Chapter 36: Musculoskeletal Disorders Flashcards
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.
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.
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
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.
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
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.
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
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.
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.
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.
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
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.
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
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.
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
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.
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.
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.
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
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.
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
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.
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
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.
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
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.
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
ANS: D
Rationale: Laboratory studies in clients with osteomalacia will reveal a low serum calcium and low phosphorus level.
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
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.
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
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.
