Ignatavicius Ch 50: Care of Patients with Musculoskeletal Problems Flashcards
A client has a bone density score of 2.8. What action by the nurse is best?
a. Asking the client to complete a food diary
b. Planning to teach about bisphosphonates
c. Scheduling another scan in 2 years
d. Scheduling another scan in 6 months
b. Planning to teach about bisphosphonates
A T-score from a bone density scan at or lower than 2.5 indicates osteoporosis. The nurse should plan to teach about medications used to treat this disease. One class of such medications is bisphosphonates. A food diary is helpful to determine if the client gets adequate calcium and vitamin D, but at this point, dietary changes will not prevent the disease. Simply scheduling another scan will not help treat the disease either.
A nurse is assessing an older client and discovers back pain with tenderness along T2 and T3. What action by the nurse is best?
a. Consult with the provider about an x-ray.
b. Encourage the client to use ibuprofen (Motrin).
c. Have the client perform hip range of motion.
d. Place the client in a rigid cervical collar.
a. Consult with the provider about an x-ray.
Back pain with tenderness is indicative of a spinal compression fracture, which is the most common type of osteoporotic fracture. The nurse should consult the provider about an x-ray. Motrin may be indicated but not until there is a diagnosis. Range of motion of the hips is not related, although limited spinal range of motion may be found with a vertebral compression fracture. Since the defect is in the thoracic spine, a cervical collar is not needed.
A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client admits to not doing the prescribed exercises. What action by the nurse is best?
a. Ask the client about fear of falling.
b. Instruct the client to increase calcium.
c. Suggest other exercises the client can do.
d. Tell the client to try weight lifting.
a. Ask the client about fear of falling.
Fear of falling can limit participation in activity. The nurse should first assess if the client has this fear and then offer suggestions for dealing with it. The client may or may not need extra calcium, other exercises, or weight lifting.
The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option?
a. Client with diabetes who has a serum creatinine of 0.8 mg/dL
b. Client who recently fell and has vertebral compression fractures
c. Hypertensive client who takes calcium channel blockers
d. Client with a spinal cord injury who cannot tolerate sitting up
d. Client with a spinal cord injury who cannot tolerate sitting up
Clients on bisphosphonates must be able to sit upright for 30 to 60 minutes after taking them. The client who cannot tolerate sitting up is not a good candidate for this class of drug. Poor renal function also makes clients bad candidates for this drug, but the client with a creatinine of 0.8 mg/dL is within normal range. Diabetes and hypertension are not related unless the client also has renal disease. The client who recently fell and sustained fractures is a good candidate for this drug if the fractures are related to osteoporosis.
A client has been prescribed denosumab (Prolia). What instruction about this drug is most appropriate?
a. Drink at least 8 ounces of water with it.
b. Make appointments to come get your shot.
c. Sit upright for 30 to 60 minutes after taking it.
d. Take the drug on an empty stomach.
b. Make appointments to come get your shot.
Denosumab is given by subcutaneous injection twice a year. The client does not need to drink 8 ounces of water with this medication as it is not taken orally. The client does not need to remain upright for 30 to 60 minutes after taking this medication, nor does the client need to take the drug on an empty stomach.
A client in a nursing home refuses to take medications. She is at high risk for osteomalacia. What action by the nurse is best?
a. Ensure the client gets 15 minutes of sun exposure daily.
b. Give the client daily vitamin D injections.
c. Hide vitamin D supplements in favorite foods.
d. Plan to serve foods naturally high in vitamin D.
a. Ensure the client gets 15 minutes of sun exposure daily.
Sunlight is a good source of vitamin D, and the nursing staff can ensure some sun exposure each day. Vitamin D is not given by injection. Hiding the supplement in food is unethical. Very few foods are naturally high in vitamin D, but some are supplemented.
A client is in the internal medicine clinic reporting bone pain. The clients alkaline phosphatase level is 180 units/L. What action by the nurse is most appropriate?
a. Assess the client for leg bowing.
b. Facilitate an oncology workup.
c. Instruct the client on fluid restrictions.
d. Teach the client about ibuprofen (Motrin).
a. Assess the client for leg bowing.
This client has manifestations of Pagets disease. The nurse should assess for other manifestations such as bowing of the legs. Other care measures can be instituted once the client has a confirmed diagnosis.
An older client with diabetes is admitted with a heavily draining leg wound. The clients white blood cell count is 38,000/mm3 but the client is afebrile. What action does the nurse take first?
a. Administer acetaminophen (Tylenol).
b. Educate the client on amputation.
c. Place the client on contact isolation.
d. Refer the client to the wound care nurse.
c. Place the client on contact isolation.
In the presence of a heavily draining wound, the nurse should place the client on contact isolation. If the client has discomfort, acetaminophen can be used, but this client has not reported pain and is afebrile. The client may or may not need an amputation in the future. The wound care nurse may be consulted, but not as the first action.
A nurse is caring for four clients. After the hand-off report, which client does the nurse see first?
a. Client with osteoporosis and a white blood cell count of 27,000/mm3
b. Client with osteoporosis and a bone fracture who requests pain medication
c. Post-microvascular bone transfer client whose distal leg is cool and pale
d. Client with suspected bone tumor who just returned from having a spinal CT
c. Post-microvascular bone transfer client whose distal leg is cool and pale
This client is the priority because the assessment findings indicate a critical lack of perfusion. A high white blood cell count is an expected finding for the client with osteoporosis. The client requesting pain medication should be seen second. The client who just returned from a CT scan is stable and needs no specific postprocedure care.
A client has a metastatic bone tumor. What action by the nurse takes priority?
a. Administer pain medication as prescribed.
b. Elevate the extremity and apply moist heat.
c. Handle the affected extremity with caution.
d. Place the client on protective precautions.
c. Handle the affected extremity with caution.
Bones invaded by tumors are very fragile and fracture easily. For client safety, the nurse handles the affected extremity with great care. Pain medication should be given to control pain. Elevation and heat may or may not be helpful. Protective precautions are not needed for this client.
A hospitalized client is being treated for Ewings sarcoma. What action by the nurse is most important?
a. Assessing and treating the client for pain as needed
b. Educating the client on the disease and its treatment
c. Handling and disposing of chemotherapeutic agents per policy
d. Providing emotional support for the client and family
c. Handling and disposing of chemotherapeutic agents per policy
All actions are appropriate for this client. However, for safety, the nurse should place priority on proper handling and disposal of chemotherapeutic agents.
A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the clients psychosocial needs?
a. Assess the clients coping skills and support systems.
b. Explain that the surgery leads to a longer life expectancy.
c. Refer the client to the social worker or hospital chaplain.
d. Reinforce physical therapy to aid with ambulating normally.
a. Assess the clients coping skills and support systems.
The first step in the nursing process is assessment. The nurse should assess coping skills and possible support systems that will be helpful in this clients treatment. Explaining that a limb salvage procedure will extend life does not address the clients psychosocial needs. Referrals may be necessary, but the nurse should assess first. Reinforcing physical therapy is also helpful but again does not address the psychosocial needs of the client.
A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What explanation by the nurse is best?
a. Your feet have less blood flow, so healing is slower.
b. The bones in your feet are hard to operate on.
c. The surrounding bones and tissue are damaged.
d. Your feet bear weight so they never really heal.
a. Your feet have less blood flow, so healing is slower.
The feet are the most distal to the heart and receive less blood flow than other organs and tissues, prolonging the healing time after surgery. The other explanations are not correct.
A client has scoliosis with a 65-degree curve to the spine. What action by the nurse takes priority?
a. Allow the client to rest in a position of comfort.
b. Assess the clients cardiac and respiratory systems.
c. Assist the client with ambulating and position changes.
d. Position the client on one side propped with pillows.
b. Assess the clients cardiac and respiratory systems.
This degree of curvature of the spine affects cardiac and respiratory function. The nurses priority is to assess those systems. Positioning is up to the client. The client may or may not need assistance with movement.
A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first?
a. Client taking calcium with vitamin D (Os-Cal) who reports flank pain 2 weeks ago
b. Client taking ibandronate (Boniva) who cannot remember when the last dose was
c. Client taking raloxifene (Evista) who reports unilateral calf swelling
d. Client taking risedronate (Actonel) who reports occasional dyspepsia
c. Client taking raloxifene (Evista) who reports unilateral calf swelling
The client on raloxifene needs to be seen first because of the manifestations of deep vein thrombosis, which is an adverse effect of raloxifene. The client with flank pain may have had a kidney stone but is not acutely ill now. The client who cannot remember taking the last dose of ibandronate can be seen last. The client on risedronate may need to change medications.
