Nokea
The nurse is assessing a new patient in the clinic. Which of the following information about the patient's medications should be of most concern?
- A. The patient takes a daily multivitamin and calcium supplement.
- B. The patient has migraine headaches that are treated with nonsteroidal anti-inflammatory drugs (NSAIDs).
- C. The patient has severe asthma and requires frequent therapy with oral steroids.
- D. The patient takes hormone replacement therapy (HRT) to prevent 'hot flashes.'
Correct Answer: C
Rationale: Corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. The use of HRT and calcium supplements will help prevent osteoporosis. NSAID use does not increase the risk for musculoskeletal problems.
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The nurse is caring for a patient who has a new prescription for magnetic resonance imaging (MRI) to evaluate for right femur osteomyelitis. Which of the following patient information indicates that the nurse should consult with the health care provider before scheduling the MRI?
- A. The patient has a pacemaker.
- B. The patient is claustrophobic.
- C. The patient wears a hearing aid.
- D. The patient is allergic to shellfish.
Correct Answer: A
Rationale: Patients with permanent pacemakers cannot have MRI because of the force exerted by the magnetic field on metal objects. An open MRI will not cause claustrophobia. The patient will need to be instructed to remove the hearing aid before the MRI, but this does not require consultation with the health care provider. Since contrast medium will not be used, shellfish allergy is not a contraindication to MRI.
The nurse is assessing a patient in the clinic who has knee pain following an arthroscopic procedure 7 days previously and has just had an arthrocentesis. Which of the following findings should be of most concern to the nurse?
- A. Scant thin fluid
- B. Sanguinous fluid
- C. Straw-coloured fluid
- D. Purulent appearing fluid
Correct Answer: D
Rationale: The presence of purulent fluid suggests a possible joint infection. Bloody fluid might be expected after an arthroscopic procedure. Normal synovial fluid is scant in amount and straw-coloured.
The nurse is assessing an older female patient and notes that the patient has lost 2 cm in height since the previous visit 2 years ago. Which of the following diagnostic tests should the nurse include in the teaching plan?
- A. Discography studies
- B. Myelographic testing
- C. Magnetic resonance imaging (MRI)
- D. Dual-energy x-ray absorptiometry (DEXA)
Correct Answer: D
Rationale: The decreased height and the patient's age suggest that the patient may have osteoporosis and that bone density testing is needed. Discography, MRI, and myelography are typically done for patients with current symptoms caused by musculoskeletal dysfunction and are not the initial diagnostic tests for osteoporosis.
Which of the following information in a female, older-adult patient's health history will alert the nurse to the need for a more focused assessment of the musculoskeletal system?
- A. The patient experienced a sprained ankle at age 13.
- B. The patient's mother became much shorter with aging.
- C. The patient's father died of complications of military tuberculosis.
- D. The patient reports taking ibuprofen for occasional headaches.
Correct Answer: B
Rationale: A family history of height loss with aging may indicate osteoporosis, and the nurse should perform a more thorough assessment of the patient's current height and other risk factors for osteoporosis. A sprained ankle during adolescence does not place the patient at increased current risk for musculoskeletal problems. A family history of tuberculosis is not a risk factor. Occasional nonsteroidal anti-inflammatory drug (NSAID) use does not indicate any increased musculoskeletal risk.
The nurse obtains this information when assessing an older-adult patient in the outpatient clinic. Which of the following findings is of highest priority when the nurse is planning care for the patient?
- A. Symmetrical joint swelling of fingers
- B. Decreased right knee range of motion
- C. History of recent loss of balance and fall
- D. Complaint of left hip aching when jogging
Correct Answer: C
Rationale: A history of falls requires further assessment and development of fall prevention strategies. The other changes are more typical of bone and joint changes associated with normal aging.