Ch40 Complete Test Bank + Nursing Care Of Patients With - Medical Surgical Nursing 7e | Test Bank by LeMone, Burke, Bauldoff by LeMone, Burke, Gerene Bauldoff. DOCX document preview.
LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)
Chapter 40 Nursing Care of Patients with Musculoskeletal Disorders
1) A 30-year-old female patient diagnosed with early onset of osteoporosis asks how she could be at risk for this disease, since she is so active. Which response by the nurse is most correct?
1. "You might have placed underlying stress on your skeleton from your frequent exercise."
2. "You are at an age when your estrogen levels have begun to decline drastically, thus increasing your risk for the development of osteoporosis."
3. "Do your bones feel weak or painful?"
4. "Your dietary practices might be partially responsible."
Page Ref: 1451
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal disorders.
2) A patient with osteoporosis taking calcitonin is experiencing nausea and vomiting. What should the nurse do about the patient's complaint?
1. Alternate nares when administering the medication.
2. Hold the next dose of calcitonin and notify the physician.
3. Monitor and record the frequency and amount of emesis.
4. Increase the amount of vitamin D in the diet.
Page Ref: 1453
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
3) A patient is prescribed etidronate (Didronel). Which intervention would be appropriate when administering the medication to the patient? Select all that apply.
1. Administer the medication in the morning with water.
2. Administer the medication with milk.
3. Administer the medication after meals.
4. Assess fluoride levels annually.
5. Avoid intake for 30 minutes after use.
Page Ref: 1453
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
4) An older patient with osteoporosis has a history of falls and dementia. What intervention will best aid in the prevention of injuries?
1. Using wrist restraints
2. Using furniture as obstacles to keep the patient in the bed
3. Keeping the bed in a low position
4. Keeping a nightlight on in the room
Page Ref: 1455
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Quality & Safety; Practice-Know-How; Use technologies that contribute to safety | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
5) A patient diagnosed with gout is concerned that the small "lumps" on the ear and big toe will become lodged in the blood, resulting in a blood clot. What explanation by the nurse is the most accurate response to this patient?
1. "Clots will not develop if you take your anti-gout medicine."
2. "Unfortunately, this is a common complication associated with gout."
3. "You will need to talk with the physician during your next visit."
4. "These 'lumps' do not cause clot development."
Page Ref: 1461
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal disorders.
6) A patient with gout is experiencing foot pain. Which intervention will aid in promoting comfort in this patient?
1. Wrap the extremity in an elastic bandage.
2. Encourage liberal fluid intake.
3. Encourage active range-of-motion exercises to promote flexibility.
4. Elevate the extremity and use a foot a cradle.
Page Ref: 1463
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Basic Care and Comfort
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
7) A patient 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?
1. Apply heat to the affected area after applying ointment.
2. Alternate heat and cold after ointment application.
3. Limit the use of ointment to 3-4 times per day.
4. Initial skin irritation is common and will subside within a few weeks of initiating treatment.
Page Ref: 1467
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 40.2 Describe the pathophysiology and manifestations of degenerative musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
8) Prior to signing informed consent for a total hip replacement, the patient asks the nurse if she should be concerned about complications. How should the nurse respond?
1. "Complications are rare with this type of surgery."
2. "Do you know someone who had complications after this type of surgery?"
3. 'Your surgeon has a low complication rate."
4. "What complications did your surgeon mention in the explanation of your surgery?"
Page Ref: 1468
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation
Learning Outcome: 40.2 Describe the pathophysiology and manifestations of degenerative musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal disorders.
9) A patient with a history of osteoarthritis reports discomfort unrelieved by the prescribed medications. Which nonpharmacological intervention might assist the patient in managing the discomfort? Select all that apply.
1. Suggest the use of ice to the painful joints.
2. Encourage rest of the painful joints.
3. Discuss the use of relaxation techniques.
4. Encourage distraction techniques.
5. Advise the patient to avoid water-based exercises.
Page Ref: 1467-1471
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Basic Care and Comfort
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.17. Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 40.2 Describe the pathophysiology and manifestations of degenerative musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal disorders.
10) The nurse is reviewing modifiable and nonmodifiable risk factors of osteoporosis with a patient. What should the nurse include as a modifiable risk factor? Select all that apply.
1. Calcium deficiency
2. High-protein diet
3. Female
4. Decrease in estrogen levels
5. Diabetes mellitus
Page Ref: 1451
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal disorders.
11) The nurse is reviewing the health histories for a group of assigned patients. Which patient should the nurse identify as being at the greatest risk for the development of osteoporosis? Select all that apply.
1. A Caucasian female
2. A postmenopausal female
3. A large-boned African American female
4. A patient taking corticosteroid therapy
5. A 32-year-old male
Page Ref: 1450-1451
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal disorders.
12) A patient is diagnosed with Paget disease. What should the nurse expect to assess in this patient? Select all that apply.
1. Pain and aching in the spine at night that is aggravated by pressure
2. Flushing of the skin over the spine
3. Previous pathologic fractures to the vertebra
4. Elevated phosphorus levels
5. Scoliosis
Page Ref: 1458
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal disorders.
13) A patient with gout is prescribed colchicine. For which laboratory value should the nurse question administering this medication to the patient?
1. WBC 20,000
2. Uric acid level 7.8
3. BUN 68
4. Hgb 14.2
Page Ref: 1462
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal disorders.
14) A patient with osteoporosis is prescribed alendronate (Fosamax). What should the nurse include when instructing the patient about this medication? Select all that apply.
1. Report new or worsening heartburn, and difficult or painful swallowing.
2. Take the medication with orange juice one hour after food.
3. Do not lie down for 30 minutes after taking medication.
4. Take vitamin C supplements as instructed for bone mineralization.
5. This medication has a gradual response and continues for months after the drug is stopped.
Page Ref: 1453
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
15) The nurse is instructing a patient about foods high in calcium. Which food choice that the patient selects indicates teaching has been effective? Select all that apply.
1. Chicken
2. Collard greens
3. Bananas
4. Sardines
5. Whole milk
Page Ref: 1454
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
16) A patient diagnosed with systemic lupus erythematosus has laboratory values indicative of an exacerbation. Which value should the nurse report to the healthcare provider? Select all that apply.
1. Positive antinuclear antibody
2. ESR 120 mm/hr
3. Trace blood in urine
4. Hemoglobin 14.2 mg/dL
5. Sodium 138 mg/dL
Page Ref: 1490
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 40.3 Describe the pathophysiology and manifestations of autoimmune and inflammatory musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal disorders.
17) A patient diagnosed with systemic lupus erythematosus is experiencing a facial rash. What should the nurse instruct the patient regarding skin care? Select all that apply.
1. Avoid being out of doors during hours of greatest sun intensity.
2. Use sunscreen with an SPF of 15 or higher.
3. Apply hydrocortisone cream 1% to the rash 4‒6 times/day.
4. Reapply sunscreen after swimming, exercising, or bathing.
5. Wear a wide-brimmed hat when outside.
Page Ref: 1491
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 40.3 Describe the pathophysiology and manifestations of autoimmune and inflammatory musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
18) The nurse is providing discharge instructions to a patient recovering from a total hip replacement. What should the nurse include in these instructions? Select all that apply.
1. Use and weight bearing of affected limb
2. Not to do exercises if experiencing discomfort
3. Possible complications such as infection or dislocation
4. Continuing pain medications for only two days after discharge
5. Full recovery in up to six months
Page Ref: 1469-1470
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 40.2 Describe the pathophysiology and manifestations of degenerative musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
19) A patient recovering from a total hip replacement has vital signs assessed by unlicensed assistive personnel. Which vital sign value should cause the most concern for the nurse?
1. Blood pressure 110/76 mmHg
2. Heart rate 82 bpm
3. Respiratory rate 18 breaths/min
4. Temperature 102°F
Page Ref: 1470
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 40.2 Describe the pathophysiology and manifestations of degenerative musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal disorders.
20) The patient who weighs 70 kg is to receive 750 mg of abatacept (Orencia) by IV infusion for the treatment of rheumatoid arthritis. When reconstituted, the medication has dosage strength of 25 mg/mL. How many milliliters of the medication should be prepared for this dosage? Record your answer rounding to the nearest whole number.
Page Ref: 1481
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 40.3 Describe the pathophysiology and manifestations of autoimmune and inflammatory musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal disorders.
21) A patient diagnosed with Paget disease has been prescribed pamidronate 90 mg over 3 days. Medication instructions state to mix 30 mg of the drug in 500 mL NS and administer over 4 hours. This administration should be repeated for 3 days for a total of 90 mg of drug. At what IV rate, in mL/hr, should the nurse run this infusion? Record your answer rounding to the nearest whole number.
Page Ref: 1453, 1458
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal disorders.
22) The nurse is providing teaching about topical medications for a group of patients who have been diagnosed with osteoarthritis. Which medication should the nurse review as being a topical preparation?
1. Ketoprofen
2. Naproxen
3. Capsaicin
4. Celecoxib
Page Ref: 1467
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 40.2 Describe the pathophysiology and manifestations of degenerative musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal disorders.
23) The nurse is reviewing the x-ray report for a patient experiencing spinal and major joint discomfort. Which finding should indicate to the nurse that the patient will be treated for Paget disease? Select all that apply.
1. Linear fractures
2. Radiolucent bands
3. Increased bone thickness
4. Mosaic pattern of bone matrix
5. Punched out appearance of bone
Page Ref: 1452
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal disorders.
24) An older female patient is prescribed a calcium supplements every day. What should the nurse instruct the patient about this supplement? Select all that apply.
1. Take 500 mg of calcium with lunch.
2. Take 500 mg of calcium with breakfast.
3. Take 400 mg of calcium with breakfast, lunch, and dinner.
4. Take 600 mg of calcium with breakfast and 600 mg at bedtime.
5. Take the full dose of 1200 mg of calcium in the morning on an empty stomach.
Page Ref: 1454
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
25) A patient with Paget disease asks why a dose of zoledronic acid (Reclast) is being provided before having total hip replacement surgery. How should the nurse respond to this patient? Select all that apply.
1. "It is to treat your osteoporosis."
2. "It prevents a postoperative infection."
3. "It speeds healing of the surgical wound."
4. "It slows the progression of the Paget disease."
5. "It reduces the amount of bleeding from surgery."
Page Ref: 1458
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
26) The nurse is assessing a patient being treated for osteomalacia. Which findings does the nurse recognize as an indication that the patient is experiencing hypervitaminosis D? Select all that apply.
1. Bruising
2. Anorexia
3. Constipation
4. Muscle weakness
5. Frequent urination
Page Ref: 1465
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 40.1 Describe the pathophysiology and manifestations of metabolic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal disorders.
27) The parents of a 15-year-old patient are informed that diagnostic tests are needed to determine if musculoskeletal changes are being caused by muscular dystrophy. For which type of muscular dystrophy should the nurse expect these tests to be prescribed? Select all that apply.
1. Becker
2. Myotonic
3. Duchenne
4. Limb-girdle
5. Facioscapulohumeral
Page Ref: 1474
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 40.2 Describe the pathophysiology and manifestations of degenerative musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal disorders.
28) During an assessment, the nurse suspects that a patient is experiencing manifestations of rheumatoid arthritis. What finding did the nurse observe to make this clinical decision? Select all that apply.
1. Weight loss
2. Hot red swollen joints
3. Hip and knee affected
4. Cool and bony hard joints
5. Pain and stiffness in the morning
Page Ref: 1476
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 40.3 Describe the pathophysiology and manifestations of autoimmune and inflammatory musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal disorders.
29) A 36-year-old patient with rheumatoid arthritis is prescribed methotrexate. What should the nurse include when teaching the patient about this medication? Select all that apply.
1. Avoid alcohol.
2. Avoid exposure to sunlight.
3. Use effective contraception.
4. Expect the skin to turn orange.
5. Have routine eye examinations.
Page Ref: 1481
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 40.3 Describe the pathophysiology and manifestations of autoimmune and inflammatory musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
30) A patient is diagnosed with Lyme disease. Which medication should the nurse expect to be prescribed for managing the manifestations of this health problem? Select all that apply.
1. Aspirin
2. Ibuprofen
3. Erythromycin
4. Warfarin sodium
5. Amoxicillin (Amoxil)
Page Ref: 1497
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 40.3 Describe the pathophysiology and manifestations of autoimmune and inflammatory musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal disorders.
31) While completing a health history the nurse suspects that a patient is experiencing manifestations of scleroderma. What did the nurse assess to make this clinical decision? Select all that apply.
1. Dysphagia
2. Hypotension
3. Telangiectasias
4. Exertional dyspnea
5. Pursed-lip appearance
Page Ref: 1493
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 40.3 Describe the pathophysiology and manifestations of autoimmune and inflammatory musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal disorders.
32) The nurse instructs a patient with Sjögren syndrome on self-care techniques. Which patient statement indicates that teaching has been effective? Select all that apply.
1. "I will take aspirin every morning."
2. "I will use artificial tears as needed."
3. "I will make sure I drink water with each meal."
4. "I will be sure to drink fluids throughout the day."
5. "I will brush my teeth before and after every meal."
Page Ref: 1495
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning
Learning Outcome: 40.3 Describe the pathophysiology and manifestations of autoimmune and inflammatory musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
33) The healthcare provider suggests that a patient with scoliosis participate in conservative treatment. What should the nurse instruct the patient about this treatment approach? Select all that apply.
1. Reduce body weight.
2. Use braces for support.
3. Perform active and passive exercises.
4. Consume 2 to 3 L of fluid each day.
5. Schedule routine injections with corticosteroids.
Page Ref: 1509
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 40.6 Describe the pathophysiology and manifestations of other musculoskeletal disorders, including low back pain, fibromyalgia, spinal deformity, and common foot disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal disorders.
34) A patient is suspected of having osteomyelitis. Which antibiotic should the nurse anticipate being prescribed for this patient? Select all that apply.
1. Nafcillin
2. Oxacillin
3. Cefazolin
4. Ceftriaxone
5. Erythromycin
Page Ref: 1498-1499
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 40.4 Describe the pathophysiology and manifestations of infectious musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal disorders.
35) A patient with a history of intravenous drug abuse is suspected of having septic arthritis. What should the nurse expect to assess in this patient? Select all that apply.
1. Red and swollen joint
2. Pain in the infected joint
3. Anorexia and weight loss
4. Stiffness in the infected joint
5. Joint hot and tender to touch
Page Ref: 1500
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 40.4 Describe the pathophysiology and manifestations of infectious musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal disorders.
36) An adolescent male patient with a mass on the left femur is experiencing bone pain and impaired function. For which type of bone tumor should the nurse plan care for this patient? Select all that apply.
1. Enchondroma
2. Osteosarcoma
3. Ewing sarcoma
4. Osteochondroma
5. Chondrosarcoma
Page Ref: 1502
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 40.5 Describe the pathophysiology and manifestations of neoplastic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal disorders.
37) An adolescent patient is diagnosed with a bony sarcoma of the upper extremity. What should the nurse expect to assess in this patient? Select all that apply.
1. Fever
2. Muscle atrophy
3. Pain that radiates
4. Pain at night or rest
5. Worsening deep bony pain
Page Ref: 1502
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 40.5 Describe the pathophysiology and manifestations of neoplastic musculoskeletal disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal disorders.
38) A patient with chronic low back pain does not want to use medication for treatment. Which complementary therapy should be recommended to this patient? Select all that apply.
1. Massage
2. Diathermy
3. Chiropractic
4. Acupuncture
5. Hydrotherapy
Page Ref: 1505
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Basic Care and Comfort
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.17. Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation
Learning Outcome: 40.6 Describe the pathophysiology and manifestations of other musculoskeletal disorders, including low back pain, fibromyalgia, spinal deformity, and common foot disorders, and outline the interprofessional care and nursing care of patients with these disorders.
MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal disorders.
Document Information
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