← Back

Chapter 20: Special Nutritional Considerations for Musculoskeletal and Integumentary Health

Every problem in the chapter beside the book’s answer, a chapter at a time as you scroll.

Chapter 20: Special Nutritional Considerations for Musculoskeletal and Integumentary Health

18 problems · 0 figures

Case Study 20.1.1 §20.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Maria delivers a healthy baby and names him Jose. Maria’s diet was suboptimal during pregnancy because of hyperemesis gravidarum and lack of appetite, and it lacked adequate folic acid, vitamin D, and calcium. Because of her severe vomiting, Maria could not take her prenatal vitamin supplements. Maria has decided that she will breastfeed.

What information might indicate that the baby is at increased risk for musculoskeletal and integumentary issues later in infancy and throughout adulthood?
  1. a.
    The baby will be breastfed.
  2. b.
    The mother did not consume enough whole grains during the pregnancy.
  3. c.
    The mother did not consume many dairy products during the pregnancy.
  4. d.
    The baby is male.

Answer

C. The mother did not consume many dairy products during the pregnancy.
Adequate intake of dairy products helps ensure that enough calcium is consumed, which is necessary to support musculoskeletal and integumentary growth and development in the fetus.

Case Study 20.1.2 §20.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Maria delivers a healthy baby and names him Jose. Maria’s diet was suboptimal during pregnancy because of hyperemesis gravidarum and lack of appetite, and it lacked adequate folic acid, vitamin D, and calcium. Because of her severe vomiting, Maria could not take her prenatal vitamin supplements. Maria has decided that she will breastfeed.

Which body system might be most affected by suboptimal intake of vitamin D and calcium?
  1. a.
    Musculoskeletal
  2. b.
    Neurologic
  3. c.
    Integumentary
  4. d.
    Hematologic

Answer

A. Musculoskeletal
Adequate intake of calcium and vitamin D is essential for developing and maintaining healthy bones and teeth in both the pregnant client and the developing fetus.

Case Study 20.1.3 §20.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Maria’s infant, Jose, is now 6 months old and is still being breastfed.

Which statement by the client indicates that further nursing education is necessary regarding the child’s musculoskeletal health?
  1. a.
    “My baby is now 6 months old and does not need to continue their vitamin D supplement.”
  2. b.
    “My baby will not be walking for some time but putting them in a bouncer seat can help them develop the skill.”
  3. c.
    “I like to provide lots of opportunities for play for my baby, and they love to be on their tummy.”
  4. d.
    “My baby doesn’t have any teeth yet, but I’ll make a dentist appointment as soon as they get them!”

Answer

A. “My baby is now 6 months old and does not need to continue their vitamin D supplement.”
Breastfed infants should continue vitamin D supplementation until they are taking in enough vitamin D–fortified solids or vitamin D–rich foods.

Case Study 20.1.4 §20.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Maria’s infant, Jose, is now 6 months old and is still being breastfed.

The client asks the nurse if the baby needs vitamin D supplementation if the baby is given commercial formula from time to time. How should the nurse respond?
  1. a.
    “You will need to continue vitamin D supplementation until the baby is fully weaned and taking in adequate vitamin D–rich foods regardless of whether or not you are supplementing.”
  2. b.
    “Commercial formula contains adequate vitamin D, so you do not need to give the baby vitamin D on the days you supplement with formula.”
  3. c.
    “Commercial formula does not contain any vitamin D.”
  4. d.
    “You should not supplement your baby with commercial formula and should exclusively breastfeed, as that is what’s best for a growing infant.”

Answer

A. “You will need to continue vitamin D supplementation until the baby is fully weaned and taking in adequate vitamin D–rich foods regardless of whether or not you are supplementing.”
Breastfeeding does not provide an infant with enough vitamin D. To prevent musculoskeletal disorders and to promote healthy skeletal growth, experts recommend that all infants receive vitamin D supplementation.

Case Study 20.1.5 §20.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Jose is now 6 years old and has presented for a yearly checkup. Jose is overweight for their height. The nurse is doing a diet review with Maria, and learns that Jose’s daily diet includes the following:

• Breakfast – toaster pastries

• Lunch – boxed macaroni and cheese, a juice box, and mandarin oranges from a can

• Dinner – chicken nuggets, french fries, and a juice box

Jose does not like to participate in gym class because the activities are “too hard” and prefers to play on a tablet for about 2 hours a day.

Which of the following is the highest priority right now to promote the child’s musculoskeletal health?
  1. a.
    The child should begin exercising twice daily.
  2. b.
    The nurse should teach the mother about components of a healthy diet for children.
  3. c.
    The child should be excused from gym class and referred to a specialist.
  4. d.
    The child should drink whole milk instead of juice boxes with meals.

Answer

B. The nurse should teach the mother about components of a healthy diet for children.
The mother urgently needs to change this child’s diet so that they can achieve a healthy weight. Being overweight places additional strain on a child’s skeletal system putting them at increased risk for injury and may make them reluctant to participate in physical activity.

Case Study 20.1.6 §20.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Jose is now 6 years old and has presented for a yearly checkup. Jose is overweight for their height. The nurse is doing a diet review with Maria, and learns that Jose’s daily diet includes the following:

• Breakfast – toaster pastries

• Lunch – boxed macaroni and cheese, a juice box, and mandarin oranges from a can

• Dinner – chicken nuggets, french fries, and a juice box

Jose does not like to participate in gym class because the activities are “too hard” and prefers to play on a tablet for about 2 hours a day.

The mother asks the nurse to recommend foods that promote healthy bone development. Which of the following foods would be the best choice?
  1. a.
    Brown rice
  2. b.
    Legumes
  3. c.
    Red meats
  4. d.
    Spinach

Answer

D. Spinach
Leafy green vegetables are a good source of calcium, which promotes healthy bone development in the growing child.

Case Study 20.2.7 §20.2 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up from Case Study Parts A, B, and C.

Time flies! Jose is now 74 years old and has a pressure injury. Read through the following summary of Jose’s visit to the wound clinic.

Which of the following interventions would promote a healthy integumentary system and better wound-healing outcomes?
  1. a.
    Taking prescribed oral nutritional supplements
  2. b.
    Repeating the MNA screening at regular intervals
  3. c.
    Switching from skim milk to 2% milk
  4. d.
    Eating less red meat
Table 20.8 in the book ↗
Vital Signs Nurse’s Note
Temperature: 98.6° F

• 74-year-old presents for initial visit and evaluation of stage 2 pressure ulcer on right hip. Reports that wound has been present for 4 months, that it causes severe pain, and that it started when bedbound due to a right knee replacement in December. Over the past 4 months, reports occasional sadness due to loss of mobility. Is able to transfer from bed to chair but cannot leave the house like they used to. Experiencing a decrease in appetite recently because they can no longer cook for themselves and don’t like the frozen meals their daughter buys. Estimates they have lost approximately 10 pounds in the last 4 months.
Blood pressure: 122/68 mm Hg
Heart rate: 80 beats/min
Respiratory rate: 14 breaths/min
Pain: 6/10 in right hip decubitus
BMI: 18.5
Calf circumference: 29 cm

Answer

A. Taking prescribed oral nutritional supplements
Oral nutritional supplements with added protein and amino acids are recommended for clients with delayed wound healing due to malnutrition.

Case Study 20.2.8 §20.2 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up from Case Study Parts A, B, and C.

Time flies! Jose is now 74 years old and has a pressure injury. Read through the following summary of Jose’s visit to the wound clinic.

The nurse is preparing to complete the Mini Nutrition Assessment (MNA) for the client. Which of the following is a potential classification based on the results?
  1. a.
    Obese
  2. b.
    Underweight
  3. c.
    Overweight
  4. d.
    Malnourished
Table 20.8 in the book ↗
Vital Signs Nurse’s Note
Temperature: 98.6° F

• 74-year-old presents for initial visit and evaluation of stage 2 pressure ulcer on right hip. Reports that wound has been present for 4 months, that it causes severe pain, and that it started when bedbound due to a right knee replacement in December. Over the past 4 months, reports occasional sadness due to loss of mobility. Is able to transfer from bed to chair but cannot leave the house like they used to. Experiencing a decrease in appetite recently because they can no longer cook for themselves and don’t like the frozen meals their daughter buys. Estimates they have lost approximately 10 pounds in the last 4 months.
Blood pressure: 122/68 mm Hg
Heart rate: 80 beats/min
Respiratory rate: 14 breaths/min
Pain: 6/10 in right hip decubitus
BMI: 18.5
Calf circumference: 29 cm

Answer

D. Malnourished
Based on the findings, the MNA classifies individuals as either well-nourished, at risk for malnutrition, or malnourished.

20-1 §20.RQ source ↗

The nurse is educating a client about the FRAX assessment. Which statement by the client indicates the need for further teaching?
  1. a.
    “The FRAX will tell my doctor if I have osteoporosis.”
  2. b.
    “The FRAX will tell my doctor if I’m at risk for a fracture.”
  3. c.
    “The results of the FRAX will help the nurse develop my plan of care.”
  4. d.
    “The FRAX is a risk assessment for osteoporosis.”

Answer

A. “The FRAX will tell my doctor if I have osteoporosis.”
The FRAX does not diagnose osteoporosis, but it can estimate a person’s risk for a bone fracture within 10 years. This information can help the nurse and client plan care and implement strategies to help mitigate risks in the home and other environments.

20-2 §20.RQ source ↗

The nurse is reviewing a client’s chart and notes their current medications. Which classification of medication increases the client’s risk for fracture?
  1. a.
    Antibiotics
  2. b.
    Antidepressants
  3. c.
    NSAIDs
  4. d.
    Corticosteroids

Answer

D. Corticosteroids
Corticosteroids, as well as antacids, proton pump inhibitors, anticonvulsants, and loop diuretics, can affect bone health with long-term use.

20-3 §20.RQ source ↗

The nurse is teaching ways to promote healthy teeth in children. Which of the following practices is recommended for children?
  1. a.
    Brush teeth once a day in the morning.
  2. b.
    Introduce fluoride toothpaste at 3 years of age.
  3. c.
    Brush teeth with a fluoride toothpaste.
  4. d.
    Schedule the first dental visit at 1 year of age.

Answer

C. Brush teeth with a fluoride toothpaste.
Starting in infancy, parents should brush their children’s teeth at least twice a day with a fluoride toothpaste according to their dentist’s recommendations. The first dental visit should occur no later than the eruption of the first tooth, which happens well before 1 year of age in most children.

20-4 §20.RQ source ↗

The nurse is evaluating a client with PUPPP at a postpartum appointment. The client reports being very itchy. Which objective data support the diagnosis of PUPPP?
  1. a.
    Flat lesions in the vaginal area
  2. b.
    No visible rash, but the client reports itchy skin
  3. c.
    Silvery-white lines on the breasts
  4. d.
    Raised hives on the torso

Answer

D. Raised hives on the torso
Pruritic urticarial papules and plaques of pregnancy (PUPPP) is characterized by itchy, red, raised bumps and hives that most commonly appear on the abdomen, thighs, buttocks, and arms.

20-5 §20.RQ source ↗

The nurse is caring for an adolescent client who participates in sports after school 4 or 5 times a week for 2–4 hours. The adolescent reports fatigue and sore muscles. What should the nurse suggest to this client?
  1. a.
    “Drink a soda to increase your energy level after exercise.”
  2. b.
    “Don’t exercise until your symptoms go away.”
  3. c.
    “Try to eat a combination of protein and complex carbohydrates.”
  4. d.
    “Avoid whole grains, fruits, legumes, and vegetables.”

Answer

C. “Try to eat a combination of protein and complex carbohydrates.”
Adolescent athletes have increased nutritional needs and should consume adequate amounts of complex carbohydrates, proteins, and fats while avoiding processed sugars.

20-6 §20.RQ source ↗

The nurse is caring for a client with newly diagnosed osteoporosis who was prescribed bisphosphonate. Which of the following should the nurse teach the client to avoid eating after taking the medication because it can interfere with the medication’s absorption?
  1. a.
    Coffee
  2. b.
    Oranges
  3. c.
    Milk
  4. d.
    Grapefruit

Answer

C. Milk
Food, especially calcium-rich foods, can interfere with the absorption of bisphosphonates.

20-7 §20.RQ source ↗

The nurse is caring for a pregnant client who lives in a higher latitude part of the country that receives less direct sunlight. Which laboratory value should the nurse expect the health care provider to be monitoring as a priority of care with this client?
  1. a.
    Albumin level
  2. b.
    Calcium level
  3. c.
    Magnesium level
  4. d.
    Vitamin D level

Answer

D. Vitamin D level
There is a correlation between low maternal vitamin D and osteopenia in newborns and decreased bone density in childhood. Consequently, it is important to monitor vitamin D levels in the pregnant client.

20-8 §20.RQ source ↗

The nurse is caring for a menopausal client who had a FRAX assessment that indicated a high risk for fracture in the next 10 years. What should the nurse encourage the client to do now to help mitigate this risk?
  1. a.
    Ask their health care provider to prescribe an estrogen supplement.
  2. b.
    Ask their health care provider to check their calcium and vitamin D levels.
  3. c.
    Include extra protein in their diet.
  4. d.
    Get daily weight-bearing exercise such as walking.

Answer

D. Get daily weight-bearing exercise such as walking.
Weight-bearing exercise and maintenance of a healthy weight help prevent age-related osteoporotic changes in menopausal individuals.

20-9 §20.RQ source ↗

The nurse is caring for an older adult client and recognizes which musculoskeletal manifestation is most likely to benefit from increasing leucine consumption?
  1. a.
    Osteomyelitis
  2. b.
    Sarcopenia
  3. c.
    Fractures
  4. d.
    Osteopenia

Answer

B. Sarcopenia
Older adults with sarcopenia, or low muscle mass, should incorporate leucine-rich foods to stimulate muscle synthesis.

20-10 §20.RQ source ↗

The nurse is caring for a preterm newborn born at 28 weeks’ gestation. Which musculoskeletal manifestation is most likely to be observed in this infant?
  1. a.
    Osteoporosis
  2. b.
    Osteopenia
  3. c.
    Hip dysplasia
  4. d.
    Club foot

Answer

B. Osteopenia
Osteopenia may be present in an infant born before 30 weeks’ gestation because the majority of calcium uptake occurs during the third trimester of fetal life.

End of the book.

Problems and answers are adapted from Nutrition for Nurses by Emerald Charity Bilbrew, Jody Vogelzang and Kelli Whittington, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/nutrition/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.