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Management of Patients With Musculoskeletal Disorders Essay.

Management of Patients With Musculoskeletal Disorders Essay.

 

Brunner: Medical-Surgical Nursing, 11th Edition

 

Test Bank

Chapter 68: Management of Patients With Musculoskeletal Disorders

 

 

 

 

Multiple Choice

 

 

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Which of the following is important information for the nurse to provide to a group of manual laborers in a class on prevention of back pain?
A) Avoid lifting more than one-third of body weight without assistance
B) Focus on using back muscles during lifting
C) Lift objects while holding the object away from the body
D) Tighten the abdominal muscles and lock the knees during the lifting of an object

 

Ans:  A

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  2

Patient Needs:  D-3

Feedback:  The nurse instructs the group on the safe and correct way to lift objects using the strong quadriceps muscles of the thighs, with minimal use of the weak back muscles. To prevent recurrence of acute low-back pain, the nurse may instruct the group to avoid lifting more than one-third of body weight without help. The group will be informed to place the feet a hip width apart to provide a wide base of support. The manual laborer should bend the knees, tighten the abdominal muscles, and lift the object close to the body with a smooth motion, avoiding twisting and jerking.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

Which of the following may be an effective approach to managing tendonitis conservatively?
A) Weight reduction
B) Stress reduction
C) Intermittent application of ice and heat to the affected joint
D) Range of motion of the affected joint

 

Ans:  C

Chapter:  68

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Teaching/Learning

Objective:  3

Patient Needs:  D-4

Feedback:  Conservative management of tendonitis includes rest of the extremity, intermittent ice and heat to the joint, and the use of nonsteroidal anti-inflammatory drugs to control the inflammation and pain.

 

 

 

 

While discussing pain management with a patient experiencing low back pain, the nurse discusses modifiable risk factors. Which of the following is a modifiable risk factor that may contribute to the presence of low back pain?
A) Obesity
B) History of a musculoskeletal disorder
C) Age
D) Depression

 

Ans:  A

Chapter:  68

Cognitive Level:  Application

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  1

Patient Needs:  B

Feedback:  Obesity is a modifiable risk factor that may contribute to back pain. Through proper nutritional intake, the patient will be able to modify his weight and reduce his back pain.

 

 

 

 

A patient who works as a jackhammer operator informs the nurse at the ambulatory clinic that he is experiencing pain in his wrist at night and has noticed numbness and weakness in the hand during the day. Based upon this information, the nurse anticipates that the patient will be diagnosed with:
A) Impingement syndrome
B) Carpal tunnel syndrome
C) Ganglion
D) Dupuytren’s contracture

 

Ans:  B

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Patient Needs:  D-4

Feedback:  The patient will most likely be diagnosed with carpel tunnel syndrome. Patients who perform repetitive movements along with hand exposure to cold, vibration, or extreme direct pressure are at a greater risk of developing carpal tunnel syndrome. The patient experiences pain, numbness, paresthesia, and possibly weakness along the median nerve.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

An orthopedic nurse instructs a patient with plantar fasciitis that the pain associated with this condition is best relieved by:
A) Wrapping the affected area in lamb’s wool or gauze
B) Gently stretching the foot and the Achilles tendon
C) Wearing open-toed shoes
D) Application of keratolytic ointment

 

Ans:  B

Chapter:  68

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Teaching/Learning

Objective:  4

Patient Needs:  D-3

Feedback:  Plantar fasciitis leads to pain that is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

Twelve hours after a patient has foot surgery, the nurse assesses the presence of edema in the foot. Which nursing measure will the nurse implement to control the edema?
A) Elevate the foot on several pillows
B) Apply warm compresses intermittently to the surgical area
C) Administer a diuretic
D) Increase circulation through frequent ambulation

 

Ans:  A

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Patient Needs:  D-3

Feedback:  To control the edema in the foot of a patient after foot surgery, the nurse elevates the foot on several pillows when the patient is sitting or lying down. Ice packs should be applied to the surgical area intermittently during the first 24 to 48 hours after surgery to control edema and provide some pain relief. Diuretic therapy is not an appropriate intervention for edema related to inflammation. Ambulation will gradually be resumed based upon the guidelines provided by the surgeon.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

A patient on long-term corticosteroid therapy is diagnosed with osteoporosis. The corticosteroids are discontinued, but the patient remains concerned about her osteoporosis and long-term prognosis. Which of the following statements is the nurse’s best response to the patient’s concerns regarding the corticosteroid therapy’s effect on her osteoporosis?
A) “Now that the corticosteroids have been stopped, you will regain the lost bone mass in about 2 months.”
B) “Discontinuing the corticosteroids will halt the progression of osteoporosis, but restoration of the lost bone mass usually does not occur.”
C) “Studies indicate that after stopping steroid therapy you will continue to lose bone mass for approximately 12 to 18 months, but the physician will prescribe a medication to strengthen your bones during this period of time.”
D) “With the intake of adequate calcium and vitamin D, you will see a rapid restoration of lost bone mass over the next 3 to 6 months.”

 

Ans:  B

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  2

Patient Needs:  D-3

Feedback:  When the corticosteroid therapy is discontinued, the progression of osteoporosis is halted, but restoration of lost bone mass usually done not occur.

 

 

 

 

While providing an educational class to a group of older adults at a community senior center, the nurse informs the group that the recommended adequate intake (RAI) level of calcium daily is:
A) 1000 mg
B) 1100 mg
C) 1200 mg
D) 1300 mg

 

Ans:  C

Chapter:  68

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  5

Patient Needs:  D-2

Feedback:  The RAI level of calcium for adults 51 years of age and older is 1200 mg per day. The RAI level of calcium for ages 9 to 19 years of age is 1300 mg per day. The RAI level for adults 19 to 50 years of age is 1000 mg per day.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

Which of the following statements by the nurse providing information to a patient diagnosed with osteoporosis is correct?
A) Osteoporosis is a disease of the elderly.
B) A non-modifiable risk factor for osteoporosis is a person’s level of activity.
C) Secondary osteoporosis occurs in women after menopause.
D) Slow discontinuation of your corticosteroid therapy will halt the progression of the osteoporosis but will not restore the lost bone mass.

 

Ans:  D

Chapter:  68

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Teaching/Learning

Objective:  2

Patient Needs:  B

Feedback:  When corticosteroid therapy is discontinued, the progression of osteoporosis is halted, but restoration of lost bone mass does not occur. Osteoporosis is not a disease of the elderly because its onset occurs earlier in life, when bone mass peaks and then begins to decline. A person’s level of physical activity is a modifiable factor that influences peak bone mass. Lack of activity increases the risk for the development of osteoporosis. Primary osteoporosis occurs in women after menopause.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

Which of the following breakfast options will the nurse who is assisting a patient diagnosed with osteomalacia suggest considering the dietary consideration associated with osteomalacia?
A) Cereal with milk, a scrambled egg, and grapefruit
B) Fresh fruit with granola sprinkled on the fruit
C) Waffles with fresh strawberries and powdered sugar
D) A bagel topped with vegetable cream cheese and a side dish of grapes

 

Ans:  A

Chapter:  68

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Teaching/Learning

Objective:  6

Patient Needs:  D-3

Feedback:  The nurse will assist the patient in selecting the meal option that contains the highest dietary sources of calcium and vitamin D. The best selection is eggs and cereal with milk, as these foods contain calcium and vitamin D in a higher quantity than the other menu options.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

The nurse caring for a patient with Paget’s disease is analyzing the patient’s laboratory values. Which of the following values is most often seen in a patient with Paget’s disease?
A) An elevated serum alkaline phosphatase level and an elevated serum calcium level
B) A low serum alkaline phosphatase level and a low serum calcium level
C) An elevated serum alkaline phosphatase level and a normal serum calcium level
D) A normal serum alkaline phosphatase level and a low serum calcium level

 

Ans:  C

Chapter:  68

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  7

Patient Needs:  D-4

Feedback:  Patients with Paget’s disease have normal blood calcium levels. Elevated serum alkaline phosphatase concentration and urinary hydroxyproline excretion reflect the increase in osteoblastic activity associated with this condition.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

While performing assessments on a group of medical-surgical patients, the nurse recognizes which of the following patients as being at the highest risk for the development of osteomyelitis?
A) A middle-age adult who takes ibuprofen daily for rheumatoid arthritis
B) An elderly patient with an infected pressure ulcer in the sacral area
C) A 17-year-old football player who had orthopedic surgery 6 weeks prior
D) An infant diagnosed with jaundice

 

Ans:  B

Chapter:  68

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  8

Patient Needs:  D-3

Feedback:  Patients who are at high risk of developing osteomyelitis include those who are poorly nourished, elderly, and obese. The elderly patient with an infected sacral pressure ulcer is at the greatest risk for the development of osteomyelitis, as this patient has two risk factors: age and the presence of a soft tissue infection that has the potential to extend into the bone. The patient with rheumatoid arthritis has one risk factor: the arthritis. The football player 6 weeks’ post-surgery is beyond the window of time for the development of a postoperative surgical wound infection. The infant with jaundice has no identifiable risk factors.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

The nurse recognizes that the initial clinical and laboratory assessment findings for bloodborne osteomyelitis present as manifestations of:
A) Osteoporosis
B) Sepsis
C) Paget’s disease
D) Anemia

 

Ans:  B

Chapter:  68

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  8

Patient Needs:  D-4

Feedback:  When the infection is bloodborne, the onset is usually sudden, often occurring with the clinical and laboratory manifestation of sepsis. Such clinical manifestations include chills, high fever, rapid pulse, and general malaise.

 

 

 

 

Which of the following instructions is important for the nurse to discuss with a patient with septic arthritis preparing for discharge to home?
A) Perform aseptic dressing changes daily after your wound care.
B) Range-of-motion exercises will assist in management of the infection.
C) Episodic removal of the splint will result in an increased comfort level.
D) Oral antibiotic therapy will be required for 3 to 6 months.Management of Patients With Musculoskeletal Disorders Essay.

 

Ans:  A

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  8

Patient Needs:  D-3

Feedback:  The nurse teaches the patient strategies to promote healing through aseptic dressing changes and proper wound care. The patient is encouraged to perform range-of-motion exercises after the infection subsides. The inflamed joint is supported and immobilized in a functional position by a splint to increase the patient’s comfort. Antibiotic therapy will be required until the symptoms disappear.

 

 

 

 

Which of the following interventions will assist the patient with a bone tumor to reduce the risk for pathologic fractures?
A) Work to achieve maximum weight-bearing capabilities
B) Strengthen the affected muscles through weight training
C) Support the affected extremity with external supports (splints)
D) Limit the use of reliance on assistive devices

 

Ans:  C

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  9

Patient Needs:  D-3

Feedback:  During nursing care, the affected extremities will be supported and handled gently. External supports (splints) may be used for additional protection. Prescribed weight-bearing restrictions must be followed. Assistive devices are used to strengthen the unaffected extremities.

 

A patient who is complaining of back pain that goes all the way down the back of the leg to the foot. This type of pain is referred to as:
A) Bursitis
B) Radiculopathy
C) Sciatica
D) Tendonitis

 

Ans:  C

Chapter:  68

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Patient Needs:  D-4

Feedback:  Sciatica nerve pain travels down the back of the thigh to the foot of the affected leg.

 

 

 

 

The nurse is caring for a patient who has presented to the emergency department with back pain. The most appropriate diagnostic test to detect degenerative disk or disk protrusions is:
A) Myelogram
B) Bone scan
C) Epidural venogram
D) Electromyogram

 

Ans:  A

Chapter:  68

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Patient Needs:  D-4

Feedback:  The most appropriate diagnostic test to detect degenerative disk or disk protrusions is the myelogram.

 

 

 

 

Appropriate information for the nurse to give a patient with lower back pain who is being discharged from the hospital would be:
A) Bend often to exercise the back.
B) Stay in bed for 1 week.
C) Limit sitting to 20 to 50 minutes.
D) Engage in conditioning exercises as soon as possible.

 

Ans:  C

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  2

Patient Needs:  D-3

Feedback:  The patient should limit sitting to 20 to 50 minutes, avoid bending, maintain bed rest for only 2 to 4 days if pain is severe, and begin conditioning exercises in 2 weeks.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

To promote proper body mechanics for a patient with lower back pain, the nurse would recommend which of the following?
A) Sleep supine with legs flat.
B) Rest one foot on a stool while standing for long periods.
C) Ensure that knees are locked when standing for short periods.
D) The knees should be lower than the hips when sitting.Management of Patients With Musculoskeletal Disorders Essay.

 

Ans:  B

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  2

Patient Needs:  D-1

Feedback:  A patient who is required to stand for long periods should rest one foot on a low stool and should sit with knees at or above the level of the hips, decreasing lumbar lordosis. Sleeping on the side or back with knees flexed is recommended. Avoid locking the knees when standing.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

A female patient who is an auto mechanic tells the nurse that she has pain and numbness to her thumb and first and second finger of her right hand is increased while working. This indicates that the patient could have:
A) Carpel tunnel syndrome
B) Tendonitis
C) Impingement syndrome
D) Dupuytren’s contracture

 

Ans:  A

Chapter:  68

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Patient Needs:  D-4

Feedback:  Carpel tunnel syndrome may be manifested by numbness, pain, paresthesia, and weakness along the median nerve.

 

 

 

 

A nurse caring for a patient with Dupuytren’s contracture of the fingers is aware that the contracture is due to:
A) An extending nodule of the tendon sheaths, causing fibrous thickening
B) An extending nodule of the palmar fascia, causing fibrous thickening
C) A neuropathy of the median nerve, causing fibrous thickening
D) Edema of the quadriceps, pressing on the palmar fascia

 

Ans:  B

Chapter:  68

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Patient Needs:  D-4

Feedback:  Dupuytren’s contracture is caused by an extending nodule on the palmar fascia, creating a fibrous thickening and producing a contracture of the fingers. It generally affects the middle, fourth, and fifth fingers.

 

 

 

 

What information is most important for the nurse to provide to a patient being discharged after undergoing a digital fasciectomy?
A) Avoid flexing the fingers for 5 days after the surgery.
B) Report symptoms of mild swelling to the surgeon.
C) Bathe the hand once a day to avoid infection.
D) Report unrelenting pain to the surgeon.Management of Patients With Musculoskeletal Disorders Essay.

 

Ans:  D

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  3

Patient Needs:  D-3

Feedback:  Unrelenting pain must be reported to the surgeon or physician immediately. Mild swelling can be controlled with elevation and intermittent ice application. The wound should be kept dry until healed; finger exercises are begun 1 to 2 days postoperative.

 

 

 

 

An appropriate nursing intervention to immediately implement postoperatively for a patient who has had a surgical release of the transverse carpal ligament would be:
A) Neurovascular assessment of the hand every 3 hours
B) Heat applied to the surgical site to reduce pain
C) Active extension and flexion of the patient’s wrist
D) Assistance with required ADLs as needed

 

Ans:  D

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Patient Needs:  D-1

Feedback:  The patient needs help with ADLs because one hand will be bandaged, and independent self-care is inhibited. Neurovascular assessment is done every hour for the first 24 hours after surgery. Intermittent ice packs may be applied to help control pain and swelling. Extension and flexion on the patient’s fingers is encouraged.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

The nurse suspects that a patient who reports a throbbing, burning feeling in the right foot during the day that is relieved with rest may have:
A) Morton’s neuroma
B) Pes cavus
C) Hallux valgus
D) Onychocryptosis

 

Ans:  A

Chapter:  68

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Patient Needs:  D-4

Feedback:  Morton’s neuroma is a swelling of the third (lateral) branch of the median plantar nerve, which causes a throbbing, burning pain that is usually relieved with rest. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Hallux valgus is a deformity in which the great toe deviates laterally and there is a marked prominence of the medial aspect of the first metatarsal-phalangeal joint and exostosis. It is also referred to as a bunion. Onychocryptosis (ingrown toenail) occurs when the free edge of a nail plate penetrates the surrounding skin, laterally or anteriorly.

 

 

 

 

Hallux valgus may manifest by which of the following signs and symptoms?
A) Deviation of a great toe laterally
B) A great toe pulled in an upward position
C) An abnormally high arch of the foot
D) A diminished longitudinal arch of the foot

 

Ans:  A

Chapter:  68

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Patient Needs:  D-4

Feedback:  A deformity in which the great toe deviates laterally and there is a marked prominence of the medial aspect of the first metatarsal-phalangeal joint and exostosis is referred to as hallux valgus (bunion). Hammertoe is a flexion deformity of the interphalangeal joint, which may cause the toe to be pulled upward. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. A diminished longitudinal arch of the foot is referred to as flatfoot or pes planus.

A patient with Charcot-Marie-Tooth disease or diabetes is at an increased risk of developing which of the following foot problems?
A) Pes cavus
B) Hallux valgus
C) Morton’s neuroma
D) Onychocryptosis

 

Ans:  A

Chapter:  68

Cognitive Level:  Knowledge

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  4

Patient Needs:  D-4

Feedback:  Charcot-Marie-Tooth disease and diabetes are common causes of pes cavus

 

Which of the following is appropriate information for the nurse to provide to the patient who is scheduled for foot surgery?
A) Wear snug-fitting footwear postoperatively to decrease swelling.
B) When experiencing discomfort in the foot, massage it.
C) Full weight bearing on the affected foot postoperatively is necessary to increase circulation.
D) Apply ice packs intermittently to decrease pain.

 

Ans:  D

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  4

Patient Needs:  D-1

Feedback:  Ice packs may be applied intermittently to decrease pain. Snug footwear should be avoided; special protective footwear may be worn over the dressing. Massaging the surgical area is contraindicated. The patient will be prescribed gradual weight-bearing limits.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

The hormone that inhibits bone resorption and promotes bone formation is:
A) Estrogen
B) Parathyroid
C) Calcitonin
D) Progesterone

 

Ans:  C

Chapter:  68

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  5

Patient Needs:  D-4

Feedback:  Calcitonin inhibits bone resorption and promotes bone formation. Estrogen inhibits bone breakdown. Parathyroid increases bone resorption.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

The nurse advises a 36-year-old diabetic woman to take what step to prevent osteoporosis:
A) Include adequate intake of vitamin E.
B) Walk 20 to 30 minutes 3 days a week.
C) Engage in isometric exercises 20 to 30 minutes 3 days a week.
D) Include an average daily intake of 300 mg of calcium.

 

Ans:  B

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Patient Needs:  B

Feedback:  Exercise should include activities such as walking, which provides the stress of weight and muscle activity to enhance bone formation. Average daily intake of calcium for a 36-year-old is 1000 mg a day.

 

 

 

 

A 58-year-old woman being treated for osteoporosis states that she has occasional spotting and has noted a weight gain. The nurse is aware that these symptoms may be side effects from which of the following medications?
A) Estrogen-replacement therapy
B) Alendronate
C) Calcitonin
D) Vitamin D replacement

 

Ans:  A

Chapter:  68

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  5

Patient Needs:  D-2

Feedback:  Common side effects of hormone-replacement therapy include periodic bleeding or spotting, fluid retention, and weight gain.

 

 

 

 

The nurse expects to find which of the following laboratory study results present in a patient suspected of having osteomalacia:
A) High serum calcium and low phosphatase level
B) High serum calcium and high phosphatase level
C) Low serum calcium and high phosphorus level
D) Low serum calcium and low phosphorus level

 

Ans:  D

Chapter:  68

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  6

Patient Needs:  D-4

Feedback:  Laboratory studies reveal a low serum calcium and low phosphorus level.

 

 

 

 

The nurse is aware that a patient with osteomalacia who is being treated with vitamin D supplements may be at risk for which of the following?
A) Hypercalcemia
B) Hypernatremia
C) Hypermagnesemia
D) Hyperchloremia

 

Ans:  A

Chapter:  68

Cognitive Level:  Comprehension

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  6

Patient Needs:  D-2

Feedback:  Laboratory studies show low serum calcium, low phosphorus, and elevated alkaline phosphatase levels.

 

 

 

 

The nurse is discussing calcitonin therapy with a patient diagnosed with Paget’s disease who demonstrates adequate understanding of the possible side effects when she states that she may experience:
A) Diarrhea
B) Headaches
C) Flushing of the face
D) Constipation”

 

Ans:  C

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  6

Patient Needs:  D-2

Feedback:  Side effects of calcitonin include flushing of the face and nausea.

 

 

 

 

An 80-year-old man with a chronic leg ulcer states that the area has become increasingly painful. The nurse who assesses the area notes that the wound bed of the ulcer is unchanged but the site is now swollen and warm to the touch. She notifies the physician that the patient may have developed:Management of Patients With Musculoskeletal Disorders Essay.
A) Osteomyelitis
B) Osteoporosis
C) Osteomalacia
D) Infectious arthritis

 

Ans:  A

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  8

Patient Needs:  D-4

Feedback:  When osteomyelitis develops from the spread of an adjacent infection, no signs of septicemia are present, but the area becomes swollen, warm, painful, and tender to touch.

 

 

 

 

A culture is taken from a wound caused by osteomyelitis. The nurse is aware that the most common cause of osteomyelitis is:
A) Staphylococcus aureus
B) Proteus
C) Pseudomonas
D) Escherichia coli

 

Ans:  A

Chapter:  68

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  8

Patient Needs:  D-4

Feedback:  S. aureus causes 70% to 80% of bone infections. The Proteus, Pseudomonas, and E. coli pathogens are also causes but to a lesser percent.

 

 

 

 

When providing postoperative care for a patient who has undergone limb-sparing surgery to remove a bone tumor, the nurse assesses for which of the following complications from surgery?
A) Nutritional deficiency
B) Delayed wound healing
C) Loss of body weight
D) Pathologic fractures

 

Ans:  B

Chapter:  68

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  9

Patient Needs:  D-3

Feedback:  Delayed wound healing is a complication of surgery due to tissue trauma from the surgery. Nutritional deficiency is usually due to the effects of chemotherapy and radiation therapy, which may cause weight loss. Pathologic fractures are not a complication of surgery.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

When teaching an elderly female with osteoporosis, the nurse should include information about which major complication?
A) Bone fracture
B) Loss of estrogen
C) Negative calcium balance
D) Dowager’s hump

 

Ans:  A

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  5

Patient Needs:  D-3

Feedback:  Bone fracture is a major complication of osteoporosis that 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.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

The first priority for the nurse caring for a patient with a history of falls is:
A) Placing the call light for easy access.
B) Keeping the bed in the lowest possible position
C) Instructing the patient not to get out of bed without assistance
D) Keeping the bedpan available so the patient doesn’t have to get out of bed

 

Ans:  B

Chapter:  68

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Patient Needs:  A-2

Feedback:  Keeping the bed at the lowest possible position is the first priority for patients at risk for falling. Keeping the call light easily accessible is important but isn’t a top priority. Instructing the patient not to get out of bed may not effectively prevent falls, for example, if the patient is confused. Even when assistance is required, the bed must first be in the lowest position. The patient may not require a bedpan.Management of Patients With Musculoskeletal Disorders Essay.

 

 

 

 

What instructions should the nurse caring for a patient who complains of lower back pain give to prevent back injury?
A) Bend over the object you’re lifting.
B) Narrow the stance when lifting.
C) Push or pull an object using your arms.
D) Stand close to the object you’re lifting.

 

Ans:  D

Chapter:  68

Cognitive Level:  Application

Difficulty:  Easy

Integrated Process:  Teaching/Learning

Objective:  1

Patient Needs:  D-3

Feedback:  Standing close to an object being lifted moves the body’s center of gravity closer to the object, allowing the legs, rather than the back, to bear the weight. No one should bend over an object when lifting; instead, the back should be straight, and bending should be at the hips and knees. When lifting, spreading the legs apart widens the base of support and lowers the center of gravity, providing better balance. Pushing or pulling an object using the weight of the body, rather than the arms or back, prevents back strain. Using a larger number of muscle groups distributes the workload.Management of Patients With Musculoskeletal Disorders Essay.

Discussion

Patients with endocrine and musculoskeletal disorders often require long-term treatment and care resulting in the need for extensive patient education. By appropriately educating patients, advanced practice nurses can assist patients with the management of their disorders. In clinical settings, patients with endocrine and musculoskeletal disorders typically seek treatment for symptoms that pose problems to their everyday lives as ordinary tasks may become difficult to complete. For instance, patients might have difficulty walking short distances, preparing meals, or even running errands. To reduce these symptoms and additional health risks, it is essential to develop drug therapy plans with individual patient factors in mind.

To prepare:
-Select one of the following endocrine or musculoskeletal disorders: thyroid disease, osteoarthritis, rheumatic arthritis, gout, multiple sclerosis, or fibromyalgia. Consider the types of drugs that would be prescribed to patients to treat symptoms associated with this disorder.
-Select one of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how this factor might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.
With these thoughts in mind:

By Day 3
Post a description of the endocrine or musculoskeletal disorder you selected including types of drugs that would be prescribed to patients to treat associated symptoms. Then, explain how the factor you selected might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.Management of Patients With Musculoskeletal Disorders Essay.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.Management of Patients With Musculoskeletal Disorders Essay.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

 

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.Management of Patients With Musculoskeletal Disorders Essay.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.Management of Patients With Musculoskeletal Disorders Essay.

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