NSG 210 FINAL
1. Alendronate (Fosamax) is given to a client with osteoporosis. The nurse advises the client to? A. Take the medication in the morning with meals.B. Take the medication 2 hours before bedtime.C. Take the medication with a glass of water after rising in the morning.D. Take the medication during lunch.
Answer: C. Take the medication with a glass of water after rising in the morning. C: Alendronate needs to be taken with a glass of water after rising in the morning in order to prevent gastrointestinal effects. A, B, D: Not taking Alendronate on the specified time of the day could cause GI upset.
A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care? "Cover the cast with a blanket until the cast dries." "Keep your right leg elevated above heart level." "Use a knitting needle to scratch itches inside the cast." "A foul smell from the cast is normal."
Correct response: "Keep your right leg elevated above heart level." Explanation: The nurse should instruct the client to elevate the leg to promote venous return and prevent edema. The cast shouldn't be covered while drying. Covering the cast will cause heat buildup and prevent air circulation. The client should be instructed not to insert foreign objects into the cast because of the risk of cutting the skin and causing an infection. A foul smell from a cast is never normal and may indicate an infection.
A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? "Use your continuous passive motion machine for 2 hours each day." "You need to perform weight-bearing exercises twice a week." "You need to limit the amount of protein and calcium in your diet." "You will receive IV antibiotics for 3 to 6 weeks."
Correct response: "You will receive IV antibiotics for 3 to 6 weeks." Explanation: 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.
The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given? Alendronate Raloxifene Teriparatide Denosumab
Correct response: Alendronate Explanation: Alendronate is a bisphosphonate medication. Raloxifene is a selective estrogen receptor modulator. Teriparatide is an anabolic agent, and denosumab is a monoclonal antibody agent.
Which is not one of the general nursing measures employed when caring for the client with a fracture? cranial nerve assessment administering analgesics providing comfort measures assisting with ADLs
Correct response: cranial nerve assessment Explanation: Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care.
A patient is concerned about having multiple sclerosis (MS). The nurse determines that the patient has which of these assessment findings characteristic of MS? Select all that apply. Tremors of large and small muscle groups. Progressive weakness in extremities. Double vision. Sudden strength and burst of hyperactivity. Bowel and bladder dysfunction.
Multiple sclerosis is an autoimmune disease of the central nervous system that affects the brain and spinal cord. Tremors, weakness in extremities, visual disturbances, and loss of muscular tone causing bowel and bladder dysfunction may occur with MS.
What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? Bone spurs Diarrhea Increased heel pain Decreased height
Correct response: Decreased height Explanation: Clients with osteoporosis become shorter over time.
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? Alendronic acid Calcitonin Raloxifene Teriparatide
Correct response: Teriparatide Explanation: Teriparatide (Forteo) is a subcutaneously administered anabolic agent that is taken once daily. The other drug choices are oral preparations.
Which of the following inhibits bone resorption and promotes bone formation? Calcitonin Estrogen Parathyroid hormone Corticosteroids
Correct response: Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis.
Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? Deficient knowledge about osteoporosis and the treatment regimen Acute pain related to fracture and muscle spasm Risk for constipation related to immobility Risk for injury related to fractures due to osteoporosis
Correct response: Risk for injury related to fractures due to osteoporosis Explanation: 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 client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class? Alendronate Calcium gluconate Tamoxifen Raloxifene
Correct response: Raloxifene Explanation: An example of a selective estrogen receptor modifier (SERM) is raloxifene (Evista). Alendronate is a bisphosphonate; calcium gluconate is an oral calcium preparation; tamoxifen is an antiestrogen agent.
Which client would the nurse identify as having the greatest risk for osteoporosis? 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 A 20-year-old male athlete with repeated injuries
Correct response: A small-framed, thin 45-year-old white woman Explanation: 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.
Most cases of osteomyelitis are caused by which microorganism? Staphylococcus aureus Proteus species Pseudomonas species Escherichia coli
Correct response: Staphylococcus aureus Explanation: Staphylococcus aureus causes 70% to 80% of bone infections. Proteus species, Pseudomonas species, and E. coli are frequently found in osteomyelitis, they do not cause the majority of bone infections.
Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What will the nurse suspect? Compartment syndrome. Phlebitis. Infection. Chronic venous insufficiency.
Correct response: Compartment syndrome. Explanation: Compartment syndrome refers to the compression of nerves, blood vessels, and muscle within a closed space. This leads to tissue death from lack of oxygenation.
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 packing Wound irrigation Vitamin supplements Surgical debridement
Correct response: Surgical debridement Explanation: 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.
Which is the priority finding for a patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and should be reported immediately? 1+ Edema UOP: 60 mL/hr Headache: 8/10 pain BP:150/92 mm Hg
Headache: 8/10 pain A headache is most concerning for a patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH) because this is a symptom of hyponatremia. A headache is an early symptom of hyponatremia, which is an electrolyte imbalance that can lead to confusion, seizures, and death. Hyponatremia is a serum sodium level of <135 mEq/L. Decreased lab levels and symptoms of hyponatremia should be reported immediately due to the life-threatening nature of the electrolyte imbalance.
Which symptoms are most associated with hypoparathyroidism? Select all that apply. Constipation Laryngeal spasms Hypercalcemia Positive Kernig sign Positive Trousseau sign
Positive Trousseau sign Laryngeal spasms Hypoparathyroidism is a condition where the body doesn't produce enough parathyroid hormone (PTH). Symptoms most associated with hypoparathyroidism are laryngeal spasm, hypocalcemia, positive Trousseau and Chvostek signs
Which factor inhibits fracture healing? Increased vitamin D and calcium in the diet Age of 35 years History of diabetes Immobilization of the fracture
Correct response: History of diabetes Explanation: Factors that inhibit fracture healing include diabetes, smoking, local malignancy, bone loss, extensive local trauma, age greater than 40, and infection. Factors that enhance fracture healing include proper nutrition, vitamin D and calcium, exercise, maximum bone fragment contact, proper alignment, and immobilization of the fracture.
Which patient should NOT be prescribed alendronate (Fosamax) for osteoporosis? A. A female patient being treated for high blood pressure with an ACE inhibitor.B. A patient who is allergic to iodine/shellfish.C. A patient on a calorie restricted diet.D. A patient on bed rest who must maintain a supine position.
Answer: D. A patient on bed rest who must maintain a supine position. D: Alendronate can cause significant gastrointestinal side effects, such as esophageal irritation, so it should not be taken if a patient must stay in supine position. A&B: ACE inhibitors are not contraindicated with alendronate and there is no iodine allergy relationship. C: The patient should not eat or drink for 30 minutes after administration and should not lie down.
A patient with a potassium level of 5.5 mEq/L is to receive an oral dose of sodium polystyrene sulfonate (Kayexalate). Which should the nurse monitor after giving the patient the medication? Urine output. Blood pressure. Bowel movements. ECG for tall, peaked T waves.
Bowel movements. A normal serum potassium level is between 3.5 to 5.5 mEq/L. Kayexalate may be given to exchange potassium for sodium in the intestines to lower the serum potassium level. If the patient does not have stools, the drug cannot work properly. Therefore, the nurse monitors the patient's bowel movements to determine the effectiveness of the medication.
A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean? The fracture line extends through the entire bone substance. The fracture results from an underlying bone disorder. Bone fragments are separated at the fracture line. One side of the bone is broken and the other side is bent.
Correct response: One side of the bone is broken and the other side is bent. Explanation: In a greenstick fracture, one side of the bone is broken and the other side is bent. A greenstick fracture also may refer to an incomplete fracture in which the fracture line extends only partially through the bone substance and doesn't disrupt bone continuity completely. (Other terms for greenstick fracture are willow fracture and hickory-stick fracture.) The fracture line extends through the entire bone substance in a complete fracture. A fracture that results from an underlying bone disorder, such as osteoporosis or a tumor, is a pathologic fracture, which typically occurs with minimal trauma. Bone fragments are separated at the fracture line in a displaced fracture.
Which supports the diagnosis of diabetes insipidus? Select all that apply. Hyperosmolality Serum sodium 143 mEq/L Urine specific gravity of 1.032 Excessive thirst Blood pressure 80/62 mm Hg
Hyperosmolality Excessive thirst Blood pressure 80/62 mm Hg The major symptoms of DI are extreme thirst and frequent urination. The extreme urination can lead to dehydration, hypovolemia, and hypotension. The osmolarity of the blood is high (hyperosmolality), the serum sodium level is elevated (>145 mEq/L) and urine specific gravity is low in DI. Treatment of DI requires long-term vasopressin therapy and the patient should not decrease the dose. Vasopressin is an antidiuretic hormone used to enhance reabsorption of water in the kidneys when diabetes insipidus is present.
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? Living a sedentary lifestyle to reduce the incidence of injury Stopping estrogen therapy Taking a 300-mg calcium supplement to meet dietary guidelines Initiating weight-bearing exercise routines
Correct response: Initiating weight-bearing exercise routines Explanation: 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.
A patient with a diagnosis of muscular sclerosis (MS) is prescribed baclofen. During instruction to the patient, the nurse explains which of these is the preferred outcome of the drug? It will reduce the chance of getting viral infections. It will help relieve muscular spasticity. It will decrease depression. It will help with insomnia.
Baclofen is a muscular relaxant and antispasmodic. It is used to treat pain and improve muscle movement from stiffness associated with MS. It is given intrathecally or orally. Side effects include tiredness, weakness, dizziness, headaches. Drinking alcohol with baclofen may increase these side effects. Judicious use in the elderly demographics is recommended due to the risk of confusion, depression, and hallucinations. Patients should discuss with their doctor if they have a past medical history of kidney disease, epilepsy, mental illness, or stroke.
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 oral antibiotics as ordered Instructing the client to ambulate twice daily Withholding all oral intake Administering large doses of I.V. antibiotics as ordered
Correct response: Administering large doses of I.V. antibiotics as ordered Explanation: 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.
An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? Compound Depressed Impacted Comminuted
Correct response: Comminuted Explanation: A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.
Which general nursing measure is used for a client with a fracture reduction? Encourage participation in ADLs Promote intake of omega-3 fatty acids Examine the abdomen for enlarged liver or spleen Assist with intake of immune-enhancing tube feeding formulas
Correct response: Encourage participation in ADLs Explanation: General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation in ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. The nurse does not need to examine the abdomen for enlarged liver or spleen because fracture reduction treatment does not affect these organs. It is unlikely that a client with a fracture reduction will be prescribed immune-enhancing tube feeding formulas.
A nurse is caring for a client with bone metastasis from a primary breast cancer. The client reports muscle weakness and nausea and is voiding large amounts frequently. The telemetry monitor is observed showing premature ventricular contractions. What should the nurse suspect based on the clinical manifestations? Hypercalcemia Hypocalcemia Hypokalemia Hyperkalemia
Correct response: Hypercalcemia Explanation: Hypercalcemia is present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias such a premature ventricular contractions, seizures, and coma. Hypercalcemia must be identified and treated promptly. Hypocalcemia will not be seen with bone cancer. Hypokalemia and hyperkalemia are not common with bone metastasis. *for hypercalcemia practice*
A nurse notices a client lying on the floor at the bottom of the stairs. The client is alert and oriented and denies pain other than in the arm, which is swollen and appears deformed. After calling for help, what should the nurse do? Place the client in a sitting position. Immobilize the client's arm. Help the client walk to the nearest nurses' station. Raise the client's arm above the heart.
Correct response: Immobilize the client's arm. Explanation: Signs of a fracture in an extremity include pain, deformity, swelling, discoloration, and loss of function. When a nurse suspects a fracture, the extremity should be immobilized before moving the body part. It isn't appropriate for the nurse to move the client into a sitting position without further assessment. The client shouldn't walk to the nurses' station; the client should wait for help to arrive.
Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture? Comminuted Compression Impacted Greenstick
Correct response: Impacted Explanation: An impacted fracture is one in which a bone fragment is driven into another bone fragment. A comminuted fracture is one in which the bone has splintered into several fragments. A compression fracture is one in which bone has been compressed. A greenstick fracture is one in which one side of the bon is broken and the other side is bent.
A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk? Infection Malunion Complex regional pain syndrome Depression
Correct response: Infection Explanation: This client is at the highest risk for infection because of the open fracture that was obtained while horseback riding. Infection that enters the body and affects the bone can lead to osteomyelitis. The treatment may involve long-term antibiotics and may even result in death. The client is still at risk for malunion, but this risk is slight because the bone can be visualized (either through the wound or surgical intervention) and returned to anatomical position. The other options are possible consequences of this type of injury but do not represent the most serious complication.
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
Correct response: Osteomyelitis Explanation: 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.
A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall? Impacted fracture Transverse fracture Compound fracture Pathologic fracture
Correct response: Pathologic fracture Explanation: A pathologic fracture is a fracture that occurs through an area of diseased bone and can occur without trauma or a fall. An impacted fracture is a fracture in which a bone fragment is driven into another bone fragment. A transverse fracture is a fracture straight across the bone. A compound fracture is a fracture in which damage also involves the skin or mucous membranes.
A client has been admitted with a fractured pelvis that occurred in an auto accident just a few hours ago. The nurse has noticed a slight change in behavior. Which other clinical manifestations would lead the nurse to suspect the client has developed a fat emboli? Select all that apply. Reports of substernal chest pain Reports of pain in the lower abdomen and back Pulse rate 120 with temperature of 99.7°F (37.6°C) Profuse diaphoresis with pallor noted Urine output of 30 mL/hour
Correct response: Reports of substernal chest pain Pulse rate 120 with temperature of 99.7°F (37.6°C) Profuse diaphoresis with pallor noted Explanation: Initial symptoms of FES are a subtle change in behavior and signs of disorientation resulting from emboli in the cerebral circulation combined with respiratory depression. There may be reports of substernal chest pain and dyspnea accompanied by tachycardia and low-grade fever. Diaphoresis, pallor, and cyanosis become evident as respiratory function deteriorates. It would be expected that the client has lower abdominal and back pain since he or she has a pelvic fracture. The normal urine output is a minimum of 30 mL/hour.
The nurse assesses the neurovascular status of a client who had surgery to repair a fractured hip. Which assessment data for the affected leg indicates that the client has developed a neurologic complication? Cool skin temperature Tingling sensations Nonpitting edema Ruddy skin color
Correct response: Tingling sensations Explanation: Complications of fractures include compartment syndrome (when swelling after the injury impairs blood and nerve function), delayed healing, infection, and emboli. Of these conditions, compartment syndrome has the earliest onset. The neurologic assessment includes sensation and the ability to move the toes. Vascular assessment includes capillary refill, edema, and temperature of the distal extremity.
The nurse is administering calcium gluconate to a patient experiencing laryngeal spasms and exhibiting a positive Chvostek sign. Which condition is most likely related to these symptoms and the need for immediate IV calcium gluconate? Hypothyroidism Hyperthyroidism Hypoparathyroidism Hyperparathyroidism
Hypoparathyroidism causes hypocalcemia. If a patient is experiencing laryngeal spasms and exhibiting a positive Chvostek sign, there is a need for immediate IV calcium gluconate.
A nurse is caring for a patient with a potassium of 6.5 mEq/L. Heart monitor shows the PR interval remains constant and each QRS complex is less than 100 ms wide. Which action by the nurse is priority? Give IV calcium gluconate. Start IV 50% dextrose and insulin. Administer kayexalate. Prepare the patient for dialysis.
Start IV 50% dextrose and insulin. Treating hyperkalemia requires an immediate solution to lower potassium. This is done in a specific order. If the patient is exhibiting dysrhythmias, administer IV calcium gluconate. Calcium protects the myocardium from the harmful effects of hyperkalemia. The ECG would show tall peaked T-waves, prolonged PR interval and widening of the QRS. This is usually seen when potassium levels are between 6.5 and 8.0 mEq/L. If the ECG shows no cardiac dysrhythmia, then treatment would be IV 50% dextrose and regular insulin. Insulin secretion shifts potassium into the cell.
