Chapter 50: Care of Patients with Musculoskeletal Problems Ignatavicius

Chapter 50: Care of Patients with Musculoskeletal Problems Ignatavicius

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A client has a bone density score of –2.8. What action by the nurse is best?
   1. Asking the client to complete a food diary
   2. Planning to teach about bisphosphonates
   3. Scheduling another scan in 2 years
   4. Scheduling another scan in 6 months

ANS:   B

A T-score from a bone density scan at or lower than –2.5 indicates osteoporosis. The nurse should plan to teach about medications used to treat this disease. One class of such medications is bisphosphonates. A food diary is helpful to determine if the client gets adequate calcium and vitamin D, but at this point, dietary changes will not prevent the disease. Simply scheduling another scan will not help treat the disease either.

DIF:     Applying/Application                         REF: 1030                   KEY: Musculoskeletal disorders| patient education| bisphosphonates                 MSC:                         Integrated Process: Nursing Process: Implementation                                 NOT:                          Client Needs Category: Physiological Integrity: Reduction of Risk Potential

2. A nurse is assessing an older client and discovers back pain with tenderness along T2 and T3. What action by the nurse is best?
   1. Consult with the provider about an x-ray.
   2. Encourage the client to use ibuprofen (Motrin).
   3. Have the client perform hip range of motion.
   4. Place the client in a rigid cervical collar.

ANS:   A

Back pain with tenderness is indicative of a spinal compression fracture, which is the most common type of osteoporotic fracture. The nurse should consult the provider about an x-ray. Motrin may be indicated but not until there is a diagnosis. Range of motion of the hips is not related, although limited spinal range of motion may be found with a vertebral compression fracture. Since the defect is in the thoracic spine, a cervical collar is not needed.

DIF:     Applying/Application                         REF: 1032                   KEY:      Musculoskeletal assessment| osteoporosis| older adult| pain      MSC:                         Integrated Process: Communication and Documentation  NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

3. A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client admits to not doing the prescribed exercises. What action by the nurse is best?
   1. Ask the client about fear of falling.
   2. Instruct the client to increase calcium.
   3. Suggest other exercises the client can do.
   4. Tell the client to try weight lifting.

ANS:           A

Fear of falling can limit participation in activity. The nurse should first assess if the client has this fear and then offer suggestions for dealing with it. The client may or may not need extra calcium, other exercises, or weight lifting.

DIF:            Applying/Application                         REF:    1032

KEY:          Musculoskeletal disorders| osteoporosis| psychosocial response| therapeutic

communication| older adult

MSC:          Integrated Process: Nursing Process: Assessment

NOT:          Client Needs Category: Psychosocial Integrity

4. The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option?
   1. Client with diabetes who has a serum creatinine of 0.8 mg/dL
   2. Client who recently fell and has vertebral compression fractures
   3. Hypertensive client who takes calcium channel blockers
   4. Client with a spinal cord injury who cannot tolerate sitting up

ANS:           D

Clients on bisphosphonates must be able to sit upright for 30 to 60 minutes after taking them. The client who cannot tolerate sitting up is not a good candidate for this class of drug. Poor renal function also makes clients bad candidates for this drug, but the client with a creatinine of 0.8 mg/dL is within normal range. Diabetes and hypertension are not related unless the client also has renal disease. The client who recently fell and sustained fractures is a good candidate for this drug if the fractures are related to osteoporosis.

DIF:            Analyzing/Analysis                            REF:    1034                 KEY: Musculoskeletal disorders| osteoporosis| bisphosphonates| adverse effects MSC:      Integrated Process: Nursing Process: Analysis                      NOT:                                                 Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies