Chapter 59 Musculoskeletal Dysfunction: Nursing Management My Nursing Test Banks

Chapter 59 Musculoskeletal Dysfunction: Nursing Management

MULTIPLE CHOICE

1.A client is diagnosed with osteoarthritis. The nurse would not expect to find which of the following during assessment?

1.

Bouchards nodes

2.

Crepitus

3.

Heberdens nodes

4.

Symmetrical joint involvement

ANS: 4

Symmetrical joint involvement is seen with rheumatoid arthritis, not osteoarthritis. Bouchards nodes, Heberdens nodes and crepitus are all assessment findings consistent with osteoarthritis.

PTS:1DIF:Apply

REF: Osteoarthritis: Assessment with Clinical Manifestations

2.The nurse is instructing a client diagnosed with osteoarthritis. Which of the following statements indicates that the client understands these instructions?

1.

Exercise will not be of help because it will stress my joints.

2.

I will need to lose weight; my doctor says about 20 pounds.

3.

I will take my medications only if the pain is very bad.

4.

I can still go on my marathon shopping trips with my daughter.

ANS: 2

Exercise and weight reduction help maintain joint mobility and muscle strength. Walking can be done at home and is low stress to the joints. Scheduled medications should be taken to relieve inflammation, and pain medications should be taken before the pain gets very bad. The client should schedule rest periods with activity so as not to do too much at one time.

PTS:1DIF:Analyze

REF: Osteoarthritis: Collaborative Management; Evaluation of Outcomes

3.A client diagnosed with gout is concerned about the formation of nodules. The nurse should explain that these nodules are called:

1.

Bouchards nodes.

2.

cysts.

3.

Heberdens nodes.

4.

tophi.

ANS: 4

A tophus is the characteristic nodule that develops in the patient with gout. A tophus consists of uric acid crystals. Bouchards and Heberdens nodes are present in patients with osteoarthritis. Cysts are fluid-filled areas.

PTS: 1 DIF: Apply REF: Gout: Pathophysiology

4.A client is experiencing an acute attack of gout. The nurse should be prepared to provide which of the following medications as prescribed?

1.

Allopurinol

2.

Colchicine

3.

Probenecid

4.

Sulfinpyrazone

ANS: 2

Colchicine is used for the acute attack phase. The other medications would be used for further treatment of the gout.

PTS:1DIF:ApplyREF:Gout: Pharmacology

5.A client is going to have tender points examined to determine the diagnosis of fibromyalgia. The nurse should instruct the client the number of tender points that must be positive for the diagnosis would be:

1.

11.

2.

13.

3.

15.

4.

17.

ANS: 1

The presence of at least 11 of 18 tender points is considered diagnostic for fibromyalgia. The other higher numbers would just be useful to confirm the diagnosis.

PTS:1DIF:Apply

REF: Fibromyalgia: Assessment with Clinical Manifestations

6.The nurse is teaching a group of community members at the senior center about osteoporosis. Which of the following clinical manifestations should the nurse instruct as not being related to the disorder?

1.

Decrease in height

2.

Fractures

3.

Kyphosis

4.

Pain

ANS: 4

Pain is a symptom of osteoarthritis. A person with osteoporosis may not know she has osteoporosis until height and bone changes have already occurred. Kyphosis or hunchback is a symptom of osteoporosis. A person might not know that they have osteoporosis until they experience a fracture.

PTS:1DIF:Apply

REF: Osteoporosis: Assessment with Clinical Manifestations

7.During an assessment, the nurse determines that a client has a forward curvature of the thoracic spine. Which of the following terms would the nurse use to document this assessment finding?

1.

Kyphosis

2.

Lordosis

3.

Scoliosis

4.

Spondylolisthesis

ANS: 1

Kyphosis is the forward curvature of the thoracic spine also known as humpback. Lordosis, or swayback, is an inward curvature of the lumbar spine. Scoliosis is a sideway curvature of the spine. Spondylolisthesis is when a vertebra slips over the one below.

PTS:1DIF:ApplyREF:Spinal Disorders

8.A client is being evaluated for generalized skeletal pain and pain in the hips, ribs, and feet. The nurse observes that the client walks with a waddling gait. Because of this information, which of the following should the nurse suspect is occurring with this client?

1.

Osteomalacia

2.

Osteomyelitis

3.

Osteosarcoma

4.

Pagets disease

ANS: 1

Osteomalacia is a metabolic disease that causes poor and delayed mineralization of the bone cells in mature bones. The main cause of osteomalacia is a vitamin D deficiency. Osteomalacia presents with generalized skeletal pain and pain in the hips, ribs, and feet. Pagets disease is a chronic bone disorder with no definitive cure. Osteomyelitis is a serious infection of the bone. Osteosarcoma is the most common type of primary bone cancer.

PTS: 1 DIF: Analyze REF: Osteomalacia: Pathophysiology

9.A young client has been diagnosed with a soft tissue tumor resembling striated muscle in the neck. The nurse realizes that this type of tumor would be considered:

1.

chondrosarcoma.

2.

Ewings sarcoma.

3.

neurofibrosarcoma.

4.

rhabdomyosarcoma.

ANS: 4

Rhabdomyosarcoma is a soft tissue tumor resembling striated muscle, and it is seen in the extremities, head, neck, urinary tract, or reproductive organs. Chondrosarcoma is a bone tumor most commonly seen in the knees, shoulders, and pelvis. Ewings sarcoma is a bone tumor found in the diaphysis of the femur and the flat bones of the pelvic girdle. Neurofibrosarcoma is a soft tissue tumor found in nerve sheaths.

PTS: 1 DIF: Analyze REF: Tumors of the Musculoskeletal System

10.When assessing a client diagnosed with ankylosing spondylitis, which of the following clinical manifestations will the nurse most likely assess?

1.

Small irregular pupil

2.

Heel pain

3.

Onycholysis

4.

Respiratory depression

ANS: 1

Other problems that occur with ankylosing spondylitis include uveitis that manifests as edema of the upper eyelid, excessive lacrimation, small irregular pupil, and swollen iris. Heel pain is a symptom of reactive arthritis. Onycholysis is seen in psoriatic arthritis. Respiratory depression is a manifestation of polymyositis.

PTS:1DIF:Analyze

REF:Ankylosing Spondylitis: Assessment with Clinical Manifestations

11.A client is surprised to learn that she has been diagnosed with osteoporosis since she does not smoke, is not underweight, and exercises. The nurse should assess if the client has any secondary conditions which could cause the disorder, including:

1.

diabetes mellitus.

2.

heart failure.

3.

fibromyalgia.

4.

lactose intolerance.

ANS: 4

Mild malabsorption syndrome as seen with lactose intolerance is a contributing factor to secondary osteoporosis. Secondary osteoporosis is not associated with diabetes mellitus, heart failure, or fibromyalgia.

PTS:1DIF:Apply

REF:Table 59-2 Contributing Factors to Secondary Osteoporosis

12.The nurse is assessing a client who is demonstrating clinical manifestations of Pagets disease. The nurse realizes that which of the following diagnostic tests will aid in the diagnosis of this disorder?

1.

Chest x-ray

2.

Hand x-ray

3.

Serum albumin level

4.

Serum alkaline phosphatase level

ANS: 4

An increase in serum alkaline phosphatase is often the first indication that the clients symptoms are associated with Pagets disease. Values of two to three times normal indicates the disease. X-rays of the long bones and skull aid in the diagnosis of the disorder, not x-rays of the chest or hands. Serum albumin level is not used to diagnose Pagets disease.

PTS: 1 DIF: Analyze REF: Pagets Disease: Diagnostic Tests

13.A client diagnosed with Pagets disease is prescribed alendronate (Fosamax). Which of the following should the nurse instruct the client regarding this medication?

1.

Do not eat anything for 30 minutes after taking a dose.

2.

Take the medication on a full stomach.

3.

Go to the physicians office for the medication to be provided intravenously.

4.

Expect to stay on this medication for only 6 months.

ANS: 1

Instructions regarding alendronate (Fosamax) should include Do not eat anything for 30 minutes after taking a dose, Take on an empty stomach with 6 to 8 ounces of water in the morning, and Do not lie down for 30 minutes after taking the medication. This medication is not to be taken on a full stomach. This medication is provided orally; the client does not need to go to the physicians office for intravenous administration of the medication. This medication can be taken for longer than 6 months.

PTS:1DIF:Apply

REF: Table 59-4 Biphosphonates used with Pagets Disease

MULTIPLE RESPONSE

1.The nurse is assessing a client who is diagnosed with gout. Which of the following findings will the nurse most likely assess in this client? (Select all that apply.)

1.

Decreased range of motion

2.

Edema in a joint

3.

Elevated uric acid levels

4.

Pain that develops over many weeks

5.

Fever

6.

Headache

ANS: 1, 2, 3, 5, 6

Assessment findings consistent with a client diagnosed with gout include a rapid development of pain and edema of one joint caused by increased uric acid levels. Swelling, pain, decreased range of motion in the affected joint, fever, and headache can also be present. Pain that develops over many weeks is likely to be caused by another condition.

PTS: 1 DIF: Analyze REF: Gout: Assessment with Clinical Manifestations

2.The nurse is instructing a client diagnosed with gout about a low-purine diet. Which of the following foods would be identified as those to avoid when following this diet? (Select all that apply.)

1.

Avocados

2.

Milk

3.

Scallops

4.

White bread

5.

Alcohol

6.

Bacon

ANS: 3, 5, 6

Food high in purine include scallops and bacon. Alcohol is also high in purine. Avocados, milk, and white bread are low-purine foods.

PTS:1DIF:ApplyREF:Gout: Nutrition

3.During an assessment, the nurse determines that a client has risk factors for the development of osteoporosis. Which of the following are considered risk factors for this disorder? (Select all that apply.)

1.

Balanced diet

2.

Corticosteroid therapy

3.

Low body weight

4.

Smoker

5.

Impaired vision

6.

Alcohol intake is one drink per month

ANS: 2, 3, 4, 5

Risk factors for the development of osteoporosis include corticosteroid therapy, low body weight, smoking, and impaired vision. A balanced diet does increase a clients risk for developing the disorder. Alcohol intake of more than two drinks per day would increase the clients risk, but one drink per month would not.

PTS:1DIF:Analyze

REF: Red Flag: Risk Factors for Developing Osteoporosis and Related Fractures

4.A client is experiencing symptoms associated with the second-stage of Lyme disease. Which of the following will the nurse most likely assess in this client? (Select all that apply.)

1.

Erythema migrans

2.

Numbness and pain in the arms and legs

3.

Paralysis of facial muscles

4.

Meningitis

5.

Knee pain and swelling

6.

Memory loss

ANS: 2, 3, 4

Symptoms of the second-stage of Lyme disease include numbness and pain in the arms and legs, paralysis of facial muscles, and meningitis. Erythema migrans is a symptom of the first stage of the disease. Knee pain and swelling and memory loss are symptoms of the third-stage of the disease.

PTS:1DIF:Apply

REF: Lyme Disease: Assessment with Clinical Manifestations

5.A client has been diagnosed with fibromyalgia. The nurse realizes that which of the following categories of medications have been successful in the treatment of this disorder? (Select all that apply.)

1.

Antiarrhythmics

2.

Antibiotics

3.

Antidepressants

4.

Analgesics

5.

Calcium channel blockers

6.

Muscle relaxants

ANS: 3, 4, 6

Analgesics, antidepressants, and muscle relaxants are medications commonly prescribed in the treatment of fibromyalgia. Antiarrhythmics, antibiotics, and calcium channel blockers are not used in the treatment of this disorder.

PTS: 1 DIF: Analyze REF: Fibromyalgia: Pharmacology

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