Chpt 64: Musculoskeletal Problems Flashcards Quizlet PDF

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Chpt 64: Musculoskeletal Problems Flashcards | Quizlet

11/21/21, 1&44 PM

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Chpt 64: Musculoskeletal Problems Terms in this set (27) The nurse is caring for patients in a

C. 32-year-old male with type 1 diabetes mellitus and a

primary care clinic. Which

stage IV pressure ulcer

individual is most at risk to develop osteomyelitis caused by

Osteomyelitis caused by Staphylococcus aureus is

Staphylococcus aureus?

usually associated with a pressure ulcer or vascular

A. 22-year-old female with

insufficiency related to diabetes mellitus. Osteomyelitis

gonorrhea who is an IV drug user

caused by Staphylococcus epidermidis is usually

B. 48-year-old male with muscular

associated with indwelling prosthetic devices such as

dystrophy and acute bronchitis

joint replacements. Osteomyelitis caused by Neisseria

C. 32-year-old male with type 1

gonorrhoeae is usually associated with gonorrhea.

Chpt 64: Musculoskeletal Problems

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D. Nausea, vomiting, and altered mental status

woman with breast cancer who is admitted for severe back pain

Breast cancer can metastasize to the bone. Vertebrae

related to a compression fracture.

are a common site. Pathologic fractures at the site of

The patient's laboratory values

metastasis are common because of a weakening of the

include serum potassium of 4.5

involved bone. High serum calcium levels result as

mEq/L, serum sodium of 144

calcium is released from damaged bones. Normal serum

mEq/L, and serum calcium of 14.3

calcium is between 8.6 to 10.2 mg/dL. Clinical

mg/dL. Which signs and symptoms

manifestations of hypercalcemia include nausea,

will the nurse expect the patient to

vomiting, and altered mental status (e.g., lethargy,

exhibit?

decreased memory, confusion, personality changes,

A. Anxiety, irregular pulse, and

psychosis, stupor, coma). Other manifestations include

weakness

weakness, depressed reflexes, anorexia, bone pain,

B. Muscle stiffness, dysphagia, and

fractures, polyuria, dehydration, and nephrolithiasis.

dyspnea

Manifestations of hypomagnesemia include hyperactive

C. Hyperactive reflexes, tremors,

reflexes, tremors, and seizures. Symptoms of

and seizures

hyperkalemia include anxiety, irregular pulse, and

D. Nausea, vomiting, and altered

weakness. Symptoms of hypocalcemia include muscle

mental status

stiffness, dysphagia, and dyspnea.

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The nurse provides instructions to

A. "Acupuncture to the lower back would cause

a 30-year-old female office

irreparable nerve damage."

worker who has low back pain. Which statement by the patient

Acupuncture is a safe therapy when the practitioner has

requires an intervention by the

been appropriately trained. Very fine needles are

nurse?

inserted into the skin to stimulate specific anatomic

A. "Acupuncture to the lower back

points in the body for therapeutic purposes.

would cause irreparable nerve damage." B. "Smoking may aggravate back pain by decreasing blood flow to the spine." C. "Sleeping on my side with knees and hips bent reduces stress on my back." D. "Switching between hot and cold packs provides relief of pain and stiffness."

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The nurse receives report from the

C. "The patient who had spinal surgery 3 hours ago is

licensed practical nurse about

complaining of a headache and has clear drainage on

care provided to patients on the

the dressing."

orthopedic surgical unit. It is most important for the nurse to follow

After spinal surgery there is potential for cerebrospinal

up on which statement?

fluid (CSF) leakage. Severe headache or leakage of CSF

A. "The patient who had a spinal

(clear or slightly yellow) on the dressing should be

fusion 12 hours ago has hypoactive

reported immediately. The drainage is CSF if a dipstick

bowel sounds and is not passing

test is positive for glucose. Patients after spinal surgery

flatus."

may experience paralytic ileus and interference with

B. "The patient who had cervical

bowel function for several days. Postoperatively most

spine surgery 2 days ago wants to

patients require opioids such as morphine IV for 24 to 48

wear her soft cervical collar when

hours. Patient-controlled analgesia is the preferred

out of bed."

method for pain management during this time. After

C. "The patient who had spinal

cervical spine surgery patients often wear a soft or hard

surgery 3 hours ago is

cervical collar to immobilize the neck.

complaining of a headache and has clear drainage on the dressing." D. "The patient who had a laminectomy 24 hours ago is using patient-controlled analgesia with morphine for pain management."

The nurse prepares to administer

B. Serum creatinine

IV ibandronate (Boniva) to a 67year-old woman with

Ibandronate is a bisphosphonate that is administered IV

osteoporosis. What is a priority

every 3 months and is administered slowly over 15 to 30

laboratory assessment to make

seconds to prevent renal damage. Ibandronate should

before the administration of

not be used by patients taking other nephrotoxic drugs

ibandronate?

or by those with severe renal impairment (defined as

A. Serum calcium

serum creatinine above 2.3 mg/dL or creatinine

B. Serum creatinine

clearance less than 30 mL/min).

C. Serum phosphate D. Serum alkaline phosphatase

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Chpt 64: Musculoskeletal Problems Flashcards | Quizlet

During a health screening event

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B. A measurable loss of height

which assessment finding would alert the nurse to the possible

A gradual but measurable loss of height and the

presence of osteoporosis in a

development of kyphosis or "dowager's hump" are

white 61-year-old female?

indicative of the presence of osteoporosis in which the

A. The presence of bowed legs

rate of bone resorption is greater than bone deposition.

B. A measurable loss of height

Bowed legs may be caused by abnormal bone

C. Poor appetite and aversion to

development or rickets but is not indicative of

dairy products

osteoporosis. Lack of calcium and Vitamin D intake may

D. Development of unstable, wide-

cause osteoporosis but are not indicative it is present. A

gait ambulation

wide gait is used to support balance and does not indicate osteoporosis.

The nurse is reinforcing health

D. Even with a family history of osteoporosis, the calcium

teaching about osteoporosis with

loss from bones can be slowed by increased calcium

a 72-year-old patient admitted to

intake and exercise

the hospital. In reviewing this disorder, what should the nurse

The rate of progression of osteoporosis can be slowed if

explain to the patient?

the patient takes calcium supplements and/or foods high

A. With a family history of

in calcium and engages in regular weight-bearing

osteoporosis, there is no way to

exercise. Corticosteroids interfere with bone metabolism.

prevent or slow bone resorption

Estrogen therapy is no longer used to prevent

B. Continuous, low-dose

osteoporosis because of the associated increased risk of

corticosteroid treatment is

heart disease and breast and uterine cancer.

effective in stopping the course of osteoporosis C. Estrogen therapy must be maintained to prevent rapid progression of the osteoporosis D.

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The nurse determines that dietary

C. A sardine (3 oz) sandwich on whole wheat bread, 1

teaching for a 75-year-old patient

cup of fruit yogurt, and 1 cup of skim milk

with osteoporosis has been successful when the patient

The highest calcium content is present in the lunch

selects which highest-calcium

containing milk and milk products (yogurt) and small fish

meal?

with bones (sardines). Chicken, onions, green peas, rice,

A. Chicken stir-fry with 1 cup each

ham, whole wheat bread, broccoli, apple, eggs, and

onions and green peas, and 1 cup

grapefruit each have less than 75 mg of calcium per 100

of steamed rice

g of food. Swiss cheese and American cheese have more

B. Ham and Swiss cheese

calcium, but not as much as the sardines, yogurt, and

sandwich on whole wheat bread,

milk.

steamed broccoli, and an apple C. A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk D. A two-egg omelet with 2 oz of American cheese, one slice of whole wheat toast, and a half grapefruit

The nurse is caring for a patient

B. Localized pain and warmth

admitted to the nursing unit with osteomyelitis of the tibia. Which

Osteomyelitis is an infection of bone and bone marrow

symptom will the nurse most likely

that can occur with trauma, surgery, or spread from

find on physical examination of the

another part of the body. Because it is an infection, the

patient?

patient will exhibit typical signs of inflammation and

A. Nausea and vomiting

infection, including localized pain and warmth. Nausea

B. Localized pain and warmth

and vomiting and paresthesia of the extremity are not

C. Paresthesia in the affected

expected to occur. Pain occurs, but it is localized, not

extremity

generalized throughout the leg.

D. Generalized bone pain throughout the leg

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A 54-year-old patient with acute

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A. "IV antibiotics are usually required for several weeks."

osteomyelitis asks the nurse how this problem will be treated. Which

The standard treatment for acute osteomyelitis consists

response by the nurse is most

of several weeks of IV antibiotic therapy. This is because

appropriate?

bone is denser and less vascular than other tissues, and it

A. "IV antibiotics are usually

takes time for the antibiotic therapy to eradicate all of

required for several weeks."

the microorganisms. Surgery may be used for chronic

B. "Oral antibiotics are often

osteomyelitis, which may include debridement of the

required for several months."

devitalized and infected tissue and irrigation of the

C. "Surgery is almost always

affected bone with antibiotics.

necessary to remove the dead tissue that is likely to be present." D. "Drainage of the foot and instillation of antibiotics into the affected area is the usual therapy."

A 67-year-old patient hospitalized

D. Perform frequent position changes and range-of-

with osteomyelitis has an order for

motion exercises

bed rest with bathroom privileges with the affected foot elevated on

The patient is at risk for atelectasis of the lungs and for

two pillows. The nurse would

contractures because of prescribed bed rest. For this

place highest priority on which

reason, the nurse should place the priority on changing

intervention?

the patient's position frequently to promote lung

A. Ambulate the patient to the

expansion and performing range-of-motion (ROM)

bathroom every 2 hours

exercises to prevent contractures. Assisting the patient to

B. Ask the patient about preferred

the bathroom will keep the patient safe as the patient is

activities to relieve boredom

in pain, but it may not be needed every 2 hours.

C. Allow the patient to dangle legs

Providing activities to relieve boredom will assist the

at the bedside every 2 to 4 hours

patient to cope with the bed rest, and dangling the legs

D. Perform frequent position

every 2 to 4 hours may be too painful. The priority is

changes and range-of-motion

position changes and ROM exercises.

exercises

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The nurse identifies a nursing

B. Elevate the head of the bed 20 degrees and flex the

diagnosis of pain related to

knees

muscle spasms for a 45-year-old patient who has low back pain

The nurse should elevate the head of the bed 20

from a herniated lumbar disc.

degrees and flex the knees to avoid extension of the

What would be an appropriate

spine and increasing the pain. The slight flexion provided

nursing intervention to treat this

by this position often is comfortable for a patient with a

problem?

herniated lumbar disc. ROM to the lower extremities will

A. Provide gentle ROM to the

be limited to prevent extremes of spinal movement.

lower extremities

Reverse Trendelenburg and a pillow under the patient's

B. Elevate the head of the bed 20

upper back will more likely increase pain.

degrees and flex the knees C. Place the bed in reverse Trendelenburg with the feet firmly against the footboard D. Place a small pillow under the patient's upper back to gently flex the lumbar spine

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The nurse is admitting a patient

C. "Does the pain radiate down the buttock or into the

who complains of a new onset of

leg?"

lower back pain. To differentiate between the pain of a lumbar

Lower back pain associated with a herniated lumbar disc

herniated disc and lower back

is accompanied by radiation along the sciatic nerve and

pain from other causes, what

can be commonly described as traveling through the

would be the best question for the

buttock, to the posterior thigh, or down the leg. This is

nurse to ask the patient?

because the herniated disc causes compression on

A. "Is the pain worse in the

spinal nerves as they exit the spinal column. Time of

morning or in the evening?"

occurrence, type of pain, and pain relief questions do

B. "Is the pain sharp or stabbing or

not elicit differentiating data.

burning or aching?" C. "Does the pain radiate down the buttock or into the leg?" D. "Is the pain totally relieved by analgesics, such as acetaminophen (Tylenol)?"

The nurse is admitting a patient to

A. Bending or lifting

the nursing unit with a history of a herniated lumbar disc and low

Back pain that is related to a herniated lumbar disc often

back pain. In completing a more

is aggravated by events and activities that increase the

thorough pain assessment, the

stress and strain on the spine, such as bending or lifting,

nurse should ask the patient if

coughing, sneezing, and lifting the leg with the knee

which action aggravates the pain?

straight (straight leg-raising test). Application of moist

A. Bending or lifting

heat, sleeping position, and ability to sit in a fully

B. Application of warm moist heat

extended recliner do not aggravate the pain of a

C. Sleeping in a side-lying position

herniated lumbar disc.

D. Sitting in a fully extended recliner

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The nurse has reviewed proper

C. "I should pick up items by leaning forward without

body mechanics with a patient

bending my knees."

with a history of low back pain caused by a herniated lumbar disc.

The patient should avoid leaning forward without

Which statement made by the

bending the knees. Bending the knees helps to prevent

patient indicates a need for further

lower back strain and is part of proper body mechanics

teaching?

when lifting. Sleeping on the side or back wi...