Chapter 26: Management of Clients with Musculoskeletal Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 26: Management of Clients with Musculoskeletal Disorders

MULTIPLE CHOICE

1. The nurse assesses that the individual most susceptible to osteoporosis is the

a.

muscular 50-year-old man with diabetes.

b.

obese 50-year-old woman who is allergic to milk.

c.

thin 70-year-old man with gout.

d.

very slender 75-year-old woman.

ANS: D

Women have accelerated bone loss after menopause because of the loss of exogenous estrogen. Low body weight (<127 pounds) is an additional risk factor.

DIF: Analysis/Analyzing REF: p. 488 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. The nurse counseling a client with osteoporosis identifies one of the medications that may have contributed to the condition as

a.

aspirin.

b.

colchicine.

c.

ibuprofen.

d.

prednisone.

ANS: D

Osteoporosis can also result from underlying medical conditions, such as hyperparathyroidism, thyrotoxicosis, anorexia nervosa, and Cushings syndrome, and from long-term use of medications such as thyroid hormone, anticonvulsants, furosemide, and corticosteroids (e.g., prednisone).

DIF: Comprehension/Understanding REF: p. 488 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

3. A nurse admitting a 22-year-old client with septic arthritis in the knees would inquire about recent infection with

a.

a respiratory tract virus.

b.

gonorrhea.

c.

strep throat.

d.

urinary tract manifestations.

ANS: B

While a variety of organisms can cause septic arthritis, in adults under 30 Neisseria gonorrhoeae, the causative agent for gonorrhea, is the most common.

DIF: Application/Applying REF: p. 500 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

4. The nurse instructing a client at risk for osteoporosis would encourage the client to include which item in the clients diet?

a.

Beans

b.

Citrus fruits

c.

Dairy products

d.

Red meat

ANS: C

The major sources of dietary calcium are dairy products. Calcium can also be obtained from calcium-fortified foods.

DIF: Comprehension/Understanding REF: pp. 490-491 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

5. A client with osteoporosis complains that avoiding coffee will be very difficult. To offset coffee consumption, the nurse might suggest that for every cup of coffee consumed, the client should

a.

add 1 serving of leafy green vegetables.

b.

combine 20 minutes of exercise to the daily program.

c.

drink 1 glass of orange juice or grapefruit juice.

d.

take 40 mg of over-the-counter calcium.

ANS: D

The effect of caffeine can be offset by adding 40 mg of calcium to the diet for each cup of coffee consumed.

DIF: Application/Applying REF: p. 491 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

6. The nurse is counseling a client at risk of osteoporosis that one of the most beneficial exercises is

a.

cycling.

b.

swimming.

c.

walking.

d.

water aerobics.

ANS: C

Weight-bearing exercise, such as walking or running, is recommended over nonweight-bearing exercise, such as biking or swimming, for the prevention of osteoporosis. Weight-bearing exercises encourage bone formation, while nonweight-bearing exercises do not, probably because they do not adequately load the bones.

DIF: Comprehension/Understanding REF: p. 491 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

7. A client has been diagnosed with early osteoarthritis (OA) in the hips. The nurse explains that the first medical treatment that will be tried is administration of

a.

acetaminophen (Tylenol).

b.

celecoxib (Celebrex).

c.

misoprostol (Citotec).

d.

nonsteroidal anti-inflammatory drugs (NSAIDs).

ANS: A

NSAIDs used to be the mainstay of treatment, but because OA has minimal inflammatory properties and because of the safety concerns with long-term use of NSAIDs, acetaminophen is now considered the first-line choice. The client can be switched to an NSAID when pain is severe despite the maximum dose of acetaminophen. Celecoxib is a COX-2 selective NSAID that has fewer GI side effects than other NSAIDs but has serious safety concerns as well. Misoprostol is a synthetic prostaglandin that clients may take to minimize GI side effects of medications.

DIF: Comprehension/Understanding REF: p. 473 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

8. The nurse instructing a client on considerations regarding the medication calcium carbonate would include in the teaching plan that the client

a.

has to wait 1 hour after meals to take the medication.

b.

may experience nausea or diarrhea.

c.

needs to take the calcium with an 8-ounce glass of water.

d.

should take the calcium carbonate with food.

ANS: D

All calcium supplements should be taken with food to enhance their absorbability.

DIF: Comprehension/Understanding REF: p. 491 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

9. The nurse is assessing a client with osteoporosis. The finding that is consistent with the nurses understanding of the disease is

a.

a stiff posture.

b.

kyphosis.

c.

pain in long bones.

d.

weight loss.

ANS: B

Progressive vertebral deformities lead to shortened stature and kyphosis.

DIF: Application/Applying REF: p. 489 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

10. In the initial visit to a recently discharged client with osteoporosis, the home health nurse will reinforce the priority topic of

a.

diet low in phosphates.

b.

exercise regimen.

c.

hazards to home safety.

d.

medication administration.

ANS: C

Discussion about fall prevention strategies is imperative for the discharged client with osteoporosis. Alterations to the home may be recommended. A proper diet high in calcium and vitamin D, correct medication administration, and following an exercise regimen are also important topics, but the clients safety is the priority.

DIF: Application/Applying REF: pp. 491, 494 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Home Safety Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

11. On admission assessment of a client with Pagets disease, the nurse would anticipate the client to complain of

a.

continuous bone pain.

b.

fever in the afternoon.

c.

pain on ambulation.

d.

swelling at site of deformity.

ANS: A

Pagets disease is defined as a disorder of bone architecture characterized by an initial phase of increased bone tissue breakdown by osteoclasts, followed by excessive abnormal bone formation by osteoblasts. In clients with symptomatic Pagets disease, the most common presenting complaints include bone pain, skeletal deformity, changes in skin temperature, pathologic fractures through diseased bone, and manifestations related to nerve compression.

DIF: Knowledge/Remembering REF: p. 495 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

12. The nurse discussing treatment options with a client with Pagets disease will focus on the most frequent treatment, which is with

a.

bisphosphonates.

b.

calcium supplements.

c.

heat and cold application.

d.

splinting.

ANS: A

The current therapies of choice for Pagets disease are potent bisphosphonates, such as pamidronate (Aredia), alendronate (Fosamax), and risedronate (Actone). NSAIDs are used to control pain. Heat therapy and splinting or bracing can also be tried.

DIF: Comprehension/Understanding REF: p. 495 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

13. When counseling a client who is a strict vegan, the nurse would caution that this diet puts the client at risk for

a.

gout.

b.

osteoarthritis.

c.

osteomalacia.

d.

Pagets disease.

ANS: C

Osteomalacia mainly affects women, and it is endemic in Asia. The most common cause is malabsorption or inadequate intake of vitamin D. Occasionally the disease can be found in strict vegetarians or post-gastrectomy clients.

DIF: Analysis/Analyzing REF: pp. 495-496 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

14. The client with osteomalacia is depressed and anxious about the outcome of the illness. The most beneficial nursing response would be

a.

Cortisone and active weight-bearing exercises will reduce the symptoms.

b.

Dont worry; some adjustments in lifestyle can offer a normal life expectancy.

c.

I can see you are upset. Did the doctor tell you this is easy to treat and control?

d.

Treatment with high-dose calcium supplements will correct the disorder.

ANS: C

Interventions for clients with osteomalacia include daily vitamin D until signs of healing occur, at which time a daily low maintenance dose of vitamin D and adequate intake of calcium, phosphorus, and protein should be ensured. This answer not only gives the client correct information but shows the nurse communicating in a therapeutic manner.

DIF: Application/Applying REF: p. 496 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Therapeutic Communication

15. On admitting a client with acute osteomyelitis, the nurse is not surprised at the clients complaint of

a.

generalized bone pain.

b.

localized pain and redness.

c.

nausea and vomiting.

d.

paresthesias in the affected extremity.

ANS: B

Clinical manifestations of acute oteomyelitis may vary slightly according to the site of involvement. Infection in the long bones is accompanied by acute localized pain and redness or drainage.

DIF: Knowledge/Remembering REF: p. 499 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

16. After surgical debridement of diseased bone, a client with acute osteomyelitis asks how long antibiotics will be administered. The nurse should respond that the antibiotic protocol will be

a.

oral antibiotics for 2-4 weeks.

b.

oral antibiotics for 4-8 weeks.

c.

parenteral for 4-8 weeks, then oral for 4-8 weeks.

d.

parenteral for 4-8 weeks, then oral for 1 year.

ANS: C

Treatment requires administration of high doses of parenteral antibiotics for 4 to 8 weeks, followed by oral antibiotics for another 4 to 8 weeks.

DIF: Comprehension/Understanding REF: p. 500 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

17. The nurse recognizes the significant laboratory finding helpful in confirming the diagnosis of a bone tumor as

a.

decreased calcium level.

b.

decreased potassium level.

c.

elevated alkaline phosphatase level.

d.

elevated creatinine level.

ANS: C

An elevated serum alkaline phosphatase level may be noted with osteoblastic tumors, and LDH may mark tumor progression for Ewings sarcoma.

DIF: Knowledge/Remembering REF: p. 502 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

18. The nurse explains that the most common early manifestation of a primary bone tumor is

a.

fever.

b.

fracture.

c.

mass.

d.

redness.

ANS: B

Clients with a primary bone tumor typically present with bone pain, particularly at night, or a fracture from even slight trauma. Occasionally a mass or lesion may be felt at the tumor site. They may also report weight loss, fever, chills, or pulmonary manifestations.

DIF: Comprehension/Understanding REF: p. 501

OBJ: Intervention/Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

19. A client is being managed for prevention of gout and the nurse is reviewing the clients medication list and teaching about the medications. The nurse evaluates that the client understands the medication when the client says

a.

Allopurinol blocks production of uric acid.

b.

Colchicine can be used with probenecid.

c.

Long-term steroids are needed to prevent attacks.

d.

NSAIDs are not effective against the pain of gout.

ANS: A

Allopurinal is frequently used to block production of uric acid as a preventative measure for gout.

DIF: Evaluation/Evaluating REF: p. 497 OBJ: Evaluation

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Principles of Teaching/Learning

20. The nurse teaching a class on osteoarthritis (OA) stresses that this disorder is best described as

a.

degeneration of articular cartilage in synovial joints.

b.

enzymatic breakdown of tissue in nonweight-bearing joints.

c.

joint destruction caused by an autoimmune process.

d.

overproduction of synovial fluid, resulting in joint destruction.

ANS: A

OA is a chronic joint disease characterized by degeneration and loss of articular cartilage covering joint surfaces.

DIF: Comprehension/Understanding REF: p. 471 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

21. As a beneficial exercise program, the nurse teaching a group of clients with osteoarthritis would suggest

a.

daily vigorous aerobic exercise followed by a warm shower or bath.

b.

minimal exercise several times daily, followed by rest periods.

c.

regular daily, low-impact exercise program.

d.

strength-building exercises with weights or resistance.

ANS: C

All clients benefit from a careful balance of rest and activity. Low-impact aerobic exercise, such as walking, does not cause further harm to damaged joints.

DIF: Comprehension/Understanding REF: p. 472 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems

22. The nurse caring for a client who has undergone total hip replacement (THR) assesses for manifestations of the most common and serious complication after hip surgery, which is

a.

contractures.

b.

deep vein thrombosis.

c.

infection.

d.

prosthesis dislocation.

ANS: B

Venous thromboembolism, the most common and most serious complication after THR, can be manifested as a deep vein thrombosis. Infection is another complication, but is not seen as often.

DIF: Application/Applying REF: pp. 476-477 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures/Health Alteration

23. A client had a total hip arthroplasty from the posterolateral approach. The nurse ensures correct positioning by placing the client with the operative leg

a.

abducted with a triangular foam pillow.

b.

externally rotated to 90 degrees.

c.

in a flexed position with pillows between the knees.

d.

internally rotated to no more than 60 degrees.

ANS: A

Using this approach, the operative leg must be kept abducted and extended. When ambulating, the client should point toes slightly outward to prevent internal rotation. When turned to the side in bed, the abductor pillow stays in place. The client should also not flex the hip beyond 90 degrees, making some adaptations in ADLs necessary.

DIF: Application/Applying REF: p. 480 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

24. A client has septic arthritis of the knee and the inflammation is beginning to subside. The best nursing action to prevent joint contractures at this point is to

a.

encourage the client to get out of bed and ambulate.

b.

have physical therapy plan an active ROM regimen.

c.

immobilize the joint in a sling until the infection resolves.

d.

provide passive ROM for the affected joint.

ANS: D

When the inflammation of septic arthritis begins to resolve, passive ROM is initiated to preserve joint function. Active ROM and weight-bearing may not be allowed until the infection has almost subsided.

DIF: Application/Applying REF: p. 501 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Mobility/Immobility

25. The client returns from surgery for a THA with a Hemovac in place. The nurse assesses the first 6 hours drainage as 350 ml. The most appropriate action by the nurse is to

a.

change the clients position to supine.

b.

drain the Hemovac and record the amount.

c.

notify the physician of the amount of drainage.

d.

report the excessive drainage to the oncoming nurse.

ANS: C

The expected amount of drainage is usually less than 200 ml in the first 8 hours. The measured drainage should be reported to the physician.

DIF: Application/Applying REF: p. 478 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures/Health Alteration

26. The nurse is caring for a client with a continuous passive motion (CPM) machine after a total knee arthroplasty. An important safety measure the nurse should add to the plan of care is to

a.

allow the client to use the machine 10-12 hours daily.

b.

keep the head of the bed elevated at least 30 degrees.

c.

position the client supine during CPM machine use.

d.

remove the CPM machine during meals.

ANS: D

The CPM machine is used 6 to 8 hours a day with breaks for meals. During CPM the head of the bed is elevated no more than 15 degrees and usually is initially set at 0-degree extension and 10 to 40 degrees of flexion. Because of the low level of the head of the bed, eating poses a choking or aspiration hazard. Therefore the machine must be discontinued during meals so the client can sit upright to eat.

DIF: Application/Applying REF: p. 485 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

27. The nurse is transferring a client with a noncemented total hip arthroplasty (THA) from bed to walker. In order to assist the client safely, which action will the nurse encourage before the client uses the walker? The nurse will tell the client to

a.

place one foot on floor and hold the walker to stand.

b.

push off of the bed with the arms and gain balance on one foot.

c.

slowly bear weight on both legs.

d.

stand at the bedside on both feet so the nurse can assess for syncope.

ANS: B

With a noncemented TKA, the client should not bear weight on the affected leg. The client should push off the bed using the arms and gain balance before grasping the walker. The client should not use the walker in the process of standing because it is not stable enough to steady the client while trying to stand.

DIF: Application/Applying REF: p. 479 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

28. The nursing care of a client with muscular dystrophy is focused on symptomatic treatment and supportive care, with a major emphasis on problems pertinent to

a.

ambulation.

b.

elimination.

c.

nutrition.

d.

respiration.

ANS: D

Treatment of muscular dystrophy is largely symptomatic. Care focuses on increasing the clients comfort and functional ability. Breathing exercises may be initiated for respiratory decompensation. Death usually occurs from respiratory or cardiac failure.

DIF: Application/Applying REF: p. 504 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

29. A client has severe osteoarthritis in the hips. An important psychosocial assessment the nurse should make on this client is

a.

ability to obtain medications.

b.

hobbies and leisure time interests.

c.

job-related physical restrictions.

d.

sexual role functioning.

ANS: D

Arthritis can interfere with many aspects of role development, including sexual functioning. A nurse assessing a client in a holistic manner will include questions about sexuality in the assessment. The nurse can inform the client of possible position changes and other adaptations that can lead the client to continue a healthy sexual relationship.

DIF: Application/Applying REF: p. 475 OBJ: Assessment

MSC: Psychosocial Integrity Growth and Development Through the Lifespan-Human Sexuality

MULTIPLE RESPONSE

1. A client wears joint-protecting splints and needs assistance with some ADLs and mobility. The nurse delegating this care to an unlicensed assistive personnel (UAP) should (Select all that apply)

a.

allow the UAP to do as much for the client as possible.

b.

assess the clients baseline status and make modifications to the care plan.

c.

instruct the UAP to have the client stop activities that cause new pain.

d.

tell the UAP to report any redness or skin irritation under the splint to the nurse.

e.

verify the UAPs competency to do the assigned tasks.

ANS: B, C, D, E

The professional nurse is responsible for assessing the client and developing and/or modifying a plan of care. Tasks that can be delegated to a UAP include ROM, assisting with mobility, and removing/applying splints. Any finding that is new or abnormal needs to be reported to the nurse. The UAP may be tempted to do as much for the client as possible, but this is deleterious as it decreases the chances for the client to perform ROM and maintain independence.

DIF: Application/Applying REF: p. 494 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Delegation

2. Psychosocial implications of a diagnosis of osteoporosis the nurse should assess for can include (Select all that apply)

a.

anxiety over disfigurement.

b.

chronic pain.

c.

fear of falling.

d.

poor quality of life.

e.

self-esteem problems.

ANS: A, B, C, D, E

Osteoporosis can negatively affect quality of life for many reasons, with these answers being common. A poor quality of life can lead to depression and isolation, and poorer physical health.

DIF: Comprehension/Understanding REF: p. 489 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Quality of Life

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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