Chapter 26: Common Musculoskeletal Concerns

Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition

Multiple Choice

1. After first managing the pain being experienced by the client with gout, the treatment focuses on: a. strengthening the affected joints through a controlled exercise plan. b. minimizing joint disfigurement by using therapeutic splinting. c. preventing systemic involvement by altering the client’s diet. d. managing chronic pain by taking regular doses of salicylates.

ANS: C

After the acute attack, the goal is to prevent systemic spread of the disease. This may be done by avoiding drugs or foods that are high in purine and alcohol, both of which increase uric acid levels. Exercise and splinting are not effective in achieving the goal and salicylates should be avoided since they will affect the effectiveness of the prescribed medications for gout.

DIF: Cognitive Level: Applying REF: p. 336

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. Avoid foods high in purine. b. Encourage the patient to take in 1 L of fluid daily. c. Consume one glass of red wine daily. d. Recommend that the patient eat 12-16 ounces of foods high in protein such as red meat.

2. A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the following should the nurse include in the teaching?

ANS: A

A person who is having an acute attack of gout should avoid foods that are high in purine, take in 2 L of fluid daily, avoid alcohol, and only have 4-6 ounces of foods high in protein daily.

DIF: Cognitive Level: Applying REF: p. 336

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. Swan neck deformity of the hand b. Subluxation of the fingers c. Heberden’s nodes on the distal phalanges d. Enlarged great toe

3. Which of the following manifestations would a nurse expect in a 70- year-old patient who has the diagnosis of osteoarthritis?

ANS: C

Herbeden’s nodes are common in osteoarthritis. As the disease progresses, osteophytes develop in the joints of the fingers. Swan neck deformity and subluxation of the fingers are common in RA. An enlarged great toe is characteristic of gout.

DIF: Cognitive Level: Applying REF: p. 332

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. Following a diet with adequate amounts of calcium and vitamin D b. Increasing the intake of beverages containing phosphorus c. Having a yearl y dual-energy X-ray absorptiometry DXA (or DEXA) scan d. Including isometric exercise for at least 30 minutes three times per week

4. A nurse is planning an educational session on osteoporosis to be given at a senior center. Which of the following should be discussed as preventive measures for osteoporosis?

ANS: A

A diet with adequate amounts of calcium and vitamin D is important in preventing osteoporosis. Phosphorous is not recommended for osteoporosis prevention. The recommendation for DXA/DEXA scan is every 2 years. Exercise recommendations are for weight-bearing exercise.

DIF: Cognitive Level: Applying REF: pp. 334–335

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. The woman is obese and has hip pain with ambulation. b. The woman drinks three glasses of skim milk daily. c. The woman eats three to five servings of shrimp and liver per week. d. The woman has been taking corticosteroids for 10 years because of chronic pulmonary disease.

5. A nurse is interviewing an older woman who is a new patient in an outpatient medical clinic. Which of the following findings by the nurse is considered a risk factor for osteoporosis?

ANS: D

Bone loss is rapid in individuals who take steroids for extended periods of time.

DIF: Cognitive Level: Applying REF: p. 328

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. Avoid stressful situations. b. Schedule an annual DXA/DEXA scan. c. Remove clutter from the floors of the home. d. Encourage consumption of a high-protein diet.

6. A nurse plans for the discharge of a 75- year-old patient who has the diagnosis of osteoporosis. Which of these actions would the nurse consider first?

ANS: C

Individuals with osteoporosis are very high risk for falls. The most serious health complication of osteoporosis is the morbidity and mortality associated with a fall. There is no evidence that stress impacts osteoporosis. The recommendation for a DXA/DEXA scan is every 2 years. There is no evidence that a high-protein diet is important for an individual with osteoporosis.

DIF: Cognitive Level: Applying REF: pp. 328–329

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. Osteoarthritis b. Rheumatoid arthritis c. Osteoporosis d. Gout

7. Kyphosis in the older adult can be a result of which of the following?

ANS: C

Kyphosis is a common presentation in osteoporosis. Individuals can lose as much as 3 cm or more in height and develop a “c” shape to the vertebral column.

DIF: Cognitive Level: Applying REF: p. 330

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation

Multiple Response

1. A nursing student is preparing a presentation on arthritis. The nursing student knows that differences between osteoarthritis (OA) and rheumatoid arthritis (RA) include that: (Select all that apply.)

a. both OA and RA have an acute onset in older adults.

b. OA is a localized process, whereas RA may be systemic.

c. OA usually impacts distal interphalangeal joints; RA impacts proximal interphalangeal joints.

d. both OA and RA present with joint stiffness lasting 20-30 minutes after rest.

e. initial treatment of both OA and RA is usually nonpharmacological using heat or exercise.

ANS: B, C

OA has an insidious presentation, and RA has an acute presentation. OA presents with joint stiffness, which resolves in less than 20 minutes, and RA presents with joint stiffness that lasts more than 20-30 minutes. OA is initially treated with nonpharmacological treatments such as heat or exercise, and RA is treated with medications disease-modifying antirheumatic drugs (DMARDs) immediately after diagnosis.

DIF: Cognitive Level: Understanding REF: p. 332, Table 26-3

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. Rest the joint during the acute gout attack. b. Take acetylsalicylic acid (aspirin, or ASA) to relieve pain. c. Increase fluid intake to 2 L/day. d. Avoid foods high in purine. e. Avoid alcoholic beverages.

2. A nurse is teaching an older adult who is experiencing an acute attack of gout. Which of the following should the nurse include in the teaching? (Select all that apply.)

ANS: A, C, D, E

Individuals who are having an acute attack of gout should not take salicylates for pain. ASA is a salicylate.

DIF: Cognitive Level: Understanding REF: p. 334

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. Osteoporosis is common in females after menopause. b. Osteoporosis is a degenerative disease characterized by a decrease in bone density. c. The disease is congenital, caused by poor dietary intake of dairy products. d. Osteoporosis can cause pain and injury. e. Passive range of motion can prevent osteoporosis.

3. A patient is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease? (Select all that apply.)

ANS: A, B, D

Osteoporosis is not a congenital disease. While a low intake of calcium is a factor, there are dietary sources of calcium other than dairy products. Passive range of motion cannot prevent osteoporosis.

DIF: Cognitive Level: Understanding REF: pp. 328–329

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. Female sex b. History of joint injuries c. Advancing age d. Drinking one cup of regular coffee a day e. Obesity

4. A nurse is teaching a group of 65- year-old patients about reducing the risk of osteoarthritis. Which of the following would the nurse discuss as a modifiable risk factor for osteoarthritis? (Select all that apply.)

ANS: B, E

Gender and advancing age are nonmodifiable risk factors for osteoarthritis. There is no evidence that coffee or caffeine has any relationship to the development of osteoarthritis.

DIF: Cognitive Level: Understanding REF: pp. 330–331

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation