Musculoskeletal Hesi
Which condition is characterized by infection of a client's bone or bone marrow? A. Osteomalacia B. Osteomyelitis C. Herniated disc D. Spinal stenosis
B. Osteomyelitis Rationale Osteomyelitis is infection of bone or bone marrow. Osteomalacia is a condition characterized by softening of bones due to calcium or vitamin D deficiency. Herniated disc is caused by structural damage of the intervertebral discs in which the nucleus pulposus seeps through a torn or stretched annulus. Spinal stenosis is narrowing of the spinal canal.
A female client asks the nurse whether she should be tested for osteoporosis. Which statements reflect current advice regarding the prevention of osteoporosis? Select all that apply. One, some, or all responses may be correct. A. "A bone mineral density test is the only way to diagnose osteoporosis." B. "Everyone with osteoporosis should be treated with bisphosphonates." C. "All adults need 1000 mg calcium and 400 to 800 IU of vitamin D each day." D. "Women should be evaluated clinically for risk of osteoporosis annually after age 70." E. "Postmenopausal women and all adults over the age of 65 should be tested for osteoporosis."
A. "A bone mineral density test is the only way to diagnose osteoporosis." E. "Postmenopausal women and all adults over the age of 65 should be tested for osteoporosis." Rationale A bone mineral density test is the only way to diagnose osteoporosis and determine the risk for future fractures. The U.S. Preventive Services Task Force and the National Osteoporosis Foundation recommend testing for all postmenopausal women and all adults over the age of 65. Everyone with osteoporosis will not necessarily be treated with bisphosphonates; many other treatments are available, including calcitonin, estrogens, estrogen agonist-antagonists, and parathyroid. Adults under the age of 50 require 1200 mg of calcium and 800 to 1000 IU of vitamin D. All postmenopausal women, regardless of age, should be evaluated clinically for risk of osteoporosis and need for bone mineral density testing.
Which statement indicates effective discharge teaching for a client with osteomyelitis? Select all that apply. One, some, or all responses may be correct. A. "I will take the antibiotic at the same time every day." B. "I will take the antibiotic regularly until my symptoms subside." C. "I will take the antibiotic with food if I develop gastric distress when on the antibiotic." D. "I will notify my health care provider and stop taking the medication if I develop a rash or shortness of breath." E. "I will need to change my diet to avoid milk and milk products while on these antibiotics."
A. "I will take the antibiotic at the same time every day." C. "I will take the antibiotic with food if I develop gastric distress when on the antibiotic." D. "I will notify my health care provider and stop taking the medication if I develop a rash or shortness of breath." Rationale The antibiotic should be taken as prescribed for the full length of treatment. The statements, "I will take the antibiotic at the same time every day," "I will take the antibiotic with food if I develop gastric distress when on the antibiotic," and "I will notify my health care provider and stop taking the medication if I develop a rash or shortness of breath," demonstrate understanding of the discharge instructions. The client should not discontinue the medication when symptoms subside. The client does not need to avoid milk and milk products because the class of antibiotics typically prescribed for osteomyelitis is the quinolone class. Quinolones do not have any adverse food interactions.
A client who had an above-the-knee amputation (AKA) has a pressure dressing on the end of the residual limb. The client asks, "Why do I have to have this tight dressing on my leg?" Which response would the nurse provide? A. "It decreases the swelling of the area." B. "It decreases the formation of scar tissue." C. "It prevents the formation of blood clots." D. "It reduces phantom limb pain."
A. "It decreases the swelling of the area." Rationale The pressure dressing prevents fluid from shifting into the interstitial compartment; this promotes shrinkage of the residual limb to facilitate use of a prosthesis. Bandaging will not affect the formation of a scar, prevent blood clots, or reduce phantom limb pain.
Three days after the application of a spica cast, a toddler has a temperature of 101.4°F (38.6°C). Which clinical finding would the nurse anticipate? A. A foul odor from the cast B. An irregular respiratory pattern C. Itching around the top of the cast D. Complaints of tingling in the toes
A. A foul odor from the cast Rationale A foul smell from the cast is usually indicative of an infection under the cast that may be the cause of a fever. Respirations may increase, but do not become irregular with a fever. Itching around the top of the cast should not cause a fever; it may indicate neurovascular impairment. Tingling toes are not a sign of infection; this may indicate a neurovascular complication.
The nurse notes an older adult's admission orders include gentamicin for the treatment of osteomyelitis. Which laboratory report would the nurse review before beginning the medication? Select all that apply. One, some, or all responses may be correct. A. Blood urea nitrogen (BUN) and creatinine B. Electrolytes and urinalysis C. Erythrocyte count D. Blood platelet count E. Serum thyroxin levels
A. Blood urea nitrogen (BUN) and creatinine B. Electrolytes and urinalysis Rationale Because gentamicin can increase the risk of nephrotoxicity, the nurse should assess a client's renal function before starting therapy. Dehydration can further increase the risk of nephrotoxicity; therefore, the client's hydration status should also be checked before starting therapy. Gentamicin generally does not affect erythrocyte and blood platelet counts nor does it affect serum thyroxin levels.
Which life-threatening wound is treated with hyperbaric oxygen therapy? Select all that apply. One, some, or all responses may be correct. A. Burns B. Skin cancer C. Osteomyelitis D. Diabetic ulcers E. Myocardial infarction
A. Burns C. Osteomyelitis D. Diabetic ulcers Rationale Hyperbaric oxygen therapy is the administration of oxygen under pressure, raising the tissue's oxygen concentration. Burns, osteomyelitis, and diabetic ulcers are treated by hyperbaric oxygen therapy. Skin cancer and myocardial infarctions are not treated using hyperbaric oxygen therapy.
A client who has been receiving treatment for osteomyelitis reports hives, mouth sores, and bloody diarrhea. Which medication would the nurse expect to see in the client's medication administration record? A. Cefazolin B. Neomycin C. Tobramycin D. Ciprofloxacin
A. Cefazolin Rationale Cephalosporin antibiotics, such as cefazolin, are used to treat osteomyelitis. Cefazolin can alter gastrointestinal function, resulting in adverse effects such as watery diarrhea, bloody stools, and mouth or throat sores. Cefazolin can also alter skin integrity and cause hives. Aminoglycoside antibiotics such as neomycin and tobramycin do not generally alter the gastrointestinal system; instead, they can cause ototoxicity and nephrotoxicity. Fluoroquinolones such as ciprofloxacin generally do not alter the gastrointestinal system and do not cause watery, bloody stools. However, tendon rupture, especially of the Achilles tendon, can occur with the use of fluoroquinolones.
Which factors contribute to development of osteoporosis in female clients? Select all that apply. One, some, or all responses may be correct. A. Cigarette smoking B. Moderate exercise C. Use of street drugs D. Familial predisposition E. Inadequate intake of dietary calcium
A. Cigarette smoking D. Familial predisposition E. Inadequate intake of dietary calcium Rationale Cigarette smoking is a high-risk behavior associated with an increased incidence of osteoporosis in later life. Familial predisposition is considered a risk factor for the development of osteoporosis. Inadequate calcium intake during the premenopausal years is a risk factor for the development of osteoporosis after menopause. Moderate exercise is not considered a risk factor for the development of osteoporosis, although a sedentary lifestyle is. Use of street drugs is not considered a risk factor for osteoporosis.
A client who has severe back pain is found to have a vertebral compression fracture. Which cause of fracture would the nurse consider when planning interventions? A. Collapse of the vertebral bodies B. Demineralization of the spinal cord C. Wear and tear of the spinous processes D. Bulging of the spinal cord from the vertebra
A. Collapse of the vertebral bodies Rationale Osteoporotic vertebrae collapse under the weight of the upper body or by improper or rapid turning, reaching, or lifting. Bones, not the spinal cord, demineralize in osteoporosis. Wearing and tearing of the spinous processes occur in osteoarthritis. The spinal cord does not bulge; the nucleus pulposus bulges toward the spinal cord.
While assessing a child who has just had a short arm cast applied to a fractured right wrist, the nurse discovers that the fingers of the right hand are cool. Which action would the nurse take first? A. Compare the temperature of the two hands. B. Clip the edge of the cast to reduce pressure. C. Elevate the right arm to reduce the swelling. D. Inform the health care provider (HCP) of the circulatory impairment.
A. Compare the temperature of the two hands. Rationale Cool fingers are a sign of circulatory impairment caused by the pressure of the cast; however, the finding that both hands feel cool indicates that some factor other than circulatory impairment is responsible. The cast should not be adjusted without prior notification of the HCP. Further assessment to determine the cause of temperature change is indicated before remedial action such as elevating the right arm is taken. Further assessment is needed before the practitioner is informed.
Which client finding would the nurse associate with chronic osteomyelitis? Select all that apply. One, some, or all responses may be correct. A. Elevated white blood count B. Presence of avascular scar tissue C. Cold sensation at the infection site D. Constant bone pain relieved by rest E. Elevated erythrocyte sedimentation rate
A. Elevated white blood count B. Presence of avascular scar tissue E. Elevated erythrocyte sedimentation rate Rationale Characteristics of chronic osteomyelitis include an elevated white blood count, the presence of avascular scar tissue, and increased levels of erythrocyte sedimentation rate due to an infection. Characteristics of chronic osteomyelitis include warmth at the infection site (not cold) and constant bone pain not relieved by rest.
Which assessment findings are systemic manifestations of acute osteomyelitis? Select all that apply. One, some, or all responses may be correct. A. Malaise B. Restlessness C. Night sweats D. Warmth at the infection site E. Swelling at the infection site
A. Malaise B. Restlessness C. Night sweats Rationale Malaise, restlessness, and night sweats are systemic manifestations of acute osteomyelitis. Warmth and swelling at the infection site are local manifestations of acute osteomyelitis.
The plan of care for a client with osteoporosis includes active and passive exercises, calcium supplements, and daily vitamins. Which finding would indicate that the therapy is helping? A. Mobility increases. B. Fewer muscle spasms occur. C. The heartbeat is more regular. D. There are fewer bruises than before therapy.
A. Mobility increases. Rationale This regimen limits bone demineralization and reduces bone pain, thereby promoting increased mobility and activity. The occurrence of fewer muscle spasms is unrelated to osteoporosis; it would be an expected outcome if the client were receiving calcium for hypocalcemia. A more regular heartbeat is unrelated to osteoporosis or its therapy. The occurrence of fewer bruises than before therapy is unrelated to osteoporosis; it would be expected if the client were receiving vitamin C for capillary fragility.
Which action will the nurse anticipate when planning care for a client with an above-the-knee amputation who, two days after beginning to use a prosthesis, develops a small blister on the residual limb near the healed incision? A. Remeasuring the residual limb for correct prosthesis sizing B. Increasing the frequency of limb-toughening exercises C. Changing the type of covering used to avoid irritation D. Placing a bandage on the blister before putting the prosthesis back on
A. Remeasuring the residual limb for correct prosthesis sizing Rationale Pressure on the blister will not allow it to heal; when a blister forms underneath the prosthesis, this means that the residual limb is getting pressure from the prosthesis. Remeasuring the residual limb and resizing of the prosthesis should occur to ensure accurate sizing to prevent pressure injuries. Increasing the frequency of limb-toughening exercises will neither heal the blister nor alleviate pressure on the blister by the prosthesis. Changing the type of covering will not help heal the blister. The client should not put the prosthesis back on because it causes pressure, which will prevent healing.
A client sustains a crushing injury to the lower left leg, and a below-the-knee amputation is performed. For which common clinical manifestation of a pulmonary embolus would the nurse assess for in this client? Select all that apply. One, some, or all responses may be correct. A. Sharp chest pain B. Acute onset of dyspnea C. Pain in the residual limb D. Absence of the popliteal pulse E. Blanching of the affected extremity
A. Sharp chest pain B. Acute onset of dyspnea Rationale Emboli can occur with crushing injuries of the extremities. Lodging of a thrombus in the pulmonary system results in a lack of oxygen to pulmonary tissues, causing localized sharp chest pain. Lodging of a thrombus in the pulmonary system will result in decreased breath sounds and dyspnea. Pain in the residual limb is related not to a pulmonary embolus but to severed nerve endings in the residual limb. A pulmonary embolus will not interfere with arterial circulation to a distal portion of an extremity. Blanching of the affected extremity is associated with interference with arterial circulation to an extremity.
Which client is most at risk for osteoporosis? A. A nonsmoking 60-year-old woman, body mass index (BMI) 27.1 B. A 66-year-old white woman, body mass index (BMI) 18, who is a paralegal C. A 68-year-old black woman, body mass index (BMI) 23.3, who is a retired receptionist D. A 62-year-old woman, body mass index (BMI 23.2), who takes calcium carbonate daily
B. A 66-year-old white woman, body mass index (BMI) 18, who is a paralegal Rationale A postmenopausal woman who is small-boned, underweight (BMI 18), and relatively sedentary (paralegal) is at risk for osteoporosis; other risk factors are family history and white or Asian ethnicity. A woman who is relatively heavy (BMI 27.1) and does not smoke is at less risk for osteoporosis than is a thin postmenopausal woman. Postmenopausal women who are black are at lower risk for osteoporosis than are white and Asian women. A woman who takes a daily calcium supplement is at less risk for osteoporosis than a woman who does not take a calcium supplement.
The nurse is assessing a client with a moon-shaped face and thin arms and legs. The nurse expects which other assessment findings? Select all that apply. One, some, or all responses may be correct. A. Weight loss B. Gastric ulcer C. Pain in bones D. Poor appetite E. Muscle weakness
B. Gastric ulcer C. Pain in bones E. Muscle weakness Rationale The presence of such symptoms as a moon-shaped face and thin arms and legs indicates Cushing syndrome. In Cushing syndrome, the cortisol level rises resulting in gastric ulcer formation caused by increased hydrochloric acid secretion and decreased production of protective gastric mucus. Osteoporosis is common in Cushing syndrome; therefore bone pain is common. Clients may also feel muscle weakness. Clients with Cushing syndrome experience increased appetite and weight gain, therefore they display truncal obesity and a "buffalo hump."
The nurse provides discharge instructions to a client for self-care after application of a cast to their fractured right ulna and radius. Which clinical manifestation would the nurse instruct the client to immediately report to their primary health care provider? A. Slight stiffness of the fingers B. Increasing pain at the injury site C. Small amount of dark, bloody drainage on the cast D. Bounding radial pulse in the affected extremity
B. Increasing pain at the injury site Rationale Increasing pain at the injury site may indicate cast pressure on a nerve and requires further investigation. The client may expect some swelling causing finger stiffness after injury to tissues; the client should note the stiffness and monitor further. Some bloody drainage is expected; the client should note the amount and monitor further. Placement of the cast prevents assessment of the radial pulse of the affected arm. Assess circulation to the extremity by warmth, movement, and briefly compressing a fingernail on the affected hand and observing the return of a pink color after releasing the compression.
Which statements accurately describe the different medications available for the treatment of osteoporosis? Select all that apply. One, some, or all responses may be correct. A. Denosumab acts by stimulating bone formation. B. Individuals with an allergy to salmon can't take calcitonin. C. Bisphosphonates inhibit osteoclast-mediated bone resorption. D. Denosumab is a subcutaneous injection given once every 6 months. E. Teriparatide is used for the prevention of postmenopausal osteoporosis.
B. Individuals with an allergy to salmon can't take calcitonin. C. Bisphosphonates inhibit osteoclast-mediated bone resorption. D. Denosumab is a subcutaneous injection given once every 6 months. Rationale Individuals with an allergy to salmon cannot take calcitonin, which is salmon-based. Bisphosphonates work by inhibiting osteoclasts, which are responsible for breaking down and reabsorbing minerals such as calcium from the bone. Denosumab is a subcutaneous injection that is given once every 6 months; the client takes calcium and vitamin D daily. It is not true that denosumab acts by stimulating bone formation; it is a monoclonal antibody that blocks osteoclast activation and thus decreases the breakdown of bone. Teriparatide is not used for the prevention of postmenopausal osteoporosis; instead, it is generally reserved for the subset of clients at the highest risk—those who have suffered a previous fracture. It stimulates osteoblast function and increases gastrointestinal calcium absorption and renal tubular reabsorption of calcium.
A newly hired nurse is delegated the task of developing a care plan for a diabetic client who just returned from surgery after undergoing amputation of the leg. Which task in the care plan is inappropriate according to guidelines? A. The registered nurse (RN) administering antidiabetic medications B. Instructing the licensed practical nurse (LPN) to monitor vital signs C. The RN assessing the client's blood glucose levels at regular intervals D. Instructing the licensed practical nurse (LPN) to change the dressing at the amputation site
B. Instructing the licensed practical nurse (LPN) to monitor vital signs Rationale The LPN's scope of practice includes monitoring vital signs in clients with a stable condition. Instructing the LPN to monitor the vital signs of a client in an acute condition is inappropriate according to the guidelines. Administering antidiabetic medications to a diabetic client who underwent amputation would be done by the RN because the condition of the client is acute. The RN is responsible for assessing the blood glucose levels of the client who underwent amputation. The LPN is instructed to change the dressing at the amputation site.
The nurse completes medication reconciliation in preparation for discharge of a client recovering from osteomyelitis and a ruptured Achilles tendon. For which medication would the nurse contact the primary health care provider? A. Gentamicin B. Levofloxacin C. Acetaminophen D. Cyclobenzaprine
B. Levofloxacin Rationale Tendon rupture (especially the Achilles tendon) can occur with use of the fluoroquinolones (e.g., ciprofloxacin, levofloxacin). Aminoglycosides such as gentamicin do not cause rupture of the Achilles tendon; instead, gentamicin can cause ototoxicity and nephrotoxicity. Acetaminophen is a nonopioid analgesic used to manage pain; it does not cause rupture of the Achilles tendon. Cyclobenzaprine is a muscle relaxant; it does not cause tendon rupture.
Which finding for a client who has a cast applied to the lower extremity would indicate to the nurse the presence of a complication? Select all that apply. One, some, or all responses may be correct. A. Warmth B. Numbness C. Skin desquamation D. Generalized discomfort E. Prolonged capillary refill
B. Numbness E. Prolonged capillary refill Rationale Numbness is a neurological sign that should be reported immediately because it indicates pressure on the nerves and blood vessels. Compression of arterial vessels results in a prolonged return of blood to the periphery after compression of capillaries and is indicative of compromised circulation. Warmth is an expected reaction to a new cast. Desquamation becomes apparent after a cast is removed. Some degree of discomfort is expected after cast application.
Which clinical manifestation would lead the nurse to contact the health care provider regarding the potential development of acute osteomyelitis? Select all that apply. One, some, or all responses may be correct. A. Presence of a foot ulcer B. Temperature of 102°F (38.9°C) C. Erythema of the affected area D. Tenderness of the affected area E. Drainage from the affected area
B. Temperature of 102°F (38.9°C) C. Erythema of the affected area D. Tenderness of the affected area Rationale Osteomyelitis is the infection of bone caused by bacteria, viruses, or fungi. The symptoms of acute osteomyelitis are fever (temperature above 101ºF [38.3°C]), erythema, and tenderness near the affected area. The symptoms of chronic osteomyelitis are the presence of foot ulcers and drainage from the affected area.
Which information would cause the nurse to conclude that the postoperative course of a client who was in a motor vehicle collision would differ from a second client with chronically decreased arterial perfusion? A. The first client probably will adjust more quickly. B. The second client's incision will take longer to heal. C. These clients are likely to have very different occupations. D. The first client is more likely to have phantom limb sensations.
B. The second client's incision will take longer to heal. Rationale Decreased arterial circulation in the second client will delay healing. The first client received an amputation without preoperative preparation for the loss of the limb and will most likely have greater difficulty adapting. Both clients' responses may be influenced by their occupations, but there is no data to support this conclusion. Clients with chronic limb pain before surgery (e.g., the second client with chronically decreased arterial perfusion) are more likely to have phantom limb sensations.
A client has a right-above-the-knee amputation after trauma sustained in a work-related accident. Upon awakening from surgery, the client states, "What happened to me? I don't remember a thing." Which is the nurse's best response? A. "Tell me what you think happened." B. "You will remember more as you get better." C. "You were in a work-related accident this morning." D. "It was necessary to amputate your leg after the accident."
C. "You were in a work-related accident this morning." Rationale The correct response is truthful and provides basic information that may prompt recollection of what occurred; it is a starting point. Asking the client to tell the nurse what happened ignores the client's question; avoidance may increase anxiety. Saying "you will remember more as you get better" ignores the client's question; the frustration of trying to remember will increase anxiety. Saying "it was necessary to amputate your leg after the accident" is too blunt for the initial response to the client's question; the client may not be ready to hear this at this time.
A client returns from surgery, after a right below-the-knee amputation, with the residual limb straight, but elevated on a pillow to prevent edema. In which position would the nurse place the client after the first postoperative day? A. Any position, as long as the residual limb remains immobilized B. Turn client to the prone position for 15 to 20 minutes at least three times a day C. For short periods, position the client in the right side-lying position D. Maintain elevation of the residual limb for a total of 3 days
C. For short periods, position the client in the right side-lying position Rationale Positioning the client in the prone position for short periods helps prevent hip flexion contractures. Do not immobilize the client's residual limb, but do not keep the joint bent for prolonged periods. Begin exercises to prevent contractures as soon as possible. Positioning the client in the right side-ying position can cause trauma to the incision site and should be avoided. Do not elevate the client's residual limb for more than 48 hours because hip flexion contractures can result.
Which term will a nurse use to document when a client with peripheral arterial disease tells the nurse about having leg pain and weakness after walking a short distance? A. Rest pain B. Raynaud phenomenon C. Intermittent claudication D. Phantom limb sensation
C. Intermittent claudication Rationale Intermittent claudication is pain that results when the arterial system is unable to provide adequate blood flow to the tissues in the presence of increased demands for oxygen and nutrients during exercise; it is relieved by rest. Rest pain is not a response to exercise; it occurs in the extremities during rest, especially at night. Raynaud phenomenon is intermittent episodes of constricted arteries and arterioles in response to extreme cold or emotional stress, causing pallor, paresthesias, and pain. Phantom limb sensation is the presence of unusual sensations or pain in the removed portion of an amputation.
A client with a femoral fracture and osteomyelitis is immobilized for 3 weeks. Which rationale explains the nurse's plan to assess for the development of renal calculi? A. The client's dietary patterns have changed since admission. B. The client has more difficulty urinating in a supine position. C. Lack of weight-bearing activity promotes bone demineralization. D. Fracture healing requires more calcium, which increases calcium metabolism.
C. Lack of weight-bearing activity promotes bone demineralization. Rationale All clients who are confined to bed for any considerable period risk losing calcium from bones. Calcium precipitates in the urine, resulting in formation of calculi. There is no indication that the client's diet has changed. Although the client may have more difficulty urinating in a supine position because of an inability to assume the preferred anatomic position and the emotional effects of using a urinal, it usually does not predispose the client to developing renal calculi. The presence of a healing fracture does not increase total calcium metabolism; however, deposition of bone at the fracture site will be increased.
Which part of the client's body would the nurse assess to identify osteoporotic changes? A. Long bones B. Facial bones C. Vertebral column D. Joints of the hands
C. Vertebral column Rationale Compression fractures of the vertebrae are the most common fractures in clients with osteoporosis; a gradual collapse of vertebrae may be asymptomatic and observed as kyphosis. Changes in the long bones or facial bones associated with osteoporosis are not observable to the naked eye. Observable changes such as inflammation in the hand joints and natural alignment of the bones are associated with arthritis, not osteoporosis.
Which client statement indicates the need for further teaching about the traction device after a major fracture? A. "Traction must be applied continuously to be effective." B. "Weights of 5 to 45 pounds are used to apply the counterweight." C. "The risks of skeletal traction include infection at the pin insertion site." D. "Traction pushes the fractured ends together to prevent them from pulling apart."
D. "Traction pushes the fractured ends together to prevent them from pulling apart." Rationale Traction uses counterweights to gently pull (not push) the affected extremity to realign it. It must be applied continuously to be effective. Weights of 5 to 45 pounds are used in skeletal traction to maintain the proper alignment. Risks associated with traction include infection at the insertion site and the general risks of immobility.
Which medication may have caused a client's admission to the hospital for treatment of a peptic ulcer, osteoporosis, and hypertension? A. Everolimus B. Azathioprine C. Mycophenolate acid D. Methylprednisolone
D. Methylprednisolone Rationale Methylprednisolone is a corticosteroid that suppresses inflammatory responses and inhibits both cytokine production and T-cell activation. This medication may cause a peptic ulcer, osteoporosis, and hypertension. Everolimus may cause urinary tract infections, hyperlipidemia, and peripheral edema. Azathioprine may cause bone marrow suppression, neutropenia, and thrombocytopenia. Mycophenolate acid may cause diarrhea, neutropenia, and increased incidence of malignancies.
Which conclusion would be made by the nurse caring for a client with osteomyelitis receiving antibiotic therapy through a central line whose laboratory results reveal that the trough level is higher than the peak level after trough blood levels were obtained immediately before a prescribed dose of antibiotics was administered and peak levels were obtained 30 minutes after the infusion was completed? A. The dose should be increased. B. The dose is in excess of the client's needs. C. There was an adequate administration of the antibiotic. D. There was a problem with the obtaining of blood specimens.
D. There was a problem with the obtaining of blood specimens. Rationale Peak levels will always be higher than trough levels; therefore this result indicates that there has been some mix-up while drawing the samples. Increasing the dose would be an appropriate action if the trough level was too low. Concluding that the dose is in excess of the client's needs would be appropriate if the trough level was too high; however, the trough level still should never exceed the peak level. There is not enough information provided to determine whether there was adequate antibiotic administration.
Which statement by the client indicates that the nurse's teaching was effective regarding intravenous gentamicin therapy? A. "I should drink lots of water if I am retaining urine." B. "I should use eyeglasses if I develop vision problems." C. "I should stop the medication when the symptoms have subsided." D. "I should report any hearing loss to the primary health care provider."
D. "I should report any hearing loss to the primary health care provider." Rationale Acute osteomyelitis is treated with antibiotics such as gentamicin. Gentamicin use can cause ear toxicity; therefore, the client should report any hearing loss to the primary health care provider. Gentamicin also causes urine retention, but increasing water intake can aggravate this condition; therefore, the client should report this issue to the primary health care provider instead of increasing water consumption. Gentamicin may cause visual disturbances and should be reported to the primary health care provider; use of inappropriate eyeglasses, or use of glasses without first consulting the primary health care provider, increases the risk of falls or accidents to the patient. The client should not stop taking the medication without consulting the primary health care provider, even if the symptoms have subsided.
A client with type 1 diabetes has an above-the-knee amputation because of severe lower extremity arterial disease. Two days after surgery, which intervention is appropriate when preparing the client to eat dinner? A. Checking the client's serum glucose level B. Assisting the client out of bed into a chair C. Placing the client in the high-Fowler position D. Ensuring the client's residual limb is elevated
A. Checking the client's serum glucose level Rationale Because the client has type 1 diabetes, it is essential that the blood glucose level be determined before meals to evaluate the level of control of diabetes and the possible need for insulin coverage. To prevent flexion contractures of the hip, the client should not sit for a prolonged time; this is not the priority. Raising the head of the bed flexes the hips, which may result in hip flexion contractures. Ensuring the client's residual limb is elevated may result in a hip flexion contracture and should be avoided.
A client with a fractured hip is placed in traction until surgery can be performed. Which goal would the nurse explain as the purpose of the traction? A. Relieving muscle spasm and pain B. Preventing contractures from developing C. Keeping the client from turning and moving in bed D. Maintaining the limb in a position of external rotation
A. Relieving muscle spasm and pain Rationale Traction may be used in the treatment of a fractured hip to align the bones (reduction of fracture). If such traction is not employed, the muscles may go into spasm, shifting the bone fragments and causing pain. Traction is a temporary measure before surgery; contractures result from a shortening of the muscles by prolonged immobility. Although the affected extremity must be properly aligned, turning and moving the client can and should be done. External rotation is contraindicated and prevented by the use of positioning aids.
Which action by a 70-year-old female client would best limit further progression of osteoporosis? A. Taking supplemental calcium and vitamin D B. Increasing the consumption of eggs and cheese C. Taking supplemental magnesium and vitamin E D. Increasing the consumption of milk products
A. Taking supplemental calcium and vitamin D Rationale Research demonstrates that women past menopause need at least 1500 mg of calcium a day, which is almost impossible to obtain through dietary sources because the average daily consumption of calcium is 300 to 500 mg. Vitamin D promotes the deposition of calcium into the bone. Consumption of eggs and cheese does not contain adequate calcium to meet requirements to prevent osteoporosis; these foods do not contain vitamin D unless fortified. If large amounts of magnesium are present, calcium absorption is impeded because magnesium and calcium absorption are competitive; vitamin E is unrelated to osteoporosis. Milk and milk products may not be consumed in quantities adequate to meet requirements to prevent osteoporosis.
After an above-the-knee amputation of the right leg, a client reports pain in the right foot. Which reason would the nurse explain to the client for the phantom limb pain? A. Tactile illusions are associated with severed blood vessels. B. Nerve endings in the limb are still intact and react to stimuli. C. An unconscious phenomenon aids with grieving over the lost body part. D. Hallucinations are secondary to the emotional distress of amputation.
B. Nerve endings in the limb are still intact and react to stimuli. Rationale The neural endings that innervated the limb are still intact and may be stimulated (e.g., touch, environmental temperature, barometric pressure changes) within the residual limb. Severed blood vessels are not involved in phantom limb sensation. Although an individual must grieve over a lost body part, the grieving is unrelated to phantom limb sensation. Although phantom limb sensation is a hallucinatory-type experience, it is not a result of emotional distress.
Which action would the nurse take to promote early and efficient ambulation after a client has a mid thigh amputation? A. Keep the head of the bed elevated. B. Place the residual limb on a pillow. C. Turn the client to the prone position routinely. D. Encourage the client to lie on the unaffected side.
C. Turn the client to the prone position routinely. Rationale Flexion contracture of the hip can be prevented by routinely placing the client in a prone position to extend the hip. Lying with the head of the bed elevated does not allow for full extension of the hip. Placing the residual limb on a pillow and encouraging the client to lie on the unaffected side can cause flexion of the hip, which will result in a hip contracture.
Which rationale describes why the nurse would advise a client to have a dental examination before beginning prescribed therapy with zoledronic acid? A. To prevent kidney failure B. To prevent atrial fibrillation C. To prevent bronchoconstriction D. To prevent maxillary osteonecrosis
D. To prevent maxillary osteonecrosis Rationale Zoledronic acid is a bisphosphonate used to treat osteoporosis that can cause maxillary osteonecrosis. The client should have a dental examination before starting the medication therapy to prevent maxillary osteonecrosis. The client's serum creatinine should be checked before and after administration of the medication to prevent kidney failure. To prevent atrial fibrillation, the medication should not be infused too quickly. The medication should not be given to a client who is sensitive to aspirin as it may cause bronchoconstriction.