Deck 53: Care of Patients With Musculoskeletal Problems

Question 1

A client is seen at the clinic with the medical diagnosis of osteomalacia.When taking the client's history,what does the nurse assess for?

A) Arm and leg strength
B) Dietary intake of vitamin D
C) Dietary intake of calcium
D) Exercise habits

Answer 1

Dietary intake of vitamin D

Question 2

A client's susceptibility to osteomalacia is related to which risk factor?

A) Calcium level of 11 mg/dL
B) Diet high in milk and soy
C) Phosphate level of 1.0 mg/dL
D) Taking vitamin D supplements

Answer 2

Phosphate level of 1.0 mg/dL

Question 3

A client diagnosed with primary bone sarcoma of the leg is scheduled for tumor removal.The client expresses fear of loss of function.Which is the nurse's best response?

A) "It is normal to feel this way."
B) "Physical therapy will assist you to regain function."
C) "This surgery is better than an amputation."
D) "This surgery is necessary to save your life."

Answer 3

"It is normal to feel this way."

Question 4

A client has severe Paget's disease.Which factor has the highest priority when the nurse intervenes in the care of this client?

A) Dietary education
B) Exercise program
C) Genetic testing
D) Relief of pain

Question 5

An adult client's susceptibility to osteoporosis is caused by which aspect of his or her history?

A) Fractured arm at age 16
B) Active smoking
C) Vitamin D supplements
D) Weight lifting

Question 6

Which assessment finding relates most directly to a diagnosis of chronic osteomyelitis?

A) Erythema of the affected area
B) Swelling around the affected area
C) Temperature higher than 101° F (38° C)
D) Ulceration of the skin

Question 7

The nurse has educated a client on Paget's disease.Which statement by the client indicates good understanding of causative factors?

A) "It is caused by lack of calcium in my diet."
B) "I probably had a fracture that caused it."
C) "This disease occurs because of lack of exercise."
D) "I may have a genetic predisposition."

Question 8

A female client who is a carrier of the gene for Duchenne's muscular dystrophy asks whether any of her daughters will have this disease.Which is the nurse's best response?

A) "Both parents must have the defective gene."
B) "Your daughter cannot get the disease."
C) "Your daughters have a 50% chance of developing the disease."
D) "Your daughters will become carriers of the gene."

Question 9

After the administration of each dose of zoledronic acid (Zometa),it is most important for the nurse to determine which finding?

A) Capillary refill
B) Pain relief
C) Level of consciousness
D) Urine output

Question 10

Which nursing intervention is most effective in preventing transfer of an organism from the wound of a client with osteomyelitis to other clients?

A) Contact Precautions
B) Restriction of visitors
C) Irrigating the wound as needed
D) Leaving the wound open to air

Question 11

A client is prescribed alendronate (Fosamax).Which statement indicates that the client understands teaching about this drug?

A) "I should take this drug with a full glass of water."
B) "I need to lie down for 30 minutes after taking it."
C) "This drug should be taken after a meal."
D) "This drug needs to be taken at the same time as calcium."

Question 12

Which instruction is most important for the RN to provide to the nursing assistant assigned to care for a client with primary osteoporosis?

A) "Clean up clutter in the room."
B) "Encourage the client to bathe herself or himself."
C) "Monitor urinary output."
D) "Perform passive range-of-motion exercises."

Question 13

While caring for a client who has chronic osteomyelitis and wound drainage,which intervention is most important for the nurse to implement?

A) Cover the wound with a dressing.
B) Teach about the cause of the infection.
C) Monitor the erythrocyte sedimentation rate (ESR).
D) Prepare the client for hyperbaric oxygenation.

Question 14

The RN has assigned a client with severe osteoporosis to an LPN.Which information about the care of the client is most important for the RN to provide the LPN?

A) Provide passive range of motion (ROM) to all weight-bearing joints.
B) Position the client upright to promote lung expansion.
C) Place a pillow between the client's knees when in the side-lying position.
D) Use a lift sheet to reposition the client.

Question 15

Which exercise does the nurse recommend to a client at risk for osteoporosis?

A) High-impact aerobics 45 minutes once weekly
B) Walking 30 minutes three times weekly
C) Jogging 30 minutes four times weekly
D) Bowling for 1 hour twice weekly

Question 16

A client newly diagnosed with Ewing's sarcoma is most likely to exhibit which laboratory finding?

A) Elevated red blood cells (RBCs)
B) Elevated alkaline phosphatase (ALP)
C) Decreased erythrocyte sedimentation rate (ESR)
D) Decreased serum lactate dehydrogenase (LDH)

Question 17

Which instruction does the nurse include in the discharge teaching plan of a client who has osteoporosis?

A) "Avoid using scatter rugs."
B) "Avoid weight-bearing exercises."
C) "Use a cane when walking outside."
D) "Reduce the amount of protein in your diet."

Question 18

Which client does the nurse assess more carefully for risk of developing primary osteoporosis?

A) African-American client
B) Resident of a nursing home
C) Client who eats meat with every meal
D) Client who drinks 6 cups of coffee daily

Question 19

When preparing to care for a client with a family history of Paget's disease,it is most important for the nurse to include education in which area?

A) Avoidance of infections
B) Exercise program
C) Nutrition high in vitamin C
D) Need for genetic testing

Question 20

The mother of a 16-year-old client diagnosed with Ewing's sarcoma expresses concern that her son seems to be angry at everyone in the family.How does the nurse respond?

A) "You need to set limits with your son."
B) "This is a normal stage in the grieving process."
C) "He will be back to normal when he leaves the hospital."
D) "This is typical behavior for a teenager."

Question 21

The nurse is caring for a client with a lesion in the area of the tibia that is swollen and tender.Which client problem is the highest priority for nursing care?

A) Need for increased calories related to increased metabolism
B) Pain management related to physical injury
C) Compromised self-care related to weakness
D) Safety risk related to skeletal impairment

Question 22

The nurse is caring for a client with rheumatoid arthritis.For which condition does the nurse assess most carefully?

A) Dupuytren's contracture
B) Hallux valgus
C) Morton's neuroma
D) Plantar fasciitis

Question 23

When providing care for a client who has had a débridement for osteomyelitis,which intervention is most important for the nurse to implement?

A) Assess the white blood cell count.
B) Assess circulation in the distal extremities.
C) Administer pain medication.
D) Monitor temperature.

Question 24

The nurse is assessing a client with Paget's disease.Which assessment finding leads the nurse to notify the health care provider immediately?

A) Client is 5 feet in height and weighs 130 pounds.
B) Long bones of the legs and arms are bowing.
C) Base of the skull is enlarged with changes in vital signs.
D) Mild pain is present in the area of the hips and pelvis.

Question 25

A client who has been diagnosed with osteomyelitis is beginning antibiotic therapy.Which information does the nurse include in the client's teaching plan?

A) Needing a consultation with a surgeon
B) Continuing on Contact Isolation at home
C) Remaining in the hospital for the rest of the treatment
D) Receiving antibiotic treatment at home from the home health nurse

Question 26

The nurse is performing a medical history and physical assessment for a client.Which assessment findings lead the nurse to conclude that the client is at risk for development of osteoporosis?

A) Client is a white woman with a body mass index (BMI) of 19.4.
B) Client fractured her wrist badly in a fall last year.
C) Client drinks at least four cans of diet cola every day.
D) Client does tai chi exercises for 45 minutes every morning.
E) Client has smoked two packs of cigarettes a day for 40 years.
F) Client has taken estrogen (Premarin) 0.625 mg daily since menopause.

Question 27

The nurse reviews the health history of a client with acute osteomyelitis.Which findings might have contributed to the diagnosis?

A) Recent dental work
B) Urinary tract infection
C) Pregnancy
D) Age
E) Hemodialysis
F) Gastrointestinal infection

Question 28

Which client is at highest risk for the development of plantar fasciitis?

A) Young adult runner
B) Adolescent swimmer
C) Older adult client who walks with a cane
D) Adult client confined to a wheelchair

Question 29

Two hours after limb salvage surgery for a client with left leg bone sarcoma,the nurse notes that the toes of the left foot are more edematous,are cooler to the touch,and have a slower capillary refill.Which action does the nurse take first?

A) Apply ice to the distal extremity.
B) Check the splint for proper placement.
C) Elevate the left foot.
D) Loosen the pressure dressing.