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Flashcards in Musculoskeletal Deck (150)
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121

During a health screening event which assessment finding would alert the nurse to the possible presence of osteoporosis in a white 61-year-old female?

A. The presence of bowed legs
B. A measurable loss of height
C. Poor appetite and aversion to dairy products
D. 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 bone deposition. Bowed legs may be caused by abnormal bone development or rickets but is not indicative of osteoporosis. Lack of calcium and Vitamin D intake may cause osteoporosis but are not indicative it is present. A wide gait is used to support balance and does not indicate osteoporosis.

122

The nurse is reinforcing health teaching about osteoporosis with a 72-year-old patient admitted to the hospital. In reviewing this disorder, what should the nurse explain to the patient?

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 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/or foods high in calcium and engages in regular weight-bearing exercise. Corticosteroids interfere with bone metabolism. Estrogen therapy is no longer used to prevent osteoporosis because of the associated increased risk of heart disease and breast and uterine cancer.

123

When the patient is diagnosed with muscular dystrophy, what information should the nurse include in the teaching about this disorder?

A. Prolonged bed rest will be used to decrease fatigue.
B. An orthotic jacket will limit mobility and may contribute to deformity.
C. Continuous positive airway pressure will be used to facilitate sleeping.
D. Remain active to prevent skin breakdown and respiratory complications.

D. Remain active to prevent skin breakdown and respiratory complications.

With muscular dystrophy, it is important for the patient to remain active for as long as possible. Prolonged bed rest should be avoided because immobility leads to further muscle wasting. An orthotic jacket may be used to provide stability and prevent further deformity. Continuous positive airway pressure (CPAP) is used as respiratory function decreases, before mechanical ventilation is needed to sustain respiratory function.

124

The 24-year-old male patient who was successfully treated for Paget's disease has come to the clinic with a gradual onset of pain and swelling around the left knee. The patient is diagnosed with osteosarcoma without metastasis. The patient wants to know why he will be given chemotherapy before the surgery. What is the best rationale the nurse should tell the patient?

A. The chemotherapy is being used to save your left leg.
B. Chemotherapy is being used to decrease the tumor size.
C. The chemotherapy will increase your 5-year survival rate.
D. Chemotherapy will help decrease the pain before and after surgery.

B. Chemotherapy is being used to decrease the tumor size.

Preoperative chemotherapy is used to decrease tumor size before surgery. The chemotherapy will not save his leg if the lesion is too big or there is neurovascular or muscle involvement. Adjunct chemotherapy after amputation or limb salvage has increased 5-year survival rate in people without metastasis. Chemotherapy is not used to decrease pain before or after surgery.

125

The nurse is caring for a patient hospitalized with exacerbation of chronic bronchitis and herniated lumbar disc. Which breakfast choice would be most appropriate for the nurse to encourage the patient to check on the breakfast menu?

A. Bran muffin
B. Scrambled eggs
C. Puffed rice cereal
D. Buttered white toast

A. Bran muffin

Each meal should contain one or more sources of fiber, which will reduce the risk of constipation and straining with defecation, which increases back pain. Bran is typically a high-fiber food choice and is appropriate for selection from the menu. Scrambled eggs, puffed rice cereal, and buttered white toast do not have as much fiber.

126

The nurse is planning health promotion teaching for a 45-year-old patient with asthma, low back pain from herniated lumbar disc, and schizophrenia. What does the nurse determine 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 takes into account the patient's health status and fits the patient's lifestyle. The best exercise is walking, which builds strength in the back and leg muscles without putting undue pressure or strain on the spine. Yoga, calisthenics, and weight lifting would all put pressure on or strain the spine.

127

Which nursing intervention is most appropriate when turning a patient following spinal surgery?

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 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 centered 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. Having the patient turn by grasping the side rail to help, elevating the head of the bed, and turning with extended legs or turning the patient's head and shoulders and then the hips will not maintain proper spine alignment and may cause damage.

128

The nurse has reviewed proper body mechanics with a patient with a history of low back pain caused by a herniated lumbar disc. Which statement 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. Sleeping on the side or back with hips and knees bent and standing with a foot on a stool will decrease lower back strain. Back strengthening exercises are done twice a day once symptoms subside.

129

The nurse is admitting a patient to the nursing unit with a history of a herniated lumbar disc and low back pain. In completing a more thorough pain assessment, the nurse should ask the patient if which action 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 a 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). Application of moist heat, sleeping position, and ability to sit in a fully extended recliner do not aggravate the pain of a herniated lumbar disc.

130

The nurse determines that dietary teaching for a 75-year-old patient with osteoporosis has been successful when the patient selects which highest-calcium meal?

A. Chicken stir-fry with 1 cup each onions and green peas, and 1 cup of steamed rice
B. Ham and Swiss cheese sandwich on whole wheat bread, steamed broccoli, and an apple
C. A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk
D. A two-egg omelet with 2 oz of American cheese, one slice of whole wheat toast, and a half grapefruit



C. A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk

The highest calcium content is present in the lunch containing milk and milk products (yogurt) and small fish with bones (sardines). Chicken, onions, green peas, rice, ham, whole wheat bread, broccoli, apple, eggs, and grapefruit each have less than 75 mg of calcium per 100 g of food. Swiss cheese and American cheese have more calcium, but not as much as the sardines, yogurt, and milk.

131

The nurse is caring for a patient admitted to the nursing unit with osteomyelitis of the tibia. Which symptom will the nurse most likely find on physical examination of the patient?

A. Nausea and vomiting
B. Localized pain and warmth
C. Paresthesia in the affected extremity
D. Generalized bone pain throughout the leg

B. Localized pain and warmth

Osteomyelitis is an infection of bone and bone marrow that can occur with trauma, surgery, or spread from another part of the body. Because it is an infection, the patient will exhibit typical signs of inflammation and infection, including localized pain and warmth. Nausea and vomiting and paresthesia of the extremity are not expected to occur. Pain occurs, but it is localized, not generalized throughout the leg.

132

A 54-year-old patient with acute osteomyelitis asks the nurse how this problem will be treated. Which response by the nurse is most appropriate?

A. "IV antibiotics are usually required for several weeks."
B. "Oral antibiotics are often required for several months."
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 therapy."

A. "IV antibiotics are usually required for several weeks."

The standard treatment for acute osteomyelitis consists of several weeks of IV antibiotic therapy. This is because bone is denser and less vascular than other tissues, and it takes time for the antibiotic therapy to eradicate all of the microorganisms. Surgery may be used for chronic osteomyelitis, which may include debridement of the devitalized and infected tissue and irrigation of the affected bone with antibiotics.

133

A 67-year-old patient hospitalized with osteomyelitis has an order for bed rest with bathroom privileges with the affected foot elevated on two pillows. The nurse would place highest priority on which intervention?

A. Ambulate the patient to the bathroom every 2 hours.
B. Ask the patient about preferred activities to relieve boredom.
C. Allow the patient to dangle legs at the bedside every 2 to 4 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 place the priority on changing the patient's position frequently to promote lung expansion and performing range-of-motion (ROM) exercises to prevent contractures. Assisting the patient to the bathroom will keep the patient safe as the patient is in pain, but it may not be needed every 2 hours. Providing activities to relieve boredom will assist the patient to cope with the bed rest, and dangling the legs every 2 to 4 hours may be too painful. The priority is position changes and ROM exercises.

134

The nurse identifies a nursing diagnosis of pain related to muscle spasms for a 45-year-old patient who has low back pain from a herniated lumbar disc. What would be an appropriate nursing intervention to treat this problem?

A. Provide gentle ROM to the lower extremities.
B. Elevate the head of the bed 20 degrees 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. Elevate the head of the bed 20 degrees and flex the knees.

The nurse should elevate the head of the bed 20 degrees 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 a patient with a herniated lumbar disc. ROM to the lower extremities will be limited to prevent extremes of spinal movement. Reverse Trendelenburg and a pillow under the patient's upper back will more likely increase pain.

135

The nurse is admitting a patient who complains of a new onset of lower back pain. To differentiate between the pain of a lumbar herniated disc and lower back pain from other causes, what 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 or stabbing or burning or aching?"
C. "Does the pain radiate down the buttock or into the leg?"
D. "Is the pain totally relieved by analgesics, such as acetaminophen (Tylenol)?"

C. "Does the pain radiate down the buttock or into the leg?"

Lower back pain associated with a herniated lumbar disc is accompanied by radiation along the sciatic nerve and can be commonly described as traveling 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. Time of occurrence, type of pain, and pain relief questions do not elicit differentiating data.

136

A nurse is working with a 73-year-old patient with osteoarthritis (OA). In assessing the patient's understanding of this disorder, the nurse concludes teaching has been effective when the patient uses which description of the condition?

A. Joint destruction caused by an autoimmune process
B. Degeneration of articular cartilage in synovial joints
C. Overproduction of synovial fluid resulting in joint destruction
D. Breakdown of tissue in non–weight-bearing joints by enzymes



















B. Degeneration of articular cartilage in synovial joints

OA is a degeneration of the articular cartilage in diarthrodial (synovial) joints from damage to the cartilage. The condition has also been referred to as degenerative joint disease. OA is not an autoimmune disease. There is no overproduction of synovial fluid causing destruction or breakdown of tissue by enzymes.

137

The nurse is caring for four newly diagnosed patients with various connective tissue disorders. The nurse should be most aware of safety issues and interstitial lung involvement in the patient with which diagnosis?

A. Polymyositis
B. Reactive arthritis
C. Sjögren's syndrome
D. Systemic lupus erythematosus (SLE)

A. Polymyositis Correct

Polymyositis is an inflammatory disease affecting striated muscle and resulting in muscle weakness that increases the patient's risk of falls and injury. Weakened pharyngeal muscles increase the risk for aspiration with interstitial lung disease in up to 65% of patients. The treatment of polymyositis starts with high-dose corticosteroids that cause immunosuppression. If this does not work, other immunosuppressive drugs may be used. Reactive arthritis (Reiter's syndrome) occurs with urethritis, conjunctivitis, and mucocutaneous lesions with the asymmetric arthritis involving large joints of the lower extremities and toes. This patient is not at increased risk for safety problems. Sjögren's syndrome decreases moisture produced by exocrine glands, especially in the mouth and eyes and is without increased risk of injury or interstitial lung involvement. Systemic lupus erythematosus (SLE) is a multisystem inflammatory autoimmune disorder treated with NSAIDs, antimalarial agents. Safety would not be an important issue early in the disease.

138

The patient with fibromyalgia is suffering with pain at 12 of the 18 identification sites, including the neck and upper back and the knees. The patient also reports nonrefreshing sleep, depression, and being anxious when dealing with multiple tasks. The nurse should teach this patient about what treatments (select all that apply)?

A. Low-impact aerobic exercise
B. Relaxation strategy (biofeedback)
C. Antiseizure drug pregabalin (Lyrica)
D. Morphine sulfate extended-release tablets
E. Serotonin reuptake inhibitor (e.g., sertraline [Zoloft])

A B C E
Because the treatment of fibromyalgia is symptomatic, this patient will be prescribed something for pain, such as pregabalin, and a serotonin reuptake inhibitor for depression. Low- impact aerobic exercise will prevent muscle atrophy without increasing pain at the knees. Relaxation can help decrease the patient's stress and anxiety. Long-acting opioids are generally avoided unless pain cannot be relieved by other medications.

139

The 40-year-old African American woman has had Raynaud's phenomenon for some time. She is now reporting red spots on the hands, forearms, palms, face, and lips. What other manifestations should the nurse assess for when she is assessing for scleroderma (select all that apply)?

A. Calcinosis
B. Weight loss
C. Sclerodactyly
D. Difficulty swallowing
E. Weakened leg muscles

A. C. D.

This 40-year-old African American woman is at risk for scleroderma. The acronym CREST represents the clinical manifestations. C: calcinosis, painful calcium deposits in the skin; R: Raynaud's phenomenon; E: Esophageal dysfunction, difficulty swallowing; S: sclerodactyly, tightening of skin on fingers and toes; T: telangiectasia. Weight loss and weakened leg muscles are associated with polymyositis and dermatomyositis not scleroderma.

140

Because the incidence of Lyme disease is very high in Wisconsin, the public health nurse is planning to provide community education to increase the number of people who seek health care promptly after a tick bite. What information should the nurse provide when teaching people who are at risk for a tick bite?

A. The best therapy for the acute illness is an IV antibiotic.
B. Check for an enlarging reddened area with a clear center.
C. Surveillance is necessary during the summer months only.
D. Antibiotics will prevent Lyme disease if taken for 10 days.

B. Check for an enlarging reddened area with a clear center.

Following a tick bite, the expanding "bull's eye rash" is the most characteristic symptom that usually occurs in 3 to 30 days. There may also be flu-like symptoms and migrating joint and muscle pain. Active lesions are treated with oral antibiotics for 2 to 3 weeks, and doxycycline is effective in preventing Lyme disease when given within 3 days after the bite of a deer tick. IV therapy is used with neurologic or cardiac complications. Although ticks are most prevalent during summer months, residents of high-risk areas should check for ticks whenever they are outdoors.

141


A nurse is assessing the recent health history of a 63-year-old patient with osteoarthritis (OA). The nurse determines that the patient is trying to manage the condition appropriately when the patient describes which activity pattern?

A. Bed rest with bathroom privileges
B. Daily high-impact aerobic exercise
C. Regular exercise program of walking
D. Frequent rest periods with minimal exercise






C. Regular exercise program of walking

A regular low-impact exercise, such as walking, is important in helping to maintain joint mobility in the patient with osteoarthritis. A balance of rest and activity is needed. High-impact aerobic exercises would cause stress to affected joints and further damage.

142

The nurse is admitting a patient who is scheduled for knee arthroscopy related to osteoarthritis (OA). Which finding should the nurse expect to be present on examination of the patient's knees?

A. Ulnar drift
B. Pain with joint movement
C. Reddened, swollen affected joints
D. Stiffness that increases with movement

B. Pain with joint movement

OA is characterized predominantly by joint pain upon movement and is a classic feature of the disease. Ulnar drift occurs with rheumatoid arthritis (RA) not osteoarthritis. Not all joints are reddened or swollen. Only Heberden's and Bouchard's nodes may be. Stiffness decreases with movement.

143

The patient developed gout while hospitalized for a heart attack. When doing discharge teaching for this patient who takes aspirin for its antiplatelet effect, what should the nurse include about preventing future attacks of gout?

A. Limit fluid intake.
B. Administration of probenecid (Benemid)
C. Administration of allopurinol (Zyloprim)
D. Administration of nonsteroidal antiinflammatory drugs (NSAIDs)

C. Administration of allopurinol (Zyloprim)

To prevent future attacks of gout, the urate-lowering drug allopurinol may be administered. Increased fluid will be encouraged to prevent precipitation of uric acid in the renal tubules. This patient will not be able to take the uricosuric drug probenecid because the aspirin the patient must take will inactivate its effect, resulting in urate retention. NSAIDs for pain management will not be used, related to the aspirin, because of the potential for increased side effects.

144

A nurse assesses a 38-year-old patient with joint pain and stiffness who was diagnosed with Stage III rheumatoid arthritis (RA). What characteristics should the nurse expect to observe (select all that apply)?

A. Nodules present
B. Consistent muscle strength
C. Localized disease symptoms
D. No destructive changes on x-ray
E. Subluxation of joints without fibrous ankylosis

A. Nodules present
E. Subluxation of joints without fibrous ankylosis


In Stage III severe RA, there may be extraarticular soft tissue lesions or nodules present, and there is subluxation without fibrous or bony ankylosis. The muscle strength is decreased because there is extensive muscle atrophy. The manifestations are systemic not localized. There is x-ray evidence of cartilage and bone destruction in addition to osteoporosis.

145

A female patient's complex symptomatology over the past year has led to a diagnosis of systemic lupus erythematosus (SLE). Which statement demonstrates the patient's need for further teaching about the disease?

A. "I'll try my best to stay out of the sun this summer."
B. "I know that I probably have a high chance of getting arthritis."
C. "I'm hoping that surgery will be an option for me in the future."
D. "I understand that I'm going to be vulnerable to getting infections."

C. "I'm hoping that surgery will be an option for me in the future."

Surgery is not a key treatment modality for SLE, so this indicates a need for further teaching. SLE carries an increased risk of infection, sun damage, and arthritis.

146

Which patient statement most clearly suggests a need to assess the patient for ankylosing spondylitis (AS)?

A. "My right elbow has become red and swollen over the last few days."
B. "I wake up stiff every morning, and my knees just don't want to bend."
C. "My husband tells me that my posture has become so stooped this winter."
D. "My lower back pain seems to be getting worse all the time, and nothing seems to help."

D. "My lower back pain seems to be getting worse all the time, and nothing seems to help."


AS primarily affects the axial skeleton. Based on this, symptoms of inflammatory spine pain are often the first clues to a diagnosis of AS. Knee or elbow involvement is not consistent with the typical course of AS. Back pain is likely to precede the development of kyphosis.

147

When reinforcing health teaching about the management of osteoarthritis (OA), the nurse determines that the patient needs additional instruction after making which statement?

A. "I should take the Naprosyn as prescribed to help control the pain."
B. "I should try to stay standing all day to keep my joints from becoming stiff."
C. "I can use a cane if I find it helpful in relieving the pressure on my back and hip."
D. "A warm shower in the morning will help relieve the stiffness I have when I get up."

B. "I should try to stay standing all day to keep my joints from becoming stiff."

It is important to maintain a balance between rest and activity to prevent overstressing the joints with OA. Naproxen (Naprosyn) may be used for moderate to severe OA pain. Using a cane and warm shower to help relieve pain and morning stiffness are helpful.

148

The nurse is caring for a patient who has osteoarthritis (OA) of the knees. The nurse teaches the patient that the most beneficial measure to protect the joints is to do what?

A. Use a wheelchair to avoid walking as much as possible.
B. Sit in chairs that cause the hips to be lower than the knees.
C. Eat a well-balanced diet to maintain a healthy body weight.
D. Use a walker for ambulation to relieve the pressure on the hips.

C. Eat a well-balanced diet to maintain a healthy body weight.

Because maintaining an appropriate load on the joints is essential to the preservation of articular cartilage integrity, the patient should maintain an optimal overall body weight or lose weight if overweight. Walking is encouraged. The chairs that would be best for this patient have a higher seat and armrests to facilitate sitting and rising from the chair. Relieving pressure on the hips is not important for OA of the knees.

149

The nurse in an industrial plant receives a client with a traumatic amputation of a finger. Which action is most appropriate to perserve the amputated finger?
A. place the finger in a plastic bag and place the bag on cold normal saline
B. wrap the finger in Vaseline-saturated gauze 4x4 sponges
C. put the digit on crushed ice in a plastic covered container
D. place the digit on a saline soaked 4x4 and put it in a plastic bag

A. place the finger in a plastic bag and place the bag on normal saline.

150

A client is five hours postoperatve total knee replacement. Which assessment result requires the nurse to notify the physician?
A. temperature of 100 degrees Fahrenheit
B. Hematocrit of 24%
C. dime sized serous drainage on dressing
D. 300mL Foley output in five hours

B. Hematocrit of 24%. The client has an abnormal Hct and might need a blood transfusion.