Nursing Care of Patients with Musculoskelet 1 – Flashcards

osteoporosis rheumatoid arthritis This is the correct answer. ankylosing spondylitis osteomyelitis ​Rationale: Typical hand deformities in the patient with rheumatoid arthritis include swan neck deformity and ulnar deviation. Osteomyelitis is an infection of the bone and does not result in contracture deformities. It may cause localized tenderness and other signs of infection such as​ fever, swelling, erythema and lymph node involvement. Osteoporosis may cause pathologic fractures but does not cause joint deformity. Ankylosing spondylitis is a chronic inflammatory arthritis that primarily affects the axial skeleton and leads to pain and progressive stiffness of the spine.

Initial skin irritation is common and will subside within a few weeks of initiating treatment. Apply heat to the affected area after applying ointment. Limit the use of ointment to 3dash-4 times per day. This is the correct answer. Alternate heat and cold after ointment application. The patient diagnosed with osteoarthritis reports achieving pain relief when using an​ over-the-counter ointment on the affected areas. When reviewing safe administration​ practices, which principle should the nurse include in the​ teaching? Initial skin irritation is common and will subside within a few weeks of initiating treatment. Apply heat to the affected area after applying ointment. Limit the use of ointment to 3dash-4 times per day. This is the correct answer. Alternate heat and cold after ointment application. Rationale ​Rationale: ​Over-the-counter preparations should be used only 3dash-4 times per day. Heat use and these preparations should not be combined. Cold applications do not promote pain relief. If skin irritation is​ noted, the medication should be discontinued.

Encourage active​ range-of-motion exercises to promote flexibility. Elevate the extremity and use a foot a cradle. This is the correct answer. Wrap the extremity in an elastic bandage. Encourage liberal fluid intake. ​Rationale: The pain in the affected extremity will be lessened with elevation. Elevation will reduce inflammation. A foot cradle will prevent the pressure of linens from irritating the sore foot. Wrapping the extremity and​ range-of-motion exercises could increase the pain being experienced. Fluid intake is encouraged to reduce the risk of urinary​ stones, but will not directly reduce the​ patient's discomfort in the foot.

erythromycin This is the correct answer. warfarin sodium amoxicillin​ (Amoxil) This is the correct answer. aspirin This is the correct answer. ibuprofen correct ​Rationale: A number of antibiotics may be used to treat Lyme​ disease, including amoxicillin​ (Amoxil) or erythromycin. In addition to antibiotic​ treatment, aspirin or an NSAID may be prescribed for relief of arthritic symptoms.

previous pathologic fractures to the vertebra This is the correct answer. scoliosis elevated phosphorus levels pain and aching in the spine at night that is aggravated by pressure This is the correct answer. flushing of the skin over the spine correct ​Rationale: Most patients that are affected by Paget disease are symptom free for​ years, and the disease may be seen on an incidental​ x-ray. The pain is described as a mild to moderate deep ache that is aggravated by pressure and weight bearing. It is more noticeable at night or at rest. Because of the increase in blood flow to pagetic​ bone, flushing and warmth of the overlying skin may be apparent. Pathologic fractures from the loss of bone structure are a complication of Paget disease.​ Hypercalcemia, not​ hyperphosphatemia, is found during laboratory analyzing.​ Lordosis, not​ scoliosis, is observed in those with Paget disease.

not to do exercises if experiencing discomfort full recovery in up to six months This is the correct answer. possible complications such as infection or dislocation This is the correct answer. use and weight bearing of affected limb This is the correct answer. continuing pain medications for only two days after discharge ​Rationale: Patient education should focus on the continued progression of exercise and ambulation. There will be some degree of discomfort when exercising the affected limb but this can be controlled with mild analgesics. Patient should be instructed to report increasing​ pain, redness,​ swelling, fever, or deformity of hip. Postoperative pain medication will be necessary for longer than two days. Without proper pain​ control, the patient may not progress with exercise and ambulation. Recovery from total hip replacement is​ 80% complete in 4 weeks and​ 100% complete in six months.

125mL/hr ​Rationale: Pamidronate​ (Aredia) is among the primary treatments for severe Paget disease for inhibiting bone reabsorption. Pamidronate is given as an intravenous infusion for three successive days. The nurse would determine the rate to deliver the medication by dividing the total amount of fluid by 4 hours or 500​ mL/4 hours​ = 125​ mL/hr.

radiolucent bands linear fractures This is the correct answer. punched out appearance of bone This is the correct answer. mosaic pattern of bone matrix This is the correct answer. increased bone thickness correct ​Rationale: Radiologic changes with Paget disease include​ punched-out appearance of​ bone, increase in bone​ thickness, linear​ fractures, and mosaic pattern of bone matrix. Radiolucent bands known as​ Looser's zones are radiologic changes associated with osteomalacia.

trace blood in urine This is the correct answer. positive antinuclear antibody This is the correct answer. sodium 138 ESR 120​ mm/h This is the correct answer. Hgb 14.2 ​Rationale: Antinuclear antibody​ (ANA) testing is positive in more than​ 98% of patients with SLE. ESR is typically​ elevated, occasionally to​ >100 mm/h. Urinalysis shows hematuria during exacerbations of the disease. The hemoglobin level is within normal range. The sodium level is within normal range.

Administer the medication with milk. Administer the medication in the morning with water. This is the correct answer. Assessment of fluoride levels annually. Avoid intake for 30 minutes after use. This is the correct answer. Administer the medication after meals. ​Rationale: Etidronate​ (Didronel) is to be provided with water 30 minutes before a meal. Intake must be avoided for 30 minutes after administration. Milk products should be avoided. There is no reason to evaluate fluoride levels with this medication.

Perform active and passive exercises. This is the correct answer. Use braces for support. This is the correct answer. Consume 2 to 3 liters of fluid each day. Reduce body weight. This is the correct answer. Schedule routine injections with corticosteroids. ​Rationale: Conservative treatment for adults with scoliosis may include weight​ reduction, active and passive​ exercises, and the use of braces for support. There is no recommendation to increase fluids in the conservative treatment of scoliosis. Corticosteroid injections are not considered conservative treatment for scoliosis.

This medication has a gradual response and continues for months after the drug is stopped. This is the correct answer. Take vitamin C supplements as instructed for bone mineralization. Do not lie down for 30 minutes after taking medication. This is the correct answer. Take the medication with orange juice one hour after food. Report new or worsening​ heartburn, and difficult or painful swallowing correct ​Rationale: New or worsening​ heartburn, difficult or painful swallowing are adverse reactions to the medication. Alendronate​ (Fosamax) should be administered with water 30 minutes before food or other medications. Lying down within thirty minutes of ingestion of the medication may precipitate adverse gastrointestinal reactions. Vitamin D supplements should be used as well as calcium and not Vitamin C. This medication has a gradual response and continues for months after the drug is stopped.

Alternate nares when administering the medication. Hold the next dose of calcitonin and notify the physician. Monitor and record the frequency and amount of emesis. This is the correct answer. Increase the amount of vitamin D in the diet. ​Rationale: Calcitonin is associated with nausea and vomiting. These manifestations will subside. The nurse will need to record the event. Changing the route will not affect the adverse effects of this medication. Holding the dose is not indicated and the physician does not require immediate notification. Although vitamin D intake should be increased in the diet when calcitonin is​ prescribed, it does not address the question.

weight loss This is the correct answer. pain and stiffness in the morning This is the correct answer. cool and bony hard joints hot red swollen joints This is the correct answer. hip and knee affected ​Rationale: Manifestations of rheumatoid arthritis include weight​ loss, hot, red swollen​ joints, and pain and stiffness in the morning. Manifestations of osteoarthritis include hip and knee joints affected and cool and bony hard joints.

female ​high-protein diet This is the correct answer. diabetes mellitus calcium deficiency This is the correct answer. decrease in estrogen levels correct ​Rationale: Calcium deficiency is an important modifiable risk factor that contributes to osteoporosis. Calcium and vitamin D supplements and a diet including foods high in calcium and vitamin D will help correct the deficiency. A​ high-protein diet can cause​ acidosis, which can contribute to osteoporosis since calcium is withdrawn from the kidney as the kidneys attempt to buffer the excess acid. Acidosis can also directly stimulate osteoclast function. Being female is an unmodifiable risk factor. Decreasing levels of the hormone estrogen are a modifiable risk factor for osteoporosis. Diabetes mellitus is not a modifiable risk​ factor, although it may be controlled.

​"These 'lumps' do not cause clot​ development." This is the correct answer. ​"Unfortunately, this is a common complication associated with​ gout." ​"Clots will not develop if you take your​ anti-gout medicine." ​"You will need to talk with the physician during your next​ visit." ​Rationale: The deposits are known as tophi. They result from uric acid crystal buildup. They occur most often in locations with lower body temperature readings. They will not cause a clot. Medications prescribed to manage gout will reduce the amount of uric acid production or assist with its metabolism. The patient will need correct information concerning the tophi. Advising the patient to wait until a future visit to discuss the concern is not​ appropriate, as the patient is seeking information at the present time.

Discuss the use of relaxation techniques. This is the correct answer. Suggest the use of ice to the painful joints. This is the correct answer. Advise the patient to avoid​ water-based exercises. Encourage rest of the painful joints. This is the correct answer. Encourage distraction techniques. correct ​Rationale: ​Rest, relaxation,​ ice, and distraction are nonpharmacological methods to reduce pain associated with osteoarthritis.​ Water-based exercises are recommended for the patient with osteoarthritis.

acupuncture This is the correct answer. yoga blackberries This is the correct answer. selenium This is the correct answer. vitamin E correct ​Rationale: A variety of nutritional and herbal supplements may be used to help prevent gout or decrease the onset of manifestations. Vitamin E and selenium decrease tissue inflammation. Dark​ reddish-blue berries​ (such as cherries and​ blackberries) are good sources of​ flavonoids, which help lower uric acid​ levels, decrease​ inflammation, and prevent or repair joint tissue damage. Acupuncture helps with pain relief. Yoga is not a recommended alternative therapy for patients with gout.

30mL ​Rationale: Abatacept​ (Orencia), like other biologic​ DMARDs, is given by IV infusion. The usual dosage is 500 to 1000 mg per IV infusion every two weeks for two​ doses, then every month. To calculate the​ patient's dose the nurse can use the equation Dosage​ Required/Dosage Available​ × mL or 750​ mg/25 mg​ × 1 mL​ = 750/25​ × 1 mL​ = 30 mL.

exertional dyspnea This is the correct answer. ​pursed-lip appearance This is the correct answer. dysphagia This is the correct answer. hypotension telangectasias correct ​Rationale: The patient with visceral organ involvement may have varied symptoms. Dysphagia is common because the motility of the esophagus is affected. Pulmonary involvement can lead to exertional dyspnea due to impaired gas exchange and​ right-sided heart failure due to pulmonary hypertension. Skin manifestations include telangiectasias. Facial skin tightening leads to a​ pursed-lip appearance.

using of wrist restraints keeping the bed in a low position This is the correct answer. keeping a nightlight on in the room using furniture as obstacles to keep the patient in the bed ​Rationale: Keeping the bed in a low position will reduce the incidence of injury should the patient attempt to get up. The use of restraints could increase the incidence of injury. Using the furniture as an obstacle could cause injury if the patient is able to get up. A nightlight is useful but is not the best means to prevent injury.

Paget disease systemic lupus erythematosis This is the correct answer. gout rheumatoid arthritis ​Rationale: Systemic lupus erythematosis​ (SLE) was originally described as a skin disorder and named for the characteristic red butterfly rash across the cheeks and bridge of the nose. Most people have skin manifestations at some point during their disease. Rheumatoid arthritis does not present with a rash. Patients with Paget disease or gout do not have a rash.

The patient has inflammation present. The patient has an infection. The​ patient's gout is confirmed by the lab results. The​ patient's kidney function is decreased. correct ​Rationale: All of these lab results are elevated for a​ 35-year-old woman. While all options are correct assumptions from analyzing the​ results, the most significant and worrisome finding is the elevation of the​ creatinine, since it indicates damage to the kidney. Kidney damage is a complication of stone​ formation, which occurs with gout.

​"You are at an age when your estrogen levels have begun to decline​ drastically, thus increasing your risk for the development of​ osteoporosis." ​"Your dietary practices might be partially​ responsible." This is the correct answer. ​"Do your bones feel weak or​ painful?" ​"You might have placed underlying stress on your skeleton from your frequent​ exercise." ​Rationale: There is an increasing incidence of osteoporosis in female athletes as a result of intense dieting. Exercise is beneficial in the prevention of osteoporosis. It does not increase the likelihood of osteoporosis. The patient is seeking information. She is not requiring an assessment at this time.

a​ large-boned African American female a​ 32-year-old male a postmenopausal female This is the correct answer. a Caucasian female This is the correct answer. a patient taking corticosteroid therapy correct ​Rationale: European Americans are at a higher risk for osteoporosis. Low estrogen levels associated with being postmenopausal is a modifiable risk factor for the development of osteoporosis. Anyone who takes a glucocorticoid medication for more than 3 months is at risk for​ glucocorticoid-induced osteoporosis. African Americans have a lower risk for osteoporosis because of denser bone mass. A​ 32-year-old male has a low risk of developing osteoporosis.

bruising constipation This is the correct answer. anorexia This is the correct answer. muscle weakness This is the correct answer. frequent urination correct ​Rationale: Manifestations of hypervitaminosis D include​ anorexia, frequent​ urination, muscle​ weakness, and constipation. Bruising is not a manifestation of hypervitaminosis D.

Take 600 mg of calcium with breakfast. This is the correct answer. Take 600 mg of calcium with lunch. This is the correct answer. Take 400 mg of calcium with​ breakfast, lunch, and dinner. This is the correct answer. Take the full dose of 1200 mg of calcium in the morning on an empty stomach. Take 600 mg of calcium with breakfast and 600 mg at bedtime. ​Rationale: The nurse should recommend that the prescribed dose of calcium be limited to no more than 600 mg of calcium at a time since as the amount absorbed declines at higher doses. This means that the maximum dose for any meal should be calcium 600 mg. This would be appropriate for breakfast and lunch. Recommending calcium 400 mg with​ breakfast, lunch, and dinner would also be appropriate. Calcium should be taken with​ food, so recommending a dose in the morning on an empty stomach or at bedtime is not appropriate.

​"It reduces the amount of bleeding from​ surgery." This is the correct answer. ​"It prevents a postoperative​ infection." ​"It slows the progression of the Paget​ disease." This is the correct answer. ​"It speeds healing of the surgical​ wound." ​"It is to treat your​ osteoporosis." ​Rationale: Excessive operative bleeding is a risk in Paget disease due to increased vascularity of affected bone. Pretreatment with a potent bisphosphonate reduces disease activity prior to surgery and decreases the risk of excessive operative blood loss. A bisphosphonate before surgery in the patient with Paget disease is not provided to treat osteoporosis. Antibiotics are used to treat infection. The bisphosphonate will not speed the healing of the surgical wound.

Hgb 4.12 BUN 68 This is the correct answer. uric acid level 7.8 WBC​ 20,000 ​Rationale: The patient should be evaluated for renal failure on the basis of his elevated BUN levels. Colchicine is contraindicated in renal disease. The white blood cell​ count, uric acid​ level, and hemoglobin level are all within normal limits.

Have routine eye examinations. Avoid alcohol. This is the correct answer. Avoid exposure to sunlight. This is the correct answer. Use effective contraception. This is the correct answer. Expect the skin to turn orange. ​Rationale: The nurse should instruct the patient to avoid alcohol and exposure to sunlight or ultraviolet light and to practice effective contraception while taking methotrexate.​ Yellow-orange skin is associated with sulfasalazine​ (Azulfidine). Routine ophthalmologic examinations are needed for hydroxychloroquine​ (Plaquenil) because of the risk of developing retinopathy.

​"Your surgeon has a low complication​ rate." ​"Do you know someone who had complications after this type of​ surgery?" ​"Complications are rare with this type of​ surgery." ​"What complications did your surgeon mention in the explanation of your​ surgery?" correct ​Rationale: Complications can result from any surgery. The surgeon should include risks and benefits when the surgery is discussed with the patient. After assessing the​ patient's understanding of the​ procedure, the nurse should provide further explanations and clarification as needed. One person may not have the same postoperative course as someone else. Many variables in addition to the surgeon complication rate influence the occurrence of complications.

Start IV​ D51/2 NS at 125​ mL/hr This is the correct answer. Rocephin 1 gram IV twice a day Acetaminophen 650 mg by mouth for temperature above​ 100°F Blood cultures​ ×2 at different sites ​Rationale: The nurse should insert the intravenous access line first and draw the blood for the blood cultures through the access line prior to the initiation of the IV antibiotic. Once the intravenous line is​ established, the antibiotic can be started. Acetaminophen is not a priority at this time and can be provided at any point in the process.

chicken whole milk This is the correct answer. sardines This is the correct answer. collard greens This is the correct answer. bananas ​Rationale: Milk and milk products are the best sources of calcium. Other food sources of calcium include sardines and dark​ green, leafy vegetables such as collard greens. Chicken and bananas are not high in calcium.

ketoprofen celecoxib capsaicin This is the correct answer. naproxen ​Rationale: Capsaicin is a topical preparation proven to relieve pain in patients with osteoarthritis without the adverse systemic effects of oral medications. The other medications are oral preparations.

​"I will make sure I drink water with each​ meal." This is the correct answer. ​"I will use artificial tears as​ needed." This is the correct answer. ​"I will take aspirin every​ morning." ​"I will be sure to drink fluids throughout the​ day." This is the correct answer. ​"I will brush my teeth before and after every​ meal." correct ​Rationale: Nurses caring for patients with​ Sjögren syndrome need to teach measures to protect the​ patient's eyes and oral mucosa. Instill artificial tears as needed. Encourage the patient to sip fluids throughout the day. Instruct to perform frequent oral​ hygiene, particularly before and after meals. Ensure that the patient has sufficient fluids to drink during​ meals, because fluids help with chewing and swallowing. Aspirin is not indicated in the treatment of​ Sjögren syndrome.

Becker ​Limb-girdle This is the correct answer. Duchenne Myotonic This is the correct answer. Facioscapulohumeral correct ​Rationale: Myotonic muscular dystrophy affects males and females at any age.​ Limb-girdle muscular dystrophy affects males and females between the ages of 15 and 40. Facioscapulohumeral muscular dystrophy affects males and females between the ages of 10 and 20. Becker and Duchenne muscular dystrophies affect males.

temperature​ 102° F This is the correct answer. heart rate 82 blood pressure​ 110/76 respiratory rate 18 ​Rationale: The elevated temperature may indicate an infectious​ process, such as a surgical site​ infection, and would need rapid intervention. The other vital signs are within normal limits.

Reapply sunscreen after​ swimming, exercising, or bathing. This is the correct answer. Apply hydrocortisone cream​ 1% to the rash 4dash-6 ​times/day. Avoid being out of doors during hours of greatest sun intensity. This is the correct answer. Wear a​ wide-brimmed hat when outside. This is the correct answer. Use sunscreen with an SPF of 15 or higher. correct ​Rationale: The patient should be instructed on the relationship between sun exposure and disease​ activity, both dermatologic and systemic. The patient should avoid being out of doors during peak sun hours and always use sun screen with SPF of 15 or higher. Do not use hydrocortisone cream regularly to the face. It can cause skin atrophy and will not provide rash relief. Always reapply sunscreen after perspiring or being exposed to water. Wear loose clothing with long sleeves and​ wide-brimmed hat when out of doors.