Quiz #3 osteoporosis & osteomyelitis (Chapter 41) Type 1 and Type 2 Diabetes and Hypothyroidism (

A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? Skipping insulin doses during illness Failure to monitor blood glucose levels Recent weight gain of 20 lb (9.1 kg) Crying whenever diabetes is mentioned

Crying whenever diabetes is mentioned A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

A provider prescribes a subcutaneous anabolic agent for an older adult client to prevent fractures associated with osteoporosis. What is the most likely prescribed drug? Teriparatide Calcitonin Alendronic acid Raloxifene

Teriparatide Teriparatide (Forteo) is a subcutaneously administered anabolic agent that is taken once daily. The other drug choices are oral preparations.

The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar: Insulin will be released to facilitate the transport of sugar. Glycogenesis will be decreased by the liver. The pancreatic hormone glucagon will stimulate the liver to release stored glucose. The process of gluconeogenesis will be inhibited.

The pancreatic hormone glucagon will stimulate the liver to release stored glucose. When sugar levels are low, glucagon promotes hyperglycemia by stimulating the release of stored glucose. Glycogenolysis and gluconeogenesis will both be increased. Insulin secretion would promote hypoglycemia.

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? "You need to limit the amount of protein and calcium in your diet." "You need to perform weight-bearing exercises twice a week." "You will receive IV antibiotics for 3 to 6 weeks." "Use your continuous passive motion machine for 2 hours each day."

"You will receive IV antibiotics for 3 to 6 weeks." Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks. Continuous passive range of motion is used for clients with osteoarthritis. Weight-bearing exercises are used with clients who have osteoporosis. Limiting protein and calcium is not part of the plan of care for clients with osteomyelitis.

Health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. Select the daily dosage of calcium and vitamin D that the nurse should recommend. 1,400 mg; 1,200 IU 1,200 mg; 1,000 IU 1,600 mg; 1,400 IU 1,800 mg; 1,600 IU

1,200 mg; 1,000 IU The daily recommended dosage is 1,200 mg of calcium and 1,000 IU of vitamin D.

A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? 6 months 3 months 3 to 6 weeks 7 to 10 days

3 to 6 weeks Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for 3 to 6 weeks. Oral antibiotics then follow for as long as 3 months.

Which client would the nurse identify as having the greatest risk for osteoporosis? A 20-year-old male athlete with repeated injuries A small-framed, thin 45-year-old white woman A 40-year-old overweight African American woman A 16-year-old male with a history of asthma

A small-framed, thin 45-year-old white woman Small-framed, thin white women are at greatest risk for osteoporosis. African American women have a greater bone density and thus are less susceptible to osteoporosis. Men have an increased bone mass and do not have hormonal changes, and do not acquire osteoporosis as frequently and get it at a later age. Asthma does not increase the risk for osteoporosis.

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? Decreases risk of developing insulin resistance and hyperglycemia Increases ability for glucose to get into the cell and lowers blood sugar Decreases need for pancreas to produce more cells Creates an overall feeling of well-being and lowers risk of depression

Increases ability for glucose to get into the cell and lowers blood sugar Exercise increases trans membrane glucose transporter levels in the skeletal muscles. This allows the glucose to leave the blood and enter into the cells where it can be used as fuel. Exercise can provide an overall feeling of well-being but is not the primary purpose of including in the daily routine of diabetic clients. Exercise does not stimulate the pancreas to produce more cells. Exercise can promote weight loss and decrease risk of insulin resistance but not the primary reason for adding to daily routine.

Which statement is correct regarding glargine insulin? It cannot be mixed with any other type of insulin. It is given twice daily. Its peak action occurs in 2 to 3 hours. It is absorbed rapidly.

It cannot be mixed with any other type of insulin. Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is no peak in action. It is approved to give once daily.

A client diagnosed with osteoporosis is being discharged home. Which priority education should the nurse should provide? Increase calcium and vitamin D in the diet Remove all small rugs from the home Classify medications Participate in weight-bearing exercises

Remove all small rugs from the home A client with osteoporosis is at risk for fractures related to falls. The home environment needs to be evaluated for safety issues, such as rugs and other objects that could cause a fall. All other education is important in educating the client, but the risk for injury from a fall and potential for a fracture makes safety in the home environment a priority.

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? Sweating, tremors, and tachycardia Dry skin, bradycardia, and somnolence Bradycardia, thirst, and anxiety Polyuria, polydipsia, and polyphagia

Sweating, tremors, and tachycardia Sweating, tremors, and tachycardia, thirst, and anxiety are early signs of hypoglycemia. Dry skin, bradycardia, and somnolence are signs and symptoms associated with hypothyroidism. Polyuria, polydipsia, and polyphagia are signs and symptoms of diabetes mellitus.

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? The recommended daily allowance of calcium may be found in a wide variety of foods. To prevent fractures, the client should avoid strenuous exercise. Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.

The recommended daily allowance of calcium may be found in a wide variety of foods. Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.

The nurse is teaching a postmenopausal client about strategies to prevent the development of osteoporosis. On which topic should the nurse focus as primary prevention for the disorder? taking regular estrogen replacement therapy increasing calcium and vitamin D in the diet participating in cardiovascular exercises regularly maintaining a body mass index of less than 20

increasing calcium and vitamin D in the diet Primary prevention of osteoporosis includes maintaining optimal calcium and vitamin D intake. Although estrogen replacement can reduce the risk for osteoporosis, it can increase the risk for certain cancers and should therefore not be recommended as first-line prevention. Cardiovascular exercise will directly help in the prevention of osteoporosis only if it involves weight-bearing activity, such as walking or jogging. A lower body mass index (weight under 125 pounds for women of average height) is a risk factor for developing osteoporosis rather than preventing it.

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? ketoacidosis hepatic disorder All options are correct. hyperosmolar hyperglycemic nonketotic syndrome

ketoacidosis Kussmaul respirations (fast, deep, labored breathing) are common in ketoacidosis. Acetone, which is volatile, can be detected on the breath by its characteristic fruity odor. If treatment is not initiated, the outcome of ketoacidosis is circulatory collapse, renal shutdown, and death. Ketoacidosis is more common in people with diabetes who no longer produce insulin, such as those with type 1 diabetes. People with type 2 diabetes are more likely to develop hyperosmolar hyperglycemic nonketotic syndrome because with limited insulin, they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level.

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? "I avoid exposure to the sun as much as possible." "I always wear my medical identification bracelet." "I skip lunch when I don't feel hungry." "I always carry hard candy to eat in case my blood sugar level drops."

"I skip lunch when I don't feel hungry." The client requires further teaching if he states that he skips meals. A client who is receiving an oral antidiabetic agent should eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia. Carrying hard candy, avoiding exposure to the sun, and always wearing a medical identification bracelet indicate effective teaching.

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? Bone spurs Decreased height Diarrhea Increased heel pain

Decreased height Clients with osteoporosis become shorter over time.

Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin? Administer the total daily dosage in 2 doses. Draw up the drug first, then add regular insulin. Glargine is rapidly absorbed and has a fast onset of action. Do not mix with other insulins.

Do not mix with other insulins. Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. Glargine is a "peakless" basal insulin that is absorbed very slowly over a 24-hour period and can be given once a day. When administering glargine insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.

The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include? Decrease food intake until nausea passes. Increase frequency of glucose self-monitoring. Take half the usual dose of insulin until symptoms resolve. Do not take insulin if not eating.

Increase frequency of glucose self-monitoring. Minor illnesses such as influenza can present a special challenge to a diabetic client. The body's need for insulin increases during illness. Therefore, the client should take the prescribed insulin dose, increase the frequency of glucose monitoring, and maintain adequate fluid intake to counteract the dehydrating effects of hyperglycemia. Clear liquids and juices are encouraged. Taking less than normal dose of insulin may lead to ketoacidosis.

A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis? Proteus Salmonella Pseudomonas Staphylococcus aureus

Staphylococcus aureus More than 50% of bone infections are caused by Staphylococcus aureus and increasingly of the variety that is methicillin resistant (i.e., methicillin-resistant Staphylococcus aureus [MRSA]) (Miller & Kaplan, 2009). Other pathogens include the gram-positive organisms streptococci and enterococci, followed by gram-negative bacteria, including pseudomonas.

Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: Transport of potassium. Storage of glucose as glycogen in the liver. Synthesis of glucose from noncarbohydrate sources. Release of glucose.

Synthesis of glucose from noncarbohydrate sources. Gluconeogenesis refers to the making of glucose from noncarbohydrates. This occurs mainly in the liver. Its purpose is to maintain the glucose level in the blood to meet the body's demands.

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD? Calcitonin (Miacalcin) Raloxifene (Evista) Vitamin D Teriparatide (Forteo)

Calcitonin (Miacalcin) Calcitonin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Raloxifene reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Teriparatide has been recently approved by the FDA for the treatment of osteoporosis.

Which group is at the greatest risk for osteoporosis? African American women Caucasian women Asian women Men

Caucasian women Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Asian women of slight build are at risk for low peak bone mineral density. African American women, who have a greater bone mass than Caucasian women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.

When an infection is bloodborne, the manifestations include which symptom? Bradycardia Hypothermia Hyperactivity Chills

Chills Manifestations of bloodborne infection include chills, high fever, rapid pulse, and generalized malaise.

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? Altered glucose metabolism Rare ketosis Obesity Presence of autoantibodies against islet cells

Hypoglycemia The nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested.

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? Little relation to prediabetes Less common than type 1 diabetes Onset most common during adolescence Insufficient insulin production

Insufficient insulin production Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults and now accounts for 20% of all newly diagnosed cases. Type 1 diabetes is more likely in childhood and adolescence; although, it can occur at any age. It accounts for approximately 5% to 10% of all diagnosed cases of diabetes. Prediabetes can lead to type 2 diabetes.

A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? Glipizide Repaglinide Glyburide Metformin

Metformin Metformin is a biguanide and, along with the thiazolidinediones (rosiglitazone and pioglitazone), are categorized as insulin sensitizers; they help tissues use available insulin more efficiently. Glyburide and glipizide, which are sulfonylureas, and repaglinide, a meglitinide, are described as being insulin releasers because they stimulate the pancreas to secrete more insulin.

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing? Wound irrigation Vitamin supplements Wound packing Surgical debridement

Surgical debridement In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.

A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about a calcium supplement should the nurse include? Take weekly on the same day and at the same time. Remain in an upright position 30 minutes after taking the supplement. Take the supplement with meals or with orange juice. Take the supplement on an empty stomach with a full glass of water.

Take the supplement with meals or with orange juice. Calcium supplements should be taken with meals or with a beverage high in vitamin C for increased absorption. Calcium supplements are taken daily, not weekly. There are no special instructions about staying upright when taking calcium supplements.

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? Increase fiber in the diet Decrease the intake of vitamin A and D Walk or perform weight-bearing exercises outdoors Reduce stress

Walk or perform weight-bearing exercises outdoors Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine in moderation.

Which is not a risk factor for osteoporosis? family history small-framed, thin White or Asian women being male being postmenopausal

being male Being male is not considered a risk factor. Some of the risk factors for osteoporosis are being a small-framed, thin White or Asian woman; being postmenopausal; family history; inactivity; chronic low calcium intake; and excessive caffeine or tobacco use.

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure? Administering large doses of I.V. antibiotics as ordered Instructing the client to ambulate twice daily Withholding all oral intake Administering large doses of oral antibiotics as ordered

Administering large doses of I.V. antibiotics as ordered Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited.

During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? "After menopause, the body's bone density declines, resulting in a gradual loss of height." "After age 40, height may show a gradual decrease as a result of spinal compression" "There may be some slight discrepancy between the measuring tools used." "The posture begins to stoop after middle age."

"After menopause, the body's bone density declines, resulting in a gradual loss of height." The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? Stopping estrogen therapy Initiating weight-bearing exercise routines Living a sedentary lifestyle to reduce the incidence of injury Taking a 300-mg calcium supplement to meet dietary guidelines

Initiating weight-bearing exercise routines Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.

Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? Acromegaly Myxedemic coma Addison's disease Thyroid storm

Myxedemic coma Severe hypothyroidism is called myxedema and if untreated, it can progress to myxedemic coma, a life-threatening event. Thyroid storm is an acute, life-threatening form of hyperthyroidism. Addison's disease refers to primary adrenal insufficiency. Acromegaly refers to an oversecretion of growth hormone by the pituitary gland during adulthood.

Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? Acute pain related to fracture and muscle spasm Deficient knowledge about osteoporosis and the treatment regimen Risk for constipation related to immobility Risk for injury related to fractures due to osteoporosis

Risk for injury related to fractures due to osteoporosis The most important concern for an elderly patient with osteoporosis is prevention of falls and fractures. Pain and constipation can be managed, and knowledge can be reinforced, but fractures can cause significant morbidity and mortality.

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest? Swimming Walking Bicycling Yoga

Walking Weight-bearing exercises should be incorporated into the client's lifestyle activities. Walking is a low-impact method of weight-bearing exercise and would be the most universal or most likely form of exercise for the nurse to recommend. Bicycling, and swimming are not weight-bearing exercise and will not increase bone density. Yoga may or may not be weight-bearing exercise depending on the yoga poses being performed; it is not as likely as walking to be recommended by the nurse.

The nurse is teaching a client with osteoporosis about optimal dietary choices to reduce the severity of the condition. What instruction should the nurse provide? "Decrease your intake of nuts and seeds." "Decrease your intake of red meat." "Eat more dairy products such as cheese and yogurt." "Eat more fresh fruits and vegetables."

"Eat more dairy products such as cheese and yogurt." Osteoporosis causes a severe, general reduction in skeletal bone mass. To offset this reduction, the client should be advised to increase calcium intake by consuming more dairy products, which provide about 75% of the calcium in the average diet. Changing intake of red meat, nuts, seeds, or fruit would not prevent osteoporosis from worsening.

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." "You may be having undiagnosed infections, causing you to lose extra weight." "Your body is using protein and fat for energy instead of glucose." "I will refer you to a dietician who can help you with your weight."

"Your body is using protein and fat for energy instead of glucose." Persons with type 1 diabetes, particularly those in poor control of the condition, tend to be thin because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Patients may be underweight at the onset of type 1 diabetes because of rapid weight loss from severe hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? Assess the client's breath odor Assess the client's ability to move all extremities Assess the client's ability to take a deep breath Assess for excessive sweating

Assess the client's breath odor DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue, with eventual stupor and coma if not treated. The breath has a characteristic fruity odor due to the presence of ketoacids. Checking the client's breath will help the nurse confirm the diagnosis.

Which clinical manifestation of type 2 diabetes occurs if glucose levels are very high? Oliguria Increased energy Hyperactivity Blurred vision

Blurred vision Blurred vision occurs when blood glucose levels are very high. The other clinical manifestations are not consistent with type 2 diabetes.

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? Loss of estrogen Dowager's hump Bone fracture Negative calcium balance

Bone fracture Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

What food can the nurse suggest to the client at risk for osteoporosis? Bananas Chicken Carrots Broccoli

Broccoli Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium.

A client has been prescribed alendronate for the prevention of osteoporosis. Which is the highest priority nursing intervention associated with the administration of the medication? Ensure adequate intake of vitamin D in the diet Assess for the use of corticosteroids Have the client sit upright for at least 30 minutes following administration Encourage the client to get yearly dental exams

Have the client sit upright for at least 30 minutes following administration While all interventions are appropriate, the highest priority is having the client sit upright for 60 minutes following administration of the medication. This will prevent irritation and potential ulceration of the esophagus. The client should have adequate intake of vitamin D and obtain yearly dental exams. The concurrent use of corticosteroids and alendronate is link to a complication of osteonecrosis.

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client? Blurred vision Polydipsia Polyuria Hypoglycemia

Hypoglycemia The nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. Polyuria, polydipsia, and blurred vision are symptoms of diabetes mellitus.

A group of students are reviewing information about osteoporosis in preparation for a class discussion. The students demonstrate a need for additional review when they state which of the following as a risk factor? Excess caffeine intake Prolonged corticosteroid use Hypothyroidism Prolonged immobility

Hypothyroidism Factors associated with an increased risk for osteoporosis include: family history of osteoporosis, chronic low calcium intake, excessive intake of caffeine, tobacco use, Cushing's syndrome, prolonged use of high doses of corticosteroids, prolonged periods of immobility, hyperthyroidism, hyperparathyroidism, eating disorders, malabsorption syndromes, breast cancer (especially if treated with chemotherapy that suppresses estrogen, excluding Tamoxifen, which may reduce the risk of fractures), renal or liver failure, alcoholism, lactose intolerance, and dietary deficiency of vitamin D and calcium.

A client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings? Avascular necrosis Fat embolism Osteomyelitis Compartment syndrome

Osteomyelitis Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. A client with avascular necrosis does not have fever and chills. Clients with fat emboli will have a rash and breathing complications. A client with compartment syndrome will have numbness, not a fever.

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? Wound packing Wound irrigation Vitamin supplements Surgical debridement

Surgical debridement In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.

The client has just been diagnosed with osteomyelitis. What are possible causes of osteomyelitis? Select all that apply. Vascular insufficiency in clients with diabetes or peripheral vascular disease Progressive osteoporosis Surgical contamination, such as pin sites of skeletal traction Trauma, such as penetrating wounds or compound fractures

Trauma, such as penetrating wounds or compound fractures Vascular insufficiency in clients with diabetes or peripheral vascular disease Surgical contamination, such as pin sites of skeletal traction The following are all causes of osteomyelitis: trauma, such as penetrating wounds or compound fractures; vascular insufficiency in clients with diabetes or peripheral vascular disease; and surgical contamination, such as pin sites of skeletal traction. Osteoporosis is not a cause of osteomyelitis.

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? If two different types of insulin are ordered, they need to be given in separate injections. There is no need to inject air into the bottle of insulin before withdrawing the insulin. When mixing insulin, the NPH insulin is drawn up into the syringe first. When mixing insulin, the regular insulin is drawn up into the syringe first.

When mixing insulin, the regular insulin is drawn up into the syringe first. When rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before being drawn into the syringe. The American Diabetic Association recommends that the regular insulin be drawn up first. The most important issues are that patients (1) are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) do not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.

A client has been diagnosed with osteoporosis after a bone density test and is asking what has caused it. Discussion of risk factors would include: regular exercise, low fat intake, and recurrent trauma to the bones through increased weight-bearing activities excessive sunlight exposure, adequate calcium intake, and lactose intolerance diet deficient in vegetables and fruits, high intake of red meats, and increased alcohol intake heavy smoking, sedentary lifestyle, and high intake of carbonated drinks

heavy smoking, sedentary lifestyle, and high intake of carbonated drinks Osteoporosis has been linked to heavy smoking. A sedentary lifestyle results in more osteoclastic or breakdown activity rather than bone building or osteoblastic activity. Because carbonated drinks tend to have high phosphate levels, the inverse relationship of phosphorus to calcium results in a depletion of calcium. Sunlight exposure for vitamin D and calcium intake all promote bone density. Regular exercise and weight-bearing activities also preserve bone mass. A deficient diet has not been proven to contribute to osteoporosis.