Deck 40: Nursing Care of Patients with Musculoskeletal Disorders

Question 1

The nurse would identify that which of the following patients is at the greatest risk for the development of osteoporosis? Select all that apply.

A)a Caucasian female
B)a post menopausal female
C)an African American large-boned female
D)a patient taking corticosteroid therapy
E)a 32-year-old male

Answer 1

a Caucasian female
a post menopausal female
a patient taking corticosteroid therapy

Question 2

A patient is prescribed sodium fluoride rinse. Which of the following interventions would be appropriate when administering the medication to the patient? Select all that apply.

A)Administer the medication immediately upon arising.
B)Administer the medication with milk.
C)Administer the medication after meals.
D)Assessment of fluoride levels annually.
E)Avoid intake for 30 minutes after use.

Answer 2

Administer the medication after meals.
Avoid intake for 30 minutes after use.

Question 3

A patient is newly diagnosed with osteoporosis. List in order the nursing diagnoses according to priority for this patient. Click and drag the options below to move them up or down.

A)Imbalanced Nutrition: Less than Body Requirements related to inadequate intake of calcium
B)Risk for Injury related to effects of change in bone structure secondary to osteoporosis
C)Acute Pain of the lower spine related to vertebral compression
D)Deficient Knowledge related to osteoporosis and treatment to prevent further damage

Answer 3

C,B,A,D

Question 4

An elderly patient diagnosed with osteoporosis has a history of falls and dementia. Which of the following interventions will best aid in the prevention of injuries?

A)using of wrist restraints
B)using furniture as obstacles to keep the patient in the bed
C)keeping the bed in a low position
D)keeping a nightlight on in the room

Question 5

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

A)"You might have placed underlying stress on your skeleton from your frequent exercise."
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)"Your dietary practices might be partially responsible."

Question 6

Prior to signing informed consent for a total hip replacement the patient asks the nurse if she should be concerned about complications. How should the nurse respond?

A)"Complications are rare with this type of surgery."
B)"Do you know someone who had complications after this type of surgery?"
C)"Your surgeon has a low complication rate."
D)"What complications did your surgeon mention in the explanation of your surgery?"

Question 7

The nurse is concerned that the medication colchicine would be contraindicated for a patient because of which of the following information found in the patient's medical record?

A)WBC 20,000
B)uric acid level 7.8
C)BUN 68
D)Hgb 14.2

Question 8

A patient, diagnosed with osteoporosis who is being treated with calcitonin, is experiencing nausea and vomiting. What initial action is indicated by the nurse regarding the patient's complaint?

A)Alternate nares when administering the medication.
B)Hold the next dose of calcitonin and notify the physician.
C)Monitor and record the frequency and amount of emesis.
D)Increase the amount of vitamin D in the diet.

Question 9

A patient diagnosed with gout is concerned that the small "lumps" on his ear and big toe will become lodged in his blood, resulting in a blood clot. Which of the following explanations by the nurse will be most accurate?

A)"Clots will not develop if you take your anti-gout medicine."
B)"Unfortunately, this is a common complication associated with gout."
C)"You will need to talk with the physician during your next visit."
D)"These 'lumps' not cause clot development."

Question 10

The patient presents with contracture deformities of the hand and complains of severe pain. What musculoskeletal disorder does this patient manifest?

A)rheumatoid arthritis
B)osteomyelitis
C)osteoporosis
D)ankylosing spondylitis

Question 11

The nurse is instructing a patient on foods high in calcium. The nurse knows the teaching was effective when the patient chooses which of the following foods for a meal? Select all that apply.

A)chicken
B)collard greens
C)bananas
D)sardines
E)whole milk

Question 12

A patient diagnosed with systemic lupus erythematosus has laboratory values indicative of an excerbation. Which of the following should the nurse report to the physician? Select all that apply.

A)WBC 16,000
B)presence of bands
C)Sed rate 45
D)Hgb 14.2
E)sodium 138

Question 13

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. Which of the following 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 nursing assistants to assist with ambulation anyway.
D)Document the patient's refusal.

Question 14

A patient is experiencing Paget's disease which exhibit which of the following manifestations? Select all that apply.

A)pain and aching in the spine at night that is aggravated by pressure
B)flushing of the skin over the spine
C)three previous pathologic fractures to the vertebra
D)elevated phosphorus levels
E)scoliosis

Question 15

When providing care to a patient experiencing an exacerbation of gout and foot pain, which of the following interventions will aid in promoting comfort?

A)Wrap the extremity in an Ace bandage.
B)Encourage liberal fluid intake.
C)Active range-of-motion exercises to promote flexibility.
D)Elevate the extremity and use a foot a cradle.

Question 16

The nurse is reviewing modifiable and nonmodifiable risk factors of osteoporosis with a patient. Which of the following would the nurse include as modifiable risk factors? Select all that apply.

A)calcium deficiency
B)high-protein diet
C)female
D)decrease in estrogen levels
E)diabetes mellitus

Question 17

The patient diagnosed with osteoarthritis reports achieving pain relief when using an over-the-counter ointment on the affected areas. When assessing the patient's knowledge of safe administration practices, which of the following principles should the nurse plan to include in the teaching?

A)Apply heat to the affected area after applying ointment.
B)Alternate heat and cold after ointment application.
C)Limit the use of ointment to 3-4 times per day.
D)Initial skin irritation is common, and will subside within a few weeks of initiating treatment.

Question 18

Which of the following should the nurse include when instructing a patient regarding the medication alendronate (Fosamax)? Select all that apply.

A)Report new or worsening heartburn, difficult or painful swallowing.
B)Take the medication with orange juice one hour after food.
C)Do not lie down for 30 minutes after taking medication.
D)Take vitamin C supplements as instructed for bone mineralization.
E)This medication has a gradual response and continues for months after the drug is stopped.

Question 19

A butterfly rash is characteristic of which inflammatory connective tissue disease?

A)rheumatoid arthritis
B)systemic lupus erythematosis
C)Paget's disease
D)gout

Question 20

A patient with a history of osteoarthritis reports discomfort unrelieved by the prescribed medications. Which of the following nonpharmacological interventions might assist the patient in managing the discomfort? Select all that apply.

A)Suggest the use of ice to the painful joints.
B)Encourage rest of the painful joints.
C)Discuss the use of relaxation techniques.
D)Encourage distraction techniques.
E)Advise the patient to perform range-of-motion exercises to reduce the cramping sensation.

Question 21

A patient recovering from a total hip replacement has vital signs assessed by an unlicensed assistive personnel. Which vital sign value should cause the most concern for the nurse?

A)blood pressure 110/76
B)heart rate 82
C)respiratory rate 18
D)temperature 102° F

Question 22

A patient is prescribed ambulation on the second postoperative day after a total hip replacement. Place in order the steps the nurse should perform when preparing the patient to ambulate. Select all that apply.

A)Have the patient sit on the side of the bed.
B)Supply adequate pain management.
C)Use walker for balance.
D)Assess vital signs.

Question 23

The patient who weighs 70kg is to receive 750 mg of abatacept by IV infusion for the treatment of rheumatoid arthritis. The medication literature states that the medication has a dosage strength of 25 mg/mL when reconstituted according to direction. How many mL of abatacept will be prepared for this dosage?

Question 24

Place the "X" over the area that is commonly the first area of pain for a patient developing ankylosing spondylitis.

Question 25

A patient, diagnosed with osteomyelitis, is experiencing a fever of 101.2° F, a white blood cell count of 22,000, and is complaining of severe leg pain. The physician prescribes the following: Which of these orders should the nurse implement first? $$\begin{array} { | l | l | l | } \hline 1 & \text { Start IV } & \text { D51/2 NS at } 125 \mathrm { ml } / \mathrm { hr } \\\hline 2 & \text { Blood cultures } & \times 2 \text { at different sites } \\\hline 3 & \text { Rocephin } & 1 \text { gram IV twice a day } \\\hline 4 & \text { Acetominophin } & 650 \mathrm { mg } \text { po for temperature above } 100 ^ { \circ } \mathrm { F } \\\hline 5 & \text { Morphine } & 4 \mathrm { mg } \text { IV for pain } \\\hline\end{array}$$

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)Acetominophin 650 mg po for temperature above 100° F
E)Morphine 4 mg IV for pain

Question 26

Place an "X" on the picture that shows the common presentation of osteoarthritis.

Question 27

The nurse is reviewing the laboratory results for a 35-year-old woman who has been diagnosed with gout. Based upon the above results, what should be the nurse's greatest concern?
$\text { Laboratory tests Serum }$ $\quad$ $\quad$ $\quad$$\text { Results}$
$\begin{array}{c}\begin{array}{|l|} \hline \text { Uric Acid } \quad \quad \quad \quad \quad \quad \quad \quad \\\hline \text { WBC } \\\hline \text { ESR } \\\hline \text { Creatinine }\\\hline \end{array}\begin{array}{l|}\hline 7.2 \\\hline 12 \mathrm{X} \mathrm{10} 0^{3} \mathrm{cells} / \mathrm{mm}^{3} \\\hline 25 \mathrm{~mm} / \mathrm{hr} \\\hline 5.4 \mathrm{mg} / \mathrm{dL} \\\hline \end{array}\end{array}$

A)The patient's gout is confirmed by the lab results.
B)The patient has an infection.
C)The patient has inflammation present.
D)The patient's kidney function is decreased.

Question 28

The nurse is teaching a patient newly diagnosed with rheumatoid arthritis (RA) about pharmacologic treatment methods for the disease. In what order should the nurse present these options, from earliest to last approach? Click and drag the options below to move them up or down.

A)intra-articular corticosteroid injection
B)disease-modifying drugs
C)oral non-steroidal anti-inflammatory drugs
D)low-dose oral corticosteroids

Question 29

The nurse is providing teaching about topical medications for a group of patients who have been diagnosed with osteoarthritis. Which of these medications will the nurse discuss minimizing systemic adverse effects?

A)Ketoprofen
B)Naproxen
C)Capsaicin
D)Celecoxib

Question 30

A patient diagnosed with systemic lupus erythematosis is experiencing a facial rash. Which of the following should the nurse instruct the patient regarding skin care? Select all that apply.

A)Avoid being out of doors during hours of greatest sun intensity.
B)Use sunscreen with an SPF of 15 or higher.
C)Apply hydrocortisone cream 1% to the rash 4-6 times/day.
D)Reapply sunscreen after swimming, exercising, or bathing.
E)Wear a wide brimmed hat when outside

Question 31

A patient diagnosed with Paget's disease has been prescribed pamidronate 90 mg over 3 days. Medication instructions state to mix 30 mg of the drug in 500 mL NS and administer over 4 hours. This administration should be repeated for 3 days for a total of 90 mg of drug. At what IV rate, in mL/hr, should the nurse run this infusion?

Question 32

The nurse is providing discharge instructions to a patient recovering from a total hip replacement. Which of the following should the nurse include in these instructions? Select all that apply.

A)use and weight bearing of affected limb
B)do not do exercises if experiencing discomfort
C)possible complications such as infection or dislocation
D)continue pain medications for only two days after discharge
E)up to six months is needed for full recovery