Musculoskeletal

Question 1

Intervertebral Disc Disease

Answer 1

A common condition characterized by the breakdown (degeneration) of one or more of the discs that separate the bones of the spine (vertebrae), causing pain in the back or neck and frequently in the legs and arms.

Question 2

Osteomalacia

Answer 2

a disorder of “bone softening” in adults that is usually due to prolonged deficiency of vitamin D.

Question 3

Osteoporosis Pathophysiology

Answer 3

Fragile, porous bones
Big holes inside bones, loss of bone mass results in low bone density and very brittle bones
Body is making too little bone, calcium leaves the bone and goes into the bloodstream

Question 4

Osteoporosis Causes and risk factors

Answer 4

Female Gender
Old age
Postmenopausal
Caucasian and asian

Question 5

Osteoporosis Bad Habits

Answer 5

Excess caffeine intake
Smoking or alcohol abuse

Question 6

Osteoporosis Diseases

Answer 6

Hyperparathyroidism
Increases in PTH
Puts the calcium high in the blood
Cushing Syndrome - High steroids in the body which decreases the bone density
Diabetes Miletus

Question 7

Which off the following medications can increase their risk for development of osteoporosis?

Answer 7

Prednisone

Question 8

Which disease has an increase chance of occurrence in a 60 year old postmenopausal patient?

Answer 8

Osteoporosis

Question 9

What are the risk factors for osteoporosis

Answer 9

Steroid use
High intake of caffeine
Being white or asian women
Postmenopausal sate
Anticonvulsant therapy for seizure disorders

Question 10

Osteoporosis Signs and Symptoms

Answer 10

Frequent fractures
Reduced heigh
Kyphosis (round back, curving of upper back)

Question 11

Osteoporosis Treatment and Education

Answer 11

Vitamin D and Calcium supplements (vitamin D helps calcium to absorb)
Go outside in the sun

Activity: Weight bearing exercises
Frequent ambulation

Fall precautions: provide rubber mats in showers
Well lit halls
Not throw rugs*

Stop Bad habits
Stop smoking
Decrease Caffeine intake

Question 12

A nurse is providing education for a client who is at risk for osteoporosis. Which of the following instructions should the nurse include?

Answer 12

Walk for 30 minutes, 4 times a week

Question 13

Which interventions should the nurse implement while providing care for an elderly female patient with osteoporosis?

Answer 13

Encourage frequent ambulation
Provide rubber mats in the shower
Encourage weight bearing exercises
Encourage the patient to stop smoking

Question 14

Rheumatoid Arthritis

Answer 14

Autoimmune disorder where body attacks itself
Mainly attacks joints causing inflammation usually seen in the joints of the hands
Can involve the skin, eyes and lungs

Question 15

What is the difference between rheumatoid arthritis and osteoarthritis?

Answer 15

Rheumatoid arthritis is a systemic disease and osteoarthritis is not

Question 16

Rheumatoid arthritis Diagnosis

Answer 16

Can be very difficult to diagnosis since early signs and symptoms mimic those of many other diseases
Xrays and MRI
Synovial fluid aspiration
Arthoscopy
Blood test
RF - rheumatoid factor
ESR - erythrocyte sedimentation rate
CRP - C-reactvie protein

Question 17

Rheumatoid arthritis Signs and Symptoms

Answer 17

Early signs: Fatigue, anorexia (weight loss) and morning pain and stiffness
Symmetrical pain and swelling in the small joints of the hands

Fingers: Swan-neck and a boutonniere deformity
Contractors of joints = High priority

Joint pain:
Pain relief with activity
More pain at rest

Question 18

Suspected rheumatoid arthritis. The nurse would expect to note which early signs and symptoms

Answer 18

Fatigue
Morning stiffness

Question 19

Rheumatoid arthritis Education

Answer 19

Pain control - Assess pain levels
Do NOT elevate the knees with pillows at night
Exercise (low impact)
Swimming
heat and cold to affected joints
Warm shower or bath before bed

Question 20

A nurse is assessing a client who has a diagnosis of rheumatoid arthritis. Which of the following non-pharamacological interventions could the nurse suggest to help reduce pain

Answer 20

Alternate applying heat and cold to the affected joints

Question 21

Which nursing intervention is most appropriate for a client diagnosed with rheumatoid arthritis and reporting generalized pain?

Answer 21

Assist the client with heat application and range of motion exercises

Question 22

Rheumatoid arthritis Pharmacology

Answer 22

NSAIDS
Prednisone
Both decrease swelling
Methotrexate given to help the body to stop attacking itself

Question 23

Methotrexate

Answer 23

Mainly given for rheumatoid arthritis and psoriasis swell as certain types of cancer
Stops folic acid metabolism which stops cellular reproduction
MethNOOOtrexate
No pregnant clients
No client crowds or live vaccines to avoid infection
No razors or brushing teeth hard - huge bleed risk with those low platelets

Question 24

Methotrexate, what does it suppress

Answer 24

B and T lymphocytes
Suppresses white blood cells

Question 25

Assessment on a client with rheumatoid arthritis (RA). The nurse checks for which assessment finding that is associated with RA?

Answer 25

Systemic symptoms such as fatigue, anorexia and weight loss

Question 26

Lyme Disease

Answer 26

A thick transmitted bacterial infection that causes local inflammation and infection, left untreated can cause the immune system to react abnormally and can spread to organs and can cause systemic complications

Question 27

Lyme Disease Symptoms

Answer 27

fever
headache
fatigue
characteristic skin rash called erythema

If left untreated, infection can spread to joints, the heart, and the nervous system.

Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks.

Question 28

Lyme disease Treatment

Answer 28

most cases of Lyme disease can be cured with a 2 to 4 week course of oral antibiotics, patients can sometimes have symptoms of pain, fatigue, or difficulty thinking that lasts for more than 6 months after they finish treatment.

Question 29

Gout

Answer 29

It’s a type of arthritis due to the accumulation of uric acid in the blood.

pain, inflammation, redness, and limited mobility.

It tends to most commonly occur in the BIG TOE, but can affect the fingers, elbow, knee, small toes, wrist.

Question 30

What is uric acid?

Answer 30

It is a waste product created from the purine breakdown during digestion. It enters the blood stream and is filtered through the kidneys and excreted out in the urine.

The kidneys play a role in keeping the uric acid levels within normal range….therefore, if the kidneys are damaged there is a high risk of uric acid levels increasing.

Question 31

What can cause Gout?

Answer 31

High consumption of:

purine rich foods
fruit juice and soda drinks
alcohol…
Alcohol and uric acid compete within the kidneys, and the kidneys choose to excrete alcohol rather than uric acid, which leads to the buildup of uric acid.

Question 32

Signs and Symptoms of Gout - Acute gout attacks:

Answer 32

Happen randomly…may only happen a few times or once in a person’s lifetime and lasts 1-2 weeks.

Tends to start out in the big toe…may also affect the fingers, elbows, writs, knees, heel, toes.Patient may have flu-like like symptoms…body aches.

As the day progresses, the pain intensifies (4-24 hours), and the patient may have joint stiffness. The affected area is VERY sensitive and the slightest pressure on the joint causes intense pain.

Question 33

Nursing Interventions for Gout

Answer 33

Assess patient joints, especially toes, fingers, elbows for warmth, redness, or pain

Cold and warm compresses, if tolerated by the patient (alternate between cold and warm)

Question 34

Systematic Lupus Erythematosus

Answer 34

Systemic lupus erythematosus is an autoimmune condition that causes inflammation in the joints, organs, and tissues of the body. This inflammation can damage affected structures permanently.

Systemic lupus erythematosus can affect almost any part of the body, but the most common areas include the following:

Joints
Lungs
Skin (disoid rash, butterfly “malar” rash)
Heart
Brain
Kidneys
Blood System

Question 35

Polymyositis

Answer 35

an uncommon inflammatory disease that causes muscle weakness affecting both sides of your body. Having this condition can make it difficult to climb stairs, rise from a seated position, lift objects or reach overhead

Question 36

Dermatomyositis

Answer 36

Dermatomyositis is a rare disease that causes muscle weakness and skin rash. Symptoms include a red or purple rash on sun exposed skin and eyelids, calcium deposits under the skin, muscle weakness, and trouble talking or swallowing. There is no cure, but treatment is done to reduce the symptoms.

Question 37

Fibromyalgia

Answer 37

Fibromyalgia is a chronic (long-lasting) disorder that causes pain and tenderness throughout the body, as well as fatigue and trouble sleeping.

do not fully understand what causes it, but people with the disorder have a heightened sensitivity to pain.

Question 38

A client with rheumatoid arthritis has been taking large doses of aspirin to relieve joint pain. Which finding is likely?

Answer 38

tinnitus

Question 39

Client is admitted to the trauma center with a spinal cord transection at T4. Which of the physical limitations does the nurse anticipate when planning care? Select all that apply.

Answer 39

The client will be unable to independently ambulate.
The client will have no control of the bladder.

Question 40

The nurse is planning care with an older adult who is at risk for falling because of postural hypotension. Which intervention will be most effective in preventing falls in this client?

Answer 40

Instruct the client to sit, obtain balance, dangle their legs, and rise slowly.

Question 41

A client is recovering from an attack of gout. Client teaching should include the need to lose weight because

Answer 41

weight loss will reduce uric acid levels and reduce stress on joints.

Question 42

Which nursing intervention is essential in caring for a client with compartment syndrome?

Answer 42

removing all external sources of pressure, such as clothing and jewelry

Question 43

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

Answer 43

elevating the stump for the first 24 hours

Question 44

A client being discharged after treatment for a compound fracture asks why antibiotics are needed for a broken bone. Which response by the nurse is most appropriate?

Answer 44

This prophylactic antibiotic therapy is required because your bone broke through your skin.”

Question 45

What are important nursing priorities on the first postoperative day for a client who has had an open reduction and internal fixation (ORIF) after a right hip fracture?

Answer 45

assessing the neurovascular status in the right leg, providing pain control, encouraging position changes, and early ambulation

Question 46

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?

Answer 46

“I should use my heating pad this evening to reduce some of the pain in my knee.”

The client shouldn’t use heat at the procedure site during the first 24 hours because doing so may increase localized swelling. Ice is indicated during this time. Elevating the extremity helps reduce swelling.

Question 47

The nurse is caring for an adult with a grade III compound fracture of the right femur; the client has been placed in skeletal traction. What is the intended outcome of the traction?

Answer 47

Reduce and immobilize the fracture.

Question 48

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

Answer 48

administering ordered analgesics and monitoring their effects

Question 49

A client is diagnosed with gout. Which foods should the nurse instruct the client to avoid? Select all that apply.

Answer 49

liver
cod
sardines

Question 50

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 – S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?

Answer 50

Logroll the client from side to side.

Question 51

Osteoarthritis

Answer 51

More pain with more activity

Question 52

The nurse is teaching a client with osteoporosis about taking alendronate. What information should the nurse give the client about how to take the medication:?

The medication should be taken:The nurse is teaching a client with osteoporosis about taking alendronate. What information should the nurse give the client about how to take the medication:?

The medication should be taken:

Answer 52

with a full glass of water and remain upright for 30 minutes.

Question 53

The nurse is teaching a client with osteoporosis about optimal dietary choices to reduce the severity of the condition. What instruction should the nurse provide?

Answer 53

“Eat more dairy products such as cheese and yogurt.”

Question 54

A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true?

Answer 54

Dorsiflexion exacerbates signs and symptoms of a ganglion.

Question 55

The nurse is caring for a client with a fractured fibula who has skeletal traction and skeletal pins. What would the nurse instruct the unlicensed assistive personnel (UAP) to report immediately?

Answer 55

The traction weights are resting on the floor.

Question 56

The nurse is caring for a child with osteomyelitis who will be receiving high-dose intravenous antibiotic therapy for 3 to 4 weeks. What should the nurse plan to monitor?

Answer 56

urine specific gravity

Question 57

hich findings best correlate with a diagnosis of osteoarthritis?

Answer 57

joint stiffness that decreases with activity

Question 58

The client sustained an open fracture of the femur from an automobile accident. The nurse should assess the client for which type of shock?

Answer 58

hypovolemic

Question 59

A male client underwent a lumbar spinal fusion yesterday. Which nursing assessment should alert the nurse to the development of a possible complication?

Answer 59

clear yellowish fluid on the dressing

Question 60

hemiparesis

Answer 60

weakness or the inability to move on one side of the body

Question 61

diplopia

Answer 61

Double vision

Question 62

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?

Answer 62

keeping a pillow between the client’s legs at all times

Question 63

After a person experiences a closure of the epiphyses, which statement is true?

Answer 63

No further increase in bone length occurs.

Question 64

A nurse is teaching a client with osteomalacia how to take ordered vitamin D supplements. Which adverse effects should the nurse instruct the client to report?

Answer 64

GI upset and metallic taste

Question 65

Two days after being placed in a cast for a fractured femur, the client suddenly has chest pain and dyspnea. The client is confused and has an elevated temperature. The nurse should assess the client for which health problem?

Answer 65

fat embolism syndrome

Question 66

A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond?

Answer 66

“You may experience progressive deterioration in all voluntary muscles.”

Question 67

A client reports an onset of pain in the ankle. The ankle is swollen, red, and extremely sensitive to pressure. The health care provider diagnoses secondary gout and the client asks for more information. What disease state(s) could the nurse discuss with the client that are associated with secondary gout? Select all that apply.

Answer 67

chronic alcohol ingestion
diabetes mellitus
hypercholesterolemia
hypothyroidism

Question 68

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

Answer 68

“I don’t know if I’ll be able to get off that low toilet seat at home by myself.”

The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion.

Question 69

A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct?

Answer 69

The recommended daily allowance of calcium may be found in a wide variety of foods.

Question 70

The nurse is caring for a client who has been diagnosed with a strained ankle. The client asks the nurse what the difference is between a sprain and a strain. How should the nurse respond?

Answer 70

Sprains involve injury to the ligaments and strains to tendons or muscles.”

Question 71

In preparation for total knee surgery, a 200-lb (90.7-kg) client with osteoarthritis must lose weight. Which exercise should the nurse recommend as best if the client has no contraindications?

Answer 71

aquatic exercise

Question 72

A client has an intracapsular hip fracture. The nurse should conduct a focused assessment to detect which change near the fracture?

Answer 72

shortening of the affected leg

Question 73

A client is admitted to the hospital with a diagnosis of a right hip fracture. The client has right hip pain and cannot move the right leg. The nurse should further assess the right leg to determine if the leg is in which position?

Answer 73

shorter than the leg on the unaffected side

Question 74

A client who has had an above-the-knee amputation develops a dime-sized bright red spot on the dressing after 45 minutes in the postanesthesia recovery unit. What should the nurse do first?

Answer 74

Draw a mark around the site.

Question 75

The nurse is admitting a client with a fractured tibia. Which area should the nurse assess first?

Answer 75

area distal to the fracture

When a nerve or blood vessel is severed or obstructed at the actual fracture site, innervation to the nerve or blood flow to the vessel is disrupted below the site;

Question 76

A nurse is assigned a client with an acute exacerbation of rheumatoid arthritis (RA). Which medical facts about RA are essential in developing a plan of care? Select all that apply.

Answer 76

The client experiences stiff, swollen joints bilaterally.
Erythrocyte sedimentation rate (ESR) is elevated, and x-rays show erosions and decalcification of involved joints.
Inflamed cartilage triggers complement activation, which stimulates the release of additional inflammatory mediators.

Question 77

The nurse is setting goals with a client with rheumatoid arthritis. Which is a priority goal for the client?

Answer 77

Demonstrate the use of adaptive equipment.

Question 78

The emergency room nurse is caring for a client who fell, breaking the tibia. The nurse determines that the client understands the risk of compartment syndrome when knowing to report which early symptom following treatment?

Answer 78

paresthesia

Question 79

A client with an open femoral fracture was discharged to home and reports having a fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg. The nurse should interpret these findings as the client may be experiencing which complication?

Answer 79

osteomyelitis

Question 80

The nurse is assessing a client with a fracture of the right femur for signs of complications. Which finding indicates the client may be developing a fat embolus?

Answer 80

acute respiratory distress syndrome

Question 81

A nurse is caring for a client who has been immobilized in Buck’s traction for 3 weeks. Which actions by the nurse is most important in preventing a metabolic complication related to the immobilization?

Answer 81

Increase fluid intake and monitor urine output.

Question 82

A client who has skeletal traction to stabilize a fractured femur has not had a bowel movement for 2 days. The nurse should:

Answer 82

increase the client’s fluid intake to 3,000 mL/day.

Question 83

The nurse is advising a client who underwent femoral head prosthesis placement on the type of chair to sit in during the first 6 to 8 weeks after surgery. Which chair would be the correct type to recommend?

Answer 83

a high-backed chair with armrests

Question 84

The nurse is preparing a client who underwent a knee replacement with a metal joint to go home. What should the nurse instruct the client to do? Select all that apply.

Answer 84

Notify the health care provider (HCP) about the joint before undergoing invasive procedures.
Inform the HCP before having magnetic resonance imaging (MRI) scans.
Notify airport security that the joint may set off alarms on metal detectors.

Question 85

The client sustained a tibia fracture and a cast was applied. The client is reporting increasing pain when flexing toes. Which symptoms does the nurse assess as associated with compartment syndrome? Select all that apply.

Answer 85

Paresthesia
pain
pulselessness

Question 86

A client who has had a total hip replacement has a dislocated hip prosthesis. What should the nurse do first?

Answer 86

Notify the orthopedic surgeon.

Question 87

The client has a cast applied for a comminuted fracture of the left radius. The client returns to the emergency department (ED) with reports of pain described as “unrelenting.” Which objective findings indicate that the client is experiencing acute compartment syndrome? Select all that apply.

Answer 87

coolness in the extremity distal to the fracture
compartment pressure of 22mm Hg
poor skin color and delayed capillary refill

Question 88

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

Answer 88

with the leg on the affected side abducted
The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs.

Question 89

The nurse is caring for an older adult who has hip pain related to rheumatoid arthritis. The client is practicing appropriate self-care activities when the client chooses to sit in which type of chair?

Answer 89

straight-back chair with elevated seat

Question 90

A child diagnosed with osteomyelitis will be discharged on IV nafcillin. After teaching the parents about adverse effects that are important to report, which effects as stated by the parents indicate that they understand the teaching? Select all that apply.

Answer 90

sore mouth
stomach upset
fever

Question 91

The nurse is teaching a client about using crutches. On which part of the body should the nurse instruct the client to support the body weight?

Answer 91

hands

Question 92

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client’s chest. Which nursing action is indicated first?

Answer 92

Administer oxygen.

Question 93

On the evening of surgery for a total knee replacement, a client wants to get out of bed. What should the nurse do to safely assist the client?

Answer 93

Apply a knee immobilizer.

Question 94

The nurse is assessing a client who is reporting pain in the lower part of the leg. To differentiate bone pain from pain from trauma, the nurse should ask the client if the pain is described as what? Select all that apply.

Answer 94

Bone pain is usually described as a throbbing sensation. Sharp pain occurs with bone trauma, such as fractures or bone infections. Dull pain is associated with a bone tumor. Muscle pain is usually described as an aching sensation that increases with movement.

Question 95

Ambulating with a Cane

Answer 95

Going up stairs: Strong leg, cane, weak leg

Going downstairs: Cane, weak leg, strong leg
*Can always move before the weak leg