Upgrade to remove ads
Only $35.99/year

Chapter 61 (evolve)

Terms in this set (14)

C

Osteoporosis with fractures is a serious complication of corticosteroid therapy. The ribs and vertebrae fractures cause back and neck pain. Ataxic (staggering) gait is an adverse effect of phenytoin, an antiseizure medication. A rare adverse effect of ciprofloxacin and other fluoroquinolones is tendon rupture, usually the Achilles tendon. Antipsychotics and antidepressants may cause tardive dyskinesia, characterized by involuntary movements of the tongue and face.
A 63-yr-old woman with a kidney transplant has been taking prednisone (Deltasone) daily for several years to prevent organ rejection. What is the most important assessment for the nurse to perform?
Staggering gait
Ruptured tendon
Back or neck pain
Tardive dyskinesia
B

Decreased muscle strength is an age-related change of the musculoskeletal system caused by decreased number and size of the muscle cells. The other assessment findings indicate musculoskeletal abnormalities. A positive straight-leg-raising test indicates nerve root irritation from intervertebral disk prolapse and herniation. An ulnar deviation or drift indicates rheumatoid arthritis due to tendon contracture. Scoliosis is a lateral curvature of the spine.
The home care nurse visits an 84-yr-old woman with pneumonia after her discharge from the hospital. Which age-related change in the musculoskeletal system is expected?
Positive straight-leg-raising test
Muscle strength is scale grade 3/5
Lateral S-shaped curvature of the spine
Fingers drift to the ulnar side of the forearm
A

An ataxic gait is a staggering, uncoordinated gait. Fall risk is the highest in individuals with gait instability and visual or cognitive impairments. The other signs and symptoms (e.g., fatigue, urinary retention, radicular pain) may also occur in the patient with multiple sclerosis.
The nurse admits a 55-yr-old woman with multiple sclerosis to a long-term care facility. Which finding represents a safety concern?
Ataxic gait
Radicular pain
Severe fatigue
Urinary retention
B

DXA is painless and measures the bone mass of spine, femur, forearm, and total body with minimal radiation exposure. A quantitative ultrasound evaluates bone density using ultrasound of the calcaneus (heel). MRI would require removal of objects such as hearing aids that have metal parts.
A 57-yr-old postmenopausal woman is scheduled for dual-energy x-ray absorptiometry (DXA). Which statement by the patient indicates understanding of the procedure?
"The bone density in my heel will be measured."
"This procedure will not cause any pain or discomfort."
"I will not be exposed to any radiation during the procedure."
"I will need to remove my hearing aids before the procedure."
B

The nurse should use therapeutic communication to determine the patient's concern about the procedure. The nurse should not provide false reassurance. It is not appropriate for the nurse to conclude the patient is concerned about pain or assume the patient is asking to reschedule the procedure.
A 42-yr-old man who is scheduled for arthrocentesis arrives at the outpatient surgery unit and states, "I do not want this procedure done today." Which response by the nurse is most appropriate?
"When would you like to reschedule the procedure?"
"Tell me what your concerns are about this procedure."
"The procedure is safe, so why should you be worried?"
"The procedure is not painful because an anesthetic is used."
B

The isotope does not harm the patient. A technician administers a calculated dose of a radioisotope 2 hours before a bone scan. If the patient was injected at 9:00 AM, the procedure should be done at 11:00 AM. Increased isotope uptake indicates osteomyelitis. Bone scans are completed in about 1 hour.
A 54-yr-old patient admitted with cellulitis and probable osteomyelitis received an injection of radioisotope at 9:00 AM for a bone scan. Which statement by the nurse is correct?
"Decreased isotope uptake is seen with osteomyelitis."
"Isotopes injected for the scan are not harmful to you."
"The scan will be performed in one hour at 10:00 AM."
"The procedure takes approximately 10 minutes to complete."
D

Patients are asked to drink increased fluids after a bone scan to aid in excretion of the radioisotope, if not contraindicated by another condition. No follow-up scans are required. Only mild pain may be associated with bone scans related to 1 hour of lying supine.
A 54-yr-old patient is about to have a bone scan. In teaching the patient about this procedure, the nurse should include what information?
"Only mild pain is associated with the procedure."
"Two additional follow-up scans will be required."
"The procedure takes approximately 15 to 30 minutes."
"You will need to drink increased fluids after the procedure."
A

Corticosteroids are associated with avascular necrosis and decreased bone and muscle mass. β-Blockers, calcium-channel blockers, and antiplatelet aggregators are not commonly associated with damage to the musculoskeletal system.
When administered long-term, which medication requires ongoing musculoskeletal assessment?

Corticosteroids
β-Adrenergic blockers
Antiplatelet aggregators
Calcium-channel blockers
B

Ankylosis is stiffness or fixation of a joint, and contracture is reduced movement as a consequence of fibrosis of soft tissue (muscles, ligaments, or tendons). Atrophy is a wasting of muscle leading to decreased function and tone. Crepitation is a grating or crackling sound that accompanies joint movement. Problem identification leads to determination of an appropriate treatment.
A female patient with a history of rheumatoid arthritis complains of stiffness in her right knee and complete fixation of the joint. What problem does the nurse anticipate will be identified in the patient's history and physical examination?
Atrophy
Ankylosis
Crepitation
Contracture
A

Observing the patient's active ROM is more accurate and safe than lifting weights. Passive ROM should be performed with extreme caution; it may cause harm when performed on older patients.
The nurse is performing a musculoskeletal assessment on an 81-yr-old patient whose mobility has been progressively declining. How should the nurse safely assess range of motion (ROM) in the affected leg?
Observe the patient's unassisted ROM in the affected leg.
Perform passive ROM, asking the patient to report any pain.
Ask the patient to lift progressive weights with the affected leg.
Move both the patient's legs from a supine position to full flexion.
B

Bone remodeling is achieved when osteoclasts remove old bone and osteoblasts deposit new bone. Osteocytes are mature bone cells, and osteons or Haversian systems create a dense bone structure; however, they are not involved with bone remodeling.
What should the nurse explain to the student regarding normal bone remodeling?
Osteoclasts add canaliculi.
Osteoblasts deposit new bone.
Osteocytes are immature bone cells.
Osteons synthesize organic bone matrix.
D

The musculoskeletal system's normal changes of aging include decreased muscle mass and strength; increased rigidity in the hips, neck, shoulders, back, and knees; decreased fine motor dexterity; and slowed reaction times. Going on a diet and exercising will help but not stop these changes. Telling the patient "Something must be wrong with you..." is untrue and will not be helpful to the patient's frustrations.
An 82-yr-old patient is frustrated by loose abdominal tissue and rigid hips. How should the nurse respond?
"You should go on a diet and exercise more to feel better about yourself."
"Something must be wrong with you because you should not have these problems."
"You have arthritis and need to take nonsteroidal antiinflammatory drugs (NSAIDs)."
"Decreased muscle mass and strength and increased hip rigidity are expected with aging."
A

Bursitis is common in adults older than age 40 years and with repetitive motion, such as raking. Plantar fasciitis occurs as a stabbing pain at the heel caused by straining the ligament that supports the arch. Achilles tendonitis is an inflammation of the tendon that attaches the calf muscle to the heel bone and causes pain with walking or running. A sprained ligament occurs when a ligament is stretched or torn from a direct injury or sudden twisting of the joint, not from repetitive motion.
A 50-yr-old patient reports shoulder discomfort after raking the yard. Which problem should the nurse suspect?
Bursitis
Fasciitis
Sprained ligament
Achilles tendonitis
ACE

The diarthrodial joints include the hinge joint of the knee and elbow, ball and socket joint of the shoulder and hip, pivot joint of the radioulnar joint, and condyloid, saddle, and gliding joints of the wrist and hand. The ligaments and cartilaginous connective tissue joining the vertebrae and pubis joint and the fibrous connective tissue of the skull are synarthrotic joints.
The nurse understands that patients have the most difficulties with diarthrodial joints. Which joints are included in this group (select all that apply.)?
Hinge joint of the knee
Ligaments joining the vertebrae
Gliding joints of the wrist and hand
Fibrous connective tissue of the skull
Ball and socket joint of the shoulder or hip
Cartilaginous connective tissue of the pubis joint
Sets with similar terms