NR 324 Musculoskeletal Flashcards
A nurse is preparing a client for a bone scan. Which of the following statements indicates that the client understands the per-procedure teaching?
(Select all that apply.)
A. “I will have to drink a radioactive solution before the test begins.”
B. “A special camera will scan the bones in my entire body.”
C. “There will be better absorption of the radiation by healthy bone.”
D. “I’ll have to drink a lot of water to help get the radiation out of my body.”
E. “I understand the radiation is harmless, and I don’t have to worry about it.”
B. “A special camera will scan the bones in my entire body.”
D. “I’ll have to drink a lot of water to help get the radiation out of my body.”
E. “I understand the radiation is harmless, and I don’t have to worry about it.”
A bone scan is a radionuclide procedure that allow viewing of the entire skeleton.
- Client receives radioactive material via IV injection
- Increased absorption of contrast material indicates bone disease and disorders
A nurse is performing medication reconciliation for a newly admitted client who has rheumatoid arthritis (RA). Which of the following medications should the nurse identify as the treatment for this condition?
A. Misoprostol
B. Dantrolene
C. Celecoxib
D. Colchichine
C. Celecoxib = NSAID, also prescribed for OA, Spondylitis, and painful menstrations
Misoprostol: Histamine blocking agent
Dantrolene: Antispasmodic muscles spams multiple sclerosis
Colchinicine: Anti-inflammatory for gout
A nurse is caring for a client who has a depressed skull fracture of the bone that makes up the larger part of the upper and side wall of the cranium. This fracture is located on which of the following bones?
A. Sphenoid
B. Occipital
C. Parietal
D. Frontal
C. Parietal
Parietal bones form the larger part of the upper and side wall of the cranium.
A nurse is assessing a client who has several risk factors for osteoporosis. Which of the following findings indicates that the client requires further evaluation for this disorder?
A. Leg crams w/exercise
B. Stress incontinence
C. Abdominal distention
D. Lower back pain
D. Lower back pain
Lower back pain is common among clients who hav e osteoporosis, ecspecially when they lift, stoop, or bend. Back pain & tenderness that cause movement restriciton might indicate vertebral compression fractures, which are the most common type of fracture resulting from osteoporosis.
NOT A SYMPTOM OF OA
- Leg cramps = deficiency of Ca+ and Mg+
- Stress incontinence = urethral sphincter disorder
- Abdominal distention = GI disorder or IBS & Intestinal Obstruction
A nurse is caring for a client who had a BKA for gangrene of the right foot. Client reports sensation of burning and crushing pain in the toes of the absent right foot. Which of the following statements should the nurse make?
A. “This type of pain usually decreases over time as the limb becomes less sensitive”
B. “Try to look at the surgical wound as a reminder the limb is one.”
C. “Use a cold compress intermittently to decrease these pain sensations.”
D. “Grief over the lost limb can sometimes cause denial that the limb is really gone.”
“This type of pain usually decreases over time as the limb becomes less sensitive.”
The nurse should recognize that the client is reporting phantom limb pain, a frequent complication following amputation. The nurse should instruct the client that the sensation should decrease over time. The nurse should recognize the pain, provide treatment, and handle the limb gently to decrease the risk of triggering pain.
B. Doesn’t address clients concern
C. Instruct the client to use HEAT & MASSAGE, Pharmacological interventions.
D. Validate the client’s report of pain & treat accordingly. Client is NOT exhibiting denial. So this response is inappropriate
A nurse is preparing a client for MRI of the spine. Which of the following pieces of information should the nurse give the client prior to the procedure?
A. “You can have a mild sedative before the procedure.”
B. “You’ll have to lie still on your back for 15-20 mins.”
C. “You can’t have this test if you’ve had cataract surgery.”
D. “Your exposure to radiation will be minimal.”
A. “You can have a mild sedative before the procedure”
Some patients need mild sedation due to feelings of claustrophobic & anxious.
- Clients need to lie supine for 45-60 mins
- Cataract surgery is NOT contraindication
- There is No exposure to RADIATION during MRI
A nurse is caring for a client immediately following application of a plaster cast. The nurse should monitor for and report which of the following findings as an indication of compartment syndrome?
A. Sensation of heat on the surface of the cast.
B. Paresthesias (numbness) of the extremity.
C. Pruritus of the extremity
D. Musty odor noted from cast materials.
B. Paresthesias of the extremity
Compartment syndrome involves the compression of nerves & blood vessels in an enclosed space, leading to imparied blood flow & nerve damage.
- Cast will feel hot immediately following application due to chemical reaction.
- Pruritus indication of cast irritation
- Must odor for 24-72 hrs till drying is complete.
5 P's Pain Paralysis - Late Paresthesia Pallor Pulselessness - Late
A nurse is assesing a female client who reports severe joint pain. The nurse should identify that which of the following factors places the client at risk for gout?
A. Perimenopause
B. Migraine headaches
C. Diuretic use
D. IBS
C. Diuretic use
Gout is a systemic disorder that affects the joints as a result of high uric acid levels in the blood.
Postmenopausal is at risk for Gout
Migraine headaches, IBS = Risk factor for fibromyalgia
A nurse is preparing to care for a client who is in balanced skeletal traction to stabilize a femur fracture. Which of the following actions should the nurse include in the client’s plan of care?
A. Offering the client a diet high in fluid and fiber
B. Encourage ROM of the affected leg
C. Removing the weights prior to repositioning the client.
D. Inspecting pin sites every 24 hr for drainage.
A. Offering the client a diet high in fluid & fiber
Immobile at risk of constipation. Encourage high fiber to promote GI function.
- once weights in place, nurse should not remove them
- inspect pin sites 8-12hrs due to the risk of infection
- should not do ROM of AFFECTED leg
A patient reports shoulder pain when the nurse moves the patient’s arm behind the back. Which question should the nurse ask?
a. “Are you able to feed yourself without difficulty?”
b. “Do you have difficulty when you are putting on a shirt?”
c. “Are you able to sleep through the night without waking?”
d. “Do you ever have trouble lowering yourself to the toilet?”
ANS: B
The patient’s pain will make it more difficult to accomplish tasks such as putting on a shirt or jacket. This pain should not affect the patient’s ability to feed himself or use the toilet because these tasks do not involve moving the arm behind the patient. The arm will not usually be positioned behind the patient during sleeping.
A patient with left knee pain is diagnosed with bursitis. What area should the nurse explain is the site of inflammation in bursitis?
a. A fluid-filled sac found at some joints.
b. A synovial membrane that lines some joints.
c. The connective tissue joining bones within a joint.
d. The fibrocartilage that acts as a shock absorber in the knee.
ANS: A
Bursae are fluid-filled sacs that cushion joints and bony prominences.
Fibrocartilage is a solid tissue that cushions some joints.
Ligaments are connective tissue joining bones within a joint.
The synovial membrane lines many joints but is not affected in bursitis.
The nurse notes that a 59-yr-old female patient has lost 1 inch in height over the past 2 years. What diagnostic test should the nurse plan to discuss with the patient?
a. Discography studies
b. Myelographic testing
c. Magnetic resonance imaging (MRI)
d. Dual-energy x-ray absorptiometry (DXA)
ANS: D
The decreased height and the patient’s age suggest that the patient may have osteoporosis, and bone density testing is needed. Discography, MRI, and myelography are typically done for patients with current symptoms caused by musculoskeletal dysfunction and are not the initial diagnostic tests for osteoporosis.
Which information in a 67-yr-old woman’s health history should alert the nurse to the need for a focused assessment of the musculoskeletal system?
a. The patient sprained her ankle at age 13.
b. The patient’s father died of tuberculosis.
c. The patient’s mother became shorter with aging.
d. The patient takes ibuprofen for occasional headaches.
ANS: C
A family history of height loss with aging may indicate osteoporosis, and the nurse should perform a more thorough assessment of the patient’s current height and other risk factors for osteoporosis.
A sprained ankle during adolescence does not place the patient at increased current risk for musculoskeletal problems.
A family history of tuberculosis is not a risk factor.
Occasional nonsteroidal antiinflammatory drug (NSAID) use does not indicate any increased musculoskeletal risk.
Which information obtained during the nurse’s assessment may indicate a patient’s increased risk for musculoskeletal problems?
a. The patient takes a multivitamin daily.
b. The patient dislikes fruits and vegetables.
c. The patient is 5 ft, 2 in tall and weighs 180 lb.
d. The patient prefers whole milk to nonfat milk.
ANS: C
The patient’s height and weight indicate obesity, which places stress on weight-bearing joints and predisposes the patient to osteoarthritis.
The use of whole milk, avoidance of fruits and vegetables, and use of a daily multivitamin are not risk factors for musculoskeletal problems.
Which medication information should the nurse identify as a potential risk to a patient’s musculoskeletal system?
a. The patient takes a daily multivitamin and calcium supplement.
b. The patient has asthma requiring frequent therapy with oral corticosteroids.
c. The patient takes hormone replacement therapy (HRT) to prevent “hot flashes.”
d. The patient has headaches treated with nonsteroidal antiinflammatory drugs (NSAIDs).
ANS: B
Frequent or chronic corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis.
-The use of HRT and calcium supplements will help prevent osteoporosis.
-NSAID use does not increase the risk for musculoskeletal problems.
