Deck 18: The Musculoskeletal System

Question 1

The nurse is caring for a client with osteoarthritis and a recently repaired hip fracture. Which nursing diagnoses are the nurse's priority?
1) Risk for constipation
2) Impaired body image
3) Fatigue
4) Decreased mobility
5) Chronic pain

Answer 1

4

Question 2

The nurse has provided teaching for exercises that can be done during chronic symptomatic periods for a client with osteoarthritis. Which statement, made by the client, indicates further teaching is required?
1) "I will try riding a stationary bike."
2) "I will shuffle lightly on my treadmill."
3) "I am going to join an aqua jogging class."
4) "I am going to start walking my dog for longer periods."

Answer 2

2

Question 3

The nurse is caring for a client who is postoperative from a hip replacement three days ago. Which assessment finding should be of concern to the nurse?
1) The client is sitting with feet flat on the floor.
2) The client's affected hip is in an abducted position.
3) The client is ambulating without compression stockings.
4) The client's dressing has a moderate amount of serous drainage.

Answer 3

3

Question 4

An older patient with osteoarthritis is prescribed acetaminophen (Tylenol) for pain. What should the nurse teach the patient about this medication?
1) Excessive acetaminophen can cause gastrointestinal irritation.
2) Taking acetaminophen around-the-clock will slow the progression of osteoarthritis.
3) Acetaminophen cannot be used with nonsteroidal anti-inflammatory drugs (NSAIDs).
4) The maximum amount of acetaminophen should not exceed 4 grams in a 24-hour period.

Question 5

The nurse is instructing the client on how to perform a balance exercise. Which information should the nurse include in the instruction?
1) "Holding onto the chair, make big circles with a raised foot."
2) "Holding onto the sink, stand on your toes rocking back on your heels."
3) "Holding onto the chair, close your eyes then lift one leg and hold it up."
4) "Holding onto the sink, raise your feet one at a time and try to let go and balance."

Question 6

The preceptor has reviewed with a new nurse the routine mobility tasks that should be observed to identify an older adult's risk for falling. Which observation made by the new nurse indicates the client is at risk for falling?
1) The client requires an assistive device to ambulate.
2) The client uses the arms of the chair to help get up.
3) The client shuffles steadily up and down the hallway.
4) The client uses the hand rails on the wall while ambulating.

Question 7

An older client is surprised to learn of a diagnosis of rheumatoid arthritis. What should the nurse explain to the patient about this health problem? Select all that apply.
1) It leads to deformities of the hands.
2) It is caused by a vitamin D deficiency.
3) It is diagnosed by a positive pannus blood test.
4) It is characterized by low bone mass and compromised bone strength.
5) It causes systemic problems that can affect the heart, lungs, and kidneys.

Question 8

After assessing an older patient, which musculoskeletal changes will the nurse attribute as being a normal part of the aging process? Select all that apply.
1) Loss in height
2) Lower leg muscle atrophy
3) Calcification of the finger joints
4) Swan neck deformity of the hands
5) Decreased range of motion in the shoulders

Question 9

An older patient is concerned that many friends are having joint replacements and wants to know what can be done to prevent having to have one as well. Which modifiable risk factor should the nurse suggest the patient focus on at this time?
1) Physical inactivity
2) Cigarette smoking
3) Alcohol consumption
4) Body mass index (BMI)

Question 10

The nurse has provided medication teaching for an older client prescribed alendronate (Fosamax). Which statement made by the client indicates that further teaching is required?
1) "I will only take my medication with a glass of water."
2) "I will make sure to take calcium every day with my medication."
3) "I will take an antacid with my medication if I experience heartburn."
4) "I will make sure that I sit up for 30 minutes after I take my medication."

Question 11

The nurse is providing preventative education for an older patient at risk for osteoporosis. Which statement should the nurse include in the teaching?
1) "Reduce your intake of caffeine."
2) "Increase your daily dairy intake."
3) "Exercise for at least 20 minutes three times a week."
4) "Take your calcium supplement 1 hour prior to meals."

Question 12

The nurse is caring for an older client diagnosed with osteoarthritis. The client asks the nurse, "What is osteoarthritis?" Which statement should the nurse include in the teaching?
1) "This is a metabolic bone disease."
2) "The cartilage of the joints have become eroded."
3) "The disease is caused by synovial inflammation."
4) "This is a disease of the muscles around the joints."

Question 13

The nurse has provided teaching for an older client prescribed a methotrexate disease modifying antirheumatic drug for rheumatoid arthritis. Which statement made, by the client, indicates further teaching is required?
1) "The drug may cause sores in my mouth."
2) "This drug will stop my joints from wearing down."
3) "I understand I am at greater risk for getting an infection."
4) "This may take several weeks or months to begin working."

Question 14

The nurse reviewing the chart of an older client notes that kyphosis is present. Which assessment finding does the nurse anticipate?
1) Back pain with anorexia
2) Posterior curvature with immobility
3) Thoracic rounding of the spine
4) Curve in the spine with an S-shape

Question 15

An older patient with multiple rib fractures is diagnosed with osteomalacia. What should the nurse teach the patient to help prevent further problems from this diagnosis? Select all that apply.
1) Begin steps to stop smoking.
2) Increase the intake of chicken and fish.
3) Ingest dairy products fortified with vitamin D.
4) Engage in weight bearing exercises 3 times a week.
5) Expose the hands and the face for 15 minutes a day to direct sunlight.

Question 16

The nurse is designing a teaching plan for a middle-aged client experiencing arthritis of the hips and hands from constant computer work. What should the nurse include in this instruction? Select all that apply.
1) Alternate heat and cold therapies.
2) Avoid doing hand exercises.
3) Stand up and walk frequently to prevent constant sitting.
4) Alternate weight-bearing with non-weight-bearing exercises.
5) Take frequent rest breaks from using the computer keyboard.

Question 17

The nurse is assessing a client with pseudogout one week after the initiation of prescribed allopurinol (Zyloprim). Which finding indicates the treatment is effective?
1) Inflammation has resolved
2) Client no longer requires splints
3) Serum urate level is within normal range
4) Increased erythrocyte sedimentation rate (ESR)

Question 18

The nurse screens an older adult woman for risk factors for osteoporosis. Which does the nurse identify as a contributing factor?
1) Breastfeeding five children during reproductive years
2) Using hormone replacement therapy for menopause
3) Bone density of 2.5 standard deviations below the mean
4) A body mass index of 35

Question 19

An older patient with back pain is scheduled for computerized tomography (CT). What information should the nurse provide to the patient about this diagnostic test?
1) Only clear liquids will be permitted the evening prior to the test.
2) An IV will be inserted to administer the isotopes prior to the scan.
3) Clicking noises will occur during the test and ear plugs can be worn.
4) The machine will rotate and provide 180-degree imagery to aid in the diagnostic process.

Question 20

At the completion of an assessment the nurse determines that an older patient is at risk for the development of osteoporosis. What did the nurse assess in this patient?
1) Obese with hip pain with ambulation
2) Ingests three glasses of skim milk daily
3) Eats three to five servings of shrimp and liver per week
4) Takes corticosteroids for 10 years for chronic pulmonary disease

Question 21

An older client with arthritis is prescribed to begin an exercise regimen. How should the nurse instruct the client about exercising?
1) Perform resistive exercises daily with weights.
2) Perform active range of motion to all joints every day.
3) Stretch all muscle groups for 20 minutes each day.
4) Decide which high-intensity isometric exercises are best for you.

Question 22

The nurse is caring for an older patient recovering from a total hip replacement. Which intervention will prevent dislocation of the hip prosthesis?
1) Encourage early ambulation.
2) Provide pain medication as needed.
3) Apply intermittent compression devices.
4) Place a wedge between the legs to keep the hip in abduction.

Question 23

Which nursing observation is the BEST indicator of fall risk in the client with osteoporosis?
1) Experiencing muscle weakness around the knee when walking
2) Slowly changing from a sitting to a standing position
3) Rocking to get up from a chair
4) Slowly changing from a standing to a sitting position

Question 24

The nurse instructs an older client on ways to manage acute episodes of gout at home. Which client statement BEST indicates that teaching has been effective?
1) "During a flare-up, alternating rest with exercising the joints will relieve pain."
2) "I will need to take my NSAID ten minutes after the first sign of a flare-up."
3) "I should eat foods like liver no more than twice per week."
4) "Avoiding the application of heat to my joints is recommended."

Question 25

An older patient with rheumatoid arthritis describes severe pain during times of inflammation. What should the nurse teach the patient to do to help minimize episodes of inflammation? Select all that apply.
1) Lose weight.
2) Rest painful joints.
3) Splint the specific joints.
4) Use larger joints when possible.
5) Perform full ROM exercises daily.