HESI - Osteoporosis + Musculoskeletal Flashcards
The client sustains a Colles’ fracture while on a hiking vacation in the mountains. She received care at a local emergency care center, where asked if she has ever been screened for osteoporosis. When the client replies, “No.”, the healthcare provider (HCP) recommends that her primary provider conduct the screening after she returns home.
During the intake assessment and interview, what information indicates that the client has an increased risk for osteoporosis? (Select all that apply. One, some, or all options may be correct.) Select all that apply
Recent death of her husband of 30 years.
Gave birth to her first and only child at age 30.
Low body weight, thin build
Parent with history of osteoporosis
High alcohol intake
Low body weight, thin build
Parent with history of osteoporosis
High alcohol intake
The client is seen by the healthcare provider (HCP), who recommends osteoporosis screening since they are at risk for osteoporosis. The nurse meets with the client to provide client teaching. The client tells the nurse that they played a lot of sports as a child and teenager. The client states, “I guess I just put too much stress on my bones over the years.”
How should the nurse respond?
Excessive wear and tear during the growth years can weaken your bones as an adult.
Being active in sports only increases the risk for osteoporosis if your bones break a lot.
Brittle bones are primarily inherited and are not often affected by your level of activity.
Participating in sports activities often helps the bones become stronger and denser.
Participating in sports activities often helps the bones become stronger and denser.
Which aspect of the client’s medication history is most likely to impact the client’s risk for osteoporosis?
Chronically low calcium and/or Vitamin D intake
Took an antidepressant for 6 months immediately following spouse’s death.
Began treatment for hyperlipidemia with simvistatin 6 months ago.
Has occasionally taken ibuprofen for lower back pain for the last 2 years.
Chronically low calcium and/or Vitamin D intake
The nurse calls to schedule the client’s appointment for dual energy x-ray absorptiometry (DEXA) of the hip and spine. An appointment is available in 30 minutes or the next available appointment is in 3 weeks.
What action should the nurse implement?
Advise the client that an immediate appointment will not allow adequate time to maintain NPO status before the test.
Provide the client with the available choices of appointment times and allow the client to select the desired appointment.
Schedule the client for the immediate appointment so that emergency treatment can be started, based on the test results.
Instruct the client that it may be desirable to have a family member available following the test to drive her home.
Provide the client with the available choices of appointment times and allow the client to select the desired appointment.
The nurse should promote client autonomy by offering the client safe, reasonable choices. Since no special preparation is needed prior to the test, the client may choose to have the test completed immediately. Even though the client has recently experienced a fracture this is not an emergency situation, so the client may prefer to wait for the appointment in 3 weeks.
After the appointment for DEXA is scheduled, the client reminds the nurse that she has a number of food allergies, including shellfish, red food color, peanuts, and strawberries.
What information should the nurse provide the client concerning the effects of food allergies on osteoporosis screening?
Advise the client that an ultrasound or CT scan may need to be prescribed, rather than the scheduled DEXA.
Reassure the client that there are no dyes or products containing iodine used during a DEXA.
Advise the client that her allergy to multiple food products increases her risk for hypersensitivity to the medication used during the test.
Contact the DXA technician to ensure that the contrast medium used does not contain any of these allergens.
Reassure the client that there are no dyes or products containing iodine used during a DEXA.
DEXA is a non-invasive procedure that does not involve the use of any dyes or cleansing agents that might contain allergens such as iodine.
The client returns to the office 1 month later to discuss the results of the DEXA test with the provider and learns that the T-score (- 1.0) indicates osteopenia. The client states, “I guess I am not having any symptoms because I don’t have osteoporosis yet.”
Question 6 of 28
How should the nurse respond?
Both terms mean the same thing, so you do have osteoporosis.
Many persons with osteoporosis do not have any symptoms.
Weakness and fatigue often increase as the condition worsens.
You are fortunate that you are not having any symptoms yet.
Many persons with osteoporosis do not have any symptoms.
Osteoporosis is often referred to as a silent disease or silent thief because the first sign of osteoporosis in most people follows some kind of a fracture
Osteoporosis is often referred to as a silent disease or silent thief because the first sign of osteoporosis in most people follows some kind of a ____________
fracture
Further conversation with the client reveals that they have been experiencing lower back pain off and on for the last 2 years. The client takes ibuprofen occasionally for the pain.
What action should the nurse implement first upon learning of this problem?
Reassure the client that her lower back pain is the result of her osteopenia.
Teach the client exercises that will strengthen her abdominal muscles.
Determine if the client’s PRN use of ibuprofen provides adequate pain relief.
Ask the client if she has discussed this symptom with her healthcare provider.
Ask the client if she has discussed this symptom with her healthcare provider.
Lower back pain can be the result of many problems. The healthcare provider should first evaluate the cause of the pain before the nurse provides client teaching regarding exercises or pain management.
In addition to evaluating for the presence of subjective symptoms, what assessment technique should the nurse include in the ongoing assessment of the client’s bone density?
Record her grip strengths.
Perform an Allen’s test.
Observe her feet and toes.
Measure her height.
Measure her height.
Persons with osteoporosis often loose height over time as the vertebrae are compressed.
Persons with osteoporosis often loose _________ over time as the vertebrae are compressed.
height
The client’s healthcare provider recommends a regimen of exercise and diet. The nurse meets with the client to provide osteopenia related teaching. The client and the nurse discuss the need for adequate calcium intake.
To increase the client’s dietary intake of calcium, which snack should the nurse recommend?
A large apple.
A cup of fruit-flavored yogurt.
Twenty cheese-flavored crackers.
An ounce of low-fat cream cheese on a bagel.
A cup of fruit-flavored yogurt.
The client tells the nurse that she started taking a 500 mg calcium supplement daily after she stopped her post-hysterectomy estrogen therapy.
Question 10 of 28
What instruction(s) should the nurse provide? (Select all that apply. One, some, or all options may be correct.)
Try to take 1 tablet with each meal.
500 mg is adequate for women taking estrogen, but you now need at least 2 grams of calcium every day.
As long as your vitamin supplement also contains Vitamin D, you will be receiving adequate supplementation.
By taking 3 of your calcium tablets each day you will receive adequate amounts of calcium for your needs.
Any additional calcium supplementation could cause you to have harmful symptoms of calcium toxicity.
Try to take 1 tablet with each meal.
500 mg is adequate for women taking estrogen, but you now need at least 2 grams of calcium every day.
The client tells the nurse that she loves to hike and that she walks 2 miles every weekend to stay in shape.
How should the nurse respond?
It sounds as if your long walks provide plenty of weight-bearing exercise.
It is important to increase the frequency of your walks to at least five times per week.
Walking more than a mile at one time is likely to increase your risk for another fracture.
The best way to increase your bone strength is by lengthening your weekly walk by another mile.
It is important to increase the frequency of your walks to at least five times per week.
Regular exercise, walking for 30 minutes three to five times a week is the single most effective exercise for osteoporosis prevention. In addition, regular exercise improves muscle strength and coordination, reducing the client’s risk for falls.
A repeat DXA the following year indicates a progression from osteopenia to osteoporosis. The client states adhering to a calcium rich dietary and a faithful exercise regimen.
To help determine why osteoporosis has developed, what question should the nurse ask the client?
What medications have you taken during the last year?
How many hours of sleep do you get per night?
Have you experienced any infections recently?
Do your hands or feet ever swell when you exercise?
What medications have you taken during the last year?
Medications can contribute to the loss of bone density.
The client reports having ulcerative colitis and experienced an acute exacerbation during the past year. The client states that it has taken a number of medications over the last year to manage the ulcerative colitis.
Which medication is most likely to have contributed to the decrease in the client’s bone density?
Diphenoxylate, an antidiarrheal, taken prior to the acute exacerbation for occasional episodes of diarrhea.
Sulfasalazine, an antiinflammatory sulfonamide, administered during the acute exacerbation.
Prednisone, a corticosteroid, taken during the acute exacerbation and for several months following.
Propantheline, an anticholinergic, administered during the acute exacerbation.
Prednisone, a corticosteroid, taken during the acute exacerbation and for several months following.
Corticosteroid-induced osteoporosis is an important concern for patients who receive corticosteroid treatment for prolonged periods (longer than 3 months).
The healthcare provider prescribes alendronate PO once a week. The nurse instructs the client to select a specific day of the week when she can take the medication first thing in the morning. The client states, “Is that really necessary? I’m not much of a morning person.”
Which response(s) are appriopriate? (Select all that apply. One, some, or all options may be correct.) Select all that apply
The medication is much better absorbed when taken on an empty stomach.
Increased nausea often occurs when the medication is taken late in the day.
You may prefer to take the medication with a specific meal once a week.
It is important to have a weekly routine so you won’t forget to take the medication.
Make sure you remain upright for at least ½ hour after taking the medication.
The medication is much better absorbed when taken on an empty stomach.
Make sure you remain upright for at least ½ hour after taking the medication.
Six weeks after starting the medication [alendronate] , the client leaves a message for the nurse that she is experiencing increasingly frequent and severe heartburn.
What action should the nurse take?
Advise the client to go to the emergency department immediately.
Ask the client to describe her method of alendronate administration.
Instruct the client to use an antacid PRN 2 hours after her alendronate dose.
Reassure the client that heartburn is a common side effect of alendronate.
Ask the client to describe her method of alendronate administration.
After taking a dose of alendronate the client must remain in an upright position for 30 minutes to prevent esophageal irritation and erosion.
After taking a dose of alendronate the client must remain in an __________ position for 30 minutes to prevent esophageal irritation and erosion.
upright
A Complication Occurs
Three weeks later, the client goes to the emergency department of the local medical center, where she reports that she fell off a ladder the previous day and is experiencing increasing pelvic tenderness. The X-ray reveals a pelvic fracture, and the client is transferred to the orthopedic unit for fracture management. While being admitted to the orthopedic unit, the client develops chest pain. Her vital signs are Temperature, 99.8° F (37.6° C), Pulse 122, Respirations 40, Blood Pressure 110/74. While obtaining the client’s vital signs, the nurse notes that the client is pale and has petechiae on her anterior chest and neck.
What action should the nurse implement first?
Apply oxygen via mask.
Observe for hematuria.
Measure abdominal girth.
Administer an analgesic.
Apply oxygen via mask.
The client’s vital signs and manifestations indicate that fat embolization syndrome has occurred. Typical symptoms include chest pain, tachycardia, tachypnea, dyspnea, pallor, and petechiae on the anterior chest, neck, and axilla. Symptoms are the result of poor oxygenation, so the nurse’s first interventions should include measures to improve oxygenation, such as the application of oxygen.
After taking initial action, the nurse notes that the client is becoming cyanotic and appears restless, anxious, and disoriented with a decreasing SaO2.
What is the priority nursing action?
Prepare the client for a blood transfusion.
Initiate cardiopulmonary resuscitation.
Ensure that intubation equipment is readily available.
Position the client on her right side with her head down.
Ensure that intubation equipment is readily available.
The fat globules transported to the lungs can result in acute respiratory distress syndrome (ARDS). Acute deterioration of respiratory function may require intubation or intermittent positive pressure ventilation if satisfactory PaO2 cannot be obtained with supplemental O2 alone. The nurse should ensure that this emergency equipment is readily available.
The client’s condition stabilizes after initial treatment with oxygen and IV fluids. Mechanical ventilation is not needed, but the healthcare provider prescribes a transfer to the critical care unit, where the client can be more closely monitored for the next 24 hours. The house supervisor notifies the orthopedic unit charge nurse that no beds are available in the critical care unit and there are no clients stable enough to be transferred out of the critical care unit. The supervisor also notifies the healthcare provider, who agrees that the client can remain on the orthopedic unit if one-to-one care is received.
While arrangements are being made for one-to-one care, the nurse currently assigned requests assistance with other client care responsibilities and provides a report about the clients. An RN and two LPNs are working on the unit.
Which reported information indicates the need to assign the client to the RN?
There is no drainage in the hemovac drain of a client 2 days following an open reduction and internal fixation of the hip.
Six hours following a hip arthroplasty, the client’s autotransfusion collection device is full of sanguinous drainage.
Twenty-four hours following a vertebral khyphoplasty, a client needs the surgical dressing changed.
Twelve hours following a knee arthroplasty, a client reports pain when using the prescribed continuous passive motion device.
Six hours following a hip arthroplasty, the client’s autotransfusion collection device is full of sanguinous drainage.
This client is experiencing a large amount of postoperative drainage and may require a transfusion, as well as close monitoring. The acuity of this client requires the expertise of the RN for assessment and transfusion management.
The supervisor agrees to send additional nursing staff to the unit so that the client can receive one-to-one care.
Arrangements should be made for which nurse to provide care for the client?
An experienced critical care RN who is scheduled off for the day.
An experienced orthopedic unit RN who is scheduled off for the day.
A graduate nurse serving a critical care internship who is at work but does not have a client care assignment.
An experienced orthopedic LPN who is already at work and has requested to work overtime whenever possible.
An experienced critical care RN who is scheduled off for the day.
Fat embolism syndrome can quickly deteriorate and requires a high level of critical care expertise to effectively assess for subtle changes in the client’s status.
Pelvic Fracture Management
The client’s respiratory status gradually improves and one-on-one monitoring is no longer required. The client’s pelvic fracture involves a weight-bearing aspect of the pelvis, and the client is receiving traction with a pelvic sling.
In the planning of the client’s care, which problem has the highest priority?
Fatigue.
Acute pain.
Sleep pattern disturbance.
Impaired physical mobility.
Acute pain.
Pelvic fractures can be extremely painful, impacting all aspects of the client’s well-being and contributing to fatigue, sleep pattern disturbance, and impaired physical mobility.
The nurse also includes “Risk for peripheral neurovascular dysfunction” in the plan of care.
Which nursing action should be implemented to address this potential problem?
Assign an LPN to take the client’s vital signs every 2 hours.
Observe the client’s pupillary response to light every 8 hours.
Measure and compare calf circumferences every 12 hours.
Assess for sensation and movement of the feet every 4 hours.
Assess for sensation and movement of the feet every 4 hours.
Diminished sensation and movement of the feet, along with diminished pedal pulses, pallor, and pain indicate impaired peripheral neurovascular function. pp. 1033
