CH 42

A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following?

a) Staphylococcus aureus
b) Proteus vulgaris
c) Escherichia coli
d) Psuedomonas aeruginosa

Staphylococcus aureus Explanation: Staphylococcus aureus causes over 50% of bone infections. Other organisms include Proteus vulgaris and Pseudomonas aeruginosa, as well as E. coli.

A 35-year-old client is visiting a rheumatology group practice. The client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications?

a) Activity restrictions
b) Common adverse effects
c) Dietary restrictions
d) Loading-dose schedule

Common adverse effects Explanation: The most common adverse effects of NSAIDs are related to the GI tract: nausea, vomiting, diarrhea, and constipation. GI bleeding, which in some cases is severe, has been reported with the use of these drugs. Use of NSAIDs does not pose significant dietary or activity restrictions nor is there a loading-dose schedule.

A male patient with a musculoskeletal injury is instructed to alter his diet. The objective of this diet alteration is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which of the following food items should the nurse encourage the patient to include in the diet?

a) Vitamin D-fortified milk
b) Bananas
c) Red meat
d) Green vegetables

Vitamin D-fortified milk Explanation: The nurse should advise the patient to include dietary sources of vitamin D, such as fatty fish, vitamin D-fortified milk, and cereals. These foods protect against bone loss and decrease the risk of fracture by facilitating the absorption of calcium from food and supplements. Red meat, bananas, and green vegetables do not facilitate calcium absorption from food and supplements.

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?

a) Negative calcium balance
b) Loss of estrogen
c) Dowager's hump
d) Bone fracture

Bone fracture Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

The nurse recognizes that goal of treatment for metastatic bone cancer is to:

a) Promote pain relief and quality of life
b) Diagnose the extent of bone damage
c) Reconstruct the bone with a prosthesis
d) Cure the diseased bone and cartilage

Promote pain relief and quality of life Explanation: Treatment of metastatic bone cancer is palliative.

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?

a) Walk or perform weight-bearing exercises outdoors
b) Decrease the intake of vitamin A and D
c) Increase fiber in the diet
d) Reduce stress

Walk or perform weight-bearing exercises outdoors Explanation: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation.

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

a) "Surgery is the only sure way to manage this condition."
b) "Using arm splints will prevent hyperflexion of the wrist."
c) "This condition is associated with various sports."
d) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Explanation: Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints.

When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with:

a) Dupuytren's contracture
b) Impingement syndrome
c) Morton's neuroma
d) Carpal tunnel syndrome

Carpal tunnel syndrome Explanation: Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome.

A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?

0.5 Explanation: 100 units x 1 ml/200 units = 0.5 ml.

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?

a) Lower lumbar
b) Cervical
c) Thoracic
d) Upper lumbar

Lower lumbar Explanation: The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes.

The nurse is planning an education program for women of childbearing years. The nurse recognizes that primary prevention of osteoporosis includes:

a) Ensuring adequate calcium and vitamin D intake
b) Engaging in non-weight-bearing exercises daily
c) Having a DXA beginning at age 35 years
d) Undergoing assessment of serum calcium levels every year

Ensuring adequate calcium and vitamin D intake Explanation: Nutritional intake of calcium and vitamin D are essential for the prevention of osteoporosis.

Which group is at the greatest risk for osteoporosis?

a) Men
b) African American women
c) Asian women
d) Caucasian women

Caucasian women Explanation: Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Asian women of slight build are at risk for low peak BMD. African American women, who have a greater bone mass that Caucasian women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.

A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit?

a) Making sure the client has adequate financial resources
b) Observing for safety hazards that could be a fall risk
c) Ensuring that the client is eating enough
d) Making sure the client is receiving a daily bath

Observing for safety hazards that could be a fall risk Explanation: Clients with osteomalacia exhibit a waddling type of gait, putting them at risk for falls and fractures. Safety would be the priority in this circumstance such as scatter rugs, loose boards, and stairs. Older adult clients do not require a daily bath, and it may dry the skin. Nutrition is a necessity to question but the priority would be safety. Whether the client has adequate financial resources would be referred to social service.

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis?

a) methotrexate (Rheumatrex)
b) penicillamine (Cuprimine)
c) plicamycin (Mithracin)
d) raloxifene (Evista)

raloxifene (Evista) Explanation: Raloxifene (Evista) is used for the prevention and treatment of osteoporosis.

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?

a) Withholding all oral intake
b) Instructing the client to ambulate twice daily
c) Administering large doses of I.V. antibiotics as ordered
d) Administering large doses of oral antibiotics as ordered

Administering large doses of I.V. antibiotics as ordered Explanation: Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited.

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?

a) "After menopause, the body's bone density declines, resulting in a gradual loss of height."
b) "After age 40, height may show a gradual decrease as a result of spinal compression"
c) "The posture begins to stoop after middle age."
d) "There may be some slight discrepancy between the measuring tools used."

"After menopause, the body's bone density declines, resulting in a gradual loss of height." Explanation: The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question.

Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis?

a) Leukocytosis and localized bone pain
b) Thrombocytopenia and ecchymosis
c) Petechiae over the chest and abnormal ABGs
d) Pruritus and uremic frost

Leukocytosis and localized bone pain Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection.

Treatment of metastatic bone cancer includes which of the following?

a) Radiation
b) Palliation
c) Chemotherapy
d) Combination chemotherapy and radiation

Palliation Explanation: The treatment of metastatic bone cancer is palliative. The therapeutic goal is to relieve the patient's pain and discomfort while promoting quality of life.

The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given?

a) Raloxifene (Evista)
b) Alendronate (Fosamax)
c) Teriparatide (Forteo)
d) Denosumab (Prolia)

Alendronate (Fosamax) Explanation: Alendronate (Fosamax) is a bisphosphonate medication. Raloxifene (Evista) is a selective estrogen receptor modulator. Terparatide (Forteo) is an anabolic agent, and denosumab (Prolia) is a monoclonal antibody agent.

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?

a) Needle aspiration
b) Arthroscopy
c) Arthroplasty
d) Open reduction

Arthroscopy Explanation: Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made.

Which of the following classic symptoms would the nurse assess for to detect the development of plantar fasciitis?

a) Shortening of affected leg
b) Elevated temperature
c) Morning heel pain
d) Shortened height

Morning heel pain Explanation: Plantar fasciitis is characterized by heel pain.

On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?

a) "Bunions are congenital and can't be prevented."
b) "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth."
c) "Bunions are caused by a metabolic condition called gout."
d) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."

"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." Explanation: Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion.

A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing?

a) Wound irrigation
b) Surgical debridement
c) Wound packing
d) Vitamin supplements

Surgical debridement Explanation: In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.

Which is a risk-lowering strategy for osteoporosis?

a) Increased age
b) Smoking cessation
c) Diet low in calcium and vitamin D
d) Low initial bone mass

Smoking cessation Explanation: Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D.

Which of the following clinical manifestations would the nurse expect to find in a client who has had osteoporosis for several years?

a) Diarrhea
b) Decreased height
c) Bone spurs
d) Increased heel pain

Decreased height Explanation: Clients with osteoporosis become shorter over time.

Which of the following is the most common and most fatal primary malignant bone tumor?

a) Osteochondroma
b) Enchondroma
c) Rhabdomyoma
d) Osteogenic sarcoma (osteosarcoma)

Osteogenic sarcoma (osteosarcoma) Explanation: Osteogenic sarcoma (osteosarcoma) is the most common and most often fatal primary malignant bone tumor. Benign primary neoplasms of the musculoskeletal system include osteochondroma, enchondroma, and rhabdomyoma.

A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening?

a) Dislocated jaw
b) Temporomandibular disorder
c) Trigeminal neuralgia
d) Loose teeth

Temporomandibular disorder Explanation: The disorder can be confused with trigeminal neuralgia and migraine headaches. The client experiences clicking of the jaw when moving the joint, or the jaw can lock, which interferes with opening the mouth. Loose teeth will not cause a clicking of the jaw. The client does not have a dislocated jaw.

Which should be included in the teaching plan for a patient diagnosed with plantar fasciitis?

a) Plantar fasciitis presents as an acute onset of pain localized to the ball of the foot.
b) Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion.
c) Management of plantar fasciitis includes stretching exercises.
d) The pain of plantar fasciitis diminishes with warm water soaks.

Management of plantar fasciitis includes stretching exercises. Explanation: Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (e.g., heel cups, arch supports), and the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced with taking the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs.

The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective?

a) The patient used a narrow base of support.
b) The patient bent at the hips and tightened the abdominal muscles.
c) The patient placed the load close to the body.
d) The patient reached over head with arms fully extended.

The patient placed the load close to the body. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. Bending at the hips increases the strain on the back muscles when lifting.

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

a) "You will receive IV antibiotics for 3 to 6 weeks."
b) "You need to limit the amount of protein and calcium in your diet."
c) "You need to perform weight-bearing exercises twice a week."
d) "Use your continuous passive motion machine (CPM) 2 hours each day."

"You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks.

Most cases of osteomyelitis are caused by which of the following microorganisms?

a) Proteus species
b) Escherichia coli
c) Pseudomonas species
d) Staphylococcus

Staphylococcus Explanation: Staphylococcus aureus causes 70% to 80% of bone infections. Proteus species are frequently found in osteomyelitis, but they do not cause the majority of bone infections. Pseudomonas species are frequently found in osteomyelitis, but they do not cause most bone infections. While E. coli is frequently found in osteomyelitis, it does not cause the majority of bone infections.

What food can the nurse suggest to the client at risk for osteoporosis?

a) Broccoli
b) Bananas
c) Carrots
d) Chicken

Broccoli Explanation: Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium.

Of the following, which is not a risk factor for osteoporosis?

a) Being male
b) Being postmenopausal
c) Small-framed, thin White or Asian women
d) Family history

Being male Explanation: Being male is not considered a risk factor. The following are some of the risk factors for osteoporosis: being a small-framed, thin White or Asian women; being postmenopausal; family history; inactivity; chronic low calcium intake; and excessive caffeine or tobacco use.

In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations?

a) Wound packing
b) Surgical debridement
c) Vitamin supplements
d) Wound irrigation

Surgical debridement Explanation: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.

The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client?

a) The client will maintain adequate nutritional intake.
b) The client will maintain effective airway clearance.
c) The client will experience a tolerable level of pain.
d) The client will demonstrate wound care.
e) The client will remain free from injury.

• The client will experience a tolerable level of pain. • The client will demonstrate wound care. • The client will maintain adequate nutritional intake. Explanation: Pain is a priority problem for the client with osteomyelitis, and it can interfere with mobility of joint. In this situation, the client's jaw is the site of infection. Pain in this location can interfere with nutritional intake of the individual. Chronic osteomyelitis presents with a nonhealing ulcer over the infected bone with a connecting sinus that will intermittently and spontaneously drain pus. The client will need to be able to provide wound care in the home setting. Remaining free from injury and maintaining an effective airway clearance are not priority goals for the client.

The nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan?

a) Administer pain medication per client request.
b) Monitor vital signs every 4 hours.
c) Examine surgical dressing every hour.
d) Perform neuromuscular assessment every hour.

Perform neuromuscular assessment every hour. Explanation: The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is critical.

To help prevent osteoporosis, what should a nurse advise a young woman to do?

a) Consume at least 1,000 mg of calcium daily.
b) Keep the serum uric acid level within the normal range.
c) Encourage the use of a firm mattress.
d) Avoid trauma to the affected bone.

Consume at least 1,000 mg of calcium daily. Explanation: To help prevent osteoporosis, the nurse should encourage the client to consume at least the recommended daily allowance (RDA) of calcium. Before menopause, the RDA is 1,000 mg; after menopause, it's 1,500 mg. Because osteoporosis affects all bones, avoiding trauma to the affected bone only is inappropriate. Using a firm mattress and keeping the uric acid level within the normal range don't relate to osteoporosis. The nurse should encourage a client with ankylosing spondylitis to sleep on a firm mattress. The nurse should advise a client with gouty arthritis to keep the serum uric acid level in the normal range.

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

a) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.
b) To prevent fractures, the client should avoid strenuous exercise.
c) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss.
d) The recommended daily allowance of calcium may be found in a wide variety of foods.

The recommended daily allowance of calcium may be found in a wide variety of foods. Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.

Ms. Simpson has come to the clinic with foot pain. The physician has described her problem as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder?

a) Mallet toe
b) Hammer toe
c) Heberden's nodes
d) Hallux valgus (bunion)

Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal joint. Mallet toe is a flexion deformity of the distal interphalangeal joint. Bunion is a deformity of the great toe at its metatarsophalangeal joint. Heberden's nodes are bony enlargements of the distal interphalangeal joints. This is a finding in degenerative joint disease.

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely?

a) Skull narrowing
b) Waddling gait
c) Lordosis
d) Long bone bowing

Long bone bowing Explanation: Some clients with Paget's disease are asymptomatic with only some mild skeletal deformity. Other clients have marked skeletal deformities which may include enlargement of the skull, bowing of the long bones, and kyphosis. Waddling gait is associated with osteomalacia.

Morton's neuroma is exhibited by which of the following clinical manifestations?

a) Swelling of the third (lateral) branch of the median plantar nerve
b) Inflammation of the foot-supporting fascia
c) High arm and a fixed equinus deformity
d) Longitudinal arch of the foot is diminished

Swelling of the third (lateral) branch of the median plantar nerve Explanation: Morton's neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.

Which sign may be helpful in identifying carpal tunnel syndrome?

a) Kernig's
b) Brudzinski's
c) Babinski's
d) Tinel's

Tinel's Explanation: Tinel's sign may be used to help identify carpal tunnel syndrome. The presence of the Babinski's sign can identify disease of the brain and spinal cord in adults and also exists as a primitive reflex in infants. The Brudzinski's and Kernig's sign are indicative of meningeal irritation.

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which of the following bone disorders?

a) Osteomyelitis
b) Ganglion
c) Osteomalacia
d) Paget's disease

Paget's disease Explanation: Paget's disease results in bone that is highly vascularized and structurally weak, predisposing to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. A ganglion is a collection of neurological gelatinous material. Osteomyelitis is an infection of bone that comes from the extension of a soft tissue infection, direct bone contamination, or hematogenous spread.

Which assessment findings would the nurse expect in the client with osteomalacia?

a) Column A
b) Column B
c) Column C
d) Column D

Column B Explanation: Osteomalacia is characterized by decreased serum calcium and phosphorus and elevated alkaline phosphatase levels

Which of the following terms refers to disease of a nerve root?

a) Radiculopathy
b) Involucrum
c) Sequestrum
d) Contracture

Radiculopathy Explanation: When the patient reports radiating pain down the leg, he or she is describing radiculopathy. Involucrum refers to new bone growth around the sequestrum. Sequestrum refers to dead bone in an abscess cavity. Contracture refers to abnormal shortening of muscle or fibrosis of joint structures.

To help minimize calcium loss from a hospitalized client's bones, the nurse should:

a) provide supplemental feedings between meals.
b) provide the client dairy products at frequent intervals.
c) encourage the client to walk in the hall.
d) reposition the client every 2 hours.

encourage the client to walk in the hall. Explanation: Calcium absorption diminishes with reduced physical activity because of decreased bone stimulation. Therefore, encouraging the client to increase physical activity, such as by walking in the hall, helps minimize calcium loss. Turning or repositioning the client every 2 hours wouldn't increase activity sufficiently to minimize bone loss. Providing dairy products and supplemental feedings wouldn't lessen calcium loss — even if the dairy products and feedings contained extra calcium — because the additional calcium doesn't increase bone stimulation or osteoblast activity.

Which medication classification is prescribed when allergy is a factor causing the skin disorder?

a) Antihistamines
b) Corticosteroids
c) Local anesthetics
d) Antibiotics

Antihistamines Explanation: Antihistamines are frequently prescribed when an allergy is a factor in causing the skin disorder. They relieve itching and shorten the duration of allergic reaction. Corticosteroids are used to relieve inflammatory or allergic symptoms. Antibiotics are used to treat infectious disorders. Local anesthetics are used to relieve minor skin pain and itching.

A patient has been prescribed alendronate (Fosamax) for the prevention of osteoporosis. Which of the following is the highest priority nursing intervention associated with the administration of the medication?

a) Have patient sit upright for 60 minutes following administration
b) Encourage patient to get yearly dental exams
c) Assess for the use of corticosteroids
d) Ensure adequate intake of vitamin D in the diet

Have patient sit upright for 60 minutes following administration Explanation: While all interventions are appropriate, the highest priority is having the patient sit upright for 60 minutes following the administration of the medication. This will prevent irritation and potential ulceration of the esophagus. The patient should have adequate intake of vitamin D and obtain yearly dental exams. The concurrent use of corticosteroids and Fosamax is link to a complication of osteonecrosis.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include?

a) Sleep on the stomach to alleviate pressure on the back.
b) Use the large muscles of the leg when lifting items.
c) Avoid twisting and flexion activities.
d) A soft mattress is most supportive by conforming to the body.

Use the large muscles of the leg when lifting items. Explanation: The large muscles of the leg should be used when lifting.

Which of the following are clinical manifestations of impingement syndrome? Select all that apply.

a) Limited movement
b) Atrophy
c) Pain
d) Shoulder tenderness
e) Muscle spasms

• Pain • Shoulder tenderness • Limited movement • Muscle spasms • Atrophy Explanation: The patient experiences pain, shoulder tenderness, limited movement, muscle spasms, and atrophy. The process may progress to a rotator cuff tear.

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate?

a) Bicycling
b) Walking
c) Yoga
d) Swimming

Walking Explanation: Weight-bearing exercises should be incorporated into the client's lifestyle activities.

A client with diabetes punctured hisfoot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics?

a) 3 months
b) 3 to 6 weeks
c) 6 months
d) 7 to 10 days

3 to 6 weeks Explanation: Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for 3 to 6 weeks. Oral antibiotics then follow for as long as 3 months.

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?

a) A bone biopsy
b) Demineralization of the bone
c) Increased and decreased areas of bone metabolism
d) Elevated levels of alkaline phosphatase

A bone biopsy Explanation: A definitive diagnosis is obtained by bone biopsy. Radiographic studies demonstrate demineralization of the bone. A bone scan detects increased and decreased areas of bone metabolism. Alkaline phosphatase levels are detected from a blood sample.

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following?

a) Bunion
b) Mallet toe
c) Hallux valgus
d) Hammer toe

Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?

a) Taking a 300-mg calcium supplement to meet dietary guidelines
b) Stopping estrogen therapy
c) Living a sedentary lifestyle to reduce the incidence of injury
d) Initiating weight-bearing exercise routines

Initiating weight-bearing exercise routines Explanation: Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.

Which of the following presents with an onset of heel pain with the first steps of the morning?

a) Plantar fasciitis
b) Morton's neuroma
c) Ganglion
d) Hallux valgus

Plantar fasciitis Explanation: Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heal pain experienced with the first steps in the morning. Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.

Which is a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

a) Callus
b) Hammertoe
c) Hallux valgus
d) Dupuytren's contracture

Dupuytren's contracture Explanation: Dupuytren's disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren's contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally

The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do?

a) Wear properly fitting shoes.
b) Do active range of motion on the toes.
c) Have surgery to fix them.
d) Bind the toes so that they will straighten.

Wear properly fitting shoes. Explanation: Hammer toe is a flexion deformity of the PIP joint and may involve several toes and may result from wearing poorly fitting shoes. They will not straighten by binding the toes or doing active range of motion exercises. Surgery is an option but should be discussed with an orthopedic surgeon or podiatrist.

When an infection is blood borne the manifestations include which of the following symptoms?

a) Hypothermia
b) Hyperactivity
c) Chills
d) Bradycardia

Chills Explanation: Manifestations include chills, high fever, rapid pulse, and generalized malaise.

The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications?

a) Osteomyelitis
b) Fat embolism
c) Avascular necrosis
d) Compartment syndrome

Osteomyelitis Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection.

A client has Paget's disease. An appropriate nursing diagnosis for this client is:

a) Risk for falls
b) Delayed wound healing
c) Fatigue
d) Risk for infection

Risk for falls Explanation: The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility.

Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing BMD?

a) Calcitonin (Miacalcin)
b) Vitamin D
c) Raloxifene (Evista)
d) Teriparatide (Forteo)

Calcitonin (Miacalcin) Explanation: Miacalcin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Evista reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Forteo has been recently approved by the FDA for the treatment of osteoporosis.

A nurse is caring for a female client following a motor vehicle accident resulting in paraplegia. The client is ready for discharge to home with her husband, who states, "I'm scared to carry her because I'm afraid I'll either hurt my back or drop her." A nurse identifies a need for discharge teaching of the husband in regard to:

a) nutritional changes for the client with paraplegia.
b) ergonomic principles and body mechanics.
c) the importance of monitoring urinary elimination.
d) signs and symptoms of chronic back pain that he should report to his physician.

ergonomic principles and body mechanics. Explanation: The husband's statement indicates a need for teaching in regard to client mobility and transfer techniques. Although urinary elimination, nutrition, and pain are components of care for clients with paraplegia, education about ergonomic principles and body mechanics is most appropriate at this time based on the husband's statement.

The nurse notes that the patient's left great toe deviates laterally. This finding would be recognized as which of the following?

a) Pes cavus
b) Hammertoe
c) Flatfoot
d) Hallux valgus

Hallux valgus Explanation: Hallux valgus is commonly referred to as a bunion. Hammertoes are usually pulled upward. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. In flatfoot, the patient demonstrates a diminished longitudinal arch of the foot.

Which of the following was formerly called a bunion?

a) Ganglion
b) Plantar fasciitis
c) Morton's neuroma
d) Hallux valgus

Hallux valgus Explanation: Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and his immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client?

a) The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor.
b) The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor.
c) The nurse is caring for this client on the intensive care unit.
d) The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit.

The nurse is caring for this client on the intensive care unit. Explanation: This client is critically ill; his diagnosis and immunosuppression place him at a high risk for infection. The most appropriate place for this client is in an intensive care unit, where the nurse can focus exclusively on his health promotion. This client shouldn't be on the oncology floor. This client requires close monitoring. The nurse caring for this client shouldn't also be caring for other clients who may require frequent interventions

The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients?

a) Impaired physical mobility
b) Risk for infection
c) Inadequate nutrition
d) Disturbed body image

Disturbed body image Explanation: Amputation of a body part can result in disturbances in body image.

Which of the following aspects should a nurse include in the teaching plan for a patient with osteomalacia?

a) Include the supplements of calcium, phosphorus, and vitamin D
b) Avoid any activity or exercise
c) Avoid dairy products
d) Avoid green leafy vegetables

Include the supplements of calcium, phosphorus, and vitamin D Explanation: The nurse should encourage the patients with osteomalacia to include the supplements of calcium, phosphorus, and vitamin D; adequate nutrition; exposure to sunlight; and progressive exercise and ambulation. Patients need not avoid dairy products, leafy vegetables or mild exercise.

Which is a deformity in which the great toe deviates laterally?

a) Plantar fasciitis
b) Hammertoe
c) Pes cavus
d) Hallux valgus

Hallux valgus Explanation: Hallux valgus is a deformity in which the great toe deviates laterally. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Pes cavus refers to a foot with an abnormally high arch and a fixed equines deformity of the forefoot. Plantar fasciitis is an inflammation of the foot-supporting fascia.

A client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client's urination problem?

a) Benign prostatic hyperplasia
b) Dehydration
c) Urinary tract infection (UTI)
d) Renal calculi

Renal calculi Explanation: Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A UTI commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination.

Instructions for the patient with low back pain include that when lifting the patient should

a) bend the knees and loosen the abdominal muscles.
b) avoid overreaching.
c) place the load away from the body.
d) use a narrow base of support.

avoid overreaching. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. When lifting, the patient with low back pain should keep the load close to the body. When lifting, the patient with low back pain should bend the knees and tighten the abdominal muscles.

A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about taking a calcium supplement should the nurse include?

a) Take weekly on the same day and at the same time.
b) Remain in an upright position 30 minutes after taking the supplement.
c) Take the supplement on an empty stomach with a full glass of water.
d) Take the supplement with meals or with orange juice.

Take the supplement with meals or with orange juice. Explanation: Calcium supplements, such as Caltrate or Citracal, are over-the-counter medications. They should be taken with meals or with a beverage high in vitamin C

The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective?

a) The patient used a narrow base of support.
b) The patient placed the load close to the body.
c) The patient reached over head with arms fully extended.
d) The patient bent at the hips and tightened the abdominal muscles.

The patient placed the load close to the body. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. Bending at the hips increases the strain on the back muscles when lifting.

A nurse is educating a patient diagnosed with osteomalacia. Which of the following statements by the nurse is appropriate?

a) "You will need to engage in vigorous exercise three times a week for 30 minutes."
b) "You will need to decrease the amount of dairy products consumed."
c) "You may need to be evaluated for an underlying cause, such as renal failure."
d) "You will need to avoid foods high in phosphorus, and vitamin D."

"You may need to be evaluated for an underlying cause, such as renal failure." Explanation: The patient may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The patient needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The patient is at risk for pathological fractures and therefore should not engage in vigorous exercise.

A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class?

a) Raloxifene (Evista)
b) Calcium gluconate
c) Tamoxifen (Nolvadex)
d) Alendronate (Fosamax)

Raloxifene (Evista) Explanation: An example of a selective estrogen receptor modifier (SERM) is raloxifene (Evista). Alendronate is a biphosphonate; calcium gluconate is an oral calcium preparation; tamoxifen is an antiestrogen agent.

Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women?

a) Forteo
b) Fosamax
c) Raloxifene
d) Denosumab

Raloxifene Explanation: Raloxifene is the only selective estrogen receptor modulator (SERM) approved for osteoporosis in post menopausal women as it does not increase the risk of breast or uterine cancer, but it does come with an increased risk of thromboembolism. Fosamax is a bisphosphonate. Forteo is a subcutaneously administered medication that is given one daily for the treatment of osteoporosis. Denosumab has recently been approved for treatment of postmenopausal women with osteoporosis who are at risk for fractures.

An older adult female has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density?

a) Diabetes
b) Cardiac disease
c) Hypertension
d) Compression fractures

Compression fractures Explanation: In osteoporosis, loss of bone substance exceeds bone formation. The total bone mass and density is reduced, resulting in bones that become progressively porous, brittle, and fragile. Compression fractures of the vertebrae are common. Diabetes, hypertension, and cardiac disease may occur in response to the aging process but are not the result of osteoporosis.

A male client is to have an amputation. He is acutely ill and diagnosed with a gangrenous limb and related fever, disorientation, and electrolyte imbalances. Which of the following would be most important for the nurse to monitor in this client?

a) Signs of nausea and vomiting
b) Signs of sepsis
c) Occurrence of allergic reactions
d) Reduced urine output

Signs of sepsis Explanation: If the client is acutely ill with a gangrenous limb, related fever, disorientation, and electrolyte imbalances, the nurse should monitor for signs of sepsis and circulation in the limb for any changes such as severe pain, color changes, and lack of peripheral pulses. It is crucial for the nurse to inform the physician about the problems as they occur or else the surgery may become an emergency. Monitoring for signs of nausea and vomiting, occurrence of allergic reactions, and reduced urine output, although necessary, is not as crucial for the client.

A physician prescribes raloxifene (Evista) to a hospitalized patient. The patient's history includes a right hip fracture, hysterectomy, deep vein thrombosis, and hypertension. Which of the following actions by the nurse demonstrates safe nursing care?

a) Administering the raloxifene (Evista) with food or milk
b) Having the patient sit upright for 30-60 minutes following administration
c) Holding the raloxifene (Evista) and notifying the physician
d) Administering the raloxifene (Evista) in the evening

Holding the raloxifene (Evista) and notifying the physician Explanation: Raloxifene (Evista) is contraindicated in patients with a history of deep vein thrombosis. The nurse should hold the medication and notify the physician. Raloxifene (Evista) can be given without regard to food or time of day. Raloxifene (Evista) is a selective estrogen receptor modulation (SERM) medication. Sitting upright for 30-60 minutes is for the classification of bisphosphonates.

Dupuytren's contracture causes flexion of which area(s)?

a) Fourth and fifth fingers
b) Ring finger
c) Index and middle fingers
d) Thumb

Fourth and fifth fingers Explanation: Dupuytren's contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.

Which of the following diagnostics are used to evaluate spinal nerve root disorders (radiculopathies)?

a) Electromyogram
b) Magnetic resonance imaging
c) Bone scan
d) Computed tomography

Electromyogram Explanation: An electromyogram and nerve conduction studies are used to evaluate spinal nerve toot disorders (radiculopathies) for patients with low back pain. A bone scan may disclose information about infections, tumors, and bone marrow abnormalities. A computed tomography scan is useful in identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral column and problems of vertebral disks. Magnetic resonance imaging permits visualization of the nature and location of spinal pathology.

A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication?

a) Sodium level of 110 mEq/L
b) Calcium level of 11.6 mg/dl
c) Magnesium level of 0.9 mg/dl
d) Potassium level of 6.3 mEq/L

Calcium level of 11.6 mg/dl Explanation: In clients with bone cancer, tumor destruction of bone commonly causes excessive calcium release. When the calcium-excreting capacity of the kidneys and GI tract is exceeded, the serum calcium level rises above normal, leading to hypercalcemia (a serum calcium level greater than 10.2 mg/dl). Hyperkalemia (a potassium level greater than 5 mEq/L) isn't caused by bone cancer and is seldom associated with chemotherapy. Hyponatremia (a sodium level less than 135 mEq/L) and hypomagnesemia (a magnesium level less than 1.3 mg/dl) are potential adverse effects of chemotherapy; these electrolyte disturbances don't result directly from bone cancer.

A group of students are reviewing information about osteoporosis in preparation for a class discussion. The students demonstrate a need for additional review when they state which of the following as a risk factor?

a) Hypothyroidism
b) Excess caffeine intake
c) Prolonged corticosteroid use
d) Prolonged immobility

Hypothyroidism Explanation: Factors associated with an increased risk for osteoporosis include: family history of osteoporosis, chronic low calcium intake, excessive intake of caffeine, tobacco use, Cushing's syndrome, prolonged use of high doses of corticosteroids, prolonged periods of immobility, hyperthyroidism, hyperparathyroidism, eating disorders, malabsorption syndromes, breast cancer (especially if treated with chemotherapy that suppresses estrogen, excluding Tamoxifen, which may reduce the risk of fractures), renal or liver failure, alcoholism, lactose intolerance, and dietary deficiency of vitamin D and calcium.

When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location?

a) Distal femur around the knee
b) Wrist-hand junction
c) Proximal humerus
d) Femur-hip area

Distal femur around the knee Explanation: Malignant bone tumors usually are located around the knee in the distal femur or proximal fibula; a few are found in the proximal humerus. The wrist-hand junction and femur-hip area are not common sites.

The nurse is caring for the client following removal of a Morton's neuroma. Which of the following nursing interventions would be inappropriate?

a) Assess the surgical dressing.
b) Assist the client with incentive spirometry.
c) Elevate the foot on two pillows.
d) Perform neurovascular assessment of the hand.

Perform neurovascular assessment of the hand. Explanation: Morton's neuroma is a foot problem characterized by swelling of the median plantar nerve.

A nurse is educating a patient diagnosed with osteomalacia. Which of the following statements by the nurse is appropriate?

a) "You will need to avoid foods high in phosphorus, and vitamin D."
b) "You will need to engage in vigorous exercise three times a week for 30 minutes."
c) "You will need to decrease the amount of dairy products consumed."
d) "You may need to be evaluated for an underlying cause, such as renal failure."

"You may need to be evaluated for an underlying cause, such as renal failure." Explanation: The patient may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The patient needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The patient is at risk for pathological fractures and therefore should not engage in vigorous exercise.

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CH 42

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A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following?

a) Staphylococcus aureus
b) Proteus vulgaris
c) Escherichia coli
d) Psuedomonas aeruginosa

Staphylococcus aureus Explanation: Staphylococcus aureus causes over 50% of bone infections. Other organisms include Proteus vulgaris and Pseudomonas aeruginosa, as well as E. coli.

A 35-year-old client is visiting a rheumatology group practice. The client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications?

a) Activity restrictions
b) Common adverse effects
c) Dietary restrictions
d) Loading-dose schedule

Common adverse effects Explanation: The most common adverse effects of NSAIDs are related to the GI tract: nausea, vomiting, diarrhea, and constipation. GI bleeding, which in some cases is severe, has been reported with the use of these drugs. Use of NSAIDs does not pose significant dietary or activity restrictions nor is there a loading-dose schedule.

A male patient with a musculoskeletal injury is instructed to alter his diet. The objective of this diet alteration is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which of the following food items should the nurse encourage the patient to include in the diet?

a) Vitamin D-fortified milk
b) Bananas
c) Red meat
d) Green vegetables

Vitamin D-fortified milk Explanation: The nurse should advise the patient to include dietary sources of vitamin D, such as fatty fish, vitamin D-fortified milk, and cereals. These foods protect against bone loss and decrease the risk of fracture by facilitating the absorption of calcium from food and supplements. Red meat, bananas, and green vegetables do not facilitate calcium absorption from food and supplements.

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?

a) Negative calcium balance
b) Loss of estrogen
c) Dowager’s hump
d) Bone fracture

Bone fracture Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn’t a complication of osteoporosis. Dowager’s hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

The nurse recognizes that goal of treatment for metastatic bone cancer is to:

a) Promote pain relief and quality of life
b) Diagnose the extent of bone damage
c) Reconstruct the bone with a prosthesis
d) Cure the diseased bone and cartilage

Promote pain relief and quality of life Explanation: Treatment of metastatic bone cancer is palliative.

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?

a) Walk or perform weight-bearing exercises outdoors
b) Decrease the intake of vitamin A and D
c) Increase fiber in the diet
d) Reduce stress

Walk or perform weight-bearing exercises outdoors Explanation: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation.

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

a) "Surgery is the only sure way to manage this condition."
b) "Using arm splints will prevent hyperflexion of the wrist."
c) "This condition is associated with various sports."
d) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Explanation: Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints.

When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with:

a) Dupuytren’s contracture
b) Impingement syndrome
c) Morton’s neuroma
d) Carpal tunnel syndrome

Carpal tunnel syndrome Explanation: Tinel’s sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome.

A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?

0.5 Explanation: 100 units x 1 ml/200 units = 0.5 ml.

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?

a) Lower lumbar
b) Cervical
c) Thoracic
d) Upper lumbar

Lower lumbar Explanation: The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes.

The nurse is planning an education program for women of childbearing years. The nurse recognizes that primary prevention of osteoporosis includes:

a) Ensuring adequate calcium and vitamin D intake
b) Engaging in non-weight-bearing exercises daily
c) Having a DXA beginning at age 35 years
d) Undergoing assessment of serum calcium levels every year

Ensuring adequate calcium and vitamin D intake Explanation: Nutritional intake of calcium and vitamin D are essential for the prevention of osteoporosis.

Which group is at the greatest risk for osteoporosis?

a) Men
b) African American women
c) Asian women
d) Caucasian women

Caucasian women Explanation: Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Asian women of slight build are at risk for low peak BMD. African American women, who have a greater bone mass that Caucasian women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.

A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit?

a) Making sure the client has adequate financial resources
b) Observing for safety hazards that could be a fall risk
c) Ensuring that the client is eating enough
d) Making sure the client is receiving a daily bath

Observing for safety hazards that could be a fall risk Explanation: Clients with osteomalacia exhibit a waddling type of gait, putting them at risk for falls and fractures. Safety would be the priority in this circumstance such as scatter rugs, loose boards, and stairs. Older adult clients do not require a daily bath, and it may dry the skin. Nutrition is a necessity to question but the priority would be safety. Whether the client has adequate financial resources would be referred to social service.

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis?

a) methotrexate (Rheumatrex)
b) penicillamine (Cuprimine)
c) plicamycin (Mithracin)
d) raloxifene (Evista)

raloxifene (Evista) Explanation: Raloxifene (Evista) is used for the prevention and treatment of osteoporosis.

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client’s care, the nurse should anticipate which measure?

a) Withholding all oral intake
b) Instructing the client to ambulate twice daily
c) Administering large doses of I.V. antibiotics as ordered
d) Administering large doses of oral antibiotics as ordered

Administering large doses of I.V. antibiotics as ordered Explanation: Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn’t necessarily prohibited.

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?

a) "After menopause, the body’s bone density declines, resulting in a gradual loss of height."
b) "After age 40, height may show a gradual decrease as a result of spinal compression"
c) "The posture begins to stoop after middle age."
d) "There may be some slight discrepancy between the measuring tools used."

"After menopause, the body’s bone density declines, resulting in a gradual loss of height." Explanation: The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client’s history doesn’t indicate spinal compression. Telling the client that measuring tools used to obtain the client’s height may have a discrepancy or that the posture begins to stoop after middle age doesn’t address the client’s question.

Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis?

a) Leukocytosis and localized bone pain
b) Thrombocytopenia and ecchymosis
c) Petechiae over the chest and abnormal ABGs
d) Pruritus and uremic frost

Leukocytosis and localized bone pain Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection.

Treatment of metastatic bone cancer includes which of the following?

a) Radiation
b) Palliation
c) Chemotherapy
d) Combination chemotherapy and radiation

Palliation Explanation: The treatment of metastatic bone cancer is palliative. The therapeutic goal is to relieve the patient’s pain and discomfort while promoting quality of life.

The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given?

a) Raloxifene (Evista)
b) Alendronate (Fosamax)
c) Teriparatide (Forteo)
d) Denosumab (Prolia)

Alendronate (Fosamax) Explanation: Alendronate (Fosamax) is a bisphosphonate medication. Raloxifene (Evista) is a selective estrogen receptor modulator. Terparatide (Forteo) is an anabolic agent, and denosumab (Prolia) is a monoclonal antibody agent.

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?

a) Needle aspiration
b) Arthroscopy
c) Arthroplasty
d) Open reduction

Arthroscopy Explanation: Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made.

Which of the following classic symptoms would the nurse assess for to detect the development of plantar fasciitis?

a) Shortening of affected leg
b) Elevated temperature
c) Morning heel pain
d) Shortened height

Morning heel pain Explanation: Plantar fasciitis is characterized by heel pain.

On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?

a) "Bunions are congenital and can’t be prevented."
b) "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth."
c) "Bunions are caused by a metabolic condition called gout."
d) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."

"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." Explanation: Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn’t cause bunions. Although a client with gout may have pain in the big toe, such pain doesn’t result from a bunion.

A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing?

a) Wound irrigation
b) Surgical debridement
c) Wound packing
d) Vitamin supplements

Surgical debridement Explanation: In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.

Which is a risk-lowering strategy for osteoporosis?

a) Increased age
b) Smoking cessation
c) Diet low in calcium and vitamin D
d) Low initial bone mass

Smoking cessation Explanation: Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D.

Which of the following clinical manifestations would the nurse expect to find in a client who has had osteoporosis for several years?

a) Diarrhea
b) Decreased height
c) Bone spurs
d) Increased heel pain

Decreased height Explanation: Clients with osteoporosis become shorter over time.

Which of the following is the most common and most fatal primary malignant bone tumor?

a) Osteochondroma
b) Enchondroma
c) Rhabdomyoma
d) Osteogenic sarcoma (osteosarcoma)

Osteogenic sarcoma (osteosarcoma) Explanation: Osteogenic sarcoma (osteosarcoma) is the most common and most often fatal primary malignant bone tumor. Benign primary neoplasms of the musculoskeletal system include osteochondroma, enchondroma, and rhabdomyoma.

A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening?

a) Dislocated jaw
b) Temporomandibular disorder
c) Trigeminal neuralgia
d) Loose teeth

Temporomandibular disorder Explanation: The disorder can be confused with trigeminal neuralgia and migraine headaches. The client experiences clicking of the jaw when moving the joint, or the jaw can lock, which interferes with opening the mouth. Loose teeth will not cause a clicking of the jaw. The client does not have a dislocated jaw.

Which should be included in the teaching plan for a patient diagnosed with plantar fasciitis?

a) Plantar fasciitis presents as an acute onset of pain localized to the ball of the foot.
b) Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion.
c) Management of plantar fasciitis includes stretching exercises.
d) The pain of plantar fasciitis diminishes with warm water soaks.

Management of plantar fasciitis includes stretching exercises. Explanation: Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (e.g., heel cups, arch supports), and the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced with taking the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs.

The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective?

a) The patient used a narrow base of support.
b) The patient bent at the hips and tightened the abdominal muscles.
c) The patient placed the load close to the body.
d) The patient reached over head with arms fully extended.

The patient placed the load close to the body. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. Bending at the hips increases the strain on the back muscles when lifting.

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

a) "You will receive IV antibiotics for 3 to 6 weeks."
b) "You need to limit the amount of protein and calcium in your diet."
c) "You need to perform weight-bearing exercises twice a week."
d) "Use your continuous passive motion machine (CPM) 2 hours each day."

"You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks.

Most cases of osteomyelitis are caused by which of the following microorganisms?

a) Proteus species
b) Escherichia coli
c) Pseudomonas species
d) Staphylococcus

Staphylococcus Explanation: Staphylococcus aureus causes 70% to 80% of bone infections. Proteus species are frequently found in osteomyelitis, but they do not cause the majority of bone infections. Pseudomonas species are frequently found in osteomyelitis, but they do not cause most bone infections. While E. coli is frequently found in osteomyelitis, it does not cause the majority of bone infections.

What food can the nurse suggest to the client at risk for osteoporosis?

a) Broccoli
b) Bananas
c) Carrots
d) Chicken

Broccoli Explanation: Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium.

Of the following, which is not a risk factor for osteoporosis?

a) Being male
b) Being postmenopausal
c) Small-framed, thin White or Asian women
d) Family history

Being male Explanation: Being male is not considered a risk factor. The following are some of the risk factors for osteoporosis: being a small-framed, thin White or Asian women; being postmenopausal; family history; inactivity; chronic low calcium intake; and excessive caffeine or tobacco use.

In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations?

a) Wound packing
b) Surgical debridement
c) Vitamin supplements
d) Wound irrigation

Surgical debridement Explanation: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.

The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client?

a) The client will maintain adequate nutritional intake.
b) The client will maintain effective airway clearance.
c) The client will experience a tolerable level of pain.
d) The client will demonstrate wound care.
e) The client will remain free from injury.

• The client will experience a tolerable level of pain. • The client will demonstrate wound care. • The client will maintain adequate nutritional intake. Explanation: Pain is a priority problem for the client with osteomyelitis, and it can interfere with mobility of joint. In this situation, the client’s jaw is the site of infection. Pain in this location can interfere with nutritional intake of the individual. Chronic osteomyelitis presents with a nonhealing ulcer over the infected bone with a connecting sinus that will intermittently and spontaneously drain pus. The client will need to be able to provide wound care in the home setting. Remaining free from injury and maintaining an effective airway clearance are not priority goals for the client.

The nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan?

a) Administer pain medication per client request.
b) Monitor vital signs every 4 hours.
c) Examine surgical dressing every hour.
d) Perform neuromuscular assessment every hour.

Perform neuromuscular assessment every hour. Explanation: The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is critical.

To help prevent osteoporosis, what should a nurse advise a young woman to do?

a) Consume at least 1,000 mg of calcium daily.
b) Keep the serum uric acid level within the normal range.
c) Encourage the use of a firm mattress.
d) Avoid trauma to the affected bone.

Consume at least 1,000 mg of calcium daily. Explanation: To help prevent osteoporosis, the nurse should encourage the client to consume at least the recommended daily allowance (RDA) of calcium. Before menopause, the RDA is 1,000 mg; after menopause, it’s 1,500 mg. Because osteoporosis affects all bones, avoiding trauma to the affected bone only is inappropriate. Using a firm mattress and keeping the uric acid level within the normal range don’t relate to osteoporosis. The nurse should encourage a client with ankylosing spondylitis to sleep on a firm mattress. The nurse should advise a client with gouty arthritis to keep the serum uric acid level in the normal range.

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

a) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.
b) To prevent fractures, the client should avoid strenuous exercise.
c) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss.
d) The recommended daily allowance of calcium may be found in a wide variety of foods.

The recommended daily allowance of calcium may be found in a wide variety of foods. Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn’t show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won’t cause fractures. Although supplements are available, they aren’t always necessary.

Ms. Simpson has come to the clinic with foot pain. The physician has described her problem as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder?

a) Mallet toe
b) Hammer toe
c) Heberden’s nodes
d) Hallux valgus (bunion)

Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal joint. Mallet toe is a flexion deformity of the distal interphalangeal joint. Bunion is a deformity of the great toe at its metatarsophalangeal joint. Heberden’s nodes are bony enlargements of the distal interphalangeal joints. This is a finding in degenerative joint disease.

Assessment of a client reveals signs and symptoms of Paget’s disease. Which of the following would be most likely?

a) Skull narrowing
b) Waddling gait
c) Lordosis
d) Long bone bowing

Long bone bowing Explanation: Some clients with Paget’s disease are asymptomatic with only some mild skeletal deformity. Other clients have marked skeletal deformities which may include enlargement of the skull, bowing of the long bones, and kyphosis. Waddling gait is associated with osteomalacia.

Morton’s neuroma is exhibited by which of the following clinical manifestations?

a) Swelling of the third (lateral) branch of the median plantar nerve
b) Inflammation of the foot-supporting fascia
c) High arm and a fixed equinus deformity
d) Longitudinal arch of the foot is diminished

Swelling of the third (lateral) branch of the median plantar nerve Explanation: Morton’s neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.

Which sign may be helpful in identifying carpal tunnel syndrome?

a) Kernig’s
b) Brudzinski’s
c) Babinski’s
d) Tinel’s

Tinel’s Explanation: Tinel’s sign may be used to help identify carpal tunnel syndrome. The presence of the Babinski’s sign can identify disease of the brain and spinal cord in adults and also exists as a primitive reflex in infants. The Brudzinski’s and Kernig’s sign are indicative of meningeal irritation.

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which of the following bone disorders?

a) Osteomyelitis
b) Ganglion
c) Osteomalacia
d) Paget’s disease

Paget’s disease Explanation: Paget’s disease results in bone that is highly vascularized and structurally weak, predisposing to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. A ganglion is a collection of neurological gelatinous material. Osteomyelitis is an infection of bone that comes from the extension of a soft tissue infection, direct bone contamination, or hematogenous spread.

Which assessment findings would the nurse expect in the client with osteomalacia?

a) Column A
b) Column B
c) Column C
d) Column D

Column B Explanation: Osteomalacia is characterized by decreased serum calcium and phosphorus and elevated alkaline phosphatase levels

Which of the following terms refers to disease of a nerve root?

a) Radiculopathy
b) Involucrum
c) Sequestrum
d) Contracture

Radiculopathy Explanation: When the patient reports radiating pain down the leg, he or she is describing radiculopathy. Involucrum refers to new bone growth around the sequestrum. Sequestrum refers to dead bone in an abscess cavity. Contracture refers to abnormal shortening of muscle or fibrosis of joint structures.

To help minimize calcium loss from a hospitalized client’s bones, the nurse should:

a) provide supplemental feedings between meals.
b) provide the client dairy products at frequent intervals.
c) encourage the client to walk in the hall.
d) reposition the client every 2 hours.

encourage the client to walk in the hall. Explanation: Calcium absorption diminishes with reduced physical activity because of decreased bone stimulation. Therefore, encouraging the client to increase physical activity, such as by walking in the hall, helps minimize calcium loss. Turning or repositioning the client every 2 hours wouldn’t increase activity sufficiently to minimize bone loss. Providing dairy products and supplemental feedings wouldn’t lessen calcium loss — even if the dairy products and feedings contained extra calcium — because the additional calcium doesn’t increase bone stimulation or osteoblast activity.

Which medication classification is prescribed when allergy is a factor causing the skin disorder?

a) Antihistamines
b) Corticosteroids
c) Local anesthetics
d) Antibiotics

Antihistamines Explanation: Antihistamines are frequently prescribed when an allergy is a factor in causing the skin disorder. They relieve itching and shorten the duration of allergic reaction. Corticosteroids are used to relieve inflammatory or allergic symptoms. Antibiotics are used to treat infectious disorders. Local anesthetics are used to relieve minor skin pain and itching.

A patient has been prescribed alendronate (Fosamax) for the prevention of osteoporosis. Which of the following is the highest priority nursing intervention associated with the administration of the medication?

a) Have patient sit upright for 60 minutes following administration
b) Encourage patient to get yearly dental exams
c) Assess for the use of corticosteroids
d) Ensure adequate intake of vitamin D in the diet

Have patient sit upright for 60 minutes following administration Explanation: While all interventions are appropriate, the highest priority is having the patient sit upright for 60 minutes following the administration of the medication. This will prevent irritation and potential ulceration of the esophagus. The patient should have adequate intake of vitamin D and obtain yearly dental exams. The concurrent use of corticosteroids and Fosamax is link to a complication of osteonecrosis.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include?

a) Sleep on the stomach to alleviate pressure on the back.
b) Use the large muscles of the leg when lifting items.
c) Avoid twisting and flexion activities.
d) A soft mattress is most supportive by conforming to the body.

Use the large muscles of the leg when lifting items. Explanation: The large muscles of the leg should be used when lifting.

Which of the following are clinical manifestations of impingement syndrome? Select all that apply.

a) Limited movement
b) Atrophy
c) Pain
d) Shoulder tenderness
e) Muscle spasms

• Pain • Shoulder tenderness • Limited movement • Muscle spasms • Atrophy Explanation: The patient experiences pain, shoulder tenderness, limited movement, muscle spasms, and atrophy. The process may progress to a rotator cuff tear.

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate?

a) Bicycling
b) Walking
c) Yoga
d) Swimming

Walking Explanation: Weight-bearing exercises should be incorporated into the client’s lifestyle activities.

A client with diabetes punctured hisfoot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics?

a) 3 months
b) 3 to 6 weeks
c) 6 months
d) 7 to 10 days

3 to 6 weeks Explanation: Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for 3 to 6 weeks. Oral antibiotics then follow for as long as 3 months.

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?

a) A bone biopsy
b) Demineralization of the bone
c) Increased and decreased areas of bone metabolism
d) Elevated levels of alkaline phosphatase

A bone biopsy Explanation: A definitive diagnosis is obtained by bone biopsy. Radiographic studies demonstrate demineralization of the bone. A bone scan detects increased and decreased areas of bone metabolism. Alkaline phosphatase levels are detected from a blood sample.

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following?

a) Bunion
b) Mallet toe
c) Hallux valgus
d) Hammer toe

Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.

A female client is at risk for developing osteoporosis. Which action will reduce the client’s risk?

a) Taking a 300-mg calcium supplement to meet dietary guidelines
b) Stopping estrogen therapy
c) Living a sedentary lifestyle to reduce the incidence of injury
d) Initiating weight-bearing exercise routines

Initiating weight-bearing exercise routines Explanation: Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.

Which of the following presents with an onset of heel pain with the first steps of the morning?

a) Plantar fasciitis
b) Morton’s neuroma
c) Ganglion
d) Hallux valgus

Plantar fasciitis Explanation: Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heal pain experienced with the first steps in the morning. Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Morton’s neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.

Which is a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

a) Callus
b) Hammertoe
c) Hallux valgus
d) Dupuytren’s contracture

Dupuytren’s contracture Explanation: Dupuytren’s disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren’s contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally

The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do?

a) Wear properly fitting shoes.
b) Do active range of motion on the toes.
c) Have surgery to fix them.
d) Bind the toes so that they will straighten.

Wear properly fitting shoes. Explanation: Hammer toe is a flexion deformity of the PIP joint and may involve several toes and may result from wearing poorly fitting shoes. They will not straighten by binding the toes or doing active range of motion exercises. Surgery is an option but should be discussed with an orthopedic surgeon or podiatrist.

When an infection is blood borne the manifestations include which of the following symptoms?

a) Hypothermia
b) Hyperactivity
c) Chills
d) Bradycardia

Chills Explanation: Manifestations include chills, high fever, rapid pulse, and generalized malaise.

The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications?

a) Osteomyelitis
b) Fat embolism
c) Avascular necrosis
d) Compartment syndrome

Osteomyelitis Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection.

A client has Paget’s disease. An appropriate nursing diagnosis for this client is:

a) Risk for falls
b) Delayed wound healing
c) Fatigue
d) Risk for infection

Risk for falls Explanation: The client with Paget’s disease is at risk for falls secondary to pathological fractures and impaired gait/mobility.

Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing BMD?

a) Calcitonin (Miacalcin)
b) Vitamin D
c) Raloxifene (Evista)
d) Teriparatide (Forteo)

Calcitonin (Miacalcin) Explanation: Miacalcin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Evista reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Forteo has been recently approved by the FDA for the treatment of osteoporosis.

A nurse is caring for a female client following a motor vehicle accident resulting in paraplegia. The client is ready for discharge to home with her husband, who states, "I’m scared to carry her because I’m afraid I’ll either hurt my back or drop her." A nurse identifies a need for discharge teaching of the husband in regard to:

a) nutritional changes for the client with paraplegia.
b) ergonomic principles and body mechanics.
c) the importance of monitoring urinary elimination.
d) signs and symptoms of chronic back pain that he should report to his physician.

ergonomic principles and body mechanics. Explanation: The husband’s statement indicates a need for teaching in regard to client mobility and transfer techniques. Although urinary elimination, nutrition, and pain are components of care for clients with paraplegia, education about ergonomic principles and body mechanics is most appropriate at this time based on the husband’s statement.

The nurse notes that the patient’s left great toe deviates laterally. This finding would be recognized as which of the following?

a) Pes cavus
b) Hammertoe
c) Flatfoot
d) Hallux valgus

Hallux valgus Explanation: Hallux valgus is commonly referred to as a bunion. Hammertoes are usually pulled upward. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. In flatfoot, the patient demonstrates a diminished longitudinal arch of the foot.

Which of the following was formerly called a bunion?

a) Ganglion
b) Plantar fasciitis
c) Morton’s neuroma
d) Hallux valgus

Hallux valgus Explanation: Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton’s neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist

A nurse is caring for a client who’s experiencing septic arthritis. This client has a history of immunosuppressive therapy and his immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client?

a) The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor.
b) The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor.
c) The nurse is caring for this client on the intensive care unit.
d) The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit.

The nurse is caring for this client on the intensive care unit. Explanation: This client is critically ill; his diagnosis and immunosuppression place him at a high risk for infection. The most appropriate place for this client is in an intensive care unit, where the nurse can focus exclusively on his health promotion. This client shouldn’t be on the oncology floor. This client requires close monitoring. The nurse caring for this client shouldn’t also be caring for other clients who may require frequent interventions

The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients?

a) Impaired physical mobility
b) Risk for infection
c) Inadequate nutrition
d) Disturbed body image

Disturbed body image Explanation: Amputation of a body part can result in disturbances in body image.

Which of the following aspects should a nurse include in the teaching plan for a patient with osteomalacia?

a) Include the supplements of calcium, phosphorus, and vitamin D
b) Avoid any activity or exercise
c) Avoid dairy products
d) Avoid green leafy vegetables

Include the supplements of calcium, phosphorus, and vitamin D Explanation: The nurse should encourage the patients with osteomalacia to include the supplements of calcium, phosphorus, and vitamin D; adequate nutrition; exposure to sunlight; and progressive exercise and ambulation. Patients need not avoid dairy products, leafy vegetables or mild exercise.

Which is a deformity in which the great toe deviates laterally?

a) Plantar fasciitis
b) Hammertoe
c) Pes cavus
d) Hallux valgus

Hallux valgus Explanation: Hallux valgus is a deformity in which the great toe deviates laterally. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Pes cavus refers to a foot with an abnormally high arch and a fixed equines deformity of the forefoot. Plantar fasciitis is an inflammation of the foot-supporting fascia.

A client with Paget’s disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client’s urination problem?

a) Benign prostatic hyperplasia
b) Dehydration
c) Urinary tract infection (UTI)
d) Renal calculi

Renal calculi Explanation: Renal calculi commonly occur with Paget’s disease, causing pain and difficulty when urinating. A UTI commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget’s disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination.

Instructions for the patient with low back pain include that when lifting the patient should

a) bend the knees and loosen the abdominal muscles.
b) avoid overreaching.
c) place the load away from the body.
d) use a narrow base of support.

avoid overreaching. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. When lifting, the patient with low back pain should keep the load close to the body. When lifting, the patient with low back pain should bend the knees and tighten the abdominal muscles.

A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about taking a calcium supplement should the nurse include?

a) Take weekly on the same day and at the same time.
b) Remain in an upright position 30 minutes after taking the supplement.
c) Take the supplement on an empty stomach with a full glass of water.
d) Take the supplement with meals or with orange juice.

Take the supplement with meals or with orange juice. Explanation: Calcium supplements, such as Caltrate or Citracal, are over-the-counter medications. They should be taken with meals or with a beverage high in vitamin C

The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective?

a) The patient used a narrow base of support.
b) The patient placed the load close to the body.
c) The patient reached over head with arms fully extended.
d) The patient bent at the hips and tightened the abdominal muscles.

The patient placed the load close to the body. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. Bending at the hips increases the strain on the back muscles when lifting.

A nurse is educating a patient diagnosed with osteomalacia. Which of the following statements by the nurse is appropriate?

a) "You will need to engage in vigorous exercise three times a week for 30 minutes."
b) "You will need to decrease the amount of dairy products consumed."
c) "You may need to be evaluated for an underlying cause, such as renal failure."
d) "You will need to avoid foods high in phosphorus, and vitamin D."

"You may need to be evaluated for an underlying cause, such as renal failure." Explanation: The patient may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The patient needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The patient is at risk for pathological fractures and therefore should not engage in vigorous exercise.

A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class?

a) Raloxifene (Evista)
b) Calcium gluconate
c) Tamoxifen (Nolvadex)
d) Alendronate (Fosamax)

Raloxifene (Evista) Explanation: An example of a selective estrogen receptor modifier (SERM) is raloxifene (Evista). Alendronate is a biphosphonate; calcium gluconate is an oral calcium preparation; tamoxifen is an antiestrogen agent.

Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women?

a) Forteo
b) Fosamax
c) Raloxifene
d) Denosumab

Raloxifene Explanation: Raloxifene is the only selective estrogen receptor modulator (SERM) approved for osteoporosis in post menopausal women as it does not increase the risk of breast or uterine cancer, but it does come with an increased risk of thromboembolism. Fosamax is a bisphosphonate. Forteo is a subcutaneously administered medication that is given one daily for the treatment of osteoporosis. Denosumab has recently been approved for treatment of postmenopausal women with osteoporosis who are at risk for fractures.

An older adult female has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density?

a) Diabetes
b) Cardiac disease
c) Hypertension
d) Compression fractures

Compression fractures Explanation: In osteoporosis, loss of bone substance exceeds bone formation. The total bone mass and density is reduced, resulting in bones that become progressively porous, brittle, and fragile. Compression fractures of the vertebrae are common. Diabetes, hypertension, and cardiac disease may occur in response to the aging process but are not the result of osteoporosis.

A male client is to have an amputation. He is acutely ill and diagnosed with a gangrenous limb and related fever, disorientation, and electrolyte imbalances. Which of the following would be most important for the nurse to monitor in this client?

a) Signs of nausea and vomiting
b) Signs of sepsis
c) Occurrence of allergic reactions
d) Reduced urine output

Signs of sepsis Explanation: If the client is acutely ill with a gangrenous limb, related fever, disorientation, and electrolyte imbalances, the nurse should monitor for signs of sepsis and circulation in the limb for any changes such as severe pain, color changes, and lack of peripheral pulses. It is crucial for the nurse to inform the physician about the problems as they occur or else the surgery may become an emergency. Monitoring for signs of nausea and vomiting, occurrence of allergic reactions, and reduced urine output, although necessary, is not as crucial for the client.

A physician prescribes raloxifene (Evista) to a hospitalized patient. The patient’s history includes a right hip fracture, hysterectomy, deep vein thrombosis, and hypertension. Which of the following actions by the nurse demonstrates safe nursing care?

a) Administering the raloxifene (Evista) with food or milk
b) Having the patient sit upright for 30-60 minutes following administration
c) Holding the raloxifene (Evista) and notifying the physician
d) Administering the raloxifene (Evista) in the evening

Holding the raloxifene (Evista) and notifying the physician Explanation: Raloxifene (Evista) is contraindicated in patients with a history of deep vein thrombosis. The nurse should hold the medication and notify the physician. Raloxifene (Evista) can be given without regard to food or time of day. Raloxifene (Evista) is a selective estrogen receptor modulation (SERM) medication. Sitting upright for 30-60 minutes is for the classification of bisphosphonates.

Dupuytren’s contracture causes flexion of which area(s)?

a) Fourth and fifth fingers
b) Ring finger
c) Index and middle fingers
d) Thumb

Fourth and fifth fingers Explanation: Dupuytren’s contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.

Which of the following diagnostics are used to evaluate spinal nerve root disorders (radiculopathies)?

a) Electromyogram
b) Magnetic resonance imaging
c) Bone scan
d) Computed tomography

Electromyogram Explanation: An electromyogram and nerve conduction studies are used to evaluate spinal nerve toot disorders (radiculopathies) for patients with low back pain. A bone scan may disclose information about infections, tumors, and bone marrow abnormalities. A computed tomography scan is useful in identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral column and problems of vertebral disks. Magnetic resonance imaging permits visualization of the nature and location of spinal pathology.

A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication?

a) Sodium level of 110 mEq/L
b) Calcium level of 11.6 mg/dl
c) Magnesium level of 0.9 mg/dl
d) Potassium level of 6.3 mEq/L

Calcium level of 11.6 mg/dl Explanation: In clients with bone cancer, tumor destruction of bone commonly causes excessive calcium release. When the calcium-excreting capacity of the kidneys and GI tract is exceeded, the serum calcium level rises above normal, leading to hypercalcemia (a serum calcium level greater than 10.2 mg/dl). Hyperkalemia (a potassium level greater than 5 mEq/L) isn’t caused by bone cancer and is seldom associated with chemotherapy. Hyponatremia (a sodium level less than 135 mEq/L) and hypomagnesemia (a magnesium level less than 1.3 mg/dl) are potential adverse effects of chemotherapy; these electrolyte disturbances don’t result directly from bone cancer.

A group of students are reviewing information about osteoporosis in preparation for a class discussion. The students demonstrate a need for additional review when they state which of the following as a risk factor?

a) Hypothyroidism
b) Excess caffeine intake
c) Prolonged corticosteroid use
d) Prolonged immobility

Hypothyroidism Explanation: Factors associated with an increased risk for osteoporosis include: family history of osteoporosis, chronic low calcium intake, excessive intake of caffeine, tobacco use, Cushing’s syndrome, prolonged use of high doses of corticosteroids, prolonged periods of immobility, hyperthyroidism, hyperparathyroidism, eating disorders, malabsorption syndromes, breast cancer (especially if treated with chemotherapy that suppresses estrogen, excluding Tamoxifen, which may reduce the risk of fractures), renal or liver failure, alcoholism, lactose intolerance, and dietary deficiency of vitamin D and calcium.

When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location?

a) Distal femur around the knee
b) Wrist-hand junction
c) Proximal humerus
d) Femur-hip area

Distal femur around the knee Explanation: Malignant bone tumors usually are located around the knee in the distal femur or proximal fibula; a few are found in the proximal humerus. The wrist-hand junction and femur-hip area are not common sites.

The nurse is caring for the client following removal of a Morton’s neuroma. Which of the following nursing interventions would be inappropriate?

a) Assess the surgical dressing.
b) Assist the client with incentive spirometry.
c) Elevate the foot on two pillows.
d) Perform neurovascular assessment of the hand.

Perform neurovascular assessment of the hand. Explanation: Morton’s neuroma is a foot problem characterized by swelling of the median plantar nerve.

A nurse is educating a patient diagnosed with osteomalacia. Which of the following statements by the nurse is appropriate?

a) "You will need to avoid foods high in phosphorus, and vitamin D."
b) "You will need to engage in vigorous exercise three times a week for 30 minutes."
c) "You will need to decrease the amount of dairy products consumed."
d) "You may need to be evaluated for an underlying cause, such as renal failure."

"You may need to be evaluated for an underlying cause, such as renal failure." Explanation: The patient may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The patient needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The patient is at risk for pathological fractures and therefore should not engage in vigorous exercise.

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