Chapter 36: Management of Patients with Musculoskeletal Disorders

Question 1

1. A nurse is caring for an adult client diagnosed with a back strain. What health
   education should the nurse provide to this client?
   A. Avoid lifting more than one-third of body weight without assistance.
   B. Focus on using back muscles efficiently when lifting heavy objects.
   C. Lift objects while holding the object a safe distance from the body.
   D. Tighten the abdominal muscles and lock the knees when lifting an object.

Answer 1

ANS: A
Rationale: The nurse will instruct the client on the safe and correct way to lift objects—using the strong quadriceps muscles of the thighs, with minimal use of the weaker back muscles. To prevent recurrence of acute low back pain, the nurse may instruct the client to avoid lifting more than one-third of the client’s body weight without help. The client should be informed to place the feet hip-width apart to provide a wide base of support. The person should then bend the knees, tighten the abdominal muscles, and lift the object close to the body with a smooth motion, avoiding twisting and jerking.

Question 2

2. A nurse is discussing conservative management of tendonitis with a client. What is the
   nurse’s best recommendation?
   A. Weight reduction
   B. Use of oral opioid analgesics
   C. Intermittent application of ice and heat
   D. Passive range of motion exercises

Answer 2

ANS: C
Rationale: Conservative management of tendonitis includes rest of the extremity, intermittent ice and heat to the joint, and NSAIDs. Weight reduction may prevent future injuries but will not relieve existing tendonitis. Range-of-motion exercises may exacerbate pain. Opioids would not be considered a conservative treatment measure.

Question 3

3. A client presents at a clinic reports heel pain that impairs walking ability. The client is
   subsequently diagnosed with plantar fasciitis. This client’s plan of care should include
   what intervention?
   A. Wrapping the affected area in lamb’s wool or gauze to relieve pressure
   B. Gently stretching the foot and the Achilles tendon
   C. Wearing open-toed shoes at all times
   D. Applying topical analgesic ointment to plantar surface each morning

Answer 3

ANS: B
Rationale: Plantar fasciitis leads to pain that is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Dressings
of any kind are not of therapeutic benefit and analgesic ointments do not address the pathology of the problem. Open-toed shoes are of no particular benefit.

Question 4

4. A nurse is teaching an educational class to a group of older adults at a community
   center. In an effort to prevent osteoporosis, the nurse should encourage participants to
   ensure that they consume the recommended intake of what nutrients? Select all that
   apply.
   A. Vitamin B12
   B. Potassium
   C. Calcitonin
   D. Calcium
   E. Vitamin D

Answer 4

ANS: D, E
Rationale: A diet rich in calcium and vitamin D protects against skeletal demineralization. Intake of vitamin B12 and potassium does not directly influence the risk for osteoporosis. Calcitonin is not considered to be a dietary nutrient.

Question 5

5. A nurse is providing a class on osteoporosis at the local center for older adults. Which
   statement related to osteoporosis is most accurate?
   A. High levels of vitamin D can cause osteoporosis.
   B. A nonmodifiable risk factor for osteoporosis is a person’s level of activity.
   C. Secondary osteoporosis occurs in women after menopause.
   D. The use of corticosteroids increases the risk of osteoporosis.

Answer 5

ANS: D
Rationale: Corticosteroid therapy is a secondary cause of osteoporosis when taken for long-term use. Adequate levels of vitamin D are needed for absorption of calcium. A person’s level of physical activity is a modifiable factor that influences peak bone mass. Lack of activity increases the risk for the development of osteoporosis. Primary osteoporosis occurs in women after menopause.

Question 6

6. A nurse is teaching a client with osteomalacia about the role of diet. What would be the
   best choice for breakfast for a client with osteomalacia?
   A. Cereal with milk, a scrambled egg, and grapefruit
   B. Poached eggs with sausage and toast
   C. Waffles with fresh strawberries and powdered sugar
   D. A bagel topped with butter and jam with a side dish of grapes

Answer 6

ANS: A
Rationale: The best meal option is the one that contains the highest dietary sources of calcium and vitamin D. The best selection among those listed is cereal with milk, and eggs, as these foods contain calcium and vitamin D in a higher quantity over the other menu options.

Question 7

7. A nurse is caring for a client with Paget disease and is reviewing the client’s most
   recent laboratory values. Which of the following values are most characteristic of Paget
   disease?
   A. An elevated level of parathyroid hormone and low calcitonin levels
   B. A low serum alkaline phosphatase level and a low serum calcium level
   C. An elevated serum alkaline phosphatase level and a normal serum calcium level
   D. An elevated calcitonin level and low levels of parathyroid hormone

Answer 7

ANS: C
Rationale: Clients with Paget disease have normal blood calcium levels. Elevated serum alkaline phosphatase concentration and urinary hydroxyproline excretion reflect the increased osteoblastic activity associated with this condition. Alterations in PTH and calcitonin levels are atypical.

Question 8

8. Which of the following clients should the nurse recognize as being at the highest risk
   for the development of osteomyelitis?
   A. A middle-aged adult who takes ibuprofen daily for rheumatoid arthritis
   B. An older adult client with an infected pressure ulcer in the sacral area
   C. A 17-year-old football player who had orthopedic surgery 6 weeks prior
   D. An infant diagnosed with jaundice

Answer 8

ANS: B
Rationale: Clients who are at high risk of osteomyelitis include those who are poorly nourished, older adults, and clients who are obese. The older adult client with an infected
sacral pressure ulcer is at the greatest risk for the development of osteomyelitis, as this client has two risk factors: age and the presence of a soft-tissue infection that has the potential to extend into the bone. The client with rheumatoid arthritis has one risk factor and the infant with jaundice has no identifiable risk factors. The client 6 weeks’
postsurgery is beyond the usual window of time for the development of a postoperative surgical wound infection.

Question 9

9. A nurse is caring for a client with a bone tumor. The nurse is providing education to
   help the client reduce the risk for pathologic fractures. What should the nurse teach the
   client?
   A. Strive to achieve maximum weight-bearing capabilities.
   B. Gradually strengthen the affected muscles through weight training.
   C. Support the affected extremity with external supports such as splints.
   D. Limit reliance on assistive devices in order to build strength.

Answer 9

ANS: C
Rationale: During nursing care, the affected extremities must be supported and handled gently. External supports (splints) may be used for additional protection. Prescribed weight-bearing restrictions must be followed. Assistive devices should be used to strengthen the unaffected extremities.

Question 10

10. A client presents at a clinic reporting back pain that goes all the way down the back
    of the leg to the foot. The nurse should document the presence of what type of pain?
    A. Bursitis
    B. Radiculopathy
    C. Sciatica
    D. Tendonitis

Answer 10

ANS: C
Rationale: Sciatica nerve pain travels down the back of the thigh to the foot of the affected leg. Bursitis is inflammation of a fluid-filled sac in a joint. Radiculopathy is disease of a nerve root. Tendonitis is inflammation of muscle tendons.

Question 11

11. A client tells the nurse that they haves pain and numbness in the thumb, first finger,
    and second finger of the right hand. The nurse discovers that the client is employed as an
    auto mechanic, and that the pain is increased while working. This may indicate that the
    client has what health problem?
    A. Carpel tunnel syndrome
    B. Tendonitis
    C. Impingement syndrome
    D. Dupuytren contracture

Answer 11

ANS: A
Rationale: Carpel tunnel syndrome may be manifested by numbness, pain, paresthesia, and weakness along the median nerve. Tendonitis is inflammation of muscle tendons. Impingement syndrome is a general term that describes all lesions that involve the rotator cuff of the shoulder. Dupuytren contracture is a slowly progressive contracture of the palmar fascia.

Question 12

12. A nurse is assessing a client who reports a throbbing, burning sensation in the right
    foot. The client states that the pain is worst during the day but notes that the pain is
    relieved with rest. The nurse should recognize the signs and symptoms of what health
    problem?
    A. Morton neuroma
    B. Pes cavus
    C. Hallux valgus
    D. Onychocryptosis

Answer 12

ANS: A
Rationale: Morton neuroma is a swelling of the third (lateral) branch of the median plantar nerve, which causes a throbbing, burning pain, usually relieved with rest. Pes
cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Hallux valgus (bunion) is a deformity in which the great toe deviates laterally and there is a marked prominence of the medial aspect of the first metatarsal-phalangeal joint and exostosis. Onychocryptosis (ingrown toenail) occurs when the free edge of a nail plate penetrates the surrounding skin, laterally or anteriorly.

Question 13

13. A nurse is reviewing the pathophysiology that may underlie a client’s decreased bone
    density. What hormone should the nurse identify as inhibiting bone resorption and
    promoting bone formation?
    A. Estrogen
    B. Parathyroid hormone (PTH)
    C. Calcitonin
    D. Progesterone

Answer 13

ANS: C
Rationale: Calcitonin inhibits bone resorption and promotes bone formation, estrogen inhibits bone breakdown, and parathyroid increases bone resorption. Estrogen, which
inhibits bone breakdown, decreases with aging. Parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. Progesterone is the major naturally
occurring human progestogen and plays a role in the female menstrual cycle.

Question 14

14. A client is undergoing diagnostic testing for osteomalacia. Which of the following
    laboratory results are most suggestive of this diagnosis?
    A. High chloride, calcium, and magnesium levels
    B. High parathyroid and calcitonin levels
    C. Low serum calcium and magnesium levels
    D. Low serum calcium and low phosphorus level

Answer 14

ANS: D
Rationale: Laboratory studies in clients with osteomalacia will reveal a low serum calcium and low phosphorus level.

Question 15

15. An 80-year-old man in a long-term care facility has a chronic leg ulcer and states that
    the area has become increasingly painful in recent days. The nurse notes that the site is
    now swollen and warm to the touch. The client should undergo diagnostic testing for what
    health problem?
    A. Osteomyelitis
    B. Osteoporosis
    C. Osteomalacia
    D. Septic arthritis

Answer 15

ANS: A
Rationale: When osteomyelitis develops from the spread of an adjacent infection, no signs of septicemia are present, but the area becomes swollen, warm, painful, and tender
to touch. Osteoporosis is noninfectious. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Septic arthritis occurs when joints
become infected through spread of infection from other parts of the body (hematogenous spread) or directly through trauma or surgical instrumentation.

Question 16

16. A client has returned to the unit after undergoing limb-sparing surgery to remove a
    metastatic bone tumor. The nurse providing postoperative care in the days following
    surgery assesses for what complication from surgery?
    A. Deficient fluid volume
    B. Delayed wound healing
    C. Hypocalcemia
    D. Pathologic fractures

Answer 16

ANS: B
Rationale: Delayed wound healing is a complication of surgery due to tissue trauma from the surgery. Nutritional deficiency is usually due to the effects of chemotherapy and
radiation therapy, which may cause weight loss. Pathologic fractures are not a complication of surgery.

Question 17

17. A nurse is caring for a client who is 12 hours’ postoperative following foot surgery.
    The nurse assesses the presence of edema in the foot. What nursing measure should the
    nurse implement to control the edema?
    A. Elevate the foot on several pillows.
    B. Apply warm compresses intermittently to the surgical area.
    C. Administer a loop diuretic as prescribed.
    D. Increase circulation through frequent ambulation.

Answer 17

ANS: A
Rationale: To control the edema in the foot of a client who experienced foot surgery, the nurse will elevate the foot on several pillows when the client is sitting or lying. Diuretic
therapy is not an appropriate intervention for edema related to inflammation. Intermittent ice packs should be applied to the surgical area during the first 24 to 48 hours after surgery to control edema and provide some pain relief. Ambulation will gradually be resumed based on the guidelines provided by the surgeon.

Question 18

18. A client with diabetes is attending a class on the prevention of associated diseases.
    What action should the nurse teach the client to reduce the risk of osteomyelitis?
    A. Increase calcium and vitamin intake.
    B. Monitor and control blood glucose levels.
    C. Exercise 3 to 4 times weekly for at least 30 minutes.
    D. Take corticosteroids as prescribed.

Answer 18

ANS: B
Rationale: Since poor glycemic control can exacerbate the spread of infection from other sources, the client with diabetes should maintain blood glucose levels within a desired range. Corticosteroids can exacerbate the risk of osteomyelitis. Increased intake of calcium and vitamins as well as regular exercise are beneficial health promotion
exercises, but they do not directly reduce the risk of osteomyelitis.

Question 19

19. A nurse is planning the care of an older adult client with osteomalacia. What action
    should the nurse recommend in order to promote vitamin D synthesis?
    A. Ensuring adequate exposure to sunlight
    B. Eating a low-purine diet
    C. Performing cardiovascular exercise while avoiding weight-bearing exercises
    D. Taking thyroid supplements as prescribed

Answer 19

ANS: A
Rationale: Because sunlight is necessary for synthesizing vitamin D, clients should be encouraged to spend some time in the sun. A low-purine diet is not a relevant action, and
thyroid supplements do not directly affect bone function. Action must be taken to prevent fractures, but weight-bearing exercise within safe parameters is not necessarily
contraindicated.

Question 20

20. A client presents to a clinic reporting a leg ulcer that isn’t healing; subsequent
    diagnostic testing suggests osteomyelitis. The nurse is aware that the most common
    pathogen to cause osteomyelitis is:
    A. Staphylococcus aureus.
    B. Proteus.
    C. Pseudomonas.
    D. Escherichia coli.

Answer 20

ANS: A
Rationale: S. aureus causes more than half of all bone infections. Proteus, Pseudomonas, and E. coli are also causes, but to a lesser extent.

Question 21

21. A nurse is providing care for a client who has a recent diagnosis of Paget disease.
    When planning this client’s nursing care, what should interventions address? Select all
    that apply.
    A. Impaired physical mobility
    B. Acute pain
    C. Disturbed auditory sensory perception
    D. Risk for injury
    E. Risk for unstable blood glucose

Answer 21

ANS: A, B, C, D
Rationale: Clients with Paget disease are at risk for decreased mobility, pain, hearing loss, and injuries resulting from decreased bone density. Paget disease does not affect
blood glucose levels.

Question 22

22. A nurse is caring for a client who is being assessed following reports of severe and
    persistent low back pain. The client is scheduled for diagnostic testing in the morning.
    Which of the following are appropriate diagnostic tests for assessing low back pain?
    Select all that apply.
    A. Computed tomography (CT)
    B. Angiography
    C. Magnetic resonance imaging (MRI)
    D. Ultrasound
    E. X-ray

Answer 22

ANS: A, C, D, E
Rationale: A variety of diagnostic tests can be used to address lower back pain, including CT, MRI, ultrasound, and x-rays. Angiography is not related to the etiology of back pain.

Question 23

23. A nurse is reviewing the care of a client who has a long history of lower back pain that
    has not responded to conservative treatment measures. The nurse should anticipate the
    administration of what drug?
    A. Calcitonin
    B. Prednisone
    C. Aspirin
    D. Cyclobenzaprine

Answer 23

ANS: D
Rationale: Short-term prescription muscle relaxants (e.g., cyclobenzaprine [Flexeril]) are effective in relieving acute low back pain. ASA is not normally used for pain control,
due to its antiplatelet action and associated risk for bleeding. Calcitonin and corticosteroids are not usually used in the treatment of lower back pain.

Question 24

24. A nurse is collaborating with the physical therapist to plan the care of a client with
    osteomyelitis. What principle should guide the management of activity and mobility in
    this client?
    A. Stress on the weakened bone must be avoided.
    B. Increased heart rate enhances perfusion and bone healing.
    C. Bed rest results in improved outcomes in clients with osteomyelitis.
    D. Maintenance of baseline ADLs is the primary goal during osteomyelitis
    treatment.

Answer 24

ANS: A
Rationale: The client with osteomyelitis has bone that is weakened by the infective process and must be protected by avoidance of stress on the bone. This risk guides
the choice of activity in a client with osteomyelitis. Bed rest is not normally indicated. Maintenance of prediagnosis ADLs may be an unrealistic short-term goal for many
clients.

Question 25

25. A 32-year-old client comes to the clinic reporting shoulder tenderness, pain, and
    limited movement. Upon assessment the nurse finds edema. An MRI shows hemorrhage
    of the rotator cuff tendons and the client is diagnosed with impingement syndrome. What
    action should the nurse recommend in order to promote healing?
    A. Support the affected arm on pillows at night.
    B. Take prescribed corticosteroids as prescribed.
    C. Put the shoulder through its full range of motion three times daily.
    D. Keep the affected arm in a sling for 2 to 4 weeks.

Answer 25

ANS: A
Rationale: The client should support the affected arm on pillows while sleeping to keep from turning onto the shoulder. Corticosteroids are not commonly prescribed and a sling is not normally necessary. ROM exercises are indicated, but putting the arm through its full ROM may cause damage during the healing process.

Question 26

26. A client presents at the clinic with a report of morning numbness, cramping, and
    stiffness in the fourth and fifth fingers of the right hand. What disease process should the
    nurse suspect?
    A. Tendonitis
    B. A ganglion
    C. Carpal tunnel syndrome
    D. Dupuytren disease

Answer 26

ANS: D
Rationale: In cases of Dupuytren disease, the client may experience dull, aching discomfort, morning numbness, cramping, and stiffness in the affected fingers. This
condition starts in one hand, but eventually both hands are affected. This clinical scenario does not describe tendonitis, a ganglion, or carpal tunnel syndrome.

Question 27

27. A client’s electronic health record notes that the client has hallux valgus. What signs
    and symptoms should the nurse expect this client to manifest?
    A. Deviation of a great toe laterally
    B. Abnormal flexion of the great toe
    C. An exaggerated arch of the foot
    D. Fusion of the toe joints

Answer 27

ANS: A
Rationale: A deformity in which the great toe deviates laterally and there is a marked prominence of the medial aspect of the first metatarsal-phalangeal joint and exostosis is referred to as hallux valgus (bunion). Hallux valgus does not result in abnormal flexion, abnormalities of the arch, or joint fusion.

Question 28

28. An older adult woman’s current medication regimen includes alendronate. What
    outcome would indicate successful therapy?
    A. Increased bone mass
    B. Resolution of infection
    C. Relief of bone pain
    D. Absence of tumor spread

Answer 28

ANS: A
Rationale: Bisphosphonates such as alendronate increase bone mass and decrease bone loss by inhibiting osteoclast function. These drugs do not treat infection, pain, or tumors.

Question 29

29. A nurse is caring for a client who is being treated in the hospital for a spontaneous
    vertebral fracture related to osteoporosis. The nurse should address the nursing
    diagnosis of Acute Pain Related to Fracture by implementing what intervention?
    A. Maintenance of high Fowler positioning whenever possible
    B. Intermittent application of heat to the client’s back
    C. Use of a pressure-reducing mattress
    D. Passive range of motion exercises

Answer 29

ANS: B
Rationale: Intermittent local heat and back rubs promote muscle relaxation following osteoporotic vertebral fractures. High Fowler positioning is likely to exacerbate pain. The
mattress must be adequately supportive, but pressure reduction is not necessarily required. Passive range of motion exercises to the back would cause pain and impair
healing.

Question 30

30. A client has been admitted to the hospital with a spontaneous vertebral fracture
    related to osteoporosis. Which of the following nursing diagnoses must be addressed in
    the plan of care?
    A. Risk for aspiration related to vertebral fracture
    B. Constipation related to vertebral fracture
    C. Impaired swallowing related to vertebral fracture
    D. Decreased cardiac output related to vertebral fracture

Answer 30

ANS: B
Rationale: Constipation is a problem related to immobility and medications used to treat vertebral fractures. The client’s risks of aspiration, dysphagia, and decreased cardiac
output are not necessarily heightened.

Question 31

31. A nursing educator is reviewing the risk factors for osteoporosis with a group of
    recent graduates. What of the following risk factors should the educator describe?
    A. Recurrent infections and prolonged use of NSAIDs
    B. High alcohol intake and low body mass index
    C. Small frame and female sex
    D. Male sex, diabetes, and high protein intake

Answer 31

ANS: C
Rationale: Small-framed women are at greatest risk for osteoporosis. Diabetes, high protein intake, alcohol use, and infections are not among the most salient risk factors for
osteoporosis.

Question 32

32. A nurse is providing care for a client who has osteomalacia. What major goal should
    guide the choice of medical and nursing interventions?
    A. Maintenance of skin integrity
    B. Prevention of bone metastasis
    C. Maintenance of adequate levels of activated vitamin D
    D. Maintenance of adequate parathyroid hormone function

Answer 32

ANS: C
Rationale: The primary defect in osteomalacia is a deficiency of activated vitamin D, which promotes calcium absorption from the gastrointestinal tract and facilitates mineralization of bone. Interventions are aimed at resolving the processes underlying this deficiency. Maintenance of skin integrity is important, but is not the primary goal in care. Osteomalacia is not a malignant process. Overproduction (not underproduction) of PTH can cause the disease.

Question 33

33. A client with diabetes has been diagnosed with osteomyelitis. The nurse observes
    that the client’s right foot is pale and mottled, cool to touch, with a capillary refill of
    greater than 3 seconds. The nurse should suspect what type of osteomyelitis?
    A. Hematogenous osteomyelitis
    B. Osteomyelitis with vascular insufficiency
    C. Contiguous focus osteomyelitis
    D. Osteomyelitis with muscular deterioration

Answer 33

ANS: B
Rationale: Osteomyelitis is classified as hematogenous osteomyelitis (i.e., due to bloodborne spread of infection); contiguous-focus osteomyelitis, from contamination
from bone surgery, open fracture, or traumatic injury (e.g., gunshot wound); and osteomyelitis with vascular insufficiency, seen most commonly among clients with
diabetes and peripheral vascular disease, most commonly affecting the feet. Osteomyelitis with muscular deterioration does not exist.

Question 34

34. An orthopedic nurse is caring for a client who is postoperative day 1 following foot
    surgery. What nursing intervention should be included in the client’s subsequent care?
    A. Dressing changes should not be performed unless there are clear signs of
    infection.
    B. The surgical site can be soaked in warm bath water for up to 5 minutes.
    C. The surgical site should be cleansed with hydrogen peroxide once daily.
    D. The foot should be elevated in order to prevent edema.

Answer 34

ANS: D
Rationale: Pain experienced by clients who undergo foot surgery is related to inflammation and edema. To control the anticipated edema, the foot should be elevated
on several pillows when the client is sitting or lying. Regular dressing changes are performed and the wound should be kept dry. Hydrogen peroxide is not used to cleanse surgical wounds.

Question 35

35. A nurse is providing discharge teaching for a client who underwent foot surgery. The
    nurse is collaborating with the occupational therapist and discussing the use of assistive
    devices. On what variables does the choice of assistive devices primarily depend?
    A. Client’s general condition, balance, and weight-bearing prescription
    B. Client’s general condition, strength, and gender
    C. Client’s motivation, age, and weight-bearing prescription
    D. Client’s occupation, motivation, and age

Answer 35

ANS: A
Rationale: Assistive devices (e.g., crutches, walker) may be needed. The choice of the devices depends on the client’s general condition and balance, and on the weight-bearing
prescription. The client’s strength, motivation, and weight restrictions are not what the choice of assistive devices is based on.

Question 36

36. A client has come to the clinic for a routine annual physical. The nurse practitioner
    notes a palpable, painless projection of bone at the client’s shoulder. The projection
    appears to be at the distal end of the humerus. The nurse should suspect the presence of:
    A. osteomyelitis.
    B. osteochondroma.
    C. osteomalacia.
    D. Paget disease.

Answer 36

ANS: B
Rationale: Osteochondroma is the most common benign bone tumor. It usually occurs as a large projection of bone at the end of long bones (at the knee or shoulder). Osteomyelitis, osteomalacia, and Paget disease do not involve the development of excess bone tissue.

Question 37

37. An older, female client with osteoporosis has been hospitalized. Prior to discharge,
    when teaching the client, the nurse should include information about which major
    complication of osteoporosis?
    A. Bone fracture
    B. Loss of estrogen
    C. Negative calcium balance
    D. Dowager hump

Answer 37

ANS: A
Rationale: Bone fracture is a major complication of osteoporosis that results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause, not osteoporosis. Calcium and vitamin D supplements may be used to
support normal bone metabolism, but a negative calcium balance is not a complication of osteoporosis. Dowager hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

Question 38

38. An older adult client sought care for the treatment of a swollen, painful knee joint.
    Diagnostic imaging and culturing of synovial fluid resulted in a diagnosis of septic
    arthritis. The nurse should prioritize what aspect of care?
    A. Administration of oral and IV corticosteroids as prescribed
    B. Prevention of falls and pathologic fractures
    C. Maintenance of adequate serum levels of vitamin D
    D. Intravenous administration of antibiotics

Answer 38

ANS: D
Rationale: IV antibiotics are the major treatment modality for septic arthritis; the nurse must ensure timely administration of these drugs. Corticosteroids are not used to treat
septic arthritis and vitamin D levels are not necessarily affected. Falls prevention is important, but septic arthritis does not constitute the same fracture risk as diseases with
decreased bone density.

Question 39

39. A nurse is assessing a client for risk factors known to contribute to osteoarthritis.
    What assessment finding should the nurse interpret as a risk factor?
    A. The client has a 30 pack-year smoking history.
    B. The client’s body mass index is 34 (obese).
    C. The client has primary hypertension.
    D. The client is 58 years old.

Answer 39

ANS: B
Rationale: Risk factors for osteoarthritis include obesity and previous joint damage. Risk factors of OA do not include smoking or hypertension. Incidence increases with age, but
a client who is 58 years old would not yet face a significantly heightened risk.

Question 40

40. A nurse is caring for a 78-year-old client with a history of osteoarthritis (OA). When
    planning the client’s care, what goal should the nurse prioritize?
    A. The client will express satisfaction with the ability to perform ADLs.
    B. The client will recover from OA within 6 months.
    C. The client will adhere to the prescribed plan of care.
    D. The client will deny signs or symptoms of OA.

Answer 40

ANS: A
Rationale: Pain management and optimal functional ability are major goals of nursing interventions for OA. Cure is not a possibility, and it is unrealistic to expect a complete
absence of signs and symptoms. Adherence to the plan of care is highly beneficial, but this is not the priority goal of care; adherence is of little benefit if the regimen has no
effect on the client’s functional status.