco causes an increase in blood supply to the bones, causing osteoporosis.”
3. “Smoking low-tar cigarettes will not cause your bones to become brittle.”
4. “Nicotine impairs the absorption of calcium, causing decreased bone strength.”

4. Nicotine slows the production of osteoblasts
and impairs the absorption of calcium,
contributing to decreased bone density.


Which signs/symptoms would make the nurse suspect that the client has developed
1. The client has lost one (1) inch in height.
2. The client has lost 12 pounds in the last year.
3. The client’s hands are painful to the touch.
4. The client’s serum uric acid level is elevated.

1. The loss of height occurs as vertebral bodies collapse.


The client is being evaluated for osteoporosis. Which diagnostic test is the most accurate
when diagnosing osteoporosis?
1. X-ray of the femur.
2. Serum alkaline phosphatase.
3. Dual-energy x-ray absorptiometry (DEXA).
4. Serum bone Gla-protein test.

3. This test measures bone density in the lumbar spine or hip and is considered to be highly accurate.


Which foods should the nurse recommend to a client when discussing sources of
dietary calcium?
1. Yogurt and dark-green, leafy vegetables.
2. Oranges and citrus fruits.
3. Bananas and dried apricots.
4. Wheat bread and bran.

1. The best dietary sources of calcium are milk and other dairy products. Other sources include oysters; canned sardines or salmon; beans; cauliflower; and dark-green,
leafy vegetables.


Which intervention is an example of a secondary nursing intervention when discussing
1. Obtain a bone density evaluation test.
2. Perform non–weight-bearing exercises regularly.
3. Increase the intake of dietary calcium.
4. Refer clients to a smoking cessation program.

1. This is an example of a secondary nursing
intervention, which includes screening for
early detection.