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A 32-year-old patient comes to the clinic complaining of shoulder tenderness, pain, and limited movement. Upon assessment the nurse finds edema. An MRI shows hemorrhage of the rotator cuff tendons and the patient is diagnosed with impingement syndrome. What action should the nurse recommend in order to promote healing?
- A. Support the affected arm on pillows at night.
- B. Take prescribed corticosteroids as ordered.
- C. Put the shoulder through its full range of motion 3 times daily.
- D. Keep the affected arm in a sling for 2 to 4 weeks.
Correct Answer: A
Rationale: The patient should support the affected arm on pillows while sleeping to keep from turning onto the shoulder. Corticosteroids are not commonly prescribed and a sling is not normally necessary. ROM exercises are indicated, but putting the arm through its full ROM may cause damage during the healing process.
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A patient has come to the clinic for a routine annual physical. The nurse practitioner notes a palpable, painless projection of bone at the patient's shoulder. The projection appears to be at the distal end of the humerus. The nurse should suspect the presence of which of the following?
- A. Osteomyelitis
- B. Osteochondroma
- C. Osteomalacia
- D. Paget's disease
Correct Answer: B
Rationale: Osteochondroma is the most common benign bone tumor. It usually occurs as a large projection of bone at the end of long bones (at the knee or shoulder). Osteomyelitis, osteomalacia, and Paget's disease do not involve the development of excess bone tissue.
A patient has been admitted to the medical unit for the treatment of Paget's disease. When reviewing the medication administration record, the nurse should anticipate what medications?
- A. Calcitonin
- B. Bisphosphonates
- C. Alkaline phosphatase
- D. Calcium gluconate
- E. Estrogen
Correct Answer: A,B
Rationale: Bisphosphonates are the cornerstone of Paget therapy in that they stabilize the rapid bone turnover. Calcitonin is also used because it retards bone resorption by decreasing the number and availability of osteoclasts. Alkaline phosphatase is a naturally occurring enzyme, not a drug. Calcium gluconate and estrogen are not used in the treatment of Paget's disease.
A nurse is providing care for a patient who has osteomalacia. What major goal will guide the choice of medical and nursing interventions?
- A. Maintenance of skin integrity
- B. Prevention of bone metastasis
- C. Maintenance of adequate levels of activated vitamin D
- D. Maintenance of adequate parathyroid hormone function
Correct Answer: C
Rationale: The primary defect in osteomalacia is a deficiency of activated vitamin D, which promotes calcium absorption from the gastrointestinal tract and facilitates mineralization of bone. Interventions are aimed at resolving the processes underlying this deficiency. Maintenance of skin integrity is important, but is not the primary goal in care. Osteomalacia is not a malignant process. Overproduction (not underproduction) of PTH can cause the disease.
A nurse is reviewing the pathophysiology that may underlie a patient's decreased bone density. What hormone should the nurse identify as inhibiting bone resorption and promoting bone formation?
- A. Estrogen
- B. Parathyroid hormone (PTH)
- C. Calcitonin
- D. Progesterone
Correct Answer: C
Rationale: Calcitonin inhibits bone resorption and promotes bone formation, estrogen inhibits bone breakdown, and parathyroid increases bone resorption. Estrogen, which inhibits bone breakdown, decreases with aging. Parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. Progesterone is the major naturally occurring human progestogen and plays a role in the female menstrual cycle.
A nursing educator is reviewing the risk factors for osteoporosis with a group of recent graduates. What risk factor of the following should the educator describe?
- A. Recurrent infections and prolonged use of NSAIDs
- B. High alcohol intake and low body mass index
- C. Small frame, female gender, and Caucasian ethnicity
- D. Male gender, diabetes, and high protein intake
Correct Answer: C
Rationale: Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Diabetes, high protein intake, alcohol use, and infections are not among the most salient risk factors for osteoporosis.