Degenerative/Herniated Disc Disease
1. The nurse is caring for an elderly client diagnosed with a herniated nucleus pulposus
of
L4-L5. Which scientific rationale explains the incidence of a ruptured disc in the elderly?
1. The client did not use good body mechanics when lifting an object.
2. There is an increased blood supply to the back as the body ages.
3. Older clients develop atherosclerotic joint disease as a result of fat deposits.
4. Clients develop intervertebral disc degeneration as they age.
2. The 34-year-old male client presents to the outpatient clinic complaining of numbness
and pain radiating down the left leg. Which further data would the nurse assess?
1. Posture and gait.
2. Bending and stooping.
3. Leg lifts and arm swing.
4. Waist twists and neck mobility.
3. The occupational health nurse is preparing an in-service for a group of workers in a
warehouse. Which information should be included to help prevent on-the job-injuries?
1. Increase sodium and potassium in the diet during the winter months.
2. Use the large thigh muscles when lifting and hold the weight near the body.
3. Use soft-cushioned chairs when performing desk duties.
4. Have the employee arrange for assistance with household chores.
4. The occupational health nurse is planning health promotion activities for a group of
factory workers. Which activity would be an example of primary prevention for clients
at risk for low back pain?
1. Teach back exercises to workers after returning from an injury.
2. Place signs in the work area about how to perform first aid.
3. Start a weight-reduction group that would meet at lunchtime.
4. Administer a nonnarcotic analgesic to a client complaining of back pain.
5. The client with a cervical neck injury as a result of a motor-vehicle injury is
complaining
of unrelieved pain after administration of a narcotic analgesic. Which alternative
method of pain control would be an independent nursing action?
1. Medicate the client with a muscle relaxant.
2. Heat alternating with ice applied by a physical therapist.
3. Watch television or listen to music.
4. Discuss surgical options with the health-care provider.
,6. The client diagnosed with cervical neck disc degeneration has undergone a
laminectomy.
Which interventions should the nurse implement?
1. Position the client prone with the knees slightly elevated.
2. Assess the client for difficulty speaking or breathing.
3. Measure the drainage in the Jackson-Pratt bulb every day.
4. Encourage the client to postpone the use of narcotic medications.
7. The client is 12-hours post-lumbar laminectomy. Which nursing interventions should
be implemented?
1. Assess ability to void and log roll every two (2) hours.
2. Medicate with IV steroids and keep the bed in a Trendelenburg position.
3. Place sand bags on each side of the head and give cathartic medications.
4. Administer IV anticoagulants and place on O2 at eight (8) L/min.
8. The nurse is working with an unlicensed nursing assistant. Which action by the
assistant
warrants immediate intervention?
1. The assistant feeds a client 2 days postoperative cervical laminectomy a regular diet.
2. The assistant calls for help when turning to the side a client who is post-lumbar
laminectomy.
3. The assistant is helping the client who weighs 300 pounds and diagnosed with back
pain to the chair.
4. The assistant places the call light within reach of the client who had a disc fusion.
378
Musculoskeletal
9. The nurse is caring for clients on an orthopedic floor. Which client should be
assessed
first?
1. The client diagnosed with back pain who is complaining of a “4” on a 1–10 scale.
2. The client who has undergone a myelogram who is complaining of a slight
headache.
3. The client 2 days postop disc fusion that has a T 100.4, P 96, R 24, and BP 138/78.
4. The client diagnosed with back pain who is being discharged and whose ride is here.
10. The nurse is administering 0730 medications to clients on a medical orthopedic unit.
Which medication would be administered first?
1. The daily cardiac glycoside to a client diagnosed with back pain and heart failure.
2. The routine insulin to a client diagnosed with neck strain and Type 1 diabetes.
3. The oral proton pump inhibitor to a client scheduled for a laminectomy this A.M.
, 4. The fourth dose of IV antibiotic for a client diagnosed with a surgical infection.
11. The nurse writes the problem of “pain” for a client diagnosed with lumbar strain.
Which nursing interventions should be included in the plan of care? Select all that
apply.
1. Assess pain on a 1–10 scale.
2. Administer pain medication PRN.
3. Provide a regular bed pan for elimination.
4. Assess surgical dressing every four (4) hours.
5. Perform a position change by the log roll method every two (2) hours.
12. The nurse working on a medical-surgical floor feels a pulling in the back when lifting
a client up in the bed. Which should be the first action taken by the nurse?
1. Continue working until the shift is over and then try to sleep on a heating pad.
2. Go immediately to the emergency department for treatment and muscle relaxants.
3. Inform the charge nurse and nurse manager on duty and document the occurrence.
4. See a private health-care provider on the nurse’s off time but charge the hospital.
Osteoarthritis
13. The occupational health nurse is teaching a class on the risk factors for developing
osteoarthritisoa (OA). Which is a modifiable risk factor for developing OA?
1. Being overweight.
2. Increasing age.
3. Previous joint damage.
4. Genetic susceptibility.
14. The client is diagnosed with osteoarthritis. Which sign/symptom would the nurse
expect the client to exhibit?
1. Severe bone deformity.
2. Joint stiffness.
3. Waddling gait.
4. Swan neck fingers.
15. The client diagnosed with OA is a resident in a long-term care facility. The resident
is
refusing to bathe because she is hurting. Which instruction should the nurse give the
unlicensed nursing assistant?
1. Allow the client to stay in bed until the pain becomes bearable.
2. Tell the assistant to give the client a bed bath this morning.
3. Try to encourage the client to get up and go to the shower.
1. The nurse is caring for an elderly client diagnosed with a herniated nucleus pulposus
of
L4-L5. Which scientific rationale explains the incidence of a ruptured disc in the elderly?
1. The client did not use good body mechanics when lifting an object.
2. There is an increased blood supply to the back as the body ages.
3. Older clients develop atherosclerotic joint disease as a result of fat deposits.
4. Clients develop intervertebral disc degeneration as they age.
2. The 34-year-old male client presents to the outpatient clinic complaining of numbness
and pain radiating down the left leg. Which further data would the nurse assess?
1. Posture and gait.
2. Bending and stooping.
3. Leg lifts and arm swing.
4. Waist twists and neck mobility.
3. The occupational health nurse is preparing an in-service for a group of workers in a
warehouse. Which information should be included to help prevent on-the job-injuries?
1. Increase sodium and potassium in the diet during the winter months.
2. Use the large thigh muscles when lifting and hold the weight near the body.
3. Use soft-cushioned chairs when performing desk duties.
4. Have the employee arrange for assistance with household chores.
4. The occupational health nurse is planning health promotion activities for a group of
factory workers. Which activity would be an example of primary prevention for clients
at risk for low back pain?
1. Teach back exercises to workers after returning from an injury.
2. Place signs in the work area about how to perform first aid.
3. Start a weight-reduction group that would meet at lunchtime.
4. Administer a nonnarcotic analgesic to a client complaining of back pain.
5. The client with a cervical neck injury as a result of a motor-vehicle injury is
complaining
of unrelieved pain after administration of a narcotic analgesic. Which alternative
method of pain control would be an independent nursing action?
1. Medicate the client with a muscle relaxant.
2. Heat alternating with ice applied by a physical therapist.
3. Watch television or listen to music.
4. Discuss surgical options with the health-care provider.
,6. The client diagnosed with cervical neck disc degeneration has undergone a
laminectomy.
Which interventions should the nurse implement?
1. Position the client prone with the knees slightly elevated.
2. Assess the client for difficulty speaking or breathing.
3. Measure the drainage in the Jackson-Pratt bulb every day.
4. Encourage the client to postpone the use of narcotic medications.
7. The client is 12-hours post-lumbar laminectomy. Which nursing interventions should
be implemented?
1. Assess ability to void and log roll every two (2) hours.
2. Medicate with IV steroids and keep the bed in a Trendelenburg position.
3. Place sand bags on each side of the head and give cathartic medications.
4. Administer IV anticoagulants and place on O2 at eight (8) L/min.
8. The nurse is working with an unlicensed nursing assistant. Which action by the
assistant
warrants immediate intervention?
1. The assistant feeds a client 2 days postoperative cervical laminectomy a regular diet.
2. The assistant calls for help when turning to the side a client who is post-lumbar
laminectomy.
3. The assistant is helping the client who weighs 300 pounds and diagnosed with back
pain to the chair.
4. The assistant places the call light within reach of the client who had a disc fusion.
378
Musculoskeletal
9. The nurse is caring for clients on an orthopedic floor. Which client should be
assessed
first?
1. The client diagnosed with back pain who is complaining of a “4” on a 1–10 scale.
2. The client who has undergone a myelogram who is complaining of a slight
headache.
3. The client 2 days postop disc fusion that has a T 100.4, P 96, R 24, and BP 138/78.
4. The client diagnosed with back pain who is being discharged and whose ride is here.
10. The nurse is administering 0730 medications to clients on a medical orthopedic unit.
Which medication would be administered first?
1. The daily cardiac glycoside to a client diagnosed with back pain and heart failure.
2. The routine insulin to a client diagnosed with neck strain and Type 1 diabetes.
3. The oral proton pump inhibitor to a client scheduled for a laminectomy this A.M.
, 4. The fourth dose of IV antibiotic for a client diagnosed with a surgical infection.
11. The nurse writes the problem of “pain” for a client diagnosed with lumbar strain.
Which nursing interventions should be included in the plan of care? Select all that
apply.
1. Assess pain on a 1–10 scale.
2. Administer pain medication PRN.
3. Provide a regular bed pan for elimination.
4. Assess surgical dressing every four (4) hours.
5. Perform a position change by the log roll method every two (2) hours.
12. The nurse working on a medical-surgical floor feels a pulling in the back when lifting
a client up in the bed. Which should be the first action taken by the nurse?
1. Continue working until the shift is over and then try to sleep on a heating pad.
2. Go immediately to the emergency department for treatment and muscle relaxants.
3. Inform the charge nurse and nurse manager on duty and document the occurrence.
4. See a private health-care provider on the nurse’s off time but charge the hospital.
Osteoarthritis
13. The occupational health nurse is teaching a class on the risk factors for developing
osteoarthritisoa (OA). Which is a modifiable risk factor for developing OA?
1. Being overweight.
2. Increasing age.
3. Previous joint damage.
4. Genetic susceptibility.
14. The client is diagnosed with osteoarthritis. Which sign/symptom would the nurse
expect the client to exhibit?
1. Severe bone deformity.
2. Joint stiffness.
3. Waddling gait.
4. Swan neck fingers.
15. The client diagnosed with OA is a resident in a long-term care facility. The resident
is
refusing to bathe because she is hurting. Which instruction should the nurse give the
unlicensed nursing assistant?
1. Allow the client to stay in bed until the pain becomes bearable.
2. Tell the assistant to give the client a bed bath this morning.
3. Try to encourage the client to get up and go to the shower.
