Question 1

The client with osteomalacia is depressed and anxious about the outcome of the illness. The most beneficial nursing response would be
A) "Cortisone and active weight-bearing exercises will reduce the symptoms."
B) "Don't worry; some adjustments in lifestyle can offer a normal life expectancy."
C) "I can see you are upset. Did the doctor tell you this is easy to treat and control?"
D) "Treatment with high-dose calcium supplements will correct the disorder."

Accepted Answer

Interventions for clients with osteomalacia include daily vitamin D until signs of healing occur, at which time a daily low maintenance dose of vitamin D and adequate intake of calcium, phosphorus, and protein should be ensured. This answer not only gives the client correct information but shows the nurse communicating in a therapeutic manner.

Question 2

The nurse is counseling a client at risk of osteoporosis that one of the most beneficial exercises is
A) cycling.
B) swimming.
C) walking.
D) water aerobics.

Accepted Answer

Weight-bearing exercise, such as walking or running, is recommended over non-weight-bearing exercise, such as biking or swimming, for the prevention of osteoporosis. Weight-bearing exercises encourage bone formation, while non-weight-bearing exercises do not, probably because they do not adequately load the bones.

Question 3

In the initial visit to a recently discharged client with osteoporosis, the home health nurse will reinforce the priority topic of
A) diet low in phosphates.
B) exercise regimen.
C) hazards to home safety.
D) medication administration.

Accepted Answer

Discussion about fall prevention strategies is imperative for the discharged client with osteoporosis. Alterations to the home may be recommended. A proper diet high in calcium and vitamin D, correct medication administration, and following an exercise regimen are also important topics, but the client's safety is the priority.

Question 4

When counseling a client who is a strict vegan, the nurse would caution that this diet puts the client at risk for
A) gout.
B) osteoarthritis.
C) osteomalacia.
D) Paget's disease.

Accepted Answer

Osteomalacia mainly affects women, and it is endemic in Asia. The most common cause is malabsorption or inadequate intake of vitamin D. Occasionally the disease can be found in strict vegetarians or post-gastrectomy clients.

Question 5

A client with osteoporosis complains that avoiding coffee will be very difficult. To offset coffee consumption, the nurse might suggest that for every cup of coffee consumed, the client should
A) add 1 serving of leafy green vegetables.
B) combine 20 minutes of exercise to the daily program.
C) drink 1 glass of orange juice or grapefruit juice.
D) take 40 mg of over-the-counter calcium.

Accepted Answer

The effect of caffeine can be offset by adding 40 mg of calcium to the diet for each cup of coffee consumed.

Question 6

The nurse discussing treatment options with a client with Paget's disease will focus on the most frequent treatment, which is with
A) bisphosphonates.
B) calcium supplements.
C) heat and cold application.
D) splinting.

Accepted Answer

The current therapies of choice for Paget's disease are potent bisphosphonates, such as pamidronate (Aredia), alendronate (Fosamax), and risedronate (Actone). NSAIDs are used to control pain. Heat therapy and splinting or bracing can also be tried.

Question 7

A client is being managed for prevention of gout and the nurse is reviewing the client's medication list and teaching about the medications. The nurse evaluates that the client understands the medication when the client says
A) "Allopurinol blocks production of uric acid."
B) "Colchicine can be used with probenecid."
C) "Long-term steroids are needed to prevent attacks."
D) "NSAIDs are not effective against the pain of gout."

Accepted Answer

Allopurinal is frequently used to block production of uric acid as a preventative measure for gout.

Question 8

A client has been diagnosed with early osteoarthritis (OA) in the hips. The nurse explains that the first medical treatment that will be tried is administration of
A) acetaminophen (Tylenol).
B) celecoxib (Celebrex).
C) misoprostol (Citotec).
D) nonsteroidal anti-inflammatory drugs (NSAIDs).

Accepted Answer

NSAIDs used to be the mainstay of treatment, but because OA has minimal inflammatory properties and because of the safety concerns with long-term use of NSAIDs, acetaminophen is now considered the first-line choice. The client can be switched to an NSAID when pain is severe despite the maximum dose of acetaminophen. Celecoxib is a COX-2 selective NSAID that has fewer GI side effects than other NSAIDs but has serious safety concerns as well. Misoprostol is a synthetic prostaglandin that clients may take to minimize GI side effects of medications.

Question 9

The nurse teaching a class on osteoarthritis (OA) stresses that this disorder is best described as
A) degeneration of articular cartilage in synovial joints.
B) enzymatic breakdown of tissue in non-weight-bearing joints.
C) joint destruction caused by an autoimmune process.
D) overproduction of synovial fluid, resulting in joint destruction.

Accepted Answer

OA is a chronic joint disease characterized by degeneration and loss of articular cartilage covering joint surfaces.

Question 10

On admission assessment of a client with Paget's disease, the nurse would anticipate the client to complain of
A) continuous bone pain.
B) fever in the afternoon.
C) pain on ambulation.
D) swelling at site of deformity.

Accepted Answer

Paget's disease is defined as a disorder of bone architecture characterized by an initial phase of increased bone tissue breakdown by osteoclasts, followed by excessive abnormal bone formation by osteoblasts. In clients with symptomatic Paget's disease, the most common presenting complaints include bone pain, skeletal deformity, changes in skin temperature, pathologic fractures through diseased bone, and manifestations related to nerve compression.

Question 11

The nurse counseling a client with osteoporosis identifies one of the medications that may have contributed to the condition as
A) aspirin.
B) colchicine.
C) ibuprofen.
D) prednisone.

Accepted Answer

Osteoporosis can also result from underlying medical conditions, such as hyperparathyroidism, thyrotoxicosis, anorexia nervosa, and Cushing's syndrome, and from long-term use of medications such as thyroid hormone, anticonvulsants, furosemide, and corticosteroids (e.g., prednisone).

Question 12

After surgical debridement of diseased bone, a client with acute osteomyelitis asks how long antibiotics will be administered. The nurse should respond that the antibiotic protocol will be
A) oral antibiotics for 2-4 weeks.
B) oral antibiotics for 4-8 weeks.
C) parenteral for 4-8 weeks, then oral for 4-8 weeks.
D) parenteral for 4-8 weeks, then oral for 1 year.

Accepted Answer

Treatment requires administration of high doses of parenteral antibiotics for 4 to 8 weeks, followed by oral antibiotics for another 4 to 8 weeks.

Question 13

The nurse instructing a client on considerations regarding the medication calcium carbonate would include in the teaching plan that the client
A) has to wait 1 hour after meals to take the medication.
B) may experience nausea or diarrhea.
C) needs to take the calcium with an 8-ounce glass of water.
D) should take the calcium carbonate with food.

Accepted Answer

All calcium supplements should be taken with food to enhance their absorbability.

Question 14

The nurse is assessing a client with osteoporosis. The finding that is consistent with the nurse's understanding of the disease is
A) a stiff posture.
B) kyphosis.
C) pain in long bones.
D) weight loss.

Accepted Answer

Progressive vertebral deformities lead to shortened stature and kyphosis.

Question 15

On admitting a client with acute osteomyelitis, the nurse is not surprised at the client's complaint of
A) generalized bone pain.
B) localized pain and redness.
C) nausea and vomiting.
D) paresthesias in the affected extremity.

Accepted Answer

Clinical manifestations of acute oteomyelitis may vary slightly according to the site of involvement. Infection in the long bones is accompanied by acute localized pain and redness or drainage.

Question 16

A nurse admitting a 22-year-old client with septic arthritis in the knees would inquire about recent infection with
A) a respiratory tract virus.
B) gonorrhea.
C) strep throat.
D) urinary tract manifestations.

Accepted Answer

While a variety of organisms can cause septic arthritis, in adults under 30 Neisseria gonorrhoeae, the causative agent for gonorrhea, is the most common.

Question 17

The nurse explains that the most common early manifestation of a primary bone tumor is
A) fever.
B) fracture.
C) mass.
D) redness.

Accepted Answer

Clients with a primary bone tumor typically present with bone pain, particularly at night, or a fracture from even slight trauma. Occasionally a mass or lesion may be felt at the tumor site. They may also report weight loss, fever, chills, or pulmonary manifestations.

Question 18

The nurse assesses that the individual most susceptible to osteoporosis is the
A) muscular 50-year-old man with diabetes.
B) obese 50-year-old woman who is allergic to milk.
C) thin 70-year-old man with gout.
D) very slender 75-year-old woman.

Accepted Answer

Women have accelerated bone loss after menopause because of the loss of exogenous estrogen. Low body weight (<127 pounds) is an additional risk factor.

Question 19

The nurse instructing a client at risk for osteoporosis would encourage the client to include which item in the client's diet?
A) Beans
B) Citrus fruits
C) Dairy products
D) Red meat

Accepted Answer

The major sources of dietary calcium are dairy products. Calcium can also be obtained from calcium-fortified foods.

Question 20

The nurse recognizes the significant laboratory finding helpful in confirming the diagnosis of a bone tumor as
A) decreased calcium level.
B) decreased potassium level.
C) elevated alkaline phosphatase level.
D) elevated creatinine level.

Accepted Answer

An elevated serum alkaline phosphatase level may be noted with osteoblastic tumors, and LDH may mark tumor progression for Ewing's sarcoma.

Quiz 26: Management of Clients with Musculoskeletal Disorders

The client with osteomalacia is depressed and anxious about the outcome of the illness. The most beneficial nursing response would be

The nurse is counseling a client at risk of osteoporosis that one of the most beneficial exercises is

In the initial visit to a recently discharged client with osteoporosis, the home health nurse will reinforce the priority topic of

When counseling a client who is a strict vegan, the nurse would caution that this diet puts the client at risk for

A client with osteoporosis complains that avoiding coffee will be very difficult. To offset coffee consumption, the nurse might suggest that for every cup of coffee consumed, the client should

The nurse discussing treatment options with a client with Paget's disease will focus on the most frequent treatment, which is with

A client is being managed for prevention of gout and the nurse is reviewing the client's medication list and teaching about the medications. The nurse evaluates that the client understands the medication when the client says

A client has been diagnosed with early osteoarthritis (OA) in the hips. The nurse explains that the first medical treatment that will be tried is administration of

The nurse teaching a class on osteoarthritis (OA) stresses that this disorder is best described as

On admission assessment of a client with Paget's disease, the nurse would anticipate the client to complain of

The nurse counseling a client with osteoporosis identifies one of the medications that may have contributed to the condition as

After surgical debridement of diseased bone, a client with acute osteomyelitis asks how long antibiotics will be administered. The nurse should respond that the antibiotic protocol will be

The nurse instructing a client on considerations regarding the medication calcium carbonate would include in the teaching plan that the client

The nurse is assessing a client with osteoporosis. The finding that is consistent with the nurse's understanding of the disease is

On admitting a client with acute osteomyelitis, the nurse is not surprised at the client's complaint of

A nurse admitting a 22-year-old client with septic arthritis in the knees would inquire about recent infection with

The nurse explains that the most common early manifestation of a primary bone tumor is

The nurse assesses that the individual most susceptible to osteoporosis is the

The nurse instructing a client at risk for osteoporosis would encourage the client to include which item in the client's diet?

The nurse recognizes the significant laboratory finding helpful in confirming the diagnosis of a bone tumor as