Chapter 25: Musculoskeletal Function My Nursing Test Banks

Chapter 25: Musculoskeletal Function

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. To best identify a risk for injury in an older adult patient, the nurse assesses for:

a.

decreased muscle mass in the legs.

b.

history of falls.

c.

hyperextension of the spine.

d.

decreased bone density.

ANS: B

Musculoskeletal aging changes increase the risk for falls in older adults. Approximately one third of those age 65 or older have falls each year. About 2% of this group is hospitalized as a result of injuries incurred during the fall. The other assessments are appropriate, but a history of falls is most predictive.

DIF: Remembering (Knowledge) REF: Page 512 OBJ: 25-2

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

2. A nurse is caring for the older patient who had knee replacement surgery 8 days ago. What assessment by the nurse is most important?

a.

Determining whether the patient has sensation to the foot

b.

Asking the patient to rate his or her current pain.

c.

Observing the incision site for redness or drainage.

d.

Monitoring the calf circumference on the affected side

ANS: D

Major complications after joint replacement surgery include thromboembolism (deep venous thrombosis [DVT]), joint or wound infection, blood loss, nerve injury, joint dislocation, and surgical pain. The risk of DVT is highest between the first and second week after surgery. An increase in calf circumference can indicate the presence of a DVT. The other assessments are appropriate but not as critical.

DIF: Applying (Application) REF: N/A OBJ: 25-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

3. A patient had hip replacement surgery. What intervention is most appropriate to prevent dislocation?

a.

Instruct staff to use a fracture pan when the patient needs to toilet.

b.

Administer ordered pain medication prior to turning.

c.

Elevate the patients knee on the affected side with a pillow.

d.

Apply an abduction splint while the patient is in bed.

ANS: D

Patients who have total hip replacement surgery are at risk for hip dislocation. The hip should be maintained in a position of abduction and neutral alignment. Some physicians may require the use of pillows or abduction splints while the patient is in bed. The other actions will not prevent dislocation.

DIF: Applying (Application) REF: N/A OBJ: 25-5

TOP: Communication and Documentation MSC: Physiologic Integrity

4. An older adult patient who has experienced a left knee replacement asks the nurse, When will I be back to normal? The nurse responds that:

a.

What did the surgeon tell you about function after the surgery?

b.

Normal means different things to different people.

c.

You should be back to normal after 6 to 8 weeks.

d.

Surgery will improve your mobility but Im not sure about being normal.

ANS: A

The goal of total knee replacement surgery is to restore at least 90 degrees of knee flexion. However, the patient may have unrealistic expectations, so the nurse should first assess what the patient was told the outcome would be. The other statements do not give accurate information.

DIF: Applying (Application) REF: N/A OBJ: 25-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

5. The nurse caring for an older patient diagnosed with spinal stenosis encourages the patient to notify her physician if she experiences:

a.

sharp pain when turning her neck side-to-side.

b.

stabbing pain in her lower back.

c.

a cramping sensation in her feet.

d.

a burning sensation in either one or both legs.

ANS: D

Patients with spinal stenosis may develop claudication-like symptoms of burning and numbness in their lower extremities. This is a sign of cord compression and needs to be reported. The other symptoms are not as worrisome.

DIF: Applying (Application) REF: N/A OBJ: 25-5

TOP: Teaching-Learning MSC: Physiologic Integrity

6. The nurse is assisting a 65-year-old female patient with planning an exercise program to prevent osteoporosis. The nurse shows an understanding of appropriate exercise when stating:

a.

The local gym offers aerobics for seniors on Tuesday and Thursday evenings.

b.

Bicycling along the parks 2-mile trail twice a week would be ideal.

c.

Do you have a friend who would walk with you for 30 to 60 minutes?

d.

Are you aware that rowing is an excellent exercise for strengthening bone?

ANS: C

Exercise programs that include weight bearing and resistance have been shown to prevent bone loss. Beneficial exercises for older adults include walking, low-impact aerobics, vigorous water exercises, and racquet sports. Having a walking partner would be the best choice for this patient. The gym costs money and the classes may or may not be low impact. Bicycling and rowing are not weight-bearing exercises and do not promote bone growth.

DIF: Applying (Application) REF: N/A OBJ: 25-5

TOP: Teaching-Learning MSC: Health Promotion

7. An older adult patient has been casted for a fractured left wrist. Which action by the nurse takes priority?

a.

Assessing capillary refill in the nail beds of the fingers of the left hand.

b.

Instructing the patient on how to effectively rate pain on the pain scale.

c.

Teaching the patient to wrap the cast in plastic when the patient showers.

d.

Providing the patient with a protein-enriched milkshake as a bedtime snack.

ANS: A

Excessive constriction caused by the cast could result in compartment syndrome, leading to ischemia and tissue destruction of the extremity. Any change in capillary refilling, skin color, skin temperature, or excessive pain not controlled with medication should be immediately reported to the physician. This is the priority assessment. Pain is another important assessment, but circulatory status is first. The other actions are appropriate but not the priority.

DIF: Applying (Application) REF: N/A OBJ: 25-3

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

8. An older adult patient has been admitted to the hospital with suspected Paget disease. What clinical manifestation will help the nurse differentiate Paget disease from other types of musculoskeletal diseases?

a.

Red, swollen upper and lower extremity joints

b.

Pain on awakening that subsides with activity

c.

Ataxia or mild hearing loss

d.

Back deformity in the absence of pain

ANS: C

Manifestations of Paget disease include bone pain, headache and conductive hearing loss (if the skull is affected), barreling of the chest, kyphosis, skull enlargement, and bowing of the tibia and femur. The other manifestations are not those of this disorder.

DIF: Remembering (Knowledge) REF: Page 531 OBJ: 25-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

9. An older confused patient is recovering from a stage IV sacral pressure ulcer. The nurse shows an understanding of this patients risk for developing osteomyelitis by:

a.

adhering to sterile technique when changing the wounds dressing.

b.

assessing and documenting the patients vital signs regularly.

c.

managing the patients antibiotic therapy as prescribed.

d.

ensuring that the patients diet includes sufficient protein.

ANS: A

Prevention of osteomyelitis includes using sterile technique during dressing changes and following strict wound precautions. The other actions are not as important for preventing this complication, although they are part of the patients nursing care plan.

DIF: Applying (Application) REF: N/A OBJ: 25-5

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

10. An older adult is diagnosed with rheumatoid arthritis. When discussing exercise with the patient, the nurse makes the greatest positive impact on the patients quality of life when stating:

a.

Exercising will be important to the flexibility of your joints.

b.

It seems to help if you have someone to exercise with.

c.

Ill provide you with a list of gyms where you can exercise.

d.

Lets discuss ways for you to exercise your joints.

ANS: D

With advances in drug therapy and active participation by the patient in activities to prevent joint deformities, the patient should experience less deformity, increased comfort levels, and understanding of the disease process. By actually discussing exercise, the nurse makes the greatest impact on the patients quality of life. The other options are appropriate but will not have as great an impact as discussing actual exercises.

DIF: Applying (Application) REF: N/A OBJ: 25-5

TOP: Teaching-Learning MSC: Physiologic Integrity

11. The nurse is caring for an older adult patient prescribed allopurinol (Zyloprim). What action by the nurse is best?

a.

Offering fresh, cold water frequently during the day

b.

Monitoring temperature every 4 hours

c.

Ensuring sufficient protein intake

d.

Assessing for depression symptoms daily

ANS: A

To discourage the formation of renal stones, the patient should be encouraged to have a daily intake of 2 to 3 L of fluid unless contraindicated. The other actions are not related to preventing this adverse effect.

DIF: Applying (Application) REF: N/A OBJ: 25-5

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

12. A patient is being dismissed from the emergency department with an arm cast. What statement by the patient indicates more teaching is needed?

a.

I will keep the cast clean and dry.

b.

I will wiggle my thumb and fingers often.

c.

I will elevate my arm on two pillows.

d.

I can use a hanger to scratch under the cast.

ANS: D

Nothing goes under the cast, so scratching with any type of object is not allowed. The other statements show good understanding.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 25-3

TOP: Nursing Process: Evaluation MSC: Health Promotion

13. An older patient is in the family practice clinic reporting increasing joint pain, anorexia, and low-grade fever. The patient has a history of osteoarthritis. What action by the nurse is best?

a.

Document the findings on the patients chart.

b.

Assess for joint deformities and nodules.

c.

Tell the provider the patient needs more pain medicine.

d.

Encourage the patient to ask for physical therapy.

ANS: B

Osteoarthritis does not include systemic symptoms. The nurse should assess for other causes of joint pain, including rheumatoid arthritis, which is manifested by joint deformities and subcutaneous nodules. Findings should be documented. The patient may need a change of pain medication. Physical therapy is an appropriate intervention. However, determining the source of the patients symptoms comes first.

DIF: Applying (Application) REF: N/A OBJ: 25-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

14. A patients chart contains an assessment of tophi and podagra. What medication does the nurse plan to educate the patient on?

a.

Allopurinol (Zyloprim)

b.

Colchicine (Colcrys)

c.

Levadopa-carbidopa (Sinemet)

d.

Ibuprofen (Motrin)

ANS: A

This patient has manifestations of chronic gout, which is treated with allopurinol. Colchicine is for acute attacks. Sinemet is for Parkinson disease. Ibuprofen may or may not be needed.

DIF: Applying (Application) REF: N/A OBJ: 25-5

TOP: Teaching-Learning MSC: Physiologic Integrity

15. A nurse works in a long-term care facility where many of the residents have osteoporosis. For which resident would alendronate (Fosamax) be contraindicated?

a.

A patient on a continuous tube feeding

b.

A wheelchair-bound patient

c.

A patient over the age of 85

d.

A male patient

ANS: A

Fosamax must be taken 1 hour before meals. This would probably not be the most appropriate medication for a patient on a continuous tube feeding. The other patients are appropriate candidates for this medication.

DIF: Analyzing (Analysis) REF: N/A OBJ: 25-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

16. A patient is scheduled to have a lower extremity amputation. What action by the nurse takes priority?

a.

Discuss stump management and prostheses.

b.

Ensure informed consent is on the chart.

c.

Determine the patients goal for pain control.

d.

Administer the preoperative antibiotic.

ANS: B

Prior to any operation, the nurse ensures informed consent is on the chart. The other options are appropriate actions, but the surgery cannot occur without consent.

DIF: Applying (Application) REF: N/A OBJ: 25-7

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

17. A patient has just arrived in the postanesthesia care unit after a below-the-knee amputation. What assessment takes priority?

a.

Surgical dressing

b.

Level of pain

c.

Pulse and blood pressure

d.

Airway

ANS: D

Airway is always the priority. The other assessments are important too, but airway takes precedence.

DIF: Applying (Application) REF: N/A OBJ: 25-7

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

18. After a below-the-knee amputation, a patient has disturbed body image. What action by the patient indicates movement toward resolution of this diagnosis?

a.

The patient names his stump Pete.

b.

The patient attends physical therapy.

c.

The patient begins to change dressings.

d.

The patient asks questions about prosthetics.

ANS: C

The best indication that the patient has accepted this change to body image is participation in stump care. Asking questions is also a good sign but does not necessarily reflect body image. The other two options do not demonstrate resolution of the diagnosis.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 25-7

TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity

19. A patient has polymyalgia rheumatica. When teaching about medications, what information does the nurse provide?

a.

Take the full dose of antibiotics even if you are feeling better.

b.

You need to remain upright 1 hour after taking the medication.

c.

Stay away from large crowds and avoid people who are sick.

d.

Do not drink alcohol while taking this medication.

ANS: C

This disorder is treated with corticosteroids, which can reduce the inflammatory response. Patients should be advised on ways to avoid infection. The other statements do not relate to steroids.

DIF: Applying (Application) REF: N/A OBJ: 25-5

TOP: Teaching-Learning MSC: Physiologic Integrity

20. A patient has onychomycosis. The nurse should anticipate educating the patient on which of the following drugs?

a.

Clotrimazole (Lotrimin)

b.

Terbinafine (Lamisil)

c.

Itraconazole (Sporanox)

d.

Methylprednisolone (Solu-Medrol)

ANS: A

Clotrimazole is used as a cream for several months on this toe fungal infection. Terbinafine and itraconazole are generally not used in older adults. The steroid methylprednisolone is not indicated.

DIF: Remembering (Knowledge) REF: Page 537 OBJ: 25-8

TOP: Teaching-Learning MSC: Physiologic Integrity

21. The nurse conducting a community-screening event for osteoporosis knows that which woman is at highest risk?

a.

A slender 84-year-old Asian who smokes

b.

A heavy set 65-year-old Caucasian

c.

A 75-year-old taking a steroid burst

d.

A 68-year-old African American who consumes one drink a day

ANS: A

Risk factors for osteoporosis include thin body frame, white race, advancing age, alcoholism, and smoking, among others. The 84-year-old who smokes is at highest risk despite being Asian.

DIF: Understanding (Comprehension) REF: Page 527 OBJ: 25-6

TOP: Nursing Process: Assessment MSC: Health Promotion

MULTIPLE RESPONSE

1. To assess for osteoarthritis in an older adult patient, the nurse asks which of the following questions? (Select all that apply.)

a.

Do you have pain in your finger joints?

b.

Do your knees crackle when you bend down?

c.

Does you get dizzy when you turn your head?

d.

Does it hurt when you get up from a chair?

e.

Does your back creak when you bend over?

ANS: A, B, D, E

The distal interphalangeals, proximal interphalangeals, knees, hips, and spine are the joints most commonly affected by osteoarthritis. These would be the questions most likely to suggest osteoarthritis. Getting dizzy is not a manifestation of this disorder.

DIF: Applying (Application) REF: N/A OBJ: 25-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

2. The nurse working with older adults knows which facts about age-related musculoskeletal changes? (Select all that apply.)

a.

Muscle mass decreases, causing atrophy.

b.

Myocytes are replaced by fibrous tissue.

c.

Vertebral spaces enlarge with fluid retention.

d.

Posture and gait change, leading to fall risk.

e.

Men become bowlegged and waddle.

ANS: A, B, D

With age, muscle mass decreases, myocytes are replaced with fibrous tissue, and posture and gait change. Vertebral spaces narrow, leading to shrinkage. Women become bowlegged and develop a waddling gait.

DIF: Remembering (Knowledge) REF: Page 511-2 OBJ: 25-2

TOP: Teaching-Learning MSC: Health Promotion

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