Musculoskeletal
A nurse is caring for a patient who has undergone internal fixation surgery for fracture of the tibial shaft. The patient is on opioid drugs postsurgery to relieve postsurgical pain. On observation, the nurse finds that the patient's respiratory rate is 7 breaths per minute and the patient looks extremely drowsy. Which actions should the nurse take to prevent respiratory failure in this patient? Select all that apply. Administer oxygen to the patient. Make attempts to arouse the patient. Obtain a prescription to discontinue opioid medications. Obtain a prescription to reduce the dosage of opioid medications. Obtain a prescription to administer nonsteroidal antiinflammatory drugs (NSAIDs) instead of opioids.
Administer oxygen to the patient. Make attempts to arouse the patient. Obtain a prescription to reduce the dosage of opioid medications. Respiratory failure is a life-threatening complication associated with opioid overdose. If the patient appears drowsy and the respiratory rate is falling, the nurse should try to keep the patient awake. Oxygen should be administered to prevent hypoxia and hypoxemia. The dose of the opioid medication should be reduced to prevent any further worsening of the patient's condition. The patient has had surgery and strong pain medications are required to relieve postsurgical pain, so administration of opioids cannot be discontinued. Nonsteroidal antiinflammatory drugs (NSAIDs) are not sufficient to relieve postsurgical pain.
Which approaches does interprofessional care for the patient diagnosed with osteoarthritis (OA) include? Select all that apply. Managing pain Curing osteoarthritis Prevention of disability Managing inflammation Improving joint function Reviewing diagnostic labs
Managing pain Prevention of disability Managing inflammation Improving joint function Interprofessional care for the patient diagnosed with osteoarthritis focuses on prevention of disability, managing inflammation, improving joint function, and managing pain. Osteoarthritis cannot be cured, and laboratory tests or biomarkers cannot be used to diagnose osteoarthritis.
A nurse is educating a patient with a history of gout. What are the factors the nurse should discuss with the patient that may precipitate gout? Select all that apply. Starvation Blueberries Niacin administration Aspirin administration Peanut butter and nuts
Starvation Niacin administration Aspirin administration Patients having a history of gout should be informed that it may be precipitated by factors like excessive caloric intake or overindulgence in purine-containing foods and alcohol, starvation, and drug use (e.g., niacin, aspirin, and diuretics). Starvation may precipitate a gout attack. The low-fluid intake during starvation can result in low-urine output; the uric acid may not be excreted completely, causing it to crystallize and get despoiled in the joints. Niacin and aspirin decrease the excretion of uric acid through the kidneys, causing hyperuricemia. Blueberries, peanut butter, and nuts do not trigger gout attacks, because these foods are low in purine content.
A patient with osteomyelitis in the left femur has been receiving gentamicin therapy for two weeks. During a follow up visit, which patient statement indicates that the treatment should be discontinued? "I don't have a fever now." "I have severe pain in my left leg." "I have a ringing sensation in my ear." "The pus from the wound has stopped draining."
"I have a ringing sensation in my ear." A ringing sensation in the ear indicates ototoxicity due to the gentamicin. The treatment should be stopped to prevent worsening of the complication. Absence of fever may indicate that the infection has been reduced, but treatment should not be stopped. Severe pain in the leg is a manifestation of osteomyelitis and does not indicate that the treatment should be stopped. Absence of pus indicates effectiveness of treatment, but does not mean that the treatment should be stopped.
The nurse has taught a patient who was admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse determines that additional teaching is necessary when the patient makes which statement? "Taking a hot bath every day will help with my circulation." "I should avoid walking barefoot at all times." "I should look at the condition of my feet every day." "I need a podiatrist to treat my ingrown toenails."
"Taking a hot bath every day will help with my circulation." Hot water may injure tissue related to decreased sensation and should be avoided. Patients with diabetes mellitus should inspect the feet daily for broken areas that are at risk for delayed wound healing, avoid walking barefoot, and have a podiatrist for foot care.
The nurse knows the risk of bone fractures increases for women as they age. Bone density tests are recommended for all women over which age? 45 50 55 65
65 Bone density tests are recommended for all women over age 65. Women under 65 are recommended to have bone density tests only if they have risk factors like low body weight, smoking, and a history of fracture.
Which patients should the nurse assess for signs and symptoms of osteomyelitis? Select all that apply. A 60-year-old diabetic who has a blunt injury A 14-year-old old boy who sustained an ankle sprain A 50-year-old man who underwent a total hip replacement A 20-year-old woman with a closed fracture of the humerus A 30-year-old man with a tibia fracture and a deep wound over it
A 60-year-old diabetic who has a blunt injury A 50-year-old man who underwent a total hip replacement A 30-year-old man with a tibia fracture and a deep wound over it Osteomyelitis is the infection of the bone, its marrow, and the soft tissues surrounding it. The 60-year-old patient with diabetes mellitus will have vascular insufficiency and a suboptimal immune system, facilitating the spread of microorganisms, and resulting in osteomyelitis. The 50-year-old man who underwent a total hip replacement can be a potential source of infection. An open fracture with a deep wound may facilitate an easy access for microorganisms to get to the bone, resulting in osteomyelitis. The 14-year old boy who sustained an ankle sprain would not develop osteomyelitis due to having a good immune system and an injury limited to soft tissues. The 20-year-old woman with a closed fracture of the humerus may not develop osteomyelitis due to the closed nature of the injury. pg 1497-1498
The nurse determines that dietary teaching for a patient with osteoporosis has been successful when the patient selects which highest calcium meal? Chicken stir-fry with 1 cup each onions and green peas, and 1 cup of steamed rice Ham and Swiss cheese sandwich on whole wheat bread, steamed broccoli, and an apple A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk A two-egg omelet with 2 oz of American cheese, one slice of whole wheat toast, and a half grapefruit
A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk The highest calcium content is present in the lunch containing milk and milk products (yogurt) and small fish with bones (sardines). Chicken, onions, green peas, rice, ham, whole wheat bread, broccoli, apple, eggs, and grapefruit each have less than 75 mg of calcium per 100 g of food. Swiss cheese and American cheese have more calcium, but not as much as the sardines, yogurt, and milk.
The nurse is educating a patient about the prevention of osteoarthritis. What information would be most beneficial for the nurse to discuss with the patient? Select all that apply. Avoiding alcohol Avoiding smoking Avoiding heavy lifting Maintaining a healthy weight Promptly treating any joint injury Sliding objects rather than lifting them
Avoiding smoking Maintaining a healthy weight Promptly treating any joint injury Maintaining a healthy weight, avoiding smoking, and promptly treating any joint injuries are all measures the patient can take to prevent osteoarthritis. Avoiding alcohol, avoiding heavy lifting, and sliding objects rather than lifting them are measures that may be recommended to some patients with risk potential for other diseases, but they do not help prevent osteoarthritis.
A patient with osteoporosis has been on bed rest for one month after a complicated surgery. What is the patient at risk for after returning to daily activities? Pneumonia Depression Bone fracture Pressure ulcer
Bone fracture The patient is at risk for bone fractures due to immobility after prolonged bed rest. Pneumonia, pressure ulcers, and depression are problems associated with continued bed rest; they are not risks for after the patient has returned to daily activities.
A patient has been taking bisphosphonates for the treatment of osteoporosis and has demonstrated a low tolerance to the drug. What alternative medication does the nurse anticipate will be prescribe? Calcitonin Corticosteroids Cholestyramine Divalproex sodium
Calcitonin Calcitonin is recommended for patients who are unable to tolerate bisphosphonates. Patients on corticosteroids are put on bisphosphonates because long-term corticosteroid use to osteoporosis and hence it cannot be alternative. Cholestyramine is known for the risks associated with osteomalacia. Divalproex sodium does not contain a bisphosphonate compound. pg 1513
The nurse recommends taking calcium supplements to a patient with osteoporosis. Which supplement does the nurse recommend? Calcium lactate Calcium citrate Calcium gluconate Calcium carbonate
Calcium carbonate Calcium carbonate has the highest percentage of elemental calcium (40%). Calcium citrate contains only 20% elemental calcium. Calcium gluconate and calcium lactate do not contain elemental calcium. pg 1512
A patient is suspected of having fat embolism syndrome (FES) following a traumatic femur fracture. Which assessment data gathered by the nurse supports this suspicion? Select all that apply. Increased hematocrit Chest pain Mental status changes Petechiae on the anterior chest wall Increased partial pressure of arterial oxygen
Chest pain Mental status changes Petechiae on the anterior chest wall FES is characterized by a classic triad of symptoms, including respiratory changes such as chest pain, dyspnea and cyanosis; mental status changes including restlessness, confusion, and memory loss; and skin changes including petechiae of the neck, anterior chest wall, buccal mucosa, and conjunctiva. In FES, the partial pressure of arterial oxygen (PaO 2) and hematocrit would be decreased, not increased. pg 1480
The nurse reviews the medication profile of a patient who is being treated for osteomyelitis and determines that the patient is at risk of tendon rupture. The nurse makes this determination based on what medication that the patient is taking? Cefazolin Neomycin Tobramycin Ciprofloxacin
Ciprofloxacin Fluoroquinolones, such as ciprofloxacin, decrease collagen synthesis and increase the risk of muscle weakness and tendon damage upon prolonged use. Cefazolin is a cephalosporin antibiotic that may cause hives, mouthy sores, and watery diarrhea. Neomycin and tobramycin are aminoglycosides, which may cause nephrotoxicity in patients, but they do not decrease collagen synthesis. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. pg 1499
Which are characteristics specific to rheumatoid arthritis (RA)? Select all that apply. Common effusions Overweight patient Young to middle-age onset Stiffness lasting an hour to all day Localized disease with a variable progressive course Synovial fluid white blood cell (WBC) count less than 2,000/µL
Common effusions Young to middle-age onset Stiffness lasting an hour to all day The onset of RA occurs in a young to middle-aged patients. Effusions are common, and stiffness can last an hour to all day. The WBC count in the synovial fluid is 5,000-60,000/µL in a patient with RA. Weight loss or maintained weight occurs with RA. RA is a systemic disease with exacerbations and remissions.
A patient with osteoporosis has a history of multiple fractures. Which prescription should the nurse question the health care provider about that is contraindicated in this patient? Calcitonin Raloxifene Corticosteroids Bisphosphonates
Corticosteroids Corticosteroids should be used with extreme caution in patients with osteoporosis. Calcitonin therapy is advised in patients who have low tolerance for bisphosphonates drugs. Raloxifene is a selective estrogen receptor modulator (SERM) that decreases the risk of breast cancer in a menopausal patient with osteoporosis. Treatment with bisphosphonates is considered for patients who are already being treated with corticosteroids. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.
A patient has osteoarthritis of the knees. What finding would the nurse assess on examination of the patient's knees? Reddened, swollen affected joints Stiffness that is worse in the morning Swan-neck deformity in affected joints Crepitus upon movement of knee joints
Crepitus upon movement of knee joints Osteoarthritis is characterized predominantly by joint pain and crepitus on movement. Stiffness worse in the morning, swollen joints, and swan neck deformity are consistent with rheumatoid arthritis.
Which assessment finding would alert the nurse to the presence of osteoarthritis in a patient admitted to the hospital after a fall? Swan neck deformities A measurable loss of height Crepitus with knee movement Joint stiffness that is worse in the morning
Crepitus with knee movement Crepitus over joints is suggestive of osteoarthritis. A gradual but measurable loss of height and the development of kyphosis, or "dowager's hump," is indicative of the presence of osteoporosis; a swan neck deformity and stiffness that is worse in the morning occur with rheumatoid arthritis. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of this text over an extended period of time ensures your understanding of the mechanics of the examination and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success.
A patient is treated with glucosamine and chondroitin for the treatment of rheumatoid arthritis. What care should be exercised with the use of these medications? Select all that apply. Do not use with warfarin. Use in asthmatic patients with caution. Do not use in patients allergic to shellfish. Monitor the blood glucose of diabetic patients. Discontinue use immediately if effect is not seen.
Do not use with warfarin. Use in asthmatic patients with caution. Monitor the blood glucose of diabetic patients. Both glucosamine and chondroitin can be suggested to patients who are unable to take celecoxib or other NSAIDs to provide some relief for moderate to severe arthritic pain but not for mild arthritic pain. They have been found to increase the blot-clotting effect of warfarin, thereby increasing the risk of bleeding. Not much data is available about the safety of these drugs for asthmatic patients, and careful administration is advised. Glucosamine is found to raise the blood glucose level, and monitoring glucose levels is desirable. Although glucosamine is obtained from shells of crabs and lobsters, it is considered safe for patients allergic to shellfish. The drug should be used consistently over 90 to 120 days to get the desired effect; the drug should not be discontinued immediately if no effect is seen.
The community health nurse is teaching a group of adults about prevention of osteoarthritis (OA). What important teaching points should the nurse include? Select all that apply. Eat a balanced diet. Avoid cigarette smoking. Maintain a healthy weight. Take a low-dose aspirin daily. Consume a diet high in carbohydrates.
Eat a balanced diet. Avoid cigarette smoking. Maintain a healthy weight. Prevention measures for OA include eating a balanced diet, avoiding cigarette smoking, and maintaining a healthy weight. Taking daily low-dose aspirin may be effective for preventing cardiac disease, but it does not prevent osteoarthritis. Consuming a diet high in carbohydrates will not prevent OA and may result in excess weight gain, which places more stress on body joints.
A patient having an open reduction internal fixation (ORIF) of a left lower leg fracture will receive regional anesthesia during the procedure. Because the patient is prepared in the operating room, what should the nurse implement to maintain patient safety during surgery that is related directly to the type of anesthesia being used? Apply grounding pad to unaffected leg. Assess peripheral pulses and skin color. Verify the last oral intake before surgery. Ensure a smooth surface under the patient.
Ensure a smooth surface under the patient. Regional anesthesia decreases sensation to the anesthetized area without impairing the level of consciousness, which means the affected leg will have a decrease in sensation while the anesthetic is effective. A double tourniquet on the affected leg is used to restrict blood flow. This increases the patient's risk of impaired skin integrity because the patient has a decrease in sensation and cannot identify discomfort or foreign objects and will not be moving during surgery. The nurse's role includes positioning the patient for correct alignment, exposure of the surgical site, and preventing injury. Applying a grounding pad to the unaffected leg, assessing peripheral pulses and skin color, and verifying the last oral intake before surgery will be occurring but are not related directly to the regional anesthesia.
The nurse is reinforcing health teaching about osteoporosis with a patient admitted to the hospital. In reviewing this disorder, what should the nurse explain to the patient? Estrogen therapy must be maintained to prevent rapid progression of the osteoporosis. With a family history of osteoporosis, there is no way to prevent or slow bone resorption. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise. The rate of progression of osteoporosis can be slowed if the patient takes calcium supplements or foods high in calcium, and engages in regular weight-bearing exercise. Even if the patient has a family history of osteoporosis, there are methods to prevent and slow bone resorption. Corticosteroids interfere with bone metabolism and would not be effective. Estrogen therapy is no longer used to prevent osteoporosis, because of the associated increased risk of heart disease and breast and uterine cancer.
A nurse is caring for a patient with a fractured femur. The health care provider finds that the patient has fat embolism syndrome. What treatment (or treatments) of fat embolism syndrome should the nurse anticipate for this patient? Select all that apply. Fluid resuscitation Correction of acidosis Avoidance of coughing Fracture immobilization Frequent change in positions
Fluid resuscitation Correction of acidosis Fracture immobilization The treatment of fat embolism syndrome is directed toward the management of symptoms. This includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and fracture immobilization. The patient should be encouraged to cough and perform deep breathing. The patient should be repositioned as little as possible to prevent dislodgment of fat droplets into the general circulation.
The nurse is performing an assessment for a patient with osteoarthritis (OA). When observing small nodules on the distal interphalangeal joints of the fingers, how does the nurse document these nodules? Lymph nodes Bouchard's nodes Heberden's nodes Non-Hodgkin's lymphoma
Heberden's nodes Patients with OA may develop small hard, round nodules on the distal interphalangeal joints (near the tips of the fingers or toes) called Herberden's nodes. Lymph nodes are found throughout the body and play a role in the body's immune response. Bouchard's nodes occur with OA at the proximal interphalangeal joints. Non-Hodgkin's lymphoma is a cancer that begins in lymph cells.
An older adult patient presents to the clinic reporting joint pain. The nurse reviews the patient's medical record and discovers which risk factors for osteoarthritis (OA)? Select all that apply. Daily intake of multivitamins History of fractured right ankle Participates in yoga three times weekly Played football in high school and college
History of fractured right ankle Played football in high school and college Frequent exacerbations of chronic obstructive pulmonary disease (COPD) with steroid use OA is a rheumatoid disease affecting many patients. More than half of patients aged 65 years and older have evidence of OA on x-ray reports. Risk factors for the development of OA include advancing age, history of bone or joint trauma (e.g., the patient's fractured ankle), repetitive activities causing mechanical stress on joints (e.g., playing football in high school and college), and side effects of some medications, such as the steroids this patient takes for COPD. Taking multivitamins and participating in yoga are not risk factors for OA.
The nurse is planning the discharge teaching for a patient with rheumatoid arthritis. Which alternative therapies should the nurse suggest? Select all that apply. Hypnosis Aerobic exercises Use of a firm mattress Vigorous range-of-motion exercises Transcutaneous electrical nerve stimulation
Hypnosis Use of a firm mattress Transcutaneous electrical nerve stimulation The pain involved in rheumatoid arthritis poses a lot of distress in the patient. Hypnosis helps in reducing the psychologic stress along with relaxing the mind and body. Using a firm mattress helps in maintaining the proper body alignment and reduces the risk of stiffness. Transcutaneous electrical nerve stimulation helps in maintaining the functionality of the nerves. Aerobic and vigorous range-of-motion exercises should not be done because of the increased risk of joint injury, pain, and inflammation. A rheumatic collaborative care plan should be a mixed program of joint movements, rest, and mind and body relaxation.
A patient recently diagnosed with osteoporosis is concerned about getting a bone fracture. On what preventive measures would the nurse educate the patient? Select all that apply. Eat foods such as bananas, salmon, and broccoli Increase exposure to sunlight to at least 20 minutes a day Increase calcium supplement intake to 300 to 600 mg/day Conduct weight-bearing exercises, such as tennis or walking Participate in high-impact exercises, such as aerobics or running Eat foods such as cottage cheese, sardines, and turnip greens
Increase exposure to sunlight to at least 20 minutes a day Conduct weight-bearing exercises, such as tennis or walking Eat foods such as cottage cheese, sardines, and turnip greens Sunlight increases the body's vitamin D, which is important in calcium absorption and function. Weight-bearing exercises, such as tennis or walking, help build up and maintain bone mass. Cottage cheese, sardines, and turnip greens are all high in calcium, which is needed to help treat osteoporosis. Bananas, salmon, and broccoli are not high in calcium. Calcium supplement intake should be increased to 1000 to 1500 mg/day. High-impact exercises, such as aerobics or running, may put too much stress on the bones, and can result in stress fractures.
A patient is in extreme pain due to a fracture in the leg. A nurse understands that acute pain may elicit a stress response. What physiologic findings does the nurse expect in the patient? Select all that apply. Increased heart rate Increased blood pressure Increased muscle tension Increased respiratory rate Increased skin temperature
Increased heart rate Increased blood pressure Increased muscle tension Increased respiratory rate During any acute stress, such as pain, the body responds by physiologic and psychologic arousal. The sympathetic nervous system (SNS) gets activated, leading to an increase in parameters like the heart rate, blood pressure, muscle tension, and respiratory rate. The SNS activation is characterized by a decrease in skin temperature.
When teaching a group of postmenopausal women about the risk of osteoporosis, what information should the nurse include? Select all that apply. Inform that raloxifene prevents bone loss. Emphasize the need for estrogen replacement. Inform that Bisphosphonates enhance bone mineral density. Emphasize the need for adequate intake of calcium and vitamin E. Encourage avoidance of weight-bearing exercises, because they can cause bone loss.
Inform that raloxifene prevents bone loss. Emphasize the need for estrogen replacement. Inform that Bisphosphonates enhance bone mineral density. Estrogen deficiency causes bone loss; hence replacement prevents bone loss. Raloxifene prevents bone loss due to its estrogen-like action on bone. Bisphosphonates enhance bone mineral density by suppressing bone resorption. Calcium has to be supplemented along with vitamin D, and not with vitamin E. Weight-bearing exercises prevent bone loss.
A patient with osteoarthritis (OA) is prescribed sulfasalazine and reports an orange discoloration of the urine. What is the most appropriate action for the nurse to take? Advise the patient to decrease fluid intake to help the urine return to normal color. Report the urine discoloration to the prescriber immediately since there could be liver impairment. Report the urine discoloration to the prescriber immediately since orange-colored urine could indicate renal impairment. Inform the patient that orange discoloration of the urine often occurs with sulfasalazine, and there is no need for concern.
Inform the patient that orange discoloration of the urine often occurs with sulfasalazine, and there is no need for concern. The nurse should inform the patient that orange-yellow discoloration of the urine often occurs with sulfasalazine, and there is no need for concern. The nurse should advise the patient to take sulfasalazine with food and 8 oz of water rather than decreasing his or her fluid intake. Orange-colored urine does not mean the patient has liver or renal impairment; it is a normal side effect of sulfasalazine.
The nurse is assessing a patient reporting bone pain. Which of the patient's assessment data is most likely to be related to osteoarthritis (OA)? Persistent fever of 100.5°F to 102.0°F for the past 72 hours Severe pain in the hip with leg shortening after a recent fall Joint pain and swelling following activity that is relieved with rest Joint stiffness after rest; stiffness usually subsides 30 minutes after activity is resumed
Joint stiffness after rest; stiffness usually subsides 30 minutes after activity is resumed With OA, joint stiffness after rest (especially early-morning stiffness) or stiffness following an immobile period is common. A persistent fever may indicate the presence of infection. Severe hip pain with leg shortening after a fall is characteristic of a hip fracture. Joint pain and swelling following activity that is relieved with rest is common with rheumatoid arthritis.
The nurse is caring for the patient with skeletal traction for an extremity fracture. What action(s) by the nurse are most appropriate? Select all that apply. Keep the weights off of the floor. Elevate the end of the bed as needed. Ensure that the weights are secured to the pulleys. Confirm that the forces are pulling in the same direction. Make sure that the traction ranges from 5 to 45 pounds (2.3 to 20.4 kg). Apply the traction intermittently as prescribed by the health care provider (HCP).
Keep the weights off of the floor. Elevate the end of the bed as needed. Make sure that the traction ranges from 5 to 45 pounds (2.3 to 20.4 kg). The weights must be kept off of the floor. The end of the bed may need to be elevated so that the weights are off the floor for traction to be applied. Traction weight ranges from 5 to 45 pounds (2.3 to 20.4 kg). Weight forces have to be in the opposite direction (counter traction). Traction must be applied continuously to be effective and the weights have to move freely through the pulleys.
A patient with acute osteomyelitis has been prescribed gentamicin therapy. Before initiating the therapy, what actions should the nurse take? Select all that apply. Monitor blood glucose levels. Monitor serum creatinine levels. Check for symptoms of dehydration. Determine number of red blood cells. Assess for symptoms of pulmonary edema.
Monitor serum creatinine levels Check for symptoms of dehydration The nurse should determine if the patient has symptoms of dehydration to prevent hypovolemia. Gentamicin is an aminoglycoside antibiotic that causes fluid loss and impairs renal functioning. The nurse should evaluate the patient's renal function by monitoring serum creatinine levels. This intervention helps reduce the risk of renal disorders in the patient. Gentamicin does not impair pancreatic functioning and does not increase blood glucose levels. Corticosteroids increase blood glucose levels. Gentamicin will not alter the red blood cell count; chemotherapeutic medications do. Gentamycin does not cause pulmonary edema in the patient; excess fluid volume causes pulmonary edema. pg 1498
A patient is prescribed the nasal form of calcitonin in order to treat osteoporosis. What side effect of the medication should the nurse inform the patient is a possibility? Nausea Headache Facial flushing Nasal dryness
Nasal dryness Patients using the nasal form of calcitonin should be made aware of its side effects such as nasal dryness and irritation. Nausea is not associated with the nasal form of calcitonin administration. Headaches are not a side effect of calcitonin. Administration of the intramuscular or subcutaneous form of calcitonin at night has been shown to decrease the side effects of nausea and facial flushing.
A nurse is caring for a patient who just arrived on the surgical unit. The patient has a fractured femur. What is the most appropriate intervention the nurse should perform first? Administer analgesics as ordered. Include calcium sources in the diet. Avoid performing assessment of body systems. Perform a comprehensive assessment of all body systems.
Perform a comprehensive assessment of all body systems. After the patient is admitted and is stabilized, whether or not the current clinical problem is related to any system, comprehensive assessment of all body systems should be performed. It would help to get a baseline health status of the patient. The analgesics prescribed by the primary health care provider can be administered after the assessment. Including sources of calcium in the diet is not an immediate intervention. The assessment should not be limited to the musculoskeletal system; it should include the whole body.
A patient hospitalized with osteomyelitis has a prescription for bed rest with bathroom privileges, with the affected foot elevated on two pillows. The nurse would place highest priority on which intervention? Ambulate the patient to the bathroom every two hours. Ask the patient about preferred activities to relieve boredom. Perform frequent position changes and range-of-motion exercises. Allow the patient to dangle legs at the bedside every two to four hours.
Perform frequent position changes and range-of-motion exercises. The patient is at risk for atelectasis of the lungs and for contractures because of prescribed bed rest. For this reason, the nurse should place the priority on changing the patient's position frequently to promote lung expansion and performing range-of-motion (ROM) exercises to prevent contractures. Assisting the patient to the bathroom will keep the patient safe, because the patient is in pain, but it may not be needed every two hours. Providing activities to relieve boredom will assist the patient to cope with the bed rest, and dangling the legs every two to four hours may be too painful. The priority is position changes and ROM exercises. pg 1498
The nurse is caring for a patient with gout. Which actions are appropriate for the nurse to perform? Select all that apply. Encourage weight gain Provide warm compresses Decrease joint mobilization Encourage increased oral water intake Encourage intake of spinach, mushrooms, and cauliflower
Provide warm compresses Decrease joint mobilization Encourage increased oral water intake Gout is associated with inflammation of joints caused by deposition of uric acid crystals in one or more joints. Limiting joint mobilization helps alleviate the patient's symptoms. Providing warm compresses helps relieve joint pain. Increasing water intake enhances the elimination of uric acid from the body. Significant weight gain will affect the weight bearing joints and aggravate the patient's symptoms. Vegetables like spinach, mushrooms and cauliflower are rich in purines. A patient with gout should avoid purines. Test-Taking Tip: Look for answers that focus on the patient or are directed toward feelings.
A patient with acute osteomyelitis is prescribed gentamicin. Which clinical parameter in the patient indicates that the prescription needs to be reconsidered? Body temperature: 100° F Serum creatinine: 3.4 mg/dL White blood cell count: 11,000 cells/mcL Erythrocyte sedimentation rate (ESR): 20 mm/hr
Serum creatinine: 3.4 mg/dL Gentamicin is an aminoglycoside, which is nephrotoxic and is contraindicated in patients with renal dysfunction. A creatinine level of 3.4 mg/dL indicates renal dysfunction and administration of gentamicin may cause further renal damage. A body temperature of 100° F indicates fever, which is a common finding in osteomyelitis. A white blood cell count of 11,000 cells/mcL is above the normal levels and indicates infection. However, it may not be a contraindication for gentamicin administration. The erythrocyte sedimentation rate (ESR) of 20 mm/hr is above the normal range and indicates infection. It is not a contraindication for gentamicin administration.
The nurse is reinforcing health teaching about osteoporosis with a patient admitted to the hospital. Which risk factors for osteoporosis should the nurse include in the discussion? Select all that apply. Obesity Smoking Asian descent Hyperlipidemia Sedentary lifestyle
Smoking Asian descent Sedentary lifestyle A small frame, Asian descent, smoking, and a sedentary lifestyle all contribute to the development of osteoporosis. Obesity and hyperlipidemia are not risk factors for osteoporosis. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in one to two minutes. pg 1511
A patient with profound osteoarthritis is recommended for total hip arthroplasty (THA). The patient asks why this will relieve the discomfort. What is the nurse's best response? THA will remove degenerative debris from the joint allowing for increased mobility and decreased pain. THA removes a wedge of bone to restore alignment to the joint, alleviating pain and promoting mobility. THA will provide increased mobility for patients with arthritis by reshaping the ball of the femur rather than replacing it. THA can provide significant pain relief for patients with joint deterioration from arthritis by replacing the ball-and-socket joint as well as the upper shaft of the femur.
THA can provide significant pain relief for patients with joint deterioration from arthritis by replacing the ball-and-socket joint as well as the upper shaft of the femur. An arthroplasty is a procedure that relieves pain and promotes mobility by reconstructing or replacing a joint; a THA removes the ball-and-socket joint and the upper shaft of the femur. A hip resurfacing arthroplasty is an alternative to THA that allows the ball of the joint to be preserved and reshaped. An osteotomy removes a wedge or slice of bone to restore alignment and shift weight-bearing, thus relieving pain. A debridement procedure removes degenerative debris from the join to relieve pain and promote mobility.
The nurse suspects that a patient is experiencing a fat embolism after sustaining a femur fracture. What clinical manifestations does the nurse expect? Tachypnea, tachycardia, shortness of breath, and paresthesia Paresthesia, bradycardia, bradypnea, petechial rash on the chest and neck Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck Bradypnea, bradycardia, shortness of breath, petechial rash on the chest and neck
Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck A fat embolism may occur in a patient who has had a fracture of a large bone such as a femur or hip. The classic symptoms of a fat embolism include tachypnea, tachycardia, shortness of breath, and petechial rash on the chest and neck. Tachypnea, tachycardia, shortness of breath, and paresthesias; paresthesias, bradycardia, bradypnea, and petechial rash; and bradypnea, bradycardia, shortness of breath, and petechial rash are not directly characteristic of a pulmonary embolism.
Bisphosphonates have been recommended for a patient with osteoporosis. What patient education is important for the nurse to include? Select all that apply. Take them with a full glass of water. Drink only sips of water with the pill. Take them with a full meal at dinner. Take them 30 minutes before food or medications. Remain upright for at least 30 minutes after taking a dose. Take them first thing in the morning on an empty stomach.
Take them with a full glass of water. Take them 30 minutes before food or medications. Remain upright for at least 30 minutes after taking a dose. Bisphosphonates should be taken with a full glass of water at least 30 minutes before meals and other medications, and the patient should remain upright for at least 30 minutes after the dose. It is not recommended to take on an empty stomach, with a full meal, or with sips of water. pg 1513
The nurse is caring for an older adult who has a compound fracture of the radius. The nurse observes manifestations of inflammation. Which symptoms should the nurse document as signs of infection in this older patient? Select all that apply. Reports of pain Presence of edema Temperature 100.8°F Respiratory rate of 30 Presence of erythema Heart rate 106 beats/min
Temperature 100.8°F Respiratory rate of 30 Heart rate 106 beats/min The nurse should assess this patient's vital signs; increase in temperature, pulse, and respiratory rates indicate the presence of infection. It is important for the nurse to note vital signs when an inflammation is present. Older adults have a blunted febrile response to infection, and body temperature may not rise as expected. Loss of function occurs due to pain and edema. Edema, erythema, and pain are local manifestations of inflammation. Normal ranges are as follows: temperature 97-99 degrees; respiratory rate 12-20 breaths/minute; heart rate 60-11 beats/minute.
What should the nurse consider when managing severe pain due to fracture of a thigh bone in a patient with a history of opioid abuse? Nondrug pain relief measures are ineffective and should not be used. A mixed opioid agonist-antagonist agent is preferred over single opioid. The opioid should be given at higher dosages than in drug-naive patients. Opioids should be administered only when the patient experiences severe pain.
The opioid should be given at higher dosages than in drug-naive patients. In a patient with a history of opioid use, severe pain is treated with opioids at much higher dosages than in drug-naive patients. The use of a single opioid is preferred. Using a mixed opioid agonist-antagonist such as butorphanol or a partial agonist such as buprenorphine should be avoided because these drugs may precipitate withdrawal symptoms. Nondrug pain relief measures may also be used as appropriate. The nurse should not wait for the pain to become severe to administer the drug. The analgesic should be provided around the clock to maintain opioid blood levels and prevent withdrawal symptoms. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.
A patient receiving long-term corticosteroid therapy for rheumatoid arthritis is admitted to the hospital with a wound of the left upper extremity. What should the nurse expect while assessing this patient? Select all that apply. The patient is at risk of hyperglycemia. The wound of this patient will heal slowly. There will be reduced bleeding from the wound. The patient is at a risk of developing bone infection. The symptom of fever may be blunted in this patient.
The patient is at risk of hyperglycemia. The wound of this patient will heal slowly. The symptom of fever may be blunted in this patient. Persistent hyperglycemia (steroid diabetes) can occur because of altered glucose metabolism. Because the antiinflammatory response is depressed as a result of increased cortisol levels, the wounds of patients receiving long-term corticosteroid therapy tend to heal slowly. Because of the depressed immune system, fever may be blunted in this patient. Corticosteroid therapy does not affect the risk of bleeding from the wound or the risk of bone infection.
A patient with diabetes mellitus is diagnosed with osteomyelitis of the foot. What medication does the nurse anticipate administering to the patient? Metformin Exenatide Tobramycin Hydromorphone
Tobramycin Tobramycin is an aminoglycoside-type antibiotic that often is used to treat osteomyelitis. The medication is given by the intravenous route for several weeks, and blood levels are checked periodically to ensure that they are therapeutic. Exenatide and metformin are used to treat diabetes, and hydromorphone is used to manage pain. pg 1498
A patient with osteoarthritis (OA) is prescribed ibuprofen 800mg every eight hours for pain. What is an important nursing instruction when teaching the patient about safe drug administration? Take ibuprofen on an empty stomach. Expect the stool to appear dark and tarry. Do not take ibuprofen with milk products. Try to take ibuprofen with a meal or a snack.
Try to take ibuprofen with a meal or a snack. Ibuprofen is irritating to the stomach lining and should not be be taken on an empty stomach. Patients should be taught to take ibuprofen with food, milk, or antacids (if prescribed) to reduce the risk of gastrointestinal bleeding. Taking ibuprofen on an empty stomach raises the risk of irritation. The patient should not be told to expect dark, tarry stools; ibuprofen should be stopped immediately and the prescriber notified if signs of bleeding occur (e.g., tarry stools, bruising, and petechiae). The patient may take ibuprofen with milk products.
A 30-year-old female patient with severe rheumatoid arthritis (RA) is prescribed methotrexate for disease management. What should the nurse instruct the patient to do? Avoid use of contraceptives as this increases the risk for deep vein thrombosis. Expect an orange-yellow urine discoloration during treatment with methotrexate. Use effective contraception during and three months after treatment with methotrexate. Decrease fluid intake to reduce the risk of edema-related side effects with methotrexate
Use effective contraception during and three months after treatment with methotrexate. A female of childbearing age prescribed methotrexate should use effective conception during and three months after treatment due to drug-related teratogenic effects. Contraceptives should not be avoided since methotrexate has been linked to teratogenic effects. Sulfasalazine, not methotrexate, may cause an orange discoloration of the urine. The patient should be advised to stay well hydrated while taking methotrexate; the patient should not be told to decrease fluid intake.
A patient is at risk for bone fracture related to osteoporosis. Which weight-bearing activity does the nurse instruct the patient to use to reduce risk of bone fracture? Do chair aerobics. Swim laps in the pool. Walk 30 minutes daily. Do isometric exercises.
Walk 30 minutes daily. Weight-bearing exercises involve activities while standing or moving on the feet. Walking is a weight-bearing activity using the weight of the body. Swimming, isometric exercise, and chair aerobics do not use the weight of the body, making them less effective in preventing bone fractures. Test-Taking Tip: Multiple choice questions can be challenging because students think they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Topics
A patient is being treated for a spinal vertebral fracture due to osteoporosis. Which condition poses a risk to the patient? Loss of hearing Enlarged and thickened skull Second vertebral fracture within 18 months Wedging and fractures of the vertebrae over time
Wedging and fractures of the vertebrae over time Wedging and fractures gradually reduce the height of patients with osteoporosis, resulting in a hunched-back look. Patients with Paget's disease have a risk of loss of hearing due to an enlarged and thickened skull. A patient with osteoporosis who has a spinal vertebral fracture is at a risk of another fracture in a year's time. pg 1512
