Deck 49: Caring for the Patient With Musculoskeletal Disorders

Question 1

A 65-year-old female admitted with a fractured hip tells the nurse that she was unaware that she has osteoporosis. What is the nurse's best response?

A) "Sometimes the first sign of the disorder is a fracture."
B) "It is rare for someone your age to have osteoporosis."
C) "There is no way to prevent the disorder."
D) "Everyone has it now."

Answer 1

"Sometimes the first sign of the disorder is a fracture."

Question 2

A 50-year-old woman is diagnosed with a small malignant tumor in her spine. The nurse anticipates which interventions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Surveillance for the primary cancer site
B) Removal of the woman's ovaries because these cancers are almost always estrogen dependent
C) Pharmacologic treatment of severe pain
D) Involvement of a multidisciplinary team in designing the patient's care
E) Surgical removal of the tumor, which will facilitate rapid recovery

Answer 2

Surveillance for the primary cancer site
Pharmacologic treatment of severe pain
Involvement of a multidisciplinary team in designing the patient's care

Question 3

The nurse is instructing a patient on foods high in calcium. The nurse knows the teaching was effective when the patient chooses which foods for a meal? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Chicken
B) Kale
C) Bananas
D) Salmon
E) Low-fat milk

Answer 3

Kale
Salmon
Low-fat milk

Question 4

A 55-year-old female patient with rheumatoid arthritis is diagnosed with osteoporosis. The nurse anticipates that the patient may be prescribed which medication to help with the treatment of this bone disorder?

A) Antihypertensive
B) Cardiac glycoside
C) Parathyroid hormone
D) Vitamins A and E

Question 5

A young boy has just been diagnosed with Duchenne muscular dystrophy DMD). The nurse evaluates that teaching has been effective when the parent makes which statement?

A) "We should avoid getting a wheelchair for as long as possible."
B) "He should improve over time as the medication begins to take effect."
C) "He should not have an influenza vaccine."
D) "Even though his body is weak, his cognitive abilities should be normal."

Question 6

A patient with a musculoskeletal disorder is prescribed carbamazepine Tegretol). What medication education should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "Take your medication with food."
B) "You may be more sensitive to the sun, so be certain to wear protective clothing or sunscreen."
C) "If mouth ulcers appear, notify the prescriber."
D) "Avoid touching the pill with your fingers."
E) "If fever occurs, notify the prescriber."

Question 7

Which instruction should the nurse include when teaching a patient about the medication alendronate Fosamax)? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Report new or worsening heartburn and difficult or painful swallowing.
B) Take the medication with orange juice 1 hour after eating.
C) Do not lie down for 30 minutes after taking the medication.
D) Take vitamin C supplements as instructed for bone mineralization.
E) Chew the medication well before swallowing.

Question 8

A 50-year-old female patient is concerned that she will develop osteoporosis because both her maternal aunts have been diagnosed with the disorder. The nurse would help the patient manage which intervention?

A) Prophylactic nonsteroidal anti-inflammatory medication
B) A DEXA test
C) Prescription for risedronate Actonel)
D) Daily intake of 2,000 mg of calcium

Question 9

Review of a 7-year-old boy's chart reveals a diagnosis of Duchenne muscular dystrophy made after the patient began to exhibit Gowers' maneuver. Which movements would the nurse expect to assess?

A) The child rocks backward and forward several times before being able to get up from a chair.
B) The child extends both arms out to the sides for balance while walking.
C) The child gets onto the hands and knees before achieving a standing position from the floor.
D) The child must roll to the side and push up from the floor with the hands.

Question 10

A patient diagnosed with osteomyelitis has a fever of 101.2°F, a white blood cell count of 22,000, and is complaining of severe leg pain. Which physician's order should the nurse implement first?

A) Start IV D51/2 NS at 125 ml/hr
B) Blood cultures ×2 at different sites
C) Rocephin 1 gram IV twice a day
D) Acetaminophen 650 mg PO for temperature above 100°F
E) Morphine 4 mg IV for pain

Question 11

A patient is admitted with a purple rash on her eyelids and a slightly red rash on her face and neck. The patient tells the nurse that her muscles "hurt" and she fatigues easily. The nurse would conduct additional assessment for which condition?

A) Mitochondrial myopathy
B) Polymyositis
C) Dermatomyositis
D) Inclusion body myositis

Question 12

The nurse is planning a community education program on osteoporosis prevention. Which topics should be included in this program? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Lack of hereditary link
B) Limiting alcohol intake
C) Higher incidence in both men and women who are obese
D) Lifetime adequate intake of calcium and vitamin D
E) Avoidance of cigarette smoking

Question 13

The nurse is preparing discharge instructions for a patient diagnosed with hypokalemic myopathy. What information should be included in these instructions?

A) When to take coenzyme Q-10
B) The need for rest periods between activities
C) Foods rich in potassium
D) When to take prescribed prednisone

Question 14

The nurse has chosen the nursing diagnosis Ineffective Breathing for a patient with muscular dystrophy. Which interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Assess the gag reflex before administering food or fluids.
B) Encourage frequent rest periods during daily activities.
C) Teach pursed-lip breathing.
D) Assess capillary refill.
E) Observe for use of accessory muscles.

Question 15

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Question 16

A patient diagnosed with oculopharyngeal muscular dystrophy has been admitted for ankle surgery. What interventions should the nurse plan?

A) Provide eye patches for times when the patient cannot close the eyes.
B) Modify food consistency to allow for easier swallowing.
C) Notify anesthesiology about the patient's history.
D) Monitor for the development of fluid in the lungs.

Question 17

A patient is being discharged after treatment for a fracture. Which home management instructions would help ensure safety in the patient's home environment?

A) "Place a small rug in front of bathroom sink to reduce your risk of slipping on water."
B) "Be certain that devices used for cooking work properly."
C) "Be sure all walking paths through the house are clear of obstruction."
D) "Move the furniture around so you have lots of things to hold on to for support."

Question 18

A 30-year-old female patient diagnosed with early onset of osteoporosis asks the nurse how she could be at risk for this disease, as she is so active. Which response by the nurse is most accurate?

A) "Your frequent exercise might have placed underlying stress on your skeleton."
B) "You are at an age when your estrogen levels have begun to decline drastically, thus increasing your risk for the development of osteoporosis."
C) "Do your bones feel weak or painful?"
D) "Dietary practices have some influence on the development of osteoporosis."

Question 19

A patient who has been diagnosed with Paget’s disease in the hip is admitted to the hospital for treatment of another condition. Which assessment findings would the nurse attribute to Paget’s disease?

A) Pain and aching in the hip at night
B) Edema over the hip
C) Difficulty hearing
D) Elevation of serum phosphorus
E) Nausea and vomiting

Question 20

A patient recovering from a total hip replacement develops a fever and redness at the surgical site. The nurse's priority is to conduct additional assessment for which disorder?

A) Pathologic fracture
B) Osteomyelitis
C) Undiagnosed osteitis deformans
D) Subacute osteoporosis

Question 21

A patient diagnosed with a myopathy is at risk for aspiration. Which intervention should be included in the plan of care for this patient?

A) Instruct the patient to avoid thick liquids.
B) Instruct the patient to eat small bites of food and chew thoroughly before swallowing.
C) Instruct the patient to avoid solid foods.
D) Instruct the patient to consume thin, watery liquids with meals.

Question 22

A patient diagnosed with polymyositis has been prescribed azathioprine Imuran.) What medication education should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "This therapy increases your risk for infections."
B) "Take this medication at least 4 hours prior to or after eating."
C) "Do not drink alcohol while taking the medication."
D) "Wear sunscreen if you are outside."
E) "You may need folic acid supplementation while on this drug."

Question 23

A patient has fallen in his room. The nurse who admitted the patient says, "But when I assessed his fall status, he was only moderate risk." How should the nurse manager interpret this situation?

A) The fall assessment was not completed correctly.
B) Fall assessment alone is not sufficient to protect patients.
C) Something must have changed in the patient's condition since the assessment was completed.
D) The patient must be confused.

Question 24

A patient has been diagnosed with inclusion body myositis IBM.) Which instruction should the nurse provide?

A) "Be certain to keep your appointment to fit your foot brace."
B) "You can expect to be cured from this disorder if you take your medications as directed."
C) "Taking steroids will help you maintain long-term remission from this illness."
D) "You may be unable to drive due to weakness in your neck."

Question 25

A patient has been diagnosed with fibromyalgia. Which statement would indicate that the patient understands the nurse's instruction about the disease?

A) "This disease should run its course in about 18 months."
B) "Because my muscles are so painful, I should avoid exercise."
C) "Following a very low-fat diet has been proven to reduce the symptoms of fibromyalgia."
D) "I need to work on reducing my anxiety about things I cannot control."

Question 26

An 82-year-old woman with fibromyalgia reports that she is not sleeping well at night. The nurse realizes that this patient is at particular risk for which complication of fibromyalgia?

A) Falling
B) Point tenderness
C) Becoming addicted to pain medications
D) Respiratory difficulties

Question 27

The nurse is providing discharge instructions to a patient recovering from a total hip replacement. Which information should the nurse include in these instructions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Follow the use and weight-bearing instructions provided by the surgeon.
B) Do not do exercises if experiencing discomfort.
C) Report possible complications such as infection or dislocation.
D) Continue pain medications for only 2 days after discharge.
E) Eat protein foods with high biologic value such as meat, eggs, and dairy products.

Question 28

A patient states, "I am in such pain. Do you think I might have fibromyalgia?" Which response by the nurse is indicated?

A) "Have you been in pain over 2 months?"
B) "You must stop smoking before a diagnosis of fibromyalgia can be made."
C) "Have you considered having the blood test for fibromyalgia?"
D) "In which areas do you have pain?"

Question 29

A nursing unit has adopted the Four P strategy to reduce fall rates. Which components of patient care will this plan emphasize? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Position
B) Pain assessment
C) Personal needs
D) Prevention
E) Placement

Question 30

A patient is admitted to the hospital after being found on the floor at home. It appears that the patient had a seizure and may have been in the floor for 10 to 12 hours before being discovered. Which assessment findings would be critical for the nurse to report? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Urine is dark.
B) Low CK levels
C) Potassium level of 4.8 mEq/L
D) Complaints of new-onset muscle pain
E) Complaints of extreme hunger

Question 31

A male patient, one day postoperative from a total hip replacement, tells the nurse that he does not want to ambulate and will consider it tomorrow. What should the nurse do first to assist this patient?

A) Determine the reason he is resistant to ambulating at this time.
B) Contact the physician.
C) Call additional personnel to assist with ambulation anyway.
D) Document the patient's refusal.

Question 32

A woman who emigrated from a Third World country has just delivered a baby. The woman says, "In my country, many babies die from polio. I want my baby immunized as soon as possible." The nurse responds, "Your baby will receive the first polio immunization at age _______ months."

Question 33

A patient diagnosed with fibromyalgia is interested in alternative and complementary therapies to treat the disorder. The nurse suggests the patient examine which types of therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Acupuncture
B) Reflexology
C) Prescription antidepressants
D) Electrical stimulation
E) Prayer

Question 34

A 60-year-old man asks the nurse if he should consume sports drinks while mowing the lawn in the summer to prevent dehydration. What response by the nurse is indicated?

A) "As long as you are drinking fluids, it doesn't really matter what they are."
B) "If you drink only one sports drink a day, there should be no problem."
C) "Let me review your lab results from last week before I reply."
D) "You should drink only water."

Question 35

A patient diagnosed with fibromyalgia has been prescribed pregabalin Lyrica). Which patient statement about the drug is correct?

A) "Pregabalin will cure my fibromyalgia."
B) "I should not drive until I see how this drug affects me."
C) "It is okay for me to relax with a glass of wine in the evening before bed."
D) "If this drug doesn't help me, I can quit taking it and try something else."