Chapter 50: Care of Patients with Musculoskeletal Problems Nursing School Test Banks

Chapter 50: Care of Patients with Musculoskeletal Problems
Ignatavicius: Medical-Surgical Nursing, 8th Edition

MULTIPLE CHOICE

1. 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
ANS: B
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.

DIF: Applying/Application REF: 1030
KEY: Musculoskeletal disorders| patient education| bisphosphonates
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

2. 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.
ANS: A
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.

DIF: Applying/Application REF: 1032
KEY: Musculoskeletal assessment| osteoporosis| older adult| pain
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

3. 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.
ANS: A
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.

DIF: Applying/Application REF: 1032
KEY: Musculoskeletal disorders| osteoporosis| psychosocial response| therapeutic communication| older adult
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Psychosocial Integrity

4. 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
ANS: D
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.

DIF: Analyzing/Analysis REF: 1034
KEY: Musculoskeletal disorders| osteoporosis| bisphosphonates| adverse effects
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

5. 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.
ANS: B
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.

DIF: Understanding/Comprehension REF: 1035
KEY: Osteoporosis| musculoskeletal disorders| monoclonal antibodies
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

6. 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.
ANS: A
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.

DIF: Applying/Application REF: 1037
KEY: Musculoskeletal disorders| ethics| nursing interventions
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

7. 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).
ANS: A
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.

DIF: Applying/Application REF: 1038
KEY: Musculoskeletal disorders| musculoskeletal assessment| nursing assessment| laboratory values MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

8. 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.
ANS: C
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.

DIF: Applying/Application REF: 1041
KEY: Musculoskeletal disorders| Transmission-Based Precautions| infection control
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

9. 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
ANS: C
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.

DIF: Analyzing/Analysis REF: 1041
KEY: Musculoskeletal disorders| nursing assessment| perfusion
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

10. 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.
ANS: C
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.

DIF: Applying/Application REF: 1042
KEY: Musculoskeletal disorder| cancer| patient safety| injury prevention
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

11. 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
ANS: C
All actions are appropriate for this client. However, for safety, the nurse should place priority on proper handling and disposal of chemotherapeutic agents.

DIF: Applying/Application REF: 1043
KEY: Cancer| musculoskeletal disorders| hazardous materials| patient safety| staff safety
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

12. 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.
ANS: A
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.

DIF: Applying/Application REF: 1045
KEY: Musculoskeletal disorders| psychosocial response| nursing assessment| coping
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Psychosocial Integrity

13. 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.
ANS: A
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.

DIF: Understanding/Comprehension REF: 1046
KEY: Musculoskeletal disorders| patient education| wound healing
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

14. 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.
ANS: B
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.

DIF: Applying/Application REF: 1047
KEY: Musculoskeletal system| nursing assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

15. 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
ANS: C
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.

DIF: Applying/Application REF: 1034
KEY: Musculoskeletal system| venous thromboembolism| adverse medication effects
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

16. What information does the nurse teach a womens group about osteoporosis?
a. For 5 years after menopause you lose 2% of bone mass yearly.
b. Men actually have higher rates of the disease but are underdiagnosed.
c. There is no way to prevent or slow osteoporosis after menopause.
d. Women and men have an equal chance of getting osteoporosis.
ANS: A
For the first 5 years after menopause, women lose about 2% of their bone mass each year. Men have a slower loss of bone after the age of 75. Many treatments are now available for women to slow osteoporosis after menopause.

DIF: Remembering/Knowledge REF: 1031
KEY: Musculoskeletal disorders| osteoporosis| older adult| gender differences
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

17. A client with osteoporosis is going home, where the client lives alone. What action by the nurse is best?
a. Arrange a home safety evaluation.
b. Ensure the client has a walker at home.
c. Help the client look into assisted living.
d. Refer the client to Meals on Wheels.
ANS: A
This client has several risk factors that place him or her at a high risk for falling. The nurse should consult social work or home health care to conduct a home safety evaluation. The other options may or may not be needed based upon the clients condition at discharge.

DIF: Applying/Application REF: 1049
KEY: Musculoskeletal disorders| osteoporosis| home safety| referrals
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

18. A client is scheduled for a bone biopsy. What action by the nurse takes priority?
a. Administering the preoperative medications
b. Answering any questions about the procedure
c. Ensuring that informed consent is on the chart
d. Showing the clients family where to wait
ANS: C
The priority is to ensure that informed consent is on the chart. The preoperative medications should not be administered until the nurse is confident the procedure will occur and the client has already signed the consent, if the medications include anxiolytics or sedatives or opioids. The provider should answer questions about the procedure. The nurse does show the family where to wait, but this is not the priority and could be delegated.

DIF: Applying/Application REF: 1043
KEY: Musculoskeletal disorders| informed consent
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

19. A client is admitted with a large draining wound on the leg. What action does the nurse take first?
a. Administer ordered antibiotics.
b. Insert an intravenous line.
c. Give pain medications if needed.
d. Obtain cultures of the leg wound.
ANS: D
The nurse first obtains wound cultures prior to administering broad-spectrum antibiotics. The nurse would need to start the IV prior to giving the antibiotics as they will most likely be parenteral. Pain should be treated but that is not the priority.

DIF: Applying/Application REF: 1041
KEY: Musculoskeletal disorders| cultures
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

20. A client has an ingrown toenail. About what self-management measure does the nurse teach the client?
a. Long-term antibiotic use
b. Shoe padding
c. Toenail trimming
d. Warm moist soaks
ANS: D
Treatment of an ingrown toenail includes a podiatrist clipping away the ingrown part of the nail, warm moist soaks, and antibiotic ointment if needed. Antibiotics are not used long-term. Padding the shoes will not treat or prevent ingrown toenails. Clients should not attempt to trim ingrown nails themselves.

DIF: Understanding/Comprehension REF: 1047
KEY: Musculoskeletal disorders| patient education
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply.)
a. Alcohol
b. Caffeine
c. Fat
d. Carbonated beverages
e. Vitamin D
ANS: A, B, D, E
Dietary components that affect the development of osteoporosis include alcohol, caffeine, high phosphorus intake, carbonated beverages, and vitamin D. Tobacco is also a contributing lifestyle factor. Fat intake does not contribute to osteoporosis.

DIF: Remembering/Knowledge REF: 1031
KEY: Musculoskeletal disorders| nutrition| nursing assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

2. A nurse is providing education to a community womens group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply.)
a. Cut down on tobacco product use.
b. Limit alcohol to two drinks a day.
c. Strengthening exercises are important.
d. Take recommended calcium and vitamin D.
e. Walk 30 minutes at least 3 times a week.
ANS: C, D, E
Lifestyle changes can be made to decrease the occurrence of osteoporosis and include strengthening and weight-bearing exercises and getting the recommended amounts of both calcium and vitamin D. Tobacco should be totally avoided. Women should not have more than one drink per day.

DIF: Understanding/Comprehension REF: 1033
KEY: Musculoskeletal disorders| osteoporosis| primary prevention| patient education
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

3. A client with Pagets disease is hospitalized for an unrelated issue. The client reports pain and it is not yet time for more medication. What comfort measures can the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)
a. Administering ibuprofen (Motrin)
b. Applying a heating pad
c. Providing a massage
d. Referring the client to a support group
e. Using a bed cradle to lift sheets off the feet
ANS: B, C
Comfort measures for Pagets disease include heat and massage. Administering medications and referrals are done by the nurse. A bed cradle is not necessary.

DIF: Applying/Application REF: 1039
KEY: Musculoskeletal disorders| delegation| nonpharmacologic comfort measures| unlicensed assistive personnel (UAP)
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

4. A client with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this client and family? (Select all that apply.)
a. Adherence to the antibiotic regimen
b. Correct intramuscular injection technique
c. Eating high-protein and high-carbohydrate foods
d. Keeping daily follow-up appointments
e. Proper use of the intravenous equipment
ANS: A, C, E
The client going home with chronic osteomyelitis will need long-term antibiotic therapyfirst intravenous, then oral. The client needs education on how to properly administer IV antibiotics, care for the IV line, adhere to the regimen, and eat a healthy diet to encourage wound healing. The antibiotics are not given by IM injection. The client does not need daily follow-up.

DIF: Applying/Application REF: 1041
KEY: Musculoskeletal disorders| patient education| medication administration
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

5. A client is admitted with a bone tumor. The nurse finds the client weak and lethargic with decreased deep tendon reflexes. What actions by the nurse are best? (Select all that apply.)
a. Assess the daily serum calcium level.
b. Consult the provider about a loop diuretic.
c. Institute seizure precautions for the client.
d. Instruct the client to call for help out of bed.
e. Place the client on a 1500-mL fluid restriction.
ANS: A, B, D
The client is exhibiting manifestations of possible hypercalcemia. This disorder is treated with increased fluids and loop diuretics. The nurse should assess the calcium level, consult with the provider, and instruct the client to call for help getting out of bed due to possible fractures and weakness. The client does not need seizure precautions or fluid restrictions.

DIF: Applying/Application REF: 1034
KEY: Musculoskeletal disorders| patient safety| laboratory values
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

6. The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease? (Select all that apply.)
a. Draining sinus tracts
b. High fevers
c. Presence of foot ulcers
d. Swelling and redness
e. Tenderness or pain
ANS: A, C
Draining sinus tracts and foot ulcers are seen in chronic osteomyelitis. High fever, swelling, and redness are more often seen in acute osteomyelitis. Pain or tenderness can be in either case.

DIF: Remembering/Knowledge REF: 1040
KEY: Musculoskeletal disorders| pain| wound healing| nursing assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

7. The nurse studying osteoporosis learns that which drugs can cause this disorder? (Select all that apply.)
a. Antianxiety agents
b. Antibiotics
c. Barbiturates
d. Corticosteroids
e. Loop diuretics
ANS: C, D, E
Several classes of drugs can cause secondary osteoporosis, including barbiturates, corticosteroids, and loop diuretics. Antianxiety agents and antibiotics are not associated with the formation of osteoporosis.

DIF: Remembering/Knowledge REF: 1030
KEY: Musculoskeletal system| musculoskeletal disorders| medication adverse effects
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A client is suspected to have muscular dystrophy. About what diagnostic testing does the nurse educate the client? (Select all that apply.)
a. Electromyography
b. Muscle biopsy
c. Nerve conduction studies
d. Serum aldolase
e. Serum creatinine kinase
ANS: A, B, D, E
Diagnostic testing for muscular dystrophy includes electromyography, muscle biopsy, serum aldolase and creatinine kinase levels. Nerve conduction is not related to this disorder.

DIF: Remembering/Knowledge REF: 1048
KEY: Musculoskeletal disorders| diagnostic tests| laboratory values
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

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