Preview Extract
Chapter 55
1. A 65-year-old female admitted with a fractured hip tells the nurse that she was unaware
that she has osteoporosis. Which of the following is the nurse’s best response to this patient?
1. “Sometimes the first sign of the disorder is a fracture.”
2. “It is rare for someone your age to have the disorder.”
3. “Everyone has it.”
4. “There is no way to prevent the disorder.”
Answer: “Sometimes the first sign of the disorder is a fracture.”
Rationale:
The manifestations of osteoporosis may go undetected because many patients are
asymptomatic. The first sign of the disorder may be a fracture. There are different types of
osteoporosis that occur in postmenopausal women as a natural result of aging. It is not rare
for a 65-year-old female to be diagnosed with the disorder. Not everyone has osteoporosis,
and it can be prevented by sufficient intake of calcium and vitamin D, weight management,
and exercise.
2. A patient recovering from a total hip replacement develops a fever and redness at the
surgical site. Which of the following should the nurse consider first when assessing this
patient?
1. Development of osteomyelitis
2. Subacute osteoporosis
3. Pathological fracture
4. Undiagnosed osteitis deformans
Answer: Development of osteomyelitis
Rationale:
Acute osteomyelitis results from direct trauma or surgery. It is the direct contact of bacteria or
the implanting of bacteria from the outside environment during a surgical procedure.
Symptoms of acute osteomyelitis include fever, edema at the surgical site, warmth, redness,
tenderness, and limited mobility. Subacute osteoporosis is not a clinical disorder. This patient
is not demonstrating signs of a pathological fracture. Osteitis deformans is a chronic disorder
that causes irregular bone breakdown and bone weakness.
3. A 55-year-old female patient with rheumatoid arthritis is diagnosed with osteoporosis. The
nurse realizes this patient might be prescribed which of the following medications to help
with the treatment of this bone disorder?
1. Parathyroid hormone
2. Antihypertensive
3. Cardiac glycoside
4. Vitamins A and E
Answer: Parathyroid hormone
Rationale:
Parathyroid hormone is used to reverse the inhibitory effects of bone formation in secondary
osteoporosis resulting from the use of steroids. Steroids are often used to treat patients with
rheumatoid arthritis. For the patient with rheumatoid arthritis, the medication that will most
likely be prescribed is parathyroid hormone. The other medications listed would not be
indicated in the treatment of osteoporosis.
4. The nurse is planning a community education program on osteoporosis prevention. Which
of the following topics should be included in this program?
Select all that apply.
1. Lifetime adequate intake of calcium and vitamin D
2. Avoidance of cigarette smoking
3. Limiting alcohol intake
4. Higher incidence in both men and women who are obese
5. Lack of hereditary link
Answer: 1. Lifetime adequate intake of calcium and vitamin D
2. Avoidance of cigarette smoking
3. Limiting alcohol intake
Rationale:
Lifetime adequate intake of calcium and vitamin D. One way to prevent the onset of
osteoporosis is to have an adequate intake of calcium and vitamin D throughout the lifetime.
Avoidance of cigarette smoking. Cigarette smoking increases the risk for developing
osteoporosis. Limiting alcohol intake. Excessive use of alcohol increases the risk for
developing osteoporosis. Higher incidence in both men and women who are obese. There is a
higher incidence in small, thin-boned men and women. Lack of hereditary link. There is a
higher incidence in those with a family history of fractures and osteoporosis.
5. A 50-year-old female patient is concerned that she will develop osteoporosis because both
of her maternal aunts have been diagnosed with the disorder. Which of the following would
be indicated for this patient?
1. A DEXA test
2. Daily intake of 2000 mg of calcium
3. Prescription for Actonel
4. Prophylactic nonsteroidal anti-inflammatory medication
Answer: A DEXA test
Rationale:
Assessment of bone mass is the primary measurement for osteoporosis. The bone mineral
density test, or a DEXA test, uses a technique that measures any skeletal site and then
compares bone density values with other values in a reference population of the same age,
race, and gender. For adults, the surgeon general recommends 1000 to 1200 mg of calcium
each day, depending upon the age of the individual. The daily intake of 2000 mg of calcium
might be too much for the patient. Actonel is a medication prescribed for a patient diagnosed
with osteoporosis. There is no need for the patient to be prescribed prophylactic nonsteroidal
anti-inflammatory medication.
6. A patient is being discharged after being treated for a fracture. Which of the following
assessments would ensure safety in the patient’s home environment?
1. Safe walking path and no scatter rugs in the home environment
2. Location of furniture to aid with ambulation
3. Proper functioning of devices used for cooking
4. Presence of small rug in front of bathroom sink to reduce risk of slipping on water
Answer: Safe walking path and no scatter rugs in the home environment
Rationale:
Safety is an important consideration for patients with a history of fractures. The patient’s
home should be assessed for a safe environment that would include safe walking paths and
the absence of scatter rugs that could cause the patient to trip and possibly sustain another
fracture. Furniture should not be in the walking path. The functioning of cooking devices
would be important; however, they would not aid in determining a safe environment to
prevent any future fractures. A small rug in the bathroom in front of the sink would be in the
walking path and could lead to a future fracture.
7. The nurse is assessing an 82-year-old female. Which of the following would be considered
the best preventative action by the patient regarding bone disease and fractures?
1. Daily intake of 1200 mg calcium with vitamin D
2. Limiting scatter rugs in path to the bathroom and bedroom
3. Daily walk to the mailbox at the end of a 10-foot long driveway
4. Limiting smoking to one cigarette each evening with a glass of wine
Answer: Daily intake of 1200 mg calcium with vitamin D
Rationale:
Daily supplementation with calcium and vitamin D reduces the hip fracture rates among
high-risk older people. The patient should be counseled to remove the scatter rugs from her
home to reduce the risk of falling. The patient is probably not engaging in sufficient exercise
each day to promote muscle and bone strength with a daily walk to the mailbox. Alcohol and
smoking are risk factors for the development of osteoporosis.
8. The nurse is providing care to an elderly female patient newly diagnosed with type 2
diabetes. Which of the following should the nurse discuss with this patient to reduce the risk
of falling?
1. Home and ambulation safety
2. Adequate protein and carbohydrate consumption
3. History of strokes
4. History of wrist fractures
Answer: Home and ambulation safety
Rationale:
A female patient with the diagnosis of type 2 diabetes is at an increased risk of falling. The
nurse should discuss home and ambulation safety measures with the patient. Adequate protein
and carbohydrate consumption would be appropriate to discuss with the patient to aid in the
control of diabetes. History of strokes and wrist fractures increases the incidence of falls in
males over the age of 75.
9. A patient with severe back pain from spinal stenosis is prescribed propoxyphene. Which of
the following should be included in the nurse’s instruction for this patient?
1. Ways to reduce the risk of falls and subsequent fractures
2. The need to take this medication on an empty stomach
3. The need to take this medication first thing in the morning with a full glass of water
4. The need to sit or stand for 30 minutes after taking this medication
Answer: Ways to reduce the risk of falls and subsequent fractures
Rationale:
Patients at risk for falls and subsequent fractures include those prescribed opioids, including
propoxyphene-containing pain medication. The nurse should instruct this patient on the ways
to reduce the risk of falls and subsequent fractures. This medication should not be taken on an
empty stomach. This medication does not need to be taken first thing in the morning with a
full glass of water, and the patient does not need to sit or stand for 30 minutes after taking this
medication.
10. The nurse notices that a school-age child stands up from the floor using both hands and
knees to help him achieve a standing position. This finding is an indicator of which of the
following muscular dystrophies?
1. Duchenne
2. Becker
3. Myotonic
4. Lumbar girdle
Answer: Duchenne
Rationale:
In Duchenne muscular dystrophy, weakness begins near the trunk then progresses to the
extremities. By school age, the child has an unsteady gait and needs to use the Gower’s
maneuver to rise up from the floor. This maneuver involves the child getting on hands and
knees, raising the rear end, and then achieving a standing position. Becker muscular
dystrophy does not manifest until the person is in the teen years or young adulthood.
Myotonic muscular dystrophy is the most common adult form of muscular dystrophy.
Lumbar girdle muscular dystrophy affects the pelvis and shoulder area but has no particular
diagnostic indicator.
11. A 60-year-old patient is admitted with significant eye ptosis and progressive coughing and
choking while eating solid foods. The nurse realizes this patient is demonstrating signs of
__________ muscular dystrophy.
1. Oculopharyngeal
2. Duchenne
3. Becker
4. Myotonic
Answer: Oculopharyngeal
Rationale:
Oculopharyngeal muscular dystrophy usually affects people in their 50s or 60s and is
characterized by eyelid weakness and pharyngeal muscle weakness that causes the symptoms
of coughing and choking when eating foods. Duchenne muscular dystrophy is typically
diagnosed in a young child. Becker muscular dystrophy does not usually manifest until the
person is in his teens or young adulthood. Myotonic muscular dystrophy is a multisystem
illness that has additional presenting symptoms that affect the respiratory, gastrointestinal,
and endocrine systems. Half of the people with myotonic muscular dystrophy are usually
diagnosed by age 20, with additional individuals diagnosed by age 50.
12. A college-age female patient tells the nurse that she has trouble at times moving the
muscles of her face to smile or whistle, and her feet feel “weak” but then the symptoms “go
away.” The nurse realizes this patient is describing which of the following types of muscular
dystrophy?
1. Facioscapulohumeral
2. Oculopharyngeal
3. Duchenne
4. Myotonic
Answer: Facioscapulohumeral disease is a rare type of muscular dystrophy that affects the
face, shoulder girdle, and upper arms and is more common in females. Diagnosis is made
according to symptoms of weakness in the eye muscles, facial muscles, and weakness of the
muscles within the hip, foot, and abdomen. The progression of this type of muscular
dystrophy is insidious and has extended periods of time when the disease seems to be
arrested, which is what this patient described to the nurse. Oculopharyngeal muscular
dystrophy affects the eyes and throat, leading to dysphagia for solid food. Duchenne
muscular dystrophy is usually diagnosed in childhood. Myotonic muscular dystrophy usually
affects the respiratory, gastrointestinal, and endocrine systems.
13. The nurse is preparing discharge instructions for a patient diagnosed with hypokalemic
myopathy. Which of the following should be included in these instructions?
1. Information on foods rich in potassium
2. Suggestion on when to take coenzyme Q-10
3. Instructions on when to take prescribed prednisone
4. The need for rest periods between activities
Answer: 1. Information on foods rich in potassium
Rationale:
Hypokalemic myopathy is common in the elderly and is due to a low serum potassium level
caused by long-term diuretic use. The patient should be encouraged to eat foods rich in
potassium as part of the discharge instructions. Coenzyme Q-10 is a supplement used to
manage mitochondrial myopathy. Prednisone is used to treat polymyositis, one type of
inflammatory myopathy. A frequent rest period between activities is not indicated in the
treatment of hypokalemic myopathy.
14. A patient is admitted with a purple rash on her eyelids and a slightly red rash on her face
and neck. The patient tells the nurse that her muscles “hurt” and she fatigues easily. Which of
the following do these findings suggest to the nurse?
1. Dermatomyositis
2. Inclusion body myositis
3. Polymyositis
4. Mitochondrial myopathy
Answer: Dermatomyositis
Rationale:
Dermatomyositis is an autoimmune disease that affects the small blood vessels and capillaries
in muscles. A bluish-purple rash on the eyelids with redness of the face, chest, and neck are
commonly seen. Muscle weakness and fatigue is a gradual process that develops over several
months. Inclusion body myositis occurs primarily in men over age 50 and is characterized by
asymmetrical muscle weakness. Individuals diagnosed with polymyositis may also have a
rash but the primary symptom is weakness in the upper and lower extremities. Symptoms of
mitochondrial myopathy include muscle weakness, exercise intolerance, hearing loss, loss of
balance and coordination, and seizures.
15. A patient diagnosed with a myopathy is at risk for aspiration. Which of the following
should be included in the plan of care for this patient?
1. Instruct the patient to eat small bites of food and chew thoroughly before swallowing.
2. Instruct the patient to avoid solid foods.
3. Instruct the patient to avoid thick liquids.
4. Instruct the patient to consume thin, watery liquids with meals.
Answer: Instruct the patient to eat small bites of food and chew thoroughly before
swallowing.
Rationale:
The patient at risk for aspiration should be instructed to eat small bites of food and chew
thoroughly before swallowing. The patient does not need to avoid solid foods. Thick liquids
are easier to swallow than thin, watery liquids.
16. A patient tells the nurse that he dreads the winter, stating he does not spend much time
outdoors because of the bad weather and he becomes blue and depressed. Then all of his
muscles hurt and he “just is not able to do anything.” The nurse realizes this patient’s
symptoms are worse in the winter due to:
1. A decrease in serotonin.
2. Spending too much time in dry heat.
3. A lack of motivation.
4. Poor diet.
Answer: A decrease in serotonin.
Rationale:
The patient is describing symptoms seen in fibromyalgia. Serotonin, a brain chemical, is low
in patients diagnosed with fibromyalgia, which causes extreme sensitivity to even minor pain.
The nurse has does not have enough information to know if the patient is spending too much
time in dry heat, lacks motivation, or has a poor diet.
17. A patient tells the nurse that she feels fine most days, but when she is expected to attend
functions or do extra work to meet her family’s needs, she becomes extremely tired and achy.
Which of the following does this information suggest to the nurse?
1. The extra responsibilities add stress to the patient, which leads to the feelings of fatigue
and achy muscles.
2. The patient does not eat sufficiently when focusing on her family’s needs.
3. The patient is not getting enough exercise.
4. The patient is depressed.
Answer: The extra responsibilities add stress to the patient, which leads to the feelings of
fatigue and achy muscles.
Rationale:
One theory for the development of fibromyalgia is that it is triggered by stress. The patient
experiences conscious or unconscious tension that causes the muscles to tense, leading to
feeling fatigued and achy. There is not enough information to determine if the patient is
eating sufficiently, has an appropriate exercise level, or if the patient is depressed.
18. A patient tells the nurse that every time she “gets on track” to manage her symptoms of
fibromyalgia, something else happens with an elderly parent and she has to “start all over”
with the management of the symptoms. Which of the following should the nurse discuss with
this patient?
1. Discuss strategies to help with the care of her elderly parent.
2. Explain that missing exercise is not going to exacerbate the symptoms.
3. Suggest she talk with her health care provider about taking Lyrica so the symptoms will go
away.
4. Remind the patient that life cannot be predicted, and caring for an elderly relative must be
a priority.
Answer: Discuss strategies to help with the care of her elderly parent.
Rationale:
Anxiety and depression must be controlled in order to control fibromyalgia. The patient
would benefit from a discussion of strategies to help with the care of her elderly parent. A
steady, continuing exercise regimen is needed to control symptoms, so the nurse should not
suggest that missing exercise is not going to exacerbate the symptoms. Lyrica has helped to
reduce pain and improve sleep in patients who have taken the medication for 6 months;
however, it is uncertain if the medication will make the symptoms disappear in all patients.
Suggesting that her elderly parent’s needs are a priority does not address the patient’s
concern.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
