Deck 39: Nursing Care of People With Musculoskeletal Disorders

Question 1

What lab results would likely be seen in a person who is diagnosed with osteomalacia?

A)Elevated serum calcium, normal parathyroid hormone, and alkaline phosphatase.
B)Low serum calcium, parathyroid hormone, and alkaline phosphatase.
C)Low or normal serum calcium, elevated parathyroid hormone, and alkaline phosphatase.
D)High serum calcium, low parathyroid hormone, and alkaline phosphatase.

Answer 1

Low or normal serum calcium, elevated parathyroid hormone, and alkaline phosphatase.

Question 2

An older female adult is seen in the clinic and is surprised to find that she is shorter than she was a few years ago. The person thinks the nurse may have made a mistake. What is the best response by the nurse?

A)Teach the person that osteoporosis and age-related loss of bone mass could be responsible for a decrease in height.
B)Tell the person that height loss is very common in old people.
C)Teach the person that old people are not active enough, so eventually experience a decrease in their bone mass that they could have prevented.
D)Teach the person that older adults often lose height based on poor posture, bone compression fractures and sedentary lifestyles.

Answer 2

Teach the person that osteoporosis and age-related loss of bone mass could be responsible for a decrease in height.

Question 3

The nurse is providing information to a person about Paget's disease. Which of the following statements by the person about pathophysiology of the disease reflects understanding?

A)'Because metabolic activity is compromised, excessive bone resorption occurs followed by no bone formation.'
B)'Metabolic activity is reduced and no bone resorption occurs, followed by continuing bone formation.'
C)'Due to excessive metabolic activity, excessive bone resorption occurs, followed by excessive bone formation.'
D)'Metabolic activity remains the same, but bone resorption ceases and bones become enlarged.'

Answer 3

'Due to excessive metabolic activity, excessive bone resorption occurs, followed by excessive bone formation.'

Question 4

Impaired physical mobility is a major nursing diagnosis for persons with osteoarthritis (OA). What nursing activity relates to this diagnosis?

A)Assessing the need for continuous narcotic analgesics to prevent pain in activities of daily living.
B)Assessing the range of motion of affected joints in order to plan appropriate interventions.
C)Encouraging taking care of own self-care needs in order to remain more active.
D)Encouraging consistently high activity levels in order to slow down the progression of the condition.

Question 5

What is one of the first symptoms that the nurse would expect to find on assessment of a person with osteoarthritis?

A)Pain and stiffness in one or more weight-bearing joints.
B)Muscle spasms and weakness.
C)Pain when at rest.
D)Crepitus in the joint with movement.

Question 6

A person comes to the clinic complaining of severe pain in the right great toe that started at night. What is the most probable prognosis?

A)Osteoarthritis.
B)Scleroderma.
C)Gout.
D)A fracture of the right great toe.

Question 7

A person has early onset osteoarthritis of the left knee. The nurse expects which medication will be ordered?

A)Diclofenac (Voltaren).
B)Codeine.
C)Prednisone.
D)Allopurinol (Zyloprim).

Question 8

Which of the following statements is true about persons with Paget's disease? They:

A)are often diagnosed early due to a spike in serum parathyroid hormone levels.
B)present with a long history of various, poorly defined bone pains, often resulting in excessive pain medication usage.
C)develop symptoms early and are tested by bone biopsy to diagnose the disorder.
D)are asymptomatic for years, but can eventually develop bone pain in affected bones.

Question 9

A person is experiencing symptoms of Paget's disease. The nurse expects which of the following diagnostic test(s)will be ordered to diagnose Paget's disease? (Select all that apply.)

A) Full blood count (FBC).
B)Hydroxyproline level.
C)Serum alkaline phosphatase level
D)Erythrocyte sedimentation rate (ESR).

Question 10

The nurse is providing nutrition education at a senior citizens centre. The presentation addresses the implication of vitamin D deficiency and low serum levels of phosphorus. What are the potential complications of these deficiencies?

A)Osteoarthritis; due to low intake of nutrients needed for bone formation.
B)Osteomalacia; due to low intake of calcium and vitamin D in the diet.
C)Osteomyelitis; due to lack of nutrients for muscle cells, which then become inflamed.
D)Osteosarcoma; due to nutrient deficiencies that allow mutation of cells.

Question 11

A 52-year-old person is prescribed raloxifene (Evista)for the treatment of osteoporosis. How does this medication work on postmenopausal women? By:

A)stimulating osteoblast activity and increasing bone formation.
B)inhibiting bone breakdown.
C)inhibiting osteoclast activity.
D)preventing bone loss by mimicking what oestrogen does for bone density.

Question 12

A person with Paget's disease tells the nurse that she fears falling. What should the nurse do?

A)Recognise that the fear of falling makes the person more prone to falls, and facilitate the person's expression of these thoughts.
B)Tell the person not to worry, as proper treatment will remove the risk.
C)Tell the person to limit their physical activities to prevent falls.
D)Recognise that the fear of falling is silly, and tell the person to think more positively about their disease.

Question 13

A person was just diagnosed with gout. The nurse expects that the person will likely be prescribed which of the following medications? (Select all that apply.)

A)Probenecid (Benemid).
B)Colchicine.
C)Acetylsalicylic acid (Aspirin).
D)Dexamethasone.

Question 14

An older female adult is surprised to find that she is shorter than she was a few years ago. The nurse would teach the person that which risk factor for osteoporosis can be changed?

A)Gender.
B)Genetics.
C)Age.
D)Lifestyle.

Question 15

A person is diagnosed with Paget's disease and is experiencing mild symptoms. What does the nurse expect will be part of the person's care plan?

A)Indomethacin (Indocin)and ibuprofen (Nurofen)to stop progression of symptoms.
B)Ibuprofen (Nurofen)and hip replacement surgery to prevent further osteoarthritis.
C)Indomethacin (Indocin)for discomfort and calcitonin (Calcimar)to prevent bone formation.
D)Ibuprofen (Nurofen)for discomfort and pamidronate to inhibit bone resorption.

Question 16

The nurse is teaching a 68-year-old female, who is on oestrogen replacement, information about dietary calcium recommendations. Which dosage should be included in the nurse's teaching?

A)1000 mg per day.
B)800 mg per day.
C)700 mg per day.
D)300 mg per day.

Question 17

The nurse expects to care for persons most often with which of the following types of arthritis?

A)Gouty arthritis.
B)Osteoarthritis.
C)Reactive arthritis.
D)Rheumatoid arthritis.

Question 18

The nurse is teaching a person who has gout. Which of the following should be included in the teaching? Avoid:

A)eating cottage cheese.
B)drinking fruit juices.
C)drinking milk.
D)eating oysters.

Question 19

What does the nurse planning care for a person who was diagnosed with muscular dystrophy (MD)need to remember?

A)The treatment includes daily electrical muscle stimulus.
B)The cause is related to poor blood supply to nerves and muscles.
C)The treatment of MD is aimed at eliminating the cause by identifying the specific stimuli that cause the muscle degeneration.
D)The pathophysiology of MD involves muscle degeneration, which affects activities of daily living.

Question 20

What should care of the older person with osteoporosis focus on?

A)Slowing or stopping the process and preventing complications.
B)Diagnosis and medical management.
C)Treating the development of complications and the person's complaints.
D)Teaching compensatory actions to counter the condition.